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Self Care > Heartburn, Dyspepsia&Intestinal Gas > Flashcards

Heartburn, Dyspepsia&Intestinal Gas Flashcards

1
Q

Heartburn

A

Burning sensation in the stomach or lower chest that rises up toward the neck

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2
Q

Dyspepsia

A

Symptoms originating from the gastroscope always region ( e.g. postpradial fullness, early satiation, epigastric pain, and epigastric burning):

  • organic-identifiable cause
  • functional- no identifiable ( organic, systemic or metabolic) causes
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3
Q

Diet as risk factors

A 
Alcohol 
Caffeine 
Fatty food
Salt
Spicy food
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4
Q

Life style as risk factors

A 
Exercise 
Obesity 
Smoking 
Stress 
Tight-fitting clothing
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5
Q

Disease as risk factors

A

Motility disorder
PUD
Scleroderma

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6
Q

Medications as risk factors

A 
Alpha-adrenergic antagonist 
Anticholinergic 
Barbiturates 
Benzodiazepines 
Beta2-adrenergic agonist 
Bisphosphonates
TCAs
Tetracycline
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7
Q

Heartburn (pyrosis) clinical presentation

A

Usually 1 hour after eating a large meal
-bending over/lying down can aggravate symptoms
Occurring >_2 time a week => GERD
Nocturnal symptoms
-associated with interrupted sleep, decreased productivity
Alarm symptoms
-dysphasia, odynophagia, upper GI bleeding, unexplained weight loss

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8
Q

Dyspepsia

A

“B” symptoms- burping, benching, bloating

Feeling full early ( satiety)

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9
Q

Treatment goals

A

Provide complete relief of symptoms
Reduce recurrence of symptoms
Prevention and management unwanted effects of medications

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10
Q

Exclusions for self treatment

A

Frequent heartburn for >3 months
Heartburn while taking nonprescription H2RA or PPI
Heartburn and dyspepsia that occurs when taking a prescription H2RA or PPI
Heartburn continues after 2 weeks of treatment with otc H2RA or PPI
Severe heartburn and dyspepsia
Nocturnal heartburn
Difficulty or pain on swallowing solid foods
Vomiting up blood or black material or passing black tarry stools
Chronic hoarseness wheezing coughing, or choking
Unexplained weight loss
Continuous nausea, vomiting or diarrhea
Chest pain accompanied by sweating, pain, radiating to shoulder arm, neck or jaw, and shortness of breath
Children <2 years ( for antacid) , 12 year ( for H2RA), and 18 yo ( for PPI)
Adults >45 yo with new onset dyspepsia

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11
Q

Nonpharmacologic Treatment

A

Avoid food/beverages that precipitate heartburn
Adopt lifestyle modification that reduce esophageal acid exposure
Weight loss
Elevating head of bed by by place 6 to 8 inches blocks underneath legs at the head of the bed
Eat smaller meals to reduce dietary fat intake
Do not eat within 3 hours of going to bed / lying down

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12
Q

Antacids

A

Magnesium
Aluminum
Calcium
Sodium bicarbonate

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13
Q

Pharmacologic Treatment

A

Antacid
Histamine type 2 receptors antagonist
PPI
Bismuth sub salicylate

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14
Q

Antacid onset and duration in relief heartburn

A

Onset <5 min

Duration of relief 20-30 min

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15
Q

H2RA onset and duration in relief heartburn

A

Onset 30-45 min

Duration of relief 4-10 hr

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16
Q

H2RA +antacid onset and duration in relief heartburn

A

Onset <5 min

Duration of relief 8-10 hr

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17
Q

PPI onset and duration in relief heartburn

A

Onset 2-3 hr

Duration of relief 12-24

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18
Q

Antacid indications

A

Treatment of mild , infrequent heartburn

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19
Q

Antacid MOA

A

Neutralizes gastric acid ( buffering agents), increases intragastric pH > 5 to prevent conversions of pepsin to pepsinogen and increase LES pressure

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20
Q

Antacid ANC ( acid neutralizing capacity)

A

Amount of acid buffered per dose over a period of time

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21
Q

Antacid gen info

A

Compared with tablets, liquid antacid usually have a faster onset
Most Antacid are absorbed minimally into systemic circulation:
10% of calcium salt
15-30% of magnesium salts excreted renally, careful with renal impairment
17-30% of aluminum salts excreted renally, careful with renal impairment

