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Roomies Collab Deck 4: GI and ENT > PUD > Flashcards

PUD Flashcards

1
Q

Peptic ulcer disease includes _________________ or __________________ ulceration, which is a breach in the epithelium of the mucosa

A

gastric

duodenal

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2
Q

The main symptom of peptic ulcer disease is _________________ but other less common symptoms include nausea, indigestion, heartburn, loss of appetite, weight loss and a bloated feeling

A

upper abdominal pain

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3
Q

The main symptom of peptic ulcer disease is upper abdominal pain but other less common symptoms include…. (6)

A
  1. nausea
  2. indigestion
  3. heartburn
  4. loss of appetite
  5. weight loss
  6. a bloated feeling
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4
Q

What are the most common causes of PUD? (2)

A
  1. NSAIDs

2. H.pylori infection

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5
Q

In addition to NSAIDs and H.pylori, what other factors may contribute to the development of PUD? (3)

A
  1. Smoking
  2. Alcohol
  3. Stress
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6
Q

NSAIDs may have a(n) __________ effect if there is co-existent H. pylori infection, further increasing the risk of peptic ulceration

A

additive

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7
Q

The risk of upper gastro-intestinal side-effects varies between individual NSAIDs and is influenced by the ___________ and __________ of use.

A

dose

duration

*selective COX-2 inhibitors are less likely to cause PUD but are more likely to cause CV side effects

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8
Q

What are the complications of PUD? ( )

A
  1. Gastric outlet obstruction
  2. Potentially life-threatening GI perforation and
  3. Hemorrhage
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9
Q

Patients at high risk of developing GI complications with an NSAID include those with a history of … (9)

A
  1. Complicated peptic ulcer

OR those who have two or more of the following risk factors:

  1. Age over 65
  2. High dose NSAIDs
  3. Other drugs that increase the risk of GI adverse effects eg anticoagulants, corticosteroids, SSRIs
  4. Serious co-morbidity eg CVD, HTN, DM, renal or hepatic impairment
  5. Heavy smoker
  6. Excessive alcohol consumption
  7. Previous adverse reaction to NSAIDs
  8. Prolonged requirement for NSAIDs
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10
Q

Which drugs are associate with an increased risk of GI complications when co-prescribed with NSAIDs? (3)

A
  1. Anticoagulants
  2. Corticosteroids
  3. SSRIs
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11
Q

Which serious co-morbidities are associated with an increased risk of GI complications in patients who are taking NSAIDs? (5)

A
  1. CVD
  2. HTN
  3. DM
  4. Hepatic impairment
  5. Renal impairment
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12
Q

Which lifestyle measures are recommended for treating PUD? (9)

A
  1. Healthy diet
  2. Weight loss if obese
  3. Avoid trigger foods
  4. Eating smaller meals
  5. Eating the evening meal 3-4 hours before going to bed
  6. Raising the head of the bed
  7. Smoking cessation
  8. Reducing alcohol intake
  9. Managing stress, anxiety, and depression
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13
Q

Urgent endoscopic investigation is required for patients with ______________, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia

A

dysphagia

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14
Q

Urgent endoscopic investigation is required for patients with dysphagia, significant _________________, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia

A

acute gastrointestinal bleeding

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15
Q

Urgent endoscopic investigation is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged __________ years and over with unexplained weight loss and symptoms of upper abdominal pain, reflux or dyspepsia

A

55

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16
Q

Urgent endoscopic investigation is required for patients with dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with _____________ and symptoms of upper abdominal pain, reflux or dyspepsia

A

unexplained weight loss

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17
Q

What is the initial managment of patients with PUD? (3)

A
  1. Drugs that induce peptic ulcers, such as NSAIDs, aspirin, bisphosphonates, immunosuppressive agents (e.g. corticosteroids), potassium chloride, selective serotonin reuptake inhibitors (SSRIs) and recreational drugs such as crack cocaine should be reviewed and stopped, if clinically appropriate
  2. Antacids and/or alginates may be used for short-term symptom control, but long-term, continuous use is not recommended
  3. The patient should be tested for H. pylori infection
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18
Q

What is the management of a patient with PUD who is tested positive for H.pylori ad who has no history of NSAID use?

