G3 Responding to symptoms 3

Question 1

What are the two non ulcer dyspepsia called?

Answer 1

indigestion

heartburn

Question 2

What is heart burn also known as?

Answer 2

reflux oesophagitis
gastric reflux
reflux

Question 3

According to NICE what should a community pharmacist do with dyspepsia?

Answer 3

offer initial and ongoing help for symptoms
advice about lifestyle, use of OTC medicines, prescribed medicines and when to consult GP
record ADRs and participate in primary care medication reviews

Question 4

What are the symptoms of indigestion?

Answer 4

poorly localised, upper abdominal discomfort - pain, bloating, fullness

Question 5

What can bring on indigestion?

Answer 5

particular foods
excess food
alcohol
medication

Question 6

When should indigestion be referred?

Answer 6

children
over 45s with first time symptoms 
persistent symptoms
severe pain
blood in vomit or stools 
pain worsens on effort
persistent vomiting 
treatment failure
suspected ADR
unexplained weight loss

Question 7

What are the four treatments of indigestion?

Answer 7

Antacids
H2 antagonists
dimeticone/ simethicone
prokinetics

Question 8

What do antacids do?

Answer 8

raise the pH of the stomach contents giving symptomatic relief

Question 9

How can antacids be more effective?

Answer 9

liquids more effective that solid preps

most effective taken after 1 hour after meal

Question 10

What do H2 antagonists do?

Answer 10

block the action of histamine on parietal cells which leads to a reduction in gastric acid secretion

Question 11

How do dimeticone & semitone work?

Answer 11

reduces surface tension resulting in easier elimination of gas by gut

Question 12

How do pro kinetics such as domperidone work?

Answer 12

increase rate of gastric emptying and transit time in the small intestines

Question 13

What advice should be given to people with indigestion?

Answer 13

avoid foods such as fatty foods, spices, tea&coffee, high acid content
avoid smoking and alcohol
prolonged or worsening symptoms seek medical advice

Question 14

What is heartburn?

Answer 14

reflux of acidic stomach contents, oesophageal mucosa lacks protection from stomach acid and acid is irritant to oesophageal mucosa.

Question 15

What are the symptoms of heartburn?

Answer 15

burning discomfort/ pain in stomach, worse after eating and when bending over

Question 16

What is water brash?

Answer 16

acidic stomach contents regurgitating in back of throat

Question 17

What can cause heartburn?

Answer 17

certain foods & drinks 
alcohol
smoking
some drugs (anticholinergic action) 
obesity
pregnancy 
anatomical abnormality

Question 18

When should heartburn be referred?

Answer 18

failure to respond to treatment 
pain radiation in arms
difficulty swallowing
regurgitation 
long duration 
increased severity 
children

Question 19

What are the treatments of heartburn?

Answer 19

antacids
alginates
H2 antagonists
proton pump inhibitors

Question 20

How do alginates work?

Answer 20

form raft that sit on stomach contents and thus preventing reflux

Question 21

How do proton pump inhibitors work?

Answer 21

blocks terminal secretion process of gastric acid into stomach

Question 22

What advice would you give for heartburn?

Answer 22

as indigestion but also:
if obese, reduce weight
avoid bending, stooping and slumping
avoid tight clothing
avoid smoking, alcohol, caffeine and chocolate