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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
-
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
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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)
-
onset of action of antacids
30min-1hr
-
antacid assoc'd with diarrhea SE
magnesium-containing
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why are Mg-containing antacids contraindicated in pts w/ renal disease?
Mg excretion is impaired in pts w/ renal disease
-
how do Ca-containing antacids cause acid rebound?
Ca stimulates gastric-acid secretion
-
antacids assoc'd w/ constipation SE
Al & Ca-containing
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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
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pt counseling on concurrent use of abx & antacids
ions in antacid can chelate to some medications, causing reduced absorption - space by 2hrs to avoid
-
name 4 H2RA's
- cimetidine
- ranitidine
- famotidine
- nizatidine
-
MOA of H2RA's
decrease fasting & food-stimulated gastric acid secretion & gastric volume by inhibiting HA on the histamine2 Rs of the parietal cell
-
onset of action of H2RA's
30min-1hr
-
indicated for tx AND prevention of episodic/infrequent heartburn
H2RA's
-
when to use H2RA's for tx of heartburn
at onset of sx OR 30min-1hr prior to anticipated heartburn
-
H2RA w/ many DDI's
cimetidine
(inhibits several CYP450 isoenzymes)
-
MOA of PPI's
decrease gastric acid secretion by inhibiting proton pumps, irreversibly blocking the final step in gastric acid secretion
-
onset of action/relief
2-3hrs, but complete relief may take 1-4days
-
when are PPI's most effective?
when taken 30-60min before meal preferably before breakfast
-
how long should self-tx with PPI's be limited to?
14 days (& no more frequently than every 4 months)
-
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
-
PPI DDI's
may increase bioavailability of digoxin & methotrexate
-
MOA of bismuth subsalicylate (BSS)
acts by topical effect on stomach mucosa
-
populations to avoid BSS
- children
- ASA allergy
- pregnancy
- warfarin tx
- kidney issues
-
PPI's safe for use in pts w/ renal impairment (2)
-
omeprazole pregnancy category
C
-
combination of agents that provides immediate relief of heartburn & longer duration of action
antacid + H2RA
-
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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