Non Pharmacologic Therapies Essay

Non-Pharmacologic therapies include elevating the head of the bed at nighttime, eating smaller meals, not eating close to bedtime or before laying down, and eating less fatty and aggravating foods. The patient noted that she liked to cook big dinners so it is recommended to reduce the meal size, use less fatty foods, and move dinner time earlier in the day. Elevating the head at bedtime would also be beneficial for this patient as she mentioned that her symptoms mostly occur in the evening around bedtime.

Pharmacologic therapies include: Antacids, proton pump inhibitors (PPI), histamine type 2 receptor antagonists (H2RA), and bismuth products. Pepto-Bismol (Bismuth subsalicylate) treats heartburn, nausea, ingestion, upset stomach, and diarrhea.
It’s mechanism of action for the treatment of heartburn is unknown and the patient expressed a dislike in its side effects (dark stools) therefore it is not a recommendation. Proton pump inhibitors such as Prilosec OTC (omeprazole) would not be appropriate for this patient as PPIs are generally used for patients with frequent heartburn that occur greater than 2 days per week. H2RAs such as Pepcid AC (famotidine) are effective in treating mild-moderate infrequent heartburn and have an onset of relief of 30-45 minutes and a duration of efficacy of 4-10 hours. Tums (calcium carbonate) is an antacid which is also effective in treating mild-moderate infrequent heartburn with a shorter duration of relief compared to H2RAs. However, Tums has an onset of relief of 5 minutes which is significantly quicker than the time for H2RAs which makes this the preferred choice for the patient despite its shorter efficacy duration of 20-30 minutes. Maalox (aluminum hydroxide/ magnesium hydroxide) is also an effective antacid however there is a moderate drug interaction between sertraline and magnesium which can increase the risk of an arrhythmia and is therefore not recommended for this patient.
Subjective Findings: Patient states that symptoms occurred a couple of times in the past few days. The symptoms occurred in the evening after she ate a large dinner and worsened when she laid down to go to bed. Symptoms include a mild burning sensation in the chest and burping. Patient notes that the symptoms caused mild discomfort.

Objective Findings: The patient was burping and holding her hand to her chest
I recommended that she enact non-pharmacologic lifestyle changes including: eating smaller meals, eating less fatty foods, not eating close to bedtime or before laying down, and elevating the head of the bed.
The patient was advised not to take more than 15 tablets a day or take it more than 2 days a week. I instructed her to take her Lisinopril 2 hours before or 6 hours after taking the Tums. Taking more than the recommended amount or taking it with other calcium supplements may result in kidney stones or hypercalcemia. In rare instances it made cause rebound hyperacidity. The patient was made aware the Tums may cause flatulence, belching, constipation, and upset stomach. The patient was told to look for improvement in symptoms including a dissipation of the burning sensation after taking this medication. I advised the patient to contact her doctor if her symptoms do not improve or worsen after 2 weeks, if she finds that she needs to use it more than 2 times a week or take more than 10 tablets a day, if she experiences any of the following: unexplained weight loss, difficulty/pain on swallowing foods, dizziness and sweating with vomiting of blood or black tarry stools, chest pain with shortness of breath, chronic choking or wheezing, severe stomach pain, and/or continuous nausea vomiting or
diarrhea.