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Self/Home Care > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

PPCP: Collect

A
  1. Prominent symptoms & severity
  2. Onset & duration
  3. Any measures tried & their success
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2
Q

QuEST

A
  • Quickly assess
  • Establish self-care appropriateness
  • Suggest care
  • Talk to the patient
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3
Q

SCHOLAR

A
  • Symptoms
  • Characteristics
  • History
  • Onset
  • Location
  • Aggravating factors
  • Remitting factors
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4
Q

Influences of self-care medication

A
  • Elderly pts
  • Restricted access to prescribers through health management org
  • Increasing health care $
  • Emerging concept of non-rx drugs in disease mng
  • Internet
  • Pretax $
  • Women > men
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5
Q

FDA Drug labeling sections

A
  1. active ingredients
  2. uses
  3. warnings
  4. when to use
  5. directions
  6. inactive ingredients
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6
Q

FDA drug labeling D/I has been changed to ___

A

Ask your physician or pharmacist

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7
Q

When do we refer pts?

A
  1. Severe symptoms
  2. Minor but persistent symptoms
  3. Repeatedly returning symptoms w/ no readily recognizable cause
  4. pharmacist in doubt
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8
Q

Risk factors of T2DM

A

Age, obesity, lack of physical activity, family hx, GDM hx, PCOS, HTN, dyslipidemia, prediabetes

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9
Q

Preventative measures of diabetes

A
  • Self monitoring BG: frequency
  • Eye care
  • Dental care
  • Skin care
  • Foot care
  • Med adherence
  • Sick day mng
  • Immunization (influenza, hep B, pneumococcal)
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10
Q

DM: limit daily intake to __ alcohol beverages for men & __ for women

A

Two; one

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11
Q

ADA A1c goal

A

< 7%

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12
Q

ADA pre-prandial goal

A

80 - 130 mg/dL

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13
Q

ADA 2 hr postprandial goal

A

< 180 mg/dL

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14
Q

HTN BP goal for DM

A

< 130/80 mmHg

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15
Q

Aspirin for CV protection: secondary (hx of ASCVD)

A

Use aspirin

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16
Q

Aspirin for CV protection: primary

A
  • Age >= 50 : DM & 1 major risk factor –> aspirin
  • Age < 50 or >= 70 : X
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17
Q

Factors affecting insulin absorption- Site

A

Abdomen > arm > thigh > buttock

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18
Q

Factors affecting insulin absorption- Depth of injection

A

IV > IM > SC

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19
Q

Factors affecting insulin absorption- Other

A
  • Exercise increases
  • Skin temperature: cold decreases
  • Massaging injection site: increases
  • Smoking decreases
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20
Q

Hypoglycemia S/S

A
  • Sweating
  • Tachycardia
  • Palpitations
  • Confusion
  • Tiredness
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21
Q

Treating hypoglycemia

A

Rule of 15
- 3 teaspoonful or 3 cubes of sugar
- 5 to 6 lifesavers
- 3 glucose tablets
- 4 oz juice
- 9 oz milk

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22
Q

If glucose below 60 mg/dL after 15 mins of treating hypoglycemia

A

Repeat another 15 g of CHO

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23
Q

SMBG frequency considerations:

A
  • assess pt compliance
  • vary timing of SMBG
  • incorporate pt daily schedule and habits
  • give ownership to the pt
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24
Q

A1c reading frequency testing is recommended at least quarterly (Q 3 months) for:

A
  • newly diagnosed
  • therapy recently changed
  • poorly controlled, unstable, or intensively managed
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25
Q

A1c reading frequency testing is recommended at least twice a year (Q 6 months) for:

A

stable glycemic control

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26
Q

Ketone testing is a marker of __ and __

A

insulin deprivation and subsequent hyperglycemia

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27
Q

Ketone level should be tested every 4 to 6 hrs when:

A
  • Acute illness
  • BG > 240 ng/dL
  • Symptoms of DKA (fruity breath, thirst, frequent urination, Kussmaul breathing, abdominal pain/vomiting, flu-like symptoms, confusion, stupor, coma)
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28
Q

