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GI/Rheumatology Module > Peptic Ulcer Disease and Dyspepsia > Flashcards

Peptic Ulcer Disease and Dyspepsia Flashcards

1
Q

What are the 5 gastric protective mechanisms?

A
  1. Gastric Mucus: barrier to acid
  2. Gastric Bicarbonate: neutralizes HCl
  3. Prostaglandin E and Somatostatin: inhibit gastric acid secretion
  4. Mucosal Blood Flow: transport oxygen
  5. Rapid Cell Turnover: renewal of epithelial
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2
Q

What are the 3 Main Causes of PUD?

A
  1. Helicobacter Pylori Infection: duodenal ulcer
  2. Nonsteroidal Anti-Inflammatory Drugs: gastric ulcer
  3. Stress Related Gastric Mucosal Damage
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3
Q

What are the 3 mediators of the proton pump that stimulates gastric acid secretion?

A
  1. Histamine
  2. ACh
  3. Gastrin
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4
Q

If the patient has high suspicion or documented PUD/Erosive Esophagitis what is the recommended self-care?

A

NONE, ALWAYS REFER

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5
Q

What are common risk factors of PUD?

A
  1. Stress
  2. Cigarette Smoking
  3. NSAIDs
  4. Caffeine
  5. Spicy Foods
  6. Alcohol
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6
Q

What are the risk factors for H.Pylori Induced Ulcers?

A
  1. Colonization, close contacts
  2. Active H.Pylori infection in susceptible host
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7
Q

What are the risk factors for NSAID Induced Ulcers?

A
  1. Regular use or High Dose NSAIDs, Corticosteroids, and ASA
  2. Slow release, prodrugs, enteric coats do not decrease likelihood of PUD
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8
Q

What are the risk factors for Stress Related Induced Ulcers?

A
  1. Respiratory Failure
  2. Coagulopathy
  3. HTN
  4. Sepsis
  5. Hepatic/Renal Failure
  6. Trauma
  7. Prolonged ICU admin
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9
Q

What are the Antacids and their place in therapy?

A
  1. Calcium
  2. Aluminum
  3. Magnesium
  4. Sodium
    Intermittent Dyspepsia
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10
Q

What is the action of Antacids?

A

Quick acting, Short duration, topical buffering

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11
Q

What drugs are bound by antacids and have a decreased absorption?

A
  1. Fluoroquinolon antibiotics
  2. Tetracyclines
  3. Nitrofurantoin
  4. Isoniazid
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12
Q

What drugs require an acidic environment and have a decreased absorption when used with antacids?

A
  1. Iron
  2. Ketoconazole
  3. Itraconazole
  4. Sucralfate
  5. Calcium Carbonate
  6. Levothyroxine
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13
Q

What is the AE of Calcium and Aluminum?

A

Constipation

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14
Q

What is the AE of Magnesium?

A

Diarrhea

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15
Q

What is the AE of Sodium?

A

Fluid retention

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16
Q

What combination has the BEST BALANCE between onset and duration?

A

H2RA + ANTACID

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17
Q

Can PPIs be used as needed?

A

NO

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18
Q

What is the MOA of H2RAs?

A

Reversible competitive binding vs histamine at H2 receptors

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19
Q

Should you recommend H2RAs in acute management of upper GI bleeding?

A

NO

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20
Q

What drugs are have inhibited metabolism when used with Cimetidine?

A
  1. Theophylline
  2. Phenytoin
  3. Warfarin
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21
Q

What drugs require an acidic environment and have a reduced absorption when used with Cimetidine, Famotidine, and PPIs?

A
  1. Ketoconazole
  2. Itraconazole
  3. Sucralfate
  4. Iron
  5. Calcium Carbonate
  6. Levothyroxine
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22
Q

What are the AEs of Cimetidine?

A
  1. CNS
  2. Hematologic
  3. Gynecomastia
  4. Increase EtOH
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23
Q

Does Famotidine have CYP450 Interactions?

A

NO

24
Q

What are the AEs of Famotidine?

A
  1. CNS
  2. Hematologic
25
Q

When would a H2RA be preferred over PPI?

A

SRMD prevention in hospitals

26
Q

What is the PK of PPIs?

A

Irreversibly bind to K-H-ATPase, inhibits final step of hydrogen ion secretion

27
Q

What is the MOA of PPIs?

