Exam 1- GI Flashcards
What is GERD
When stomach contents flow back into the esophagus due to weakened or damaged LES ( Lower Esophageal Sphincter)
Foods that worsen GERD
Fatty, spicy, acidic foods. Chocolate, mint, tomato juice, garlic, onion, caffeine, alcoho
Lifestyle that worsens GERD
Smoking , drinking alcohol, obesity, tight clothing, laying down after eating, large meals
Typical symptoms of GERD
- regurgitation ( vomit)
- heartburn, belching, hypersalivation
- typical symptoms= GERD may be worse with activities that worsen reflux
Atypical GERD symptoms
- chronic cough
- hoarseness
- wheezing
- asthma ( about 50% or people with Asthma have GERD)
• atypical symptoms= associated with GERD but causality should only be considered if typical symptoms are also present
Alarm GERD symptoms
- dysphagia ( difficulty swallowing)
- odynophagia ( Pain while swallowing foods or liquids)
- weight loss
- bleeding
• alarm symptoms = may indicate GERD complications like Barrett esophagus ( Barrett’s= usually a result of repeated exposure to stomach acid. Mostly diagnosed in people with long term GERD)
Nonpharmacologic GERD treatment
- losing weight if overweight or obese
- elevate the head or bed with a foam wedge if symptoms are worse when laying down
- eating smaller meals
- avoid eating meals 3 hrs before sleeping
- stop smoking and avoid alcohol
What are antacid medications that patients can take on their own for GERD?
- magnesium hydroxide/ aluminum ( if symptoms are unrelieved with lifestyle modification and OTC meds after 2 weeks, go seek medical attention)
- antacid
Calcium carbonate ( aka Tums)
What are examples of H2RA meds?
- cimetidine
- famotidine
- nizatidine
• all end in dine.
What are examples of PPI medication?
- esomeprazole
- lansoprazole
- omeprazole
• all end in prazole
What are antacid medications good for in GERD
-Useful for intermittent treatment of GERD symptoms, used for patients with infrequent typical reflux symptoms
- effective for immediate symptomatic relief, but require frequent dosaging
- ex: aluminum or magnesium containing antacids
Side effects of antacid medications
- antacids containing magnesium= diarrhea
- Antacid containing calcium= constipation
How do Histamine- 2 receptor antagonists work? ( H2RA)
- they decrease acid secretion by blocking histamine 2 receptors in gastric parietal cells
How do PPIs work? ( proton pump inhibitors)
- Black gastric acid secretion by inhibiting gastric H+/ K+
What are the side effects of H2RA meds?
- they are generally well tolerated, but some mild side effects. Include headache and nausea
( think “ after I dine I always get a headache and feel nauseas)
What is a H2RA medication that has a lot of drug interactions?
Cimetidine
( weak inhibitor of cytochrome P- 450 with many common drug interactions)
What are some side effects of cimetidine?
- gynecomastia ( male breasts) and vitamin b 12 deficiency
When should a patient take a PPI? Morning or night?
In the morning, 30 to 60 minutes before breakfast
What are some short term side effects of PPI meds?
- they are generally well tolerated, but most common side effects are headache and stomach effects like diarrhea and nausea
What are some side effects of long-term PPI use?
- renal complications ( acute kidney injury, and chronic kidney disease)
- Bone fractures
- Infection ( C diff)
- Possibly dementia
- Pneumonia
- Vitamin deficiency ( because of reduced absorption of micro nutrients)
What medication should do not administer with PPI?
- clopidogrel
( aka Plavix, a blood thinner. Administering a PPI and Plavix together can increase cardiac risk because of interaction through CYP 2C19 which is an enzyme protein)
When should patients self treat with a short term non-prescription PPI therapy?
If they have heartburn symptoms 2 or more times a week
What should happen if a patient wants to stop long-term PPI therapy
They should be slowly titrated off due to potential for a rebound gastric acid hyper secretion with sudden withdrawal
After confirmation of a Gerd diagnosis, how long should a trial of a scheduled PPI be?
8 weeks
What are three reasons for peptic ulcer disease?
- H Pylori
- NSAID use
- Stressed related mucosal damage
How do anticholinergic medications work for anti nausea? And what are the side effects?
- ex: scopolamine
-blocks muscarinic and histamine receptors in the vomit center / vestibular system which stops signaling to the CNS - used when cause of n/v is motion sickness or vertigo
- side effects : dry mouth, dizziness, blurry vision
- use with caution in elderly patience, drowsiness may contribute to falls
GERD during pregnancy- what meds to avoid
- antacids containing magnesium trisilicate specifically should be avoided due to risk of respiratory distress and cardiovascular impairments ( mag tri= breathing and heart problems in preggos)
- medications containing sodium bicarbonate= risk for metabolic alkalosis and both mom and fetus
How is H pylori typically treated
- combo of antibiotics plus a PPI
- H pylori tx needs 3-4 meds for 10-14 days ( acid suppressing agents, 2-3 antibiotics)
H pylori treatment regimens
- clarithromycin triple ( PPI bid)
- clarithromycin 500mg bid
Amoxicillin 1g BID
Metrondiazole 500mg tid
What is the prevention of NSAID induced ulcer
-PPIs at standard doses
Example of antihistamines- anticholinergic anti n/v medication
- scopolamine ( transdermal patch)
- diphenhydramine
- hydroxyzine IM
- dimenhydrinate
- use and caution with elderly patients, drowsiness may contribute to falls
Butyrophenones
- butyrophenone haloperidol mostly used to treat n/v in palliative care setting, not considered first line treatment for uncomplicated n/v
- increased risk for prolonged QT interval
Meds used to treat simple n/v? And what are the side effects?
- phenothiazines
- phenothiazines chlorpromazine, prochlorperazine, and promethazine - minor side effects: drowsiness, headache, blurry vision
- more serious side effects: tardive dyskinesia
Meds used to treat simple n/v? And what are the side effects?
- phenothiazines
- phenothiazines chlorpromazine, prochlorperazine, and promethazine - minor side effects: drowsiness, headache, blurry vision
How to treat h pylori infection with patients allergic to penicillin
- would replace amoxicillin with another antibiotic ( ex replace with metronidazole)
How is H pylori transmitted
- the infection normally resides in the stomach and is transmitted through ingestion fecal- contaminated water or food
Antidiarreheal med
Loperamide
