PUD

Question 1

PUD stands for

Answer 1

Peptic Ulcer Disease

Question 2

types of ulcers (2)

Answer 2

gastric and duodenal

Question 3

Are H. pylori caused ulcers more prevalent in the duodenum or stomach?

Answer 3

duodenum

Question 4

Are NSAID caused ulcers more prevalent in the duodenum or stomach?

Answer 4

stomach

Question 5

Signs and Symptoms

• food can help determin location
• Duodenum - pain ___
• Stomach - pain ___

Answer 5

• relieves
• worsens

Question 6

T or F: a duodenal ulcer would be relieved by eating food

Answer 6

True

Question 7

Ways to confirm H. pylori
* endoscopy
* antibody detenction
* ___ breath test
* fecal antigen

Answer 7

urea

Question 8

principles of H. pylori Treatment

• ___ + 2-3 antibiotics

Answer 8

PPI

if you cant use a PPI, use a H2RA

Question 9

H. pylori treatment

Bismuth Quad Therapy
* what are the 4 drugs
* Duration: ___ days

Answer 9

1. PPI BID
2. bismuth subsalicylate
3. metronidazole
4. tetracycline

10-14 days

Question 10

H. pylori treatment - convenience packaging

Helidac - Bismuth Quad
* ___ administration package
* 14 blister cards containing:
* Metronidazole 250 mg (1 tab ____ )
* Tetracycline ___ mg (1 cap QID)
* bismuth subsalicylate 262.4 mg (2 tab ___ )
* must also take PPI ___

Answer 10

• daily
• QID
• 500 mg
• QID
• BID

Question 11

H. pylori treatment - convenience packaging

Pylera - Bismuth Quad
* 3-in-1 capsule containing (3 drugs)
* Dose: 3 caps ___ for 10 days
* must take PPI ___

Answer 11

1. bismuth subcitrate potassium 140 mg
2. metronidazole 125 mg
3. tetracycline 125 mg
   * QID
   * BID

Question 12

H. pylori Therapy Breakdown

Clarithromycin - Concomitant
1. PPI ___
2. Clarithromycin 250-500 mg ___
3. Amoxicillin 1 g ___
4. Metronidazole 250-500 mg ___

Duration: ___ days

Answer 12

BID
10-14 days

Question 13

T or F: Clarithromycin Triple Therapy is okay to use

Answer 13

False

Question 14

H. pylori Therapy Breakdown

Clarithromycin Hybrid Therapy
1. PPI BID days ___
2. amoxicillin 1 g BID days __
3. Clarithromycin 250-500 mg BID days ___
4. metronidazole 250-500 mg BID days ___

Duration: ___ days

Answer 14

• 1-14
• 1-14
• 7-14
• 7-14

14 days

Question 15

H. pylori Therapy Breakdown

Clarithromycin Sequential Therapy
1. PPI BID days ___
2. amoxicillin 1 g BID days ___
3. clarithromycin 250-500 mg BID days ___
4. metronidazole 250-500 mg BID days ___

Duration: ___

Answer 15

• 1-10
• 1-5
• 6-10
• 6-10
  10 days

Question 16

H. pylori Therapy Breakdown

Levofloxain Triple Therapy
1. PPI BID
2. Levofloxacin 500 mg ___
3. Amoxicillin 1g ___

Duration: ___ days

Answer 16

• daily
• BID

10-14 days

Question 17

T or F: Clarithromycin is the most commonly used H. pylori therapy in the US

Answer 17

False; not used in the US due to resistance

Question 18

H. pylori Therapy Breakdown

Levofloxacin Sequential Therapy
1. PPI BID days ___
2. amoxicillin 1 g BID days ___
3. levofloxazcin 500 mg daily days ___
4. metronidazole 500 mg BID days ___

Duration: ___

Answer 18

• 1-10
• 1-5
• 6-10
• 6-10

10 days

Question 19

H. pylori Therapy Breakdown

Levofloxacin Quadruple therapy (LOAD)
1. Levofloxacin 250 mg ___
2. Omeprazole (high dose) ___
3. Nitazoxanide (Alinia) 500 mg ___
4. Doxycycline 100 mg ___

Duration: ___
* Nitazoxanide is an antiparasitic drug

Answer 19

• daily
• daily
• BID
• daily
  7-10 days

Question 20

H. pylori Therapy Breakdown

Rifabutin Triple Therapy
Talicia: 4 caps every ___ hours
Contains 3 drugs
1. omeprazole 40 mg
2. ___ 1 g
3. rifabutin 50 mg

Duration: ___
* last line: reserved for ___ therapy

Answer 20

• 8 hrs
• amoxicillin
• 14 days
• salvage

Question 21

PPIs in H. pylori treatment

• PPIs taken ___ are the backbone of therapy
• H2RAs such as ___ should not be substituted for PPIs unless a patient cannot tolerate them
• PPIs are not usually necessary beyond ___ weeks of use for eradications

Answer 21

• BID
• famotidine
• 2 weeks

Question 22

Which PPI is not approved for H. pylori

Answer 22

Dexilant

Not FDA approved

Question 23

PPI dosing for H. pylori

omeprazole ( ___ )
___ mg

Answer 23

Prilosec 20 mg

Question 24

PPI dosing for H. pylori

pantoprazole ( ___ )
___ mg

Answer 24

Protonix 40 mg

Question 25

# PPI dosing for H. pylori esomeprazole ( ___ ) ___ - ___ mg

Answer 25

Nexium 20-40 mg

Question 26

# PPI dosing for H. pylori lansoprazole ( ___ ) ___ mg

Answer 26

Prevacid 30 mg

Question 27

# Bismuth Salts MOA: topical ___ effect improves ulcer healing by inhibiting aggressive factors and increasing protective factors AE: ___ or stools and tongue

