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Pharm 584 > MCP: Upper GI > Flashcards

MCP: Upper GI Flashcards

1
Q

Heartburn

A
  • Burning Sensation
  • Discomfort behind breastbone
  • Caused by acid reflux or regurgitation
  • Symptom of GERD
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2
Q

Dyspepsia

A
  • Persistent discomfort in upper abdominal area
  • Bloating
  • Early satiety
  • Nausea and Vomiting
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3
Q

Heartburn vs. GERD

A
  • Heartburn
    • Simple: Generally mild, associated with diet, and episodic
    • Frequent: Heartburn 2x or more/week
  • GERD
    • Symptoms or esophageal damage that results from reflux of gastric contents into the esophagus
    • Most common symptoms of GERD: heartburn that is frequent and persistant (3 mo)
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4
Q

GERD: Typical and Atypical Symptoms

A
  • Typical Symptoms:
    • Heartburn
    • Regurgitation
    • Hyper-salivation
    • Belching
  • Atypical Symptoms
    • Dental errosions
    • Chest pain
    • Pharyngitis
    • Hoarseness
    • Chronic Cough
    • Non-allergic asthma
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5
Q

When to refer:

A
  • ​Severe, recurrent, persistent symptoms
  • Dysphagia: difficulty swallowing
  • Chest pain
  • Bleeding
    • Bloody stool, black and tarry
    • Coffee ground vomit
  • Unexplained weightloss
  • Elderly
  • Consistent N/V/D
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6
Q

Lifestyle Recommendations

A
  • Don’t eat before bedtime/lying down
  • Elevate head of bed (~6 inches)
  • Weight Loss
  • Smoking cessation
  • Reduce portion sizes
  • Avoid trigger foods
    • Fatty foods
    • Chocolate
    • Spicy Foods
    • Citrus
    • Coffee
    • Salt
    • EtOH
  • Avoid trigger medications
    • NSAIDs (especially aspirin)
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7
Q

Antacid: MOA

A
  • Neutralizes stomach acid by increasing gastric pH
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8
Q

Antacid: Indications

A
  • Mild, infrequent heartburn/dyspepsia
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9
Q

Antacid: Onset

A

Instant

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10
Q

Antacid: Duration

A
  • 20 min (empty stomach)- 3 hours (full stomach)
  • What affects the duration of all antacids?
    • Food
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11
Q

Sodium Bicarbonate

  • Dissolution rate at gastric pH
  • Duration
  • Side effects
A
  • Alka Seltzer
  • rapid dissolution
  • short duration
  • Side effects:
    • Sodium overload
    • Alkalosis
    • Milk-Alkali syndrome
  • Not for pregnant or elderly
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12
Q

Calcium Carbonate

  • Dissolution
  • Duration
  • Side Effects
A
  • Max 2500 mg
  • Slower dissolution
  • Long duration
  • Side Effects:
    • Constipation
    • Hypercalcimia
    • Milk-alkali syndrome
      • build up Ca2+, damage kidney
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13
Q

Aluminum Hydroxide:

  • Dissolution
  • Duration
  • Side Effects
A
  • Slower dissolution
  • longer duration
  • Constipation
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14
Q

Magnesium Hydroxide

  • Dissolution
  • Duration
  • Side Effects
A
  • rapid dissolution
  • short duration
  • diarrhea
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15
Q

Antacids Cautions/Contraindications

A
  • Regular use for 2 weeks
  • Patients with hypercalcemia
  • Toxicity with renal impairment
  • Persons of advanced age, children, or pregnancy or breasfeeding women
    • Calcium in pregnant/breastfeed (not Nabicarb)
    • Caution with Mg in elderly
  • Al containing: Caution in patients predisposed to obstruction
    • Elderly
    • Dehydrated
    • Reduced bowel motility (opiods)
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16
Q

H2 Blockers: MOA

A
  • Reversibly binds histamine 2 receptors on parietal cells, decreases acid secretion
17
Q

H2 Blockers: Indications

A
  • Short-term treatment of mild-moderate heartburn/dyspepsia
  • Long term prophylactic use in predisposed populations
18
Q

H2 Blockers: Onset

19
Q

H2 Blockers: Duration

A
  • 4-10 hours
20
Q

H2 Blockers: Administration

A
  • Take with or without food
  • Long term prevention: QHS or BID before meals
  • Short term prevention: take 15 min-1 hour before a heartburn inducing event
  • May take along with antacids
21
Q

