Risk Factors for SRMB in Patients

Questions and Answers

What is the preferred combination for preventing NSAID-induced ulcers in patients over 65 years old on chronic NSAIDs?

Misoprostol with NSAID

H2RA with NSAID

PPI with NSAID (correct)

Acetaminophen with NSAID

Which of the following strategies should be used if it is not possible to discontinue NSAIDs?

Switch to opioids and increase NSAID doses

Add more NSAIDs for enhanced effect

Increase the frequency of NSAID intake

Reduce the dose, switch to acetaminophen, and add antisecretary agents (correct)

What is the only indication for Misoprostol in the context of NSAID use?

Fever reduction

General gastrointestinal protection

NSAID-induced ulcer prevention (correct)

Pain relief for arthritis

What is a significant side effect associated with the use of Misoprostol?

Diarrhea Signup and view all the answers

Which statement about H2 antagonists when combined with NSAIDs is true?

Their effectiveness is not optimal in this context. Signup and view all the answers

What is the sensitivity and specificity percentage of the urea breath test for detecting active H.pylori infection?

95% Signup and view all the answers

Which of the following factors can cause a false negative in urea breath tests?

Use of PPIs Signup and view all the answers

What is a known interference factor for stool antigen tests?

Bismuth compounds Signup and view all the answers

What is the overall goal of treating chronic Peptic Ulcer Disease (PUD)?

Reduce mortality Signup and view all the answers

Which of the following methods is 100% specific for detecting H.pylori?

Culture Signup and view all the answers

What is the sensitivity percentage of serologic tests for detecting H.pylori antibodies?

85% Signup and view all the answers

For H.pylori-positive patients with an active ulcer, what is the treatment goal?

To eradicate H.pylori Signup and view all the answers

Which factor is NOT suggested to be a cause for false negatives in stool antigen tests?

High dietary fat intake Signup and view all the answers

Which patients are at risk for stress-related mucosal bleeding (SRMB)?

Patients with respiratory failure on mechanical ventilation Signup and view all the answers

What is generally preferred for the prophylaxis of SRMB?

Antisecretory therapy Signup and view all the answers

Which medication showed superiority in preventing SRMB compared to oral sucralfate?

Intravenous ranitidine Signup and view all the answers

What should be done with prophylactic therapy once a patient is discharged from the ICU?

Discontinue if risk factors have resolved Signup and view all the answers

When considering pharmacotherapy for SRMB prevention, what is essential?

Overall medication costs and clinical presentation Signup and view all the answers

What is a common route for administering intravenous H2RAs?

As a continuous infusion or intermittent bolus doses Signup and view all the answers

Which of the following factors does NOT increase the risk for SRMB?

Recent hysterectomy Signup and view all the answers

What is the mainstay option for prophylaxis of SRMB given the available evidence?

Proton pump inhibitors (PPIs) Signup and view all the answers

What is the most frequent side effect associated with Rabeprazole?

Headache Signup and view all the answers

Which side effect is related to Esomeprazole?

Rash Signup and view all the answers

For which age group is Rabeprazole approved?

Children over 12 Signup and view all the answers

How long can Dexlansoprazole be taken by adults for certain conditions?

Up to 6 months Signup and view all the answers

Which of the following Proton Pump Inhibitors is not approved for use in children?

Pantoprazole Signup and view all the answers

What confirms a pylori infection after successful treatment?

A positive result on urea breath or stool antigen testing Signup and view all the answers

Which factor is NOT a risk for recurrence of pylori infection?

Low rates of primary infection Signup and view all the answers

What is a recommended approach for treating recurrence of pylori infection?

Prescribing an alternative eradication regimen Signup and view all the answers

What drug is classified as a non-acetylated salicylate?

Meloxicam Signup and view all the answers

Which is a critical step in managing NSAID-induced ulcers?

Preventing ulcers in those who are ulcer-free Signup and view all the answers

Which factor does NOT contribute to NSAID-induced Peptic Ulcer Disease (PUD)?

Non-ulcer dyspepsia Signup and view all the answers

Which statement about recurrence rates of pylori infection is true?

