Exam 1 info Flashcards
Nausea- Retching- Vomiting-
Nausea- person’s subjective feeling of a need to vomit Retching- involuntary rhythmic diaphragmatic and abdominal contractions Vomiting- rapid, forceful expulsion of GI tract contents
Motion sickness
overstimulation of the labyrinth altering the chloringinic pathway. Generally caused by unusual motion, inaccurate interpretation of the visual stimuli. Example: flying, boat, driving, etc. (Women and children 2-15 age have reported increased frequency in motion sickness, children younger than 2 years rarely get motion sickness)
Pregnancy-
unclear neurotransmitter, multifactorial. Symptoms and NV generally occur between 6-12 week of prego- hyperemesis gravidarum- severe vomiting during prego.
Food poisoning/Viral Gastroenteritis
inflammation of the stomach and small intestines generally presents as acute vomiting and diarrhea, affects all age groups. Generally caused by rotavirus and norovirus.
Signs and symptoms of dehydration in children
-Dry mouth and tongue -Sunken and/or dry eyes -Sunken fontanelle -Decreased urine output (dry diapers for several hours) -Dark urine -Fast heart beat -Thirst (drink extremely eagerly) -Absence of tears when crying -Decreased skin turgor -Unusual Lethargy- sleepiness, decreased alertness, or irritability “Floppy” body -Lightheadedness- when sitting or standing -Difficulty waking up -Weight Loss -Noticeable decrease in abdominal size -Clothes or diapers fit loosely <3% body weight loss-minimal dehydration 3-9% weight loss-mild-moderate dehydration >9% weight loss-severe dehydration
Exclusion for Nausea and Vomiting
- Urine Ketone and BG with signs of dehydration in patients with diabetes (indicate (DKA or HHS) -Food poisoning that doesn’t clear up in 24 hrs -Severe abdominal pain that in middle or right lower quad -NV with fever and diarrhea may be infectious disease -Blood in vomit (ulcers, esophageal tears, or severe nose bleed) -Yellow skin or eye discoloration and dark urine (indicate hepatitis) -Stiff neck w/w-out sensitivity to brightness or normal light (indicate meningitis -Head injury w/ NV, blurry vision, or numbness -Person with glaucoma, BPH, chronic bronchitis, asthma -Pregnancy (severe symptoms) or breastfeeding -NV caused by cancer chemotherapy, radiation, metabolic disorders, CNS, GI, or endocrine -Drug-induced NV- adverse effect -Psychogenic-bulimia, anorexia -Chronic disease induced- gastroparesis w/ diabetes, GERD
Antacid and H2RA related to NV
Antacid- overindulgence in food or beverage or consumption of disagreeable food, relieve acid indigestion and sour stomach H2RA- overindulgence in food or beverage or consumption of disagreeable food, relieve acid indigestion and sour stomach
Bismuth Salicylate related to NV
ausea associated with consumption or nonulcer dyspepsia. Nausea, heartburn, and fullness
Phosphorated Carbohydrate Solution related to NV
nausea associated with food or beverage. Solution is a mixture of dextrose, levulose, and phosphoric acid. The hyperosmolar solution relieve NV by direct local action on the GI tract wall and decrease smooth muscle contraction
Antihistamine related to NV
generally safe and tolerated for nausea and vomiting related to motion sickness- These meds work due to the anticholinergic effects. Pregnant women should avoid
Meclizine
Meclizine is the only FDA approved non prescription. Meclizine is less sedating than DD. 25-50mg 1 hour before travel Onset- 60min duration= 24 hours
Doxylamine (sleepy)
In pregnancy, 10-12.5 mg w/or w/-out pyridoxine every 8 hr
Diphenhydramine (sleepy)
25-50mg every 6-8 hr children (6-12years) 12.5-25mg every 6-8 hr onset - 15-30 min and duration is 7-12 hours
Dimenhydrinate
50-100mg every 4-6 hr children(6-12years) 25-50mg every 6-8 hr children(2-6years) 12.5-25mg every 6-8 hr Onset- 15-20min and duration is 4-6 hours
doxylamine and diphenhydramine (DD) sideeffects
Both doxylamine and diphenhydramine (DD) have been used as off label treatments for nausea. Side effects- benign prostatic hypertrophy, dry mouth, confusion, dizziness, tremors, and constipation. Caution w/ opiates, psychmeds, beta blockers, and antiarrhythmic
Complementary therapy for NV
Ginger, Pyridoxine (Vitamine B6), Acupressure and Aromatherapy.
