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Flashcards in 5 - GI: Heartburn Deck (50)
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1

Esomeprozole

AE / Counsult

Nexium

Take 60 min prior to eating

May be taken WITH Antacids

<18 y/o PPI's

Headache / Diarrhea

Constipation / Flatulence

Nausea / Ab pain / dry mouth

2

Pepcid AC

DOSE / Indication

Famotadine

OG / Max = 10mg / 20mg

H2RA for Heartburn

1 dose (10mg) taken with water

MAX 2 doses in 24 hour period

3

Mintox / Mylanta

AE / Consult

Aluminum hydroxide / MgOH / Simethicone

Diarrhea / Constipation

 

<14 days

 

 FULL GLASS OF WATER

4

Pathophysiology of Heartburn

  • Esophogeal epithelium nerve Stimulation
    • SPICY food
    • Refluxate
  • Impaired Esophageal clearing mechanisms
  • Pressure gradient between LES / Stomach is less than normal or absent:
    • REDUCED SPINCTER TONE

5

Pepcid Complete

CIP /  DI

Famotadine + Calcium Carbonate + MgOH

SAME AS PEPCID

Hypersensitive to famotadine

Impared renal fxn

Caution with Pregnancy / Lac

PREGNANCY CAT B

 

WARFARIN

6

Heartburn Epidemiology

Men = Women

No Difference in age groups

Increase in Pregnancy

7

Medications that cause a 

DIRECT IRRITANT EFFECT

Antibiotics

ASA / NSAIDs

Bisphonates

IRON / Potassium supplements

Quinidine / Zidovudine

8

Tums

AE / Consult

Calcium Carbonate

Bloating / Flatulance

 

<6000mg for 14 days

 

Take chewable tabs with FULL GLASS OF WATER

9

Medications that

REDUCE Spincter Tone

Alpha - agonist / blockers

Anticholinergics

Barbs / BZD's / TCA's

CCB's / Nitrates / Theophylline

Estrogen / Progestrone

Dopamine / Phentolamine

 

10

Omeprazole Mg

Dose / Indication

 

 

Prilosec OTC

1Tab (20mg) qd b4 breakfast

for 14 consecutive days

Corse may be repeated once every 4 months

May take up to 1-4 days for full effect

Do NOT CRUSH OR CHEW TABS

11

Tums

CIP / DI

Calcium Carbonate

DNU ​<2 yo

max dose is 6000mg

 

Tetracyclines / Penicilin

Quinalone AB's / Digoxin

Enteric coated drugs

12

Heartburn ALARM Symptoms

  • Frequent and >3 MONTHS
  • Dysphagia / odynophagia
  • Unexplained weight loss
  • N/V/D
  • Chronic hoarseness / wheezing / coughing / choking
  • Chest Pain w/
    • sweating / pain radiating to shoulder-arm-neck-jaw
    • Shortness of breath = SOB
  • Evidence of GI BLEEDING
  • Personal / H/o ULCERS

13

Zantac OTC

MAX Dose

 

Ranitidine HCL

 

<2 tabs in 24 hours

(2 - 75mg tablets = 150mg /day) 

do not use consecutive days for

>14 days!

14

Esomeprazole MgH3

Dose / Indication

Nexium 24hr

PPI for heartburn

20mg qd for 14days

May take up to 3 days to be effective

15

S/S of Heartburn

Burning Sensation Substernal area

Radiates towards neck / throat

Can occur within 2 hours of eating

Bending over / Lying Down / Sleeping

16

Zantac OTC

DOSE / Indication

Ranitidine HCL

Norm / MAX = 75mg / 150mg

H2RA for Heartburn

1 tab (75mg) taken with water

MAX 2 doses in 24 hour period

<14 days use

17

Etiology (Causes) of Heartburn

  • Certain food / Drinks / Smoking
  • Regular use of ASA / NSAIDs
  • Stress / Obesity
  • PREGNANCY
  • Diseases / medication
  • Certain types of exercise

18

Exclusions for Self-Treatment

Heartburn

 

  • PREGNANCY / NURSING
  • Continuing heartburn while taking recommended doses / durations
  •  
  • Children <12 y/o
    • ​Antacids & H2RAs
  • Children <18 y/o
    • PPI's

19

Pepcid AC

ADR / Consult

Famotadine

Headache / Dizziness / Constipation / Diarrhea

 

May be taken w/ antacids (for acute pain)

Plenty of water!

Avoid Alcohol

 

<2 dose (max) for <2 weeks

 

20

Esomeprozole

CI / P / DI

Nexium

  • DNU - pain swollowing / vomiting blood
    • bloody or black stools
  • Beware of patients with >3 months of heartburn w/:
    • frequent wheezing / weight loss / stomach pain
      • ​nausea + vomiting
  • Steven-Johnson Syndrome
  • DI's:
    • Ketoconozole / Digoxin / B12 / Ampicillin
    • Voriconozole / Cilostozole
    • Clopidogrel / Diazepam

21

Omeprazole

ADR + Consult

Prilosec

Back Pain / Cough / Constipation

Rash / Dizziness

PPI >18yr

Take 30 min prior to eating, may be taken w/ antacids

DNU for >14 days every 4 months

See MD if >3mo

lightheadedness + sweat + dizziness + chest/shoulder pain

Frequent wheezing / pain in arm or neck

 

 

22

Classification and Treatment of

FREQUENT Heartburn

  • 2+ days/ week
  • GERD if > 3 mo
  • Recommend:
    • PPIs (​slowest onset / longest duration)
      • 14 days, repeat every 4 months

23

Tums

MAX dose

 

Calcium Carbonate

 

Max 6000mg / day

 

12 regular

8 extra

6 max

24

Zantac

CIP /  DI

Ranitidine

Impared renal fxn / hepatic

Caution with Pregnancy / Lac

PREGNANCY CAT C

(cat c , pepcid is cat b)

 

WARFARIN / Lidocaine

DIazepam / Nifedipine / TCA

25

Classification and Treatment of

Mild / Infrequent Heartburn

  • Can be Episodic
  • Associated with diet / Lifestyle
  • Recommend:
    • Antiacids (​FAST ONSET / short duration)
       
    • lower dose H2RAs (slow onset / LONG DURATION)

26

Pepcid AC

CIP /  DI

Famotadine

Hypersensitive to famotadine

Impared renal fxn

Caution with Pregnancy / Lac

PREGNANCY CAT B

 

WARFARIN

27

Zantac

ADR / Consult

Ranitidine

Headache / Dizziness / Constipation / Diarrhea

+Abdominal Pain

 

If you have trouble swallowing or persistant ab pain, SEE MD

 

Plenty of water!

<2 dose (max) for <14 days

 

28

Classification and Treatment of

Moderate/ Infrequent Heartburn

  • Can be Episodic
  • Associated with diet / Lifestyle
  • Recommend:
    • Antiacids (​FAST ONSET / short duration)
       
    • HIGHER dose H2RAs (slow onset / LONG DURATION)

29

Lansoprazole

CI / P / DI​

Prevacid

Hypersensitivity to components

 

Tacrolimus / Theophylline

Ketoconazole / ampicillin

Iron salts / Digoxin

30

Lansoprazole

ADR / Consultation

Prevacid

Diarrhea / Ab Pain / Nausea / Headache

>18yo for PPI's

Take 30 min prior to eating

Can be taken WITH ANTACIDS

See MD if >3 months

DNU if trouble swallowing food / vomit blood

Black + Bloody stools