Term
|
Definition
rantidine (Zantac)*
famotidine (Pepcid)*
nizatidine (Axid)
cimetidine (Tagamet)
*Less drug-drug interactions with these medications |
|
|
Term
|
Definition
H-2 receptor antagonist
Zantac
150 mg PO bid
300 mg PO qhs
forms: 75 or 150 mg pills |
|
|
Term
|
Definition
H-2 receptor antagonists
Pepcid
Pepcid AC 10 mg
20 mg PO bid
40 mg PO qhs |
|
|
Term
|
Definition
esomeprazole (Nexium)
lansoprazole (Prevacid)
dexlansoprazole (Dexilant)
pantoprazole (Protonix)
rebeprazole (Aciphex)
omeprazole (Prilosec) |
|
|
Term
|
Definition
PPI
Nexium
40 mg PO qd
(S enantiomer of omeprazole/Prilosec) |
|
|
Term
|
Definition
PPI
Prevacid
15, 30* mg PO qd
OTC is 15 mg
low drug-drug interactions (can be taken with coumadin)
decreased absorption when taken with food |
|
|
Term
| omeprazole warning by FDA |
|
Definition
| OTC recommended for only 14 days |
|
|
Term
| What is the progression of GERD? |
|
Definition
| reflux esophagitis -> erosive esophagitis -> Barrett's esophagus -> adenocarcinoma of the esophagus |
|
|
Term
T/F
The symptoms of GERD correlate well with the severity of disease. |
|
Definition
|
|
Term
|
Definition
non-erosive reflux disease
severe reflux symptoms with normal endoscopic exam |
|
|
Term
|
Definition
gastro-esophageal reflux - common in pediatrics
"effortless vomiting in otherwise well child" |
|
|
Term
| What % of infants under 3 months regurgitate at least 1 meal daily? What % of those are symptom free at 10 months? 18 months? |
|
Definition
|
|
Term
| How is GERD different from GER in pediatrics? |
|
Definition
GERD is GER associated with sequelae or faltering growth
GERD presents with vomiting associated with irritability, excessive crying, disturbed sleep, or respiratory problems |
|
|
Term
| What is Barrett's esophagus? |
|
Definition
| normal squamous epithelium of the esophagus is replaced with columnar epithelium (similar to the intestinal lining) |
|
|
Term
| What is the pathophysiology of GERD? |
|
Definition
1. defective lower esophageal sphincter pressure
2. certain types of food
3. delayed gastric emptying |
|
|
Term
T/F
Hiatal hernia may be a part of the diagnosis of GERD. |
|
Definition
| False - they are considered separate diagnoses |
|
|
Term
| What types of foods may induce GERD? |
|
Definition
alcohol
caffeine - chocolate, coffee, soda
onions
spicy foods
orange juice
tomato juice |
|
|
Term
| What is the gold standard for diagnosis of GERD? |
|
Definition
|
|
Term
| What are the 2 key symptoms of GERD? |
|
Definition
heartburn and regurgitation
other symptoms may include hypersalivation and belching |
|
|
Term
T/F
Endoscopy is used as a confirmatory test for diagnosis of GERD. |
|
Definition
| False - it is not required |
|
|
Term
| What confirms the diagnosis of GERD? |
|
Definition
|
|
Term
| In which population are classic symptoms of GERD often absent? |
|
Definition
|
|
Term
| What % of asthmatics have GERD? |
|
Definition
|
|
Term
| What % of people with chronic cough have GERD? |
|
Definition
|
|
Term
| What 3 things are responsible for 94% of cases of chronic cough? |
|
Definition
| asthma, post-nasal drip, and GERD |
|
|
Term
| What are the signs and symptoms of an atypical presentation of GERD? |
|
Definition
| chronic cough, hoarseness, pharyngitis, chest pain, and dental erosions |
|
|
Term
T/F
Assume cardiac origin of chest pain before diagnosing GERD. |
|
Definition
|
|
Term
T/F
Dental erosions with no other signs and symptoms of GERD could be silent GERD. |
|
Definition
|
|
Term
| What are the "Red Flags" of GERD? |
|
Definition
1. dysphagia
2. loss of more than 10% of body wt
3. abdominal mass
4. jaundice
5. protracted vomiting - hematemesis
