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957 Block 2 > 1. GERD and PUD > Flashcards

1. GERD and PUD Flashcards

1
Q

What are the medications that target esophageal clearance?

A

Bethanechol

Cisapride

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2
Q

What are the medications that target esophageal mucosal resistance?

A

Alginic Acid

Sucralfate

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3
Q

What are the medications that target LES tone?

A

Bethanechol
Metoclopramide
Cisapride

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4
Q

What are the medications that target gastric emptying?

A

metoclopramide

cisapride

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5
Q

What are the medications that target gastric acid?

A

antacids
H2R Antagonist
proton pump inhibitors

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6
Q

What targets does bethanechol work on?

A

esophageal clearance

LES tone

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7
Q

What targets does cisapride work on?

A

esophageal clearance
LES tone
gastric emptying

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8
Q

What targets does Alginic acid work on?

A

esophageal mucosal resistance

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9
Q

What targets does sucralfate work on?

A

esophageal mucosal resistance

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10
Q

What targets does metoclopramide work on?

A

gastric emptying

LES tone

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11
Q

What targets do antacids, H2RAs, and PPIs work on?

A

reducing gastric acid

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12
Q

What are the typical symptoms of GERD?

A

heartburn/retrosternal pain
acid or food regurgitation
dyspepsia or belching

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13
Q

What are the Atypical symptoms of GERD?

A

pulmonary symptoms
dental erosions
hoarseness
chest pain

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14
Q

What are the alarm symptoms of GERD?

A 
GI bleeding
early satiety
dysphagia or odynophagia
unexplained weight loss
iron deficiency anemia
vomiting
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15
Q

What are some diet choices that can precipitate GERD?

A 
alcohol
obesity
peppermint
caffeine
chocolate
carbonated drinks
tomato based products
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16
Q

What are some lifestyle choices that can precipitate GERD?

A 
tobacco use
pregnancy
running
weight lifting
tight clothing
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17
Q

What are some medications that decrease LES tone?

A 
anticholinergics
dihydropyridine CCBs
barbiturates
estrogen and progesterone
opioids
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18
Q

What are some medications that are direct contact irritants to the stomach?

A 
aspirin
iron
NSAIDS
K Cl
bisphosphonates
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19
Q

What are the 2 main classifications of esophagitis?

A

erosive (ERD)

non-erosive (NERD)

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20
Q

What is esophageal stricture?

A

inflammation and scar tissue that causes the narrowing of the esophagus

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21
Q

What are some treatments for esophageal stricture?

A

PPIs

intralesional corticosteroids

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22
Q

What is Barrett’s esophagus?

A

normal squamous epithelium is replaced with specialized columnar epithelium

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23
Q

What are some diagnostic tests for GERD?

A 
endoscopy
upper GI radiography
H. pylori testing
pH testing
barium swallow test
24
Q

What are the goals of therapy for GERD?

A

relieve symptoms
heal esophagitis
avoid complications

25
Q

What are the recommendations for lifestyle modifications to relieve GERD symptoms?

A 
weight loss
elevate head of bed by 6-8 inches
avoid late evening meals
tobacco and alcohol cessation
*cessation of chocolate, caffeine, spicy food, citrus, soda
*not recommended in guidlines
26
Q

What is the MOA of antacids?

A

neutralize stomach acid to maintain intragastric pH of >4

27
Q

How does decreasing gastric pH help with GERD?

A

decreases activation of pepsinogen to pepsin

leads to increase of LES tone

28
Q

What are some adverse effects of antacids?

A

constipation
acid rebound with Ca based products
bone demineralization with Al products

29
Q

What is the MOA for H2RAs?

A

decrease gastric acid secretion by blocking the interaction of histamine and H2 receptor on parietal cell - this ultimately decreases gastric acid secretion

30
Q

What are some adverse effects of H2RAs?

A 
tachyphylaxis with prolonged use
GI effects
headache
anticholinergic
somnolence
fatigue
dizziness
31
Q

Which H2RA has the most significant drug interactions?

A

cimetidine

32
Q

H2RAs are pregnancy category ___.

A

B

33
Q

What is the MOA of PPIs?

A

Irreversibly blocks the H/K/ATPase pump of the parietal cell - this is the terminal step in acid secretion

34
Q

What are adverse effects of PPIs?

A

headache
diarrhea
constipation
abdominal pain

35
Q

What are the long term effects of PPI use?

A 
pneumonia
possible fracture risk
2x risk of C. diff
decreased Ca absorption
hypomagnesemia
36
Q

What time of day should H2RAs be administered?

A

30 minutes prior to meals

37
Q

What time of day should PPIs be administered?

A

30 minutes prior to the first meal of the day

38
Q

If there is not substantial effect PPIs can be titrated to ____.

A

BID

39
Q

PPIs are pregnancy category __ except for omeprazole which is category __.

A

B

C

40
Q

Metoclopramide is a __-_______ agent?

A

pro motility

41
Q

What is the MOA of metoclopramide?

A

D2 antagonist, 5HT-3/4 antagonist, muscarinic antagonist
This increases LES pressure
increases GI emptying
enhances esophageal paristalsis

42
Q

What are the steps of treatment for GERD?

A
  1. lifestyle changes + OTC
  2. low dose H2RA, PPI
  3. surgical
43
Q

What are some surgical interventions to GERD?

A

Nissen fundoplication

LINX

44
Q

What is Peptic Ulcer Disease?

A

defect in the gastric or duodenal wall that extends through the muscularis mucosa

45
Q

Where can PUD ulcers be located?

A

stomach

duodenum

46
Q

What are the 3 common causes of PUD?

A

H. pylori infection
NSAID induced
stress related damage

47
Q

___-___% of ulcers reoccur within 1 year.

A

60 - 100

48
Q

How is H. pylori transmitted?

A

fecal-oral

49
Q

What are some anti-ulcer agents?

A

PPIs
H2RAs
Sucralfate
Prostaglandins

50
Q

What is the MOA of sucralfate?

A

forms a protective coating that adheres to damaged mucosal area

51
Q

Misoprostol is a _________ that is pregnancy category __.

A

protaglandin

X

52
Q

What are the 2 treatment therapies for PUD and what are their durations?

A

triple therapy - 14 days

quadruple therapy - 10 days

53
Q

What agents are included in triple therapy for PUD?

A

PPI
clarithromycin
amoxicillin or metronidazole

54
Q

What agents are included in quadruple therapy for PUD?

A

PPI or H2RA
bismuth
tetracycline
metronidazole

55
Q

How is treatment confirmed for PUD?

A

8 weeks from completion of therapy:
fecal antigen test
urea breath test

56
Q

How is NSAID induced PUD treated?

A

discontinue nonselective NSAID
PPI (4 weeks)
H2RA
sucralfate

957 Block 2 (14 decks)

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