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pharmacotherapy 2 > PUD > Flashcards

PUD Flashcards

1
Q

what is PUD

A

PUD is a defect in the gastric mucosa or duodenal mucosal wall that extends through the muscularis mucosal wall into the deep layers of the submucosa

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2
Q

PUD is a significant cause of ________ and is associated with_______________.

A

morbidity

high health care costs.

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3
Q

what are the causes of PUD

A

H.pylori infections
NSAIDS use
stress related mucosal damage

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4
Q

Global prevalence of H. pylori infection

A

50%

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5
Q

factors that affect the prevalence of H.pylori infection

A

age, ethnicity, sex, geography, socioeconomic status and geographical location

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6
Q

how is the infection transmitted

A

through fecal contaminated water-food

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7
Q

what are the complications of untreated or undiagnosed H.pylori infection

A

peptic ulcer disease and gastric cancer

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8
Q

what does chronic NSAIDs use cause

A

nausea and dyspepsia in nearly half of the users

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9
Q

peptic ulceration occurs in ____% of patients who chronically use NSAIDS with ____% who develop ______ and ________ in those who develop an ulcer

A

30%
1.5%
GI bleeding and perforation

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10
Q

Risk factors for ulcers & GI complications related to NSAIDs use

A

Age older than 60 years
Multiple NSAID use (e.g., low-dose aspirin plus another NSAID)
Duration of NSAID use (> 1 month)
High-dose NSAID use
Concomitant use of corticosteroid, SSRI or anticoagulant
Previous PUD or PUD complications (bleeding / perforation)
Cardiovascular disease and other comorbid conditions
Smoking
Alcohol ingestion

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11
Q

who are affected by stress induced ulcers and why

A

critically ill patients who have a mucosal defect by gastric mucosal ischemia or intraluminal acid

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12
Q

the ulcers are non superficial. true or false

A

false. they are superficial but may penetrate into the submucosa and cause significant GI bleeding

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13
Q

Physiologically stressful situations that lead to Stress ulcer include:

A 
Sepsis
Organ failure
Prolonged mechanical ventilation
Thermal injury (burns)
Surgery.
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14
Q

what is zollinger ellison syndrome caused by

A

gastrin secreting tumor [gastrinoma]

the hypersecretion of gasric acid leads to diarrhea and malabsorption

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15
Q

Ulcers tend to be ________ and have a high risk of _____________.

A

numerous

perforation & bleeding.

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16
Q

The harmful effects of smoking on the gastric mucosa:

A

Increased pepsin secretion
Duodeno-gastric reflux of bile salts
Elevated levels of free radicals
Reduced prostaglandin-2 (PG2) production

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17
Q

decreased mucus and increased bicarbonate secretion is a side effect of smoking. true or false

A

false. decreased mucus and also decreased bicarbonate secretion

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18
Q

describe the location of each

a. H.pylori related ulcers
b. Nsaids induced ulcers

A

a. duodenal ulcer

b. gastric ulcer

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19
Q

how do ulcers form (pathophysiology)

A

ulcers form due to disruption of balance of factors that breakdown food eg. gastric acid and pepsin and factors that promote mucosal defense and repair eg. mucus secretion, bicarbonate secretion and prostaglandins

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20
Q

symptoms of PUD range from?

A

mild epigastric pain to life threatening conditions

21
Q

are duodenal ulcers relieved by food. when is their onset

A

yes relieved by food

onset - 1 to 3 hours after meals or at night

22
Q

are gastric ulcers relieved by food

A

no, aggravated by food

23
Q

how are ulcers documented in diagnosis

A

by radiologic or endologic procedures

24
Q

when is testing for H. pylori done

A

initiated in patients with active PUD, history of PUD and gastric mucosa associated lymphoid tissue lymphoma

Diagnostic tests for H. pylori presence can be endoscopic or non-endoscopic.

25
Q

what does endoscopic diagnosis involve

A

Endoscopic diagnosis involves extraction of gastric tissue samples that are subsequently tested for H. pylori.

26
Q

what is the standard identification method. what are the others?

A

histology is standard indentification method

culture, PCR and rapid urease test can also be used

27
Q

what are the non endoscopic identification procedures
what is their advantage
which one is 1st line. and why? how does it work/

A

urea breath test, serologic testing, and stool antigen assay.
These tests are less invasive and less expensive than endoscopy.

