GERD and PUD Flashcards
What modulates gastric acid secretion?
paracrine (histamine), neuroendocrine (Ach), and endocrine (gastrin) pathways which activate their respective receptors (H2, M3, CCK2).
What limit extent of acid secretion
Somatostatin-secreting D cells and prostaglandins
What are some lifestyles that are related to developing heartburn?
High fat meals
tobacco
4 mechanisms for developing gastric reflux?
Decreased Lower Esophageal Sphincter Pressure
Prolonged Esophageal Clearance
Mucosal Resistance
Delayed Gastric Emptying Time
Food causes for decreased LES
fatty meals peppermint chocolate caffeine garlic onions chili pepers
1/2 of patients with GERD have prolonged ______ clearance.
acid
what are foods that are mucosal irritants?
spicy food
citrus juice
tomato juice
coffee
what is a medication used for osteoporosis where patients must take with a large glass of water and stay upright due to forming of an esophageal ulcer.
Alendronate
what are some lifestyle factors that can cause GERD?
Obesity smoking high-fat meals tight fitting clothing pregnancy stress laying flat
what is the body’s way of trying to handle extra acid?
Hypersalivation
How can you diagnose GERD
Hx
Endoscopy
24 hr ambulatory pH monitoring
Pre-emtively treating w/ omeprazole
Complications of GERD
Esophagitis
Esophageal strictures
Barrett’s esophagus
adenocarcinoma of esophagus
What are ways to suppress gastric acid production?
Antacids after meals and at bedtime
H2 histamine receptor antagonist
Covalent inhibitors of H+, K+-ATPASe of pariteal cells (PPIs)
What are some promotility therapies for GERD?
Metoclompramide (doapmine antagonist)
Bethanechol (cholinergic agent)
what is a disadvantage of antacids?
Short duration
must separate from other drugs (can prevent absorption)
What can magnesium antacids cause?
Diarrhea
What can aluminum based antacids cause?
constipation
What can calcium and sodium bicarb based antacids cause?
gas
what products can can cause fluid overload in pts. with CHF, renal failure, cirrhosis, pregnancy, or any salt-restricted diet; avoid in anyone taking supplemental calcium or with renal dysfunction
sodium bicarb
What are some clinically significant drugs that will bind to antacids
quinolone, isoniazid, tetracycline
Ferrous sulfate, quinidine, sulfonylurea
What is teh MOA of H2-receptor angatonists
reversibly inhibit histamine-2 receptors on parietal cells
Name some H2 receptor antagonists
Famotidine
Nizatidine
Ranitidine
How are H2 receptor antagonists excreted
Unchanged in urine
need dose adjustment with renal problems
What is a rare, reversible ADR of H2 receptor antagonists
thrombocytopenia
Drug that inhibits teh metabolism of warfarin, phenytoin, nideipine, propranolol
Cimetidine
what drugs required an acidic environment to be absorbed
Ketoconazole, itraconazole, ferrous sulfate
eliminate symptoms and heal esophagitis more frequently and rapidly than other drugs
PPIs
When should PPIs be given?
Once daily before breakfast
or BID have one before breakfast, before dinner
List some PPIs
Omeprazole
end in “prazole”
MOA of PPIs
Inhibit the action of the H+,K+ -ATPase.
All PPIs are _______ and they need the acidic environment to work.
prodrugs
What drugs can you not use with PPI
antacids
H2 antagonist
with PPIs may have a higher incidence of what?
CAP
How are PPIs metabolized?
P450s
Omprazole and esomeprazole reduce the metabolism of what?
DIazepam
Phenytoin
Warfarin
What are 2 promotility agents
Metoclopramide
Bethanechol
Contraindication so r metoclopramide?
Parkinson’s
mechanical obstruction
concomittant use of dopamien antagonists, anticholinergics, pheochromocytoma
Drug that is a promotlilty agent but can cause a fatal cardiac dysrhythmia
Cisapride
A mucosal protectant that has non-absorbable alumnium salts. only recommended for mild cases of GERD, good for healing. Needs acid to turn into goo
sucralfate
For patients that are resistant to therapy what can you do
Use PPIs and H2 receptor antagonists in alternating method
If patients really aren’t responsive to GERD therapy what can you do?
Antireflux surgery
Endoluminal therapies
most common cause of duodenal ulcer
H. pylori
when will you have pain with a duodenal ulcer?
1-3 hours after eating
gets better with eating
what often cases gastric ulcers?
NSAIDs
worse with food
who has to be hospitalized with ulcerations?
Elderly, those with bleeding and perf
classify H. pylori
Gram- rod
what can H. pylori lead to?
PUD
gastric lymphoma
adenocarcinoma
what are the transmission methods of H. Pylori
Fecal-oral
oral-oral
How can you document infection with H. Pylori
Usually a blood test
Breath test for urea (faster)
What is a syndrome with gastric acid hypersection and recurring ulceration from a gastrin-secreting tumor?
Zollinger-Ellison Syndrome
How do you treat zollinger-Ellison syndrome?
PPIs
chemo
What are complications of H. Pylori.
Zollinger-Ellison Syndrome
Upper GI Bleed
Perf
Obstruction
Caused by scarring or edema of duodenal bulb or pyloric channel land lead to gastric retention. Symptoms include Early satiety, bloating, anorexia, nausea, vomiting, weight loss
Obstruction
What is your DOC for symptoms with H. pylori?
PPIs
What are antibiotics for H. Pylori?
Amoxicillina and clarithromycin
metronidazole and clarithromycin
What is a 4 drug regimen for H. Pylori?
H2 blocker (cheaper)
Pepto-Bismol
Metronidazole (can cause GI problems)
Tetracycline
If there is a treatment failure with H. Pylori what do you do?
Change antibiotics try the 4 drug regimen extend treatment duration asses AEs assess compliance
what 2 things are enhanced with bismuth subsalicylate?
Mucous and bicarb
what is misoprostol?
synthetic analogue of prostaglandin E.
What does misoprostol do?
Imitates the action of endogenous prostaglandins (PGE2 and PGI2) in maintaining the integrity of the gastroduodenal mucosal barrier.
Promotes healing
when is misoprostol indicated?
ulcer healing
ulcer prophylaxis w/ NSAID used
ADRs of misoprostol
Diarrhea
Constipation
Contraindications w/ misoprostol.
Hypotension
Breastfeeding
Pregnant
