Pharm -2- OTC GI Drugs
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| what management is best for episodic/occasional dyspepsia | managed with short term antacids or H2RA
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| What type of management is best for frequent more than 2 episodes a week of dyspepsia | managed with PPI
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| what is the management for chronic/severe persistent Dyspepsia despite OTC treatment | best managed with Rx H2RA or PPIs
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| what are the sx of dyspepsia | belching, bloating, heartburn, dysphagia, nausea, regurgitation, upper abdominal pain above naval, most often in supine position at night
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| What non pharm tx should be tried to alleviate dyspepsia | dietary/lifestyle changes (avoid precipitating foods, loose weight), raise head of bed
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| What are the three bases for antacids | magnesium, aluminum, calcium
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| list the H2 receptor antagonists | Tagamet (cimetidine), Axid (tizanidine), Pepcid (famotidine), Zantac (ranitidine)
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| List the proton pump inhibitors | Prilosec (Omeprazole), Prevacid (pantoprazole), Zegerid (Omeprazole plus NaCHO3
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| When would it not be appropriate for a pt to self treat dyspepsia | frequent heartburn >3months, Symptoms continue despite OTC H2RA or PPI tx, Severe Heartburn, Nocturnal Heartburn, swallowing difficulties, chronic hoarseness, radiating chest pain, hemoptysis, unexplained weight loss, pregnant, child
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| What clinical pearl should you think about with regards to antacids | they have a high sugar content and can impact bowel pattern, and give Ca/AL w/ mg to offset SE
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| What clinical pearls should you think about with H2RAs | potential drug interactions, Cimetidine can interfere with warfarin, Phenytoin, etc. Also make sure you give them 2hrs apart from other drugs
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| What clinical pearl should you think about with PPIs | 14day guidelines only 4 courses per year max
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| What is the clinical pearl regarding children's Pepto | it is a different drug than adult Pepto it is CaCO3 instead of bismuth subsalicylate
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| What clinical pearl should you be aware of if combining PPIs w/ H2RAs | give them at least 12 hours apart for best efficacy
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| What is the realistic goal in gas non rx-tx | decrease frequency, intensity and duration
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| What non drug therapies should be considered for gas tx | dietary modification (avoid foods that cause it), exercise and rest, minimize tight clothing, reduce antihistamine/anticholinergic use, remain upright after eating.
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| What otc drugs can help with GAS | simethicone, activated charcoal, alpha-galactosidase, probiotics
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| this drug helps reduce gas by acting as a defoaming agent it reduces surface tension of gas bubbles | simethicone
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| this gas tx is an adsorbent agent | Activated charcoal
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| this gas tx breaks down oligosaccharides and should be taken with each meal | Alpha-galactosidase
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| This gas tx is actually giving bacteria or yeast in an effort to create digestive balance | probiotics-lactobacillus, bifantis, Saccharomyces
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| What are the common trade names for simethicone | gas-x, Mylanta gas, mylicon, Phazyme
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| what are the common brand names for probiotics | align, florastor
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| what are the common brand names for alpha-galactosidase | Beano
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| What are the self exclusions for gas tx | frequent heartburn >3months, Symptoms continue despite OTC tx, Severe sx, sudden sx location change, sudden onset >40y/o, sx associated w/ bowel function change, significant unexplained weight loss
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| What clinical pearl should you be aware of with simethicone | component of many antacid products
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| What clinical pear should you be aware of w/ mylicon drops | use a dye free formula
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| what clinical pearl should you be aware of w/ charcoal | pt should swallow whole and take 2hrs apart from meds
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| what clinical pearl should you think about w/ alpha galactosidase | add drops to room temp food only, THIS is the only preventative product
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| What is the only OTC preventative tx for gas | Alpha-galactosidase (beano)
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| What is the difference between a prebiotic and a probiotic | prebiotic indigestible carbohydrate that stimulates intestinal flora; Probiotic- living microorganism. You should probably use prebiotic if pt is on antibacterial therapy because probiotic will probably just get killed
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| This disease results from a lactase deficiency | lactose intolerance- results in intolerance to dairy products and inability to break down lactose to glucose and galactose
