Week 5
What pharmacologic agents are currently recommended for the treatment of GERD?
Antacids
Antacids relieve heartburn (indigestion). They work by changing the stomach acid that causes
heartburn. Common OTC antacids include:
• Mylanta
• Rolaids
• Tums
Histamine-2 (H2) blockers
H2 blockers relieve and prevent heartburn and work by reducing the amount of acid produced by
the stomach. Typically, they start to work within one to three hours and provide acid-suppression
for several hours. Because acid reducers may interact with certain other medicines, ask your
doctor or pharmacist before use if you are taking a prescription drug. Common OTC H2-blockers
include:
• Tagamet HB (cimetidine)
• Pepcid Complete or Pepcid AC (famotidine)
• Axid AR (nizatidine)
Proton pump inhibitors (PPIs)
OTC PPIs treat frequent heartburn (occurs 2 or more days a week) and are not intended for
immediate relief of heartburn, as they may take one to four days for full effect. In contrast,
prescription PPIs are used to treat conditions like gastroesophageal reflux disease (GERD),
stomach and small intestine ulcers, and inflammation of the esophagus. PPIs work by reducing
the amount of acid produced by the stomach. Because acid reducers may interact with certain
other medicines, ask your doctor or pharmacist before use if you are taking a prescription
drug. OTC PPIs are only intended for a 14-day course of treatment and can be used up to three
times per year.
• Prevacid 24HR (lansoprazole)
• Nexium 24HR (esomeprazole)
• Prilosec OTC (omeprazole magnesium)
• Zegerid OTC (omeprazole and sodium bicarbonate)
-
What are the pharmacologic regimens for treatment of H-pylori?
RECOMMENDED
Clarithromycin triple therapy consists of a PPI, clarithromycin (Biaxin), and amoxicillin or
metronidazole (Flagyl) for 14 days. The effect of H. pylori resistance to clarithromycin is well
documented. Clarithromycin should be avoided in locations where resistance is greater than 15%
and in patients with any previous macrolide exposure.
Bismuth quadruple therapy consists of a PPI, bismuth, tetracycline, and a nitroimidazole for 10 to
14 days. It may be a particularly good option in patients with macrolide exposure or who are
allergic to penicillin. Although metronidazole resistance impacts the effectiveness of this
regimen, it is not nearly as profound as with clarithromycin triple therapy. Bismuth quadruple
This study source was downloaded by 100000839832718 from CourseHero.com on 06-11-2023 18:19:14 GMT -05:00
https://www.coursehero.com/file/98427519/NU-636-Quiz-5pdf/
, therapy should be strongly considered as first-line treatment where clarithromycin resistance is
high or in patients with any previous macrolide exposure.
Concomitant therapy consists of a PPI, clarithromycin, amoxicillin, and a nitroimidazole
(tinidazole [Tindamax] or metronidazole) for 10 to 14 days. This regimen is a promising option
that has been shown in international studies to be at least as effective as clarithromycin triple
therapy with similar tolerability. Limited data show that the effects of clarithromycin resistance
with this regimen are less than with clarithromycin triple therapy. A duration of 10 to 14 days
seems appropriate, although studies to assess whether extending therapy to 14 days improves
eradication are ongoing.
What would the pharmacologic regimen for the treatment of H-pylori be for a patient with a documented allergy to
penicillin?
Bismuth quadruple therapy consists of a PPI, bismuth, tetracycline, and a nitroimidazole for 10 to
14 days. It may be a particularly good option in patients with macrolide exposure or who are
allergic to penicillin. Although metronidazole resistance impacts the effectiveness of this
regimen, it is not nearly as profound as with clarithromycin triple therapy. Bismuth quadruple
therapy should be strongly considered as first-line treatment where clarithromycin resistance is
high or in patients with any previous macrolide exposure.
What pharmacologic agent is the standard for treatment of ulcerative colitis?
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis and
are appropriate for the majority of people with this condition. These drugs include:
• 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine),
mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum).
Which one you take, and whether it is taken by mouth or as an enema or suppository,
depends on the area of your colon that's affected.Corticosteroids. These drugs, which
include prednisone and budesonide, are generally reserved for moderate to severe
ulcerative colitis that doesn't respond to other treatments. Due to the side effects, they are
not usually given long term.
What pharmacologic agent is often prescribed for exacerbations of inflammatory bowel disease?
• Corticosteroids. These drugs, which include prednisone (Orasone, deltasone),
methylprednisolone (medrol) and controlled release oral budesonide (entocort EC), are
generally reserved for moderate to severe ulcerative colitis that doesn't respond to other
treatments. Due to the side effects, they are not usually given long term.
o Oral budesonide treatment of choice in mild to mod exacerbations with 5-ASA or as
monotherapy
• Dosage
o Oral prednisone 40-60 mg/day PO or R for mild-mod exacerbations for 4-8 weeks then
dose is tapered by 5-10 mg weekly until daily dose 20 mg is reached then tapered by 2.5
mg/week
This study source was downloaded by 100000839832718 from CourseHero.com on 06-11-2023 18:19:14 GMT -05:00
https://www.coursehero.com/file/98427519/NU-636-Quiz-5pdf/
What pharmacologic agents are currently recommended for the treatment of GERD?
