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Clinical Pharmacy 1 - Term 1 > 8 - Dyspepsia & GERD > Flashcards

8 - Dyspepsia & GERD Flashcards

1
Q

Where do symptoms of dyspepsia originate?

A

Gastroduodenal area

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2
Q

What are common symptoms of dyspepsia?

A
  • Pain/burning
  • Postprandial fullness
  • Early satiety
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3
Q

What is a common term for dyspepsia?

A

Indigestion

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4
Q

Is dyspepsia a diagnosis?

A

No, its a categorization of symptoms that may vary between patients and may or may not have pathological causes

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5
Q

What is organic dyspepsia?

A

Identifiable causes/structural abnormalities

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6
Q

What are some causes of organic dyspepsia?

A
  • PUD
  • Reflux esophagitis
  • Gastric/esophageal cancer
  • Medications (erythromycin, NSAIDs, garlic, white willow)
  • Infections
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7
Q

What is functional dyspepsia?

A
  • No identifiable cause or structural abnormalities
  • Also called idiopathic or non-ulcer
  • Thought to be due to psychological factors, GI motility and organ sensory dysfunction
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8
Q

What are the different categories of dyspepsia symptoms?

A
  • Reflux-like
  • Ulcer-like
  • Dismotility
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9
Q

What are the different classifications of dyspepsia and GERD symptoms?

A
  • Frequent – 2 or more days per week
  • Episodic – mild and sporadic symptoms which are usually predictable
  • Persistent/chronic – occurs over long periods (over 3 months)
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10
Q

What are the ALARM symptoms of dyspepsia and GERD?

A
  • Chest/cardiac pain (pain radiating to arm and/or neck, jaw, or back; pain occurs w/ exercise)
  • Dysphagia or odynophagia (difficulty or pain when swallowing)
  • Choking/globus sensation
  • Upper GI bleeding (vomiting blood, or black, tarry stools)
  • Persistent vomiting
  • Unexplained or involuntary weight loss
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11
Q

What are some red flags for dyspepsia and GERD?

A
  • ALARM symptoms
  • Dental erosions
  • Pain unrelated to meals
  • Persistent nausea or diarrhea
  • Children
  • Symptoms recurring or prolonged over 3 months
  • Sx occur or continue after taking OTC tx for 2 weeks
  • Px over 50 y/o w/ no known cause or worsening of sx
  • Px on long-term NSAIDs
  • History of upper GI cancer or PUD
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12
Q

What are common symptoms of GERD?

A
  • Frequent regurgitation of stomach acid or burning feeling in stomach or esophagus
  • Hypersalivation
  • Non-cardiac chest pain
  • Burping and belching
  • Worsens when px bends over or lays down
  • Occurs w/in 1-2 hours after eating
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13
Q

What is GERD described as?

A

Heartburn

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14
Q

What is the difference between GERD and normal reflux?

A

GERD occurs when reflux becomes bothersome and/or inflicts structural damage to esophagus

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15
Q

What are potential causes of GERD?

A
  • Defective lower esophageal sphincter
  • Hiatal hernia
  • Impaired esophageal peristalsis
  • Delayed gastric emptying
  • Excessive gastric acid production
  • Bile reflux
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16
Q

What must occur with respect to the lower esophageal sphincter for GERD to occur?

A

Pressure gradient between LES and stomach must be less than normal or absent

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17
Q

What are some contributing factors to GERD and dyspepsia?

A
  • Foods that decrease LES tone (alcohol, carbonated beverages, chocolate, caffeinated beverages, foods w/ high fat and sugar, garlic, onions, peppermint, spearmint)
  • Foods that exert a direct irritant effect (citrus, coffee, spicy foods, tomatoes)
  • Pregnancy
  • Lifestyle (obesity, smoking, diet)
  • Over 65 y/o
  • Medications (anticholinergics or drugs w/ anticholinergic side effects decrease LES tone; antibiotics and NSAIDs exert a direct irritant effect)
  • Disease status
  • Posture
  • Stress and anxiety
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18
Q

Do symptoms of GERD correlate to the severity of structural esophageal damage?

A

No

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19
Q

What are differential diagnoses of GERD and dyspepsia?

A
  • IBS
  • Peptic ulcer
  • Gastric and pancreatic cancer
  • Angina
  • MI
  • Gallstones
  • Asthma
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20
Q

What are the goals of treatment for dyspepsia and GERD?

A
  • Relieve symptoms
  • Prevent recurrence of symptoms
  • Heal esophageal mucosa
  • Improve quality of life
  • Prevent complications
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21
Q

What are some non-pharms for dyspepsia and GERD?

