PUDFC

Question 1

Peptic Ulcer Disease Causes

Answer 1

Helicobacter pylori positive ulcers
NSAIDs
Stress
Zollinger-Ellison syndrome, G-cell hyperplasia, mastocytosis, basophilic leukemias

Question 2

Symptoms of h pylori infections

Answer 2

Epigastric pain
Heartburn, belching, bloating, nausea, anorexia
Eating lessens pain with duodenal ulcers
Eating worsens pain with gastric ulcers

Question 3

H. Pylori , consequence if not treated, how to diagnose

Answer 3

Can lead to cancer if left untreated
Diagnostic tests: urea breath test (UBT), fecal antigen test, and blood test

Question 4

Treatment of H. Pylori, what are the three regimens

Answer 4

Triple therapy: PPI + clarithromycin + amoxicillin or metronidazole for 14 days: PCN or macrolide allergy replace with metronidazole 500mg BID
Quadruple therapy: PPI + bismuth + metronidazole + tetracycline for 10-14 days: alcohol use - do not use metronidazole; pregnancy - do not use tetracyclines
Sequential therapy: PPI + amoxicillin for 5 days, then PPI + clarithromycin + tinidazole for 5 days

Question 5

Combination Agents for h. pylori including dosing schedule

Answer 5

Prevpac (BID x 14 days): lansoprazole/amoxicillin/clarithromycin all on one blister card
-Pylera (QID x 10 days): bismuth/metronidazole/tetracycline in one capsule
-Helidac (QID x 14 days): bismuth/metronidazole/tetracycline all on one blister card

Question 6

Drug Interactions of the h pylori medications

Answer 6

PPIs have many
Clarithromycin is a 3A4 major inhibitor
tetracycline Can chelate
metronidazole: avoid alcohol and monitor warfarin
bismuth Can increase risk of salicylate toxicity with aspirin

Question 7

H. Pylori Counseling

Answer 7

Medications may upset stomach, take with food
tetracycline: do not use if pregnant, oral contraceptives may be less effective
clarithromycin may cause diarrhea, nausea, and abnormal taste
do not drink alcohol with metronidazole

Question 8

NSAID-Induced are normally where and how does it happen?

Answer 8

Primarily gastric, Direct irritation of the gastric epithelium, Systemic inhibition of prostaglandin synthesis (by inhibiting COX-1)

Question 9

RF for nsaid induced ulders

Answer 9

Risk factors: >65, previous ulcer, high dose NSAID, and concomitant use of steroids, anticoagulants, antiplatelet drugs, oral bisphosphonates, and SSRIs

Question 10

NSAID-Induced Ulcers Treatment

Answer 10

PPI for 8 weeks
In patients with cardiovascular risk, naproxen + PPI is recommended