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Pharmacy 255 > Peptic Ulcer > Flashcards

Peptic Ulcer Flashcards

1
Q

What is steps of an ulcer?

A

erosion, then acute ulcer, chronic ulcer

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2
Q

What depth indicates ulcer?

A

> 5mm

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3
Q

Common Causes of ulcers?

A

H pylori, NSAIDs, alcohol, smoking

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4
Q

How does NSAIDs cause ulcers?

A

lower Cox 1= no prostaglandins which is protective
acid then irritates and makes it worse

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5
Q

What are the lowest risk NSAIDs?

A

Celecoxib, ibuprofen

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6
Q

Are we sure that celecoxib is the safest? When is it not?

A

> 6 month use, usinf with ASA, >400mg/day loses selectivity

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7
Q

What puts people at risk of NSAID induced ulcers?

A

> 60, CVD, ASA, CS, anticoag, SSRI

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8
Q

What type of bacteria is H pylori? Why is it bad for gi?

A

gram neg bacillus
makes ammonia= body cant tell how acidic stomach is, toxic
makes catalase, phospholipase to hide from immune

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9
Q

Sx of ulcers?

A

mostly asymptomatic
dyspeptic sx

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10
Q

If food helps dyspeptic pain what does this mean?

A

duodenal ulcer

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11
Q

If food makes pain worse what does this mean?

A

gastric ulcer

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12
Q

What is usual first sign of ulcer?

A

bleeding

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13
Q

A patient that is know to have ulcers complains of tary stool. What do we tell them?

A

they have an ulcer in the upper and its bleeding

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14
Q

A patient that is know to have ulcers complains of bright red blood in stool. What do we tell them?

A

MED EMERGENCY
hematochezia

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15
Q

What can happen eventually with ulcers?

A

obstruction- due to scarring
perforation or fistula

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16
Q

What would indicate that a perforation or fistula has occurred?

A

sudden change in sx
bad breathe

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17
Q

A patient finds out they are colonized with H pylori. Will they get sx of ulcer

A

NOT necessarily

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18
Q

When is H pylori testing indicated?

A

past PUD or active, past pylori, sx other than GERD or no NSAID

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19
Q

How can we test for H pylori?

A

endoscopy, urea breath test= if radioactive CO2
stool antigen

20
Q

What increase recurrence rates of PUD?

A

NSAID, smoking, alcohol

21
Q

What is general treatment for ulcer?

A

stop NSAID if can
PPI
H2RA high dose
misoprostal

22
Q

When do you HAVE to stop NSAID for ulcer?

A

if bleeding is occurring in gi

23
Q

How long do you treat gastric ulcer and duodenal ulcer/

A

G= 8-12 weeks
D=4-8 weeks

24
Q

How can we prevent NSAID PUD?

A

lower dose, switch to celecoxib, add PPI, add misoprostol

25
Q

Rate the level of success of celocoxib/other NSAIDS with prevention meds?

A

Celecoxib/PPI>NSAID/PPI>
Celecoxib mono>NSAID/Misoprostal> NSAID/H2RA

26
Q

How does misoprostol work?

A

prostaglandin analogue that increase mucous and bicarb

27
Q

WHy dont people use misoprostol?

A

4 x daily so bad adherence
can cause dyspepsia
interact with Mg

28
Q

What is first line treatment for H pylori? And when is one preferred over the other?

A

PBMT-pill burden, MOST efficacious
PAMC-pen allergy!,clarithro bad, simpler

29
Q

WHy is metronidazole causes issues in treatment?

A

no alcohol, metallic taste

30
Q

What is the benefit of bismuth?

A

lowers resitance

31
Q

What is length of duration of therapy for H pylori?

A

14 days

32
Q

What are the second line therapy for H pylori?

A

PAC=better compliance, but bad
PMC=better compliance, but bad
PAM=better compliance, but bad
PAL or PABL=bad, for treat failure
PAR= better against resistance

33
Q

Why do we hate using PAR?

A

rifabutin is NECESSARY for TB

34
Q

Why isnt sequential therapy used?

A

high fail and complex

35
Q

If a patient is on anticoag or antiplatelet should you use bismuth?

A

risk of bleed theoretical

36
Q

What are issues with Bismuth (s/e)

A

darkening stool/tongue

37
Q

S/e of rifabutin?

A

urine discolor, myelotoxicity

38
Q

If you fail PAMC what is next step?

A

PAL then PBMT

39
Q

If you fail PBMT what is next step?

A

PAL then optimized PBMT

40
Q

Who should need confirmation of eradication of h pylori?

A

complicated duodenal ulcer, gastric ulcer

41
Q

What test for confirmation that pylori is gone?

A

fecal stool antigen four weeks after therapy

42
Q

How long should you continue PPI if duodenal ulcer vs gastric?

A

d= 2 weeks
g=8 weeks

43
Q

Are probiotics helpful for H pylori?

A

not bad

44
Q

Is sucralfate helpful?

A

binds to ulcers and protects but not great agent

45
Q
A

Pharmacy 255 (16 decks)

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