GERD and PUD

Question 1

PPIs that are always once daily dosing

Answer 1

esomeprazole

dexlansoprazole

Question 2

PPI dose timing

Answer 2

take 30-60 minutes before meals on an empty stomach

Question 3

how long do you need to take PPIs to see a benefit

Answer 3

1-4 days

Question 4

PPIs and osteoporosis

Answer 4

ok to do unless patient has more risk factors for hip fracture

Question 5

PPIs and community-acquired pneumonia

Answer 5

increased risk of acquiring for acute use, but no elevated risk in long-term users

Question 6

PPIs and C.diff

Answer 6

PPIs are risk factor and should be used with care in patients at risk

Question 7

PPIs and clopidogrel

Answer 7

no changes needed as there is not increased risk of CV event

Question 8

PPI side effects

Answer 8

well tolerated

sometimes diarrhea or headache

Question 9

PPI differences in efficacy

Answer 9

no major difference

Question 10

typical PPI course

Answer 10

8 weeks

Question 11

if GERD symptoms still present after typical course

Answer 11

maintenance PPI at the minimal effective dose

Question 12

H2RA adverse effects

Answer 12

well tolerated

diarrhea or constipation

Question 13

which GERD drugs need to decrease dose in renal impairment

Answer 13

H2RAs

Question 14

why don’t we use cimetidine much

Answer 14

drug interactions

Question 15

H2RAs place in therapy

Answer 15

• less effective that PPIs
• can be used for maintenance if no erosive disease
• can be used for bedtime relief

Question 16

calcium carbonate side effect

Answer 16

constipation

Question 17

sodium bicarbonate side effect

Answer 17

burps

Question 18

aluminum hydroxide side effect

Answer 18

constipation

Question 19

magnesium hydroxide side effect

Answer 19

diarrhea

Question 20

antacid drug interactions

Answer 20

fluroquinolones
tetracyclines
allopurinol
iron
cefuroxime

Question 21

antacid place in therapy

Answer 21

infrequent episodic heartburn only

Question 22

empiric therapy for GERD

Answer 22

• PPI rx for 8 weeks
• if good response stop PPI
• if still symptoms continue therapy and consider more diagnostics

Question 23

H.pylori treatment options

Answer 23

• clarithromycin triple therapy
• bismuth quadruple therapy
• concomitant therapy

Question 24

clarithromycin triple therapy regimens

Answer 24

• clarithromycin 500 BID
• Amoxicillin 1000 BID/metronidazole 500 mg TID
• PPI BID

Question 25

clarithromycin triple therapy regimen duration

Answer 25

14 days

Question 26

when to use clarithromycin triple therapy regimens

Answer 26

in areas of low clarithromycin resistance who have not had a macrolide previously

Question 27

bismuth quadruple therapy regimen

Answer 27

- PPI BID - bismuth subsalicylate - metronidazole 500 TID - tetracycline 500 QID

Question 28

bismuth quadruple therapy regimen duration

Answer 28

10-14 days

Question 29

when to use bismuth quadruple therapy regimen

Answer 29

patients that have had a macrolide

Question 30

bismuth quadruple therapy regimen adverse effect

Answer 30

increased GI effects

Question 31

concomitant therapy regimen

Answer 31

- PPI BID - clarithromycin 500 BID - amoxicillin 1000 BID - metronidazole 500 BID

Question 32

concomitant therapy regimen duration

Answer 32

10-14 days

Question 33

testing for H.pylori after treatment

Answer 33

-urea breath test, fecal antigen test or biopsy at least 4 weeks after completion of antibiotic treatment and 2 weeks after PPI have been withheld

Question 34

risk factors for NSAID GI toxicity

Answer 34

- age >65 - high dose of NSAID - previous uncomplicated ulcer - using with aspirin, corticosteroid or anticoagulant

Question 35

what patients are considered high risk of NSAID GI toxicity

Answer 35

more than 2 risk factors present

Question 36

treatments for moderate-high risk of NSAID induced ulcer

Answer 36

PPI or misoprostol | stop NSAID

Question 37

duodenal NSAID ulcers should be treated for how long

Answer 37

4 weeks

Question 38

gastric NSAID ulcers should be treated for how long

Answer 38

8 weeks

Question 39

misoprostol use

Answer 39

NSAID ulcers

Question 40

issues with misoprostol

Answer 40

- most cannot tolerate abdominal pain and diarrhea | - contraindicated in pregnancy

Question 41

sucralfate use

Answer 41

NSAID ulcers

Question 42

sucralfate MoA

Answer 42

forms coating along gastric lining

Question 43

issue with sucralfate

Answer 43

troublesome constipation