A
  • Smaller, more frequent meals
  • Quit smoking
  • Decrease caffeine and alcohol intake
  • Decrease fat intake
  • Avoid exercising for 3 hours after eating or bending on a full stomach
  • Avoid lying down right after eating
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22
Q

What is the initial treatment for mild or intermittent GERD in the absence of ALARM symptoms?

A

Diet and lifestyle modifications

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23
Q

What are the 3 categories of pharmacological options for GERD and dyspepsia?

A
  • Symptom relief (antacids, foaming agents, antiflatulents)
  • Symptom relief and prevention (H2 receptor antagonists)
  • Prevention and symptom relief (proton pump inhibitors)
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24
Q

How long does it take for antacids to provide symptomatic relief?

A

About 5 minutes

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25
Q

How long do antacids last?

A
  • Less than 1 hour if given w/o food

- 1-3 hours if given after food

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26
Q

What is Acid Neutralizing Capacity (ANC)?

A
  • Amount of acid buffered / dose over a specified period

- Determines dosing equivalents between antacids

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27
Q

How are antacids dosed?

A

As needed after meals and at bedtime

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28
Q

What are the potencies of antacids from highest to lowest?

A
  • Calcium carbonate
  • Sodium bicarbonate
  • Magnesium salts
  • Aluminum hydroxide
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29
Q

Are suspensions or solid dosage forms preferred for antacids?

A

Suspensions

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30
Q

What is the most common side effect of magnesium antacids?

A

Diarrhea

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31
Q

When should magnesium antacids be avoided?

A
  • Elderly
  • Renal failure
  • Unknown in pregnancy; safe in breast feeding
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32
Q

What are some side effects of aluminum based antacids?

A
  • Constipation
  • Hemorrhoids
  • Osteomalacia and osteoporosis
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33
Q

What are some precautions of aluminum based antacids?

A
  • Avoid long term use in renal dysfunction
  • Avoid in px prone to constipation
  • Caution in elderly
  • Unknown in pregnancy; safe in breastfeeding
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34
Q

What are some side effects of calcium carbonate antacids?

A
  • Constipation, belching, flatulence
  • Rebound acidity
  • High doses can cause hypercalcemia and milk-alkali syndrome
  • Kidney stones
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35
Q

What are some precautions of calcium carbonate antacids?

A
  • Preferred agent in renal dysfunction
  • Caution if px has high Ca intake
  • Safe in pregnancy and breastfeeding
36
Q

What are some side effects of sodium bicarbonate antacids?

A
  • Ingestion after large meal can cause gastric detention

- Belching and flatulence

37
Q

What are some precautions of sodium bicarbonate antacids?

A
  • Avoid in px w/ restricted sodium intake
  • Avoid in pregnancy
  • Not recommended during breastfeeding
38
Q

Antacids interact w/ drugs via _____

A
  • Interfere w/ absorption by increasing gastric pH
  • Interfere w/ elimination by increasing urine pH
  • Alteration to GI transit time
39
Q

What are the main drug interactions w/ antacids?

A
  • Enteric coated and buffered products
  • Antibiotics (tetracyclines, fluoroquinolones, azithromycin)
  • Iron and digoxin
40
Q

What should be recommended w/ respect to medications and antacids?

A

Don’t take any other oral medication w/in 2 hours of antacids

41
Q

What is the mechanism of action for foaming agents?

A
  • Alginates precipitate in acid medium of stomach to form sponge-like matrix of alginic acid
  • Bicarbonate reacts w/ gastric acid to form CO2 which is trapped in matrix and helps it float, allowing it to act as a barrier between the stomach and esophagus
42
Q

Do foaming agents neutralize acid?

A

No

43
Q

What are foaming agents available as?

A

Combination of alginic acid and an antacid

44
Q

What is the onset and duration of foaming agents?

A
  • Onset = minutes

- Duration = about 4 hours

45
Q

How are foaming agents ingested?

A
  • Chew tablet and drink glass of water immediately after

- Only works if px is upright

46
Q

What are some side effects to foaming agents?

A
  • Nausea and vomiting

- Flatulence and belching

47
Q

What is the most common drug interaction w/ foaming agents?

A

Simethicone

48
Q

What are some precautions to foaming agents?

A
  • Only use in adults

- Compatible w/ pregnancy and lactation

49
Q

Why is bismuth subsalicylate not recommended for treatment of dyspepsia and GERD?

A

Contains salicylate (aspirin) which can cause these symptoms and irritate the stomach

50
Q

What is bismuth subsalicylate used for?

A
  • Treatment of overindulgence of food and alcohol
  • Diarrhea
  • Eradication of H. pylori in combination w/ other agents
51
Q

What are some side effects of bismuth subsalicylate?

A
  • Darkening of tongue
  • Gray-black stools
  • Bismuth toxicity
  • Tinnitus
52
Q

What are some precautions for bismuth subsalicylate?