Ginger-
Ginger- use for nausea related to pregnancy, motion sickness and surgery, 250mg per day in 3-4 divided dosage. As effective as pyridoxine
Pyridoxine
Pyridoxine- water soluble B vitamin that is important in various metabolic functions, 1.3-2mg/day. NVP-10-25mg 3 times a day.
Acupressure
pressure on the wrist, pressure can be placed with two fingers or wrist band, vary from as need to 10min 3xday. Can throw off pace maker
Aromatherapy
peppermint oil for NV, does not have reliable evidence to support is efficacy.
ORS
ORS- Oral Rehydration Salt, used for dehydration associated with vomiting or diarrhea. Consists of carbohydrates, sodium, potassium, chloride, citrate. Glucose based ORS does not consist of potassium so supplementation of bananas and orange juice should be given.
Anorectal Gas
- Anorectal disorders occur in the perianal area, anal canal, and lower portion of the rectum. - Hemorrhoids are abnormally large, bulging, symptomatic conglomerates of hemorrhoidal vessels, supporting tissues, and overlying mucous membranes of skin in the anorectal region
List some Non-Hemorrhoidal anorectal disorders and can they be self treated?
Potentially serious non-hemorrhoidal anorectal disorders, including abscesses, fistulas, fissures, neoplasms, polyps, pruritus ani, and inflammatory bowel disease (IBD), may present with hemorrhoid-like symptoms and SHOULD NOT be self-treated. Patients should be referred for medical evaluation if any of the conditions are suspected
self treatable anorectal disorders
Itching (pruritus) Discomfort Irritation Burning Inflammation Swelling
Medical referal for Anorectal Disorder
-Pain - internal hemorrhoids usually painless; external hemorrhoids often cause mild pain Bleeding - hemorrhoids most common cause -Seepage- involuntary passage of fecal material or mucus caused by an anal sphincter not closed completely -Change in bowel pattern - Unexplained change in bowel frequency or in stool form; may signal serious underlying GI disorder (e.g. IBD, or colorectal cancer -Prolapse (protrusion) - protrusion of hemorrhoidal or rectal tissue of variable size into anal canal -Thrombosis (blood clotting)- associated pain is most acute during the first 48-72 hours, but usually resolves after 7-10 days. Minimal pain with thrombosed internal hemorrhoids
Exclusions for Self-Treatment for Anorectal Disorder
Anorectal disorders, including hemorrhoids, in patients <12 years Diagnosed GI diseases associated with colorectal bleeding: ulcerative colitis Crohn’s disease Family history of colon cancer Potentially serious anorectal disorder such as abscess, fistula or fissures, neoplasm or malignancy, polyps, or anorectal disorders previously diagnosed by PCP Anorectal signs or symptoms such as acute onset of severe pain; bleeding; seepage; prolapse; thrombosis; black tarry stools; and moderate-to-severe itching, burning, inflammation, swelling, and discomfort Minor anorectal symptoms that do not respond to 7 days of self-treatment
Nonpharmacologic Therapy for Anorectal Disorder
-Dietary modification -Improvement of hygiene practices -Surgical intervention -Avoid lifting heavy objects -Discontinue foods that irritate or aggravate symptoms -Increased dietary fiber or adding in fiber supplements can prevent further irritation -Proper bowel habits -Sitting in warm water in the bathtub for 10-20 min for 2-4 times/day
Local Anesthetics for anorectal disroder
- Benzocaine -Benzyl alcohol -Dibucaine -Lidocaine -Pramoxine hcl -Tetracaine Provide relief of itching, burning, discomfort, and pain by reversibly blocking transmission of nerve impulses Avoid using on open sores
Vasoconstrictors for anorectal disorder
*Ephedrine sulfate Epinephrine HCL *Phenylephrine HCL reduction of swelling/slight anesthetic effect
Skin Protectants
-*Aluminum hydroxide gel, cocoa butter, hard fat, kaotin, lanolin, mineral oil, white petrolatum, calamine, shark liver oil, zinc oxide, cod liver oil -Glycerin Provide a physical protective barrior and soften the anal canal by preventing fecal matter from irritating the perianal mucosa Glycerin is for external use only (all others are approved for internal and external) Apply to clean and dry skin
Astringents
*Calamine *Zinc Oxide Witch Hazel Promote coagulation of surface protein in the anorectal skin cells to protect the underlying tissue; decrease cell volume, drying the area; create a thin protective layer
Corticosteroids
Hydrocortisone Acts as a vasoconMay take up to 12 hours to feel effectstrictor and antipruritic -Onset of action:up to 12 hours -Duration of action: much longer than other agents
exclusion for Intestinal Gas
Nonpharmacologic Therapy for intestinal gas
Patient may benefit from changes in eating habits
- Don’t rush through a meal
- Do not overeat
- Avoid smoking
- Etc.
