August 10, 2015 - NSAIDs Flashcards
Peptic Ulcer Complications
- Acute bleeding which can be life-threatening
- Chronic bleeding which can cause iron deficiency anemia
- Stricture/obstruction
- Perforation which can lead to a pneumatoperitoneum
Risk of Poor Outcomes
Older age (>60)
Severe comorbidity
Active bleeding
Hypotension or shock
Red blood cell transfusion of > 6 units
Inpatient status at the time of bleed
Severe coagulopathy
Types of GI Bleeding
Coffee-ground emesis
Hematemesis
Melena
Hematochezia
Ligament of Treitz
Usually bleeds are proximal to the ligament of Treitz to cause melena.
Hematochezia
The passing of maroon-coloured stool or of fresh blood. Usually indicitive of a lower GI bleed or a brisk upper GI bleed.
Hematochezia AND hematemesis is very very very BAD as it indicates a massive bleed within the digetive system.
Types of Endoscopic Therapy
Injection Therapy
Thermal (Cautery or argon/plasma)
Mechanical (hemoclips)
Foam (hemospray)
Endoscopic therapy reduces the risk of re-bleeding and reduces mortality.
Surgical Management of an Ulcer
When all else fails, you must over sew the ulcer.
Anti-Ulcer Drugs
Antacids
H2 receptor antagonists (H2RA)
Proton pump inhibitors
Antibiotics for H. pylori eradication
Timing of PPIs
Best taken 30 minutes before a meal.
Risks of PPI Therapy
Risks are small, but they can include…
Potential for bacterial overgrowth
May increase the risk of aspiration pneumonia
May decrease bone density
May excaburate iron deficiency
May excaberate vitamin B12 deficiency
NSAID Mechanism of Action
Inhibits Cox1 or Cox2
Cox 1 is involved with physiological stimulus such as platelet aggregation, vasoconstriction, vasodilation etc.
Cox 2 is involved with inflammatory stimulus such as pain sensitization
How COX-1 and COX-2 Inhibitors Can Cause PUD
Cox-Inhibitors
Work more specifically than NSAIDs, but still carry a risk of increased PUD as well as cardiac and vascular events.
