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What is the most common cause of PUD? Other 2 common causes?
H. pylori (95%)
NSAIDs and low-dose ASA
Whats the main difference in clinical sx that differentiates GERD from PUD?
With PUD, epigastric pn occurs 1-3hrs after meal and MAY be relieved by eating
What is the most common sign of PUD and when is it the worst (at what timing)?
What are 5 other asso'd sx's?
Most common: Epigastric pn, possibly worse at nite (pn occurs 1-3hrs after eating and may be relieved by eating)
- Asso'd sx:
- Bloated feeling
Why must practitioners be willing to treat H. pylori if pt is tested positive?
Its a known carcinogen
In terms of GI toxicity, name the following:
3 low risk NSAID
1 mod risk NSAID
2 HI risk NSAID
- Low risk NSAID:
- Mod risk NSAID:
- Naproxen (fyi is best for high CV risk d/t low CV events in studies)
- Hi risk NSAID:
What are two MAIN points to get from invasive and non-invasive dx tests for H. pylori (i.e. false negatives, etc)?
1. False negatives may result frm partly tx'd infx with PPI's or H2RA's
2. Pt should d/c antisecretory agents 1-2 wks before test AND wait 4 wks to re-test for eradication
FYI UBT (urea breath test) and stool antigen tests are preferred dx to confirm eradication per ACG
Per ACG recommendations, whats the recommendation for combo meds (drug classes) for eradication of H. pylori? Preferred days of tx?
PPI + two Abx (Clarithromycin and Amox/Metronidazole)
Metronidazole if PCN-allergy
Days: 14 days preferred
Per ACG, when is quadruple therapy for H. pylori indicated? (2) What is the regimen?
- Indicated if:
- 1. Pt is allergic/intolerant to Triple therapy
- 2. Failed triple therapy
- Quadruple therapy:
- PPI + (Metronidazole + TCN + Bismuth) (Pylera)
What are the DOSES of the 4 preferred triple therapy for H. pylori? (HINT: ROLE)
- 1. Rabeprazole 20mg BID + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
2. Omeprazole (10, 20, 40mg caps; 20mg OTC tabs) 20mg BID + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
3. Lansoprazole (15, 30mg caps) 30mg BID + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
4. Esomeprazole (20, 40mg caps) 40mg DAILY + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
What are the doses for the alternative quadruple therapy for H. pylori?
- PPI BID (ROL)
- Bismuth subsalicylate 525mg (=2 chew tabs) QID
- Metronidazole 500mg TID
- TCN 500mg QID
Per ACG, which pt's are considered as "high CV risk"?
Which NSAID is preferred in pt with high CV risk?
High CV risk = pt who require daily low-dose ASA
Preferred NSAID = Naproxen (doesnt appear to inc risk of CV events)
For healing or tx of ulcers from NSAID use, what is the general preferred tx choices? Which tx is less tolerated? (2)
- 1. PPI
- 2. Misoprostol (Cytotec) 200mcg QID WF (last dose HS) - less tolerated d/t diarrhea, abd cramping, and freq dosing
If CV risk greatly outweighs GI bleed risk, what NSAID must be avoided at all cost?
What is admin instruction for pt taking both ASA and another NSAID (like ibuprofen) and why?
Take ibuprofen 8 hours BEFORE or 30 mins AFTER ASA
d/t inc GI bleed AND may limit cardioprotective efx of ASA