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OTC Therapy > Heartburn & Dyspepsia > Flashcards

Heartburn & Dyspepsia Flashcards

1
Q

What is another word for heartburn?

A

Pyrosis

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2
Q

What is anther word for pyrosis?

A

Heartburn

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3
Q

What is the definition of heartburn?

A

Burning sensation in stomach/lower chest that rises up toward the neck and occasionally to the back

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4
Q

What is another word for dyspepsia?

A

Indigestion

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5
Q

What is another word for indigestion?

A

dyspepsia

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6
Q

What is hiatal hernia?

A

Relaxation of lower esophageal sphincter and leads to increased acid exposure

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7
Q

Lower esophageal sphincter (relaxes/contracts) at rest and (relaxes/contracts) on swallowing

A

rest - contracted

swallow - relax

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8
Q

Clinical presentation of heartburn is….

A

within 1 hr of eating; laying down, bending over may exacerbate

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9
Q

Clinical presentation of GERD is….

A

heartburn occurring 2+ per week

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10
Q

What is dysphagia?

A

Difficulty swallowing

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11
Q

What is odynophagia?

A

Painful swallowing

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12
Q

Which should you use for mild and less frequent symptoms of heartburn/dyspepsia?

Antacid
H2RA
PPI

A

Antacid

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13
Q

Which should you use for moderate and less frequent symptoms of heartburn/dyspepsia?

Antacid
H2RA
PPI

A

H2RA

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14
Q

Which should you use for severe and more frequent symptoms of heartburn/dyspepsia?

Antacid
H2RA
PPI

A

PPI; use H2RAs first, if it doesnt work then use PPIs

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15
Q

Exclusion of heart burn/dyspepsia

Duration?

A

> 3 months

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16
Q

Exclusion of heart burn/dyspepsia

Age?

A
  1. > 45 yrs old w/ new onset dyspepsia
  2. <12 yrs old for H2RAs
  3. <18 yrs old for PPI
  4. <2 yrs old
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17
Q

Exclusion of heart burn/dyspepsia

Prescription?

A

Heartburn with the use of prescription

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18
Q

Non-Drug Therapy for heart burn/dyspepsia

Meals?

A
  1. 3 or 4 balanced meals/day
  2. Smaller meals
  3. Reduce spicy + fatty foods
  4. Avoid eating 3 hrs before bedtime
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19
Q

Non-Drug Therapy for heart burn/dyspepsia

Positioning?

A
  1. Elevate torso
  2. Raise head of bed by 6 to 8 inches
  3. Wedge pillow
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20
Q

Non-Drug Therapy for heart burn/dyspepsia

OTC to avoid?

A

NSAIDS, unless absolutely necessary

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21
Q

Non-Drug Therapy for heart burn/dyspepsia

Extra info?

A

Keep a heartburn diary; correlate Sx with worst food triggers

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22
Q

Tums, Mylanta, Maalox, and Alka-seltzer are considered:

Antacids
H2RA
PPI

A

Antacids

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23
Q

Zantac, Pepcid, Axid, and Tagamet are considered:

Antacids
H2RA
PPI

A

H2RA

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24
Q

Prilosec, Prevacid, and Nexium are considered:

Antacids
H2RA
PPI

A

PPI

25
Q

How often should you dose antacids?

A

Every 1 to 2 hrs

26
Q

How often should you dose H2RAs?

A

Twice a day

27
Q

How often should you dose PPIs?

A

Once a day

28
Q

How long do antacids last?

A

20 to 30 min

29
Q

How long do H2RAs last?

A

4 to 10 hrs

30
Q

How long do PPIs last?

A

12 to 24 hrs; may take 1 to 4 days for full relief

31
Q

How long do antacids take to work?

A

<5 min

32
Q

How long do H2RAs take to work?

A

30 to 45 min

33
Q

How long do PPIs take to work?

A

2 to 3 hrs

34
Q

MOA of antacids?

A

Increase pH + Neutralize

35
Q

MOA of H2RAs?

A

Increase pH

36
Q

MOA of PPIs?

A

Inactivates pump that extrudes H2 into lumen?

37
Q

Which of these is for acute use?

Antacid
H2RAs
PPIs

A

Antacid

38
Q

What salt in antacids has a slower onset, but effect lasts slightly longer?

A

Calcium carbonate

39
Q

If you wanted to make antacids last longer, what could you do?

A

Have some food; duration of action can stay up to 3 hrs

40
Q

What is the AE of aluminum salts in antacids?

A

Constipation

41
Q

What is the AE of magnesium salts in antacids?

A

Diarrhea

42
Q

What is the AE of carbonate salts in antacids?

A

Belching/Flatulence

43
Q

What is the drug interaction concern w/ antacids?

A

Can affect absorption of other RX by decreasing absorption into bloodstream; affects tetracyclines, fluoroquinolones, zithromax, ketoconazole, itraconazole, iron, or synthroid

44
Q

What is the FDA warning of antacids?

A

Avoid w/ products containing both ASA and antacids; causes bleeding and watch out for >60 yr olds

45
Q

Which H2RA should you not recommend? Why?

A

Cimetidine; lots of rx interactions + inhibits P450 + causes gynecomastia in men

46
Q

What are some things to watch out for H2RAs?

A
  1. Not anti-allergy (use H1RAs)

2. Tolerance can develop

47
Q

What is a rare side effect of H2RAs?

A

Thrombocytopenia

48
Q

What is the recommended use of PPIs?

A

Once daily 30 to 60 min before breakfast for 14 days; repeat in 4 months

49
Q

What are some side effects of PPIs?

A
  1. Increased % to enteric infections

2. Fracture risk in ppl >50 yrs old who have taken PPIs for 1 yr

50
Q

All PPIs interact with what medication?

A

Diazepam, warfarin, phenytoin, theophylline, tacrolimus, and methotrexate

51
Q

Which PPIs interact with clopidogrel and cilostazol?

A

Omeprazole + Esomeprazole

52
Q

Long term use of PPIs are linked with….

A
  1. Dementia
  2. Chronic Kidney Disease
  3. C. difficile infection
  4. Lower Magnesium
  5. Fractures
  6. Community acquired pneumonia
  7. Added to Beer’s List
53
Q

Who should not use Pepto-Bismol?

A

Children, Pts with bleeding risk or renal failure

54
Q

AE of Pepto-Bismol?

A

Black tongue and tarry looking feces

55
Q

For pregnant women, what are their options?

A

Lifestyle modification first; PPIs not studied (Cat. C) and calcium/magnesium based antacids = okay

56
Q

For breastfeeding, what are their options?

A

Aluminum, calcium or magnesium antacids = okay; Famotidine best option for H2RA
Avoid PPIs

57
Q

How do you manage drug interactions with antacids?

A

Separate by other medications by 2 hrs

58
Q

What are the long term consequences of GERD?

A

Barrett’s esophagitis leading to esophageal cancer

OTC Therapy (43 decks)

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