Escolar Documentos
Profissional Documentos
Cultura Documentos
C o n t i n u i n g E d u c at i o n
G
severity in their patients.
3. Assist patients in making informed decisions astroesophageal reflux disease (GERD) is defined by the 2004 Canadian Consensus
about their therapy. Conference as a chronic condition in which gastric contents reflux into the esophagus
4. Understand the importance of continued causing symptoms that affect the persons quality of life and/or that cause esophageal
follow-up with these patients and injury.1 The Montreal definition7, an international consensus statement, indicates that it is a
recognize when patients will require further
investigations.
condition which develops when the reflux of stomach contents causes troublesome symptoms
5. Accurately discuss the potential for and/or complications; the emphasis again being placed on quality of life. Symptoms become
drug interactions and identify potential troublesome when they decrease patients wellbeing.
interactions based on the current literature. GERD is a common problem that affects approximately 1020% of the population in the
6. Describe how current provincial regulations
western world.2 Based on a survey from the 1999 DIGEST study, 17% of Canadians report
can expand the pharmacists ability to
provide ongoing care to GERD patients (e.g., experiencing heartburn in the last three months and 13% have experienced moderate to
through prescription adaptations). severe upper GI symptoms a minimum of once per week.3 It is the most prevalent acid-
related disorder in Canada.1
INSTRUCTIONS Given its high incidence, and how common these symptoms are, pharmacist involvement
in the management of GERD in the community could positively impact the success of
1. After carefully reading this lesson, study each
question and select the one answer you treatment for these patients. In 2008, prescribed proton pump inhibitors (PPIs) ranked in
believe to be correct. Circle the appropriate the top 20 products dispensed in Canada.4
letter on the attached reply card or answer This lesson will focus on a pharmacist-specific plan based on the Canadian Consensus
online for immediate results at www. Conference of GERD management. Pharmacist involvement can assist patients in making
canadianhealthcarenetwork.ca.
2. To pass this lesson, a grade of at least 70%
appropriate selections of over-the-counter products or in using their prescription
(18 out of 25) is required. If you pass, please medications. Following up with these patients with clear guidelines in mind will prevent
retain a record in your learning portfolio. unnecessary visits to doctors offices. Knowing when to direct patients to seek further
medical intervention will also help to avoid potentially serious complications.
ANSWERING OPTIONS
Etiology/Pathophysiology/Risk Factors
A. Answer online for immediate results at
www.canadianhealthcarenetwork.ca The symptoms of GERD manifest themselves when stomach contents are refluxed into the
B. Mail or fax the printed answer card to (416) esophagus. The erosive effects of gastric acid and pepsin on the esophageal tissue cause the
764-3937. Your reply card will be marked and injury or symptoms that define GERD. The cause of the reflux itself is most likely due to a
you will be advised of your results within six to decrease in the lower esophageal sphincter pressure (LES). The LES normally relaxes when
eight weeks in a letter from Rogers Publishing.
NOTE: All faxed or mailed reply cards must be
there is no swallowing or esophageal peristalsis occurring and these are called transient LES
submitted one month before lesson expiry date. relaxations. An increase in the number or duration of LES relaxations can lead to GERD.5
Risk factors, triggers and comorbidities that are associated with or have been proven to
This CE lesson is published by Rogers Publishing Limited (Pharmacy Group), One Mount
cause GERD are varied. There appears to be a link between body mass index and GERD
Pleasant Rd., Toronto, Ont. M4Y 2Y5. Tel.: (416) 764-3916 Fax: (416) 764-3931. No part symptoms. Transient relaxation of the LES can be exacerbated by obesity or weight gain.
of this CE lesson may be reproduced, in whole or in part, without the written permission
of the publisher. 2009 These epidemiologic characteristics should be taken into consideration when evaluating a
Figure 1.
