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PDAT1 > 5 - GI: Heartburn > Flashcards

5 - GI: Heartburn Flashcards

1
Q

Esomeprozole

AE / Counsult

Nexium

A

Take 60 min prior to eating

May be taken WITH Antacids

<18 y/o PPI’s

Headache / Diarrhea

Constipation / Flatulence

Nausea / Ab pain / dry mouth

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2
Q

Pepcid AC

DOSE / Indication

A

Famotadine

OG / Max = 10mg / 20mg

H2RA for Heartburn

1 dose (10mg) taken with water

MAX 2 doses in 24 hour period

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3
Q

Mintox / Mylanta

AE / Consult

Aluminum hydroxide / MgOH / Simethicone

A

Diarrhea / Constipation

<14 days

FULL GLASS OF WATER

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4
Q

Pathophysiology of Heartburn

A
  • Esophogeal epithelium nerve Stimulation
    • SPICY food
    • Refluxate
  • Impaired Esophageal clearing mechanisms
  • Pressure gradient between LES / Stomach is less than normal or absent:
    • REDUCED SPINCTER TONE​
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5
Q

Pepcid Complete

CIP / DI

Famotadine + Calcium Carbonate + MgOH

A

SAME AS PEPCID

Hypersensitive to famotadine

  • Impared renal fxn*
  • Caution with Pregnancy / Lac*

PREGNANCY CAT B

WARFARIN

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6
Q

Heartburn Epidemiology

A

Men = Women

No Difference in age groups

Increase in Pregnancy

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7
Q

Medications that cause a

DIRECT IRRITANT EFFECT

A

Antibiotics

ASA / NSAIDs

Bisphonates

IRON / Potassium supplements

Quinidine / Zidovudine

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8
Q

Tums

AE / Consult

Calcium Carbonate

A

Bloating / Flatulance

<6000mg for 14 days

Take chewable tabs with FULL GLASS OF WATER

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9
Q

Medications that

REDUCE Spincter Tone

A

Alpha - agonist / blockers

Anticholinergics

Barbs / BZD’s / TCA’s

CCB’s / Nitrates / Theophylline

Estrogen / Progestrone

Dopamine / Phentolamine

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10
Q

Omeprazole Mg

Dose / Indication

A

Prilosec OTC

1Tab (20mg) qd b4 breakfast

for 14 consecutive days

Corse may be repeated once every 4 months

May take up to 1-4 days for full effect

Do NOT CRUSH OR CHEW TABS

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11
Q

Tums

CIP / DI

Calcium Carbonate

A

DNU ​<2 yo

max dose is 6000mg

Tetracyclines / Penicilin

Quinalone AB’s / Digoxin

Enteric coated drugs

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12
Q

Heartburn ALARM Symptoms

A
  • Frequent and >3 MONTHS
  • Dysphagia / odynophagia
  • Unexplained weight loss
  • N/V/D
  • Chronic hoarseness / wheezing / coughing / choking
  • Chest Pain w/​
    • sweating / pain radiating to shoulder-arm-neck-jaw
    • Shortness of breath = SOB
  • ​Evidence of GI BLEEDING
  • Personal / H/o ULCERS
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13
Q

Zantac OTC

MAX Dose

A

Ranitidine HCL

<2 tabs in 24 hours

(2 - 75mg tablets = 150mg /day)

do not use consecutive days for

>14 days!

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14
Q

Esomeprazole MgH3

Dose / Indication

A

Nexium 24hr

PPI for heartburn

20mg qd for 14days

May take up to 3 days to be effective

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15
Q

S/S of Heartburn

A

Burning Sensation Substernal area

Radiates towards neck / throat

Can occur within 2 hours of eating

Bending over / Lying Down / Sleeping

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16
Q

Zantac OTC

DOSE / Indication

A

Ranitidine HCL

Norm / MAX = 75mg / 150mg

H2RA for Heartburn

1 tab (75mg) taken with water

MAX 2 doses in 24 hour period

<14 days use

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17
Q

Etiology (Causes) of Heartburn

A
  • Certain food / Drinks / Smoking
  • Regular use of ASA / NSAIDs
  • Stress / Obesity
  • PREGNANCY
  • Diseases / medication
  • Certain types of exercise
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18
Q

Exclusions for Self-Treatment

Heartburn

A
  • PREGNANCY** / **NURSING
  • Continuing heartburn while taking recommended doses / durations
    • Children <12 y/o
      • ​Antacids & H2RAs
  • ​Children <18 y/o
    • PPI’s
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19
Q

Pepcid AC

ADR / Consult

Famotadine

A

Headache / Dizziness / Constipation / Diarrhea

May be taken w/ antacids (for acute pain)

Plenty of water!

