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Pharm 830 IP3 > Pancreatitis, GERD, and Peptic Ulcer Disease > Flashcards

Pancreatitis, GERD, and Peptic Ulcer Disease Flashcards

1
Q

Causes of Acute Pancreatitis

A
  • Gallstones
  • Alcohol
  • High triglycerides
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2
Q

Acute Pancreatitis Signs and Symptoms

A
  • Severe abdominal pain
  • Elevated pancreatic enzymes in blood
  • Self limiting
  • Will spontaneously resolve in most patients
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3
Q

Management of Acute Pancreatitis

A
  • Pain relief
  • Fluid replacement
  • Prevention of complications
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4
Q

Pain Management in Acute Pancreatitis

A
  • Treat pain IV then PO
    1) Morphine
  • Concerns with use do to spasm of sphincter of Oddi
  • This concern has never been proven (i.e. Morphine is safe/effective)
    2) Meperidine
  • Not as effective
  • Active metabolites can accumulate
  • Risk of seizure (due to metabolites)
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5
Q

Fluid Management in Acute Pancreatitis

A
  • Hemoconcentration associated with organ failure and pancreatic necrosis
  • Treat with normal saline
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6
Q

Preventing complications in Acute Pancreatitis

A
  • Electrolyte balance
  • Hyperglycemia can increase the risk of infections
  • Infection is a large concern
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7
Q

Treating Infections in Acute Pancreatitis

A
  • Do NOT use antibiotics for prophylaxis
  • Determine that the patient does have an infection before beginning antibiotic therapy
  • If there is an infection treat patient with
    a) 500mg imipenem-cilastin q8h
    b) Ciprofloxacin and metronidazole (if pt has a penicillin allergy)
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8
Q

Chronic Pancreatitis Patho

A
  • Chronic state
  • Results in functional and structural damage to pancreas
  • Often undiagnosed for many years
  • Alcohol consumption = big risk factor
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9
Q

Sings and symptoms of Chronic Pancreatitis

A
  • Loss of pancreatic exocrine function
  • Malnutrition
  • Weight loss
  • Diabetes Mellitus
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10
Q

Chronic Pancreatitis Treatment Goals

A
  • Control pain
  • Correct malabsorption
  • Assess need for exogenous insulin
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11
Q

Pain Management in Chronic Pancreatitis

A
  • Stop alcohol and tobacco use
  • Eat small, low fat meals
  • NSAIDs, Tylenol, or Tramadol
  • Add on narcotic if pain persists
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12
Q

Correcting malabsorption in Chronic Pancreatitis

A

-Start exogenous enzyme supplementation
a) Acid Suppressive therapy- to increase stomach pH
(H2 antagonists or PPIs)
-Reduce dietary fat to <20g/meal
-Supplement with lipase, amylase, protease
-Lipase is most important one (30,000 to 90,000 units per meal)
-Take pancreatic enzymes with first bite of meal

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13
Q

Examples of pancreatic enzymes

A
  • Creon
  • Pancreaze
  • Pancrelipase
  • Pertzye
  • Ultresa
  • Viokace
  • Zenpep
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14
Q

GERD Treatment

A

1) Weight loss and Dietary modifications
2) Antacids
3) Surface agents and alginates (Sucralfate)
4) H2 blockers
5) PPIs

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15
Q

Antacids

A
  • Acts as on demand symptom relief for mild GERD
  • Pro: fast onset
  • Con: short duration
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16
Q

Surface Agents

A
  • Used in mild cases
  • And in pregnancy
  • Viscous gum that coats and protects stomach
17
Q

H2 Antagonists/Blockers

A
  • More effective than antacids
  • Pro: longer duration of action
  • Con: longer onset, becomes less effective in subsequent dosing
18
Q

Proton Pump Inhibitors (PPI)

A
  • Most effective in treating GERD
  • Pro: short onset
  • Con: more expensive, drug interactions
19
Q

Peptic Ulcer Disease Patho (PUD)

A
  • Ulcers due to H. pylori infection, NSAID use, or stress

- Contributing factors: smoking and drinking

20
Q

Types of Ulcers in PUD

A

a) Gastric- caused by NSAIDs or H. pylori,
- Usually WORSE with food
b) Duodenal- mostly caused by H. pylori can be caused by NSAIDs
- Usually gets BETTER with food
c) Complications include bleeding, obstruction, or perforation (ulceration into cavity) erosion of ulcer into artery (non-variceal bleed)
- Non variceal bleed can be insidious and fatal!

21
Q

Diagnosis of H. pylori

A
  • Breath test
  • Stool antigen test
  • PPIs, bismuth, and antibiotics can interfere with stool and breath test
  • Endoscopy (scope): often used for H. pylori and to rule out other GI issues
22
Q

Treatment of H. pylori

A

a) 3 drug regimen
- PPI bid (or esomeprazole 40mg qd)
- Clarithromycin 500mg bid
- Amoxicillin 1g bid (substitute with metronidazole 500mg bid if pt has a PCN allergy)
b) 4 drug regimen
- PPI bid (or esomeprazole 40mg qd)
- Bismuth 525mg qid
- Metronidazole 250 to 500mg qid
- tetracycline 500mg qid
c) If pt cannot tolerate PPI give H2 blocker instead

23
Q

Pylera

A

-Pylera has bismuth, metronidazole, and tetracycline in it!

24
Q

NSAID Induced Ulcers

A
  • Highest risk with piroxicam and ketorlac
  • Moderate risk with naproxen
  • Lowest risk with ibuprofen and diclofenac
25
Q

Risk factors of NSAID Induced Ulcers

A
  • Age > 65
  • Previous PUD or any upper GI bleed (UGIB)
  • Concomitant corticosteroid
  • Anticoagulant therapy
  • High dose/Multiple NSAIDs
  • Chronic organ impairment
26
Q

Treatment of NSAID Induced Ulcers

A
  • STOP the NSAID!
  • Add PPI so the ulcers can heal
  • H2 blocker if PPI will not be tolerated
27
Q

Stress related mucosal damage (SRMD) bleed causes

A
  • lack of oxygenation in GI tract due to respiratory failures leading to mucosal damage
  • Prophylaxis: H2 blocker or PPI
28
Q

Risk factors for SRMD bleed

A
  • Respiratiory failure
  • Acute hepatic failure
  • Coagulation therapy
  • Hypotension
  • Chronic renal failure
29
Q

Why is acid suppression needed to treat an ulcer

A
  • Increasing the pH allows clotting and platelet aggregation to occur
  • Which stabilizes blood loss and allows for healing of ulcer
30
Q

Why do patients with an UGIB get a PPI

A
  • Until a cause is clearly identified PPIs are always give

- Once diagnosis of UGIB is confirmed, PPIs should be stopped

31
Q

Adverse effects of PPIs

A
  • Drug interactions
  • Fracture/ osteoporosis
  • C. diff
32
Q

Indirect drug interactions caused by altered stomach pH

A
  • HIV therapies

- Protease inhibitors

33
Q

De-escalating acid suppressive therapy

A

a) Patients treated for GERD or dyspepsia
- taper after being asymptomatic for >3 months
b) Acute duodenal or gastric ulcers up to 8 weeks
- NO taper is needed (for acute therapy)
c) Moderate to high dose PPI
- Reduce dose by 50% every week until pt is on lowest dose
- After 1 week at lowest dose, d/c medication
- If symptoms recur treat with high dose H2 blocker
- Consider addition of antacids

Pharm 830 IP3 (7 decks)

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