A1 Responding to symptoms 1 Flashcards
in the pharmacy services contract, what are some essential services?
- promotion of healthy lifestyles (public health)
- signposting
- support for self-care
in the pharmacy services contract, what are some advanced service?
Pharmacy First (from 31st January 2024)
what are the 7 clinical pathways in the Pharmacy First scheme?
uncomplicated UTIs in women
shingles
impetigo
infected insect bites
sinusitis
sore throat
acute otitis media
since the introduction of the Pharmacy First scheme, what are pharmacists now experts in?
- responding to symptoms
- clinical examination
- prescribing
- clinical and professional judgement
what are symptoms?
what a patient tells you they are experiencing
what are signs?
what you see a patient is experiencing
what is differential diagnosis?
systematic method for ruling in and out different conditions
what are minor ailments?
conditions that do not generally require action by another healthcare professional
steps for responding to symptoms
- gather info
- respond and recommend
- quality assurance and audit
what is vital with the patient whilst responding to symptoms?
- rapport
- need the patient to open up
what might we mean by ‘treatment’ when responding to symptoms?
- self care advice
- signpost / refer
- recommend a medicine (how to use, goal of treatment)
what must be explained when a treatment is given out to a patient?
- the course of action
- how to achieve the intended outcomes
- disease and medicine information
general referral criteria
- long duration of symptoms
- recurring or worsening symptoms
- severe pain
- failed medication
- suspected ADR / interaction
- danger symptoms
- special care groups (young, pregnant, elderly, comorbidity)
general red flag symptoms
- blood in sputum, vomit, faeces, urine
- unexplained weight loss
- many others
describe (non-ulcer) dyspepsia
- indigestion
- GORD
- aka: reflux oesophagitis, gastric reflux, reflux
NICE clinical guidelines state that pharmacists should offer initial and ongoing help for people with symptoms of dyspepsia. what does this include advice about?
- lifestyle changes
- using OTC medication
- help with prescribed drugs
- advice about when to consult a GP
what should community pharmacists record and where?
adverse reactions in primary care medication review clinics
describe what happens when patients come into a community pharmacy with indigestion and / or heartburn
- often self-diagnosed by patient
- patients may use terms interchangeably, what do they mean?
- need to establish if the self-diagnosis is correct
- need to exclude serious disease
symptoms of indigestion
- poorly localised, upper abdominal discomfort (pain, bloating, fullness)
what may indigestion be brought on by?
some foods
excess food
alcohol
medication
referral criteria for indigestion
- children
- over 45 with first time symptoms
- persistent or recurrent symptoms
- persistent vomiting
- blood in vomit or stools
- severe pain (origin should be considered)
- pain worsens on effort
- treatment failure
- suspected adverse drug reactions (ADRs)
- unexplained weight loss
what is heartburn?
- reflux of acidic stomach contents which is normally prevented by lower oesophageal sphincter
- oesophageal mucosa lacks protecting form stomach acid
what people is heartburn common in?
- more common in older people because function of lower oesophageal sphincter is worse (open or leaky)
- common in pregnant women due to baby pressing on stomach as well as progesterone fluctuations affecting lower oesophageal sphincter function
symptoms of heartburn
- burning discomfort / pain in the stomach and upwards (behind the sternum)
- worse after eating
- worse on bending or lying down
- water brash
what is water brash?
acidic stomach contents regurgitation in back of throat
causal / aggravating factors of heartburn
- certain foods and drinks
- alcohol
- smoking
- some drugs
- obesity
- pregnancy
- anatomical abnormality
examples of drugs that can be aggravating towards heartburn
antimuscarinics
beta-blockers
NSAIDs
referral criteria for heartburn are the same as for indigestion plus some more, what are the additional criteria?
- failure to respond to treatment
- pain radiating to arms
- difficulty swallowing (dysphagia)
- regurgitation
- increased severity
which ulcer is worse after food, duodenal or gastric?
gastric
which ulcer is better after food, duodenal or gastric?
duodenal
