Gastrointestinal Pharmacology and GERD
30 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is one goal of therapy for esophageal reflux?

  • Alleviate or eliminate symptoms (correct)
  • Promote overeating
  • Increase gastric acid production
  • Decrease LES pressure

    • Proton pump inhibitors (PPIs) are the preferred initial choice for treating moderate to severe GERD.

    True

    Name one prokinetic agent used in the treatment of GERD.

    Metoclopramide

    Lifestyle modifications include avoiding ______________ for at least 3 hours post-prandial.

    <p>recumbency</p> Signup and view all the answers

    Match the following phases of treatment with their descriptions:

    <p>Phase I = Lifestyle changes and OTC medications Phase II = Standard/high-dose antisecretory therapy Phase III = Surgical intervention for severe cases</p> Signup and view all the answers

    Which of the following is NOT a lifestyle modification for managing esophageal reflux?

    <p>Increasing fat intake</p> Signup and view all the answers

    Esophageal mucosal resistance is not influenced by lifestyle changes.

    <p>False</p> Signup and view all the answers

    What should be elevated by 6-8 inches to help manage GERD symptoms?

    <p>The head of the bed</p> Signup and view all the answers

    Phase II treatment for GERD involves standard doses of proton pump inhibitors for ______________ weeks.

    <p>4-8</p> Signup and view all the answers

    What is a common symptom of gastroesophageal reflux disease (GERD)?

    <p>GI bleeding</p> Signup and view all the answers

    What is the classic symptom of gastroesophageal reflux disease (GERD)?

    <p>Frequent and persistent heartburn</p> Signup and view all the answers

    The lower esophageal sphincter (LES) relaxes to prevent reflux of stomach contents into the esophagus.

    <p>False</p> Signup and view all the answers

    Name one factor that can decrease lower esophageal sphincter (LES) pressure.

    <p>Chocolate</p> Signup and view all the answers

    Gastroesophageal reflux is defined as the abnormal reflux of _____ contents into the esophagus.

    <p>gastric</p> Signup and view all the answers

    Match the contributing factors of GERD with their effects:

    <p>Chocolate = Decreases LES pressure Tomato-based products = Directly irritates gastric mucosa Smoking = Stimulates acid secretions Spicy foods = Directly irritates gastric mucosa</p> Signup and view all the answers

    Which of the following is NOT considered a factor contributing to GERD?

    <p>High-fiber foods</p> Signup and view all the answers

    The relaxation of the lower esophageal sphincter (LES) is one of the three lines of defense impairment for GERD.

    <p>True</p> Signup and view all the answers

    What is one way in which clearance of refluxed materials from the esophagus is achieved?

    <p>Primary peristalsis from swallowing</p> Signup and view all the answers

    The extent of esophageal damage depends on the composition of refluxed material, which can be either _____ or alkaline.

    <p>acidic</p> Signup and view all the answers

    Which of the following drugs can contribute to GERD symptoms?

    <p>NSAIDs</p> Signup and view all the answers

    Which of the following is an example of a Proton Pump Inhibitor (PPI)?

    <p>Omeprazole</p> Signup and view all the answers

    Antacids promote esophageal healing.

    <p>False</p> Signup and view all the answers

    What is the dose range for Esomeprazole when prescribed?

    <p>20 to 40 mg daily</p> Signup and view all the answers

    Prokinetic agents improve the tone of the lower esophageal __________.

    <p>sphincter</p> Signup and view all the answers

    Match the following drug classes with their main function:

    <p>Antacids = Neutralize gastric acid PPIs = Reduce acid production Prokinetics = Enhance gastrointestinal motility</p> Signup and view all the answers

    Which of the following products contains alginic acid?

    <p>Gaviscon</p> Signup and view all the answers

    The standard dose of Lanosprazole is 40 mg daily.

    <p>False</p> Signup and view all the answers

    What is Metoclopramide used for?

    <p>Motility dysfunction</p> Signup and view all the answers

    The usual dose of Omeprazole is between __________ mg daily.

    <p>20 to 40</p> Signup and view all the answers

    Which of the following conditions would warrant a higher dose of PPIs?

