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OTC > heartburn and dyspepsia > Flashcards

heartburn and dyspepsia Flashcards

1
Q

heartburn definition

A

burning sensation arising from substernal area and moves up toward neck/throat/potentially back

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2
Q

episodic heartburn

A

less than two days per week, mild and infrequent

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3
Q

frequent heartburn

A

more than or equal to 2 days per week

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4
Q

dyspepsia

A

‘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

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5
Q

GERD

A

a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications

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6
Q

factors that contribute to heartburn

A

dietary, lifestyle, disease, meds, genetic factors, and pregnancy

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7
Q

dietary examples that cause heartburn

A

alcohol, caffeine, carbonated beverages, chocolate, citrus, fruit, juices, fatty or greasy foods, garlic, onions, mint, salt, spicy foods, tomatoes

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8
Q

lifestyle examples that cause heartburn

A

exercise, obesity, smoking, stress, supine body position, tight fitting clothes

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9
Q

disease examples that cause heartburn

A

motility diseases, PUD, scleroderma, Zollinger-Ellison syndrome

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10
Q

exclusions for self care

A
  1. frequent heartburn for more than 3 months
  2. heartburn while taking recommended dosages of nonRX H2RA or PPI
  3. heartburn that continues after 2 weeks of treatment
  4. heartburn and dyspepsia that occur during treatment
  5. severe heartburn or dyspepsia
  6. nocturnal heartburn
  7. difficulty or pain swallowing food
  8. vomiting blood or black material or tarry stools
  9. chronic hoarseness, wheezing, coughing, or choking
  10. unexplained weight loss
  11. continuous n/v/d
  12. chest pain
  13. adults > 45 years with new onset dyspepsia
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11
Q

non pharm treatment

A

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

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12
Q

antacid MOA

A

neutralize gastric acid, may increase LES pressure

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13
Q

administration antacid

A

every 1-2 hours as needed but should not exceed max daily dose

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14
Q

advantages of antacid

A

least expensive, rapid onset

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15
Q

antacids containing magnesium

A

may cause diarrhea

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16
Q

antacids containing aluminum or calcium

A

may cause constipation

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17
Q

onset/duration for antacids

A

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

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18
Q

drug interactions with antacids

A

can usually be avoided if administered at least 2 hours apart

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19
Q

antacids can be combined with

A

H2RA for better symptom relief

20
Q

BSS should not be used in

A

children ( < 16 years), pregnancy, breast feeding, or those with an increased bleeding risk

21
Q

H2RA MOA

A

blocks H2 receptors to decrease gastric acid secretion which decreases the volume of secreted acid

22
Q

compared to antacids, H2RAs

A

do not relieve heartburn or dyspepsia as rapidly, but have a longer duration of action

23
Q

onset/duration of H2RA

A

onset averages 30-45 min and duration is 4-10 hours

24
Q

dosing of h2ra

A

should be limited to no more than twice daily

25
Q

administration of h2ra

A

may be used to prevent heartburn and acid ingestion when taken 30-60 min before exercise or eating a heavy or spicy meal

26
Q

most common AE of h2ras

A

headache, diarrhea, constipation, dizziness, and drowsiness

27
Q

cimetidine is associated with

A

weak antiandrogenic effects (can cause decreased libido, impotence, and gynecomastia)

28
Q

MOA of PPIs

A

irreversibly shuts down ATPase proton pump which blocks acid secretion; inhibits basal and meal time acid secretion

29
Q

Nonrx PPIs are drug of choice for

A

patients with frequent heartburn OR in pateitns who do NOT respond to nonRx h2ra

30
Q

onset/duration of ppis

A

takes approximately 2-3 hours for onset and complete relief may take up to 4 days

31
Q

administration of ppis

A

take daily for 14 days, may be repeated every 4 months. take 30-60 min before meal

32
Q

most common short term AE for ppis

A

diarrhea, constipation, and headache

33
Q

high dose of ppis have been associated with

A

increased risk for hip, spine, or wrist fracture in patients >50; along with b12 deficiency, low magnesium, and iron malabsorption

34
Q

potential ppi drug interactions

A

cyp2c19 (Plavix concern)

35
Q

pregnancy and antacids

A

antacids may be used safely if max dosages are not exceeded; do not exceed 2500 mg/day

36
Q

pregnancy and h2ras

A

considered compatible with pregnancy

37
Q

pregnancy ppis

A

refer if frequent to severe heartburn

38
Q

lactation and antacids

A

considered safe

39
Q

lactation and h2ras

A

cimetidine is compatible, famotidine however is preferred

40
Q

lactation and ppis

A

not currently recommended

41
Q

elderly and antacids

A

if renal impairment is present, use with caution

42
Q

elderly and h2ras

A

if renal impairment is present, low doses and cimetidine should be avoided

43
Q

elderly and ppis

A

may be used in renal impairment, otherwise is inappropriate

44
Q

pediatrics and antacids

A

for children > 2 years with mild, transient, and infrequent heartburn, acid indigestion or sour stomach

45
Q

pediatrics and h2ras

A

must be at least 12 or older

46
Q

pediatrics and ppis

A

must be at least 18 or older

OTC (22 decks)

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