The urea breath test is 1st line because of its high sensitivity and specificity and short time needed to perform.
The urea breath test can also be used to confirm eradication of H. pylori
The test is based on the ability of the H. Pylori to convert urea to ammonia

28
Q

what are the non pharmacology goals in PUD

A

reduce psychological stress
avoid smoking or alcohol consumption
avoid NSAIDs and aspirin

29
Q

what is the ttt for patients with RA who need NSAIDs chronically

A

ulcer prophylaxis ttt and/or paracetamol if possible

30
Q

when is surgical intervention initiated

A

for complicated and refractory cases

31
Q

what is the ttt of acute GI bleeding

A

contact thermal therapy, mechanical therapy using clips and epinephrine injection followed by contact therapy and/or mechanical therapy

32
Q

in H.pylori induced ulcers are acid suppressants used? why?

A

acid suppressants are not used as they increase ulcers and ulcer related complications

33
Q

in h pylori induced ulcers which regimen is more effective triple therapy or quadruple therapy

A

triple therapy

34
Q

what is regimen 1 and regimen 2 in h pylori induced ulcers

A 
regimen 1 
PPI - omeprazole or lansoprazole 
clarithromycin [klacid] 500 mg bid
amoxicllin [amoxil] 1000mg bid 
for 1 wk or some recommed 10-14 days 
continue for 1 month with PPis
regimen 2 
bismuth subsalicylate 524mg qid
metronidazole [flagyl] 250mg qid
tetracycline [tetradar] 500mg qid 
H2RA antagonist [cimetidine or ranitidine] (some replace w PPi) 
for 2 wks 
continue with H2RA for 1 month
35
Q

what are drugs are used to prevent NSAID related ulcers

A

DC and alternative is paracetamol

if can not Dc then PPis, H2RAs and sucralfate prevent ulcers and promote healing

36
Q

why are ppis preferred

A

strongest acid suppression, faster relief from symptoms and prevent recurrences

at standard doses for gastric and duodenal ulcers as effective as misoprostol

37
Q

at standard doses for gastric and duodenal ulcers ppis are not as effective as misoprostol. true or false

A

false

38
Q

PPis are better tolerated than misoprotol. true or false.

A

true

39
Q

what are the goals of therapy in stress ulcers

A

hemodynamic stability for increased mesentric perfusion and pharmaco GI acid suppression

40
Q

stress ulcer prophylaxis is used only in?

A

ICU patients

41
Q

weigh risk vs benefits of ppis in _________

A

low risk patients

42
Q

what are the DOC in stress ulcers and 2nd lines in some patients

A

DOC - ppis and H2RAs

antacids and sucralfate accepted in some patients.

43
Q

brief indications of stress ulcers (10) points

A
  • mechanicalventilation longer than 48 hours. coagulopathy. Hepatic failure
  • Gi ulceration or bleeding within 1 yr
  • head trauma, glassgow coma less than or equal to 10
  • thermal injuries > 30% BSF
  • partial hepatectomy
  • transplant pt ICU preoperatively
    1 spinal cord injuries
    -2 of following, sepsis, ICU stay greater than 1 wk
    occult bleeding less than or equal to 6 days, corticosteroids 250mg/day or more of hydrocortisone or equivalent
44
Q

describe the long term maintenance of ulcers

A

PPis and H2RAs in pts w severe complications 2ndry to PUD

  • gastric outlet obstruction
  • chronic use of NSAIDs or high dose coticosteroids w high risk of bleeding.
45
Q

name first line 3 drugs good to excellent

A
  • clarithromycin + metro + omeprazole

- clarithromycin + amoxil + lansoprazole

46
Q

name helidac (good)

A
  • bismuth subsalicylate + metro + tetra …. + ranitidine (BTRM)
47
Q

name pylera [good to excellent]

A
  • bismuth subcitrate potassium + metro + tetra … 3 caps bid + omeprazole (tomb)
48
Q

concomitant therapy

A

eso + amoxil + clarithromycin + metro ( cema)

49
Q

sequential therapy

A

Amoxil + eso (1-5days) .. Amoxil + eso + metro (6-10days)

pharmacotherapy 2 (8 decks)

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