GERD and PUD Flashcards
PPIs that are always once daily dosing
esomeprazole
dexlansoprazole
PPI dose timing
take 30-60 minutes before meals on an empty stomach
how long do you need to take PPIs to see a benefit
1-4 days
PPIs and osteoporosis
ok to do unless patient has more risk factors for hip fracture
PPIs and community-acquired pneumonia
increased risk of acquiring for acute use, but no elevated risk in long-term users
PPIs and C.diff
PPIs are risk factor and should be used with care in patients at risk
PPIs and clopidogrel
no changes needed as there is not increased risk of CV event
PPI side effects
well tolerated
sometimes diarrhea or headache
PPI differences in efficacy
no major difference
typical PPI course
8 weeks
if GERD symptoms still present after typical course
maintenance PPI at the minimal effective dose
H2RA adverse effects
well tolerated
diarrhea or constipation
which GERD drugs need to decrease dose in renal impairment
H2RAs
why don’t we use cimetidine much
drug interactions
H2RAs place in therapy
- less effective that PPIs
- can be used for maintenance if no erosive disease
- can be used for bedtime relief
calcium carbonate side effect
constipation
sodium bicarbonate side effect
burps
aluminum hydroxide side effect
constipation
magnesium hydroxide side effect
diarrhea
antacid drug interactions
fluroquinolones tetracyclines allopurinol iron cefuroxime
antacid place in therapy
infrequent episodic heartburn only
empiric therapy for GERD
- PPI rx for 8 weeks
- if good response stop PPI
- if still symptoms continue therapy and consider more diagnostics
H.pylori treatment options
- clarithromycin triple therapy
- bismuth quadruple therapy
- concomitant therapy
clarithromycin triple therapy regimens
- clarithromycin 500 BID
- Amoxicillin 1000 BID/metronidazole 500 mg TID
- PPI BID
clarithromycin triple therapy regimen duration
14 days
when to use clarithromycin triple therapy regimens
in areas of low clarithromycin resistance who have not had a macrolide previously
bismuth quadruple therapy regimen
- PPI BID
- bismuth subsalicylate
- metronidazole 500 TID
- tetracycline 500 QID
bismuth quadruple therapy regimen duration
10-14 days
when to use bismuth quadruple therapy regimen
patients that have had a macrolide
bismuth quadruple therapy regimen adverse effect
increased GI effects
concomitant therapy regimen
- PPI BID
- clarithromycin 500 BID
- amoxicillin 1000 BID
- metronidazole 500 BID
concomitant therapy regimen duration
10-14 days
testing for H.pylori after treatment
-urea breath test, fecal antigen test or biopsy at least 4 weeks after completion of antibiotic treatment and 2 weeks after PPI have been withheld
risk factors for NSAID GI toxicity
- age >65
- high dose of NSAID
- previous uncomplicated ulcer
- using with aspirin, corticosteroid or anticoagulant
what patients are considered high risk of NSAID GI toxicity
more than 2 risk factors present
treatments for moderate-high risk of NSAID induced ulcer
PPI or misoprostol
stop NSAID
duodenal NSAID ulcers should be treated for how long
4 weeks
gastric NSAID ulcers should be treated for how long
8 weeks
misoprostol use
NSAID ulcers
issues with misoprostol
- most cannot tolerate abdominal pain and diarrhea
- contraindicated in pregnancy
sucralfate use
NSAID ulcers
sucralfate MoA
forms coating along gastric lining
issue with sucralfate
troublesome constipation
