nhs forth valley formulary 11 - Community Pharmacy

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Forth Valley Formulary Eleventh Edition 2012/13Appendix 3Treatment Algorithm for Dyspepsia GuidanceThis algorithm should be used in conjunction with written guidance. Forth Valley Guidelines onmanagement of patients with Dyspepsia and GORD are available athttp://www.sign.ac.uk/pdf/qrg68.pdf"INDIGESTION"Consider• Heart• Liver• GallBladder• Pancreas• Bowel• NSAIDsetcNODYSPEPSIAPREDOMINANTHEARTBURNYESMANAGE ASGORDYESREFER TOHOSPITALSPECIALISTALARM FEATURES• Dysphagia• Evidence of GI blood loss• Persistent vomiting• Unexplained weight loss• Upper abdominal mass• (See also GP referral for UpperG-I Endoscopy)NOUNCOMPLICATED DYSPEPSIACONSIDER• Lifestyle• Antacids/H²RAPersistent / recurrent symptomsHp Test + veHp testHp Test -veEradicate HpPersistent / recurrent symptomsdespite confirmed eradicationAgeAsymptomaticManage as functionaldyspepsia55Consider referral to hospitalspecialist**If a patient is causing concern but does not fit into this treament algorithm, orfurther advice is necessary, please contact on call gastroenterologistof the week (0:900 to 17:00 Mon-Fri) via the GI unit secretaries.Pharmacist Lead:Pauline MorrisonPage 52
Forth Valley Formulary Eleventh Edition 2012/13Appendix 4Forth Valley Acute Hospitals ServicesGuidelines For The Prevention Of Constipation In AdultsReassureDetermine normal pattern of bowel movements for individual.Identify the causeThe following factors may be responsible for the development of constipation:• poor diet/change in diet• underlying disease e.g. hypothyroidism, hypercalcaemia• change of environment• immobility• pregnancyMedication reviewThe following drugs may exacerbate constipation. Where possible these drugs should bereviewed if constipation develops.• Opioid analgesics• Antacids containing aluminium• Anticholinergics e.g. oxybutinin, procyclidine• Antihistamines e.g. chlorpheniramine• Calcium channel blockers e.g. verapamil• Diuretics• Iron salts• Antidepressants and antipsychoticsEducateAdvise patient on the following:• adequate dietary fibre intake e.g. Weetabix®, pulses, fruit - refer to Dietician ifnecessary• adequate fluid intake - 8 to 10 cups per day• increase mobility - refer to physiotherapist if necessaryIf necessary - prescribe a laxativePage 53
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nhs forth valley formulary 11 - Community Pharmacy

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