Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PDAT2 > 25 - PUD / SRMD > Flashcards

25 - PUD / SRMD Flashcards

1
Q

First-Line Regimens for

Treatment of H.Pylori

GERD

A

CLARITHROMYCIN TRIPLE
PPI + Clarythromycin + Amoxicillin
14 days

  • *BSMUTH QUADRUPLE**
  • *PPI + Tetracycline + Metronidazole + Bismuth Subcitrate**

10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clarithromycin Triple

First Line Treatment for H. Pylori

PUD

A

14 Day treatment - PCA

  • *PPI BID**
  • *standard OR double dose**
  • *Clarithromycin**
  • *500mg BID**
  • *Amoxicillin**
  • *1000 mg BID**
  • IF PCN ALLERGY –>*
  • *Metronidazole 500mg TID** instead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Bismuth Quadruple

First Line Treatment for H. Pylori

PUD

Helidac = pack w/o PPI

Pylera = pack with PPI

A

10 - 14 Day Treatment - PTMB

PPI
STANDARD dose = BID

  • *Tetracycline**
  • *500 mg QID**
  • *Metronidazole**
  • *250 mg QID** or 500mg TID/QID
  • *Bismuth Subcitrate** or Subalicylate
  • *120-300mg** or 300mg QID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mucosal Protectants

for PUD

A

Sucralfate
1g QID or 2g BID
ALUMINUM may accuminate in RENAL FAILURE

  • *Misoprostol**
  • *100-200mcg QID**
  • Contraindicated in PREGNANCY*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

GI RISKS
PUD: NSAID-Induced

A

Low = 0 // moderate = 1-2 // high > 2 Risk factors

GI Risks:

h/o of PUD (+ complications)

Age > 60 years

Concomitant Medications
anticoags / corticosteroids / other NSAIDS (includes baby aspirin)

contributing factors:
smoking / CVD / H. Pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CV Risks

for PUD: NSAID-Induced

A
  • *High Risk**
  • *requirement for Low-dose Aspirin**

such as individuals with:
prior CV event
diabetes / HT
hyperlipidemia / obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Table for treating a patient with

NSAIDs

based on CV / GI Risk

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk Factors for

PUD BLEEDING

A

Higher risk w/ poor prognosis:
> 60 y/o
Comorbid Conditions
HIGH Transfusion Requirements
ongoing blood loss
hypoVolemic Shock
prolonged PTT / increased INR
erratic mental status

may need aggressive intervention or ICU stay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Comparison Chart of DIFFERENT PUD’s

SRMD / NSAID / H. Pylori

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RISK FACTORS

for SRMB PUD

A

Mechanical Ventilation > 48 hours

Coagulopathy
Platelets <50K // INR >1.5 // PTT> 2.5 normal

Liver Failure / Sepsis / GIB History

Major Surgery / ICU >7 days

HIGH-DOSE Corticosteroids (>250mg/d HC)

Severe Burns (>35% BSA)
traumatic Spinal / Head Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PROPHYLAXIS

for SRMB PUD

A

FLUID replacement -> restore mucosal blood flow

Intragastric pH > 4 = for mucosal protection

  • *Pharmacotherapy**
  • *anti-secratory** or Mucosal protectant

H2RA > PPI
by IV or PO route, make sure they can take PO first
only use PPI if
renal dysfunction develops thrombocytopenia or mental status changes while on H2Ra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GIB Treatment

PUD

A

correct fluid loss

Endoscopic intervention

IV PPI
LD is equivalent to 80mg omeprazole
then do 8mg/h continuously for 72 hours

  • WHY NOT H2RA?*
  • does NOT achieve* pH of 6
  • does NOT PREVENT rebleeding / tachyphylaxis*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Signs & Symptoms of

PUD

A

Dyspepsia / Indigestion

Post-prandial Bleeding (bleeding after meals)

Abdominal fullness/bloating

Anorexia / weight loss / early satiety

N/V + Cramping/pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PUD ALARM Symptoms

When to REFER TO MD

A

ANEMIA

  • *Hematemesis**
  • vomiting of blood*

Melena / Heme +pos+ stool

Anorexia / Weight Loss

SEVERE Upper Abdominal Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes / Risks of PUD

A

NSAID USE = #1
H. PYLORI = #2
50% of population has H.pylori, 10-15% develop PUD

SRMD / Stress Ulcer

Zollinger-Ellison Syndrome = ZES
gastrin-secreting tumor or hyperplasia of the islet cells in the pancreas resulting in recurrent peptic ulcers

Cigarette Smoking / Alcohol / Diet

Idiopathic / Radiation / Genetic Subtypes

MEDICATIONS = Steroids / bisphosphate / chemo / SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of PUD

A

Active UPPER Gi Bleeding
PUD = MOST common cause of acute GI bleed

Perforation

Gastric Outlet Obstruction
scarring / edema

can require Surgery or cause Death

17
Q

Timing of PUD Symptoms

A

GU = Gastric
occurs SOON after a meal

DU = Duodnem

occurs usually 2-5 hours after a meal or during the night

18
Q

Ulcerogenic / Hostile Factors

vs Protective / Healing Factors

in PUD

A

Gastric Acid / H. Pylori / Pepsin
NSAIDS

vs

  • *Bicarb / Prostaglandins / Mucus Production**
  • *Blood Flow** to Mucosa
19
Q

Treatment Chart of

PUD

A

dyspepsia (indigestion) ->
Alarm Symptoms or >55 y/o

Yes -> EGD (esophagogastroduodenoscopy)

