Gastrointestinal Self-care

Question 0

Persistent heartburn

Answer 0

3 or more months

Question 1

Frequent heartburn

Answer 1

2 or more days/week

Question 2

Exclusions to heartburn/dyspepsia self-care

Answer 2

Frequent heartburn + persistent
Heartburn continues after 2 weeks of treatment
Difficulty swallowing
Unexplained weight loss

Antacids < 18 years

Question 3

Antacid

Answer 3

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

Question 4

Histamine-2 receptor antagonists

H2RA

Answer 4

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

Question 5

Proton pump inhibitors

Answer 5

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)

Question 6

Lansoprazole

Answer 6

Proton pump inhibitor
Take 30 min before meal
CYP 2C19 inhibition
No better than omeprazole

Question 7

Zegerid

Answer 7

Omeprazole + NaCO3

Question 8

Prilosec OTC/omeprazole

Answer 8

14 day course treatment
May repeat in 4 months
Interacts and lessens effect of ketoconazole (requires acidic environment)

Question 10

Bismuth subsalicylate

Peptobismol

Answer 10

Do not take if aspirin allergy

Decrease effectiveness of tetracyclines & quinolones

Question 11

Diarrhea

Answer 11

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

Question 12

Pinworm

Answer 12

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

Question 13

Constipation

Answer 13

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

Question 14

Methylcellulose, polycarbophil, psyllium (MPP)

Answer 14

Bulk Forming Laxative
First line

Take with adequate fluid
Interaction with warfarin
Avoid in children <1 week

Question 15

Docusate sodium, Docusate calcium

Answer 15

Emollient - softens fecal mass, lessens pain+strain
Best suited for severe HTN/CVD, MI

Avoid in children <1week

Question 16

Mineral Oil

Answer 16

Lubricant
Not preferred, use decussate for pain

Do not take within 2 hours of eating
Avoid in children <6

Question 17

Magnesium citrate, magnesium hydroxide, sodium phosphate, magnesium sulfate, enemas

Answer 17

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

Question 18

Polyethylene Glycol (PEG) - 3350
Glycerin Suppository
MiraLAX

Answer 18

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

Question 19

Bisacodyl
Senna
Dulcolax

Answer 19

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

Question 20

Intestinal Gas

Answer 20

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

Question 21

Hemorrhoids (piles)

Answer 21

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