Dyspepsia

Question 1

What is the difference between GERD and Dyspepsia?

Answer 1

GERD is a specific cause of dyspepsia
Dyspepsia is epigastric pain and discomfort

Question 2

What is the most common cause of dyspepsia?

Answer 2

Functional dyspepsia

Question 3

What is functional dyspepsia?

Answer 3

No abnormality found for their dyspepsia

Question 4

What are risk factors for dyspepsia?

Answer 4

diet
drugs
H pylori
smoking
alcohol

Question 5

What are the drugs that can cause dyspepsia? What is the mechanism?

Answer 5

Bisphosphonates
iron
NSAID
Potassium
Change motility or irritant (this is for Iron, NSAID, Potassium)

Question 6

What is the main sx of GERD?

Answer 6

heartburn and regurgitation

Question 7

What are alarm sx?

Answer 7

Vomiting
Bleeding/anemia
Abdominal mass/weight loss
Dysphagia/odynophagia

Question 8

What are other bad risk factors of dyspepsia? Why?

Answer 8

greater than 50 or greater than 60
GI cancer

Question 9

Which is more serious erosive or non erosive esophagitis?

Answer 9

erosive

Question 10

What are some causes of GERD?

Answer 10

bad sphincter
over eat/pregnancy= high pressure
hiatal hernia= diaphragm cant close sphincter
delayed gastric emptying
too much acid

Question 11

What drugs can induce GERD and what is MOA?

Answer 11

anticholinergic and benzos
MOA= slow peristalsis or relax sphincter

Question 12

Sx of GERD?

Answer 12

belch, water brash, chest pain, cough, throat clearing, dental erosion

Question 13

What would indicate moderate-severe GERD?

Answer 13

nocturnal symptoms, >3 x a week

Question 14

Complications of GERD?

Answer 14

esophagitis, barretts esophagus, cancer

Question 15

What is refractory GERD?

Answer 15

failed PPI after good 4-8 weeks

Question 16

How can we diagnose GERD?

Answer 16

endoscopy
barium swallow
Manometry or pH monitoring

Question 17

What are some lifestyle mods for GERD?

Answer 17

lose weight, stop smoking, elevate head

Question 18

Fastest treatment for GERD?

Answer 18

antacid

Question 19

What are the alginates and what is their role?

Answer 19

Sodium alginate- makes foamy that makes it feel better
adjunctive

Question 20

What are the counselling tips for sodium alginate?

Answer 20

take 1 hour after eating

Question 21

Who cant get antacids?

Answer 21

avoid in renal

Question 22

MOA of antacids?

Answer 22

neutralizes acid

Question 23

When to take antacids?

Answer 23

30-60 min after meal

Question 24

What is common s/e of aluminum antacids?

Answer 24

constipating and bone issues

Question 25

Main s/e of magnesium antacids?

Answer 25

laxative

Question 26

Common drug interactions with antacids and how to fix?

Answer 26

antibiotics, Iron, bisphosphonates, levothyroxine space by 1 hour before or 2 hours after

Question 27

What are the H2RAs? MOA?

Answer 27

Cimetidine, end in tidine MOA- block histamine relesae= less acid

Question 28

What is dose of H2RA for GERD and not GERD?

Answer 28

GERD has lower dose

Question 29

S/e of H2RAs?

Answer 29

gi but cimetidine is poorly tolerated

Question 30

Which H2RA is not tolerated and why?

Answer 30

cimetidine because more CNS effect also more DI

Question 31

What is the main issue with H2RA?

Answer 31

tachyphylaxis after 8 weeks

Question 32

Which pantoprazole sodium is better for the night/ longer duration?

Answer 32

magnesium

Question 33

What is one PPI doesnt work for GERD?

Answer 33

try a different after 4-8 weeks

Question 34

When to give PPI for GERD?

Answer 34

30 min before meal

Question 35

How long to see benefit with PPI?

Answer 35

3-5 days

Question 36

In relation to standard dosing and double dosing, which should we do?

Answer 36

standard dose

Question 37

How do we adjust dose in renal patients with PPI?

Answer 37

NOTHING

Question 38

s/e of PPI?

Answer 38

metalic taste, ND, C diff, colitis, polyps, B12 deficiency, cancer

Question 39

If you experience s/e on one PPI, does a switch help at all?

Answer 39

yes

Question 40

What PPI is worst for causing colitis?

Answer 40

lansoprazole

Question 41

Which PPI do we chose if we want to avoid DI?

Answer 41

pantoprazole, rabeprazole, dexlansoprazole

Question 42

What are the prokinetic drugs? MOA? Which is less tolerated

Answer 42

domperidone and metoclopramide MAO- dopamine antagonist= stim motility less tolerated is metoclopramide

Question 43

When do you administer prokinetic drug?

Answer 43

within 30 min of eatingWH

Question 44

Who cant use metoclopramide?

Answer 44

gi obstruct, seizure, parkinsons

Question 45

Who cant take domperidone?

Answer 45

gi obstruction, QT if at high doses

Question 46

s/e of domperidone

Answer 46

dr mouth, QT, gynecomastia

Question 47

S/e of metoclopramide?

Answer 47

drowsy, muscle weak, pseudo parkinsons

Question 48

What enzyme does metoclopramide use?

Answer 48

2D6

Question 49

What enzyme does domperidone use?

Answer 49

3A4

Question 50

What is a predictor of failure on PPI?

Answer 50

weakly acidic or alkaline reflux

Question 51

Which people should be deprescribed off of PPI?

Answer 51

responded, proper duration, no sx for 3 days, no H pylori

Question 52

Who should never be deprescribed?

Answer 52

Barretts, chronic NSAID use includes ASA, severe esophagitis, bleeding ulcer

Question 53

What do we do for functional dyspepsia?

Answer 53

PPI for 8 weeks, H pylori testing, add TCA, add prokinetic

Question 54

What signs in a baby should be treated for GERD?

Answer 54

loss of weight, blood in stool, irritable when taking food

Question 55

What signs in a baby make it more serious than GERD?

Answer 55

forceful vomit, fever, distention

Question 56

Who has a lower chance of having GERD, breast or bottle fed?

Answer 56

breast

Question 57

What do we do for infant with GERD?

Answer 57

PPI for 2 weeks if improve do for 3 months

Question 58

If pregnant and have GERD what should you do? What about lactation

Answer 58

pregnant= avoid sodium bicarb and magnesium trisilicate lactate= pantoprazole

Question 59

What drugs can cause esophagitis?

Answer 59

Doxycylcine, Potassium tab, NSAIDs, Bisphosphonates

Question 60

How can we lower DI esophagitis?

Answer 60

don't lie down, water, smaller pills