Term
| Aggressive/Offensive Factors |
|
Definition
Gastric Acid (HCl);
Pepsin;
Bile acid;
Pancreatic Enzymes |
|
|
Term
|
Definition
Mucous secretion;
Sodium bicarb. secretion;
Endogenous PGs;
Mucosal blood flow |
|
|
Term
|
Definition
amount of acid secreted under basal & fasting conditions;
- follows circadian rhythm
- most occurs at night
- least occur in morning |
|
|
Term
| Maximal Acid Output (MAO) |
|
Definition
| amount of acid secreted after maximal stimulation |
|
|
Term
| Factors that affect BAO & MAO |
|
Definition
time of day;
patient factors;
gender;
health status; |
|
|
Term
| Peptic Ulcer Disease (PUD) |
|
Definition
| mucosal break or erosion in mucosa that is 3 mm or greater in size that can involve stomach or duodenum |
|
|
Term
|
Definition
| superficial inflammation of the stomach mucosal lining |
|
|
Term
|
Definition
Men = Women BUT:
- decreasing in younger men (less smoking)
- increasing in older women (NSAID use) |
|
|
Term
|
Definition
Chronic condition;
Found in duodenum > stomach;
More dependent on intragastric pH;
Sx: Epigastric pain;
Superficial ulcer depth;
Less severe GI bleeding |
|
|
Term
|
Definition
Chronic condition;
Stomach > duodenum;
Less dependent on intragastric pH;
Asymptomatic;
Deep ulcer depth;
More severe GI bleeding; |
|
|
Term
| Stress-Related Mucosal Damage (SRMD) - Stress Ulcer |
|
Definition
Acute condition;
Stomach > duodenum;
Less dependent on intragastric pH;
Asymptomatic;
Most superficial;
More severe GI bleeding; |
|
|
Term
|
Definition
NSAIDS;
Helicobacter pylori;
Smoking (>10 cigs/day);
Excess EtOH;
Age >50 yrs old;
Psychological Stress;
**NOT DIET - no evidence of caffeine or spicy food causing it** |
|
|
Term
|
Definition
gnawing/burning epigastric & abdominal pain;
pain b/w meals or at bedtime;
occurs 1-3 hrs after meals;
relieved w/ food/antacids; |
|
|
Term
|
Definition
gnawing/burning epigastric & abdominal pain;
pain more constant;
food may precipitate/accentuate pain |
|
|
Term
|
Definition
based on clinical Hx;
- Upper GI radiography (upper GI series);
**Endoscopy** - GOLD STANDARD |
|
|
Term
|
Definition
relieve pain;
heal ulcer;
prevent recurrence;
decrease ulcer-related complications; |
|
|
Term
|
Definition
Avoid foods & beverages that intensify pain;
Limit EtOH intake;
Stop smoking;
Reduce stress;
Avoid taking NSAIDs if possible |
|
|
Term
| Proton Pump Inhibitors (PPIs) - omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex) |
|
Definition
MoA: inhibits H/K/ATPase pump --> inhibits release of gastric acid;
Heals ulcer in 4 wks;
Take 15-30 min before meals; |
|
|
Term
|
Definition
Manufactured Dosage Forms: capsule, tablet, packet for oral suspension;
Extemp. Oral Preps: mix w/ applesauce, juice, bicarbonate;
NO IV |
|
|
Term
|
Definition
Manufactured Dosage Forms: capsule, ODT, packet for oral suspension;
Extemp. Oral Preps: mix w/ applesauce, juice, bicarb.;
Parenteral: IV |
|
|
Term
|
Definition
Manufactured Dosage Forms: tablet;
Extemp. Oral Preps: bicarbonate;
Parenteral: IV |
|
|
Term
| Histamine-2 Receptor Antagonists (H2RAs) - famotidine (Pepcid), ranitidine (Zantac), nizatidine (Axid), cimetidine (Tagamet) |
|
Definition
MoA: competitive & reversible inhibition of gastric parietal cells --> inhibits gastric acid secretion;
Heals ulcer in 6-8 wks; |
|
|
Term
|
Definition
MOA: viscous adhesive binds electrostatically to positively charged protein molecules --> protective barrier;
Frequently dose: attachment to ulcer lasts only 6 hrs;
Take on empty stomach;
Disadvantages:
- large tablet
- multiple doses per day
- separate from meals & other interacting meds;
Dosing:
- Initial: 1 g PO before meals (AC) & qHS
- Maintenance: 1 g PO BID;
ADRS:
- constipation, nausea, dry mouth, dizziness, metallic taste;
C/I: renal failure |
|
|
Term
