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  1. Types of chronic ulcers
    • H. pylori assoicated
    • NSAID assoicated
    • Zollinger-Ellison syndrome associated
  2. Zollinger-Ellision syndrome associated ulcers
    multiple duodenal ulcers caused by hypersecretion of gastrin

    caused by gastrin producing tumor
  3. clinical symptoms of PUD
    • abdominal pain (burning, vague discomfort, abdominal fullness, cramping)
    • heartburn
    • belching
    • bloating
    • N/V
    • weight loss/anorexia
  4. pain of duodenal ulcers in relationship to food
    usually 1-3 hrs after eating and is relieved by eating
  5. pain of gastric ulcer in relationship to food
    precipitated by eating
  6. patients not indicated for endoscopy in PUD
    • patients <45 yo
    • w/o alarm symptoms
    • at low risk for malignancy
  7. indications for endoscopy in PUD
    • automatically for pts >45 yo
    • pts with alarm symptoms
  8. alarm symptoms of PUD
    • dysphagia
    • unintentional weight loss
    • anorexia/early satiety
    • bleeding
    • abdominal mass
    • anemia
  9. when conducting an invasive test for H. pylori, what to do with meds?
    • Hold H2RAs for 24-28 days prior
    • Hold PPIs for 2 weeks prior
    • Hold antibiotics and bismuth for 4 weeks prior
  10. Biopsy with histology
    • microbiologic examination of biopsy specimen
    • gold standard but too expensive
  11. Biopsy with culture
    • not recommended for initial diagnosis
    • allows for susceptibility testing after failed first line therapy
  12. Biopsy with Rapid Urease Test (CLO test)
    • biopsy sample tested for ammonia
    • test of choice
    • preferred test for testing post treatment eradication
  13. Non-invasive PUD tests
    • serology
    • urea breath test
    • stool antigen test
  14. Serology used for
    • antibody detection
    • not used for post treatment testing b/c antibodies can persist
  15. serology and false negatives
    not induced by presence of therapies (H2RAs, PPIs, antibiotics)
  16. Urea breath test
    C labled urea ingested, patient inhales and labeled CO2 is labeled

    • best initial diagnostic test (non-invasive)
    • preferred test for post treatment eradication unless endoscopy is required
  17. Urea breath test and false negatives
    • possible if all therapies not held
    • H2RAs 1-2 days before
    • PPIS 2 weeks before
    • antibiotics and bismuth 4 weeks before
  18. stool antigen test
    can be used to determine eradication but less accurate than UBT
  19. stool antigen test and false negatives
    • possible if all therapies not held
    • H2RAs 1-2 days before
    • PPIS 2 weeks before
    • antibiotics and bismuth 4 weeks before
  20. 3 drug regimen for H. pylori eradication
    • eradication dose of PPI
    • clarithromycin 500 mg BID
    • Amoxicillin 1 g BID or Metronidazole 500 mg BID
  21. 4 drug regimen for H. pylori eradication
    • eradication dose of PPI or healing dose of H2RA
    • Clarithromycin 250-500 mg QID or Tetracylcine 500 mg QID
    • metronidazole 500 mg QID
    • Bismuth subsalicylate 525 mg QID
  22. with what resistance rates should clarithromycin not be used
  23. when is culture and sensitivity testing needed?
    when the second line treatment fails
  24. antibiotics to be used in rescue therapy
    • levofloxacin
    • rifabutin
  25. When if follow up H. pylori testing needed?
    4 weeks after eradication therapy in patients with:

    • H. pylori ulcers
    • MALT-lymphoma
    • persistent dyspepsia
    • gastric cancer
  26. H. pylori negative, NSAID induced ulcers
    • healing doses of PPI for 4 weeks
    • healing doses of H2RAs or sucralfate for 6-8 weeks

    if NSAID can't be stopped treat with PPI for 8-12 weeks
  27. PPI dosing frequencyin Zollinger-Ellison
    given every 8-12 hrs
  28. PPI frequency for H. pylori eradication
    BID except esomeprazole (QD)
  29. PPI freq for ulcer healing
  30. PPI freq for maintenance dosing
  31. H2RA freq for ulcer healing
    QID, BID, or HS depending on dose
  32. H2RA freq for maintenance of ulcer healing
  33. Sucralfate MOA
    • nonabsorbable Al salt
    • forms adherent and protective protein complex/barrier at site of ulcer in presence of gastric acid
    • inc endogenous prostaglandin release, epithelial cell growth, mucous production, bicarb secretion
  34. Sucralfate patient education
    • take on empty stomach
    • take 2 hours before taking any other drug
    • antacids, H2RAs, PPIs dec effectiveness
  35. Sucralfate AEs
    • constipation
    • metallic taste
    • hypophosphatemia with long term use
    • Al toxicity w/ long term use
  36. Bismuth subsalicylate MOA
    • local gastroprotective effects and stim of PG production
    • eradication of H. pylori (disruption of cell wall or inhibition of urease enzymes)
  37. Bismuth major AEs
    • tongue discoloration
    • black stools
    • N/V/D
  38. Bismuth subsalicylate DIs
    • methotrexate
    • Warfarin
  39. Misoprostol MOA
    • synthetic prostaglandin E1 analog
    • inhibits acid secretion
    • increases mucosal defenses
  40. Misoprostol patient education
    take with or after food to prevent side effects
  41. Misoprostol AEs
    • diarrhea (10-30%)
    • N//V, cramping, bloating, flatulence
    • CONTRAINDICATED in pregnancy (abortive agent)
  42. Misoprostol DIs
    Mag containing products (inc diarrhea)
Card Set:
2013-02-23 21:40:21
GI exam

exam 1
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