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Heartburn & Dyspepsia Flashcards

(58 cards)

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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

25
How often should you dose antacids?
Every 1 to 2 hrs
26
How often should you dose H2RAs?
Twice a day
27
How often should you dose PPIs?
Once a day
28
How long do antacids last?
20 to 30 min
29
How long do H2RAs last?
4 to 10 hrs
30
How long do PPIs last?
12 to 24 hrs; may take 1 to 4 days for full relief
31
How long do antacids take to work?
<5 min
32
How long do H2RAs take to work?
30 to 45 min
33
How long do PPIs take to work?
2 to 3 hrs
34
MOA of antacids?
Increase pH + Neutralize
35
MOA of H2RAs?
Increase pH
36
MOA of PPIs?
Inactivates pump that extrudes H2 into lumen?
37
Which of these is for acute use? Antacid H2RAs PPIs
Antacid
38
What salt in antacids has a slower onset, but effect lasts slightly longer?
Calcium carbonate
39
If you wanted to make antacids last longer, what could you do?
Have some food; duration of action can stay up to 3 hrs
40
What is the AE of aluminum salts in antacids?
Constipation
41
What is the AE of magnesium salts in antacids?
Diarrhea
42
What is the AE of carbonate salts in antacids?
Belching/Flatulence
43
What is the drug interaction concern w/ antacids?
Can affect absorption of other RX by decreasing absorption into bloodstream; affects tetracyclines, fluoroquinolones, zithromax, ketoconazole, itraconazole, iron, or synthroid
44
What is the FDA warning of antacids?
Avoid w/ products containing both ASA and antacids; causes bleeding and watch out for >60 yr olds
45
Which H2RA should you not recommend? Why?
Cimetidine; lots of rx interactions + inhibits P450 + causes gynecomastia in men
46
What are some things to watch out for H2RAs?
1. Not anti-allergy (use H1RAs) | 2. Tolerance can develop
47
What is a rare side effect of H2RAs?
Thrombocytopenia
48
What is the recommended use of PPIs?
Once daily 30 to 60 min before breakfast for 14 days; repeat in 4 months
49
What are some side effects of PPIs?
1. Increased % to enteric infections | 2. Fracture risk in ppl >50 yrs old who have taken PPIs for 1 yr
50
All PPIs interact with what medication?
Diazepam, warfarin, phenytoin, theophylline, tacrolimus, and methotrexate
51
Which PPIs interact with clopidogrel and cilostazol?
Omeprazole + Esomeprazole
52
Long term use of PPIs are linked with....
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
Who should not use Pepto-Bismol?
Children, Pts with bleeding risk or renal failure
54
AE of Pepto-Bismol?
Black tongue and tarry looking feces
55
For pregnant women, what are their options?
Lifestyle modification first; PPIs not studied (Cat. C) and calcium/magnesium based antacids = okay
56
For breastfeeding, what are their options?
Aluminum, calcium or magnesium antacids = okay; Famotidine best option for H2RA Avoid PPIs
57
How do you manage drug interactions with antacids?
Separate by other medications by 2 hrs
58
What are the long term consequences of GERD?
Barrett's esophagitis leading to esophageal cancer

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