| Tx of non-NSAID-induced, non-H.pylori-induced Ulcer |
|
Definition
1) H2RA x 6-8 wks
OR
2) PPI x 4 wks
OR
3) Sucralfate |
|
|
Term
| Maintenance Therapy for non-NSAID-induced, non-H.pylori-induced Ulcer |
|
Definition
Goal: maintain ulcer healing & prevent ulcer-related complications;
1) Change to PPI or increase dose of PPI;
2) Add H2RA qHS |
|
|
Term
| Duodenal/Gastric Ulcer Healing Dose - famotidine [Pepcid] |
|
Definition
20 mg PO BID, 40 mg qHS;
Reassess after 8-12 wks |
|
|
Term
| Duodenal/Gastric Ulcer Healing Dose - ranitidine [Zantac] |
|
Definition
150 mg PO BID, 300 mg PO qHS;
Reassess after 8-12 wks |
|
|
Term
| Duodenal/Gastric Ulcer Healing Dose - lansoprazole [Prevacid] |
|
Definition
15-30 mg qday;
Reassess after 8-12 wks |
|
|
Term
| Duodenal/Gastric Ulcer Healing Dose - omeprazole [Prilosec] |
|
Definition
20-40 mg qday;
reassess after 8-12 wks |
|
|
Term
| Duodenal/Gastric Ulcer Healing Dose - pantoprazole [Protonix] |
|
Definition
40 mg qday;
Reassess after 8-12 wks |
|
|
Term
| Duodenal/Gastric Ulcer Healing Dose - sucralfate [Carafate] |
|
Definition
1 g PO QID OR 2 g PO BID;
Reassess after 8-12 wks |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - famotidine [Pepcid] |
|
Definition
20-40 mg PO qHS;
Reassess after 8-12 wks |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - ranitidine [Zantac] |
|
Definition
150-300 mg PO qHS;
Reassess after 8-12 wks |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - lansoprazole [Prevacid] |
|
Definition
15-30 mg PO qday to BID;
Reassess after 8-12 wks |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - omeprazole [Prilosec] |
|
Definition
20-40 mg PO qday-BID;
Reassess after 8-12 wks; |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - rabeprazole [Aciphex] |
|
Definition
20 mg PO qday-BID;
Reassess after 8-12 wks |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - pantoprazole [Protonix] |
|
Definition
20 mg PO qday-BID;
Reassess after 8-12 wks |
|
|
Term
| Maintenance Dose for Duodenal/Gastric Ulcer - sucralfate [Carafate] |
|
Definition
1-2 g PO BID OR 1 g PO QID;
Reassess after 8-12 wks |
|
|
Term
|
Definition
1) Upper GI Bleed;
2) Perforation: sudden, sharp, severe pain;
3) Obstruction |
|
|
Term
|
Definition
occur over several months:
- early satiety
- anorexia
- bloating
- N/V
- weight loss |
|
|
Term
|
Definition
spiral-shaped bacteria w/ flagella;
Gram-Neg organism;
Uses flagellum to move;
Transmitted fecal-oral; |
|
|
Term
| Risk Factors for H.pylori-induced PUD |
|
Definition
Socioeconomic factors;
Crowded living situations;
Multiple children;
Unclean water;
Consumption of raw veggies;
Sharing a bed;
High-risk of NSAID-induced GI toxicity |
|
|
Term
| Complications of H.pylori-induced PUD |
|
Definition
chronic gastritis;
PUD;
gastric cancer;
mucosa-related lymphoid tissue (MALT) lymphoma |
|
|
Term
| Invasive Diagnosis of H.pylori-induced Ulcer |
|
Definition
**REQUIRES Endoscopy**
- expensive, uncomfortable, requires 3 different samples from different sites;
1) Stop ABx/bismuth for >4 wks, PPI & H2RA for >2 wks;
2) Histology: GOLD STANDARD, but reserved for active infection, not recommended for initial;
2) Culture: 100% specific, requires time to culture species, used after failure of 2nd-line tx;
**4) Biopsy** - rapid urease test, TEST OF CHOICE at endoscopy, results w/in 24 hrs |
|
|
Term
| Non-invasive Diagnosis of H.pylori-induced Ulcers |
|
Definition
1) Antibody detection: NOT used to detect active infection, IgG Abs in serum up to 1 yr after eradication;
2) Urea Breath Test: (+) if bicarb excreted in breath; (-) if excreted unchanged in urine; **PREFERRED Method**
3) Stool Antigen: tests for active infection, confirms eradication |
|
|
Term
| Goal of Tx of H.pylori-induced Ulcer |
|
Definition
| Eradicate organism (absence of organism >4 wks after tx completed) |
|
|
Term
| 1st Line Therapy for H.pylori Induced Ulcers |
|
Definition
PPI + 2 Antibiotics:
PPI: omeprazole 20 mg BID OR lansoprazole 30 mg BID OR pantoprazole 40 mg BID OR esomeprazole 40 mg DAILY OR rabeprazole 20 mg DAILY
+
Clarithromycin 500 mg BID
+
Amoxicillin 1 g BID OR Metronidazole 500 mg BID (if PCN Allergic)
x 10 days |
|
|
Term
| 2nd Line Therapy for Tx of H.pylori-induced Ulcers |
|
Definition
Bismuth-based 4-drug Regimen:
1) PPI: omeprazole 40 mg BID OR lansoprazole 30 mg BID OR pantoprazole 40 mg BID OR esomeprazole 40 mg DAILY OR rabeprazole 20 mg DAILY
+
2) bismuth subsalicylate 525 mg QID
+
3) metronidazole 250-500 mg QID
+
4) tetracycline 500 mg QID OR amoxicillin 500 mg QID OR clarithromycin 250-500 mg QID
x 10 days |
|
|
Term
|
Definition
Antibiotic;
stable in acid pH;
Little/NO resistance;
Dose: 1 g PO BID
C/I: PCN allergy |
|
|
Term
|
Definition
antibiotic;
stable in acid pH;
SLIGHT resistance;
Dose: 500 mg PO BID; |
|
|
Term
|
Definition
Antibiotic;
effective at gastric pH;
Resistance INCREASING;
Dose:
- 500 mg PO BID
- 250-500 mg PO QID;
ADRs: Disulfiram-like reaction when using EtOH |
|
|
Term
|
Definition
antibiotic;
Little resistance;
effective at gastric pH;
Dose: 500 mg PO QID;
**DO NOT USE in CHILDREN or PREGNANT WOMEN** |
|
|
Term
| bismuth subsalicylate (Pepto Bismol, Kaopectate) |
|
Definition
MoA: antimicrobial action, antisecretory effect, increased synthesis of PGs, forms protective layer;
Dose: 525 mg PO QID - no systemic absorption;
ADRs:
- darkened stool, darkened tongue, nausea/diarrhea;
Warning:
- renal dysfunction, Preg. cat. C/D |
|
|
Term
| Role of PPI or H2RA for H.pylori-induced Ulcer Tx |
|
Definition
| raise gastric pH to increase effectivenss of some antibiotics |
|
|
Term
|
Definition
combo product containing:
Prevacid (lansoprazole)
+
amoxicillin
+
clarithromycin |
|
|
Term
|
Definition
combo product containing:
Bismuth subsalicylate
+
metronidazole
+
tetracycline
**Requires addition of PPI for full coverage** |
|
|
Term
|
Definition
combo pack containing:
Bismuth subsalicylate
+
metronidazole
+
tetracycline |
|
|
Term
| Definite Risk Factors for NSAID-induced Ulcer |
|
Definition
Hx of PUD, NSAID-related GI effect or Upper GI bleed;
Age >60;
High dose or multiple NSAID use;
Anticoag. or corticosteroid use;
Chronic major organ impairment;
Antiplatelet use;
Concomitant use of corticosteroids, bisphosphonates, SSRIs;
Chronic Illnesses |
|
|
Term
| Possible Risk Factors for NSAID-induced Ulcers |
|
Definition
NSAID-related dyspepsia;
Increased NSAID duration;
H.pylori infection;
Rheumatoid Arthritis; |
|
|
Term
|
Definition
housekeeping gene;
gastric & duodenal cytoprotection;
Platelet aggregation;
Renal fcn |
|
|
Term
|
Definition
Inflammatory gene;
Mitogenesis & growth;
regulation of female reproduction;
renal fcn;
bone formation |
|
|
Term
|
Definition
| indomethacin (Indocin), piroxicam (Feldene), ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), sulindac (Clinoril), ketoprofen (Orudis), ketorolac (Toradol), diclofenac (Cataflam, Voltaren) |
|
|
Term
| Partially Selective NSAIDs |
|
Definition
| etodolac (Lodine), nabumetone (Relafen), meloxicam (Mobic) |
|
|
Term
|
Definition
|
|
Term
| Tx for NSAID-induced Ulcer |
|
Definition
D/C NSAID (if possible);
If NSAID must be continued, use LOWEST effective dose;
Change to APAP;
Change to selective NSAID;
Use PPI (preferred over H2RA) |
|
|
Term
| Zollinger-Ellison Syndrome (ZES) |
|
Definition
hypersecretory disorder caused by a tumor;
Severe & recurrent peptic ulceration w/ epigastric pain w/ esophagitis, GI bleeding, or perforation;
Occurs in duodenum;
Tx: High-dose PPI (omeprazole 20-120 mg TID, lansoprazole 60-90 mg BID, rabeprazole 60 mg qday or BID, pantoprazole 40-80 mg BID-TID; |
|
|
