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Case 2:

 

GERD sx: weakness, fatigue, dizziness (these 3 could reflect anemia), cough, chest pain (with DM must rule out gastroparesis) but no CAD/angina diagnosis; PMH notes anemia, mild memory loss (worsened by anemia?), involuntary weight loss (alarm symptom if not otherwise explained).

Provoking factors: advanced age, smoking, alcohol, ferrous sulfate, alendronate (assure weekly dose to decrease esophageal mucosa contact time ? switch to once-monthly ibandronate), trazodone, diphenhydramine in Tylenol PM

Questions: frequency of antacid use?, other alarm symptoms?

Recommend: If possible, decrease doses/substitute provocative meds. After MD assessment (if not already recently done) and GERD diagnosis, since persistent sx on antacid, recommend H2RA trial if NERD, otherwise a PPI plus lifestyle changes (smoking cessation, curtail alcohol use, elevate head of bed, avoid irritating foods, if obese-weight loss). with f/u monitoring of GERD response and complications (see case 1).




 
 
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©2001 College of Pharmacy, University of Minnesota
Course Director: David R. P. Guay