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Advanced Pharma > GERD > Flashcards

GERD Flashcards

1
Q

esomeprazole: brand name

A

Nexium

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2
Q

clopidogrel: brand name

A

Plavix

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3
Q

COGEN trial results

A

addition of omeprazole to clopidogrel reduced gastrointestinal events without increasing cardiovascular events

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4
Q

osteoporosis+
remain on PPI?

A

remain on PPI therapy

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5
Q

long term PPI use leads to

A

does NOT increase the risk of CKD, dementia, bone fx, MI, pneumonia, micronutrient deficiencies, and GI cancer

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6
Q

PPI therapy is safe up to how many years?

A

3 years

limiting prescription of PPI therapy bc of concerns of long-term harm is not warranted

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7
Q

hallmark symptom of GERD

A

heartburn

retrosternal chest pain in association w/ certain foods or in the first hour/2hr after eating, or constantly)

maybe associated w/:
significant morbidity
atypical or alarm sxs

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8
Q

treatment goals

A
  1. relieve associated sxs
  2. promote esophageal healing
  3. avoid complication
  4. prevent recurrence
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9
Q

is routine global elimination (eg. strict elimination in ALL patients) of food that can trigger reflux recommended?

A

not recommended
although some pts may benefit depending on their history

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10
Q

magnesium causes

A

diarrhea

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11
Q

calcium causes

A

constipation

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12
Q

which antacids cause diarrhea?

A

Phillips milk of magnesia (also laxative)

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13
Q

which antacids cause constipation?

A

Tums
AlternaGEL

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14
Q

which antacids should be used cautiously in renal disease?

A

Phillips Milk of Magnesia
Tums
AlternaGEL
Alka-Seltzer

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15
Q

alka-seltzer: a/e

A

alkalosis
fluid retention

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16
Q

what is Gaviscon?

A

Combination products

forms a viscous solution that floats on surface of gastric contents

17
Q

why can’t (OTC) antacids be used for more than 2 weeks?

A

Tums for 2 weeks = hypercalcemia

18
Q

signs of hypercalcemia

A

-digestive sxs: N/V, poor appetite, constipation
-inc. thirst or more freq. urination due to changes in kidneys
-muscle weakness or twitches
-tired, fatigued, confusion
-bone pain & fragile bones

19
Q

trial of OTC therapy (step 1)

A

not exceed 2 weeks

h2RAs-up to BID
PPI - up to QD

20
Q

initial therapy for GERD (step 2)

A
  1. lifestyle modifications
  2. standard dose for acid suppression therapy

H2RAS (BID) x6-12wks
or
PPIs (QD) x4-8 wk

21
Q

GERD+
Pt is taking PPIs (QD) but has only partial response

A

increase the dose to BID or switch to different PPI

22
Q

efficacy varies among H2RAs at standard dose?

A

no significant difference

23
Q

efficacy varies among PPIs at standard dose?

A

no significant difference

more effective than H2 blockers

24
Q

cimetidine: s/e

A

headache
drownsiness
diarrhea
dizziness
breast englargment

toxicity: warfarin, carbamazepine, propranol, diazepam, etc.

25
Q

PPI

A

block gastric secretion by irreversibly binding & inhibiting the hydrogen-potassium ATPase pump on parietal cell membrane

given 30-60min before meal (food may affect absorption)

onset: 3-4 days for full inhibition (onset: 2-3 hr)
duration: 24 hrs

26
Q

pt is on PPI and symptomatic (step 3)

A

-lifestyle modifications
-PPIs (QD-BID) x4-16 weeks

27
Q

step 4

A

maintenance PPI for GERD pts continue to have sxs (erosive esophagus and BArrett’s esophagus) after PPI is discontinued

-surgery

28
Q

for maintenance therapy, add h2Ra for patients

A

with a goal of night-time reflux

after few weeks may lead to tachyphylaxis (drug tolerance)

29
Q

PPIs have good efficacy for symptom control and healing of

A

esophagitis over approximately 8 weeks but serious risks after long term use (>1 yr) inc fractures, pneumonia, C. diff, and recently linked dementia

30
Q

treatment for C. diff

A

Vanc 125mg 4x QD for 10 days OR
fidaxocmicin 200mg 2x DQ for 10 days
alternate if above agents are unavailable:
metronidazole 500mg 3x QD PO for 10days

Advanced Pharma (27 decks)

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