Patients may benefit from dietary modifications
- Keeping a dietary diary
- Avoiding foods that cause gas symptoms
- Avoid carbonated beverages, such as sodas and beer
Medication use and lifestyle habits
- Avoid long-term or frequent intermittent use of medications intended for relief of cold symptoms
- Avoid tight fitting garments, girdies, and belts
- Do not lie down or sit in the slumped position immediately after eating
- Develop a regular routine of exercise and rest
Pharmacological Therapy for intestinal gas
Simethicone, Activated Charcoal, 𝝰 Galactosidase Replacement Products, Lactase Replacement Products
Simethicone for intestinal gas
Simethicone
- Used as a defoaming agent to relieve gas
- Used in patients with acute, non specific diarrhea
- Used to treat intestinal gas AFTER it has occurred
- No side effects
- discontinue if adequate relief is not obtained within 24 hours
Activated Charcoal in terms of intestinal gas
Promoted BUT NOT approved nor shown to be effective for intestinal gas, DON’T RECOMMEND
𝝰 Galactosidase Replacement Products in terms of intestinal gas
- For use as an antiflatulent
- Recommended as a preventive treatment of intestinal gas symptoms produced by high-fiber diets of foods that contain oligosaccharides.
- Must be administered just BEFORE or with the first bite of food that causes flatus and/or bloating
- Heat can inactivate the enzyme
Lactase Replacement Products in terms of intestinal gas
- Used in patients with lactose intolerance.
- No adverse effects
- To be taken with the 1st bite of food containing dairy
- Lactase enzyme use with ages >12 years old
dosage for intestinal gas
probiotic for intestinal gas
- Used for GI complaints including intestinal gas and bloating.
- Formulated from either one bacterium or multiple bacteria
Complementary Treatments for intestinal gas
Fennel can cause photodermatitis, is contraindicated during pregnancy, and enters breast milk in lactating women. If fennel is used, patients should be advised to avoid excessive sunlight and avoid use during pregnancy and lactation. It can also lower ciprofloxacin levels
Differentiate between the clinical presentation of heartburn, gastroesophageal reflux disease (GERD), dyspepsia and peptic ulcer disease (PUD).
Contributing Factors to Heartburn
Dietary
- Fatty foods
- Spicy foods
- Chocolate
- Salt and salt substitutes
- Caffeinated or carbonated beverages
- Citrus fruits or juices
- Tomatoes/tomato juice
Lifestyle
- Exercise
- Smoking
- Obesity
- Stress
- Laying down after eating
- Tight-fitting clothing
Diseases
- Motility disorders (e.g. gastroparesis)
- Scleroderma -rare disease that causes the hardening and tightening of skin
- PUD (peptic ulcer disease)- painful sores or ulcers in the lining of the stomach
- Zollinger-Ellison syndrome- disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers
Medications
- Bisphosphonates
- Aspirin/NSAIDs
- Iron
- Potassium
- Quinidine
- Tetracycline
- Zidovudine
- Anticholinergic agents
- Calcium channel blockers
- Alpha/Beta adrenergic agonists
- Progesterone
- Chemotherapy
Exclusion to self treatment GERD
Alarm Systems for GERD
GERD
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- Chest pain
- Upper GI bleeding
- Unexplained weight loss
- Continuous nausea, vomiting, and diarrhea
Alarm system PUD
PUD
- Upper GI bleeding
- Unexplained weight loss
- Continuous nausea, vomiting, and diarrhea may occur
Non Pharmacologic Treatment for GERD
Dietary and lifestyle modifications as described previously in the table
Avoid medications that may aggravate symptoms
Avoid eating large meals
Stop/reduce smoking
Lose weight if overweight and not pregnant
Wearl loose fitting clothes
If symptoms at night:
- Avoid lying down within 3 hours of a meal
- Elevate the head of the bed
Antacids for GERD
Neutralizes stomach acid or for mild infrequent heartburn
Okay to use with anyone >2 years old
- Magnesium can cause diarrhea
- Aluminum can cause constipation
- Calcium carbonate & Sodium bicarbonate can cause flatulence
Quick relief. Can take on an empty stomach or after meal
Onset <5min and durationg is 20-30min.
