http://www.cmepilot.com/activity-demos/aspire/launch.html
Great talk re: use of H2RAs vs PPIs vs sucralfate for stress ulcer ppx in high risk ICU pts. It's part of the daily bundle at the Univ of Michigan to eval if pt needs SU ppx, what kind, and when it can be stopped. They usually start out with H2RAs (also Zantac), but then escalate to PPIs if needed. Sucralfate has some evidence for adverse outcomes and is discouraged. Also, I had never known that tachyphalaxis occurs with H2RAs and often the dose needs to be increased after a couple of days in order to remain effective. The highest risk groups who need to be on SU ppx are pts on mechanical ventilation or on anticoagulants (including ASA 325 and plavix), but there are other subgroups. The above website is a reference of a CME conf, but the guidelines are being updated, and another website should be coming out soon.
Thursday, March 20, 2008
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