GERD/PUD - GERD

18 important questions on GERD/PUD - GERD

Protective ring of muscle fibers that prevents backflow of acidic gastric contents into the esophagus

Lower esophageal sphincter (LES)

Non-drug GERD treatment

Elevate head of bed, avoid foods that decrease LES, avoid foods/meals with high fat content 2-3 hrs before bedtime, weight loss

1st line for frequent (<2 times/week) or severe GERD symptoms

8 week course of PPI
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What next, if symptoms return after 8 weeks of PPI?

Start maintenance therapy:
1st line: PPI at lowest effective dose
Alt: H2RA 

Not recommended for maintenance therapy

Metoclopramide and sucralfate

Max length of time to self treat heart burn

2 weeks

How do antacids work?

Neutralize gastric acid to increase gastric pH

Calcium carbonate + simethicone

Maalox advanved max strength

Warnings with aluminum and magnesium

Risk of bleeding with aspirin products

Why can antacids with aluminum or magnesium NOT be used in renal dysfunction?

Risk of drug accumulation and toxicity (seizures)

How do H2RAs work?

Reversibly inhibit H2 receptors on gastric parietal cells, which decreases gastric acid secretion

How do PPIs work?

Irreversibly bind to gastric H/K ATPase pump in parietal cells to shut down the pump and block gastric acid secretion

How often should omeprazole be taken to be effective?

Daily (NOT prn)

Which PPIs capsules can be opened (not crushed), mixed in applesauce and swallowed immediately (w/o chewing)

Esomeprazole, omeprazole, lansoprazole, dexlansoprazole, rabeprazole

What can PPIs do to clopidogrel?

Diminish therapeutic effect. Do not use with esomeprazole or omeprazole

How does metoclopramide work?

DA antagonist, but at higher doses, it blocks serotonin receptors to help n/v. It enhances response to acetylcholine to increase motility, accelerate gastric emptying and increase LES tone

Because of EPS and parkinsonian-like symptoms, who should NOT use metoclopramide?

Parkinson patients

Avoid completely when taking H2RAs or PPIs

Risedronate (Atelvia) delayed release form

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