Gastric and duodenal ulcers Flashcards
What 4 drugs used in ulcers
1) H2
2)ppi
3) sucralfate
4) misoprostol
misoprostol
synthetic prostaglandin analogue
- teratogentic
- colic diarrhoea dose limiting s/e
-if diarrhoea severe withdraw
sucralfate
chelate and complex
bezoar form; 1 hr before food/ 1 gap between enteral food
H pylori ulcers triple therapy and if allergies
PPI (twice daily) + clarithromycin +amoxicillin or metronidazole
if allergy to amoxicillin: PCM
if allergy to clarithromycin: PAM
if allergy to metronidazole: PCA
NSAID induced ulcer tx
- withdraw NSAID if possible
1st line= PPI alt H2/ misoprostol
test for Hpylori on healing
if continue non selective NSaid; give PPI or misoprostol
if history upper GI bleed: cont PPI + cox 2 nsaid instead
risk factors for NSAID induced ulcers
age 65+, prev history, diabetes, liver kidney heart problem, taking certain meds
at risk : PPI alt H2/ misoprostol
3 or more risk: PPI + cox 2 nsaid
GORD mild to mod tx
Alginates/ antacids
alt ppi/ h2
maintain remission with intermittent tx
GORD severe
PPI 4-6 weeks
maintain remision , low dose ppi, intermittent ppi or substitute with H2
GORD pregancy
1st = alginates/ antacids
2nd = ranitidine
3rd line= omeprazole but usually resevred severe/ complicated gord
GORD kids
common in babies and kids resolves after 12-18months
thickened feeds or alginates (gaviscon infant)
H pylori diagnosis
c-urea breath test
dont do until 4 weeks after antibacterial therapy
and 2 weeks after ppi therapy
Food allergy and symptoms
Immune reaction to food
4 symptoms
1) cutaneous i.e. hives urticaria
2) GI
3) respiratory
4) anaphylaxis
common allergens
peanut, tree nut , shellfish, fish, soy, cows milk , hen eggs
tx of food allergy
avoid allergen
sodium cromoglicate adjunct to dietary
chlorphenamine - symptomatic control
in case anaphylaxis - epi pen - adrenaline
