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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
Q

Antacid ADE calcium

A

Belching, flatulence, constipation

Hypcalcemia( renally impaired)

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26
Q

Antacid ADE sodium bicarbonate

A

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

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27
Q

Antacid DDI

A

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

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28
Q

H2RA indications

A

Treatment of mild to moderate, infrequent or episodic heartburn and prevention of heartburn

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29
Q

H2RA MOA

A

Decrease gastric acid secretions and gastric volume by inhibiting histamine on the histamine type 2 receptor Of parietal cell

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30
Q

H2RA shortest acting

A

Cemitidine

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31
Q

H2RA dose reduction

A

Renally impaired and geriatrics

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32
Q

H2RA tolerance

A

To gastric antisecretory effect may develop when H2RA are taking daily so better to take it on as needed basis

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33
Q

H2RA usage

A

Twice daily dose
Not to exceed 2 weeks
Use at symptoms onset or 30-60 min prior to event

34
Q

H2RA ADE

A

Headache, diarrhea, constipation, dizziness and drowsiness
Thrombocytopenia ( rare)=> reversible on discontinuation
Cimitidine ( high dose) => decreased libido, importance, gynecomastia ( men)

35
Q

H2RA products

A 
Cimetidine 200 mg
Ranitidine 75mg, 150 mg
Famotidine 10 mg, 20 mg
Nizatidine75 mg( no longer in the US market)
Combinations: Pepsid complete
36
Q

Cimitidine brand

A

Tagamet

37
Q

Ranitidine brand

A

Zantac

38
Q

Famotidine brand

A

Pepcid

39
Q

Nizatidine brand

A

Axid

40
Q

Pepcid complete ( ingredients)

A

Famotidine, magnesium hydroxide, calcium carbonate

41
Q

H2RA DDI

A

Cimitidine-CYP 3 A4. 2D6, IA2,2C9: phenytoin, warfarin, theophylline, TCA, amiodarone
Cimitidine inhibit renal tubular secretion drugs:
Procainamide, metformin, dofetilide

42
Q

H2RA interchangeable

A

Despite minor differences on potency, onset duration of symptomatic relief and ADE

43
Q

PPI indications

A

Treatment of frequent heartburn in patients with symptoms >_ 2 days a week

44
Q

PPI MOA

A

Decrease gastric secretion by inhibiting hydrogen potassium ATPase ( proton pump), irreversibly blocking gastric acid secretion, anti secretory effect.

45
Q

PPI controlled released tablets

A

Do not crush /chew

46
Q

PPI not recommended

A

In pregnancy

<18 years old

47
Q

PPI usage

A

Take30-60 min before breakfast
Not to exceed 2 weeks
No more frequently than 4 months

48
Q

PPI ADE

A

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
Q

Long term use of PPI ADE

A

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
Q

PPI products

A

Omeprazole 20 mg
Lansoprasole 15 mg
Esomeprasole 20 mg
Omeprazole 20 mg/sodium bicarbonate 1100 mg

51
Q

Omeprazole brand

A

Prilosec

52
Q

Lansoprazole brand

A

Prevacid

53
Q

Esomeprazole brand

A

Nexium 24 hr

54
Q

Omeprazole 20 mg/ sodium bicarbonate 1100 mg brand

A

Zegerid

55
Q

PPI DDI

A

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
Q

Bismuth subsalicylate indications

A

Treatment of heartburn, upset stomach, indications, nausea and diarrhea

57
Q

Bismuth subsalicylate MOA

A

Unknown

58
Q

Bismuth subsalicylate dosing

A

262-525 mg every 30-60 min

59
Q

Bismuth subsalicylate ADE

A

May cause dark tarry tongue and stool

60
Q

Bismuth subsalicylate warning

A

Avoid in patients with renal failure

Not recommended for children => Reye’s syndrome

61
Q

Special populations: Elderly

A

Renal impairment
Sodium bicarbonate should be avoided in patients taking cardiovascular medications
Patient has tendency toward constipation: use magnesium hydroxide, avoid calcium bicarbonate

62
Q

Special populations: children >2

A

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
Q

Special populations: pregnancy

A

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
Q

Intestinal gas clinical representation

A

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
Q

Intestinal gas pathophysiology

A

Dietary sugar , complex carbohydrates, indigestible oligosaccharides=> intestinal lumen=> colon=>bacterial fermentation => production of H2 and co2 => intestinal gas

66
Q

Intestinal gas causes

A

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
Q

Exclusion criteria for self treatment of Intestinal gas

A

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
Q

Goals of treatment Intestinal gas

A

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
Q

Nonpharmacological Treatment Of Intestinal gas

A

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
Q

Pharmacologic therapy anti flatulence medication

A

Simithicone

Activated charcoal

71
Q

Simethicone brand

A

Mylicon

72
Q

Simeticone( mylicon) API

A

Mixture of inert silicon polymers

Defoaming agent to relief gas

73
Q

Simeticone( mylicon) MOA

A

Acts in stomach and intestine to reduce surface tension of gas bubbles in mucus of GI tract

74
Q

Simeticone( mylicon) Dose

A

Pediatric formulation contains 40mg/0.6 ml suspension

75
Q

Activated Charcoal

A

Adsorbent effects to eliminate intestinal gas
Beneficial to eliminate malodorous sulfur-based gas
Poor palatable

76
Q

Pharmacological treatment digestive enzymes

A

Alpha-Galactosidase

Lactase replacement

77
Q

Alpha-Galactosidase brand

A

Beano

78
Q

Alpha-Galactosidase MOA

A

Hydrolyzes oligosacharides Before they can metabolized by colonic bacteria

79
Q

Alpha-Galactosidase warnings

A

Should not be used in patients with diabetes or galactosemia

80
Q

Lactase replacement MOA

A

Breaks down lactose( disaccharides) into monosaccharides glucose and galactose

Self Care (6 decks)

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