GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Question 1

What is GERD?

Answer 1

Acid or bile reflux back into the esophagus . Primarly due to incompetent lower esophageal sphincter.

Question 2

HiSTAMINE RECEPTOR ANTAGONIST (H2RA)

Answer 2

First treatment choice for PUD AND GERD.
MECHANISM OF ACTION : promote gastric healing by preventing secretion.
ADVERSE EFFECTS : Usually uncommon

Question 3

H2RA DRUGS ( IDINE endings)

Answer 3

ADVERSE EFFECT: increase the risk of pneumonia but CIMETIDINE also affect the CNS
DDI: antacids but CIMETIDINE is an inhibitor of CYP450 enzymes.

Question 4

PROTON PUMP INHIBITORS (PPI)

DRUGS HAVE THE PRAZOLE endings

Answer 4

MECHANISM OF ACTION : inhibit acids secretion
ADVERSE EFFECTS : headaches , nausea , vomiting , risk of pneumonia , fractures, rebound acid hypertension , hypomagnesemia , clostridium difficile infection.
DDI: Decrease absorption of HIV meds (alozamir) , anti platelet effects of clopidogrel, ADMINISTER 60 MINUTE BEFORE MEAL.

Question 5

SULFATE

Answer 5

MECHANISM OF ACTION : undergo polymerization and cross linking in the stomach ,sticky gel, binds to ulcer , block acid and pepsin from reaching tissue.
PHAMACOKENETICS : minimal systemic absorption, last 6 hours.
INDICATION : treat and maintain PUD
ADVERSE EFFECTS : constipation
DDI : may decrease absorption of some drugs
NURSING APPLICATION : give 1 hour before meds, separate from other meds by 2 hours.

Question 6

MISOPROSOL

Answer 6

MECHANISM OF ACTION : analog of prostaglandins E1 (PGE) , promote PGE synthesis.
INDICATION: prevent ulcer in patient on chronic NSAID therapy.
ADVERSE EFFECTS : diarrhea and abdominal pain
CONTRAINDICATION : pregnancy (category X drug), precaution must be taken in woman at child bearing age.

Question 7

ANTIACIDS

Answer 7

Alkaline production that neutralize stomach acid. If PH rise >5 , may inhibit action of pepsin , may increase production of PGE. It is poorly absorbed systematically (except sodium bicarbonate)

Question 8

ALUMINIUM COMPOUND

Answer 8

Aluminum hydroxide binds to phosphate (hypophosphatemia)

ADVERSE EFFET : constipation

Question 9

MAGNESIUM COMPOUNDS

Answer 9

Magnesium hydroxide and oxide
ADVERSE EFFECT: diarrhea
OTHER CONSIDERATION : avoid in renal impairment ( accumulate Mg) and in undiagnosed abdominal pain

Question 10

CALCIUM COMPOUND

Answer 10

Calcium carbonate
ADVERSE EFFECT : constipation
OTHER CONSIDERATION : avoid in renal impairment ( accumulate ca)

Question 11

SODIUM COMPOUND

Answer 11

Sodium bicarbonate increase serum PH
ADVERSE EFFECT: no diarrhea or consitipation.
OTHER CONSIDERATION : avoid in renal impairment (NA retention )

Question 12

ANTIACID DDI

Answer 12

Decrease absorption of H2RA so separate them by 1 hour
Interfere with sulfate ,therefore separate by 1 hour.
Decrease absorption of drugs to drugs binding therefore separate by 2 hours.