ch 64 Flashcards by Brittany Blackston

most cases of PUD are caused by

H.Pylori

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a group of upper GI disorders characterized by varying degrees of erosion of the esophagus, stomach and sm intestines

Peptic ulcer disease

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major aggressive factors of PUD

H pylori
NSAiDS
gastric acid
pepsin

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what are the defensive factors of the stomach against PUD

mucus
Bicarbonate
Blood flow
prostaglandins

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H pylori is a gram

gram negative bacillus

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what other things can H. Pylori lead to

PUD
gastric cancer (gastric mucosa-associated lymphoid tissue (MALT) lymphomas)

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primary disorder in which hypersecretion of acid alone causes ulcers

Zollinger-Ellison syndrome

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Smoking and PUD

delays ulcer healing and increases r/o occurance

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Goals of drug therapy in PUD

alleviate symptoms
promote healing
prevent complications such as hemorrhage, perforation and obstruction
prevent recurrence

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prophylaxis for NSAID induced ulcers

PPIs are preferred

Misoprostol is effective but can cause diarrhea

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Treatment for NSAID treatment for ulcers

H2 receptor blockers and PPIS are preferred

d/c NSAIDS if possible

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Treatment for H Pylori

Amoxicillin plus PPI plus Clarithromycin

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if allergic to PCN how do you treat H pylori

Flagyl plus PPI plus clarithromycin

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methods to determine eradication of H pylori

Breath tests
serologic tests
stool tests
microscopic of of a stained biopsy sample

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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

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what should be avoided with PUD

smoking
aspirin - unless for heart disease
NSAIDS

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when do you use ABX for pt that test positive for H pylori

only if symptomatic

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abx that can be used for H pylori

amoxicillin
clarithromycin
flagyl
metronidazole
tetracycline

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harmless adverse effect of Bismuth for H pylori

black coloration to tongue and stool

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metronidazole or Tinidazole and alcohol

disulfiram like reaction

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treat h pylori in places where resistance to clarithromycin is high

quad therapy
Bismuth subsalicylate
metronidazole
tetracycline
PPI or an H2RA

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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

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H2 receptor antagonists work by

suppressing secretion of gastric acid

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How do you take Cimetidine (Tagamet)

when taken with food it decreases rate of absorption and beneficial effects prolonged

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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