Questions and Answers
What is the number one cause of Peptic Ulcer Disease (PUD)?
What is the minimum treatment regimen for H. Pylori?
Three antibiotics plus PPI for 10-14 days
Amoxicillin disrupts the cell wall of H. Pylori.
True
Clarithromycin inhibits __________.
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Tetracycline is contraindicated in pregnancy and can stain teeth.
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What is the main concern of using Metronidazole?
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What are the specific treatments approved for women with IBS?
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Which medications are used for Inflammatory Bowel Disease?
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What causes Iron Deficiency Anemia?
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Cyanocobalamin is used to treat Vitamin B12 deficiency.
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Pregnant women require a minimum of __________ of folic acid.
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Study Notes
H. Pylori
- Number one cause of PUD
- Causes: NSAIDS
- Treatment: minimum of 3 antibiotics + PPI for 10-14 days
Antibiotics for H. Pylori
- Amoxicillin:
- Low rate of resistance
- Disrupts cell wall
- Give antisecretory agent (omeprazole) to enhance antibacterial activity
- Clarithromycin:
- Inhibits protein synthesis
- Bismuth (Pepto-Bismol):
- Disrupts cell wall of H. Pylori
- Side effects: black discoloration of the tongue and stool, long-term therapy can cause neurologic injury
- Tetracycline:
- Inhibits protein synthesis
- Resistance is rare
- Interacts with many medications, causes photosensitivity
- Do not use in pregnancy and young children, stains teeth
- Metronidazole:
- Effective against sensitive strains
- Avoid alcohol (disulfiram-like reaction)
- Tinidazole:
- Similar to Metronidazole
Diarrhea
- Diphenoxylate + atropine (Lomotil): opioid, atropine discourages abuse
- Difenoxin + atropine (loperamide): opioid
- Bismuth subsalicylate
- Bulk-forming agents
- Anticholinergic antispasmodics
- Management:
- Antibiotics should only be used for: salmonella, shigella, campy, or clostridium
- Traveler's diarrhea: e.coli self-limiting if not cipro, norfloxacin, Azithro in children
IBS
- Diagnosis: present for 12 weeks/3 months over the past year
- Treatment:
- Alosetron:
- Approved for women only
- GI toxicities, constipation, perforation, and ischemic colitis risk management program
- Eluxadoline
- Lubiprostone:
- Approved for women >18
- Minimal benefits
- Linaclotide:
- Tx IBS with constipation and chronic idiopathic constipation
- Works by increasing intestinal fluid secretion
- Alosetron:
Inflammatory Bowel Disease
- Crohn disease and Ulcerative colitis
- Treatment:
- Budesonide (Glucocorticoids):
- Mild-mod Crohn's
- Prolong use can cause adrenal suppression, Cushing syndrome, osteoporosis, and increased infection risk
- Sulfasalazine (5-aminosalicylates):
- Reduces inflammation
- Mild-mod UC
- Azathioprine (immunosuppressants):
- Induce/maintain remission in both UC and Crohn
- Reserved for patients who have not responded to traditional therapy
- Infliximab (immunomodulators):
- Same as reserved patients
- Mod-sev Crohn and UC
- Increased risk of infection, yearly TB screening
- Metronidazole and cipro:
- Ineffective for UC
- Budesonide (Glucocorticoids):
Iron Deficiency Anemia
- Imbalance in iron uptake and iron demand
- Causes: pregnancy, infancy, chronic blood loss (find the underlying reason)
- Labs:
- Decreased reticulocyte count
- Decreased ferritin
- Increased serum iron-binding capacity (IBC)
- Treatment:
- Ferrous sulfate:
- 325mg 2-3x daily
- Give on an empty stomach if possible
- Monitor HH and ferritin in 4 weeks
- AE: staining of teeth
- Vitamin C and ascorbic acid enhance absorption but can increase AE, do not give with antacids and tetracycline
- Ferrous sulfate:
Vitamin B12 Deficiency
- Causes: strict vegetarians, impaired absorption disease, and alcohol, absence of intrinsic factor: pernicious anemia
- Treatment: Cyanocobalamin SQ or IM
Folic Acid Deficiency
- Women of childbearing age or pregnant women require extra folic acid
- 400mcg for non-pregnant/lactating women
- In pregnancy: at least 600mcg
- Treatment:
- 1-2 mg/day for deficiency
- IM injection of B12 helps stimulate
- Do not give folic acid routinely, can mask B12 deficiency if present
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Description
This quiz covers the causes and treatment of H. Pylori infections, including the role of NSAIDS and the use of antibiotics such as Amoxicillin, Clarithromycin, and Bismuth.
