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otc > Heartburn > Flashcards

Heartburn Flashcards

1
Q

Definition of heartburn:

A

burning sensation in the stomach or lower chest that rises up toward neck and occasionally to the back

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2
Q

Heartburn is described as…

A
  • indigestion
  • sour stomach
  • bitter belching
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3
Q

Heartburn is a common symptom of…

A

gastroesophageal reflux disease (GERD)

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4
Q

Dyspepsia is…

A
  • feeling full after eating a small amount of food
  • epigastric pain
  • epigastric burning
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5
Q

Pathophysiology of heartburn and dyspepsia:

A

esophageal defense mechanisms to help protect mucosa from damage

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6
Q

Lower esophageal sphincter (LES) provide a…

A

physical barrier against gastric contents being refluxed into the esophagus

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7
Q

LES will relax when…

A

one is swallowing to allow things to go into the stomach

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8
Q

Risk factors for heartburn:

A
  • food
  • lifestyle
  • medications
  • medical conditions
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9
Q

Why are chocolate, peppermint, and fatty food a risk factor for heartburn?

A

they decrease LES pressure, which leads to increased reflux

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10
Q

Why are citrus, tomato-based, and spicy foods a risk factor for heartburn?

A

they can irritate inflamed esophageal mucosa

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11
Q

How does smoking contribute to heartburn?

A

it relaxes LES pressure and decreasing salivation

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12
Q

How does obesity contribute to heartburn?

A

it increases intra-abdominal pressure

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13
Q

What are some lifestyle risk factors, excluding smoking and obesity?

A
  • tight fitting clothes
  • lying on your back
  • stress
  • pregnancy
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14
Q

Which medications decrease LES pressure and increase reflux?

A
  • theophylline
  • morphine
  • Ca2+ channel blockers
  • diazepam
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15
Q

Which medications can cause dyspepsia through direct gastric mucosal injury, or changes to GI function?

A
  • iron
  • antibiotics
  • narcotics
  • digoxin
  • estrogens
  • theophylline
  • NSAIDs
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16
Q

What medical conditions contribute to heartburn?

A
  • motility disorders
  • PUD
  • Zollinger-Ellison syndrome
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17
Q

Heartburn is more frequently noted within…

A

one hour after eating

- especially after a large meal or indigestion

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18
Q

Why does lying down or bending over make heartburn worse?

A

it can cause regurgitation, which allows acidic fluid in back of throat
- no abdominal contractions

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19
Q

If you have heartburn that occurs two or more times, then it is suggestive of…

A

GERD

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20
Q

Exclusions to self treatment:

A
  • dysphagia: difficulty swallowing
  • odynophagia: painful swallowing
  • upper GI bleeding
  • unexplained weight loss
  • continuous nausea, vomiting, or diarrhea
  • severe stomach pain
  • chest pain or shoulder, arm, or neck pain (sign of heart attack)
  • heartburn or dyspepsia for > 3 months
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21
Q

Types of pharmacologic treatments:

A
  • antacids
  • histamine type 2 receptor antagonists (H2RAs)
  • combo of antacid and H2RA
  • proton pump inhibitors (PPI)
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22
Q

Antacids and H2RAs are recommended for individuals with…

A

mild, infrequent heartburn and dyspepsia

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23
Q

Antacids provide…

A

rapid relief of symptoms w/in 5 minutes

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24
Q

Antacids lasts for…

A

20-30 minutes

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25
Q

H2RAs are preferred to an antacid when individuals with mild-moderate heartburn need…

A

more prolonged relief of symptoms

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26
Q

Onset of H2RAs:

A

30-45 minutes

- longer than antacids

27
Q

Duration of H2RAs:

A

4-10 H

28
Q

How can H2RAs be used to prevent heartburn?

A

should be taken 30 min to 1 hr before anticipation of heartburn

29
Q

What is the benefit to combo products?

