Case Study 1: The Garcia Lopez Family Flashcards
Santiago comes into the pharmacy and tells you that for the last month he has been experiencing:
- A burning feeling in his chest mainly after eating
- Feels bloated
- Feels nauseated at times
- Been more windy than usual
What do you think he has/ is experiencing ?
Dyspepsia/ indigestion / heartburn
What can exacerbate heartburn ?
Smoking and alcohol
Eating fatty, spicy, tomatoes or coffee
Some drugs
What are the red-flag symptoms associated with heartburn?
Unintentional weight loss
swallowing difficulties
Vomiting (especially blood stained)
Give some counselling advice on indigestion
- Raise head and shoulders up in bed
- If overweight, lose weight
- Cut down on tea, coffee, cola and alcohol, tomatoes
- Dont smoke
- Dont take ibuprofen
- Dont eat 3-4 hours before going to bed
- Dont eat rich, spicy or fatty foods
Santiago bought gaviscon to manage his symptoms however this hasn’t been working.
What would be the next step in his treatment ?
Sell Nexium control (esomeprazole) 20mg to him
Take 20mg once daily for 2 weeks
GSL (pack size 7 and 14)
What infection does 13 carbon urea breath test detect ?
H.pylori
Does any medication need to be stopped prior to taking a 13 carbon urea breath test? If so what medication should be stopped ?
All medication should be stopped besides medication for the:
- Heart
- Breathing problem
- Hormone replacement therapy
Is there an alternative test t 13 carbon urea breath test ?
Yes, H.pylori stoll antigen test
What counselling points would you provide to someone on amoxicillin and clarithromycin ?
- Take the full course of the antibiotics
- Avoid alcohol
- Take medication at the same time until course is complete
- Avoid grapefruit juice
What questions would you ask if someone asked you for a pregnancy test ?
Does she think that she already could be pregnant ?
Is this a planned pregnancy ?
Have you mad any plans ? (continuing or not)
Are you on any medication?
What does a pregnancy test test in urine ?
HcG -human chorionic gonadotropin. levels are highest in the morning
If a pregnancy test is negative should you retest a week later?
Yes, negative tests are less reliable
Test may have been taken too early
why is it important to take folic acid during pregnancy ?
Should be taken before and during pregnancy to reduce the risk of neuronal tube defects. Standard dose is usually 400micograms but in some cases doctors can recommend 5mg
What public heath should you ask a woman who has just found out that she is pregnancy?
Does she smoke ? if so you should refer to a GP or specialist
How much alcohol does she drink?
Is she on any medication ?
What conditions/drugs increase the risk of neuronal tube defects ?
- Anti-epileptic medication
- Family history or previous pregnancy affected by neuronal tube defects
- Coeliac disease
- Diabetes millitus
- Sickle cell anaemia
Mercedes has no family history of neuronal tube defects or previous pregnancy history. she also isnt on any other medication.
What folic acid preparation should she take an how long for ?
400 micrograms once daily.
Yes, this is the dose recommended for women at low risk.
Women who have not been taking folic acid and who suspect they are pregnant should start at once and continue until week 12 of pregnancy.
She also needs to take vitamin D (10 micrograms a day) throughout pregnancy and breastfeeding.
What heath issues are caused by pregnancy ?
Haemorrhoids Hypertension Thrush GORD Diabetes N&V constipation Venous thromboembolism
What non-pharmacological treatment would you recommend for someone with constipation ?
- Increase fluid intake
- Eat plenty of fruits and veg
- iIncrease fibre intake
- Exercise
- Avoid iron supplements
Give an example of a bulk laxative
Ispaghula
Give an example of an osmotic laxative
Lactulose
Give an example of a stimulant laxative
senna
Give an example of a softener laxative
Docusate sodium
What laxative would you recommend for a pregnant woman
Ispaghula (Fybogel) (bulk) laxative- if dietary and lifestyle treatment fails
What advice would you give a pregnant woman who is suffering from nausea and vomiting ?
- Continue with high fibre diet e.g foods such a crackers, pasta rice etc
- Eat small potions
- Drink plenty of tepid water, sipping little and often
- Avoid foods or smells that makes you feel sick or sweet and spicy foods
- Eat cold foods that do not smell
Ginger
What advice would you give mercedes about lactulose ?
- Continue drinking water
- May take 2 days to act
- If constipation is bad, continue with Fybrogel for a couple of days whilst taking laculose as it may take a whole to act.
Mercedes comes back to the pharmacy and asks you about writing her birth plan and wants to ask you about the meds she can take in hospital ?
What should you advice?
Suggest that she should talk to her midwife and obstetrician
They will discuss the local policies on epidural and pethidine and risk of potential adverse effects
What medicine given at labor can make the baby drowsy ?
Pethidine
Are low molecular weight heparins used during pregnancies ? Can this effect her suitability for an epidural ?
Yes, they’re sometimes used but can affect her suitability for epidural
what is active management of third labour?
Involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta
Oxytocin can be given
Why is vit K given to new borns ?
Helps prevent bleeding that could occur due to low levels of vit K
this is administered by an injection
what is the name for babies born at less than 37 weeks gestation ?
Pre-term newborn infants
What is the name for babies at 0-27 days old
Term newborn babies
What is the age range for infants to toddlers?
28 days-23 months
What is the age range for children ?
2-11 years old
What is the age range fro adolescents ?
12-16 (or 18) years old
what should be considered when looking at a woman who has just given births drug chart?
Whether she is breastfeeding
Drugs such as codeine us not appropriate for breast-feeding women
What questions would you need to ask when deciding whether a medicine is safe to be used in breast-feeding?
- Was the babu born full term
- Is the baby healthy?
- Is the medicine essential?
- What dose, route, frequency of medicine ?
- How often is the mother feeding?
What are the symptoms of presented in children who are seriously ill ?
- a high temperature
- cold hands and feet
- vomiting
- confusion
- breathing quickly
- muscle and joint pain
- pale, mottled or blotchy skin
- spots or a rash
- headache
- a stiff neck
- a dislike of bright lights
- being very sleepy or difficult to wake
- fits (seizures)
Babies:
- refuse feeds
- be irritable
- have a high-pitched cry
- have a stiff body or be floppy or unresponsive
- have a bulging soft spot on the top of their head
What drug is recommenced for empirical therapy ? What dose should be given ?
The BNF recommends Ceftriaxone for child and adults 3 months to 50 years
Ceftriaxone 80mg/kg IV every 24 hours (meningitis)
Conchita weighs 15.5kg so the dose would be 15.5 x 80 = 1,240mg every 24hrs
What is the method of administration of ceftriaxone ?
The Method of Administration states for the 2 gram vials:
Dissolve 2 grams in 40ml 0.9% sodium chloride to give a final volume of 41.2ml
For a 1240mg dose the nurses need to take 1240/2000x41.2 = 25.5ml
What is the dilution rate of ceftiaxone ?
From the BNFc ceftriaxone should be diluted with sodium chloride 0.9% and given as an infusion over 30 minutes.
