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frequency fo low-dose non RX H2 blockers
prn and prophylaxis
Standard dose H2 blocker frequency
BID for 6-12 weeks for mild symptoms
higher dose or QID for used for erosive disease (not cost effective compared to PPIs)
H2 blocker MOA
dec gastric acid secretion and gastric volume by inhibiting binding of histamine on H2 receptor of parietal cell
High-dose H2 blocker treatment duration
QID or BID for 8-12 wks
indication and duration for OTC PPIs
heartburn that happens 2 or more times a week.
take daily (not effective for prn use)
PPIs MOA
irreversible binding to HK ATPase pumps of the parietal cells - inhibits the final step of gastric acid secretion
when can complete relief of symptoms be expected in PPIs
in about 4 days
PPI freq for mild hearburn
daily for 14 days
PPI freq for symptomatic GERD
daily for 4-8 wks
PPI freq for healing erosive esophagitis
daily or BID for 4-16 wks
PPI treatment for atypical symptoms
BID for 4 weeks initially
MOA of Bethanechol
promotility agent
cholinergic stimulant
increases LES
increases esophageal clearance
metoclopramide MOA
dopamin antagonist
increases LES
accelerates gastric emptying
cisapride MOA
promotility
facilitates Ach release resulting inc in LES pressure and accelerated gastric emptying
sucralfate and GERD
limited value; similar in efficacy to H2 blockers in mild esophagitis
who gets maintenance therapy in GERD?
pts with complications like strictures, hemorrhage, Barrett's esophagus, and recurrence of residual symptoms after healing
DOC: PPIs
When do you refer the pt to the MD with GERD
1. atypical symptoms
2. alarm symptoms
3. children under 12 yo
4. failure of OTC therapy
what are the atypical GERD symptoms?
chest pain that mimics angina
non allergic asthma
chronic cough
hoarseness
pharyngites
dental erosion
what are alarm GERD symptoms?
dysphagia (difficulty swallowing)
odynophagia (painful swallowing)
unexplained weight loss
GI bleeding
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Author
jcu1
ID
197634
Card Set
GERD treatment
Description
GERD
Updated
2013-02-03T21:35:19Z
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