Use control solutions when:

A
  • New monitor & test strips
  • Improper storage for test strips
  • Unusual results
  • Symptoms do not match your results
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29
Q

Tips for using control solutions:

A
  • Discard after 90 days or expired
  • Check to see if there is more than one solution for your meter
  • Know you model when you reorder
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30
Q

Do not use alternate testing sites when:

A
  • Acutely/frequently hypoglycemic
  • Within 2 hrs after a meal, insulin dose, or exercise
  • Acutely ill
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31
Q

Fermentation process of prebiotics

A
  1. Prebiotics must be fermented in the colon
  2. Fiber can act as a prebiotic and are fermented by bifidobacteria and lactobacilli
  3. Fermentation leads to short chain fatty acids and lactate production
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32
Q

What are the two common bacteria that ferment fiber in the colon?

A

bifidobacteria and lactobacilli

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33
Q

Most common type of prebiotics is ____

A

inulin-type fructans

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34
Q

Benefits of prebiotics

A
  1. Reduce duration and prevalence of infectious and antibiotic-associated diarrhea
  2. Stool bulking and decreased constipation
  3. Reduce inflammation and symptoms with IBD
  4. Enhance absorption of minerals (Ca, Mg)
  5. Promote satiety and weight loss
  6. Increase bifidobacterium for digesting fiber and preventing infections
  7. Enhancement by synbiotics
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35
Q

Protective effects of probiotics

A
  1. GI barrier function
  2. Antimicrobial activity
  3. Alter EC inflammatory responses
  4. Enhance antiviral activity
  5. Increase CD4+ (regulatory) T cells
  6. Activate MP
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36
Q

Safety considerations of probiotics

A
  1. Minor GI AEs
  2. Systemic infections
  3. Avoid in immunocompromised
  4. Probiotics via a jejunostomy tube increase risk of AEs
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37
Q

CoenzymeQ10 E/S, clinical pearls (CP)

A
  • Likely effective for CoQ10 deficiency, mitochondrial dysfunction
  • Likely safe
  • Diarrhea, N/V, heartburn, vit K-like activity
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38
Q

Fish oil E/S, CP

A
  • Effective for hypertriglyceridemia
  • Likely safe
  • Increase LDL 1%, fishy burps
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39
Q

Niacin dose, E/S, CP

A
  • 500 mg PO, max 2 g daily
  • Likely effective for dyslipidemia & pellagra
  • Likely safe
  • Flushing, abdominal pain, increased LFTs
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40
Q

Red yeast rice E/S, CP

A
  • Likely effective for hyperlipidemia
  • Possibly safe
  • X in preg, abdominal pain
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41
Q

Gingko Biloba E/S, CP

A
  • Possibly effective for anxiety, dementia, hearing loss, PMS, schizophrenia, stroke, tardive dyskinsea, vertigo
  • Likely safe
  • Caution w/ DTIs (dabigatran), GI upset, N/V, dizziness
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42
Q

Garlic E/S, CP

A
  • Possibly effective for atherosclerosis, diabetes, HTN, NAFLD, periodontitis, endometriosis
  • Likely safe
  • Body odor/bad breath
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43
Q

Melatonin E/S, CP

A
  • Likely effective for delayed sleep phase syndrome, non 24 hr sleep wake disorder
  • Likely safe
  • Onset w/i 1 hr, may increase VLDL & trig, mood swings
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44
Q

St. John’s Wort E/S, CP

A
  • Likely effective for depression
  • Likely safe
  • Palpitations, sedation, insomnia, major DDI
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45
Q

Three major DDIs for St. John’s Wort

A

Contraceptives, omeprazole, SSRIs

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46
Q

Alpha lipoic acid E/S, CP

A
  • Possibly effective for diabetic neuropathy, hyperlipidemia, obesity
  • Possibly safe
  • Headache, heartburn, N/V
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47
Q

Echinacea E/S, CP

A
  • Possibly effective for common cold
  • Likely safe
  • Severe allergic reactions < 12 yrs, N/V, abdominal pain
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48
Q

