Unit 6- Chapter 32 GERD and PUD

Question 1

What are the functions of the stomach? (3)

Answer 1

1. Store food 2. Mix food 3. Emptying to upper part of GI tract

Question 2

What are the 3 types of secretory cells?

Answer 2

1. Chief 2. Parietal 3. Mucus

Question 3

What do chief cells secrete?

Answer 3

Secrete pepsinogen inactive enzyme. HCl activates pepsinogen into pepsin

Question 4

What do parietal cells secrete?

Answer 4

Hydrocholoric acid and intrinsic factor

Question 5

What do mucus cells secrete?

Answer 5

Mucus

Question 6

What is required to absorb vitamin B12?

Answer 6

Hydrochloric acid and intrinsic factor

Question 7

What is the pH of the stomach?

Answer 7

1-5

Question 8

Prostaglandins are secreted by what? What functions are the functions of prostaglandins in the stomach?

Answer 8

Cells lining the stomach; helps prevent damage to the lining by inhibiting acid productions, maintains blood flow and stimulates mucus and bicarbonate production

Question 9

What causes GERD? (heartburn)

Answer 9

Dysfunction of lower esophageal sphincter allows reflux of gastric contents into esophagus (pepsin and HCl). Also could be caused by delayed gastric emptying, making stomach stay full for too long. Leads to feelings of bloating, results in stretching and regurgitation

Question 10

What are the symptoms of GERD?

Answer 10

Burning, bloating, belching, regurgitation

Question 11

What are the symptoms of PUD?

Answer 11

Burning gnawing, aching, bloating, N&V, anorexia, sensation of fullness

Question 12

Where are the the ulcers commonly found in PUD?

Answer 12

gastric and duodenal ulcers

Question 13

What is PUD caused by?

Answer 13

Oversecretion of HCl which causes injury to mucosal barrier in stomach; NSAIDs,which inhibit prostaglandins; infection by H. Pylori

Question 14

What can GERD mimic?

Answer 14

Myocardial infarction or stomach cancer

Question 15

What are the goals of treatment of GERD and PUD? (6)

Answer 15

1. relieve symptoms 2. Decrease frequency and duration of reflux
2. Heal tissue injury 4. Prevent recurrence 5. Manage any bleeding 6.Treat infection caused by H. Pylori

Question 16

How can epigastric pain sometimes be relieved by?

Answer 16

Antacids and sometimes relief with eating

Question 17

What is the pt education for GERD and PUD? (6)

Answer 17

1. Weight reduction 2. Smoking cessation - increases gastric acid production 3. Avoid foods that. Increase acid production (i.e. alcohol) 4. Consume smaller meals 5. Avoid eating at bedtime- Remain upright after meals for 2 hours because full stomach increases pressure on lower esophageal sphincter which creates opening in lower esophageal sphincter that allows gastric contents to go into esophagus (regurgitation) 6. Avoid tight clothing over abdomen

Question 18

What is the goal of drug therapy for GERD and PUD? (4)

Answer 18

1. Used to relieve symptoms 2. Promote healing 3. Prevent recurrence 4. Antibiotics used for symptomatic H. Pylori

Question 19

Why should NSAIDs be limited? What should be used instead (if feasible)

Answer 19

NSAIDs inhibit prostaglandins (which help prevent damage to the lining of the stomach by inhibiting acid production and stimulates mucus and bicarbonate production; acetaminophen

Question 20

What antibiotics are used. For symptomatic H. Pylori? (5)

Answer 20

1. Tetracycline 2. Amoxicillin 3. Metronidazole 4. Clarithromycin 5. Rifabutin

Question 21

What percent of the US population suffers from GERD on a daily basis?

Answer 21

5-7%

Question 22

What are the most effective antacid combinations? (3)

Answer 22

1. Aluminum hydroxide 2. Magnesium oxide or hydroxide 3. Calcium carbonate

Question 23

What type of antacids is not for pts with renal disease? Why?

Answer 23

Magnesium oxide or hydroxide- May cause hypermagnesemia

Question 24

When should other drugs be administered when a pt is prescribed an antacid?

Answer 24

Administer other drugs either 1 hour before or 2 hours after antacid

Question 25

What other ingredient is found in antacid combination products and why?

Answer 25

Simethicone- deforming agent that breaks up gas bubbles in the stomach, reducing stomach distention and heartburn. It is effective in pts who have overeaten or who have heartburn, but it is not effective in treating PUD

Question 26

What antacids may cause rebound hyperacidity?

Answer 26

Calcium carbonate and sodium bicarbonate

Question 27

Which antacid treats high phosphate levels in those with renal disease/ pt on hemodialysis?

Answer 27

Calcium carbonate

Question 28

What is the usual pH of the stomach?

Answer 28

1-2

Question 29

Antacids reduce the pH in the stomach to what?

Answer 29

3-4

Question 30

What is the action of antacids?

