GERD Flashcards
esomeprazole: brand name
Nexium
clopidogrel: brand name
Plavix
COGEN trial results
addition of omeprazole to clopidogrel reduced gastrointestinal events without increasing cardiovascular events
osteoporosis+
remain on PPI?
remain on PPI therapy
long term PPI use leads to
does NOT increase the risk of CKD, dementia, bone fx, MI, pneumonia, micronutrient deficiencies, and GI cancer
PPI therapy is safe up to how many years?
3 years
limiting prescription of PPI therapy bc of concerns of long-term harm is not warranted
hallmark symptom of GERD
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
treatment goals
- relieve associated sxs
- promote esophageal healing
- avoid complication
- prevent recurrence
is routine global elimination (eg. strict elimination in ALL patients) of food that can trigger reflux recommended?
not recommended
although some pts may benefit depending on their history
magnesium causes
diarrhea
calcium causes
constipation
which antacids cause diarrhea?
Phillips milk of magnesia (also laxative)
which antacids cause constipation?
Tums
AlternaGEL
which antacids should be used cautiously in renal disease?
Phillips Milk of Magnesia
Tums
AlternaGEL
Alka-Seltzer
alka-seltzer: a/e
alkalosis
fluid retention
what is Gaviscon?
Combination products
forms a viscous solution that floats on surface of gastric contents
why can’t (OTC) antacids be used for more than 2 weeks?
Tums for 2 weeks = hypercalcemia
signs of hypercalcemia
-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
trial of OTC therapy (step 1)
not exceed 2 weeks
h2RAs-up to BID
PPI - up to QD
initial therapy for GERD (step 2)
- lifestyle modifications
- standard dose for acid suppression therapy
H2RAS (BID) x6-12wks
or
PPIs (QD) x4-8 wk
GERD+
Pt is taking PPIs (QD) but has only partial response
increase the dose to BID or switch to different PPI
efficacy varies among H2RAs at standard dose?
no significant difference
efficacy varies among PPIs at standard dose?
no significant difference
more effective than H2 blockers
cimetidine: s/e
headache
drownsiness
diarrhea
dizziness
breast englargment
toxicity: warfarin, carbamazepine, propranol, diazepam, etc.
