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OTC > Exam 1 Challenging topics > Flashcards

Exam 1 Challenging topics Flashcards

1
Q

What does the Q stand for in QuEST/SCHOLAR-MAC

A

quickly and accurately assess the patient

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2
Q

What does the E stand for in QuEST/SCHOLAR-MAC

A

Establish the patient is an appropriate self-care candidate

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3
Q

What does the S stand for in QuEST/SCHOLAR-MAC

A

Suggest appropriate self-care strategies

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4
Q

What does the T stand for in QuEST/SCHOLAR-MAC

A

Talk with the patient

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5
Q

What does the S stand for in QuEST/SCHOLAR-MAC

A

symptoms
*What are the main and associated symptoms

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6
Q

What does the C stand for in QuEST/SCHOLAR-MAC

A

Characteristics
*what is the situation like
*is it stable or changing

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7
Q

What does the H stand for in QuEST/SCHOLAR-MAC

A

History
*what have you done so far to try to relieve the symptoms

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8
Q

What does the O stand for in QuEST/SCHOLAR-MAC

A

Onset
*when did the condition start

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9
Q

What does the L stand for in QuEST/SCHOLAR-MAC

A

Location
*what is the precise location of the problem or symptoms

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10
Q

What does the A stand for in QuEST/SCHOLAR-MAC

A

Aggravating Factors
*what makes it worse

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11
Q

What does the R stand for in QuEST/SCHOLAR-MAC

A

Remitting factors
*what makes it better

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12
Q

What does the MAC stand for in QuEST/SCHOLAR-MAC

A

medications, allergies, and health conditions

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13
Q

When should a patient be referred

A

-symptoms are too severe to be endured by patient without definitive diagnosis and treatment
-persistent, minor symptoms that are not the result from and easily identifiable cause
-symptoms that repeatedly return with no recognizable cause
-wen pharmacist is in doubt about patients medical condition

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14
Q

What are social identities

A

defined by physical, social, mental aspects of individuals

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15
Q

What is cultural humility

A

lifelong commitment to self-evaluation and self-critique to address power imbalances and advocate for others

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16
Q

What are the 5R’s of cultural humility

A

reflection
respect
regard
relevance
resiliency

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17
Q

What is implicit bias

A

attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner

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18
Q

What is the LEARN technique we can apply when learning about culturally diverse groups

A

Listen
Explain
Acknowledge
Recommend
Negotiating

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19
Q

What are the 4C’s we use in conjunction with the LEARN technique

A

what do you CALL the problem
what do you think CAUSED the problem
how do you COPE with the problem
what CONCERNS do you have about the problem or treatment

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20
Q

What are some considerations when it comes to the care process and pediatric patients

A

patient age: many pharmacologic treatments have age requirements
weight: dosing is mg/kg in many cases
caregiver factors: literacy/health literacy
childcare or school schedules: can interfere with dosing schedule

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21
Q

What is the dosing of acetaminophen of those under the age of 12

A

10-15mg/kg given every 4-6 hours as needed
*max 480mg per dose up to 5 doses or 75/mg/kg/day
**do not exceed 2400mg in 24 hours

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22
Q

What is the dosing of ibuprofen for those under the age of 12

A

5-10 mg/kg every 6-8 hours as needed
*300mg per dose up to 4 doses or 40mg/kg/day
**do not exceed 1200mg in 24 hours

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23
Q

What are the symptoms of teething discomfort

A

mild pain
gum irritation and redness
drooling
mouth biting
low-grade fever
irritability and crankiness

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24
Q

How early can teething start

A

as early as 3 months old and will discomfort will last for as long as 8 days per tooth

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25
Q

What are non-drug treatment options for teething

A

gum massage
twisted, damp, frozen washcloth
*if tolerates food, dry toast or teething biscuits

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26
Q

What are the drug treatment options for teething discomfort

A

acetaminophen(PREFERRED)
ibuprofen
*make sure appropriate doses, dosage forms, and administration

