armacologic Therapy1) Elevate head of bed (6-8 inches)2) Avoid large meals and aggravating foods3) Smoking cessation4) Avoid tight-fitting clothing5) Avoid Alcohol consumption6) Evaluate current drug therapyPharmacological TherapyAntacidsTums, Mylanta, RolaidsH2- AntagonistsPepcid, Zantac, TagamentProkinetic AgentsMetoclopramideProton pump inhibitorsPrilosec, PrevacidStepwise TreatmentTreatment for Step 1 patientsIndicated for mild, intermittent reflux Life-style modifications (Non- pharmacologic therapy)+/- Pharmacologic therapyAntacids or OTC H2-antagonists as neededStepwise TreatmentTreatment for Step 2a patientsMild to moderate, typical symptoms not relieved by Step 1 treatment or Atypical symptoms Life-style modifications+ Pharmacologic threatmentPrescription H2 Antagonists, proton pump inhibitors or Prokinetic agentsStepwise TreatmentTreatment for Step 2b patients Moderate to severe symptoms or those with erosive diseaseLife-style modifications+ Pharmacologic treatmentHigher dosed H2 antagonists or Proton Pump InhibitorsStepwise TreatmentTreatment for Step 3 patientsSurgeryReconstruction of lower esophageal sphincter Indicated for patients with moderate to severe symptoms or those with erosive disease 90% effectiveIndicated last line when drug therapy has failedNot indicated for the elderly populationPharmacoeconomic ConsiderationsDrug efficacy vs. Therapeutic OutcomesMany interaction with some agents and less with othersDrug Efficacy vs. Direct CostWeigh the advantages & disadvantages of eachPatient ComplianceHigh cost can cause compliance issuesTherapeutic OutcomesMeasurements of Success Ability to relieve symptomsHealing of injured mucosaDecreased risk of complicationsPatient EducationNon-pharmacological treatmentWhat to expect form the medication?Safety and EfficacyMechanism Of ActionH2 Receptor AntagonistsCompetitive Equilibrium Antagonist at the H2 Receptor resulting in a block of acid secretionProton Pump Inhibitor2 sep...
