Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPFC 2 Midterm 2 > Management of Dyspepsia, GERD, and PUD > Flashcards

Management of Dyspepsia, GERD, and PUD Flashcards

1
Q

How do antacids work?

A

Direct chemical interaction with H+ to raise pH
- make stomach less acidic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which are the potency levels of each antacid (3)

A

Al3+ < Mg2+ < Ca2+

Liquid more potent than tablets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the role of gaviscon

A

Combined with antacids forms a gel layer when in contact with stomach acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the side effects of the different antacids? Dosing?

A

Al3+ and Ca2+ : constipation
Mg2+: diarrhea (laxative)
Ca2+: bloating/gas
Al3+ and Mg2+: caution in renal function

Dosing: 30 min after meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dosing/potency of H2RAs

A

Slower onset (give 15-30 min before meals)
more potent than antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dosing/potency of PPI

A

Slowest onset (give 30 min prior to eating in morning) PRN dosing n/a

More potent and longer lasting than H2RAs (24 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are long-term adverse effects (4) and drug interactions with PPI (3)

A

ADE
- C. diff
- fractures
- B12 deficiency
- pneumonia

Interact with drugs that require acidity for absorption
- ketoconozole
- digoxin
- iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some non-pharm strategies for dyspepsia?

A
  • small more frequent meals
  • food diary to identify triggers with acidic food
  • smoking cessation
  • weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which medications are the strongest drivers for dyspepsia (regardless of type

A
  • Nitrates
  • Tricyclic antidepressants
  • Calcium channel blockers
  • Aspirin, NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the flow for patients who present to pharmacy with symptoms of dyspepsia?

A
  1. Rule out red flags (VBAD, age)
  2. Recommend non-pharm
  3. perform med review to adjust meds
  4. If needed, try OTC antacid, H2RA or PPI
  5. Refer if patient
    - continues to experience symptoms despite therapy
    OR
    - requires medication daily 2+ weeks
    - Requires medication for 3+ episodes/year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you treat someone with uninvestigated dyspepsia?

A
  1. Rule out red flags
    - Present: perform endoscopy
  2. Rule out Local H. pylori prevelance 20%+ or unknown
    - Yes: Test H. pylori and treat
  3. PPI x 4-8 weeks (step down if symptoms resolve)
  4. If ongoing, consider endoscopy H. pylori
  5. If nothing, then diagnose Non-ulcer/functional dyspepsia
    - provide empathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the approach to functional dyspepsia

A
  • Empathy
  • Dyspepsia is benign
  • Use non-pharms
    If necessary:
  • on-demand therapy with H2RA
  • Aggresive H. pylori test
  • Consider use of antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are red flags for NON-urgent referrals of heartburn and GERD?

A
  • Age <18
  • Age 50+ with new or worsening heartbearn
  • epigastric mass (tumour)
  • unexplained weight loss
  • Dysphagia
  • Nocturnal + severe symptoms
  • Recurrent GERD within 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some non-pharm strategies for heartburn and GERD

A
  • stop smoking
  • reduce alcohol and caffeine intake
  • eat smaller meals more frequently
  • avoid eating 2-3 hours before bed time
  • Lose weight if obese
  • Avoid lying down after eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to deal with someone who comes in with heartburn and mild symptoms ONCE/week if symptoms keep persisting

What do you do if symptoms resolve in any steps

A

Step up approach
1. OTC antacid, H2RA x 2 weeks PRN
2. Rx H2RA x 2 weeks BID
3. Switch to PPI daily x 4 weeks PRN
4. Refer to MD

If symptoms resolve in any step
- go back to OTC dose PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to deal with someone who comes in with symptoms 2+/week OR MODERATE symptoms (occasional nocturnal) if symptoms keep persisting?

What do you do if symptoms resolve in any steps?

A
  1. Start PPI once daily x 4 weeks
  2. Refer to MD

If resolved
- Continue another 4 weeks then D/C and us OTC PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does severe GERD look like?

A

Significant impact on daily activities
- mainly nocturnal symptoms
- evidence of complications

18
Q

How to deal with someone who comes in with severe GERD if symptoms keep persisting

What do you do if symptoms resolve in any steps?

A
  1. Start PPI x 8 weeks daily
  2. PPI 4-8 weeks BID
  3. Refer to specialist (refractory GERD)

If symptoms resolve
- reduce to lowest effective maintenance dose

19
Q

What are some mitigation strategies for primary prevention for patients on NSAIDs

A
  • lower risk agents
  • lowest effective dose
  • shortest duration
  • lifestyle modification (no smoking, no excessive alcohol)
  • avoid combo nsaid
  • Ensure prednisone, anticoagulants, clopidogrel, citalopram + sertraline is indicated
20
Q

What are risk factors for patients on NSAIDs (3)

A
  1. Age 65+
  2. High-dose NSAID therapy
  3. Concurrent use of aspirin, corticosteroids, anticoagulants
21
Q

How to treat someone with No risk factors for PUD

A

Use mitigation strategies (eg. lowest dose, lowest risk agents)

22
Q

How to treat someone with 1 or 2 risk factors for PUD

A

NSAID plus PPI or misoprostol

23
Q

How to treat someone with 3 risk factors for PUD

A

Alternative therapy if possible OR
COX-2 selective (celecoxib) plus PPI or misoprostol

