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41 Cards in this Set
- Front
- Back
what is heartburn?
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condition that occurs when refluxed stomach contents lead to troublesome Sx &/or complications
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what is GERD?
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chronic freq heart burn >2x/wk
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Sx of GERD include:
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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) |
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complications of heartburn include:
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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) |
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what 2 factors inc the risk of cancer due to GERD?
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1. smoking
2. drinking |
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the main problem causing GERD is
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decreased lower esophageal sphincter tone
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what causes GERD?
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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 |
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drugs that lower LES tone include:
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1. CCBs (esp DHP)
2. antichol agents 3. barbiturates 4. estrogen & progesterone 5. opioids 6. theophylline |
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alarming GERD Sx include:
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1. GI bleeding
2. early satiety 3. dysphagia or odynophagia (painful swallowing) 4. unintentional wt loss 5. unexplained Fe def anemia 6. vomiting |
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exclusions for self TX include:
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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) |
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what are some lifestyle modifications that will improve GERD?
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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 |
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1. how do promotility agents work?
2. are they well tolerated? 3. what is an examp of a promotility agent? |
1. increase LES tone
2. not well tolerated 3. metoclopramide |
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what drug drug interaxns are there w/ antacids?
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1. tetracyclines
2. quinolone Abx 3. levothyroxine |
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what are some adverse effects of antacids?
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1. constipation (Ca & Al)
2. diarrhea (Mg) 3. acid rebound (Ca) |
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What are disadvantages of antacids?
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1. short DOA
2. poor for healing esophagitis |
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what are advantages of antacids?
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1. useful for occasional relief
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what's the longest you should use OTC antacids w/o consulting a PCP?
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14 days
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gastric acid secretion is stimulated by:
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1. histamine
2. gastrin 3. acetylcholine |
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what drug drug interaxns are there for H2 Rc antags?
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1. warfarin
2. alcohol 3. phenytoin 4. theophylline |
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what's the longest you should use OTC H2 Rc antagonists w/o consulting a PCP?
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14 days
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what can you develop from long term H2 Rc antag use?
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tachyphylaxis
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advantages of H2 Rc antags:
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1. useful for preventing Sx
2. useful for healing mild esophagitis 3. best for intermittent therapy of mild/moderate GERD |
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fill in the blank
1. _____ are best for GERD flare ups 2. ____ are better than ____ for short term use bc ____ take longer to work |
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 |
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advantages of PPI:
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1. most effective class
2. DOC for healing esophagitis or severe GERD 3. prolonged duration 4. reasonably safe long term |
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disadvantage of PPI:
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1. delayed onset
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when should you take PPI?
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30 min before meal
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what's the max # days you can use OTC PPIs for (w/o consulting PCP)?
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14 days
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what conditions may ensue from long term PPI use?
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1. osteoporosis
2. pneumonia 3. acute interstitial nephritis 4. C difficile assoc/d diarrhea |
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severe GERD Tx w/ ____?
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PPI
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occasional/internmittent GERD Tx w/ ____?
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H2 blocker
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generic names of PPIs end in _____
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-prazole
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1. which 2 PPIs are enantiomers?
2. which is stronger? |
1. esomeprazole & omeprazole
2. esomeprazole 2x stronger than omeprazole |
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what bacteria increases the risk of cancer?
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H. pylori
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what warning signs would suggest an endoscopy was necessary?
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1. dysphagia
2. unexplained wt loss 3. blood in stool/black tarry stools |
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1. step up
2. step down |
1. H2 blocker
2. PPI |
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cost effective therapy
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1. lifestyle modifications
2. attempt step up therapy for mild Sx 3. attempt step down therapy for well cntrlled Sx 4. promote generics |
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what are probiotics?
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nonpathogenic, living microorganisms that have beneficial effect on host when consumed in adequate amts
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what is an issue w/ probiotics?
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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 |
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proposed uses/benefits of probiotics:
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1. diarrhea
2. inflammatory bowel disease 3. IBS 4. atopic dermatitis 5. GI & GU infs 6. otitis media 7. dental caries |
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common AE of probiotics
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1. bloating
2. flatulence 3. infs (rare) |
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common microorganisms used in probiotics:
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1. lactobacillus (strain GG)
2. bifidobacterium 3. streptococcus spp. 4. saccharomyces boulardii |