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27
Q

What should be avoided when treating teething discomfort(both drug and non-drug)

A

no benzocaine, lidocaine or homeopathic teething tablets/gels
avoid teething necklaces, bracelets, etc…
avoid high sugar/carb foods

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28
Q

What are the 7 considerations we should consider when looking at nonprescription treatment options for pregnant people

A
  1. nondrug therapy is often more appropriate than medications at any stage of pregnancy especially in the first trimester
  2. importance of determining stage of pregnancy 40 weeks typically
  3. recommend lowest possible dose
  4. topical or local dosage forms preferable to systemic forms
  5. avoid extra strength and long-acting formulations
  6. avoid combo products
  7. adherence issues due to nausea and vomitting
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29
Q

What are the 6 things we should consider when recommending nonprescription treatment options for patients to use during lactation

A
  1. recommended timing of medication with feeding nursing.
    *immediately after breast/chest feeding OR before the infant’s length sleep period
  2. recommend drug that has been shown to be safe in infants
  3. recommend topical or local therapy rather than oral forms
  4. advise against extra strength, max strength, or long-acting products
  5. recommend products with the shortest half-life
  6. avoid combo products
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30
Q

What is express warranty

A

specific statements made by the seller
*no sales fluff

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31
Q

What is implied warranty

A

fitness for a particular use(proper indication)
merchantability(outdated, contaminated, sub-potent)

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32
Q

What serious drug interactions are issues in older adults

A

altered PK and PD
impaired kidney function
decreased liver blood flow
decreased liver size
increased body fat
decreased lean body mass
changes in receptor sensitivity
concomitant medical conditions

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33
Q

What OTC drugs are on the BEERs list and what effect do they cause

A

1st gen antihistamines: decreased clearance from the body as you get older
Aspirin(primary CV prevention): not recommended
H2RA: worsen mental status
Mineral Oil: can go into lungs and get pneumonia
Non-cox-selective NSAIDs: increased risk of ulcers, compromise kidneys
PPI: higher rate of C.diff infections, decreased bone density, inc. in gastrointestinal malignancy

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34
Q

Why were phenylephrine and pseudoephedrine removed from the BEERs list

A

effects are not unique to older adults and can happen to everyone

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35
Q

What is the percentage of people over the age of 65 that use analgesics

A

20-30%

36
Q

What is the percentage of older adults with PUD and GI from NSAID use

A

81% older adults
*95% of these adults use OTC NSAIDs

37
Q

What symptoms do we treat when it comes to cold and cough

A

sore throat
rhinitis
nasal/sinus treatment
sneezing
coughing
myalgia
fatigue

38
Q

What symptoms associated with cough do we not self-treat

A

-difficulty breathing/SOB/dyspnea
-cyanosis
-hemoptysis
-weight loss
-night sweats
-worsens after 3-5 days
-persists after 2-3 weeks
-children younger than 4 years old
-temp greater than 100.4
-returns after resolving
-temp greater than 100 for more than 3 days
-barking cough with stridor
-severe spells with whooping
-sudden onset without fever or URI
-immunocompromised
-TB exposures
-HIV risk factors
-chronic conditions

39
Q

What are the non-pharmacologic treatment options available for coughs

A

honey
nonmedicated lozenges
humidification
nasal drainage
hydration

40
Q

What is the efficacy of honey

A

honey is more effective in reducing cough when compared to placebo or no treatment
honey is equally effective as dextromethorphan
honey is more effective than diphenhydramine

41
Q

What are steps and ingredients used to create saline for nasal irrigation

A

1-2 cups of water(distilled, sterile, or boiled) should be warmed to body temp
1/4 - 1/2 teaspoon of non-iodized salt added to water
pinch of baking soda

42
Q

When should a patient follow-up with a provider

A

symptoms worsen during treatment
no improvement after 7 days of self-care
exclusions for self-care develop

