PAC3421 Study Guide - Final Guide: Peptic Ulcer, Helicobacter Pylori, Amoxicillin
21 Jun 2018
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PUD – H.pylori-induced ulcers
Which of the following statement is INCORRECT?
A. The prevalence of H.pylori associated ulcers is higher in elderly
B. The symptoms experienced by elderly due to peptic ulcers is minimal
C. Most H.pylori infected people is asymptomatic
D. Only about 50% of patients report with the characteristic pattern of peptic ulcer symptoms
E. A person is always considered to be H.pylori negative if the H. pylori test result is negative.
F. H. pylori infection is the most common cause of peptic ulcer disease (PUD)
G. B and D only
What is the rationale for drug use in H.pylori-induced ulcers?
-Heal gastric and duodenal ulcers caused by H. pylori to provide symptom control
-Reduce relapse rate of gastric and duodenal ulcers caused by H. pylori
-Reduce risk of PUD in patients who are H.pylori positive
-Reduce risk of PUD in patients who are at an increased risk of NSAID-induced ulcer complications before
starting long-term NSAID
What antibiotics are used as first-line in management of H.pylori-induced ulcers? State a reason.
a) Amoxycillin
b) Clarithromycin
c) Metronidazole
d) A and B
e) All of the above
Because there is only rare resistance of these antibiotics in Australia
What is the recommended management of H.pylori-induced ulcers (i.e. first-line H.pylori eradication)?
i) PPI (esomeprazole OR omeprazole)
ii) Clarithromycin (beware of warfarin interaction)
iii) Amoxycillin (beware of penicillin allergy -> substitute with metronidazole tds)
*every drug taken bd for 7/7
*poor compliance = main reason for treatment failure
What medications are included in triple therapy (i.e. second-line H.pylori eradication)?
i) PPI
ii) Amoxycillin
iii) Levofloxacin/rifabutin
*this set taken for 10/7
What medications are included in quadruple therapy (i.e. second-line H.pylori eradication)?
i) PPI
ii) Bismuth subcitrate (only available under SAS)
iii) Tetracycline
iv) Metronidazole
*Disadvantages: less tolerated than 1st line treatment by causing nausea, loose or discoloured stools & taste
disturbance -> adherence/compliance issue
*Advantage: 80-85% success rate
find more resources at oneclass.com
find more resources at oneclass.com
Which of the following is INCORRECT regarding PPI therapy in H.pylori-induced ulcers?
A. Follow-on PPI therapy should be recommended for complicated or larger ulcers (>1cm diameter)
B. Follow-on PPI therapy should be given for 8 weeks (including one week of H.pylori eradication therapy)
C. Healing rate of ulcers is faster by maintaining PPI therapy
D. It is necessary to maintain PPI therapy if H.pylori is eradicated in order to prevent relapse
E. It is necessary to maintain PPI therapy if H.pylori is not eradicated successfully in order to decrease relapse
rate
PUD – NSAID-induced ulcers
What is the rationale for drug use in NSAID-induced ulcers?
-Heal ulcers caused by NSAID to provide symptom control
-Reduce risk of complications (e.g. bleeding, perforation, obstruction)
Which of the following is INCORRECT regarding management of NSAID-induced ulcers?
A. Rectal formulations (e.g. suppository) do not reduce the risk of gastric injury
B. Enteric coated tablets reduce the risk of gastric injury
C. COX2-selective NSAIDS reduces the risk of ulcer disease and complications (feedback: no abolish only)
D. Switching to a celecoxib (i.e. COX2-selective NSAIDs) is not recommended before the ulcer is healed
(feedback: inadequate human data; animal studies showed impaired ulcer healing by coxibs)
E. None of the above
Summary (from Therapeutic Guidelines in Dan’s note):
-Always add PPI to non-selective NSAID (if used) when the person has HIGH risk of NSAID adverse effect in
gut
-Avoid NSAID if possible in patients with HIGH cardiovascular risk and HIGH risk of NSAID adverse effect in
gut (i.e. the rest of conditions do not warrant the avoidance of NSAID)
Note: We have not discussed “PUD-stress” ulcers” AND “PUD-infant colic”! – Refer Dan’s note
Dyspepsia
What is dyspepsia?
Dyspepsia is a chronic and recurrent pain or discomfort centered in the upper abdomen.
What are the symptoms of dyspepsia?
-Excessive burping
-Abdominal bloating
-Nausea
-Feeling of fullness
-Pain or discomfort
What are the major causes of dyspepsia?
-Functional / non-ulcer dyspepsia (40-60%) – e.g. gastric secretion/emptying/motility issue?
-GORD (23-30%)
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Heal gastric and duodenal ulcers caused by h. pylori to provide symptom control. Reduce relapse rate of gastric and duodenal ulcers caused by h. pylori. Reduce risk of pud in patients who are h. pylori positive. Reduce risk of pud in patients who are at an increased risk of nsaid-induced ulcer complications before starting long-term nsaid. State a reason: amoxycillin, clarithromycin, metronidazole, a and b, all of the above. Because there is only rare resistance of these antibiotics in australia. What is the recommended management of h. pylori-induced ulcers (i. e. first-line h. pylori eradication)? i) ii) iii) Amoxycillin (beware of penicillin allergy -> substitute with metronidazole tds) *poor compliance = main reason for treatment failure. What medications are included in triple therapy (i. e. second-line h. pylori eradication)? i) ii) iii) What medications are included in quadruple therapy (i. e. second-line h. pylori eradication)? i) ii) iii) iv)