Lower in developed countries Signup and view all the answers

What is a concern regarding the duration of eradication therapy for pylori infection?

Shorter courses may increase resistance Signup and view all the answers

Study Notes

Risk Factors for SRMB

Patients at risk for stress-related mucosal bleeding (SRMB) include those with respiratory failure requiring mechanical ventilation, and coagulopathy (INR >1.5), along with two or more of the following: platelet count <250 mg/day of hydrocortisone, multiple trauma, severe burns covering more than 35% of body surface area, head injury, traumatic spinal cord injury, major surgery, prolonged ICU stay (>7 days), or a history of gastrointestinal (GI) bleeding.

SRMB Treatment and Prophylaxis

Antisecretory therapy is preferred for SRMB prophylaxis due to its effectiveness.
Parenteral Histamine-2 receptor antagonists (H2RAs) can be administered via continuous infusion or intermittent bolus dosing.
Intravenous ranitidine is found to be superior to oral sucralfate in preventing SRMB without increasing the risk of nosocomial pneumonia.
H2RAs are recommended for SRMB prevention although Proton Pump Inhibitors (PPIs) are considered the mainstay option.
Limited evidence suggests no clinical superiority of PPIs over H2RAs or placebo.

Pharmacotherapy Plan for SRMB Prevention

Selecting the pharmacotherapy plan for SRMB prevention depends on the patient's clinical presentation and medication costs.
Patients able to take oral medications or have a working NG tube should use oral or compounded PPI suspensions as a cost-effective option.
If oral routes are unavailable, intravenous H2RAs should be utilized.
Prophylactic therapy should be discontinued upon resolution of risk factors, patient discharge from ICU, extubation, or the capability for oral intake.

Noninvasive Diagnosis of PUD

Urea breath tests (sensitive and specific for H. pylori infection) may yield false negatives with antibiotic or PPI use.
Serologic tests detect H. pylori antibodies with 85% sensitivity but are not effective for monitoring eradication.
Stool antigen tests for active H. pylori infection show 88-92% sensitivity and can be influenced by bismuth, PPI, and antibiotic use.

Treatment Goals for PUD

Primary goals include rapid symptom relief, ulcer healing, prevention of recurrences, reducing ulcer-related complications, and minimizing morbidity and mortality.
Treatment varies based on ulcer etiology, initial vs. recurrent status, and presence of complications.
For H. pylori-positive patients, eradication is defined by negative results on breath or stool antigen testing at least six months post-treatment.

NSAID-Induced PUD Management

Management involves healing existing ulcers and preventing new ulcers in patients who are currently ulcer-free.
Key strategies for prevention include using the least GI-toxic agent at the lowest effective dose.
Options include discontinuing NSAIDs, administering H2RAs or PPIs for eight weeks, or switching to acetaminophen or non-acetylated salicylates combined with antisecretory agents for 12 weeks.

Pharmacologic Agents for PUD

Proton Pump Inhibitors (PPIs) are effective for NSAID-induced ulcers.
Misoprostol is indicated for NSAID-induced ulcers but may cause diarrhea and cramping.
H2 Receptor Antagonists (like Cimetidine) are less preferred for prevention.

PPI Overview

Various PPIs including rabeprazole, pantoprazole, esomeprazole, and dexlansoprazole are available for ulcer management.
Common side effects of PPIs include headache, dizziness, rash, and gastrointestinal disturbances.
Specific dosages and administration routes vary across PPI types, with most requiring adult usage of up to 16 weeks or more.

Risk Factors and Recurrence of PUD

Recurrence rates of PUD are higher in populations with certain risk factors.
Alternative eradication regimens may be required based on symptoms and complication risk profile.
Emerging studies will determine if shorter courses of eradication therapy might influence resistance rates.

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Description

This quiz covers the various risk factors associated with Stress-Related Mucosal Bleeding (SRMB) in patients. It explores conditions such as respiratory failure, coagulopathy, and other clinical scenarios that increase the likelihood of SRMB occurrence. Test your understanding of these critical risk factors and their implications in patient care.