Cp111 Cam And Dietary Supplement Legislation

Front 1

What did the DSHEA accomplish?

Back 1

1) Regulate DS as foods
2) Define DS as any: vitamin, mineral, herb, amino acid, extract/concentrate, and other substances

Front 2

What are some domains of CAM? Give examples of each.

Back 2

1) Biologically based: herbs, dietary supplements
2) Mind-body: yoga, prayer, hypnosis
3) Energy: biofield, reiki, bioelectromagnetic bracelets,
4) Manipulative & body based: chiropractic & osteopathic manipulation

Front 3

Distinguish b/t gastric and duodenal ulcers.

Back 3

Gastric ulcers have:
1) general but more severe pain,
2) occurs soon after a meal,
3) little relief by antacids or food.

Duodenal ulcers have:
1) localized pain,
2) occurs 2 - 5 hours after meals (no food=no pain) or in the middle of the night,
3) Relief with food

Front 4

What is a common cause (etiology) of PUD?

Back 4

H. pylori infection and NSAIDs

Front 5

What are some alarm symptoms of PUD?

Back 5

GI bleed,
unexplained weight loss,
continuous N/V/D

Front 6

What are some alarm symptoms of GERD?

Back 6

Dysphagia (difficulty swallowing),
Odynophagia (painful swallowing),
Upper GI bleed,
Unexplained weight loss,
Continuous N/V/D

Front 7

What are some atypical symptoms of GERD?

Back 7

Asthma,
Lump feeling in throat,
Chronic laryngitis,
Hoarseness,
Dental erosion,
non-cardiac chest pain

Front 8

What are some NON-pharmacological treatment options?

Back 8

Diet:
1) decrease meal size,
2) avoid laying down after meals,
3) avoid eating meals close to bedtime,
4) avoid foods such as coffee, colas, juice, tomatoes, chocolate, fats, milk

Lifestyle:
1) Weight loss
2) Stop smoking
3) Decrease intake of alcohol
4) Avoid tight clothing

Also, raise head of bed.

Front 9

When do you refer a heartburn patient to a physician?

Back 9

When pt exhibits any alarm or atypical symptoms of GERD or PUD as well as if pt:
1) is unresponsive to OTC/Rx meds,
2) had HB for >3 mon,
3) is pregnant, nursing, is a child, or if chest pain is accompanied with sweating and radiating to arm/neck/jaw

Front 10

What are some treatment goals of HB therapy recommendations?

Back 10

1) prevent meal or exercise-related symptoms,
2) prevent complications,
3) use most cost-effective therapy,
4) relieve abdominal discomfort,
5) identify candidates for self-tx and recommend appropriate OTC meds.

Front 11

What are some pharmacological therapy options for heartburn?

Back 11

1) Antacids (Maalox, Tums, Mylanta),
2) H2RAs (famotidine, nizatidine, ranitidine, cimetidine),
3) Proton Pump Inhibitors (Omeprazole, Esomeprazole, Lansomeprazole, Pantoprazole)

Front 12

What is the MOA of antacids?

Back 12

Acid production is NOT suppressed, however antacids:
Neutralize acid of pepsin,
Alkalize gastric content.

Front 13

What is the MOA of H2RAs?

Back 13

Inhibits histamine effect on histamine receptors of parietal cells, thereby blocking 90% of gastric acid.

Front 14

What is the MOA of PPIs?

Back 14

Inhibits hydrogen potassium ATPase (proton pump), irreversibly blocking final step in gastric acid secretion.

Front 15

What are some counseling points for taking PPIs?

Back 15

Take QD for full 14-day course,
Do not chew or crush (b/c of enteric coating),
Complete relief in 1-4 days

Front 16

What are some advantages and disadvantages to using H2RAs?

Back 16

Pros:
1) Only class that can prevent HB,
2) Longer duration,

Cons:
1) Tolerance w/daily chronic dosing,
2) HA, D/constipation, N/fatigue,
3) Must decrease dosing with renal pts,
4) DDIs with cimitedine