Peptic Ulcer Disease (PUD)

Question 1

What is the management of H. pylori eradication?

Answer 1

1. Triple therapy: "CAP"
Clarithromycin
Amoxicillin 
PPI
*Metronidazole if PCN allergic

Question 2

What is an alternate tx for a Peptic ulcer instead of the traditional “CAP” therapy?

Answer 2

1. Bismuth subsalicylate
2. Tetracycline
3. Methronidazole

OR for quadruple therapy: add a PPI

Question 3

If a patient’s PUD is refractory, what is the best management for this patient?

Answer 3

1. Parietal cell vagotomy

2. Bilroth II

Question 4

What is a complication associated with the Bilroth II procedure?

Answer 4

Associated with Dumping syndrome

Question 5

What is the MCC of Upper GI bleed?

Answer 5

Peptic ulcer

Question 6

What is the MCC of PUD?

Answer 6

H. pylori infx

-2nd MCC is NSAIDs

Question 7

What is the gold standard for diagnosing PUD?

Answer 7

Endoscopy with biopsy

Question 8

Which method of testing is >90% specific and can be used to confirm infection and eradication after therapy of H. Pylori PUD?

Answer 8

H. Pylori stool antigen (HpSA)

Question 9

Which method of H. pylori testing is used for testing for infection if endoscopy cannot be done? This method can also be done to confirm eradication after therapy.

Answer 9

Urea breath test

Question 10

Which method of H. pylori testing is only useful in confirming infection but not eradication?

Answer 10

+ serological antibodies

Question 11

What are side effects of PPIs? It is important to know these so you can educate your patients when they ask you…

Answer 11

1. HA
2. Diarrhea

Effect Lab values:

3. Hypomagnesemia
4. B12 deficiency*
5. Hypocalcemia

Question 12

Which PPI inhibits CP450, causing increased levels of Theophylline, Warfarin, and Phenytoin?

There is an H2 blocker that also does this, which one is it?

Answer 12

1. Omeprezole (Prilosec)

2. Cimetidine (Tagamet)

Question 13

How do PPIs work? Again, your patients will ask you…

Answer 13

Proton-pump-inhibitors: block H+/K+ ATPase of parietal cell, reducing acid secretion

Question 14

How should you educate your patients on taking their PPIs?

Answer 14

30min before meals

Question 15

Cimetidine sucks as a drug because it inhibits CP450, causing increased levels of Theophylline, Warfarin, and Phenytoin. It has some other unfortunate SE, what are they?

Answer 15

Anti-androgen effects:

1. Gynecomastia
2. Impotence
3. Decreased libido

Question 16

Which medication used to treat PUD causes an increase in LFTs?

Answer 16

H2 blockers

-Careful in renal and hepatic patients

Question 17

Which medication used to treat PUD increases bicarbonate and mucus secretion, and reduces acid production? This medication can also be used to keep ductus arteriosus patent.

Answer 17

Misoprostol: a prostaglandin E1 analog

Question 18

Which medication used to treat PUD is good for preventing NSAID induced ulcers, however, it cannot be used for healing existing ulcers?

Answer 18

Misoprostol: a prostaglandin E1 analog

-also used to keep ductus arteriosus patent

Question 19

Why should Misoprostol be avoided in pre-menopausal women?

Answer 19

Becuase it is an abortifacient and causes cervical ripping

Question 20

Which medication used to treat PUD is an antibacterial and cytoprotectant?

Answer 20

Bismuth compounds:

• Pepto-Bismol
• Kaopectate

Question 21

A patient is experiencing a darkening of her tongue and stool. She also says she is constipated. What medication is likely to cause this?

Answer 21

Bismuth compounds:

• Pepto-Bismol
• Kaopectate

Question 22

Which medication used to treat PUD may reduce the bioavailability of H2RA and PPIs when given simultaneously?

Answer 22

Sucralfate: its MOA is cytoprotective

Question 23

Which medication used to treat PUD is usually used as an ulcer prophylaxis measure?

Answer 23

Sucralfate (Carafate)

Question 24

A patient is currently on Carafate, what SE should you educate the patient might occur with this medication?

Answer 24

1. Metallic taste
2. Constipation
3. Nausea
4. ANTACIDS MAY INTERFERE WITH ITS ACTION