NSG 533 Advanced Pharm test 1 with correct questions and answers
,GERD physiology - correct ans:Lower esophageal sphincter dysfunction
(LES)- transient relaxtions, low tone
Hiatal hernia=promotes reflux
Delayed gastric emptying/increased intra ab pressure: obesity, pregnancy
Injury is from acid+pepsin exposure to esophageal mucosa-severity relates
to exposure time +clearance
What worsens GERD - correct ans:ETOH, smoking, obesity, late meals,
large/fatty meals
caffeine, chocolate/peppermint may reduce LES tone- Peppermint may
worsen reflux by relaxing LES
MEDS that worsen: anticholinergics, CCB, nitrates, theophylline,
progesterone
symptoms of GERD - correct ans:typical: heartburn, regurgitation
atypical: chronic cough, hoarseness, asthma like symptoms
ALARM: dysphagia, odynophagia, wt loss, GI bleed anemia
alarm= endoscopy, not OTC trial
when to test vs tx GERD - correct ans:uncomplicated GERD-> empiric PPI
trial 8 wk
Alarm or refractory GERD--> EGD
,Persistent symptoms despite PPI--> pH monitioring, manometry
PPI risks - correct ans:Increased risk of fractures (postmenopausal women)
pneumonia, C diff, hypomagnesemia, B12 and iron malabsorption, atrophic
gastritis, kidney disease
Non-pharm interventions for all GI conditions - correct ans:Diet+trigger:
greasy/spicy foods, ETOH, caffeine; lactose/FODMAPS is IBS type symptoms
hydration
tobacco cessation
wt mgmt
meds reveiw: remove/replace offending meds when possible- NSAIDs, iron,
opiods, anticholinergics.
When to refer/escalate: alarm symptoms (GI bleed, wt loss, progressive
dysphagia, severe dehydration, persistent vomiting, severe ab pain
GERD pharmacology - correct ans:Antacids-PRN fastest relief
neutralize acid: short duration
counseling: separate from other meds (chelation/absorption issues)
TUMS (calcium carbonate): highest acid neutralizing, rapid
Risks: hypercalcemia, constipation (Al), kidney stones (Ca), diarrhea (Mg)
, H2 receptor antagonist (H2RAs)
good for mild/intermittent symptoms, nocturnal symptoms
less potent that PPIs for healing/maintenance of erosive disease
PEPCID (famotidine): most potent, +Nocturnal, fewer interactions than
cimetidine (CYP), longer duration of action, min CNS effects
PPIs
MOST effective acid suppression + best for esophagitis healing and
maintenance
Take before meals (30-60 min before breakfast)
PANTOPRAZOLE (safest): preferred when on clopidogrel, fewer interactions
OMEPRAZOLE/ESOMEPRAZOLE: most potent, part of H.pylori regimen--
decreases clopidogrel activation
-long term PPI-Bad bones & bugs (fractures, cdiff, low mg/b12)
Mild intermittent symptoms? → Antacid or H2RA
Erosive GERD or ulcers? → PPI
On clopidogrel? → Pantoprazole
Needs rapid relief? → Antacid
Needs healing? → PPI
Why is self directed GERD therapy (OTC) limited to 2 weeks - correct
ans:avoid masking ALarm symptoms: cancer, erosive disease, bleeding,
strictures
prevent inappropriate, prolonged used without diagnosis/monitoring
PUD causes - correct ans:MOST COMMON
,GERD physiology - correct ans:Lower esophageal sphincter dysfunction
(LES)- transient relaxtions, low tone
Hiatal hernia=promotes reflux
Delayed gastric emptying/increased intra ab pressure: obesity, pregnancy
Injury is from acid+pepsin exposure to esophageal mucosa-severity relates
to exposure time +clearance
What worsens GERD - correct ans:ETOH, smoking, obesity, late meals,
large/fatty meals
caffeine, chocolate/peppermint may reduce LES tone- Peppermint may
worsen reflux by relaxing LES
MEDS that worsen: anticholinergics, CCB, nitrates, theophylline,
progesterone
symptoms of GERD - correct ans:typical: heartburn, regurgitation
atypical: chronic cough, hoarseness, asthma like symptoms
ALARM: dysphagia, odynophagia, wt loss, GI bleed anemia
alarm= endoscopy, not OTC trial
when to test vs tx GERD - correct ans:uncomplicated GERD-> empiric PPI
trial 8 wk
Alarm or refractory GERD--> EGD
,Persistent symptoms despite PPI--> pH monitioring, manometry
PPI risks - correct ans:Increased risk of fractures (postmenopausal women)
pneumonia, C diff, hypomagnesemia, B12 and iron malabsorption, atrophic
gastritis, kidney disease
Non-pharm interventions for all GI conditions - correct ans:Diet+trigger:
greasy/spicy foods, ETOH, caffeine; lactose/FODMAPS is IBS type symptoms
hydration
tobacco cessation
wt mgmt
meds reveiw: remove/replace offending meds when possible- NSAIDs, iron,
opiods, anticholinergics.
When to refer/escalate: alarm symptoms (GI bleed, wt loss, progressive
dysphagia, severe dehydration, persistent vomiting, severe ab pain
GERD pharmacology - correct ans:Antacids-PRN fastest relief
neutralize acid: short duration
counseling: separate from other meds (chelation/absorption issues)
TUMS (calcium carbonate): highest acid neutralizing, rapid
Risks: hypercalcemia, constipation (Al), kidney stones (Ca), diarrhea (Mg)
, H2 receptor antagonist (H2RAs)
good for mild/intermittent symptoms, nocturnal symptoms
less potent that PPIs for healing/maintenance of erosive disease
PEPCID (famotidine): most potent, +Nocturnal, fewer interactions than
cimetidine (CYP), longer duration of action, min CNS effects
PPIs
MOST effective acid suppression + best for esophagitis healing and
maintenance
Take before meals (30-60 min before breakfast)
PANTOPRAZOLE (safest): preferred when on clopidogrel, fewer interactions
OMEPRAZOLE/ESOMEPRAZOLE: most potent, part of H.pylori regimen--
decreases clopidogrel activation
-long term PPI-Bad bones & bugs (fractures, cdiff, low mg/b12)
Mild intermittent symptoms? → Antacid or H2RA
Erosive GERD or ulcers? → PPI
On clopidogrel? → Pantoprazole
Needs rapid relief? → Antacid
Needs healing? → PPI
Why is self directed GERD therapy (OTC) limited to 2 weeks - correct
ans:avoid masking ALarm symptoms: cancer, erosive disease, bleeding,
strictures
prevent inappropriate, prolonged used without diagnosis/monitoring
PUD causes - correct ans:MOST COMMON
