Peptic Ulcer Disease Triple Therapy Mnemonic

Here's the Mnemonic for Peptic Ulcer Disease Triple therapy that can include PPIs and H2 blockers in addition to the ones listed in the actual mnemonic. The important thing is that we reduce acid and kill the H. Pylori bacteria to help institute ulcer healing.

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Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. I’m excited to bring you another mnemonic that’s going to help you through pharmacology class. So, what I wanted to do is talk a little bit about Peptic Ulcer Disease where we’re going to have these triple and quad therapies. In this section, we’re going to talk about the triple therapy where you take a couple of antibiotics and you add something to reduce the acid and there are a number of choices that you can make. So, I just wanted to be clear that it doesn’t have to be this proton pump inhibitor. There are many proton pump inhibitors that you can use and some prescribers even use H2 blockers such as Famotidine and so forth. So, as we go through this lesson, think of it more as what kind of antibiotics am I going to use and what kind of acid reducers would I use more generally and then have a better understanding of how we protect the stomach and allow it to heal and get rid of the ulcer.

Question number six: Name three antibiotics in a triple Peptic Ulcer Disease regimen and how we dose the PPI? Number six: Triple Peptic Ulcer Disease (PUD) therapy. We’ll use the mnemonic ‘aced PUD’. ‘A’ Amoxicillin brand name Moxatag, ‘C’ Clarithromycin brand name Biaxin, ‘E’ Esomeprazole brand name Nexium, ‘D’ Double dosing of the PPI.

Quick summary: Triple therapy means we are using three drugs usually one acid reducer and two antibiotics. Quad therapy adds another antimicrobial for four drugs in total. After a recent update to H pylori preferred drug regiments, a round of first-line triple therapy now includes Metronidazole but it would be confusing to throw it in this mnemonic.

Peptic Ulcer Disease describes ulcers that develop in the stomach or duodenum and extend deep into the mucosa. Ulcers can lead to GI bleeds. Three main Peptic Ulcer Disease causes are stress, NSAID use, and H pylori - a helicopter-like organism that burrows into the stomach lining.

The Mainstay treatment for H pylori ulcers includes antibiotics to wipe out infection and ppis to reduce acid. Treatment typically lasts 10 to 14 days. Traditionally, H pylori infection treatments have included triple therapy - a PPI, Amoxicillin, and Clarithromycin.

For triple therapy, I used ‘Ace’ as the mnemonic as the three-drug combination aced killing Helicobacter pylori - the causative organism. You can include any of the ppis in the treatment regimen but Esomeprazole’s ‘E’ made creating mnemonics easier.

‘A’ Amoxicillin - a penicillin antibiotic. The ‘cillin’ stem lets us know Amoxicillin is a penicillin antibiotic with Amoxicillin side effects we worry about penicillin allergic patients.

‘C’ Clarithromycin - a macrolide antibiotic. Clarithromycin has a throw T-H-R-O substance with mycin M-Y-C-I-N as a suffix or you could look at the throw T-H-R-O which rhymes with the crow CRO in macrolide. Be careful with mycin it only lets you know the bacteria comes from the Streptomyces class but it does not tell you the antibiotic class.

For Clarithromycin, we think of the metallic taste and QT prolongation.

‘E’ Esomeprazole - a proton pump inhibitor.

And ‘D’ Double dosing of the PPI means we use bid twice daily dosing rather than traditional QD once daily dosing.

Why do we use two or three antibiotics?"

If you use more than one antimicrobial, you can reduce resistance and decrease dosages to lower the risk of side effects. Why do we use quad therapy? If a patient is penicillin allergic, we might use the bed M regimen which we’ll look at next.

Alright, let’s continue with a couple of quiz questions from the teachable course. What are two antibiotics used in triple therapy to treat Peptic Ulcer Disease? Is it Vancomycin and Cefepime, Amoxicillin and Clarithromycin, Cefdinir and Ciprofloxacin or Tobramycin and Levofloxacin? Yep, if you answered Amoxicillin and Clarithromycin, you can check your answer and that is correct.

Alright, continuing to the next question. How do you dose a proton pump inhibitor in triple therapy to treat Peptic Ulcer Disease? Do you have the dose triple the dose double the dose or quadruple the dose? So again, how do you dose a proton pump inhibitor in triple therapy to treat Peptic Ulcer Disease? Is it half triple double or quadruple? Awesome, if you answered double the dose, you can check that. You see that it is correct.

And what you want to do is you want to make sure you get that significant acid suppression to help that ulcer heal. Again, if you want to continue on in a course that helps you out in Pharmacology, there’s really three ways that I’ve kind of set it up. You can just get the audiobook Memorizing Pharmacology: Relaxed Approach Second Edition. Again, Audible’s very good about giving you a free book if you’ve never been with Audible before.

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But if you’ve got questions I’m always happy to send emails back. A lot of people have me help them with their homework too if you’re having some struggles with pharmacology and there’s a question or two that you really don’t understand why it was right or wrong or something like that Tony the pharmacist gmail.com I’m happy to help you out again I just want you to succeed need in Pharmacology okay thanks again for listening to the memorizing pharmacology podcast excited to have you again make sure to get on our email list at residence not at residency.teachable.

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