SELF CARE Heartburn and dyspepsia (Module 3)

Selfcare heartburn

What does dyspepsia mean? (Heartburn M3)

Upper GI tract uncomfortable feeling that does not reach pain level due to indigestion

What is the clinical symptoms of Heartburn? (Heartburn M3)

Stomach churning up contents back into the esophagus. This causes a burning sensation in the chest and/or throat

What are the 4 things that can cause heartburn symptoms? (Heartburn M3)

After eating large meals, laying down within 4 hours of eating, bending over shortly after meal, exercising after a meal.

What is considered a mild heartburn? (Heartburn M3)

infrequent and episodic (Short periods of time per heartburn)

What is considered a frequent heartburn? (Heartburn M3)

Heartburn that occurs 2 or more times a week

What does PUD stand for? (Heartburn M3)

Peptic ulcer disease

What are the symptoms of heartburn? (Heartburn M3)

Burning sensation behind breastbone that can radiate

What are the symptoms of GERD? (Heartburn M3)

Heartburn symptoms as well as acid reflux

What are the symptoms of Dyspepsia? (Heartburn M3)

Postprandial fullness, epigastric pain, gas.

What does Postprandial fullness mean? (Heartburn M3)

Being full for an unusually long time after a meal

What are the symptoms of PUD? (Heartburn M3)

Gnawing/burning epigastric pain. Happens frequently at night.

What are the foods that can cause heartburn?

Spicy and fatty foods, chocolate, peppermint, alcohol, caffeinated/carbonated drinks.

What lifestyle choices can lead to heartburn? (Heartburn M3)

Overeating, stress, going to bed within 2 hours of a meal.

What are the 7 medications that can increase risk of Heartburn? (Heartburn M3)

NSAIDS (Aspirin)

Estrogen/progesterone

Theophylline

Bisphosphonates

Anticholinergic agents

Nitrates

Chemotherapy

What 3 medical conditions increase risk of heartburn? (Heartburn M3)

Pregnancy

Certain disease states (gastroparesis, scleroderma,

peptic ulcer disease, Zollinger-Ellison syndrome

Genetics :(

What is gastroparesis? (Heartburn M3)

What is scleroderma? (Heartburn M3)

What is Zollinger-Ellison syndrome? (Heartburn M3)

What are the 9 (Womp womp) symptoms that is an exclusion for self care in treating heartburn? (Heartburn M3)

Frequent heartburn

Severe heartburn

heartburn that disturbs them in the night

Vomiting blood or coffee ground texture

Chronic hoarseness, wheezing, coughing.

Unexpected weightless

Constant N/V/D

Chest pain with sweating, and pain that radiates to arm

Difficulty swallowing solid food

What is classified as frequent heartburn (Heartburn M3)

>3 months

What are the 3 age/treatment related exclusions for selfcare? (Heartburn M3)

No improvement after selfcare treatment after 2 weeks

Children under 2

Adults over 45 with sudden onset of dyspepsia

What are the classifications of heartburn based on the pain scale? (Heartburn M3)

0: No symptoms

1-3: Mild

4-6: Moderate

7-10: Severe

How many days a month is having a heartburn considered infrequent/episodic?

1

What are the three OTC treatment options for someone with heartburn who meets selfcare criteria? (Heartburn M3)

Antacids, H2RAs, PPI.

What is the MOA of antacids? (Heartburn M3)

Neutralizes gastric acid

When would you use an Antacid? (Heartburn M3)

Patient with mild infrequent heartburn or dyspepsia?

What is the onset of relief for someone taking an antacid? (Heartburn M3)

<5 minutes

What is the duration of relief for a patient taking an antacid? (Heartburn M3)

As long as it is in the stomach (20~30 minutes)

What drugs do antacids interact with? (Heartburn M3)

Anything that needs an acidic environment to absorb. Iron, itraconazole, ketoconazole.

Tetracycline, azithromycin, fluoroquinolone.

Can pregnant people take antacids? (Heartburn M3)

Yes but don’t exceed given dose

How often can you repeat a dose of antacids? (Heartburn M3)

every 1-2 hours based on product

How many times should you not exceed taking an antacid? (Heartburn M3)

4 times, or regularly for 2 weeks.

