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Therapeutics > 64: Peptic Ulcer Disease > Flashcards

64: Peptic Ulcer Disease Flashcards

1
Q

Peptic Ulcer Disease

A

-large ulcersthat extend deeper into muscalaris mucosa
-gastric or duodenal

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2
Q

PUD epidemioligy

A

-lifetime 5-10%
-H. pylori 30-40%
-30-50% of chronic NSAID users

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3
Q

Contibuting factors to PUD

A

-h. pylori
-NSAID use
-gastric acid + pepsin
-cigs
-critical illness
-dietary factors

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4
Q

PUD pathophysiology

A

-acid and pepsin overcome mucosal defense

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5
Q

Clinical presentation of h. pylori PUD

A

-chronic
-duodenum more than tummy
-more dependent on gas pH
-superficial ulcer
-less severe GI bleeding

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6
Q

NSAID and stress PUD clinical presentation

A

-chronic
-stomach more than duodenum
-less dependent on gas pH
-often asymptomatic
-more severe bleeding
-deep ulcers from NSAIDs
-most superficial ulcers from stress

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7
Q

PUD complications

A

-GI bleed
-GI perforation
-GI obstruction (life threatenting)

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8
Q

Signs and symptoms of PUD

A

-epigastric pain
-nausea
-belching, heartburn
-weight loss
-nausea
-bloating
-early satiety

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9
Q

Goals of PUD care

A

-relieve symptoms
-heal ulcer
-prevent recurrence and complications
-eradicate or withdrawal of offending agent

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10
Q

Non-pharma tx of PUD

A

-stress reduction
-smoking cessation
-avoid food and drink triggers
-avoid NSAIDs
-surgery

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11
Q

H. Pylori induced PUD

A

-bacteria bind to wall
-colonize gastric acid
-acid damages tissue and leads to ulcer

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12
Q

H. pylori PUD diagnosis

A

-endoscopy
-antibody detect
-urea breath test
-fecal antigen

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13
Q

Principles of H. Pylori Tx

A

-several diff regimens
-usually consist of acid suppressor + 2-3 antibiotics
-helpful to determine if patient has had any recent antibiotic exposure to predict resistance

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14
Q

H. Pylori Tx options

A

-Bismuth
-Clarithromycin
-Levofloxacin
-Rifabutin
-Vonoprazan

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15
Q

Bismuth salts

A

-inhibit aggressive factors and inc protective factors
=bacterizidal
-DO NOT USE in kids UNDER 12

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16
Q

Bismuth Quadruple therapy

A
  1. PPI BID
  2. Bismuth 525mg QID
  3. Metronidazole 250-500mg QID
  4. Tetracycline 500mg QID

10-14 days

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17
Q

Helidac

A

-daily admin package
-14 blister cards w metro, terta, and bismuth
-must also take PPI BID

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18
Q

Pylera

A

-3in1 capsule
-bismuth (140mg), metro, (125mg) tetra (125mg)
-3 caps QID for 10 days
-must take w PPI BID

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19
Q

Clarithromycin Concomitant therapy

A
  1. PPI BID
  2. Clarithromycin 250-500 BID
  3. Amoxicillin 1g BID
  4. Metronidazole 250-500mg BID

-10-14 days

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20
Q

Clarithromycin sequentail therapy

A

PPI and amox the whole time or first half
-add metro and clar for last half

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21
Q

Levofloxacin therapy option

A

-triple
-quad
-sequential

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22
Q

Levofloxacin trip therapy

A
  1. PPI BID
  2. Levofloxacin 500mg qd
  3. Amox 1 g BID

-10-14 days

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23
Q

Levofloxacin Quad therapy

A
  1. Levo 250mg qd
  2. Omeprazole or other PPI at high dose qd
  3. Nitazoxanide 500mg BID
  4. Doxycycline 100 mg qd

-7-10 days

24
Q

Levofloxacin Sequential

A
  1. PPI BID (day 1-10)
  2. Amox 1 g BID (day1-5)
  3. Levo qd (day 6-10)
  4. Metro BID (day 6-10)
25
Q

Rifabutin Triple therapy

A
  1. omeprazole 40mg q8h
  2. Amox 1g q8h
  3. Rifabutin 50mg 18h

-14 days
-no determined place in therapy

26
Q

Vonoprazan therapy options

A

-dual
-triple
-potassium-competitive acid blocker
0inhibits H/K ATPase in parietal cells via competitive ANTAgonism of potassium
-onset 2-3 hours
-can also use for erosive GERD

