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Therapeutics > final exam lecture 4 > Flashcards

final exam lecture 4 Flashcards

1
Q

causes of GERD

A

decrease in esophageal resistance
Lower LES pressure (sphincter is more relaxed and open)
delayed gastric emptying
acid pocket formation

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2
Q

Foods that decrease LES pressure

A

chocolate

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3
Q

Foods that irritate esophageal mucus

A

spicy/acidic food

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4
Q

medications that decrease LES pressure

A

Tetracyclines caffeine

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5
Q

Medications that directly irritate esophageal mucosa

A

Aspirin, NSAID, Bisphosphonates

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6
Q

Name the two categories of clinical presentation of GERD

A

Symptom based (heart burn, regurgitation, chest pain)
Extraesophageal (cough, laryngitis, wheezing, asthma)

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7
Q

3 key symptoms of symptom based GERD

A

Heartburn
regurgitation
Reflux chest pain

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8
Q

Extraesophageal symptoms

A

Wheezing, asthma, laryngitis, cough

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9
Q

What are alarm symptoms for GERD

A

Dysphagia (difficulty swallowing)
Bleeding
odynophagia (painful swallowing)
weightloss

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10
Q

Length of OTC GERD symptoms?
Length of Px treatment

A

2 weeks for OTC
8 weeks for Px

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11
Q

Name the treatment options for GERD

A

Lifestyle mods
PRN meds (antacids, H2RAs)
Scheduled meds (PPIs)
Surgery

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12
Q

PRN meds for GERD

A

Antacids, H2RAs

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13
Q

scheduled meds for GERD

A

PPIs, H2RAs

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14
Q

1st line of therapy for GERD symptoms

A

Lifestyle mods

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15
Q

2nd line of therapy for GERD

A

OTC TREATMENT
Infrequent symptoms- Antacids PRN
or
Mild/moderate- H2RA or PPI for 14 days

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16
Q

When to refer for GERD symptoms

A

14 day trial with OTC med

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17
Q

3rd line of treatment for GERD. What to do if failed

A

PPIx8 weeks. If failed, try different PPI

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18
Q

lifestyle mods for GERD

A

fatty meals
carbonated beverages
stop smoking
sleep on left side
sleep with head elevated
lose weight

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19
Q

not recommendable for GERD

A

Alcohol
caffeinated beverages

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20
Q

How do antacids help with GERD

A

offer immediate symptomatic relief by neutralizing stomach acid.

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21
Q

side effects of antacids

A

Calcium- causes constipation and mild alkali syndrome
Mg causes Diarrhea and accumulation
Al causes constipation and confusion

All can cause nausea and vomiting

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22
Q

onset and duration for antacids

A

5 min onset and 30-60 min duration

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23
Q

Common drug interactions for antacids

A

Antimicrobials (fluoroquinolones, tetracyclines, azole antifungals)
LEVOTHYROXINE
Iron
Steroid
digoxin
HIV meds

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24
Q

When to take medications when taking Antacids

A

2 hours before or 4-6 hours after antacids

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25
Q

Tums dosing? max number of tabs?

A

2-4 tabs PRN up to 4X/day
Max- 16 tab/day

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26
Q

most common side effect for CaCO3

A

Constipation

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27
Q

Most common side effect for MgOH

A

Diarrhea (MEGA BOWEL MOVEMENTS)
AL- ALL BACKED UP

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28
Q

What elements does maalox contain

A

Al+Mg+Simethicone

29
Q

Which medications not to recommend for children under 12 due to reyes syndrome

A

Alkaseltzer
peptobismol (BSS)
Simethicone (GAS-x)

30
Q

What side effect to expect from milk of magnesia

A

Diarrhea (Mg)

31
Q

Mechanism of H2RAs

A

reversible inhibition of histamine receptor in parietal cells, decreasing the amount of acid

32
Q

Most common H2RA

A

Famotidine (PEPCID)

33
Q

Dosing of famotidine (PEPCID) (OTC and Rx)

A

OTC- 10-20 mg up to bid
MAX- 40 mg/day

RX- 10 mg BID PRN
10-60 mins before trigger foods

If symptoms persist after 2-4 weeks increase to 20 Mg BID

34
Q

Name H2RA drugs

A

Famotidine (Pepcid)
Cimetidine(tagamet)

35
Q

Cimetidine (tagamet) dosing

A

OTC/RX 200 mg daily
30 mins prior to trigger food
Lots of drug-drug interactions

36
Q

side effects of H2RAs

A

headache, dizziness, constipation or diarrhea
delirium(in those above 50 yo)
B12 deficiency with longterm use

