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CDM 2 Exam 3 > Lecture 11 - GI inpatient > Flashcards

Lecture 11 - GI inpatient Flashcards

1
Q

Upper GI Bleeding Major causes

A

inflammation, ulcers, cancer within Esophagus, gastric or Duodenal speces

Mallory-weiss tear

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2
Q

Misoprostol MOA

A

synthetic analog of prostaglandin E to replace those lost when other agents that inhibit the roduction

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3
Q

Sucralfate MOA

A

provides protective covering, not widely used.

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4
Q

Achgalasia

A

Disorder involving lower esophageal sphincter

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5
Q

Zollinger-Ellison’s Syndrome

A

Hypersecretion of gastrin due to tumor

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6
Q

Modifiable risk factors PUD

A 
Multiple NSAID use
Concomitant anticoagulants
Corticosteroids
SSRIs
Tobacco use
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7
Q

Non-modifiable risk factors PUD

A

Age > 25
History of PUD
H.Pylori infectin

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8
Q

Acid suppression therapy recommended in patients who….

A

are receiving prolonged ( > 6 months) high-dose steroids or when used concomitantly with NSAIDs

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9
Q

PUD and SSRI therapy

A
  1. using PPIs appear to mitigate the risk

2. no really clinically relevant, would prob keep person on SSRI in practice

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10
Q

PUD and smoking

A

> 10 cig per day can increase gastric acid secretion

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11
Q

Stress-related mucosal damage (SMRD)

A

most likely to occur in critical care patients

Estimated in 75% of pts will develop within 72hrs

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12
Q

SMRD in critically ill patients

A

Coagulopathy
long time on vent
head injury
History of GI bleed

2 + of following
Sepsis, > 7 days ICU, High dose Corticosteroids > 250mg hydrocort, overt bleeding > 6 day

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13
Q

SMRD in non-critically ill patients

A

> 2 of the following

GERD
Duodenal or Gastric ulcer
H.pylori infection active
Presumed/known upper GI bleed
pts receiving antiplatelet/ aspirin therapy
Receiving H2 blocker or PPI at home
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14
Q

Prophylaxis against PUD

A

Most compelling to consider in….

Chronic NSAIDs + multiple NSAIDs
Previous PUD
Concomitant use w/ corticosteroids

Less compelling to consider in…
65+
combo SSRI + NSAIDs

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15
Q

Prophylaxis for SRMD

A

hospitalized pts meeting criteria previously outlined, only while criteria is met**

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16
Q

Agents for Prophylaxis NSAIDs

A

Oral H2RAs (able dose) = famotidine 20mg BID or 40mg QD

PPI - omen 20mg daily

Misoprostol 800mcg/.day

17
Q

Agents for Prophylaxis SRMD

A

H2RA are preferred, PPI for those who cant tolerate or take

same doses as other….famotidine 20mg BID, 40mg QD, or omeprazole 20mg QD

sucralfate maybe considered if either or both CI

18
Q

When are H2RAs and PPI CI

A

Hypersensitivity is only firm CI

19
Q

Cautiously use H2RAs when…

A

CNS toxicity in pts > 50 w/ renal or hepatic dysfunction

Famotidne = specific QTc prolong in pts w/ renal dysfunction

20
Q

Cautiously use PPI when….

A

combo w/ clopidogrel (esp omep/esomep)

Long-term use associated w/ inc MI, C.Dif, Bone fracture

21
Q

what makes pt high risk for GI bleed?

A

previous GI bleed

22
Q

Rockall score

A

Good score = < 3

Bad score = > 8

23
Q

Risks for mortality from GI bleed

A 
> 60yrs old
Addition comorbidities, renal failure or metastatic cancer
> 8 unit of blood w/in 1st 12hrs
INR > 1.5 while not on anything
Elevated BUN
24
Q

Acute management of GI bleed

A
  1. Fluid resuscitation - IV fluids
  2. Endoscopic procedure +
    can do pantoprazole 40mg IV q12hrs, or 80mg bolus X 1, then 8mg/hr drip for 42-72hrs…then move to 40mg PO BID

Continuous PPI > Intermittent
IV > PO

25
Q

Re-bleeding risks

A

> 65yrs old
Chronic CVD comorbidities….HTN/CAD
Shock or coagulopathy at presentation

26
Q

Long term management PUD

A

PPI > H2RAs

PPI - 1 QD dosing, can use 2 BID for severe case, 4-8weeks for those without severe complicating factors

refractory = ulcers after 12weeks of therapy

27
Q

H2RA specific info

A

renal adjust
comparable results between agents
concern for thrombocytopenia
cimetidine numerous DDI

28
Q

PPI specific infco

A

no renal adjust
no efficacy diff between agents
30-60min b4 meal = max pump inhib

DDI
Atazanavir = dec bioavailability
Levo = reduced absorption
Digoxin/nifedipine = inc absorption

29
Q

Omeprazole info

A

Prilosec

40 QD, 20-40mg/day range

30
Q

Lansoprazole info

A

Prevacid

30 QD, 15-30mg/day range

31
Q

Pantoprazole info

A

Pantoprazole

40 QD, 40-80mg/day

32
Q

Dexlansoprazole info

A

Dexilant

30-60mg QD dose + range

33
Q

Famotidine info

A

20mg BID or 40mg HS

20-40mg day range

34
Q

Cimetidine info

A

switch, dont use this shit

35
Q

anticoagulant & anti platelet use after UGIB

A

Aspirin: reinitaiton w/ 7 days, ideally 1-3 days and with use of PPI

Thienopyridines: can use after resolution of bleeding/endoscopy

Warfarin: 1-7 days, but inc risk for recurrent UGIB

Novel anticoagulants: no sooner than 7 days after UGIB

36
Q

PUD prophylaxis summary indications

A

Inpatient: highest risk include critically ill

Outpatient: highest risk include chronic NSAID/anticoag use

CDM 2 Exam 3 (13 decks)

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