PUD

Question 1

Ulceration of the mucosa anywhere in the GI tract that is exposed to acid and pepsin

Answer 1

Peptic ulcer disease

Question 2

What are the 2 common forms of PUD?

Answer 2

1. Duodenal ulcer
2. Gastric ulcer

Question 3

What is the most common form of PUD?

Answer 3

Duodenal ulcer

Question 4

What ages do duodenal ulcers usually occur?

Answer 4

Between ages 30-50

Question 5

What ages are usually diagnosed with Gastric ulcers?

Answer 5

> 60 years

Question 6

What are the 3 most common types of PUD?

Answer 6

1. H. Pylori
2. NSAID induced
3. Stress related mucosal damage

Question 7

True or false: cigarette smoking can help ease the pain caused by PUD

Answer 7

False

Question 8

People who develop PUD tend to be more adversely affected by _____.

Answer 8

Stress

Question 9

What 4 foods can cause dyspepsia but do not increase the risk of PUD?

Answer 9

1. Coffee
2. Tea
3. Soda
4. Spices

Question 10

What is found in most people with duodenal and gastric ulcers?

Answer 10

H. Pylori

Question 11

How is H. Pylori primarily spread?

Answer 11

Through fecal to oral route

Question 12

What is the mechanism for H. Pylori causing PUD?

Answer 12

Catalyzes urea—> ammonia—> erodes mucus barrier—> epithelial damage

Question 13

What 2 things does H. Pylori produce?

Answer 13

1. Cytotoxins
2. Mucolytic enzymes

Question 14

NSAIDs are weak ___ and _______ at gastric pH

Answer 14

Acids; nonionized

Question 15

What do NSAIDS decrease the production of?

Answer 15

Prostaglandins

Question 16

Since prostaglandin production is decreased what 3 things can happen?

Answer 16

1. Reduction in gastric and mucosal blood flow
2. Decreased mucus and bicarbonate secretion
3. Decrease cellular replication and repair

Question 17

NSAID induced PUD is prevalent in what type of patients?

Answer 17

1. Pts > 60
2. Pts with a prior history of PUD
3. Pts taking high dose NSAIDS

Question 18

Concurrent administration with what 5 drugs can lead to NSAID induced PUD?

Answer 18

1. Corticosteroids
2. Anticoagulants
3. Oral bisphosphonates
4. Antiplatelet agents
5. SSRIs

Question 19

NSAID induced ulcers are often ____.

Answer 19

Silent

Question 20

What is the most ulcernogenic NSAID?

Answer 20

Aspirin

Question 21

What do symptoms of PUD depend on?

Answer 21

1. Ulcer location
2. Patient age

Question 22

Pain does not follow a consistent pattern with which type of ulcer?

Answer 22

Gastric Ulcer

Question 23

Food often relieves pain with which type of ulcer?

Answer 23

Duodenal ulcer

Question 24

Pain is more likely to follow a consistent pattern with what type of ulcer?

Answer 24

Duodenal ulcer

Question 25

Nocturnal epigastric pain is highly suggestive of what kind of ulcer?

Answer 25

Duodenal ulcer

Question 26

What are the 3 major complications of PUD?

Answer 26

1. Bleeding 2. Perforation 3. Mortality

Question 27

What is the rapid urease test?

Answer 27

H. Pylori + HP urease —> NH3 + CO2 —> increase pH and color change

Question 28

What does the serological test detect?

Answer 28

IgG to HP

Question 29

What 3 tests can be used as an initial screen?

Answer 29

1. Serologic 2. UBT 3. FAT

Question 30

What therapy is first line therapy of PUD?

Answer 30

Standard Triple Therapy

Question 31

How long is the first line therapy given for?

Answer 31

10-14 days preferably 14

Question 32

What do you give a patient as an alternative if they are allergic to penicillin?

Answer 32

Metronidazole

Question 33

What is the standard triple therapy?

Answer 33

Amoxicillin PLUS Clarithromycin PLUS a PPI

Question 34

What drug has the highest resistance rates?

Answer 34

Clarithromycin

Question 35

When is Clarithromycin considered 1st line therapy based on resistance?

Answer 35

If resistance is < 15%. And in patients who have never been exposed to a macrolide antibiotic

Question 36

What therapy can be used if Clarithromycin cannot be used?

Answer 36

Bismuth- based Quadruple therapy

Question 37

What drugs are in the bismuth based quadruple therapy?

Answer 37

Tetracycline PLUS metronidazole PLUS bismuth subsalicylate PLUS a PPI

Question 38

What is used for concomitant therapy?

Answer 38

Clarithromycin PLUS amoxicillin PLUS metronidazole or tinidazole PLUS a PPI

Question 39

What is used as second line therapy or “salvage therapy”?

Answer 39

1. Levofloxacin based triple therapy 2. Levofloxacin Sequential therapy

Question 40

What is included in Levofloxacin based triple therapy?

Answer 40

Amoxicillin PLUS Levofloxacin PLUS PPI

Question 41

What is included in the Levofloxacin sequential therapy?

Answer 41

Amoxicillin PLUS PPI PLUS Levofloxacin PLUS metronidazole

Question 42

Rifabutin based triple therapy includes what?

Answer 42

Omeprazole PLUS amoxicillin PLUS rifabutin

Question 43

How long can you use a PPI for anti-secretory therapy?

Answer 43

2 weeks

Question 44

What should you use for treatment of H. Pylori negative Ulcers?

Answer 44

H2 antagonists or sucralfate

Question 45

How long can you use conventional treatment for H. Pylori negative ulcers?

Answer 45

4 weeks

Question 46

How should you treat NSAID induced ulcers?

Answer 46

1. Ideally d/c NSAID 2. Treat with standard doses of h2 antagonists, sucralfate, or PPI

Question 47

If an NSAID MUST be continued what should you do? 2

Answer 47

1. Reduce NSAID dose 2. Change to APAP or selective COX-2 inhibitors In addition to a PPI for both

Question 48

What can be used as maintenance therapy for NSAID induced ulcers?

Answer 48

1. PPIs in standard maintenance dose OR 2. Misoprostol

Question 49

What should you caution patients to look out for with PUD

Answer 49

Signs of GI bleeding