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Pharmacotherapeutics - Final > GERD > Flashcards

GERD Flashcards

1
Q

alarm sx of GERD (8)

A

GIB
IDA
anorexia
unexplained wt loss
dysphagia
odynophagia
persistent vomiting
GI cancer in first degree relative

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2
Q

4 meds that can exacerbate GERD

A

CCB
plavix
ICS
nitrates

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3
Q

5 food triggers for GERD

A

caffeine
chocolate
spicy food
peppermint
carbonated drinks

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4
Q

mc s.e of PPIs (6)

A

ha
rash
dizzy
GI
arthralgias
B12

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5
Q

4 foods high in potassium

A

banana
avocado
oranges
beans

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6
Q

what drug can decrease sensitivity of h.pylori testing

A

ppi

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7
Q

how do you manage effect of ppi for pt who needs h.pylori testing

A

hold ppi 1-2 weeks prior to testing

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8
Q

what is considered an adequate trial of ppi

A

qd x 8 weeks

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9
Q

t/f: ppi’s affect Ca absorption

A

f!

but long term use does increase risk for OP -> follow DEXA recs

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10
Q

how do ppi’s increase risk for OP

A

decreased gastrin ->
hypochlorydia -> altered osteoclast

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11
Q

GERD affects the __ sphincter

A

lower esophageal

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12
Q

5 causes of lowered LES pressure

A

high fat/CHO diet
etoh
tobacco
acidic foods/drinks
meds

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13
Q

classes of GERD meds

A

antacids
sucralfate (carafate)
h2 blockers
ppi

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14
Q

what GERD med works by increasing pH (alklalinization) of gastric refluxate by neutralizing gastric acid

A

antacids:
alka-seltzer
tums
MOM
pepto bismol

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15
Q

2 indications for antacids as first line therapy

A

no e.o esophagitis
mild intermittent sx

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16
Q

can antacids be used in combo w. ppi/h2 blockers

A

yep!

for breakthrough sx

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17
Q

what antacids should be avoided for pt w. CKD

A

aluminum based

ok to use calcium-based

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18
Q

what off label GERD med acts as a mucosal coating to form protective barrier btw esophageal tissue and gastric refluxate

A

sucralfate

19
Q

sucralfate is approved for what 2 sx

A

erosive esophagitis
ulcerations

20
Q

why may antacids and sulcralfate have poor pt compliance

A

frequent dosing

21
Q

2 cautions w. sucralfate

A

not mono-therapy
contains aluminum -> not for CKD pt

22
Q

what GERD med works by inhibiting action of histamine at the parietal cell and decreasing basal acid secretion

A

h2 blockers:
cimetidine (tagemet)
famotidine (pepcid)

23
Q

what h2 blocker was pulled from the market dt increased risk for ca

A

ranitidine (zantec)

24
Q

t/f: all h2 blockers are equally effective

A

t!

all OTC as well

25
Q

h2 blockers are effective in __% of pt’s w. mild-mod GERD

A

50-70

26
Q

h2 blockers are less effective for pt’s with

A

true esophagitis

27
Q

your pt says cimetidine is no longer working for him, should you trial famotidine instead

A

no! switching does not help

28
Q

added benefit of h2 blockers

A

help w. allergic rxn

29
Q

2 s.e of h2 blockers

A

ha
hepatitis

both are very rare!

30
Q

what GERD med works by irreversibly binding to the parietal cell and inhibiting the final step of acid secretion

A

ppi:
omeprazole (prilosec)
pantoprazole (protonix)
lansoprazole (prevacid)
esomeprazole (nexium)

31
Q

what pump do ppi’s bind to

A

H+/K+ ATPase

32
Q

5 adverse effects of ppi’s

A

c.diff
fx risk
B12 deficiency
CKD
worse PNA

33
Q

3 common drugs w. ddi to ppi’s

A

plavix
diazepam
phenytoin

34
Q

what 2 GERD drugs cause acid suppression

A

h2 blockers
ppi’s

35
Q

your patient tells you that prilosec no longer works for him and he thinks he has developed a tolerance, what do you tell him

A

tolerance does not occur w. ppi’s

but it does w. h2 blockers

36
Q

ppi’s are more effective than h2 blockers for treating

A

erosion/esophagitis

37
Q

the fda has issued a warning regarding the use of __ with anticoags and antiplatelets

A

omeprazole

38
Q

order of tx for heartburn in pregnancy

A
  1. antacids PRN -> first line
  2. H2 blockers -> cat B
  3. ppi’s -> cat B
39
Q

which ppi is a category c in pregnancy

A

omeprazole

40
Q

any pt with __ should be started on ppi (3)

A

(+) h.pylori
GIB
any e.o esophagitis

41
Q

consideration with ASA for GERD pt

A

make sure it’s enteric coated

42
Q

2 ppi that are contraindicated w. anticoags

A

nexium (esomeprazole)
prilosec (omeprazole)

43
Q

2 ppi that are ok w. anticoags

A

prevacid (lansoprazole)
protonix (pantoprazole)

Pharmacotherapeutics - Final (6 decks)

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