What age can calcium carbonate be used in? (Heartburn M3)

Older than 2 years

What does H2RA stand for? (Heartburn M3)

Histamine 2 receptor antagonist

What is the MOA of a H2RA? (Heartburn M3)

Inhibit histamine 2 receptor of parietal cell in stomach to decrease acid production

What type of heartburn causes does H2RA treat? (Heartburn M3)

Fasting and food-stimulated

What time of day would you tell a patient to take an H2RA? (Heartburn M3)

30-45 minutes before eating

What is the duration of action for H2RAs? (Heartburn M3)

4-10 hours

How many times a day can you take an H2RA?

No more than 2

What are the two brand names for Famotidine? (Heartburn M3)

Pepcid AC, Zantac.

What is Famotidine? (Heartburn M3)

H2RA

What is Pepcid AC? (Heartburn M3)

H2RA (Brand name for famotidine)

What is Zantac? (Heartburn M3)

H2RA (Brand name for Famotidine)

What strength does Famotidine come in? (Heartburn M3)

10mg and 20mg

What drug is sometimes in Famotidine products that is no longer on market? (Heartburn M3)

Ranitidine

What is Cimetidine? (Heartburn M3)

H2RA

What are the drug interactions of Cimetidine? (Heartburn M3)

CYP 450 drugs (IDK man Warfarin is on there)

What are the common 5 side effects of H2RAs? (Heartburn M3)

Headache

Diarrhea

Constipation

Drowsiness

Dizziness

What organ metabolizes H2RAs? (Heartburn M3)

Liver

Do H2RAs need to be dosed based on Renal Function? (Heartburn M3)

Yes

Can pregnant people take H2RAs? (Heartburn M3)

Yes 😀

When should you stop taking H2RAs with no improvement? (Heartburn M3)

14 days

What are the five counseling points for H2RAs? (Heartburn M3)

Tolerance can build up if you take it daily (Use PRN)

Contact Doctor if no improvement after 14 days of use

Only >12 years old can take them

Take 30-60 mins before anticipated symptoms

No more than twice daily

What is the age range illegible for H2RAs? (Heartburn M3)

>12 years

What does PPI Stand for? (Heartburn M3)

Proton-pump inhibitor

What is the MOA of PPIs (Heartburn M3)

Irreversibly bind to parietal cell ATPase system stopping that last step of acid secretion

What is the duration of action for PPIs? (Heartburn M3)

12-24 hours

What is the onset of relief after taking a PPI (Heartburn M3)

2-3 hours

When would you want to take a PPI instead of another OTC? (Heartburn M3)

Frequent Heartburn with symptoms more than twice a week

What is omeprazole? (Heartburn M3)

PPI

What is Prilosec? (Heartburn M3)

Generic for Omeprazole. PPI

What is the available dose for omeprazole? (Heartburn M3)

20.6 (Equivalent to 20mg omeprazole)

What are the 3 main side effects of PPI? (Heartburn M3)

Headache, constipation, diarrhea.

What are the three important drug interaction notes for Omeprazole? (Heartburn M3)

CYP 2C19

Reduce antiplatelet effects of other drugs (Blood clot)

Reduce absorption of antifungals, antivirals, and iron sup.

What are the 4 patient education points for PPIs? (Heartburn M3)

Do not crush/chew tablets

Take 30-60 minutes before meal

Can repeat treatment every 4 months

>18 years of age

Can pregnant people take PPIs? (Heartburn M3)

Nes. There isn’t much data but what we have suggests low risk.

What is gaviscon? (Heartburn M3)

Alginic acid. Reacts with the sodium bicarbonate in saliva that then forms a layer of sodium alginate over stomach contents to form a protective layer

What is bismuth subsalicylate? (Heartburn M3)

Pepto-Bismol. We don’t know how it works for Heartburn but it is safe… probably.

What are the 5 conditions that bismuth subsalicylate is indicated for? (Heartburn M3)

Heartburn, upset stomach, indigestion, diarrhea, nausea

Can children take bismuth subsalicylate? (Heartburn M3)

No

Would you recommend bismuth subsalicylate to a patient with renal issues? (Heartburn M3)

You better not

What is the main counseling point for patients using bismuth subsalicylate? (Heartburn M3)

May cause stool or tongue to turn black but as long as stool isn’t coffee ground texture it’s fine.

What are the 7 non-pharmaceutical recommendations you can give a patient seeking to improve heartburn symptoms? (Heartburn M3)

Weight loss

Reduce meal sizes

avoid laying down 3 hours after meal

elevate head of bed 60 inches

Reduce food/medication that cause it to get worse

Stop smoking

Don’t wear tight clothing