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OTC > Heartburn and Dyspepsia > Flashcards

Heartburn and Dyspepsia Flashcards

1
Q

What is heartburn

A

-burning in the stomach or lower chest; may extend up toward neck and occasionally the back
-usually occurs within 1 hour after eating; often after a large meal
-may be referred to as indigestion, acid indigestion, sour stomach

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2
Q

What is GERD

A

-frequent reverse flow of stomach acid and contents into the esophagus
*chronic condition
**NOT for pharmacists to recommend therapy
-characterized as heartburn 2 or more times a week

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3
Q

What is dyspepsia

A

-early fullness, epigastric pain/burning
-symptoms originate from gastroduodenal region
-can cause anorexia, belching, nausea, vomiting, upper abdominal bloating, heartburn, regurgitation

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4
Q

for those experiencing heart burn and dyspepsia, who should not self-treat?

A

-dysphagia(difficulty swallowing)
-odynophagia(painful swallowing)
-vomiting
-GI bleeding
-unexplained weight loss
-noncardiac chest pain
-asthma
-voice changes
-feeling of “lump in the throat”
-chronic cough
-trouble sleeping
-dental erosion

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5
Q

What are some non-pharmacologic options someone might try to help with their heartburn or dyspepsia

A

-acupuncture for symptoms
-weight loss
-no food within 2-3 hours of bedtime
-sleep on left side (relieves pressure on LES)
-elevate head of bed with 6-8 in blocks underneath legs or foam GERD pillow
-stop tobacco use
-limit or stop alcohol intake
-mediterranean diet
-symptom diary
-assess rx and OTC meds
-modify lifestyle

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6
Q

What might you consider when recommending a OTC treatment option for heartburn/dyspepsia

A

-frequency, duration and severity of symptoms
-medication cost
-drug-drug interactions
-adverse effects
-patient preference

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7
Q

What are the classes of medications available for heartburn/dyspepsia?

A
  1. Antacids
  2. H2RAs
  3. PPI
  4. Bismuth subsalicylate
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8
Q

What medication could someone take if they are experiencing mild-mod, infrequent heartburn or dyspepsia and they only need short-term relief?

A

Antacid
-rapid relief
-interchangeable at recommended doses
-antacid/alginic acid more effective in combo

H2RA
-slower relief

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9
Q

What would you recommend someone experiencing mild-mod infrequent HB or dyspepsia but need longer-lasting relief

A

H2RA
-slower relief
-can use with antacid
-can use to prevent HB if taken 3-60 minutes prior to know cause of symptoms
-lower dose for mild symptoms
higher dose for mod symptoms

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10
Q

What would you recommend a patient take if they are experiencing heart burn 2 or more fays a week

A

PPI and/or H2RA
-take the PPI daily for 14 days ONLY
-take H2RA as needed

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11
Q

What is the onset of relief and duration of relief for antacids?

A

onset within 5 minute
*if liquid, no time delay
lasts for 20-30 minutes on empty stomach
lasts for up to 3 hours if there is food in the stomach

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12
Q

What is the duration and onset of relief of H2RAs

A

onset of relief in 30-45 minutes
duration is 4-8 hours for cimetidine and 4-10 hours for famotidine

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13
Q

What is the duration and onset of relief of H2RAs and antacid combine together

A

onset of relief is within 5 minutes and duration is 8-10 hours

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14
Q

What is the duration and onset of relief of PPIs

A

onset of relief occurs within 1-3 hours of taking but may need 1-4 days for full effect
duration is 12-24 hours for a single dose

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15
Q

What should you recommend someone if the initial therapy of antacid or alginic acid/antacid combo or H2RA/antacid combo not helpful

A

try a different agent
OR
medical referral

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16
Q

If HB occurs 2 or more days per week and taking a PPI once a day for 14 days or H2RA is needed

A

-refer if not better after 2 weeks
-if better, continue with lifestyle/diet changes, stop PPI
*may repeat PPI every 4 months if needed or continue H2RA as needed

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17
Q

What is the MOA of antacids

A

neutralize the gastric acid and increase LES pressure
aliginic acid + sodium bicard in saliva = layer of sodium alginate on top of stomach contents(= protective barrier)

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18
Q

What is the indication of antacids?

A

Treatment of mild, infrequent heartburn, sour stomach, and acid indigestion

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19
Q

Rank the formulations of antacids from fastest to slowest: liquid, chewable, quick-dissolving

A

Liquid formulation > quick-dissolving tablets > chewable tablets

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20
Q

What is the duration of antacid on an empty stomach?

A

lasts for 20-30 minutes on an empty stomach
lasts 2-3 hours when food is in stomach

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21
Q

What is the dosing for antacids

A

-take dose at symptom onset
-repeat dose in 1-2 hours if needed
*there are product-recommended dosing and they should not exceed

22
Q

When should you reevaluate antacid use

A

-using more than twice a week
-using regularly for more than 2 weeks

23
Q

What are some side effects that can occur when taking antacids

A

-aluminum: cause constipation(can be managed when used in combo with magnesium), hypophosphatemia
-calcium carbonate: belching, intestinal gas, constipation; hypercalcemia can occur is kidney dysfunction
-magnesium: diarrhea(manage by taking with aluminum)
-sodium bicarb: belching, intestinal gas

24
Q

When should antacids be avoided?