Avoid Alcohol

<2 dose (max) for <2 weeks

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20
Q

Esomeprozole

CI / P / DI

Nexium

A
  • DNU - pain swollowing / vomiting blood
    • bloody or black stools
  • Beware of patients with >3 months of heartburn w/:
    • frequent wheezing / weight loss / stomach pain
      • ​nausea + vomiting
  • Steven-Johnson Syndrome
  • DI’s:
    • Ketoconozole / Digoxin / B12 / Ampicillin
    • Voriconozole / Cilostozole
    • Clopidogrel / Diazepam
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21
Q

Omeprazole

ADR + Consult

Prilosec

A

Back Pain / Cough / Constipation

Rash / Dizziness

PPI >18yr

Take 30 min prior to eating, may be taken w/ antacids

DNU for >14 days every 4 months

See MD if >3mo

lightheadedness + sweat + dizziness + chest/shoulder pain

Frequent wheezing / pain in arm or neck

22
Q

Classification and Treatment of

FREQUENT Heartburn

A
  • 2+ days/ week
  • GERD if > 3 mo
  • Recommend:
    • PPIs (​slowest onset / longest duration)
      • ​14 days, repeat every 4 months
23
Q

Tums

MAX dose

A

Calcium Carbonate

Max 6000mg / day

12 regular

8 extra

6 max

24
Q

Zantac

CIP / DI

Ranitidine

A
  • Impared renal fxn / hepatic*
  • Caution with Pregnancy / Lac*

PREGNANCY CAT C

(cat c , pepcid is cat b)

