PUD

Question 1

Define PUD + causes

Answer 1

• Action of pepsin and hydrochloric acid
• Most common causes of Peptic Ulcer:
• NSAIDs: Aspirin – most ulcerogenic among the NSAIDs
• H. pylori: Gastrin release due to infection → increased amount of gastric acid (HCl). Most cases are caused by the organism; oral-faecal mode of transmission. Spiral shape of H. pylori allows them to penetrate your stomach lining - protected by mucus hence body’s immune cells are not able to reach them

Question 2

Marie has a history of Gastritis secondary to H. pylori infection in 2020. OGD
revealed a 2 x 2 cm ulcer on the gastric fundus.
Which mechanism related to Helicobacter pylori facilitates the development of
Peptic Ulcer Disease?

A. Somatostatin increase
B. Prostaglandin increase
C. Increased gastric acid secretion
D. Increased bicarbonate secretion

Answer 2

C

Question 3

Name the green drugs and class for PUD

Answer 3

PPI and antibiotics triple therapy
omeprazole+ amoxicillin and clarithromycin

Question 4

Red drugs and class for PUD

Answer 4

antacids (sod bicarb, calcium carb, mg(OH2), Al(OH)3)
h2 receptor antagonist: famotidine
mucosal protective agents: sucralfate, bismuth, misoprostol
alt ab: metronidazole (inplace of amoxicillin)

Question 5

In taking a new patient’s history, the nurse notices that
he has been taking omeprazole (Prilosec) consistently
over the past 6 months for treatment of epigastric
pain. Which recommendation would be the best for
the nurse to give this patient?
1. Try switching to a different form of the drug.
2. Try a drug like cimetidine (Tagamet) or famotidine (Pepcid).
3. Try taking the drug after meals instead of before
meals.
4. Check with his healthcare provider about his continued discomfort.

Answer 5

4 Rationale: PPIs such as omeprazole (Prilosec) are recommended for short-term therapy,
approximately 4 to 8 weeks in length. If symptoms of
epigastric pain and discomfort continue, other therapies and screening for H. pylori may be indicated.
Options 1, 2, and 3 are incorrect. Switching to another
PPI still exceeds the recommended time of use for
this category of drugs. H2@receptor antagonists such
as cimetidine (Tagamet) and famotidine (Pepcid) may
be indicated but their use should be evaluated by a healthcare provider because more definitive treatment
(e.g., for H. pylori) may be required. PPIs should be
taken 30 minutes before meals.

Question 6

The nurse is assisting the older adult diagnosed with
a gastric ulcer to schedule her medication administration. What would be the most appropriate time for this
patient to take her lansoprazole (Prevacid)?
1. About 30 minutes before her morning meal
2. At night before bed
3. After fasting at least 2 hours
4. 30 minutes after each meal

Answer 6

Answer: 1 Rationale: PPIs such as lansoprazole (Prevacid) should be taken before the first meal of the
day. The proton pump is activated by food intake. The
administration of a PPI 20 to 30 minutes before the first
major meal of the day will allow peak serum levels
to coincide with the occurrence of maximum acidity
from the proton pump activity. Options 2, 3, and 4 are
incorrect. PPIs should be taken before the first major
meal of the day, not at night or after meals. Fasting is
not required for this drug.

Question 7

A woman reports using OTC aluminum hydroxide
(AlternaGEL) for relief of gastric upset. She is on renal
dialysis three times a week. What should the nurse
teach this patient?
1. Continue using the antacids but if she needs to continue them beyond a few months, she should consult
the healthcare provider about different therapies.
2. Take the antacid no longer than for 2 weeks; if it
has not worked by then, it will not be effective.
3. Consult with the healthcare provider about the
appropriate amount and type of antacid.
4. Continue to take the antacid; it is OTC and safe.

Answer 7

Answer: 3 Rationale: Antacids are generally combinations of aluminum hydroxide, calcium, and/or magnesium hydroxide. Hypermagnesemia, hypercalcemia,
or hypophosphatemia can develop with use of OTC
antacids. Because this patient is on renal dialysis, her
kidneys are unable to adequately control the excretion
of electrolytes. The nephrologist should be contacted
about whether an antacid is appropriate for this patient.
Options 1, 2, and 4 are incorrect. Because of concerns
about electrolyte imbalance, taking the antacid for limited periods may not be advisable. A drug’s availability OTC does not guarantee its safety, and it may
produce adverse effects in patients.

Question 8

Patients with gastric ulcer typically exhibit the following symptoms:
(a) epigastric pain worse after eating and weight loss.
(b) epigastric pain worse before meals, pain awakening patient from sleep, and melena.
(c) decreased bowel sounds, rigid abdomen, rebound tenderness, and fever.
(d) boring epigastric pain radiating to back and left shoulder, bluish-gray
discoloration of periumbilical area, and ascites

Answer 8

A