PC707 Module 3 GI Exam 2024

PC707 Module 3 GI Exam 2024 What are the 3 classes of drugs that are used to treat GERD? - Answer ️️ -Antacids H2RA (histamine receptor antagonists) PPIs (proton pump inhibitors) What is the first step in determining how to care for someone with GERD? - Answer ️️ - Determine if it is dyspepsia/mild gerd or moderate to severe gerd/erosive disease If someone has dyspepsia or mild GERD symptoms and no erosive disease, what medications would you start with? - Answer ️️ -OTC antacids or H2RAs for symptom control get a careful medication hx to see if they have tried either of these in order to determine which med to start with How would you manage someone who has moderate to severe GERD or erosive disease ? - Answer ️️ -Lifestyle Modifications and PPIs x 8 weeks If, after 8 weeks of PPIs, someones GERD symptoms have improved, what can you do? - Answer ️️ -wean them off PPIs (slowly reduce the dose) and restart if symptoms return If someone has erosive esophogitis or barrett's esophogitis, it is recommended to - Answer ️️ - keep them on their PPI (not d/c after 8 weeks) If, after 8 weeks of PPIs, someones GERD symptoms have not improved, what can you do? - Answer ️️ -refer to a GI specialist How often should you reassess PPIs and consider whether or not to refer to a GI specialist? - Answer ️️ -every 6-12 months How do antacids work? - Answer ️️ -They neutralize HCL and raise the gastric pH to above 4.0 it works immediately What medication works the fastest/slowest for managing symotoms of GERD? - Answer ️️ - antacids fastest, then H2RAs, then PPIs What side effects can antacids cause? - Answer ️️ -either diarrhea or constipation, depending on the specific antacid If someone is taking enteric drugs and antacids, what should you do? - Answer ️️ -separate by 2hrs b/c antacid changes the pH of the stomach, the enteric coated medication may release in the stomach instead of the intestines. you should separate other meds from antacids by _______ hrs - Answer ️️ -2, due to chelation and enteric coatings Calcium Carbonate (Tums, Rolaids) can cause - Answer ️️ -constipation Sodium bicarbonate antacids (Alka Seltzer) can cause - Answer ️️ -fluid retention Sodium bicarbonate antacids (Alka Seltzer) contain - Answer ️️ -aspirin Sodium bicarbonate antacids (Alka Seltzer) are not recommended for people with - Answer ️️ - HTN, fluid retention, CHF, pregnancy What antacid is contraindicated in pregnancy? - Answer ️️ -sodium bicarbonate antacids, due to the ASA Magnesium (Milk of Magnesia) can cause - Answer ️️ -diarrhea Do not prescribe magnesium for someone with - Answer ️️ -renal insufficiency Aluminum hydroxide can decrease ___________ absorbtion - Answer ️️ -warfarin While ________________________ is not the first choice of antacids in pregnancy, it is not ____________________ - Answer ️️ -not first choice in pregnancy but not contraindicated. In pregnancy, antacids should never be taken with ___________ or ____________ - Answer ️️ -iron or prenatal vitamins ________________ stimulates the secretion of gastric acid in the stomach - Answer ️️ - histamine How do H2 receptor antagonists work? - Answer ️️ -bind to the histamine receptors on parietal cells, which causes them to stop secreting gastric acid They neutralize acid that has already been secreted and stop future production of acid Examples of H2 receptor antagonists - Answer ️️ -Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) What is unique about Cimetidine (Tagamet), compared to the other H2RAs? - Answer ️️ - Cimetidine is an inhibitor of the P450 enzymes CYP1A2, CYP2C9, CYP2C19, CYP2 D6, CYP2E1, CYP3A4. What precautions do you need to take when taking cimetidine? - Answer ️️ -MANY DRUG TO DRUG INTERACTIONS Cimetidine (Tagamet) may reduce the hepatic metabolism of warfarin-type anticoagulants, phenytoin, propranolol, nifedipine, chlordiazepoxide, diazepam, certain tricyclic antidepressants, lidocaine, theophylline, and metronidazole, thereby delaying elimination and increasing blood levels of these drugs. What is unique about Famotadine (Pepcid), compared to the other H2RAs? - Answer ️️ -least effect on the CYP450 enzyme pathways, fewest drug to drug interactions What anacid has the most drug to drug interactions? - Answer ️️ -Cimetidine (Tagamet) What antacid has the least number of drug to drug interactions? - Answer ️️ -Famotadine (Pepcid) How do proton pump inhibitors work? - Answer ️️ -they stop the production and secretion of gastric acid PPIs are the ________ and ___________ anti-secretory agents, but they take the ________________ to work - Answer ️️ -strongest, most effective, longest to work PPIs can impact absorption of ______________ - Answer ️️ -iron, protein, vitamin B12, calcium PPIs may have an increased risk of ____________ and possibly _______________ - Answer ️️ -increased risk of fractures possibly an increase risk of gastric malignancy If you deprescribe PPIs too quickly - Answer ️️ -you can get an immediate acid rebound, even if the underlying condition is under control but, it is important to deprescribe whenever possible- you just need to taper How should tapering PPIs take place? - Answer ️️ -look at triggers make sure the original indication is resolved have them avoid things that may increase the symptoms of GERD like orange juice, cows milk, alcohol, caffeine, animal fat slowly taper over 2-4 weeks (higher dose= long