PUD Flashcards
PUD stands for
Peptic Ulcer Disease
types of ulcers (2)
gastric and duodenal
Are H. pylori caused ulcers more prevalent in the duodenum or stomach?
duodenum
Are NSAID caused ulcers more prevalent in the duodenum or stomach?
stomach
Signs and Symptoms
- food can help determin location
- Duodenum - pain ___
- Stomach - pain ___
- relieves
- worsens
T or F: a duodenal ulcer would be relieved by eating food
True
Ways to confirm H. pylori
* endoscopy
* antibody detenction
* ___ breath test
* fecal antigen
urea
principles of H. pylori Treatment
- ___ + 2-3 antibiotics
PPI
if you cant use a PPI, use a H2RA
H. pylori treatment
Bismuth Quad Therapy
* what are the 4 drugs
* Duration: ___ days
- PPI BID
- bismuth subsalicylate
- metronidazole
- tetracycline
10-14 days
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 ___
- daily
- QID
- 500 mg
- QID
- BID
H. pylori treatment - convenience packaging
Pylera - Bismuth Quad
* 3-in-1 capsule containing (3 drugs)
* Dose: 3 caps ___ for 10 days
* must take PPI ___
- bismuth subcitrate potassium 140 mg
- metronidazole 125 mg
- tetracycline 125 mg
* QID
* BID
H. pylori Therapy Breakdown
Clarithromycin - Concomitant
1. PPI ___
2. Clarithromycin 250-500 mg ___
3. Amoxicillin 1 g ___
4. Metronidazole 250-500 mg ___
Duration: ___ days
BID
10-14 days
T or F: Clarithromycin Triple Therapy is okay to use
False
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
- 1-14
- 1-14
- 7-14
- 7-14
14 days
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: ___
- 1-10
- 1-5
- 6-10
- 6-10
10 days
H. pylori Therapy Breakdown
Levofloxain Triple Therapy
1. PPI BID
2. Levofloxacin 500 mg ___
3. Amoxicillin 1g ___
Duration: ___ days
- daily
- BID
10-14 days
T or F: Clarithromycin is the most commonly used H. pylori therapy in the US
False; not used in the US due to resistance
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: ___
- 1-10
- 1-5
- 6-10
- 6-10
10 days
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
- daily
- daily
- BID
- daily
7-10 days
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
- 8 hrs
- amoxicillin
- 14 days
- salvage
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
- BID
- famotidine
- 2 weeks
Which PPI is not approved for H. pylori
Dexilant
Not FDA approved
PPI dosing for H. pylori
omeprazole ( ___ )
___ mg
Prilosec 20 mg
PPI dosing for H. pylori
pantoprazole ( ___ )
___ mg
Protonix 40 mg
PPI dosing for H. pylori
esomeprazole ( ___ )
___ - ___ mg
Nexium 20-40 mg
PPI dosing for H. pylori
lansoprazole ( ___ )
___ mg
Prevacid 30 mg
Bismuth Salts
MOA: topical ___ effect
improves ulcer healing by inhibiting aggressive factors and increasing protective factors
AE: ___ or stools and tongue
- bacteriocidal
- darkening
Aggressive factors
- pepsin
- gastric acid
NSAIDs and H. pylori
Protective Factors
- blood flow to mucosa
- bicarbonate
- prostaglandins and mucus
Antibiotic Adverse Effects
Metronidazole - Avoid alcohol due to ___ like reaction
disulfiram
Antibiotic Adverse Effects
Levofloxacin
class: ___
* ___ rupture
* ___ status change
* ___ prolongation
fluroquinolone
* tendon
* mental
* QTc
Antibiotic Adverse Effects
Amoxicillin
class: ___
* ___ upset
* take with food to help alleviate
penicillin
* GI
Antibiotic Adverse Effects
tetracycline and doxycycline
class: ___
* ___ sensitivity
tetracyclines
* photosensitivity
Antibiotic Adverse Effects
clarithromycin
class: ___
* ___ prolongation
* ___ sensitivity
* ___ upset
macrolide
* QTC
* photosensitivity
* GI
T or F: probiotics can potentially be used as prophylaxis for H. pylori colonization
True
T or F: when compared to a placebo, probiotics in combination with antibiotics increase eradication rates
True
T or F: when considering antibiotic treatment for H. pylori, you should use an antibiotic that the patient has taken
False; avoid antimicrobialsa patient has already taken
T or F: bismuth quad is first line in H. pylori
True
NSAIDs block prostaglandins which with impair ___ defense
mucosal
NSAID caused ulcers
Prophylaxis
* PPIs
* H2RAs ( ___ ulcer ONLY)
* ___
- duodenal
- micoprostol
NSAID caused ulcers
Treatment
* PPIs
* H2RAs
* ___
sucralfate
NSAID caused ulcers
Treatment duration
* ___ weeks if NSAID stopped
* ___ weeks if NSAID continued
- 8 weeks
- 12 weeks
Dosing PPIs for NSAID induced Ulcers
omeprazole ___
pantoprazole ___
esomeprazole ___
lansoprazole ___
40 mg
40 mg
40 mg
30 mg
Dosing H2RAs for NSAID induced Ulcers
- famotidine ___ mg HS or ___ mg BID
- cimetidine ___ mg HS, ___ mg BID, or ___ mg QID
- 40 mg, 20 mg
- 800 mg, 400 mg, 300 mg
misoprostol dose: ___ mcg QID with food
MOA: prostaglandin ___ analog
* increases mucus and ___ secretion
* increases surface active ___
* increases gastric mucosal blood flow
* inhibits ___ sectretion
abortifacient
- 200 mcg
- E1
- bicarbonate
- phospholipids
- acid
T or F: many patients cannot tolerate full dose of misoprostol due to the side effects
True; SEs include diarrhea, abdominal cramping, N/V, flatulence, and headache
T or F: mistoprostol is treatment only
FALSE: prophylaxis
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
- QID
- albumin and fibrinogen
Sucralfate SE: metalic taste, ___, aluminum toxicity in chronic renal failure
constipation
T of F: Sucralfate is treatment only
True
NSAID induced ulcer prevention Strategies
- preferred non-selective agent ___
- decreased CV risk vs selective agent ___
- naproxen
- celecoxib
COX-2 specific NSAIDs like celecoxib are ___ likely to cause stomach ulcers
* increased ___ adverse effects
less
* CV
H2RAs do not have efficacy in prevention of gastric ulcers
* only used for ___ ulcer prevention
duodenal
If a patient has a low-moderate ulcer risk, but a high CV risk, use ___ + ____
Naproxen + PPI/misoprostol
low dose aspirin is required for high CV risk
if a patient has high ulcer risk and a low CV risk, use ___ therapy if possible. If not, try ___ inhibitor + ___
- alternative
- COX-2
- PPI/misoprostol
H. pylori vs NSAID
H. pylori: PPIs dosed ___
NSAIDs: PPIs dosed ___
- BID
- daily
H. pylori vs NSAID
H. pylori treatment duration: ___
NSAID induces treatment duration: ___ if NSAID stopped, ___ weeks if continuing
- 10-14 days
- 8 weeks, 12 weeks