H2RAs for GERD
- For mild to moderate infrequent heartburn and for the prevention of heartburn associated with acid indigestion and sour stomach
- Cimetidine is the shortest-acting (4-8 hours of relief) whereas ranitidine, famotidine, and nizatidine have a somewhat longer duration
- Not as rapid onset as antacids, but longer duration of relief
- Tolerance may develop, use as needed
- Take 30 minutes before eating
- Okay to use with anyone >12 years old
- onset 30-45min- 4-10 hours for duration
PPIs (proton pump inhibitor) GERD
Omeprazole
Lansoprazole
Esomeprazole
-Brand examples are Prilosec, Prevacid, Nexium
Inhibits the proton pump. <br></br>For the treatment of frequent heartburn in patients who have symptoms 2 or more days a week.
Complete relief may take 1-4 days
Most effective when taken 30-60 min before a meal
Okay to use with anyone >18 years old
Onset- 2-3 hours duration 12-24hours
Bismuth Subsalicylate for GERD
- Brand example are Pepto-Bismol
- For heartburn, upset stomach, indigestion, nausea, and diarrhea
- Side effects may cause the tongue and stool to turn black
- You wouldn’t use if the patient only has symptoms of heartburn
GERD onset and duration
Constipation
Bowel movement less than 3 times a week
refer if it lasts more than 7 days
Constipation and pregnant
non-pharm and then bulk-forming agent then stool softener, not a suppository
various physiological conditions, disturbances, and lifestyle that cause constipation
Primary- slower than normal GI transit time or defecatory disorder.
Secondary- cause include systemic, neurological, and psychological disorder and/or structural abnormalities
Others- inadequate dietary fiber and fluid intake (dietary fiber dissolves or swells in the intestinal fluid, which increases fecal bulk to aid peristalsis and eliminating stool). Diet low in calories, carbs, or fiber can decrease fecal bulk. Inadequate intake of fluids may promote constipation in dehydrated patients.
Some medications that cause constipation
Analgesic
Antacids,
Anticholinergics
Anticonvulsants
Antidepressants
Antihistamines
Antimuscarinic
Opiates
Serotonin agonist
Diuretics etc.
Conditions associated with constipation
structural
Colorectal or anorectal injury, inflammation or damage
Pelvic floor disorder
structural abnormalities, ex: tumors, hernias, bowel obstruction
Systemic
Thyroid disorder, diabetes mellitus, irritable bowel syndrome, a neurological disorder, autominka, etc.
Psychological
Depression, eating disorder, situational stress
Constipation exclusion
- Marked abdominal pain or significant distention or cramping
- Marked or unexplained flatulence
- Fever or NV
- Chronic medical conditions
- Unexplained changes in bowel habits, especially w/ weight loss
- Blood in stool or dark, tarry stool
- Symptoms persists >2 weeks or recur over a period of at least 3 months
- Anorexia
Age <2 years
Diarrhea exclusion
- Young age <6 months
- Persistent fever
- Visible blood, pus, or mucus in stool
- High output, including frequent and substantial -volumes of diarrhea
- Persistent vomiting
- Severe dehydration
- Severe abdominal pain/distress
- Risk for significant complications, including chronic -medical conditions
- Pregnancy
- Chronic or persistent diarrhea
Bulk-forming laxatives- constipation
contains methylcellulose, polycarbophil, and psyllium. Dosage form includes tablets, capsules, powders to be mixed with water or other liquid, and fiber few, wafters, or gummies.
