heartburn and dyspepsia

Question 1

heartburn definition

Answer 1

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

Question 2

episodic heartburn

Answer 2

less than two days per week, mild and infrequent

Question 3

frequent heartburn

Answer 3

more than or equal to 2 days per week

Question 4

dyspepsia

Answer 4

‘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

Question 5

GERD

Answer 5

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

Question 6

factors that contribute to heartburn

Answer 6

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

Question 7

dietary examples that cause heartburn

Answer 7

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

Question 8

lifestyle examples that cause heartburn

Answer 8

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

Question 9

disease examples that cause heartburn

Answer 9

motility diseases, PUD, scleroderma, Zollinger-Ellison syndrome

Question 10

exclusions for self care

Answer 10

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

Question 11

non pharm treatment

Answer 11

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

Question 12

antacid MOA

Answer 12

neutralize gastric acid, may increase LES pressure

Question 13

administration antacid

Answer 13

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

Question 14

advantages of antacid

Answer 14

least expensive, rapid onset

Question 15

antacids containing magnesium

Answer 15

may cause diarrhea

Question 16

antacids containing aluminum or calcium

Answer 16

may cause constipation

Question 17

onset/duration for antacids

Answer 17

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

Question 18

drug interactions with antacids

Answer 18

can usually be avoided if administered at least 2 hours apart

Question 19

antacids can be combined with

Answer 19

H2RA for better symptom relief

Question 20

BSS should not be used in

Answer 20

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

Question 21

H2RA MOA

Answer 21

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

Question 22

compared to antacids, H2RAs

Answer 22

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

Question 23

onset/duration of H2RA

Answer 23

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

Question 24

dosing of h2ra

Answer 24

should be limited to no more than twice daily

Question 25

administration of h2ra

Answer 25

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

Question 26

most common AE of h2ras

Answer 26

headache, diarrhea, constipation, dizziness, and drowsiness

Question 27

cimetidine is associated with

Answer 27

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

Question 28

MOA of PPIs

Answer 28

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

Question 29

Nonrx PPIs are drug of choice for

Answer 29

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

Question 30

onset/duration of ppis

Answer 30

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

Question 31

administration of ppis

Answer 31

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

Question 32

most common short term AE for ppis

Answer 32

diarrhea, constipation, and headache

Question 33

high dose of ppis have been associated with

Answer 33

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

Question 34

potential ppi drug interactions

Answer 34

cyp2c19 (Plavix concern)

Question 35

pregnancy and antacids

Answer 35

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

Question 36

pregnancy and h2ras

Answer 36

considered compatible with pregnancy

Question 37

pregnancy ppis

Answer 37

refer if frequent to severe heartburn

Question 38

lactation and antacids

Answer 38

considered safe

Question 39

lactation and h2ras

Answer 39

cimetidine is compatible, famotidine however is preferred

Question 40

lactation and ppis

Answer 40

not currently recommended

Question 41

elderly and antacids

Answer 41

if renal impairment is present, use with caution

Question 42

elderly and h2ras

Answer 42

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

Question 43

elderly and ppis

Answer 43

may be used in renal impairment, otherwise is inappropriate

Question 44

pediatrics and antacids

Answer 44

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

Question 45

pediatrics and h2ras

Answer 45

must be at least 12 or older

Question 46

pediatrics and ppis

Answer 46

must be at least 18 or older