6. family history of gastric cancer
7. previous PUD
8. anorexia
9. early satiety |
|
|
Term
| What % of patients with dyspepsia test positive for H. pylori? |
|
Definition
|
|
Term
| What are the treatment options for GERD? |
|
Definition
lifestyle modifications
antacids
H-2 receptor antagonists
proton pump inhibitors
prokinetic agents |
|
|
Term
| When are prokinetic agents used to treat GERD? |
|
Definition
| treatment for refractory GERD (not first line agents) |
|
|
Term
| List some lifestyle modifications that may help with GERD. |
|
Definition
weight loss
low fat diet
elevation of the head of the bed
eating smaller meals
no food within 3 hours of bedtime
avoid foods that exacerbate symptoms
smoking cessation
avoidance of alcohol |
|
|
Term
| What medications may cause GERD symptoms? And how? |
|
Definition
affect tone:
anticholinergics
barbituates
CCB
theophyline
contact irritants:
ASA, NSAIDs
iron supplements
KCl
quinidine
bisphosphonates |
|
|
Term
| What is antacid made of? What is one side effect? |
|
Definition
Calcium carbonate (CaCO3)
may cause constipation |
|
|
Term
|
Definition
OTC treatment for GERD symptoms
from brown seaweed
watch out for Aluminum and Magnesium |
|
|
Term
| Which cells secrete HCl? How much do they secrete? |
|
Definition
|
|
Term
| What are the 3 functions of the acid in the stomach? |
|
Definition
1. kills bacteria
2. aids digestion by making food more water soluble
3. promotes calcium chloride uptake |
|
|
Term
| What is the optimal pH for the function of the digestive enzyme pepsin? |
|
Definition
|
|
Term
| What important factor is also produced by parietal cells? And what is it for? |
|
Definition
intrinsic factor
it's necessary for B12 uptake |
|
|
Term
| what 3 neurotransmitters affect gastric secretion? |
|
Definition
histamine - major factor in acid secretion
acetylcholine
gastrin |
|
|
Term
| H-2 receptor antagonist drug-drug interactions |
|
Definition
theophyline, warfarin, phenytoin, nifedipine, propanolol
rantidine and famotidine have fewer interactions |
|
|
Term
| How do H-2 receptor antagonists work? |
|
Definition
| The parietal cell receptor for histamine is of the H2 type. These meds block these receptors and prevent acid excretion. |
|
|
Term
| How do proton pump inhibitors work? |
|
Definition
| they cause an irreversible inactivation of proton pumps (H+/K+ ATPase) |
|
|
Term
T/F
Action of PPI depends on blood concentration. |
|
Definition
| False - depends on the cycling rate at which pumps are synthesized, inactivated, and degraded. |
|
|
Term
T/F
H-2 RA inhibitory effects last longer than PPI inhibitory effects. |
|
Definition
| False - PPIs have longer lasting inhibitory effects |
|
|
Term
| What is the DOC for GERD? |
|
Definition
|
|
Term
T/F
PPIs are prodrugs activated by protonation from acid in the stomach. |
|
Definition
|
|
Term
T/F
PPI conversion to active drug is pH dependent. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| omeprazole (Prilosec) and esomeprazole (Nexium) |
|
|
Term
|
Definition
| lansoprazole (Prevacid) and rabeprazole (Aciphex) |
|
|
Term
T/F
PPIs are faster acting than H-2 blockers. |
|
Definition
| False - they are slower; take 3-4 days to establish maximum clinical effect |
|
|
Term
T/F
The higher the pKa activation point, the faster the PPI is activated. |
|
Definition
| False - the higher the pKa, the PPI is not activated as quickly. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Name 3 common side effects of both H-2 blockers and PPIs. |
|
Definition
| Diarrhea, constipation, headache |
|
|
Term
| How is H. pylori related to GERD? |
|
Definition
It is not usually the source of dyspepsia in GERD.