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22
Q

Antacid dose at onset symptoms

A

May repeat in 1-2 hours, if needed

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23
Q

Antacid ADE magnesium

A

Magnesium: dose related diarrhea, not used in renal impairment patients ( CrCl< 30 ml/ minutes)

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24
Q

Antacid ADE aluminum

A

Aluminum: dose related constipation, hypophosphatemia ( with prolonged use, aluminum binds dietary phosphate)
Aluminum Toxicity in renal failure

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25
Antacid ADE calcium
Belching, flatulence, constipation | Hypcalcemia( renally impaired)
26
Antacid ADE sodium bicarbonate
Belching , flatulence Not used in aCHF, renal failure, cirrhosis or pregnancy => fluid overload Milk-alkali Syndrome ( high intake of calcium with alkalizing agent) - hypercalcemia, alkalosis, irritability, headache, nausea, vomiting, weakness, and malaise
27
Antacid DDI
Affects absorption of other medications ( increase/decreases) Antibiotic ( decreased absorption) - flouroquinolones, azithromycon, tetracycline Anti fungal ( decreases absorption) - intracinazole, ketoconazole Recommended: separate medications with potential DDI by at least 2 hours before meal or 4 hours after meal
28
H2RA indications
Treatment of mild to moderate, infrequent or episodic heartburn and prevention of heartburn
29
H2RA MOA
Decrease gastric acid secretions and gastric volume by inhibiting histamine on the histamine type 2 receptor Of parietal cell
30
H2RA shortest acting
Cemitidine
31
H2RA dose reduction
Renally impaired and geriatrics
32
H2RA tolerance
To gastric antisecretory effect may develop when H2RA are taking daily so better to take it on as needed basis
33
H2RA usage
Twice daily dose Not to exceed 2 weeks Use at symptoms onset or 30-60 min prior to event
34
H2RA ADE
Headache, diarrhea, constipation, dizziness and drowsiness Thrombocytopenia ( rare)=> reversible on discontinuation Cimitidine ( high dose) => decreased libido, importance, gynecomastia ( men)
35
H2RA products
``` Cimetidine 200 mg Ranitidine 75mg, 150 mg Famotidine 10 mg, 20 mg Nizatidine75 mg( no longer in the US market) Combinations: Pepsid complete ```
36
Cimitidine brand
Tagamet
37
Ranitidine brand
Zantac
38
Famotidine brand
Pepcid
39
Nizatidine brand
Axid
40
Pepcid complete ( ingredients)
Famotidine, magnesium hydroxide, calcium carbonate
41
H2RA DDI
Cimitidine-CYP 3 A4. 2D6, IA2,2C9: phenytoin, warfarin, theophylline, TCA, amiodarone Cimitidine inhibit renal tubular secretion drugs: Procainamide, metformin, dofetilide
42
H2RA interchangeable
Despite minor differences on potency, onset duration of symptomatic relief and ADE
43
PPI indications
Treatment of frequent heartburn in patients with symptoms >_ 2 days a week
44
PPI MOA
Decrease gastric secretion by inhibiting hydrogen potassium ATPase ( proton pump), irreversibly blocking gastric acid secretion, anti secretory effect.
45
PPI controlled released tablets
Do not crush /chew
46
PPI not recommended
In pregnancy | <18 years old
47
PPI usage
Take30-60 min before breakfast Not to exceed 2 weeks No more frequently than 4 months
48
PPI ADE
Diarrhea, constipation, headache We ( high dose) Increase risk of enteric infection ( due to low ph): clostridium difficile Rebound acid hyper secretion ( discontinuation with long term use)
49
Long term use of PPI ADE
Increase risk of hip, spine and wrist fractures in geriatric( > 50) Increase in risk for chronic renal disease and dementia Vitamin B12 deficiency, hypo magnesemia, iron malabsorption
50
PPI products
Omeprazole 20 mg Lansoprasole 15 mg Esomeprasole 20 mg Omeprazole 20 mg/sodium bicarbonate 1100 mg
51
Omeprazole brand
Prilosec
52
Lansoprazole brand
Prevacid
53
Esomeprazole brand
Nexium 24 hr
54
Omeprazole 20 mg/ sodium bicarbonate 1100 mg brand
Zegerid
55
PPI DDI
Inhibit metabolism of cyp 2c 19: - diazepam, phenytoin, warfarin, theophylline, tacrolimus -interfere with elimination of methotrexate => increase risk of Toxicity - increase bioavailability of digoxin Omeprazole and Esomeprazole -clopidogrel ( reduce antiplatelet effect) -inhibit metabolism of cilostazol
