Exam 1 info Flashcards

Question

Medical referal for Anorectal Disorder

Answer 1

-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

Answer 2

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

Answer 3

-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

Answer 4

- 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

Answer 5

\*Ephedrine sulfate Epinephrine HCL \*Phenylephrine HCL reduction of swelling/slight anesthetic effect

Answer 6

-\*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

Answer 7

\*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

Answer 8

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

Answer 9

_{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}

Answer 10

Simethicone, Activated Charcoal, 𝝰 Galactosidase Replacement Products, Lactase Replacement Products

Answer 11

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

Answer 12

Promoted BUT NOT approved nor shown to be effective for intestinal gas, DON’T RECOMMEND

Answer 13

* 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

Answer 14

* 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

Answer 15

* Used for GI complaints including intestinal gas and bloating. * Formulated from either one bacterium or multiple bacteria

Answer 16

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

Answer 17

_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

Answer 18

GERD * Dysphagia (difficulty swallowing) * Odynophagia (painful swallowing) * Chest pain * Upper GI bleeding * Unexplained weight loss * Continuous nausea, vomiting, and diarrhea

Answer 19

PUD * Upper GI bleeding * Unexplained weight loss * Continuous nausea, vomiting, and diarrhea may occur

Answer 20

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

Answer 21

Neutralizes stomach acid or for mild infrequent heartburn ## Footnote 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.

Answer 22

* 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**

Answer 23

_Omeprazole _Lansoprazole _Esomeprazole _{-Brand examples are Prilosec, Prevacid, Nexium} _{Inhibits the proton pump.
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

Answer 24

* 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

Answer 25

Bowel movement less than 3 times a week refer if it lasts more than 7 days

Answer 26

non-pharm and then bulk-forming agent then stool softener, **not** **a suppository**

Answer 27

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.

Answer 28

Analgesic Antacids, Anticholinergics Anticonvulsants Antidepressants Antihistamines Antimuscarinic Opiates Serotonin agonist Diuretics etc.

Answer 29

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

Answer 30

- 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

Answer 31

- 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

Answer 32

_{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 12-24 hours, onset may be delayed up to 72 hours} _{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}

Answer 33

_{includes polyethylene glycol 3350 and glycerin. Product}_contain_{large, poorly absorbed ions, or molecules that draw water into the colon and rectum through osmosis to stimulate a bowel movement.} _{Glycol 3350 is only for patients 17 years of age and older. Dosage is generally 17g (1 capsule or 1 packet) mixed in with water once daily as needed. Produce bowel movement in 12-72 hours, onset may take up to 96 hours.} _{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.}

Answer 34

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.

Answer 35

Mineral oil is the only non prescription lubricant. **Onset of action 6-8hours** after oral administration a**nd 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. N**ot for younger than 6 years, pregnant women, and bedridden or older adults, or people with difficulty swallowing. Don’t recommend it.**

Answer 36

**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. T**akes about 30min to 6 hour for effect**. Adverse effects, abdominal cramping, nausea, vomiting, and dehydration.

Answer 37

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.

Answer 38

- 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

Answer 39

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**

Answer 40

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

Answer 41

_{-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.}

Answer 42

referee patient if does not improve in 10 days

Answer 43

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.

Answer 44

-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.

Answer 45

(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.

Answer 46

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.

Answer 47

- 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.

Answer 48

are important barrier contraceptive devices that help protect against STIs.

Answer 49

Not subjected to degradation by oil-based products. But are not as elastic as latex condoms.

Answer 50

labeled for pregnancy prevention only because the presence of pores in the membrane may allow passage of viral organisms, including HIV and HepB viruses.

Answer 51

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.

Answer 52

Use surface-active agents to immobilize and kill sperm. It also acts as a physical barrier against sperm. (Does not protect from STI).

Answer 53

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.

Answer 54

- Ovulation tests test LH, and predicts ovulation - Pregancy test test hCG and tells you if your pregnant.

Answer 55

-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

Answer 56

Uses a woman’s monthly menstrual cycle length to calculate the fertile period. Should avoid intercourse on days 8-19 of her menstrual cycle.

Answer 57

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.

Answer 58

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.

Answer 59

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.

Answer 60

- 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 .

Answer 61

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.

Answer 62

- Non-Pharm: For vulvovaginal candidiasis: Yogurt. - Pharmacologic Therapy for vulvovaginal candidiasis - Vaginal Antifungals (imidazole)

Answer 63

Pharmacologic Therapy: -Can be treated with a variety of lubricants

Answer 64

-using lactobacillus preparations (yogurt), to reestablish normal vaginal flora and inhibit growth of candida organisms. (data effectiveness are limited and inconsistent)

Answer 65

may provide prompt, temporary relief of vulvar irritation associated with a candida vaginal infection before antifungal agents can provide noticeable benefit. (symptom relief)

Answer 66

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)

Answer 67

- 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.

Answer 68

_{-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}

Answer 69

- 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.