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37 Cards in this Set
- Front
- Back
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Why might H pylori cause distal gastric cancer?
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oxygen free radicals from chronic inflammation, reduced concentrations of ascorbic acid, increased epithelial cell proliferation, overgrowth of bacteria in stomach due to hypochlorhydria
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Why does H pylori protect from proximal gastric cancer?
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decreased GERD and complications
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What are definite indications for anti H pylori therapy?
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PUD, MALToma
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What are possible indications for H pylori therapy?
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premalignant states, NSAID therapy proton pump inhibitor therapy, Menetrier's disease
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How do you determine successful H Pylori treatment?
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can't detect bacteria after 4-6 weeks
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What are the properties of metronidazole?
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weak base, rapid resistance, low cure rate
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What are the side effects of metronidazole?
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neuropathy, nausea, vomiting, metallic taste
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What are the properties of amoxicillin?
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low MIC, three ionizable groups, delivered from oral intake, no movement from blood
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What are the side effects of amoxicillin?
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allergic reaction, diarrhea, candidiasis, pseudomembranous colitis
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What are the properties of clarithromycin?
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basic, active secretion into gastric juice
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What are teh side effects of clarithromycin?
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altered taste sensation, nausea
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Why is metronidazole particularly good?
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increased gastric concentration becasue of lipid diffusion and acid trapping
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Why is amoxicillin good?
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little passive diffusion/secretion, must have a topical effect
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Why is clarithromycin effective?
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active transport
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What's good about tetracycline?
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no resistance, active at low pH
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What are the side effects of tetracycline?
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stains developing teeth
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How does bismuth work?
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disrupts integrity of cell walls, prevents adhesion to gastric cells
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What are the side effects of bismuth?
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dark stools, dark tongue
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What is good about PPI for H pylori?
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suppresses, but doesn't eradicate H pylori, enhances antimicrobial efficacy
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How do you combine therapies for H pylori eradication?
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Bismuth, metronidazole, tetracycline
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What are teh side effects of clarithromycin?
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altered taste sensation, nausea
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Why is metronidazole particularly good?
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increased gastric concentration becasue of lipid diffusion and acid trapping
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Why is amoxicillin good?
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little passive diffusion/secretion, must have a topical effect
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Why is clarithromycin effective?
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active transport
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What's good about tetracycline?
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no resistance, active at low pH
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What are the side effects of tetracycline?
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stains developing teeth
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How does bismuth work?
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disrupts integrity of cell walls, prevents adhesion to gastric cells
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What are the side effects of bismuth?
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dark stools, dark tongue
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What is good about PPI for H pylori?
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suppresses, but doesn't eradicate H pylori, enhances antimicrobial efficacy
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How do you combine therapies for H pylori eradication?
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Bismuth, metronidazole, tetracycline
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What's bad about the typical triple therapy?
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side effects, complex, resistance
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What is the newer triple therapy?
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PPI, two antibiotics for one week
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What are the advantages of the new triple therapy?
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reduced side effects, effective
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How does omeprazole enhance antibiotics?
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decreased gastric volume, increased antibiotic absorption, increased gastric pH enhances antibiotic activity
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What happens when you give omeprazole and metronidazole?
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reduces concentration, reduced acid trapping, less effective
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What happens when you give omeprazole and amoxicillin?
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increases concentration due to reduced gastric juice volume, more effective due to increased concentration and pH
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What happens when you combine omeprazole and clarithromycin?
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no significant change
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