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NAPLEX > Chapter 72: GERD and PUD > Flashcards

Chapter 72: GERD and PUD Flashcards

1
Q

GERD tx algorithm: Lifestyle Modifications

A
  • Weight loss
  • Elevate head of bed with foam wedges or blocks
  • Avoid eating high fat meals within 2 to 3 hours of bedtime
  • Avoid food/beverages that trigger reflux
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2
Q

GERD tx algorithm: Initial Drug Tx

A

PPI once daily for 8 weeks (can increase to bid if partial response or if nocturnal symptoms)

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3
Q

GERD tx algorithm: Maintenance Tx

A
  • 1st line PPI at lowest effective dose
  • Aly: HR2A if there is no erosive esophagitis and it relieves symptoms
  • metoclopramide and sucralfate not recommended
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4
Q

Antacids Warnings, SE, Notes

A

Warnings: aluminum and magnesium can accumulate with severe renal dysfunction

SE:
Calcium: constipation
Aluminum: constipation
Magnesium: loose stools

Notes: Calcium containing antacids are preferred in pregnancy

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5
Q

H2RA Warnings, SE, Notes

A

Warnings: Confusion (risk factors: elderly, severely ill, renal impairment)
SE: Cimetidine: gynecomastia, impotence
Notes: Decrease dose when CrCl <50ml/min, avoid cimetidine due to drug interactions

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6
Q

Injectable H2RA

A

Famotidine

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7
Q

Before Breakfast PPIs

A
  • Esomeprazole (at least 60 minutes before breakfast)
  • Lansoprazole
  • Omeprazole
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8
Q

Dexlansoprazole Administration

A

Without regard to meals

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9
Q

Pantoprazole Administration

A

Tablet: without regard to meals
Suspension: 30 minutes before a meal

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10
Q

Injectable PPIs

A

Esomeprazole

Panoprazole

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11
Q

PPI warnings

A

C. diff associated diarrhea
Hypomagnesemia
Vit B12 deficiency with prolonged use (>=2 years)
Osteoporosis-related bone fractures with high dose or long-term (>=1yr)

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12
Q

PPI and Clopidogrel

A

Do not use omeprazole or esomeprazole. Will reduce therapeutic effect of plavix

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13
Q

PPI capsules that can be opened

A 
Dexlansoprazole
Esomeprazole
Lansoprazole
Omeprazole
Rabeprazole
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14
Q

ODT PPIs

A

Lansoprazole

Omeprazole

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15
Q

PPI Packets for suspension

A

Esomeprazole
Omeprazole
Pantoprazole

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16
Q

Metoclopramide dosing

A

10-15mg qid 30 minutes before meals and hs

CrCl <60 decrease dose by 50% to avoid CNS/EPS side effects

17
Q

Metoclopramide Warnings and SE

A

Boxed Warning: Tardive dyskinesia
Warning: EPS (including Parkinson types symptoms)
SE: drowsiness

18
Q

Drugs that Require Acidic Gut

A
  • Antiretrovirals (rilprivinem atazanavir)
  • Antivirals (ledipasvir, velpatasvir/sofosbuvir)
  • Azole antifungals
  • Cephalosporins
  • Iron products
  • Mesalamine
  • Risendronate dr
  • Tyrosine kinase inhibitors (dasatanib, erlotinib, pazopanib)
19
Q

Drugs that Bind Antacids

A
  • Antiretrovirals (bictegravir, dolutegravir, elvitegravir, raltegravir)
  • Bisphosphonates
  • Isoniazid
  • Levothyroxine
  • Mycophenolate
  • Quinolones
  • Sotalol
  • Steroids (especially budesonide)
  • Tetracyclines
20
Q

Causes of PUD

A
  • H. pylori (spiral shaped gram negative bacterium)
  • NSAID induced ulcers
  • Stress ulcer (critically ill and medically ventilated patients)
21
Q

H. pylori symptoms

A

Pain is usually worse 2-3 hours after eating and eating food or taking antacids lessens the pain

22
Q

Gastric ulcer symptoms

A

Eating generally worsens the pain

23
Q

1st Line H. pylori Tx: Quadruple therapy

A
  • Bismuth subsalicylate
  • Metronidazole
  • Tetracycline
  • PPI bid

Pylera QID + PPI bid

24
Q

1st Line H. pylori Tx: Concomitant therapy

A
  • Amoxicillin
  • Clarithromycin
  • Metronidazole
  • PPI bid
25
Q

1st Line H. pylori Tx: Clarithromycin Triple Therapy

A
  • Amoxicillin
  • Clarithromycin
  • PPI BID

Prevpac (amox, clarith, lansoprazole)

26
Q

NSAID with Cox selective inhibition

A

Have decreased GI risk but increased cardiovascular risk

27
Q

Vimovo

A

Naproxen/esomeprazole

28
Q

Yosprala

A

Asa/omeprazole

29
Q

Misoprostol Boxed Warnings and SE

A

Boxed Warning: Abortifacient, do not use in women of childbearing age
SE: Diarrhea, abdominal pain

30
Q

Sucralfate SE

A

Constipation
Difficult to use because of binding interactions

Take before meals

NAPLEX (45 decks)

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