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PHRM 825 > PUD > Flashcards

PUD Flashcards

1
Q

PUD stands for

A

Peptic Ulcer Disease

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2
Q

types of ulcers (2)

A

gastric and duodenal

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3
Q

Are H. pylori caused ulcers more prevalent in the duodenum or stomach?

A

duodenum

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4
Q

Are NSAID caused ulcers more prevalent in the duodenum or stomach?

A

stomach

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5
Q

Signs and Symptoms

  • food can help determin location
  • Duodenum - pain ___
  • Stomach - pain ___
A
  • relieves
  • worsens
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6
Q

T or F: a duodenal ulcer would be relieved by eating food

A

True

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7
Q

Ways to confirm H. pylori
* endoscopy
* antibody detenction
* ___ breath test
* fecal antigen

A

urea

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8
Q

principles of H. pylori Treatment

  • ___ + 2-3 antibiotics
A

PPI

if you cant use a PPI, use a H2RA

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9
Q

H. pylori treatment

Bismuth Quad Therapy
* what are the 4 drugs
* Duration: ___ days

A
  1. PPI BID
  2. bismuth subsalicylate
  3. metronidazole
  4. tetracycline

10-14 days

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10
Q

H. pylori treatment - convenience packaging

Helidac - Bismuth Quad
* ___ administration package
* 14 blister cards containing:
* Metronidazole 250 mg (1 tab ____ )
* Tetracycline ___ mg (1 cap QID)
* bismuth subsalicylate 262.4 mg (2 tab ___ )
* must also take PPI ___

A
  • daily
  • QID
  • 500 mg
  • QID
  • BID
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11
Q

H. pylori treatment - convenience packaging

Pylera - Bismuth Quad
* 3-in-1 capsule containing (3 drugs)
* Dose: 3 caps ___ for 10 days
* must take PPI ___

A
  1. bismuth subcitrate potassium 140 mg
  2. metronidazole 125 mg
  3. tetracycline 125 mg
    * QID
    * BID
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12
Q

H. pylori Therapy Breakdown

Clarithromycin - Concomitant
1. PPI ___
2. Clarithromycin 250-500 mg ___
3. Amoxicillin 1 g ___
4. Metronidazole 250-500 mg ___

Duration: ___ days

A

BID
10-14 days

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13
Q

T or F: Clarithromycin Triple Therapy is okay to use

A

False

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14
Q

H. pylori Therapy Breakdown

Clarithromycin Hybrid Therapy
1. PPI BID days ___
2. amoxicillin 1 g BID days __
3. Clarithromycin 250-500 mg BID days ___
4. metronidazole 250-500 mg BID days ___

Duration: ___ days

A
  • 1-14
  • 1-14
  • 7-14
  • 7-14

14 days

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15
Q

H. pylori Therapy Breakdown

Clarithromycin Sequential Therapy
1. PPI BID days ___
2. amoxicillin 1 g BID days ___
3. clarithromycin 250-500 mg BID days ___
4. metronidazole 250-500 mg BID days ___

Duration: ___

A
  • 1-10
  • 1-5
  • 6-10
  • 6-10
    10 days
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16
Q

H. pylori Therapy Breakdown

Levofloxain Triple Therapy
1. PPI BID
2. Levofloxacin 500 mg ___
3. Amoxicillin 1g ___

Duration: ___ days

A
  • daily
  • BID

10-14 days

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17
Q

T or F: Clarithromycin is the most commonly used H. pylori therapy in the US

A

False; not used in the US due to resistance

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18
Q

H. pylori Therapy Breakdown

Levofloxacin Sequential Therapy
1. PPI BID days ___
2. amoxicillin 1 g BID days ___
3. levofloxazcin 500 mg daily days ___
4. metronidazole 500 mg BID days ___

Duration: ___

A
  • 1-10
  • 1-5
  • 6-10
  • 6-10

10 days

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19
Q

H. pylori Therapy Breakdown

Levofloxacin Quadruple therapy (LOAD)
1. Levofloxacin 250 mg ___
2. Omeprazole (high dose) ___
3. Nitazoxanide (Alinia) 500 mg ___
4. Doxycycline 100 mg ___

Duration: ___
* Nitazoxanide is an antiparasitic drug

A
  • daily
  • daily
  • BID
  • daily
    7-10 days
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20
Q

H. pylori Therapy Breakdown

Rifabutin Triple Therapy
Talicia: 4 caps every ___ hours
Contains 3 drugs
1. omeprazole 40 mg
2. ___ 1 g
3. rifabutin 50 mg

Duration: ___
* last line: reserved for ___ therapy

A
  • 8 hrs
  • amoxicillin
  • 14 days
  • salvage
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21
Q

PPIs in H. pylori treatment

  • PPIs taken ___ are the backbone of therapy
  • H2RAs such as ___ should not be substituted for PPIs unless a patient cannot tolerate them
  • PPIs are not usually necessary beyond ___ weeks of use for eradications
A
  • BID
  • famotidine
  • 2 weeks
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22
Q

