heartburn and dyspepsia Flashcards
heartburn definition
burning sensation arising from substernal area and moves up toward neck/throat/potentially back
episodic heartburn
less than two days per week, mild and infrequent
frequent heartburn
more than or equal to 2 days per week
dyspepsia
‘bad digestion’, consistent or recurrent discomfort with on or more of the following: epigastric pain, burning, postprandial fullness, and early satiety. discomfort is usually located in upper abdomen
GERD
a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications
factors that contribute to heartburn
dietary, lifestyle, disease, meds, genetic factors, and pregnancy
dietary examples that cause heartburn
alcohol, caffeine, carbonated beverages, chocolate, citrus, fruit, juices, fatty or greasy foods, garlic, onions, mint, salt, spicy foods, tomatoes
lifestyle examples that cause heartburn
exercise, obesity, smoking, stress, supine body position, tight fitting clothes
disease examples that cause heartburn
motility diseases, PUD, scleroderma, Zollinger-Ellison syndrome
exclusions for self care
- frequent heartburn for more than 3 months
- heartburn while taking recommended dosages of nonRX H2RA or PPI
- heartburn that continues after 2 weeks of treatment
- heartburn and dyspepsia that occur during treatment
- severe heartburn or dyspepsia
- nocturnal heartburn
- difficulty or pain swallowing food
- vomiting blood or black material or tarry stools
- chronic hoarseness, wheezing, coughing, or choking
- unexplained weight loss
- continuous n/v/d
- chest pain
- adults > 45 years with new onset dyspepsia
non pharm treatment
eating smaller meals, reduce intake of dietary fat, refrain from lying down within 3 hours after meal, losing weight, stopping or reducing smoking, wearing loose-fitting clothing, avoid alcohol, tobacco, or caffeine, drink water and chew gum, elevate head of bed
antacid MOA
neutralize gastric acid, may increase LES pressure
administration antacid
every 1-2 hours as needed but should not exceed max daily dose
advantages of antacid
least expensive, rapid onset
antacids containing magnesium
may cause diarrhea
antacids containing aluminum or calcium
may cause constipation
onset/duration for antacids
rapid onset of symptom relief (< 5 min); short duration of action when taken on an empty stomach (20-30 min); duration of relief may be prolonged for several hours by taking after meal
drug interactions with antacids
can usually be avoided if administered at least 2 hours apart
antacids can be combined with
H2RA for better symptom relief
BSS should not be used in
children ( < 16 years), pregnancy, breast feeding, or those with an increased bleeding risk
H2RA MOA
blocks H2 receptors to decrease gastric acid secretion which decreases the volume of secreted acid
compared to antacids, H2RAs
do not relieve heartburn or dyspepsia as rapidly, but have a longer duration of action
onset/duration of H2RA
onset averages 30-45 min and duration is 4-10 hours
dosing of h2ra
should be limited to no more than twice daily
administration of h2ra
may be used to prevent heartburn and acid ingestion when taken 30-60 min before exercise or eating a heavy or spicy meal
most common AE of h2ras
headache, diarrhea, constipation, dizziness, and drowsiness
cimetidine is associated with
weak antiandrogenic effects (can cause decreased libido, impotence, and gynecomastia)
MOA of PPIs
irreversibly shuts down ATPase proton pump which blocks acid secretion; inhibits basal and meal time acid secretion
Nonrx PPIs are drug of choice for
patients with frequent heartburn OR in pateitns who do NOT respond to nonRx h2ra
onset/duration of ppis
takes approximately 2-3 hours for onset and complete relief may take up to 4 days
administration of ppis
take daily for 14 days, may be repeated every 4 months. take 30-60 min before meal
most common short term AE for ppis
diarrhea, constipation, and headache
high dose of ppis have been associated with
increased risk for hip, spine, or wrist fracture in patients >50; along with b12 deficiency, low magnesium, and iron malabsorption
potential ppi drug interactions
cyp2c19 (Plavix concern)
pregnancy and antacids
antacids may be used safely if max dosages are not exceeded; do not exceed 2500 mg/day
pregnancy and h2ras
considered compatible with pregnancy
pregnancy ppis
refer if frequent to severe heartburn
lactation and antacids
considered safe
lactation and h2ras
cimetidine is compatible, famotidine however is preferred
lactation and ppis
not currently recommended
elderly and antacids
if renal impairment is present, use with caution
elderly and h2ras
if renal impairment is present, low doses and cimetidine should be avoided
elderly and ppis
may be used in renal impairment, otherwise is inappropriate
pediatrics and antacids
for children > 2 years with mild, transient, and infrequent heartburn, acid indigestion or sour stomach
pediatrics and h2ras
must be at least 12 or older
pediatrics and ppis
must be at least 18 or older