Answer 27

* bacteriocidal * darkening

Question 28

Aggressive factors

Answer 28

* pepsin * gastric acid | NSAIDs and H. pylori

Question 29

Protective Factors

Answer 29

* blood flow to mucosa * bicarbonate * prostaglandins and mucus

Question 30

# Antibiotic Adverse Effects Metronidazole - Avoid alcohol due to ___ like reaction

Answer 30

disulfiram

Question 31

# Antibiotic Adverse Effects Levofloxacin class: ___ * ___ rupture * ___ status change * ___ prolongation

Answer 31

fluroquinolone * tendon * mental * QTc

Question 32

# Antibiotic Adverse Effects Amoxicillin class: ___ * ___ upset * take with food to help alleviate

Answer 32

penicillin * GI

Question 33

# Antibiotic Adverse Effects tetracycline and doxycycline class: ___ * ___ sensitivity

Answer 33

tetracyclines * photosensitivity

Question 34

# Antibiotic Adverse Effects clarithromycin class: ___ * ___ prolongation * ___ sensitivity * ___ upset

Answer 34

macrolide * QTC * photosensitivity * GI

Question 35

T or F: probiotics can potentially be used as prophylaxis for H. pylori colonization

Answer 35

True

Question 36

T or F: when compared to a placebo, probiotics in combination with antibiotics increase eradication rates

Answer 36

True

Question 37

T or F: when considering antibiotic treatment for H. pylori, you should use an antibiotic that the patient has taken

Answer 37

False; avoid antimicrobialsa patient has already taken

Question 38

T or F: bismuth quad is first line in H. pylori

Answer 38

True

Question 39

NSAIDs block prostaglandins which with impair ___ defense

Answer 39

mucosal

Question 40

# NSAID caused ulcers Prophylaxis * PPIs * H2RAs ( ___ ulcer ONLY) * ___

Answer 40

* duodenal * micoprostol

Question 41

# NSAID caused ulcers Treatment * PPIs * H2RAs * ___

Answer 41

sucralfate

Question 42

# NSAID caused ulcers Treatment duration * ___ weeks if NSAID stopped * ___ weeks if NSAID continued

Answer 42

* 8 weeks * 12 weeks

Question 43

# Dosing PPIs for NSAID induced Ulcers omeprazole ___ pantoprazole ___ esomeprazole ___ lansoprazole ___

Answer 43

40 mg 40 mg 40 mg 30 mg

Question 44

# Dosing H2RAs for NSAID induced Ulcers * famotidine ___ mg HS or ___ mg BID * cimetidine ___ mg HS, ___ mg BID, or ___ mg QID

Answer 44

* 40 mg, 20 mg * 800 mg, 400 mg, 300 mg

Question 45

misoprostol dose: ___ mcg QID with food MOA: prostaglandin ___ analog * increases mucus and ___ secretion * increases surface active ___ * increases gastric mucosal blood flow * inhibits ___ sectretion | abortifacient

Answer 45

* 200 mcg * E1 * bicarbonate * phospholipids * acid

Question 46

T or F: many patients cannot tolerate full dose of misoprostol due to the side effects

Answer 46

True; SEs include diarrhea, abdominal cramping, N/V, flatulence, and headache

Question 47

T or F: mistoprostol is treatment only

Answer 47

FALSE: prophylaxis

Question 48

Sucralfate Dose: 1 g ___ before meals and at bedtime MOA: sucrose-sulfate-aluminum complex interacts with ___ and ___ to form a physical barrier over an open ulcer

Answer 48

* QID * albumin and fibrinogen

Question 49

Sucralfate SE: metalic taste, ___, aluminum toxicity in chronic renal failure

Answer 49

constipation

Question 50

T of F: Sucralfate is treatment only

Answer 50

True

Question 51

# NSAID induced ulcer prevention Strategies * preferred non-selective agent ___ * decreased CV risk vs selective agent ___

Answer 51

* naproxen * celecoxib

Question 52

COX-2 specific NSAIDs like celecoxib are ___ likely to cause stomach ulcers * increased ___ adverse effects

Answer 52

less * CV

Question 53

H2RAs do not have efficacy in prevention of gastric ulcers * only used for ___ ulcer prevention

Answer 53

duodenal

Question 54

If a patient has a low-moderate ulcer risk, but a high CV risk, use ___ + ____

Answer 54

Naproxen + PPI/misoprostol | low dose aspirin is required for high CV risk

Question 55

if a patient has high ulcer risk and a low CV risk, use ___ therapy if possible. If not, try ___ inhibitor + ___

Answer 55

* alternative * COX-2 * PPI/misoprostol

Question 56

# H. pylori vs NSAID H. pylori: PPIs dosed ___ NSAIDs: PPIs dosed ___

Answer 56

* BID * daily

Question 57

# H. pylori vs NSAID H. pylori treatment duration: ___ NSAID induces treatment duration: ___ if NSAID stopped, ___ weeks if continuing

Answer 57

* 10-14 days * 8 weeks, 12 weeks