GERD Flashcards
Signs and symptoms of GERD
HEARTBURN!
Substernal burning, chest pain, regurgitation of stomach contents
Diagnosis of GERD
Heartburn for an extended period (3 months)
Tried OTC products but symptoms came back
Can also use endoscopy to see possible esophagitis and Barrett’s esophagus
Complications of GERD
If left untreated, can lead to esophagitis, Barrett’s esophagus, or esophageal cancer
Non-pharm treatment of GERD
Small frequent meals, remain upright after/during eating, don’t eat at least 3 hours before bed, avoid trigger foods, weight loss, smoking cessation, prop head of bed with foam wedge, avoid tight-fitting clothing
GERD treatment goals
Relieve symptoms, heal any damaged mucosal tissue, prevent complications
Antacids for GERD
Tums, Rolaids
ADEs of antacids
Mg-containing salts may cause diarrhea
Al and Ca-containing salts may cause constipation
Overall well tolerated
H2RAs for GERD
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
OTC dosing for H2RAs is ? of the Rx dose.
Half of the Rx dose
What can develop with long-term H2RA use?
Tolerance
Dosing frequency of H2RAs
BID
Which drug class has the most potent acid suppression for GERD?
PPIs
PPI drugs
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Esomeprazole (Nexium)
PPI counseling point about when to take it
Dosed once daily in the morning (take before first meal of the day)
OTC duration of PPI therapy
14 days
Rx duration of PPI therapy
8 weeks
PPI side effects
Increased risk of C. diff infection, CAP, thrombocytopenia, CNS effects, osteoporosis and increased fracture risk with long-term use
When to use PPI chronically
Complications (esophagitis, Barrett’s)
NSAID use in NSAID-induced PUD
Symptoms return when stopping PPI
How to manage chronic PPI use
Titrate to lowest effective dose to prevent ADEs, maybe intermittent treatment, PRN dosing, OTC strength
Alternate therapy for chronic PPI use
Can also use an H2RA PRN or antacids for episodic relief
Dyspepsia signs and symptoms
Discomfort in the epigastrum (bra line), burning, fullness, gnawing, bloating, early satiety
Is dyspepsia always associated with GERD?
Sometimes, but sometimes not
