GERD and PUD Tx II Flashcards
which has fastest onset of action between antacids, H2RAs and PPIs
antacids then H2RAs last is PPIs
which has longest duration of action
antacis, H2RAs and PPIs
PPIs then H2RAs then antacids
H2RA and PPI
which heals peptic ulcers more
PPIs
tolerance occurs with what
H2RA
what occurs with discontinuation of PPIs and H2RAs
rebound dyspeptic Sx and acid hypersecretion
moa bismuth compounds
coat ulcers and erosions creating protective layer against acid and pepsin
stimulates PG, mucus and bicarb
what is purpose of salicylate in bismuth subsalicylate
like ASA inhibits intestinal PG and chloride secretion
reduce stool frequencys and liquidity in infecitous diarrhea
PK of bismuth
> 99% appears in stool
rapid dissociation
therapeutic use of bismuth compounds
dyspepsia and acute diarrheatravelers diarrhea
H pylor infection
what is the drug combination for H pylori
bismuth salicylate, bismuth subcitrate potassium with metronidazole and tetracycline
adverse effects of bismuth compounds
blackening of stool
carefule in children with flu or chicken pox because of reyes
used short periods to avoid encephalopathy and renal impairment
What is misoprostel
PG analog
MOA misoprostel
methyl analog PGE1, mucosal protective and acid inhibitory
may stimulate mucus and bicarb secretion and enhance mucosal blood flow
bind PG R on parietal cells reducing histamine stimulated cAMP production causing acid inhibition
Use of prostaglandin analogs
prevention NSAID induced ulcers
adverse drug reactions prostaglandin analogs
diarrhea, cramping abdominal pain
stimulates uterine contraction so not used in pregnancy or those of childbearing age without negative pregnancy test
MOA sucralfate
negatively charged sucrose sulfate binds positively charged proteins at base of erosions forming a physical barrier that restricts further damage
stimulates mucosal OG and bicarb secretion
use of sucralfate
stress related mucosal injury
administered through NG tube
adverse drug reactions of sucralfate
not absorbed, no systemic effects
some say contipation due to aluminum salt
drug drug interactions sucralfate
may impair absorption of other drugs, separate administration times
What type microbe is H pylori
spiral shaped gram - rod
When do you test for H pylori
active PUD
past Hx of documented peptic ulcer
gastric mucosa associated with MALT lymphoma
univestigated dyspepsia, <55 y.o
side effects clarithromycin
GI upset, diarrhea, altered taste!!!!
side effects of amoxicillin
GI upset, HA and diarrhea
side effects metronidazole
metallic taste!!!!!, dyspepsia, intolerance to alcohol!!!!!!
side effects tetracycline
GI upset, photsensitivity!!!!
how do PPIs promote eradication of H pylori
direct antimicrobial properties and lower minimal inhibitory [ ] of antibiotics against H pylori
recommented epirical Tx for patients with H pylori and not on clarithromycin
14 days
PPI +
clarithromycin +
amoxicillin or metronidazole
rec Tx for H pylori in patients given a macrolide previously or failed standard Tx
14 day
- PPI or H2RA +
- metronidazole +
- tetracycline or doxycycline +
- bismuth subsalicylate
what is the sequential therapy used in europe for H pylori
5 days PPI and amoxicillin
then 5 days PPI, clarithromycin and tinidazole
What is the european salvage regimen for h pylori
levofloxacin based triple therapy for 10 days
modification for GERD patient that has Sx after lying down
head of bed elevation
modification for nocturnal GERD Sx
avoid meals 2-3 hrs before bed
modification for tobacco users who have GERD
smoking cessation
what are some triggers for GERD patients
caffeine, coffee, chocolate, spicy foods, acidic foods, high fat content
what is preferrent for infrequent heartburn
H2RAntagonist
what is preferred for milk, intermittent Sx of GERD
antacid or H2RA prn
what is preferred for NERD
antacid of H2RA (PPI may be required)
what is preferred for erosive esophagitis
PPI x 8 weeks
rec for duodenal ulcer
H2RA or PPI x 4 weeks
recommendation for gastric ulcer
PPI x 8 weeks
therapy for NSAID induced ulcers
discontinue NSAIDs,
PPIs if have to stay on NSAID
Tx stress ulcers prophylaxis
omeprazole NaHCO3
H2RAs preferred IV if there is no NG tube