Heartburn Key Drugs

PPI, abdominal pain, constipation, 14, before, 4, crush, 20, tablet, 4

omeprazole and esomeprazole are both the therapeutic class —

Side Effects: Headache, — —, diarrhea, —, flatulence (uncommon)

Counseling: # day course, take — breakfast, not immediate relief - takes 1 to # days, do not chew or —

Dosing: about a # mg dose, take 1 — with water before breakfast for 2 weeks, repeat no more than every # months

Prilosec, esophagitis, GERD, H. pylori, gastric, duodenal, hypersecretory, asian, geriatric

omeprazole brand name: — OTC

FDA-Approved indications: healing and maintenance of erosive —, treating —, eradicating — — infection, healing of — and — ulcer, treatment of pathological — conditions

Special Populations: a decreased dosage of omeprazole should be given to — and — patients, also be cautious with patients who have liver or kidney issues

Nexium, esophagitis, GERD, H. pylori, hepatic

esomeprazole brand name: — 24HR

FDA-Approved indications: healing and maintenance of erosive —, treating —, eradicating — — infection

Special populations: patients with severe — impairment should not exceed 20 mg daily

Pepcid, H2Ra, gastric, duodenal, esophagitis, GERD, headache, diarrhea, thrombocytopenia, antacids, onset, as needed, 2, 10, 20

Famotidine brand name: — AC

Therapeutic class: —

FDA Approved Indications: — and — ulcers, erosive — (heartburn), and treating —

Side Effects: —, constipation, —, dizziness, drowsiness, rare: — (reversible)

Counseling: slower onset than — but lasts longer, can be taken at — or before a known trigger, better taken — — than daily, max dose # daily, see provider if needed after 2 weeks

Dosing: # or # mg by mouth, can self-treat up to 14 days

Tums, antacid, indigestion, belching, carbonate, calcium, kidney stones, active, calcium, as needed

Calcium carbonate brand name: —

Therapeutic Class: —

FDA-Approved indications: heartburn, —, upset stomach

Side effects: —/gas because the — reacts with the stomach acid and forms CO2, the — may cause constipation, hypercalcemia, or — —

Counseling: fast relief, works best on — pumps, add it to your — intake to prevent hypercalcemia

Unique Special populations: there are children’s formulations for ># years old

Dosing: 2-4 tablets — —

Milk of Magnesia, antacids, diarrhea, shorter, renal, aluminum

Magnesium hydroxide brand name: — — —

Therapeutic Class: —

FDA Approved indications: heartburn, indigestion, constipation

Side effects: —, magnesium accumulation in renal impairment

Counseling: fast onset, — duration than calcium carbonate

Unique Special Populations: in geriatrics causes decreased — function so use lower dose

Dosing: product-specific, often combined with — hydroxide

Gaviscon, Mylanta, Maalox, antacid, constipation, phosphate, toxicity, magnesium

Aluminum hydroxide brand name: —, —, —

Therapeutic Class: —

FDA approved uses: heartburn, GERD, peptic ulcer pain, esophageal reflux

Side effects: —, Hypophosphatemia because aluminum binds to —, — can occur in patients with renal failure

Counseling: slower onset, but longer duration, prolonged use can lower (<prev), often paired with — hydroxide to offset constipation

Dosing: product-specific dosing

Antacids, neutralize, 5, as needed, episodic, 12, constipation, constipation, diarrhea, pregnancy, breastfeeding

- MOA: — gastric acid (producing salt and water) thus increasing gastric pH. This provides relief within minutes.
- Onset: within # minutes (liquid faster)
- Duration: Relief may last 20 mins to 3 hours depending on how long antacids remain in stomach (and whether patient has eaten).
medication
- Dose: varies based on formulation, but no more than 4x daily, take — —

OTC use: for mild — heartburn

Special populations: safe for — and —

Age OTC: ≥# years old
- Side effects
* Calcium can cause —
* Aluminum may cause —
* Magnesium may cause — (may use together with aluminum to counter [<prev])

H2RAs, parietal, 30-45, 30, 1 hour, episodic, 12, as needed, pregnancy, breastfeeding, delirium

- MOA: Blocks histamine 2 receptors in — cells decreasing gastric acid secretion
- Onset: #-# minutes
- Duration: Relief may last 4-10 hours
- Dose: Give 1 tablet at onset of symptoms or # mins to # —before heartburn anticipated. Max 2 tablets daily

OTC use: for mild to moderate — heartburn

Age OTC: ≥# years
- Side effects: headache, diarrhea, constipation
- Counseling: Best used — —

Special populations: compatible with — and — (cimetidine); avoid in geriatrics as it may cause —

PPIs, irreversibly, 4, 24, frequent, daily, 18, renal

- MOA: Inhibit proton pump — blocking gastric acid secretion
- Onset: Full relief in # days
- Duration: Relief may last # hours
- Dose: Give 1 tablet at onset of symptoms or 30-60 mins before heartburn anticipated. Max 2 tablets daily

OTC use: — heartburn, take — before breakfast for 14 days, and only reuse after 4 months

Age OTC: ≥# years
- Side effects: headache, diarrhea, constipation

Special populations: can be used in — impaired patients

Mylanta Ultimate Strength Liquid

Brand name: — — — —

Generic name: Aluminum hydroxide and magnesium hydroxide

Tums, antacid

Brand name: —

Generic name: Calcium carbonate

Class: —

Nexium

Brand name: —

Generic name: esomeprazole

Prevacid

Brand name: —

Generic name: lansoprazole

Prilosec OTC, PPI

Brand name: — —

Generic name: omeprazole

Class: —

Pepcid AC, H2RA

Brand name: — —

Generic name: famotidine

Class: —

Pepcid Complete

Brand name: — —

Generic name: famotidine, calcium carbonate, magnesium

Pepto-Bismol

Brand name: — —

Generic name: bismuth subsalicylate

Rolaids, antacid

Brand name: —

Generic name: calcium carbonate, magnesium hydroxide

Class: —

tagamet, H2RA, cytochrome P450, drug interactions

generic: cimetidine

brand name: —

class: —

Note: inhibits several — — (CYP) enzymes causing the most — —, especially in older adults

alginic acid

Gaviscon is an antacid combined with an — — that allows it to form a floating “raft” on top of stomach contents and is more effective than just antacids in reducing heartburn

dysphagia, painful swallowing, upper GI bleed, unexplained weight loss

Alarm symptoms! refer these patients

chest pain with sweating, shortness of breath, pain radiating to shoulder/arm/neck/jaw

Cardiac mimic! Treat as an emergency!

3

chronic treatment resistant occurs when symptoms last longer than # months despite already taking an H2RA or PPI, refer these treatments

noncardiac, laryngitis, chronic cough, lump

atypical/extraesophageal symptoms: — chest pain, difficulty breathing, —, hoarseness, — —, dental erosion, or feeling a — in the throat. Refer these patients

clopidogrel

omeprazole and esomeprazole have drug interactions with —