Chapter 35 - Gastroesophageal Reflux Disease and Peptic Ulcer Disease

Question 1

Antacids

• mylanta

Answer 1

 mylanta
 MOA: Neutralizes gastric acid by raising pH
 Use: PUD, GERD, esophagitis, heartburn, GI bleed, gastritis, stress ulcers
 Admin: Shake liquids well to thoroughly mix, caution in those with renal impairment (Mg accumulates)
 AE: Constipation (aluminum), diarrhea (magnesium), hypermagnesemia

Question 2

H2 Blockers

• cimetidine (Tagamet)

Answer 2

 cimetidine (Tagamet)
 MOA: Inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin
 Use: GERD, PUD, esophagitis, GI bleed, duodenal ulcers, heartburn
 Admin: IV must be diluted, give slowly
 AE: Diarrhea, dizziness, drowsiness, headache, confusion, and gynecomastia. They occur infrequently following the usual doses and standard duration of treatment

Question 3

Proton Pump Inhibitors (PPIs)

• omeprazole (Prilosec)

Answer 3

 omeprazole (Prilosec)
 MOA: Bind irreversibly to the gastric proton pump to prevent the “pumping” or release of gastric acid from parietal cells
 Use: PUD, GERD with erosive esophagitis, H. pylori
• More likely to be used in patients who have been scoped with a known peptic ulcer, as opposed to H2 blockers which are more used for reflux like symptoms
 AE: Minimal with both short- and long-term use. Nausea, diarrhea, and headache are the most frequently reported adverse effects. High dose or long-term use of PPIs carry a possible increased risk of bone fractures

Question 4

Adjuvant Medications

• sucralfate (Carafate)

Answer 4

 sucralfate (Carafate)
 MOA: Binds to normal and ulcerated mucosa. Thought to act locally on the gastric and duodenal mucosa
• Drink a whole glass of water, pill makes a gelatinous coating over mucosa of stomach (heals ulcer); must make sure to be swallowed all the way down so it does not gelatinize before it gets to stomach
 Use: Treatment and prevention of PUD; ulcer treatment (requires 4 to 8 weeks unless healing is confirmed by radiologic or endoscopic exam); when used long term to prevent ulcer recurrence, dosage reduction is necessary