A

H.pylori eradication

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19
Q

What is the management of a patient with PUD who has tested positive for H.pylori and also has a strong history of NSAID use?

A

Prescribe a PPI or H2-receptor antagonist for 8 weeks, followed by H.pylori eradication treatment

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20
Q

If the ulcer is associated with NSAID use, a proton pump inhibitor or H2-receptor antagonist should be used for _____________, followed by Helicobacter pylori infection eradication treatment if the patient has tested positive for H. pylori

A

8 weeks

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21
Q

If the ulcer is associated with NSAID use, a(n) ________________ or _________________ should be used for 8 weeks, followed by Helicobacter pylori infection eradication treatment if the patient has tested positive for H. pylori

A

proton pump inhibitor

H2-receptor antagonist

22
Q

What is the management of patients with PUD who have tested negative for H.pylori and have no history of NSAID use?

A

Prescribe a PPI or H2-receptor antagonist for 4-8 weeks

23
Q

In patients who have tested negative for H. pylori and have no history of NSAID use, a proton pump inhibitor or histamine2-receptor antagonist (H2-receptor antagonist) should be used for ___________

A

4–8 weeks

24
Q

In patients who have tested negative for H. pylori and have no history of NSAID use, a(n) _____________ or ____________ should be used for 4–8 weeks

A

proton pump inhibitor

histamine2-receptor antagonist (H2-receptor antagonist)

25
Q

Is follow-up testing required after H.pylori eradication therapy?

A

Yes, 6-8 weeks after starting eradication therapy

  • Patients with a gastric ulcer who tested positive for H. pylori should also have a repeat endoscopy 6–8 weeks after treatment to confirm ulcer healing, depending on the size of the lesion
26
Q

Patients with a gastric ulcer who tested positive for H. pylori should also have a _______________ 6–8 weeks after treatment to confirm ulcer healing, depending on the size of the lesion

A

a repeat endoscopy

27
Q

If the peptic ulcer is healed and the patient is to continue taking NSAIDs, the potential harm from NSAID treatment should be discussed. The need for NSAIDs should be reviewed at least every _______________, and use on a limited, ‘as-needed’ basis trialled. Consider reducing the dose, substituting the NSAID with _______________, or use of an alternative analgesic or low dose ibuprofen

A

6 months

paracetamol

28
Q

In patients with previous ulceration, for whom NSAID continuation is necessary, or those at high risk of gastro-intestinal side effects, consider a(n) ________________ instead of a standard NSAID

A

cyclo-oxygenase (COX)-2 inhibitor

29
Q

Gastro-protection with ____________ therapy should always be co-prescribed with NSAIDs. A(n) ______________ is the preferred choice for gastro-protection

A

acid suppression

proton pump inhibitor

*other options include a H2-receptor antagonist or misoprostol, but the side effects of misoprostol limit its use

30
Q

Gastro-protection with acid suppression therapy should always be co-prescribed. A proton pump inhibitor is the preferred choice for gastro-protection; other options include a(n) ______________ or ______________

A

H2-receptor antagonist

misoprostol (but the side effects of misoprostol limit its use)

31
Q

If symptoms of PUD recur after initial treatment, how should patients be managed?

