which of the following would be prescribed as initial treatment for uncomplicated pud?

What are the treatment goals for peptic ulcer disease (PUD)?

Mar 01, 2022 · Non–bismuth-based quadruple therapy (10 days of a proton pump inhibitor, amoxicillin 1 g, clarithromycin 500 mg [Biaxin], and metronidazole 500 mg [Flagyl] or tinidazole 500 mg [Tindamax] twice ...

What are the treatment options for postpartum ulcerative colitis (PUD)?

Jul 22, 2021 · Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any scarring caused by the infection. For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID. Prompt antibiotic treatment can prevent severe damage to the reproductive organs.

What are the diagnostic guidelines for dyspepsia with ulcerative colitis (PUD)?

triple therapy: PPI + 500mg clarithromycin BID + 1g of Amoxicillin BID or 500mg metronidazole BID (for beta-lactam allergy) if second course, choose different antibiotics. 4-drug therapy: PPI + Bismuth + Metronidazole + 500mg tetracycline 2-4 times a day x2 weeks (alternate first line; can sub PPI for H2RA in 4-course therapy) Continue acid ...

What is the treatment for idiopathic peptic ulcer cq-9?

Feb 23, 2021 · What is the first-line drug for the initial non-eradication treatment of gastric ulcers? Either PPIs or P-CAB is recommended. Recommendation: strong, 100% agreed, evidence level A. If PPIs and P-CAB cannot be prescribed, H 2 RAs are recommended. Recommendation: strong, 100% agreed, evidence level B.

What is the first line treatment for PUD?

What is the best treatment for PUD?

What is the drug of choice for pud?

What is uncomplicated PUD?

What is the treatment for PUD in addition to discontinuing irritating factors?

What is PUD diagnosis?

What are the 3 drug classes used to treat peptic ulcers?

Why is the patient prescribed with two anti ulcer medications?

What is the treatment of H. pylori?

Which of the following is a complication of PUD?

What are the complications of peptic ulcers?

What is the most common medication for OCD?

86. A) Paroxetine (Paxil CR) Antidepressants are the most common medications used for OCD. Those antidepressants that are approved for OCD by the Food and Drug Administration (FDA) include clomipramine (Anafranil), fluvox- amine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).

What is the best treatment for COPD?

The initial treatment of choice for chronic bronchitis/COPD is ipratropium bromide or Atrovent (an anticholinergic).

What is a proventil inhaler?

118. A) Albuterol inhaler (Proventil) Proventil inhaler is a short-acting bronchodila- tor and is used for immediate relief of shortness of breath. It acts quickly to dilate the tubes in the lungs. Medications that have steroids and leukotrienes help the inflamed channels to remain open and clear but take longer to get into the system to work.

What is Lasix used for?

69. C) Furosemide (Lasix) Lasix would be used to help remove the extra fluid load.

What is the G6PD deficiency?

A) G6PD deficiency anemia Glucose-6-phosphate dehydrogenase (G6PD) defi- ciency is a hereditary condition that occurs when the red blood cells break down, causing hemolysis, due to a missing or lack of a sufficient enzyme that is needed to help the red blood cells work efficiently. Certain foods and medications may trigger this reaction and hemolysis will occur. Some of these medications include antimalarial drugs, aspirin, nitrofurantoin, NSAIDs, quinidine, quinine, and sulfa medications.

Does Coumadin increase bleeding?

A) The high Vitamin K levels will increase bleeding time Foods containing Vitamin K may enhance the anticoagulation effect of Coumadin, thus increasing bleeding time. 163. You are following up a 65-year-old male who has been on a new prescription of flu- vastatin (Lescol) for 6 weeks.

What causes PUD?

Author disclosure: No relevant financial affiliations. The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). The test-and-treat strategy for detecting H. pylori is appropriate in situations where the risk of gastric cancer is low based on age younger ...

What is the best treatment for H. pylori?

Treatment choices include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. Standard triple therapy is only recommended when resistance to clarithromycin is low. Chronic use of NSAIDs in patients with H. pylori infection increases the risk of PUD.

What is a serologic antibody test?

Serologic antibody testing detects immunoglobulin G specific to H. pylori in serum and cannot distinguish between an active infection and a past infection. Serologic tests may be most useful in mass population surveys and in patients who cannot stop taking PPIs (e.g., those with gastrointestinal bleeding or continuous NSAID use) because the tests are not affected by PPI or antibiotic use. 1, 2

Why is a history and physical exam important?

The history and physical examination are important to identify patients at risk of ulcer, perforation, bleeding, or malignancy. However, a systematic review of models using risk factors, history, and symptoms found that they did not reliably distinguish between functional dyspepsia and organic disease. 8 Therefore, the test-and-treat strategy for H. pylori is recommended for patients with dyspepsia who have no alarm symptoms. 1

Which test is most accurate for identifying H. pylori infection?

Urea breath tests and stool antigen tests are most accurate for identifying H. pylori infection and can be used to confirm cure; serologic tests are a convenient but less accurate alternative and cannot be used to confirm cure.

Can NSAIDs cause ulcers?

Peptic ulcers are more common in patients taking NSAIDs who are H. pylori positive compared with those who are negative (pooled odds ratio [OR] = 1.81; 95% confidence interval [CI], 1.40 to 2.36). Bleeding is also more likely to occur in patients taking NSAIDs who are H. pylori positive (pooled OR = 5.21; 95% CI, 3.48 to 7.78). 5 Eradicating H. pylori in NSAID users reduces the likelihood of peptic ulcer by about one-half (OR = 0.43; 95% CI, 0.2 to 0.9). 25 However, a meta-analysis found that the use of a maintenance PPI was more effective than H. pylori eradication therapy for preventing NSAID-related ulcers (OR = 7.4; 95% CI, 1.3 to 44). 25 The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive. 22

Is PUD a common symptom in children?

Although gastrointestinal symptoms are common in children, PUD is rare (24.8 per 100,000 children annually). 29 Recurrent abdominal pain is not associated with H. pylori infection, and there is conflicting evidence regarding the association between epigastric pain and H. pylori infection. 30 One study found that nausea, vomiting, and diarrhea were associated with H. pylori, but that abdominal pain and heartburn were not. 31 An evidence-based clinical guideline developed by an international panel makes recommendations for H. pylori infection in children and adolescents. The best supported recommendations are presented in Table 5. 32

What is the treatment for PID?

PID is usually treated with antibiotics to provide empiric, broad spectrum coverage of likely pathogens. Recommended regimens can be found in the 2015 STD Treatment Guidelines.

Why do women delay antibiotics for PID?

The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes. PID is usually treated with antibiotics to provide empiric, broad spectrum coverage ...

Can antibiotics cure PID?

Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any scarring caused by the infection. For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID. Prompt antibiotic treatment can prevent severe damage to the reproductive organs.

Why is PPI administered after endoscopic treatment?

PPI administration after endoscopic treatment for hemorrhagic peptic ulcers is recommended to improve treatment outcomes.

Why is interventional radiology used for hemorrhagic peptic ulcers?

In patients undergoing refractory endoscopic treatment for hemorrhagic peptic ulcers, interventional radiology (IVR) is suggested due to its safety and effectiveness.

What is the purpose of PPIs in DAPT?

In DAPT, we recommend the combined use of PPIs to prevent upper gastrointestinal bleeding (UGIB).

Is IVR a viable option for refractory PUB?

They reported that compared to surgery, IVR exhibits a higher re-bleeding rate, but no significant difference in mortality, need for additional interventions, or complication rates between treatments. IVR could be a viable option for the treatment of refractory PUB; however, a limited number of institutions can perform IVR.

Can you take warfarin with antiplatelet agents?

In patients receiving both antiplatelet agents and warfarin, suggested to change antiplatelet agents to aspirin or cilostazol. Continue warfarin under a suitable prothrombin time-international normalized ratio (PT-INR) or to change warfarin to heparin.

Can you suspend warfarin after hemostasis?

Recommended to suspend warfarin, if necessary, in endoscopic hemostasis patients. If warfarin is discontinued, we suggest heparin or resuming warfarin as soon as hemostasis is established.

Can you change antiplatelet agents to aspirin?

Suggested to change antiplatelet agents to aspirin in patients with conditions with a high risk of thromboembolic events.

What medications are used for PUD?

Medications associated with developing uncomplicated PUD included current use of acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, selective serotonin reuptake inhibitors, antidepressants, antihypertensives or acid suppressants. Uncomplicated PUD was significantly associated with being a current or former smoker and having had a score of at least 3 on the Townsend deprivation index. Approximately 50% of patients who were users of ASA (19% of patients) or chronic users of NSAIDs (7% of patients) at diagnosis did not receive another prescription of the medication in the 60 days after diagnosis, and 30% were not represcribed therapy within a year. Among patients who were current users of ASA or chronic NSAIDs at the time of the PUD diagnosis and received a subsequent prescription for their ASA or NSAID during the following year, the vast majority (80–90%) also received a proton pump inhibitor coprescription.

What is the purpose of PUD analysis?

To analyze risk factors associated with uncomplicated PUD and medication use after diagnosis.

Can NSAIDs cause GI symptoms?

GI symptoms in individuals receiving ASA or NSAID treatment may be more closely monitored than in non-users of these drugs, and this might increase the likelihood of ASA or NSAID users eventually being diagnosed with uncomplicated PUD compared with non-users (i.e. detection bias). At the same time, initial symptoms of uncomplicated PUD might lead to early discontinuation of ASA or NSAIDs followed by investigations that ultimately result in diagnosis of uncomplicated PUD (i.e. inverse protopathic bias). We attempted to minimize the effect of these biases by adjusting for health services utilization and GI symptoms in the year before the event, and by using a date earlier than that of the recorded diagnosis as the index date in the case–control analysis. However, it is difficult to predict how these two seemingly opposing biases might have affected our results. Similarly, the positive associations that we observed between uncomplicated PUD development and PPI or H 2 RA use may be due to confounding by indication. Thus, the associations with gastroprotective medications, GI symptoms and use of healthcare services are likely to be part of the natural history of uncomplicated PUD, or comorbidities, rather than being factors that directly increase the risk of PUD.

Does PPI increase risk of PUD?

Patients who received a PPI prescription sometime after their first ASA prescription had a significantly increased risk of developing uncomplicated PUD compared with non-users of a PPI (OR: 2.29; 95% CI: 1.45–3.63). In contrast, this association was not apparent among patients who received a PPI at the same time as their first ASA prescription, compared with non-users of a PPI (OR: 0.86; 95% CI: 0.42–1.78 for patients with continuous PPI use until the index date) ( Table 4, the unadjusted values are presented in Table S5 ). These results suggest that PPI use does not increase the risk of uncomplicated PUD and that the observed association with uncomplicated PUD is due to PPI prescription to treat upper GI symptoms, possibly associated with undiagnosed PUD.

Can NSAIDs cause PUD?

Taken together, the results presented here indicate that use of NSAIDs, ASA (across the cardioprotective dose range) and several other medications are risk factors for uncomplicated PUD. These and other identified risk factors, including smoking, are also risk factors for PUD complications. About 70% of patients who are users of ASA or chronic users of NSAIDs at diagnosis are represcribed their medication within a year of diagnosis of uncomplicated PUD; most of these patients also receive PPI therapy, in accordance with guidelines [31]. However, the 30% of patients who do not receive another prescription of ASA may include some individuals in need of continuous ASA therapy, who will be at increased risk of cardiovascular events compared with those who continue to receive ASA [32]. For patients with risk factors for uncomplicated PUD, it is important to take preventative measures to reduce the likelihood of ulcer development.

Does ASA cause ulcers?

The association between medication use and uncomplicated PUD development was also analyzed according to ulcer location ( Table 3, the unadjusted values are presented in Table S3 ). Current use of ASA was associated with an increased risk of uncomplicated gastric ulcer (OR: 1.69; 95% CI: 1.45–1.96) and of uncomplicated duodenal ulcer (OR: 1.36; 95% CI: 1.16–1.61). Current use of NSAIDs was more strongly associated with the development of uncomplicated gastric ulcer than with uncomplicated duodenal ulcer, and the results indicated that oral anticoagulant use may be associated with uncomplicated gastric ulcer, but not uncomplicated duodenal ulcer.

Can you restart ASA after PUD?

Our results indicate that several risk factors for upper gastrointestinal bleeding are also predictors of uncomplicated PUD, and that some patients do not restart therapy with ASA or NSAIDs after a diagnosis of uncomplicated PUD. Further investigation is needed regarding the consequences for these patients in terms of increased cardiovascular burden due to discontinuation of antiplatelet therapy.

What is the treatment for peptic ulcer disease?

Given the current understanding of the pathogenesis of peptic ulcer disease, most patients with peptic ulcer disease are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory agents (NSAIDs), along with the appropriate use of antisecretory therapy.

What is the procedure for a peptic ulcer?

The appropriate surgical procedure depends on the location and nature of the ulcer. Many authorities recommend simple oversewing of the ulcer with treatment of the underlying H pylori infection or cessation of NSAIDs for bleeding peptic ulcer disease . Additional surgical options for refractory or complicated peptic ulcer disease include vagotomy and pyloroplasty, vagotomy and antrectomy with gastroduodenal reconstruction (Billroth I) or gastrojejunal reconstruction (Billroth II), or a highly selective vagotomy.

What is the treatment for H pylori?

Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings , and H pylori serology followed by triple therapy for patients who are infected. Breath testing for active H pylori infection may be used.

What is an EGD?

Urgent esophagogastroduodenoscopy (EGD) is the treatment of choice in the setting of a bleeding peptic ulcer for diagnostic and therapeutic reasons . Endoscopy provides an opportunity to visualize the ulcer, to determine the degree of active bleeding, and to attempt hemostasis by direct measures. Primary endoscopic hemostatic therapy (EHT) is successful in about 90% of patients; when this fails, transcatheter embolization may be useful. [ 42] Medical management usually serves as an adjunct to direct endoscopic therapy.

How to treat bleeding ulcers?

Hemoclips have been used successfully to treat an acutely bleeding ulcer by approximating two folds and clipping them together. Several clips may need to be deployed to approximate the gastric ulcer folds. In treating high-risk bleeding ulcers, combined therapy with epinephrine and hemoclips seems to be more efficacious than injection alone. However, it is not clear whether hemoclip use or thermal coagulation is more effective in treating an acutely bleeding ulcer; both modalities are used depending on physician experience and the equipment availability.

When should NSAIDs be discontinued?

NSAIDs should be immediately discontinued in patients with positive H pylori test results if clinically feasible. The 2017 ACG guidelines for the treatment of H pylori infection (HPI) have reaffirmed testing for HPI before initiating NSAID therapy. [ 33]

When should endoscopy be performed?

Endoscopy should be performed early in patients older than 45-50 years and in patients with associated so-called alarm symptoms, such as dysphagia, recurrent vomiting, weight loss, or bleeding. Age is an independent risk factor for the incidence and mortality from bleeding peptic ulcer, with the risk increasing in persons older than 65 years and increasing further in those older than age 75 years. [ 37] In one study, at least two risk factors (previous duodenal ulcer, H pylori infection, use of acetylsalicylic acid (ASA)/NSAID, and smoking) were present in two thirds of persons with acute gastroduodenal bleeding. [ 38]

Diagnosis

Treatment

• Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium if present, eliminating or reducing use of NSAIDsif possible, and helping your ulcer to heal with medication. Medications can include: 1. Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your docto...

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