Elderberry E/S, CP

A
  • Possibly effective for influenza
  • Likely safe
  • Unripe, raw = toxic -> severe NVD so cook
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49
Q

Cranberry E/S, CP

A
  • Possibly effective for recurrent UTIs
  • Likely safe
  • GI upset or diarrhea
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50
Q

Turmeric/Curcumin E/S, CP

A
  • Possibly effective for allergic rhinitis, depression, dyspepsia, hyperlipidemia, NAFLD, osteoarthritis, pruritus
  • Likely safe
  • Unsafe in preg & lac
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51
Q

Black Cohosh E/S, CP

A
  • Possibly effective for menopausal symptoms
  • Possibly safe
  • Unsafe in preg & lac, breast tenderness, dizziness, GI upset, risk of liver damage if taken w/ other hepatotoxic drugs
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52
Q

Fenugreek E/S, CP

A
  • Possibly effective for T2DM, dysmenorrhea, sexual arousal/dysfunction
  • Likely safe
  • Bloating, dyspepsia, GI upset, hypoglycemia
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53
Q

Glucosamine E/S, CP

A
  • Possibly effective for osteoarthritis (only w/ chondroitin)
  • Likely safe
  • do NOT take if on warfarin, use caution in pts with asthma, beware of shellfish allergy
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54
Q

What is the only effective herbal?

A

Fish oil

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55
Q

What are examples of likely effective herbals?

A
  • Coenzyme Q10
  • Niacin
  • Red Yeast Rice
  • Melatonin
  • St. John’s Wort

St. Red MeN 10

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56
Q

What are examples of possibly safe herbals?

A
  • Black cohosh
  • Alpha lipoic acid
  • Red yeast rice

BAR

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57
Q

Bacterial Vaginosis marked symptom

A

Unpleasant “fishy” odor

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58
Q

Bacterial Vaginosis treatment

A
  • X self-treat
  • Topical or oral clindamycin or metronidazole
  • Sexual partners not warranted for routine tx
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59
Q

Trichomoniasis marked symptom

A

Copious, malodorous, yellow-green (discolored), frothy discharge

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60
Q

Trichomoniasis treatment

A
  • X self-treat
  • Metronidazole or tinidazole
  • MUST treat partners
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61
Q

Vulvoganial Candidiasis marked symptoms

A

Thick, white “cottage cheese” discharge

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62
Q

Vulvoganial Candidiasis exclusions for self-treatment

A
  1. Pregnancy
  2. Girls < 12 yrs
  3. Concurrent or systemic symptoms
  4. Steroids, antineoplastic
  5. Medical disorders (DM, HIV)
  6. Recurrent infection
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63
Q

Vulvoganial Candidiasis nonpharmacologic therapy

A
  • Decrease sugar, refined CHO consumption
  • Increase yogurt containing live culture consumption
  • D/C drugs that may predispose to infection
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64
Q

Vulvoganial Candidiasis pharmacological therapy

A
  1. Non-rx imidazole antifungal
  2. Butoconazole, clotrimazole, miconazole, tioconazole
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65
Q

Vulvoganial Candidiasis pharmacologic therapy pt counseling points

A
  1. Start tx at night, before going to bed
  2. Wash applicator with warm water and soap b/w uses
  3. Complete tx to prevent recurrence
  4. Continue using even during menstruation
  5. Should improve w/i 24 - 72 hrs in 7 days
  6. If > 7days, no improvement in 3 days -> PCP
  7. Avoid sexual intercourse
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66
Q

Atrophic Vaginitis marked symptoms

A

Dyspareunia, vaginal dryness

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67
Q

Atrophic Vaginitis pharmacologic therapy

A
  • Vaginal lubricants
  • Water > Silicone-based
  • Vaseline should NOT be used
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68
Q

Vaginal Disorder home test kit pH > 5.0

A

BV or trichomoniasis

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69
Q

Vaginal Disorder home test kit pH 4.5

A

Yeast infection (BVC)

