ch 64 Flashcards
most cases of PUD are caused by
H.Pylori
a group of upper GI disorders characterized by varying degrees of erosion of the esophagus, stomach and sm intestines
Peptic ulcer disease
major aggressive factors of PUD
H pylori
NSAiDS
gastric acid
pepsin
what are the defensive factors of the stomach against PUD
mucus
Bicarbonate
Blood flow
prostaglandins
H pylori is a gram
gram negative bacillus
what other things can H. Pylori lead to
PUD gastric cancer (gastric mucosa-associated lymphoid tissue (MALT) lymphomas)
primary disorder in which hypersecretion of acid alone causes ulcers
Zollinger-Ellison syndrome
Smoking and PUD
delays ulcer healing and increases r/o occurance
Goals of drug therapy in PUD
alleviate symptoms
promote healing
prevent complications such as hemorrhage, perforation and obstruction
prevent recurrence
prophylaxis for NSAID induced ulcers
PPIs are preferred
Misoprostol is effective but can cause diarrhea
Treatment for NSAID treatment for ulcers
H2 receptor blockers and PPIS are preferred
d/c NSAIDS if possible
Treatment for H Pylori
Amoxicillin plus PPI plus Clarithromycin
if allergic to PCN how do you treat H pylori
Flagyl plus PPI plus clarithromycin
methods to determine eradication of H pylori
Breath tests
serologic tests
stool tests
microscopic of of a stained biopsy sample
what is the ulcer diet
a change in eating pattern may be beneficial - 5-6 small meals a day instead of 3 large - reduces fluctuations in gastric pH and facilitate recovery
what should be avoided with PUD
smoking
aspirin - unless for heart disease
NSAIDS
when do you use ABX for pt that test positive for H pylori
only if symptomatic
abx that can be used for H pylori
amoxicillin clarithromycin flagyl metronidazole tetracycline
harmless adverse effect of Bismuth for H pylori
black coloration to tongue and stool
metronidazole or Tinidazole and alcohol
disulfiram like reaction
treat h pylori in places where resistance to clarithromycin is high
quad therapy Bismuth subsalicylate metronidazole tetracycline PPI or an H2RA
what is the sequential therapy for H pylori for those who cant take all at once?
PPI plus amox for 5 days
then
PPI plus clarithromycin plus tinidazole for 5 days
H2 receptor antagonists work by
suppressing secretion of gastric acid
How do you take Cimetidine (Tagamet)
when taken with food it decreases rate of absorption and beneficial effects prolonged
Cimetidine promotes healing of
gastric and duodenal ulcers treatment
lower dose for prophylaxis against recurrence
to heal gastric ulcers how long is needed with cimetidine
8-12 weeks
Cimetidine is also used in
GERD Zollinger ellison syndrome Heartburn Acid indigestion sour stomach
antiandrogenic effects of Cimetidine
gynecomastia
reduced libido
impotence
CNS effects of cimetidine
most likely in older adults who have renal or hepatic impairment
confusion
hallucinations
CNS depression or excitation
cimetidine and resp effects
increased r/o pneumonia due to elevation of pH with antisecretory agent - bacterial colonization of stomach increases results in secondary increase in colonization of resp tract
Cimetidine is a CYP
inhibitor
drugs of concern with cemetidine
warfarin
phenytoin
theophylline
lidocaine
these drugs dosage should be reduced
Antacids can _____ the absorption of cimetidine so they should be administered how
decrease
at least one hour apart
what should pt report when taking H2 receptor antagonists
lethargy somnolence restlessness confusion hallucinations
PPIs can increase risk for
fractures (decreased absorption of Calcium)
pneumonia
acid rebound
intestinal infection with C. Diff
Omeprazole is approved for
short term therapy of duodenal ulcers gastric ulcers erosive esophagitis GERD
long term therapy for hypersecretory conditions (Zollinger-Ellison syndrome)
prevent
stress ulcers in pt who are in ICU and have an additional risk factor such as multiple trauma, spinal cord injury, prolonged mechanical ventilation longer than 48 hours
GERD is characterized by
heartburn
acid regurgitation
characterized by breaks in them esophageal mucosa
erosive esophagitis
characterized by mucosal breaks are absent
NERD (nonerosive reflux disease)
Adverse effects of Omeprazole
Pneumonia Fractures (decrease absorption of Ca) rebound acid hypersecretion hypomag diarrhea - increase r/o c diff
erosive GERD can lead to
esophageal adenocarcinoma
Barrett esophagus
Pt with NERD, PPIS are taken
PRN
Pt with erosive GERD, PPIS are taken
continuously until symptoms resolve
by elevating pH, omeprazole and other PPIs can significantly reduce absorption of
HIV
atazanavir
delavirdine
nelfinavir
antifungal
ketoconazole
itraconazole
omeprazole and other PPIs can reduce the adverse effects of
Plavix but it may also reduce beneficial effects
what is the dilemma with clopidogrel (plavix)
if used alone, there is a significant risk for GI bleeding
if combined with a PPI - risk of GI bleeding is decreased but antiplatelet effects are decreased as well.
if pt has risk factors for GI bleeding (advanced age, use of NSAIDS or anticoagulants) - benefits outweigh risk
if lack risk factors for GI bleeding - avoid combining PPI with clopidogrel
symptoms of hypomag
muscle cramps
palpitations
tremors
sucralfate is approved for
acute therapy and maintenance therapy of duodenal ulcers
adverse effects of sulcralfate
constipation
by raising gastric acid above pH above 4, _____ may interfere with sucralfate effects
antacids space 30 min apart
sucralfate may impede the absorption of what drugs
phenytoin theophylline digoxin warfarin fluoroquinolone abx (Ciprofloxacin)
administer at least 2 hours apart
Misoprostol is approved for
prevention of gastric ulcers caused by long term therapy of NSAIDS
what PUD med must be avoided in pregnancy
Misoprostol
what PPI is safe in pregnany
esomeprazole
what H2 receptor antagonist is safe in pregnancy
rantidine
what drugs are safe for breastfeeding
omeprazole
esomeprazole
ranitidine
PUD med consideration for older adults
PPIS
increased risk for fractures from osteoporosis
med interactions
vitamin/mineral deficiencies
adverse effects misoprostol
diarrhea
abd pain
spotting
dysmenorrhea
women of childbearing age that needs to use misoprostol must be able to
1) comply with birth control measures
2) be given oral and written warnings about the med
3) have a neg serum pregnancy test within 2 weeks before beginning therapy
4) begin therapy only on second or third day of next menstrual cycle
principal indications for antacids
PUD
GERD
adverse effects of antacids
constipation and diarrhea
sodium loading - some have substantial amounts of Na, can exacerbate hypertension and heart failure
by raising gastric pH, antacids can influence dissolution and absorption of drugs such as
cimetidine and ranitidine
give one hour gap
2 most common antacids
magnesium hydroxide
aluminum hydroxide
2 less common antacids
calcium carbonate
sodium bicarbonate
PPI and H2 receptor antagonists can be used as young as
1 month old
which antacid promotes constipation
aluminum hydroxide
which antacid promotes diarrhea
mag hydroxide
