Exam 2 Acid-Peptic Disorders

What is considered GERD?

heartburn that occurs 2 or more days per week and occurs for 3 months or longer

What are the atypical symptoms that we would refer a patient?

chest pain that mimics angina

symptoms of aspiration of refluxed material

weight loss and vomiting

What are exclusions to self-care?

atypical symptoms

GERD

symptoms that last 2 or more weeks while on OTC products

chronic NSAID use

difficult or painful swallowing

What is the MOA of antacids?

neutralizes gastric acid and increases pH of gastric contents

What type of heartburn are antacids used for?

mild and infrequent

What are some examples of antacids?

aluminum salts, magnesium salts, sodium bicarbonate, calcium carbonate

What is the key side effect of aluminum?

constipation

Which patients should aluminum antacids be avoided?

elderly, alcoholics, patients with recent GI hemorrhage

What is the key side effect with magnesium?

diarrhea

What are the adverse effects of sodium bicarbonate antacids?

weight gain

water retention

sodium overload

milk-alkali syndrome

Which patients should we avoid sodium bicarbonate antacids?

those with hypertension, congestive heart failure, pregnancy

Which patients should we be cautious with calcium carbonate antacids?

those with kidney issues

What is alginic acid?

not an antacid but is an ingredient found with sodium bicarbonate in some compounds

How long do the effects of antacids last?

a few hours

When should we counsel patients to take antacids?

1 hour after meals

All antacids decrease absorption of what other medications?

tetracyclines and iron salts

How far apart should antacids be spaced from other medications?

2 hours

What is the MOA of H2 receptor antagonists?

inhibit acid secretion by binding to the H2 receptor of parietal cells

What is the indication for H2RAs?

mild to moderate heartburn and for prevention

What is the age restriction for H2RAs?

12 and older

What are the adverse effects of H2RAs?

constipation or diarrhea

abdominal discomfort or pain

changes in blood counts

What are the drug interactions with H2RAs?

cephalosporins

iron salts

ketoconazole

warfarin (cimetidine)

benzos (cimetidine)

What is the indication for PPIs?

frequent heartburn for those 18 and older

What is the max amount of time to self-treat with PPIs or H2RAs?

14 days

For PPIs, after self-treating for 14 days how long until you can self-treat for up to 14 days again?

4 months

What is the onset of action for PPIs?

1-4 days

PPIs cause decreased absorption of which drugs?

azole antifungal agents

erlotinib

protease inhibitors

PPIs can increase levels of which drugs?

benzos

digoxin

phenytoin

warfarin

methotrexate (high dose)

Should patients on clopidogrel use a PPI?

no

What is the MOA of bismuth subsalicylate?

suppresses H. pylori function

What is the age restriction with bismuth subsalicylate?

12 and older