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Exam 10 > GERD and N/V > Flashcards

GERD and N/V Flashcards

1
Q

Parietal cells has receptors for: (on the non gastric lumen side)

A

Ach, Histamine (H2), gastrin

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2
Q

Treatment for GERD is determined based on ___

A

severity (symptom based or tissue injury based)

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3
Q

What are symptoms that determine the GERD severity

A

heart burn, regurgitation, dysphagia

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4
Q

What are tissue injury based determinations of disease severeity for GERD

A

esophagitis, Barrett’s, strictures, esophageal adenocarcinoma

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5
Q

For GERD treatment, start strong with ____ and step down to ___ when possible

A

PPI, H2RA
use lowest possible
discontinue 8 weeks of no sx

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6
Q

Always incorporate ___ changes for GERD treatment. These include:

A

lifestyle

weightless, elevate head of bed, avoid eating 2-3 hrs before bedtime, decrease food triggers

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7
Q

What are the PPIs used (what do they end with)

A

Prazole (The praise alls)

omeprazole, panto, esome, lanso, dexlanso, rabe

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8
Q

PPIs take __ hours for effect. Because of this they should use ___ or ___ for breakthrough

A

24-72 hours

H2RA or antacid

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9
Q

PPI side effects

A

Hypo K
Hypo Mg
Increase risk fractures, B12, CAP

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10
Q

PPIs have a lot of ___ because there is ____

A

drug drug interactions. decreased/increased absorptions from reduced acid content. (cephalosporins, chemo, HIV meds, Fe supplements) (increased: methylphenidate)
CYP2C19

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11
Q

Which two PPIs should be avoided with clopidogrel

A

esomeprazole and omeprazole. decreased effectiveness of clopidogrel

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12
Q

Which PPI maybe can be used with clopidogrel

A

pantoprazole

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13
Q

Which PPI should be used with clopidogrel

A

Rabeprazole

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14
Q

What to do if in 8 week patient is not responding to PPI

A

change PPI or BID dosing (ex. 40 twice a day)

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15
Q

What GERD compilation makes someone need to stay on maintenance therapy

A

Barrett’s

and those who have sx return

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16
Q

Which are the 2 H2RAs used for GERD and which is preferred

A

Famotidine (Pepcid)-> preferred

Cimetidine (Tagamet)-> not preferred because CYP3A4 interactions

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17
Q

H2RAs take __ for onset and effect lasts for ____ hours. For breakthroughs with this use

A

1 hour, last 12-24 hours

use antacids for breakthroughs

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18
Q

Side effects of H2RAs

A

headache, dizziness, diarrhea, constipation

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19
Q

For dosing with H2RAs used for GERD, what to do

A

high dose, not OTC dosing (write prescription because otherwise taking OTC tog et to that dose is a lot)
could BID or switch drugs

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20
Q

H2RAs have some ____ due to reduced acid content in stomach

What are some reduced/increased absorption?

A

drug drug interactions
Reduced absorption: cephalosporins, SM chemo, HIV meds, Fe supp, HCV, antifungals
Increased absorption: methylphenidate

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21
Q

Antacids neutralize stomach acid. What 3 components does it have?

A

CaCO3, Mg(OH)2, Al(OH)3

22
Q

Antacids have binding ____ at two major med groups

A

DDIs

levothyroxine, certain cephalosporins (2 hrs before drug or 4 hrs after)

23
Q

Antacids works _____ and effect can last from ______.

A

immediately, minutes to hours

great for symptom management

24
Q

What is the problem with calcium based antacids

A

Ca2+ is part of the mechanism of releasing acid into the stomach in parietal cells

25
Q

Ranitidine (Zantac) was removed but it is actually ___ now

A

famotidine

26
Q

Promotility agents like _____ can be used with PPI only if etiology is related to ______

A

metoclopramide

delayed gastric emptying

27
Q

What are the 6 drugs that treat N/V caused through the chemoreceptor trigger zone (outside blood brain barrier)?

