Gastrointestinal Self-care Flashcards
Persistent heartburn
3 or more months
Frequent heartburn
2 or more days/week
Exclusions to heartburn/dyspepsia self-care
Frequent heartburn + persistent
Heartburn continues after 2 weeks of treatment
Difficulty swallowing
Unexplained weight loss
Antacids < 18 years
Antacid
Base
Potency in ANC (acid neutralization)
For mild, infrequent heartburn
Sodium bicarbonate (alka-seltzer) Calcium carbonate (tums) - caution constipation Alum hydroxide - more potent Mg hydroxide - caution diarrhea Aliginic acid - foam gastric mech
Histamine-2 receptor antagonists
H2RA
Decrease gastric acid
Take no longer than 2 weeks
Treat mild moderate infrequent heartburn
Prevent heartburn from indigestion, sour stomach
Common drowsiness
Cimetidine most drug-drug interactions (warfarin)
Ranitidine preferred
Proton pump inhibitors
Suppress gastric acid secretion Frequent heartburn (2 or more days/week)
Interaction with clopidogrel
Possible increase in fracture risk in older patients
Chronic acid suppression can impair natural defense and increase risk of infection (CAPneumo, C. diff)
Lansoprazole
Proton pump inhibitor
Take 30 min before meal
CYP 2C19 inhibition
No better than omeprazole
Zegerid
Omeprazole + NaCO3
Prilosec OTC/omeprazole
14 day course treatment
May repeat in 4 months
Interacts and lessens effect of ketoconazole (requires acidic environment)
Bismuth subsalicylate
Peptobismol
Do not take if aspirin allergy
Decrease effectiveness of tetracyclines & quinolones
Diarrhea
Commonly viral 60-70%
May be bacterial 10%
Exclusions < 6 months Severe dehydration (no tears, behavior change, no urination) >38C fever >10% body weight loss
Fluid/electrolyte replacement(75mEq, Main 50mEq)
Diet - complex carbs, fruit, veg
Avoid fatty, spicy, simple sugar
No signs of dehydration - use dextrose-electrolyte
Loperamide >6, BismutSubS>12
Pinworm
Ingestion of eggs by anus-mouth transfer
Nonpharm - wash bed linens, clothes, of household in hot water, Open blinds (sunlight), hygiene education
Pyrantel for all household members - 11 mg/kg
common GI side effects
Constipation
low fiber diet, low fluid intake, sedentary
may be caused by antacids, analgesics
Exclusions - abd pain, use of laxative >7 days
Liver, kidney, heart disease
Establish dietary and exercise habits
14g/1000kcal of fiber, wheat, fruit, veg
Use laxative for only <1week
Avoide within 2 hours of other medications
2-6 can use decussate sodium, MgHydroxide, glycerin suppository, Na2PO4
Methylcellulose, polycarbophil, psyllium (MPP)
Bulk Forming Laxative
First line
Take with adequate fluid
Interaction with warfarin
Avoid in children <1 week
Docusate sodium, Docusate calcium
Emollient - softens fecal mass, lessens pain+strain
Best suited for severe HTN/CVD, MI
Avoid in children <1week
Mineral Oil
Lubricant
Not preferred, use decussate for pain
Do not take within 2 hours of eating
Avoid in children <6
Magnesium citrate, magnesium hydroxide, sodium phosphate, magnesium sulfate, enemas
Saline - osmosis of water into intestines
Most rapid, can use for colonoscopy exam
NOT for long-term management
Caution: electrolyte imbalance, renal impairment, hypernatremia, hyperphosphatemia
Avoid in children <6
Oral - acute phosphate nephropathy
Rectal administration preferred
Polyethylene Glycol (PEG) - 3350
Glycerin Suppository
MiraLAX
Hyperosmotic - Large ions/molecules osmotic effect that draws water to rectum
First line
Suppositories indicated for children 17 years
Especially for clean bowel before colonoscopy
Bisacodyl
Senna
Dulcolax
Stimulants - increase peristaltic activity
2nd line to bulk forming & hyperosmotic
Take 1 hour before antacids/milk b/c of enteric coating
Avoid H2RA and PPI
Senna may discolor urine
Intestinal Gas
Avoid increasing gastric pressure
Modify diet, tight clothes, smoking
Simethicone - Antiflatulent
Alpha-glacto: add to food after cooled
Lactase Enzyme: lactaid - take at first bite
Probiotics: bifodobacterium, lactobacillus
Hemorrhoids (piles)
Can be internal or external
Avoid in patients <12 years
limit 7 days of self-treatment
Local anesthetics: Benzocaine, lidocaine
Vasoconstrictors: ephedrine, phenylephrine (reduce swelling) caution with HTN medication
Protectant: for irritation - cocoa butter, lanolin, glycerin, aluminum hydroxide gel
Astringent: Witch hazel, calamine, for irritation
External irritation only use Keratolytic: Resorcinol or analgesic (menthol, camphor), MINOR itching - hydrocortisone.
Use external use products if pregnant
