GERD and PUD Flashcards by Meg Dolohanty

What modulates gastric acid secretion?

paracrine (histamine), neuroendocrine (Ach), and endocrine (gastrin) pathways which activate their respective receptors (H2, M3, CCK2).

How well did you know this?

Not at all

Perfectly

What limit extent of acid secretion

Somatostatin-secreting D cells and prostaglandins

How well did you know this?

Not at all

Perfectly

What are some lifestyles that are related to developing heartburn?

High fat meals

tobacco

How well did you know this?

Not at all

Perfectly

4 mechanisms for developing gastric reflux?

Decreased Lower Esophageal Sphincter Pressure
Prolonged Esophageal Clearance
Mucosal Resistance
Delayed Gastric Emptying Time

How well did you know this?

Not at all

Perfectly

Food causes for decreased LES

fatty meals
peppermint
chocolate
caffeine
garlic
onions
chili pepers

How well did you know this?

Not at all

Perfectly

1/2 of patients with GERD have prolonged ______ clearance.

acid

How well did you know this?

Not at all

Perfectly

what are foods that are mucosal irritants?

spicy food
citrus juice
tomato juice
coffee

How well did you know this?

Not at all

Perfectly

what is a medication used for osteoporosis where patients must take with a large glass of water and stay upright due to forming of an esophageal ulcer.

Alendronate

How well did you know this?

Not at all

Perfectly

what are some lifestyle factors that can cause GERD?

Obesity
smoking
high-fat meals
tight fitting clothing
pregnancy
stress
laying flat

How well did you know this?

Not at all

Perfectly

what is the body’s way of trying to handle extra acid?

Hypersalivation

How well did you know this?

Not at all

Perfectly

How can you diagnose GERD

Hx
Endoscopy
24 hr ambulatory pH monitoring
Pre-emtively treating w/ omeprazole

How well did you know this?

Not at all

Perfectly

Complications of GERD

Esophagitis
Esophageal strictures
Barrett’s esophagus
adenocarcinoma of esophagus

How well did you know this?

Not at all

Perfectly

What are ways to suppress gastric acid production?

Antacids after meals and at bedtime
H2 histamine receptor antagonist
Covalent inhibitors of H+, K+-ATPASe of pariteal cells (PPIs)

How well did you know this?

Not at all

Perfectly

What are some promotility therapies for GERD?

Metoclompramide (doapmine antagonist)

Bethanechol (cholinergic agent)

How well did you know this?

Not at all

Perfectly

what is a disadvantage of antacids?

Short duration

must separate from other drugs (can prevent absorption)

How well did you know this?

Not at all

Perfectly

What can magnesium antacids cause?

Diarrhea

How well did you know this?

Not at all

Perfectly

What can aluminum based antacids cause?

constipation

How well did you know this?

Not at all

Perfectly

What can calcium and sodium bicarb based antacids cause?

gas

How well did you know this?

Not at all

Perfectly

what products can can cause fluid overload in pts. with CHF, renal failure, cirrhosis, pregnancy, or any salt-restricted diet; avoid in anyone taking supplemental calcium or with renal dysfunction

sodium bicarb

How well did you know this?

Not at all

Perfectly

What are some clinically significant drugs that will bind to antacids

quinolone, isoniazid, tetracycline

Ferrous sulfate, quinidine, sulfonylurea

How well did you know this?

Not at all

Perfectly

What is teh MOA of H2-receptor angatonists

reversibly inhibit histamine-2 receptors on parietal cells

How well did you know this?

Not at all

Perfectly

Name some H2 receptor antagonists

Famotidine
Nizatidine
Ranitidine

How well did you know this?

Not at all

Perfectly

How are H2 receptor antagonists excreted

Unchanged in urine

need dose adjustment with renal problems

How well did you know this?

Not at all

Perfectly

What is a rare, reversible ADR of H2 receptor antagonists

thrombocytopenia

How well did you know this?

Not at all

Perfectly

Drug that inhibits teh metabolism of warfarin, phenytoin, nideipine, propranolol

Cimetidine

what drugs required an acidic environment to be absorbed

Ketoconazole, itraconazole, ferrous sulfate

eliminate symptoms and heal esophagitis more frequently and rapidly than other drugs

PPIs

When should PPIs be given?

Once daily before breakfast | or BID have one before breakfast, before dinner

List some PPIs

Omeprazole | end in "prazole"

MOA of PPIs

Inhibit the action of the H+,K+ -ATPase.

All PPIs are _______ and they need the acidic environment to work.

prodrugs

What drugs can you not use with PPI

antacids | H2 antagonist

with PPIs may have a higher incidence of what?

CAP

How are PPIs metabolized?

P450s

Omprazole and esomeprazole reduce the metabolism of what?

DIazepam Phenytoin Warfarin

What are 2 promotility agents

Metoclopramide | Bethanechol

Contraindication so r metoclopramide?

Parkinson's mechanical obstruction concomittant use of dopamien antagonists, anticholinergics, pheochromocytoma

Drug that is a promotlilty agent but can cause a fatal cardiac dysrhythmia

Cisapride

A mucosal protectant that has non-absorbable alumnium salts. only recommended for mild cases of GERD, good for healing. Needs acid to turn into goo

sucralfate

For patients that are resistant to therapy what can you do

Use PPIs and H2 receptor antagonists in alternating method

If patients really aren't responsive to GERD therapy what can you do?

Antireflux surgery | Endoluminal therapies

most common cause of duodenal ulcer

H. pylori

when will you have pain with a duodenal ulcer?

1-3 hours after eating | gets better with eating

what often cases gastric ulcers?

NSAIDs | worse with food

who has to be hospitalized with ulcerations?

Elderly, those with bleeding and perf

classify H. pylori

Gram- rod

what can H. pylori lead to?

PUD gastric lymphoma adenocarcinoma

what are the transmission methods of H. Pylori

Fecal-oral | oral-oral

How can you document infection with H. Pylori

Usually a blood test | Breath test for urea (faster)

What is a syndrome with gastric acid hypersection and recurring ulceration from a gastrin-secreting tumor?

Zollinger-Ellison Syndrome

How do you treat zollinger-Ellison syndrome?

PPIs | chemo

What are complications of H. Pylori.

Zollinger-Ellison Syndrome Upper GI Bleed Perf Obstruction

Caused by scarring or edema of duodenal bulb or pyloric channel land lead to gastric retention. Symptoms include Early satiety, bloating, anorexia, nausea, vomiting, weight loss

Obstruction

What is your DOC for symptoms with H. pylori?

PPIs

What are antibiotics for H. Pylori?

Amoxicillina and clarithromycin | metronidazole and clarithromycin

What is a 4 drug regimen for H. Pylori?

H2 blocker (cheaper) Pepto-Bismol Metronidazole (can cause GI problems) Tetracycline

If there is a treatment failure with H. Pylori what do you do?

``` Change antibiotics try the 4 drug regimen extend treatment duration asses AEs assess compliance ```

what 2 things are enhanced with bismuth subsalicylate?

Mucous and bicarb

what is misoprostol?

synthetic analogue of prostaglandin E.

What does misoprostol do?

Imitates the action of endogenous prostaglandins (PGE2 and PGI2) in maintaining the integrity of the gastroduodenal mucosal barrier. Promotes healing

when is misoprostol indicated?

ulcer healing | ulcer prophylaxis w/ NSAID used

ADRs of misoprostol

Diarrhea | Constipation

Contraindications w/ misoprostol.

Hypotension Breastfeeding Pregnant

GERD and PUD Flashcards

(63 cards)