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20 Cards in this Set
- Front
- Back
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Treatment goals for GERD
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-alleviate symptoms
-promote healing of inflamed mucosa -decrease frequency - - |
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treatment of GERD phases
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I: intermittent mild heartburn can use OTC Histamine (H2) blockers or antacids
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GERD lifestyle modifications
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-elevate HOB 30 degress
-dietary changes -smoking cessation -avoid alcohol -avoid drugs that lower esophageal: ASA, NSAIDS, nitraites, ca channel beta blockers) |
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Antacids
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-for mild and occasional relief of heartburn
-neutralizes gastric acids -contain AI, Mg, Ca salts alone or in combo: Gaviscon -food prolongs pH lowering effects to 2 hrs -AE: aluminim containing can cause constipation and Mg can cause diarrhea; interferes with absorption of other drugs; Al salts may cause problems in renal insifficiency pts; Ca --> gas |
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H2 Blockers
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-decrease gastric acid secretion
-nocturnal basal secretion as well as meal related acid production -Cimetidine, Ranitidine, famotidine (Pepcid), nizatidine -should be taken once in morning and once at night |
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H2 blockers cont
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-Cimetidine has most sig effect on cytochrome P450-->DI
-Ranitidine can be used in infants with GERD (fewest DI) -Famotidine has longest duration of effect -if using H2 blockers for healing esophagitis use high doses -AE: HA, fatigue, dizziness, constipation or diarrhea |
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Proton pump inhibitors (PPIs)
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-superior effects and drug of choice for mod to svere GERD
-MOA: bind to cysteine residues on parietal cell's H+/K+ pump --> marked acid suppression -Esomeprazole (Nexium), Omeprazole (Prilosec), Iansoprazole (Prevacid), rabeprazole and pantoprazole (Protonix) |
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PPI pharm
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-P450 metabolism so DI may occur
-less w/pantoprazole -dose prior to meals -cat B -Pantoprazole, iansoprazole, esomeprazole avail in IV form -also useful for PUD -AE: N, constipation,flatulence, diarrhea, HA |
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Sulcrafate
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-for GERD
-cross-links and adheres to epithelial cells and ulcer craters --> sticky and viscous gel -protects tissue from hydolysis and local inflamm damage -AE: constipation |
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most pts with chornic GERD require
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-long term acid suppressive therapy!
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3 types of peptic ulcers
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1. Helicobacter pylori
2. NSAIDs 3. Stress Ulcers |
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NSAIDs and PUD
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-acidic and other direct toxic effects on gastric mucosa
-ASA is most damaging -adherence of neutrophils to blood vessels -inhibition of COX enzymes which leads to decreased production of protective prostaglandins |
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Complications of PUD
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-upper GI bleed
-perforation -obstruction -H.pylori increases the risk of gastric cancer |
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Treatment of H. pylori
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-eradication of H.pylori
-3 drug regimen: -2 abx (clarithromycin + metronidazole or clarithromycin + amoxicillin* and PPI for 14 days (prevpack)-take on empty stomach -Bismuth based 4 drug regimens (2 abx + bismuth + PPI) 4x/day; stool and tongue turns black, N/V/C, salicylate toxicity |
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Pylera
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-Bismuth, metronidazole, tetracycline
-add omeprazole BID -3 pylera capsules 4x after meals and at bedtime plus 1 omeprazole capsule at breakfast and at dinner with full glass of H20 -less $$ than prevpac |
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Bismuth preps and PUD
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-Pepto and ranitidine busmuth citrate...
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NSAID-induced ulcers
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-stop NSAID or go to a partially selective NSAID such as meloxicam or COX 2 inhibitors
-add PPI -add PPI if you must continue NSAID therapy |
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Maintenance of Ulcer healing and prevention of recurrent ulcers
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-maintenance indications: recurrent, bleeding, pts on NSAIDs, heavy smoking
-therapy includes: H2 blockers, PPIs, sucralfate |
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prevention of NSAID-induced ulcers in high risk pts
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-Cotherapy with PPIs or H2 blockers
-PPIs more effective -H2 blockers should not be used as cotherapy with a nonselective NSAID for prophylaxis -cotherapy with misoprostol (cat X) a prostaglandin E1, PGe1 analog: combo product is Arthrotec |
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Misoptostol
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-diarrhea common AE
-preg cat X |