Patient seeking
medication for
Heartburn
Patient describes Patient describing any of
symptoms of the following: dysphagia, Refer
GERD or Heartburn SYMPTOMS odynophagia, bleeding, chest g immediately
consistent with pain, vomiting, involuntary to MD
definitions weight loss, chest pain
Mild/infrequent i Moderate/severe/
2X/WEEK frequent
FREQUENCY/SEVERITY/
Minimal effect on
Effect on HRQL
>3X/WEEK g Refer to MD
Follow blue chart
HRQL Significant effect
on HRQL i
PPI once daily
PREDICTABILITY dosing
YES NO
i i PHARMACIST INTERVENTIONS
Response: continue Refer to MD
this as PRN therapy Follow blue chart PHYSICIAN INTERVENTIONS
Omeprazole 20 mg once daily Recommended to: 1) give dose twice daily in non-responders or partial responders 2)
Example: Losec; Losec MUPS 30 minutes before breakfast or halve dose for maintenance therapy when possible.
dinner Caution when combining with other medication metabolized by CYP450 enzymes.
Side effects: Abdominal pain, diarrhea, headache
Rabeprazole 20 mg once daily See recommendations and caution for omeprazole
Example: Pariet 30 minutes before breakfast or Side effects: Diarrhea, nausea, vomiting, constipation, headache
dinner
BC Case Study Details on each of these elements can be found in the CPBCs
Orientation Guide for PPP-58.
Prescription adaptation by pharmacists in BC
The BC governments 2008 Health Professions (Regulatory Reform) Types of adaptation
Amendment Act formalizes a pharmacists authority to renew The current scope of practice in BC specifies three professional
existing prescriptions. The College of Pharmacists of British activities as adapting a prescription:
Columbia (CPBC) developed Professional Practice Policy #58 (PPP- Changing the dose, formulation or regimen of a prescription
58), entitled Protocol for Medication Management Adapting to enhance patient outcomes;
a Prescription, to guide pharmacists in the safe and effective Renewing a prescription for continuity of care; and
adaptation, including renewal, of existing prescriptions. This policy Making a therapeutic substitution within the same therapeutic
took effect January 1st, 2009. (See College of Pharmacists of British class for a prescription to best suit the needs of the patient.
Columbia. Professional Practice Policy #58 Orientation Guide: Details on the three types of prescription adaptation can be
Medication Management [Adapting a Prescription]). Pharmacists found in the College of Pharmacists of BCs Orientation Guide
in BC have the authority to adapt prescriptions without prior for PPP-58 and the Amendment to the Orientation Guide. It is
approval from the prescriber; however, they are not obligated to important to be aware of the specific requirements around the
do so. The decision to adapt or not to adapt a prescription is at three types of adaptation; for example, renewals apply only to
the discretion of the individual pharmacist. Once a pharmacist stable, chronic conditions for which the patient has taken the same
adapts a prescription, they assume responsibility and liability, for medication for at least six months. As well, changes to dose or
that prescription. PPP-58 sets out seven fundamental elements that regimen and therapeutic substitutions are restricted to specific
must be fulfilled when adapting a prescription: conditions or classes of drug unless the pharmacist is in a practice
Individual competence setting where collaborative relationships or appropriate protocols
Appropriate information are established.
Prescription Pharmacists cannot adapt a prescription if the original prescription
Appropriateness of prescription has expired (one year from the date the original prescription was
Informed consent written, or two years for oral contraceptives). Pharmacists also
Documentation cannot adapt a prescription for narcotic, controlled drugs or
Notification of other health professionals targeted substances.
