Analrectal Flashcards
1
Q
Definition
A
• Engorged blood vessels in the anal area can be itchy and/or painful
2
Q
Contributing Factors
A
- Erect posture
- Pregnancy
- Prolonged standing or sitting
- Lack of dietary fiber
- Constipation
- Diarrhea
3
Q
Contributing Factors Cont
A
- Heavy lifting with straining
- Toilet habits
- Hereditary
- Socioeconomic factors
- Cultural factors
- Geographic location
- Age
4
Q
Internal
A
Above the dentate line
Nerve fibers endless feeling of pain
5
Q
External
A
Below the dentate line
Bluish bumps
6
Q
Minor Disorder S&S
A
- Itching
- Discomfort
- Irritation
- Burning
- Inflammation
- Swelling
7
Q
Referral required
A
• Pain • Bleeding Crohn’s Colitis Anal fissure CA • Seepage • Change in bowel patterns • Prolapse • Thrombosis
8
Q
Exclusions to Self-Treatment
A
- <12 y.o.
- Known GI diseases
- Family hx of colon cancer
- Potentially serious anorectal disorder
- Patients with serious signs/symptoms
- Minor anorectal sx unresponsive after 7 days of treatment
9
Q
Treatment Goals
A
- Alleviate symptoms
- Prevents reoccurrence of symptoms
- Prevent complications that could lead to adverse consequences
10
Q
General Treatment Approaches
A
- Nonpharmacologic measures
- Nonprescription meds
- Prescription meds/intervention
- Surgery
11
Q
Non-pharm Treatments
A
• Well-balanced diet
o High fiber/bulk
o If unable, then bulk laxative
• Good perianal hygiene
o Clean with soap and water or hygiene wipes or pads
o Don’t scrub when bathing/showering
o Sitz bath – warm water BID-TID for 15 minutes
12
Q
Non-pharm cont.
A
• Avoid prolonged sitting on toilet o No more than 10 minutes • Avoid lifting heavy objects • Avoid food that may irritate or aggravate sx • Exercise
13
Q
Local Anesthetic location
A
- External Only
* Topical anesthetics
14
Q
LA - function
A
- Itching
- Irritation
- Burning
- Discomfort
- Pain
15
Q
LA- MOA
A
- Rapid absorption through rectal mucosa and abraded perianal skin
- Numb the area
16
Q
LA- cautions
A
- Caution with allergic reactions
- Not for internal use
- Contact dermatitis common with benzocaine – may be used in the mouth
17
Q
LA - types
A
- Benzocaine
- Benzyl alcohol
- Dibucaine HCl
- Dyclonine HCl
- Lidocaine
- Pramoxine HCl
- Tetracaine HCL
- Tertracaine
18
Q
Vasoconstrictors - location
A
Internal:
• Ephedrine sulfate
• Phenlphrine
19
Q
VC - function
A
- Itching
- Discomfort
- Irritation
20
Q
VC- MOA
A
• Reduction of swelling and slight anesthetic effect
21
Q
VC - avoid
A
- Diabetic
- Thyroid disease
- Hypertension
- Angina Pectoris
- Enlarged prostate
- Antidepressants
- Antihypertensives
- Cardiac Meds
22
Q
VC - types
A
- Ephedrine sulfate
- Epinephrine HCl
- Epinephrine
- Phenylephrine HCl – min effects on cardiac rhythm, and for bags under eyes
23
Q
Protectants location
A
• Glycerin: external only
24
Q
Pro - function
A
- Irritation
- Itching (kaolin and AlOH gel)
- Burning
- Discomfort
25
Pro -MOA
* Form a physical barrier on the skin
| * Protective coat, soften area (moisture)
26
Pro - cautions
• Must be a 50% conc. if a single protectant is used in a combination product
27
Pro - types
* AlOH gel
* Cocoa butter
* Glycerin
* Hard fat
* Kaolin
* Lanolin (sheep)
* Astringents
* Others, multiple active ingredients
28
Astringents location
* Witch hazel – external only
| * Calamine and ZnO – external and internal
29
Ast function
* Itching
* Burning
* Irritation
30
Ast MOA
* Promote coagulation of the skin cells protects underlying tissue and cell vol
* Thin layer of protection
* Contracting, wrinkling, blanching, and secretion = dryness
31
Ast types
* Witch hazel
* Calamine
* ZnO
32
Keratolytocs location
External Only
33
Ker Function
* Itching
| * Discomfort
34
Ker MOA
• Desquamation and debridement (sloughing)
35
Ker cautions
* Should not be used internally
| * Resorcinol – allergic reactions, do not apply to open wounds
36
Ker Types
* Al chlorhydroxy allantoinate
| * Resorcinol
37
Analgesics/Anesthetics/Antipruitis location
External Only
38
A/A/A function
* Pain
* Itching
* Burning
* Discomfort
39
A/A/A MOA
• Produce a local sensation (cool, warm, tingling) that distracts
40
A/A/A cautions
* Menthol – allergic reaction
| * Do not use internally
41
A/A/A Types
* Menthol
* Juniper Tar
* Camphor
42
Corticosteroids location
External Only
43
CS - function
* Itching
| * Pain
44
CS - MOA
* Vasoconstrictor
* Antipruitic
* Onset – 12 hours but longer effect than others
45
CS - cautions
* Do not use internally
| * Can mask symptoms of fungal and bacterial infections
46
CS - types
• Hydrocortisone 1%
47
internal dosage forms
* Ointments
* Creams
* Suppositories
* Gels
* Foams
48
external dosage forms
* Creams
* Ointments
* Gels
* Pastes
* Liquids
* Foams
49
Diet and LS
* Consume sufficient dietary fiber and fluids, exercise, and proper perianal hygiene
* Avoid lifting heavy objects
* Avoid foods that irritate/aggravate symptoms
50
Product Selection
* Fewest active ingredients possible to minimize side effects
* Special Population
* Proper Use
51
Pregnant/breastfeeding use
External use products except protectants (internal)
52
<12 use
Refer
53
Peru Balsam
• Suppository to treat hemorrhoids
54
Plantain
* Pulverized seeds mixed with oil applies topically or taken orally as bulk laxative
* Reduces bleeding and pain during defecation
55
Witch Hazel
• FDA approved
56
Butcher's Broom
• Supportive therapy for itching and burning
57
Sweet Clover
• Supportive therapy for itching and burning
58
Polar bud
• Semisolid preps approved to aid in wound healing
59
Manna. black/blonde psyllium seed husks
• Prevents further irritation/development of hemorrhoids because of their laxative effects
