GI Disorders Flashcards
Clarithromycin triple therapy for H Pylori
PPI (standard or double dose) BID + amoxicillin 1000 mg BID (or metronidazole 500 mg TID) +
clarithromycin 500 mg BID for 14 days
Bismuth quadruple therapy for H Pylori
PPI (standard dose) BID + Bismuth subsalicylate 300 mg QID (or Bismuth subcitrate 120-300 mg
QID) + metronidazole 250 QID or 500 mg TID-QID
+ tetracycline 500 mg QID
for 10-14 days
Concomitant therapy for H Pylori
PPI (standard dose) BID + clarithromycin 500 mg
BID + amoxicillin 1000 mg BID + metronidazole or
tinidazole 500 mg BID for 10-14 days
Sequential therapy for H Pylori
PPI (standard dose) BID + amoxicillin 1000 mg BID
for 5–7 days; then PPI BID + clarithromycin 500 mg
BID + metronidazole or tinidazole 500 mg BID for
5–7 days
H2 Blockers
Reversibly inhibit histamine-2 receptors on the parietal cell
used for for intermittent mild-to-moderate GERD
symptoms
preventive dosing before meals or exercise is also possible.
Prolonged use
is associated with the development of tolerance and reduced efficacy
less effective than PPIs in healing erosive esophagitis.
Proton pump inhibitors
Irreversibly inhibit the final step in gastric acid secretion
greater degree of acid suppression achieved and longer duration of action than H2 RAs
Most effective agents for short- and long-term management of GERD and for management of
erosive disease
Acute interstitial nephritis (AIN) with PPIs
Limit the dose and duration of PPIs.
Renal function monitoring may not be necessary for short-term use (4–8 weeks) use
consider annual monitoring, dose reduction, and deprescribing in patients with long-term use.
AIN may recur with PPI rechallenge
Risk of fracture (hip, wrist, spine) with PPIs
Concern about fractures should not affect decision to use PPIs, except in patients with
other risk factors for hip fracture
patients with osteoporosis can
remain on PPIs if you:
-limit dose and duration
-ensure adequate calcium and vitamin D
-BMD screening if at risk of low bone mass
-weight-bearing exercise
Hypomagnesemia with PPIs
Reevaluate need of PPI use
limit dose and duration
consider baseline testing
(presence of diuretics, digoxin)
supplementation with magnesium
C diff with PPIs
Reevaluate need of PPI use
limit dose and duration
evaluate for C. difficile if patient
receiving PPI has diarrhea that is not improving
have patients report diarrhea
Community-acquired pneumonia with PPIs
Short-term use may increase risk
long-term risk is not elevated
assess vaccine status
Metoclopramide
dopamine antagonist
associated with adverse effects such as dizziness, fatigue, drowsiness, extrapyramidal symptoms (EPS), and hyperprolactinemia
Bethanechol
cholinergic agonist
poorly tolerated because of adverse effects such as diarrhea,
blurred vision, and abdominal cramping
may also increase gastric acid production.
Used for urinary retention, off-label for GERD
Treatment of H. pylori–associated ulcers
ACG guidelines, are to
include an antisecretory agent (preferably a PPI) plus at least two antibiotics (clarithromycin and amoxicillin or metronidazole)
Quadruple therapy an alternative first line
sequential therapy requires further validation before used widespread
A bismuth-based quadruple therapy for 14 days or a levofloxacin-based triple therapy for 10 days can be used in patients who have not responded to initial regimens as salvage therapy
Sulfasalazine
Aminosalicylate
cleaved by colonic bacteria to the active portion (5-aminosalicylate) and the inactive carrier molecule sulfapyridine
Efficacy is best in colonic disease because of colonic activation of the drug.
Dose-related adverse effects (due to the sulfapyridine portion): GI disturbance, headache, arthralgia, folate malabsorption
Avoid in patients with a sulfa allergy
