CC Sept 2017 Proton Pump Inhibitors and Fracture Risk

echoecho's version from 2017-10-15 21:35


Question Answer
PPIs are potent inhibitors of _____ _____ secretion?gastric acid
What is the mechanism of action of PPIs?irreversible blocking of the hydrogen-potassium ATP pump of the gastric parietal cells
Absorption and effectiveness of PPIs is reduced by taking the medication with ____?food
PPIs are indicated for what diseases?1) dyspepsia 2) GERD 3) Helicobacter pylori eradication 4) Barrett's esophagus 5) gastrinomas 6) PUD
True or false, PPIs are among the most commonly prescribed medications in the US?true
*** In 2006, a retrospective study in the United Kingdom suggested a link between long-term PPI use (defined as > 1 year) in patients > 50 years of age and the risk of ______ ______ fractures?osteoporotic hip (with a higher risk seen as length of treatment increased {adjusted odds ratio for hip fracture 1.22 at 1 year of use, 1.41 at 2 years of use, 1.54 at 3 years of use and 1.59 at 4 years of use)
What is the proposed mechanism of increased hip fractures?a decrease in absorption of dietary calcium due to a higher gastric pH caused by PPI use
If a calcium supplement is necessary, the _____ form may be substituted for calcium carbonate because its absorption does not require an acidic pH?citrate
A 2010 case-controlled study showed an increased risk of osteoporotic hip fracture with prolonged PPI use, but only when other ____ factors for osteoporosis were present?risk
In 2010, the US FDA revised the labeling of all PPI to include a warning about increased risk of fractures of the ____, ____, ____?1) hip 2) wrist 3) spine
Higher doses of PPI were associated a ____ risk of fracture compared to lower dose PPI?increased
The 2013 guidelines from the American College of Gastroenterology on the treatment of GERD recommends that PPI use for erosive esophagitis should be limited to ____ weeks and that maintenance PPI should be limited to patients who continue to have symptoms after PPI is discontinued and in patients with complications including Barrett's esophagus?eight
Maintenance therapy should be at the _____ dose possible and used only as needed, if feasible?lowest
Unfortunately, patients who attempt to wean off PPIs may experience a flare in their symptoms with rebound _____ _____?acid hypersecretion
Although the data are conflicting, between ___ to ___% experience this side effect after just 8 weeks of use?22-44%
Patients should be warned of the above potential side effect and weaning should take place slowly over weeks, decreasing the dose by ______ every 3-5 days until as needed use is tolerated?1/2
*** SUMMARY = PPIs are appropriate for treatment of what diseases?GERD, PUD, Barrett's esophagitis, dyspepsia
*** SUMMARY = A variety of adverse effects from long-term use of PPIs have been report, list these?1) increased risk of fractures 2) community acquired pneumonia 3) iron deficiency anemia in the elderly 4) risk of C. difficile infections
*** SUMMARY = The use of PPI should be for specific indications and closely monitored to determine the appropriateness of dosing and duration of therapy, true or false?true