Final: GI - Peptic Ulcer Disease

Question 1

Omeprazole (PPI)

Answer 1

Inhibits enzyme that generates gastric acid

Education: Take before meals, do not crush, monitor signs of GI bleeding

Adverse effects: n/v/d, headache, constipation

Long-term use: Risk of fractures, pneumonia, hypomagnesemia, C.diff-associated diarrhea, B12 deficiency, CKD, dementia

Question 2

Cimetidine (Tagamet)

Answer 2

H2 Receptor Antagonist

Gastric and duodenal ulcers, GERD, Zollinger-Ellison Syndrome, dyspepsia, prophylaxis for stress-induced ulcers (burn PT), prevention of aspiration pneumonitis (give as pre-op med)

Action: Reduces gastric acid production by blocking histamine at H2 receptor sites

Adverse effects: Gynecomastia, decreased libido, impotence, CNS effects (kidney and liver dysfunction)

Drug-drug: Hepatic inhibitor, antacids, alcohol, smoking, NSAIDS

Elevator HOB

Chronic use adverse effect: PNEUMONIA

Question 3

H. Pylori

Answer 3

Treated with use of two antibiotics and a PPI (normal course: 14 days)

Antibiotics: Clarithromycin (distortion of taste, nausea, diarrhea, high resistance), metronidazol (high resistance)

Question 4

Calcium Carbonate (Tums)

Answer 4

Antacid, associated with acid rebound

Adverse effects: Constipation, hypercalcemia

Education: Avoid sodium in HTN/HF patients, For maximum effectiveness take 1 hour before eating a meal or snack/1 hour before or 2 hours after taking medications

Question 5

Pancrelipase (Pancreatic enzyme)

Answer 5

Contraindication: Hypersensitivity to porcine proteins, acute or flares of chronic pancreatitis

Assess: Signs of GI irritation and oily stool

Education: Take with meals and snacks