A

A PPI at the lowest dose possible to control symptoms; always on an ‘as-needed’ basis with patients managing their own symptoms

32
Q

In cases where there are persistent symptoms or an unhealed ulcer, the patient’s _______________ should be checked and _____________ reinforced

A

adherence to initial management

lifestyle advice

33
Q

In cases where there are persistent symptoms or an unheralded ulcer, which other causes should be considered? (6)

A
  1. Malignancy
  2. Failure to detect H.pylori
  3. Inadvertent NSAID use
  4. Other ulcer-inducing medications
  5. Rare causes such as Zollinger-Ellison syndrome or
  6. Crohn’s disease
34
Q

Switching to an alternative acid suppression therapy, e.g. ________________ may be beneficial if the response to proton pump inhibitor therapy is inadequate

A

H2-receptor antagonists

35
Q

Referral to a specialist for investigations and management should occur in ______________ or ______________ peptic ulcer cases with gastro-oesophageal symptoms that are unexplained, or non-responsive to treatment

A

refractory

recurrent

36
Q

Patients with peptic ulcer disease who are on long-term treatment should receive a(n) ______________ review of their symptoms and treatment. A step down approach, or stopping treatment, should be encouraged if possible and clinically appropriate

A

annual

37
Q

Patients with peptic ulcer disease who are on long-term treatment should receive an annual review of their symptoms and treatment. A _________________ approach, or _____________ treatment, should be encouraged if possible and clinically appropriate

A

step down

stopping

38
Q

What are the first generation histamine antagonists? (5)

A
  1. Brompheniramine
  2. Chlorpheniramine
  3. Dimenhydrinate
  4. Diphenhydramine
  5. Doxylamine
39
Q

What are the second generation antihistamines? (3)

A
  1. Loratidine
  2. Cetirizine
  3. Fexofenadine

(The fox, satyr, and rat)

40
Q

What is the main advantage of second generation antihistamines over first generation?

A

Less sedation

Also fewer side effects and interactions in general

41
Q

All antihistamines should be prescribed with caution in patients with signs and symptoms of ____________

A

Gastric cancer (might mask symptoms and delay treatment)

42
Q

What are the common general side effects shared by all antihistamines? (6)

A
  1. Diarrhea, constipation
  2. Dizziness
  3. Fatigue
  4. Headache
  5. Myalgia
  6. Skin reactions
43
Q

What are the rare but dangerous side effects associated with antihistamines? (5)

A
  1. Bone marrow suppression and agranulocytosis
  2. AV block
  3. Acute interstitial nephritis
  4. Dyskinesia
  5. Acute pancreatitis
44
Q

Are antihistamines safe to use in pregnancy and breastfeeding?

A

Avoid unless essential during pregnancy

Significant amount in breast milk but not known to be harmful

45
Q

Are antihistamines safe to use in renal and/or hepatic impairment?

A

Decrease dose in renal impairment

46
Q

Children under 6 years should not be given over-the-counter cough and cold medicines containing __________________.

A

chlorphenamine (chlorpheniramine), a first generation antihistamine

47
Q

First generation antihistamines should be prescribed with caution in which patients? (5)

A
  1. Epilepsy
  2. Prostatic hypertrophy
  3. Pyloroduodenal obstruction
  4. Susceptibility to angle closure glaucoma
  5. Urinary retention

(Due to antimuscarinic side effects of first gen antihistamines)

48
Q

Common or very common side effects of first generation antihistamines include… (8)

A
  1. Impaired concentration
  2. Abnormal coordination
  3. Dizziness
  4. Blurred vision
  5. Dry mouth
  6. Fatigue
  7. Headache
  8. Nausea

(Think sedation and antimuscarinic side effects)

49
Q

_______________ may be a side effect of antihistamines administered parenterally

A

Confusional psychosis

50
Q

Use of antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as _____________, _____________, and ______________

A

irritability

paradoxical excitability

tremor

51
Q

Are first generation antihistamines safe to prescribe in patients with hepatic and/or renal impairment?

A

Use caution in hepatic impairment

52
Q

What patient and carer advice should be given regarding use of first generation antihistamines? (2)

A

Drowsiness may affect ability to perform skilled tasks eg driving, cycling

Sedating effects enhanced by alcohol

Roomies Collab Deck 4: GI and ENT (23 decks)

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