GERD and PUD

Question 1

Calcium carbonate

Answer 1

Tums

+ Magnesium (Mylanta Supreme)

+ Simethacone (Maalox Advanced Maximum Strength)

Question 2

Magnesium hydroxide

Answer 2

Milk of Magnesia

+ Aluminum and simethicone (Mylanta Maximum Strength)

Question 3

Components of Alka-Seltzer

Answer 3

Sodium bicarbonate/ASA/Citric acid

Question 4

Duration of relief of antacids

Answer 4

30-60 min

Question 5

ADR of antacids based on components

Answer 5

Al and Mg can accumulate in renal dysfunctions

Mg: Diarrhea
Al: Constipation
Ca: Constipation

Question 6

Which antacid is preferred in pregnancy

Answer 6

Calcium-containing

Question 7

Ci with Alka-selter? Why

Answer 7

> 500 mg of sodium can worsen edema in HF or cirrhosis in patients

Question 8

Duration of PPI

Answer 8

8 weeks at least

Question 9

Famotidine

Answer 9

Pepcid

Question 10

ADR of H2RAs

Answer 10

Confusion (elderly, renal dysfunction, severely ill): Delirium, dementia, cognitive impairment

Cimetidine: gynecomastia, impotnece

Question 11

PPIs that should be take before breakfast

Answer 11

Esomeprazole
Lansoprazole
Omeprazole

(60 min before)

Question 12

PPIs that can be take regardless of meals

Answer 12

Dexlansoprazole
Pantoprazole

Question 13

Dexlansoprazole

Answer 13

Dexlant

Question 14

Pantoprazole

Answer 14

Protonix

Question 15

Omeprazole

Answer 15

Prilosec

Question 16

Esomeprazole

Answer 16

Nexium

Question 17

Lansoprazole

Answer 17

Prevacid

Question 18

Warning with chronic PPI use

Answer 18

C diff risk or infection risk
B12 deficiency
Osteoporosis
Hypomagnesia

Question 19

IV PPIs

Answer 19

Esomeprazole or Pantoprazole

Question 20

PPIs that interact with Plavix

Answer 20

Esomeprazole and Omeprazole

Question 21

Indication for Metoclopramide

Answer 21

Gastroparesis

Question 22

Dosing of Reglan

Answer 22

Before meals and at bedtime

CrCl <60: reduce by 50% to avoid CNS/EPS side effects

Question 23

BBW of Reglan

Answer 23

Tardive

Question 24

ADR of Metoclopramide

Answer 24

EPS (acute dystonia), parkinson-sx due to dopamine blockage

Drowsiness

Question 25

Drugs that require an acidic gut?

Answer 25

NNRTIs and PU
Antivirals: ledipasivr, velparasvir/sofosbuvir
Azoles
PO Cephalosporins
Iron
Risedronate
TKI

Question 26

H. pylori vs GI ulcer

Answer 26

H. pylori: Eating food or taking antacids lessen pain
GI ulcer: worsens with eating

Question 27

First line for H pylori with dosing

Answer 27

Bismuth quad therapy x 10-14 days:
1. Pepto Bismol 300 mg QID
2. Metronidazole 250-500 mg QID
3. Tetracycline 500 mg QID
4. PPI BID

Pylera (pesto 420 mg, metronidazole 375 mg, tetracyclinee 375 mg) QID with PPI BID

Question 28

When is concomitant therapy used?

Answer 28

If local resistance to clarithromycin is <15% and no previous exposure to macrolides

Question 29

Components of concomitant therapy

Answer 29

10-14 days preferred over Clarithro triple therapy:
1. Amoxicillin 1000 mg BID
2. Clarithromycin 500 mg BID
3. Metronidazole 500 mg BID
4. PPI BID

Question 30

Components of cclarithrymyvin triple therapy? Penicillin allergy?

Answer 30

14 days:
1. Amoxicillin 100 mg BID
2. Clarithromycin 500 mg BID
3. PPI BID (or esomeprazole 40 mg QD)

Prepac: Amoxicillin, Clarithromycin, lansoprazole

Penicillin allergy: replace with amoxicillin with metronidazole 500 mg TID or use quad therapy

Question 31

Risk factors of NSAID-Induced Ulcers

Answer 31

<60 YO
PUD hx
High-dose NSAIDs
>1 NSAID
Concomitant anticoagulant, steroid, SSRI, SNRI

Question 32

Selective COX2 NSAIDs

Answer 32

Celecoxib
Meloxicam
Nabumtone
Diclofenac
Etodolac

Question 33

Risk of COX2

Answer 33

Decreased GI risk but Increased CV risk

Question 34

Cytoprotective drugs

Answer 34

Misoprostol
Sucralfate

Question 35

BBW of Misoprostol

Answer 35

Abortifacient
Arthrotec: NSAIDs ↑ risk for GI events

Question 36

Misoprostonol

Answer 36

Cytotec

Question 37

Sucralfate

Answer 37

Carafate

Question 38

ADR of sucralfate

Answer 38

Constipation