A2-A3 Responding to symptoms 2&3 Flashcards
what would you advise someone to avoid if they are struggling with indigestion?
- aggravating foods
- smoking
- alcohol
- meals close to bedtime
what should your advice be for someone with prolonged or worsening indigestion symptoms?
seek medical advice
state some foods that aggravate indigestion and / or heartburn
fatty foods
spicy foods
tea
coffee
high acid content foods
what would you advise someone to avoid if they are struggling with heartburn?
- aggravating foods
- alcohol
- meals close to bedtime
- smoking
- bending, stooping and slumping
- tight clothing
- caffeine
- chocolate
how do smoking, alcohol, caffeine and chocolate worsen heartburn?
they all make the oesophageal sphincter less competent
what should your advice be for someone presenting with prolonged or worsening heartburn symptoms?
seek medical advice
what lifestyle advice surrounding BMI can be given for heartburn symptoms?
if obese, reduce weight
according to the NICE clinical guidelines, what are the common elements of care for indigestion / heartburn?
- simple lifestyle advice
- advise to avoid known precipitants
- provide access to educational materials
- recognise that psychological therapies may reduce dyspepsia symptoms
what advice should be given surrounding long term use of indigestion / heartburn remedies?
- encourage stepwise approach
- use minimum effective dose and try ‘as needed’ use
OTC treatments for indigestion / heartburn
- antacids
- alginates (heartburn)
- PPIs
- simeticone / dimeticone (wind / bloating)
which is used more, H2 antagonists or PPIs? why?
- H2 antagonists are rarely used now as PPIs are superior and have less problems associated with them
- they are rarely found in pharmacies now
what do antacids do?
- raise pH of the stomach contents
- provide symptomatic relief
examples of antacids
- sodium bicarbonate
- calcium bicarbonate
- aluminium hydroxide
- magnesium salts
which formulations are there for antacids? which ones act fastest?
- tablets and liquids
- tablets can be chewed or sucked (makes them faster than standard tablets)
- liquids act faster than solid preparations
when are antacids taken to be most effective?
- most effective taken soon after meal
- as soon as symptoms starts (not when they become too bad)
what needs to be considered with antacids surrounding sodium content?
- some have high sodium content
- avoid in patients who require low sodium diet
- BNF states what are low sodium in each monograph (see ‘prescribing and dispensing information’)
side effects of antacids. describe which metals in antacids cause these side effects the most
constipation and diarrhoea
- aluminium especially
- calcium can cause both
- magnesium can cause diarrhoea
- sodium doesn’t really impact
why should chronic use of antacids be avoided?
- acid rebound (continual neutralisation urges stomach to secrete more acid to overcompensate)
- possible high systemic absorption
interactions of antacids
- enteric coated tablets (increased gastric pH)
- can affect the absorption of many drugs
- taking at different times (2-4 hours apart) can combat these interactions
describe dimeticone / simeticone in terms of what it does and what it may be added to?
- reduces surface tension (easier elimination of gas by gut)
- reduces belching and farting due to indigestion
- may be added to antacid preparations
describe the action of alginates for heartburn
- form a raft that sits on stomach contents, so prevent reflux
examples of alginates
alginic acid
sodium alginate
magnesium alginate
describe the alginate products available
- fast-acting (local effect)
- products also contain antacids
- none are low sodium (new Gaviscon may be low sodium?)
- there are chewable tablets and liquids are fastest acting
are alginate products safe for pregnant people?
- yes
- used quite a lot due to baby pushing on stomach and reduced sphincter competence in pregnancy - due to fluctuations in progesterone)
when should alginates be taken if the patient gets heartburn at night?
take before bed
describe PPI action
block the terminal secretion process of gastric acid into the stomach
when should PPI use be considered?
- with frequent heartburn
- NOT for indigestion symptoms with no heartburn
PPIs licensed OTC
esomeprazole
omeprazole
pantoprazole
(all others POM)
what should be checked before giving PPIs to patients?
- check legal category
- check conditions of license
maximum duration of use for OTC PPIs. describe other rules around administration
- 2-4 weeks (before seeing GP)
- stop using when relief is obtained
how long can PPIs take to be effective?
up to 2 days
when should patients be referred if relief isn’t obtained with PPIs?
if relief is not obtained within 2 weeks
drug interactions of PPIs
- affected by drugs which affect cytochrome enzyme metabolism of PPI (PPIs inhibit CYP450)
- affect gastric pH (may affect absorption of other drugs)
how is esomeprazole related to omeprazole?
esomeprazole is the S enantiomer of omeprazole
is omeprazole safe in pregnancy / breastfeeding?
- not known to be harmful in either
- no info to prove that it is harmful but we do not have sufficient data to confidently say it’s safe
describe the choice of treatment if a patient presents with dyspepsia symptoms
- tend to start with antacid / alginate (antacid for indigestion, alginate for heartburn)
- may be reasonable to change to (or start with) a PPI
- depending on the severity of symptoms, you don’t necessarily need to start with the simplest
- formulation must also be considered
