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Year2 GI Exam I > GERD and PUD Tx II > Flashcards

GERD and PUD Tx II Flashcards

1
Q

which has fastest onset of action between antacids, H2RAs and PPIs

A

antacids then H2RAs last is PPIs

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2
Q

which has longest duration of action

antacis, H2RAs and PPIs

A

PPIs then H2RAs then antacids

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3
Q

H2RA and PPI

which heals peptic ulcers more

A

PPIs

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4
Q

tolerance occurs with what

A

H2RA

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5
Q

what occurs with discontinuation of PPIs and H2RAs

A

rebound dyspeptic Sx and acid hypersecretion

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6
Q

moa bismuth compounds

A

coat ulcers and erosions creating protective layer against acid and pepsin
stimulates PG, mucus and bicarb

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7
Q

what is purpose of salicylate in bismuth subsalicylate

A

like ASA inhibits intestinal PG and chloride secretion

reduce stool frequencys and liquidity in infecitous diarrhea

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8
Q

PK of bismuth

A

> 99% appears in stool

rapid dissociation

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9
Q

therapeutic use of bismuth compounds

A

dyspepsia and acute diarrheatravelers diarrhea

H pylor infection

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10
Q

what is the drug combination for H pylori

A

bismuth salicylate, bismuth subcitrate potassium with metronidazole and tetracycline

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11
Q

adverse effects of bismuth compounds

A

blackening of stool
carefule in children with flu or chicken pox because of reyes
used short periods to avoid encephalopathy and renal impairment

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12
Q

What is misoprostel

A

PG analog

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13
Q

MOA misoprostel

A

methyl analog PGE1, mucosal protective and acid inhibitory
may stimulate mucus and bicarb secretion and enhance mucosal blood flow
bind PG R on parietal cells reducing histamine stimulated cAMP production causing acid inhibition

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14
Q

Use of prostaglandin analogs

A

prevention NSAID induced ulcers

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15
Q

adverse drug reactions prostaglandin analogs

A

diarrhea, cramping abdominal pain

stimulates uterine contraction so not used in pregnancy or those of childbearing age without negative pregnancy test

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16
Q

MOA sucralfate

A

negatively charged sucrose sulfate binds positively charged proteins at base of erosions forming a physical barrier that restricts further damage
stimulates mucosal OG and bicarb secretion

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17
Q

use of sucralfate

A

stress related mucosal injury

administered through NG tube

18
Q

adverse drug reactions of sucralfate

A

not absorbed, no systemic effects

some say contipation due to aluminum salt

19
Q

drug drug interactions sucralfate

A

may impair absorption of other drugs, separate administration times

20
Q

What type microbe is H pylori

A

spiral shaped gram - rod

21
Q

When do you test for H pylori

A

active PUD
past Hx of documented peptic ulcer
gastric mucosa associated with MALT lymphoma
univestigated dyspepsia, <55 y.o

22
Q

side effects clarithromycin

A

GI upset, diarrhea, altered taste!!!!

23
Q

side effects of amoxicillin

A

GI upset, HA and diarrhea

24
Q

side effects metronidazole

A

metallic taste!!!!!, dyspepsia, intolerance to alcohol!!!!!!

25
Q

side effects tetracycline

A

GI upset, photsensitivity!!!!

26
Q

how do PPIs promote eradication of H pylori

A

direct antimicrobial properties and lower minimal inhibitory [ ] of antibiotics against H pylori

27
Q

recommented epirical Tx for patients with H pylori and not on clarithromycin

A

14 days
PPI +
clarithromycin +
amoxicillin or metronidazole

28
Q

rec Tx for H pylori in patients given a macrolide previously or failed standard Tx

A

14 day

  • PPI or H2RA +
  • metronidazole +
  • tetracycline or doxycycline +
  • bismuth subsalicylate
29
Q

what is the sequential therapy used in europe for H pylori

A

5 days PPI and amoxicillin

then 5 days PPI, clarithromycin and tinidazole

30
Q

What is the european salvage regimen for h pylori

A

levofloxacin based triple therapy for 10 days

31
Q

modification for GERD patient that has Sx after lying down

A

head of bed elevation

32
Q

modification for nocturnal GERD Sx

A

avoid meals 2-3 hrs before bed

33
Q

modification for tobacco users who have GERD

A

smoking cessation

34
Q

what are some triggers for GERD patients

A

caffeine, coffee, chocolate, spicy foods, acidic foods, high fat content

35
Q

what is preferrent for infrequent heartburn

A

H2RAntagonist

36
Q

what is preferred for milk, intermittent Sx of GERD

A

antacid or H2RA prn

37
Q

what is preferred for NERD

A

antacid of H2RA (PPI may be required)

38
Q

what is preferred for erosive esophagitis

A

PPI x 8 weeks

39
Q

rec for duodenal ulcer

A

H2RA or PPI x 4 weeks

40
Q

recommendation for gastric ulcer

A

PPI x 8 weeks

41
Q

therapy for NSAID induced ulcers

A

discontinue NSAIDs,

PPIs if have to stay on NSAID

42
Q

Tx stress ulcers prophylaxis

A

omeprazole NaHCO3

H2RAs preferred IV if there is no NG tube

Year2 GI Exam I (18 decks)

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