GERD Flashcards
(61 cards)
1
Q
When LES pressure is low, it is ___ for stomach contents to flow back into the esophagus.
A
easier
this is bad
2
Q
Which of the following mechanisms is known to cause or increase the risk of developing GERD?
A) faster gastric emptying
B) higher LES pressure
C) increase in esophageal mucosal resistance
D) acid pocket formation
A
acid pocket formation
3
Q
extraesophageal symptoms
* ___ cough
* laryngitis
* wheezing
* ___
A
- chronic
- asthma
4
Q
i
immediate medical attention
* dysphagia (difficulty ___ )
* odynophagia
* bleeding
* ___ % unexplained weight loss
automatic referal
A
- swallowing
- 5%
5
Q
Rx therapy for GERD should last for ___ weeks
A
8
6
Q
OTC therapy for GERD should last ___ weeks
A
2
7
Q
diagnostic tests
upper ___ - preferred for assessing mucosal injury and complications
A
endoscopy
8
Q
diagnostic tests
___ pH test (+ impedance) - useful for patietns not respodning to acid suppression after normal endoscopy
A
reflux
9
Q
diagnostic tests
manometry (+/- impedance) - useful for patients who failed 2 trials of ___ with normal endoscopy findings to identify motor dysfunction
A
PPIs
looking for functions of the esophagus
10
Q
diagnostic tests
___ radiography - lacks sensitivity + specificity; not routinely recommended
A
Barium
11
Q
Complications of GERD
- ___ esophagitis
- Stricture ( ___)
- ___ esophagus
- ___ (cancer)
A
- erosive
- narrowing
- Barrett’s
- adenocarcinoma
12
Q
prn medications for GERD
A
- antacids
- H2RAs
13
Q
scheduled medications for GERD
A
- H2RAs
- PPIs
14
Q
GERD treatment steps
- lifestyle modifications
- OTC treatments
- Rx treatment (___ weeks )
- If Rx fails, ___
- Surgery
A
- 8 weeks
- switch
15
Q
REFER
- ___ symptoms
- OTC trial longer than ___ days with no relief
A
- alarm
- 14
16
Q
Antacids
- ___ relief
- make intragastic pH > ___
- decrease activation of pepsinogen to ___
- increased ___ pressure
A
- immediate
- 4
- pepsin
- LES
17
Q
T or F: only antacids increase LES pressure
A
True
18
Q
antacids
caution in patients with ___ impairment taking ___ or ___ containing products
A
- renal
- calcium
- aluminum
19
Q
Side effects of antacids
Calcium
* constipation
* ___ - alkali syndrome
Magnesium
* ___
* accumulation
Aluminium
* consitpation
* ___/neurotoxicity
A
- milk
- diarrhea
- confusion
20
Q
Antacid Drug Interactions
affects ___ of :
* fluroquinolones
* tetracyclines
* azole antifungals
* levothyroxine
* Fe
* steroids
* digoxin
* HIV meds
* select oral antineoplastics
A
absorption
21
Q
antacid drug interactions
take medications ___ hours before or ___ hours after antacids
A
- 2 hrs
- 4-6 hrs
22
Q
single element containing antacids (2)
A
- Tums (calcium carbonate)
- Milk of Magnesia (magnesium hydroxide)
23
Q
mixed antacids (4)
A
- Al + Mg: Maalox and Gaviscon (+ alginate acid)
- Al + Mg + simethicone: Mylanta, Maalox advanced max strength
- Ca + Mg: Rolaids, Mylanta Ultra
- Ca + simethicone: Alka-Seltzer heart burn + gas, Tums gas relief
24
Q
Brand name
sodium bicarbonate + ASA + citric acid
A
Alka-Seltzer
25
# Brand name
bismuth subsalicylate
Pepto-Bismol
26
# Brand name
simethicone
Gas-X
27
T or F: Alka-Selzer is approved for children < 12 years
FALSE; ASA can cause Reye's syndrome
28
# H2RAs
MOA: ___ inhibition of histamine receptors in ___ cells
* reversible
* parietal
29
Tums dosing: ___ tablets PRN up to 4x/day
Max: ___ tabs/day
* 2-4
* 16
30
Milk of Magnesia dosing: ___ mL PRN up to 4x/day
Max: ___mL/day
* 5-15
* 60
31
Maalox dosing: ___ mL PRN or at meals + bedtime up to 4x/day
Max: ___ mL/day
* 10-20
* 80
32
Gaviscon dosing: ___ tablets or ___ mL at meals + bedtime 4x/day
Max: ___ tabs/day
* 2-4
