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NAPLEX Review > GERD and Peptic Ulcer Disease > Flashcards

GERD and Peptic Ulcer Disease Flashcards

1
Q

What drugs can worsen GERD symptoms

A 
Aspirin/NSAIDs
Bisphosphonates
Dabigatran
Estrogen products
Fish oil products
Iron supplements
Nicotine replacement therapy
Steroids
Tetracyclines
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2
Q

When should a patients be referred for further evaluation for GERD?

A

If they do not respond to lifestyle modifications and/or two weeks of self-treatment with OTC products or if alarm symptoms are present

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3
Q

What are alarm symptoms for GERD?

A 
Painful swallowing
Dysphagia
Frequent N/V
Hematemesis
Black bloody stools
Unintentional weight loss
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4
Q

How to treat infrequent heartburn (<2x/week)

A

PRN OTC antacids or H2RAs

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5
Q

What is the treatment algorhythm for GERD?

A

Lifestyle modifications
Initial drug treatment
Maintenance treatment

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6
Q

What are lifestyle modifications for GERD?

A 
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)
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7
Q

What is the initial drug treatment for GERD?

A

PPI daily x 8 weeks

Can increase to BID if partial response or nocturnal sx are present

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8
Q

What are the maintenance therapies for GERD?

A

PPI at lowest effective dose (preferred)
H2RA if no erosive esophagitis
Metoclopramide or sucralfate not recommended

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9
Q

What antacids are used for GERD?

A 
Calcium carbonate (Tums) 
" + Mg (Mylanta)
" + Simethicone (Maalox)
Magnesium hydroxide (Milk of Mag)
" + Al + simethicone (Mylanta)
Sodium bicarb/ASA/citric acid (Alka-Seltzer)
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10
Q

What antacids cause constipation/diarrhea?

A

Constipation: aluminum and calcium
Diarrhea: magnesium

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11
Q

What antacid is preferred in pregnancy?

A

Calcium containing

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12
Q

What medications are H2RA?

A

Famotidine (Pepcid)
Ranitidine (Zantac)
Cimetidine

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13
Q

H2RA warnings, SE, and notes

A

Warnings: confusion (esp with prolonged use), caution with CNS depressants
SE: cimetidine - gynecomastia, impotence
Notes; decrease dose when CrCl < 50 or <30 (cimetidine)

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14
Q

What medications are PPIs?

A 
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Dexlansoprazole (Dexilant
Pantoprazole (Protonix)
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15
Q

PPI warnings and notes

A

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

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16
Q

What PPIs should be taken before breakfast?

A

Esomeprazole - at least 60 mins
Lansoprazole - not specified
Omeprazole - not specified

17
Q

Metoclopramide dose reduction with what CrCl?

A

CrCl < 40 decrease dose 50%

18
Q

Metoclopramide BBW, warnings, and SE

A

BBW: tardive dyskinesia
Warnings: EPS, parkinsonian-like symptoms, avoid in parkinson disease
SE: drowsiness

19
Q

Drugs that have decreased absorption when taken with antacids

A 
Antiretrovirals
Antivirals
Azole antifungals
Cephalosporins
Iron products
Mesalamine
Risendronate DR
Tyrosine kinase inhibitors
20
Q

Drugs that bind antacids

A 
Antiretrovirals (INSTIs)
Bisphosphonates
Isoniazid
Levothyroxine
Mycophenolate
Quinolones
Sotalol
Steroids
Tetracyclines
21
Q

What is PUD?

A

Mucosal erosion within the GI tract

22
Q

3 most common causes of PUD

A

H. pylori-positive ulcers
NSAID-induced ulcers
Stress ulcers

23
Q

Sx of PUD

A

Dyspepsia (gastric pain)

24
Q

What non-invasive test detects H. pylori? What can cause false negative results?

A

Urea breath test (UBT)

PPIs, busmuth, and antibiotics - d/c 2 weeks in advance

25
Q

In PUD, if eating decreases the pain, where is the ulcer located?

A

Duodenum

26
Q

What is first-line therapy for H. pylori infection in PUD?

A

Quadruple therapy 10-14 days OR triple therapy 14 days if clarithromycin resistance rates are low (<15%)
Bismuth subsalicylate QID+ metronidazole QID+ tetracycline QID+ PPI BID
Amoxicillin BID + Clarithromycin BID + metronidazole QID + PPI BID
Amoxicillin BID + Clarithromycin BID + PPI BID
Prevpac (amoxicillin + clarithromycin + lansoprazole)

27
Q

NSAID induced ulcer risk factors

A 
>60 years old
Hx of PUD
High-dose NSAIDs
Using > 1 NSAID (including ASA)
Concomitant use of anticoagulants, steroids, SSRIs, or SNRIs
28
Q

Vimovo generic name

A

Naproxen/esomeprazole - used to prevent NSAID ulcers

29
Q

How to treat NSAID induced ulcer?

A

PPI x 8 weeks and d/c NSAIDs

Can use H2RA second line

30
Q

What medication is approved for secondary prevention of CV nad CVA events in patients at risk for aspirin-associated ulcers?

A

Yosprala (ASA and omeprazole)

31
Q

What medications are cytoprotective

A

Misoprostol - replaces gastro-protective prostaglandins removed by NSAIDs
Sucralfate (Carafate) - forms physical barrier in GI tract

32
Q

Misoprostol BBW

A

Abortifacient

NAPLEX Review (79 decks)

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