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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
Q

Classification and Treatment of

Mild / Infrequent Heartburn

A
  • Can be Episodic
  • Associated with diet / Lifestyle
  • Recommend:
    • Antiacids (​FAST ONSET / short duration)
    • lower dose H2RAs (slow onset / LONG DURATION)
26
Q

Pepcid AC

CIP / DI

Famotadine

A

Hypersensitive to famotadine

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

PREGNANCY CAT B

WARFARIN

27
Q

Zantac

ADR / Consult

Ranitidine

A

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
Q

Classification and Treatment of

Moderate/ Infrequent Heartburn

A
  • Can be Episodic
  • Associated with diet / Lifestyle
  • Recommend:
    • Antiacids (​FAST ONSET / short duration)
    • HIGHER dose H2RAs ​(slow onset / LONG DURATION)
29
Q

Lansoprazole

CI / P / DI​

Prevacid

A

Hypersensitivity to components

Tacrolimus / Theophylline

Ketoconazole / ampicillin

Iron salts / Digoxin

30
Q

Lansoprazole

ADR / Consultation

Prevacid

A

Diarrhea / Ab Pain / Nausea / Headache

>18yo for PPI’s

Take 30 min prior to eating

Can be taken WITH ANTACIDS

See MD if >3 months

DNU if trouble swallowing food / vomit blood

Black + Bloody stools

31
Q

H2RAs

Onset / Indications

A

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
Q

Lansoprazole

Dose / Indication

A

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
Q

Non-Pharmacologic Treatment of Heartburn

A
  • 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
Q

EX-ST For Heartburn in Children

Antacids & H2RAs

A

<12 y/o

35
Q

Mintox / Mylanta

Dose / Indication

A

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
Q

Foods that REDUCE SPHINCTER TONE

A

Alcohol / Soda

Garlic / Onions

Foods high in SUGAR / FAT

Chocolate / Caffeine

PEPPERMINT / SPEARMENT

37
Q

Pharmacologic Treatment of

Heartburn

A

Antacids

Histamine 2 Receptor Agonist (H2RA)

PPI

38
Q

EX-ST For Heartburn in Children

PPIs

A

<18 y/o

39
Q

General Counseling for

H2RAs

A
  • 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
Q

Foods that cause a

DIRECT IRRITANT EFFECT

A

Citrus

Coffee

Spicy foods

Tomato Products

41
Q

PPIs

Onset / Indications

A

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
Q

Classification and Treatment of

Mild / Infrequent Heartburn

A
  • Can be Episodic
  • Associated with diet / Lifestyle
  • Recommend:
    • Antiacids (​FAST ONSET / short duration)
    • lower dose H2RAs (slow onset / LONG DURATION)
43
Q

H2RA + Antacid

A

Pepcid / Tums COMPLETE

Combines FAST ONSET of antiacid (<5 min)

with

LONGER DURATION of H2RA (8-10 hrs)

44
Q

Mintox / Mylanta

CIP / DI

Aluminum hydroxide / MgOH / Simethicone

A

DNU ​<2 yo

DNU in renal disease -> HYPER MAGNESEMIA

<14 days

Tetracyclines / Penicilin

Quinalone AB’s / Digoxin

Enteric coated drugs

45
Q

General Counseling for

ANTACIDS

(Tums / Mylanta)

A
  • 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
Q

Tums

Dose / Indication

A

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
Q

Pepcid Complete

DOSE / Indication

A

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
Q

Pepcid Complete

ADR / Consult

Famotadine + Calcium Carbonate + MgOH

A

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
Q

Omeprazole

CI / P / DI​

Prilosec

A

PREGNANCY CATEGORY C

Gastric carcinoid tumors (long term use)

Diazepam / Phenytoin

Tacrolimus / Warfarin

Ketoconazole / ATAZANAVIR / digoxin

B12 / Ampicillin / IRON

50
Q

Antacids

Onset / Indications

A

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)

PDAT1 (27 decks)

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