56
Bismuth subsalicylate indications
Treatment of heartburn, upset stomach, indications, nausea and diarrhea
57
Bismuth subsalicylate MOA
Unknown
58
Bismuth subsalicylate dosing
262-525 mg every 30-60 min
59
Bismuth subsalicylate ADE
May cause dark tarry tongue and stool
60
Bismuth subsalicylate warning
Avoid in patients with renal failure | Not recommended for children => Reye’s syndrome
61
Special populations: Elderly
Renal impairment Sodium bicarbonate should be avoided in patients taking cardiovascular medications Patient has tendency toward constipation: use magnesium hydroxide, avoid calcium bicarbonate
62
Special populations: children >2
Nonprescription antacid containing calcium carbonate are labeled for children ages 2 yo and older Nonprescription H2RA are labeled for patients ages 12 yo and older Nonprescription PPI are indicated for patients ages 18 yo or older
63
Special populations: pregnancy
Calcium and magnesium containing antacid may be used safely H2RA are considered compatible with pregnancy Data for use of PPI during pregnancy are limited
64
Intestinal gas clinical representation
Eructation ( belching of swallowed air), bloating ( excessive gas after eating) flatulence ( passage of air through GI tract), borborygmi ( audible bowel sounds) , dyspepsia, or indigestion
65
Intestinal gas pathophysiology
Dietary sugar , complex carbohydrates, indigestible oligosaccharides=> intestinal lumen=> colon=>bacterial fermentation => production of H2 and co2 => intestinal gas
66
Intestinal gas causes
Carbohydrate malabsorption Bacterial overgrown Medical conditions ( celiac disease, diabetic gastroparesis) Medications: - affects intestinal flora ( antibiotic, lactulose) -affects metabolism of glucose and dietary substances ( alpha-glucosidase inhibitors, biguanides, metformin) -GI lipase inhibitors -GI motility ( narcotics, anticholinergic, CCBs) - Nonabsorbable plymers ( cholestyramine)
67
Exclusion criteria for self treatment of Intestinal gas
Intestinal gas symptoms that persist for more than several days or occur more often than occasionally Severe debilitating symptoms Sudden change in the location of abdominal pain, significant increase in the frequency or severity of symptoms, or an onset of symptoms in individuals >40 yo Presence of accompanying symptoms such as severe or persistent diarrhea or constipation, GI bleeding, fatigue, unintentional weight loss, or frequent nocturnal symptoms
68
Goals of treatment Intestinal gas
Reduce frequency, intensity and duration of gas symptoms Reduce impact of intestinal gas symptoms -complete elimination of intestinal gas is an unattainable goal, necessary for GI function)
69
Nonpharmacological Treatment Of Intestinal gas
Change in eating habits -chew food thoroughly -eat and drink slowly -avoid chewing gum or sucking hard candy -avoid washing down solids with beverages Change in diet -Reduce consumption of gas producing foods -may need to avoid some food altogether -lactose intolerance => avoid dairy products
70
Pharmacologic therapy anti flatulence medication
Simithicone | Activated charcoal
71
Simethicone brand
Mylicon
72
Simeticone( mylicon) API
Mixture of inert silicon polymers | Defoaming agent to relief gas
73
Simeticone( mylicon) MOA
Acts in stomach and intestine to reduce surface tension of gas bubbles in mucus of GI tract
74
Simeticone( mylicon) Dose
Pediatric formulation contains 40mg/0.6 ml suspension
75
Activated Charcoal
Adsorbent effects to eliminate intestinal gas Beneficial to eliminate malodorous sulfur-based gas Poor palatable
76
Pharmacological treatment digestive enzymes
Alpha-Galactosidase | Lactase replacement
77
Alpha-Galactosidase brand
Beano
78
Alpha-Galactosidase MOA
Hydrolyzes oligosacharides Before they can metabolized by colonic bacteria
79
Alpha-Galactosidase warnings
Should not be used in patients with diabetes or galactosemia
80
Lactase replacement MOA
Breaks down lactose( disaccharides) into monosaccharides glucose and galactose

Self Care (6 decks)

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