PUD and and Gastrointestinal Dysmotility Exam 3

Question 1

What are the types of ulcers?

Answer 1

• H. pylori - Induced Ulcers
• NSAID - Induced Ulcers
• Stress - Related Mucosal Disease

Question 2

What are risk factors for H. pylori - Induced Ulcers?

Answer 2

active H. pylori infection

Question 3

What are risk factors for NSAID - Induced Ulcers?

Answer 3

regular use or high doses of NSAIDS (esp. nonselective agents), corticosteroids, aspirin

Question 4

What are risk factors for Stress - Related Mucosal Disease?

Answer 4

• respiratory failure (mechanical ventilation > 48 hours)
• coagulopathy (INR >1.5
• low platelet count)
• hypotension
• sepsis
• hepatic failure
• acute renal failure
• high-dose corticosteroid therapy
• multiple trauma
• severe burns (>35% of body surface area)
• head injury
• traumatic spinal cord injury
• major surgery
• prolonged ICU admission (>7 days)
• history of GI bleeding

Question 5

Antacid onset, duration, symptom relief

Answer 5

• onset: < 5 min
• duration: 20-30 min
• symptom relief: Good to Excellent

Question 6

H2RA onset, duration, symptom relief

Answer 6

• onset: 30-45 min
• duration: 4-10 h
• symptom relief: Excellent

Question 7

H2RA + Antacid onset, duration, symptom relief

Answer 7

• onset: < 5 min
• duration: 8-10 h
• symptom relief: Excellent

Question 8

PPIs onset, duration, symptom relief

Answer 8

• onset: 2-3 h
  (48 h to max effect)
• duration: 12-24 h
• symptom relief: Superior

Question 9

Which medications have renal / hepatic dosing considerations?

Answer 9

• H2RA (renal)

- Metoclopramide (renal)

Question 10

CrCl equation

Answer 10

((140 - age) IBW) / (72 * Scr)

multiply by 0.85 if female

Question 11

Which drugs require acidic environment?

Answer 11

iron supplements, ketoconazole, itraconazole capsule, sucralfate, calcium carbonate, levothyroxine

Question 12

Synthetic Prostaglandin counseling

Answer 12

GI effects usually subside within one week

Question 13

H2RA counseling

Answer 13

Take before meals

Question 14

PPIs counseling

Answer 14

Take before meals

Question 15

Lansoprazole counseling

Answer 15

Do not use granules in gastric tubes because it can clog them

Question 16

Sucralfate counseling

Answer 16

Liquid formulation commonly clogs feeding tubes when given at same time as enteral food

Question 17

Antacids uses

Answer 17

Intermittent dyspepsia

Question 18

H2RAs

Answer 18

• Occasional or persistent dyspepsia
• Prevention of stress ulcers
• Treatment of mild esophagitis
• Treatment of peptic ulcers but NOT recommended for acute management of upper GI bleed

Question 19

PPIs

Answer 19

• Occasional or chronic dyspepsia
• Treatment of peptic ulcer + cute upper GI bleed
• H. pylori-negative ulcers
• Prevention of NSAID-induced ulcers
• Treatment of esophagitis
• Prevention of stress ulcers in hospitalized ICU patients

Question 20

Misoprostol

Answer 20

Prevention of NSAID-induced ulcers

Question 21

Sucralfate

Answer 21

• Prevention of stress ulcers

- NOT used for treatment of peptic ulcers

Question 22

Prokinetic Agents

Answer 22

• Adjuvant therapy for gastroesophageal reflux disease

- reserved for patients with underlying hypomotility disorders

Question 23

When should you treat Helicobacter pylori infection in an individual with peptic ulcer disease?

Answer 23

• Treatment clearly indicated for infection with gastric and duodenal ulcer, mucosa-associated lymphoid tissue (MALT) lymphoma, endoscopic resection of gastric cancer, uninvestigated dyspepsia.
• Treatment controversial with nonulcer dyspepsia, GERD, use of NSAIDs, individuals at high risk of gastric cancer, unexplained iron deficiency anemia.
• Treatment may worsen GERD symptoms.

Question 24

Triple therapy medications

Answer 24

• PPI once or twice daily
• Clarithromycin 500 mg twice daily
• Amoxicillin 1 g twice daily or metronidazole 500 mg twice daily

Question 25

What are the types of quadruple therapy?

Answer 25

• Bismuth-based quadruple therapy
• Non-Bismuth-based quadruple therapy
• Sequential therapy
• Second-line (salvage) therapy for persistent infections

Question 26

Drugs of Bismuth-based quadruple therapy

Answer 26

• PPI or H2RA once or twice daily
• Bismuth subsalicylate 525 mg 4 times daily
• Metronidazole 250–500 mg 4 times daily
• Tetracycline 500 mg 4 times daily

Question 27

Drugs of Non-Bismuth-based quadruple therapy

Answer 27

• PPI once or twice daily on days 1 through 10
• Clarithromycin 250-500 mg twice daily on days 1-10
• Amoxicillin 1 g twice daily on days 1 through 10
• Metronidazole 250-500 mg twice daily on days 1 through 10

Question 28

Drugs of Sequential therapy quadruple therapy

Answer 28

• PPI once or twice daily on days 1–10
• Amoxicillin 1 g twice daily on days 1–5
• Metronidazole 250–500 mg twice daily on days 6–10
• Clarithromycin 250–500 mg twice daily on days 6–10

Question 29

Drugs of Second-line (salvage) therapy for persistent infections for quadruple therapy

Answer 29

• PPI or H2RA once or twice daily
• Bismuth subsalicylate 525 mg 4 times daily
• Metronidazole 250–500 mg 4 times daily
• Tetracycline 500 mg 4 times daily

Question 30

Drugs of Second-line (salvage) therapy for persistent infections for triple therapy

Answer 30

• PPI once or twice daily
• Amoxicillin 1 g twice daily
• Levofloxacin 250 mg twice daily