สวัสดี มาบูเฮย์ ฟิลิปปินส์ Day 4.3

is a broad term for an ulcer occurring in the
esophagus, stomach, or duodenum within the upper gastrointestinal (GI) tract.

REMEMBER: Ulcers are more specifically named
according to the site of involvement: esophageal, gastric, and
duodenal ulcers

_________ occur 10 times more frequently than gastric and esophageal ulcers.

The release of _________ from the parietal cells of the stomach
is influenced by histamine, gastrin, and acetylcholine

The release of Hydrochloric Acid (HCl) from the parietal cells of the stomach is influenced by

Peptic ulcers occur when there is a hypersecretion of ____ and _____,  which erode the GI mucosal lining.

The gastric secretions in the stomach strive to maintain a
pH of

______ a digestive enzyme, is activated at a pH
of 2, and the_______  of gastric secretions can
cause mucosal damage.

TRUE OR FALSE: If the pH of gastric secretions
increases to pH 5, the activity of pepsin declines.
True False

is a thick, viscous, mucous material
that provides a barrier between the mucosal lining and acidic
gastric secretions.

maintains the integrity of the
gastric mucosal lining and is a defense against corrosive substances

The two sphincter muscles, —act as barriers to prevent
reflux of acid into the esophagus and duodenum.

results from reflux of acidic gastric secretions into the esophagus as a result of a defective or incompetent cardiac sphincter.

frequently occurs because of a breakdown of the GMB.

is caused by hypersecretion of acid from the stomach
passing into the duodenum because of (1) insufficient buffers
to neutralize gastric acid in the stomach, (2) a defective or
incompetent pyloric sphincter, or (3) hypermotility of the
stomach.

is inflammation or erosion of the esophageal mucosa caused by a
reflux of gastric acid content from the stomach into the
esophagus.

Predisposing factors of ulcers include

Healing of an ulcer takes

mechanical disturbances

Genetic Influences

Environmental influences

Helicobacter pylori

Drugs

The classic symptom of peptic ulcers is

With a gastric ulcer, pain occurs ___ minutes to ___ hours
after eating, and with a duodenal ulcer,  __ to __hours after
eating.

REMEMBER:  Small, frequent meals of nonirritating foods decrease the pain. With treatment, pain usually subsides in 10 days; however, the healing process may take 1 to 2 months

usually follows a critical situation such as
extensive trauma or major surgery

a gram-negative bacillus, is linked with
the development of peptic ulcer and is known to cause gastritis, gastric ulcer, and duodenal ulcer.

When a peptic ulcer
recurs after antiulcer therapy, and the ulcer is not caused by
nonsteroidal antiinflammatory drugs (NSAIDs) such as
aspirin or ibuprofen, the patient should be tested for the presence of the

In the past, endoscopy and a biopsy of the gastric antrum were needed to check for H. pylori. Currently a noninvasive breath test,_____, can detect H. pylori

This test, Meretek UBT, consists of drinking a liquid containing ____ and breathing into a container. If H. pylori is present, the bacterial urease hydrolyzes the urea, releasing _____, which is detected by a _______. This test is 90% to 95% effective for detecting H. pylori.

may be performed to check for antibodies to H. pylori.

REMEMBER! There are various protocols for treating H. pylori infection, but antibacterial agents are the treatment of choice. The useof only one antibacterial agent is not effective for eradicating H. pylori, because the bacterium can readily become resistant to that drug. Treatment to eradicate this bacterial infection
includes using a dual-, triple-, or quadruple drug therapy
program in a variety of drug combinations, such as amoxicillin (Amoxil), tetracycline (Achromycin V), clarithromycin
(Biaxin), omeprazole (Prilosec), lansoprazole (Prevacid),
metronidazole (Flagyl), bismuth subsalicylate (PeptoBismol), and ranitidine bismuth citrate (Tritec), on a 7- to
14-day treatment plan

A common treatment protocol is the triple therapy of ______, ______, _____. The drug regimen eradicates more
than 90% of peptic ulcer caused by H. pylori.

