Notes in GERD-PUD

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Published	09/08/2024	acid suppressions are: {{c1::•Antacids •H2 receptor antagonists (H2RA or H2 blockers) •Proton pump inhibitors (PPIs)}}
Published	09/08/2024	mucosal protection meds are:{{c1::•Sucralfate* •Alginate}}
Published	09/08/2024	•Increase gastric emptying / increase LES pressure meds are:{{c1::•Metoclopramide** only recommended for use in specific populations}}
Published	09/08/2024	Histamine blockers -> {{c1::block h2 receptor which stimulates h/k pump that makes acid}}
Published	09/08/2024	PPI MOA -> {{c1::inhibits the H/K ATPase pump and reduces acid}}
Published	09/08/2024	Antacids -> {{c1::neutralizes the acid that has already been released }}
Published	09/08/2024	Antacids•Mechanism:  {{c1::neutralize gastric acid}} •Role: {{c1::on-demand relief or PRN (infrequent/mild episodes)}} •Onset/duration …
Published	09/08/2024	Antacids•Precautions: o{{c1::Renal}} dysfunction: {{c1::aluminum}} & {{c1::magnesium}} may accumulate •Drug interaction considerations: oAcid red…
Published	09/08/2024	{{c1::calcium carbonates}} are the type of antacids that should be used with a patient with renal impairment
Published	09/08/2024	H2RAs•Mechanism: decrease {{c1::gastric acid secretion}} by blocking {{c1::H2 receptors }} on {{c1::parietal cells}} •Role: {{c1::milder GER…
Published	09/08/2024	H2RAs•Precautions: oAdjust dose in {{c1::renal impairment}} → not {{c1::contraindicated}} but must be {{c1::considered}} → {{c1::indivi…
Published	09/08/2024	PPIs -> most potent •Mechanism: block {{c1::H+/K+ ATPase pump}} ({{c1::last step}} before secretion of {{c1::protons}} to form {{c1::gast…
Published	09/08/2024	PPIs•Administration: o {{c1::recommendation per ACG: take 30-60 min prior to a meal}} •Drug interaction considerations: oAcid reduction may affec…
Published	09/08/2024	PPIs – examples of possible risks•Vitamin and mineral deficiencies: {{c1::Calcium, Vitamin B12 -> need an acidic environment. Magnesium, Iron}}•Ost…
Published	09/08/2024	Long-term PPI safety & patient education•Studies have identified {{c1::association}} between PPIs and these adverse conditions, but most…
Published	09/08/2024	PPI management•2022 ACG guidelines: stratify by initial symptom presentation •Typical GERD symptoms without extraesophageal involvement: oA standard&n…
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Published	09/08/2024	PPI management•For those who do not have erosive esophagitis or Barrett’s esophagus, and whose symptoms have resolved with PPI therapy:  att…
Published	09/08/2024	Optimizing PPIs and management of refractory GERD•Optimization of PPI therapy should be the 1st step in {{c1::refractory GERD}} oVerification of&…
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Published	09/08/2024	{{c1::sucralfate and alginate}} are mucosal protective agents
Published	09/08/2024	Prokinetic therapy - metoclopramide•Mechanism: {{c1::dopamine antagonist}} - increases {{c1::LES pressure}} and enhances {{c1::peristalsis & …
Published	09/08/2024	Gastroesophageal Reflux Disease (GERD)•Symptoms/complications related to {{c1::reflux }}of {{c1::gastric contents}} into the {{c1::esophagus, ora…
Published	09/08/2024	possible pathophysiology of GERD:LES is supposed to create {{c1::high enough pressure}} that stomach contents cant back flow {{c1::Decreased to…
Published	09/08/2024	Symptom classification of GERD: •Typical symptomso{{c1::Heartburn oRegurgitation}}•Examples of extraesophageal symptoms o{{c2::Chest pain oCough …
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Published	09/08/2024	NSAID-induced ulcers •NSAIDs can cause {{c1::mucosal}} injury to the upper GI tract including development of {{c1::PUD}}, with com…
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Published	09/08/2024	Prevention strategies for ulcers from NSAID use•Minimize {{c1::risk factors}}•Use {{c1::lowest effective dose}} of NSAID •Generally, 2 …
Published	09/08/2024	Tools to reduce NSAID GI toxicityPPIs → Usually the {{c1::most popular}} choice for GI protection; Widely {{c1::available}} and very {{c1::effect…
Published	09/08/2024	Tools to reduce NSAID GI toxicityCOX-2 selective NSAIDs: background •Traditional NSAIDs inhibit {{c1::cyclooxygenase (COX)}} type 1 & 2.…
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Published	09/08/2024	pain relief powders have an incredibly high dose of {{c1::aspirin}} and {{c1::acetaminophen}} and {{c1::caffeine}}
Published	09/08/2024	Stress-Induced Ulcers•Ulceration of upper GI tract due to {{c1::hospitalization}} o{{c1::Physiologic}} stress (e.g. shock, sepsis, trauma) •…
Published	09/08/2024	posssible precipitating medications for causes of GERD are:{{c1::anticholinergics and benzodiazepines}} which {{c2::reduce LES pressure}} and {{c1::NS…
Published	09/08/2024	for prevention of NSAID related ulcer complications, it is recommended that a patient with HIGH CV risk and low or moderate GI risk use {{c1::nop…
Published	09/08/2024	for prevention of NSAID related ulcer complications, it is recommended that a patient with LOW CV risk and moderate GI risk use {{c1::a…
Published	09/08/2024	for prevention of NSAID related ulcer complications, it is recommended that a patient with LOW CV risk and low GI risk use {{c1::a…
