GERD Flashcards
alarm sx of GERD (8)
GIB
IDA
anorexia
unexplained wt loss
dysphagia
odynophagia
persistent vomiting
GI cancer in first degree relative
4 meds that can exacerbate GERD
CCB
plavix
ICS
nitrates
5 food triggers for GERD
caffeine
chocolate
spicy food
peppermint
carbonated drinks
mc s.e of PPIs (6)
ha
rash
dizzy
GI
arthralgias
B12
4 foods high in potassium
banana
avocado
oranges
beans
what drug can decrease sensitivity of h.pylori testing
ppi
how do you manage effect of ppi for pt who needs h.pylori testing
hold ppi 1-2 weeks prior to testing
what is considered an adequate trial of ppi
qd x 8 weeks
t/f: ppi’s affect Ca absorption
f!
but long term use does increase risk for OP -> follow DEXA recs
how do ppi’s increase risk for OP
decreased gastrin ->
hypochlorydia -> altered osteoclast
GERD affects the __ sphincter
lower esophageal
5 causes of lowered LES pressure
high fat/CHO diet
etoh
tobacco
acidic foods/drinks
meds
classes of GERD meds
antacids
sucralfate (carafate)
h2 blockers
ppi
what GERD med works by increasing pH (alklalinization) of gastric refluxate by neutralizing gastric acid
antacids:
alka-seltzer
tums
MOM
pepto bismol
2 indications for antacids as first line therapy
no e.o esophagitis
mild intermittent sx
can antacids be used in combo w. ppi/h2 blockers
yep!
for breakthrough sx
what antacids should be avoided for pt w. CKD
aluminum based
ok to use calcium-based
what off label GERD med acts as a mucosal coating to form protective barrier btw esophageal tissue and gastric refluxate
sucralfate
sucralfate is approved for what 2 sx
erosive esophagitis
ulcerations
why may antacids and sulcralfate have poor pt compliance
frequent dosing
2 cautions w. sucralfate
not mono-therapy
contains aluminum -> not for CKD pt
what GERD med works by inhibiting action of histamine at the parietal cell and decreasing basal acid secretion
h2 blockers:
cimetidine (tagemet)
famotidine (pepcid)
what h2 blocker was pulled from the market dt increased risk for ca
ranitidine (zantec)
t/f: all h2 blockers are equally effective
t!
all OTC as well
h2 blockers are effective in __% of pt’s w. mild-mod GERD
50-70
h2 blockers are less effective for pt’s with
true esophagitis
your pt says cimetidine is no longer working for him, should you trial famotidine instead
no! switching does not help
added benefit of h2 blockers
help w. allergic rxn
2 s.e of h2 blockers
ha
hepatitis
both are very rare!
what GERD med works by irreversibly binding to the parietal cell and inhibiting the final step of acid secretion
ppi:
omeprazole (prilosec)
pantoprazole (protonix)
lansoprazole (prevacid)
esomeprazole (nexium)
what pump do ppi’s bind to
H+/K+ ATPase
5 adverse effects of ppi’s
c.diff
fx risk
B12 deficiency
CKD
worse PNA
3 common drugs w. ddi to ppi’s
plavix
diazepam
phenytoin
what 2 GERD drugs cause acid suppression
h2 blockers
ppi’s
your patient tells you that prilosec no longer works for him and he thinks he has developed a tolerance, what do you tell him
tolerance does not occur w. ppi’s
but it does w. h2 blockers
ppi’s are more effective than h2 blockers for treating
erosion/esophagitis
the fda has issued a warning regarding the use of __ with anticoags and antiplatelets
omeprazole
order of tx for heartburn in pregnancy
- antacids PRN -> first line
- H2 blockers -> cat B
- ppi’s -> cat B
which ppi is a category c in pregnancy
omeprazole
any pt with __ should be started on ppi (3)
(+) h.pylori
GIB
any e.o esophagitis
consideration with ASA for GERD pt
make sure it’s enteric coated
2 ppi that are contraindicated w. anticoags
nexium (esomeprazole)
prilosec (omeprazole)
2 ppi that are ok w. anticoags
prevacid (lansoprazole)
protonix (pantoprazole)