Usually, the onset of action is <strong>12-24 hours</strong>, onset may be delayed up to <strong>72 hours</strong>
Treatment generally for 1) patients on low-fiber diet 2) postpartum women 3) older adults 4) patients with colostomies, irritable bowel syndrome, or diverticular disease
Few systemic adverse effects, most common abdominal cramping and flatulence. If dose not taken with adequate fluid, maybe swell in throat or esophagus, potentially causing choking.
Patients with intestinal obstruction, intestinal ulcerations, stenosis, or disabling adhesions should not take bulk-forming products.
Calcium polycarbophil contains 150mg of calcium, big risk in hypercalcemia
Hyperosmotic agent- constipation
includes polyethylene<strong> glycol 3350 and glycerin</strong>. Product contain large, poorly absorbed ions, or molecules that draw water into the colon and rectum through osmosis to stimulate a bowel movement.
<strong>Glycol 3350 is only for patients 17 years of age and older</strong>. Dosage is generally 17g (1 capsule or 1 packet) mixed in with water once daily as needed. <strong>Produce bowel movement in 12-72 hours, onset may take up to 96 hours. </strong>
Effective for short term treatment. Adverse effects are bloating, abdominal discomfort, cramping, and flatulence. Consult doctor if renal or irritable bowel syndrome. Glycerine is available as a suppository for lower bowel evacuation. Effective in 15-30min.
Emollient agent- constipation
stool softeners. Docusate. Time onset of 12-72 hours, and may take up to 3-5 days to effect laxation. Generally combined with a stimulant laxative for opioid-induced constipation.
Lubricant agent-constipation
Mineral oil is the only non prescription lubricant. Onset of action 6-8hours after oral administration and 5-15 after rectal administration. Major concern is lipid pneumonia resulting from aspiration into the lungs after an oral dose. Should not be taken lying down or in patient with aspiration. Not for younger than 6 years, pregnant women, and bedridden or older adults, or people with difficulty swallowing. Don’t recommend it.
Saline laxative-constipation
Magnesium citrate, Magnesium hydroxide, dibasic sodium phosphate, monobasic sodium phosphate, and magnesium sulfate. available in liquid or solid for oral and liquid for rectal. For occasional constipation in healthy people. Takes about 30min to 6 hour for effect. Adverse effects, abdominal cramping, nausea, vomiting, and dehydration.
Stimulant agent-constipation
Stimulant agent- anthraquinones or diphenylmethanes. Primarily in the colon to increase intestinal motility either by local irritation of the mucosa or by a more selective action on the intramural nerve plexus of intestinal smooth muscle. The onset of action for bisacodyl is 6-10 hours after oral administration. Bisacodyl suppositories usually take effect 15-60 minutes after administration.
Diarrhea
- more than 3 bowel movements in the day
Causes- pathogenic, antibiotics, noravirus…..
Non-Pharm= ORS- Oral Rehydration Solution, mild to moderate dehydration
Referee within 72 hours if nothing gets fixed
signs and symptoms of dehydration in children
Loperamide-diarrhea
Loperamide- produces antidiarrheal effects by stimulating peripheral micro-opioids receptors on the intestinal circular muscles to slow intestinal motility. 6 years < older. Used generally for traveler’s diarrhea. Duration of use 48 hours
bismuth subsalicylate and lactase (diarrhea)
bismuth subsalicylate- Duration of use 48 hours. Black tarry stool Reacts with hydrochloric acid in the stomach to form bismuth oxychloride and salicylic acid, which is insoluble and poorly absorbed from the GI Tract. 12years <.
Lactase- may be taken with milk or other dairy product to prevent osmotic diarrhea
Insomnia
-Insomnia is a symptom with diverse etiologies, and it can progress to a disorder. Insomnia occurs when a person has trouble falling or staying asleep, wakes up too early and cannot return to sleep, or does not feel refreshed after sleeping.
-REM cycle is the 4 stage, at the end, most important, something with memory.
