GERD Study Guide Flashcards
The three classes of drugs most often used for the management of GERD include?
Anatacids
Histamine Receptors subtype (Antihistamine and H2 Receptor Antagonist)
Proton Pump Inhibitors
What are the non pharmacological Management of GERD?
Quit smoking and alcohol intake
Loose weight if obese or overweight
Avoid large meals
Avoid certain foods that may trigger GERD symptoms
- caffeine, coffee, chocolate, spicy foods, highly acidic food, high fat foods
Avoid tight clothing
Avoid lying down for two hours after eating
Avoid a recumbent position
Raise the head of the bed (wedges or blocks)
According to research studies what pharmacological group has superior effects for heartburn, healing the esophagus, and NERD pt heartburn relief?
Proton Pump Inhibitor
A ____ week course of PPI is recommended for symptom relief and healing for erosive esophagitis
8
Describe the step down approach
PPI started as initial therapy
Then swap to a H2 Receptor Antagonist or PPI dose lowered based on symptom relief
PPI therapy should be initiated at what frequency? And given at what time?
Once daily dosing
Given before the first meal of the day
Less effective when taken at bedtime
List the three types of antacids?
Sodium bicarbonate
Aluminum and Magnesium Salts
Calcium Carbonate
What is the mechanism of action of antacids?
React rapidly with hydrochloride acid in the acid environment of the stomach to neutralize stomach acid
What is the formed by the reaction between the antacid and hydrochloride acid?
Water and insoluble salts
What is also formed beside water and insoluble salt, when calcium carbonate and hydrochloric acid?
Carbon Dioxide gas is also formed
What is the side effect from the carbon dioxide produced by the calcium carbon and hydrochloric acid?
Belching and flatulence
What is the onset of action of antacids?
Minutes
What is the duration of action of antacids?
1 to 2 hours
Describe the history fo ranitidine?
The FDA requested manufacturers in April of 2020 to withdraw all prescription and OTC formulations of ranitidine from the market immediately
Due to the presence of a contaminant known as MBDA, which is a probable human carcinogen
The FDA determine that the impurity increases over time, especially when stored at temperatures above room temperature.
Zantac is now back on the market, should you let your family take it?
Yes, it has a new formulation that contains the active ingredient famotidine instead of ranitidine
How many histamine receptors are there in the body?
4
H1 Receptor Antagonist are known as?
Antihistamines
Give 3 examples of antihistamines
Benadryl
Claritin
Allegra
What is the mechanism of action of H2 receptor Antagonist?
Competitive inhibitor with histamine for H2 receptor sites
Blocking histamine from H2 receptors causes what effect?
Diminishes the promotion of acid secretion
H2 receptor antagonist perform ______________ binding.
Selective
The onset of action for H2 receptor antagonist is?
30 to 60 minutes
What is the duration of action of H2 receptor antagonist?
6 to 10 hours
What is the major side effect of H2 receptor antagonist?
Gynecomastia
Gyneomastia occurs in H2 receptor antagonist why?
Directly blocking the androgen receptor activation and by affecting estradiol metabolism
The side effect with famotidine is?
Headaches
The side effects with cimetidine are?
Dizziness
Rashes
Headaches
Gynecomastia
H2 receptor blockers generic name end in ?
Dine
What is the mechanism of action of proton pump inhibitors?
Irreversibly bind to the proton potassium ATP AKA the proton pump
The proton pump is located in the ?
Apical membrane of the parietal cells
Due to the irreversible nature of PPI binding, the proton pump activity is restored only after what?
The body has sufficient time to biosynthesis the new proton potassium ATP
What is the onset of action of a PPI
30 to 60 minutes
How long does it take of dosing for PPI to reach maximum inhibition of acid secretion and why?
Several days, because all proton pumps are not inhibited with the first or second dose of a proton pump inhibitor
What is the duration of action of a PPI?
24 hours
What are common adverse effects of a PPI?
Gastrointestinal disturbances
Increased risk of bone fractures
Increased incidence of hypomagnesemia
Kidney dysfunction (interstitial nephritis)
List the GI disturbances seen with PPI?
Diarrhea
Constipation
Nausea
Abdominal pain
Why are patients on proton pump inhibitors at risk for bone fractures?
Decreased absorption of calcium due to a reduction in the acidic environment which promotes calcium absorption
The risk for bone fractures increases for patients taking PPI if what? (3)
Advanced age
High prescription PPI
Duration of PPI use is greater than one year
What type of calcium supplement is preferred to prevent bone fractures when taking a PPI? Why?
Calcium citrate, because it does not require an acidic environment in order to be absorbed.
Which patients taking PPIs are at high risk for hypomagnesemia?
3 or more months of PPI use
The association for hypomagnesemia and patients on PPI therapy is the highest in which patients?
Those on PPI therapy for over one year
Concurrent use of _______ may increase the potential for symptoms of low magnesium levels when taking a PPI
Diuretic
What treatment will be effective in treating hypomagnesemia for patients on PPI medication if the case is mild? If the case is severe?
Magnesium supplementation
Discontinuation of PPIs if severe
Magnesium levels will return to normal ___________ ___________ after discontinuation with a PPI therapy.
1 week
Symptoms of low magnesium include? (4)
Tremors
Seizures
QT prolongation
Cardiac arrhythmias
PPI are distributed where?
Throughout the body
PPI are activated by?
PPI are selectively activated by the low pH found in parietal cells
Proton pump inhibitors must pass through the stomach as an intact pill to be dissolved where?
Small intestine
PPI reach their ultimate site of action which is ?
Parietal cells via systemic arterioles and capillaries which feed these cells
Once converted into its active species, the PPI is _______ in the parietal cells.
Trapped
PPIs are _______ regarding their efffect on the body
Selective
Why do we have enteric coating medications?
Serve as a barrier to prevent the gastric acids in the stomach from dissolving or degrading drugs after you swallow them, ensuring the dosage and drug are provided to the site of absorption.
What would happen if PPI were not enterically coated?
They would fall apart rapidly in the stomach acids, they would be inactivated before absorption
PPIs must pass through the _______ as an intact pill and dissolve in the _________________, which has a higher pH
Stomach
Small intestine
What do prokinetic agents do?
Help strengthen the LES to have increased pressure and lessen regurg
Prokinetic agents provide benefits as an active therapy to help acid suppression in patients with _______ disorders that contribute to reflex symptoms
Motility
Name a prokinetic agent
Metoclopramide/reglan
Reglan is a antiemetic and prokinetic medication that acts primarily as a ?
Dopamine receptor antagonist
Reglan increases ______ pressure and enhances?
LES
Gastric emptying
Reglan does not contribute to?
Esophageal healing
Reglan is not recommended for GERD d/t its potential to cause signs and symptoms mimicking?
Parkinson disease (AKA extrapyramidal symptoms)
EPS includes:
Involuntary movement that are seen with Parkinson disease
EPS symptoms with Reglan occurs within?
24 to 48 hours of initiating therapy
EPS symptoms with reglan can last up to?
Six months
Metoclopramide should not be prescribed for GERD in the absence of individual that have _______. Why?
Gastroparesis
Due to the development of tardive dyskinesia
Use of metoclopramide for longer than _____ weeks is not recommend.
12
The tardive dyskinesia with metoclopramide can be ________
Irreversible
Metoclopramide should not be used in which two patient populations for the risk of developing tardive dyskinesia
Pediatric patients
Adults less than 30 years of age