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70
Q

Vaginal douching counseling points

A
  • NOT recommended
  • C/I during pregnancy
  • Delay douching for 6 - 8 hrs after intercourse if vaginal spermicide was used
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71
Q

Cow’s milk formula CHO, protein, fat

A
  • CHO: lactose
  • Protein: whey +/- casein
  • Fat: vegetable oil > coconut, soy, palm olein, safflower, sunflower oil
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72
Q

Soy-based formula indication

A

Lactose deficiency/intolerance, galactosemia, cow’s milk protein allergy, vegetarians

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73
Q

Soy-based C/I for:

A

Preterm infants < 1800 mg, CF, prevention of colic or allergic, infants who developed cow milk protein induced enterocolitis

74
Q

Soy-based formula CHO, protein, fat

A
  • CHO: sucrose or corn syrup solids
  • Protein: soy and methionine
  • Fat: vegetable oil
75
Q

Premature formula indication

A

Preterm infant < 2-3 kg, < 36 wks gestational age

76
Q

Compared to term infant formulas, premature formulas:

A
  • More protein, MCT, Ca, phosphorous, Vit AED
  • Less lactose
  • More growth & cognitive functions
77
Q

Premature formula CHO, protein, fat

A
  • CHO: lactose
  • Protein: whey +/- casein (6:4)
  • Fat: MCT
78
Q

DHA and ARA infant formula indication, CHO, protein, fat

A
  • Indication: normal and healthy
  • CHO: lactose
  • Protein: whey
  • Fat: vegetable oil + long chain FA
79
Q

Casein Hydrolysate-based formula CHO, protein, fat

A
  • CHO: corn syrup solids, modified corn/tapioca starch, sucrose, dextrose
  • Protein: hydrolyzed casein, smaller peptides, AA
  • Fat: long-chain fat & MCT
80
Q

Disadvantage of casein hydrolysate-based formulas

A

High cost, bad taste, high osmolality (intolerance, diarrhea)

81
Q

Amino acid-based formula indication

A

Extreme milk protein, soy, food allergies

82
Q

Amino acid-based formula CHO, protein, fat

A
  • CHO: corn syrup solids
  • Protein: 100% synthetic free AA
  • Fat: vegetable oils & MCT
  • All iron-fortified
83
Q

Infant formula preparation points

A
  1. Always wash hands
  2. Wash top of the can with hot water & detergent, rinse in hot water, dry
  3. If ready to use formula, always shake well
  4. If powdered formula, always read mixing directions
84
Q

Modular nutrient component indication

A

Enhance a single nutrient component

85
Q

Polycose provides additional ___

A

CHO

86
Q

Beneprotein, Promod, Liquid protein fortifier provides additional ___

A

Protein

87
Q

MCT oil and Microlipid provides additional ___

A

Fat

88
Q

Enfamil HMF liquid, Prolact +4, Similac Special Care with Iron Fortifier provides additional ___

A

Human Milk Fortifier (HMF)

89
Q

Benecalorie provides additional

A

Protein + Fat

90
Q

Duocal provides additional

A

Carbohydrate + Fat

91
Q

Dysmenorrhea S/S

A

Cramping pain, N/V, fatigue, nervousness, dizziness, diarrhea, headache

92
Q

Dysmenorrhea exclusions for self-tx

A
  1. Severe
  2. Secondary
  3. Hx of PID, infertility, irregular menstrual cycles, endometriosis, ovarian cysts
  4. Presence of IUD
  5. Aspirin or NSAID allergy
  6. Warfarin, heparin, lithium
  7. Active GI disease
  8. Bleeding disorder
93
Q

Dysmenorrhea: preferred agent

A

NSAIDs
- Ibuprofen, Naproxen

94
Q

Dysmenorrhea mild cases are treated with

A

Acetaminophen and Aspirin

95
Q

Dysmenorrhea: NSAIDs counseling point

A
  • Difference in responses
  • GI effects; take with food
  • Anticoagulants, antiHTN, lithium
  • Relative C/I with aspirin/NSAID allergy, active GI disease, bleeding disorders, CKD
  • Take with water
96
Q

