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IP 2 Exam review GERD

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alchemist04's version from 2018-11-05 00:42

Diagnostic test for GERD

Question Answer
Upper Endoscopy (UE) is forAlarm SXs, evaluation of non-cardiac chest pain, unresponsive to PPI, esophageal mucous (EM)
Ambulatory reflux monitor (ARM)Impedance pH, pt w/ NERD, pt refractory to PPI therapy
Esophageal biopsy (EB) is forpt suspected of esophageal cancer, Barret's esophagus, strictures, eosinophilic esophagitis
Barium radiographs (BR) or Barium swallow (BS) is fordysphagia
Esophageal manometry (EM) is formvmt and pressure of the esophageal (motility)
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Adverse effects of GERD medicines

Question Answer
Antacidscation components could be absorbed by pt w/ renal impairment
H2Agynecomastia, head ache, GI problems, reduce acid secretion which could be needed for other medications
PPIsClostridium difficile (diarrhea), decreased Calcium absorption, bone fractures, GI disturbances
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Promotility

Question Answer
MetoclopramideReglan
Reglan MOAacts on dopamine receptor, increase LES pressure and enhance gastric emptying
Reglan side effectscarries Black Box Warning, tardive dyskinesia, pseudoparkinsonism w/n 6 mo, Extrapyramidal Syndrome w/n 1-2 days, not recommended for pt that is less than 30 yo, not use more than 12 weeks
CisapridePropulsid (for mild reflux symptoms)
Propulsid side effectsassociated w/the risk of serious cardiac arrhythmias; hence, withdrawn form market
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Question Answer
Bethanechol (BU)Urecholine
Urecholine MOAis a cholinergic agonist
Balcofen (BaLi)Lioresal
Balcocen MOAa GABAb agonist skeletal muscle relaxant; reduces transient LES relaxations, reflux episodes and nocturnal reflux activity
Balcofen side effectsdizziness, somnolence, and constipation, as well as a lack of long-term data supporting its efficacy for GERD.
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