History: K.M is a 29 year old male who
presented to the pharmacy at UBC to fill a new prescription for Pantoprazole
for his GERD.
KM has no known allergies. He
had a mild intolerance to clarithromycin few years back (stomach upset). KM
currently using ibuprofen 300mg PO QID prn and Rub A-535 prn topically for his Muscle
Pain. KM is a non-smoker who drinks 3-4 cups of coffee a day in addition to 2
glasses of coke per day. He has around 3 beers/week. Patient is relatively
active, plays hockey with his friends. His diet is imbalanced full of junk food
(burgers and fries).
Patient went to see the doctor
today because of uncontrolled symptoms of GERD. He tried Maalox suspension and
Signs and symptoms: KM
expressed heartburn and reflux symptoms are bothersome. The doctor prescribed a
4 week course of Pantoprazole 40mg Extended release.
Necessary: This patient has GERD. GERD causes
reduction in LES tone and resulting in regurgitation of stomach content. Most
common symptoms may include heartburn, hypersalivation, and regurgitation of
acidic contents into the mouth and throat. epigastric pain may be present. GERD
can decrease the quality of life for the patient and may result in erosion or
bleeding of the esophagus. Causes of GERD are multifactorial and usually
challenging to determine.
Patient’s history consists of
the common signs and symptoms for GERD and it is enough to diagnoses KM with
GERD. No invasive testing is
recommended. The presence of heartburn and acid reflux confirms the diagnosis
of GERD. There is no alarming symptoms present; odynophagia, dysphagia,
frequent nausea and vomiting, hematemesis, black bloody stools and
unintentional weight loss. The goal of therapy in KM is to cure GERD and
prevent recurrence if possible. Elimination of the heartburn and acid reflux.
of GERD is based on the severity of
the presenting symptoms. In patients with mild symptoms and no complications
is composed of:
Non-pharmacological options and pharmacological choices (Prescription and OTC).
Lifestyle modifications is the cornerstone of therapy in GERD. The most
important lifestyle modifications include weight loss, decrease caffeine, and
alcohol intake. Avoid meals 2-3 hours before bedtime, no fatty-fried foods,
chocolates and others. But the most efficient one is weight loss. Other
non-pharmacological majors include elevating the head of the bed and avoiding
tight fitted clothes.
There are few OTC medications
available including antacids, alginates and H2RA. It may be used in
mild-moderate cases to self-treat. Proton pump inhibitors are a prescription
only options for patients with moderate-severe GERD.
was taking the occasion Maalox (Aluminium
hydroxide/ Magnesium hydroxide) oral suspension 15ml as needed. It didn’t relief his symptoms. Patient requires a different therapy for his
The patient went to the doctor
to assess his condition and doctor prescribed Pantoloc® (pantoprazole sodium) 40mg Tablet once daily for 4 weeks. followed by an
appointment with the physician to reassess his GERD.
The patient would have benefited from H2RA
trials first before starting him on PPI. The
Pantoprazole is a proton pump
inhibitor (PPI), it irreversibly bind to the gastric H+/k+-ATPase pump in the
parietal cells in the stomach. This closes the proton pump resulting in blockage
of gastric acid secretion.(1) It is indicated for the treatment of GERD and other GI
disorders involving gastric acid. PPI are most effective in treating/managing
GERD. Usually a course of 8 weeks is recommended to produce healing (2).
Pantoloc was prescribed as 40 mg once daily extended release tablets for 4
weeks taken 30 minutes before breakfast. This is the dose approved for GERD.
Healing usually achieved at end of 4 weeks.(1) The patient is expected to see
relief of symptoms in 1 week. It has no drug- drug interactions with the
current medication this patent is taking.
therapies includes the use of H2RA first. Such as Ranitidine.
Safe: this drug has common adverse effects that
might experience such as headache, nausea, rash and diarrhea. This medication