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ISRN Obstet Gynecol, 2012; 2012: 481870. doi: 10.5402/2012/481870. Accreditation Number: A2008RP1 (Exp: 31/07/2022) This activity has been accredited for 1 hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacists CPD plan, which may be converted to 1 hour of Group Two CPD (or 2 CPD credits) upon successful completion of the associated assessment activity. 1. What is the FIRST step in addressing patients with GORD taking a proton pump inhibitor (PPI) who experience inadequate symptom control after four to eight weeks of PPI therapy? A) Increase the dose of the PPI to a high-dose regimen. B) Refer the patient for an endoscopy. C) Start the patient on a PPI in the morning and histamine H2 receptor antagonist at night. D) Taper the dose or cease the PPI completely. E) Check the adherence of the patient to their PPI therapy regimen. 2. Which of the following describes the mechanism of action of alginates in the management of GORD symptoms? A) Neutralisation of stomach acid. B) Limit exposure of the oesophagus to stomach acid by forming a buffer between the acid pocket and oesophagogastric junction and modulate other GORD factors such as pepsin. C) Elevate gastric pH for about six hours by inhibiting one pathway of gastric acid secretion. D) Inhibition of the final common step in three different pathways that contribute to acid secretion to reach a maximum effect after three to four days. 3. Which of the following statements about proton pump inhibitors (PPIs) is INCORRECT? A) PPIs only inhibit active forms of the proton pump. B) The maximum effect of PPIs is not reached until three to four days after commencing therapy as not all proton pumps are active after a meal. C) About one-third of patients taking PPIs experience breakthrough symptoms D) Standard doses of PPIs include 40mg pantoprazole, 20mg omeprazole and 40mg esomeprazole. E) PPIs are generally more effective at suppressing acid secretion than histamine H2 receptor antagonists. 4. Which of the following statements about treatment of GORD is INCORRECT? A) Antacids persist in an empty stomach for 20 minutes and for 60 minutes when taken after a meal. B) Both antacids and alginates have a fast onset of action. However, systematic review indicates that alginates provide a significant treatment benefit over antacids. C) Systematic review indicates that PPIs and H2RAs are more effective than alginates at managing GORD symptoms. However, this was not statistically significant. D) Systematic review indicates that H2RAs are more effective than alginates at managing GORD symptoms and elevate stomach pH for at least 24 hours. E) H2RAs can be used as add-on therapy for patients with symptoms that are inadequately controlled with a PPI. 5. Which of the following statements about treatment of GORD is INCORRECT? A) H2RAs have a relatively slow onset of action as they must be absorbed systemically. B) H2RAs should be added into PPI therapy in the morning as they have been shown to inhibit daytime acid secretion. C) Meta-analysis suggests that H2RAs are more effective than alginates. However, the pooled estimate was not significant. D) Education plus add-on alginate therapy has been shown to help patients taper their PPI dose leading to cessation of PPI therapy. E) Pharmacists and support staff have a key role to play in helping patients taper and cease their PPI, including recommendation of OTC add-on therapies. CPD ACTIVITY 53 OTC options to help patients reduce and cease PPI use 2 CPD CREDITS RETAIL PHARMACY • AUG 2020