PUD

Question 1

H pylori treatment options

Answer 1

Clarythro based triple therapy
bismuth quad therapy
levofloxacin based triple therapy

Question 2

triple therapy Clarythro based for H pylori

Answer 2

PPI BID
Clarythromycin 500mg po BID
AMoxicillin 1g po BID/flagyl 500mg TID

x10-14d

Question 3

bismuth quad therapy for H pylori and its pros

Answer 3

PPI BID
bismuth subsalicylate or subcitrate QID
Tetracycline 500mg QID
Metronidazole 250mg PO QID or 500mg TID

x10-14d
can use for penicillin allergy

Question 4

Levofloxacin triple therapy for H pylori and its

pros

Answer 4

PPI BID
Levofloxacin 500mg po qd
Amoxicillin 1g BID

x10-14d
adherence better!!

Question 5

how long do we have to wait to confirm H pylori eradication regardless of treatment used and why
What are the tests?

Answer 5

4 weeks
bismuth and PPIs can alter test results
urea breath test and fecal Ag tests

Question 6

what type of ulcer does H pylori usually cause

Answer 6

duodenal ulcer (intestinal)

Question 7

risk factors for NSAID induced PUD

Answer 7

>65
hx any ulcer
steroid use w NSAID
non-selective NSAID being used 
anticoagulant use w NSAID
antiplatelet use w NSAID

has one of these and on NSAID–> PPI prophylaxis

Question 8

what are the selective NSAIDs

Answer 8

inihbit COX-2 only
Celecoxib (Celebrex(
Meloxicam (Mobic)
Nabumetone
Etodolac

Question 9

NSAID induced PUD treatment

Answer 9

PPI qg x 4+ wks up to 8 weeks

or chonically if NSAID tx is chronic

Question 10

in critical care (hospital) what is needed for a patient to need to be on stress ulcer prophylaxis

Answer 10

> /=1 major risk
resp failure aka ventilator
coagulopathy INR >1.5, plts <50

OR

>/=2 minor risk
sepsis
HTN requiring pressors
hx GIB
high dose steroid (>250mg Hydrocortisone equiv)

Question 11

critical care stress ulcer prophylaxis treatment

Answer 11

H2RA bc PPIs be doin a little too much yf and have infection risk! (PPIs do work to tho)
continue until no risk factors (leaves ICU)

famotidine
cimetidine

Question 12

Zollinger Ellison syndrome
define
treatment

Answer 12

gastrin-producing tumor

PPI q8-12h

Question 13

UGIB in emergent care suspected in ____________

Answer 13

hematemesis, melena, NSAID user, anticoag/antiplatelet with no PPI prophylaxis

Question 14

patient in emergency room and ends up with an UGIB
s/sx?
what do we give them?

Answer 14

epigastric pain, may be asx, tachycardic, hypotensive, dec Hgb, dec Hct

IV isotonic crystalloids BOLUS >2L in minutes
supp O2 (goal is >92%)
reverse anticoagulation w FFP
if Hgb <7 give packed RBC (1U inc Hgb by 1!)
endoscopy with targeted tx (epinephrine, contact thermal tx)
high dose short term PPI Pantoprazole/Esomeprazole 80 mg bolus then 8mg/hr IV inf x72h

Question 15

if patient got a stent in the last 90d, on ASA, prasugrel
UGIB in hospital
do we d/c ASA/prasugrel?

Answer 15

no, the risk of a cardiac event outewighs the benefit of disocntinuing for a GI bleed
once the patient is stabilized, re-initiate anti-platelet tx
(needs to have stable Hgb, be initiated within 7d of d/c

** if has an UGIB, antiplatelets or anticoagulants will be D/C regardless. the decision comes into play when debating whether or not to re initiate in that 7 day window

Question 16

on ASA, gets UGIB, no cardiac hx and taking ASA on their own

should ASA be re-initiated post UGIB tx?

Answer 16

no, ASA is for secondary prevention usually and probably caused the bleed!