GERD Flashcards by Alice Richards

alarm sx of GERD (8)

GIB
IDA
anorexia
unexplained wt loss
dysphagia
odynophagia
persistent vomiting
GI cancer in first degree relative

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4 meds that can exacerbate GERD

CCB
plavix
ICS
nitrates

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5 food triggers for GERD

caffeine
chocolate
spicy food
peppermint
carbonated drinks

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mc s.e of PPIs (6)

ha
rash
dizzy
GI
arthralgias
B12

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4 foods high in potassium

banana
avocado
oranges
beans

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what drug can decrease sensitivity of h.pylori testing

ppi

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how do you manage effect of ppi for pt who needs h.pylori testing

hold ppi 1-2 weeks prior to testing

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what is considered an adequate trial of ppi

qd x 8 weeks

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t/f: ppi’s affect Ca absorption

but long term use does increase risk for OP -> follow DEXA recs

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how do ppi’s increase risk for OP

decreased gastrin ->
hypochlorydia -> altered osteoclast

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GERD affects the __ sphincter

lower esophageal

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5 causes of lowered LES pressure

high fat/CHO diet
etoh
tobacco
acidic foods/drinks
meds

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classes of GERD meds

antacids
sucralfate (carafate)
h2 blockers
ppi

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what GERD med works by increasing pH (alklalinization) of gastric refluxate by neutralizing gastric acid

antacids:
alka-seltzer
tums
MOM
pepto bismol

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2 indications for antacids as first line therapy

no e.o esophagitis
mild intermittent sx

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can antacids be used in combo w. ppi/h2 blockers

yep!

for breakthrough sx

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what antacids should be avoided for pt w. CKD

aluminum based

ok to use calcium-based

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what off label GERD med acts as a mucosal coating to form protective barrier btw esophageal tissue and gastric refluxate

sucralfate

sucralfate is approved for what 2 sx

erosive esophagitis
ulcerations

why may antacids and sulcralfate have poor pt compliance

frequent dosing

2 cautions w. sucralfate

not mono-therapy
contains aluminum -> not for CKD pt

what GERD med works by inhibiting action of histamine at the parietal cell and decreasing basal acid secretion

h2 blockers:
cimetidine (tagemet)
famotidine (pepcid)

what h2 blocker was pulled from the market dt increased risk for ca

ranitidine (zantec)

t/f: all h2 blockers are equally effective

all OTC as well

h2 blockers are effective in __% of pt's w. mild-mod GERD

50-70

h2 blockers are less effective for pt's with

true esophagitis

your pt says cimetidine is no longer working for him, should you trial famotidine instead

no! switching does not help

added benefit of h2 blockers

help w. allergic rxn

2 s.e of h2 blockers

ha hepatitis both are very rare!

what GERD med works by irreversibly binding to the parietal cell and inhibiting the final step of acid secretion

ppi: omeprazole (prilosec) pantoprazole (protonix) lansoprazole (prevacid) esomeprazole (nexium)

what pump do ppi's bind to

H+/K+ ATPase

5 adverse effects of ppi's

c.diff fx risk B12 deficiency CKD worse PNA

3 common drugs w. ddi to ppi's

plavix diazepam phenytoin

what 2 GERD drugs cause acid suppression

h2 blockers ppi's

your patient tells you that prilosec no longer works for him and he thinks he has developed a tolerance, what do you tell him

tolerance does not occur w. ppi's but it does w. h2 blockers

ppi's are more effective than h2 blockers for treating

erosion/esophagitis

the fda has issued a warning regarding the use of __ with anticoags and antiplatelets

omeprazole

order of tx for heartburn in pregnancy

1. antacids PRN -> first line 2. H2 blockers -> cat B 3. ppi's -> cat B

which ppi is a category c in pregnancy

omeprazole

any pt with __ should be started on ppi (3)

(+) h.pylori GIB any e.o esophagitis

consideration with ASA for GERD pt

make sure it's enteric coated

2 ppi that are contraindicated w. anticoags

nexium (esomeprazole) prilosec (omeprazole)

2 ppi that are ok w. anticoags

prevacid (lansoprazole) protonix (pantoprazole)