A2 and A3. Responding to symptoms Flashcards
Indigestion advice?
Avoid:
-Foods which aggravate indigestion e.g. fatty food, spices, tea and
coffee, high acid content
-Smoking
-Alcohol
-Meals close to bedtime
Heartburn advice?
-If obese, reduce weight
-Avoid bending, stooping and slumping
-Avoid tight clothing
-Avoid smoking, alcohol, caffeine and chocolate (direct effect - makes
oesophageal sphincter less competent)
OTC Treatment for indigestion and / or
heartburn?
-Antacids
-Alginates (heartburn)
-Proton pump inhibitors
-Simeticone / dimeticone (wind, bloating)
What do antacids do?
raise pH of stomach contents causing symptomatic relief
examples of antacids?
-Sodium bicarbonate
-Calcium carbonate
-Aluminium hydroxide
-Magnesium salts
How to take antacids?
-Liquids quicker acting than solid preparations
-Tablets - chew / suck
-Most effective taken soon after meal
cautions with antacids?
-Some have high sodium content
-Avoid in patients who require low sodium diet
-BNF states which are low Na+ in each monograph - see
‘Prescribing and dispensing information’
side effects of antacids?
Side-effects:
-Constipation or diarrhoea (depends on metal salt)
-Avoid chronic use
-Acid rebound; possible high systemic absorption
describe interactions with antacids?
-Enteric coated tablets (increased gastric pH)
-Can affect the absorption of many drugs
-Take at different times (2-4 hours apart)
Describe how dimeticone / simeticone works
-Reduces surface tension → easier elimination of gas by gut
-May be added to antacid preparations
Describe alginates
-Form a raft that sits on stomach contents, so prevent reflux
-Alginic acid, sodium alginate and magnesium alginate
-Products also contain antacids
-Fast-acting (local effect)
-Safe in pregnancy
-None are low sodium (according to BNF)
-Chewable tablets - some find them unpleasant
-Liquids are quicker acting
-Take before bed if symptoms at night
Describe proton-pump inhibitors
-Block the terminal secretion process of gastric acid into the stomach
-Consider if frequent heartburn
-Esomeprazole, omeprazole and pantoprazole licensed as OTC medicines (otherwise POM)
How to take proton-pump inhibitors?
-Check legal category and conditions of licence
-Maximum duration of use 2 or 4 weeks (before seeing GP)
-Stop using when complete relief obtained
-Can take up to 2 days to be effective
-Refer if relief is not obtained within 2 weeks
-Lower doses OTC than on prescription (see BNF ‘Exceptions to Legal
Category’)
-Omeprazole not known to be harmful in pregnancy and breastfeeding
Drug interactions with proton-pump inhibitors (PPIs)?
-Inhibit cytochrome P450 (esp omeprazole & esomeprazole)
-Affected by drugs which affect cytochrome enzyme metabolism of PPI
-Affect gastric pH - other drug absorption
How to decide with a choice of treatment?
-Judge symptoms
-Tend to start with antacid / alginate
-But may be reasonable to move to (or even start with) e.g. PPI
-Depending on severity of symptoms, don’t necessarily need to start ‘at
the bottom’ Give what is most appropriate.
-Cost?
-Palatability / ability to swallow tabs/caps
