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NAPLEX 21 > GERD/PUD > Flashcards

GERD/PUD Flashcards

1
Q

Acidic gastric contents are normally prevented from back flow into the esophagus by a protective ring of muscle fibers called:
However, patients with GERD have reduced ___ pressure.

A

lower esophageal sphincter (LES)

reduced LES pressure

^ this causes back flow!

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2
Q

How is GERD diagnosed?

A

based on patient-reported symptoms (duration, daytime and/or night), frequency (>2 times per week) and risk factors (family history, diet and eating habits, sleep position )

endoscopy might be performed if more serious symptoms arise (esophageal 24 hour pH monitoring)

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3
Q

What is the name of the condition where abnormal cell growth in the esophageal lining which can lead to esophageal cancer?

A

Barrett’s esophagus

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4
Q

What drugs can worsen GERD symptoms?

A 
Aspirin/ NSAIDs
Bisphosphanates
Dabigatran
Estrogen products
Fish oil products
Iron supplements
NRT
Steroids
Tetracyclines
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5
Q

How long before a pharmacist should refer a patient to a PCP, with failed OTC attempts to treat GERD?

A

two weeks; and immediately if alarm sx are present

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6
Q

List the alarm symptoms of GERD

A 
painful swallowing (odynophagia)
dysphagia 
frequent nausea and vomitting 
hematemesis
black bloody stool
unintentional weight loss
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7
Q

How is infrequent heartburn (<2 times per week) treated?

A

PRN OTC antacids or H2RAs

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8
Q

What is the initial treatment of choice for GERD?

A

an eight-week course of a proton pump inhibitor; and is used to heal any erosive esophagitis

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9
Q

This drug works by neutralizing gastric acid (producing salt and water), which increases gastric pH

A

Antacids

provides relief within minutes! Short Half life 30-60 mins

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10
Q

What can happen if a person is using OTC antacids that’s mixed with aspirin?

A

risk of bleeding if used too frequently

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11
Q

Brand: Tums

A

Generic: calcium carbonate

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12
Q

Brand: Mylanta

A

Generic: calcium carbonate + magnesium

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13
Q

Brand: Maalox

A

Generic: calcium carbonate + simethicone

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14
Q

Brand: Milk of Magnesia

A

Generic: magnesium hydroxide

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15
Q

Brand: Mylanta Classic

A

Generic: magnesium hydroxide + aluminum + simethicone

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16
Q

Brand: Alkaseltzer

A

Generic: sodium bicardonate/aspirin/citric acid

*contains >500mg of Na… bad for edema, HF, cirrhosis

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17
Q

What is the dosing for antacids?

A

varies, but many require administration 4-6x per day

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18
Q

What antacids are preferred in pregnancy?

A

calcium-containing

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19
Q

Calcium can cause –>
Aluminum can cause –>
Magnesium can cause –>

A

Calcium can cause –> constipation
Aluminum can cause –> constipation
Magnesium can cause –> loose stools

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20
Q

Initial drug treatment is once daily for 8 weeks, but when can you increase to twice daily?

A

if partial response or if nighttime symptoms are present

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21
Q

What is the maintenance treatment for GERD?

A

1st line: PPI at the lowest effective dose

alt: H2RA, if there is no erosive esophagitis

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22
Q

Famotidine
Ranitidine
Cimetidine

what drug class?

A

H2RAs

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23
Q

Brand: Pepcid, Pepcid AC

A

Generic: famotidine

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24
Q

Brand: Zantac

A

Generic: ranitidine

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25
Q

This drug class reversibly inhibit H2 receptors on gastric parietal cells, which decreases gastric acid secretions

A

H2RAs

used PRN for infrequent or mild heartburn but have a slower onset than antacids

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26
Q

What class has warnings for confusion, especially in elders with renal impairment?

A

H2RAs

cimetidine - gynecomastia, impotence ; tbh just avoid because drug interactions and side effects lol

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27
Q

For H2RAs, decrease dose when CrCl

A

<50

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28
Q

This drug class irreversibly binds to the gastric H+/K+ ATPase pump in parietal cells, which shuts down the proton pump and blocks gastric acid secretion

A

PPIs

*The MOST effective drug for GERD, all the clout

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29
Q

Brand: Nexium

A

Generic: esomeprazole

INJ!!!!

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30
Q

Brand: Prevacid

A

Generic: lansoprazole

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31
Q

Brand: Dexilant

A

Generic: dexlansoprazole

32
Q

Brand: Protonix

A

Generic: pantoprazole

INJ!!!!

33
Q

Which PPIs are taken 60 mins before breakfast?

A

Nexium
Prevacid
Prilosec

34
Q

This drug class has warnings for:
C.diff / pneumonia
hypomagnesia
Vitamin B12 deficiency with longterm use (>2 years)
osteoporosis related bone fracture with high doses or longterm use >1 year

A

PPIs

35
Q

Don’t use omeprazole and esomeprazole with which drug due to diminishing the effect of the drug?

A

clop-i-dog-rel

36
Q

Which PPIs are available IV?

A

pantoprazole and esomeprazole

37
Q

Of the H2RAs, which are oral solutions/suspensions?

A

cimetidine
famotidine
nizatidine
ranitidine

38
Q

Of the H2RAs, which are inj formulations?

A

famotidine

ranitidine

39
Q

Of the PPIs, which are ODT?

A

lansoprazole

omeprazole

40
Q

of the PPIs, which are oral solutions/suspension?

A 
lansoprazole
packets for suspension ----
esomeprazole
omeprazole
pantoprazole
41
Q

Which drugs can be used for peptic ulcer disease?

A

misoprostol and sucralfate

42
Q

Which drugs are commonly used when patients have coexisting gastroparesis?