37
Q

H2RA clinical pearls

A

Tachyphylaxis- longer use leads to lower effectiveness
On beers criteria- avoid in pateints with or at risk for delirium
famotidine is the best in class

38
Q

PPI moa

A

irreversible inhibition of proton pump

39
Q

Name PPI drugs

A

Dexlansoprazole (dexilant)
Esomeprazole(nexium)
Lansoprazole (prevacid)
Omeprazole
pantoprazole (protonix)
rabeprazole(aciphex)

All ER except omeprazole

40
Q

Dexlansoprazole (dexilant) dosing

A

No complications present- 30 mg daily
Complications present- 60 mg daily x 8 weeks then 30 mg indefinitely

ER
Dual release allows 2 different onsets
Only PPI that is taken without regard to meals

41
Q

Esomeprazole (nexium) dosing

A

PO rx 20-40 mg daily
IV RX 20-40 mg daily
OTC- 20 mg daily x 14 days- may repeat course in 4 months if needed (refer if it has not been 4 months0
must be taken 60 mins before meals

42
Q

Lansoprazole (prevacid) dosing

A

Rx 15-30 mg daily
OTC 15 mg daily for 14 days, may repeat in 4 months if needed
administer 30-60 mins before meal

43
Q

Which PPI drug is the only one that is not ER

A

Omeprazole

44
Q

omeprazole dosing

A

OTC- 20 mg daily x 14 days, may repeat in 4 months if needed
Rx- 10-40 mg daily
only IR formulation available
30-60 min before meal

45
Q

The only two IV PPIs available

A

Pantoprazole (prilosec)
Esomeprazole

46
Q

Pantoprazole dosings

A

Po rx- 20-40 mg
IV rx 40 mg
Tablet can not be crushed
60 min before meal

47
Q

Rabeprazole (aciphex) dosing

A

Rx only- 10-20 mg
30 min before meal

48
Q

Which PPIs do not need renal dose adjustements

A

No renal dose adjustments for all

49
Q

side effects of PPIs (short term)

A

Headache, dizziness, diarrhea, flatulence, nausea

50
Q

Side effects of PPIs (long term)

A

Hypomagnesemia
bone density decrease
vit b12 deficiency
CKD

51
Q

Which drugs are cyp2c19 inhibitors

A

Omeprazole and esomeprazole
(increase and decrease effects of different meds)

52
Q

Use of PPI and H2RA combo

A

reduces nocturnal symptoms

53
Q

GERD treatment for pregnant women

A

1st- lifestyle recommendations
if fails then
1st- Antacids or sucralfate
2nd line- H2RAs
Last line- any PPI except omeprazole

54
Q

GERD treatment for lactating mothers

A

PPIs and H2RAs are present in breast milk.
Use antacids

55
Q

symptoms of GERD in pediatric population

A

Refusing to eat
wheezing
dental erosion
regurgitation

56
Q

nonpharm options for infants experiencing GERD

A

Thickening formula/foods
Decreasing volume of intake
Milk free diet
Positioning therapy

57
Q

Drugs to avoid in children experiencing GERD? What should be used to treat GERD

A

Aluminum and bismuth subsalicylate. PPIs and H2RAs

58
Q

3 different causes of PUD

A

H. Pylori
NSIAD
Stress

59
Q

Which PUD causes are chronic? Which are acute?

A

H pylori and NSAID are chronic
Stress is acute

60
Q

Site of damage in the different causes of PUD

A

H pylori- Duodenal
NSAID- stomach
Stress- stomach

61
Q

Which cause of PUD is dependent on intergastric PH

A

H.pylori

62
Q

Ulcer depth of the different types of PUD

A

H. pylori- Superficial
NSAID- Deep
Stress- most superficial

63
Q

Aggressive vs protective factors for PUD

A

aggressive- pepsin, NSAID, H. Pylori, Gastric acid
Protective factors- Blood flow to mucosa, bicarbonate, prostaglandins and mucus

64
Q

How do we know if it is duodenal or stomach PUD

A

If pain relieves with food, it is duodenum
if worsens it is stomach

65
Q

Non- pharmacologic treatment for PUD

A

AVOID NSAIDS
reduce stress

66
Q

how do we treat PUD caused by H. Pylori

A

PPI + 2-3 antibiotics

67
Q

number 1 preferred regimen used for H pylori treatment

A

QUADRUPLE therapy

PPI BID
BSS
Metronidazole
tetracycline X10-14 days

68
Q

Which convenience package includes metronidazole, tetracycline and BSS

A

Helidac (14 days)or pylera(10 days). Must take PPI BID separately

Therapeutics (46 decks)

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