Antacids
Antacids relieve heartburn (indigestion). They work by changing the stomach acid that causes
heartburn. Common OTC antacids include:
• Mylanta
• Rolaids
• Tums
Histamine-2 (H2) blockers
H2 blockers relieve and prevent heartburn and work by reducing the amount of acid produced by
the stomach. Typically, they start to work within one to three hours and provide acid-suppression
for several hours. Because acid reducers may interact with certain other medicines, ask your
doctor or pharmacist before use if you are taking a prescription drug. Common OTC H2-blockers
include:
• Tagamet HB (cimetidine)
• Pepcid Complete or Pepcid AC (famotidine)
• Axid AR (nizatidine)
Proton pump inhibitors (PPIs)
OTC PPIs treat frequent heartburn (occurs 2 or more days a week) and are not intended for
immediate relief of heartburn, as they may take one to four days for full effect. In contrast,
prescription PPIs are used to treat conditions like gastroesophageal reflux disease (GERD),
stomach and small intestine ulcers, and inflammation of the esophagus. PPIs work by reducing
the amount of acid produced by the stomach. Because acid reducers may interact with certain
other medicines, ask your doctor or pharmacist before use if you are taking a prescription
drug. OTC PPIs are only intended for a 14-day course of treatment and can be used up to three
times per year.
• Prevacid 24HR (lansoprazole)
• Nexium 24HR (esomeprazole)
• Prilosec OTC (omeprazole magnesium)
• Zegerid OTC (omeprazole and sodium bicarbonate)
-
What are the pharmacologic regimens for treatment of H-pylori?
RECOMMENDED
Clarithromycin triple therapy consists of a PPI, clarithromycin (Biaxin), and amoxicillin or
metronidazole (Flagyl) for 14 days. The effect of H. pylori resistance to clarithromycin is well
documented. Clarithromycin should be avoided in locations where resistance is greater than 15%
and in patients with any previous macrolide exposure.
Bismuth quadruple therapy consists of a PPI, bismuth, tetracycline, and a nitroimidazole for 10 to
14 days. It may be a particularly good option in patients with macrolide exposure or who are
allergic to penicillin. Although metronidazole resistance impacts the effectiveness of this
regimen, it is not nearly as profound as with clarithromycin triple therapy. Bismuth quadruple
This study source was downloaded by 100000839832718 from CourseHero.com on 06-11-2023 18:19:14 GMT -05:00
https://www.coursehero.com/file/98427519/NU-636-Quiz-5pdf/
, therapy should be strongly considered as first-line treatment where clarithromycin resistance is
high or in patients with any previous macrolide exposure.
Concomitant therapy consists of a PPI, clarithromycin, amoxicillin, and a nitroimidazole
(tinidazole [Tindamax] or metronidazole) for 10 to 14 days. This regimen is a promising option
that has been shown in international studies to be at least as effective as clarithromycin triple
therapy with similar tolerability. Limited data show that the effects of clarithromycin resistance
with this regimen are less than with clarithromycin triple therapy. A duration of 10 to 14 days
seems appropriate, although studies to assess whether extending therapy to 14 days improves
eradication are ongoing.
What would the pharmacologic regimen for the treatment of H-pylori be for a patient with a documented allergy to
penicillin?
Bismuth quadruple therapy consists of a PPI, bismuth, tetracycline, and a nitroimidazole for 10 to
14 days. It may be a particularly good option in patients with macrolide exposure or who are
allergic to penicillin. Although metronidazole resistance impacts the effectiveness of this
regimen, it is not nearly as profound as with clarithromycin triple therapy. Bismuth quadruple
therapy should be strongly considered as first-line treatment where clarithromycin resistance is
high or in patients with any previous macrolide exposure.
What pharmacologic agent is the standard for treatment of ulcerative colitis?
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis and
are appropriate for the majority of people with this condition. These drugs include:
• 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine),
mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum).
Which one you take, and whether it is taken by mouth or as an enema or suppository,
depends on the area of your colon that's affected.Corticosteroids. These drugs, which
include prednisone and budesonide, are generally reserved for moderate to severe
ulcerative colitis that doesn't respond to other treatments. Due to the side effects, they are
not usually given long term.
What pharmacologic agent is often prescribed for exacerbations of inflammatory bowel disease?
• Corticosteroids. These drugs, which include prednisone (Orasone, deltasone),
methylprednisolone (medrol) and controlled release oral budesonide (entocort EC), are
generally reserved for moderate to severe ulcerative colitis that doesn't respond to other
treatments. Due to the side effects, they are not usually given long term.
o Oral budesonide treatment of choice in mild to mod exacerbations with 5-ASA or as
monotherapy
• Dosage
o Oral prednisone 40-60 mg/day PO or R for mild-mod exacerbations for 4-8 weeks then
dose is tapered by 5-10 mg weekly until daily dose 20 mg is reached then tapered by 2.5
mg/week
This study source was downloaded by 100000839832718 from CourseHero.com on 06-11-2023 18:19:14 GMT -05:00
https://www.coursehero.com/file/98427519/NU-636-Quiz-5pdf/