Answer 30

Buffer hydrochloric acid to a lower concentration (3-4 pH) from excessive eating and drrinking

Question 31

What are the uses of antacids?

Answer 31

Treats heartburn from excessive eating and drinking; acute ulcer treatment requires large volumes

Question 32

What is the common adverse effect of antacids?

Answer 32

Chalky taste

Question 33

What are the serious adverse effects of antacids?

Answer 33

Constipation (with calcium or aluminum); diarrhea with magnesium; electrolyte imbalance

Question 34

For whom are antacids contraindicated? What is recommended instead?

Answer 34

If pt is pregnant (safe if MD says it’s OK), has edema, heart failure, hypertension or salt restrictions. Low sodium antacid

Question 35

What is the action of histamine-2 receptor antagonist?

Answer 35

Blocks H2 receptors resulting in decreased volume of acid secreted

Question 36

What is the suffix of histamine-2 receptor antagonist?

Answer 36

-tidine

Question 37

What are the uses of Histamine-2 Receptor antagonists?

Answer 37

Treat GERD, duodenal ulcers, stress ulcers, Zollinger-Ellison syndrome (a hypersecretory condition), prevents gastric ulcers in critically ill patients

Question 38

What are the common adverse effects of histamine-2 receptor antagonists?

Answer 38

Dizziness, HA, somnolence, diarrhea, constipation

Question 39

What are the serious adverse effects of histamine-2 receptor antagonists?

Answer 39

Confusion, disorientation, hallucinations, gynecomastia, hepatotoxicity

Question 40

What histamine-2 receptor antagonist increases risk of cancer. How long is the recommended course of tx with this drug?

Answer 40

Ranitidine (Zantac) use no more than 8 weeks unless advised by doctor

Question 41

What is the name of the drug that’s a gastrointestinal prostaglandins?

Answer 41

Misoprostol (cytotoxic)

Question 42

What is the action of misoprostol (cytotec) (gastrointestinal prostaglandin)

Answer 42

Inhibits gastric acid and pepsin secretion; increases gastric mucus (helps put mucosal layer back into action and prevents new ulcers from forming)

Question 43

What is the use of gastrointestinal prostaglandins (misoprostol- Cytotec)

Answer 43

Prevents and treats gastric ulcers caused by NSAIDs (including aspirin) because it erodes mucosal barrier

Question 44

What is the common adverse effect of gastrointestinal prostaglandins?

Answer 44

Diarrhea

Question 45

What is the contraindication of misoprostol (cytotec) gastrointestinal prostaglandins?

Answer 45

Risk of miscarriage, causes uterine contractions; contraindicated for pt’s within child-bearing years. Ensure pt isn’t pregnant prior to administration. Ensure pt is using birth control and instruct pt to start drug on the 2nd or 3rd day of next menstrual cycle.

Question 46

What is the suffix of proton pump inhibitors?

Answer 46

-prazole

Question 47

What is the action of proton pump inhibitors?

Answer 47

Inhibits gastric secretion by inhibiting gastric acid pump of the parietal cells (H+/K+ ATP pump)

Question 48

What are the uses of proton pump inhibitors?

Answer 48

Treat severe esophagitis, GERD, gastric and duodenal ulcers caused by H. Pylori, hypersecretory disorders (Zollinger-Ellison syndrome)

Question 49

What are the common adverse effects?

Answer 49

Diarrhea, HA, fatigue, muscle pain

Question 50

What are the serious adverse effects of proton pump inhibitors?

Answer 50

Rash, risk of fractures (osteoporosis); hypomagnesemia; Since it changes the acid production of acid in the stomach- increases risk of C. Diff; B-12 deficiency in pts using longer than 2 years

Question 51

Why do proton pump inhibitors come in enteric forms. What is the eduction for these drugs?

Answer 51

They’re highly unstable in acid; want drug to pass through stomach and begin to dissolve in small intestine ; enteric to help decrease risk of reactivity; For short term use only (2 weeks). Should be taken 30 minutes prior to meds. take whole, do not crush or open capsule

Question 52

In what patients taking proton pump inhibitors at an increased risk of fractures and osteoporosis?

Answer 52

Pts taking a high dose of med or for long periods of time

Question 53

What type of drug is sucralfate (carafate)?

Answer 53

Coating agent

Question 54

What is the action of sucralfate (carafate) coating agent?

Answer 54

Adheres to craters of an ulcer, protecting it from acids, pepsin, and bile salts

Question 55

What is the use of coating agents? (Sucralfate- carafate))

Answer 55

Treatment of duodenal ulcers, for pts who cannot tolerate other therapies

Question 56

What are the common adverse effects of coating agents?

Answer 56

Constipation, dry mouth, dizziness; METALLIC TASTE

Question 57

How do coating agent s work? When should they be taken?

Answer 57

Acts locally in the stomach and reacts with HCl in a positive way to form a thick paste like substance that adheres to gastric mucosa. binds to the ulcer and promotes healing of the ulcer.