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Year 3 - OSCE > Dyspepsia > Flashcards

Dyspepsia Flashcards

1
Q

What is dyspepsia?

A

Predominant epigastric pain for at least 1 month

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2
Q

Difference between organic and functional dyspepsia

A
  • Organic = peptic ulcer disease, GERD, cancer

- Functional = non-ulcer

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3
Q

Difference between PUD and GERD

A
  • Peptic ulcer disease sx = episodic epigastric pain and heartburn
  • GERD -> considered a chronic disease or chronically relapsing disorder; sx:
    • Classical = regurgitation, heartburn, dysphagia, odynophagia (pain on swallowing)
    • Atypical = coughing, wheezing, globus sensation, chest pain
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4
Q

Potential causes of PUD and GERD

A
  • Peptic ulcer disease -> H. pylori, NSAIDs, smoking, EtOH, caffeine
  • GERD -> pregnancy, obesity, increased age, histus hernia
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5
Q

What is considered PUD recurrence

A
  • Failure of 8-week therapy in duodenal ulcer
  • Failure of 12-week therapy in gastric ulcer
  • *Always look for a reason (non-adherence, H. pylori, NSAIDs)
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6
Q

Functional dyspepsia tx

A
  • Functional dyspepsia: dyspepsia of at least 3 months w/ no clearly identifiable pathology
    1. Test and treat for H pylori
    2. Pt is H pylori negative -> endoscopy, PPI, prokinetics, CBT and other psychological approaches
    3. If pt tries PPI and has no sx relief -> consider TCA (amitriptyline, imipramine) over prokinetics
  • 4 weeks is an adequate trial period
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7
Q

Use of antacids for dyspepsia

A
  • Peptic ulcer disease and GERD -> used for sx relief
    • Take at 1 and 3 hours post-meal and at HS
    • Can be used PRN for GERD
  • AE = constipation/diarrhea, drug interactions
  • *Important -> don’t use sodium bicarb products in CHF/cirrhosis px and don’t use magnesium products chronically in dialysis px (use aluminum or calcium instead)
  • Functional dyspepsia -> limited to no benefit
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8
Q

Use of H2 receptor blockers for dyspepsia

A
  • All agents the same at appropriate dosage
  • All can be given 1 or 2x/day
  • GERD -> can be up to 2x the PUD dose (ex: ranitidine 300 mg BID) but rarely done b/c PPIs cost around the same
  • AE = very low; drug interactions w/ cimetidine, so recommend ranitidine
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9
Q

Use of PPIs for dyspepsia

A
  • Gold standard for PUD and GERD
  • Functional dyspepsia -> only small benefit; more beneficial for ulcer & reflux-like sx; limit to once daily
  • Effects last 3 days
  • Increasing omeprazole dose from 20 mg to 40 mg only decreases acid by further 6%
  • AE = nausea, headache, dizziness, diarrhea, sweating
  • Take 30 mins before morning meal or evening meal if primarily nocturnal sx
  • *Don’t continue long-term unless attempt to stop/reduce tx at least once/year except if Barrett’s or GI bleed
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10
Q

Drug interactions w/ PPIs

A
  • Any drugs w/ low pH dependent absorption
  • May increase MTX, digoxin, and tacrolimus levels
  • Omeprazole and esomeprazole may decrease clopidogrel’s conversion to active drug; may consider switching to pantoprazole
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11
Q

Red flags for dyspepsia

A
  • Alarm features = VBAD (warrants prompt endoscopy)
  • Vomiting > 7 days
  • Bleeding
  • Abdominal mass or unexplained weight loss (ex: 10% body weight)
  • Dysphagia
  • Others = jaundice, family hx of gastric cancer, prior ulcer
  • Refractory GERD
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12
Q

Case specific assessment questions for dyspepsia

A
  • Do you regularly use NSAIDs?
  • Is the predominant sx heartburn and/or regurgitation? (if yes, indicates GERD)
  • Have you been tested for H. pylori?
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13
Q

Non-pharms for dyspepsia (general)

A
  • Peptic ulcer disease -> avoid large meals right before bed (increases HS acid production); avoid precipitants (NSAIDs, ASA, smoking, EtOH > 20% proof, excess caffeine)
  • GERD and functional dyspepsia -> smaller, more frequent meals; avoid precipitants (certain foods, smoking, alcohol, caffeine); stress reduction; smoking cessation, exercise and weight loss
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14
Q

General monitoring for dyspepsia

A
  • For FD px, 4 weeks is plenty of time to determine if a drug is working or not
  • Pt monitor symptoms daily
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15
Q

General follow up for dyspepsia

A
  • Pharmacist follow up in 1 week to see if sx improving
  • Reassess GERD therapy in 4 weeks -> if sx improve, stop therapy; if sx don’t improve w/ PPI, increase to BID for 4-8 weeks then reassess
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16
Q

Describe monitoring for PUD

A
  • Monitor for sx improvement and side effects from the drug daily/weekly
  • Common SE of PPI = N, headache, dizziness, diarrhea, constipation
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17
Q

Describe when to go to a Dr for PUD

A

Go to doctor if sx haven’t improved after using PPI for 8 weeks in duodenal ulcer, or after using PPI for 12 weeks in gastric ulcer