43
Q

What drug interactions exist with codeine

A

CNS depressants
alcohol

44
Q

What drug interactions exist for dextromethorphan

A

strong CYP2D6 inhibitors
SSRIs
MAO inhibitors

45
Q

What drug interactions exist for diphenhydramine

A

CNS depressants
narcotics
alcohol
benzos
tranquilizers

46
Q

Who should not be given honey as a treatment for cough

A

children under the age of 1 year old because of the risk of botulism

47
Q

What can be substituted for honey

A

corn syrup

48
Q

What is the timeline of symptoms for a cold

A

Days 1-3: sore throat first then nasal symptoms dominate 2 and 3
Days 4-5: cough appears in 20% of people, secretions thicken and color may change in color
Days 6 and onward(up to 14 days): secretions return to clear as cold resolves

49
Q

When should you not self-treat a cold

A

oral temp of more than 100.4
chest pain
shortness of breath
worsening of symptoms or new symptoms occur during self-care
concurrent health conditions
AIDS or chronic immunosuppressive therapy
Frail older adults of advanced age
infants younger than 3 months of age

50
Q

What are some complementary and non-pharmacologic options available for the treatment of colds

A

hydration: water, juice, broth, chicken soup, ice pop
adequate rest: placebo effect
nutritious diet: no evidence that withholding dairy decreases cough or congestion
increased humidification: cool vapors only, saline and nasal spray or drops, saline gargles, steamy showers
aromatic oils: camphor, menthol, eucalyptus
zinc and vit C
breath right nasal strips
antiviral disinfectant
hand hygeine
body positioning
nasal bulb syringe

51
Q

What is the MOA of Zinc

A

inhibits rhinovirus binding and replication in the nasal mucosa which subsequently suppresses inflammation

52
Q

When should zinc be administered

A

within 24 hours of cold symptom onset
reduces duration and severity of cold

53
Q

What is the dosing of zince

A

1 lozenge(13mg/lozenge) every 2 hours while awake
*MDD of 75mg/day

54
Q

What is the MOA of vitamin C

A

antioxidant properties
stimulate neutrophil and monocyte activity

55
Q

When is vit C most beneficial

A

NOT beneficial after symptoms start
efficacy of prophylaxis and treatment of colds has been debated for 70 years
*not helpful to prevent colds in the gen population
**helpful for patients with severe physical stress such as marathon runners

56
Q

When should a patient be recommended to have a follow up with a PCP when trying to self-treat a cold

A

sore throat lasts longer than several days, is severe, or also has a fever/headache or nausea/vomiting
symptoms worsen during nonrx treatment
thick and colored nasal secretions persist
temp higher than 101.5
shortness of breath
chest congestion
wheezing
rash
ear pain

57
Q

What are the side effects of pseudoephedrine

A

elevated BP and/or HR, palpitations, arrhythmias
tremor, insomnia, anxiety, irritability, dizziness, HA
rebound congestion, nausea/anorexia, difficult urination

58
Q

What are the 4 topical decongestants

A

naphazoline
oxymetazoline
phenylephrine
propylhexedrine

59
Q

What are the drug interactions that exist with the topical decongestants

A

albuterol

60
Q

Why is oxymetazoline preferred over the other decongestants

A

only 2 sprays/drops in 24 hours
can use in pregnancy due to poor systemic absorption

61
Q

What is the MOA of first-gen antihistamines

A

blocks histaminic and muscarinic receptors in medulla

62
Q

What is the MOA of pseudoephedrine

A

alpha-adrenergic agonist that constricts blood vessels, decreasing sinusoid vessel engorgement and mucosal edema and swelling

63
Q

What drug interactions exist with 1st gen antihistamines

A

duloxetine
alprazolam
MAOI(brompheniramine)
Parkinson’s meds

64
Q

What 1st gen antihistamine is preferred when pregnant

A

chlorpheniramine

65
Q

What 1st gen antihistamine is preferred when lactating

A

low doses of chlorpheniramine as needed are okay
short-term as needed use of diphenhydramine is likely ok