WARFARIN / Lidocaine

DIazepam / Nifedipine / TCA

25
**Classification and Treatment of** ## Footnote ***Mild / Infrequent Heartburn***
* *Can be Episodic* * Associated with **diet / Lifestyle** * Recommend: * **Antiacids** (​FAST ONSET / short duration) * ***lower dose H2RAs*** (slow onset / LONG DURATION)
26
**Pepcid AC** **CIP / DI** Famotadine
**Hypersensitive** to famotadine * Impared **renal fxn*** * Caution with **Pregnancy / Lac*** **_PREGNANCY CAT B_** ***WARFARIN***
27
**Zantac** **ADR / Consult** Ranitidine
***Headache / Dizziness / Constipation / Diarrhea*** * +**Abdominal Pain*** * If you have trouble **swallowing** or persistant **ab pain, SEE MD*** **_Plenty of water!_** **_\<2 dose (max) for \<14 days_**
28
**Classification and Treatment of** ## Footnote **Moderate/ Infrequent Heartburn**
* *Can be Episodic* * Associated with **diet / Lifestyle** * Recommend: * **Antiacids** (​FAST ONSET / short duration) * **_HIGHER dose H2RAs_** ***​***(slow onset / LONG DURATION)
29
**Lansoprazole** **CI / P / DI​** Prevacid
**Hypersensitivity** to components **Tacrolimus / Theophylline** **Ketoconazole / ampicillin** **Iron salts / Digoxin**
30
**Lansoprazole** **ADR / Consultation** Prevacid
***Diarrhea / Ab Pain / Nausea / Headache*** **\>18yo** for PPI's Take 30 min prior to eating Can be taken WITH ANTACIDS See MD if **_\>3 month_****_s_** *DNU if **trouble swallowing food / vomit blood*** ***Black + Bloody stools***
31
**H2RAs** Onset / Indications
_Pepcid - AC (famotidine) / Zantac (ranitidine)_ Binds competitively/rev to H2 receptors of gastric **parietal cells** **INCREASES gastric pH** Onset = **30-45 min** (slow) Duration = **4-10 hours** (long) **_Preventative**_ med: take _**15-60min_** before known irritating foods **_TOLERANCE CAN OCCUR_**
32
**Lansoprazole** **Dose / Indication**
_Prevacid_ **PPI** for frequent heartburn (2+ days in a week, \>18yo) **1 Cap (15mg)** **30min b4 BF** **_q14 consecutive days_** 14 day course may be repeated **_once every 4 months_** may take **1-4 days for full effect** *DO NOT CRUSH OR CHEW TABS*
33
**Non-Pharmacologic Treatment of Heartburn**
* ***Avoid:*** * ***​*****Foods / Activities / Medications** (that trigger symptoms) * Large meals / Smoking * ***Lose Weight** if overweight* * *Wear loose-fitting clothes* * **Elevate head of bed** * **_AVOID LYING DOWN WITHIN 3 HOURS OF A MEAL_**
34
**EX-ST** **For Heartburn in Children** ## Footnote **Antacids & H2RAs**
**\<12 y/o**
35
**Mintox / Mylanta** **Dose / Indication**
_Aluminum hydroxide / MgOH / Simethicone_ **200mg / 200mg / 25mg** Liquid is **20mg simethicone** + others / 5mL **Antacid** for heartburn **_2-4 doses QID after meals_** **_& at bedtime_**
36
**Foods that *_REDUCE SPHINCTER TONE_***
**Alcohol / Soda** Garlic / Onions Foods high in SUGAR / FAT **Chocolate / Caffeine** **_PEPPERMINT / SPEARMENT_**
37
**Pharmacologic Treatment of** **Heartburn**
**Antacids** **Histamine 2 Receptor Agonist (H2RA)** **PPI**
38
**EX-ST For Heartburn in Children** **PPIs**
**\<18 y/o**
39
**General Counseling for** **H2RAs**
* ADRs * **Diarrhea / Constipation / Headache** * generally WELL TOLERATED * DI's * ***Cimetidine is cyp inhibitor*** * ***​***not used anymore * *Reduced absorption of: (due to low acid environment)* * *​**Ketoconazole*** * ***Itraconazole*** * ***IRON***
40
**Foods that cause a** **_DIRECT IRRITANT EFFECT_**
**Citrus** **Coffee** **Spicy foods** **Tomato Products**
41
**PPIs** **Onset / Indications**
Prilosec / Prevacid / Nexium Omeprazole / Lansoprazole/ Pantoprazole **_FOR PREVENTATIVE TREATMENT_** onset is **2-3 hours** (slow onset) Complete relief in **1-4 days** Binds irreversibly to proton pump in gastric **parietal cells** *inhibits secretion of **gastric acid***
42
**Classification and Treatment of** ## Footnote ***Mild / Infrequent Heartburn***
* *Can be Episodic* * Associated with **diet / Lifestyle** * Recommend: * **Antiacids** (​FAST ONSET / short duration) * ***lower dose H2RAs*** (slow onset / LONG DURATION)
43
**H2RA + Antacid**
**_Pepcid / Tums COMPLETE_** Combines **FAST ONSET** of antiacid (\<5 min) with **LONGER DURATION** of H2RA (8-10 hrs)
44
**Mintox / Mylanta** **CIP / DI** Aluminum hydroxide / MgOH / Simethicone
***DNU ​\<2 yo*** ## Footnote *DNU in **renal disease -\> HYPER MAGNESEMIA*** **\<14 days** ***Tetracyclines / Penicilin*** ***Quinalone AB's / Digoxin*** ***Enteric coated drugs***
45
**General Counseling for** **ANTACIDS** (Tums / Mylanta)
* **Liquids \> Chewable tabs** (onset time) * chewables need to be **chewed COMPLETELY** * **GLASS OF WATER** * ​​*Dosing should NOT be more than **4xDay*** * Caution in RENAL impairment * beware of **DI's** * ADRS: * **Diarrhea** w/ MG or Mg/al products * (mylanta / mintox) * **Constipation** w/ Ca or Al products * (tums)
46
**Tums** **Dose / Indication**
_Calcium Carbonate_ Reg / Extra / Ultra = **500/750/100mg** **Antacid** for heartburn **_Chew 2-3 tabs_** **_Repeat HOURLY if symptoms occur_** Max **6000mg** (12 regular strength) in a day
47
**Pepcid Complete** **DOSE / Indication**
_Famotadine + CaCo2 + MgHO_ Complete = **10mg / 800mg / 165mg** **_H2RA_** for Heartburn / + extra for indigestion **1 dose taken with water** MAX 2 doses in 24 hour period
48
**Pepcid Complete** **ADR / Consult** Famotadine + Calcium Carbonate + MgOH
**_SAME AS PEPCID_** ***Headache / Dizziness / Constipation / Diarrhea*** May be taken w/ **antacids** (for acute pain) **_Plenty of water!_** *Avoid **Alcohol*** **_\<2 dose (max) for \<2 weeks_**
49
**Omeprazole** **CI / P / DI​** Prilosec
**_PREGNANCY CATEGORY C_** Gastric carcinoid tumors (long term use) ***Diazepam / Phenytoin*** ***Tacrolimus / Warfarin*** Ketoconazole / ATAZANAVIR / digoxin B12 / Ampicillin / IRON
50
**Antacids** **Onset / Indications**
**_Tums / Mylanta_** Rxn with stomach acid to form SALT ***NOT FOR PREVENTION*** **FAST ONSET** (5 minutes) Duration ranges from: **20 min - 3 hours** (empty - full stomach)

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