Case Study says hes managed to reduce his coffee intake to three cups a day
This case study is an example of a scenario that could occur in and hes even playing soccer regularly. You congratulate him and
a community pharmacy. It illustrates how pharmacists can play a encourage him to continue with his changes.
role in helping their patients manage a condition such as GERD. About six months later Gordon returns with a refill prescription
In an effort to ensure an optimal patient outcome, the pharmacist for pantoprazole. He explains that will be away for business for the
may decide to adapt a prescription. This decision must follow the next six weeks and would like to get a two-month supply instead
seven fundamental elements outlined in PPP-58. The intention of of the usual four weeks. The prescription is written for a four-week
this case is to examine how a pharmacist may handle a specific supply, it is Saturday afternoon and Gordon will be leaving the next
situation involving a specific patient. It is not the intention of this day. During your discussion, you administer the PASS test15 and
case study to imply that all pharmacists should adapt a prescription Gordon reports satisfactory symptom relief.
in this manner or that it would be appropriate for all situations. In the interest of continuity of care, you explain to Gordon that
Forty-year-old Gordon, a regular patient in your pharmacy, you can adapt the prescription and dispense an eight-week supply.
arrives to pick up a prescription for omeprazole 20 mg daily. You also tell him that you will fax his doctor to let him know of this
Previously, Gordon had used whatever antacids he had on hand to change. Gordon agrees.
relieve his symptoms of GERD. He has been using these products Two months later, Gordon has run out of his medication. He
off and on for the past few months but lately his symptoms have was unable to keep his last doctors appointment and he is leaving
worsened. Gordon confides that he doesnt understand why his town again. You proceed with an assessment. You determine that
symptoms are getting worse and that his doctor suggested that he he is not experiencing any alarm symptoms but this time his
talk to you about some lifestyle changes. You work closely with his PASS test is positive: his sleep has been affected by his heartburn,
doctor and have established a good working relationship with him, especially when he is away on business. After reviewing the
so this request is not a surprise. You tell Gordon that changes to seven fundamentals of adapting a prescription, as defined by
ones food and lifestyle habits sometimes help with symptoms. PPP-58, you decide to adapt Gordons prescription by making a
Gordon says he is 59 and weighs 190 lbs; you calculate his BMI therapeutic substitution. You explain to Gordon that his present
to be 28 Kg/m2. He tells you that he has gained some weight over therapy regimen is not effective and suggest an alternative PPI,
the last few months because of his new position. He has an office esomeprazole 40 mg once daily. As with your earlier adaptation to
job and likes to eat out quite a bit, especially at greasy spoons. He ensure continuity of care, in reaching this decision you meet the
does not smoke but lives on coffee. His idea of relaxing is having seven fundamentals of adaptation:
a few beers with his buddies while watching sports on television. Individual competence You have adequate understanding of the
When you ask if any particular foods or beverages seem to trigger condition being treated, treatment alternatives and the drug
his symptoms, he reluctantly admits that spicy foods really cause being prescribed. You are familiar with the Practice Guidelines
a burn. prepared by the Canadian Consensus Conference on the
You realize that Gordon may benefit from a few lifestyle management of gastroesophageal reflux disease.2
interventions (see Table 5). You make the following suggestions: Appropriate information You have enough information about
lose some weight, eat smaller meals, avoid wearing tight clothing, the specific patients health status to ensure that the prescribing
limit his alcohol and coffee intake, and avoid spicy and fatty foods. decision will maintain or enhance the effectiveness of the drug
You also suggest Gordon keep a food diary. therapy and will not put the client at increased risk. You have
You ask him how confident he would be about making these assessed the patient and feel comfortable that the client has
changes. He says some would be fairly easy, but hes not sure if hes shared all pertinent information available with you.
ready to cut back on coffee and alcohol. You agree that it would be Prescription You have the original prescription for
a lot to change at once so you ask him what changes he would be pantoprazole.
willing to commit to. He agrees to eat smaller meals and to limit his Appropriateness of adaptation According to the PPP-58
alcohol intake to no more than two drinks per day. He will also try amendments, unless in practice settings such as hospital,
to go to the gym once a week. Its a great start and you tell him so. long-term care facilities or multi-disciplinary environments
But you also explain to him that, even with the suggested lifestyle where collaborative relationships or appropriate protocols are
changes, his symptoms may persist, but to a lesser degree. Gordon established, pharmacists will limit therapeutic substitution to:
understands, but says his physician told him his symptoms could histamine 2 receptor blockers (H2 blockers), non-steroidal anti-
get worse over time and he would like to prevent that. inflammatory drugs (NSAIDs), nitrates, angiotension converting
Nine weeks later, Gordon returns with a new prescription for enzyme inhibitors (ACE inhibitors), dihydropyridine calcium
pantoprazole 40 mg daily. He had been experiencing inadequate channel blockers (dihydropyridine CCBs) and proton pump
symptom relief so his physician decided to try him on this inhibitors (PPIs)similar to government policies.