NO:
detect / treat H. Pylori
Advice DC of NSAIDS / Smoking / Alcohol / Drug
Administer antisecretory therapy = PPI f4weeks

20
Q

H. Pylori

A

Gram negative bacteria, sits between mucus/gastric epithelium

Produces UREASE –> hydrolyzes urea in gastric juice
–> Ammonia & CO2 –> buffer effect from gastric acid

NOT appropriate to test ALL PATIENTS

transmitted by:
oral/fecal/gastro
contaminated food/water
infected patients within household

21
Q

Non-Endoscopic

Tests for H. Pylori

A

Test whether ENDOSCOPY is Required
or Strengths / Weaknesses of each test

  • *Serologic Test**
  • easy, but positive might reflect a PAST INFECTION*

Urea Breath Test
useful before and after treatment
false negatives in presence of PPIs / other antibiotics

Fecal Antigen Test
useful before and after treatment
false negatives with PPI/antibiotics /bismuth

22
Q

Key Questions for

H.Pylori PUD Treatment

A

is there a PENICILLIN ALLERGY? PCN
use metronidazole 500mg TID –> instead of AMOX
in Clarithromycin Triple Therapy

Is there a PREVIOUS MACROLIDE EXPOSURE
MCL, for anyreason?

23
Q

What to do AFTER
H.Pylori Treatment for PUD

A

Check eradication using:
UBT (urease breath test)
FAT ( Fecal Antigen Test)
Biopsy based test (endoscopic)

  • *> 4 weeks** after :
  • *completing AB therapy** & withholding PPI therapy for 1-2 weeks
24
Q

After H. Pylori PUD Treatment

if a SMALL <1cm Uncomplicated Ulcer?

A

sufficient with
Triple Regimen Alone + 4 Weeks PPI

follow up may NOT be needed

25
Q

After H. Pylori PUD Treatment

if COMPLICATED ULCERS

A

REPEAT Endoscopy w/ BIOPSY
after therapy completion to confirm healing

CONTINUE PPI THERAPY
antisecretory = PPI or H2RA

26
Q

What should a patient take for
NSAID-INDUCED PUD

if MODERATE (1-2 risk factors) GI RISK

A

or if also has HIGH CV RISK = needs a baby aspirin

NSAID needs to be taken with:

PPI** or **MISOPROSTOL
100-200 mcg QID

27
Q

PROPHYLAXIS / PREVENTION

of NSAID -Induced PUD

A

Only give to HIGH RISK PATIENTS
>2 GI Risk factors / CV Risk = baby aspirin need

  • *MISOPROSTOL** = Cytotec
  • *200 mcg QID**
  • not for PREGNANCY, also diarrhea / ab pain*

PPIs are also an acceptable alternative

H2RA / Sucralfate are NOT recommended for prophylaxis
Antacids / EC-ASA do NOT reduce risk of complications

28
Q

TREATMENT

of NSAID-Induced PUD

A

Discontinue the NSAID
if possible –> replace with other AGENT
(COX-2 inhibitor in non-CV patients)

Or Reduce NSAID DOSE** & **Add Ulcer Prevention strategies

low dose ASA should be held for 7-10 days

PPI = Agent of Choice
to heal NSAID-Induced ulcers
also when NSAID needs to be continued, or if H.Pylori is involved

29
Q

PUD-Related GIB

Signs / Symptoms

A

Hematemesis / Hematochezia
blood in VOMIT / STOOL

Melena
dark / sticky feces

Intravascular Volume Loss
HR > 100
hypoTension SBP < 100 / postural changes
Mucous mebranes

30
Q

Treatment considerations for PUD

H2RAs

A

Equipotent, generally do NOT want to use

RENALLY CLEARED

Tachyphylaxis = TOLERANCE to antisecretory effects

Cigarette smokers may need HIGHER dose / Longer treatment

DO NOT USE FOR GI BLEED
does NOT achieve pH 6
does NOT prevent re-bleeding

31
Q

Sucralfate

PUD Treatment Considerations

A

NOT often used for PUD

multiple doses / day

Large tabs

ADRs - Constipation / Seizures

need to seperate from interacting drugs

32
Q

NSAIDs & ASA

Effects on PUD

A

NON-SELECTIVE
INHIBIT BOTH COX-1 & COX-2

_COX1
DIRECT IRRITANTS_
of the gastric epithelium

COX 2
Inhibition of the endogenous
Prostaglandin Synthesis

33
Q

COX-2 Inhibitors

Effects on PUD

A

COX-2
Inducible by Cytokines + GF’s

  • *Inhibition of the endogenous**
  • *Prostaglandin Synthesis**

COX = rate limitign step in:
Arachidonic acid –> Prostaglandins

34
Q

Pathophysiology of SRMD

A

Critical Illness
vasoconstriction / reduced cardiac output / Inflammatory release
v v v v
Splanchnic hypoPerfusion
reduced HCO3 secretion / mucosal blood flow
dereased GI motility / acid back
v v v v
ACUTE STRESS ULCER

35
Q

Salvage Therapy for
H. Pylori INFECTION - PUD

A

mainly based on:
WHAT THEY FIRST TOOK
Clarithromycin 3x Therapy /// Bismuth 4x Therapy
&
WHAT THEY ARE ALLERGIC TO
Quinolone /// PCN Allergy

PDAT2 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions