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PY3 > GERD > Flashcards

GERD Flashcards

1
Q

Chronic symptoms or mucosal damage produced by abnormal reflux of gastric contents into the esophagus

A

GERD

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2
Q

Prolonged periods of inflammation of the esophagus can progress to what?

A

Erosion of the epithelium of the esophagus

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3
Q

What two things can GERD be further classified as?

A
  1. NERD
  2. ERD
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4
Q

What does NERD stand for?

A

Non-erosive Reflux disease

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5
Q

What does ERD stand for?

A

Erosive reflux disease

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6
Q

What is the most frequent clinical complaint of GERD?

A

Heartburn

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7
Q

What age does GERD most commonly occur?

A

Ages >40

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8
Q

True or False: Males experience GERD more than females

A

False (equal)

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9
Q

True or false: infants can experience GERD

A

True

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10
Q

What are 5 risk factors of GERD?

A
  1. Genetic
  2. Obesity
  3. Excessive alcohol use
  4. Smoking
  5. Excessive coffee intake
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11
Q

What does GERD decrease? 4

A
  1. LES pressure or tone
  2. Clearance of gastric contents
  3. Mucosal resistance
  4. Gastric emptying
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12
Q

What does GERD do to gastric fluid?

A

Makes it extra acidic

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13
Q

GERD can cause a _____ hernia

A

Hiatal

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14
Q

If a patient is experiencing heartburn for _____ on a regular basis it could be GERD

A

> or = 2x/week

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15
Q

What are 4 atypical symptoms of GERD?

A
  1. Chronic cough
  2. Asthma like symptoms
  3. Laryngitis/ hoarseness
  4. Recurrent sore throat
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16
Q

What are 4 alarm symptoms of GERD that you should refer on for?

A
  1. Dysphasia
  2. Odynophagia
  3. Bleeding
  4. Unexplained weight loss
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17
Q

Trouble swallowing

A

Dysphasia

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18
Q

Odynophagia

A

Painful swallowing

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19
Q

What may the alarm symptoms be indicative of?

A

Barretts esophagus

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20
Q

What are 5 aggravating factors of GERD?

A
  1. Recumbancy (lying down)
  2. Increased abdominal pressure
  3. Decrease in gastric motility
  4. Decreased LES
  5. Direct mucosal irritation
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21
Q

What foods can decrease LES pressure?

A
  1. Fatty foods
  2. Peppermint
  3. Spearmint
  4. Chocolate
  5. Coffee
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22
Q

What medications decrease LES pressure? 7

A
  1. Anticholinergics
  2. BZDs
  3. Caffeine
  4. DHP calcium channel blockers
  5. Estrogen
  6. Ethanol
  7. Nicotine
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23
Q

What 4 foods are direct irritants to the esophageal mucosa?

A
  1. Spicy food
  2. Orange juice
  3. Tomato juice
  4. Coffee
24
Q

What 5 medications are direct irritants to the esophageal mucosa?

A
  1. Oral bisphosphonates
  2. Aspirin
  3. Iron
  4. NSAIDs
  5. Potassium
25
Q

When normal squamous epithelium may convert to a columnar cell epithelium after long standing disease

A

Barrett’s esophagus

26
Q

Those with Barrett’s esophagus can develop what?

A

Adenocarcinoma

27
Q

When should patients be monitored for adenocarcinoma?

A

Every few years

28
Q

What is heartburn also known as?

29
Q

When is invasive testing not indicated?

A

In uncomplicated GERD

30
Q

Technique of choice to identify complication of GERD

31
Q

What is the mainstay of therapy for GERD?

32
Q

What are three agents primarily used to treat GERD?

A
  1. PPIs
  2. H2 antagonists
  3. Antacids or alginic products
33
Q

Why are PPIs preferred over H2RAs?

A

PPIs have faster esophageal healing rates and faster, more complete heartburn relief

34
Q

When should Omeprazole be taken?

A

30-60 minutes before a meal (usually breakfast)

35
Q

What 3 PPIs can be taken without regard to meals?

A
  1. Dexlansoprazole
  2. Pantoprazole
  3. Rabeprazole
36
Q

What are 4 warnings associated with the PPIs?

A
  1. C-diff
  2. Osteoporosis related fractures
  3. Hypomagnesia
  4. Vitamin b12 deficiency
37
Q

What are the 6 PPIs?

A
  1. Omeprazole
  2. Pantoprazole
  3. Lansoprazole
  4. Dexlansoprazole
  5. Esomeprazole
  6. Rabeprazole
38
Q

Which 2 PPIs may decrease the effectiveness of clopidogrel via CYP2C19?

A
  1. Omeprazole
  2. Esomeprazole
39
Q

What are 3 H2RAs used to treat GERD?

A
  1. Famotidine
  2. Nizatidine
  3. Cimetidine
40
Q

True or false: H2RAs can be used in pregnancy if indicated

41
Q

Which PPIs are available in IV formulations?

A
  1. Pantoprazole
  2. Esomeprazole
42
Q

What drug can cause gynecomastia?

A

Cimetidine

43
Q

Why do the H2RAs become less effective over time?

A

Induce tachyphylaxis

44
Q

What 3 drug classes can be used for intermittent, mild heartburn without GERD?

A
  1. Antacids
  2. OTC H2 antagonists
  3. OTC PPIs
45
Q

What is the initial drug treatment for GERD?

A

PPI once daily for 8 weeks

46
Q

When can you increase PPIs dose to twice daily?

A

If partial response is seen or nocturnal symptoms are present

47
Q

If symptoms return, what can you use first line for maintenance therapy?

A

PPIs at lowest effective dose

48
Q

What is the regimen for erosive esophagitis or severe symptoms and complications?

A
  1. Lifestyle modifications
  2. PPIs up to twice daily for 8 weeks
49
Q

What are 7 lifestyle modifications?

A
  1. Weight loss
  2. Elevation of the head of the bed
  3. Eat smaller meals more frequently
  4. Avoid eating 3 hours prior to sleeping or lying down
  5. Avoid foods that aggravate GERD
  6. Avoid alcohol
  7. Tobacco cessation
50
Q

What patients should receive maintenance therapy?

A
  1. Those w a symptomatic relapse of GERD following d/c of the drug
  2. Those with a history of complications (Barrett’s esophagus)
51
Q

Adding a ____ at bedtime can control breakthrough symptoms at night.

52
Q

True or false: H2RAs need to be taken with meals in order to block acid secretion that is triggered by histamine

53
Q

Why might it be hard for patients to stop taking PPIs?

A

Because of rebound acid secretion caused by the PPIs

54
Q

When should you taper PPIs?

A

Over 4 to 6 weeks

55
Q

How should you taper PPIs?

A
  1. Lower the dose
  2. Extend interval to QOD then every 3rd day
  3. Can give an antacid or H2RA for “off days”
56
Q

What else can you suggest for rebound acid secretion?

A

Suggest switching to an H2RA and taking an antacid PRN for several weeks then d/c

PY3 (24 decks)

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