peptic ulcers and GORD Flashcards
What are common causes
NSAIDS
H.pylori
bisphosphonates, immunosuppressive agents (e.g. corticosteroids)
potassium chloride,
selective serotonin reuptake inhibitors (SSRIs)
What is a peptic ulcer?
lesion in the lining of the digestive tract
how do you test for h.pylori infections?
breath test
stool sample
blood test
cannot be tested of patient was on antibiotics in past 4 weeks OR on antisecreotry
PPI
What are their indications
Peptic ulcers
h.pylori
dyspepsia
what are side effects of PPIs?
headaches
GI upset
hypomagnesia- leads to arrhythmias and neurological symptoms
what are main interactions with PPI
clopidogrel
what are main warnings of PPIs?
Can give false h.pylori test
can mask symptoms of gastrointestinal cancer
Can cause rebound symptoms
NSAIDs
what are main indications?
Pain/ inflammation
rheumatoid arthritis
acute gout
How do NSAIDs work
inhibit COX
what are important warnings of NSAIDs?
Avoid in renal impairment
active bleeding
Avoid in asthma due to risk of bronchospasm
renal impairment
heart failure
liver failure
What are important interactions of NSAIDs?
SSRI, ACEi/ARB, Blood thinners, diuretics
impairs effectiveness of antihypertensives
what are side effects of NSAIDS?
Peptic ulcers/ GI bleeding, hypersensitivity reactions; bronchospasm and oedema ,
Major cardiovascular event
fluid retention- worsen hypertension and oedema
which NSAIDs are LEAST likely to cause GI toxicity?
low dose ibuprofen and selective COX-2 inhibitors
which NSAIDs are likely to cause renal impairment?
all
which NSAIDs are MOST likely to cause cardiovascular event?
High dose iburpofen, diclofenac, COX-2 inhibitors.
examples of selective and non-selective COX-2 inhibitors?
selective: celecoxib, etoricoxib, meloxicam, and rofecoxib.
non-selective;diclofenac, ibuprofen, and naproxen
Sucralfate
what is it indicated for?
gastric and duodenal ulcers
sucralfate
what are risks of this medication?
bezoar formation
caution is needed for patients who are very iIl need enteral feeds or those with delayed gastric emptying.
What is treatment line for pregnant women with GORD?
Lifestyle changes
2nd: if severe ; omeprazole or ranitidine (unlicensed)
What is treatment of GORD in children?
Lifestyle advice: thickened needs/ changes volume of feeding
2nd:antacids
3rd: H2 antagonist or omeprazole