medication. Gordons doctor has encouraged him to continue Esomeprazole is a proton pump inhibitor and is indicated for
working with you on his lifestyle changes. You ask Gordon about treatment of conditions where a reduction in gastric secretion
his progress and he says he made all the changes the two of you is required, such as reflux esophagitis and maintenance
had discussed. The food diary has helped him be more aware treatment of patients with reflux esophagitis.3 Reflux symptom
ofand avoid the foods that bother him. After some discussion, improvements in PASS study results were associated with a switch
Gordon agrees to limit his coffee to no more than three cups a to esomeprazole 40 mg daily from another PPI. Esomeprazole at
day four, tops! He has a follow-up appointment with his doctor a dose of 40 mg daily produces more prolonged acid suppression
in four weeks and promises to let you know how it goes. than standard doses of the four other PPIs available in Canada4
Gordon returns four weeks later with a prescription to refill his and is associated with somewhat higher healing rates than
pantoprazole. He tells you the medication seems to be working and omeprazole,5,6 lansoprazole,7 and pantoprazole8 for patients
9. The best choice for treatment of patients infection in up to 20% of patients. professionals of an adaptation which
with mild GERD with predictable b) PPI use can cause pneumonia of the following does not need to be
symptoms is: in 45% of elderly patients with included:
a) Tums underlying respiratory conditions. a) patient information and pharmacist
b) ranitidine 3060 minutes prior to c) The risk of side effects with PPI use information
trigger event (e.g., large meal) is low. b) description of the adaptation
c) avoid lying down after the meal d) When PPIs are compared with (including all relevant prescription
placebo, headaches occur more details)
10. Approximately what percentage
frequently in patients on PPIs than c) rationale for adaptation (including
of pregnant patients entering your
in patients on placebo. pertinent details of your assessment
pharmacy will experience GERD?
and patient history along with
a) 1015% 17. The H2RA associated with the most
any directions to the patient and
b) 2530% significant drug interactions due to
relevant follow-up plan)
c) 4580% inhibition of CYP450 enzymes is:
d) patient medication profile
d) 90% a) ranitidine
e) acknowledgment of informed
b) cimetidine
11. Which of the following statements consent
c) nizatidine
about the treatment of GERD during
d) famotidine 23. When making a therapeutic drug
pregnancy is most accurate?
a) First-line treatment should be 18. All PPIs have demonstrated competitive substitution within the same
H2RAs since most patients dont inhibition of the following CYP450 therapeutic class, which of the
respond to antacids. enzyme: following conditions must be met?
b) Pharmacists should always suggest a) 3A4 a) The decision is in the best interest
using the lowest effective dose b) 2C9 of the patient.
possible for the shortest period of c) 2C19 b) You maintain your professional
time possible. d) 2D6 independence and avoid any
c) Health Canada states that PPIs are e) none conflict of interest.
safe and effective in pregnancy. c) You have considered all relevant
19. On PPI prescription renewal, which of information about the patient, the
d) Patients should be referred to their
the following questions are the most condition and the medication and
physician for treatment.
important to ask? have communicated this to the
12. When treating moderate to severe a) Are you still experiencing patient and have received their
GERD the physician will often heartburn? consent for the substitution.
a) order an endoscopy b) Are you taking any other d) You take full responsibility for your
b) begin with twice-daily PPI therapy medications for heartburn? decision.
