WEEK 6 DISCUSSION.pdf - Week 6 Discussion Mike is a...

Week 6 Discussion
Mike is a 46-year-old who presents with a complaint of "heartburn" for 3 months. He
describes the pain as burning and it is in the epigastric area. The pain improves after he
takes an antacid or drinks milk. He has been taking either over-the-counter (OTC)
famotidine or ranitidine off and on for the past 2 months and he still has recurring
epigastric pain. He has lost 6 lb. since his last visit.
Assessment
His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are
normal complete blood count (CBC) and a positive serum Helicobacter pylori test.
1.
What would you prescribe initially?
2.
How long would you prescribe these medications?
3.
What other possible meds could you prescribe to assist with the side effects from the
medications prescribed?
4.
How would the treatment vary if the patient has GERD instead?

lansoprazole, amoxicillin, and clarithromycin (LAC), which has been approved for either 10
days or 14 days of treatment. Mike must be carefully educated regarding the importance of
completing the prescription and about the potential adverse effects of the medications.
This situation would vary if treating for GERD, whose signs and symptoms include heartburn,
regurgitation, dysphagia, and bleeding. Relief from lifestyle changes and over-the-counter
medications is temporary. Orders for Antacids are needed, such as Maalox (magnesium
hydroxide and aluminum hydroxide) H2 receptor blockers, such as Tagamet ( cimetidine ),
Zantac ( ranitidine ), and Pepcid ( famotidine ).
Discussion Question 2
List differential diagnosis that would help confirm GERD while ruling out other diagnosis.
Which medication is the best medication for treatment of GERD and why? What labs or
other diagnostic tests that are used to confirm GERD? There aren't any reliable
differentiating signs or symptoms; functional heartburn denotes endoscopy-negative heartburn. A
normal esophageal pH study differentiates between nonerosive GERD and functional heartburn.