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72 Cards in this Set

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Classification of PUD
Duodenal (more common)
Gastric (More freq NSAID induced)

Can be:
- H. pylori related
- non-H. pylori related
- NSAID related
- non-NSAID related
- stress related (stress doesn't cause PUD but how one response to stress, ex: smoking, drinking)
Diagnostic Criteria for PUD
Invasive (Endoscopy)

Non-invasive
PUD Dx Criteria:

Invasive Diagnostic Methods (Endoscopy)
- Histology (use if pt recently taken PPI but do NOT give PPI before test)
- Rapid Urea Test (RUT) - use if pt have NOT taken PPI w/in 2 wks or ABx or bismuth w/in 4 wks
PUD Dx Criteria:

Non-Invasive Diagnostic Methods
Antibody testing
- does NOT ID active H. pylori (duh, cause it IDs the antigen)
- do NOT use to confirm eradication of H. pylori

Urea Breath Test (UBT)
- can be used to confirm H. pylori eradication NO sooner than 4 wks after completion of therapy
- 13C UBT w/ Pranactin = non-radioactive
- 14C Pytest = radioactive <-- AVOID in pregnant females

Fecal Antigen Test
- can be used to confirm H. pylori eradication NO sooner than 4 wks after completion of therapy
- not as standarized as UBT
Tx of PUD
Amer College of Gastroenterology Guidelines =
Triple therapy x 14 days (PPI + Biaxin + Amox or Flagyl)

OR

Quadruple therapy x 10 - 14 days (bismuth + Flagyl + Tetracycline + H2RA or PPI)
Tx NSAID related PUD
antisecretory --> PPI or H2RA x 4 wks to PROMOTE healing & relieve symptoms (sucralfate may also be used to AID ulcer healing but req multiple daily dosing & is assoc w/ many drug interactions)

use ABx if H. pylori present

Pts who require chronic NSAIDs or at risk for developing PUD --> use PPI, H2RA, or misoprostol to PREVENT PUD
PUD Drug Therapy:

MOA of PPI
Inhibits H+/K+/ATPase enzyme system of the secretory surface of the gastric parietal cell --> gastric acid secretion = suppressed
PUD Drug Therapy:

MOA of H2RA
reversibly blocks histamine-2 receptors on the surface of gastric parietal cells --> gastric acid secretion = suppressed
MOA of sucralfate
sucralfate forms a viscous adhesive that binds to positively charged protein molecules in the ulcer crater --> thus forming a protective barrier
PUD Patient Counseling:

PPI
take before meals

generally, do not crush or chew
PUD Patient Counseling:

ANTACIDS used to control breakthrough symptoms
take 1 - 2 hours before/after H2RA is taken
PUD Patient Counseling:

H2RA
can be taken w/o regards to meals
PUD Patient Counseling:

Amoxil
Biaxin
Flagyl
Tetracycline
Amox, biaxin, flagyl maybe taken w/o regard to meals HOWEVER taking biaxin &amp;amp; flagyl WITH meals helps reduce stomach upset

Tetracycline is best taken on an EMPTY STOMACH
- antacids, dairy products, or iron-containing cpd should be taken 2 hrs BEFORE/AFTER tetracycline
PUD Patient Counseling:

Sucralfate
Take 1 hour BEFORE meals &amp; at bedtime
PUD Drug Therapy:

What are the 4 main PPIs &amp;amp; what is their pregnancy category?
Cat C
Omeprazole (Prilosec)

Cat B
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantoprazole (Protonix)
PUD Drug Therapy:

Dosage: Omeprazole (Prilosec)
Rx: 20 - 40 mg QD

OTC: 20 mg QD x 14 days

Omeprazole + Na_Bicarb (Zegerid)
20 - 40 mg QD

Esomeprazole (Nexium)
20 - 40 mg QD --> has IV
PUD Drug Therapy:

Dosage: Lansoprazole (Prevacid)
15 mg QD

To

30 mg BID

Dexlansoprazole (Kapidex)
30 - 60 mg QD
PUD Drug Therapy:

Dosage: Rabeprazole (Aciphex)
10 - 20 mg QD
PUD Drug Therapy:

Dosage: Pantoprazole (Protonix)
40 - 80 mg QD
PUD Drug Therapy:

What are the 4 H2RA?
Cimetidine (Tagamet)
Ranitidine (Zantac)
Nizatidine (Axid)
Famotidine (Pepcid)
PUD Drug Therapy:

Dosage: Cimetidine (Tagamet)
300 mg QID

to

800 mg QHS
PUD Drug Therapy:

Dosage: Ranitidine (Zantac)
150 mg BID or 300 mg QHS

same as Axid
PUD Drug Therapy:

Dosage: Nizatidine (Axid)
150 mg BID or 300 mg QHS

same as Zantac
PUD Drug Therapy:

Dosage: Famotidine (Pepcid)
20 mg BID or 40 mg QHS
PUD Drug Therapy:

What are the 4 antibacterial used in PUD?
Clarithromycin (Biaxin)
Amoxicillin (Amoxil)
Metronidazole (Flagyl) --> has IV
Tetracycline
PUD Drug Therapy:

Dosage: Clarithromycin (Biaxin)
500 mg BID x 10 - 14 days
PUD Drug Therapy:

Dosage: Amoxicillin (Amoxil)
1 g BID x 10 - 14 days
PUD Drug Therapy:

