NSG6005 Week 6 Project.pptx - Pharmacological Therapy for GERD in the Pediatric Population NSG6005 Week 6 Sarah Toler What is GERD Prevalent in

NSG6005 Week 6 Project.pptx - Pharmacological Therapy for...

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Unformatted text preview: Pharmacological Therapy for GERD in the Pediatric Population NSG6005 Week 6 Sarah Toler What is GERD? Prevalent in premature infants Breastfed infants are less likely to suffer from GERD than formula or bottle fed infants GERD peaks around 4 months of age and slowly declines or resolves by year 1 GERD in infants include regurgitation or vomiting associated with irritability, anorexia or feeding refusal, poor weight gain, dysphagia, presumably painful swallowing, and arching of the back during feedings Symptoms of GERD in children 1 to 5 years of age include regurgitation, vomiting, abdominal pain, anorexia, and feeding refusal Children and adolescents are most likely to present with symptoms seen in adults including heartburn, epigastric pain, chest pain, nocturnal pain, dysphagia, and sour burps Other illnesses associated with GERD can include respiratory symptoms, including cough and laryngitis, as well as wheezing in infancy (Lightdale & Gremse, 2013) Diagnosing GERD in Pediatrics The most important diagnostic feature in GERD is a detailed patient history and physical exam In adolescents classic symptoms are utilized to diagnose GERD Providers must exclude other diagnoses such as pyloric stenosis and failure to thrive (FTT) in infants prior to GERD because symptoms can mimic one another in infants Parent questionnaires, upper GI X-ray, esophageal pH study, endoscopy, and esophageal biopsy are sometimes used in diagnosing GERD in pediatrics (Lightdale & Gremse, 2013) Pharmacological Intervention Infants- short term trial of Ranitidine (Zantac) under one year, omeprazole (Prilosec) over one year Indications for medication therapy in infants include: poor weight gain, unsuccessful lifestyle modifications, refuses to feed, evidence of an inflamed esophagus, chronic asthma and reflux Older children and adolescents- Ranitidine, famotidine, esomeprazole, omeprazole, lansoprazole, pantoprazole Life style changes for older children and adolescents include: weight loss if needed, smaller frequent meals, avoid high fat content foods, being up 3 hours post meals, elevate head of bed Omeprazole dosing: 20 lb or less 10mg QD for 4 to 8 weeks, greater than 20 lb 20mg QD 4-8 weeks Ranitidine dosing: greater than 6 years 4-10mg/kg/day; max dose 300mg/day (Infant Reflux, 2018), (Treatment for GER & GERD in Children & Teens, 2015) Pharmacodynamics of Omeprazole Medication class- Proton Pump Inhibitor (PPI) Mechanism of action- suppress gastric acid secretion by inhibition of the H+/K+/ATPase enzyme system Route- by mouth; granules for liquid suspension (2.5, 10mg packet) capsules delayed release (10, 20, 40mg) Pharmacokinetics- rapid absorption after granules leave the stomach, half life is 30 to 60 minutes depending on hepatic impairment maybe as high as 3 hours Metabolism/Elimination- metabolized in the liver, 77% excreted unchanged in urine, remaining in feces Precautions- Pregnancy class C Contraindications- hypersensitivity to ingredients, use with caution in liver patients due to being metabolized in the liver Black Block Warning- not to be used with Clopidogrel (Plavix) decreases metabolism of clopidogrel by 46% (Woo & Robinson, 2015) Pharmacodynamics of Ranitidine Medication class- Histamine 2 Blockers Mechanism of action- inhibit acid secretion by gastric parietal cells by blocking histamine at the histamine 2 receptor site Route- by mouth; tablets (75, 150, 300mg), effervescent tablets (150mg), geldose (150mg), syrup (15mg/ml), efferdose: granules (150mg) Pharmacokinetics- decreased absorption when taken with antacids, rapid absorption following oral ingestion, half life of 2-3 hours Metabolism/Elimination- metabolized in the liver, excreted unchanged in the urine Contraindications- renal impairment may cause CNS reactions, occasional reversible hepatitis, contraindicated with patients with liver disease (Woo & Robinson, 2015) Goal of Therapy Elimination and/or relief of symptoms Healing of esophageal lesions Management of complications Prevention of relapse If symptoms of GERD are not managed, referral to pediatric gastroenterologist is needed (Woo, 2015) Education Topics for PPI and Histamine 2 Blockers Follow all directions on your medicine label and package Use the dosing syringe provided for exact amount Tell each of your healthcare providers about all your medical conditions, allergies, and all medicine prescribed or OTC If a dose is missed, take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose Common side effects of ranitidine include NVD, constipation, abdominal pain Common side effects of omeprazole include headache, diarrhea, constipation, and nausea (Woo & Robinson, 2015) Summary Infants and children diagnosed with GERD should try lifestyle modifications prior to pharmacological intervention If symptoms are not relieved with short term therapy of Histamine 2 Blockers and PPI then referral to gastroenterologist is warranted PPI and Histamine 2 Blockers are the most common treatment of GERD among infants and children Ranitidine should be used in infants less than one year of age and Omeprazole can be used in children older than a year Common side effects include GI related symptoms References Infant reflux. (2018, October 26). Retrieved from Lightdale, J. R., & Gremse, D. A. (2013). Gastroesophageal Reflux: Management Guidance for the Pediatrician. Pediatrics,131(5). doi:10.1542/peds.2013-0421 Treatment for GER & GERD in Children & Teens. (2015, April 01). Retrieved from Woo, T. & Robinson, M. (2015). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with Davis Plus eResourses, 4th ed. F.A. Davis Company. ISBN: 9780803638273 ...
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  • Fall '16
  • Gastroesophageal reflux disease,  Prevalent,  GERD

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