Pharmaceutical Care of Gastrointestinal patients 1 dyspepsia and GORD Flashcards

1
Q

Define : Dyspepsia

A

any symptom of the upper GI tract, present for 4 weeks or more, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea or vomiting

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2
Q

list the symptoms of dyspepsia

A

1) Heartburn
2) Fullness
3) Early satiety
4) Upper abdominal pain or ache
5) Flatulence
6) Hiccups coughing
7) Belching

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3
Q

list some drugs that cause dyspepsia

A

1) Calcium antagonists
2) Nitrates
3) Theophylline
4) Bisphosphonates
5) NSAIDs
- Review medications as possible cause

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4
Q

Urgent specialist referral, is indicated for patients of any age with dyspepsia when presenting with certain alarm symptoms. list some of these alarm symptoms

A

Urgent referral for endoscopic investigation:

1) Chronic GI bleed
2) Progressive, unintentional weight loss
3) Progressive difficulty swallowing
4) Persistent vomiting
5) Iron deficient anaemia
6) Epigastric mass
7) Suspicious barium meal

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5
Q

what does the acronym ALARM stand for with regards to dyspepsia

A

1) Age >55
2) L significant and unintentional weight loss
3) Anemia
4) Recurrent vomiting/difficulty swallowing
5) Malaena - dark sticky faeces containing partly digested blood

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6
Q

what Medicines can be used to treat dyspepsia?

A

1) Antacids (contain aluminium or magnesium)
- Best given when symptoms occur or are expected: With meals/bedtime
2) Magnesium = laxative
3) Aluminium = constipating
4) Alginates
- Increases the viscosity of the stomach contents taken in combination with antacids
- Protects against acid-reflux - Raft

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7
Q

what effect do antacids have on EC tablets?

A

Antacids damage enteric coatings designed to prevent dissolution in the stomach

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8
Q

discuss what you should consider when recommending a particular formulation for the treatment of dyspepsia to a consumer.

A

1) Patient choice
2) Practicality- do they want tablets or a liquid?
3) Taste!
4) Effectiveness- double action?

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9
Q

list the different formulations Gaviscon is available as

A

1) Gaviscon Liquid, tablets, liquid sachets
2) Gaviscon Double action liquid, tablets, liquid sachets
3) Gaviscon Advance liquid, tablets

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10
Q

list the lifestyle changes recommended for patients who suffer from dyspepsia

A

1) Smoking
2) Alcohol
3) Coffee
4) Chocolate
5) Fatty foods
6) Weight
7) Raise head of bed
8) Don’t eat too late

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11
Q

what is GORD?

  • who is normally affected?
  • what is the treatment?
A

1) gastro-oesophageal reflux disease refers to endoscopically determined oesophagitis or endoscopy-negative reflux disease.
2) GORD is a common digestive condition.
3) Adults aged 40 years or over are mainly affected
4) Offer patients who have GORD a full-dose PPI for 1 or 2 months.
5) If symptoms recur – low dose PPI

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12
Q

Discuss the causes of GORD and outline the known risk factors

A

1) Most common is the failure of the lower oesophageal sphincter (LOS)
2) This acts like a valve, opening to let food fall into the stomach, then closing to prevent acid leaking out of the stomach back into the oesophagus.
3) In GORD, this sphincter doesn’t close properly, allowing acid to leak up out of the stomach.
4) Known risk factors for GORD include:
- being overweight or obese
- being pregnant
- eating a high-fat diet

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13
Q

outline the role of a pharmacist in the treatment of GORD

A

1) advice regarding lifestyle factors that may affect reflux:
- Smaller meals, eat earlier in the evening
- Weight management
- Smoking cessation
- If practical, advise the person to try raising the head of their bed
- Stress management
2) Review the person’s medication and, if possible, avoid drugs that may cause or exacerbate symptoms.

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14
Q

list the drugs that reduce lower oesophageal sphincter pressure

A

1) Theophylline
2) nitrates
3) calcium-channel blockers
4) beta-blockers
5) alpha-blockers
6) benzodiazepines
7) tricyclic antidepressants
8) anticholinergics

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15
Q

how do PPI’s work and why should you use them with caution?

- what is the dosage and treatment period?

A

1) Inhibit gastric secretion by blocking hydrogen-potassium adenosine triphosphatase enzyme system
2) Caution: can mask signs of gastric cancer – ALARM
3) Prescribed at lowest effective dose and for shortest period of time

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16
Q

what are the side effects of PPI’s?

A

1) GI disturbances,
2) Rarely: hyponatraemia and hypomagnesaemia (usually >1 year)
3) By reducing gastric acidity = increased risk of GI infections for example Clostridium difficile.
4) Increased risk of fractures, particularly in elderly

17
Q

list 3 PPI’s and state their doses

A

1) Esomeprazole: 40mg OD 4 weeks (max 8 weeks) then 20mg OD
2) Lansoprazole: 30mg OD 4 weeks (max 8 weeks) then 15-30mg OD
3) Omeprazole: 20-40mg OD for 4 weeks (max 8 weeks) then 20mg OD
- 8mg/hr 72 hours (IV infusion)

18
Q

what counselling advice would you provide for Esomeprazole

A

1) oral : Do not crush/chew. Can be dispersed in water if taken within 30 mins
2) Granules ( Gastric tube/ difficulty swallowing/ children): Disperse in 15ml water. Stir and leave to thicken and use within 30 mins, rinse 15ml water to obtain full dose

19
Q

what counselling advice would you provide for Lansoprazole

A

1) capsules: Do not take indigestion remedies 2 hours before/after taking medicine. Take 30-60 mins before food. Swallow whole
2) FasTab (dispersable tabs) Gastric tube/ difficulty swallowing Children: Place tablet on tongue, allow disperse and swallow.

20
Q

what counselling advice would you provide for Omeprazole

A

1) Capsules: swallow whole
2) MUPS capsules- gastric tube: Disperse contents in sodium bicarbonate administer gastric tube
3) MUPS tablets- Swallowing difficulty/children: Disperse in water or mix with fruit juice/ yogurt

21
Q

discuss the Medicines management issues with regards to PPI’s

A

1) High dose PPI not reviewed
2) Clostridium difficile
3) Polypharmacy
4) Just an extra medicine to take?
- Capsule size, Taste,Drug interactions

22
Q

1) What is the duration of PPI treatment recommended in GORD?
2) Avoiding precipitating factors should NOT be recommended – True or False?
3) H2 antagonists should be recommended first line for the treatment of GORD – True or False?
4) The highest dose of PPI should be prescribed – True or False?

A

1) offer patients who have GORD a full-dose PPI for 1 or 2 months.
2) false
3) false
4) false - prescribed at lowest effective dose and for shortest period of time