Jim presents with complaints of “heartburn” that is minimally relieved with
Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux
disease (GERD). An appropriate first-step therapy would be:
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Omeprazole (Prilosec) twice a day
Ranitidine (Zantac) twice a day
Famotidine (Pepcid) once a day
Metoclopramide (Reglan) four times a day
An elderly person has been prescribed lactulose for treatment of chronic
constipation. Monitoring with long-term treatment would include:
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Electrolytes, including potassium and chloride
Bone mineral density for osteoporosis
Magnesium level
Liver function
The next step in treatment when a patient has been on proton pump
inhibitors twice daily for 12 weeks and not improving is:
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Add a prokinetic (metoclopramide)
Referral for endoscopy
Switch to another proton pump inhibitor
Add a cytoprotective drug
If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy,
the second-line treatment is:
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