-H1 receptor, post synaptic receptor, results in wakefulness. But blocking it with an anti-histamine, promote sleepiness, sedation.
exclusion for self-treatment insomia
referee patient if does not improve in 10 days
Diphenhydramine and doxylamine
exclusion related insomnia
Diphenhydramine and doxylamine are not indicated to treat insomnia in children younger than 12 years because diphenhydramine may cause paradoxical excitation in younger children and is not recommended to induce sleep in infants.
-Pregnancy-related to insomnia
-Pregnancy: Should not take it because the safety of antihistamines during pregnancy has not been established. For example pregnant women in the past has experienced nausea and vomiting. And also one trial reported increased risk of teratogeninicty with the use of diphenhydramine during the first trimester and one trial trpoerted cleft palate alone and other fetal abnormailities. Also increased risk of CNS adverse effects can occur in breastfed neonates after maternal intake of a sedating antihistamine.
Medical disorders associated with insomia
drugs that can exacerbate insomia
sleep hygiene
-Antihistamines: related to insomnia
(Diphenhydramine and doxylamine)
-Diphenhydramine (FDA approved)
H1 antagonist, efficacy poor in chronic insomnia, max sedation 3-6 hours after doses. Tolerance develops within days. Do not use more than 7-10 consecutive nights. 25-50mg nightly. (use 2-3 nights and take a night off b/c of tolerance)
Sideffects: antinocholorgic: can cause dry muscus, dry mouth, constipation, increase in temperature, confusion.
-Doxylamine: not FDA approved, not suggested.
exclusion for insomnia
-Pregnancy: related to caffeine
Caffeine freely crosses the placenta (gynecologists has concluded that moderate caffeine consumption <200mg/day does not contribute to miscarriages or preterm births.
-Children are more susceptible to the cardiovascular and CNS adverse effects of caffeine because of their lower body weight. In one study of adolsecents, 50mg of dosage, increased their diastolic blood pressure significantly.
treat fatigue and drowsiness
- Caffeine is the only FDA over the counter use as a stimulant.
- Blocks adenosine, that promotes sleep.
- Higher dosages causes jitters, and even less sleep.
Understand and be able to explain to a patient which STI’s are preventable with vaccination, curable and incurable
STI’s preventions
-Male condoms
are important barrier contraceptive devices that help protect against STIs.
Polyurethan condoms:
Not subjected to degradation by oil-based products. But are not as elastic as latex condoms.
-Lamb cecum condoms:
labeled for pregnancy prevention only because the presence of pores in the membrane may allow passage of viral organisms, including HIV and HepB viruses.
-Female Condoms:
Breakage rate of the female condom has been lower than that of latex male condoms. But it can cause irritation and discomfort. (Does protect from STI). The female condom consists of an outer ring, a sheath or pouch that fits over the vaginal musoca, and an inner ring that secures the sheath by fitting like a diaphragm over the cervix.
-Vaginal Spermicides:
Use surface-active agents to immobilize and kill sperm. It also acts as a physical barrier against sperm. (Does not protect from STI).
-Contraceptive Sponge:
Doesn’t protect against STI’s. Acts as a contraceptive by serving as a mechanical barrier, providing a spermicide, and absorbing semen. Is a small, circular, disposable sponge made of polyurethane permeated with the spermicide.
selected lubricant/products that are safe or unsafe with latex condoms
emergency contraception
Pregtests
- Ovulation tests test LH, and predicts ovulation
- Pregancy test test hCG and tells you if your pregnant.
-Disadvantage of FAB methods
-Disadvantage of FAB methods is that it lacks STI protection, and it has a lower efficacy than some other contraceptive methods, and the need for periods of abstinence or the use of another method of contraception
-Calendar Methods:
Uses a woman’s monthly menstrual cycle length to calculate the fertile period. Should avoid intercourse on days 8-19 of her menstrual cycle.
Cervical Mucus Methods:
Relies on changes in cervical mucus that takes place during a normal menstrual cycle. Basically monitoring cervical secretions, where if she notices any secretions (muscus) that day she is likely to be fertile. If she does not note any secretions, she is unlikely to be fertile.
-Symptothermal Method:
Combines cervical muscus method along with tracking basal body temperature monitoring. Basal body temperature monitoring is to identify the end of the fertile period, and also used to predict ovulation for conception. Best results seen when taken after 3 hours of uninterrupted sleep and before getting out of bed at the same time every day.