Which PPI is not approved for H. pylori

A

Dexilant

Not FDA approved

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23
Q

PPI dosing for H. pylori

omeprazole ( ___ )
___ mg

A

Prilosec 20 mg

24
Q

PPI dosing for H. pylori

pantoprazole ( ___ )
___ mg

A

Protonix 40 mg

25
Q

PPI dosing for H. pylori

esomeprazole ( ___ )
___ - ___ mg

A

Nexium 20-40 mg

26
Q

PPI dosing for H. pylori

lansoprazole ( ___ )
___ mg

A

Prevacid 30 mg

27
Q

Bismuth Salts

MOA: topical ___ effect
improves ulcer healing by inhibiting aggressive factors and increasing protective factors
AE: ___ or stools and tongue

A
  • bacteriocidal
  • darkening
28
Q

Aggressive factors

A
  • pepsin
  • gastric acid

NSAIDs and H. pylori

29
Q

Protective Factors

A
  • blood flow to mucosa
  • bicarbonate
  • prostaglandins and mucus
30
Q

Antibiotic Adverse Effects

Metronidazole - Avoid alcohol due to ___ like reaction

A

disulfiram

31
Q

Antibiotic Adverse Effects

Levofloxacin
class: ___
* ___ rupture
* ___ status change
* ___ prolongation

A

fluroquinolone
* tendon
* mental
* QTc

32
Q

Antibiotic Adverse Effects

Amoxicillin
class: ___
* ___ upset
* take with food to help alleviate

A

penicillin
* GI

33
Q

Antibiotic Adverse Effects

tetracycline and doxycycline
class: ___
* ___ sensitivity

A

tetracyclines
* photosensitivity

34
Q

Antibiotic Adverse Effects

clarithromycin
class: ___
* ___ prolongation
* ___ sensitivity
* ___ upset

A

macrolide
* QTC
* photosensitivity
* GI

35
Q

T or F: probiotics can potentially be used as prophylaxis for H. pylori colonization

A

True

36
Q

T or F: when compared to a placebo, probiotics in combination with antibiotics increase eradication rates

A

True

37
Q

T or F: when considering antibiotic treatment for H. pylori, you should use an antibiotic that the patient has taken

A

False; avoid antimicrobialsa patient has already taken

38
Q

T or F: bismuth quad is first line in H. pylori

A

True

39
Q

NSAIDs block prostaglandins which with impair ___ defense

A

mucosal

40
Q

NSAID caused ulcers

Prophylaxis
* PPIs
* H2RAs ( ___ ulcer ONLY)
* ___

A
  • duodenal
  • micoprostol
41
Q

NSAID caused ulcers

Treatment
* PPIs
* H2RAs
* ___

A

sucralfate

42
Q

NSAID caused ulcers

Treatment duration
* ___ weeks if NSAID stopped
* ___ weeks if NSAID continued

A
  • 8 weeks
  • 12 weeks
43
Q

Dosing PPIs for NSAID induced Ulcers

omeprazole ___
pantoprazole ___
esomeprazole ___
lansoprazole ___

A

40 mg
40 mg
40 mg
30 mg

44
Q

Dosing H2RAs for NSAID induced Ulcers

  • famotidine ___ mg HS or ___ mg BID
  • cimetidine ___ mg HS, ___ mg BID, or ___ mg QID
A
  • 40 mg, 20 mg
  • 800 mg, 400 mg, 300 mg
45
Q

misoprostol dose: ___ mcg QID with food
MOA: prostaglandin ___ analog
* increases mucus and ___ secretion
* increases surface active ___
* increases gastric mucosal blood flow
* inhibits ___ sectretion

abortifacient

A
  • 200 mcg
  • E1
  • bicarbonate
  • phospholipids
  • acid
46
Q

T or F: many patients cannot tolerate full dose of misoprostol due to the side effects

A

True; SEs include diarrhea, abdominal cramping, N/V, flatulence, and headache

47
Q

T or F: mistoprostol is treatment only

A

FALSE: prophylaxis

48
Q

Sucralfate
Dose: 1 g ___ before meals and at bedtime
MOA: sucrose-sulfate-aluminum complex interacts with ___ and ___ to form a physical barrier over an open ulcer

A
  • QID
  • albumin and fibrinogen
49
Q

Sucralfate SE: metalic taste, ___, aluminum toxicity in chronic renal failure

A

constipation

50
Q

T of F: Sucralfate is treatment only

A

True

51
Q

NSAID induced ulcer prevention Strategies

  • preferred non-selective agent ___
  • decreased CV risk vs selective agent ___
A
  • naproxen
  • celecoxib
52
Q

COX-2 specific NSAIDs like celecoxib are ___ likely to cause stomach ulcers
* increased ___ adverse effects

A

less
* CV

53
Q

H2RAs do not have efficacy in prevention of gastric ulcers
* only used for ___ ulcer prevention

A

duodenal

54
Q

If a patient has a low-moderate ulcer risk, but a high CV risk, use ___ + ____

A

Naproxen + PPI/misoprostol

low dose aspirin is required for high CV risk

55
Q

if a patient has high ulcer risk and a low CV risk, use ___ therapy if possible. If not, try ___ inhibitor + ___

A
  • alternative
  • COX-2
  • PPI/misoprostol
56
Q

H. pylori vs NSAID

H. pylori: PPIs dosed ___
NSAIDs: PPIs dosed ___

A
  • BID
  • daily
57
Q

H. pylori vs NSAID

H. pylori treatment duration: ___
NSAID induces treatment duration: ___ if NSAID stopped, ___ weeks if continuing

A
  • 10-14 days
  • 8 weeks, 12 weeks

PHRM 825 (49 decks)

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