GERD is a functional dyspepsia and has no established underlying cause in 50% of patients. |
|
|
Term
| In what % of GERD patients is there no underlying cause? |
|
Definition
|
|
Term
| If GERD symptoms persist after using starting dose of PPI, what next? |
|
Definition
Endoscopic exam - looking for Barrett's esophagus and gastric cancer
usually negative/unremarkable
If negative, increase dose of PPI |
|
|
Term
| When is a patient considered to have complicated GERD? |
|
Definition
| if symptoms persist after treating with starting dose of PPI |
|
|
Term
| When is a patient considered to have refractory GERD? |
|
Definition
| symptoms persist even when using maximum dose of a PPI |
|
|
Term
| How do you treat refractory GERD? |
|
Definition
Review lifestyle modifications and
classify the type of reflux to better treat the specific issue |
|
|
Term
| What are the 4 types of reflux? |
|
Definition
1. nocturnal acid reflux
2. non-acid relfex
3. delayed gastric emptying
4. heartburn without reflux |
|
|
Term
| What device is used to classify the type of reflux? |
|
Definition
|
|
Term
| Treatment for refractory GERD with nocturnal acid reflux |
|
Definition
|
|
Term
| Treatment for refractory GERD with non-acid reflux |
|
Definition
decrease transient LES relaxations with a muscle relaxer
baclofen (5-20 mg PO TID) |
|
|
Term
| Treatment for refractory GERD with delayed gastric emptying |
|
Definition
prokinetic therapy
metoclopramide (Reglan) |
|
|
Term
| Treatment for refractory GERD - heartburn without reflux |
|
Definition
| TCA or SSRI to modify pain perception |
|
|
Term
| What are 3 symptoms of delayed gastric emptying? |
|
Definition
| nausea, early satiety, bloating |
|
|
Term
| What is the Black Box Warning for metoclopramide (Reglan)? |
|
Definition
tardive dyskinesia - monitor biweekly
use for max of 12 weeks |
|
|
Term
| What treatments are available for GERD in children? |
|
Definition
1. alter viscosity of food (D)
2. alter gastric pH with:
- antacids (D)
- H2 blocker (B)
- PPI (B)
3. alter gut motility
- metoclopramide
- erythromycin[ |
|
|
Term
| What are the possible complications of using thickening agents? |
|
Definition
| dehydration and intestinal obstruction |
|
|
Term
| How young can PPIs be given? |
|
Definition
|
|
Term
| What is the H2 blocker of choice for children? |
|
Definition
|
|
Term
| What are the PPIs of choice for children? |
|
Definition
| lanzoproazole, omeprazole, and esomeprazole |
|
|
Term
T/F
H2 blockers have decreased effectiveness with time. |
|
Definition
| True - other transmitters can be increased to cause an increase in acid secretion |
|
|
Term
T/F
Clinical studies show that PPIs are all equally efficacious. |
|
Definition
|
|
Term
T/F
First consideration in choice of PPI should be cost. |
|
Definition
True - no differences in efficacy
also consider possible drug-drug interactions |
|
|
Term
| Name 4 side effects that you should monitor for with PPI use. |
|
Definition
1. increased rates of CAP
2. increased rates of C. difficile colitis
3. increased rates of H. pylori infection/re-infection
4. increased rates of fracture in female patients |
|
|
Term
T/F
Post menopausal women should be on a calcium supplement when on a PPI |
|
Definition
| True - calcium citrate because it is less dependent on gastric pH for absorption than calcium carbonate |
|
|
Term
| What patient population may be on a PPI even without GERD? |
|
Definition
| Arthritis sufferers, or those on NSAID longterm - in order to prevent gastric bleed. |
|
|
