GERD Flashcards
Complications of GERD?
- ulcers
- strictures
- throat problems (due to acid reflux i.e. sore throat, hoarse voice)
- Barrett’s esophagus
- esophageal adenocarcinoma
- pulmonary disease
Etiology of GERD?
- transient lower esophageal sphincter (LES) relaxation
- hypotensive LES
- anatomic disruption of gastro-esophageal junction a/w hiatal hernia (stomach pushes up thru a hole in diaphragm muscle e.g. coughing)
Risk factors of GERD? (7)
- elderly
- pregnancy (estrogen & progesterone increase esophageal sphincter muscle relaxation)
- obesity
- comorbidities (IBS, PUD, anxiety, depression, sleep disorders)
- medications
- diet
- cigarette smoking
Medications that affect LES pressure? (8)
- anticholinergics: atropine, hyoscine butylbromide, oxybutynin
- beta adrenergic agonists: salbutamol etc
- alpha adrenergic antagonist: prazosin, terazosin
- CCB: non-DHP, nifedipine
- opioids
- progesterone
- caffeine, theophylline
- TCA: amitriptyline
Difference between GERD & PUD?
Acidic taste in mouth
Extra-esophageal symptoms of GERD? (4)
- cough, wheezing, SOB
- sore throat, hoarseness
- teeth erosion
- otitis media
Pharm options for GERD? and forensic classification
- antacids, alginates (mostly GSL)
- H2RA (POM with exemption)
- PPI (POM / POM with exemption)
When to take H2RA / PPI?
30-60 minutes before meals
Which is superior: PPI or H2RA?
PPI
What should patients take if they have predictable or unpredictable symptoms?
- predictable: H2RA, PPI
- unpredictable: antacids, alginates PRN
Examples of antacids?
- aluminium hydroxide
- magnesium hydroxide
- calcium carbonate
- sodium bicarbonate
Examples of alginates?
- Gaviscon (sodium alginate, calcium carbonate, sodium bicarbonate)
Requirements to purchase famotidine?
- max daily dose: 20mg
- max supply: 2 weeks
Requirements to purchase omeprazole, pantoprazole and esomeprazole? (except zenpro 20 and omesec 20)
- min age: 18
- max daily dose: 20mg
- max supply: 2 weeks
Which PPI is not P+?
Lansoprazole
For antacids, are solid or liquid formulations faster?
Liquid
Potency of antacids?
Al < Mg < Na < Ca
When to administer antacids & alginates?
after food, before bedtime
For alginates, what should patient do after taking?
remain upright and avoid food & drinks for ≥30min
What drugs require spacing apart from GERD meds and why?
- iron
- enteric coated meds
etc
because they need acidic env to be absorbed
What are short term and long term use of PPI a/w?
short term: CAP
long term: vit B12 deficiency, C diff, hypo Mg, increased risk of fractures
PPIs are CYP___ inhibitors/inducers?
CYP2C19 inhibitors
What is suitable for pregnancy for GERD?
- antacids (caution sodium: risk of metabolic alkalosis, fluid overload in mum & kid)
- H2RAs
- PPIs (probably)
What is NOT suitable for pregnancy? Why?
magnesium trisillicate (risk of nephrolithiasis, hypotonia, resp distress in fetus)
What is suitable for lactation?
- antacids
- H2RA
What is not suitable for lactation and why?
PPI, secreted into breastmilk
Place of treatment for GERD in pregnancy?
antacid > H2RA > PPI
Most suitable option for GERD in elderly? Why not the rest?
PPI
H2RA a/w CNS effects
Minimum age for using antacids?
- magnesium carbonate aromatic mixture
- eno powder
- Rennie tablet
- magnesium carboante aromatic mixture: 1y
- eno powder: 2y
- Rennie tablet: 6y
What CrCl to avoid antacid? Which med need renal dose adjustment?
<30
H2RA need dose adjust, PPI no need