_______ may increase the risk for photosensitivity when taken with tetracycline

One of the __________  is frequently used as a component of combination drug therapy, because each suppresses acid secretion by inhibiting the enzyme hydrogen or potassium ATPase, which makes gastric acid. These agents block the final steps of acid production.

If triple therapy fails to eradicate H. pylori, then...

also called reflux esophagitis, is an inflammation of the esophageal mucosa caused by reflux of gastric acid content into the esophagus. Its main cause is an INCOMPETENT LOWER ESOPHAGEAL SPHINCTER. Smoking tends to accelerate the disease process.

This includes use of the common antiulcer
drugs to neutralize gastric contents and reduce gastric acid
secretion. Drugs used in the treatment of GERD include

REMEMBER: A PPI relieves
symptoms faster and maintains healing better than an H2
blocker. Once the strictures are relieved by dilation, they are
less likely to recur if the patient was taking PPIs rather than
an H2 blocker.

NONPHARMACOLOGIC MEASURES FOR
MANAGING PEPTIC ULCER AND
GASTROESOPHAGEAL REFLUX DISEASE

To relieve symptoms of GERD, the patient should (nonpharmacologic)

There are seven groups of antiulcer agents:

which decrease vagal activity (antiulcer agents)

which decrease acetylcholine by blocking the cholinergic receptors; (antiulcer agents)

which neutralize gastric acid; (antiulcer agents)

which block the H2 receptor (antiulcer agents)

which inhibit gastric acid secretion, regardless of acetylcholine or histamine release (antiulcer agents)

which inhibits gastric acid secretion and protects the mucosa

Currently, ______ and _______ are used infrequently due to potential adverse effects and much more effective drugs on the market.

______ have minimal effect in preventing and treating
ulcers; however, they reduce vagal stimulation and decrease
anxiety

a reformulated product
of the anxiolytic chlordiazepoxide (Librium) and the anticholinergic clidinium bromide (Quarzan), may be used in the treatment of ulcers.

Adverse effects of tranquilizers

____________ delay gastric emptying time, so they are
used more frequently for duodenal ulcers than for gastric
ulcers.

The anticholinergic ___________, inhibits gastric secretions in the treatment of peptic ulcers.

REMEMBER: Anticholinergics should be taken before meals to decrease the acid secretion that occurs with eating. Antacids can slow
the absorption of anticholinergics and therefore should be
taken 2 hours after anticholinergic administration

Because anticholinergics
decrease GI motility, gastric emptying time is _____,
which can stimulate gastric secretions and aggravate the
ulceration.

promote ulcer healing by neutralizing hydrochloric
acid and reducing pepsin activity; they do not coat the ulcer.

There are two types of antacids

a systemically absorbed antacid, was
one of the first antiulcer drugs. Because it has many side
effects (sodium excess, causing hypernatremia and water
retention; metabolic alkalosis caused by excess bicarbonate;
and acid rebound [excess acid secretion]), it is seldom used to treat peptic ulcers.

is most effective in neutralizing acid;
however, one third to one half of the drug can be systemically
absorbed and can cause ACID REBOUND.

can result from excessive use of calcium carbonate.

Burnett’s syndrome is intensified if _________are ingested with calcium carbonate (antacids)

The nonsystemic antacids are composed of alkaline salts
such as

Magnesium compounds can cause ______, and aluminum and calcium compounds can cause ______ with long-term use

Antacids containing magnesium salts are contraindicated
in patients with __________ because of the risk
for hypermagnesemia

Prolonged use of aluminum hydroxides can
cause

are popular drugs used in the treatment of gastric and
duodenal ulcers

These drugs block the H2 receptors of the parietal cells in the stomach, thus reducing gastric acid secretion and concentration

The first H2 blocker was

REMEMBER: . Antacids can be given 1 hour
before or after cimetidine (H2 Blocker) as part of an antiulcer drug regimen; however, if they are given at the same time, the effectiveness of the H2 blocker is decreased

