Ch 78 Peptic Ulcer Disease Flashcards
The term ___ refers to a group of upper GI disorders characterized by varying degrees of erosion of the gut wall.
peptic ulcer disease (PUD)
PUD develops when __ outweigh defensive factors (mucus, bicarbonate, submucosal blood flow, prostaglandins).
aggressive factors (H. pylori, NSAIDs, acid, pepsin)
__ is an absolute requirement for ulcer formation.
Gastric acid
In the absence of acid, no ulcer will form.
The most common cause of PUD is __.
infection with H. pylori.
The next most common cause is the use of NSAIDs.
The goal of PUD therapy is to (4).
alleviate symptoms, promote healing, prevent complications (hemorrhage, perforation, obstruction), and prevent recurrence.
The major drugs used to treat PUD are __.
antibiotics and antisecretory agents (H2RAs, PPIs)
With the exception of ___, antiulcer drugs do not alter the disease process; rather, they simply create conditions conducive to healing. Because nonantibiotic therapies do not cure ulcers, the relapse rate with them alone is high.
antibiotics
In contrast, the relapse rate following successful antibiotic therapy is low.
All patients with gastric or duodenal ulcers and confirmed infection with H. pylori should be treated with ___.
antibiotics in combination with an antisecretory agent
The antibiotics employed most often are (5).
clarithromycin, amoxicillin, bismuth, tetracycline, and metronidazole.
To avoid resistance and increase efficacy, at least two __ should be used.
antibiotics
___ suppress secretion of gastric acid by blocking histamine2 receptors on parietal cells of the stomach.
Cimetidine and other H2RAs
__ inhibits hepatic drug-metabolizing enzymes and can thereby cause levels of other drugs to rise.
Cimetidine
In contrast to cimetidine, __ has little effect on drug metabolism.
ranitidine
___ suppress acid secretion by inhibiting gastric H+, K+ -ATPase, the enzyme that makes gastric acid.
Proton pump inhibitors (e.g., omeprazole, lansoprazole)
__ are the most effective inhibitors of acid secretion.
PPIs