c) order an H2RA blocker first to c) Do your symptoms affect your e) The medication falls into one of the
determine if this is sufficient for the sleep? following drug classes: H2 blockers,
patient d) All of the above NSAIDs, nitrates, ACE Inhibitors,
d) begin treatment with a once-daily e) a and c dihydropyridine CCBs or PPIs
PPI unless you work in a practice
20. Which of the following statements
e) advise patients to begin treatment with an established protocol or
about PPI superiority over H2RAs in
with antacids collaborative relationship.
the treatment of GERD is inaccurate:
13. Patients started on PPI therapy should a) Patients do not exhibit f) All of above
be reassessed after: tachyphylaxis to PPI effects on acid 24. In BC, which of the following
a) two weeks suppression. medications would be allowed under
b) six months b) PPIs have been shown to heal PPP-58?
c) four to eight weeks esophagitis faster. a) esomeprazole
d) one week c) PPIs have a longer duration of b) captopril
action. c) lorazepam
14. Patients who have responded well to
d) PPIs have fewer side effects. d) a and b
standard treatment for GERD can
e) PPIs are more effective at keeping e) all of the above
discontinue their medication to see if
gastric pH above 4 for longer
continued therapy is warranted. 25. Which of the following is not considered
periods of time.
a) true an adaptation?
b) false 21. The seven fundamentals of a) changing the dose, formulation
adaptation in BC are: individual or regimen of a prescription to
15. Intermittent therapy is step-down
competence, appropriate information, enhance patient outcomes
therapy used for patients with frequent
prescription, appropriateness of b) renewing a prescription for
severe GERD to control symptoms
adaptation, education, documentation continuity of care
without being on continuous therapy.
and notification of other health c) making a therapeutic substitution
a) true
professionals. within the same therapeutic class
b) false
a) true for a prescription to best suit the
16. Which of the following statements b) false needs of the patient
about PPI side effects is most accurate? d) none of the above
a) PPI use can cause C. difficile 22. When notifying other health
References, main lesson 26. Li XQ, Anderson TB, Ahlstrom M et al. Comparison of inhibitory effects of the proton pump-
1. Armstrong D, Marshall JK, Chiba N et al. Canadian consensus conference on the inhibiting drugs omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole on
management of gastroesophageal reflux disease in adults, update 2004. Can J Gastroenterol human cytochrome P450 activities. Drug Met Disposition 2004;32(8): 821-7.
2005;19:15-35. 27. Gerson LB, Triadafilopoulos G. Proton pump inhibitors and their drug interactions: an
2. Dent J, El-Serag HB, Wallander MA et al. Epidemiology of gastro-oesophageal reflux disease: evidence-based approach. Eur J Gastroenterol Hepatol 2001;13(5):611-6.
a systematic review. Gut 2005;54:710-7. 28. Wang L-S, Zhou G, Zhu B, et al: St Johns wort induces both cytochrome P450 3A4-catalyzed
3. Tougas G, Chen Y, Hwang P et al. Prevalence and impact of upper gastrointestinal symptoms sulfoxidation and 2C19-dependent hydroxylation of omeprazole. Clin Pharmacol Ther 2004;
in the Canadian population: Findings from the DIGEST study. Am J Gastroenterol 75(3):191-7.
1999;94:2845-54. 29. Juurlink DN, Gomes T, Ko DT et al. A population-based study of the drug interaction
4. Carter B, Campeau L. The top Rx drugs in Canada. Our annual look at whats topping the between proton pump inhibitors and clopidogrel. CMAJ March 31, 2009; 18(7)713-8.
charts in prescriptions. Pharmacy Practice 2009:April/May:30-4. 30. Ho MP, Maddox TM, Wang L et al. Risk of adverse outcomes associated with concomitant
5. Moayyedi P, Santana J, Khan M, et al. Medical treatments in the short-term management use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA
of reflux oesophagitis. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: 2009;301:937-44.
CD003244. DOI:10.1002/14651858.CD003244.pub2. 31. ODonoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical
6. Greenberger N, Current Diagnosis and Treatment in Gastroenterology, Hepatology and efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of
Endoscopy. 3rd Edition: McGraw Hill Companies, Inc, 2009. two randomised trials. The Lancet 2009;374(9694):989-97.
