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Ms. Lear Thomson is a 47 y.o patient who comes in today complaining of heartburn that...

Ms. Lear Thomson is a 47 y.o patient who comes in today complaining of heartburn that is no longer responding to TUMS and Mylanta. She complains of heartburn especially after lunch and dinner. She recently lost her job as bookkeeper for an auto parts store that went out of business. She is very stressed, as she is a single parent to two bright kids who are college material. She doesn’t know how she will afford college tuition, but is determined to make it possible for them. She denies melena or bloody stools, or nausea/ vomiting. She has gained about 22 lbs in the past 2 years. She has been working overtime as much as possible and has found very little time for exercising. She has no past history of heart disease, diabetes, or ulcerative colitis or Crohn’s disease. She has a normal CBC and has normal vital signs. You diagnose her with GERD.

What would be the appropriate medication to prescribe?

What education regarding the prescription would she need?

Solutions

Expert Solution

1. GERD

Gastrooesophageal Reflux Disease is a very common problem presenting as heart burn, acid eructation, sensation of stomach contents coming back in the food pipe, especially after a large meal, aggravated by stooping or lying flat.

Appropriate medications to GERD are:

  • Proton pumb inhibitors: Pantoprazole, omeprazole, lansoprasole

These are the most effective drugs both for symptomatic relief as well as for healing of esophageal lesions,

  • H2 blockers: Ranitidine, cimetidine, famotidine

They reduce acidity of gastric contents and have no effects on LES tone.

  • Antacids: sodium bicarbonate, magnesium hydroxide, aluminium hydroxide

Their use in GERD is limited to occassional or intercurrent relief of heartburn because they act within few minutes

  • Prokinetic agents: Metoclopramide, cisapride.

These prokinetic agents may relieve regurgitation and heartburn by increasing LES tone, improving esophageal clearance and facilitating gastric emptying but do not affect gastric acidity or promote healing of esophagitis.

2. H2 receptor antagonists and proton pumb inhibitors should be taken half hour before food

Antacids and proton pump inhibitor/ H2receptor antagonists are not taken at same time since antacids might interfere with the action of later.

Life style modification of GERD includes obesity, lack of exercise , avoid fatty and spicy food.

Nightingale answered 1 year ago
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