NAPLEX > GERD & PUD > Flashcards

GERD & PUD Flashcards

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1
Q

GERD is characterized by reduced ____ pressure and ____ backflow into the esophagus

A

lower esophageal sphincter (LES)
acidic gastric contensts

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2
Q

GERD symptoms

A

heartburn, regurgitation, cough

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3
Q

diagnosis of symptoms

A

symptoms >=2 times per week
endoscopy
esophageal pH monitoring

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4
Q

drugs that can worsen GERD

A

aspirin/NSAIDs
bisphosphonates
dabigatran
estrogen products
fish oils
iron supplements
NRT
steroids
tetracyclines

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5
Q

when should pharmacists refer patients for evaluation

A

do not respond with OTCs after 2 weeks or if alarm symptoms present

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6
Q

infrequent heartburn can be managed with what PRN

A

OTC antacids or H2RAs

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7
Q

1st step for management of frequent GERD symptoms

A

weight loss**
elevate head of bed, avoid high fat meals before bed, avoid food/drink that trigger reflux

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8
Q

initial drug treatment (2nd step) for frequent GERD symptoms

A

PPI once daily x8 weeks (can increase to BID)

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9
Q

what to do once 8 weeks of initial treatment is complete

A

stop, assess if symptoms return, then start maintenance therapy

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10
Q

maintenance treatment (step 3) for frequent GERD symptoms

A

1st line- PPI at lowest effective dose
alt- H2RA if no erosive esophagitis

not recommended- metoclopramide, sucralfate

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11
Q

neutralize gastric acid which increases gastric pH
provide relief in minutes but duration is short (30-60 mins)

A

antacids

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12
Q

examples of antacids (all OTC)

A

calcium carbonate (+ magnesium, simethicone)
magnesium hydroxide (+ aluminum, simethicone)
sodium bicarbonate/aspirin/citric acid