A

Noncompetitive, irreversible binding to sulfhydryl group of H/K Atpase

28
Q

What is the AE risk with prolonged use of PPI?

A
  1. Hypomagnesemia and B12 deficiency
  2. Hypergastrinemia-gastric carcinoid tumors
29
Q

When are PPIs preferred for treatment?

A

Severe PUD
Mod/Severe Esophagitis

30
Q

What are the drugs that can cause an interaction with PPIs?

A
  1. Clopidogrel
  2. Benzos
  3. SSRIs: Citaloprama nd Escitalopram
  4. Cyclosporine
  5. Methylphenidate
  6. Methotrexate
  7. Phenytoin
  8. Vit K Antagonists: Warfarin
31
Q

What is the recommendation for H.pylori negative ulcers?

A

QD with PPI or H2RAs for 4-8 weeks

32
Q

When should you administer antacid drugs?

A

Separate administration of all other drugs by at least 2 hrs

33
Q

When should you administer PPI drugs?

A

Before meal to improve efficacy

34
Q

Recommended treatment for severe peptic ulcer bleeding includes what?

A
  1. IV PPI loading dose
    • 72-hr continuous infusion
  3. Maintain intragastric pH >6
35
Q

If you had to use clopidogrel with a PPI which PPI would you recommend?

A

Pantoprazole

36
Q

What are typical symptoms of PUD?

A
  1. Dyspepsia
  2. Duodenal Ulcer: pain 1-3 hrs after meal
  3. Gastric Ulcer: pain enhanced with food
37
Q

What are alarm symptoms of PUD?

A
  1. Bleeding
  2. Unintentional weight loss
  3. Choking
  4. Dysphagia
  5. Odynophagia
38
Q

What is the PK of Misoprostol?

A

Cyctoprotective, inhibits acid secretion

39
Q

Misoprostol is the only drug approved for what?

A

Prevention of NSAID induced ulcers

40
Q

What are the AEs of Misoprostol?

A

GI Effects common, diarrhea
CI in WOMEN with childbearing potential

41
Q

What are the AEs of Sucralfate?

A
  1. Severe Constipation
  2. Accumulation in renal impaired
  3. Liquid form CLOGS feeding tubes w/enteral food
42
Q

What are the drug interactions for Sucralfate?

A

Binds
1. Fluoroquinolone antibiotics
2. Tetracycline
3. Nitrofurantoin
4. Isoniazid

43
Q

What is the dosing for Sucralfate?

A

QID dosing, large tablet size, very constipating

44
Q

What is the place of therapy for Prokinetic Agents?

A

ADJUNCT for GERD
Reserved for patients with underlying hypo-motility disorders

45
Q

What are the AEs of Metoclopramide Prokinetic Agent?

A
  1. Somnolence
  2. Increased Prolactin
  3. Extrapyramidal Symptoms
46
Q

What are other pro kinetic agents?

A

Erythromycin and Domperidone

47
Q

When is treatment clearly indicated for Eradication of H.Pylori?

A
  1. Gastric and Duodenal Ulcer
  2. MALT
  3. Endoscopic Gastric Cancer
  4. Uninvestigated Dyspepsia
48
Q

What is first line treatment in H.Pylori?

A

Bismuth Quadruple therapy

49
Q

What is the 4-Drug Therapy first line therapy?

A
  1. PPI or H2RA
  2. Bismuth Subsalicylate
  3. Metronidazole
  4. Tetracycline
50
Q

What is the 3-Drug Therapy?

A
  1. PPI or H2RA
  2. Clarithromycin
  3. Amoxicillin/Metronidazole
51
Q

What is LOAD Therapy?

A
  1. Levofloxacin
  2. Omeprazole
  3. Alinia (Nitazoxanide)
  4. Doxycycline
52
Q

What is secondary treatment after initial failure for H.Pylori?

A

Avoid antibiotics previously used
Bismuth quadruple or LOAD or Clarithromycin

53
Q

How do you manage NSAID Induced Ulcer?

A
  1. DC NSAID
  2. Add protective agent: Misoprostol, H2RA, and PPI
54
Q

PPI co therapy reduces risk of NSAID Induced Ulcers the same as what and better than what?

A

Same as Misoprostol
Better than H2RA

55
Q

Standard PPI and Nonselective NSAID have as similar efficacy as that when reducing risk of NSAID induced ulcers?

A

Celecoxib?

GI/Rheumatology Module (18 decks)

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