GERD and N/V

Question 1

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

Answer 1

Ach, Histamine (H2), gastrin

Question 2

Treatment for GERD is determined based on ___

Answer 2

severity (symptom based or tissue injury based)

Question 3

What are symptoms that determine the GERD severity

Answer 3

heart burn, regurgitation, dysphagia

Question 4

What are tissue injury based determinations of disease severeity for GERD

Answer 4

esophagitis, Barrett’s, strictures, esophageal adenocarcinoma

Question 5

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

Answer 5

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

Question 6

Always incorporate ___ changes for GERD treatment. These include:

Answer 6

lifestyle

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

Question 7

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

Answer 7

Prazole (The praise alls)

omeprazole, panto, esome, lanso, dexlanso, rabe

Question 8

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

Answer 8

24-72 hours

H2RA or antacid

Question 9

PPI side effects

Answer 9

Hypo K
Hypo Mg
Increase risk fractures, B12, CAP

Question 10

PPIs have a lot of ___ because there is ____

Answer 10

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

Question 11

Which two PPIs should be avoided with clopidogrel

Answer 11

esomeprazole and omeprazole. decreased effectiveness of clopidogrel

Question 12

Which PPI maybe can be used with clopidogrel

Answer 12

pantoprazole

Question 13

Which PPI should be used with clopidogrel

Answer 13

Rabeprazole

Question 14

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

Answer 14

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

Question 15

What GERD compilation makes someone need to stay on maintenance therapy

Answer 15

Barrett’s

and those who have sx return

Question 16

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

Answer 16

Famotidine (Pepcid)-> preferred

Cimetidine (Tagamet)-> not preferred because CYP3A4 interactions

Question 17

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

Answer 17

1 hour, last 12-24 hours

use antacids for breakthroughs

Question 18

Side effects of H2RAs

Answer 18

headache, dizziness, diarrhea, constipation

Question 19

For dosing with H2RAs used for GERD, what to do

Answer 19

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

Question 20

H2RAs have some ____ due to reduced acid content in stomach

What are some reduced/increased absorption?

Answer 20

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

Question 21

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

Answer 21

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

Question 22

Antacids have binding ____ at two major med groups

Answer 22

DDIs

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

Question 23

Antacids works _____ and effect can last from ______.

Answer 23

immediately, minutes to hours

great for symptom management

Question 24

What is the problem with calcium based antacids

Answer 24

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

Question 25

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

Answer 25

famotidine

Question 26

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

Answer 26

metoclopramide | delayed gastric emptying

Question 27

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

Answer 27

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

Question 28

Simple nausea should be treated with

Answer 28

antacids, H2RA, anti-His, phenothiazine

Question 29

Motion sickness should be treated with

Answer 29

antihistamine, scopoamine

Question 30

Post operative N/V should be treated with

Answer 30

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

Question 31

Chemotherapy NV should be treated with

Answer 31

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

Question 32

Pregnancy NV should be treated with

Answer 32

Vitamind B6 and doxylamine

Question 33

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

Answer 33

neutralize acid. Brands: tums, rolaids, gaviscon, malanga | DDI from binding!

Question 34

How do H2RA work to treat simple nausea

Answer 34

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

Question 35

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

Answer 35

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

Question 36

Meclizine MOA for motion sickness? SEs?

Answer 36

Muscarinic and histamine receptors in VC | SE: drowsiness (from hist)

Question 37

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

Answer 37

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

Question 38

Types of CINV:

Answer 38

anticipatory, acute, delayed, breakthrough, refractory

Question 39

Treatment of CINV depends on _________. _____ is key

Answer 39

emetogenic potenial or chemo regime. | prevention

Question 40

Anticipatory NV from chemo is best treated with______.

Answer 40

lorazepam-> anxiety/anticipation | not first line for ANY other NV

Question 41

Prevention of acute CINV meds? (there are 4)

Answer 41

5HT3 NK1 receptor antagonists Dexamethasone Olanzapine

Question 42

Too much dopamine could cause

Answer 42

Parkinson-like things | Extrapyramidal side effects (rigid)

Question 43

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

Answer 43

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

Question 44

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

Answer 44

QTc prolongation | antipsychotics, antibiotics, antiarrythmics, antidepressants

Question 45

What are the 4 Neurokinin receptor antagonists used

Answer 45

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

Question 46

How does dexamethasone work for CINV

Answer 46

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

Question 47

Breakthrough CINV should be prescribed

Answer 47

phenothiazines, 5HT2 antagonists (PRN)

Question 48

What are risk factors for post op NV

Answer 48

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

Question 49

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

Answer 49

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

Question 50

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

Answer 50

phenothiazine, metoclopramide

Question 51

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

Answer 51

metoclopramide. | blocking dopamine at CTZ

Question 52

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

Answer 52

gastric emptying, diabetic gastroparesis | haloperidol, olanzapine, any CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion)