Chapter 13: Heartburn and Dyspepsia Flashcards
what is the medical term for heartburn?
pyrosis
heartburn is the main symptom of what disease?
gastroesophageal reflux disease (GERD)
what does dyspepsia mean?
discomfort or pain that occurs in the upper abdomen
dietary factors that may contribute to heartburn and GERD?
alcohol caffeine chocolate citrus fatty foods spicy foods sugar mint
lifestyle factors that may contribute to heartburn and GERD?
obesity
smoking
stress
heartburn symptoms occurring two+ times a week are suggestive of?
GERD
what are some “alarm symptoms” of heartburn?
dysphagia (difficulty swallowing) odynophagia (painful swallowing) vomiting GI bleed unexplained weight loss
what is dysphagia?
difficulty swallowing
what is odynophagia?
painful swallowing
what is PUD?
peptic ulcer disease
what is a good recommendation for a pt for rapid relief of symptoms of heartburn?
antacids
what is a good recommendation for longer-lasting symptom relief of infrequent heartburn or dyspepsia?
histamine type 2 receptor antagonists (H2RAs)
patient should not exceed __ days of self-treatment with an antacid or H2RA w/o consulting PCP
14
what’s a good recommendation for treating frequent heartburn (2 or more x/wk) and is taken daily?
proton pump inhibitors (PPIs)
patient should not exceed __ days of self-treatment with a PPI and should not use again for __ months
14, 4
what is a lifestyle modification to recommend a pt w/ heartburn or dyspepsia who is overweight?
weight loss
what is a GERD pillow?
foam wedge placed beneath torso and head to decrease symptoms at night
if pt is experiencing mild, infrequent heartburn, what is the recommendation?
if pt sees no improvement, what else can they do?
lifestyle/dietary changes and-
antacid, low-dose H2RA, or combination of the two
use a PPI or see Dr
if pt is experiencing moderate, infrequent heartburn, what is the recommendation?
if pt sees no improvement, what else can they do?
lifestyle/dietary changes and-
antacid or high-dose H2RA
use a PPI or see Dr
if pt is experiencing heartburn 2 or more times a week, what is the recommendation?
lifestyle/dietary changes and-
PPI daily for 14 days or H2RA as needed
what are the exclusions for self-treatment of heartburn?
- HB lasting more than 3 months
- HB while taking correct dosing of H2RA/PPI
- HB continuing after 2 weeks w/ H2RA/PPI
- HB occurring when taking H2RA/PPI
- Severe HB or dyspepsia
- HB at night
- Difficulty/pain swallowing solid foods
- vomiting blood or black material
- unexplained weight loss
- wheezing, coughing, choking
- continuous nausea, vomiting, or diarrhea
- chest pain with sweating, shortness of breath
- adults over 45 with new-onset dyspepsia
how quickly do antacids work?
duration of relief?
less than 5 minutes
20-30 minutes
how quickly do H2RAs work?
duration of relief?
30-45 min
4-10 hours
how quickly do H2RA + antacid work?
duration of relief?
less than 5 minutes
8-10 hours
how quickly do PPIs work?
duration of relief?
1-3 hours
12-24 hours
what’s a good diet for lowering risk of GERD?
what should pts do to keep track of/determine foods, beverages, and activities that correlate w/ symptom onset and severity?
Mediterranean diet
Symptom diary
how do antacids work in the stomach?
antacids contain basic ingredients to react with stomach acid to make the stomach less acidic
what are the adverse effects of antacids?
nausea bloating or gas, but usually well-tolerated
what are common side effects of antacids containing calcium carbonate and sodium bicarbonate?
belching and flatulence
antacid-asprin combination products should not be used for patients with risks of?
bleeding risks or salicylate sensitivities
what other acid can be taken with an antacid to provide better symptomatic relief than just antacid alone?
Alginic acid
what are the primary ingredient(s) found in pepto-bismol ultra liquid?
what is dosage?
max per day?
bismuth subsalicylate
15 mL q30min prn
8 doses (120 mL)
what are the primary ingredient(s) found in pepto-bismol chewable tablets?
what is dosage?
max per day?
bismuth subsalicylate
chew or dissolve 2 tabs every 30-60min prn
16 tabs
what are the primary ingredient(s) found in tums extra strength tablets?
what is dosage?
max per day?
calcium carb
chew 2-4 tabs prn
10 tabs
how to take cimetidine?
max per day?
1 tab w/ glass of water
2 tabs
how to take famotidine?
max per day?
1 tab w/ glass of water
2 tabs
how to take omeprazole?
max per day?
1 tab w/ glass of water 30 min before morning meal for 14 days
1 tab
how to take lansoprazole?
max per day?
1 cap w/ glass of water 30 min before morning meal for 14 days
1 cap
how to take esomeprazole?
max per day?
1 cap w/ glass of water 30 min before morning meal for 14 days
1 cap
what are the adverse effects of H2RAs?
none, they are usually well-tolerated
common side effects of H2RAs?
headache, diarrhea, constipation, dizziness, and drowsiness
adverse effects with short-term use of PPIs are?
uncommon
what are the names of all the antacids?
sodium bicarb.
calcium carb
magnesium hydrox.
aluminum hydrox.
what are the names of all the H2RAs?
cimetidine
famotidine
what are the names of all the PPIs?
omeprazole
esomepreazole
lansoprazole
