Question

For this module's discussion, research one of the following:

• Gastroesophageal Reflux Disease (GERD)
• Urinary Tract Infection (UTI)

In your initial post:

1. Provide a brief description of the condition you selected and its symptoms.
2. Identify medications that are commonly prescribed for its treatment. Be sure to include both generic and trade names.
3. Explain how the medication is administered.

For your reply post:

Review the posts made by your classmates and reply to at least one suggesting options other than medications that can help patients who suffer from GERD or UTIs.

Answer 1

• Gastroesophageal Reflux Disease (GERD)

The backward flow of stomach contents (chyme) into the esophagus without associated vomit. It is considered a disease when symptoms are severe, mucosal damage has occurred, or symptoms occur frequently.

The main pathophysiology behind the Gastroesophageal Reflux Disease is due to the decreased lower esophageal sphincter pressure allows stomach contents to backflow into the esophagus, this causes an inflammatory response to occur
With long term exposure this inflammation becomes chronic

Signs and symptoms :

The most common symptom is heartburn
-Sour taste in the morning
-Regurgitation
-Dysphagia
-Coughing
-Belching
-Chest pain
-Atypical symptoms: asthma and cough

Medications:

The medications that are commonly prescribed for the treatment of GERD are :

*Rabeprazole (Trade name: AcipHex, generic name: rabeprazole sodium; Eisai)

Administration:

Healing or erosive or ulcerative GERD

• 20 mg PO qDay for 4-8 weeks; if not healed after 8 weeks, an additional 8-week course may be considered
• Maintenance dosing (20 mg/day for up to 12 months) shown to reduce relapse rates

Symptomatic GERD

• Treatment of daytime and nighttime heartburn and other symptoms associated with GERD
• 20 mg PO qDay for 4 weeks; if symptoms not completely resolved after 4 weeks, an additional course may be considered

*Esomeprazole (Trade name: Nexium, generic name: Esomeprazole)

Administration:

GERD With Erosive Esophagitis

Adult Patients

The recommended adult dose is either 20 mg or 40 mg NEXIUM given once daily by intravenous injection (no less than 3 minutes) or intravenous infusion (10 minutes to 30 minutes). Safety and efficacy of NEXIUM I.V. for Injection as a treatment of GERD patients with erosive esophagitis for more than 10 days have not been demonstrated. Dosage adjustment is not required in patients with mild to moderate liver impairment (Child-Pugh Classes A and B). For patients with severe liver impairment (Child-Pugh Class C), a maximum dose of 20 mg once daily of NEXIUM should not be exceeded.

Pediatric Patients

The recommended doses for children ages 1 month to 17 years, inclusive, are provided below. The dose should be infused over 10 minutes to 30 minutes.

1 year to 17 years:

Body weight less than 55 kg: 10 mg

Body weight 55 kg or greater: 20 mg

1 month to less than 1 year of age: 0.5 mg/kg

*Lansoprazole (Trade name: Prevacid, generic name: lansoprazole)

Administration: Prevacid and Prevacid SoluTab are indicated in adults and pediatric patients one year of age and older for the treatment of heartburn and other symptoms associated with GERD for up to eight weeks

*Omeprazole (Trade name: Prilosec, Zegerid, Generic name: omeprazole)

Administration:

Symptomatic GERD

Prilosec is indicated for the treatment of heartburn and other symptoms associated with GERD in pediatric patients and adults for up to 4 weeks.

The efficacy of PRILOSEC used for longer than 8 weeks in these patients has not been established. If a patient does not respond to 8 weeks of treatment, an additional 4 weeks of treatment may be given. If there is the recurrence of GERD symptoms (eg, heartburn), additional 4-8 week courses of omeprazole may be considered.

*Pantoprazole (Trade name: Protonix, generic name: Pantoprazole)

Administration:

Protonix for Delayed-Release Oral Suspension and Protonix Delayed-Release Tablets are indicated for:

Short-Term Treatment Of Erosive Esophagitis Associated With Gastroesophageal Reflux Disease (GERD)

Protonix is indicated in adults and pediatric patients five years of age and older for the short-term treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis (EE). For those adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of Protonix may be considered. Safety of treatment beyond 8 weeks in pediatric patients has not been established.

