Instructions: CF is a 48-year-old man who presents for evaluation of heartburn. He denies current tobacco use but has a history of one ppd for 15 years. He consumes a glass of wine nightly, more on the weekends. He has a sedentary job.

He reports a burning feeling in his chest after eating. It is worse when he eats spicy foods or tomato sauce. He is sometimes awakened at night with these symptoms. He has tried over-the-counter antacids and histamine H2 receptor antagonists (H2RAs) with partial relief. He is on no medications regularly. His examination today is normal. An upper gastrointestinal (GI) x-ray series reveals gastroesophageal reflux.

1. What lifestyle modifications do you recommend for CF?
2. Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.
3. What counseling points about this medication do you give CF?

Answer: Gastroesophageal reflux disease is a condition in which the contents of the stomach leak upwards from the stomach and into the esophagus…….