Three h2 blockers more potent than cimetidine. In addition to blocking gastric acid secretions, they promote healing of the ulcer by eliminating its cause

is 50% to 80% more potent than
cimetidine and is five to eight times more potent than ranitidine. It is indicated for short-term use (4 to 8 weeks) for
duodenal ulcer and for Zollinger-Ellison syndrome.

is an H2 blocker that can relieve nocturnal gastric acid secretion for 12 hours. This drug is similar to famotidine and ranitidine, and none of these agents suppresses the metabolism of other drugs.

The most frequently prescribed h2 blocker

REMEMBER: Side effects and adverse reactions of H2 blockers include headache, dizziness, constipation, pruritus, skin rash, gynecomastia, decreased libido, and impotence. Ranitidine and famotidine have fewer side effects than cimetidine

REMEMBER: Cimetidine can cause an increase in blood urea nitrogen (BUN), serum creatinine, and serum alkaline phosphatase. Neither cimetidine nor ranitidine should be taken with antacids, because their H2 blocking action could be decreased. Ranitidine can increase the effect of ORAL COAGULANTS

Patient teaching on H2 blockers

suppress gastric acid secretion by inhibiting the
hydrogen/potassium adenosine triphosphatase (ATPase)
enzyme system located in the gastric parietal cells.

They tend to inhibit gastric acid secretion up to 90% greater than the H2 blockers (histamine antagonists). These agents block the
final step of acid production.

was the first PPI marketed, followed by lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium), and dexlansoprazole (Dexilant), a delayed-release oral capsule.

PPIs suppress gastric acid secretion by inhibiting the
____________ enzyme system located in the gastric parietal cells

With lansoprazole (PPI), ulcer relief usually occurs in _ week.

Rabeprazole is more
effective in treating duodenal ulcers than gastric ulcers, but it
is most effective for treating ____ and ____.

______ is prescribed to treat short-term erosive GERD

has the highest success rate for healing erosive GERD, more so than omeprazole

REMEMBER: Omeprazole promotes IRREVERSIBLE hydrogen or potassium ATPase inhibition until new enzyme is synthesized, which could take days, whereas rabeprazole causes REVERSIBLE ATPase inhibition.

is prescribed to treat erosive esophagitis and symptomatic nonerosive GERD

Sodium Bicarbonate (Zegerid) is the only drug given to prevent stress ulcers in critically ill patients.

Two combination medications involving PPIs are

is an immediate-release PPI layered over an enteric coated NSAID in one tablet used to prevent NSAID-associated
gastric ulcers.

PPIs can enhance the action of
digoxin, oral anticoagulants, certain benzodiazepines, and
phenytoin, because they interfere with liver metabolism of
these drugs.

a complex of sulfated sucrose and aluminum hydroxide, is classified as a pepsin inhibitor, or mucosal protective drug

It is nonabsorbable and combines
with protein to form a viscous substance that covers the ulcer
and protects it from acid and pepsin. This drug does not
neutralize acid or decrease acid secretions.

The dosage of sucralfate is 1 gram, usually four times a day
before meals and at bedtime. If antacids are added to decrease
pain, they should be given either ____ minutes before or ___
minutes after the administration of sucralfate

Because
sucralfate is not systemically absorbed, side effects are few;
however, it can cause

If the drug is stored at
room temperature in an airtight container, it will remain
stable for up to 2 years.

a synthetic prostaglandin analogue, is a drug
used to prevent and treat peptic ulcer. It appears to suppress
gastric acid secretion and increase cytoprotective mucus in
the GI tract. It causes a moderate decrease in pepsin secretion

Patients
who complain of gastric distress from NSAIDs such as aspirin
or indomethacin prescribed for long-term therapy can benefit
from______. When a patient takes high doses of NSAIDs,
_____ is frequently recommended for the duration of
the NSAID therapy

Misoprostol is contraindicated during