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Competency > GERD > Flashcards

GERD Flashcards

1
Q

Complications of GERD?

A
  • ulcers
  • strictures
  • throat problems (due to acid reflux i.e. sore throat, hoarse voice)
  • Barrett’s esophagus
  • esophageal adenocarcinoma
  • pulmonary disease
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2
Q

Etiology of GERD?

A
  • 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)
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3
Q

Risk factors of GERD? (7)

A
  • elderly
  • pregnancy (estrogen & progesterone increase esophageal sphincter muscle relaxation)
  • obesity
  • comorbidities (IBS, PUD, anxiety, depression, sleep disorders)
  • medications
  • diet
  • cigarette smoking
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4
Q

Medications that affect LES pressure? (8)

A
  • 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
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5
Q

Difference between GERD & PUD?

A

Acidic taste in mouth

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6
Q

Extra-esophageal symptoms of GERD? (4)

A
  • cough, wheezing, SOB
  • sore throat, hoarseness
  • teeth erosion
  • otitis media
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7
Q

Pharm options for GERD? and forensic classification

A
  • antacids, alginates (mostly GSL)
  • H2RA (POM with exemption)
  • PPI (POM / POM with exemption)
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8
Q

When to take H2RA / PPI?

A

30-60 minutes before meals

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9
Q

Which is superior: PPI or H2RA?

A

PPI

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10
Q

What should patients take if they have predictable or unpredictable symptoms?

A
  • predictable: H2RA, PPI
  • unpredictable: antacids, alginates PRN
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11
Q

Examples of antacids?

A
  • aluminium hydroxide
  • magnesium hydroxide
  • calcium carbonate
  • sodium bicarbonate
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12
Q

Examples of alginates?

A
  • Gaviscon (sodium alginate, calcium carbonate, sodium bicarbonate)
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13
Q

Requirements to purchase famotidine?

A
  • max daily dose: 20mg
  • max supply: 2 weeks
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14
Q

Requirements to purchase omeprazole, pantoprazole and esomeprazole? (except zenpro 20 and omesec 20)

A
  • min age: 18
  • max daily dose: 20mg
  • max supply: 2 weeks
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15
Q

Which PPI is not P+?

A

Lansoprazole

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16
Q

For antacids, are solid or liquid formulations faster?

A

Liquid

17
Q

Potency of antacids?

A

Al < Mg < Na < Ca

18
Q

When to administer antacids & alginates?

A

after food, before bedtime

19
Q

For alginates, what should patient do after taking?

A

remain upright and avoid food & drinks for ≥30min

20
Q

What drugs require spacing apart from GERD meds and why?

A
  • iron
  • enteric coated meds
    etc
    because they need acidic env to be absorbed
21
Q

What are short term and long term use of PPI a/w?

A

short term: CAP
long term: vit B12 deficiency, C diff, hypo Mg, increased risk of fractures

22
Q

PPIs are CYP___ inhibitors/inducers?

A

CYP2C19 inhibitors

23
Q

What is suitable for pregnancy for GERD?

A
  • antacids (caution sodium: risk of metabolic alkalosis, fluid overload in mum & kid)
  • H2RAs
  • PPIs (probably)
24
Q

What is NOT suitable for pregnancy? Why?

A

magnesium trisillicate (risk of nephrolithiasis, hypotonia, resp distress in fetus)

25
Q

What is suitable for lactation?

A
  • antacids
  • H2RA
26
Q

What is not suitable for lactation and why?

A

PPI, secreted into breastmilk

27
Q

Place of treatment for GERD in pregnancy?

A

antacid > H2RA > PPI

28
Q

Most suitable option for GERD in elderly? Why not the rest?

A

PPI

H2RA a/w CNS effects

29
Q

Minimum age for using antacids?
- magnesium carbonate aromatic mixture
- eno powder
- Rennie tablet

A
  • magnesium carboante aromatic mixture: 1y
  • eno powder: 2y
  • Rennie tablet: 6y
30
Q

What CrCl to avoid antacid? Which med need renal dose adjustment?

A

<30

H2RA need dose adjust, PPI no need

Competency (30 decks)

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