Tx for PUD II

Question 1

Indications of Lansoprazole and Pantoprazole (PPIs)

Answer 1

short-term relief of heartburn, dyspepsia and
hyperacidity

Question 2

Dosage of Lansoprazole

Answer 2

max 15mg/day for max 14 days

Question 3

Dosage of Pantoprazole

Answer 3

max 20mg/day for max 14 days

Question 4

Which drugs are the most potent suppressors of gastric acid secretion?

Answer 4

PPIs

Question 5

MOA of proton pump inhibitors

Answer 5

Inhibiting the H+/K+-ATPase enzyme of the gastric parietal cells.

Question 6

Indications of PPIs (5)

Answer 6

• Short term management of PUD and GORD
• Long term prevention of relapse of GORD
• H. pylori eradication in combination with antibiotics
• Treatment of Zollinger-Ellison syndrome
• Treatment and prevention of NSAID-associated erosions and ulcers

Question 7

What to give a child with severe ulcerative reflux esophagitis

Answer 7

Omeprazole

Question 8

ROA of PPIs

Answer 8

IV or oral

Question 9

DI of PPIs

Answer 9

Absorption of other drugs due to high pH
Agents metabolised by the cytochrome P450 enzyme system

Question 10

Common adverse effects of PPIs

Answer 10

diarrhoea, constipation, vomiting, flatulence, headache, vertigo,
abdominal discomfort

mask symptoms of gastric cancer

Question 11

What are the long term adverse effects of PPIs

Answer 11

to reduced vitamin and mineral
absorption:
* Iron (anaemia)
* Calcium (osteoporosis)
* Magnesium (muscle spasms)
* Vitamin B12 (anaemia)
Infections due to bacterial proliferation:
* C. diff infection
* Community acquired pneumonia
Alteration in pH-dependent drug
pharmacokinetics
CKD
Dementia

Question 12

Name other GORD drugs (4)

Answer 12

Domperidone
Metoclopramide
Sucralfate
Bismuth subcitrate

Question 13

Fucntion of Domperidone and metoclopramide

Answer 13

facilitate gastric emptying (prokinetics)
and increase gastrooesophageal tone, antiemetics. Used when other measures fail

Question 14

What is the function of sucralfate

Answer 14

cytoprotective, forms a vicious paste & adheres to the base of the ulcer
* Requires strict and frequent admin
* Requires acid environment, take 1 hr before meals & before bedtime
* Constipation

Question 15

Bismuth subcitrate function

Answer 15

has high affinity for damaged tissue
* forms a protective coating at the base of the ulcer
* Black discoloration of stool

Question 16

What is the function of PGE2 and I2?

Answer 16

Prostaglandins E2 and I2 inhibit acid, stimulate mucus and
bicarbonate secretion, and dilate mucosal blood vessels

Question 17

Misoprostol and prostaglandin analogues are used with____________

Answer 17

NSAIDs

Question 18

AE and CI of prostaglandin analogues

Answer 18

AE: abdominal cramp, diarrhoea
CI in pregnancy- uterine contractions, premature abortion

Question 20

What is peptic ulcer disease?

Answer 20

a gastric or duodenal ulcer caused by an imbalance between aggressive (gastrin and pepsin) and protective (mucosal defense and repair) factors.

Question 21

Common causes of peptic ulcer disease

Answer 21

• Helicobacter pylori (HP) infection
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Critical illness (stress-related mucosal damage)

Question 22

Uncommon causes of PUD

Answer 22

• Hypersecretion of gastric acid (Zollinger-Ellison syndrome)
• Viral infections
• Radiation therapy
• Cancer chemotherapy
• Medical illnesses (cirrhosis, chronic kidney disease)

Question 23

How does H pylori cause PUD?

Answer 23

Helicobacter pylori infection causes release of enzymes (urease,
lipases, proteases) that cause gastric inflammation and mucosal
injury.

Question 24

How do NSAIDs cause PUD

Answer 24

NSAIDs cause gastric mucosal damage by:
* Direct irritation of gastric epithelium
* Systemic inhibition of endogenous mucosal prostaglandin synthesis

Question 25

Clinical presentation of PUD

Answer 25

Abdominal pain that is often epigastric and described as burning but may present as
vague discomfort, abdominal fullness, or cramping
* A typical nocturnal pain that awakens the patient from sleep (especially between 12 and
3 AM)

-Pain can be seasonal
-Causes belching, heartburn and bloating

Question 26

Non-pharmacologic PUD tx

Answer 26

Eliminate or reduce:
* Psychological stress
* Cigarette smoking
* NSAID use
* Avoid foods and beverages that cause dyspepsia symptoms.
Emergency surgery may be required for:
* Bleeding
* Perforation
* Obstruction

Question 27

PUD Tx for H pylori -ve

Answer 27

PPI, e.g.:
* Lansoprazole, oral, 60 mg daily.
* Duodenal ulcer: for 14 days.
* Gastric ulcer: for 28 days.
* Stop NSAID until ulcer has healed.
* If patient is unable to stop NSAID:
* Decreasing NSAID dose
* Switching to paracetamol
* Using more selective COX-2 inhibitor

Question 28

PUD Tx for H. pylori +ve

Answer 28

PPI, e.g.: Lansoprazole, oral, 30 mg 12 hourly.
* Duodenal ulcer: for 7 days.
* Gastric ulcer: for 28 days.
* AND
* H. PYLORI ERADICATION:
* Amoxicillin, oral, 1 g 12 hourly for 14 days. OR For severe penicillin allergy:
Azithromycin, oral, 500 mg daily for 3 days.
* AND
* Metronidazole, oral, 400 mg 12 hourly for 14 days.