GI

Question 1

What increases the risk of peptic ulcer disease

Answer 1

Countries that have high H pylori infections, nsaid use, older age

Question 2

What meds can cause peptic ulcers?

Answer 2

NSAIDs and corticosteroids

Question 3

What are the causes of idiopathic PUD

Answer 3

IBS, gastronomy, smoking, rack cocaine, meth

Question 4

What are the two major considerations in diagnosing peptic ulcer disease?

Answer 4

Determining whether symptoms are due to PUD and determining the ideology of the ulcer

Question 5

What two test can you do to find ulcers?

Answer 5

Endoscopy or radiography

Question 6

What are the traits of H pylori?

Answer 6

It is spiral shaped pH, sensitive, in the mucus layer and surface, epithelial cells of the stomach

Question 7

What does the H pylori bacteria produce once it’s in the mucosal linings do what does that cause?

Answer 7

Urease which converts Syria in the stomach into ammonium to neutralize stomach acid and allows bacteria to survive

Question 8

Other than PUD, what does H. pylori also cause an increased risk for?

Answer 8

Gastric adenocarcinoma, and B cell lymphoma of the stomach

Question 9

How does H. pylori infections present when their symptomatic?

Answer 9

Nausea, vomiting, abdominal pain, heartburn, diarrhea, and halitosis

Question 10

When is testing for H. pylori indicated

Answer 10

And patient with lymphoma active PUD dyspepsia and adults less than 60 years old, unexplained, iron deficiency, anemia, and one other household members have H pylori

Question 11

What are the invasive and non-invasive testing for H pylori?

Answer 11

Invasive is an endoscopy obtained biopsy
Non-invasive is a urea breath, test and rapid fecal antigen

Question 12

What can skew the results of a biopsy urease test?

Answer 12

Patients taking PPI or have recent G.I. bleeding

Question 13

What is the preferred therapy for treatment naive H pylori infection

Answer 13

A 10-14 day empiric treatment with optimized bismuth quadruple therapy (BQT)

Question 14

How should you determine if treatment was successful after H pylori treatment?

Answer 14

A urea breath, test or fecal antigen test or upper endoscopy four weeks after treatment and PPI should be withheld for one to two weeks prior to testing for eradication

Question 15

If a patient fails, H pylori treatment what is the next step?

Answer 15

Salvage therapy

Question 16

What is the salvage regimen in first line failure for H Pylori

Answer 16

BQT if big previously treated with it, titanium triple therapy or PCAB dual therapy * 14 days.

Question 17

What medication’s should you avoid use in H pylori salvage regiments

Answer 17

Clarithromycin and levofloxacin

Question 18

Which drug combination would have the highest likelihood of achieving eradication of H. pylori in a patient that’s allergic to penicillin

Answer 18

PPI metronidazole, tetracycline and Bismith subsalicylate

Question 19

What are the three stimuli of HCl in the gastric lumen

Answer 19

Acetylcholine, histamine, and gastrin

Question 20

What do proton pump inhibitors inhibit

Answer 20

H– K – ATPase pump that secretes gastric acid

Question 21

True or false proton pump inhibitors are more efficacious than H2 blockers

Answer 21

True

Question 22

Which proton pump inhibitors are the most bioavailable and achieve the highest plasma levels

Answer 22

Lansoprazole Dexlansoprazole, pantoprazole

Question 23

Which three PPI’s are available over-the-counter

Answer 23

Landsoprazole esomeprazole and omeprazole

Question 24

What are PPIs indicated in treating

Answer 24

PUD, GERD, gastronoma, prevention of PUD with long term NSAID therapy, dyspepsia, heartburn

Question 25

Which medication is more suitable for intermittent heartburn?

Answer 25

H2

Question 26

How do you discontinue patients from PPI’s?

Answer 26

When patients are asymptomatic for three months, they can be discontinued by slow taper

Question 27

What are the side effects of PPIs

Answer 27

Headache, GI, cdiff

Question 28

What is long-term use of PPI is associated with

Answer 28

Dementia, health care, associated pneumonia, risk for kidney disease, micronutrient deficiencies, increased fracture, risk, and spontaneous bacterial peritonitis

Question 29

What patient population has an increased risk for polymorphisms to PPI

Answer 29

Asian

Question 30

What meds do PPI decrease the absorption of

Answer 30

Atazanvir, ketoconazole, itracinazole, digoxin

Question 31

Which electrolytes do PPI decrease

Answer 31

Magnesium and calcium

Question 32

Which proton pump inhibitors have less potential for drug drug interactions

Answer 32

Esomeprazole, lansoorazole, raberprazole and pantoprazole

Question 33

When H2 receptor agonist and PPI are used together, what can it result in?

Answer 33

Decreased absorption of nutrients like vitamin B 12 iron calcium

Question 34

How should PPI be dosed

Answer 34

30 minutes before the first meal of the day

Question 35

Which PPI is the least safe for pregnancy?

Answer 35

Omeprazole

Question 36

When are PCABs indicated

Answer 36

Healing of erosive esophagitis and heart burn

Question 37

What medications can you combine with potassium competitive acid inhibitors for the treatment of H pylori?

Answer 37

In combination with amoxicillin alone or amoxicillin plus clarithromyocin

Question 38

How long should you take PCA bees for the healing of erosive esophagitis?

Answer 38

Eight weeks to six months

Question 39

Which PCAB is most commonly used

Answer 39

Vonoprazan

Question 40

Which dog accumulates in the basal side of bridal cells and undergoes conversion to a derivative that is irreversibly inhibited h k atpase

Answer 40

Esomeprazole

Question 41

Which drug is most recommended as part of the dual or triple therapy with amoxicillin for h pylori

Answer 41

Vonoprazan