Gastric Disorders 2 Flashcards
brand name famotidine
pepcid
brand name ranatadine
Zantac
brand name cimetidine
Tagamet
brand name omeprazole,
Prilosec
brand name lansoprazole
Prevacid
brand name dexlansoprazole
Dexilant
brand name rabeprazole
Aciphex
brand name esomeprazole/sodium bicarbonate
Zegerid
brand name pantoprazole
Protonix
brand name esomeprazole
nexuim
medications safe in pregnancy
PPI
H2 receptor agents
mild tx (GERD/gastritis)
- Lifestyle
- Antacids
- H2 receptor agonist
- PPI
- Carafate
- Bismuth
- Misoprostol
lifestyle modifications
eat smaller meals elimination acidic foods eliminate triggers weight loss avoid lying down 2-3 hours after eating HOB 3-4 inches
antacids
rapid relief of heartburn
appropriate for occasional GERD
last <2 hrs
Tums, Rolaids, Maalox, Gaviscon
antacids to watch in CKD
those with MG
H2 receptor agonists MOA
block effect of histamine on gastric cells
decreased histamine req. to make acid + elimination of potentiation of Ach and gastrin in acid production
H2 receptor antagonists used
Pepcid (preferred)
Axid
Tagamet
Zantac
-dine
H2 receptor antagonists act when? who can’t use?
30 min until action
dose adjust in CKD
Se of H2 blockers
B12 deficiency
AMS
IV: sinus Brady, hypotension, AVB, QT prolongation
PPIs use
most powerful
take ON EMPTY stomach
need some acid to work (cant take with H2 blocker)
PPIs special populations
OK in CKD, Pregancy
not okay in liver dz
PPIs used
Prilosec Prevacid dexilant aciphex protonix nexium/zegerd
PPI in children
> 1 mo: Prilosec
3 mo: Prevacid
12 yrs: dexilant
ADR of PPI
increased C Diff diarrhea
increased osteoporosis related factors
hypomagnesemia
impaired B-12
possible increased risk of CKD
rare ADR of PPI
DILE/lupus worse
increased risk fo dementia
increased risk of gastric tumor
rebound hyper secretion if stopped abrupbtly
Carafate
ulcer adherent complex
protects ulcer from acid/pepsin/bile (allows it to heal)
stimulates angiogenesis
bismuth
surpasses h. pylori, doesn’t inhibit or neutralize gastric acid
turns stool back
misoprostol
prostaglandin E hints acid secretion and enhances mucosa defense
prevent NSAID gastritis
can’t be given to women of childbearing age not on BC
gastritis tx algorithm
tx with meds on daily basis for freq. symptoms
PPI and H2s can’t be combined and antacids should not be used with PPI
inadequate response or no response in gastritis tx
increase PPI to bid or add adjunct tx
endoscopy (reflux esophagitis, GI lesion, complication of GERD)
nissen fundoplication
surgical tx of Gerd
pull stomach up to reinforce LES
duration of PPI or H2 blocker in PUD
gastric ulcer: 8 weeks
duodenal ulcer: 4 weeks
management of NSAID ulcer
reduction to lowest effective dose
administration with meals
concomitant PPI or Cytotec
when to do repeat EGD
gastric ulcers, 6-8 weeks after tx over to document heal/rule out CA
