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NSG 533 > Exam 1- GI > Flashcards

Exam 1- GI Flashcards

1
Q

What is GERD

A

When stomach contents flow back into the esophagus due to weakened or damaged LES ( Lower Esophageal Sphincter)

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2
Q

Foods that worsen GERD

A

Fatty, spicy, acidic foods. Chocolate, mint, tomato juice, garlic, onion, caffeine, alcoho

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3
Q

Lifestyle that worsens GERD

A

Smoking , drinking alcohol, obesity, tight clothing, laying down after eating, large meals

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4
Q

Typical symptoms of GERD

A
  • regurgitation ( vomit)
  • heartburn, belching, hypersalivation
  • typical symptoms= GERD may be worse with activities that worsen reflux
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5
Q

Atypical GERD symptoms

A
  • 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
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6
Q

Alarm GERD symptoms

A
  • 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)

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7
Q

Nonpharmacologic GERD treatment

A
  • 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
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8
Q

What are antacid medications that patients can take on their own for GERD?

A
  • 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)
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9
Q

What are examples of H2RA meds?

A
  • cimetidine
  • famotidine
  • nizatidine

• all end in dine.

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10
Q

What are examples of PPI medication?

A
  • esomeprazole
  • lansoprazole
  • omeprazole

• all end in prazole

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11
Q

What are antacid medications good for in GERD

A

-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

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12
Q

Side effects of antacid medications

A
  • antacids containing magnesium= diarrhea
  • Antacid containing calcium= constipation
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13
Q

How do Histamine- 2 receptor antagonists work? ( H2RA)

A
  • they decrease acid secretion by blocking histamine 2 receptors in gastric parietal cells
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14
Q

How do PPIs work? ( proton pump inhibitors)

A
  • Black gastric acid secretion by inhibiting gastric H+/ K+
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15
Q

What are the side effects of H2RA meds?

A
  • 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)

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16
Q

What is a H2RA medication that has a lot of drug interactions?

A

Cimetidine
( weak inhibitor of cytochrome P- 450 with many common drug interactions)

17
Q

What are some side effects of cimetidine?

A
  • gynecomastia ( male breasts) and vitamin b 12 deficiency
18
Q

When should a patient take a PPI? Morning or night?

A

In the morning, 30 to 60 minutes before breakfast

19
Q

What are some short term side effects of PPI meds?

A
  • they are generally well tolerated, but most common side effects are headache and stomach effects like diarrhea and nausea
20
Q

What are some side effects of long-term PPI use?

A
  • 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)
21
Q

What medication should do not administer with PPI?

A
  • 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)
22
Q

When should patients self treat with a short term non-prescription PPI therapy?

A

If they have heartburn symptoms 2 or more times a week

23
Q

What should happen if a patient wants to stop long-term PPI therapy

A

They should be slowly titrated off due to potential for a rebound gastric acid hyper secretion with sudden withdrawal

24
Q

After confirmation of a Gerd diagnosis, how long should a trial of a scheduled PPI be?

A

8 weeks

25
Q

What are three reasons for peptic ulcer disease?

A
  • H Pylori
  • NSAID use
  • Stressed related mucosal damage
26
Q

How do anticholinergic medications work for anti nausea? And what are the side effects?

A
  • 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
27
Q

GERD during pregnancy- what meds to avoid

A
  • 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
28
Q

How is H pylori typically treated

A
  • combo of antibiotics plus a PPI
  • H pylori tx needs 3-4 meds for 10-14 days ( acid suppressing agents, 2-3 antibiotics)
29
Q

H pylori treatment regimens

A
  • clarithromycin triple ( PPI bid)
    - clarithromycin 500mg bid
    Amoxicillin 1g BID
    Metrondiazole 500mg tid
30
Q

What is the prevention of NSAID induced ulcer

A

-PPIs at standard doses

31
Q

Example of antihistamines- anticholinergic anti n/v medication

A
  • scopolamine ( transdermal patch)
  • diphenhydramine
  • hydroxyzine IM
  • dimenhydrinate
  • use and caution with elderly patients, drowsiness may contribute to falls
32
Q

Butyrophenones

A
  • 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
33
Q

Meds used to treat simple n/v? And what are the side effects?

A
  • phenothiazines
    - phenothiazines chlorpromazine, prochlorperazine, and promethazine
  • minor side effects: drowsiness, headache, blurry vision
  • more serious side effects: tardive dyskinesia
34
Q

Meds used to treat simple n/v? And what are the side effects?

A
  • phenothiazines
    - phenothiazines chlorpromazine, prochlorperazine, and promethazine
  • minor side effects: drowsiness, headache, blurry vision
35
Q

How to treat h pylori infection with patients allergic to penicillin

A
  • would replace amoxicillin with another antibiotic ( ex replace with metronidazole)
36
Q

How is H pylori transmitted

A
  • the infection normally resides in the stomach and is transmitted through ingestion fecal- contaminated water or food
37
Q

Antidiarreheal med

A

Loperamide

NSG 533 (4 decks)

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