Self Instructional

Front 1

symptoms of GERD?

Back 1

heartburn
angina-like pain
odynophagia
dysphagia
pharyngitis
water brash
non-allergic asthma
chronic cough
aspiration pneumonia

Front 2

factors causing an increase in pressure?

Back 2

full stomach
obesity
lying down
bending forward
lifting heavy objects
pregnancy

Front 3

pathology of heartburn and GERD?

Back 3

LES (lower esophageal sphincter) relaxes too frequently allowing acid to reflux

Front 4

factors causing reduced esophageal pressure?

Back 4

fatty foods
anticholinergics
scleroderma
progesterone
caffeine

Front 5

signs and symptoms of GERD?

Back 5

heartburn or sour taste
pain in middle of chest
coughing/choking while lying down
increased asthma symptoms while asleep

Front 6

medications for GERD?

Back 6

cimetadine (tagamet)
ranitidine (zantac)
famotidine (pepcid)
nizatidine (axid)
omeprazole (prilosec)
metoclopramide (reglan)

Front 7

H2 blockers in GERD therapy?

Back 7

cimetidine
famotidine
nizatidine
ranitidine

Front 8

complications of GERD?

Back 8

severe chest pain
esophageal stricture
bleeding
barrett's esophagus

Front 9

symptoms suggesting severe damage due to GERD has already occurred?

Back 9

dysphagia
bleeding (vomiting or tarry stools)
choking
weight loss

Front 10

stage 1 treatment for GERD?

Back 10

lifestyle modification:
elevate head of bed
decrease fat intake
smoking cessation
weight reduction
avoidance of recumbency for 3 hrs postprandial
avoid large meals and certain foods

Front 11

stage 2 treatment for GERD?

Back 11

as needed pharmacologic therapy:
antacid/antacid product containing alginic acid;
OTC H2 blocker

Front 12

stage 3 treatment for GERD?

Back 12

scheduled pharmacologic therapy:
H2 blocker or prokinetic agent (8-12 weeks);
high dose H2 blocker or PPI for addtl 8-12 weeks for persistent sx;
with erosive esophagitis, PPI as 1st line

Front 13

stage 4 treatment for GERD?

Back 13

maintenance therapy:
lowest effective H2 blocker or PPI
for symptomatic relapse or complicated dz

Front 14

stage 5 treatment for GERD?

Back 14

surgery:
laparoscopic nissen or toupet funcoplication;
appropriate for severe sx (erosive esophagitis, dz complications)

Front 15

promotility agents?

Back 15

increase LES pressure
prevent acid reflux
improve movement of food from stomach

Front 16

metoclopramide?

Back 16

DA antagonist
increase LES tone
stimulate gastric emptying

Front 17

metoclopramide uses?

Back 17

reflux esophagitis
treatment prior to gi exams
diabetic gastroparesis

Front 18

metoclopramide side effects?

Back 18

sedation
EP actions
increased prolactin secretion

Front 19

domperidone?

Back 19

peripheral DA antagonist;
regulates motility of gastric and small intestinal smooth muscle;
similar symptomatic improvement to metoclopramide;
short-term relief of symptoms in dyspepsia or gastroesophageal reflux

Front 20

exenatide

Back 20

GLP-1 analog resistant to DDP-IV degradation;
promote b-cell regeneration

Front 21

sitagliptin

Back 21

DDP-IV inhibitor;
side effect of acute pancreatitis

Front 22

vildagliptin

Back 22

DDP-IV inhibitor
not FDA approved

Front 23

liraglutide

Back 23

GLP-1 analog
slower degradation due to non-covalent binding to serum albumin

Front 24

pramlintide

Back 24

amylin analog
slowed gastric emptying
regulation of postprandial glucagon
reducation of food intake

Front 25

bisphosphonate examples

Back 25

etidronate
pamidronate
alendronate
risedronate
tiludronate
ibandronate
zoledronate

Front 26

bisphosphonate activity

Back 26

suppress activity of osteoclasts via inhibition of farnesyl pyrophosphate synthetase;
poor oral absorption and pt tolerance;
hypercalcemia assoc with malignancy, paget's dz, osteoporosis

Front 27

calcitonin-slamon

Back 27

suppress bone resorption
seldom restores calcium to normal and refractoriness frequently develops

Front 28

calcitriol

Back 28

1,25(OH)2D3
rapid action for hypocalcemia correction
for chronic kidney disease with vit D def or insuff

Front 29

cholecalciferol

Back 29

natural form of vit D3
stimulate intestinal Ca absorption, bone resorption, renal calcium and phosphate;
decrease PTH;
promote innate immunity;
inhibit adaptive immunity

Front 30

glucocorticoids

Back 30

chronic hypercalcemia of sarcoid, vit D intoxication, and certain cancers;
other causes of hypercalcemia (primary hyperparathyroid) do not respond

Front 31

teriparatide

Back 31

recombinant PTH1-34
stimulates bone formation

Front 32

saline rehydration

Back 32

most severe hypercalcemia have substantial prerenal azotemia due to dehydration so kidney cannot compensate;
reduce Ca to a point where definitive diagnosis can be made

Front 33

furosemide

Back 33

follow saline rehydration
enhance urine flow
inhibit calcium reabsorption

Front 34

pentamidine uses

Back 34

PCP
t. brucei (african sleeping sickness)
leishmaniasis (visceral > cutaneous)

Front 35

sodiumstibogluconate

Back 35

first line for cutaneous and visceral leishmaniasis

Front 36

pyrimethamine

Back 36

inhibit plasmodial dihydrofolate reductase
+ sulfadiazine for toxoplasmosis
+ sulfadoxine (fansidar)

Front 37

toxicities of fansidar?

Back 37

erythema multiforme
stevens-johnson syndrome
toxic epidermal necrolysis

Front 38

nitazoxanide

Back 38

giardia
cryptosporidium

Front 39

suramin

Back 39

first line for early hemolymphatic east african trypanosomiasis

Front 40

melarsoprol

Back 40

1st line for advanced cns east african trypanosomiasis;
second line for advanced west african trypanosomiasis;
very toxic

Front 41

melarsoprol toxicity?

Back 41

reactive encephalopathy
renal and cardiac disease
hypersensitivity reactions

Front 42

eflornithine

Back 42

inhibits ornithine decarboxylase
first line for west african trypanosomiasis (not east)

Front 43

nifurtimox

Back 43

mc used for chagas but fails to prevent progression to gi and cardiac symptoms

Front 44

albendazole

Back 44

doc for hydatid dz and cysticercosis
inhibit microtubule synthesis
empiric for those returning from tropics with eosinophilia

Front 45

mebendazole

Back 45

inhibit microtubule synthesis
ascariasis, trichuriasis, hookworm, pinworm
decreased plasma levels with carbamazepine, phenytoin and increased by cimetidine - caution with cirrhosis

Front 46

ivermectin

Back 46

doc in strongyloidiasis, onchocerciasis
intensify GABA mediated transmissions - paralyze nematodes and arthropods

Front 47

toxicity with ivermectin

Back 47

corneal opacities - resolve
avoid with other GABA activity enhancers (barbiturates, benzodiazepines, valproic acid)

Front 48

praziquantel

Back 48

increased permeability in trematodes and cestode cell membranes to calcium --> paralysis, dislodgement, death;
schistosome, trematodes, cestodes (inc cysticercosis)