Heartburn_Dyspepsia Fall 2012 (1)

Administration may be used at onset of symptoms or 30

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Administration May be used at onset of symptoms or 30 min – 1 hr before meal when heartburn is anticipated Lower doses Mild heartburn Higher doses Moderate heartburn Should not use more than twice daily (for self- treatment) Refer to health care provider if used for more than 2 wk Dose of all H 2 antagonists should be in patients with renal dysfunction
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Proton Pump Inhibitors (PPIs)
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Proton Pump Inhibitors (PPIs) Useful for moderate/severe, frequent heartburn Symptoms ≥ 2 days/week or for patients who do not respond to OTC H 2 antagonists MOA: Irreversibly innhibits hydrogen/potassium ATPase pump in parietal cell → decreased acid secretion Efficacy 90% Superior to H 2 antagonists Onset: 1-3 hours Duration: 12-24 hours
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Proton Pump Inhibitors (PPIs) Degrades in acidic environments Do not crush Take before meals to increase efficacy → inhibits only active pumps Vitamin B 12 deficiency No tachyphylaxis
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Proton Pump Inhibitors (PPIs) Drug Dose Side Effects Omeprazole (Prilosec OTC ® ) 20 mg daily Nausea, headache, diarrhea Lansoprazole (Prevacid 24 hour ® ) - available 11/09 15 mg daily
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Administration Should be taken once daily x 14 days May repeat course after 4 mo if symptoms recur Should be taken 30 min before breakfast Do not crush Tablet contains enteric-coated pellets Degrades in acidic environments efficacy Refer to health care provider if: Symptoms continue while taking PPI Symptoms persist > 2 wk Symptoms recur within 4 mo
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Combination Therapy Lifestyle therapy ± antacids + H 2 receptor antagonist Pepcid Complete ® (famotidine, calcium carbonate, and magnesium hydroxide) PPI Zegerid OTC ® Omeprazole: 20mg or 40mg Sodium bicarbonate: 1100mg
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Treatment Algorithm Berardi, RR et al. Figure 14-2
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Questions to Ask the Patient? What is the frequency, severity, and duration of the heartburn? What makes it worse and what makes it better? What risk factor(s) does the patient have that might contribute to his/her heartburn (any triggers, contributing factors, or medications that may exacerbate the symptoms)? Does he/she have any exclusion to self-treatment? What other medical disorders does the patient have and what prescription and OTC medications is he/she taking? What dietary and lifestyle measures have you tried for your heartburn and were they effective? What OTC medications have you tried for heartburn and were they effective?
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Patient Counseling Tips Diet or lifestyle changes Proper use of medication Dose Adverse effects Onset of action (when they should see relief) Duration of use When to refer to a HC provider
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Questions?
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Patient Case #1 JR is a 59 yo WM who presents to his PCP complaining of “heartburn and an upset stomach”. His PMH is significant for a MVA 2 years ago and HTN. His current medications include amlodipine 10mg po daily (CCB for HTN) and a multivitamin. What questions would you ask? What are some likely causes? What would you recommend?
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Administration May be used at onset of symptoms or 30 min 1...

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