27
Q

Vonoprazan Dual therapy

A
  1. Vonoprazan 20mg BID
  2. Amoxicillin 1g q8h

-14 days

28
Q

Vonoprazan triple therapy

A
  1. Vonoprazan 20mg BID
  2. Amoxicillin 1g BID
  3. Clarithromycin 500mg BID

-14 days

29
Q

Importance of PPIs in H/ pylori

A

-antisecretory effects enhance antibiotic acivity
-dec acidity = inc antibiotic
-higher eradication rates
-H2RAs should not be used unless patient cannot tolerate PPI
-PPIs not necessary beyonf 2 weeks of use for eradication

30
Q

PPI dosing for H. pylori

A

-Omeprazole 20
-Pantoprazole 40
-Esomeprazole 20-40
-Lansoprazole 30

31
Q

Probiotics

A

-potentially used as prophylaxis for H. pylori colonization
-can be taken to supplement antibiotic therapy to inc eradication rates when compared to placebo
-may also reduce effects of therapy

32
Q

Metronidazole side effects

A

-acoid alcohol due to disulfram reaction

33
Q

Clarithromycin side effects

A

-GI upset

34
Q

Tetracycline side effects

A

-photosensitivity
-avoid use in children

35
Q

Bismuth salts adverse effects

A

-darkening of stool and tongue

36
Q

Treatment considerations for H pylori

A

-avoid antibiotics the pt has already taken
-patient adherence
-consider allergies + intolerances

37
Q

Facotrs that predict Tx outcomes for H. pylori

A

-antibiotic resistance
-poor medication adherence
-short duration of therapy
-high bacterial load

38
Q

PUD treatment failure

A

-confirmed by diagnostic test 4 weeks after completion of antibiotics and after PPI has been discontinued for 2 weeks

39
Q

Patients who fail PUD should

A

-be referred to gastroenterologist
-perform a penicillin skin test if allergy previously listed

40
Q

If PUD Tx fails,

A

-select salvage therapy
-chose antibiotics that were not used in previous regimen
-reference specific resistance rates
-use extended treatment duration of 10-14 days

41
Q

NSAID induced PUD patho

A

-rule out H. pylori and confirm with endoscopy and low Hgb and Hct if ulcers are bleeding

42
Q

Patients at high risk for NSAID GI toxicity

A

-hist of ulcer
-multiple risk factors

43
Q

Patients at moderate risk for NSAID GI toxicity

A

-over 65 years old
-high dose NSAID therapy
-previous history of ulcer
-use of aspririn, corticosteroids, anticoagulents

44
Q

Low risk patients for NSAID GI toxicity

A

-no risk factors

45
Q

Prevention of NSAID induced ulcers

A

-PPI w NSAID
-H2RA w NSAID
-Misoprostol w NSAID
-COX-2 inhibitor

46
Q

NSAID induced ulcer dosing

A

ome, panto, esome 40mg qd
-Lansoprazole 30mg
-Famotidine 40 once or 20 BID
-Cimetidine 300 QID, 200 BID, 800 qd
-Misoprostol 200mcg QID w food

47
Q

Misoprostol for NSAID induced ulcer prevention

A

-200mcg w food
-prostaglandin E1 analog
-inc mucus and bicarbonate secretion, surface active phospholipids, and gastric blood flow which inhibits secretion

48
Q

Misoprostol side effects

A

-diarrhea, ab pain. N/V, headache
-boxed warning abortifacient
-induces labor/abortion

49
Q

Celecoxib (Celebrex) for NSAID induced ulcer prevention

A

-selective CoX-2 inhibitor
-anti inflammatory but preserves prostaglandins
-inc CV risk
-prefer Naproxen

50
Q

NSAID treatment in LOW GI risk and HIGH CV risk

A

-low dose celecoxib (200mg)
-Naproxen + PPI

51
Q

NSAID treatment in LOW GI risk and LOW CV risk

A

-celecoxib
-any ns-NSAID + PPI

52
Q

NSAID treatment in HIGH GI risk and HIGH CV risk

A

-low dose celecoxib + PPI
-avoid NSAIDs

53
Q

NSAID treatment in HIGH GI risk and LOW CV risk

A

-celecoxib + PPI

54
Q

NSAID-induced ulcer treatment if patient can stop NSAID

A

-PPI, H2RA, or sucralfate for 8 weeks

55
Q

NSAID-induced ulcer treatment if patient can NOT stop using NSAIDs

A

-PPI for 12 weeks
-lowest effective dose of NSAIDd
-may consider continuing PPI

56
Q

Sucralfate (Carafate)

A

-1g QID before meals and at bedtime
-sucrose-sulfate-al complex
-interacts w albumin and fibrinogen = physical barrier over ulcer for protection

57
Q

Sucralfate (carafate) side effects

A

-constipation
-metabolic taste
-aliminum toxicity in chronic renal failure
-admin on empty stomach 2 hours before or 4 hours after other medications

Therapeutics (78 decks)

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