*Dexlansoprazole (Trade name :Dexilant,generic name :Dexlansoprazole)

Administration: Symptomatic Non-Erosive GERD,30mg once daily for 4 weeks

• Urinary Tract Infection

Urinary tract infection is the inflammation of the Urinary Epithelium following invasion and colonization by some pathogen within the urinary tract. Females are having a higher occurrence of UTI's because of the close proximity of the reproductive tract, urinary tract, and rectum.

*Signs and symptoms signs and symptoms of lower UTI :

-Dysuria,
-Urgency
-Frequency
-Nocturia
-Hematuria

*Signs and symptoms of Upper UTI:

-Flank pain
-Fever
-Nausea/Vomiting
-Malaise

*Medications:

*Generic Name: Trimethoprim/sulfamethoxazole Trade Name: Bactrim, Septra, others)

Administration:

For the treatment of urinary tract infection (UTI), including pyelonephritis and cystitis.

Oral dosage

Adults

160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours. The Infectious Diseases Society of America (IDSA) recommends a 3 day treatment course for acute, uncomplicated cystitis and a 14 day treatment course for pyelonephritis in female patients. For catheter-associated UTIs, the IDSA suggests that 7 days is appropriate for patients who have prompt resolution of symptoms and 10 to 14 days is recommended for those with a delayed response. The FDA-labeled duration for UTIs in general is 10 to 14 days.

Children and Adolescents 3 to 17 years

8 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 160 mg trimethoprim/800 mg sulfamethoxazole per dose) for 10 days.

Infants and Children 2 months to 2 years

6 to 12 mg/kg/day (trimethoprim component) PO divided every 12 hours for 7 to 14 days is recommended by the American Academy of Pediatrics (AAP) for the treatment of initial febrile UTI in infants and young children. The FDA-approved dosing is 8 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 160 mg trimethoprim/800 mg sulfamethoxazole per dose) for 10 days.

Intravenous dosage

Adults

For severe infections, the manufacturer recommends 8 to 10 mg/kg/day (trimethoprim component) IV in 2 to 4 equally divided doses for up to 14 days. The Infectious Diseases Society of America (IDSA) recommends a 14 day treatment course for pyelonephritis in female patients. For catheter-associated UTIs, the IDSA suggests that 7 days is appropriate for patients who have prompt resolution of symptoms and 10 to 14 days is recommended for those with a delayed response.

Infants, Children, and Adolescents 2 months to 17 years

8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for up to 14 days (Max: 960 mg trimethoprim/4,800 mg sulfamethoxazole per day) is recommended in FDA-approved labeling for severe infections.

*Generic name: Fosfomycin Trade name: Monurol

Administration:

The recommended dosage for women 18 years of age and older for uncomplicated urinary tract infection (acute cystitis) is one sachet of MONUROL. MONUROL may be taken with or without food.

MONUROL should not be taken in its dry form. Always mix MONUROL with water before ingesting.

Preparation

MONUROL should be taken orally. Pour the entire contents of a single-dose sachet of MONUROL into 3 to 4 ounces of water (½ cup) and stir to dissolve. Do not use hot water. MONUROL should be taken immediately after dissolving in water.

*Generic name: Nitrofurantoin Trade name: Macrodantin, Macrobid

Administration:

For the treatment of uncomplicated urinary tract infection (UTI) including acute cystitis.

Oral dosage (all products except oral suspension and Macrobid)

Adults

50 to 100 mg PO every 6 hours. Give for 7 days or for at least 3 days after the urine is sterile.

Infants, Children, and Adolescents

5 to 7 mg/kg/day PO given in 4 divided doses. Give for 7 days or for at least 3 days after the urine is sterile.

Oral dosage (oral suspension containing 25 mg/5mL of nitrofurantoin)

Adults

50 to 100 mg PO every 6 hours. Give for 7 days or for at least 3 days after the urine is sterile.

