TY - CHAP M1 - Book, Section TI - Gastroesophageal Reflux Disease A1 - May, Dianne A1 - Thiman, Michael A1 - Rao, Satish S.C. A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael PY - 2017 T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - Patient Care Process for the Management of Gastroesophageal Reflux DiseaseCollectPatient characteristics (e.g., age, race, sex, weight, body mass index, pregnancy status)Patient history (past medical, family, social, dietary habits, tobacco use)Health literacy and barriers to medication accessHistory of prescription, nonprescription, and natural medication useMedication allergies and intolerances (include actual reactions to medication)Laboratory results for major organ function (e.g., SCr, liver enzymes)The type, frequency, and duration of GERD symptoms, and identify exacerbating factors (see Clinical Presentation)AssessAssess major organ function (e.g., creatinine clearance, hepatic impairment)Determine if alarm symptoms or extraesophageal symptoms are present that require further diagnostic evaluation. (see Clinical Presentation)Identify lifestyle factors, foods, and medications that may be contributing to symptoms. (see Table 32-1)Assess the effectiveness of previous and current treatments for GERD (including medications and lifestyle modifications).Assess the appropriateness and effectiveness of current GERD regimen. Determine if goals of therapy are currently being met. (see Desired Outcomes)Plan*Identify individualized lifestyle modifications that can be made to improve symptoms. (see Table 32-4)Determine appropriate therapy (may include both nonpharmacologic and pharmacologic) based on patient's presentation. (see Table 32-2)For pharmacologic therapy, include medication name, dose, route, frequency, and duration of therapy recommendation. (see Table 32-3)Establish monitoring parameters for safety (e.g., drug-drug, drug-food, drug-disease, and drug-lab interaction checking; short- and long-term adverse effects, and prevention of complications).Establish monitoring parameters for efficacy (e.g., resolution of symptoms, improvement of symptoms, and healing of injured mucosa). (see Table 32-5)Identify patient education that may be needed (e.g., purpose of medication, individualized lifestyle modifications, adverse effects, administration clinical pearls, adherence, potential need for long-term maintenance therapy, etc.)Implement*Provide patient education with regard to disease state, lifestyle modifications, and treatment plan. (see Table 32-4)Initiate appropriate nonpharmacologic and pharmacologic therapy based on patient presentation. (see Table 32-2, Table 32-3)Recommend additions, modifications, or discontinuations to therapy based on patient response. Provide patient education with regard to disease state, lifestyle modifications, and treatment plan (see Table 32-4). Explain a) what causes GERD and things to avoid; b) when to take medication (e.g., 30 minutes before meal); c) what potential adverse effects or drug interactions may occur.Use motivational interviewing techniques to maximize medication adherence.Schedule follow-up as appropriate.Follow-up: Monitor and EvaluateFollow up after 8-16 weeks to assess effectiveness of acid-suppression therapy. Recommend alternative therapy when necessary.For refractory symptoms, seek potential causes such as medication adherence, timing of medication, drug interactions, etc.Evaluate the need for maintenance therapy based on patient presentation and response to therapy.Assess improvement in quality-of-life measures such as physical, psychological, and social functioning and well-being.Evaluate patient for the presence of adverse drug reactions, complications or new drug-drug interactions.Stress the importance of medication adherence to treatment plan*Collaborate with patient, caregivers, and other health professionals SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1165937718 ER -