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Session 3 Pharm- 2

Pharm -2- OTC GI Drugs

what management is best for episodic/occasional dyspepsia managed with short term antacids or H2RA
What type of management is best for frequent more than 2 episodes a week of dyspepsia managed with PPI
what is the management for chronic/severe persistent Dyspepsia despite OTC treatment best managed with Rx H2RA or PPIs
what are the sx of dyspepsia belching, bloating, heartburn, dysphagia, nausea, regurgitation, upper abdominal pain above naval, most often in supine position at night
What non pharm tx should be tried to alleviate dyspepsia dietary/lifestyle changes (avoid precipitating foods, loose weight), raise head of bed
What are the three bases for antacids magnesium, aluminum, calcium
list the H2 receptor antagonists Tagamet (cimetidine), Axid (tizanidine), Pepcid (famotidine), Zantac (ranitidine)
List the proton pump inhibitors Prilosec (Omeprazole), Prevacid (pantoprazole), Zegerid (Omeprazole plus NaCHO3
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
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
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
What clinical pearl should you think about with PPIs 14day guidelines only 4 courses per year max
What is the clinical pearl regarding children's Pepto it is a different drug than adult Pepto it is CaCO3 instead of bismuth subsalicylate
What clinical pearl should you be aware of if combining PPIs w/ H2RAs give them at least 12 hours apart for best efficacy
What is the realistic goal in gas non rx-tx decrease frequency, intensity and duration
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.
What otc drugs can help with GAS simethicone, activated charcoal, alpha-galactosidase, probiotics
this drug helps reduce gas by acting as a defoaming agent it reduces surface tension of gas bubbles simethicone
this gas tx is an adsorbent agent Activated charcoal
this gas tx breaks down oligosaccharides and should be taken with each meal Alpha-galactosidase
This gas tx is actually giving bacteria or yeast in an effort to create digestive balance probiotics-lactobacillus, bifantis, Saccharomyces
What are the common trade names for simethicone gas-x, Mylanta gas, mylicon, Phazyme
what are the common brand names for probiotics align, florastor
what are the common brand names for alpha-galactosidase Beano
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
What clinical pearl should you be aware of with simethicone component of many antacid products
What clinical pear should you be aware of w/ mylicon drops use a dye free formula
what clinical pearl should you be aware of w/ charcoal pt should swallow whole and take 2hrs apart from meds
what clinical pearl should you think about w/ alpha galactosidase add drops to room temp food only, THIS is the only preventative product
What is the only OTC preventative tx for gas Alpha-galactosidase (beano)
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
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
What are the sx of lactose intolerance diarrhea(most prevalent sx), nausea, abdominal cramps, bloating, gas
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
what non drug tx should be considered for lactose intolerance avoid/minimize dairy products
What drug tx can be given for lactose intolerance lactase replacement taken w/ dairy products (dairy ease, Lactaid)
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
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
there are three components of emesis what are they nausea, retching, and vomiting
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
who is most likely to suffer from motion sickness kids, females more than males
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
What is retching dry heaves- involuntary unsuccessful effort to vomit
What are the associated conditions with N/V hypersalivation, defecation, cardiac dysrhythmias
What are the goals in tx of N/V of adults identify and eliminate cause
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
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
What are drugs that can be given OTC for N/V antacids, antihistamines (Meclizine, Diphenhydramine, dimenhydrinate), Phosphorylated carbohydrates (Emetrol)
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
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
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
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,
What is the clinical pearl for s/e with antihistamines drowsiness is common s/e with all antihistamines
Should pt dilute Emetrol when they are taking it no
What might reduce N/V in pregnancy taking multivitamins at conception
What are the different types of diarrhea etiology Drug Induced, Disease associated diarrhea (aids), Acute, Persistent, Chronic
What type of diarrhea lasts <14days (Gen. self limiting in 72hrs) associated w/ flu like sx and viral gastroenteritis Acute Diarrhea
type of diarrhea that lasts 14-28 days persistent
type of diarrhea that lasts more than 1 month gen associated w/ inadequate fiber/diet and dietary intolerance chronic diarrhea
what are the common viral causes of diarrhea rotavirus, norovirus
what bacteria commonly caused diarrhea campylobacter, salmonella, Shigella, E. Coli, clostridium, staph aureus
what protozoan species commonly cause diarrhea Giardia, Isospora
what antibacterial agents often cause diarrhea ampicillin, amoxicillin, amox/clavulanate, cefixime, cephalosporins, clindamycin, fluoroquinolones, macrolides, tetracycline
What non rx tx can be given for diarrhea Oral Rehydration Therapy, Bismuth subsalicylate (not recommended in pediatric), loperamide (not recommended in pediatric)
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
what clinical pearls should you be aware of for diarrhea with regards to ORT products there sugar content
what clinical pearl should you be aware of with bismuth black tongue and salicylate caution
What clinical pearl should you be aware of with differential cause of diarrhea that is related to diet and autoimmune celiac disease
What non drug tx can you use for constipation hydration, dietary measures, exercise
what drug tx can you give for constipation bulk forming agents, emollients, lubricants, saline, hyperosmotic, stimulant therapy
what is the OTC example of bulk forming agent used to tx constipation fiber
what is the OTC example of emollient used to tx constipation docusate sodium
what is the OTC example of lubricant used to tx constipation mineral oil
What is the OTC example of saline used to tx constipation Mg. Citrate
What is the hyperosmotic used to tx constipation glycerin
what is the stimulant used to tx constipation senna/bisacodyl
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
what clinical pearl do you need to think about with constipation and chronic laxative use pt can develop dependence on laxatives
what type of mineral oil is used topically heavy not light is used topically for laxative
this condition is caused by swollen veins in the peri-anal region hemorrhoids
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
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
Which type of hemorrhoid is usually painful external, internal is usually pain free
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
What oral drugs can be taken to help with hemorrhoids fiber-non absorbable, or docusate
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)
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
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
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
What is the tx for pinworms pyrantel pamoate (treat entire family), cleanse linens, disinfect toilet seats, trim nails
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
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
Created by: smaxsmith