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71 Cards in this Set

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T or F
Vomiting is a symptom of GERD?
False
What is waterbrash?
bitter taste with hypersalivation, body's way of compensating for higher pH
Chest pain is a warning sign symptom and atypical symtom of GERD...T or F
True
Pulmonary symptoms are a warning sign of GERD?
False, they are atypical symptoms of GERD
GERD can trigger an asthma attack?
True
When should you avoid self-treatment for GERD?
When patients present with warning signs or atypical symptoms, esp if they are exhibiting symptoms for 2 weeks or longer, or > 2 week...should refer to a physician
primary method for confirming the diagnosis of GERD
Endoscopy
Treatment Goals of GERD
1. alleviate Sx
2. promote healing
3. avoid recurrence of reflux
4. avoid complications
Non-pharmacologic Treatment of GERD
1. wt. loss
2. smoking cessation
3. elevate head of bed by 6-8 inches
4. sleep on left side
5, dietary changes
6. avoid aggravating meds
7. avoid alcohol and tobacco
8. avoiding tight fitting cloths
T of F..is there acid rebound symptoms with aluminum salts antiacids?
nope
Antiacids interfere with absorption through chelation with what drugs?
quinolones, tetracyclines, bisphosponates
H2 receptor antagonists
reduce gastric acid secretion
H2 antagonists
Ranitidine
Cimetidine
Famotidine
Nizatidine
Ranitidine max dose
300 mg QID
What age are H2 antagonists approved for?
12 + years
Use H2 antagonists for how many weeks for GERD?
8-12 weeks, minimum 6 weeks
Cimetidine has 2 bad side effects, what are they?
gynocomastia, impotence
Rare AE's of H2 antagonists
CNS (confusion), hematologic, C.diff?
Both H2 antagonists and PPI's have healing cabability for GERD? T or F
True
Typical omeprazole dose and max dose
20 mg QD, up to 60 mg a day
How long do PPI's take for maximal acid suppression
3-4 days, so not good for immediate relief of symptoms
PPI duration of treatment for PPI's
4-8 weeks
Dexilant dosing
60 mg daily for 8 weeks for healing, then 30 mg daily for 6 months for maintainence
GERD dosing of dexilant
30 mg daily for 1 month
dexilant is a PPI?
True
most common AE's of PPI's
dizzy, headache
what drug interactions are there with PPI's?
pH decreased absorption of ketoconazole, digoxin, iron, drug interaction with diazepam, warfarin, phenytoin, possible plavix interaction
What class of drugs has a pneumonia risk with their use?
PPI's
what percentage of GERD patients have delayed gastric emptying?
40%
metoclopramide(Reglan) MOA
dopamine antagonist that increases LES tone and improves gastric emptying
Reglan's role in GERD
dopamine antagonist that increases LES tone and improves gastric emptying
Reglan's dose in GERD
10-20 mg QID
what is the black box warning of Reglan?
tardive dyskensia
Cisapride isn't used because...
– although cisapride is probably the most effective promotility agent in terms of symptomatic improvement and healing, it has many serious drug interactions and has been associated with potentially life threatening arrhythmias
What drug plays a controversial role in GERD?
Carafate
What is carafate's MOA?
binds to and protects damaged mucosa in the esophagus
What drug is the most effective in terms of promotility and healing?
Cisapride
Why is Cisapride no longer used?
high incidence of arrhythmias
What is the most common problem with GERD?
decreased LES tone
Severity of symptoms does not correlate with severity of disease?
True
1st line in pregnancy
liquid antiacids
Do antiacids heal the esophagus?
no need something else for GERD
magnesium side effect?
diarrhea
aluminum side effect?
constipation
which antiacid is not good for CrCL < 30 ml/min?
magnesium
antiacids indicated for what age?
2+ years
H2 antagonists indicated for what age?
12+ years
Side effects of H2 antagonists?
Nausea, Headache, dizzy, diarrhea
H2 antagonists take how long to work?
up to 60 min
How many times a day are H2 antagonists dosed?
BID for standard dosing
typical treatment duration for GERD with H2 antagonists?
8-12 weeks
PPI's are typically dosed how many times a day?
once, but sometimes require BID dosing
When do you give PPI's?
15 minutes before breakfast
GERD treatment of duration with PPI's?
4-8 weeks
Reglan is dosed how many times daily?
4x daily
When do you give reglan?
30 min before meals and bedtime
Reglan's side effects
 High incidence of adverse effects, up to 30% (e.g. somnolence, anxiety/agitation, fatigue, dizziness, extrapyramidal reactions, diarrhea, confusion)
Carafate dosing
1 gm 1 hour before meals and bedtime
4 types of surgery for GERD
Nissen, Belsey, Toupet, Enteryx
are vomiting and wt. loss associated with PUD?
yes
Non-pharmacologic treatment of PUD
1. reduce stress
2 stop NSAIDS or switch
3. stop smoking
4. surgery
5. avoid spicy foods
What ANC do we need for duodenal ulcers for PUD?
100 - 144 mEq of acid neutralizing capacity 1 and 3 hours after meals and at bedtime
H2 antagonist duration of treatment for duodenal ulcers?
6-8 weeks, sometimes longer
H2 antagonist duration of treatment for gastric ulcers?
8-12 weeks
Best test for PUD?
endoscopy with biopsy
H2 antagonist dosing in PUD
BID + HS
PPI dosing in PUD
for duodenal and gastric ulcers 4 weeks
For bleeding ulcers, what do you use?
IV PPI or IV nexium
Sucralafate dosing in duodenal ulcers
1 g 1 hr before meal (empty stomach) and at bedtime, treatment 6-8 weeks
Misoprostol used for duodenal and gastric ulcers...dosed
200 mcg QID, has anti-secretory and cytoprotective effects
Misoprostol side effect
Diarrhea