7. Vakil N, van Zanten S, Kahrilas P, et al. The Montreal Definition and classification of 32. Kahrilas PJ, Gastroesophageal reflux disease. N Engl J Med 2008;359:1700-7.
gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 33. Micromedex Healthcare Series [intranet database]. Version 5.1. Greenwood Village, Colo:
2006;101:1900-20. Thomson Reuters (Healthcare) Inc.
8. Armstrong D, Marchetti N. Pharmacist-specific guidelines for the medical management of 34. Reimer C, Sondergaard B, Hilsted L, et al. Proton-pump inhibitor therapy induces acid-
GERD in adults. Can Pharmacists J 2008:141(Suppl. 1);S10-S15. related symptoms in healthy volunteers after withdrawl of therapy. Gastroenterology
9. Chiba N, Wilkinson JM, Hunt RH. Speed of healing and symptom relief in grade II to IV 2009;137:80-7.
gastroesophageal reflux disease: a meta-analysis. Gastroenterology 1997;112(6):1798-1810. 35. BJornsson H, Abrahamsson M, Simren N, et al. Discontinuation of proton pump inhibitors
10. vanPinxteren B, Numans ME, Lau J, et al. Short-term treatment of gastroesophageal reflux in patients on long-term therapy: a double-blind, placebo-controlled trial.
disease. J Gen Intern Med 2003;18:755-63. 36. Hunfeld NG, Geus WP, Kuiper EJ, et al. Systematic Review: Rebound acid hypersecretion
11. Shi S, Klotz U. Proton pump inhibitors: an update of their clinical use and after therapy with proton pump inhibitors. Aliment Pharmacol wTher 2007;25:39-46.
pharmacokeinetics. Eur J Clin Pharmacol 2008;64:935-51. 37. Ali T, Roberts NR, Tierney WM. Long-term safety concerns with proton pump inhibitors; Am
12. Klotz U. Clinical impact of CYP2C19 polymorphism on the action of proton pump J Med 2009;122:896-903.
inhibitors: a review of a special problem. Int J Clin Pharmacol Ther. 2006 Jul;44(7):297-302. 38. Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in
13. Saitoh T, Otsuka H, Kawasaki T et al. Influences of CYP2C19 polymorphism on patients taking acid suppression. Am J Gastroenterol 2007:102(9):2047-56.
recurrence of relux esophagitis during proton pump inhibitor maintenance therapy. 39. Myles PR, Hubbard RB, McKeever TM, et al. Risk of community-acquired pneumonia and the
Hepatogastroenterology. 2009 May-Jun;56(91-92):703-6. use of statins, ACE inhibitors and gastric acid suppressants: a population-based case control
14. Furuta T, Sugimoto M, Kodaira C et al. CYP2C19 genotype is associated with symptomatic study. Pharmacoepidemiol Drug Saf 2009:18(4):269-275.
recurrence of GERD during maintenance therapy with low-dose lansoprazole. Eur J Clin
Pharmacol. 2009 Jul;65(7):693-8.
15. Armstrong D, Veldhuyzen SJ, Chung SA et al. Validation of a short questionnaire in English
References, BC case study
1. Armstrong D, Veldhuyzen SJ, Chung SA et al. Validation of a short questionnaire in English
and French for use in patients with persistent upper gastrointestinal symptoms despite
and French for use in patients with persistent upper gastrointestinal symptoms despite
proton pump inhibitor therapy: the PASS (Proton pump inhibitor acid suppression symptom)
proton pump inhibitor therapy: the PASS (Proton pump inhibitor acid suppression symptom)
test. Can J Gastroenterol 2005:19:350-8.
test. Can J Gastroenterol 2005:19:350-8.
16. Veldhuyzen SJ, Bradette M, Chiba N et al. Evidence-based recommendations for short-
2. Armstrong D, Marshall JK, Chiba N et al. Canadian consensus conference on the
and long-term management of uninvestigated dyspepsia in primary care: an update
management of gastroesophageal reflux disease in adults, update 2004. Can J Gastroenterol
of the Canadian Dyspepsia Working Group (CanDys) clinical management tool. Can J
2005;19:15-35.
