PHRD5975 Self-Care: Heartburn & Dyspepsia

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daynuhmay
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264987
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PHRD5975 Self-Care: Heartburn & Dyspepsia
Updated:
2014-03-04 03:57:30
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Heartburn Dyspepsia
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Description:
Heartburn & Dyspepsia
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  1. exclusions for self-tx of heartburn/dyspepsia
    • 1) frequent heartburn for >3mos
    • 2) sx continue after 2 weeks of tx w/ OTC H2RA or PPI
    • 3) continuous NVD
    • 4) <12yo
    • 5) chest pain accompanied by sweating, radiating pain, & SOB
  2. non-pharm tx rec's for heartburn/dyspepsia
    • 1) dietary mods (avoid foods that ppt sx)
    • 2) weight loss
    • 3) eat smaller meals
    • 4) refrain from eating @ least 3hrs before laying down
    • 5) avoid tobacco, alcohol, caffeine
  3. MOA's of antacids in tx of heartburn/dyspepsia
    • neutralize gastric acid & increases intragastric pH
    • may also increase LES pressure

    (acts as buffering agent in lower esophagus, gastric lumen, duodenal bulb)
  4. onset of action of antacids
    30min-1hr
  5. antacid assoc'd with diarrhea SE
    magnesium-containing
  6. why are Mg-containing antacids contraindicated in pts w/ renal disease?
    Mg excretion is impaired in pts w/ renal disease
  7. how do Ca-containing antacids cause acid rebound?
    Ca stimulates gastric-acid secretion
  8. antacids assoc'd w/ constipation SE
    Al & Ca-containing
  9. MOA of Gaviscon in tx of heartburn
    alginic acid reacts w/ sodium bicarbonate in saliva to form a viscous layer of sodium alginate that floats on the surface of gastric contents, forming a protective barrier against esophageal irritation
  10. pt counseling on concurrent use of abx & antacids
    ions in antacid can chelate to some medications, causing reduced absorption - space by 2hrs to avoid
  11. name 4 H2RA's
    • cimetidine
    • ranitidine
    • famotidine
    • nizatidine
  12. MOA of H2RA's
    decrease fasting & food-stimulated gastric acid secretion & gastric volume by inhibiting HA on the histamine2 Rs of the parietal cell
  13. onset of action of H2RA's
    30min-1hr
  14. indicated for tx AND prevention of episodic/infrequent heartburn
    H2RA's
  15. when to use H2RA's for tx of heartburn
    at onset of sx OR 30min-1hr prior to anticipated heartburn
  16. H2RA w/ many DDI's
    cimetidine

    (inhibits several CYP450 isoenzymes)
  17. MOA of PPI's
    decrease gastric acid secretion by inhibiting proton pumps, irreversibly blocking the final step in gastric acid secretion
  18. onset of action/relief
    2-3hrs, but complete relief may take 1-4days
  19. when are PPI's most effective?
    when taken 30-60min before meal preferably before breakfast
  20. how long should self-tx with PPI's be limited to?
    14 days (& no more frequently than every 4 months)
  21. PPI SE's (3)
    • 1) increased risk of infection (C.difficile, community acquired pneumonia)
    • 2) increased risk of fractures in elderly 
    • 3) increased risk for vit. B12 deficiency
  22. PPI DDI's
    may increase bioavailability of digoxin & methotrexate
  23. MOA of bismuth subsalicylate (BSS)
    acts by topical effect on stomach mucosa
  24. populations to avoid BSS
    • children
    • ASA allergy
    • pregnancy
    • warfarin tx
    • kidney issues
  25. PPI's safe for use in pts w/ renal impairment (2)
    • omeprazole
    • lansoprazole
  26. omeprazole pregnancy category
    C
  27. combination of agents that provides immediate relief of heartburn & longer duration of action
    antacid + H2RA
  28. antacids that are NOT secreted in breast milk & may be safely recommended for self-tx of heartburn in nursing mothers
    • Magnesium hydroxide
    • Aluminum hydroxide

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