Dosage: Metronidazole (Flagyl)
500 mg TID x 10 - 14 days
PUD Drug Therapy:

Dosage: Tetracycline
500 mg QID x 10 - 14 days
PUD Drug Therapy:

Dosage: Sucralfate (Carafate)
1 g QID
GERD Drug Therapy:

Magnesium hydroxide
(Milk of Magnesia)
GERD Drug Therapy:

Aluminum hydroxide
(Amphojel)
(ALternaGEL)
GERD Drug Therapy:

Aluminum carbonate
(Basaljel)
GERD Drug Therapy:

Magnesium hydroxide + aluminium hydroxide
(Maalox)
GERD Drug Therapy:

Magaldrate
(Riopan)
GERD Drug Therapy:

Calcium carbonate
(Tums)
(Titralac)
GERD Drug Therapy:

Alginic acid + aluminum OH + magnesium OH
(Gaviscon)
Pt is taking antacid for GERD & quinolone. What should be counseled?
Antacids & quinolones should be taken 4 - 6 hrs apart
Pt is taking antacid for GERD & tetracycline / iron / digoxin. What should be counseled?
Antacids should be taken AT LEAST 2 hrs apart from tetracycline, iron, and digoxin
GERD Drug Therapy:

Is alginic acid effective for esophageal healing?
No data indicates esophageal healing on endoscopy
GERD Drug Therapy:

What is MOA of alginic acid?
Reacts with Na bicarbonate in the saliva to form sodium alginate viscous solution, which floats on the surface of gastric contents.

The solution acts as a barrier to protect the sophagus from the corrosive effects of gastric reflux.

For this reason, it's ineffective if pt = supine position &amp; MUST NOT be taken at bedtime
GERD AE:

Magnesium containing antacids frequently cause. . .
diarrhea
GERD AE:

Aluminum containing antacids frequently cause. . .
constipation &amp; bind to the phosphate in the gut, which can lead to bone demineralization
GERD AE:

Sodium bicarbonate may cause. . .
sodium overload, particularly in patients with hypertension, CHF, &amp; chronic renal failure

It may lead to systemic alkalosis

Should be used on a SHORT-TERM basis, if at all
GERD Drug Interactions:

Antacids
tetracycline / ferrous sulfate / quinolones = reduced absorption & effectiveness b/c antacids form chelates w/ them

Azoles / sucralfate = decreased absorption b/c antacids incr gastric pH

Quinidine = decr clearance b/c antacids incr urine pH

Digoxin / H2RA = decr systemic absorption when taken concomitantly w/ antacids

Phenytoin = decr absorption if large doses of antacids taken

Digoxin & Phenytoin levels should be monitored frequently when antacids are used concomitantly
GERD Non-drug Therapy:

Foods to avoid
Alcohol
Coffee
Chocolate
High-fat foods
Spicy foods
Acidic foods
carbonated drinks
GERD Non-drug Therapy:

Drugs that Decrease LES pressure
CCBs
Beta-Blockers
NItrates
Barbiturates
Anticholinergics
Therophylline
GERD Non-drug Therapy:

Drugs that have Direct Irritant Effects on the Esophageal Mucosa
Tetracyclines
NSAIDs
Aspirin
Bisphosphonates
Iron
Quinidines
Potassium Chloride
IBD Drug Therapy:

Mesalamine (Delayed-release Tablets)
(Asacol)
(Lialda)
IBD Drug Therapy:

Mesalamine (Delayed-released Capsules)
(Pentasa)
(Rowasa)
IBD Drug Therapy:

Mesalamine (Enema and suppository)
(Salofalk)
(Claversal)

(Canasa) - suppository only
IBD Drug Therapy:

Balsalazide
(Colazal)
IBD Drug Therapy:

Budesonide
(Entocort EC)

In asthma = Pulmicort
IBD Drug Therapy:

Azathioprine
(Imuran)
IBD Drug Therapy:

6-mercaptopurine
(Purinethol)
IBD Drug Therapy:

Methotrexate
(Abitrexate)

In RA = Rheumatrex
In Cancer = Trexall
IBD Drug Therapy:

Infliximab
(Remicade)
IBD Drug Therapy:

Adalimumab
(Humira)
IBD Drug Therapy:

Certolizumab pegol
(Cimzia)
IBD Drug Therapy:

Natalizumab
(Tysabri)
IBD Drug Therapy:

Cyclosporine
(Neoral)
(Sandimmune)
IBD Patient Counseling:

Sulfasalazine (Azulfidine)
Take after meals

Avoid sun exposure

Take folic acid supplementation to avoid anemia

May cause orange discoloration of urine & skin
IBD Patient Counseling:

Mesalamine
Tablets: swallow whole

Enemas: shake well before use
IBS Drug Therapy:

Dicyclomine
(Bentyl)
IBS Drug Therapy:

Amitriptyline
(Elavil)
IBS Drug Therapy:

Paroxetine
(Paxil)
IBS Drug Therapy:

Tegaserod
(Zelnorm)
IBS Drug Therapy:

Polycarbophil
(Fibercon)
IBS Drug Therapy:

Alosetron
(Lotronex)
IBS Drug Therapy:

Lubiprostone
(Amitiza)
IBS Drug Therapy:

Loperamide
(Imodium)
IBS Drug Therapy:

Diphenoxylate + Atropine
(Lomotil)