A

-dyspepsia
-aluminum or calcium should be avoided if there is kidney dysfunction
-magnesium if creatine clearance is less than 30mL/min
-Sodium bicarb should be avoided in those with: sodium restriction, heart failure, kidney failure, cirrhosis, pregnancy, taking calcium supplements, concomitant aspirin therapy

25
Q

What are the 2 HR2A products on the market

A

cimetidine and famotidine

26
Q

What is the MOA of HR2A

A

reduce acid secretion by inhibiting histamine at the H2 receptors on parietal cells in the lining of the stomach

27
Q

What is the indication for cimetidine and famotidine

A

-for mild to moderate, infrequent or episodic HB or prevention of HB

28
Q

Can you combine HR2A with antacids

A

Yes, you can combine if not already pre-medicated with HR2A

29
Q

What is the duration for famotidine

A

4-10 hours

30
Q

What is the duration of cimetidine

A

4-8 hours

31
Q

What is the onset for cimetidine and famotidine

A

30-45 minutes

32
Q

What are the side effects that can occur when taking cimetidine or famotidine

A

-Both: headache, diarrhea, constipation, drowsiness, dizziness
-Cimetidine: high doses may cause decreased libido, impotence or enlargement of breast tissue due to weak antiandrogenic effect

33
Q

Who should avoid taking H2RA

A

-older adults: high risk for delirium, sodium-sensitive conditions
-those younger than 12 years old
-Okay to use in pregnancy, but studies suggest association of childhood asthma
-Famotidine preferred when lactating due to lower milk concentrations

34
Q

What is the dosing on H2RA

A

-take at onset of symptoms OR 30 minutes prior to when HB is expected
-Cimetidine: 200mg once a day(may need adjustment due to kidney dysfunction)
-Famotidine: 10-20 mg once or twice daily(max 40mg in 24 hr)

35
Q

What is the MOA of PPIs

A

inhibit hydrogen potassium ATPase in stomach parietal cells

36
Q

What is the indication for PPIs

A

heartburn symptoms that happen 2 or more days per week

37
Q

How long does it usually take for someone taking PPIs to see an effect

A

relief should start within 1-3 hours but can take up to 1-4 days for full effect to occur

38
Q

What is the duration for a single dose of PPI

A

12-24 hours

39
Q

What side effects can occur when taking a PPI

A

headache
abdominal pain
diarrhea
constipation
gas
*Increased risk for C. diff and travelers diarrhea

40
Q

Who or when should PPIs be avoided

A

-avoid crush/chewing tablets or capsules
-if you have severe diarrhea/gastroenteritis symptoms
-younger than 18 years
-older adults(Beers list)

41
Q

What is the dosing of PPIs

A

take 30-60 minutes prior to meal(most commonly breakfast)
take a max of 14 days(don’t have to take full 14 days, can see how you feel after 3-4 days)
1 course every 4 months

42
Q

What is the MOA of Bismuth subsalicylate(Pepto-Bismol)

A

protects gastric mucosa

43
Q

What is Pepto indicated for

A

nausea, heartburn, upset stomach, indigestion, diarrhea

44
Q

How long does it take for Pepto to start working and how long do the effects last

A

onset: 30-60 min
duration: 30-60 min

45
Q

What side effects can occur from taking Pepto

A

black-colored tongue/stool, tinnitus

46
Q

What drug interactions exist with Pepto

A

warfarin
tetracycline antibiotics
methotrexate

47
Q

Who should avoid taking Pepto

A

children younger than 18 y.o.(risk of Reyes syndrome)
salicylate sensitivity/allergy
bleeding risks
live vaccines
pregnant or lactating individuals

48
Q

What is the dosing for pepto

A

262-525mg every 30-60 minutes as needed
*chew chewable tablets thoroughly
*take non-chewable tabs with full class of water
**TAKE FOR MAX 48 HOURS

49
Q

If a pregnant person is experiencing heartburn, what are some things they can do to help?

A

-Make lifestyle/food changes first
-First-line OTC: calcium or magnesium antacids
**MAX food/OTC calcium per day should be 2500mg

50
Q

What can be done for a child older than 2 years old experiencing mild, transient, infrequent HB or sour stomach

A

-take children’s formulation of calcium carb antacid and make food/lifestyle change
*Refer if frequent HB or antacid is ineffective

51
Q

What is the MAX amount of daily calcium for children(including food/beverages)

A

Ages 2-3: 700mg
Ages 4-8: 1000mg
Ages 9-18: 1300 mg

52
Q

When recommending treatments for older adults what should be taken into consideration?

A

-consider drug-drug interactions
-consider other health conditions and kidney function
-avoid H2RAs if high risk for delirium
-avoid long-term use of PPI due to risk of C. diff, fractures and other infections
*long-term use can be done under recommendation of DOCTOR
*triage carefully because HB may be symptom of a more serious pathology

OTC (33 decks)

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