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255C > GERD > Flashcards

GERD Flashcards

1
Q

List of drugs in Alginates

A

sodium alginate (gavison)

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2
Q

List of drugs in antacids

A

Al Hydroxide
mg hydroxide
mg trisilicate
Ca carbonate
Na Bicarbonate

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3
Q

List of drugs in H2RAs

A

cimetidine
famotidine
ranitidine

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4
Q

List of drugs in PPIs

A

cimetidine
famotidine
ranitidine

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5
Q

List of drugs in PPI

A

rabeprazole
omeprazole
esomeprazole
pantoprazole
lansoprazole
dexlansoprazole

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6
Q

List of drugs in prokinetics

A

domperidone
metoclopramide

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7
Q

Indication for alginates

A

mild
intermittent
post pradial

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8
Q

Indication for antacids

A

mild
infrequent
post pradial

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9
Q

Indication for H2RAs

A

use for noctural
GERD
PUD
H. Pylori
+ others

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10
Q

Indication for PPI

A

H. pylori
GERD
NSAID ulcer
PUD
+more

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11
Q

Indication for prokinetics

A

GI motility disorders
sometime used for GERD

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12
Q

CI for alginates

A

none

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13
Q

CI for antacids

A

renal -> Ca and Al

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14
Q

CI for H2RAs

A

none

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15
Q

CI for PPI

A

none

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16
Q

CI for prokinetics

A

met -> cross BBB (tremors, parkinsons, seizures)
domper -> QT interval (only with high dose)
electrolytic disorder

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17
Q

MOA of Alginates

A

form a viscous “raft” that floats in stomach

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18
Q

MOA of antacids

A

neutral acid
inhibit pepsin generation binds to bile acid

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19
Q

MOA of H2RAs

A

parietal cells pump H+
inhibit H2R to prevent H+
decrease basal/stimulated acid secretion

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20
Q

MOA of PPI

A

direct inhibit proton pump prodrug activated by duodenum

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21
Q

MOA of prokinetics

A

dopamine antagonist stimulate gastric motility

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22
Q

Administration of alginates

A

~1 hr after meal

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23
Q

Administration of Antacids

A

up to QID

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24
Q

Administration of H2RAs

A

give 30-60 min before meal

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25
Q

Administration of PPI

A

give 30-60 min before meal

25
Q

Onset/duration of H2RAs

A

acid inhibitor 1-3 h
stimulate acid inhibition 3-5 h
nocturnal inhibitor 8-13 h

25
Q

Onset/duration of Prokinetics

A

with 30 min
lasts 1-2 h

25
Q

Administration of Prokinetics

A

30 min before meal
BID b/c of failed trial, h. pylori, ulcer/blood

25
Q

Onset/duration of alginates

A

rapid
short duration

25
Q

Safety Concerns of Antacids

A

DDI - chelation
Fe, bisph, diogixin, pheno, levothy, FQ, tetra

DDI - pH sedation
dabigatran, HIV meds

25
Q

Onset/duration of PPI

A

initial mild
3-5 days for maximal effect
takes 24-28 hours to recover

25
Q

Safety Concerns of alginates

A

bloating
flatulence
belching

25
Q

Onset/duration of Antacids

A

rapid
short duration

25
Q

Safety Concerns of H2RAs

A

Cim - weakly inhibitors
1A2
2C19
2D6
3A4

25
Q

Safety Concerns of Prokinetics

A

meto
parkinsons meds, 2D6 sub
makes antipsy, SSRI/TCA toxic

dom
3A4
QT prolongation

25
Q

Efficacy of alginates

A

better than placebo
worse than other agents

26
Q

Safety Concerns of PPIs

A

decrease absorption for ph sensitivity drugs
om/eso also cause decrease in clopidogrel

26
Q

Efficacy of Antacids

A

limited evidence (old drug)
better than placebo
add on therapy

26
Q

Efficacy of H2RAs

A

don’t use cim (not well tolerated)
more than antacid worse than PPI

26
Q

Efficacy of PPIs

A

all equal best overall class

26
Q

Common S/E of Antacids

A

AL - C
Mg - D
Ca - best tolerated

26
Q

Common S/E of H2RAs

A

extremely well tolerated
HA/V/D/drowiness

27
Q

Common S/E of PPIs

A

well tolerated
HA/N/D/C
rash/prutisis
dygeusia
dizziness

28
Q

Common S/E of Prokinetics

A

meto
drowiness
muscle weakness
HA
dizziness
confusion

Dom
dry mouth
mild HA

29
Q

Seriours S/E of Antacids

A

Al - bone demineralization
Mg - hypermagnesemia
Ca- well tolerated

30
Q

Seriours S/E of H2RAs

31
Q

Seriours S/E of PPIs

A

C. diff
microscopic colitis
hypomagenisemia
fractures
fundic gland polyps
B12 defiency
penumonia
gastric cancer
mortality increase

32
Q

Seriours S/E of Prokinetics

A

Meto
pseudoparkinson
EPS syndrome
gynecomastia
(less tolerated)

Dom
QT prolongation
gynecomastia

33
Q

Monitor of Antacids

A

gauge for overuse
renal fxn

34
Q

Monitor of H2RAs

35
Q

indication of misoprostol

A

prevent NSAID induced ulcer
tx of duo ulcer

36
Q

Monitor of PPI

A

sx recur >3 m - new trial with same med
sx recur <3 m, tx agin but investigate

watch hypomg
BMD if numerous risk factors
increase risk of C. diff infection

37
Q

CI of misoprostol

38
Q

MOA of misoprostol

A

prostagladin analogue
leading increase gastric mucous
increase bicarbonate secretion
all to balance out NSAIDs

39
Q

Administration of misoprostol

A

duo - QID 4-8w
prevent NSAID - qid

40
Q

safety concern of misoprostol

A

DDI
Mg antacids
increases ADR of mis

41
Q

warning of misoprostol

A

occupational hazard

42
Q

common s/e of misoprostol

A

D/abdominal pain
dyspepsia
not well tolerated/adherence

43
Q

Pregnancy and GERD

A

do not use Na bicarb/al tris
tums are great (Ca carb)
can use H2RA/ PPI
lans, omo, panto

44
Q

Peds and GERD

A

don’t normally treat
try smaller meals and allergies

45
Q

Definition of Refractory GERD

A

failed on 2 m of daily PPI
sx rec <3 m
~25% pt will refrac

46
Q

cause of failure GERD tx

A

medication timing adherence
different metabolism
alternative diagnosis

255C (8 decks)

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