- Prevents the diaphragm muscle from holding the LES in normal position and the sphincter shifts above the diaphragm - Significant risk factor for GERD in persons over 50

- Helicobacter pylori is the #1 cause for PUD - Family history of ulcers - Living with close relatives who have PUD - Age - Medicines (Salicylates, NSAIDS, corticosteroids)

- difficulty swallowing - Dry cough - Bad breath - Bloating - Burping - Respiratory problems - Hoarseness

- Hoarseness - Voice fatigue or breaks - Sore throat - Excessive phlegm or saliva - Chronic cough - Bad breath - Wheezing

- Burning pain in the gut beginning 2-3 hours after a meal - Weight loss - Appetite loss

- aluminum hydroxide - magnesium hydroxide - aluminum hydroxide/magnesium hydroxide - aluminum hydroxide/magnesium hydroxide/simethicone - calcium carbonate - calcium carbonate/magnesium hydroxide - sodium bicarbonate/ASA/citric acid - sodium bicarbonate/citric acid

- With Magnesium: Diarrhea - With Aluminum: Constipation, hypophosphatemia - With Calcium: Constipation, hypercalcemia, kidney stones - Sodium Bicarbonate: Rebound hyperacidity, metabolic alkalosis, edema, hypertension

GERD, Peptic Ulcer Disease - Chapter 21 Flashcards by Tayler Trainer

Gastroesophageal Reflux Disease (GERD)

A motility disorder associated with impaired peristalsis

- Causes backflow of gastric contents into esophagus

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Factors Contributing to GERD

Foods
Lifestyle
Body position
Hiatal Hernia
Pregnancy
Obesity
Immature digestive system (infants <1 year)
Rx and OTC medications

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Hiatal Hernia

Prevents the diaphragm muscle from holding the LES in normal position and the sphincter shifts above the diaphragm
Significant risk factor for GERD in persons over 50

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Drugs that aggravate GERD

Anticholinergics
Opioids
Calcium channel blockers
Nonsteroidal antiinflammatory drugs
Xanthines

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What Causes LPR (Laryngopharyngeal Reflux)

Gastric contents reflux into the larynx and the pharynx and cause inflammation
Anatomical barriers that protect against LPR fail (upper/lower esophageal sphincters)

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Peptic Ulcer Disease (PUD)

An ulcer is an open wound or sore

- A peptic ulcer is an ulcer that is located in the stomach (gastric) or duodenum (duodenal)

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Risk Factors for PUD

Helicobacter pylori is the #1 cause for PUD
Family history of ulcers
Living with close relatives who have PUD
Age
Medicines (Salicylates, NSAIDS, corticosteroids)

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Symptoms of GERD

difficulty swallowing
Dry cough
Bad breath
Bloating
Burping
Respiratory problems
Hoarseness

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Symptoms of LPR

Hoarseness
Voice fatigue or breaks
Sore throat
Excessive phlegm or saliva
Chronic cough
Bad breath
Wheezing

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Symptoms of PUD

Burning pain in the gut beginning 2-3 hours after a meal
Weight loss
Appetite loss

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Common symptoms of GERD, LPR, and PUD

Heartburn
Stomachache
Hunger pains
Nausea/vomiting
Chest pain

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Treatment Strategies for GERD, LPR, and PUD

1) Reduce GI irritants
2) Increase protective factors
3) Eliminate H. pylori (PUD)
4) Enhance peristalsis (GERD)

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Drug Classifications for GERD, LPR and PUD

1) Acid neutralizing drugs (antacids)
2) Acid supressing drugs (histamine2 receptor antagonists, proton pump inhibitors)
3) Mucosal Protectants (prostaglandins, sucralfate)
4) Antiinfectives (eliminate H. pylori)
5) Prokinetic drugs (promote peristalsis)

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Acid Neutralizers (Antacids)

-Oldest drugs used for the treatment of 
GERD and PUD
-OTC
-Neutralize gastric acids which decreases pepsin secretion
-Effects only last 30-60 mins

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Antacids Examples

aluminum hydroxide
magnesium hydroxide
aluminum hydroxide/magnesium hydroxide
aluminum hydroxide/magnesium hydroxide/simethicone
calcium carbonate
calcium carbonate/magnesium hydroxide
sodium bicarbonate/ASA/citric acid
sodium bicarbonate/citric acid

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Generic: aluminum hydroxide

Amphojel

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Generic: magnesium hydroxide

Milk of Magnesia

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Generic: calcium carbonate

Tums

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Generic: aluminum hydroxide/magnesium hydroxide

Maalox

Gelusil

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Generic: aluminum hydroxide/magnesium hydroxide/simethicone

Diovol Plus

Maalox Suspension w/ Antigas

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Generic: calcium carbonate/magnesium hydroxide

