GERD/PUD Part 2 Flashcards
Misoprostol MOA
Synthetic analog of prostaglandin E1, increases amplitude and frequency of uterine contractions and stimulates uterine bleeding
Misoprostol is contraindicated in what specific population?
Pregnant women
Misoprostol clinical indications
- Prevention of NSAID-induced ulcers
- Tx of PUD
- Various obstetric indications
Misoprostol ADRs
- Diarrhea
- Abdominal pain
Give me a general stepwise approach for GERD/PUD in pregnancy
- Step 1: lifestyle modifications
- Step 2: antacids can be tried for symptomatic relief
- Step 3: Sucralfate can be tried if antacids fail to relieve symptoms
- Step 4: an H2RA can be used if needed
- Step 5: if symptoms persist on an H2RA, a PPI can be considered
Recommended antacids for GERD/PUD in pregnancy
- Aluminum hydroxide/magnesium hydroxide = cat B (watch for ADRs)
- Calcium carbonate (watch for ADRs)
Antacids to avoid for GERD/PUD in pregnancy
- Magnesium trisilicates -> can cause fetal nephrolithiasis, hypotonia, and respiratory distress with chronic use/high doses
- Sodium bicarb -> can cause maternal/fetal metabolic alkalosis and fluid overload
Other options for GERD/PUD in pregnancy
- Sucralfate = cat B
- H2 Antagonists = cat B (ranitidine > cimetidine»_space; famotidine)
- PPIs = cat B, except omeprazole = cat C
- Misoprostol = cat X (abortifacient)
How are iron supplements best absorbed?
On empty stomach, take with food if iron causes GI upset
Iron supplements may decrease absorption of what 5 drugs?
- Bisphosphonates (alendronate, risendronate, zolendronic acid)
- Levodopa
- LT4
- FQs
- TTCs
What three medications can decrease absorption of iron supplements? What particular population is this especially important to consider?
- Ca/Al/Mg-containing antacids
- H2RAs
- PPIs
- Consider in pregnant women
Eradication of H. pylori can promote what, prevent recurrence of what, and decrease incidence of what?
- Promote gastric healing
- Prevent recurrence of duodenal and gastric ulcers
- Decrease incidence of gastric CA
Historically, how was H. pylori treated?
Clarithromycin triple therapy (PPI, clarithromycin, and amox or metro)
What are the new guidelines for treatment of H. pylori? What are the two options?
- Quadruple therapy for 14d, test post-tx
- Option 1: non-bismuth quad therapy -> PPI + amoxicillin + metro + clarithromycin = PAMC, dosed BID
- Option 2: bismuth quad therapy -> PPI + bismuth + metro + TTC = PBMT, dosed QID
In what particular instance might you pick bismuth quad therapy for a patient with H. pylori?
True PCN allergy or prior macrolide exposure
