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22 Cards in this Set
- Front
- Back
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Things that people can avoid to help treat GERD (lots):
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Patients should avoid the following:
Smoking, Alcohol, Fatty foods, Chocolate, Large meals, Lying down immediately after eating, coffee, citrus juice, spicy foods |
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How can pregnancy an obesity lead to GERD?
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They cause increased abdominal pressure which pushes on the stomach
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How do fatty foods, anticholinergics, scleroderma, progesterone, and caffeine all lead to GERD?
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Reduced esophageal pressure
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Two aims of GERD therapy:
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Decrease gastric acidity, and increases lower esophageal sphincter tone.
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Three medications that delay gastric emptying and decrease LES tone (people with GERD should avoid these):
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Theophylline
Anticholinergic agents Progesterone |
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Two drugs which increase the LES tone:
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Bethanechol
Metoclopramide |
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Treatment for stage 1 (relatively minor) GERD:
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Lifestyle modifications
Antacids H2 antagonists Bethanechol |
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This drug is often used for patients who do not respond to Stage 1 therapy, however it's increasingly being used as a first line agent due to cost reductions:
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Proton Pump Inhibitors (ex: Omeprazole)
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Besides increasing the frequency of proton pump inhibitors, what drug could you add as part of stage 3 treatment for GERD?
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Prokinetic agents like Metoclopramide
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This prokinetic agent was withdrawn from the market in 2001 due to side effects. However it can be ordered from the manufacturer for patients who failed other treatments:
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Cisapride (Propulsid)
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Two groups of patients who are candidates for Metoclopramide:
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Reserved for those in whom delayed gastric emptying is the primary cause of GERD
Also for diabetic gastroparesis |
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Why does metoclopramide help reduce vomiting?
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It is a dopamine antagonist
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This drug uses the 'gut brain' to propel stomach contents into the small intestine by coordinated gastric and pyloric and duodenal motor activity:
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Metoclopramide
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Which class of drugs can block metoclopramide
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Anti-cholinergics
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Three ways emesis can be elicited:
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Direct action on the chemoreceptor trigger zone
Indirectly by stimulation of GI tract Combination of the two |
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Cletus was busy pumping gas into his 1983 Ford Pinto when suddenly he got thirsty. Rather than go inside and buy a six pack of Busch Beer, he decides to drink the gasoline (after all, it does look like water).
Luckily his wife saw him do this and decided to call for help. Until help comes, she decides to give him an emetic agent to induce vomiting. Why was this a bad idea? |
Because people can aspirate the volatile contents back into the lungs after retching and vomiting.
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Review: How come the second dose of morphine doesn't trigger vomiting like the first one does?
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Because by the second dose, some morphing reaches the CTZ center where it inhibits vomiting.
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This drug produces vomiting within 30 minutes of ingesting. It can be given with activated charcoal to absorb toxic substances (sounds fun).
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Syrup of Ipecac
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Class of drugs used to treat vestibular problems (which causes nausea and motion sickness)
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Antihistamines
Note: Antihistamines with antimuscarinic effects used for motion sickness, nausea and vomiting in ambulatory patients receiving morphine, vomiting assoc with migraine or flu, or dopamine antagonists to decrease motor effect. |
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This drug is used post-op when antimuscarinics would be of benefit. It has higher efficacy for motion sickness than antihistamines, but worse side effects:
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Anticholinergics
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(T/F) dopamine antagonists plus droperidol and metoclopramide are useless for post-op emesis as well as vomiting from vestibular disturbance.
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False! They are useful for post-op emesis, but useless for vestibular disturbance.
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Three agents used to treat vomiting caused by chemotherapy:
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Dexamethazone
Cannabinoids Metoclopramide |
