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16. GERD/PUD > Drugs > Flashcards

Drugs Flashcards

1
Q

Treatment for GERD

  • Pharmacological
  • Non-pharmacological
A

Pharmacological tx

  • PPI
  • Antacids
  • H2RA
  • Reglan
  • Alginic Acid

Non-pharmacological

  • Eliminating acidic foods and EtOH
  • Decrease weight
  • Not lying down within 3H after meals
  • Elevating the bed 6 inches
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2
Q

Cause of Peptic ulcer disease (PUD)

A
  • H. Pylori
  • ASA
  • NSAIDs
  • Corticosteroids
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3
Q

Treatment of PUD

A
  • Antacid, H2 Blockers, PPI
  • If pt is on NSAIDS, add misoprostol
  • For H. Pylori: use ABX
  • Sucralfate
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4
Q

Carafate

  • Use
  • Administer
  • # 1 SE:
A

Sucralfate

  • Bandaid for ulceration of PUD
  • Take b/4 food ON EMPTY STOMACH up to QID
  • # 1 SE: Constipation (xerostomia = dry mouth)
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5
Q

Antacid

  • Agents
  • DDIs
  • SEs
  • Pregnancy Cat
A

Agents:

  • NaHCO3: do not take w/ high BP and pregnancy (Na retain water)
  • CaCO3: Constipation
  • Al(OH)3: Constipation. Do not give to renal imp pt
  • Mg(OH)2: Diarrhea. Do not give to renal imp pt
DDIs
- Chelation of Tetracycline
  => Tetracycline, minocyline, doxycyline 
  => Do not give Antacids w/in 2H 
- Quinolones
  => Give 2H b/4 or 6H after antacids
- Levothyroxine
- Iron
- Absorption of drugs require acid pH 
  => Ketoconazole, itraconazole, etc

SEs

  • HyperCa, HyperMg
  • Constipation: Al, Ca
  • Diarrhea - Mg
  • Flatulence - NaHCO3
  • Aluminum intoxication
  • Na load
  • Safe in pregnancy
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6
Q

Gaviscon

  • Indication
A

Alginic Acid

  • I: Protects esophageal mucosa (need to be in upright position)
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7
Q

Tagament

  • Dose
  • Forms
  • SEs
  • DDIs
A

Cimetidine

  • Dose: 400-800mg/day
  • Forms: IV/IM, tab, PO sol’n
  • SEs: drowsiness, dizziness, agitation, gynecomastia
  • DDIs: Inhibitor => has most DDI of all H2RAs
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8
Q

Zantac

  • Forms
  • Dose
A

Ranitidine

  • Forms: IV/IM, tabs, caps, syrup
  • Dose: 150mg BID or 300mg QHS PO
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9
Q

Pepcid

  • Forms:
  • Dose
A

Famotidine

  • Forms: IV, tabs, suspension
  • Dose: 20mg BID or 40mg QHS
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10
Q

Axid

  • Forms
  • Dose
A

Nizatidine

  • Forms: Tabs, caps, sol’n
  • Dose: 150mg BID or 300mg QHS
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11
Q

All H2RAs come in IV except:

A
  • Except Nizatidine - Axid
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12
Q

All H2RAs take at HS except

A

Cimetidine - Tagament 400-800mg/day

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13
Q

H2RA

  • Which cause endocrine SEs: galactorrhea, gynecomastia, impotence?
A
  • Endocrine SEs: Cemetidine - Tagament
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14
Q

H2RA

  • DOC in Pregnancy
A
  • All Cat B

- DOC: Ranitidine - Zantac

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15
Q

H2RA

  • Renal adjust
A
  • Rec 1/2 dose
  • Cemetidine: CrCl less 30
  • All other: CrCl less than 50
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16
Q

H2RA

  • SEs
A
  • CNS: dizziness, sedation, HA, confusion

=> List in Beer criteria for elderly > 65y.o => worsen dementia and delirium

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17
Q

H2RAs

  • Which drug has DDI?
A
  • Cimetidine (CYP 1A2 inhibitor):

incr warfarin and theophylline

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18
Q

For nocturnal acid breakthrough, add what

A

Add H2RA QHS

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19
Q

Prilosec
Prilosec OTC

  • Dose:
  • DDI
A

Omeprazole

  • Dose: 20mg PO QD on EMPTY stomach
  • DDI:
    • Inc diltiazem, warfarin, phenytoin.
    • Decrease ketocontazole, itraconazole, iron, digoxin
20
Q

