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