18
Q

Describe when to go to emergency for PUD

A

Go to emergency if vomiting for > 7 days, jet black stools/bleeding (melena), abdominal mass of unexplained weight loss (10% body weight), dysphagia (VBAD)

19
Q

Describe non pharms for PUD

A
  • Avoid large meals before bed
  • Try to remain upright for a few hours after eating
  • Avoid caffeine, spicy foods, chocolate, etc. (trigger foods)
  • Avoid NSAIDs if possible
  • Exercise and weight loss
  • Smoking cessation and moderate alcohol intake
20
Q

Describe follow up for PUD

A

I will follow up with you 1 week to discuss sx improvement, adherence, and SE management

21
Q

Describe monitoring for GERD

A
  • Monitor for sx improvement and SE of medication daily
  • Mild sx (< 3x/week, short duration, low intensity) can often be managed w/ lifestyle and dietary changes
  • Typical sx = heartburn and/or acid regurgitation
  • Common SE of PPI = N, headache, dizziness, diarrhea, constipation
22
Q

Describe when to go to a Dr for GERD

A

Go to doctor if refractory GERD, trial of PPI for 4-8 weeks

23
Q

Describe when to go to emergency for GERD

A

Go to emergency if vomiting for > 7 days, jet black stools/bleeding (melena), abdominal mass of unexplained weight loss (10% body weight), dysphagia (VBAD)

24
Q

Describe non pharms for GERD

A
  • Avoid large meals before bed
  • Try to remain upright for a few hours after eating
  • Avoid caffeine, spicy foods, chocolate, etc. (trigger foods)
  • Avoid NSAIDs if possible
  • Exercise and weight loss
  • Smoking cessation and moderate alcohol intake
  • *List of drugs that cause can GERD on bottom of pg. 67 RxFiles
25
Q

Describe follow up for GERD

A

I will follow up with you 1 week to discuss sx improvement, adherence, and SE management

26
Q

Describe monitoring for functional dyspepsia

A
  • Monitor for sx improvement daily/weekly

- Common SE of PPI = N, headache, dizziness, diarrhea, constipation

27
Q

Describe when to go to a Dr for functional dyspepsia

A

Go to doctor if no sx relief after 4-week trial of PPI

28
Q

Describe when to go to emergency for functional dyspepsia

A

Go to emergency if vomiting for > 7 days, jet black stools/bleeding (melena), abdominal mass of unexplained weight loss (10% body weight), dysphagia (VBAD)

29
Q

Describe non pharms for functional dyspepsia

A
  • Avoid large meals before bed
  • Try to remain upright for a few hours after eating
  • Avoid caffeine, spicy foods, chocolate, etc. (trigger foods)
  • Avoid NSAIDs if possible
  • Exercise and weight loss
  • Smoking cessation and moderate alcohol intake
30
Q

Describe follow up for functional dyspepsia

A
  • I will follow up with you 1 week to discuss sx improvement, adherence, and SE management
  • After 4 weeks we will reassess if you should stay on the drug or stop it and try something else
31
Q

Describe monitoring for a new PPI Rx

A
  • Monitor for sx improvement and side effects daily/weekly

- Common SE of PPI = N, headache, dizziness, diarrhea, constipation

32
Q

Describe when to go to a Dr for a new PPI Rx

A

Go to doctor if no sx improvement after 4-8 week trial of PPI; next step = 4-8 week trial of BID PPI

33
Q

Describe when to go to emergency for a new PPI Rx

A

Go to emergency if vomiting for > 7 days, jet black stools/bleeding (melena), abdominal mass of unexplained weight loss (10% body weight), dysphagia (VBAD)

34
Q

Describe non pharms for a new PPI Rx

A
  • Avoid large meals before bed
  • Try to remain upright for a few hours after eating
  • Avoid caffeine, spicy foods, chocolate, etc. (trigger foods)
  • Avoid NSAIDs if possible
  • Exercise and weight loss
  • Smoking cessation and moderate alcohol intake
35
Q

Describe follow up for a new PPI Rx

A
  • I will follow up with you 1 week to discuss sx improvement, adherence, and SE management.
  • We will reassess your sx at 4 weeks and decide if we should continue or stop the drug
36
Q

Describe monitoring for a new H. pylori infection

A
  • Monitor for sx improvement daily and SE
  • Common SE of PPI = N, headache, dizziness, diarrhea, constipation
  • Common SE of antibiotics = GI upset
37
Q

Describe when to go to a Dr for a new H. pylori infection

A

Go to doctor if no sx improvement after full course completed or if minimal sx improvement 7 days after antibiotic course completed

38
Q

Describe when to go to emergency for a new H. pylori infection

A
  • Go to emergency if vomiting for > 7 days, jet black stools/bleeding (melena), abdominal mass of unexplained weight loss (10% body weight), dysphagia (VBAD)
  • If sx worsen as any point
39
Q

Describe non pharms for a new H. pylori infection

A
  • Avoid large meals before bed
  • Try to remain upright for a few hours after eating
  • Avoid caffeine, spicy foods, chocolate, etc. (trigger foods)
  • Avoid NSAIDs if possible
40
Q

Describe follow up for a new H. pylori infection

A
  • I will follow up with you 3 days to discuss adherence to the complicated regimen and to see if sx have improved
  • I will also follow up at 14 days when the regimen should be completed to see how your sx are doing

Year 3 - OSCE (6 decks)

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