Final Exam - GERD + PUD Flashcards
Barrett’s esophagus and esophageal adenocarcinoma are more common in ____
a. men
b. women
a. men
which of the following is known to cause or increase the risk of developing GERD?
a. faster gastric emptying
b. higher LES Pressure
c. increase in esophageal mucosal resistance
d. acid pocket formation
d. acid pocket formation
what is the preferred diagnostic test to assess mucosal injury and complications?
upper endoscopy
which diagnostic test for GERD is useful for patients who failed 2 trials of PPI with normal endoscopy findings?
a. barium radiography
b. manometry
c. reflux (pH) test
b. manometry
antacids decrease activation of ___ to ____
pepsinogen; pepsin
true or false: antacids decrease LES pressure
false
(increase)
too much calcium can cause ____
a. constipation
b. diarrhea
a. constipation
too much magnesium can cause ____
a. constipation
b. diarrhea
b. diarrhea
too much aluminum can cause ____
a. constipation
b. diarrhea
a. constipation
pepto-bismol and alka-seltzer are not recommended for children under 12 because of risk for _____ syndrome
Reye’s
which of these medications contains simethicone?
a. alka-seltzer
b. pepto-bismol
c. gas-X
d. tums
c. gas-X
H2RA’s mechanism of action: _____ inhibition of histamine receptors in the parietal cells
a. irreversible
b. reversible
b. reversible
max/day for pepcid
40 mg/day
which is not an H2RA?
a. cimetidine
b. omeprazole
c. nizatidine
d. famotidine
b. omeprazole
_____ occurs with long term use of H2RAs
tachyphylaxis
(the more you use it, the less it tends to work)
which H2RA has the most concern for lots of drug-drug interactions?
a. ranitidine
b. famotidine
c. cimetidine
d. nizatidine
c. cimetidine
PPIs mechanism of action: _____ inhibition of proton/potassium ATPase
a. reversible
b. irreversible
b. irreversible
true or false: dexlansoprazole can be taken without regard to meals
true
lansoprazole brand name
prevacid
omeprazole is metabolized by which CYP?
CYP2C19
what is the most common PPI found on hospital formularies?
a. omeprazole
b. lansoprazole
c. dexlansoprazole
d. esomeprazole
e. pantoprazole
e. pantoprazole
rabeprazole (AcipHex) should be administered ____ minutes before a meal
a. 15
b. 30
c. 60
d. 90
b. 30
which PPI interacts with clopidogrel and bisphosphonates and may decrease its effectiveness?
a. omeprazole
b. lansoprazole
c. pantoprazole
d. dexlansoprazole
a. omeprazole
what is the problem with prokinetics such as metoclopramide and bethanechol as non-acid suppressing therapy?
they have undesired side effects and are not as effective as acid suppression therapy
why do we taper PPI’s?
risk of rebound hyperacidity
1st line therapy for pregnant patients with GERD: antacids or ______
sucralfate
in children under 12 with GERD, we should not what two ingredients in antacids?
aluminum or bismuth subsalicylate
true or false: Children’s Pepto is safe to use in kids under 12 years old
true
(contains calcium carbonate and not bismuth subsalicylate)
3 most common etiologies for peptic ulcer disease
bugs, drugs, stress
true or false: a duodenal ulcer would be relieved by eating food
true
true or false: a stomach ulcer would be relieved by eating food
false
H. pylori induced peptic ulcer disease is confirmed via ______
endoscopy
the _____ breath test can be done to confirm H. pylori induced PUD
urea
quadruple therapy for H. pylori induced PUD includes what 4 things?
- PPI BID
- bismuth subsalicylate
- metronidazole
- tetracycline
(x 10-14 days)
clarithromycin-based therapies are no longer recommended in the US due to _____
resistance
levofloxacin triple therapy includes what 3 things?
- PPI BID
- levofloxacin 500 mg daily
- amoxicillin 1 g BID
what is levofloxacin LOAD therapy?
quadruple therapy (spells out LOAD)
- levofloxacin 250 mg daily
- omeprazole (or other high dose PPI) daily
- nitazoxanide (alinia) 500 mg BID
- doxycycline 100 mg daily
helidac is _____ therapy for H. pylori induced PUD
a. triple
b. quadruple
quadruple
true or false: Pylera is a 3-in-1 capsule containing bismuth subcitrate potassium, metronidazole, and amoxicillin
false
(contains tetracycline, not amoxicillin)
rifabutin is salvage therapy for H. pylori induced PUD containing what 3 things?
- omeprazole 40 mg q8h
- amoxicillin 1 gm q8h
- rifabutin 50 mg q8h
(x 14 days)
______ are the backbone of H. pylori induced PUD therapy
BID PPIs
which PPI is not FDA-approved for treating PUD?
a. omeprazole
b. esomeprazole
c. dexlansoprazole
d. lansoprazole
e. pantoprazole
c. dexlansoprazole (dexilant)
bismuth salts mechanism of action for H. pylori PUD
topical bactericidal effect
adverse effect of tetracyclines for PUD
a. tendon rupture
b. GI upset
c. photosensitivity
d. QTC prolongations
c. photosensitivity
which antibiotic can cause tendon rupture?
a. metronidazole
b. amoxicillin
c. clarithromycin
d. levofloxacin
d. levofloxacin
probiotics could potentially be used as ______ for H. pylori colonization
prophylaxis
NSAID-induced PUD is due to the fact that NSAIDs inhibit ____
prostaglandins
PPIs, H2RAs (for duodenal ulcer only), or ______ can be used for prophylaxis of NSAID induced PUD
misoprostol
which is not used for treatment of NSAID induced PUD?
a. PPIs
b. H2RAs
c. misoprostol
d. sucralfate
c. misoprostol
all of these are dosed at 40 mg daily for NSAID-induced ulcers except for which one?
a. lansoprazole
b. omeprazole
c. esomeprazole
d. pantoprazole
a. lansoprazole
misoprostol mech of action of NSAID-induced PUD
prostaglandin E1 analog
sucralfate mech of action
sucrose-sulfate-aluminum complex that interacts with albumin and fibrinogen to form a physical barrier over an open ulcer
if a patient has CV problems, what is the preferred non-selective NSAID to use?
naproxen
H2RAs are only used for _____ ulcer prevention
a. duodenal
b. gastric
a. duodenal
the boxed warning for misoprostol makes it contraindicated in what patient population?
a. women
b. males
c. pregnancy
d. pediatrics
c. pregnancy