    <p>Breakthrough symptoms</p> Signup and view all the answers

    Study Notes

    Gastrointestinal (GI) Pharmacology

    • GI Pharmacology encompasses drug actions affecting GI system function.
    • These drugs normalize impaired function in the GI tract.
    • The GI tract is the pathway of the digestive system, running from the mouth to the anus. This includes the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, and anal canal.

    Gastroesophageal Reflux Disease (GERD)

    • Reflux is the flow back or return of substance.
    • GERD is abnormal reflux of gastric contents into the esophagus that causes symptoms, or mucosal damage.
    • Gastroesophageal reflux is when stomach contents back up into the esophagus.
    • A classic symptom of GERD is frequent and persistent heartburn.

    Normal Physiology of the Esophagus

    • The esophagus transports food from the mouth to the stomach through peristaltic contractions.
    • The lower esophageal sphincter (LES) relaxes to allow food to enter the stomach and then contracts to prevent reflux.

    Pathogenesis of GERD

    • GERD develops when three lines of defense are impaired.
    • Impairment of the LES barrier.
    • Relaxation of the lower esophageal sphincter (LES).
    • Low resting LES pressure.
    • Increased gastric pressure.
    • Decreased clearance of refluxed materials from the esophagus.
    • Decreased esophageal mucosal resistance.

    Contributing Factors to GERD

    • Decreased LES pressure is caused by chocolate, alcohol, fatty meals, coffee, cola, tea, garlic, onions, and smoking.
    • Foods that directly irritate gastric mucosa include tomato-based products, coffee, spicy foods, citrus juices, NSAIDs, aspirin, iron, potassium chloride, and alendronate.
    • Foods that stimulate acid secretions include soda and beer, and smoking.

    Lines of Defense Against GERD

    • Clearance of refluxed material from the esophagus.
    • Primary peristalsis from swallowing, increasing salivary flow.
    • Secondary peristalsis from esophageal distension.
    • Gravitational effects.
    • Esophageal mucosal resistance.
    • Mucus production in the esophagus
    • Bicarbonate movement from blood to mucosa.

    Factors Determining Extent of Esophageal Damage

    • Extent of esophageal damage depends on multiple factors including the composition of refluxed material, volume of refluxed material, length of contact time, natural sensitivity of esophageal mucosa, and rate of gastric emptying.
    • Acid or alkaline refluxed material is less desirable.

    Typical Symptoms of GERD

    • Common symptoms occur when pH is less than 4.
    • Heartburn.
    • Belching.
    • Regurgitation.
    • Hypersalivation.
    • Symptoms may be aggravated by meals and reclining position.

    Atypical Symptoms of GERD

    • Chronic cough.
    • Hoarseness.
    • Chest pain (mimics angina).
    • Sometimes the only symptoms are seen during omeprazole testing.

    Complications of GERD

    • Esophagitis.
    • Esophageal strictures and ulcers.
    • Hemorrhage.
    • Perforation.
    • Aspiration.
    • Precipitation of an asthma attack.

    Warning Signs Indicating GERD For Endoscopy

    • Dysphagia (difficulty swallowing).
    • Odynophagia (painful swallowing).
    • Bleeding.
    • Unexplained weight loss.
    • Choking.
    • Chest pain

    Diagnosis of GERD

    • Clinical symptoms and history.
    • Presenting symptoms and associated risk factors.
    • Empiric therapy for symptom improvement.
    • Endoscopy if warning signs are present.

    When to Refer Patients for Further GERD Care

    • Patients experiencing chest pain.
    • Patients with heartburn while taking PPIs.
    • Patients with heartburn that continues after 2 weeks of treatment.
    • Patients with nocturnal heartburn.
    • Patients with frequent heartburn for more than 3 months.
    • Patients experiencing GI bleeding or other warning signs.
    • Patients who concurrently use NSAIDs.
    • Pregnant or nursing patients.
    • Children under 12 years of age.

    Therapy Goals for GERD

    • Alleviate or eliminate symptoms.
    • Diminish frequency and duration of esophageal reflux.
    • Promote healing if mucosa is injured.
    • Prevent complications.

