GERD and PUD Tx II

Question 1

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

Answer 1

antacids then H2RAs last is PPIs

Question 2

which has longest duration of action

antacis, H2RAs and PPIs

Answer 2

PPIs then H2RAs then antacids

Question 3

H2RA and PPI

which heals peptic ulcers more

Answer 3

PPIs

Question 4

tolerance occurs with what

Answer 4

H2RA

Question 5

what occurs with discontinuation of PPIs and H2RAs

Answer 5

rebound dyspeptic Sx and acid hypersecretion

Question 6

moa bismuth compounds

Answer 6

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

Question 7

what is purpose of salicylate in bismuth subsalicylate

Answer 7

like ASA inhibits intestinal PG and chloride secretion

reduce stool frequencys and liquidity in infecitous diarrhea

Question 8

PK of bismuth

Answer 8

> 99% appears in stool

rapid dissociation

Question 9

therapeutic use of bismuth compounds

Answer 9

dyspepsia and acute diarrheatravelers diarrhea

H pylor infection

Question 10

what is the drug combination for H pylori

Answer 10

bismuth salicylate, bismuth subcitrate potassium with metronidazole and tetracycline

Question 11

adverse effects of bismuth compounds

Answer 11

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

Question 12

What is misoprostel

Answer 12

PG analog

Question 13

MOA misoprostel

Answer 13

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

Question 14

Use of prostaglandin analogs

Answer 14

prevention NSAID induced ulcers

Question 15

adverse drug reactions prostaglandin analogs

Answer 15

diarrhea, cramping abdominal pain

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

Question 16

MOA sucralfate

Answer 16

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

Question 17

use of sucralfate

Answer 17

stress related mucosal injury

administered through NG tube

Question 18

adverse drug reactions of sucralfate

Answer 18

not absorbed, no systemic effects

some say contipation due to aluminum salt

Question 19

drug drug interactions sucralfate

Answer 19

may impair absorption of other drugs, separate administration times

Question 20

What type microbe is H pylori

Answer 20

spiral shaped gram - rod

Question 21

When do you test for H pylori

Answer 21

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

Question 22

side effects clarithromycin

Answer 22

GI upset, diarrhea, altered taste!!!!

Question 23

side effects of amoxicillin

Answer 23

GI upset, HA and diarrhea

Question 24

side effects metronidazole

Answer 24

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

Question 25

side effects tetracycline

Answer 25

GI upset, photsensitivity!!!!

Question 26

how do PPIs promote eradication of H pylori

Answer 26

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

Question 27

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

Answer 27

14 days PPI + clarithromycin + amoxicillin or metronidazole

Question 28

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

Answer 28

14 day - PPI or H2RA + - metronidazole + - tetracycline or doxycycline + - bismuth subsalicylate

Question 29

what is the sequential therapy used in europe for H pylori

Answer 29

5 days PPI and amoxicillin | then 5 days PPI, clarithromycin and tinidazole

Question 30

What is the european salvage regimen for h pylori

Answer 30

levofloxacin based triple therapy for 10 days

Question 31

modification for GERD patient that has Sx after lying down

Answer 31

head of bed elevation

Question 32

modification for nocturnal GERD Sx

Answer 32

avoid meals 2-3 hrs before bed

Question 33

modification for tobacco users who have GERD

Answer 33

smoking cessation

Question 34

what are some triggers for GERD patients

Answer 34

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

Question 35

what is preferrent for infrequent heartburn

Answer 35

H2RAntagonist

Question 36

what is preferred for milk, intermittent Sx of GERD

Answer 36

antacid or H2RA prn

Question 37

what is preferred for NERD

Answer 37

antacid of H2RA (PPI may be required)

Question 38

what is preferred for erosive esophagitis

Answer 38

PPI x 8 weeks

Question 39

rec for duodenal ulcer

Answer 39

H2RA or PPI x 4 weeks

Question 40

recommendation for gastric ulcer

Answer 40

PPI x 8 weeks

Question 41

therapy for NSAID induced ulcers

Answer 41

discontinue NSAIDs, | PPIs if have to stay on NSAID

Question 42

Tx stress ulcers prophylaxis

Answer 42

omeprazole NaHCO3 | H2RAs preferred IV if there is no NG tube