A
  • Avoid use in young children and px w/ bleeding disorders
  • Avoid in px on medications that may interact w/ salicylates
  • Do not use during pregnancy or lactation
53
Q

What is the method of action of simethicone?

A
  • Decrease surface tension of gas bubbles in stomach and intestine
  • Gas bubbles broken and eliminated more easily
54
Q

Simethicone is often added to products with _____

A

Antacids

55
Q

What is the onset and duration of simethicone?

A
  • Onset about 15 minutes

- Duration about 3 hours

56
Q

When should simethicone be ingested?

A

After meals and at bedtime

57
Q

What are the side effects of simethicone?

A

No known

58
Q

Who can take simethicone?

A
  • Infants and adults

- Pregnant and breastfeeding women

59
Q

Who shouldn’t take simethicone?

A

Px w/ suspected intestinal perforation or obstruction

60
Q

What is the mechanism of action of histamine 2 receptor antagonists (H2RA)?

A
  • Competitively and reversibly bind to H2 receptors in gastric parietal cells
  • Dose-dependent inhibition of gastric acid secretion
  • Inhibits basal and nocturnal gastric acid secretion more than meal stimulated acid secretion
61
Q

What is the onset and duration of H2RA?

A
  • Onset = 30-60 minutes

- Duration = 6-8 hours depending on dose

62
Q

What are the chemical names of H2RA?

A

Ranitidine and famotidine

63
Q

What is the dosing of H2RA for prevention?

A
  • Ranitidine 75-150 mg 30-60 minutes before meals

- Famotidine 10 mg 10-15 minutes before meals

64
Q

What is the dosing of H2RA for treatment in adults?

A
  • 1 tablet BID

- Second dose can be taken 1 hour after 1st dose if 1st dose is ineffective

65
Q

Does food affect the bioavailability of H2RA?

A

No

66
Q

What are the side effects of H2RA?

A
  • Nausea, vomiting, diarrhea

- Headache, drowsiness, dizziness

67
Q

Which medication affects H2RA?

A

Antacids, so don’t take antacids w/in 0.5-1 hour of H2RA ingestion

68
Q

What medications do H2RA interact w/?

A
  • Iron
  • Intraconazole
  • Ketoconazole
  • Sulcralfate
69
Q

What ages are recommended for H2RA?

A
  • Ranitidine over 16

- Famotidine over 12

70
Q

Are H2RA safe in pregnancy?

A

Yes

71
Q

What are the chemical names of PPI’s?

A

Omeprazole and esomeprazole

72
Q

What are PPI’s used for?

A

Treatment of frequent heartburn for patients who have symptoms 2 or more days per week

73
Q

What is the mechanism of action for PPI’s?

A

Inhibits hydrogen potassium ATPase (proton pump), which irreversibly blocks the final step of gastric acid secretion

74
Q

What is the onset of PPI’s?

A

About 2-3 hours, but complete relief may take 1-4 days

75
Q

What is the dosing of PPI’s?

A
  • Omeprazole – 1 tablet (20 mg) 30-60 mins before eating every morning for 14 days; may be repeated after 4 months if symptoms recur
  • Esomeprazole – 18 years and older, 20 mg w/ water every morning before eating for 14 days; may be repeated after 4 months
76
Q

When should you refer a patient that is taking PPI’s?

A

If symptoms persist for more than 2 weeks or recur w/in 4 months

77
Q

What drugs do PPI’s interact w/?

A

CYP 2C19 and may decrease absorption of pH-dependent drugs

78
Q

What are some side effects of short time use of PPI’s?

A

Diarrhea, constipation, headache

79
Q

What are some side effects of long time use of PPI’s?

A
  • Increased risk of osteoporosis or bone fracture

- C. difficile infections

80
Q

When should H2RA’s be used?

A

Patients w/ predictable pattern of symptoms

81
Q

When should antacids be used?

A

Patients who need immediate relief or have unpredictable pattern of symptoms

82
Q

What is the maximum length of self-treatment?

A

14 days

83
Q

Which antacid is preferred for pregnancy?

A

Calcium carbonate

84
Q

Which H2RA and PPI are preferred for pregnancy?

A

Ranitidine and omeprazole

85
Q

What should be monitored while on therapy for dyspepsia or GERD?

A
  • Monitor daily for side effects and hypersensitivity

- Monitor symptoms daily as well as regularly over long term

86
Q

What are red flags for dyspepsia and GERD after treatment has been completed?

A
  • Symptoms lasting over 2 weeks
  • Symptoms worsen or are unrelieved by drug therapy
  • Development at any time of ALARM or atypical symptoms
  • Symptoms recurring 2-3 times per year

Clinical Pharmacy 1 - Term 1 (18 decks)

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