Term
| What should be reduced in patients with PUD? |
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Definition
| psychological stress, cigarette smoking, and nonsteroidal antiinflammatory drug (NSAID) use and avoid foods and beverages that exacerbate ulcer symptoms. |
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Term
| How should H. pylori be treated generally for PUD? |
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Definition
| Eradication is recommended |
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Term
| How do PPIs affect NSAIDs? |
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Definition
| PPI cotherapy reduces the risk of NSAID-related gastric and duodenal ulcers and is at least as effective as recommended dosages of misoprostol and superior to the histamine-2 receptor antagonists (H2RA) |
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Term
| Are COX2 selective inhibitors better thank PPI + COX1? |
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Definition
| Standard PPI dosages and a nonselective NSAID are as effective as a selective cyclooxygenase-2 (COX-2) inhibitor in reducing the risk of NSAID-induced ulcers and upper gastrointestinal (GI) complications. |
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Term
| When should misoprostol cotherapy be used? |
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Definition
| The cost effectiveness of misoprostol cotherapy is greatest for patients with the highest risk for GI complications |
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Term
| What is the recommended Tx for severe PUD bleeding? |
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Definition
| The recommended treatment for severe peptic ulcer bleeding after appropriate endoscopic treatment is the intravenous administration of a PPI loading dose followed by a 72-hour continuous infusion with a goal of maintaining an intragastric pH of 6 or greater. |
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Term
|
Definition
| Stress-related mucosal bleeding - seen in critically ill patients. Tx with PPI or H2A IV |
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Term
| For which type of ulcers is the mortality rate higher? |
|
Definition
|
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Term
| What are the types/causes of PUD? |
|
Definition
- H. Pylori - duodenum > gastric. pH dependent, superficial
- NSAID - gastric > duodenum, pH independent and deep
- SRMB - acute hospital related. Gastric and superficial |
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Term
| What are the properties of H. Pylori? |
|
Definition
Gram negative, spiral, flagellated bacteria.
Can protect itself from the pH of the stomach.
NOT associated w/ GERD or smoking
**Prevalence increases w/ age |
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Term
| What is the mechanism of an NSAID induced ulcer? |
|
Definition
Direct irritation to the epithelium, inhibition of mucosal prostaglandins
**Upper GI bleeds!
**Risk factors: Age, NSAID use. Use w/ steroids, bisphosphonates, anticoags, SSRIs, smoking, alcohol. |
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Term
| What are complications of long-term PUD? |
|
Definition
- Perforation into peritoneal cavity - Mortality higher in gastric ulcers
- Penetration into an adjacent structure
- Gastric obstruction |
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|
Term
| What are the differences in presentation between a gastric and duodenal ulcer? |
|
Definition
- Gastric - Food worsens pain
- Duodenal - Relieved by food |
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Term
| How is H. Pylori diagnosed? |
|
Definition
- Endoscopy - Invasive, need a biopsy
- Non-endoscopy - antibodies or urea breath test
**Withhold PPIs, antibiotics, bismuth prior to testing |
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Term
| What are the basic components of an H. Pylori regimen? |
|
Definition
- Antibiotics - Clarithromycin, Metronidazole, Amoxicillin
- Bismuth salt
- Antisecretory agent - PPI preferred.
**Initially: Biaxin + Flagyl + PPI x14 days, then add bismuth.
DO NOT substitute or use a short therapy. |
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Term
| What PPIs and their doses are given to heal an ulcer? |
|
Definition
- Omeprazole 20-40 mg/day
- Lansoprazole 15-30 mg/day
- Rabeprazole 20 mg/day
- Pantoprazole 40 mg/day
- Esomeprazole 20-40 mg/day |
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Term
| What H2 antagonists and their doses are used to heal an ulcer? |
|
Definition
- Cimetidine - 300 mg QID, 400 mg BID, 800 mg HS
- Famotidine - 20 mg BID or 40 mg Hs
- Nizatidine - 150 mg BID or 300 mg HS
- Ranitidine - 150 mg BID or 300 mg HS *** most common. |
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Term
| Which PPIs should not be used with plavix? |
|
Definition
| Omeprazole and esomeprazole |
|
|
Term
| What are H2 antagonist doses for maintenence of an ulcer? |
|
Definition
- Cimetidine - 400 or 800 mg HS
- Famotidine - 20 or 40 mg HS
- Nizatidine - 150 or 300 mg HS
- Ranitidine - 150 or 300 mg HS |
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|
Term
| When should a bismuth quadruple regimen be used? |
|
Definition
When a patient is allergic to PCN
Cannot use w/ impaired kidney fxn |
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|
Term
| What is sucralfate/Carafate used for in PUD? |
|
Definition
Promotion of mucosal defense - for 4-8week tx of active ulcers. Off label radiation use.
Has aluminum - cannot use in renal disease
**Separate from antacids by 30 min
Bewere of bezoars |
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Term
| What can you do if a patient must take NSAIDs chronically? |
|
Definition
- Add a PPI to regimen
- Don't take ASA
- Concurrent Misoprostol use - 200mg TID - QID. Causes DIARRHEA, especially w/ Mg salts. |
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