Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHAR 255 > Peptic Ulcer > Flashcards

Peptic Ulcer Flashcards

1
Q

Main causes of peptic ulcers?

A

NSAID induced
H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Main alarm sx of peptic ulcers?

A

VBAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

WHo needs an endoscopy?

A

new onset of sx, >50yrs
any VBAD sx
refractory sx
at risk for barrett’s esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is peptic ulcer disease?

A

any breach in mucosa of digestive tract, majority are in gastric and duodenal ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Difference between ulcer and gastric erosion?

A

gastric erosion is first step of ulcer formation; erosion is damage but isn’t through mucosa fully whereas ulcers are.-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of an Ulcer?

A

imbalance of aggressive and protective factors;
aggressive facotr incluce:
- NSAIDs*
- H pylori*
- Pepsin
- Physiologic stress
- acid
- ethanol
- smoking?
- psychological stress?
Protective factors include:
- Gastric mucosa
- HCO3
- prostaglandins
- mucosal blood flow
- epithelial cell regenration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do NSAIDs cause peptic ulcers?

A

decrease COX1 therfore decrease prostiglandins –> predispose mucosa to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Do the presence of dyspeptic sx and severity correlate to peptic ulcers?

A

poorly correlate –> can be on NSAID for years and have nothing then ulcer forms or damages enough to have complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is important when determining risk of NSAID induced peptic ulcers?

A

dose and duration, but a short therapy can still cause an ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does mucosa injury progress?

A

positive feedbackloop ish;
mucosa damage –> microscopic damage –> tissue damage
erosions –> ulcers –> perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

WHich NSAIDs induce ulcers?

A

ALL can trigger; potent COX1 highest risk
COX2 selective may have protective role in stomach so, COX2 selective can be harmful as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Highest risk NSAIDs for peptic ulcers?

A

Piroxicam
Ketorolac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Low risk NSAIDs for peptic ulcers?

A

Celecoxib (very low)
Ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NSAID induced peptic ulcer risk factors?

A

history of uncomplicated ulcer
age> 60 (+++risk of >70)
high dose or multiple NSAID use
Concomitant ASA, GCs, anticoagulants, antiplatlets, SSRIs (each drug counts as 1 risk factor)
History of CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

High risk NSAID induced PUD?

A

complicated ulcer history or >=3 risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Moderate risk NSAID induced PUD?

A

1-2 risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Low risk NSAID induced PUD?

A

No risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

H. pylori bacteria type?

A

gram negative rod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is H. pylori spread?

A

fecal-oral route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors of H. pylori colonization?

A

crowded living conditions
unclean water
raw veggies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

H. pylori enzymes produced?

A

urease –> converts urea to ammonia
phospholipase and catalase –> antioxidant effect preventing immune system from detecting bacterium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does H. pylori end up causing damage to gastric epithelium?

A

direct cytotoxic effect of bacteria
renders udnerlying mucosa more vunerable to acid damage
high level of ammonia:
- prevents detection of acidity
- direct toxic effect on epithelial cells
Promotes cytokines and inflammation –> increases permeability of cells –> acid more easily able to cause damage to tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what % of ulcers are asymptomatic?

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms of peptic ulcers?

