Peptic Ulcer Disease 51
BUY
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Gastrointestinal Disorders
Peptic Ulcer Disease
1. Admit to:
2. Diagnosis: Peptic ulcer disease.
3. Condition:
4. Vital Signs: q4h. Call physician if BP >160/90, <90/60; P >120, <50; T
>38.5
C
5. Activity: Up ad lib
6. Nursing: Guaiac stools.
7. Diet: NPO 48h, then regular, no caffeine.
8. IV Fluids: D5 1 NS with 20 mEq KCL at 125 cc/h. NG tube at low intermittent
suction (if obstructed).
9. Special Medications:
-Ranitidine (Zantac) 50 mg IV bolus, then continuous infusion at 12.5 mg/h
(300 mg in 250 mL D5W at 11 mL/h over 24h) or 50 mg IV q8h OR
-Cimetidine (Tagamet) 300 mg IV bolus, then continuous infusion at 50 mg/h
(1200 mg in 250 mL D5W over 24h) or 300 mg IV q6-8h OR
-Famotidine (Pepcid) 20 mg IV q12h OR
-Nizatidine (Axid) 300 mg PO qhs OR
-Omeprazole (Prilosec) 20 mg PO bid (30 minutes prior to meals) OR
-Lansoprazole (Prevacid) 15-30 mg PO qd prior to breakfast [15, 30 mg
caps].
Eradication of H. pylori
A. Bismuth, Metronidazole, Tetracycline, Ranitidine
1. 14 day therapy.
2. Bismuth (Pepto bismol) 2 tablets PO qid.
3. Metronidazole (Flagyl) 250 mg PO qid (tid if cannot tolerate the qid
dosing).
4. Tetracycline 500 mg PO qid.
5. Ranitidine (Zantac) 150 mg PO bid.
6. Efficacy is greater than 90%.
B. Amoxicillin, Omeprazole, Clarithromycin (AOC)
1. 10 days of therapy.
2. Amoxicillin 1 gm PO bid.
3. Omeprazole (Prilosec) 20 mg PO bid.
4. Clarithromycin (Biaxin) 500 mg PO bid.
C. Metronidazole, Omeprazole, Clarithromycin (MOC)
1. 10 days of therapy
2. Metronidazole 500 mg PO bid.
3. Omeprazole (Prilosec) 20 mg PO bid.
4. Clarithromycin (Biaxin) 500 mg PO bid.
5. Efficacy is >80%
6. Expensive, usually well tolerated.