Published	09/08/2024	for prevention of NSAID related ulcer complications, it is recommended that a patient with LOW CV risk and HIGH GI risk use {{c1::…
Published	09/08/2024	for prevention of NSAID related ulcer complications, it is recommended that a patient with HIGH CV risk and HIGH GI risk use {{c1::AVOI…
Published	09/08/2024	{{c1::naproxen}} is the safest NSAID in the setting of CV disease
Published	09/08/2024	If a patient who has been previously empirically treated with PPIs without objective workups has incomplete response to PPIs you first want to {{…
Published	09/08/2024	If a patient who has been previously empirically treated with PPIs without objective workups has incomplete response to PPIs and you have optimized th…
Published	09/08/2024	If a patient who has been previously empirically treated with PPIs without objective workups has incomplete response to PPIs and you have op…
Published	09/08/2024	If a patient who has been previously empirically treated with PPIs with previously objectively defined GERD has incomplete response to PPIs …
Published	09/08/2024	If a patient who has been previously empirically treated with PPIs with previously objectively defined GERD  has incomplete response to…
Published	09/08/2024	If a patient who has been previously empirically treated with PPIs with previously objectively defined GERD  has isymptom relief to PPI…
Published	09/08/2024	for management of a patient with TYPICAL GERD symptoms:do an {{c1::8 week once before meal daily PPI}} trial.if patient has COMPLETE  relief → GE…
Published	09/08/2024	for management of a patient with TYPICAL GERD symptoms:do an {{c1::8 week once before meal daily PPI}} trial.if patient has INcomplete relief → have p…
Published	09/08/2024	goals of treatment for GERD are:{{c1::relief}} of symptoms{{c1::prevent return}} of symptomsallow {{c1::healing}} of {{c1::esophagitis}}prevent {{c1::…
Published	09/08/2024	- aluminum hydroxide + magnesium hydroxide/orcarbonate- calcium carbonate + magnesium hydroxide - calcium carbonate are {{c1::antacids}}
Published	09/08/2024	famotidine, nizatidine, and cimetidine are {{c1::H2RAs}}
Published	09/08/2024	PPIs end in {{c1::"prazole"}}
Published	09/08/2024	H2RAs end in {{c1::tidine}}
Published	09/08/2024	sucrulfate provides {{c1::physical barrier}} to {{c3::block}} diffusion of acid across the {{c2::esophageal mucosa }}
Published	09/08/2024	sucrulfate should be cautioned in {{c2::geriatric}} patients or in {{c1::renal failure}} patients
Published	09/08/2024	there is no recommended role for sucralfate in patients except in {{c1::pregnant}} patients
Published	09/08/2024	alginate forms a {{c1::foamy gel}} in presence of gastric acid and acts like a {{c2::raft}} substance {{c3::floating}} on stomach acid to create …
Published	09/08/2024	alginate may be a component of some {{c1::OTC formulations}}
Published	09/08/2024	approximately 2/3 of pregnant women experience heartburn. Prefer to use {{c1::non-pharm options (lifestyle, diet)}} first. {{c2::Sucralfate}}, {{c2::a…
Published	09/08/2024	All PPIs are FDA category B except {{c1::OMEPRAZOLE}} which is a category C
Published	09/08/2024	PUD is the formation of {{c1::ulcers}} in the lining of the {{c2::stomach}} or {{c2::duodenum }}
Published	09/08/2024	most common causes of PUD are {{c1::H. pylori}} or {{c2::chronic use of NSAIDS }}
Published	09/08/2024	Pts with PUD often have {{c1::dyspepsia, epigastric discomfort, burning}}
Published	09/08/2024	{{c1::bleeding, perforation, gastric outlets obstructions, and gastric cancer}} are complications of PUD
Published	09/08/2024	for treatment selection of h. pylori, consider patient {{c1::allergies}}, previous {{c1::antibiotic}} exposure, and local {{c1::resistance}} patterns.…
Published	09/08/2024	clarithromycin triple therapy is useful in areas with clarithromycin resistance less than {{c1::15%}} and pts wiht no previous hx of {{c1::macrolide}}…
Published	09/08/2024	clarithromycin triple therapy includes:{{c1::PPI BID}} 14 days{{c2::Clarithromycin}} 500 mg{{c3::amoxicillin}} or {{c4::metronidazole}} 500mg TID&nbsp…
Published	09/08/2024	bismuth quadruple therapy is useful in pts with {{c1::previous macrolide}} exposure and patients with an {{c2::amoxicillin}} allergy
Published	09/08/2024	bismuth quadruple therapy includes:{{c5::PPI}} BID 10-14 days{{c3::bismuth subcitrate}} 120-300 mg or {{c4::subsalicyclate}} 300 mg QID{{c2::Tetracycl…
Published	09/08/2024	patients should not drink alcohol while on {{c1::metronidazole}} therapy because it causes facial flushing, increased HR, N/V, and headaches
Published	09/08/2024	{{c1::clarithromycin}} can cause taste disturbances (dysgeusia) such as a metallic taste
Published	09/08/2024	{{c1::tetracycline}} can cause photosensitivity so patitnes should stay out of the sun and use sunscreen
Published	09/08/2024	{{c1::bismuth}} can darken the tongue or stool
Published	09/08/2024	patients should be advised about antibiotic associated {{c1::diarrhea}}
Published	09/08/2024	{{c1::salvage therapy}} is used if first line therapy failed to eradicate H. pylori. You want to avoid previously used antibiotics. if the the fi…
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