Acute GI bleeding

Question 1

Mechanical ventilation more than __ hours is a risk factor for ulcer/GI bleeding

Answer 1

48

Question 2

INR > __ is risk factor for bleeding

Answer 2

1.5

Question 3

Platelets < __ K is risk factor for bleeding

Answer 3

50

Question 4

According to the El-Kersh study eating alone is enough to prevent significant bleeding and probably don’t need PPI

a. true
b. false

Answer 4

a. true

Question 5

According to the Huang meta analysis in pts receiving enteral feeding, pharmacologic SUP is not beneficial

a. true
b. false

Answer 5

a. true

may increase risk of nosocomial pneumonia

Question 6

Sucralfate limitations:

Answer 6

• DDIs
• may clog feeding tubes
• electrolyte abnormalities (Al accumulation, hypophosphatemia)
• constipation

Question 7

Antacids provide no mortality benefit

a. true
b. false

Answer 7

a. true

Question 8

H2RAs should be renally adjusted for CrCl < _ mL/min

Answer 8

50

Question 9

H2RAs may __ the incidence of pneumonia

a. increase
b. decrease

Answer 9

a. increase

Question 10

H2RAs may have what serious AE?

Answer 10

thrombocytopenia

Question 11

PPIs may cause increased incidence of __ associated diarrhea

Answer 11

C diff

may increase pneumonia incidence

Question 12

PPIs are much better at preventing a drop to 4 or lower pH, but no difference in preventing bleeding when compared to H2RAs

a. true
b. false

Answer 12

a. true

Question 13

There is no difference in mortality rate between PPIs and placebo in ICU pts

a. true
b. false

Answer 13

a. true

Question 14

Other risk factors for stress ulcers:

Answer 14

Hx of GI bleeding
hypotension
hepatic failure
trauma
severe thermal injury
head injury
spinal cord injury

Question 15

What is main pre-endoscopic Tx for PUD?

Answer 15

IV proton pump inhibitor

Question 16

Which is used for intermittent dose IV PPI therapy for PUD?

a. pantoprazole
b. esomeprazole

Answer 16

a. pantoprazole

Question 17

Pantoprazole intermittent dose forIV PPI therapy?

Answer 17

40mg IV BID

Question 18

High dose IV PPI therapy for PUD with pantoprazole and esomeprazole?

Answer 18

80mg IV bolus followed by 8mg/hr

Question 19

Sucralfate is the preferred Tx for PUD post-endoscopic therapy

a. true
b. false

Answer 19

b. false

limited to no efficacy

Question 20

Guidelines recommend against the use of H2RAs in the setting of upper gastric bleed

a. true
b. false

Answer 20

a. true

Question 21

___ are shown to decrease rebreeding, need for surgery, and possibly mortality

a. H2RAs
b. PPIs
c. sucralfate
d. antacids

Answer 21

b. PPIs

no real mortality benefit

Question 22

High dose PPIs infusion is used for__ hours after endoscopy

Answer 22

72

Question 23

There are no specific therapies for lower GI bleeds

a. true
b. false

Answer 23

a. true

Limit NSAIDs, antiplatelets
PPI unlikely to have a difference

Question 24

PPIs are unlikely to have a difference with lower GI bleed

a. true
b. false

Answer 24

a. true