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What is the pathophysiology of GERD?
Abnormal structure or function of sphincter causes it to open and allow gastric acid reflux
What are the typical symptoms of GERD?
Heartburn, regurgitation, belching, bloating, nausea, early satiety, hyper salivation and globus sensation
What are atypical symptoms of GERD?
chronic cough, non-allergic asthma/rhinitis, hoarseness, dental enamel erosion
What are some alarm symptoms of GERD?!
difficulty breathing, weight loss, vomiting, blood in vomit/stool, choking, chest pain and painful swallowing [REFER right away!]
What are risk factors of GERD?
obesity, smoking, diet, diabetes, asthma, pregnancy and delayed stomach emptying
Foods that trigger reflux are _______, _______, ____________ and _________
coffee, chocolate, fatty foods and alcohol
Foods that trigger heartburn are _____________, _______________ and ______
spicy foods, acidic foods and carbonation
What are some medication triggers to esophageal mucosa?
aspirin/NSAIDs, bisphosphates, KCl, iron and chemo
What are some lower esophageal sphincter relaxant triggers?
Anticholinergics, calcium channel blockers, antidepressants, narcotics, barbiturates, nitrates, estrogen and progesterone
What are some non-pharmacologic treatment options?
smoking cessation, exercise/weight loss, eat small, frequent meals, raise head of bed, eliminate trigger foods and increase water and avoid laying down after meals
Antacids are _______ medications that act as _____ ____ to neutralize __________ ____________
PRN; weak bases; gastric acid
Antacids have a __________ onset of action and __________ duration
What are some examples of antacid brands?
Tums, Milk of Magnesia, Maalox, and Gaviscon
What are common side effects of antacids?
* all can cause nausea and vomiting
What are the drug interactions with antacids?
Fluroquinolones, tetracyclines, azoles, levothyroxine, iron, steroids, digoxin, HIV meds
*1 hour before or 4 hours after
H2RAs are scheduled meds that _________ inhibit _________ receptors and reduce _____________ _______ secretion
reversibly; H2; gastric acid
What are some H2RA medications?
Ranitidine, Famotidine, Cimetidine
H2RA medications are taken ________
BID (for full days worth)
Take H2RAs _________ minutes _________ a meal
10-60; before (empty stomach!)
What are some common side effects of H2RAs?
Headache and somnolence confusion
How must the dose adjust with renal impairment? (CrCl<50)
DECREASE dose or EXTEND interval
Cimetidine increases concentrations of?
Amiodarone, calcium channel blockers and warfarin
PPI medications are schedules meds that _________ inhibit ____________ and reduce ____________ secretion
irreversibly; H+/K ATPase; gastric acid
PPI have a ______ onset of action and ______ duration
What are some PPI medications?
How are PPIs dosed?
ONCE daily 60 minutes before breakfast (empty stomach!)
What are some common side effects of PPI?
Headache, dizziness, constipation, diarrhea, nausea and long-term concerns
What are some drug interactions with PPIs?
Increase effect of methotrexate, phenytoin and warfarin
Decrease effect of iron, bisphosphonates and HIV meds
What are some drug combination options?
What are the treatment options for pregnancy/lactation?
(First line: non-pharm)
First line: Antacids
Second line: Sucralfate or H2RA
Last line: PPI
What are the treatment options for children?
Non-pharm options: thicken food, decrease volume, position therapy
PPIs and H2RAs (4-8 wks)
Should not use antacids chronically (*do not use Al containing antacids in <12 yrs)
Simethicone, probiotics, herbal options
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