Children and Adolescents weighing 42 kg or more

50 to 100 mg PO every 6 hours. Give for 7 days or for at least 3 days after the urine is sterile.

Infants, Children, and Adolescents weighing less than 42 kg

5 to 7 mg/kg/day PO given in 4 divided doses. Give for 7 days or for at least 3 days after the urine is sterile.

Oral dosage (Macrobid)

Adults

100 mg PO every 12 hours for 7 days. For uncomplicated cystitis, the Infectious Diseases Society of America (IDSA) suggests 5 days of treatment.

Adolescents

100 mg PO every 12 hours for 7 days. For uncomplicated cystitis, the Infectious Diseases Society of America (IDSA) suggests 5 days of treatment.

For long-term suppressive therapy for urinary tract infection (UTI) prophylaxis in patients predisposed to urinary tract infection.

Oral dosage (all products except Macrobid)

Adults

50 to 100 mg PO as a single dose at bedtime.

Infants, Children, and Adolescents

1 mg/kg/day PO as a single dose at bedtime, or divided every 12 hours.

*Generic Name: Cephalexin Trade Name: Keflex

Administration:

For the treatment of genitourinary infection (i.e., urinary tract infection (UTI), cystitis, prostatitis).

Oral dosage

Adults

1 to 4 g daily, divided in 2 to 4 doses and generally 250 mg PO every 6 hours or 500 mg PO every 12 hours; higher doses may be necessary for more severe infections. Maximum dose is 4 g/day. In general, a treatment duration of 7 to 14 days is recommended for most indications. Guidelines recommend a beta-lactam for 3 to 7 days as alternative therapy for cystitis when other agents cannot be used. Beta-lactams generally have inferior efficacy than other agents.

Children and Adolescents 3 to 17 years

25 to 50 mg/kg/day PO in 2 to 4 divided doses (Max: 2 g/day). For severe infections, 50 to 100 mg/kg/day PO in 3 to 4 divided doses (Max: 4 g/day) may be used. In general, a treatment duration of 7 to 14 days is recommended for most indications.

Infants† and Children 2 months to 2 years

50 to 100 mg/kg/day PO in 4 divided doses for 7 to 14 days is recommended by the American Academy of Pediatrics (AAP) for the treatment of initial UTI in febrile infants and young children. The general FDA-approved dosage for pediatric patients older than 1 year is 25 to 50 mg/kg/day PO in 2 to 4 divided doses. For severe infections, 50 to 100 mg/kg/day PO in 3 to 4 divided doses may be used. In general, a treatment duration of 7 to 14 days is recommended for most indications.

*Generic Name: Ceftriaxone Sodium Trade Name: Rocephin

Administration:

For the treatment of urinary tract infection (UTI).

Intravenous or Intramuscular dosage

Adults

1 to 2 g/day IV or IM divided every 12 to 24 hours, depending on the severity of the infection. Guidelines recommend treatment for 10 to 14 days for pyelonephritis. A single dose prior to oral therapy may be used in patients not requiring hospitalization.

Infants, Children, and Adolescents

50 to 75 mg/kg/day IV or IM divided every 12 to 24 hours (Max: 2 g/day) is the FDA-approved dosage. The American Academy of Pediatrics (AAP) recommends 75 mg/kg/dose IV/IM once daily for 7 to 14 days for the treatment of initial UTI in febrile patients 2 to 24 months of age.

Premature† and Term Neonates

50 mg/kg/dose IV or IM every 24 hours is recommended by the American Academy of Pediatrics (AAP). The FDA-approved labeling recommends 50 to 75 mg/kg/day IV or IM divided every 12 to 24 hours as the general dose for pediatric patients.

*Some lifestyle modifications to lessen GERD:

-Avoid fatty foods

-Avoid peppermint

- Avoid spicy foods

-Limit ETOH

-Minimize caffeine

-Eat small meals

-Avoid medications that can worsen GERD

-Don't eat before bed

-Elevate the head of the bed

-Lose weight

-Avoid tight clothing

-Stop smoking

*Some lifestyle changes may decrease recurrence of UTI:

- urinate after coitus
- avoid diaphragms and or spermicides
- cranberry juice