Data Bases • Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism? Links • Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com Free Essays • Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers	Search Lots of Essays Back to Subjects - Science Gastroesophageal Reflux Disease Gastroesophageal Reflux Disease 10% of all Americans experience GERD Low mortality rate approximately 1 death per 100,000 persons Largely effects QOL: more than angina, menopause,untreated HTN, mild CHF Clinical or histological disorder resulting from gastric materials “refluxing” into the esophagus This reflux causes a breakdown of the esophageal mucosa Excessive reflux of gastric juices from the stomach to the esophagus resulting in a breakdown of the defensive mechanisms of the esophagus. This breakdown leads to irritation and injury of the esophageal mucosa. Causes of esophageal mucosa breakdown: Transient/spontaneous LES relaxation Transient increase in intra-abdominal pressure LES tone can be caused by certain foods, drugs, hormones, or other physiologic factors Classic Symptoms: “Heartburn” Hypersalivation, belching, and regurgitation especially after a large meal Antacids are commonly used to treat this symptoms Chronic cough, hoarseness, pharyngitis, and angina like pain Non-allergic asthmatic symptoms have been reported Continual pain, dysphagia, bleeding, weight loss, choking and chest pain Differentiate from MI or Angina Pain Alleviate pain and discomfort associated with the symptoms of GERD Decrease frequency and duration of reflux Often used as monotherapy in mild or intermittent heartburn from GERD May be used in mild cases if uncontrolled from non-pharmacologic treatment alone Accompanied by non-pharmacologic treatment 2) Avoid large meals and aggravating foods Indicated for mild, intermittent reflux Life-style modifications (Non- pharmacologic therapy) Antacids or OTC H2-antagonists as needed Mild to moderate, typical symptoms not relieved by Step 1 treatment or Atypical symptoms Prescription H2 Antagonists, proton pump inhibitors or Prokinetic agents Moderate to severe symptoms or those with erosive disease Higher dosed H2 antagonists or Proton Pump Inhibitors Reconstruction of lower esophageal sphincter Indicated for patients with moderate to severe symptoms or those with erosive disease Indicated last line when drug therapy has failed Not indicated for the elderly population Drug efficacy vs. Therapeutic Outcomes Many interaction with some agents and less with others Weigh the advantages & disadvantages of each High cost can cause compliance issues Competitive Equilibrium Antagonist at the H2 Receptor resulting in a block of acid secretion 2 separate drug molecules bind covalently to the proton pump and inhibit its acid secreting ability Forms a gel which has high affinity for an ulcerated site and protects that site from the acidic envirionment of the stomach Increases gastric motility to speed up digestive process which decreases reflux occurrence Weak bases which neutralize the stomach acid and decrease reflux SE = Diarrhea, HA, Skin rash, dizziness Many drug interactions due to cyp450 inhibition Dosage adjustments are needed for patients with renal and hepatic dysfunction SE = HA, dizziness, diarrhea, constipation Very few drug interactions have been reported No dose adjustment needed for patients with hepatic dysfunction SE = Fatigue, dizziness, HA, GI discomfort Interactions with Procainamide, Diazepam, and Warfarin have been reported No dose adjustment is required for patients with hepatic dysfunction SE = HA, dizziness, diarrhea, abdominal pain, nausea, vomiting Omeprazole increases the concentrations of Benzodiazepines, phenytoin, and warfarin Clarithromycin and Sucralfate will decrease Omperazole concentrations Dose adjustment required for patients with liver impairment but not for renal impairment Lansoprazole decreases theophyline concentrations Sucralfate decreases Lansoprazole levels Dose adjustment for liver dysfunction patients but not for renal patients Dose = 1 gram QID on an empty stomach No dosage adjustments needed for kidney or liver impaired patients SE = Restlessness, drowsiness, fatigue Dosage adjustment are required for renally impaired patients No adjustment needed in hepatic impairment Decreases signs and symptoms of GERD Hypersensitivity reactions ex. Rash Side effects to the specific agent being used Bibliography: Word Count: 961
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