GERD

Question 1

antacids

Answer 1

aluminum hydroxide
calcium citrate
al/mg hydroxide

Question 2

antacids MOA

Answer 2

neutralizes acids - raises pH

Question 3

antacids uses

Answer 3

mild-intermittent heartburn or reflux - <1 episode/wk

Question 4

calcium based antacids side effects

Answer 4

constipation
hypercalcemia
alkalosis
acute or chronic renal injury

Question 5

aluminum based antacids side effects

Answer 5

constipation
hypophosphatemia

Question 6

magnesium based antacids side effects

Answer 6

diarrhea
hypermagnesemia

Question 7

aluminum based antacids caution with

Answer 7

renal failure (al retention = neurotoxic)

Question 8

magnesium based antacids caution with

Answer 8

renal failure

Question 9

surface agents

Answer 9

sucralfate
sodium alginate
bismuth

Question 10

surface agents MOA

Answer 10

coats esophageal/gastric mucosa, creates physical barrier between mucosa and acid

Question 11

surface agents use

Answer 11

short term management of GERD symptoms - swallow after meals, avoid drinking/eating after

Question 12

sucralfate side effects

Answer 12

constipation
aluminum toxicity

Question 13

sucralfate caution with

Answer 13

renal failure (aluminum toxicity)
diabetes - can cause hyperglycemia

Question 14

H2 receptor antagonists

Answer 14

cimetidine
famotidine

Question 15

H2 receptor antagnoists MOA

Answer 15

block stimulation of gastric parietal cells by competing with histamine at H2 receptors

Question 16

H2 receptor antagonists uses

Answer 16

GERD, dyspepsia, PUD

Question 17

H2 receptor antagonists side effects

Answer 17

HA, dizziness, diarrhea, constipation
cimetidine: gynecomastia
prolonged use (>2 years) may lead to B12 deficiency

Question 18

H2 receptor antagonists caution with

Answer 18

renal impairment (dose adjust)

Question 19

PPIs

Answer 19

omeprazole
esomeprazole
lansoprazole
pantoprazole

Question 20

PPI MOA

Answer 20

block the gastric H/K-ATPase inhibiting gastric acid secretion

Question 21

PPI uses

Answer 21

GERD, dyspepsia, PUD, h pylori

Question 22

PPI education

Answer 22

take 30-60min before first meal of the day
taper off is taken >6mo to avoid rebound gastric hypersecretion

Question 23

PPI long term risks

Answer 23

malabsorption of some minerals and vitamins (mag, Ca, B12)
increased risks of some diarrheal illness C diff infection, microscopic colitis
increased risk of bacterial pneumonia
acute interstitial nephritis, chronic kidney disease
gastric polyps

Question 24

PPI side effects

Answer 24

HA, nausea, abd pain, diarrhea

Question 25

PPi interactions

Answer 25

decreased absorption of certain HIV protease inhibitors increased concentration of digoxin, carbamzepine theophyline, warfarin, diazepam, phenytoin increased methotrexate concentration/toxicity can decrease anti platelet effects of clopidogrel can decrease absorption of PO iron

Question 26

H pylori triple therapy

Answer 26

clarithromycin + amoxicillin + PPI

Question 27

PUD quad therapy

Answer 27

bismuth subsalicylate + tetracylate + metronidazole + PPI

Question 28

bismuth MOA

Answer 28

stimulates prostaglandins/mucosa/bicarbinate production in stomach - mild microbial activity with h pylori - reduces inflammation in stomach (is ulcer protective/coating)

Question 29

side effects of bismuth

Answer 29

black stools, black tongue neurotoxicity - encephalopathy, aseptic meningitis, seizures

Question 30

bismuth caution with

Answer 30

increased risk of bleeding neurotoxicity tinnitus

Question 31

quad therapy side effects

Answer 31

diarrhea/abnormal stools, nausea, HA skin: SJS intercranial HTN, photosensitivity (tetracycline)

Question 32

quad therapy caution with

Answer 32

BLACK BOX WARNING: metronidazole is carcinogenic in mice and rats hepatic impairment

Question 33

misoprostol MOA

Answer 33

synthetic prostaglandins E1 analogs - prostaglandins inhibit acid secretion by reducing the ability of parietal cells to respond to histamine

Question 35

misoprostol use

Answer 35

prevention of NSAID induced gastric ulcers

Question 36

misprostol side effects

Answer 36

diarrhea, abd pain, HA

Question 37

misprostol drug interactions

Answer 37

avoid with magnesium containing antacids

Question 38

misprostol caution with

Answer 38

BLACK BOX WARNING: containdicated in pregnancy or women of childbearing age - birth defects, premature birth, abortion, uterine rupture can induce uterine contractions