Peptic ulcer

Question 1

Symptoms

Answer 1

• Burning pain
• Dyspepsia
• Heartburn
• Nausea
• Bloating
• Appetite loss
• Weight loss

Question 2

High risk patients

Answer 2

History of complicated ulcer

2+ Risk factors

• 65+ years
• High dose + prolonged use
• Drugs inc risk of GI bleeding (SSRI)
• Serious co-morbidity (CVD, HT, diabetes)
• Heavy smoker or excessive alcohol
• NSAID adverse reaction

Question 3

Treatment: NSAID induced ulcer

Answer 3

PPI OR H2 receptor antagonist 8 weeks
- H pylori test → if positive: eradication therapy
STOP NSAID, if continued or high risk: Cox 2 inhibitor + gastro protection

Question 4

Treatment: no NSAID, H pylori

Answer 4

PPI OR H2 receptor antagonist 4 to 8 weeks

Question 5

Diagnosis

Answer 5

• Urea breath test + stool helicobacter antigen
• Do not perform test within 2 weeks of PPI OR 4 weeks of abx

Question 6

Treatment: H pylori eradication therapy

Answer 6

PPI (BD) + 2 abx (amoxicillin, clarithromycin, metronidazole)

• First line: PAC/PAM
• Pen allergy: PMC
• Second line: PAC/PAM
• Pen allergy: PML (levofloxacin)

If recently had an antibiotic to treat another infection, it shouldn’t be given again to treat H pilori - increases risk of resistance

Question 7

Antacid + alginate: MOA

Answer 7

• antacid: neutralises gastric acid, symptomatic relief w/in 15-30 mins
• alginate: forms viscous gel raft on top of stomach contents to prevent reflux

Question 8

Antacid + alginate: drugs

Answer 8

• liquid formulation more effective than tablets
• Low Na+ prep: HPT, heart, liver or kidney failure (fluid retention) OR lithium (sodium restricted diet)

Antacids:
- Aluminium salts (constipating: LA)
- Magnesium salt (laxative: LA)

Alginates:
- Sodium alginate

Question 9

Antacid + alginate: indication

Answer 9

• Dyspepsia + GORD
• Symptomatic relief

Question 10

Antacid + alginate: how to take

Answer 10

After each main meal, at bedtime or PRN

Question 11

Antacid + alginate: interaction

Answer 11

Bisphosphonate, tetracycline, quinolone → RED drug absorption: 2 hr gap

Damage enteric coating medication
- Coating designed to bypass acidic environment of the stomach and dissolve it in more alkaline pH in the intestines. Antacids neutralise acids so they end up making the stomach more alkaline, which can cause these coatings to dissolve prematurely.

Question 12

PPI: MOA

Answer 12

• Blocks gastric acid secretion by blocking H+/K+ ATPase in parietal cells
• Most effective acid suppressor
• Lansoprazole (30-60min before food)
• Omeprazole (safe in pregnancy)

Question 13

PPI: indication

Answer 13

• Peptic ulcer
• Dyspepsia
• GORD

Question 14

PPI: dose

Answer 14

Lowest effective dose for shortest period

Question 15

PPI: how to take

Answer 15

Swallow whole, 2 hour gap - indigestion remedy

Question 16

PPI: side effect

Answer 16

GI disturbances

Fractures + hypOMg
- Monitoring: Mg levels esp w digoxin

SCLE
- MHRA: rash on sun exposed areas w arthralgia

Question 17

PPI: caution

Answer 17

• Masks gastric cancer
• INC fractures + GI infections

Question 18

PPI: interaction

Answer 18

• Clopidogrel → RED antiplatelet effect
• Methotrexate → RED clearance

Question 19

H2 receptor antagonist: MOA

Answer 19

Blocks gastric acid secretion by blocking H2 receptors in parietal cells

Question 20

H2 receptor antagonist: indication

Answer 20

• Peptic ulcer
• Dyspepsia
• GORD

Question 21

H2 receptor antagonist: drugs

Answer 21

• Cimetidine (enzyme inhibitor)
• Famotidine

Question 22

H2 receptor antagonist: side effect

Answer 22

• Headache
• Rashes
• Dizziness
• Diarrhoea

Question 23

H2 receptor antagonist: caution

Answer 23

Masks gastric cancer