Diovol Plus AF

Rolaids

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Generic: sodium bicarbonate/ASA/citric acid

Alka-Seltzer

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Generic: socium bicarbonate/citric acid

Eno

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Antacids ADR’s

With Magnesium: Diarrhea
With Aluminum: Constipation, hypophosphatemia
With Calcium: Constipation, hypercalcemia, kidney stones
Sodium Bicarbonate: Rebound hyperacidity, metabolic alkalosis, edema, hypertension

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Unique GERD Treatment

- alginic acid/aluminum carbonate | - alginic acid/magnesium carbonate

Generic: alginic acid/aluminum carbonate

Gaviscon Liquid

Generic: alginic acid/magnesium carbonate

Gaviscon Tablets

Acid Suppressing Drugs: Histamine2 Receptor Antagonists

-Common ending: "tidine" - Block histamine stimulated acid secretion - Used for treatment of GERD, LPD, and PUD

Generic: cimetidine

cimetidine Warning Labels: - AVOID ALCOHOL - AVOID GRAPEFRUIT PRODUCTS - AVOID ANTACIDS WITHIN 2 HOURS OF DOSE

Generic: famotidine

Pepcid, Pepcid AC

Generic: nizatidine

Axid Warning Labels: -AVOID ANTACIDS WITHIN 2 HOURS OF DOSE

Generic: ranitidine

Zantac

Generic: famotidine/calcium carbonate/ magnesium hydroxide

Pepcid Complete

H2 Receptor Antagonists ADR's

- Dizziness - Headache - Constipation/diarrhea - Nausea - Abdominal pain - Bloating - Gynecomastia (cimetidine)

Acid suppressing Drugs: PPI's

-Common ending: "prazole" - Interfere with the final step in gastric acid production and decrease gastric acids - More potent than H2 antagonists

Proton Pump Inhibitors Examples

- omeprazole - rabeprazole - esomeprazole - pantoprazole sodium - pantoprazole magnesium - lansoprazole - dexlansoprazole - esomeprazole/naproxen

Generic: omeprazole

Losec, Olex

Generic: rebeprazole

Pariet

Generic: esomeprazole

Nexium

Generic: pantoprazole sodium

Pantoloc

Generic: pantoprazole magnesium

Tecta

Generic: lansoprazole

Prevacid | Prevacid FasTab

Generic: dexlansoprazole

Dexilant

Generic: esomeprazole/naproxen

Vimovo

PPI Tech Note

- Are delayed release formulations and must not be crushed or chewed - Should be taken on an empty stomach

PPI's ADR's

- Abdominal pain - Diarrhea or constipation - Nausea/vomiting - Headache - Vitamin B12 deficiency; calcium absorption deficiency - Rebound hyperacidity - Skin rash - Tiredness/fatigue - Agitation

PPI Warning Labels

- TAKE 1/2 HOUR BEFORE MEAL | - DO NOT CRUSH OR CHEW; SWALLOW WHOLE

Mucosal Protectants

Protect cells that line the stomach and small intestine from damage by gastric acids, pepsin, and H. pylori

Mucosal Protectants Examples

- misoprostal | - sucralfate

`Generic: misoprostal

misoprostal

Misoprostal ADR's

- Abdominal cramps - Diarrhea - Menstrual irregularities - Miscarriage - Headache - Dizziness

Misoprostal Warning Labels

-AVOID PREGANCY

Generic: sucralfate

Sulcrate

Sucralfate ADR's

- Constipation - Gas - Dry mouth - Headache

Sucralfate Warning Labels

- TAKE ON EMPTY STOMACH - NO ANTACIDS 1/2 HOUR PRIOR - SEPERATE DOSING OF OTHER DRUGS - SHAKE SUSPENSION WELL

Antiinfectives

- Antibacterials to eradicate H. pylori infection | - Prescribed in combination with drugs that decrease gastric acids and protect gastric mucosa

Prokinetic Drugs

-Increase peristalsis, GI motility, gastric emptying, and improve sphincter tone

Prokinetic Drugs Examples

- domperidone - metoclopramide - prucalopride

Generic: domperidone

domperidone, motilium Warning Labels: -AVOID GRAPEFRUIT

Generic: metoclopramide

metoclopramide, Maxeran, Reglan

Generic: prucalopride

Resotran

Prokinetic Drugs ADR's

- Abdominal pain/bloating - Constipation/diarrhea - Restlessness (metoclopramide) - Dizziness - Headache - Drowsiness (metoclopramide) - Irregular heartbeat - Gynecomastia (domperidone) - Galactorrhea (domperidone)

Prokinetic Drugs Warning Labels

- MAY CAUSE DROWSINESS - AVOID ALCOHOL - TAKE 15-30 MINUTES BEFORE MEALS

GERD, Peptic Ulcer Disease - Chapter 21 Flashcards

(63 cards)