Heartburn and Dyspepsia Flashcards
What is heartburn
-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
What is GERD
-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
What is dyspepsia
-early fullness, epigastric pain/burning
-symptoms originate from gastroduodenal region
-can cause anorexia, belching, nausea, vomiting, upper abdominal bloating, heartburn, regurgitation
for those experiencing heart burn and dyspepsia, who should not self-treat?
-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
What are some non-pharmacologic options someone might try to help with their heartburn or dyspepsia
-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
What might you consider when recommending a OTC treatment option for heartburn/dyspepsia
-frequency, duration and severity of symptoms
-medication cost
-drug-drug interactions
-adverse effects
-patient preference
What are the classes of medications available for heartburn/dyspepsia?
- Antacids
- H2RAs
- PPI
- Bismuth subsalicylate
What medication could someone take if they are experiencing mild-mod, infrequent heartburn or dyspepsia and they only need short-term relief?
Antacid
-rapid relief
-interchangeable at recommended doses
-antacid/alginic acid more effective in combo
H2RA
-slower relief
What would you recommend someone experiencing mild-mod infrequent HB or dyspepsia but need longer-lasting relief
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
What would you recommend a patient take if they are experiencing heart burn 2 or more fays a week
PPI and/or H2RA
-take the PPI daily for 14 days ONLY
-take H2RA as needed
What is the onset of relief and duration of relief for antacids?
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
What is the duration and onset of relief of H2RAs
onset of relief in 30-45 minutes
duration is 4-8 hours for cimetidine and 4-10 hours for famotidine
What is the duration and onset of relief of H2RAs and antacid combine together
onset of relief is within 5 minutes and duration is 8-10 hours
What is the duration and onset of relief of PPIs
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
What should you recommend someone if the initial therapy of antacid or alginic acid/antacid combo or H2RA/antacid combo not helpful
try a different agent
OR
medical referral
If HB occurs 2 or more days per week and taking a PPI once a day for 14 days or H2RA is needed
-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
What is the MOA of antacids
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)
What is the indication of antacids?
Treatment of mild, infrequent heartburn, sour stomach, and acid indigestion
Rank the formulations of antacids from fastest to slowest: liquid, chewable, quick-dissolving
Liquid formulation > quick-dissolving tablets > chewable tablets
What is the duration of antacid on an empty stomach?
lasts for 20-30 minutes on an empty stomach
lasts 2-3 hours when food is in stomach
What is the dosing for antacids
-take dose at symptom onset
-repeat dose in 1-2 hours if needed
*there are product-recommended dosing and they should not exceed
When should you reevaluate antacid use
-using more than twice a week
-using regularly for more than 2 weeks
What are some side effects that can occur when taking antacids
-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
When should antacids be avoided?
-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
