PUD and GERD
Majority of ulcers are attributable to what? How to test this?
Why do we used 2 different antibiotics to treat ulcers caused by H. pylori?
H-Pylori infection [non-invasive breath testing can confirm H pylori infection]
Use of only one is NOT effective due to resistance
- Peptic Ulcer disease is different from GERD. The majority of gastric and duodenal ulcers can be attributed to H Pylori infection.
Anti-acid MOA? What two things do they treat? Two types of antacids? Two examples of each?
MOA: Neutralizes HCl acid and reduces pepsin activity (They do NOT coat the ulcer)
[Treats GERD and Ulcers]
- Systemic: Sodium bicarb (Alka Seltzer) and Calcium Carbonate (TUMS)
- Non-systemic: Aluminum and Magnesium
What Antacid is aka Alka Seltzer (contains citric acid, ASA, bicarb)? Systemic or Non-systemic?
Rarely used to treat ___ ulcers
Systemic: Sodium bicarb
- Rarely used to treat peptic ulcers
* One of the 1st anti ulcer drugs * but many SE's
Prostaglandin analogue drug example?
Misoprostol (Cytotec)
Ending for the Proton Pump Inhibitors (PPI’s)? Examples?
The “prazoles”: Lansoprazole (Prevacid), Omeprazole (Prilosec), Pantoprazole (Protonix), and Esomeprazole (Nexium)
All ____ are approved for GERD treatment; do they or H2 Blockers work better? What is GERD?
PPI's
- PPI’s relieve symptoms faster and maintain healing better than H2 blockers
- GERD, also called reflux esophagitis, is chronic and presents as indigestion and a burning sensation above the stomach
What antacid causes constipation and lowers phosphorus levels? Is is systemic or Non-systemic?
Non-systemic: Aluminum
What Antacid is AKA TUMS (Burnett syndrome – AKA milk-alkali syndrome and renal calculi) Systemic or Non-systemic?
Systemic: Calcium Carbonate
Prostaglandin Analogue: pregnancy test negative ___ weeks before therapy; pt must comply with what? when to start med?
- Negative pregnancy test required < 2 weeks before start of therapy
- Patient capable of complying with effective contraception
- Oral and written instructions understood re: warnings of hazards to fetus and danger of sharing medication with others
- Start med on 2nd or 3rd day of next normal menstrual period
Teach patient to recognize signs of low magnesium levels ____; do PPI's or H2 Blockers work better?
(fatigue, muscle cramps, arrhythmias, dizziness, nausea, vomiting, numbness/tingling, anxiety, insomnia)
- Inhibits gastric acid secretion 90% more than the H2 blockers!
How many Anti-Ulcer classes are there?
7
- 7 Groups of Anti-Ulcer Agents:
1.Tranquilizers
2. Anticholinergics
3. Antacids
4. Histamine 2 Blockers
5. Proton Pump Inhibitors (PPI’s)
6. Pepsin Inhibitors
7. Prostaglandins E Analogues
What is the Low Sodium option for antacids? Esp. good for which pt's?
Riopan (Magaldrate)
- Esp. for cardiac patients on sodium restriction; HF
Prostaglandin analogue drug, Can you use during Pregnancy?
Misoprostol (Cytotec) – NO PREGNANCY!
When to take PPI's? Tablets?
Take 30-60 min BEFORE meals
- Swallow tablets whole, do not crush, chew or split
What is the Quadruple Therapy? Triple?
How long do you treat Peptic Ulcer Disease – Acute?
What do you do after the 2 week treatment?
Evidence-based treatment is triple or quadruple therapy of antibacterials, proton pump inhibitors (PPI’s) and bismuth and/or metronidazole for 7-14 days
After triple or quadruple treatment, H2 Blocker therapy is recommended for 6 wks
- Quadruple: Esomeprazole, Metronidazole, Tetracycline, Bismuth
- Triple: Esomeprazole, Amoxicillin, Clarithromycin / Lansoprazole, Amoxicillin, Clarithromycin / Esomeprazole, Metronidazole, Clarithromycin
What antacid causes diarrhea and is contraindicated with impaired renal function? Is is systemic or Non-systemic?
Non-systemic: Magnesium
- Causes diarrhea, is a better neutralizer, contraindicated with impaired renal function due to risk of hypermagnesemia
Prostaglandin analogue drug.. When to take? How often? Food?
Misoprostol (Cytotec)
- Take 4 times per day with meals and at bedtime
What do PPI's increase and decrease?
- Increase in LFT’s, creatinine, potassium, BUN, and triglycerides
- May cause low magnesium levels, low sodium levels and high triglycerides levels
Ulcer: Gastric Versus Duodenal (hours and eating relation)?
Ulcers present as a gnawing/aching pain
- Gastric: Pain begins 30 minutes to 1.5 hours after eating
- Duodenal: Pain begins 2-3 hours after eating
Contraindicated with impaired renal function
Magnesium
Prostaglandin analogue drug.. used for patients with long term ____ therapy
Misoprostol (Cytotec)
- For patient taking high doses of NSAID’s for long term therapy, misoprostol is recommended as an adjunct for the duration of NSAID therapy