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CHAPTER 4: TRANSITIONS OF CARE IN THE OUTPATIENT SETTING

When treating a patient in a community pharmacy, it is important to collect enough information in order to appropriately assess their problem(s). MW presents to the pharmacy with many GERD symptoms. Which of the following signs/symptoms are NOT suggestive of GERD?

A. Frequent clearing of throat

B. Night-time burning sensations

C. Sleeps with head elevated in a recliner

D. Back pain

Correct answer: D

Rationale: The back pain the patient is experiencing is not a sign or symptom of GERD. He is needing to sleep in the recliner due to his GERD symptoms at night that worsen while lying flat, thus it is the sleeping position causing the back pain. Answers A through C are all signs and symptoms of GERD.1

Collecting a thorough medical history and pertinent information on the patient’s current complaint is critical so you can determine if they are able to be treated or must be referred to a physician for further evaluation. Often a patient approaches the community pharmacist for a product recommendation, but the pharmacist must gather sufficient information to determine if they are excluded from self-care.

Which of the following is an alarm symptom that would warrant the pharmacist to advise the patient to follow up with their physician for further evaluation?

A. Painful swallowing

B. Regurgitation

C. Nighttime awakenings

D. Water brash

Correct answer: A

Rationale: Alarm symptoms for GERD that should result in a patient referral to a physician include dysphagia, odynophagia (painful swallowing), recurrent bronchial symptoms, aspiration pneumonia, dysphonia, recurrent or persistent cough, gastrointestinal (GI) tract bleeding, frequent nausea and/or vomiting, persistent pain, iron-deficiency anemia, progressive unintentional weight loss, lymphadenopathy, epigastric mass, new-onset atypical symptoms at age 45 to 55 years (a lower age threshold may be appropriate, depending on local recommendations), and family history of either esophageal or gastric adenocarcinoma. Answer choices B and D are incorrect, as these are typical GERD symptoms. Answer choice C is incorrect, as symptoms often worsen when lying flat and thus may result in nighttime awakening and the need to sleep with additional pillows to elevate the head of the bed or sleep in a recliner.1

It is important to take a thorough medication history, including nonprescription agents, in all patients who visit the outpatient community pharmacy for advice, whether they are in the pharmacy system or not. ...

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