Dysmenorrhea: APAP counseling point

A
  • Avoid alcohol
  • APAP containing rx drugs
97
Q

Dysmenorrhea: ASA counseling point

A
  • Take with food
  • X for adolescents < 18 yrs
  • DDI with anticoagulant, methotrexate, oral hypoglycemics, high doses of antacids
  • Relative C/I with PUD, gastritis, asthma, bleeding disorders
  • May increase menstrual flow
98
Q

PMS exclusions for self-tx

A
  1. Severe
  2. Atypical timing of symptoms
  3. Onset related to oral contraceptives or hormonal replacement
  4. C/I to pharmacologic agents
99
Q

PMS pharmacologic therapies

A

Vit B6/E, Calcium (with vit D), Mg, NSAIDs, Diuretics (caffeine and pamabrom)

100
Q

PMS counseling points

A
  1. Initial tx = Ca, Mg, pyridoxine
  2. Caffeine/Pamabrom = relief of bloating
  3. Xanthines C/I in pts with ulcer disease or taking MAOIs
  4. NSAIDs reserved for women with both PMS and dysmenorrhea
101
Q

Toxic Shock Syndrome (TSS) S/S

A
  1. Occurs w/i 2 days of onset of menses
  2. Prodromal phase: malaise, myalgias, chills (2-3 days) before severe symptoms
  3. 5-12 days after onset = desquamation of the skin on face, trunk, extremities
102
Q

TSS counseling points

A
  1. Tampon use review
  2. Change tampons at least every 6 hrs
  3. Alternate use b/w sanitary pads and tampons
  4. Seek medical attention appropriately
103
Q

Male condom counseling point

A
  1. Keep in sealed package and protect from light and heat
  2. Expiration date
  3. Discoloration, brittleness, stickiness
  4. Decreased sensitivity and contact dermatitis
  5. If dissatisfied with one brand/style, try another
104
Q

Female condom counseling point

A
  1. One-time use only
  2. May insert up to 8 hrs prior to intercourse
  3. Effective immediately
  4. Store at room temp, unopened
  5. do NOT use with male condom
  6. Vaginal irritation, increased noise, decreased sensation, discomfort
105
Q

Opill C/I

A
  • Hx breast cancer
  • Allergy to norgestrel or FD&C yellow No.5 (tartrazine)
  • Current use of other birth control pill, vaginal ring, patch, implant, injection, IUD
  • Known/suspected pregnancy
  • Male
106
Q

Opill counseling points

A
  1. Not an emergency contraceptive
  2. Does not protect against STIs
  3. Use barrier method for first two days; not effective for the first 48 hrs
  4. If >3 hrs late: take 1 ASAP, then return to taking a daily tablet at usual time and use barrier method for the next two days
107
Q

LGBTQIA+ STIs screening guideline

A
  1. Screen every 3 months (Chaperone trauma-informed approach, Self-collection of samples)
  2. Transgender women undergone vaginoplasty do not have a cervix -> cervical HPV NOT appropriate
  3. Infectious prostatitis should be included in sexually active transgender women
108
Q

Heartburn and dyspepsia (HB/D) S/S

A

Burning feeling, acid regurgitation

109
Q

HB/D treatment for mild, infrequent s/s

A

Antacids, H2RA

110
Q

HB/D treatment for moderate, infrequent s/s

A

H2RA

111
Q

HB/D treatment for frequent s/s

A

PPI

112
Q

What is considered frequent s/s for HB/D?

