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Risk factors for GERD
- Being overweight
- Being pregnant
- Certain diseases (e.g. diabetes, asthma, peptic ulcers)
- Certain drugs (e.g. nonsteroidal anti-inflammatory drugs)
- Drinking alcohol and caffeinated beverages
- Eating foods with high acid content (e.g. tomatoes, orange juice)
- Eating fatty and spicy foods
- Lying down too soon after meals
- Smoking
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How does famotidine (Pepcid) work?
Famotidine is a histamine H2 blocker that causes decreased stimulation of H2 receptors in gastric cells that secrete hydrochloric acid leading to a decrease in gastric acid secretion.
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What are the adverse effects of famotidine?
- Abnormal heart rhythms
- decreased white blood cell count
- anemia
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What to teach patients taking famotidine?
- Notify prescriber if taking OTC H2 blockers for more than 2 weeks and still experiencing reflux.
- Do not smoke; smoking interferes with action of these drugs.
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What are the most powerful drugs used for treating PUD or GERD?
Proton Pump Inhibitors [rabeprazole (AcipHex)]; should be used only for a limited time.
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Why should rabeprazole only be used for limited time?
- PPIs may lead to stomach infections because inhibition of stomach acid that help kill bacteria.
- May lead to anemia because loss of stomach acid reduces digestion of protein.
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When should PPIs be given?
PPIs should be given before meals, preferable in the morning.
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When taking aluminum hydroxide (Amphojel) with other drugs, when should they be taken?
Patients should not take an aluminum hydroxide or a calcium carbonate antacid within 1 or 2 hours of taking other drugs.
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Why is sucralfate (Carafate) prescribed?
Sucralfate is prescribed to protect open-sore areas in the GI tract and allow ulcers to heal.
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What are the six types of generalized seizures?
Generalized seizures affect most or all of the brain and are divided into six types: tonic-clonic, tonic, clonic, absence, myoclonic, and atonic.
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What is a tonic-clonic (grand mal) seizure?
Tonic-clonic (or grand mal) seizures last 2 to 5 minutes with stiffening or rigidity of the arm and leg muscles and immediate loss of consciousness.
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What is a tonic seizure?
Tonic seizures include sudden increase in muscle tone, loss of consciousness, and loss of autonomic signs for 30 seconds to several minutes.
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What is a clonic seizure?
- Clonic seizures are characterized by muscle contraction and relaxation.
- [G. klonos, a tumult]
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What is an absence (or petit mal) seizure?
Absence (or petit mal) seizures are more common in children and tend to occur in families. They last a few seconds with loss of consciousness and blank staring like daydreaming.
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What is a myoclonic seizure?
A myoclonic seizure involves brief asymmetric or symmetric jerking or stiffening of the extremities that lasts a few seconds.
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What is an atonic seizure?
An atonic seizure typically has sudden loss of muscle tone for a few seconds, followed by postictal (after the seizure) confusion.
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What is a simple partial seizure?
With a simple partial seizure the patient remains conscious and may report an aura. It typically includes one-sided movement of an extremity, unusual sensations, or autonomic changes such as heart rate, flushing, or epigastric discomfort.
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What is a complex partial seizure?
Complex partial seizures cause patients to lose consciousness for 1 to 3 minutes. Patients may have automatisms such as lip smacking, patting, or picking at clothes, typically followed by amnesia.
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What is status epilepticus?
Status epilepticus is a seizure lasting longer than 30 minutes or a series of any type of repeated seizure. Rapid recognition and treatment of this disorder is essential in preventing brain damage, coma, and death.
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What is the action of first-line drugs for partial and generalized seizures?
First-line drugs for partial and generalized seizures act on the brain and nervous system to cause a decrease in the voltage, frequency, and spread of electrical impulses within the motor cortex of the brain.
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List two first-line drugs for partial and generalized seizures:
- carbamazepine (Tegretol)
- phenytoin (Dilantin)
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What is an adverse effect of phenytoin?
Phenytoin can lead to Stevens-Johnson syndrome.
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What should clients taking carbamazepine (Tegretol) avoid consuming?
Clients taking carbamazepine (Tegretol) should avoid grapefruit and grapefruit juice because they increase the effects of this drug.
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Name a first-line drug for absence seizure:
ethosuximide (Zarontin)
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What should a client taking ethosuximide (Zarontin) be taught to wear out-of-doors?
Ethosuximide (Zarontin) makes eyes more sensitive to light, therefore should protect eyes with dark glasses in bright light.
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Name a second-line drug for seizures:
clonazepam (Klonopin)
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What is an adverse effect of clonazepam?
Clonazepam is a benzodiazepine CNS drug with the life-threatening adverse reaction of respiratory depression.
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Which anti-seizure drugs can increase the effects of anticoagulant drugs?
- Valproic acid
- Phenytoin
- Carbamazepine
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