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13
Q

brand name of calcium carbonate

A

Tums

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14
Q

brand name of calcium carbonate + magnesium

A

Mylanta Supreme

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15
Q

brand name of calcium carbonate + simethicone

A

Maalox Advanced Max Strength

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16
Q

brand name magnesium hydroxide

A

Milk of Magnesia

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17
Q

brand name of magnesium hydroxide + aluminim + simethicone

A

Mylanta Maximum Strength

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18
Q

brand name of sodium bicarbonate + aspirin + citric acid

A

Alka Seltzer

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19
Q

warnings for Al and Mg containing antacids

A

can accumulate with renal dysfunction

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20
Q

warning for aspirin containing antacids

A

bleeding

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21
Q

AE of calcium and aluminum containing antacids

A

constipation

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22
Q

AE of magnesium containing antacids

A

loose stools

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23
Q

which type of antacids are preferred in pregnancy

A

calcium containing antacids

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24
Q

how often may antacids require administration

A

4-6 times per day

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25
reversibly inhibit H2 receptors which decreases gastric acid secretion
H2RAs famotidine, cimetidine, nizatidine
26
brand names of famotidine
Pepcid AC, Zantac 360
27
aside from PO options, famotidine is also available as an
injection
28
when does the dose of famotidine need to be reduced
CrCl <60
29
warning for H2RAs
confusion (risk factors- older adult, severely ill, renal impairment)
30
AEs of cimetidine (high doses)
gynecomastia, impotence
31
avoid use of cimetidine due to
DDIs and AEs
32
irreversibly inhibit the gastric H+/K+-ATPase pump which blocks gastric acid secretion
PPIs dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole
33
brand name dexlansoprazole
Dexilant
34
brand name esomeprazole
Nexium (24h, IV)
35
brand name lansoprazole
Prevacid (24h, SoluTab)
36
brand name omeprazole
Prilosec (OTC)
37
brand name pantoprazole
Protonix
38
which PPIs are available as IV injection
pantoprazole, esomeprazole
39
warnings for PPIs
C-diff-associated diarrhea (CDAD) hypomagnesemia B12 deficiency with prolonged use (>=2 years) osteoporosis-related fractures with high dose or long term use (>=1 year) may diminish effect of clopidogrel, do not use with omeprazole, esomeprazole
40
counseling for PPI capsules, can be
opened
41
when to take esomeprazole
60 minutes before breakfast
42
brand name esomeprazole + naproxen
Vimovo
43
which PPIs need to be taken before breakfast
esomeprazole, lansoprazole, omeprazole
44
when should dexlansoprazole be taken
without regard to meals
45
when should pantoprazole oral suspension be taken
30 minutes before a meal tablets without regard to meals
46
long term risks from PPIs
changes in gastric pH --> inc risk GI infections (C diff) pneumonia inc osteoporosis, fractures do not use beyond 8 weeks in older adults
47
which 2 H2RAs are available OTC
cimetidine famotidine
48
which 3 PPIs are available OTC
esomeprazole lansoprazole omeprazole
49
which 2 PPIs are available as ODT
lansoprazole omeprazole
50
which H2RAs are available in solutions/suspensions
cimetidine famotidine
51
which 3 PPIs are available as packets for suspension
esomeprazole omeprazole pantoprazole
52
DA agonist that accelerates gastric emptying and inc LES tone commonly used for gastroparesis but not recommended for NV
metoclopramide
53
brand name metoclopramide
Reglan
54
when to take metoclopramide
before meals and at bedtime
55
when to reduce the dose (and how much) of metoclopramide to avoid AEs such as CNS effects/EPS
CrCl <60 reduce by 50%
56
BBW metoclopramide
tardice dyskinesia
57
warnings for metoclopramide
EPS (including acute dystonia) parkinsonian-like symptoms
58
avoid metoclopramide in patients with
Parkinsons disease
59
AE of metoclopramide
drowsiness
60
drugs with DECREASED ABSORPTION when given with antacids/PPIs/H2RAs (require an acidic gut)
antiretrovirals (rilpivirine, atazanavir) azoles cephalosporins (cefpodoxime, cefuroxime) direct-acting antivirals (ledipasvir, velpatasvir) iron products risedronate DR
61
drugs with DECREASED ABSORPTION THAT ANTACIDS BIND
INSTIs bisphosphonates isoniazid levothyroxine mycophenolate quinolones sotalol steroids (esp budesonide) tetracyclines
62
DDIs with H2RAs
CNS risks- added delirium, dementia, cognitive impairment use lower doses in renal impairment cimetidine inhibits CYP450
63
additional DDIs for PPIs
inhibit 2C19- omeprazole and esomeprazole can decrease effectiveness of clopidogrel
64
DDIs for metoclopramide
do not use with APS or promethazine do not use in parkinsons
65
3 most common causes of PUD
H pylori NSAIDs stress ulcers (critically ill, ventilated)
66
spiral shaped gram negative bacteria
H pylori
67
how to observe ulcers
upper endoscopy
68
main symptom of PUD
dyspepsia (gastric pain in the middle or upper stomach), heartburn, bloating, belching, cramping, nausea, anorexia if ulcer is duodenal- pain is worse after eating, food or antacids can lessen the pain if ulcer is gastric- eating will worsen the pain
69
diagnosis of H pylori
urea breath test (UBT)
70
what needs to be done to avoid false negatives from UBTs
d/c PPIs 2 weeks prior d/c bismuth and antibiotics 4 weeks prior
71
patients who test positive with UBT should be
treated
72
can substitutions be made for H pylori treatment regimens
no
73
treatment duration for H pylori
14 days
74
preferred bismuth quadruple therapy for H pylori
bismuth subsalicylate 300mg QID + metronidazole 500mg TID or QID + tetracycline 500mg QID + PPI BID
75
alt triple therapy option for H pylori treatment
amoxicillin 1000mg TID + rifabutin 50mg TID + omeprazole 40mg TID
76
H pylori treatment do not use metronidazole if
alcohol use
77
H pylori treatment tetracycline- do not use if
pregnancy/children <8
78
H pylori treatment do not use bismuth subsalicylate if
salicylate allergy
79
chronic use of NSAIDs through inhibition of COX1 can increase risk for
gastric ulcers
80
NSAIDs with lower GI risk but higher CV risk
COX2 selective celecoxib, meloxicam, nabumetone, diclofenac, etodolac
81
patients with high GI risk who require non-selective NSAID can use what to decrease risk
PPI
82
if NSAID ulcer develops, how should it be treated
PPI for 8 weeks
83
examples of combo products to reduce NSAID ulcer risk
naproxen/esomeprazole diclofenac/misoprostol
84
PG E1 analog that replaced gastroprotective prostaglandins
misoprostol
85
complex that forms a physical barrier over open ulcers
sucralfate
86
brand name misoprostol + diclofenac
Arhtrotec
87
brand name sucralfate
Carafate
88
BBW for Arthrotec
abortifacient diclofenac inc risk GI and CV events
89
AEs of Arthrotec
diarrhea, abdominal pain
90
AE of sucralfate
constipation
91
note what type of interactions with sucralfate
binding interactions
92
prevacid solutab contains phenylalanine so do not use with
PKU
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