24
Q

Differentiate between the agents for primary prevention (3)

A

Misoprostol 200 mcg QID (3rd line)
- decreases GASTRIC ulcer risk
- not as well tolerated as PPIs

PPI 1D (1st line)
- decreases PUD risk w/ NSAIDs

H2RA BID (2nd line)
- reserved for patients who cannot tolerate PPIs
- Not as good as PPI

25
Q

How to manage a BLEEDING PUD. (cold, tachycardia) (6)

Gastric vs duodenal treatment time line

A
  1. Stabilize patient
  2. Hold NSAIDs, anticoagulants, antiplatelets
  3. Give pantoprazole IV 80 mg
  4. Perform endoscopy (diagnostic, risk assessment, therapeutic
  5. Put on Pantoprazole
    High risk:
    - for 72 hours: give 8mg/hr IV + 40mg q12h IV
    - for next 2 weeks: 40 mg BID
    - Then standard 1D dosing
    Low risk:
    - Standard 1D dosing

Duodenal: 4-8 weeks
Gastric: 8-12 weeks

  1. Prevent recurrence
    - test and treat for H. pylori
    - Treat for high risk NSAID use (Cox-2 + PPI)
    - Decision to restart anticoagulants and antiplatelet agents depends on risk of clot vs risk of bleed.
26
Q

How to manage a NON-bleeding PUD. (3)

A
  1. Standard PPI 1D dosing
    - NSAID-induced: 4-8 weeks
    - Non-h. pylori, non-NSAID: usually long-term
  2. Test for H.pylori
  3. Give NSAID w PPI if not possible to d/c
    - Decision to restart anticoagulants and antiplatelet agents depends on risk of clot vs risk of bleed.
27
Q

When do you test for H. pylori?

A
  • Part of management of pt w/ dyspepsia
  • To make a diagnosis of PUD in symptomatic patients UNDER 60 (to avoid endoscopy)
  • To identify cause of any patient diagnosed with PUD endoscopically (even if they use (NSAIDs, h. pylori can still be there)
28
Q

What do you need to be off to test for H. pylori?

A
  • Must be off PPI for min. 2 weeks
  • Must be off bismuth/ antimicrobials for at least 1 month
29
Q

What are the 4 possible H. pylori tests?

A
  1. Serology for antibodies
    - does not differentiate between current & past infection
  2. Stool antigen assay
  3. Urea breath test (most common)
  4. Tissue biopsy
    - requires endoscopy
    - allows for culture and sensitivity
30
Q

Explain the steps of Urea breath test (4)

A
  1. Subjects are given orally radio labelled urea C13
  2. H. pylori produces urease which breaks down urea into 13CO2 and ammonia
  3. 13CO2 is exhaled
  4. Examine the ratio of 12CO2 and 13CO2
31
Q

Is resistance common for H. pylori?

A

Yes

32
Q

What are the first choice treatment of H. pylori? (2)

A

PBMT (PPI, Bismuth, Metronidazole, tetracycline)

OR

PAMC (PPI, amox, metronidazole, clarithromycin)

33
Q

What is the treatment if you know clarithromycin resistance is LESS than 15%? (3)

A

PAC (PPI, amox, clarith)
PAM (PPI, amox, metronidazole)
PMC (PPI, metronidazole, clarithromycin)

34
Q

When would you confirm H. pylori is gone?

A

Via UBT or SAA

At least 4 weeks post-Rx
and off PPI at least 2 weeks

35
Q

What are 2 reasons people fail h. pylori therapy

A
  • resistance
  • non-adherence
36
Q

What do you give if they fail 1 h. pylori therapy?

A
  • If fails clarith or levo, NEVER use again
  • PMBT x 14 days, with higher PPI and metronidazole doses
    OR
  • PAL x 14 days, try levo
37
Q

What do you give if they fail 3 h. pylori therapies?

A

PAR (PPI, amox, rifabutin) x 10 days

38
Q

When do you continue taking PPI? (4)

A
  • Barrett’s esophagus
  • Chronic NSAID users with bleeding risk
  • Severe esophagitis
  • Documented history of bleeding GI ulcer
39
Q

When would you recommend deprescribing?

A
  • PUD already treated
  • Upper GI symptoms without endoscopy stopped for 3 consecutive days
  • If using ICU stress ulcer prophylaxis and are out of ICU
  • uncomplicated H. pylori treated and asymptomatic
  • GERD treated
40
Q

After deprescribing, What symptoms do you monitor for at 4 and 12 weeks? What is its treatment

A

Verbal
- heartburn, regurgitation
- dyspepsia, epigastric pain
Treatment: Use non-pharm

Non-verbal
- loss of appetite
- weight loss
- agitation
Treatment: OTC antacid or H2RA

41
Q

After deprescribing and monitoring symptoms and symptoms still relapse what should you do?

A

If symptoms persist 3-7 days and interfere with normal activity
1) treat and test h. pylori
2) consider return to previous dose

42
Q

How to pick between tapering doses and on-demand? Define on-demand

A

Equal evidence for both; up to the patient

on demand
- take the PPI daily for a period of time long enough to control symptoms, then stop when symptoms resolve

IPFC 2 Midterm 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions