PUD Flashcards
What is peptic ulcer disease?
- a break in the mucous lining of GI tract
- occurs in the esophagus, stomach and duodenum
What age group do gastric ulcers commonly affect?
Older clients.
What type of ulcers are most common in peptic ulcer disease?
Duodenal ulcers
What is the duodenal?
First part of the small intestines.
Is PUD more frequent in men or women?
Men.
Why is PUD not common in women of child-bearing age?
Because the body protects the woman. When menopause hits, the protection leaves and women are just as susectible.
What is H. Pylori?
A bacteria that is a common cause of peptic ulcer disease.
Esophageal ulcers occur as a result of what?
The backward flow of HCI from the stomach into the esophagus(GERD).
Does stress cause ulcers?
No.
What do most ulcers result from?
Infection of H. pylori bacteria.
Infection of H. pylori bacteria and what are synergistic risks?
Concomitant use of NSAIDs.
What blood type is more susceptible to PUD?
TYPE O.
Where can peptic ulcers affect?
Stomach, esophagus, and duodenum.
Why do peptic ulcers occur mainly in the gastroduodenal mucosa?
Because this tissue cant withstand the digestive action of gastric acid and pepsin.
What are the risk factors of peptic ulcer disease?
- Chronic H. pylori infection
- chronic aspirin and NSAID use with concurrent use of glucocorticoids or bisphosphonates.
- family history fo PUD
- old age
- unsanitary living conditions(poor hand hygiene)
Prevention of PUD is related to the etiology: What are some preventions?
- meticulous hand washing
- correct food prep, washing and cooking thoroughly
- have long-term NSAID users get tested
What is the classic symptom of a peptic ulcer?
Dull, gnawing pain or burning sensation in the midepigastric area of the back.
When does gastric ulcer pain occur?
Immediately after eating.
When does duodenal ulcer pain occur?
2-3 hours after eating,
Is the presentation of gastric ulcer pain normal in older adults?
No, often they get different symptoms, even referred pain.
Older adults after think pain is a normal old thing.
What are the complications of a peptic ulcer?
Hemorrhage, pyloric obstruction or gastric outlet obstruction, perforation, signs of hypovolemia,
What are the diagnostic tests for PUD?
- upper GI series
- gastroscopy(test specimen for H.pylori)
- noninvasive tests
- CBC
- stools for hemoccult
- Gastric analysis if ZES is expected
What is Zollinger-Ellison syndrome?
A form of peptic ulcer disease caused by a gastrin-secreting tumor.
What type of pharmacological therapy is used for H.pylori?
A combination. Multiple antibiotics, with PPI and H2 receptor blockers possibly.
How can you treat an NSAID-induced ulcer?
- discontinue NSAID if possible
- if you can’t (RA) dose with PPI
What is the generic name for Macrolide?
Clarithromycin.
What is the trade name for clarithromycin?
Macrolide.
What type of drug is clarithromycin?
Broad-spectrum antibiotic.
What is the MOA for Clarithromycin?
It inhibits protein synthesis by binding to the bacterial ribosome.
(Effective against most gram+ and many gram- bacteria)
What is the primary use of Clarithromycin?
Whooping cough, legionnaire’s disease, infections by streptococcus, H.influenza, and mycoplasma pneumoniae
What are the AE of Clarithromycin?
N/v, abdominal cramping, diarrhea, superinfections, resistant bacterial strains.
How often is clarithromycin given?
Twice a day. Has a acid-resistant covering on it so it doesn’t dissolve too early.
What class is amoxicillin a part of?
Penicillins.
What is the MOA of amoxicillin?
Kill bacteria by disrupting the call wall.
What kind of bacteria is amoxicillin most effective on?
Gram-positive bacteria.
Do human cells have cell walls?
No. (Squamous cells)
Of the cases of allergy to penicillin what percentage is the reaction anaphylactic?
0.04%
What is amoxicillin used for?
Pneumonia, meningitis, skin, bone, joint, stomach infections, blood and valve infections, gas gangrene, tetanus, anthrax
What are the AE f amoxicillin?
Bacteria can become resistant, possible allergy, lowered W/R blood cell count, and platelet levels.
What is tetracycline?
The drug of choice for only a few diseases because of resistant bacterial strains(Rocky Mountain spotted fever, typhus, cholera, Lyme disease, peptic ulcers and chlamydia)
What are the AE of tetracycline?
Superinfections, nausea, vomiting, diarrhea, discoloration of teeth, photosensitivity
What is the antiprotozoal prototype drug?
Metronidazole (Flagyl)
What reacts very badly with flagyl?
Alcohol consumption.
What is the MOA for metronidazole?
To act as a antiprotozoal drug that also has antibiotic activity against anaerobic bacteria.
What is the primary use of metronidazole?
Amebic diseases
What are the AE of metronidazole?
Anorexia, nausea, diarrhea, dizziness, headache, dry mouth, unpleasant metallic taste, flushing of skin
What are some miscellaneous drugs to treat PUD?
- Sucralfate (Carafate)
- Misoprostol (Cytotec) Prostglandin Analog
- Bismuth compounds (Peptobismal)
What does carafate do?
Coats ulcer and protects it from further erosion
What does cytotec do?
Inhibits acid and stimulates production of mucus, can cause miscarriage.
What do bismuth compounds (peptobismal) do?
Inhibit bacterial growth and prevent h.pylori from adhering to gastric mucosa.
True or false.
H.pylori infection can remain active for life if not treated.
True
There is a very high reoccurrence when H.pylori is not what?
Eradicated.
What has greatly decreased the need for surgery with PUD?
Treatment of H.pylori
What are some nonpharmacological therapies for PUD?
Good nutrition
Mild alcohol intake(not more than one a day)
Smoking is discouraged.
Is surgical management still used for the treatment of PUD?
Not often
What is the number one thing to do to maintain homeostasis?
Restore and maintain fluid volume.
It’s important to assess these things in a pt with PUD:
-health hx
-pain
-relief measures being used
-n/v, stool characteristics
-meds
-smoking/alcohol
Physical examination
-general appearance
-abdominal exam
-VS
