GERD & PUD Flashcards
What drugs worsen GERD sx
ASA/NSAIDs
fish oils
bisphosphonates
iron supplements
NRT
steroids
TTC
dabigatran
patient who experiences GERD sx about once a week.
tx recommendation?
<2x/week so can do OTC antacids or H2RA
what are the criteria for a patient to receive 8 week PPI instead of OTC antacids or H2RA
2+ incidences of HB a week
Ca carbonate brand
Tums
Ca carbonate + mag hydroxide
Mylanta
mag hydroxide brand
MOM
ca carbonate + simethicone
Maalox
Al + mag hydroxide + simethicone
Mylanta max strength
what are the components of Alka Seltzer
ASA
sodium bicarb
citric acid
Al and Ca products are CI in _____. why?
CI in CrCl <30 due to renal deposits
what is the preferred treatment for acid reflux in pregnancy
ca carbonate (tums)
how long do antacids typically last
30-60 min
how do antacids work
produce salt and water to increase gastric pH
famotidine
brand name
dosing
Pepcid
OTC: 10-20mg PO QD-BID PRN
Rx: 20mg PO BID
de dose if CrCl <60 2/2 ECG changes with renal dysfunction
famotidine (Pepcid) comes in combinations with
mag hydroxide (Pepcid complete)
ibuprofen (Duexis)
when should famotidine be taken
30-60 min before a meal
adverse effects of famotidine
ECG changes in renal dysfunction
psych SE
B12 deficiency
HA
H2RAs are reversible or irreversible?
reversible
cimetidine dosing
OTC: 200mg 1-2x/day PRN
Rx: 400mg PO Q6H
SE of all H2RAs
HA
B12 deficiency
what H2RA was pulled of the market in April of 2020
ranitidine
dexlansoprazole
brand
OTC, Rx or both?
dosing
Dexilant
Rx only
30-60mg PO QD without regard to meals
pantoprazole
brand
OTC, Rx or both?
dosing
Protonix
Rx only
40mg PO QD
what PPIs are available IV
pantoprazole
esomeprazole
adverse effects of pantoprazole IV
thrombophlebitis
SJS/TEN
omeprazole
brand
OTC, Rx or both?
dosing
Prilosec
Rx and OTC
OTC: 20mg PO QD
RX: 20-40mg PO QD
pantoprazole and dexlansoprazole can be taken
without regard to meals
omeprazole comes in which dosage forms SATA
A. IV
B. cap
C. tab
D. powder for suspension
E. solution
F. ODT
B. cap
C. tab
D. powder for suspension
F. ODT
esomeprazole
brand
OTC, Rx or both?
dosing
Nexium
OTC and Rx
OTC: 20mg PO QD
Rx: 20-40mg PO QD
lansoprazole
brand
OTC, Rx or both?
dosing
Prevacid
OTC and Rx
OTC: 15mg PO QD
Rx: 15-30mg PO QD
which PPIs come in a packet for suspension
opemrazole (Prilosec)
esomeprazole (Nexium)
pantoprazole (Protonix)
which PPIs come in ODT form
omeprazole (Prilosec)
lansoprazole (Prevacid)
warnings for all PPIs
c. diff diarrhea
B2 deficiency when used 2+ years
OP related fractures if high dose or 1+ years
hypomagnesemia
AIN
SJS/TEN
DO NOT USE X>8 WEEKS IN ELDERLY
DDI between esomeprazole and omeprazole with plavix
omeprazole and esomeprazole inhibit 2C19 which activates plavix and they therefore decrease plavix efficacy
what drugs need an acidic gut and therefore interact with antacids, H2RAs and PPIs
rilpivirine (NNRTI), atazanavir (PI)
-azoles
cefpodoxime and cefuroxime (po cephalos)
iron products
mesalamine
rsendronate DR
TK-is (-nibs)
what drugs bind antacids
INSTIs
levothyroxine
bisphosphonates
isoniazid
MMF
FQs
sotalol
TTCs
steroids
first line treatment for h, pylori PUD
BSS quad therapy
BSS 300mg PO QID +
metronidazole 250-500mg PO QID +
tetracycline 500mg QID +
PPI BID
all x14 days
counseling points for BSS Quad therapy for h pylori
no pregnancy
no alcohol
not for <8 yo
when are clarithromycin-containing h pylori regimens appropriate
if resistance is <15% AND the patient has never ever received a macrolide in their life for any reason
risk factors for NSAID-induced ulcers
> 60 yo
high dose NSAIDs
use with ASA
use with anticoagulants, steroids, SSRI, SNRI
use of >1 NSAID
hx of any PUD
NSAID-induced PUD tx
PPI x8 weeks
alternatives to PPI treatment for NSAID-induced PUD
hgh dose H2RA or sucralfate
sucralfate dosing
1g PO QID before meals