Gastroenterol. 2005 May;19(5):285-303.
3. Compendium of Pharmaceuticals and Specialities. Ottawa:Canadian Pharmacists Association
17. Schaefer C, Drugs During Pregnancy and Lactation: Handbook of Prescription Drugs and
2009.
Comparative Risk Assessment. First Edition: Elsevier Science B.V., 2001.
4. Miner P, Katz P, Chen Y, et al. Gastric acid control with esomeprazole, lansoprazole,
18. Gill SK, OBrien L, Koren G. The safety of histamine 2 (H2) blockers in pregnancy: a meta-
omeprazole, pantoprazole, and rabeprazole: a five-way crossover study. Am J Gastroenterol
analysis. Dig Dis Sci. 2009 Sept;54(9):1835-8.
2003; 98:2616-20.
19. Gill SK, OBrien L, Einarson TR et al. The safety of proton pump inhibitors (PPIs) in
5. Richter J, Kahrilas P, Johanson J, et al. Efficacy and safety of esomeprazole compared with
pregnancy: a meta-analysis. Am J Gastroenterol. 2009 Jun;104(6):1541-5.
omeprazole in GERD patients with erosive esophagitis: a randomized controlled trial. Am J
20. Repchinsky C, editor. Compendium of pharmaceuticals and specialties. Ottawa, ON:
Gastroenterol 2001;96:656-65.
Canadian Pharmacists Association: 2008
6. Kahrilas P, Falk G, Johnson D, et al. Esomeprazole improves healing and symptom resolution
21. Helms RA, Quan DJ, Herfindal ET, et al. Textbook of Therapeutics Drug and Disease
as compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial.
Management; 8th Edition: Lippincott Williams and Wilkins, 2006.
The Esomeprazole Study Investigators. Aliment Pharmacol Ther 2000;14:1249-58.
22. Lindblad A, Sadowski C. The safety of proton pump inhibitors. Can Pharmacists J
7. Castell D, Kahrilas P, Richter J, et al. Esomeprazole (40 mg) compared with lansoprazole (30
2008:141(Suppl.1);S19-S21.
mg) in the treatment of erosive esophagitis. Am J Gastroenterol 2002; 97:575-83.
23. Yang YX, Lewis JD, Epstein S, et al. Long-term proton pump inhibitor therapy and risk of hip
8. Labenz J, Armstrong D, Lauritsen K, et al. A randomized comparative study of esomeprazole
fracture. JAMA 2006;296:2947-53.
40 mg versus pantoprazole 40 mg for healing erosive oesophagitis: the EXPO study. Aliment
24. Garcia Rodriguez LA, Ruigomez A. Gastric acid, acid-suppressing drugs, and bacterial
gastroenteritis: how much of a risk? Epidemiology 1997;8:571-4. Pharmacol Ther 2005;21:739-46.
25. Dial S, Alrasadi K, Manoukian C, et al. The safety of proton pump inhibitors: cohort and
case-control studies. CMAJ 2004;171:33-38.
Faculty: Pharmacist Guidelines for the Management of GERD in Adults: Opportunities for Practice Change under B.C.s Protocol for
Medication Management (PPP # 58).
If you have not registered for our Online Ce Program and wish to answer online,
please click here: http://ce.pharmacygateway.com/Pharmacy/login/adduser.asp
Mayra Ramos
Pharmacy Practice, Pharmacy Post, Drugstore Canada, Novopharm CE Series,
More CCCEP-approved CEs or Tech Talk CEs (English and French)
Fax: (416) 764-3937
Email: mayra.ramos@rci.rogers.com
Francine Beauchamp
Quebec Pharmacie and Lactualite Pharmaceutique
Fax: (514) 843-2183
Email: francine.beauchamp@rci.rogers.com