Chapter 2.2 - HeartBurn Flashcards
What is Heartburn?
Symptoms are caused when there is a reflux of gastric acid into the oesophagus, which irritates the mucosal surface.
What are the main symptoms of heartburn? (5)
- Burning/painful discomfort
- Acid taste in throat
- Pain (can be sudden/severe) - can radiate to back & arms (mimic heart attack-referral)
- Difficulty swallowing
- Regurgitation
Who is it that commonly suffers from heart burn? (2)
Over 55 years & pregnant women (over 30 years more likely)
When would you refer a patient with heartburn? (6)
- Failure to respond to medication/treatment
- Children
- Pain radiating to arms
- Dysphagia
- Regurgitation
- Increasing severity
How long should treatment be, before referral?
1 week
What can bring on heart burn? what would you ask patient to determine it really is heartburn. (4)
- Bending/lying down
- Overweight/Recent increase in weight
- After a large meal
- After belching
Which type of medications can cause the symptoms of heartburn? (7)
- Anticholingerics e.g. hycosine
- Tricyclic antidepressants
- Phenothiazines
- Calcium channel blockers
- Nitrates
- Theophylline
- Caffeine
What are the 4 groups of medicines used for heartburn? and give examples of each
- Antacids - Calcium bicarbonate
- Alginates - Gaviscon
- H2 antagonists - ranitidine, cimetidine, famotidine
- Proton Pump Inhibitor (PPI) - Omeprazole
Since some antacids can have high sodium content. Which patients should avoid using these?
Those with a sodium-restricted diet
- Congestive heart disease
- Kidney/Liver problems
What heartburn treatment can be recommended for those with a sodium restricted diet?
Antacids/Alginates that contain potassium bicarbonate
How do Alginates work?
Alginates form a raft that sits on the surface of the stomach contents
and prevents reflux. Some alginate-based products contain sodium
bicarbonate, which, in addition to its antacid action, causes the release
of carbon dioxide in the stomach, enabling the raft to float on top of
the stomach contents.
What is the treatment time limit on H2 antagonists? & why?
2-week treatment limit
The H2 antagonists have both a
longer duration of action (up to 8–9 h) and a longer onset of action
than antacids.
Which drugs should be avoided with cimetidine (h2 antagonist) due to interactions?
Increases their levels (3)
- Theophylline
- Warfarin
- Phenytoin
What is the dose & max daily dose of Ranitidine?
75mg
300mg max daily dose
How does omeprazole work?
works by suppressing gastric acid secretion in the stomach.
It inhibits the final stage of gastric hydrochloric acid production by blocking the hydrogen-potassium ATPase enzyme in the parietal
cells of the stomach wall (also known as the proton pump).
