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Therapeutics - Exam 6 > Lecture 63 > Flashcards

Lecture 63 Flashcards

GERD

1
Q

foods that decrease LES pressure

A

fatty meals
peppermint and spearmint
chocolate
coffee
soda
tea
garlic
onions
chili peppers
alcohol

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1
Q

GERD risk factors

A

pregnancy
obesity
tobacco smoking
genetic predisposition
alcohol consumption
triggering medications and foods

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2
Q

direct irritant foods

A

spicy foods
orange juice
tomato juice
coffee
tobacco

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3
Q

medications that decrease LES pressure

A

anticholinergics
barbiturates
caffeine
DHP CCB
dopamine
estrogen and progesterone
nicotine
nitrates
tetracycline

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4
Q

medications that are direct irritants

A

aspirin
bisphosphonates
NSAIDs
iron
quinidine
potassium chloride

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5
Q

GERD symptoms

A

heartburn
regurgitation and belching
reflux chest pain
chronic cough
laryngitis
wheezing
asthma

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6
Q

alarm symptoms of GERD

A

dysphagia (difficulty swallowing) –> odynophagia (painful swallowing) –> bleeding –> weight loss

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7
Q

symptoms of GERD in children

A

refusing to eat
wheezing/coughing
dental erosion
recurrent regurgitation
irritability

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8
Q

alarm symptoms of GERD in children

A

weight loss
fever
seizure
persistent vomiting and diarrhea

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9
Q

complications of GERD

A

erosive esophagitis
stricture
barrett’s esophagus
adenocarcinoma of the esophagus

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10
Q

Tums

A

calcium carbonate
OTC Dosing - 2 to 4 tablets prn for up to four times a day; max of 16 tablets per day
SE - constipation, NV, flatulence

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11
Q

milk of magnesia

A

magnesium hydroxide
OTC Dosing - 5 to 15mL for up to four times a day; max of 60mL per day
SE - diarrhea, NV, flatulence

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12
Q

Aluminum and magnesium

A

maalox
gaviscon (plus alginate acid)
could bring diarrhea or constipation
NV and flatulence

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13
Q

famotidine

A

OTC Dosing - 10 to 20mg BID; max 40mg per day
RX Dosing - 10mg BID PRN; take 10-60 minutes before meals; if symptoms persist after 2-4 weeks increase to 20mg BID for 2 weeks —> persist, consider PPI
Renal adjustments if CrCL is under 50mL/min give 50% of dose

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14
Q

Cimetidine

A

OTC/RX Dosing - 200mg daily up to 30 minutes before meals; max of 400mg per day
interacts with CYP1A2, 2C9, 2D6, and 3A4

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15
Q

H2RA SE profiles

A

headache
dizziness and fatigue
constipation or diarrhea
somnolence and confusion
agitation
B12 deficiency

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16
Q

H2RAs clinical pearls

A

BEERS criteria
used alone or in combo with other classes to treat mild to moderate GERD
all H2RAs are equally efficacious
not as effective as PPIs

17
Q

omeprazole dosing

A

OTC - 20mg qd x14d, may repeat in 4 months
RX - 10 to 40mg qd
no renal adjustments
administer 30 to 60 minutes before first meal of day

18
Q

pantoprazole dosing

A

PO RX - 20 to 40mg qd
IV RX - 40mg qd
No renal adjustments
administer 60 minutes before first meal of day

19
Q

Esomeprazole dosing

A

OTC - 20mg qd x14d, may repeat in 4 months
PO/IV RX - 20 to 40mg QD
no renal adjustments
administer 30 to 60 minutes before first meal of day

20
Q

Lansoprazole Dosing

A

OTC - 15mg qd x14d, may repeat in 4 months
RX - 15 to 30mg qd
no renal dose adjustments
ODT available

21
Q

dexlansoprazole (dexilant) dosing

A

RX only if complications, 60mg qd x8w then 30mg indefinitely; if no complications, 30mg qd
no renal adjustments
dual release formulation with onset in 1-2 hours and again at 4-5 hours

22
Q

rabeprazole dosing

A

RX - 10 to 20mg qd
no renal dose adjustments
administer 30 minutes before first meal of the day

23
Q

PPI short term SE

A

headache
dizziness
diarrhea, flatulence
nausea, abdominal pain
enteric infections
community acquired pneumonia

24
Q

PPI long term SE

A

hypomagnesemia
bone density decrease/fractures
vitamin b12 deficiency
chronic kidney disease

25
Q

increased effects of PPI

A

through methotrexate, phenytoin, warfarin

26
Q

decreased effects of PPI

A

through iron, bisphosphonates, HIV/HCV drugs, clopidogrel

27
Q

PPI clinical pearls

A

initial treatment duration should last no more than 8 weeks on RX PPI and 14 days on OTC PPI
maximize therapy by increasing dose, frequency, or switching PPIs
BEERS criteria
recommended taper after long-term therapy

28
Q

promotility agents

A

metoclopramide
bethanechol
may be used as adjunct therapy if there is a known motility defect in GERD
not as effective as acid suppression therapy and have undesirable side effects

29
Q

mucosal protectants

A

sucralfate
limited use in treatment of GERD but may be useful for management of radiation esophagitis and nonacid reflux GERD

30
Q

antacid and H2RA combination therapy

A

may be helpful for heartburn after meals
pepcid ac - famotidine and calcium carbonate/magnesium

31
Q

PPI and H2RA combination therapy

A

nighttime dose of H2RA can help with overnight acid production
H2RA can provide breakthrough relief in patients on PPI

32
Q

nonpharm treatments for GERD

A

lifestyle modifications (weight loss, sleep with head elevated, avoiding late meals, avoiding triggers, portion control, exercise) and surgical management

33
Q

antireflux surgery

A

consider when long-term pharmacotherapy is undesirable or when patients have complications
reinforces the LES
reduces regurgitation and acid backflow

34
Q

OTC patient guided GERD

A

no alarm symptoms
mild to moderate
new onset
identifiable triggers minimized

35
Q

medical referral GERD

A

presence of alarm symptoms
OTC trial for 14 days with no relief

36
Q

treatment of GERD in pregnancy

A

recommend lifestyle changes prior to pharmacologic options
1st - antacids that do not contain aspirin
2nd - H2RAs
last line - severe or refractory cases

37
Q

treatment of GERD in lactation

A

antacids - lacking data but considered generally acceptable
H2RAs - excreted in breast milk at low amounts
PPIs - excretion into breast milk is minimal; most data on pantoprazole and omeprazole

38
Q

non-pharmacologic treatment of GERD in childrens

A

thickening formula and foods
decreasing volume of intake
milk free diet
positioning therapy

39
Q

pharmacologic treatments of GERD in children

A

PPIs and H2RAs (treat for 4-8w, only for diagnosed GERD or esophagitis)
antacids (not used chronically; no aluminum or BSS)
Simethicone and Probiotics (safe and otc)
Herbal options (ginger ale, chamomile, peppermint)

Therapeutics - Exam 6 (11 decks)

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