GERD & PUD

Question 1

What is first-line treatment for frequent (≥2x/week) or severe GERD symptoms?

Answer 1

PPI tx for 8 weeks; interrupt therapy and only continue if symptoms do not return

Question 2

What are the first-line treatments for infrequent heartburn (<2 x/week)?

Answer 2

OTC antacids/ H2RAs

Question 3

What are Warnings/SEs with antacids?

Answer 3

Warnings: Al and Mg containing products can accumulate with poor renal function
SE: Constipation (Al and Ca), Diarrhea (Mg)

Question 4

What antacids are preferred in pregnancy?

Answer 4

Ca carbonate (Tums)

Question 5

How often are antacids dosed?

Answer 5

usually 4-6 times per day

Question 6

Calcium carbonate

Answer 6

Tums

Question 7

Calcium Carbonate + Mg

Answer 7

Mylanta supreme

Question 8

Ca Carbonate + Simethicone

Answer 8

Maalox Advanced Maximum Strength

Question 9

Mg Hydroxide

Answer 9

Milk of magnesia

Question 10

Mg hydroxide + Al + simethicone

Answer 10

Mylanta Maximum strength

Question 11

Na bicarbonate/ aspirin/ citric acid

Answer 11

Alka Seltzer

Question 12

What are warnings/SEs with H2RAs?

Answer 12

Warnings:
1. Confusion (elderly, ill, renal impairment)
2. B12 deficiency if used ≥2 years
3. Famotidine: QT prolongation with renal dysfunction (reduce dose if CrCl<60)
SE:
1. Agitation/vomiting in children < 1y
2. Gynocomastia/Impotence (Cimetidine)

Question 13

Famotidine

Answer 13

Pepcid AC
Zantac 360

Question 14

What PPIs have specific administration instrucions?

Answer 14

1. Esomeprazole at least 60 min before breakfast
2. Omeprazole + Na bicarb (Zegerid)
3. Pantoprazole oral suspension: 30 min before meal
4. Rebeprazole (Aciphex) sprinkles: 30 min before meal

Question 15

What are warnings with PPIs?

Answer 15

1. C.diff associated diarrhea
2. Hypomagnesemia
3. B12 deficiency use ≥2y
4. Osteoporosis related bone fractures
5. acute interstitial nephritis
6. cutaneous and systemic lupus erythematosus
7. IV protonix: thrombophlebitis, SJS/TEN
   *** DI: Esomeprazole and Omeprazole should not be used with Clopidogrel (2C19 inhibition)

Question 16

Which PPIs are avalible IV?

Answer 16

1. Esomeprazole
2. Pantoprazole

Question 17

What PPi capsules can be opened and mixed with applesauce?

Answer 17

All except for pantoprazole (tablet or packet for suspension)

Question 18

What PPIs are avalible OTC?

Answer 18

Esomeprazole (Nexium)
Omeprazole (Prilosec)
Lansoprazole (Prevacid)

Question 19

Dexlansoprazole

Answer 19

Dexilant

Question 20

When should metoclopramide (Reglan) dose be decreased?

Answer 20

CrCl<60: reduce dose by 50%

Question 21

What are warnings with metoclopramide (Reglan)?

Answer 21

Tardive dyskinesia/ EPS, neuroleptic malignant syndrome
AVOID with Parkinsons

Question 22

What medications should not be used with H2RAS/PPIs?

Answer 22

1. Risendronate (Atelvia)
2. Rilpivirine
3. Epclusa (velpatasvir/sofosbuvir)
4. Tyrosine Kinase inhibitors: erlotinib
5. Azoles/cephalosporines

Question 23

What is first line therapy for H.Pylori?

Answer 23

Quadruple therapy:
Bismuth subsalicylate 300mg QID + Metronidazole 250-500mg QID + Tetracycline 500mg QID + PPI BID for 10-14 days
Pylera (bismuth subsalicylate 420mg + metronidazole 375mg + tetracyline 375) QID + PPI BID

Question 24

What are alternative therapies for H.pylori?

Answer 24

1. Amoxicillin 1g BID + Clarythromycin 500mg BID+ Metronidazole 500mg BID + PPI BID
2. Amoxicillin 1g BID + Clarythromycin 500mg BID + PPI BID or esomeprazole 40mg QD
3. Metronidazole 500mg TID + Clarithromycin 500mg BID+ PPI BID or esomeprazole 40mg QD
4. Prevpac (amoxicillin + clarithromycin + lansoprazole
   *** 10-14 days
   Do not use Tetracycline <8y

Question 25

What are RFs for NSAID induced ulcers?

Answer 25

1. Age>60 2. Hx of PUD 3. NSAIDs (high dose or >1 agent) 4. Anticoagulants, steroids, SSRI/SNRI

Question 26

What are BBWs/SE with misoprostol (Cytotec)?

Answer 26

BBW: abortafactant SE: Diarrhea abdominal pain

Question 27

What are issues with sucralfate?

Answer 27

Lots of interactions, not really used, must separate from PPIS and everything