ADVANCED PHARMACOLOGY NSG 533 EXAM SCRIPT
QUESTIONS AND ANSWERS RATED A+
✔✔H2RAs decrease acid secretion less than - ✔✔PPIs
✔✔Provider directed therapy for GERD - ✔✔trial daily PPI for 8 weeks
not controlled by trial: retrial w PPI 2x/day
✔✔Provider directed therapy for erosive esophagitis - ✔✔tx w at least 8 week PPI
2x/day
if continued > 8 weeks: use lowest effective PPI dose and schedule
✔✔Maintenance GERD therapy - ✔✔adding H2RA therapy may be effective
on demand PPI dosing
✔✔Pts who wish to stop long term PPI - ✔✔slowly titrate off
gastric hypersecretion with sudden withdrawal
use H2RAs for breakthrough s/s
✔✔GERD and pregnancy - ✔✔use mild-mod antacids to tx
avoid antacids with mag trisilicate
avoid compounds with sodium bicarb
if severe freq heartburn: start PPI
✔✔3 most common causes of PUD - ✔✔H. pylori, NSAIDs, SRMD
✔✔H. pylori - ✔✔commonly causes DU
when selecting 1st line tx consider if PCN allergy, previous exposure to macrolide abx
✔✔Macrolide abx - ✔✔-omycin's
✔✔Strongest H. Pylori 1st line tx recommendations - ✔✔Bismuth Quad Therapy for 10-
14 days & Concomitant Therapy for 10-14 days
✔✔Bismuth Quad Therapy for 10-14 Days - ✔✔Bismuth 300 mg QID
Metronidazole 250-500 mg QID
Tetracycline 500 mg QID
PPI BID
✔✔Concomitant Therapy for 10-14 days - ✔✔clarithromycin 500 mg BID
amoxicillin 1 g BID
nitroimidazole 500 mg BID
PPI BID
, ✔✔weaker 1st line H. Pylori tx if no previous macrolide exposure - ✔✔clarithromycin
triple therapy for 14 days
✔✔Clarithromycin triple therapy for 14 days - ✔✔Clarithromycin 500 mg BID
Amoxicillin 1g BID OR metronidazole 500 mg TID
PPI BID
✔✔Initial tx was Bismuth Quad Therapy w no PCN allergy failed, secondary tx -
✔✔levofloxacin triple therapy if no previous quinolone exposure
concomitant therapy
rifabutin triple therapy
high dose dual therapy
✔✔Initial tx was Clarithromycin Triple Therapy w no PCN allergy failed, secondary tx: -
✔✔Bismuth Quad Therapy
Levofloxacin triple therapy
rifabutin triple therapy
high dose dual therapy
IF PCN ALLERGY: bismuth quad therapy
✔✔Retest for H. Pylori after: - ✔✔at least 4 weeks off regimen and 1-2 weeks after DC
of PPI
✔✔Preferred tx of NSAID ulcers - ✔✔PPIs preferred to sucralfate and H2RAs
4 weeks of PPI use
✔✔Meds for NSAID ulcer tx - ✔✔Misoprostol
Duexis
Prevacid NapraPAC
Vimovo
Celecoxib
Sucralfate
✔✔Misoprostol - ✔✔synthetic prostaglandin
200 mcg 4x/day
inhibits acid secretion
promotes mucosal defense
superior to H2RAs
SEs: abd pain, gas, diarrhea
✔✔Misoprostol contraindicated in - ✔✔pregnancy
✔✔Arthotec - ✔✔combination product for NSAID induced GU
diclofenac 50 or 75 mg
misoprostol 200 mcg
QUESTIONS AND ANSWERS RATED A+
✔✔H2RAs decrease acid secretion less than - ✔✔PPIs
✔✔Provider directed therapy for GERD - ✔✔trial daily PPI for 8 weeks
not controlled by trial: retrial w PPI 2x/day
✔✔Provider directed therapy for erosive esophagitis - ✔✔tx w at least 8 week PPI
2x/day
if continued > 8 weeks: use lowest effective PPI dose and schedule
✔✔Maintenance GERD therapy - ✔✔adding H2RA therapy may be effective
on demand PPI dosing
✔✔Pts who wish to stop long term PPI - ✔✔slowly titrate off
gastric hypersecretion with sudden withdrawal
use H2RAs for breakthrough s/s
✔✔GERD and pregnancy - ✔✔use mild-mod antacids to tx
avoid antacids with mag trisilicate
avoid compounds with sodium bicarb
if severe freq heartburn: start PPI
✔✔3 most common causes of PUD - ✔✔H. pylori, NSAIDs, SRMD
✔✔H. pylori - ✔✔commonly causes DU
when selecting 1st line tx consider if PCN allergy, previous exposure to macrolide abx
✔✔Macrolide abx - ✔✔-omycin's
✔✔Strongest H. Pylori 1st line tx recommendations - ✔✔Bismuth Quad Therapy for 10-
14 days & Concomitant Therapy for 10-14 days
✔✔Bismuth Quad Therapy for 10-14 Days - ✔✔Bismuth 300 mg QID
Metronidazole 250-500 mg QID
Tetracycline 500 mg QID
PPI BID
✔✔Concomitant Therapy for 10-14 days - ✔✔clarithromycin 500 mg BID
amoxicillin 1 g BID
nitroimidazole 500 mg BID
PPI BID
, ✔✔weaker 1st line H. Pylori tx if no previous macrolide exposure - ✔✔clarithromycin
triple therapy for 14 days
✔✔Clarithromycin triple therapy for 14 days - ✔✔Clarithromycin 500 mg BID
Amoxicillin 1g BID OR metronidazole 500 mg TID
PPI BID
✔✔Initial tx was Bismuth Quad Therapy w no PCN allergy failed, secondary tx -
✔✔levofloxacin triple therapy if no previous quinolone exposure
concomitant therapy
rifabutin triple therapy
high dose dual therapy
✔✔Initial tx was Clarithromycin Triple Therapy w no PCN allergy failed, secondary tx: -
✔✔Bismuth Quad Therapy
Levofloxacin triple therapy
rifabutin triple therapy
high dose dual therapy
IF PCN ALLERGY: bismuth quad therapy
✔✔Retest for H. Pylori after: - ✔✔at least 4 weeks off regimen and 1-2 weeks after DC
of PPI
✔✔Preferred tx of NSAID ulcers - ✔✔PPIs preferred to sucralfate and H2RAs
4 weeks of PPI use
✔✔Meds for NSAID ulcer tx - ✔✔Misoprostol
Duexis
Prevacid NapraPAC
Vimovo
Celecoxib
Sucralfate
✔✔Misoprostol - ✔✔synthetic prostaglandin
200 mcg 4x/day
inhibits acid secretion
promotes mucosal defense
superior to H2RAs
SEs: abd pain, gas, diarrhea
✔✔Misoprostol contraindicated in - ✔✔pregnancy
✔✔Arthotec - ✔✔combination product for NSAID induced GU
diclofenac 50 or 75 mg
misoprostol 200 mcg
