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64 Cards in this Set
- Front
- Back
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What is GERD?
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a condition which develops when the reflux of stomach contents cause troublesome symptoms and/or complications
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According to the AGA Guidelines, what is the standard definition of GERD?
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"There can be no criterion standard definition of GERD because the threshold dinstinction between physiologic reflux and reflux disease is ultimately arbitrary"
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Who is more prone to GERD, men or women?
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equal
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What age group is GERD more common in?
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> 40 yoa
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What are common drugs that can cause heartburn symptoms?
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ASA, NSAIDS, Iron, KCL, bisphophonates
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What are the three categories of clinical presentation of GERD?
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Typical, atypical, alarm
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What are the characteristics of the clinical presentation of typical GERD?
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substernal pain due to regurgitation, belching, hypersalivation, acid taste in mouth, nocturnal, positional
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What are the characteristics of the clinical presentation of atypical GERD?
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asthma symptoms, laryngitis, pharngitis
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What are the characteristics of the clinical presentation of alarm GERD?
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dysphagia, odynophagi, bleeding (hematemesis, melena), anemia, unexplained weight loss, chest pain
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What are the treatment goals in GERD?
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alleviate or eliminate the patients symptoms, decrease the frequency or recurrence and duration of reflux
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What are the non-pharmacological therapies for GERD?
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weight loss in obese patients, more pillow, avoiding late meals, avoiding specific foods, avoiding precipitating factors or events, smoking cessation, decreasing alcohol intake, patient directed OTC selection
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What are the four main classes of medications available OTC?
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antacids, bismuth subsalicylates (BSS), h2 receptor antagonists, proton pump inhibitors
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What are h2 receptor antagonists indicated for?
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wide spectrum gerd and heartburn severities
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Which is preferable for endoscopic healing rates, PPI or H2?
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PPI
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Is there a difference in H2 receptor antagonist efficacies?
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no; selection should depend on dosing, cost, drug interactions
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How often is H2 receptor antagonists dosed?
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once or twice daily
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When should H2 receptor antagonists be taken?
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30 mins to 1 h before meal
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How long is the duration of action for H2 receptor antagonists?
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8-10 h
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What is the generic name for Axid?
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nizatidine
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What is the generic name for pepcid?
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famotidine
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What is the generic name for tagamet?
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cimetidine
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What is the generic name for Zantac?
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ranitidine
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What drugs does cimetidine interact with?
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warfarin, theophylline, phenytoin, antifungals (3A4 among others)
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What are PPIs indicated for?
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wide spectrum GERD and heartburn severities (intermitten heartburn to erosive esophagitis)
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What is the generic name for Protonix?
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pantoprazole
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What is the generic name for prevacid?
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lansoprazole
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What is the generic name for prilosec?
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omeprazole
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What is the generic name for aciphex?
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rabeprazole
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What is the generic name for dexilant?
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dexlansoprazole
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What is the generic name for Nexium?
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esomeprazole
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What two infective conditions have PPIs been linked to?
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Clostridium Difficile Colitis and pneumonia
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Which PPI shows a possible interaction with plavix?
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omeprazole
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Should calcium carbonate or calcium citrate be used for long term PPI therapy?
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Calcium citrate as it requires less acid for breaking down
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What PPI would be good for a patient that can't swallow?
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Prevacid as it comes in ODT
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What condition can H2 receptor antagonists cause related to platelets?
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thrombocytopenia
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Why can PPI use cause anemia?
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increased stomach ph (less acid) causes less iron to be absorbed
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Which PPI can cause a false positive drug test for THC?
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Protonix
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How should a patient on levothyroxine take PPI?
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take levothyroxine at night instead of in morning with ppi
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What are the causes of PUD?
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H. pylori, NSAIDS, Zollinger-ellison syndrome, stress, smoking
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What is the dominate cause of PUD?
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h. pylori and nsaids
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What are the S&S of PUD?
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Ulcer-related pain; if in the duodenum, pain occurs 1-3h after meals, relieved by food; if in the stomach, precipitated by food
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What are some potential complications of PUD?
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bleeding (melena or hematemesis), perforation (extremely painful, opening in peritoneal cavity), gastric outlet obstruction (cause by scarring)
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What kind of bacteria is H. pylori?
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spiral shaped gram negative bacilli
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What is the #1 cause of PUD?
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h pylori
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How is h pylori transmitted?
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contaminated water and food or by person-to-person contact
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What does h pylori do to create ammonia?
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h pylori produces a large amount of urease which catalyzes the hydrolysis of urea to ammonia
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What does the ammonia created by h pylori do?
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acts as a buffer for h pylori and possibly causes disruption of the integrity of the gastric mucosa
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Who is indicated for h pylori testing?
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pts with active peptic ulcer disease, past history of documented peptic ulcers, or gastric MALT lymphoma
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What are the tests for h pylori diag?
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endoscopic (histologic, culture, biopsy) or nonendoscopic (serum antibody testing, urea breath test, stool antigen)
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What are the treatment goals in h pylori?
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eradication of h pylori, relief of symptoms, promote ulcer healing, prevent recurrence, prevent complications
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What is the generalized 3 drug PPI based regimen for h pylori?
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PPI+clarithromycin+(amoxicillin OR metronidazole)
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What is the generalized 4 drug bismuth based regimen for h pylori?
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(PPI or H2)+bismuth+metronidazole+(tetracycline OR amoxicillin or claithromycin)
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What is in Prevpac?
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Lansoprazole 30mg (bid), amoxicillin 1g (bid), clarithromycin 500mg (bid); 14 day with low-med adverse effects
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What is in Helidac?
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Bismuth 262mg x2 QID, Metronidazole 250mg qif, tetracycline 500mg qid; 14 day therapy; must include h2 bid x 30 days
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How do NSAIDS induce formation and impair ulcer healing?
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direct irritations of the gastric epithelium and systemic inhibition of endogenous mucosal prostaglandin synthesis
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What is the treatment for NSAID induced PUD?
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d/c nonselective NSAID or decrease dose or switch to cox-2 inhib, start PPI or H2 or Sucralfate; PPI= standard of care (use 4-8 wks, 8-12 if NSAID continued)
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What is the generic for arthrotec?
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diclofenac sodium/misoprostol
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What kind of drugs are in arthrotec?
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nsaid + prostaglandin
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Who usually uses arthrotec?
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pts with RA or OA who are at high risk for GI ulcers/bleeds
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What are the disease-state risk factors for NSAID ulcer risk?
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age > 60, previous peptic ulcer, cv illness
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What is Zollinger-ellison's syndrome?
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gastrin-producing tumor (causes peptic ulcers)
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What is the tx for zollinger-ellison's syndrome?
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HIGH dose of PPI (3-6x normal), octreotide q 4 wk, chemotherapy/surgical resection
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Who should receive stress ulcer prophylaxis?
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pts in ICU on mechanical ventilation > 48h, coagulopathy, traumatic brain injury/spinal injury, major burn injury, multitrauma, sepsis, transplant, hepatic injury
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H2 or PPI for stress ulcer prophylaxis?
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no evidence suggesting one over the other
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