August 10, 2015 - NSAIDs Flashcards Preview

COURSE 1 > August 10, 2015 - NSAIDs > Flashcards

Flashcards in August 10, 2015 - NSAIDs Deck (14):
1

Peptic Ulcer Complications

- Acute bleeding which can be life-threatening

- Chronic bleeding which can cause iron deficiency anemia

- Stricture/obstruction

- Perforation which can lead to a pneumatoperitoneum

2

Risk of Poor Outcomes

Older age (>60)

Severe comorbidity

Active bleeding

Hypotension or shock

Red blood cell transfusion of > 6 units

Inpatient status at the time of bleed

Severe coagulopathy

3

Types of GI Bleeding

Coffee-ground emesis

Hematemesis

Melena

Hematochezia

4

Ligament of Treitz

Usually bleeds are proximal to the ligament of Treitz to cause melena.

5

Hematochezia

The passing of maroon-coloured stool or of fresh blood. Usually indicitive of a lower GI bleed or a brisk upper GI bleed.

 

Hematochezia AND hematemesis is very very very BAD as it indicates a massive bleed within the digetive system.

6

Types of Endoscopic Therapy

Injection Therapy

Thermal (Cautery or argon/plasma)

Mechanical (hemoclips)

Foam (hemospray)

 

Endoscopic therapy reduces the risk of re-bleeding and reduces mortality.

7

Surgical Management of an Ulcer

When all else fails, you must over sew the ulcer.

8

Anti-Ulcer Drugs

Antacids

H2 receptor antagonists (H2RA)

Proton pump inhibitors

Antibiotics for H. pylori eradication

9

Timing of PPIs

Best taken 30 minutes before a meal.

10

Risks of PPI Therapy

Risks are small, but they can include...

Potential for bacterial overgrowth

May increase the risk of aspiration pneumonia

May decrease bone density

May excaburate iron deficiency

May excaberate vitamin B12 deficiency

11

NSAID Mechanism of Action

Inhibits Cox1 or Cox2

 

Cox 1 is involved with physiological stimulus such as platelet aggregation, vasoconstriction, vasodilation etc.

Cox 2 is involved with inflammatory stimulus such as pain sensitization

12

How COX-1 and COX-2 Inhibitors Can Cause PUD

A image thumb
13

Cox-Inhibitors

Work more specifically than NSAIDs, but still carry a risk of increased PUD as well as cardiac and vascular events.

14

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