Zegerid
Zegerid OTC

  • Direction to take:
A

Omeprazole + Na Biocar

  • Mix w/ 30mL of water and consume immediately
21
Q

Nexium

  • Dose
  • Adm
A

Esomeprazole

  • Dose: 20-40mg QD (Zollinger-Ellision 40mg BID)
  • Adm: on empty stomach
22
Q

Vimovo

A

Esomeprozole/Naproxen

23
Q

Prevacid
Prevacid 24H

  • NG tube
  • Forms
  • Dose
A

Lansoprazole

  • NG tube: Suspension do not give through NG tube
  • Forms: Cap, ODT, Suspension
  • Dose: 15-30mg QD before meals
24
Q

Dexilant

  • Dose
A

Dexlansoprazole

  • R-isomer of lansoprazole
  • Dose: 30-60mg PO Daily w/ or w/o foods
25
Q

Protonix

  • Indication
  • Dose
A

Pantoprazole

  • GERD, PUD, Zollinger-Ellision
  • Dose: 40mg QD
26
Q

Aciphex

  • Indication
  • Dose
A

Rabeprazole

  • Indication: GERD, PUD, Zollinger-Ellision
  • Dose: 20mg QD (Zollinger-Ellision upto 60mg BID)
27
Q

PPI

  • Which available in OTC
A
  • Omeprazole: Prilosec OTC
  • Omeprazole/Na Biocar: Zegerid OTC
  • Lansoprazole 24H: Prevacid-24H
28
Q

PPI

  • Agents come in IV
  • SEs
  • Renal dose adjuted
A

IV = LEP

  • Lansoprazole
  • Esomeprazole
  • Pantoprazole

SEs

  • HA, dizziness
  • Chronic use = B12 deficiency
  • May increase C.diff
  • Decrease Ca, Mg
  • Renal dose adjusted: No
29
Q

Rapinex

A
  • Omeprazole oral suspension
30
Q

PPI

Tx Zollinger-Ellision

A

PER

  • Pantoprazole - Protonix: 40 mg BID
  • Esomeprazole - Nexium: 40mg BID
  • Rabeprazole - Aciphex: up to 60 mg BID
31
Q

PPI

  • Can give via NG - PEL
A

=> Pantoprazole (Protonix): sus can give via NG-Tube

  • Esomeprazole (Nexium) Cap & suspension

=> Lansoprazole also comes in suspension but DO NOT give via NG tube but CAP can open up and give thr NG-tube

32
Q

PPI

  • Come in ODT
A
  • Lansoprazole - Prevacid
33
Q

Prevpac

A

=> CAL
Lansoprazole 30 mg PLUS
Amoxicillin 500 mg PLUS
Clarithromycin 500 mg

34
Q

Naprapac

A

Lansoprazole 15mg PLUS

Naproxen 500 mgoai

35
Q

PPI

  • Come only in PO
A
  • Dexlansoprazole - Dexilant
  • Omeprazole
  • Lansoprazole
  • Rabeprazold

IV

  • Esomeprazole
  • Protonix
36
Q

PPI

  • Can give with or without foods => RDP
A
  • Dexlansoprazole - Dexilant
  • Pantoprazole - Protonix
  • Rabeprazole - Aciphex
37
Q

PPI

  • Can give to children w/ GERD
A
  • Rabeprazole - Aciphex
  • /= 15 kg: 10 mg PO QD up to 12 W
  • > /= 12 y.o: 20 mg PO QD up to 8W
38
Q

PPI DDI

  • Inhibitors of 2C19
A
  • Omeprazole
  • Esomeprazole
    => Decr: diazepam, phenytoin, warfarin
    => Inhibit enzyme convert plavix to its active form
39
Q

PPI DDI

  • Dont interact w/ CYP450
    => PR
A
  • Pantoprazole

- Rabeprazole

40
Q

PPI

Preg Cat B
=> PRL

A
  • Pantoprazole
  • Rabeprazole
  • Lansoprazole
41
Q

PPI

Preg Cat C

A
  • Omeprazole

- Esomeprazole

42
Q

PPI

  • Decrease bioavailability
A
  • Ketoconazole
  • Itraconazole
  • Cefpodoxime
43
Q

Misoprolol

  • SEs
  • Preg Cat
A

Cytotec

  • SEs: diarrhea, uterine bleeding, spontaneous abortion
  • Preg Cat: X
44
Q

Cytoprotective agents

A
  • Misoprolol
  • Bismuth
  • Sucralfate
45
Q

GERD in children

  • H2RA
  • PPI - LEO
A

H2RA

  • Famotidine: approve all age
  • Ranitidine: > 1mo

PPI

  • Lansorprazole
  • Omeprazole
  • Esomeprazole
46
Q

GERD in Pregnancy

  • Rec
A
  • Antacids
  • Alginate
  • Sucrafate 1g TID (constipation)
  • H2RA: Ranitidine (most study) => take after meal
  • PPI: Lansoprazole 30 mg b/4 breakfast

16. GERD/PUD (1 decks)

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