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PY3 > PUD > Flashcards

PUD Flashcards

1
Q

Ulceration of the mucosa anywhere in the GI tract that is exposed to acid and pepsin

A

Peptic ulcer disease

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2
Q

What are the 2 common forms of PUD?

A
  1. Duodenal ulcer
  2. Gastric ulcer
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3
Q

What is the most common form of PUD?

A

Duodenal ulcer

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4
Q

What ages do duodenal ulcers usually occur?

A

Between ages 30-50

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5
Q

What ages are usually diagnosed with Gastric ulcers?

A

> 60 years

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6
Q

What are the 3 most common types of PUD?

A
  1. H. Pylori
  2. NSAID induced
  3. Stress related mucosal damage
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7
Q

True or false: cigarette smoking can help ease the pain caused by PUD

A

False

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8
Q

People who develop PUD tend to be more adversely affected by _____.

A

Stress

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9
Q

What 4 foods can cause dyspepsia but do not increase the risk of PUD?

A
  1. Coffee
  2. Tea
  3. Soda
  4. Spices
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10
Q

What is found in most people with duodenal and gastric ulcers?

A

H. Pylori

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11
Q

How is H. Pylori primarily spread?

A

Through fecal to oral route

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12
Q

What is the mechanism for H. Pylori causing PUD?

A

Catalyzes urea—> ammonia—> erodes mucus barrier—> epithelial damage

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13
Q

What 2 things does H. Pylori produce?

A
  1. Cytotoxins
  2. Mucolytic enzymes
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14
Q

NSAIDs are weak ___ and _______ at gastric pH

A

Acids; nonionized

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15
Q

What do NSAIDS decrease the production of?

A

Prostaglandins

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16
Q

Since prostaglandin production is decreased what 3 things can happen?

A
  1. Reduction in gastric and mucosal blood flow
  2. Decreased mucus and bicarbonate secretion
  3. Decrease cellular replication and repair
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17
Q

NSAID induced PUD is prevalent in what type of patients?

A
  1. Pts > 60
  2. Pts with a prior history of PUD
  3. Pts taking high dose NSAIDS
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18
Q

Concurrent administration with what 5 drugs can lead to NSAID induced PUD?

A
  1. Corticosteroids
  2. Anticoagulants
  3. Oral bisphosphonates
  4. Antiplatelet agents
  5. SSRIs
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19
Q

NSAID induced ulcers are often ____.

A

Silent

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20
Q

What is the most ulcernogenic NSAID?

A

Aspirin

21
Q

What do symptoms of PUD depend on?

A
  1. Ulcer location
  2. Patient age
22
Q

Pain does not follow a consistent pattern with which type of ulcer?

A

Gastric Ulcer

23
Q

Food often relieves pain with which type of ulcer?

A

Duodenal ulcer

24
Q

Pain is more likely to follow a consistent pattern with what type of ulcer?

A

Duodenal ulcer

25
Q

Nocturnal epigastric pain is highly suggestive of what kind of ulcer?

A

Duodenal ulcer

26
Q

What are the 3 major complications of PUD?

A
  1. Bleeding
  2. Perforation
  3. Mortality
27
Q

What is the rapid urease test?

A

H. Pylori + HP urease —> NH3 + CO2 —> increase pH and color change

28
Q

What does the serological test detect?

A

IgG to HP

29
Q

What 3 tests can be used as an initial screen?

A
  1. Serologic
  2. UBT
  3. FAT
30
Q

What therapy is first line therapy of PUD?

A

Standard Triple Therapy

31
Q

How long is the first line therapy given for?

A

10-14 days preferably 14

32
Q

What do you give a patient as an alternative if they are allergic to penicillin?

A

Metronidazole

33
Q

What is the standard triple therapy?

A

Amoxicillin PLUS Clarithromycin PLUS a PPI

34
Q

What drug has the highest resistance rates?

A

Clarithromycin

35
Q

When is Clarithromycin considered 1st line therapy based on resistance?

A

If resistance is < 15%. And in patients who have never been exposed to a macrolide antibiotic

36
Q

What therapy can be used if Clarithromycin cannot be used?

A

Bismuth- based Quadruple therapy

37
Q

What drugs are in the bismuth based quadruple therapy?

A

Tetracycline PLUS metronidazole PLUS bismuth subsalicylate PLUS a PPI

38
Q

What is used for concomitant therapy?

A

Clarithromycin PLUS amoxicillin PLUS metronidazole or tinidazole PLUS a PPI

39
Q

What is used as second line therapy or “salvage therapy”?

A
  1. Levofloxacin based triple therapy
  2. Levofloxacin Sequential therapy
40
Q

What is included in Levofloxacin based triple therapy?

A

Amoxicillin PLUS Levofloxacin PLUS PPI

41
Q

What is included in the Levofloxacin sequential therapy?

A

Amoxicillin PLUS PPI PLUS Levofloxacin PLUS metronidazole

42
Q

Rifabutin based triple therapy includes what?

A

Omeprazole PLUS amoxicillin PLUS rifabutin

43
Q

How long can you use a PPI for anti-secretory therapy?

A

2 weeks

44
Q

What should you use for treatment of H. Pylori negative Ulcers?

A

H2 antagonists or sucralfate

45
Q

How long can you use conventional treatment for H. Pylori negative ulcers?

A

4 weeks

46
Q

How should you treat NSAID induced ulcers?

A
  1. Ideally d/c NSAID
  2. Treat with standard doses of h2 antagonists, sucralfate, or PPI
47
Q

If an NSAID MUST be continued what should you do? 2

A
  1. Reduce NSAID dose
  2. Change to APAP or selective COX-2 inhibitors

In addition to a PPI for both

48
Q

What can be used as maintenance therapy for NSAID induced ulcers?

A
  1. PPIs in standard maintenance dose
    OR
  2. Misoprostol
49
Q

What should you caution patients to look out for with PUD

A

Signs of GI bleeding

PY3 (24 decks)

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