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| What are the sx of lactose intolerance | diarrhea(most prevalent sx), nausea, abdominal cramps, bloating, gas
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| Do sx of lactose intolerance correspond directly to degree of lactose malabsorption if yes/no explain what they do correlate to | No- they correlate more to age, ethnicity blacks>Asians>Hispanics>native Americans, digestion rate
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| what non drug tx should be considered for lactose intolerance | avoid/minimize dairy products
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| What drug tx can be given for lactose intolerance | lactase replacement taken w/ dairy products (dairy ease, Lactaid)
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| When should a pt not self tx for lactose intolerance | acute pancreatitis, chronic pancreatitis, non ruled out milk allergy, presence of abdominal pain, pediatric pt less than 5years old
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| What clinical pearls should you be aware of for lactose intolerance | use lowest amount of lactase possible for relief, can add drops to milk 24hrs before ingestion, most pts can consume 2cups of milk per day w/o lactase w/o sx, lactose intolerance does not equal milk allergy
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| there are three components of emesis what are they | nausea, retching, and vomiting
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| what are common causes of N/V | motion sickness/vestibular disturbances, medications/chemo/radiation, stress/psychogenic, GI tract disturbances, medical conditions, pregnancy, diabetes, concussion, gall bladder, neoplasms
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| who is most likely to suffer from motion sickness | kids, females more than males
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| what GI problem is a major cause of N/V | viral gastroenteritis (food poisoning), may be associated w/ diarrhea, up to 3 episodes per year in pediatric population, generally self limiting
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| What is retching | dry heaves- involuntary unsuccessful effort to vomit
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| What are the associated conditions with N/V | hypersalivation, defecation, cardiac dysrhythmias
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| What are the goals in tx of N/V of adults | identify and eliminate cause
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| What are the goals in tx of N/V in pediatrics | indentify and eliminate cause, Newborns need to be evaluated by PCP, infants may just be regurgitation not vomiting, Children you need to prevent dehydration associated w/ vomiting
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| What non drug tx can be used to tx N/V | clear view out car window, acupressure, ORT, be aware of sensory impact of taste and odors
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| What are drugs that can be given OTC for N/V | antacids, antihistamines (Meclizine, Diphenhydramine, dimenhydrinate), Phosphorylated carbohydrates (Emetrol)
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| What antihistamines are not recommended in children | cyclizine and Meclizine are not recommended for kids 2-6, Meclizine also not recommended for kids 6-12
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| What drug is a combination of phosphoric acid, Dextrose and Fructose and is direct acting on stomach smooth muscle to delay gastric emptying time and is used for motion sickness and pregnancy | Emetrol
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| When should a pt not self tx for N/V | severe dehydration, refusal of fluids, No urination >8hrs, cont. projectile vomiting, vomiting w/ diarrhea, concurrent severe headache, presence of head/abdominal injury, suspected poisoning, sig unexplained abdominal pain, concurrent DM or CNS disorder
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| What clinical pearl should you be aware of in N/V with antihistamines | know ingredients in antihistamines Dramamine less drowsy is actually Meclizine and shouldn't be used for kids,
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| What is the clinical pearl for s/e with antihistamines | drowsiness is common s/e with all antihistamines
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| Should pt dilute Emetrol when they are taking it | no
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| What might reduce N/V in pregnancy | taking multivitamins at conception
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| What are the different types of diarrhea etiology | Drug Induced, Disease associated diarrhea (aids), Acute, Persistent, Chronic
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| What type of diarrhea lasts <14days (Gen. self limiting in 72hrs) associated w/ flu like sx and viral gastroenteritis | Acute Diarrhea
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| type of diarrhea that lasts 14-28 days | persistent
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| type of diarrhea that lasts more than 1 month gen associated w/ inadequate fiber/diet and dietary intolerance | chronic diarrhea
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| what are the common viral causes of diarrhea | rotavirus, norovirus
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| what bacteria commonly caused diarrhea | campylobacter, salmonella, Shigella, E. Coli, clostridium, staph aureus
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| what protozoan species commonly cause diarrhea | Giardia, Isospora
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| what antibacterial agents often cause diarrhea | ampicillin, amoxicillin, amox/clavulanate, cefixime, cephalosporins, clindamycin, fluoroquinolones, macrolides, tetracycline
