GERD PUD Flashcards
which cells secrete HCl in the stomach
parietal
diagnosis of GERD involves experience of symptoms how often
2 times per week
what drugs can worsen GERD symptoms
ASA, NSAIDs, bisphosphonates, dabigatran, estrogen products, fish oil products, iron supplements, NRT, steroids, tetracyclines
when should you refer GERD patient to a doctor
2 weeks OTC/lifestyle mods, alarm symptoms (odynophagia, dysphagia, N/V, hematemesis, bloody stoold, unintentional weight loss)
frequent or severe GERD should be treated with
8 weeks of PPI
infrequent heartburn should be treated with
antacids or H2RAs
couseling point for alka seltzer
aspirin component will inc risk of bleeding if used too frequently
calcium SE
constipation
aluminum SE
constipation
magnesium SE
loose stools
alka seltzer contains >500 mg Na which can
worsen edema in pt with heart failure or cirrhosis
H2RAs may cause confusion in
elderly, severely ill, renal impairment
high dose of cimetidine may cause
gynecomastia, impotence
PPIs reversibly/irreversibly bind to the proton pump
irreversibly
H2RAs reversibly/irreversibly bind to the H2 receptors
reversibly
oral PPIs that must be given before breakfst
nexium, prevacid, prilosec
oral PPIs that can be given without regard to meals
dexilant, protonix
PPI warnings
C diff diarrhea, hypOmagnesemia, vitamin B12 deficiency, osteoporosis bone fracture
PPIs that should NOT be used with clopidogrel
omeprazole, esomeprazole
which PPIs are available IV
pantoprazole, esomeprazole
which H2RA can be injected
famotidine
metoclopramide should not be used in patients with which disease
parkinsons
which drugs should be avoided completely if taking H2RAs or PPIs
dastinib, pazopanib, risedronate DR and (erlotinib and rilpivirine for PPI only)
drugs that require an acidic gut
iron, mesalamine, TKIs, cephalosporins, azole antifungals, rilpivirine, atazanavir
drugs that bind antacids
bictegravir, dolutegravir, elvitegravir, raltegravir, bisphosphonates, isoniazid, levothyroxine, mycophenolate, quinolones, sotalol, steroids, tetracyclines
H2RAs and CNS depressants may cause
delerium, dementia, and cognitive impairment
which H2RA should not be used with highest risk QT prolonging drugs
famotidine
which H2RA has many drug interactions
cimetidine
PPIs inhibit which enzyme
CYP2C19
which PPIs should not be used with clopidogrel
omeprazole and esomeprazole
h pylori is gram
negative
PUD occurs when there is
mucosal erosion in GIT
eating will decrease the pain in which type of ulcer
duodenal
eating will increase the pain in which type of ulcer
gastric
diagnostic test for h pylori
urea breath test (CO2)
ACG recommends triple therapy for first line treatment of H pylori if
clarithromycin resistance rates are low; otherwise quadruple therapy
h pylori treatments last for
10-14 days
quadruple therapy can consist of which drug combinations
bismuth+metronidazole+tetracycline+PPI OR amoxicillin+clarithromycin+metrnidazole+PPI
how often is PPI given in h pylori treatment
BID
how often are the drugs given in the bismuth treatment for h pylori
QID
how often are the drugs given in the amoxicillin treatment for h pylori
BID
risk factors for nsaid induced ulcers
> 60y, history of PUD, high dose NSAIDs, use more than 1 NSAID, also using anticoag/steroid/SSRI/SNRI
NSAIDs should be used in caution in
renal and CV disease
celecoxib has ________ GI risk and __________ CV risk
dec, inc
Vimovo
naproxen/esomeprazole
yosprala
aspirin/omeprazole
how is sucralfate cytoprotective
forms physical barrier over ulcer
how is misoprostol cytoprotective
prostaglandin analog
Dosing considerations for pepcid
Dec dose if crcl <60
Which PPIs are taken 60 min before meal, 30 min before meal, and without regard to meals?
60 min: nexium, prevacid, prilosec
30 min: protonix
Without regard: dexilant
H2RAs and PPIs may cause deficiency of
Vit B12
Metoclopramide moa
Dopamine ANTagonist
Avoid use in PD
Metoclopramide