A

metoclopramide and erythromycin

43
Q

This drug is a dopamine antagonist and at higher doses blocks serotonin receptors in the chemoreceptor zone of the CNS.

Enhances the response to ACh in the upper GI tract, causing increased motility, accelerated gastric emptying, and inc LES tone

A

Metoclopramide

44
Q

Brand: Reglan

A

Generic: Metoclopramide

45
Q

When should you take metoclopramide?

A

30 min before meals, and at bedtime

When CrCl <40, decrease dose 50% to avoid CNS/EPS side effects

46
Q

This drug has a boxed warning for tardive dyskinesia, and warnings for EPS.. should not be used in PD patients

A

metoclopramide

can also cause dizziness

47
Q

Drugs that require an acidic gut (absorption dec by antacids, H2RAs, and PPIs

Separate 2-4h before, 2-6 after

A

antiretrovirals (rilpivirine - NNRTI, atazanavir - PI)
Antivirals: ledipasvir, velpatasvir/sofosbuvir
azole antifungals
cefpodoxime, cefuroxime
iron
mesalamine
risedronate DR
tyrosine kinase inhibitors: dasatanib, erlotinib, pazopanib

48
Q

Oral drugs that antacids bind…

A 
INSTIs
bisphosphonates
isoniazid
levothyroxine
mycophenolate
quinolones
sotalol
steroids (esp budesonide)
tetracyclines
49
Q

This condition occurs when there is a mucosal erosion within the GI tract - deep into the mucosa

A

peptic ulcer disease

50
Q

What are the three most common causes of PUD?

A

H. pylori (spiral shaped, gram negative)
NSAID induced unclers
stress ulcers

51
Q

What is the primary symptom of PUD?

A

dyspepsia, a gastric pain which can feel like gnawing or burning sensation in the middle or upper stomach

52
Q

If the ulcer is duodenal, pain is typically worse 2-3 hours after eating when the stomach is empty. Eating foot or taking antacids lessens the pain – what is the offender?

A

H. Pylori

53
Q

With gastric ulcers, eating generally worsens the pain – what is the offender?

A

NSAIDs

54
Q

What is the name of the test that tests for H. pylori?

A

urea breath test – identifies gas (co2) produced by the bacteria

fecal antigen test detects h pylori in the stool

d/c PPIs, bismuth and antibiotics to avoid false negatives

55
Q

Due to failure rates with triple therapy (often caused by clarithromycin resistance), it is now recommended for…

A

QUADRUPLE THERAPY

the use of triple can be used if clarithromycin resistance is <15% and history of no macrolide

56
Q

The three first-line H. Pylori treatment regimens

A

1st line - bismuth quadruple therapy

Alt: concomitant therapy

Depends: clarithromycin triple therapy

57
Q

What is in the bismuth quadruple therapy? How long is the therapy?

A

bismuth subsalicylate 300mg QID+

metronidazole 250-500mg QID +

tetracycline 500mg QID +

PPI BID (or esomeprazole 40mg daily)

x10-14 days

58
Q

Brand: Pylera

A

Generic: bismuth substrate potassium+ metronidazole +tetracycline) …taken QID

you’d want to add PPI BID

Do not use in pregnancy bc of tetracycline!

59
Q

What is in the concomitant therapy? Take for how long?

A

amoxicillin 1000mg BID +

clarithromycin 500mg BID +

metronidazole 250-500mg QID +

PPI BID (or esomeprazole 40 mg daily)

x 10-14 days

60
Q

What is in the clarithromycin triple therapy? used for how long?

A

Amoxicillin 1,000mg BID +

Clarithromycin 500mg BID +

PPI BID (or esomeprazole 40mg daily)

*if penicillin allergy, switch amoxicillin with metronidazole 500mg TID

61
Q

Brand: Prevpac

A

Generic: amoxicillin + clarithromycin + lansoprazole

x 14 days

62
Q

How do NSAIDs cause drug-induced ulcer?

A

direct irritation of the gastric epithelium and systemic inhibition of PG synthesis (by inhibiting COX-1)

63
Q

NSAIDs with selective inhibition of COX-2 (i.e. celecoxib) have deceased ____ risk, but increased _____ risk

A

dec GI risk

inc CV risk

64
Q

NSAIDs that approach the selectivity of celecoxib are:

A

meloxicam
nabumetone
diclofenac
etodolac

65
Q

Brand: Vimovo

A

Generic: naproxen/esomeprazole

marketed to reduce the risk of NSAID-induced ulcers

66
Q 
Age >60
History of PUD
High dose NSAIDs
using >1 NSAID
\+ anticoagulants, steroids, SSRIs, SNRIs
are risk factors for what?
A

NSAID induced ulcers

67
Q

Brand: Yosprala

A

Generic: aspirin/omeprazole

68
Q

If an ulcer develops, it should be treated with a ____ x8 weeks, and NSAIDs should be discontinued.

A

PPIs

if PPI cannot be used, high dose H2RAs or sucralfate are other options

69
Q

a prostaglandin E1 analog that replaces the gastro-protective prostaglandins removed by NSAIDs

A

misoprostol

70
Q

a sucrose-sulfate-aluminum complex that can interact with albumin and fibrinogen to form a physical barrier over an open ulcer

A

sucralfate

71
Q

Misoprostol and sucralfate are what types of drugs?

A

cytoprotective

72
Q

Brand: cytotec

A

Generic: misoprostol

73
Q

This drug has a boxed warning for: abortifacient

A

misoprostol

74
Q

Brand: Carafate

A

generic: sucralfate

* taken BEFORE meals… can cause constipation … has binding interactions

75
Q

If a patient has phenylketonuria don’t use what drug?

A

Prevacid SoluTab

NAPLEX 21 (60 decks)

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