Heartburn and dyspepsia

Question 1

Some exclusions for treatment of heartburn and dyspepsia

Answer 1

Frequent heartburn for more than 3 months

Heartburn while taking nonRx doses of H2RA or PPI

Heartburn that continues after taking nonRx dose of H2RA or PPI for 2 weeks

Age < 2 for antacids, < 12 years for H2RA and < 18 years for PPI

Question 2

Non pharm treatment for heartburn and dyspepsia

Answer 2

Elevating the head of the bed 6-8 inches or placing a foam wedge beneath the patient’s upper torso and head

Eat smaller meals

Reduce intake of dietary fat

Refrain from eating 3 hours before bed or lying down

Discontinue tobacco and lower caffeine and alcohol intake

Question 3

List of antacids

Answer 3

magnesium

aluminum

calcium carbonate

sodium bicarbonate

Question 4

Side effect of magnesium

Answer 4

Diarrhea

Diarrhea may be reduced by combining Mg containing product with Al hydroxide

Question 5

Side effect of aluminum hydroxide

Answer 5

Constipation

Prolonged use may result in hypophosphatemia (muscle dysfunction/weakness, mental status changes, cell membrane instability [anemia as a result of destroyed RBC])

Question 6

Side effect of calcium carbonate

Answer 6

belching and flatulence

Question 7

Side effect of sodium bicarbonate

Answer 7

belching and flatulence

Question 8

Antacids things needs to remember

Answer 8

Provide excellent symptom relief, usually in 5 minutes or less, and lasts 20-30 minutes

Food helps keep antacid in the stomach (up to 3 hours if administered within 1 hour of a meal

Interaction can be avoided by separating the antacid dose and interacting drug by 2 hours

Question 9

Histamine Type 2 Receptor Antagonists (H2RA) OTC options

Answer 9

Cimetidine, ranitidine, famotidine and nizatidine

Question 10

Histamine Type 2 Receptor Antagonists (H2RA)

Answer 10

Block histamine from stimulating the parietal cell receptor thus decreases gastric acid secretion and gastric volume

H2RA may be used
Onset of symptoms
30-60 minutes prior to meal/exercise where heartburn is anticipated

No more than 2 times per day and only for 2 weeks

Question 11

H2RA side effects

Answer 11

Headache
Diarrhea
Constipation
Dizziness
Drowsiness
Thrombocytopenia (less common and reversible)

Question 12

Tums

Answer 12

Calcium Carbonate USP 1000mg.

Not more than 7 tabs/day

Question 13

Dosage for pepcide

Answer 13

Famotidine 20mg QD to BID

Question 14

Proton Pump Inhibitors (PPI)

Answer 14

Irreversibly inhibit the proton pump (H+/K+/ATPase) thus more potent and prolonged antisecretory effect

Omeprazole tablets are almost completely absorbed after oral administration, regardless of the presence of food

Symptom relief occurs in 2-3 hours but complete relief may take 1-4 days

Most effective if taken 30-60 minutes before a meal, preferably breakfast

Question 15

PPI dosage

Answer 15

Omeprazole Mg 20.6 mg, lansoprazole 15mg, esomeprazole 20mg

Take 1 PPI tablet/capsule every morning for 14 days 30 minutes before morning meal

Question 16

If heartburn is > = 2 days/week, what treatment should we consider? What if episodic?

Answer 16

We should consider PPI treatment x14 days

If episodic, can use antacids and H2RA

Question 17

Side effects of PPI

Answer 17

Diarrhea, Constipation, Headache

Question 18

Bismuth Subsalicylate

Answer 18

Indicated for heartburn, indigestion, nausea and diarrhea

Thought to have a topical effect on stomach mucosa
BSS 262-525mg every 30-60 minutes prn

Not recommended for children <12 (Reyes syndrome)

Cause stool to turn black