GERD and Peptic Ulcer Disease Flashcards
What drugs can worsen GERD symptoms
Aspirin/NSAIDs Bisphosphonates Dabigatran Estrogen products Fish oil products Iron supplements Nicotine replacement therapy Steroids Tetracyclines
When should a patients be referred for further evaluation for GERD?
If they do not respond to lifestyle modifications and/or two weeks of self-treatment with OTC products or if alarm symptoms are present
What are alarm symptoms for GERD?
Painful swallowing Dysphagia Frequent N/V Hematemesis Black bloody stools Unintentional weight loss
How to treat infrequent heartburn (<2x/week)
PRN OTC antacids or H2RAs
What is the treatment algorhythm for GERD?
Lifestyle modifications
Initial drug treatment
Maintenance treatment
What are lifestyle modifications for GERD?
Weight loss (if overweight or recently gained weight) Elevate the head of the bed Avoid eating high fat meals within 2-3 hours of bedtime Avoid foods/beverages that trigger reflux (caffeine, chocolate, acidic/spicy, carbonated beverages)
What is the initial drug treatment for GERD?
PPI daily x 8 weeks
Can increase to BID if partial response or nocturnal sx are present
What are the maintenance therapies for GERD?
PPI at lowest effective dose (preferred)
H2RA if no erosive esophagitis
Metoclopramide or sucralfate not recommended
What antacids are used for GERD?
Calcium carbonate (Tums) " + Mg (Mylanta) " + Simethicone (Maalox) Magnesium hydroxide (Milk of Mag) " + Al + simethicone (Mylanta) Sodium bicarb/ASA/citric acid (Alka-Seltzer)
What antacids cause constipation/diarrhea?
Constipation: aluminum and calcium
Diarrhea: magnesium
What antacid is preferred in pregnancy?
Calcium containing
What medications are H2RA?
Famotidine (Pepcid)
Ranitidine (Zantac)
Cimetidine
H2RA warnings, SE, and notes
Warnings: confusion (esp with prolonged use), caution with CNS depressants
SE: cimetidine - gynecomastia, impotence
Notes; decrease dose when CrCl < 50 or <30 (cimetidine)
What medications are PPIs?
Omeprazole (Prilosec) Esomeprazole (Nexium) Lansoprazole (Prevacid) Dexlansoprazole (Dexilant Pantoprazole (Protonix)
PPI warnings and notes
Warnings: C diff, low Mg and B12 with prolonged use, osteoporosis, may diminish the therapeutic effect of clopidogrel
Pantoprazole and esomeprazole are available in IV
What PPIs should be taken before breakfast?
Esomeprazole - at least 60 mins
Lansoprazole - not specified
Omeprazole - not specified
Metoclopramide dose reduction with what CrCl?
CrCl < 40 decrease dose 50%
Metoclopramide BBW, warnings, and SE
BBW: tardive dyskinesia
Warnings: EPS, parkinsonian-like symptoms, avoid in parkinson disease
SE: drowsiness
Drugs that have decreased absorption when taken with antacids
Antiretrovirals Antivirals Azole antifungals Cephalosporins Iron products Mesalamine Risendronate DR Tyrosine kinase inhibitors
Drugs that bind antacids
Antiretrovirals (INSTIs) Bisphosphonates Isoniazid Levothyroxine Mycophenolate Quinolones Sotalol Steroids Tetracyclines
What is PUD?
Mucosal erosion within the GI tract
3 most common causes of PUD
H. pylori-positive ulcers
NSAID-induced ulcers
Stress ulcers
Sx of PUD
Dyspepsia (gastric pain)
What non-invasive test detects H. pylori? What can cause false negative results?
Urea breath test (UBT)
PPIs, busmuth, and antibiotics - d/c 2 weeks in advance
