Peptic Ulcer Disease (PUD) Pharmacotherapy Quiz

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Questions and Answers

Which of the following is a main culprit of upper GI complications?

H. pylori bacteria

Gastric acid (correct)

NSAIDs

Mucosal damage

What is the characteristic size of erosions in Peptic Ulcer Disease (PUD)?

Greater than 5 mm (correct)

Less than 5 mm

Around 2 mm

Exactly 5 mm

Which of the following is a common cause of Peptic Ulcer Disease (PUD)?

Stomach flu

Bacterial pneumonia

Viral infection

H. pylori infection (correct)

What is the annual affected population percentage by Peptic Ulcer Disease (PUD)?

0.1-0.3% Signup and view all the answers

Which demographic group has a higher mortality rate related to PUD?

Patients over 65 Signup and view all the answers

What is the lifetime prevalence of Peptic Ulcer Disease (PUD)?

5-10% Signup and view all the answers

Which type of mucosal damage results in impaired quality of life, work loss, and high-cost medical care?

Stress-related mucosal damage Signup and view all the answers

What has declined in relation to Peptic Ulcer Disease (PUD) in the US?

Mortality Signup and view all the answers

Which condition has shown an increase in GI hemorrhage readmission rates?

Peptic Ulcer Disease (PUD) Signup and view all the answers

What are the two commonly grouped etiologies of Peptic Ulcer Disease (PUD)?

H. pylori-positive and NSAID-induced Signup and view all the answers

What is the major side effect of sucralfate?

Constipation Signup and view all the answers

Which medication is contraindicated in pregnancy?

Misoprostol Signup and view all the answers

What is the potential drawback of long-term use of bismuth preparations?

Potential for bismuth toxicity Signup and view all the answers

Which type of antacids causes constipation?

Aluminum-containing antacids Signup and view all the answers

When should eradication of H. pylori be confirmed in individuals with peptic ulcer disease?

Within 14 days of treatment completion Signup and view all the answers

What is the recommended treatment for Zollinger-Ellison Syndrome (ZES)?

Proton pump inhibitors and H2 receptor antagonists Signup and view all the answers

What is the mechanism of action of prostaglandins like misoprostol in peptic ulcer disease?

Moderately inhibits acid secretion and enhances mucosal defense Signup and view all the answers

What is the drawback of sucralfate in terms of dosing?

Multiple daily doses necessary, large tablet size, must be separated from meals to prevent interacting with concomitant medications (fluoroquinolones) Signup and view all the answers

What is the effect of bismuth preparations on stool or tongue color?

Black color to stool or tongue Signup and view all the answers

What should be assessed in all patients who fail therapy for peptic ulcer disease?

Medication adherence Signup and view all the answers

Which factor does not affect H. pylori infection rates?

Gender Signup and view all the answers

What is the risk factor for developing gastric ulcers in 30-50% of users?

Chronic use of NSAIDs Signup and view all the answers

By how much does H. pylori infection increase the risk of gastrointestinal bleeds?

What effect may H. pylori eradication have on symptoms of gastroesophageal reflux disease (GERD)?

Worsen symptoms Signup and view all the answers

What is a complication of gastric ulcers?

Obstruction Signup and view all the answers

What is included in the treatment for gastric ulcers?

Antimicrobial therapy with acid suppression therapy Signup and view all the answers

What testing should be done in all NSAID-induced ulcers?

Testing for H. pylori Signup and view all the answers

For prevention of NSAID-related ulcers, which strategy is recommended?

Using NSAIDs with PPI or misoprostol Signup and view all the answers

What is the recommended treatment for idiopathic ulcers?

Following guidelines for NSAID-induced PUD Signup and view all the answers

What has been seen to be equally effective for treating idiopathic ulcers?

Famotidine 40 mg daily Signup and view all the answers

Study Notes

H. pylori infection rates are higher in Black and Hispanic Americans compared to non-Hispanic white Americans.
Gender and smoking status do not affect H. pylori infection rates.
Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin, increases the risk of developing gastric ulcers in 30-50% of users.
H. pylori infection increases the risk of gastrointestinal (GI) bleeds by 3-7 times.
H. pylori eradication may worsen symptoms of gastroesophageal reflux disease (GERD) but is necessary due to the known risk of gastric cancer.
NSAIDs cause gastric mucosal damage both locally and systemically.
Complications from gastric ulcers include bleeding, perforation, and obstruction, with the highest mortality in patients with uncontrolled bleeding or re-bleeding events.
Treatment for gastric ulcers includes antimicrobial therapy with acid suppression therapy to eradicate H. pylori and relieve symptoms, as well as lifestyle modifications such as stress reduction and smoking cessation.
Non-pharmacological therapy includes probiotics to limit H. pylori colonization and increase eradication rates, and surgical intervention is typically only done in emergent situations.
Testing for H. pylori should be done in all NSAID-induced ulcers, and treatment includes discontinuing NSAIDs and starting acid suppression therapy, or continuing NSAID use with a COX-2 selective and PPI or misoprostol.
For prevention of NSAID-related ulcers, strategies include COX-2 selective NSAIDs with PPI, COX-2 selective NSAIDs alone, non-selective NSAIDs with PPI, and medical co-therapy with misoprostol.
Idiopathic ulcers are not commonly diagnosed but may be increasing in prevalence, and treatment follows the guidelines for NSAID-induced PUD.
Famotidine 40 mg daily and lansoprazole 30 mg daily have been seen to be equally effective for treating idiopathic ulcers, and long-term maintenance may be required in some cases.

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Description

Test your knowledge of the pathophysiologic mechanisms, causes, treatment options, complications, diagnosis, and patient-specific treatment plans for Peptic Ulcer Disease (PUD). This quiz covers the pharmacotherapy of H. pylori-caused and NSAID-caused PUD.