A

> = 2 days/week

113
Q

HB/D exclusions for self-tx

A
  1. More than 3 months or 2 weeks while taking OTC acid suppressive
  2. Severe
  3. Nocturnal HB
  4. Difficulty or pain swallowing
  5. > 45 yrs with new onset
  6. Vomiting blood or black tarry stools
  7. Chronic hoarseness, wheezing, coughing, choking
  8. Continuous NV, diarrhea
  9. Chest pain or weight loss
  10. Preg or nursing
  11. Children < 12 yrs
114
Q

HB exclusions

A

Dysphagia, GI bleeding, odynophagia, unexplained iron-deficiency anemia, unintended weight loss

115
Q

Dyspepsia exclusions

A

> 45 yrs with new onset, family hx of upper GI cancer, GI bleeding, jaundice, odynophagia, palpable mass or lymphadenopathy, persistent vomiting, progressive dysphagia, unexplained iron-deficiency anemia, unintended weight loss

116
Q

HB/G: Antacid
- MoA

A
  • Neutralize acid
  • Cytoprotective effect
  • Simethicone (decrease surface tension of gas bubbles)
  • Alginic acid (symptomatic relief of GERD)
117
Q

HB/G Sodium bicarbonate AEs

A
  • Metabolic alkalosis
  • Milk-alkali syndrome
  • Sodium overload: fluid retention, weight gain
118
Q

HB/G Calcium carbonate AEs

A
  • Hypercalcemia
  • Milk-alkali syndrome
119
Q

HB/G Aluminum salts AEs

A
  • Constipation
  • Hyperaluminemia
  • Hypophosphatemia
120
Q

HB/G Magnesium salts AEs

A
  • Diarrhea
  • Hypermagnesemia
121
Q

HB/G antacids DDI

A
  • Binding of drugs in the gut; decreased oral absorption
  • Decreased absorption of ketoconazole, itraconazole, iron, atazanavir
  • Decreased efficacy of enteric coatings
  • Increased urinary pH
122
Q

HB/G antacids FDA warnings

A
  • Combination with antacid-aspirin containing products
  • Serious bleeding can occur
  • Greatest risk: > 60 yrs, hx of stomach ulcers/bleeding problems, anticoagulant, systemic, steroids, NSAIDs, > 3 alcoholic
123
Q

HB/D H2RA MoA

A
  • Competitive inhibition of histamine at H2 receptors on parietal cells
  • Decrease volume of secreted acid
124
Q

HB/D H2RA AEs

A
  • Common: headache, diarrhea, nausea
  • Rare: confusion, hallucinations, anemia, leukopenia, thrombocytopenia, elevated liver enzymes, impotence, gynecomastia
125
Q

HB/D H2RA D/I

A
  • Inhibition of CYP450: Cimetidine, theophylline, phenytoin, warfarin, amiodarone, clopidogrel, TCAs
  • Reduced absorption due to increased pH: ketoconazole, itraconazole, iron, Ca
  • decreased tubular secretion: procainamide
126
Q

HB/D PPI MoA

A
  • Irreversibly inhibit H/K ATPase in parietal cells
127
Q

HB/D PPI AEs

A
  • Common: abdominal pain, headache, diarrhea, vomiting, dizziness
  • Rare: skin rash, anemia, neutropenia, thrombocytopenia, hematuria, hepatotoxicity, peripheral neuropathy
128
Q

HB/D PPI D/I

A
  • Inhibit CYP450: warfarin, phenytoin, diazepam, tacrolimus, methotrexate
  • Decreased oral absorption: ketoconazole, itraconazole, iron, Ca, mycophenolate mofetil
  • Clopidegrel: omeprazole, esomeprazole may decrease antiplatelet effects -> inhibit CYP2C19
129
Q

HB/G Bismuth Subsalicylate MoA

A
  • Topical effect on gastric mucosa
  • Binds bacterial toxins in GI tract -> suppress H. pylori growth
  • Antisecretory effect
130
Q

HB/G Bismuth Subsalicylate maximum dose

A

8 doses/day

131
Q

HB/G Bismuth Subsalicylate AEs

A
  • Darkening of the tongue and stool
  • Bismuth toxicity: headache, confusion, ataxia, seizures
  • Salicylate toxicity: tinnitus, hypersensitivity, bleeding disorders
  • Reye’s syndrome in children
132
Q

Gas exclusions for self-tx

A
  • S/S persisting for more than several days&times/month
  • severe
  • Sudden change in abdominal pain location
  • increased severity or frequency
  • > 40 yrs
133
Q

