Term
| Indications for GI Prophylaxis |
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Definition
Stress-related Mucosal Damage (SMRD - "stress ulcers");
NSAID-induced ulcers |
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Term
| Stress-related Mucosal Damage (SMRD - "Stress Ulcers") |
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Definition
occurs in critically ill pts;
mucosal erosions begin w/in hrs of "stress";
increased gastric acid production, decreased protection; |
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Term
|
Definition
best treatment for SMRD (stress ulcers);
Indicated when:
- if major risk factor present
OR
- if >2 minor risk factors present |
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Term
|
Definition
MAJOR:
mechanical ventilation;
coagulopathy (Plt <50,000; INR >1.5; PTT >2 x control);
Hx of GI ulceration w/in past year;
MINOR:
Sepsis;
ICU admission >1 wk;
Occult GI bleeding lasting > or = 6 days;
Glucocorticoid therapy (>250 mg hydrocortisone); |
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Term
|
Definition
| restore mucosal blood flow |
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Term
| Antisecretory Meds - PPI, H2RA |
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Definition
| preferred option for tx/prophylaxis of SMRD |
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Term
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Definition
| antisecretory med preferred in ICU pts on PO medication |
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Term
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Definition
| preferred antisecretory med for ICU pts that are NPO (not by mouth) |
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Term
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Definition
most studied antisecretory med;
found to be most effective;
given BID most commonly |
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Term
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Definition
| 2 antisecretory meds that generally are NOT used for prophylaxis of SMRD |
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Term
| Zegerid (IR omeprazole + NaHCO3) |
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Definition
IR omeprazole 40 mg + NaHCO3 20 mEq;
- give 40 mg q6-8 hr x 2 doses, then 40 mg/day x 14 days |
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Term
|
Definition
| H2RA that can be given as IV infusion |
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Term
| High Risk for NSAID-induced Ulcer |
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Definition
Hx of complicated ulcer;
More than 2 risk factors for NSAID-induced GI toxicity;
Low dose ASA + (glucocorticoids OR warfarin OR clopidogrel OR prasugrel); |
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Term
| Moderate Risk (1-2) for NSAID-induced Ulcers |
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Definition
>65 yr old;
High-dose NSAID;
Previous uncomplicated ulcer;
**If you have ALL 3 of these --> HIGH RISK** |
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Term
| Low CV Risk AND Low GI Toxicity Risk (no indication for ASA) |
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Definition
| Can use lowest dose NSAID |
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Term
| Low GI toxicity risk AND High CV Risk (need ASA for CV protection) |
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Definition
| naproxen + (PPI or misoprostol) |
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Term
| Moderate GI Toxicity Risk AND Low CV Risk (no need for ASA) |
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Definition
| NSAID + (PPI or misoprostol) |
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Term
| High GI Toxicity Risk AND Low CV Risk (no need for ASA) |
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Definition
Alternative Tx
OR
COX-2 inhibitor + (PPI or misoprostol) |
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Term
| Moderate GI Toxicity Risk AND High CV Risk (needs ASA) |
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Definition
| naproxen + (PPI or misoprostol) |
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Term
| High GI TOxicity Risk AND High CV Risk (ASA needed) |
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Definition
Alternative Tx --> Use tramadol, then opiates if tramadol is not effective;
**NO COX-2 inhibitors OR NSAIDs** |
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Term
| naproxen + esomeprazole (Vimovo) |
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Definition
| 375 mg/20 mg - 500 mg/20 mg BID |
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Term
|
Definition
better than placebo at protecting gut;
equivalent to PPI/H2RA at 200 mcg QID;
use limited due to ADRs (GI side effects); |
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Term
| PPI - esomeprazole [Nexium] 20-40 mg qday, lansoprazole [Prevacid] 15-30 mg qday |
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Definition
| significantly reduced gastric & duodenal ulcer in pts taking NSAIDs & COX-2 inhibitors; |
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Term
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Definition
can use standard doses to relieve NSAID-induced dyspepsia;
NOT recommended as prophylaxis for GI complications;
use standard doses |
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Term
| Secondary Prevention of GI Prophylaxis |
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Definition
| Continued use of NSAID/low-dose ASA --> use PPI at lowest dose |
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Term
| Improvement of Pt's Status |
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Definition
| can stop prophylaxis when this occurs |
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Term
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Definition
CYP enzyme that metabolizes PPIs;
Can have genetic polymorphisms (more common in Asians) |
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Term
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Definition
antiplatelet med activated by CYP 2C19 & 3A;
PPIs cause decreased activation --> decreased efficacy; |
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Term
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Definition
another antiplatelet medication activated by CYP 3A, 2B6, 2C9, 2C19;
PPIs decrease activation --> decreased efficacy; |
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Term
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Definition
antiplatelet medication activated via CYP 3A4;
PPIs decrease activation --> decreased efficacy |
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Term
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Definition
antiviral w/ ADR & GI problems;
Metabolized by CYP 2C19 & 3A4;
If HIV pt is stable (no detectable VL), try to AVOID PPI**
If you HAVE to use PPI, use for LESS than 14 days; |
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Term
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Definition
| anticoagulant that interacts w/ omeprazole --> PT decreases by 10% |
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Term
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Definition
| benzodiazepine that interacts w/ omeprazole --> increases T1/2 by 130% |
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Term
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Definition
| anticonvulsant that interacts w/ omeprazole --> T1/2 increased by 30% |
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Term
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Definition
| antiarrhythmic that interacts with omeprazole --> AUC increased by 10% |
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Term
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Definition
| anticonvulsant that interacts w/ omeprazole --> AUC increased by 75% |
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Term
| Drug Interactions with PPIs |
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Definition
decreased effectiveness of alendronate;
decreased Mg absorption;
increased risk of fractures;
increased risk of C. diff infections;
rebound hypersecretion;
increased risk for nosocomial & community-acquired pneumonia;
decreased Vit. B12 absorption;
decreased Iron absorption |
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