A

there is quick relief along with longer duration of action

30
Q

Onset of combo product:

A

less than 5 min

31
Q

Duration of combo product:

A

8-10 H

32
Q

When do you use PPIs?

A

frequent heartburn or when patients don’t respond to H2RAs

33
Q

PPIs should be limited to a duration of…

A

14 days and retreatment to every 4 months

34
Q

Onset of PPIs:

A

2-3 H

35
Q

Duration of PPIs:

A

12-24 H

- first time might need up to 4 days for complete relief of symptoms

36
Q

What are non-pharmacologic therapies for heartburn?

A

dietary and lifestyle modifications

37
Q

Examples of dietary and lifestyle modifications:

A
  • weight loss if overweight
  • wear loose-fitting clothing
  • elevate head of bed
  • eat smaller meals
  • don’t eat within 3 H of going to bed/lying down
  • limit alcohol and caffeine
38
Q

Dosing of antacids can be repeated within…

A

1-2H if need be

39
Q

Antacids contain at least one of the following salts:

A
  • magnesium
  • aluminum
  • calcium carbonate
  • sodium bicarbonate
40
Q

Antacids with magnesium can lead to…

A

dose related diarrhea

41
Q

Antacids with aluminum can lead to…

A

dose related constipation

- can lead to hypophosphatemia

42
Q

Antacids with calcium can lead to…

A

constipation

43
Q

Antacids with sodium bicarbonate can lead to…

A

fluid overload

44
Q

Which have a faster onset, liquid or tablet antacids?

A

liquid antacids b/c they’re already dissolved and provide maximal surface area for action

45
Q

Antacids can potentially decrease absorption of medications such as…

A
  • iron
  • azithromycin
  • fluoroquinolones
  • tetracyclines
  • ketoconazole
  • should separate doses by 2 H
46
Q

Examples of antacids:

A
  • alka-seltzer: sodium bicarb
  • mylanta: magnesium+aluminum or calcium
  • tums: calcium carbonate
  • rolaids: calcium+magnesium
47
Q

T/F: H2RAs should be taken every day

A

F, should take it PRN b/c tolerance can develop

48
Q

Which H2RA should you avoid?

A

cimetidine (Tagamet) b/c several drug interactions

49
Q

Examples of H2RAs:

A
  • famotidine
  • ranitidine
  • cimetidine
50
Q

PPIs are considered a…

A

last resort

51
Q

Since PPIs inhibit proton pumps that actively secrete acid, PPIs would be most effective when taken…

A

30-60 min before meal, preferably before breakfast

52
Q

Self treatment with PPIs should be limited to…

A

14 days and no more frequently than every 4 months

53
Q

Chronic use of PPIs has the potential to…

A

impair natural defenses and increase risk of infection

54
Q

PPIs can cause reduced gastric acid secretion, which can decrease…

A

calcium absorption

55
Q

Decreased calcium absorption leads to…

A

increased bone fractures > 50 YO

56
Q

Calcium citrate is the preferred calcium supplement form for patients on PPIs b/c…

A

it doesn’t require acid environment for dissolution

57
Q

Examples of PPIs:

A
  • omeprazole
  • lansoprazole
  • esomeprazole
58
Q

Dosage for all PPIs:

A

1 capsule 30-60 minutes before morning meal and take QD for 14 days

59
Q

If under 2 YO w/ mild infrequent heartburn, they can take…

A

calcium carbonate containing antacids

60
Q

H2RAs are indicated for patients ages…

A

12 YO and older

61
Q

PPIs are indicated for patients ages…

A

18 YO and older

62
Q

Patients with decreased renal function should be cautioned about using…

A

aluminum and magnesium antacids, PPIs

- if H2RAs is appropriate, then lower dose should be selected

63
Q

Pregnant women should initially try…

A

dietary and lifestyle modifications

64
Q

What are some medically safe options for pregnant women?

A
  • calcium and magnesium containing antacids
  • ranitidine
  • omeprazole
  • esomeprazole

otc (23 decks)

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