PUD & GERD Flashcards
Peptic Ulcer Disease and why they occur
GI Bleeds
Upper GI disorders characterized by erosion of the gut wall. Occur d/t an imbalance of aggressive factors (Infection, NSAIDs, gastric acid, pepsin) and protective factors (mucus, bicarb, blood flow, prostaglandins)
Complicated by hemorrhage and perforation
PUD Treatment goals
Alleviate symptoms
Promote healing by eradication of bacteria and restoring the GI lining
Prevent complications (hemorrhage, perforation, obstruction)
Prevent reoccurrence
H. Pylori Treatment
1: Clarithromycin-based triple therapy: Clarithromycin , Amoxicillin, and a standard dose PPI
2: Clarithromycin-based triple therapy 2: Used for pts allergic to penicillin. Clarithromycin, Metronidazole, and a standard dose PPI
3: Bismuth-based quadruple therapy: Pt allergic to Penicillin OR a Clarithromycin resistant strand. Bismuth subsalicylate, Metronidazole, Tetracylcine and a standard dose PPI
Amoxicillin
IND: H. Pylori eradication MOA: Inhibits Cell wall synthesis BOX: NONE CONTRA: NONE ADRs: Allergic reaction to penicillin M/E: Renal adjustments needed
Clarithromycin
IND: H. Pylori eradication
MOA: Inhibits Cell wall synthesis
BOX: NONE
CONTRA: Hx of cholestatic jaundice/hepatic dysfunction with prior use (or wit any prior macrolides). Concomitant use with CYP 3A4 substrates
ADRs: NONE
M/E: Adjustment in renal impairment. STRONG CYP 3A4 INHIBITOR
Metronidazole
Flagyl
IND: Anaerobic bacterial infections (Bacterial vaginosis), trichomoniasis, Sx prophylaxis, and amebiasis
MOA: Causes loss of DNA structure and strand leakage = cell death
BOX: Carcinogenic in mice and rats
CONTRA: 1st Tri pregnancy. Alcohol will cause a Disulfiram reaction (extreme vomiting)
ADRs: Nausea, headache, metallic taste
M/E: Reduce dose by 50% in severe liver impairment
Tetracycline
IND: Off label for H. Pylori eradication
BOX: NONE
MOA: Inhibits bacterial protein synthesis
CONTRA: Children, causes tooth mottling. Can use it if there’s no other option
ADRs: Tooth mottling and photosensitivity
M/E: Renal adjustment needed
Bismuth Subsalicylate
Pepto
IND: Diarrhea, dyspepsia, traveler’s diarrhea
MOA: Disrupt the cell wall of H. Pylori (like an abx) and has anti-secretory effects
BOX: NONE
CONTRA: Allergy to salicylates (aspirin), bleeding problems, or bloody/black stool
ADRs: Tongue and fecal discoloration. Not a lot.
M/E: NONE
Tinidazole
IND: Amebiasis, bacterial vaginosis, giardiasis, trichomoniasis. Off label for H. Pylori eradication (probably won’t work). Related to metronidazole
MOA: Damages DNA and prevents further DNA synthesis
BOX: NONE
CONTRA: NONE
ADRs: Disulfiram reaction with alcohol
M/E: NONE
Proton Pump Inhibitors
IND: MOST effective drug for suppressing gastric acid secretion. H. Pylori eradication, GERD, Heartburn, PUD, Zollinger-Ellison syndrome
MOA: Inhibits the H/K ATPase pump, halting the secretion of H ions (acid) in the stomach. Irreversible (destroys pump), takes 3-5 days to reverse the effects.
Best taken 30-60min before a meal
BOX: NONE
CONTRA: NONE
ADRs: Increased risk of fractures d/t secondary Hyperparathyroidism, which increases bone resorption and decreases bone mineral density.
Hypomagnesemia: tetany, arrhythmias, seizures, and death. (25% of discontinuation)
VB12 Def: pernicious/megaloblastic anemias long term
Aspiration Pneumonia: D/t overgrowth of bacteria in stomach
C Diff.
M/E: NONE
PPI Examples
Omeprazole (Prilosec): Can be used ODT and Susp
Pantoprazole (Protonix)
Lansoprazole
Esomeprazole: Active enantomer of Omeprazole
Dexlansoprazole and Rabeprazole: Barely used
All pretty similar and effective. Usage is mostly based on cost, availability, and pt response
Famotidine
Pepcid
IND: GERD, Ulcers, Zollinger-Ellison syndrome, heartburn/indigestion
MOA: Antagonist at H2 Receptors = Inhibition of gastric acid secretion. Decreases volume and acidity (H) of gastric acid.
BOX: NONE
CONTRA: NONE
ADRs: Confusion, hallucinations, lethargy, somnolence
M/E: Renal adjustment needed
Cimetidine
IND: GERD, ulcers, Zollinger-Ellison, heartburn/indigestion
MOA: H2RA like Famotidine but also an Immune response modifier. Activates T cells, improving survival in GI cancers and is useful in plantar warts
BOX: NONE
CONTRA: NONE
ADRs: Same as Pepcid. Confusion, hallucinations, lethargy, somnolence and also pneumonia
M/E: Renal adjustment needed. LOTS OF DRUG INTERACTIONS/STRONG CYP 3A4 INHIBITOR
Sucralfate
IND: Ulcers, GERD in pregnancy
MOA: In acidic conditions, forms a viscid and very sticky gel that adheres to the ulcer and stomach lining to prevent further irritation
BOX: NONE
CONTRA: NONE
ADRs: Constipation
M/E: Safe in pregnancy d/t minimal systemic absorption. IMPEDES absorption of other drugs, need to administer meds at least 2 hours apart which is tricky cause this one is dosed 4x a day
Misoprostol
IND: Gastric ulcer PREVENTION from NSAIDS and termination of intrauterine pregnancy. Off label for cervical ripening/labor induction, post-partum hemorrhage, or an incomplete/missed abortion
MOA: Replaces protective prostaglandins inhibited by NSAIDs. Suppresses acid secretion, promotes bicarbonate secretion (base). Also induces uterine contractions
BOX: PREGNANCY effects. Can cause birth defects, abortion, premature birth, and uterine rupture. Patients must be warned of abortive effect and told not to give it to anyone else.
CONTRA: PREGNANCY
ADRs: Diarrhea/ab pain, spotting/dysmenorrhea
M/E: NONE
