Heartburn Flashcards
Define: Heartburn
occurs when stomach contents back up and out the stomach into the esophagus causing a burning sensation in the chest or throat
Define: Dyspepsia
bad digestion that causes an uncomfortable feeling that is recurrent or consistent in the upper abdominal area
What are risk factors for heartburn?
-> food and beverages= spicy/fatty foods, coffee, alcohol, carbonated/caffeinated beverages
-> lifestyle= overeating, eating <2 hours before bedtime, stress
-> medications= aspirin/NSAIDs, anticholinergic agents, chemotherapy, estrogen/progesterone
-> pregnancy
-> genetics
-> some disease states, such as gastroparesis (slowing of the GI tract) and peptic ulcer disease
What is the SYMPTOM based criteria for exclusion for self-care for heartburn?
-frequent heartburn for > 3 months (2+ days a week)
-severe heartburn
-nocturnal heartburn
-vomiting blood or coffee ground appearance
-chronic hoarseness, wheezing, coughing, or choking
-unexpected weight loss
-continuous nausea, vomiting, diarrhea
-chest pain with sweating, shortness of breath, pain radiating to shoulder, arm, neck, or jaw
-difficulty or pain swallowing solid food
we want to ensure it is not cardiac in nature
What age recommendations are there for self-care of heartburn?
do not treat heartburn OTC in children under 2 and adults over the age of 45 with new onset dyspepsia
Define: Episodic/infrequent heartburn
1 or less times a month
Mechanism of Action: Antacids
neutralize gastric acidity
When is it appropriate to use antacids?
mild, infrequent heartburn or dyspepsia
Onset of Relief: Antacids
<5 minutes
Duration of Action: Antacids
20-30 minutes, duration is as long as the antacid is in the stomach
Drug Interactions: Antacids
may bind with certain antibiotics, certain drug also need an acidic environment to be absorbed, may cause drug which are enteric-coated to be broken down early
Mechanism of Action: H2RAs
inhibit histamine on the H2 receptor of the parietal cell, which decreases gastric acid secretion
When is it appropriate to use H2RAs?
mild to moderate, infrequent or episodic heartburn and for the prevention of heartburn, requires renal dose adjustment
Onset of Relief: H2RAs
30-45 minutes
Duration of Action: H2RAs
4-10 hours, can be dosed 2x a day
FAMOTIDINE
H2RA pepcid AC, Zantac 360, pepcid AC maximum strength. comes in 10 and 20 mg
Drug Interactions: H2RAs
inhibits CYP450 which metabolizes lots of drugs, other H2RAs, and some drug need an acidic environment for absorption
What are side effects of H2RAs?
headache, diarrhea, constipation, dizziness, drowsiness, possible thrombocytopenia(low blood platelet count)
Pregnancy & Antacids?
category B- do not exceed recommended daily dose
Patient Education Points: Antacids
-do not use more than 4x a day or regularly for 2 weeks
-calcium carbonate can be used in children under 2
Patient Education Points: H2RAs
-tolerance can develop if taken daily, better to take as needed
-take 30 minutes-1 hour before symptoms or at symptom occurrence
-no more than 2x daily
-seek medical attention if used for more than 14 days
- >12 years old
Pregnancy & H2RAs?
category B- compatible
Mechanism of Action: PPIs
irreversibly inhibit the parietal cell H+/K+/ATPase enzyme system- blocking the first step of gastric secretion (bioavailability increases with continued doses)
When is it appropriate to use PPIs?
for frequent heartburn in patients who have symptoms 2+ days a week- not intended for immediate relief of heartburn
Onset of Relief: PPIs
2-3 hours, but complete relief could be 1-4 days
Duration of Action: PPIs
12-24 hours
What are the side effects of PPIs?
diarrhea, constipation, headache
Drug Interactions: PPIs
reduces antiplatelet effect of clopidogrel and decreases absorption of antifungals, antiretrovirals, and iron supplements
OMEPRAZOLE
PPIs Prilosec OTC, comes in 20mg
Patient Education Points: PPIs
-do not crush or chew capsules
-take 30-60 minutes before a meal
-only take for 2 weeks
-can repeat in 4 months
- >18 years old
Pregnancy & PPIs?
low risk
Mechanism of Action: Alginic acid
reacts with sodium bicarbonate in saliva to form a viscous layer of sodium alginate that floats on the surface of gastric contents to form a protective barrier
Mechanism of Action: bismuth subsalicylate
unclear for heartburn, but for upset stomach it acts via a topical effect on stomach mucosa
Indication: bismuth subsalicylate
heartburn, upset stomach, indigestion, nausea, and diarrhea
Patient Education Points: bismuth subsalicylate
may cause black stool or tounge
What are nonpharmacologic recommendation for heartburn?
-elevate head of bed 6 inches or sleep with a foam wedge
-reduce size of meals
-avoid lying down for 3 hours
-avoid tight fitting clothes
-stop smoking
-weight loss
-avoid foods/medications that worsen symptoms
