Peptic Ulcer Disease

Question 1

The causes of peptic ulcer disease in adults is…

Answer 1

H pylori, NSAID associated and idiopathic

Question 2

Primary ulcers tend to be chronic and are located in…

Answer 2

Duodenal portion

Question 3

Secondary ulcers tend to be…

Answer 3

Acute

Question 4

What is a minor virulence factor of H pylori?

Answer 4

CagPAI

Question 5

What determines the survival of H pylori in the GI system?

Answer 5

The actions of urease which produces ammonia

Question 6

Which molecules induces changes in the cells cytoskeleton, pedestal formation and induces the expression of pro inflammatory cytokines?

Answer 6

CagA

Question 7

What does VacA do?

Answer 7

Induce alterations of the tight junctions, forms large vacuoles and induces the release of Cyto C

Question 8

What does NAP do?

Answer 8

Recruits neutrophils and monocytes

Question 9

What are the indications for omeprazole?

Answer 9

Active duodenal ulcers in adults

Question 10

What is the target for omeprazole?

Answer 10

Potassium-transporting ATPase alpha chain 1 antagonist and aryl hydrocarbon receptor agonist

Question 11

What is the pharmacological effect of omeprazole?

Answer 11

Proton pump inhibitor binds covalently to cysteine residues via disulfide bridges on the alpha subunit of the H+/K+ ATPase pump inhibiting gastric acid secretion for up to 36 hours

Question 12

Omeprazole raise what?

Answer 12

Gastric pH

Question 13

PPI’s inhibit what enzyme?

Answer 13

Urease

Question 14

What is bismuth subsalicylate for?

Answer 14

Nausea, heartburn, indigestion, upset stomach, diarrhea, etc

Question 15

What is the mechanism of action of bismuth subsalicylate?

Answer 15

Weak antacid properties
When this compound is hydrolyzed in the stomach to salicylic acid and bismuth oxychloride it inhibits the synthesis of a prostaglandin responsible for intestinal inflammation and hypermotility

Question 16

What does the bismuth oxychloride do?

Answer 16

It binds bacterial toxins and bactericidal action

Question 17

What are the indications for misoprostol?

Answer 17

Ulceration and as prophylaxis for NSAID induced ulceration
Termination of an intrauterine pregnancy used alone or in combination with methotrexate
Induction of labour
Serious postpartum hemorrhage

Question 18

What is the target for misoprostol?

Answer 18

Prostaglandin receptor E2 , EP3 and EP4 subtype agonist

Question 19

What are the pharmacological effects of misoprostol?

Answer 19

Inhibits gastric acid secretion by direct action of the parietal cells through binding of the prostaglandin receptor

Question 20

Misoprostol decreased what?

Answer 20

Production, translocation and activation of proton pumps

Question 21

What effect does misoprostol have on the gastric epithelial cells?

Answer 21

Increase the secretion of bicarbonate and mucus

Question 22

What is the first line therapy for a patient who has a peptic ulcer caused by H pylori but is allergic to penicillin?

Note clarithromycin resistance is over 15%

Answer 22

Bismuth plus PPI plus tetracycline plus metronidazole (14 days)

Question 23

What is the first line therapy for a patient who has a peptic ulcer caused by H pylori who has a penicillin allergy

Note the clarithromycin resistance is less than 15%

Answer 23

Double dose PPI plus metronidazole plus clarithromycin

Question 24

What is the rescue therapy for a patient who has a peptic ulcer due to H pylori who happens to have a penicillin allergy?

Answer 24

PPI plus clarithromycin plus levofloxacin with or without bismuth (14 days)

Question 25

If a PPI plus clarithromycin plus levofloxacin with or without bismuth doesn’t work what do you do?

Answer 25

Give bismuth + PPI * tetracycline + metronidazole (14 days)

Question 26

If bismuth + tetracycline + metronidazole + PPI for 14 days doesn’t work what do you do?

Answer 26

Rifabutin+ PPI + amoxicillin for ten days