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Naplex 2025 > GERD > Flashcards

GERD Flashcards

1
Q

What is the way that gastric acid is made within the body?

A
  • Parietal cells in the stomach secrete HCl via ATPase pump [Proton Pump]
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2
Q

When should a patient that was taking OTC Heartbrun medications go seeks a doctor?

A
  • IF lifestyle modifications do not work;
  • Taking OTC product for longer than 2 weeks
  • Alarm Symptoms (Painful swallowing, N/V, bloody stools, weight loss)
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3
Q

If someone is having Infrequent Heartburn (< 2w) was is the recommended treatment?

A
  • Antacids
  • H2RAs
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4
Q

If someone is having Frequent Heartburn (> 2w) what is the recommended treatment?

A
  • PPI for 8 weeks
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5
Q

What is the MOA for Antacids used in GERD?

A
  • Neutralizing gastric acid (makes salt and water) which increases gastric pH (decrease acidity)

Relief within minutes but dont last as long (like 30 - 60 mins)

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6
Q

What are some of the Antacid products that are available?

A
  • Calcium Carbonate (Tums) + Magnesium (Mylanta) + Simethicone (Maalox [antigas])
  • Magnesium Hydroxide (Milk of Mag) + Aluminum + Simethicone (Mylanta)
  • Sodium Bicarb/Aspirin/Citric Acid (Alka-Seltizer)
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7
Q
A
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8
Q

What are some of the warnings for the Antacids used for GERD?

A
  • Al & Mg products = accumulation with renal dyfunction
  • Increased bleeding risk with Alka-Seltizer
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9
Q

What are some of the side effects with the antacids used for GERD?

A
  • Ca & Al = Constipation
  • Mg = Diarrhea
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10
Q

What are some of the additional notes for the antacids that are used for GERD?

A
  • Ca products are best in pregnancy
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11
Q

What is the MOA for the H2RAs used for GERD?

A
  • Reversibly inhibits H2 receptors on gastric parietal cells, which decreases gastric acids secretions

best for maintenance treatment after the 8 weeks of PPI

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12
Q

What are some of the H2RAs that are used for GERD?

A
  • Famotifine (Pepcid, Zantac)
  • Cimetidine
  • Nizatidine
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13
Q

What are some of the warnings for the H2RAs used for GERD?

A
  • Confusion (risk factors: elderly, severly ill, renal impariement)
  • Vit B12 deficiency with used for too long
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14
Q

What are some so of the side effects for the H2RAs used for GERD?:

A
  • Headache, agitation/vomiting in kids < 1 year
  • Cimetidine [high doses] = gynecomastia, impotence
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15
Q

What is the MOA for the PPIs used for GERD?

A
  • Irreversibly binds to the “Proton Pump” in parietal cells = shuts down the pump and blocks the fastric acid secretions

MOST effective for GERD & 8 weeks is the best course
Long term course = lowest dose possible

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16
Q

What are some of the PPIs that are used for GERD?

A
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Dexlansoprazole (Dexliant)
  • Pantoprazole (Protonix)
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17
Q

For Nexium, Prevacid, Prilosec & Zegerid; when is the best time to take them?

A
  • Before breakfast (at least 60 minutes)
18
Q

For Dexliant & Protonix; when is the best time to take them?

A
  • Without meals (Dexliant)
  • Protonix Suspension = 30 minutes before
19
Q

What are some of the warnings for the PPIs used for GERD?

A
  • C. Diff Diarrhea
  • HYPOmagnesemia
  • Vitamin B12 Deficiency with prolonged use [> 2y]
  • Osteoporosis with high doses and long use [> 1y]
  • Decreased therapeutic effect of clopidogrel
20
Q

What are some of the side effects for the PPIs used for GERD?

-

A
  • Headache, abdominal pain, nausea, diarrhea
21
Q

What are some of the risk associated with PPI therapy for GERD?

A
  • Increased GI Infection risk (C. Diff or Pneumonia)
  • Increased Osteoporosis and Facture risk
  • Beers Criteria (NOT to be used for longer than 8w in elderly)
22
Q

What are some drug interactions with the H2RAs used in GERD?

A
  • Caution with CNS Depressants = increase risk of deilrium, dementia, cognative impairment in elderly
  • Cimetidine in an inhibitor
23
Q

What are some of the drug interactions for the PPIs used in GERD?

A
  • ALL inhibit 2C19
  • Omep & Esomep decrease clopidogrel (due to 2C19)
24
Q

What are some of the drug interactions with Metoclopramide used for GERD?

-

A
  • DO NOT used with parkinsons patients
  • When in combo with SSRIs, SNRIs, TCAs watch for serotonin syndrome
25
What are the **3** most common causes of **Peptic Ulcer Disease**?
- H. Pylori - NSAIDs - Stress Ulcers
26
What are some of the **symptoms** of **PUD**?
- Dyspepsia, Gastric Pain (burning sensation in middle or upper stomach)
27
What is the a way to tell the **difference** between where the **peptic ulcuer** could be **located**?
- **Duodenal Ulcer** [H. Pylori]; pain 2 - 3 hours after eating - **Gastric Ulcer** [NSAIDs]; eating makes the pain worse
28
What is the **test** that is used to **detect** for **H. Pylori**?
- Urea Breath Test = looks at CO2 made from the bacteria
29
What is the **guideline treatment** for someone with **H. Pylori** infection?
- **QUAD** treament (due to Clarithro resistance) - **Triple** Treatment (if LOW Clarithro resistance) ## Footnote **DO NOT** make substitutions to any regimen for H. Pyori
30
What is the **Bismuth Quad Therapy** for **H. Pylori**? ## Footnote **1st Line**
- Bismuth Subsalicylate 300 mg QID + - Metronidazole 250 - 500 mg QID + - Tetracycline 500 mg QID + - PPI BID ## Footnote **for 10 - 14 days**
31
What is the **Concomitant Therapy** for **H. Pylori**?
- Amoxicillin 1000 mg BID + - Clarithromycin 500 mg BID + - Metronidazole 500 mg BID + - PPI BID ## Footnote Used when **Clarithro resistance is low & no MACs before** Better than Clarithromycin Triple Therapy
32
What is **Clarithromycin Triple Therapy** for **H. Pylori**?
- Amoxicillin 1000 mg BID + - Clarithromycin 500 mg BID + - PPI BID (or Esomep 40 mg daily) | Used when **Clarithro resistance is low & no MACs before**
33
What is the way that **NSAIDs** can cause **peptic ulcer disease**?
- Inhibition of **Prostaglandin** synthesis (**COX-1**)
34
What is important to know about **ALL NSAIDs** when it comes to **peptic ulcers**?
- ALL will increase blood pressure and decrease renal blood flow -
35
What are some of the **combination products** that are marketed to reduce the risk of **NSAID Ulcers**?
- Vimovo [Naproxen/Esomeprazole] - Yosprala [Aspirin/Omeprazole]
35
What is the best treatment for **NSAID Ulcers**?
- PPI for 8 weeks & DC NSAID
36
What are the **2** Cytoprotective Drugs used for **NSAIDs Ulcers**?
- Misoprostol - Sucralfate (Carafate) - Taking before meals
37
What are some of the **Boxed warnings** for **Misoprostol** used for **NSAID Ulcers**?
- Its an **Abortifacient**; DO NOT use in those females of childbearing potential
38
What are some **side effects** for **Misoprostol** used for **NSAID Ulcers**?
- Diarrhea, Abdominal Pain
39
what are some **side effects** for **Sucralfate** used for **NSAID Ulcurs**?
- Constipation

Naplex 2025 (48 decks)

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