Lecture 4 - Management of GORD Flashcards
When would we refer a patient?
Prolonged symptoms, severe symptoms, unresponsive to therapy, danger symptoms
someone over 50 with the disease
Alginates?
Peptac, gaviscon (rafting agents)
form a foam across the top of the stomach (raft), which provides a physical barrier and neutralise stomach acid, making it harder to be pushed back up to the oesophagus
Antacids?
Co-magaldrox, magensium trisilicate
neutralise stomach acid, very fast acting
Cautions of antacids and alginates?
some interfere with tetracyclines and form chelates
peptac etc have a very high sodium content so shouldn’t use in patients with CV disease or pregnant women with high blood pressure
Proton pump inhibitors?
Name and doses
omeprazole (10mg, 20mg, 40mg)
lansoprazole (15mg, 30mg)
esomeprazole (20mg, 40mg)
pantoprazole (20mg, 40mg)
rabeprazole (10mg, 20mg)
PPI’s used for?
Peptic ulcer disease, H pylori eradication, hyspepsia, GORD, prevention of NSAID damage and rebleed after surgery
PPI in eradication of H pylori
Week long course of antibiotic to treat H pylori with a PPI in high dose to eradicate H pylori
PPI effectiveness?
act very effectively with a once/twice daily dosing
Esomeprazole?
more expensive than omeprazole/lansoprazole without adding a lot more benefits
PPI dosage forms?
GR tablets GR capsules GR granules dispersible tablets Oro-dispersible tablets Oral liquids - from specials manufacturers Injections
Oral liquid PPI disadvantages?
have very short half-lives (shelf life of ~2 weeks)
omeprazole is most commoly prescribed suspension
PPI cautions?
increased risk of bone fracture in prolonged use in susceptible patients
increase risk of C difficile infection (acid counteracts C diff)
mask symptoms of cancer
rebound hyper-secretion of acid on cessation
Bone fracture on use of PPI?
Implicated in thinning bones so have to be used with caution in frail elderly people or people with osteoporosis
particularly bad with omeprazole
Esomeprazole and omeprazole interactions?
decrease the antiplatelet effect of clopidogrel
Pantoprazole drug interactions?
increase the coagulant effect of warfarin (coumarins)
Common and very common PPI side effects?
1 in 10 to 1 in 100
abdominal pain, headaches
Uncommon PPI side effects?
1 in 100 to 1 in 1000
arthralgia (pain in joints)
parasthesia
Rare side effects of PPIs?
1 in 1000 to 1 in 10,000
confusion, gynaecomastia (breast tissue in men)
H2 receptor antagonists?
Name and dosage
ranitidine (150mg, 300mg)
cimetidine (200mg, 400mg, 800mg)
famotidine (20mg, 40mg)
nizatidine (150mg, 300mg)
H2 receptor antagonist dosage forms?
Tablets capsules effervescent tablets oral liquids injections
Zantac use?
advantages over PPIs because it is available as an oral liquid and has better stability
used in patients fed with naso-gastric tubes
H2 receptor antagonist common side effects?
diarrhoea, dizziness
H2 receptor antagonist uncommon side effects?
erythema multiform
Rare side effects of H2 antagonists?
hepatitis, confusion
can also mask symptoms of cancer