A

dyspeptic sx
duodenal ulcer –> food intially relieves pain, then 2-5 hrs after meal pain and at night
Gastric –> immediately worsened by food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Complications of an ulcer?
QoL decrease GI bleeds perforations and fistulations gastric outlet obstruction mortality increase
26
Symptoms of PUD complications of bleeding?
N&V Hematemesis Melena orthostatic Hypotension RBCs in stool if massive bleed (very red flag)
27
Symptoms of PUD complications of obstruction?
N&V early satiety bloating indigestion anorexia wt loss
28
Symptoms of PUD complications of perforation or fistula occurs?
Sudden change in sx pattern halitosis ( bad breath) post-prandial diarrhea wt loss
29
How to diagnose PUD?
endoscopy gold standard but, remember who is indicated, cost on HC system
30
Who should be tested for H. pylori?
active or past history of PUD history of H. pylori and recurrent sx uninvestigated dyspepsia sx otehr than GERD or no NSAID use (guidlines could be changing) Unexplained iron defeciency ongoing dyspeptic sx despite PPI use Potentially if considering chronic NSAID use (including ASA)
31
What must be done before H. pylori testing?
d/c of PPI x 2 weeks d/c of bismuth and antibiotics x 4 weeks
32
Most common H. pylori testing?
urea breath test; accurate and cheap
33
Risk that increase recurrence of H. pylori PUD?
NSAIDs smoking alcohol use long standing PUD H. pylori suboptimal eradication or reinfection
34
Goals of tehrapy for PUD treatment?
relieve dyspepsia heal ulcer prevent complications pevent recurrence implement lifestyle changes
35
Treatment of NSAID induced PUD?
d/c NSAID if possible begin ulcer healing therapy; - PPI standard dose*** - H2RA high dose - Misoprostol H. pylori testing Consider secondary prevention for some pts
36
Duration of therapy for NSAID induced PUD therapy?
Gastric ulcer: 8-12 weeks Duodenal ulcer: 4-8 weeks
37
Strategies for secondary prevention for NSAID induced ulcer?
lower NSAID dose switch to celecoxib add long-term PPI add misoprostol (limited b/c poor efficacy)
38
Efficacy of secondary prevention strategies for NSAID induced PUD?
Celecoxib + PPI > NSAID + PPI = celecoxib alone > NSAID + misoprostol > NSAID + H2RA
39
Secondary prevention of NSAID induced PUD indicated for?
Continued NSAID use Giant ulcer(>1cm diameter) and age > 50 H. pylori resistance refractory peptic ulcer recurrent peptic ulcer
40
Primary prevention of NSAID induced PUD indicated for?
High risk or past complicated ulcer strongly considered if moderate risk
41
Primary prevention strategies?
Same as secondary except Misoprostol is = PPI
42
Misoprostol MOA?
prostaglandin analogue --> increases gastric mucous, bicarb secretion, inhbition of basal and nocturnal gastric acid secretion
43
Misoprostol indications for PUD?
treatment of duodenal ulcer Primary prevention of NSAID induced ulcers
44
WHy is misoprostol's use limited?
QID dosing (poor adherence) SEs of diarhea, abdominal pain, and dyspepsia
45
H. pylori ulcer treatment?
Quadruple therapy Longer duration favoured over short durations
46
Drugs used in H. pylori eradication treatment?
PPI standard doses Bismuth (pepto) Amoxicillin Metronidazole tetracycline clarithromycin levofloxacin rifabutin
47
First line H. pylori options?
PPI + Bismuth + Metronidazole + tetracycline PPI + amoxicillin + metronidazole + clarithromycin
48
Second line treatment of H. pylori?
PPI + amox + Levofloxacin +/- bismuth
49
Last line treatment of H. pylori?
PPI + amox + rifabutin
50
PBMT advantages? Disadvantages? duration? dosing sig?
ADvantages: - highly effective - ovecomes resistance - preferred if penicillin allergy similar tolerability to triple therapy Disadvantages: - high pill burden - Metronidazole interacts w/ alcohol 14 day duration PPI - BID Bismuth - QID Metro - TID or QID tetra - QID
51
Main benefit to taking PAMC?
simplified more adherence b/c all drugs are BID
52
Disadvantages of PAMC?
previous use of antibiotic may impact efficacy/ resistance (clarithromycin***) more GI AEs Penicillin allergies
53
Why are triple therapy options restricted?
b/c ony to be used in >15% resistance which is not known so Quad therapy should be recommended b/c less failure rate
54
Sequential therapy regiment?
PPI BID + Amox BID x 5 days PMC x 5 days
55
How to choose a regiment for H. pylori treatment?
use local resistance rates (usually not known) follow guideline recommendations pt factors: - allergies** - recent antibiotic use** - alcohol use - DIs - adherence/ pill burden - anticoagulants or antipaltelets use if consideringbismuth (low risk can still be used)
56
SE of H. pylori treatment?
GI Diarrhea Headache Dizziness (each antibiotic has unqiue SEs)
57
What is one of the most important things to discuss w/ a pts when counseling quad therapy for H. pylori?
ADHERENCE --> missing even a few doses can cause treatment failure resulting in 14 days of another quad therapy
58
H. pylori canadian guidelines flow of treatment?
1. PAMC --> PAL --> PBMT --> PAR 2. PBMT --> PAL --> Optimized PBMT --> PAR
59
Causes of H. pylori treatment failure?
Poor adherence*** incorrect regiment used high local resistance
60
Who is recommended to get confirmation of eradication testing for H. pylori? When tested and what test?
complciated duodenal ulcer gastric ulcer gastric cancer persistent sx Test 4 weeks after therapy completion, fecal stool antigen test is optimal for confirmation
61
Use of PPI after H. pylori eradication?
duodenal ucler: genrally not indacted, possibly 2 weeks gastric ulcer: continue PPI for 8 weeks Continued PPI should be reduced to once daily
62
Probiotics place in P. pylori ulcer management?
meh; wont hurt to try

PHAR 255 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions