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| Question | Answer |
| What are 3 rationales for treatment of GORD | 1. Symptom relief and control 2. Heal oesophagitis 3. Reduce risk of complications |
| What on demand medications are recommended to treat GORD and what is their mode of action? Identify 2. | Antacid MOA: Neutralise the excessive gastric acid, raise pH and provide rapid relief or Antacid + alginate MOA: + form a thick layer (raft) on top of the stomach contents once it makes contact with gastric acid stopping reflux |
| What medications are recommended for GORD when firstline symptom relief is not effective? Name the Class and drugs. | 1. H2 Receptor antagonist (blocker) - Cimetidine, Famotidine, Nizatidine, Ranitidine 2. PPIs - Omeprazole, Lansoprazole, Pantoprazole |
| What is the class and MOA for: Lansoprazole Omeprazole Pantoprazole | CLASS: PPI MOA: Bind irreversibly to H/K ATPase and inhibit the protein pump, producing long lasting suppression of gastric acid secretion. Act irrespective of stimulus as do not act on receptors. |
| What is the class and MOA for: Cimetidine, Famotidine, Nizatidine and Ranitidine | Class: H2 receptor antagonist MOA: Competitively antagonist of histamine H2 receptor, inhibiting the action of the H2 receptor at the parietal cell reducing secretion of gastric acid |
| Protein pump inhibitor Adverse Effects | Headache, n&v, diarrhoea, abdo pain, constipation, flatulence Long term: osteoporosis, VB12 deficiency |
| Lifestyle changes for GORD | 1. Reduce alcohol intake and cease smoking 2. Weight loss 3. Raising bed head 4. Avoid trigger foods: caffeine, chocolate, fatty or spicy 5. Smaller meals |
| Which Gord medication is preferred in pregnancy? | H2 receptor antagonist: Ranitidine |
| Which medications can worsen reflux | 1. NSAIDs 2. CCBs 3. Nitrates |
| How long should PPIs be taken before reveiw | 2 weeks then referral to see a GP if symptoms persist |
| Risk factors for Peptic Ulcer Disease | 1. H. pylori 2. long term NSAID use |
| How is H. pylori treated? | Triple treatment PPI + 2 antibiotics 1. Omeprazole, amoxicillin, clarithromycin or; 2. Omeprazole, clarithromycin and metronidazole Clarithromycin inhibits CYP3A4 leading to enhanced PPI activity |
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