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Pediatric Pharm Exam 3 > GERD > Flashcards

GERD Flashcards

1
Q

Gastroesophageal reflux

A

Retrograde movement of gastric contents from the stomach in to the esophagus

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2
Q

Gastroesophageal reflux disease (GERD)

A

A condition which develops when reflux of stomach contents causes troublesome symptoms and/or complications

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3
Q

Reflux esophagitis

A

Inflammation of the esophagus

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4
Q

Erosive esophagitis

A

Visible damage as seen on endoscopy

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5
Q

Epidemiology (4)

A
  1. Difficult to detect in infants and children
  2. Up to 35% of all children may have reflux within the first few months of life
  3. Reflux usually outgrown by 1 year of age
  4. Risk of reflux not subsiding increases with strong family history of GERD
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6
Q

Defense Mechanisms (5)

A
  1. Lower esophageal sphincter (LES)
  2. Esophageal mucus
  3. Esophageal clearance
  4. Acid neutralization, Via saliva
  5. Gastric emptying
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7
Q

Contributing Factors (6)

A
  1. Hiatal hernia
  2. Obesity
  3. Zollinger-Ellison Syndrome (Increased acidity due to gastrin production)
  4. Hypercalcemia
  5. Scleroderma
  6. Medications (Prednisone, CCBs, NSAIDs)
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8
Q

GERD Factors (5)

A
  1. Gastric Acid
  2. Pepsin
  3. Bile salts
  4. Pancreatic enzymes
  5. NSAID use
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9
Q

GERD risk factors (4)

A
  1. Decreased/increased LES pressure
  2. Delayed gastric emptying
  3. Increased gastric acid secretion
  4. Impaired gastro-esophageal pressure gradient
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10
Q

Treatment - Diet
Infant (1)
Children (3)

A

• Infant
Formula composition

• Children
Avoid foods that irritate GERD symptoms
Eat small meals
Avoid eating immediately prior to sleeping

Avoid exacerbating Meds

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11
Q

Treatment - Positioning Therapy
Infants (1)
Children (2)

A

Infants
Supine versus prone

Children
Elevate head of bed
Avoid reclining after meals

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12
Q

Pharmacological Treatments of GERD (4)

A
  1. Antacids
    • Calcium carbonate
    • Magnesium Hydroxide
  2. Histamine 2 Receptor Antagonists
  3. Proton Pump Inhibitors
  4. Prokinetic Agents
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13
Q

Antacids MOA (2)

A
  1. Neutralize stomach acid

2. Deactivate pepsin and acidity of reflux

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14
Q

Antacids Place in therapy (2)

A
  1. Mild GERD

2. Immediate relief

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15
Q

Antacids (2) Available Agents

A
  1. Calcium Carbonate (Tums®, Maalox®)

2. Aluminum Hydroxide/Magnesium Hydroxide (Mylanta®)

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16
Q

Antacids ADE (4)

A
  1. Diarrhea (magnesium containing products)
  2. Constipation (aluminum containing products)
  3. Alteration in mineral metabolism
  4. Caution with acid rebound*
17
Q

Antacids Drug Interactions (2)

A
  1. Fluoroquinolones

2. Tetracyclines

18
Q

H2 Receptor Blockers MOA (2)

A
  1. Block histamine-mediated gastric acid secretion

2. Decrease acidity of reflux

19
Q

H2 Receptor Blockers Available Agents (2)

A
  1. Ranitidine (Zantac®)
    - TID dosing
    - Large dosing range recommendation
  2. Famotidine (Pepcid®)
    - Twice daily dosing
    - Standard dosing 1 mg/kg twice daily
20
Q

H2 Receptor Blockers Place in Therapy (2)

A
  1. Mild to severe GERD

2. Also use for prevention

21
Q

H2 Receptor Blockers ADE (6)

A
  1. Headache
  2. Mental confusion
  3. Somnolence
  4. Dizziness
  5. Abdominal discomfort
  6. Thrombocytopenia
22
Q

H2 Receptor Blockers Pearls (2)

A
  1. Dose adjust with renal dysfunction

2. Tachyphylaxis – Increased risk with chronic use

23
Q

Proton Pump Inhibitors MOA (3)

A
  1. Blocks acid secretion by inhibiting ATPase enzyme system in parietal cells
  2. Causes prolonged decrease in gastric acid secretion
  3. Decreases acidity of reflux
24
Q

Proton Pump Inhibitors Available Agents(4)

A
  1. Esomeprazole (Nexium®)
  2. Omeprazole (Prilosec®)
  3. Lansoprazole (Prevacid®)
  4. Pantoprazole (Protonix®)
25
Q

Proton Pump Inhibitors Place in Therapy (2)

A
  1. Used for more severe GERD symptoms

2. Erosive esophagitis

26
Q

Proton Pump Inhibitors ADE (6)

A
  1. Diarrhea
  2. Flatulence
  3. Abdominal discomfort
  4. Dizziness
  5. Headache
  6. Infections
27
Q

Omeprazole - Alternative Admin Technique/Pearls

A

Open capsules, mix with applesauce/Juice

28
Q

Esomeprazole - Alternative Admin Technique/Pearls

A

Open capsules, dissolve in 60mL water for NG tube

29
Q

Lansoprazole - Alternative Admin Technique/Pearls (2)

A
  1. Open capsules mix with applesauce, cottage cheese, pudding yogurt, strained pears, or 60mL tomato/orange/apple juice
  2. Liquid formulation is best option for enteral tube feeding
    * If a child can’t take a capsule or has a G-tube or NG-tube, then lansoprazole should be go to agent
30
Q

Pantoprazole - Alternative Admin Technique/Pearls (3)

A
  1. DO NOT CRUSH capsules
  2. delayed release packets (Do not use partial doses!)
  3. CYP drug-drug interactions
31
Q

Prokinetic Agents MOA (2)

A
  1. Increase gastric emptying

2. Increase LES pressure

32
Q

Prokinetic Agents Place in Therapy (2)

A
  1. Mild to moderate GERD

2. Severe GERD

33
Q

Prokinetic Agents Available Agents (2)

A
  1. Metoclopramide (Reglan®)

2. Erythromycin

34
Q

Prokinetic Agents ADE (6)

A
  1. Abdominal discomfort
  2. Acute dystonic reactions (Metoclopramide)
  3. Anxiety
  4. Insomnia
  5. Fatigue
  6. QT prolongation
35
Q

Sucralfate (Carafate®) MOA

A

Forms a paste in the presence of gastric pH to coat the lining of the esophagus and stomach

36
Q

Sucralfate (Carafate®) Place in Therapy (2)

A
  1. Used in combination with other therapies

2. Mild to moderate GERD

37
Q

Sucralfate (Carafate®) ADE (4)

A
  1. Constipation
  2. Bezoar formation
  3. Abdominal discomfort
  4. Caution with administration with other medications

Pediatric Pharm Exam 3 (11 decks)

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