Module 2: GERD Flashcards
What is the I Can PresCribE A Drug mnemonic?
I = indication
Can = contraindication
PresCribE = Precautions, cost/compliance, efficacy
A = adverse effects
Drug = dose/duration/direction
What does GERD stand for?
Gastroesophageal Reflux Disease
True or False: GERD is primarily caused by the malfunction of the lower esophageal sphincter (LES).
True
Fill in the blank: In GERD, stomach contents are often refluxed back into the ______.
esophagus
What is a common symptom of GERD?
Heartburn
Which of the following factors can contribute to the development of GERD? A) Obesity B) Smoking C) Pregnancy D) All of the above
D) All of the above
How is GERD diagnosed?
- Rule out cardiac, hepatobillary, medication-induced, lifestyle or diet
- > 60 + vomiting, bleeding, abd mass unexplained, weight loss, dysphagia? Consider organic cause e.g Ca or ulcer (endoscopy)
- NSAID use? Stop therapy if possible.
- Dominant symptom heartburn or regurgitation? If yes - likely GERD.
- H. pylori infection?
Dx often confirmed with symptomtatic response to antisecratory treatment.
What is Barrett’s esophagus and it’s risk factors?
Condition in which there is an abnormal change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small and large intestine.
Risk factor = chronic GERD (5 years of persistent symptoms) plus 3 of the following:
- age > 50
- male
- obesity
- tobacco use
- first-degree + relative
What is mild and intermittent vs severe or frequent GERD?
Mild and intermittent = fewer than 2 episodes/week
severe or frequent = 2 or more episodes/week end/or severe (impair quality of life)
What is first line therapy for mild and intermittent GERD?
- Lifestyle & diet
- Low or standard dose H2RA PRN and/or
- Antacids and/or sodium alginate as needed
Assess symptom response at 4 weeks
If mild and intermittent Gerd is resolved after 4 weeks of initial treatment, what is recommended?
Continue lifestyle & diet changes
H2RA, antacid and/or alginates PRN
What is recommended for persistent mild and intermittent GERD?
Standard dose H2RA x2 daily
Assess symptom response at 2-4 weeks
If persists = switch to standard dose PPI and assess at 4-8 weeks
Taper off PPI or if persist - treat as refractory GERD ( doesn’t respond to high dose PPI - needs further investigation - possible sx)
What is recommended as first line therapy for severe or frequent GERD?
Standard dose PPI OR
vonoprazan 10 mg OD
Assess at 4 weeks (vonoprazan) or 8 weeks (PPI)
If resolved, taper off and lifestyle + on-demand antacids, alginates, H2RAs or PPIs
If not resolved treat as refractory GERD
Management of pregnant patients with GERD?
Lifestyle changes
Antacids, alginates or sucralfate
If symptoms persist: H2RAs and the PPI’s.
Vonoprazan should not be used.
Does vonoprazan have significant drug interactions?
Yes - need to look it up before prescribing.
What are some concerns related to adverse effects of vonoprazan?
Increase risk for C.diff when used with PPI.
Severe cutaneous reactions including Setvens-Johnson syndrome and toxic epidermal necrolysis
Increase of osteoperosis-related fractures.
Fundic gland polyps with long-term use.
Hypomagnesemia.
Tubulointerstitial nephritis.
Vit B12 deficiency.
Can vonoprazan be taken in pregnancy and brestfeeding?
Adverse events observed in animal reproduction studies.
Breastfeeding not recommended.
What are some monitoring parameters for vonoprazan?
Magnesium and calcium periodically for prolonged therapy.
What is the classification for vonoprazan?
Potassium-Competitive Acid Blocker.
Describe the roles of antacids, H2RA’s and PPI’s in tx of GERD.
Antacids = neutralize stomach acid providing quick but temporary relief of symptoms associated with GERD.
H2RA’s = Reduce the amount of acid produced by the stomach, helping to alleviate symptoms of GERD.
PPI’s = block the proton pump in the stomach lining, effectively decreasing acid and production providing longer-term relief.
What is the difference in the MOA for H2RA’s and PPI’s?
H2RA’s = block histamine receptors on stomach cells, preventing the signal to produce acid.
PPI’s = inhibit the enzyme responsible for the final steps of acid secretion within the stomach lining.
PPI’s provide a more potent and prolonged reduction in gastric acid production.
Essentially, H2RA’s ‘signal’ the stomach to produce less acid and PPI’s block the ‘pump’ that generates the acid itself.
