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17 Cards in this Set
- Front
- Back
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List the categories of patients for whom Stress Ulcer Prophylaxis is recommended.
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1) Coagulopathy [Platelet count < 50,000/mm^3, INR > 1.5, PTT > 2x control], 2) Mechanical Ventilation > 48 hrs, 3) Hx of GI ulceration or bleeding in the past yr, 4) Two or more of the following risk factors: sepsis, ICU stay of > 1 wk, occult bleeding lasting > 6 days, Use of high-dose corticosteroids ( > 250 mg/d of hydrocortisone or the equivalent).
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List the four medications for Stress Related Mucosal Bleeding (SRMB) Prophylaxis.
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Sucralfate, Antacids, H2RAs, PPIs
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What is the MOA of Sucralfate?
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Sucralfate provides protection to and coats the gastric mucosa. [Note: It does not effect gastric acid secretion and does not buffer gastric acid significantly.]
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How is sucralfate dosed for SRMB prophylaxis?
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1 g 4x/day
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How does Sucralfate compare with Antacids for SRMB Prophylaxis?
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Meta-analysis revealed antacids had a lower rate of GI bleeding than sucralfate, but the difference was not statistically significant.
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How do H2RAs compare with Antacids for SRMB Prophylaxis?
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Meta-analysis of 42 RTCs that while both decrease GI bleeding, H2RAs are more effective.
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How do H2RAs compare with Sucralfate for SRMB Prophylaxis?
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Patients on ranitidine were less than half as likely to experience major GI bleeding than patients on sucralfate.
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How do H2RAs compare with PPIs for SRMB Prophylaxis?
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Meta-analysis of 8 RTCs and 5 abstracts revealed less GI bleeding w/ PPIs than w/ H2RAs.
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Three complications associated w/ elevation of intragastric pH include...
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1) Gastric Microbial Colonization, 2) Tracheobronchial Colonization, & 3) Nosocomial Pneumonia
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How do H2RAs compare with PPIs with respect to risk of Nosocomial Pneumonia?
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A study showed that patients treated with ranitidine were less likely to contract nosocomial pneumonia than patients treated with pantoprazole.
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List five symptoms resulting from blood loss / anemia.
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Light-headedness, Syncope, Fatigue, Angina, Dyspnea
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Describe Rx treatment for an endoscopy finding of active bleeding ulcer, a non-bleeding visible vessel (NBVV), or an adherent clot.
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IV PPI 80 mg bolus, followed by 8 mg/hr continuous infusion for 72 hrs.
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Describe Rx treatment for an endoscopy finding of stigmata that is either flat pigmented spot or clean base.
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Oral PPI once daily
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Above what pH must the stomach be adjusted for the prevention of ulcer re-bleeding?
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Above a pH of 7, platelet aggregation becomes markedly more effective.
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Why are H2RAs not utilized to reduce gastric pH for recovery from an active bleed?
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Tolerance to H2RAs develops, reducing their effectiveness at raising gastric pH.
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What treatment is recommended for the prevention of GI rebleed in high-risk patients?
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IV PPI (bolus and continuous infusion) or high-dose oral PPI if IV PPI is not available.
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What treatment is recommended for the prevention of GI rebleed in patients who are not considered high risk?
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Oral PPI
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