* 10-20
* 16
33
# H2RAs
Famotidine (___)
OTC: 10-20 mg up to ___ (Max ___ mg/day)
Rx: ___ BID prn ___ minutes before trigger foods
* if symptoms persist after 2-4 weeks, increase to ___ mg BID for ___ weeks; if symptoms improve, may continue therapy if needed
* onset: ___ hours
* Duration ___ hours
* CrCL < 50 mL/min: give ___% of dose
* Pepcid
OTC: BID, 40 mg/day
Rx: 10 mg, 10-60 min
* 20 mg, 2 weeks
* 1-3 hrs
* 10-12 hrs
* 50%
34
# H2RAs
Cimetidine (___)
OTC/Rx: ___ mg daily up to ___ min prior to trigger foods (Max: ___ mg/day)
* onset: ___ hr
* duration: ___ hrs
* only adjust dose with ___ renal impairment
* MANY drug reactions via ___
* not commonly used
* Tagamet
* 200 mg, 30 min, 400 mg/day
* 1 hr
* 4-5 hrs
* severe
* CYPs
35
# H2RAs
Nizatidine (___)
Rx only: ___ mg BID
* adjust dose in renally impaired patients
* Onset: ___ hrs
* Duration: ___ hrs
* not readily available/commonly used. Small revival after ___ was pulled from the market
* Axid
* 150 mg
* 0.5-3 hrs
* 5-10 hrs
* ranitidine
36
# H2RA Side Effects
* Headache
* dizziness/fatigue
* constipation or diarrhea
* Somnolense Confusion/___
* agitation
* ___ deficiency (long term use)
| Increased with risk if > 50 years with renal/hepatic impairment
* delirium
* B12
| B12 is absorbed and activated in the stomach
37
# H2RAs: Pearls
* ___ occurs with long term use
* ___ Criteria - avoid in patients with/high risk of ___
* used alone or in combination with other classes to treat mild to moderate GERD
* NOT as efficacious as ___
* all H2RAs are considered equally efficacious
* useful in treatment of ___ symptoms
* tachyphylaxis
* Beer's, delirium
* PPIs
* nocturnal
38
Which H2RA has the most concern for lots of drug-drug interactions?
A) ranitidine
B) famotidine
C) cimetidine
D) nizatidine
cimetidine
39
T or F: H2RAs are equally as efficacious as PPIs
False; PPIs are stronger bc they almost completely inhibit acid production
40
# PPIs
MOA: ___ inhibition of proton/potassium ATPase in ____ cells
* irreversible
* parietal
41
T or F: PPIs do NOT require renal dose adjustments
True
42
# PPIs
Dexlansoprazole (___)
* NO complications: ___ mg daily
* Complications: ___ mg daily for ___ weeks then ___ mg indefinitely
* Onset: ___ hr, then ___ hr
* Duration: ___ hr
* ___ formulation allows 2 different onsets
* can be taken without regard to ___
* Dexilant
* 30 mg
* 60 mg, 8 weeks, 30 mg
* 1-2 hrs, 4-5 hrs
* 16-18 hrs
* dual
* meals
43
# PPIs
Lansoprazole ( ___ )
* Rx: __ mg daily
* OTC: ___ mg daily for ___ days; may repeat in ___ months if needed
* Onset: ___ hrs
* Duration: ___ days
* can open contents of capsule and mix in ___ only
* ___ tablet available
* administer ___ minutes before a meal
* Prevacid
* 15-30mg
* 15 mg, 14 days, 4 months
* 1-3 hrs
* >1 day
* water
* oral disuntegrating tablet
* 30-60 minutes
44
# PPIs
Omeprazole ( ___ )
* OTC: ___ mg daily for ___ days; may repeat in ___ months if needed
* Rx: ___ mg daily
* when combined with ___, product becomes the only immediate release PPI
* administer ___ min before a meal
* metabolzed by CYP ___
* Onset: ___ hr
* Duration: up to ___ hrs
* Prilosec
* 20 mg, 14 days, 4 months
* 10-40 mg daily
* sodium bicarbonate
* 30-60 min
* CYP2C19
* 1-3 hr
* 72 hrs
45
# PPIs
Pantoprazole ( ___ )
* PO Rx: ___ mg daily
* IV Rx: ___ mg daily
* tablet cannot be ___ or ___
* administer ___ min before a meal
* most common PPI found on hospital formularies
* Onset PO: ___ hrs
* Onset IV: ___ min
* Duration: ___ hrs
Protonix
* 20-40 mg
* 40 mg
* crushed, altered
* 60 min
* 2.5
* 15-30 min
* 24 hrs
46
# PPIs
Rabeprazole ( ___ )
* Rx: ___ mg daily
* can open contents of capsule, but cannot crush tablet
