Example research essay topic: Drug Interactions Drug Therapy - 1,011 words

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Gastroesophageal Reflux Disease Robert Super Longitudinal Care Dr. Slater 3 / 26 / 01 Overview of GERD 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 GERD is defined as: Clinical or histological disorder resulting from gastric materials refluxing into the esophagus This reflux causes a breakdown of the esophageal mucosa Pathophysiology of GERD 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. Pathophysiology of GERD Causes of esophageal mucosa breakdown: Transient / spontaneous LES relaxation Transient increase in intra-abdominal pressure Atonic LES LES tone can be caused by certain foods, drugs, hormones, or other physiologic factors Typical Presentation Classic Symptoms: Heartburn Hypersalivation, belching, and regurgitation especially after a large meal Antacids are commonly used to treat this symptoms Atypical Presentation Chronic cough, hoarseness, pharyngitis, and angina like pain Non-allergic asthmatic symptoms have been reported Further work is usually needed Complicated Presentation Continual pain, dysphagia, bleeding, weight loss, choking and chest pain Differentiate from MI or Angina Pain Further work up is necessary Diagnostic Testing for GERD Endoscopy 24 hour pH monitoring Barium esophagogram Acid perfusion test (induce reflux) Treatment Goals Alleviate pain and discomfort associated with the symptoms of GERD Decrease frequency and duration of reflux Promote esophageal healing Avoid complications Prevent recurrence Types of Treatment Non-Pharmacologic Often used as monotherapy in mild or intermittent heartburn from GERD Pharmacologic May be used in mild cases if uncontrolled from non-pharmacologic treatment alone Always used for more severe cases Accompanied by non-pharmacologic treatment Non-Pharmacologic Therapy 1) Elevate head of bed (6 - 8 inches) 2) Avoid large meals and aggravating foods 3) Smoking cessation 4) Avoid tight-fitting clothing 5) Avoid Alcohol consumption 6) Evaluate current drug therapy Pharmacological Therapy Antacids Tums, Mylanta, Rolaids H 2 - Antagonists Pepcid, Zantac, Tag ament Prokinetic Agents Metoclopramide Proton pump inhibitors Prilosec, Prevacid Stepwise Treatment Treatment for Step 1 patients Indicated for mild, intermittent reflux Life-style modifications (Non- pharmacologic therapy) +/- Pharmacologic therapy Antacids or OTC H 2 -antagonists as needed Stepwise Treatment Treatment for Step 2 a patients Mild to moderate, typical symptoms not relieved by Step 1 treatment or Atypical symptoms Life-style modifications + Pharmacologic treatment Prescription H 2 Antagonists, proton pump inhibitors or Prokinetic agents Stepwise Treatment Treatment for Step 2 b patients Moderate to severe symptoms or those with erosive disease Life-style modifications + Pharmacologic treatment Higher dosed H 2 antagonists or Proton Pump Inhibitors Stepwise Treatment Treatment for Step 3 patients Surgery Reconstruction of lower esophageal sphincter Indicated for patients with moderate to severe symptoms or those with erosive disease 90 % effective Indicated last line when drug therapy has failed Not indicated for the elderly population Pharmacoeconomic Considerations Drug efficacy vs. Therapeutic Outcomes Many interaction with some agents and less with others Drug Efficacy vs. Direct Cost Weigh the advantages &# 038; disadvantages of each Patient Compliance High cost can cause compliance issues Therapeutic Outcomes Measurements of Success Ability to relieve symptoms Healing of injured mucosa Decreased risk of complications Patient Education Non-pharmacological treatment What to expect form the medication?

Safety and Efficacy Mechanism Of Action H 2 Receptor Antagonists Competitive Equilibrium Antagonist at the H 2 Receptor resulting in a block of acid secretion Proton Pump Inhibitor 2 separate drug molecules bind covalently to the proton pump and inhibit its acid secreting ability Mechanism Of Action Sucralfate Forms a gel which has high affinity for an ulcerated site and protects that site from the acidic environment of the stomach Metoclopramide Increases gastric motility to speed up digestive process which decreases reflux occurrence Antacids Weak bases which neutralize the stomach acid and decrease reflux Antacids Tablets 1) Maalox XS (Strongest) 2) Tums Ex 3) Mylanta 4) Rolaids (Weakest) Liquids 1) Roman Plus (Strongest) 2) Maalox Whip XS 3) Mylanta II 4) Gaviscon (Weakest) Antacids Used as P. R. N Treatment Not recommended for chronic use Ingredients Sodium Bicarbonate Calcium Carbonate Aluminum Hydroxide Magnesium Hydroxid H 2 Receptor Antagonists Cimetidine (Target) Dose = 400 - 600 mg BID or 800 mg QHS SE = Diarrhea, HA, Skin rash, dizziness Many drug interactions due to cyp 450 inhibition Pregnancy category B Dosage adjustments are needed for patients with renal and hepatic dysfunction H 2 Receptor Antagonist Famotidine (Pepcid) Dose = 40 mg QHS SE = HA, dizziness, diarrhea, constipation Very few drug interactions have been reported Pregnancy category B No dose adjustment needed for patients with hepatic dysfunction H 2 Receptor Antagonist Ranitidine (Zantac) Dose = 150 mg BID or 300 mg QHS SE = Fatigue, dizziness, HA, GI discomfort Interactions with Procainamide, Diazepam, and Warfarin have been reported Pregnancy category B No dose adjustment is required for patients with hepatic dysfunction Proton Pump Inhibitors Omeprazole (Prilosec) Dose = 20 mg QD SE = HA, dizziness, diarrhea, abdominal pain, nausea, vomiting Omeprazole increases the concentrations of Benzodiazepines, phenytoin, and warfarin Clarithromycin and Sucralfate will decrease Omeprazole concentrations Pregnancy category C Dose adjustment required for patients with liver impairment but not for renal impairment Proton Pump Inhibitors Lansoprazole (Prevacid) Dose = 30 mg QD SE = Same as with Omeprazole Lansoprazole decreases theophylline concentrations Sucralfate decreases Lansoprazole levels Pregnancy category C Dose adjustment for liver dysfunction patients but not for renal patients Other Agents To Treat GERD Sucralfate (Carafate) Dose = 1 gram QID on an empty stomach SE = constipation Many drug interactions Pregnancy category B No dosage adjustments needed for kidney or liver impaired patients Other Agents To Treat GERD Metoclopramide (Region) Dose = 10 - 15 mg QID SE = Restlessness, drowsiness, fatigue Many drug interactions Pregnancy Category B Dosage adjustment are required for really impaired patients No adjustment needed in hepatic impairment Monitoring Parameters Decreases signs and symptoms of GERD Monitor for appropriate OTC use Hypersensitivity reactions ex. Rash Side effects to the specific agent being used Change in social habits Decreased alcohol use and smoking

Research essay sample on Drug Interactions Drug Therapy