Gas: Simethicone MoA

A
  • Defoaming agent = reduce surface tension of gas bubbles
134
Q

Gas: alpha-D-galactosidase MoA & dosage

A
  • MoA: degrades insoluble oligosaccharides into digestible sugars
  • Take 2-3 tablets with first bit of food
135
Q

Gas: lactase replacement MoA

A
  • Breaks down lactose into glucose and galactose
136
Q

Gas: first choice agent

A

Simethicone

137
Q

N/V motion sickness tx

A

antihistamine

138
Q

N/V antihistamine is safe to use during pregnancy: T/F

A

False

139
Q

N/V phosphorylate carbonate solution C/I

A

DM, hereditary fructose intolerance

140
Q

Constipation S/S

A
  • Decreased frequency of bowel movements
  • Abdominal discomfort
  • Straining
  • Passing hard, dry, small stools
  • Bowel evacuation not complete
  • NOT defined by number of bowel movements per day or week
141
Q

Constipation exclusions for self-tx

A
  • Abdominal pain, distension, cramping
  • Unexplained flatulence
  • Fever, N/V
  • Para- or quadriplegia
  • Daily laxative use
  • Blood in stool, dark tarry stool
  • Persisting > 2 weeks
142
Q

Constipation nonpharmacologic therapy

A
  • Gradually increase daily fiber intake
  • Drink non-caffeinated
  • Exercise
143
Q

Constipation: order of pharmacological therapy

A
  1. Bulk-forming laxatives
  2. Hyperosmotic laxatives
  3. Stimulant laxatives
  • Straining: stool softeners: emmolients, lubricants
144
Q

Constipation: bulk forming laxatives MoA

A

Retain water, increase bulk volume, stimulate peristalsis

145
Q

Constipation bulk forming laxatives AEs

A

abdominal cramping, bloating, flatulence

146
Q

Constipation bulk forming laxatives C/I

A

fluid-restriction, partial intestinal obstruction, fecal impaction, diff swallowing

147
Q

Constipation: bulk forming laxatives ex

A

psyllium, methylcellulose, Ca polycarbophil

148
Q

Constipation: hyperosmotic laxatives 3 classes

A
  1. Saline laxatives
  2. Lactulose
  3. Polymer-type
149
Q

Constipation: Saline laxatives MoA

A

Osmotic effect draws fluid into intestine

150
Q

Constipation: saline laxatives AEs

A

abdominal cramping, excessive diuresis, dehydration, electrolyte disturbances

151
Q

Constipation: saline laxative C/I
- Mg-containing
- Na-containing

A
  • Mg: ileus of GI obstruction, heart block, renal failure
  • Na: fluid restriction, CHF, cirrhosis
152
Q

Constipation: saline laxative ex

A

Mg citrate, Mg hydroxide, Dibasic sodium phosphate

153
Q

Constipation: sodium phosphate caution

A
  • BBW: acute kidney injury
  • Non-rx NOT for bowel cleansing
154
Q

Constipation: polymer-type laxatives MoA

A

form H bonds with water, increase bulk, stimulate peristalsis, large molecular weight, create osmotic effect

155
Q

Constipation: polymer-type AEs

A

abdominal cramping, bloating, flatulence

156
Q

Constipation: polymer-type ex

A

Polyethylene glycol 3350

157
Q

Constipation: stimulant laxative MoA

A
  • Stimulate peristalsis by local mucosal irritation
  • Stimulate fluid and electrolyte secretion
158
Q

Constipation: stimulant AEs

A

severe cramping, fluid and electrolyte imbalance, malabsorption

159
Q

Constipation: stimulant ex

A
  1. Senna
  2. Bisacodyl
  3. Glycerin suppositories
  4. Castor oil
160
Q

Constipation: stimulant Senna AEs

A
  • Can discolor urine (pink/red)
  • chronic use cause brown pigment of the colon wall
161
Q

Constipation: stimulant Bisacodyl AEs

A

Chronic use can cause metabolic acidosis/alkalosis, hypocalcemia, malabsorption

162
Q

Constipation: stool softner emollient MoA

A

anionic surfactant
- Soften feces by increasing the wetting efficiency of water in the intestine to soften the fecal mass

163
Q

Constipation: emollient AEs

A
  • Minimally absorbed
  • Mild abdominal cramps
  • Can increase digoxin, warfarin, mineral oil absorption
164
Q

Constipation: emollient ex

A

docusate sodium/calcium

165
Q

Constipation: lubricant MoA

A

Soften feces by coating stool and preventing water loss

166
Q

Constipation: lubricant AEs

A

Foreign body reactions, aspiration

167
Q

Anorectal Disorders: exclusions for self-tx

A
  1. <12 yrs
  2. UC or Crohn’s disease
  3. Family hx of colon cancer
  4. Abscess, fistula/fissures, malignancy, diagnosed by PCP
  5. black tarry stools
  6. no response to 7 days of self-tx
168
Q

Anorectal disorder: external application
- Local anesthetics warnings & ex

A
  • Benzocaine, pramoxine hydrochloride, lidocaine
  • allergic rxn, avoid on open sores
169
Q

Anorectal disorder: external application
- Keratolytics MoA & ex

A
  • MoA: Desquamation and debridement of epidermal surface cells leading to cell turnover
  • resorcinol, alcloxa
170
Q

Anorectal disorder: external application
- analgesics, anesthetics, antipruritis MoA & ex

A
  • MoA: temporary relief of burning, pain, itching by producing cool, warm, or tingling sensation
  • menthol, juniper tar, camphor
171
Q

Anorectal disorder: internal application
- Astringents MoA & ex

A
  • MoA: promote coagulation of surface protein in the anorectal skin cells to protect underlying tissue
  • Calamine, zinc oxide, witch hazel
172
Q

Anorectal disorder: internal application
- Protectants MoA, ex

A
  • MoA: create physical protective barrier over inflamed anal tissue and soften the lining of the anal canal
  • Cocoa butter, glycerin, kaolin, calamine, shark/cod liver oil, zinc oxide
173
Q

What two agents are both astringents and protectants?

A

Calamine and zinc oxide

174
Q

Anorectal disorder: internal application
- Vasoconstrictors MoA & AEs & ex

A
  • MoA: relief of itching, discomfort, and irritation and to shrink and decrease swelling of the hemorrhoidal tissues
  • AE: cardiac arrhythmias if absorbed systemically
  • Phenylephrine, ephedrine, EP
175
Q

Diarrhea S/S

A
  • loose, watery stool
  • more frequent bowel movements >=3
  • acute: >=3 for =<14 days
  • persistent: 14 days - 4 wks
  • chronic: >= 4 wks
176
Q

Diarrhea exclusions for self-tx

A
  • Children ( < 6 months, severe dehydration, >= 6 months with high fever)
  • Blood, mucus, pus in stool
  • Severe abdominal pain
  • Substantial volumes of diarrhea
  • Severe dehydration/suboptimal response to rehydration
  • Protracted vomiting
  • DM, CVD, CKD, immunosuppressed
  • Pregnancy
  • Chronic or persistent > 14 days
177
Q

Diarrhea: BRAT method

A

Banana, Rice, Apple sauce, Toast

178
Q

Diarrhea: Loperamide MoA

A

Selective mu-opioid receptor agonist on gut wall
- Decrease GI motility
- Decrease secretion of fluid and electrolytes

179
Q

Diarrhea: Loperamide AEs

A
  • Headache, drowsiness, abdominal pain
  • CV risks
180
Q

Diarrhea: loperamide recommended dose

A
  • 4 mg po initially, then 2 mg after each loose stool
  • Max dose 8 mg/day
  • Max duration 48 hrs
181
Q

Diarrhea: Bismuth Subsalicylate MoA

A
  • Bismuth increase water absorption
  • Salicylate decrease prostaglandin formation -> induce inflammation & HYPERmotility
182
Q

Diarrhea: Bismuth Subsalicylate AEs

A
  • black hairy tongue and black stools, N, bitter taste

Self/Home Care (3 decks)

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