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| What non rx tx can be given for diarrhea | Oral Rehydration Therapy, Bismuth subsalicylate (not recommended in pediatric), loperamide (not recommended in pediatric)
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| When should a pt not self tx their diarrhea | sever dehydration, fever >102.2, blood or mucus in stool, vomiting, severe abdominal pain, can keep ORT down, chronic/persistent diarrhea, concurrent chronic condition (DM, CVD, AIDS), pregnancy, pediatric pt < 6 months of age
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| what clinical pearls should you be aware of for diarrhea with regards to ORT products | there sugar content
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| what clinical pearl should you be aware of with bismuth | black tongue and salicylate caution
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| What clinical pearl should you be aware of with differential cause of diarrhea that is related to diet and autoimmune | celiac disease
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| What non drug tx can you use for constipation | hydration, dietary measures, exercise
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| what drug tx can you give for constipation | bulk forming agents, emollients, lubricants, saline, hyperosmotic, stimulant therapy
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| what is the OTC example of bulk forming agent used to tx constipation | fiber
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| what is the OTC example of emollient used to tx constipation | docusate sodium
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| what is the OTC example of lubricant used to tx constipation | mineral oil
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| What is the OTC example of saline used to tx constipation | Mg. Citrate
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| What is the hyperosmotic used to tx constipation | glycerin
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| what is the stimulant used to tx constipation | senna/bisacodyl
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| when should a pt not self tx for constipation | unexplained flatulence, fever, paraplegia or quadriplegia, protracted vomiting, severe abdominal pain or distention, unexplained change in bowel habits, bloody or black tarry stool, daily laxative use (except fiber), history of IBD
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| what clinical pearl do you need to think about with constipation and chronic laxative use | pt can develop dependence on laxatives
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| what type of mineral oil is used topically | heavy not light is used topically for laxative
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| this condition is caused by swollen veins in the peri-anal region | hemorrhoids
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| What have caused the hemorrhoids to develop in the first place | constipation and associated straining, diarrhea with repeated elimination of loose stools, sitting or standing for extended periods, obesity, pregnancy and childbirth
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| what is the dividing line between internal and external hemorrhoids | dentate line above it =internal made of columnar tissue, below = external made of squamous epithelium
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| Which type of hemorrhoid is usually painful | external, internal is usually pain free
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| what lifestyle changes may help with hemorrhoids | increase fiber, increase dietary fluids, regular exercise, do not strain, evacuate bowel when urge strikes, frequent warm sitz baths , apply cool pack to reduce swelling, use moist pad/wipes instead of dry toilet paper
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| What oral drugs can be taken to help with hemorrhoids | fiber-non absorbable, or docusate
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| What topical creams, ointments, or supposes can help hemorrhoids | anesthetics (caine derivatives), Witch Hazel astringent, Hydrocortisone, mineral oil, shark liver oil, petrolatum, lanolin, zinc oxide, phenylephrine (vasoconstrictor)
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| When should a pt not self tx for hemorrhoids | don't respond to OTC tx over 7days, acute onset of pain, family hx of colon cancer, presence of fistula, or polyps, unexplained bowel habits, bloody or black tarry stool, hx of colitis, pt younger than 12
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| what are some clinical pearls for hemorrhoids tx | genetic tendency, use a blow dryer to dry the area, docusate calcium vs. sodium, a lot of the drugs are external use only
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| what are the sx of pinworm infestation | nocturnal peri-anal irritation, severe if intractable, abdominal discomfort, pain, insomnia or appetite loss. Rarely causes vaginitis, PID, dysuria, urethritis. May have psychological manifestations
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| What is the tx for pinworms | pyrantel pamoate (treat entire family), cleanse linens, disinfect toilet seats, trim nails
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| When should a pt not self tx for pinworms | not responsive to OTC tx, anemia, vague non confirmed sx, hypersensitive to pyrantel, pregnant or breast feeding, pt younger than 2
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| What are some clinical pearls for pinworm infections | open windows as light destroys eggs, vacuum floors rather than sweep, scotch tape test, can use corticosteroid or antihistamine for itch relief. Secondary bacterial infections can result from scratching and dirty nails
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