GERD

Question 1

List of drugs in Alginates

Answer 1

sodium alginate (gavison)

Question 2

List of drugs in antacids

Answer 2

Al Hydroxide
mg hydroxide
mg trisilicate
Ca carbonate
Na Bicarbonate

Question 3

List of drugs in H2RAs

Answer 3

cimetidine
famotidine
ranitidine

Question 4

List of drugs in PPIs

Answer 4

cimetidine
famotidine
ranitidine

Question 5

List of drugs in PPI

Answer 5

rabeprazole
omeprazole
esomeprazole
pantoprazole
lansoprazole
dexlansoprazole

Question 6

List of drugs in prokinetics

Answer 6

domperidone
metoclopramide

Question 7

Indication for alginates

Answer 7

mild
intermittent
post pradial

Question 8

Indication for antacids

Answer 8

mild
infrequent
post pradial

Question 9

Indication for H2RAs

Answer 9

use for noctural
GERD
PUD
H. Pylori
+ others

Question 10

Indication for PPI

Answer 10

H. pylori
GERD
NSAID ulcer
PUD
+more

Question 11

Indication for prokinetics

Answer 11

GI motility disorders
sometime used for GERD

Question 12

CI for alginates

Answer 12

none

Question 13

CI for antacids

Answer 13

renal -> Ca and Al

Question 14

CI for H2RAs

Answer 14

none

Question 15

CI for PPI

Answer 15

none

Question 16

CI for prokinetics

Answer 16

met -> cross BBB (tremors, parkinsons, seizures)
domper -> QT interval (only with high dose)
electrolytic disorder

Question 17

MOA of Alginates

Answer 17

form a viscous “raft” that floats in stomach

Question 18

MOA of antacids

Answer 18

neutral acid
inhibit pepsin generation binds to bile acid

Question 19

MOA of H2RAs

Answer 19

parietal cells pump H+
inhibit H2R to prevent H+
decrease basal/stimulated acid secretion

Question 20

MOA of PPI

Answer 20

direct inhibit proton pump prodrug activated by duodenum

Question 21

MOA of prokinetics

Answer 21

dopamine antagonist stimulate gastric motility

Question 22

Administration of alginates

Answer 22

~1 hr after meal

Question 23

Administration of Antacids

Answer 23

up to QID

Question 24

Administration of H2RAs

Answer 24

give 30-60 min before meal

Question 25

Administration of PPI

Answer 25

give 30-60 min before meal

Question 25

Onset/duration of H2RAs

Answer 25

acid inhibitor 1-3 h stimulate acid inhibition 3-5 h nocturnal inhibitor 8-13 h

Question 25

Onset/duration of Prokinetics

Answer 25

with 30 min lasts 1-2 h

Question 25

Administration of Prokinetics

Answer 25

30 min before meal BID b/c of failed trial, h. pylori, ulcer/blood

Question 25

Onset/duration of alginates

Answer 25

rapid short duration

Question 25

Safety Concerns of Antacids

Answer 25

DDI - chelation Fe, bisph, diogixin, pheno, levothy, FQ, tetra DDI - pH sedation dabigatran, HIV meds

Question 25

Onset/duration of PPI

Answer 25

initial mild 3-5 days for maximal effect takes 24-28 hours to recover

Question 25

Safety Concerns of alginates

Answer 25

bloating flatulence belching

Question 25

Onset/duration of Antacids

Answer 25

rapid short duration

Question 25

Safety Concerns of H2RAs

Answer 25

Cim - weakly inhibitors 1A2 2C19 2D6 3A4

Question 25

Safety Concerns of Prokinetics

Answer 25

meto parkinsons meds, 2D6 sub makes antipsy, SSRI/TCA toxic dom 3A4 QT prolongation

Question 25

Efficacy of alginates

Answer 25

better than placebo worse than other agents

Question 26

Safety Concerns of PPIs

Answer 26

decrease absorption for ph sensitivity drugs om/eso also cause decrease in clopidogrel

Question 26

Efficacy of Antacids

Answer 26

limited evidence (old drug) better than placebo add on therapy

Question 26

Efficacy of H2RAs

Answer 26

don't use cim (not well tolerated) more than antacid worse than PPI

Question 26

Efficacy of PPIs

Answer 26

all equal best overall class

Question 26

Common S/E of Antacids

Answer 26

AL - C Mg - D Ca - best tolerated

Question 26

Common S/E of H2RAs

Answer 26

extremely well tolerated HA/V/D/drowiness

Question 27

Common S/E of PPIs

Answer 27

well tolerated HA/N/D/C rash/prutisis dygeusia dizziness

Question 28

Common S/E of Prokinetics

Answer 28

meto drowiness muscle weakness HA dizziness confusion Dom dry mouth mild HA

Question 29

Seriours S/E of Antacids

Answer 29

Al - bone demineralization Mg - hypermagnesemia Ca- well tolerated

Question 30

Seriours S/E of H2RAs

Answer 30

TA

Question 31

Seriours S/E of PPIs

Answer 31

C. diff microscopic colitis hypomagenisemia fractures fundic gland polyps B12 defiency penumonia gastric cancer mortality increase

Question 32

Seriours S/E of Prokinetics

Answer 32

Meto pseudoparkinson EPS syndrome gynecomastia (less tolerated) Dom QT prolongation gynecomastia

Question 33

Monitor of Antacids

Answer 33

gauge for overuse renal fxn

Question 34

Monitor of H2RAs

Answer 34

TA

Question 35

indication of misoprostol

Answer 35

prevent NSAID induced ulcer tx of duo ulcer

Question 36

Monitor of PPI

Answer 36

sx recur >3 m - new trial with same med sx recur <3 m, tx agin but investigate watch hypomg BMD if numerous risk factors increase risk of C. diff infection

Question 37

CI of misoprostol

Answer 37

none

Question 38

MOA of misoprostol

Answer 38

prostagladin analogue leading increase gastric mucous increase bicarbonate secretion all to balance out NSAIDs

Question 39

Administration of misoprostol

Answer 39

duo - QID 4-8w prevent NSAID - qid

Question 40

safety concern of misoprostol

Answer 40

DDI Mg antacids increases ADR of mis

Question 41

warning of misoprostol

Answer 41

occupational hazard

Question 42

common s/e of misoprostol

Answer 42

D/abdominal pain dyspepsia not well tolerated/adherence

Question 43

Pregnancy and GERD

Answer 43

do not use Na bicarb/al tris tums are great (Ca carb) can use H2RA/ PPI lans, omo, panto

Question 44

Peds and GERD

Answer 44

don't normally treat try smaller meals and allergies

Question 45

Definition of Refractory GERD

Answer 45

failed on 2 m of daily PPI sx rec <3 m ~25% pt will refrac

Question 46

cause of failure GERD tx

Answer 46

medication timing adherence different metabolism alternative diagnosis