1. GERD and PUD Flashcards by Alexis Elliott

What are the medications that target esophageal clearance?

Bethanechol

Cisapride

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What are the medications that target esophageal mucosal resistance?

Alginic Acid

Sucralfate

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What are the medications that target LES tone?

Bethanechol
Metoclopramide
Cisapride

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What are the medications that target gastric emptying?

metoclopramide

cisapride

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What are the medications that target gastric acid?

antacids
H2R Antagonist
proton pump inhibitors

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What targets does bethanechol work on?

esophageal clearance

LES tone

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What targets does cisapride work on?

esophageal clearance
LES tone
gastric emptying

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What targets does Alginic acid work on?

esophageal mucosal resistance

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What targets does sucralfate work on?

esophageal mucosal resistance

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What targets does metoclopramide work on?

gastric emptying

LES tone

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What targets do antacids, H2RAs, and PPIs work on?

reducing gastric acid

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What are the typical symptoms of GERD?

heartburn/retrosternal pain
acid or food regurgitation
dyspepsia or belching

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What are the Atypical symptoms of GERD?

pulmonary symptoms
dental erosions
hoarseness
chest pain

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What are the alarm symptoms of GERD?

GI bleeding
early satiety
dysphagia or odynophagia
unexplained weight loss
iron deficiency anemia
vomiting

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What are some diet choices that can precipitate GERD?

alcohol
obesity
peppermint
caffeine
chocolate
carbonated drinks
tomato based products

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What are some lifestyle choices that can precipitate GERD?

tobacco use
pregnancy
running
weight lifting
tight clothing

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What are some medications that decrease LES tone?

anticholinergics
dihydropyridine CCBs
barbiturates
estrogen and progesterone
opioids

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What are some medications that are direct contact irritants to the stomach?

aspirin
iron
NSAIDS
K Cl
bisphosphonates

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What are the 2 main classifications of esophagitis?

erosive (ERD)

non-erosive (NERD)

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What is esophageal stricture?

inflammation and scar tissue that causes the narrowing of the esophagus

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What are some treatments for esophageal stricture?

PPIs

intralesional corticosteroids

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What is Barrett’s esophagus?

normal squamous epithelium is replaced with specialized columnar epithelium

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What are some diagnostic tests for GERD?

endoscopy
upper GI radiography
H. pylori testing
pH testing
barium swallow test

What are the goals of therapy for GERD?

relieve symptoms
heal esophagitis
avoid complications

What are the recommendations for lifestyle modifications to relieve GERD symptoms?

``` weight loss elevate head of bed by 6-8 inches avoid late evening meals tobacco and alcohol cessation *cessation of chocolate, caffeine, spicy food, citrus, soda *not recommended in guidlines ```

What is the MOA of antacids?

neutralize stomach acid to maintain intragastric pH of >4

How does decreasing gastric pH help with GERD?

decreases activation of pepsinogen to pepsin | leads to increase of LES tone

What are some adverse effects of antacids?

constipation acid rebound with Ca based products bone demineralization with Al products

What is the MOA for H2RAs?

decrease gastric acid secretion by blocking the interaction of histamine and H2 receptor on parietal cell - this ultimately decreases gastric acid secretion

What are some adverse effects of H2RAs?

``` tachyphylaxis with prolonged use GI effects headache anticholinergic somnolence fatigue dizziness ```

Which H2RA has the most significant drug interactions?

cimetidine

H2RAs are pregnancy category ___.

What is the MOA of PPIs?

Irreversibly blocks the H/K/ATPase pump of the parietal cell - this is the terminal step in acid secretion

What are adverse effects of PPIs?

headache diarrhea constipation abdominal pain

What are the long term effects of PPI use?

``` pneumonia possible fracture risk 2x risk of C. diff decreased Ca absorption hypomagnesemia ```

What time of day should H2RAs be administered?

30 minutes prior to meals

What time of day should PPIs be administered?

30 minutes prior to the first meal of the day

If there is not substantial effect PPIs can be titrated to ____.

BID

PPIs are pregnancy category __ except for omeprazole which is category __.

B | C

Metoclopramide is a __-_______ agent?

pro motility

What is the MOA of metoclopramide?

D2 antagonist, 5HT-3/4 antagonist, muscarinic antagonist This increases LES pressure increases GI emptying enhances esophageal paristalsis

What are the steps of treatment for GERD?

1. lifestyle changes + OTC 2. low dose H2RA, PPI 3. surgical

What are some surgical interventions to GERD?

Nissen fundoplication | LINX

What is Peptic Ulcer Disease?

defect in the gastric or duodenal wall that extends through the muscularis mucosa

Where can PUD ulcers be located?

stomach | duodenum

What are the 3 common causes of PUD?

H. pylori infection NSAID induced stress related damage

___-___% of ulcers reoccur within 1 year.

60 - 100

How is H. pylori transmitted?

fecal-oral

What are some anti-ulcer agents?

PPIs H2RAs Sucralfate Prostaglandins

What is the MOA of sucralfate?

forms a protective coating that adheres to damaged mucosal area

Misoprostol is a _________ that is pregnancy category __.

protaglandin | X

What are the 2 treatment therapies for PUD and what are their durations?

triple therapy - 14 days | quadruple therapy - 10 days

What agents are included in triple therapy for PUD?

PPI clarithromycin amoxicillin or metronidazole

What agents are included in quadruple therapy for PUD?

PPI or H2RA bismuth tetracycline metronidazole

How is treatment confirmed for PUD?

8 weeks from completion of therapy: fecal antigen test urea breath test

How is NSAID induced PUD treated?

discontinue nonselective NSAID PPI (4 weeks) H2RA sucralfate