H2 Blockers: Side Effects

A
  • GI pain
  • N/V/D
  • Constipation
  • Headache
  • Dizziness
  • Agitated/Confused
22
Q

H2 Blockers: Cautions/Contraindications

A
  • Decrease activity of drugs that require acidic pH for absoprtion
    • Have OJ when taking med
    • Ketoconazole
    • Fe supplement
  • Decrease dose in renal or hepatic impairement
  • Caution in pregant/breastfeeding/elderly patients/children
23
Q

H2 Blockers: Generic, Brand Name, OTC/RX

A
  • Cimetidine
    • Tagamet
    • Careful in drug interaction screen
    • Oldest in class
    • OTC: 200mg
  • Famotidine
    • Pepcid
    • OTC: 10mg
    • Rx: 20mg
  • Ranitidine
    • Zantac
    • OTC: 25, 75, 150mg
24
Q

Proton Pump Inhibitor: MOA

A
  • Irreversibly inhibits proton pumps (proton-potassium ATPase) on parietal cells
  • Decrease acid secretion
25
Q

PPI: Indications

A
  • Frequent heartburn/dyspepsia more than 2 days per week
  • GERD
  • Peptic Ulcers
  • In combo with antibiotics to treat ulcers
26
Q

PPI: Onset

A
  • 2-3 hours; several days (1-4) for complete relief
27
Q

PPI: Duration

A
  • 12-24 hours
28
Q

PPI: Administration

A
  • Take 30-60 minutes before a meal
  • May open capusles and sprink on soft food/liquids
  • Duration: GERD 4-8 weeks, gastric/duodenal ulcer 8-12 weeks
    • Note: OTC PPI’s not for long term use, not to exceed 14 days every 4 months
29
Q

PPI: Side Effects

A
  • Headache
  • Diarrhea
  • Constipation
30
Q

PPI: Caution/Contraindications

A
  • Decrease activity of drugs that require acidic pH for absorption
  • Renal or hepatic impairement
  • Caution in pregnant/breastfeeding/elderly patients
  • Potential drug interations due to CYP450 2C19** enzyme metabolism**
    • Thought to potentially interact with clopidogrel (especially omeprazole/esomeprazole)
    • Not absolute, run by cardiologist
31
Q

PPI: Long Term Use May Result In…

A
  • Vitamin B12 deficiency
    • Weakness, tiredness, increased HR, neuropathy
  • Hypomagnesmia
    • Careful with other meds that lower magnesium (BP meds)
    • Baseline magnesium levels consideration for patients on long term PPI
  • Increased risk of hip, spine, and wrist fractures in patients > 50 yo
    • Recommend Ca2+ citrate
  • Rebound hyper-secretion upon d/c
    • taper off slowly
  • Increased risk of infection (controversial)
    • C-dificile associated diarrhea
    • pneumonia
32
Q

PPI: Generic, Brand Name, OTC/Rx

A
  • Esomeprazole magnesium (new: sodium)
    • Nexium
    • Rx and OTC
    • 20-40 mg orally once daily
  • Lansoprazole
    • Prevacid
    • Rx and OTC
    • 15-30 mg orally once daily
  • Omeprazole
    • Prilosec
    • Rx and OTC
    • 20-40 mg oraly once daily
  • Pantoprazole
    • Protonix
    • Rx
    • 40 mg orally once daily
  • Rabeprazole
    • Aciphex
    • Rx
    • 20 mg orally once daily
33
Q

Antacids

  • Line of therapy
  • Indiactions
  • Onset
  • Duration
A
  • 1st line of therapy
  • mild, infrequent heartburn/dyspepsia
  • instant onset
  • 20-30 min duration
34
Q

H2 Blockers

  • Line of Therapy
  • Indication
  • Onset
  • Duration
A
  • 2nd line of therapy
  • mild-moderate epidsodic heartburn/dyspepsia
  • onset: 30-45 min
  • duration: 4-10 hours
35
Q

PPIs: Line of Therapy, Indication, Onset, Duration

A
  • 3rd line of therapy
  • frequent heartburn/dyspepsia 2+ days per week, GERD, peptic ulcers
  • Onset: 2-3 hours, several days for complete relief
  • Duration: 12-24 hours

Pharm 584 (13 decks)

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