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Therapeutics - Exam 6 > Lecture 64 > Flashcards

Lecture 64 Flashcards

Peptic Ulcer Disease (Hebenstreit)

1
Q

contributing factors to PUD

A

H pylori infection
NSAID use
gastric acid and pepsin
cigarette smoking
critical illness
dietary fators

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2
Q

types of PUD

A

H pylori induced
NSAID induced
stress induced

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3
Q

H pylori-induced PUD factors

A

condition: chronic
Site of Damage: Duodenum > stomach
Intragastric pH: more dependent
Symptoms: epigastric pain
Ulcer depth: superficial
GI bleeding: less severe

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4
Q

NSAID-induced PUD factors

A

condition: chronic
Site of Damage: Stomach > duodenum
Intragastric pH: less dependent
Symptoms: often asymptomatic
Ulcer depth: deep
GI bleeding: more severe

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5
Q

stress-induced PUD factors

A

condition: acute
Site of Damage: Stomach > Duodenum
Intragastric pH: less dependent
Symptoms: asymptomatic
Ulcer depth: most superficial
GI bleeding: more severe

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6
Q

complications of PUD

A

GI bleeding
GI perforation
GI obstruction (life threatening)

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7
Q

signs and symptoms of PUD

A

epigastric pain
belching, heartburn
weight loss
nausea
bloating, abdominal fullness
early satiety

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8
Q

H Pylori-induced PUD treatment

A

several different regimen options
typically acid suppressor with 2-3 antibiotics
helpful to determine if patients has had any recent antibiotic exposure to predict resistance

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9
Q

treatment options for H Pylori Induced PUD

A

Bismuth –> quadruple therapy
Clarithromycin –> triple, concomitant, sequentia, hybrid
Levofloxacin –> triple, quadruple (LOAD), sequential
Rifabutin –> triple
Vonoprazan –> dual, triple

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10
Q

Bismuth quadruple therapy

A

preferred regimen
contains 1. PPI BID 2. BSS 525mg QID 3. Metronidazole 250-500mg QID 4. Tetracycline 500mg QID
comes in convenience packaging - Helidac and Pyleria
duration: 10 to 14 days
Education: do not recommend in children under age of 12

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11
Q

Helidac

A

contains metronidazole 250mg, tetracycline 500mg, BSS 262.4mg
must also take PPI BID
14 blister cells

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12
Q

Pyleria

A

contains Bismuth subcitrate potassium 140mg, metronidazole 125mg, tetracycline 125
3-1 packaging
3 caps QID for 10 days

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13
Q

clarithromycin triple therapy

A

contains PPI BID, clarithromycin 500mg BID, Amoxicillin 1g BID or Metronidazole 500mg BID
Duration - 14 days
Education - not preferred in the US due to macrolide resistance

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14
Q

clarithromycin concomitant therapy

A

contains PPI BID, clarithromycin 250-500mg BID, Amoxicillin 1G BID, Metronidazole 250-500mg BID
duration: 10 to 14 days
education: another first line therapy; also known as non-bismuth quad

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15
Q

clarithromycin sequential therapy

A

contains PPI BID (days 1-10), Amoxicillin 1G BID (days 1-5), Metronidazole 250-500mg BID (days 6-10), clarithromycin 250-500mg BID (days 6-10)
duration - 10 days

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16
Q

clarithromycin hybrid therapy

A

contains PPI BID (days 1-14), amoxicillin 1G BID (days 1-14), Metronidazole 250-500mg BID (days 7-14), clarithromycin 250-500mg BID (days 7-14)
duration: 14 days

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17
Q

levofloxacin triple therapy

A

contains - PPI BID, Levofloxain 500mg QD, Amoxicilin 1G BIB
Duration: 10-14 days

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18
Q

Levofloxacin quadruple therapy (LOAD)

A

contains Levofloxacin 250mg QD, PPI (like omeprazole) at high dose QD, Nitazoxanide 500mg BID, Doxycycline 100mg QD
Duration: 7-10 days

19
Q

Levofloxacin sequential therapy

A

contains PPI BID (days 1-10), amoxicillin 1G BID (days 1-5), levofloxacin 500mg QD (days 6-10), metronidazole 500mg BID (days 6-10)
duration - 10 days

20
Q

rifabutin triple therapy

A

contains omeprazole 40mg q8h, amoxicillin 1g q8h, ribabutin 50mg q8h
duration: 14 days
education: no determined place in therapy, typically used as a salvage therapy currently

21
Q

vonoprazan dual therapy

A

contains vonoprazan 20mg BID and amoxicillin 1G q8h
duration: q4 days

22
Q

vonoprazan triple therapy

A

contains vonoprazan 20mg BID, amoxicillin 1g BID, and clarithromycin 500mg BID
duration: 14 days

23
Q

importance of PPI in H Pylori PUD

A

backbone due to antisecretory effects enhancing antibiotic activity
shown to produce higher eradication rates
H2RAs should not be used unless PPI is not tolerated
do not use beyond 2 weeks

24
Q

PPI dosing in H Pylori induced PUD

A

omeprazole - 20mg
pantoprazole - 40mg
esomeprazole - 20 to 40mg
lansoprazole - 30mg

25
Q

Metronidazole SE

A

avoid alcohol due to disulfiram-like reaciton

26
Q

clarithromycin SE

A

GI upset (NVD)

27
Q

tetracycline SE

A

photosensitivity
avoid use in children

28
Q

bismuth salts SE

A

darkening of stool and tongue

29
Q

monitoring parameters of antibiotic treatments of H Pylori PUD

A

avoid antibiotics that patient has already taken
patient adherence
consider allergies and intolerances

30
Q

NSAID induced PUD High Risk factors

A

history of previously complicated ulcer, especially recent
multiple (over 2) risk factors

31
Q

NSAID PUD Moderate Factors (1-2)

A

age over 65 yo
high dose NSAID therapy
a previous history of uncomplicated ulcer
concurrent use of aspirin (including low dose), corticosteroids, or anticoagulants

32
Q

NSAID PUD low factors

A

no risk factors

33
Q

prevention of NSAID PUD

A

PPI (30 to 40mg QD)
H2RAs
Misoprostol (Cytotec)
Celecoxib

34
Q

H2RA usage in prevention of NSAID PUD

A

Famotidine - 40mg QHS, 20mg BID
Cimetidine - 500mg QHS, 400mg BID, or 300mg BID

35
Q

Misoprostol in NSAID PUD Prevention

A

Dosing - 200mcg QID with food
SE - diarrhea, abdominal cramping, NV, flatulence, headache
BBW - abortifacient (must confirm pt is not pregnant)

36
Q

celecoxib in prevention of NSAID PUD

A

Dosing - 200mg QID
BBW - increased risk of CV events

37
Q

If the patient has a low GI risk and a high CV risk,

A

low dose celecoxib (200mg qd)
Naproxen and PPI

38
Q

if the patient has a low GI risk and low CV risk,

A

celecoxib
any ns-NSAID and PPI

39
Q

if the patient has high GI risk and high CV risk

A

low dose celecoxib and PPI
avoid NSAIDs

40
Q

if the patient has high GI risk and low CV risk

A

celecoxib and PPI

41
Q

treatment of NSAID PUD if the pt can stop taking NSAIDs

A

PPI
H2RA
Sucralfate (carafate) for 8 weeks

42
Q

Sucralfate for NSAID PUD treatment

A

dosing - 1g QID before meals and at bedtime
SE - constipation, metallic taste, aluminum toxicity in chronic renal failure
education - administer on empty stomach 2 hours before or 4 hours after other medication

43
Q

treatment of NSAID PUD if patient continues NSAIDs

A

PPI for 12 weeks
use lowest effective dose of NSAIDs
may consider continuing PPI

44
Q

non-pharmacological treatment of PUD

A

stress reduction
smoking cessation
avoid food and drink triggers
avoid NSAIDs
surgery

Therapeutics - Exam 6 (11 decks)

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