GERD and Peptic Ulcer Disease - Mingura Flashcards
(35 cards)
How does normal reflux work?
- Acid and food reflux into the esophagus
- Peristalsis returns stuff to the stomach
- Acid remains in the esophagus
- Saliva neutralizes acid
How does reflux change in GERD?
- Decreased resting tone of lower esophageal sphincter
- delayed gastric emptying
- transient LES relaxation
- impaired peristalsis
- decreased salivation
- impaired tissue resistance
- no change in acid production
What are the symptoms of GERD?
heartburn acid brash (lots of salivation) belching chest pain Others: chronic cough laryngitis asthma dental enamel erosion
What symptoms of GERD would cause alarm?
Bleeding Anemia Dysphagia (difficulty swallowing) Odynophagia (painful swallowing) weight loss
How is GERD diagnosed?
Through clinical history and empiric acid-suppression
What are some key differences between angina and heartburn in regards to chest pain?
Heartburn: burning, squeezing, spontaneous or after meals, relieved by antacids or food, worse with lying down
Angina: pressure, heaviness, exertion or stress-induced, relieved by rest or nitroglycerin, radiation to neck or jaw
What lifestyle modifications can you make to assist with GERD symptoms?
weight loss elevate head trigger foods - keep diary! avoid tight-fitting clothes avoid tobacco/alcohol
What are some side effects associated with sodium bicarbonate?
Alkalosis, hypercalcemia in renal impairment if taken with dairy
What are some clinical pearls about antacids?
- chew tablets (breaks tablet down, increases saliva production)
- check ingredients
- Ca carbonate is first line for pregnancy after lifestyle modifications
What adverse drug reactions are associated with H2 antagonists?
headache, dizziness, confusion, B12 deficiency with long use
What drugs are contraindicated with H2 antagonists?
antifungals, monoclonal antibodies
Clinical pearls with H2 antagonists?
- ok with antacids
- Need to really adjust (50% of famotidine if CrCl is <50mL/min
- Cimetidine 1A2, 2D6, 3A4
- tolerance
What drugs are contraindicated with PPI’s?
- azoles, –nib, -antivirals
- omeprazole and esomeprazole are both moderate 2C19 inhibitors
What do you need to watch out for longterm with PPI use?
- Bacterial infection
- poor absorption of B12, Mg, Ca, Fe
- gastric cancer
Is there an interaction between methotrexate and PPIs?
Yes. Consider switch to H2RA
What PPIs are formulated for IV use?
Esomeprazole and Pantoprazole
Which two PPIs can be taken without regards to food?
Dexlansoprazole and rabeprazole
If you are on sucralfate, what other medications do you have to avoid?
warfarin, digoxin, and much more.
What are some clinical pearls for sucralfate?
- liquid and tablet formulation are brand-only
- 2nd line for pregnancy
- 2 hours before, 6 hours after interacting meds. But you have to dose it 4 times daily, so impossible to do correctly
What is misoprostol indicated for? What is the black box warning for?
NSAID-induced ulcers.
For women of childbearing age (negative pregnancy test, contraception, warnings, begin on 2nd day of normal period.
What is bismuth saubsalicylate indicated for? What are some counseling points?
dyspepsia, diarrhea, H. pylori treatment (in combo)
- black hairy tongue/stool, Reye’s syndrome
What are the guidelines for GERD in pregnancy?
- Lifestyle modifications
- Antacids (calcium carbonate then aluminum hydroxide/mg hydroxide)
- Sucralfate
- Ranitidine (has more data/famotidine)
PPIs
What are the two kinds of peptic ulcer disease
Chronic (NSAID induced or H. pylori)
Acute (stress-related mucosal damage)
What are some risk factors for PUD -NSAID induced?
- older than 65
- NSAID-related dyspepsia
- High dose NSAIDs, COX1>COX2
- Chronic conditions
- H. pylori
- smoking/alcohol use
- NSAID + aspirin, prednisone, anticoags, SSRI
