Case Study 1: The Garcia Lopez Family Flashcards
(41 cards)
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
