A 28-year-old pregnant woman is seen in her obstetricianâs office for a routine appointment during her thirtieth week of gestation. This is her second pregnancy, and she has been feeling tired. The baby is measuring large for gestational age, and she states that the baby has been giving her heartburn. She is craving spicy, Mexican food and cannot get enough of chips and salsa. The NMW reminds the young woman that she still has approximately 10 weeks until delivery. She reminds her to continue to take her vitamins and iron supplements and to cut back on the spicy foods, especially before bedtime, to decrease the incidence of heartburn or gastroesophageal reflux.

In the digestive system, the stomach is stimulated by eating to produce large volumes of gastric secretions. The secretion that is responsible for converting pepsinogen to pepsin and acts as a bactericide against swallowed organisms is:

1. Gastroferrin
2. Hydrochloric acid
3. Intrinsic factor
4. Chymotrypsin

Explain your answer and why the other 3 are not correct:

The patient returns for her f/u appt in 2 weeks. Despite being faithful with her lifestyle modifications, her heartburn is worse. Sheâs unable to sleep at night because of it even with her husband putting the head of their bed up on blocks. She is miserable and exhausted. Sheâs tried TUMS without any relief. Although sheâs not lost weight, her appetite has decreased as sheâs afraid to eat due to the pain. What would be the first line medication you would consider for this patient? Why?