A

antihistmines, anticholinergics, 5HT3 antagonists, cannabinoids, neurokinin-receptor antagonists, dopamine antagoinists

28
Q

Simple nausea should be treated with

A

antacids, H2RA, anti-His, phenothiazine

29
Q

Motion sickness should be treated with

A

antihistamine, scopoamine

30
Q

Post operative N/V should be treated with

A

Phenothiazine, 5HT-3, RA, steroid, butyrophenone

31
Q

Chemotherapy NV should be treated with

A

5TH-3, NK1, lorazepam, dexamethasone, olanzapine, cannabinoids, bdtyrophenone, scopolamine

32
Q

Pregnancy NV should be treated with

A

Vitamind B6 and doxylamine

33
Q

How do antacids work for treating simple nausea? What are brands? what do you need to be careful about

A

neutralize acid. Brands: tums, rolaids, gaviscon, malanga

DDI from binding!

34
Q

How do H2RA work to treat simple nausea

A

reduce acid content
cimetidine has a lot of CYP3A4 interactions (avoid)
Nizatidine/ranitidine-> removed by FDA

35
Q

Which re the Phenothiazines used? How do they work? What are the major side effects?

A

Prochlorperazine, promethazine
Block dopamine receptors in CTZ (drug drug interactions)
SE: drowsiness, agitation possible

36
Q

Meclizine MOA for motion sickness? SEs?

A

Muscarinic and histamine receptors in VC

SE: drowsiness (from hist)

37
Q

Scopolamine MOA for motion sickness? How is it delivered? works best when used for_____

A

block Acetylcholine and histamine receptors in VC
Patch behind the ear
prevention
These are prescription

38
Q

Types of CINV:

A

anticipatory, acute, delayed, breakthrough, refractory

39
Q

Treatment of CINV depends on _________. _____ is key

A

emetogenic potenial or chemo regime.

prevention

40
Q

Anticipatory NV from chemo is best treated with______.

A

lorazepam-> anxiety/anticipation

not first line for ANY other NV

41
Q

Prevention of acute CINV meds? (there are 4)

A

5HT3
NK1 receptor antagonists
Dexamethasone
Olanzapine

42
Q

Too much dopamine could cause

A

Parkinson-like things

Extrapyramidal side effects (rigid)

43
Q

What are the 1st and 2nd generation 5HT3 antagonists

A

1: Ondansetron, granisetron, (Dolasetron not longer avoidable)
2: Palonosetron (more selective for 5HT3

44
Q

5HT3 has a class effect of ____ especially when paired with

A

QTc prolongation

antipsychotics, antibiotics, antiarrythmics, antidepressants

45
Q

What are the 4 Neurokinin receptor antagonists used

A

Aprepitant (DDIs), Fosaprepitant, Rolapitant, Netupitant/palonosetron (NEPA, this is a combo)

46
Q

How does dexamethasone work for CINV

A

?????

we know it prevents acute and delayed CINV and not indicated for simple NV

47
Q

Breakthrough CINV should be prescribed

A

phenothiazines, 5HT2 antagonists (PRN)

48
Q

What are risk factors for post op NV

A

Patient: age <50, female, non smoker, hx, motion sickness, hydration
Surgery related: general anesthesia, volatile anesthesia, NO, opioids, duration, type of procedure

49
Q

Prophylaxis for post op NV can be done with (7 things)

A

5HT3 antagonists, dexamethasone or methylprednisolone, haloperidol (QTc), antihistamines, anticholinergics, NK1 antagonists

50
Q

To treat post op NV, use ___ (2 things)

A

phenothiazine, metoclopramide

51
Q

If B6 and Doxylamine are not working for pregnancy, can use____ which works by

A

metoclopramide.

blocking dopamine at CTZ

52
Q

metoclopramide increases rate of _____ which is helpful for ____.
It should not be used with:

A

gastric emptying, diabetic gastroparesis

haloperidol, olanzapine, any CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion)

Exam 10 (4 decks)

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