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Tx of GER, PUD
Pharm I - Fall 2011
| Question | Answer |
|---|---|
| What are the 3 MC causes of PUD? | H.pylori, NSAIDS, Stress-related mucosal damage, respectively. |
| Potential RF's for PUD? | Alcohol, Cigarettes, Corticosteroids (w/NSAIDs) |
| Relationship of duodenal ulcers to food? | Pain usually relieve by food; pain 1-3 hrs after meals |
| Tests for H.pylori may produce false negative results when? and which test will not produce false negative with these? | Tests (except ab detection) may produce false- results if abx or bismuth taken w/in last 4 wks or if PPIs taken w/in last 2 wks |
| MOA od antacids? | Gastric acid neutralization |
| What AEs can be caused by the components of antacids? | -Mg=diarrhea -Al, Ca2+=constipation |
| Drug interax w/ antacids? | -Chelation of tetracyclines, FQs, Fe -Decrsd abs or drugs that are pref absorbed at low pHs |
| MOA of H2-RAs? | Competitive inhib of histamine at H2-receptors of the gastric parietal cells = inhib gastric acid secretion |
| MOA of PPIs? | Inhibit H+/K+ ATPase of parietal cell = decrs acid secretion |
| Are H2RAs or PPIs more effective? | PPIs |
| 1st line H.pylori regimen? | -PPI + amoxicillin 1g BID 5 days, followed by: -PPI, Clarithromycin 500mg, Tinidazole 500 mg BID for 5 days |
| Which component of the rec 1st line tx for H.pylori has some resistance issues? | Clarithromycin |
| Full course of 10-14 days is rec for H.pylori tx to prevent? | Reistance |
| How and when can you confirm cure of H.pylori infex? | With Urea Breath Test or Stool Antigen >8wks after the end of tx |
| NSAIDS inhibit mucosal synthesis of what? | Prostaglandins |
| What are some established RFs for NSAID-induced ulcers and UGI complications? | -Age>60 -Prior ulcer or bleed -High dose of more toxic NSAIDs -Concominant use of steroids, oral bisphosphonates, SSRI -Anticoag use or coagulopathy -Antiplatelet use (ASA or clopidogrel) -Chronic illness |
| Ibuprofen and Naproxen are considered what kind of NSAIDs? | Nonselective |
| What analgesic is NOT as NSAID and is an alternative for those who cannot use NSAIDs? | Acetaminophen |
| Which NSAID has the lowest tox/is a Cox-2 inhib, solely? | Celebrex (celecoxib) |
| H2 blockers are only effective in preventing which kind of ulcers? | Duodenal ulcers |
| Prevention of NSAID-induced ulcers in high-risk pts? | Misoprostol (200mcg TID) or PPI |
| If NSAID-developed ulcer is present and must continue NSAID use, use what? | PPI |
| Primary pathogenic fx for stress-related mucosal damage? | Mucosal ischemia d/t decrsd gastric blood flow |
| Relief of ulcer pain does not directly correlate with? | Ulcer healing |
| What are some things that decrs LES tone? | Meds, smoking, hormones, pregnancy, chalasia, scleroderma, chocolate, peppermint, spearment, fatty meals, alcohol |
| WHat are some important drugs that can decrs LES tone? | Ca2+Channel blockers, Estrogens, Theophylline, Progesterone, nitrates, narcotics... |
| With GERD, you should avoid direct irritant foods, such as? | Spicy foods, OJ, Tomato jc, coffee |
| What kind of meals should be included in the diet of those w/ GERD? | Protein-rich meals (augment LES tone) |
| Tx of intermittent/mild hrtburn? | Lifestyle mods and Antacids; If not relieved after 2 wks, start a PPI or H2RA @ std dose |
| Which antacids need a decreased dose in those with renal failure? | Aluminum and Calcium-containing |
| Mild GERD can usually be treated effectively with? | H2RAs |
| Pts w/mod to severe sx of GERD should receive what as their initial tx? | PPI |
| What is important to remember about long-term PPI tx? | Many AEs and must taper off to avoid rebound |
| If a pt is not responding to acid suppressing therapy (or has persistent atypical sxs) what they may be a candidate for? | Antireflux surgery or endoscopic therapies |
| Tx for symptomatic GERD? | Lifestyle mods + std dose H2RA x 6-12 wks OR std dose PPI x 4-8 wks (PPI more intense, so shorter pd) |
| Tx for erosive esoph healing or tx of mod to severe sxs or complications? | Lifestyle mods + PPI (up to BID) for 4-16wks |
| MOA of promotility agents? | ^es gastric emptying rate by unknown mechanism |
| Which drug may cause extrapyramidal effects and what can be used as prophylaxis or prn? | Reglan/Metoclopramide; Benadryl |
| D/t the ^d motility with metoclopramide, what may occur? | Diarrhea |
| What is the black box warning on metoclopramide? | Tardive dyskinesia w/long-term use |
| NSAIDs block protective....? | Prostaglandins |
| Which med replaces protective prostaglandins consumed w/prostaglandin-inhibiting therapies? | Misoprostol |
| What is a pretty common AE w/misoprostol? | Diarrhea (30-40%)--start w/low dose & titrate to avoid |
| What preg category is misoprostol and why? | X; causes uterine contraction |
| MOA of sucralfate? | Forms a protective barrier in stomach; wk acid neutralizer |
| Sucralfate is safe in preg, but can cause? | Constipation |
| Are there any drug interax w/sucralfate? | Chelation of phenytoin, warfarin, FQs, thyroxine |
| Which med inhibits gastric acid spikes with meals and seeing food? | PPIs |
| What is another name for bismuth-subsalicylate? | Pepto-bismol |
| Why is pepto-bismol and ASA not to be used in children (<19yo)? | ^es chance for Reye's Syndrome (d/t the salicylate) -- can lead to fatal brain and liver damage and low blood sugars |
| Which med may cause black stool or tongue? | Bismuth-subsalicylate |
Created by:
ferrier.kath
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