NMA: Nonprescription Medicines Academy

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Case Study

AM is a 52 year-old male who presents to the pharmacist complaining of a burning sensation behind in his upper chest every time he eats. He states that his symptoms usually occur after he eats dinner and worsen when he is lying down. He feels the pain is related to heartburn. About two months ago, he began having burning after eating only large fatty meals. The past two weeks, however his symptoms have been occurring more at least three nights per week after dinner. AM typically eats dinner around 7pm and lies back in his recliner to watch TV and relax after dinner. He has noticed that his discomfort is more noticeable when he is lying down. When AM first starting experiencing heartburn, his provider recommended he take an antacid like Tums® if he was experiencing pain after eating or he could take Zantac® before a large meal to prevent his heartburn from occurring. Zantac and Tums provide symptom relief, but he is “sick and tired” of having to think about taking a medication with each meal. He states that he isn’t sure what meals will cause him to have heartburn and if he waits until after the meal to take an antacid he still has to deal with burning in his throat.

PmHx: Acid Reflux
ALL: NKDA

Current medications: Zantac and Tums as needed for heartburn relief

1. Using the QuEST method, quickly and accurately assess AM
2. Using the SCHOLAR-MAC method, classify the pertinent information illustrated in this case

Using the QuEST method, establish if this patient is an appropriate self care candidate. Provide a rationale:

• No severe symptoms
• Uses suggested medication appropriately
• No history of MI
• Not self-treating to avoid medical care

If this patient is a self care candidate, suggest appropriate strategies (QuEST) for AM. Include supportive measures with your recommendations:

• AM is suffering from frequent heartburn (symptoms 2 or more days a week). Frequent heartburn should be treated with a PPI.
• An appropriate alternative treatment would be to suggest non-prescription omeprazole (Prilosec OTC).
• General care measures:
• • Avoid lying down within three hours of a meal
  • If you must go to sleep after a large meal, elevate the head of the bed four to six inches, perhaps by sliding blocks of wood under the bedposts.
  • Eat smaller meals and avoid night-time snacks.
  • Avoid wearing tight clothing, especially tight belts or clothing that is restrictive around the abdomen.
  • Stay away from foods and beverages that trigger your heartburn symptoms.
  • Exercise and a proper diet that avoids alcohol and large fatty meals not only decrease the incidence of heart-burn, but also lead to weight loss.
  • Shedding excess abdomen weight also reduces the severity and frequency of heartburn.

If recommending self care, talk with AM regarding 2-3 counseling points (QuEST)

1. Take one capsule with a full glass of water every morning thirty minutes before breakfast.
2. Prilosec OTC should be taken for 14 consecutive days and then discontinued. AM may repeat a 14-day course every four months.
3. Most people who take Prilosec® OTC do not experience any side effects; however, constipation, cough, dizziness or back pain may occur.

When can the patient expect relief from symptoms?

• Most people get complete relief of symptoms within 24 hours, but it may take 3 to 4 days to obtain the full therapeutic effect of Prilosec OTC.

When should AM seek his primary care provider?

• AM should call 911 if he is experiencing chest pain lasting longer than a few minutes.
• If AM’s symptoms continue or worsen despite use of Prilosec OTC he should contact his provider.

Source: http://www.heartburnalliance.org/medication_guidelines.php

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