-Home Tests for Ovulation Prediction:
Designed to aid couples in conceiving by detecting the surge in luteinizing hormone that occurs shortly before ovulation. It detects an increase in urinary excretion of the hormone, which usually occurs 8-40 hours before actual ovulation.
urine test for pregnancy and fertility
Vaginal/Vulvovaginal/Menstruation
- Out of the three below, bacterial vaginosis (BV), Trichomoniasis (TV), and Vulvovaginal Candidiasis (VC),
- Vulvovaginal Candidiasis (VC) is the only one that can be treated with over the counter drugs.
- (A easy way to differentiate the three, (VC) is usually absent of odor and has white discharge. Also there is no change in pH in the vaginia .
-Atrophic vaginitis:
Is inflammation of the vagina related to atrophy of the vaginal mucosa secondary to decreased estrogen levels. It is also associated with a decrease in vaginal lubrication. Other symptoms include vaginal irritations, dryness, burning, itching, leucorrhea, and dyspareunia. A thin, watery (occasionally bloody), or yellow malodorous vaginal discharge or “spotting” may also be present.
vulvovaginal candidiasis exclusions
Atrophic vaginitis exclusions
vulvovaginal candidiasis
- Non-Pharm: For vulvovaginal candidiasis: Yogurt.
- Pharmacologic Therapy for vulvovaginal candidiasis
- Vaginal Antifungals (imidazole)
pregnanta with VC
Pharmacologic Therapy:
-Can be treated with a variety of lubricants
using lactobacillus preparations (yogurt) for
vaginal problems
-using lactobacillus preparations (yogurt), to reestablish normal vaginal flora and inhibit growth of candida organisms. (data effectiveness are limited and inconsistent)
A sodium bicarbonate sitz bath for vaginal problems
may provide prompt, temporary relief of vulvar irritation associated with a candida vaginal infection before antifungal agents can provide noticeable benefit. (symptom relief)
Tea tree oil:
- Gentian Violet:
- Boric Acid.
Tea tree oil: has antibacterial and antifungal properties. (no evidence)
- Gentian Violet: A dye as an old treatment for VVC. (Use up to 5 days, symptom relief)
- Boric Acid. 70% cure rates when used in women whose infection did not respond to vaginal antifungals. (14 days and should consult with doctor first)
Primary dysmemorrhea and seconday dysmemorrhea
exclusions for secondary dysmenorrhea
exclusion for primary dysmenorrhea
Special Populations for dysmenorrhea pharmacology
- Special Populations for dysmenorrhea pharmacology:
- Children – adolcenscents who have or are recovering from chickenpox or influenza like should avoid
- Pregnant or menopausal women will not experience dysmenorrhea.
- Women attempting to become pregnant should avoid use of NSAIDS
- Acetaminophen and ibuprofen can safely be taken by breastfeeding women.
- Aspirin should be avoided if women is breastfeeding.
- Naproxen sodium should be avoided if woman is breastfeeding.
-SPECIAL POPULATIONS realted to PMS
-SPECIAL POPULATIONS:
PMS DOES NOT OCCUR DURING PREGNANCY OR AFTER MENOPUASE. ADOLESCENTS AND ADULT WOMEN SHOULD INITIALLY ATTEMPT TO MANAGE SYMPTOMS WITH LIFESTYLE CHANGES AND THERAPIES SUCH AS CALCIUM SUPPLEMENTATION.
-Adolescents should avoid combinations products containing aspiring
-Women who are breastfeeding should avoid all herbal products
-Diuretics should be avoided during breastfeeding
-Pharmacologic Therapy PMS
- Pharmacologic Therapy
- Pyridoxine 80-100mg
- Calcium and Vitamin D (1000-1300mg daily for calcium)
- Magnesium 360mg a day
- Nonsteroidal anti-inflammatory Drugs (several days prior to onset of and during the first several days of menses.) For the physical symptoms such as headache and muscle/joint pains and mood symptoms.
- Diuretics (ammonium chloride, caffeine, and pamabrom) helps with abdominal bloating and water retention.
- Ammonium chloride 3g/day, 3 doses, no more than 6 consecutive days
- Caffeine: 100-200mg every 3-4 hours
- Pamabrom: 50mg 4 times daily.