* administer ___ min before a meal
* Onset: ___
* Duration: ___
AcipHex
* 10-20 mg
* 30 min
* 1 hr
* 24 hrs
| Rx only
47
# PPI drug interactions
biggest interactions from ___ and ___
* Increase effect (3)
* Decrease effect (4)
omeprazole and esomeprazole
* methoytexate, phenytoin, warfarin
* iron, bisphosphonates, HIV/HCV drugs, clopidogrel
48
# PPIs Short Term Side Effects
* headache
* dizziness
* diarrhea
* flatulence
* nausea
* abdominal pain
* enteric infections ( ___ )
* community-acquired ___
* C. diff
* pneumonia
49
# PPIs Long Term Side Effects
* hypomagnesemia ( due to less ___ )
* bone density decrease/fractures ( less ___ absorption)
* vitamin ___ deficiency
* chronic ___ disease
* absorption
* Ca2+
* B12
* kidney
50
Which PPI interacts wih clopidogrel and may decrease its effectiveness (meaning it should be avoid if at all possible).
A) Omeprazole
B) Lansoprazole
C) Pantoprazole
D) Dexlansoprazole
Omeprazole
51
# Prokinetic Drugs
* metoclopramide and ___
* used as adjunct therapy is known ___ defect
* problems: these have ___ side effects and are not as effective as ___ suppression therapy
* ___ is NOT recommended
* Sucralfate - NOT useful in GERD management unless ___ reflux GERD present
* bethanechol
* motility
* undesireable, acid
* baclofen
* nonacid
52
# Combination Therapy
antacids + H2RAs
* helpful for heartburn after ___
* Pepcid AC = ___
PPIs + H2RAs
* nighttime administration of a single H2RA dose can help with ___ acid production
* ___ can also help with ___ heartburn
* eating
* famotidine + calcium carbonate and magnesium
* nocturnal
* H2RAs, breakthrough
53
# PPI Clincal Pearls
* ___ formulation is just as effective as PO
* All PPIs are considered equally efficacious
* patients who do not respond to an initial PPI trial should be switched to a different PPI with ___ effective dose
* ___ dosing for patients who faily once daily max tolerated dose PPIs
* when discontinuing after long term theraly, consider ___ due to risk of ___
* Beer's Criteria
* IV
* lowest
* BID
* tapering, rebound hyperacidicty
54
# Surgery
* anti-reflux surgery focuses on restoring normal ___ pressure
indicated if :
* long term therapy is undesireable
* persistent symptoms or damage despite appropriate therapy
* presence of ___ hernia
* LES
* hiatal
55
# Special Populations: Pregnancy
First line: lifestyle recommendations
First line meds: antacids or ___
Second line: ___
Last line: ___ reserved for complications of GERD or treatment failure (exception: ___)
* sucralfate
* H2RAs
* PPIs, omeprazole
56
# Special Populations: Lactation
* ___ and ___ are present in breastmilk
* low risk to infants at standard doses
* stick to ___
* PPIs and H2RAs
* antacids
57
T of F: GERD symptoms occur in 2/3 of pregnancies
True
58
# Special Populations: Kiddos
Symptoms/Signs
* refusing to eat
* wheezing/coughing
* ___ erosion
* recurrent ___ or belching irritability
Alarm Symptoms
* Weight loss
* fever
* seizure
* persistent vomiting/diarrhea
* dental
* regurgitation
59
# Pediatric GERD Non-Pharm Options
* ___ formula/foods
* ___ volume of intake
* ___ free diet
* ___ therapy
* thickening
* decrease
* milk
* positioning
60
# Pediatric Meds for GERD
PPIs and H2RA's
* treat for ___ weeks
* only for diagnosed GERD or ____
Simethicone and Probiotics: safe ___
Herbal options: ___ , ___ , or ___
Antacids
* should not use ___
* do not use ___ or ___ in children < 12
* 4-8 weeks
* esophagitis
* OTC
* peppermint, ginger, chamomile
* aluminum or bismuth subsalicylate
61
T or F: Children's Pepto is safe to use in kids under 12 years old
True! children's "pepto" is just calcium carbonate
