Critical Care: Preventing Stress Ulcers Flashcards
The incidence of stress-related mucosal bleeding in critically ill adult is estimated to me about __%
6%
List four signs and symptoms of stress ulcers
- Hematemesis
- Gross blood in gastric tube aspirates
- Coffee ground emesis/aspiration from gastric tube
- Melena
Define a clinically significant stress ulcer
Those that cause hemodynamic compromise or necessitate blood transfusion
List three ways that cause someone to be selected for Stress Ulcer Prophylaxis (SUP)
- Any one of the major risk factors
- Two or more of minor risk factors
- History of GI ulceration or bleeding within 1 year before ICU admission
List two major risk factors that are indications for SUP
- Respiratory failure necessitating mechanical ventilation (for more than 48 hours)
- Coagulopathy
List three lab parameter derangements that would designate coagulopathy
- Platelet count less than 50,000 cells/mm3
- INR greater than 1.5
- Activated partial thromboplastin time greater than twofold the control value
List four categories of minor risk factors for stress ulcer prophylaxis
- Trauma
- Organ damage
- Surgery
- Medication
List 3 “traumatic” minor risk factors for SUP
- Head or spinal cord injury
- Severe burn (more than 35% of BSA)
- Multiple trauma
List four “organ damage” minor risk factors for SUP
- Hypoperfusion
- Acute organ dysfunction
- Liver failure with associated coagulopathy
- Acute kidney injury
List two “surgery” minor risk factors for SUP
- Transplantation
2. Major surgery
List 1 “Medication” minor risk factor for SUP
High doses of corticosteroids (more than 250 mg/day of hydrocortisone or equivalent)
What is the balance of risk/benefit for SUP?
- The benefits of preventing stress ulcers by increasing the stomach pH must be weighed against
- An increased risk of infection, including C. Diff, hospital-acquired pneumonia, and community-acquired pneumonia (for patients discharged with a PPI).
Efficacy of IV _____ in preventing stress-related upper GI bleeding has been shown in several clinical trials
IV H2 blockers
Despite limited evidence, IV or PO _____ are often used for SUP
PPI
How to choose route of administration for SUP?
Enteral administration is preferred for patient who can tolerate
List three H2 receptor blockers that can be dosed by IV bolus
- IV Ranitidine 50 mg every 8 hours
- IV famotidine 20 mg every 12 hours
- IV Cimetidine 300 mg every 6 hours
List 1 H2 receptor blocker than can be dosed by continuous IV infusion
IV Cimetidine 37.5-50 mg/hour
List four H2 receptor blockers that can be dosed PO
- Ranitidine 150 mg PO every 12 hours
- Famotidine 20 mg PO every 12 hour
- Nizatidine 150 mg PO every 12 hour
- Cimetidine 300 mg PO every 6 hour
Describe the bioavailability of H2 blockers
Excellent bioavailability
Describe the cost of H2 receptor blockers
Cheapter than PPI
Describe the risk of infection of H2 blockers
Low risk of nosocomial pneumonia
Describe dose adjustment for H2 blockers
Renal dysfunction adjustment
H2 blockers have a potential for reduced ______ over time
Efficacy (tachyphylaxis)
Cimetidine is not routinely used because of ____ and ____
Drug interactions and adverse effects
