Question | Answer |
Alarm symptoms for GERD | GI bleeding, black stools, vomiting blood |
What is Zollinger-Ellison? How do you treat? | hypersecretion of acid by a tumor. Give PPI BID |
Definition of peptic ulcer disease and causes | mucosal erosions. May be due to H. pylori, aspirin, NSAIDs, corticosteroids |
Antacids that are renally cleared (AVOID in renal dysfunction) | Aluminum (AlOH3) and Magnesium (MgOH2) |
Antacid to Avoid in Pregnancy | Sodium containing! (can cause fluid overload/metabolic alkalosis) NaHCO3 (Sodium Bicarbonate). Also avoid in HTN and CHF |
Major side effects of Aluminum containing antacids | Constipation, Aluminum intoxication(renal) |
Major side effect of Calcium containing antacids | Constipation (Calcium=Constipation)** |
Major side effect of Magnesium containing antacids | Diarrhea! (Remember, Mag Citrate treats constipation...) |
3 Major drug interactions with antacids | Antibiotics: Tetracyclines(chelate), Quinolones
Levothyroxine
Things that need acidic environment: Iron, Ketoconazole, itraconazole |
Gaviscon | Alginic Acid |
Alginic Acid MOA | Floats on top of the stomach to protect the esophageal mucosa... therefore requires an upright position (no impact on nocturnal GERD) |
H2RAs = All are Pregnancy Category ___ | B |
Tagament | Cimetidine |
Zantac | Ranitidine |
Pepcid | Famotidine |
Axid | Nizatidine |
Cimetidine (Tagament) - unique side effects; Drug interactions, max dose | SE: gynecomastia, galactorrhea; CYP1A2 Inhibitor (increases warfarin/theophylline), MDD=800 mg |
Ranitidine(Zantac) - DOC for..., max dose | DOC in pregnancy, MDD=300 mg |
Famotidine (Pepcid) - Max dose | MDD=40mg |
Nizatidine (Axid) - unique point, Max dose | Unique: only one not available IV/IM, MDD= 300 mg |
H2RA dose comparison | Cimetidine 400=famotidine 20 = Nizatidine 150=Ranitidine 150 |
H2RA Class effects | CNS (dizzy, sedation, confusion, can worsen dementia), all pregnancy category B, Dose adjust for renal dysfunction!!!! <50 ml/min for most (<30 ml/min for cimetidine) |
PPI MOA | Irreversibly block H+/K+ ATPase in the gastric parietal cells |
PPI Administration time and reason | 30 minutes before breakfast - because your body starts making proton pumps in the morning, drug is then onboard to work when they become active with eating |
Prilosec | omeprazole |
Zegerid | omeprazole/sodium bicarb |
Nexium | esomeprazole |
Vimovo | Esomeprazole/naproxen |
Prevacid | Lansoprazole |
Dexilant | Dexlansoprazole |
Protonix | Pantoprazole |