    Therapy Targets for GERD

    • Increasing LES pressure.
    • Enhancing esophageal acid clearance.
    • Improving gastric emptying.
    • Protecting esophageal mucosa.
    • Decreasing acidity of reflux.
    • Decreasing gastric volume available to be refluxed.

    Treatment Phases for GERD

    • Phase I: Lifestyle changes (two weeks). Lifestyle modifications combined with over-the-counter medications.
    • Phase II: Pharmacologic intervention (standard or high dose antisecretory therapy).
    • Phase III: Surgical intervention (for patients who do not respond to phases I and II or who have severe complications). LES positioned within the abdomen under positive pressure.

    Treatment Selection for GERD

    • Mild intermittent heartburn: Lifestyle changes plus antacids.
    • Symptomatic relief of mild to moderate GERD: Lifestyle changes plus standard doses of proton pump inhibitors (PPIs) for 4-8 weeks.
    • Healing of erosive esophagitis or severe GERD: Lifestyle modifications plus PPIs for eight to sixteen weeks. PPIs generally preferred as an initial choice because of quicker symptom relief and faster healing. A prokinetic agent may be added to selected patients.

    Examples of Prokinetic Agents

    • Metoclopramide.
    • Domperidone.

    Lifestyle Modifications for GERD

    • Elevate the head of the bed.
    • Decrease fat intake.
    • Stop smoking.
    • Avoid recumbency for at least 3 hours post-prandial.
    • Weight loss.
    • Limit alcohol intake.
    • Wear loose-fitting clothing.
    • Avoid aggravating foods.

    Drug Therapy - Antacids

    • Antacids increase LES pressure and do not promote esophageal healing.
    • Antacids neutralize gastric acid, causing alkalinization.
    • Alginic acid (in Gaviscon) forms a highly viscous solution that floats on top of gastric contents.
    • Products include magnesium salts, aluminum salts, calcium carbonate, and sodium bicarbonate.

    Drug Therapy - PPIs

    • Used to treat moderate to severe GERD.
    • All agents are effective, so choose based on cost.
    • Omeprazole released over the counter in 2003.
    • Use for heartburn that occurs two or more times a week.
    • Standard dosing: esomeprazole 20-40 mg daily; lansoprazole 15-30 mg daily; omeprazole 20-40 mg daily; pantoprazole 40 mg daily; rabeprazole 20 mg daily. The PPI should be taken 30-60 minutes prior to eating. Higher doses may be given twice a day for patients with incomplete response, breakthrough symptoms, or severe esophageal dysmotility. Patients should take the second dose 30-60 minutes prior to their evening meal.

    Drug Therapy - Prokinetics

    • Agents that enhance smooth muscle motility from the esophagus to the proximal small bowel.
    • Results in accelerated gastric emptying and intestinal content transit from the duodenum. Resulting in improved gastric emptying, enhanced tone of the LES, and stimulated esophageal peristalsis.

    Prokinetic Agents - Products

    • Metoclopramide: only take if motility dysfunction is documented. Administered 30 minutes prior to meals and doses range from 10-15 mg.

    Special Populations (Pregnancy)

    • GERD is common during pregnancy, due to decreased LES pressure and increased abdominal pressure.
    • Antacids generally considered safe, but chronic high doses should be avoided.

    Counseling Questions

    • To recommend therapy, ask about: duration and frequency of symptoms; quality and timing of symptoms; use of alcohol and tobacco; dietary choices; medications already tried; other disease states present and medications being used.

    Case Study

    • AA, a 45-year-old male postal worker, complains of heartburn after meals 3-4 times a month. He has tried Tums, but wants a more effective treatment.

    Case Study Questions

    • What questions should be asked of the patient?
    • What would cause a referral to a physician?
    • What type of GERD does the patient have (mild, moderate, or severe)?
    • What treatment should be recommended?

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Gastro-Intestinal Pharmacology GERD PDF

    Description

    This quiz covers the key concepts of gastrointestinal pharmacology, focusing on drug actions affecting the GI system, as well as gastroesophageal reflux disease (GERD). You'll explore the normal physiology of the esophagus and the pathogenesis of reflux. Test your understanding of these important topics in GI health.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser