What is Gastroesophageal reflux disease (GERD)?
chronic condition characterized by persistent heartburn
What is the process of GERD?
Results when acidic stomach contents enter esophagus
lower esophageal sphincter weakening or relaxation occurs
decreased salivary secretions
diminished esophageal motility
What are the etiologic risk and factors associated with peptic ulcer disease?
infection w/ Helicobacter pylori
close family history of PUD
use of drugs
glucocorticoids, NSAIDs, platelet inhibitors
smoking tobacco
consumption of beverages and foods w/ excessive caffeine
excessive psychologic stress
What are the goals of PUD pharmacotherapy?
relieve symptoms
promote healing of ulcer
prevent complications
prevent future recurrence
What are key factors to be able to achieve the goals of PUD pharmacotherapy?
eradicate H. pylori
discontinue NSAID/other ulcer-promoting meds when possible
Whare are the major drug classes in GERD & PUD pharmacotherapy?
Proton pump inhibitors (PPIs)
H2-receptor antagonists
antacids
miscellaneous drugs
What are risk factors for H. pylori?
domestic crowding
unclean water
exposure to gastric content of an infected individual
What is the goal in the pharmacotherapy of H. pylori infection?
kill bacteria while minimizing emergence of resistance
PPI or histamine 2 receptor antagonist use
*eradication rates = good w/ 10 day course AB, 14 day course AB= slightly better
What is the mechanism of action of PPIs?
reduces acid secretion in stomach by binding to H+,K+, ATPase
inhibits final pathway involved in acid secretion and active proton pumps
What are examples of PPIs?
omeprazole
esomeprazole (Nexium)
lansoprazole (Prevacid)
pantoprazole (Protonix)
^can be given IV
What is the therapeutic classification and use of omeprazole (Prilosec)?
antiulcer drug
OTC = relief of heartburn
prx = short-term (4-8 weeks) for active duodenal & gastric ulcers, GERD, or maintenance of erosive esophagitis
should be taken 20-30 mins BEFORE 1st major meal of day (due to it being activated by food)
What are the adverse effects of PPIs?
*usually minor
headache
nausea
diarrhea
rash
abdominal pain
*DR Omeprazole = higher risk of C. diff in hospitalized pt’s
What are the drug interactions of PPI’s?
Warfarin
may increase likelihood of bleeding
What is the mechanism of action of H2-receptor antagonists?
Blocks h2 receptors of parietal cells in stomach
this decreases acid production
What are examples of H2-receptor antagonists?
famotidine (PepcidAC)
cimetidine (Tagamet)
What is the therapeutic classification and use of famotidine (PepcidAC)?
antiulcer drug
USE:
duodenal and gastric ulcers
acute stress-induced bleeding ulcers
hypersecretory conditions in hospitalized pt’s
Heartburn
GERD
What are the drug interactions of H2-receptor antagonists?
Antacids should NOT be given w/in 1 hour of H2-receptor antagonists
smoking decreases effectiveness
What is the mechanism of action of antacids?
reacts w/ gastric acid = neutral salts/salts of low acidity
reduces destruction of gut wall by neutralizing acid
Caution in use w/ renal impairment
What are some examples of antiacids?
aluminum hydroxide (AlternaGel)
calcium carbonate (Titralac, Tums)
calcium carbonate w/ magnesium hydroxide (Rolaids)
Sodium bicarbonate (Alka-Seltzer)
magnesium trisilicate & Aluminum hydroxide (Gaviscon)
magnesium hydroxide & Aluminum hydroxide w/ simethicone (Mylanta)
What are the different types of antacids and their disadvantages ?
Sodium - fluid retention
Magnesium - fatigue, hypotension, dysrhythmias, interact w/ laxatives
Calcium - constipation, aggravated kidney stones, milk-alkali syndrome
Aluminum - constipation, hypophosphatemia
Bicarbonate - metabolic acidosis, bloating, belching
What are 2 miscellaneous drugs use for PUD & GERD?
bismuth compounds (Kaopectate, Pepto)
sucralfate (Carafate)
What is the mechanism of action of bismuth compounds?
stimulates mucosal bicarb and prostaglandin production
inhibits H. pylori from attaching to tissue
NOT used for kids if salicylate is contained
CAN cause black stools!
What is the mechanism of action of sucralfate ?
stimulates mucus, bicarb, and prostaglandin secretion
creates effective protective barrier (up to 6 hours)
requires 4 daily dosing @ each meal & bed time
CAN cause constipation
MAY interfere w/ sucralfate