66
Q

Who should avoid the use of topical anesthetics

A

avoid benzocaine in patients allergic to anesthetics

67
Q

What is the general recommendation when treating cough and colds in older adults

A

REFER
older adults are more sensitive to side effects of systemic decongestants
decongestants may exacerbate diseases sensitive to adrenergic stimulation

68
Q

Why are OTC cold products not recommended in young children

A

lack of evidence of safety and efficacy

69
Q

What is the 2,4,6 rule regarding OTC cold products

A

FDA does not recommend use in children younger than 2
Mfg do not recommend use in children younger than 4 years
Pediatric experts recommend avoiding in children younger than 6 years

70
Q

What topical decongestants are available for younger children (age 2-6 years)

A

Naphazoline: only under PCP recommendation
Oxymetazoline: 2-3 drops or sprays every 10-12 hours
Phenylephrine: 2-3 drops or sprays every 4 hours

71
Q

What nondrug therapies are there for infants when treating a cold

A

upright positioning to enhance nasal drainage
maintain adequate fluid intake
increase humidity of inspired air
irrigate nose with saline drops
carefully clear nasal passageways with bulb syringe

72
Q

What are the exclusions of self-treatment when it comes to body pain

A

pain score more than a 6 on a scale of 0-10
pain lasting longer than 10 days total or 7 days with treatment with topical analgesic
increased intensity or change in pain
associated n/v, fever or infection
visual deformity, abnormal movement, weakness, numbness, or possible fracture
OTC intolerances
achilles tendonitis
pregnancy
less than 2 years of age

73
Q

When you have experienced an injury when should you start icing

A

as soon as possible following injury, 3-4 times a day for up to 72 hours

74
Q

When should you start applying heat to the area of pain/injury

A

do not apply within the first 48 hours due to risk of worsening inflammation
then apply heat to area for 15-20 minutes at a time, 3-4 times a day

75
Q

What is RICE therapy

A

Rest: after injury and until pain decreases
Ice: ASAP for 10-15 minutes 3-4 times a day
Compression: elastic support/bandage, unwind 12-18 inches and wrap overlapping layer by about 1/2 of it. begin wrapping below the injury and move up and over. decrease tightness as you wrap
Elevate: at or above heart 2-3 hours per day

76
Q

What is the max amount of days you should use systemic analgesics to help with pain

A

max of 10 days
*then you should refer if not better

77
Q

What is the max amount of time you should use topical counterirritants when it comes to pain

A

max amount of 7 days
*should refer if not better

78
Q

What are the adverse effects of acetaminophen

A

hepatotoxicity with doses greater than 4 grams per day

79
Q

What are the adverse effects of NSAIDs

A

GI issues
dizziness
fatigue
*use of more than 3 months increases the risk of gastric ulceration between 15-33%
*increased risk of myocardial infarction(ibuprofen), increase in BP and edema

80
Q

What is the dosing for OTC NSAID agents

A

Ibuprofen 200mg: 20-800mg QID, max OTC dose of 1200mg/day
Naproxen 220mg: 220mg twice a day with a max of 660mg/day
Diclofenac topical gel: apply 2-4 grams(depending on location) 4 times a day. Do not apply to more than 2 spots on the body

81
Q

What are topical counterirritants

A

relieve pain through nerve stimulation as opposed to depression
paradoxical pain relief effect

82
Q

What are the 4 categories of topical counterirritants

A

rubefacients: methyl salicylate, ammonia water
cooling agents: camphor, menthol
vasodilation: histamine dihydrochloride, methyl nicotinate
irritant: capsicum, capsaicin

83
Q

What is the frequency and duration of use for rubefacients, cooling agents, vasodilation

A

apply no more than TID-QID as needed for UP TO 7 days

84
Q

What is the frequency and duration of use for irritants

A

apply TID-QID for duration of pain

85
Q
A

OTC (33 decks)

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