GERD/PUD

Question 1

drugs that decrease LES pressure

Answer 1

ANTICHOLINERGICS
barbs, benzos, caffeine, ca channel blockers, dopamine, estrogen, ethanol, isoproterenol, narcotic, nicotine, nitrates, phentolamine, progesterone, theophylline

Question 2

meds that are esophageal mucosa irritants

Answer 2

ALENDRONATE, aspirin, iron, NSAIDs, quinidine, potassium chloride

Question 3

these three classes suppress gastric acid production

Answer 3

antacids
H2 receptor agonists
PPIs

Question 4

these two drugs can be used as promotility therapy in the treatment of GERD

Answer 4

metoclopramide

bethanechol

Question 5

this class rapidly neutralizes acid to raise intragastic pH (decrease pepsinogen, increase LES pressure)

Answer 5

antacids

Question 6

this antacid includes alginigc acid, which adds a viscous layer acting as a barrier to reflux

Answer 6

Gaviscon

Question 7

this class can cause diarrhea, constipation, or gas. Should not be given in anyone taking a calcium supplement or with renal dysfuntion

Answer 7

antacids

Question 8

this class has many drug reactions. It alters gastric and urinary pH and provides a physical barrier to absorption. Be careful with quinolone, isoniazid, tetracycline, ferrous sulfate, quinidine, and sulfonylurea

Answer 8

antacids

Question 9

Patients should not have to take these meds for over 14 days. If so, should be evaluated for Barret’s or upper GI pathology

Answer 9

antacids

Question 10

this class reversibly inhibits H2 receptors on parietal cells

Answer 10

H2 receptor antagonists

Question 11

this class is used for on-demand therapy for mild to moderate GERD symptoms. can be used before exercise or meals

Answer 11

H2 receptor antagonists

Question 12

these drugs are rapidly and well absorbed after oral admin. they are largely excreted unchanged in the urine (adjust w renal impairment)

Answer 12

H2 receptor antagonists

Question 13

this H2 RA is 90% bioavailable after first pass metabolism (others are 50%)

Answer 13

nizatidine

Question 14

this class can cause HA, somnolence, fatigue, dizziness, constipation, or diarrhea. Thrombocytopenia is a rare but reversible SE

Answer 14

H2 receptor antagonist

Question 15

this class interacts with CIMETIDINE to inhibit metab of warfarin, phenytoin, nifedipine, and propranolol. Also messes with ketoconazole, itraconazole, and ferrous sulfate (bc they require acidic environment for absorption)

Answer 15

H2 receptor antagonist

Question 16

combine an antacid with what for more effective therapy?

Answer 16

H2 RA

Question 17

this class eliminates symptoms and heals esophagitis more rapidly than other drugs, and should always be given before meals

Answer 17

PPIs

Question 18

this class inhibits the action of H, K, -ATPase

Answer 18

PPIs

Question 19

all drugs in this class are considered prodrugs- need the acidic environment to work

Answer 19

PPIs

Question 20

this class doesn’t usually cause ADRs, but can cause N/D/C, HA, dizznessiness, somnolence, perhaps a higher incidence of CAP

Answer 20

PPIs

Question 21

be cautious giving this class to patients with asthma, COPD, immunocompromise, young, old

Answer 21

PPIs

Question 22

which PPIs are metabolized by P450

Answer 22

OLEP

reduce metabolism of diazepam, phenytoin, warfarin

Question 23

this class works to reverse LES incompetence, decreased esophageal clearance, and delayed gastric emptying

Answer 23

promotility agents

Question 24

CNS effects of this class include drowsiness, irritability, extrapyramidal effects

Answer 24

promotility agents

Question 25

this drug is contraindicated in parkinsons, mechanical obs, use of dop ags, anticholinergics, and pheochromocytoma

Answer 25

metoclopramide

Question 26

this drug may increase acid production and is not well tolerated due to cholinergic side effects

Answer 26

bethanechol

Question 27

this promo agent can cause fatal cardiac dysrhythmia

Answer 27

cisapride

Question 28

this class of drug is not recommended for use except in very mild cases of GERD

Answer 28

mucosal protectants

Question 29

this drug polymerizes and cross links to form a sticky, yellow-white gel that adheres to atypical epithelial cells in the base of ulcer craters (when pH is below 4-administer before meals)

Answer 29

sucralfate

Question 30

this drug is effective at promoting motility in PUD and is more efficacious in duodenal rather than gastric ulcers. Can be used to prevent stress ulcers

Answer 30

sucralfate

Question 31

ADRS include constipation, dry mouth, and abdominal discomfort

Answer 31

sucralfate

Question 32

this drug should not be administered with agents that decrease acid. Reacts with phenytoin, digoxin, tetracycline, ketoconazole, fluroquinolone

Answer 32

sucralfate

Question 33

Is this effective for maintenance of GERD: full dose H2 receptor antagonist once daily?

Answer 33

NO. Use reduced dose PPIs (alternate day dosing or weekend therapy)

Question 34

treatment for zollinger-ellison syndrome

Answer 34

PPIs, chemo

Question 35

DOC for PUD

Answer 35

PPI

Question 36

3 dose regimen for PUD: PAC

Answer 36

PPI Amoxicillin Clarithromycin

Question 37

3 dose regimen for PUD: PMC

Answer 37

PPI Metronidazole Clarithromycin

Question 38

4 dose regimen PUD: PBMT

Answer 38

PPI Bismuth subsalicylate metronidazole tetracycline

Question 39

this drug is beneficial for treating PUD: cytoprotection through enhanced secretion of mucous and HCO3, inhibit pepsin activity, antibacterial effects, promotes ulcer healing

Answer 39

bismuth subsalicylate

Question 40

this is a prostaglandin analogue that helps maintain the integrity of the gastroduodenal mucosal barrier and promotes healing

Answer 40

misoprostol

Question 41

this class is indicated for ulcer healing and prophylaxis w NSAID use

Answer 41

prostaglandin analogue

Question 42

this class can cause diarrhea or constipation. It is contraindicated in people with hypotension, breastfeeding, or pregnancy

Answer 42

prostaglandin analogue