Peptic Ulcer Treatment Flashcards

1
Q

General measures include

A

Avoid smoking, aspirin and NSAIDs?
No special dietary advice.

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2
Q

Drugs used to treat PUD

A

-antacids
-proton pump inhibitors
-H2 receptor antagonists
-drugs, which enhance mucosal defense
-Misoprostol

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3
Q

Antacids used are

A

🟢Aluminum hydroxide
🔴magnesium trisilicate

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4
Q

Proton pump inhibitors include

A

ام رابي راكبة لينزو وياها عصومي وبنتو
40،40،30،30،20،20 mg

Omeprazole 20mg
Rabiprazole 20mg
Lansoprazole 30mg
Dexlanzoprazole 30mg
Esomeprazole 40mg
Pantoprazole 40mg

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5
Q

How proton pump inhibitors work?

A

The reversibly inhibit H/K ATPase in parietal cell membrane

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6
Q

The characteristics of PPIs

A

🟢 the most potent acid inhibitory agents
🔴 efficiency is maximized if they are administrated before meal

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7
Q

What are the H2 receptor antagonists?

A

Nizatidine
Ranitidine
Cimetidine
Famotidine

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8
Q

How H2 receptor antagonists work

A

They inhibit the H2 receptor competitively on parietal cells

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9
Q

Side effects of Cimetidine

A

🔵 anti-androgenic, resulting in reversible gynecomastia and impotence
🟡 confusion
🟣 elevated levels of serum aminotransferase creatinine, and serum prolactin

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10
Q

Which one among H2 receptor antagonists is more potent

A

Ranitidine, famotidine and nizatidine are more potent than cimetidine

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11
Q

When H2 receptor antagonists are used in the day?and how long

A

Each can be used once a day at bed time, for 8 weeks for duodenal ulcer, and 8-12 weeks for gastric ulcer

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12
Q

How sucralfate works?

A

This compound is insoluble in water, and becomes a viscous paste within the stomach and duodenum binding primarily two sites of active ulceration.

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13
Q

What is the standard dose of sucralfate?

A

1g four times per day
or
2g two times per day

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14
Q

Is sucralfate taken before or after meal?

A

It should be taken 30-60 min before meals.

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15
Q

what is the dose of Colloidal bismuth compound

A

125 mg/6h

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16
Q

Is colloidal bismuth compound recommended for maintenance therapy?

A

No, since it has side effects include blacken tongue, teeth, and feces

17
Q

What is misoprostol?

A

A prostaglandin analogue

18
Q

What are the side effects of Misoprostol?

A

🟡 diarrhea
🟣 uterine bleeding and uterine contractions

19
Q

In which group of people misoprostol is contraindicated?

A

In women of childbearing age

20
Q

What is the standard therapeutic dose of misoprostol?

A

200 microgram 4 times per day

21
Q

What is eradication therapy of H. pylori?

A

Triple therapy OCLAM
The combination of 2 antibiotics taken simultaneously with PPI twice daily for 10-14 days, eradication rate is 70-85%
PPI+ Clarithromycin 500mg +amoxicillin 1g (or metronidazole 500mg)

Quadruple therapy OBMT
🟢PPI+bismuth+metronidazole 500mg +tetracycline 500mg
🔴PPI+amoxicillin 1g+clarithromycin + nitroimidazole ( or metronidazole or tinidazole )500mg

22
Q

When H2RAs are substituted for
PPIs and used in high dose ?

A

If there is allergy or adverse effects due to PPIs