Otc 1:2 Gerd & Probiotics

Front 1

what is heartburn?

Back 1

condition that occurs when refluxed stomach contents lead to troublesome Sx &/or complications

Front 2

what is GERD?

Back 2

chronic freq heart burn >2x/wk

Front 3

Sx of GERD include:

Back 3

1. heartburn/retrosternal pain
2. acid/food regurgitation (acidic taste in mouth)
3. dyspagia
4. dyspepsia
atypical sx:
5. pulmonary Sx (ie. unexplained cough)
6. dental erosions
7. hoarseness (acid in larynx)

Front 4

complications of heartburn include:

Back 4

1. esophagitis
2. esophageal stricture
3. esophageal bleeding/ulceration
4. barrett's esophagus (changes in esophagus, pre-cancer cells) only small %age develop
5. esophageal adenocarcinoma (even smaller %age develop cancer)

Front 5

what 2 factors inc the risk of cancer due to GERD?

Back 5

1. smoking
2. drinking

Front 6

the main problem causing GERD is

Back 6

decreased lower esophageal sphincter tone

Front 7

what causes GERD?

Back 7

1. dec LES tone
2. inc gastric P (high gastric vol, obesity, prego)
3. caustic agents (acid, pepsin)

NOT directly assoc'd w/ H. pylori

Front 8

drugs that lower LES tone include:

Back 8

1. CCBs (esp DHP)
2. antichol agents
3. barbiturates
4. estrogen & progesterone
5. opioids
6. theophylline

Front 9

alarming GERD Sx include:

Back 9

1. GI bleeding
2. early satiety
3. dysphagia or odynophagia (painful swallowing)
4. unintentional wt loss
5. unexplained Fe def anemia
6. vomiting

Front 10

exclusions for self TX include:

Back 10

1. freq Sx > 3 mo
2. Sx despite H2 blocker &/or PPI
3. alarm Sx
4. prego/lactating
5. children (12-18 may take H2 blockers)

Front 11

what are some lifestyle modifications that will improve GERD?

Back 11

1. smaller, more freq meals
2. lower fat diets
3. avoid chocolate, peppermint, caffeine
4. reduce/eliminate alcohol
5. stop smoking
6. avoid eating too close to bedtime
7. elevate head of bed
8. wt loss if overwt/obese

Front 12

1. how do promotility agents work?
2. are they well tolerated?
3. what is an examp of a promotility agent?

Back 12

1. increase LES tone
2. not well tolerated
3. metoclopramide

Front 13

what drug drug interaxns are there w/ antacids?

Back 13

1. tetracyclines
2. quinolone Abx
3. levothyroxine

Front 14

what are some adverse effects of antacids?

Back 14

1. constipation (Ca & Al)
2. diarrhea (Mg)
3. acid rebound (Ca)

Front 15

What are disadvantages of antacids?

Back 15

1. short DOA
2. poor for healing esophagitis

Front 16

what are advantages of antacids?

Back 16

1. useful for occasional relief

Front 17

what's the longest you should use OTC antacids w/o consulting a PCP?

Back 17

14 days

Front 18

gastric acid secretion is stimulated by:

Back 18

1. histamine
2. gastrin
3. acetylcholine

Front 19

what drug drug interaxns are there for H2 Rc antags?

Back 19

1. warfarin
2. alcohol
3. phenytoin
4. theophylline

Front 20

what's the longest you should use OTC H2 Rc antagonists w/o consulting a PCP?

Back 20

14 days

Front 21

what can you develop from long term H2 Rc antag use?

Back 21

tachyphylaxis

Front 22

advantages of H2 Rc antags:

Back 22

1. useful for preventing Sx
2. useful for healing mild esophagitis
3. best for intermittent therapy of mild/moderate GERD

Front 23

fill in the blank
1. _____ are best for GERD flare ups
2. ____ are better than ____ for short term use bc ____ take longer to work

Back 23

1. H2 Rc blockers are best for GERD flare ups
2. H2 Rc blockers are better than PPI for short term use bc PPI take longer to work

Front 24

advantages of PPI:

Back 24

1. most effective class
2. DOC for healing esophagitis or severe GERD
3. prolonged duration
4. reasonably safe long term

Front 25

disadvantage of PPI:

Back 25

1. delayed onset

Front 26

when should you take PPI?

Back 26

30 min before meal

Front 27

what's the max # days you can use OTC PPIs for (w/o consulting PCP)?

Back 27

14 days

Front 28

what conditions may ensue from long term PPI use?

Back 28

1. osteoporosis
2. pneumonia
3. acute interstitial nephritis
4. C difficile assoc/d diarrhea

Front 29

severe GERD Tx w/ ____?

Back 29

PPI

Front 30

occasional/internmittent GERD Tx w/ ____?

Back 30

H2 blocker

Front 31

generic names of PPIs end in _____

Back 31

-prazole

Front 32

1. which 2 PPIs are enantiomers?
2. which is stronger?

Back 32

1. esomeprazole & omeprazole
2. esomeprazole 2x stronger than omeprazole

Front 33

what bacteria increases the risk of cancer?

Back 33

H. pylori

Front 34

what warning signs would suggest an endoscopy was necessary?

Back 34

1. dysphagia
2. unexplained wt loss
3. blood in stool/black tarry stools

Front 35

1. step up
2. step down

Back 35

1. H2 blocker
2. PPI

Front 36

cost effective therapy

Back 36

1. lifestyle modifications
2. attempt step up therapy for mild Sx
3. attempt step down therapy for well cntrlled Sx
4. promote generics

Front 37

what are probiotics?

Back 37

nonpathogenic, living microorganisms that have beneficial effect on host when consumed in adequate amts

Front 38

what is an issue w/ probiotics?

Back 38

1. living org so probs w/ storage & mfring
2. need to get to site of action
3. must be nonpathogenic
4. don't "replace" existing flora

Front 39

proposed uses/benefits of probiotics:

Back 39

1. diarrhea
2. inflammatory bowel disease
3. IBS
4. atopic dermatitis
5. GI & GU infs
6. otitis media
7. dental caries

Front 40

common AE of probiotics

Back 40

1. bloating
2. flatulence
3. infs (rare)

Front 41

common microorganisms used in probiotics:

Back 41

1. lactobacillus (strain GG)
2. bifidobacterium
3. streptococcus spp.
4. saccharomyces boulardii