GERD and antacids Flashcards
Gastroesophageal Reflux Disease (GERD) and Peptic Ulcer Disease (PUD): What is Dyspepsia?
Chronic or reoccurring epigastric and reflux pain
Frequency heartburn symptoms classified as GERD
GERD and PUD epidemiology?
Statistics difficult since large number of patients treated OTC
GERD review of patho?
relaxation of the lower esophageal sphincter…..
reflux into esophagus……
thus causing heartburn
or regurgitation
GERD tx?
Lifestyle modification
Stepwise approach
Mild Disease
GERD tx for mild disease?
Sleep head bed elevated 6-8 inches
Avoid lying down within 3 hours eating
No exercise within 3 hours after eating
No excessive squatting or bending within 3 hours after eating
lose weight - **sub C fat and pressure on the upper abdomen = organ pressure = LES easiest to open up*
stop overeating
stop smoking
GERD tx for mild disease? diet?
Avoid foods acidic, spicy, excessive fat
Avoid chocolate, peppermint, citric acids
Avoid alcohol, coffee, tea
**Cubano Collate $1 Miami*
Meds for GERD?
Antacids H2 antagonists Proton Pump Inhibitors (PPI’s) Cytoprotective Agents Prokinetic Agents
Antacids MOA?
Weak bases react with HCL to form salt/water
Antacids neutralize stomach acid by?
Increase in gastric pH above 4
The normal volum of the stomach fluid is 20 to 100 ml and pH is acidic ( 1.5-3.5)
numbers can be converted to actual acid production in units miles.
Antacids inhibit the activity of ______?
pepsin
Lower esophageal sphincter tone
Antacid has acid neutralizing capability (ANC)?
Expressed in mEq for dose purposes
At least 5 mEq per dose
More effective doses
Suspensions > powders / tablets
Ingested fasting – 20-40 minutes (gastric emptying)
After meals up to 3 hours
how many antacids are on the market?
150 over
The way to express the ability of an antacid to neutralize acid is by determining the _______________?
antacid’s neutralizing capacity (ANC).
The ANC is expressed as ____________ of acid that is neutralized, and it measures the ability of the antacid to _________ acids (to a ph of 3.5 to 4 or greater).
milliequivalents (mEq)
neutralize
Per FDA requirements, an antacid must have a neutralizing capacity of_________ per dose.
≥5 mEq
The most effective antacids should have a high ______________________ and rapid gastric __________________.
acid neutralization capacity
and
acid neutralization qualities
Antacids such as _____________ and _______________ have the greatest neutralizing capacity.
sodium bicarbonate
and
calcium carbonate
Antacids are not used for long periods of time due to adverse events that are _____ term.
short
An antacid’s onset of ______________ (how fast the drug dissolves in gastric acid) varies among different antacids.
neutralizing action
____________ and ___________dissolve quickly and provide a rapid buffering effect, while _________________ and ________________dissolve slowly.
Sodium bicarbonate and magnesium hydroxide
aluminum hydroxide and calcium carbonate
_________________ generally dissolve more easily than tablets or powders.
Antacid suspensions
If a tablet antacid is used, however, it is advisable to ____________________ for maximal effectiveness.
chew the tablets thoroughly
The difference in antacids is the _______?
duration of action
___________ and _____________ have the shortest duration of neutralizing action
Sodium bicarbonate and magnesium hydroxide
______________ and ___________have the longest duration of action.
Aluminum hydroxide and calcium carbonate
Combination ____________________ have an intermediate duration of action.
aluminum magnesium antacids
Conscientious prescribing of Antacids?
May cause dark tarry stools (excess calcium, carbonate, bismuth subsalicylate)
Chew followed by a glass of water
Excess means rebound excess
Max 2 weeks
Alum / calcium = constipation….fiber diet
Magnesium based may cause diarrhea
Milk of Magnesia?
Magnesium Hydorxide
Alu-tab - dissolvable tab?
Aluminum hydroxide
Rolaids / Tums?
Calcium carbonate
Maalox?
Aluminum hydroxide/Magnesium hydroxide
used in GI cocktails
Mylanta, Maalox?
Combo Alum Hydroxide / Mag hydroxide / Simethicone
** Simethicone is anti foaming agent gas bubbles, does not control acid - reduces H ion gas - used a lot in neonatal unit cause kids get a lot of gastric air ( bloating gas)*
