PUD

Question 1

3 common forms of PUD

Answer 1

H. pylori positive
NSAID-induced
Stress related mucosal damage

Question 2

H. pylori site of damage

Answer 2

duodenum

Question 3

NSAID site of damage

Answer 3

stomach

Question 4

stress related site of damage

Answer 4

stomach

Question 5

which type of PUD is more dependent on pH

Answer 5

H. pylori

Question 6

which type/s of PUD are asymptomatic

Answer 6

NSAID

stress related

Question 7

which type of PUD has deep ulcers

Answer 7

NSAID

Question 8

Describe GI bleeding associated with H. pylori

Answer 8

less severe

single vessel

Question 9

describe GI bleeding associated with NSAID

Answer 9

more severe

single vessel

Question 10

describe GI bleeding associated with stress

Answer 10

more severe

superficial mucosal capillaries

Question 11

PUD risk factors

Answer 11

H. pylori 
NSAIDs
Stress
Gastric acid hypersecretion 
Cigarette smoking
Diet
Chronic diseases
Vascular insufficiency
Chemo/radiation

Question 12

Risk factors for NSAID induced ulcer

Answer 12

age >65
previous peptic ulcer, ulcer-related complications
high dose NSAIDs
Multiple NSAIDs
Selection of NSAID
Use of ASA, bisphosphonates, corticosteroids, anticoagulants, antiplatelets, SSRIs
chronic debilitating disorders
H. pylori infection
Smoking
Alcohol

Question 13

Name nonselective NSAIDs

Answer 13

indomethacin
piroxicam
ibuprofen 
naproxen
sulindac
ketoprofen
ketorolac

Question 14

name partially selective NSAIDs

Answer 14

etodolac
meloxicam
nabumetone
diclofenac

Question 15

PUD complications

Answer 15

Upper GI bleed
Perforation
Obstruction

Question 16

PUD complications

Answer 16

Upper GI bleed
Perforation
Obstruction

Question 17

PUD clinical presentation

Answer 17

Epigastric pain
Nocturnal pain
Duodenal ulcer (1-3 hours after eating, aggrevated by food)
Gastric ulcer (resolved by food)

Question 18

Urease test requirements

Answer 18

Endoscopic
no PPIs x 2 weeks
no antibiotics/bismuth salts x 4 weeks

Question 19

4 non-pharm treatments for PUD

Answer 19

reduce stress
smoking cessation
d/c NSAIDs
avoid aggrevating food/beverages

Question 20

H2RA MOA

Answer 20

reversible inhibition of histamine receptor on parietal cells - acid production reduced 70%

Question 21

Famotidine dosing

Answer 21

20 mg IV/PO BID or 40 mg HS

Question 22

Famotidine dosing renal

Answer 22

CrCl

Question 23

Ranitidine dosing

Answer 23

150 mg PO BID or 300 mg HS

50 mg IV Q6-8 hours

Question 24

Ranitidine dosing renal

Answer 24

CrCl

Question 25

H2RA AEs

Answer 25

Tolerance develops quickly Thrombocytopenia Neuro effects: somnolence, HA

Question 26

PPI MOA

Answer 26

irreversibly inhibit proton pump, reduce acid up to 99%

Question 27

Omeprazole dosing

Answer 27

20-40 mg PO daily

Question 28

Esomeprazole dosing

Answer 28

40 mg PO/IV daily

Question 29

Pantoprazole dosing

Answer 29

40 mg PO/IV daily

Question 30

PPI AEs

Answer 30

``` Fractures C. diff Pneumonia Thrombocytopenia GI upset (N/V/D) ```

Question 31

Antacids MOA

Answer 31

neutralize gastric acid inhibit action of peptin no effect on acid production

Question 32

Antacids AEs

Answer 32

GI upset - diarrhea (magnesium), constipation (calcium) Accumulation in renal dysfunction -> toxicity frequent administration drug interactions

Question 33

Antacids AEs

Answer 33

GI upset - diarrhea (magnesium), constipation (calcium) Accumulation in renal dysfunction -> toxicity frequent administration drug interactions

Question 34

Sucralfate MOA

Answer 34

forms polyvalent bonds with damaged tissue and normal GI mucosa

Question 35

Sucralfate AEs

Answer 35

``` Aluminum toxicity Cheap Decreased risk of pneumonia PO only Drug interactions Constipation Frequent administration ```

Question 36

Misoprostol MOA

Answer 36

inhibits gastric acid secretion, increase in mucosal defense | synthetic prostaglandin analog

Question 37

Misoprostol AEs

Answer 37

diarrhea abdominal cramping N/V

Question 38

Misoprostal preg cat

Answer 38

X

Question 39

Bismuth subsalicylate MOA

Answer 39

antibacterial effect local gastroprotective effect stimulation of endogenous prostaglandins

Question 40

Bismuth subsalicylate AEs

Answer 40

Discoloration of the tongue Gray/Black stools tinnitus

Question 41

Bismuth subsalicylate AEs

Answer 41

Discoloration of the tongue Gray/Black stools tinnitus

Question 42

When is 14 day therapy for treatment of H. pylori preferred

Answer 42

1st line 3 drug regimen and recurrence

Question 43

duration of therapy for treatment of H. pylori

Answer 43

10-14 days