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OTC Theraputics > Exam 1 Spring 2025 > Flashcards

Exam 1 Spring 2025 Flashcards

1
Q

What is the normal pH of the vagina?

A

4-4.5 pH

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2
Q

Is douching recommended or not recommended?

A

No it is not

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3
Q

What are the 3 most common vaginal infections?

A

Vulvovaginal Candidiasis (VVC/ yeast infection), bacterial vaginosis (BV), and trichomoniasis

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4
Q

If the vaginal discharge has any odor, it is most likely NOT a _______ ____________.

A

Yeast infection

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5
Q

What are the seven common risk factors for vulvovaginal candidiasis (VVC/ yeast infection)?

A

Pregnancy, high dose of oral contraceptives, antibiotics/immunosuppression, increased estrogen, diabetes, onset of sexual activity, clothes and food.

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6
Q

Why is diabetes a risk factor for vulvovaginal candidiasis (yeast infection)?

A

Diabetes increases sugar excretion in the urine which feeds the fungi.

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7
Q

What is the discharge like if someone have bacterial vaginosis?

A

The discharge is typically white and clear with a fishy odor.

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8
Q

What is the typical vaginal pH value for someone who has bacterial vaginosis?

A

Greater than 4.5

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9
Q

What is the typical vaginal pH value for someone with vulvovaginal candidiasis (yeast infection)?

A

4.0 (it is typically normal)

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10
Q

What is the typical vaginal pH value for someone trichomoniasis?

A

5-6 pH

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11
Q

What is the typical vaginal discharge for vulvovaginal candidiasis (yeast infection)?

A

The discharge is white, thick, creamy, and curdy while having no odor.

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12
Q

What is the typical vaginal discharge for someone who has trichomoniasis?

A

The discharge is green and/or yellow and can be frothy.

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13
Q

What is the main clinical symptom of vulvovaginal candidiasis (yeast infection)?

A

Vulvar itching

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14
Q

What are the 7 exclusion factors for self-treatment for vuvlovaginal candidiasis (yeast infection)?

A
  1. Pregnancy
  2. Younger than 12 years
  3. Concurrent symptoms of fever, pain in pelvic area, lower abdomen, back and/or shoulder
  4. Medication that predisposes you to VVC (corticosteroids and antineoplastics)
  5. Medication disorders that can predispose to VVC (diabetes and HIV)
  6. More than 3 VVC in the past year and/or 1 in the past 2 months
  7. First VVC episode (must go to PCP)
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15
Q

What is the generic name for AZO?

A

Phenazopyridine

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16
Q

What are the 3 types of non-prescription antifungals for vulvovaginal candidiasis (yeast infection)?

A

Clotrimazole, miconazole, and tioconazole

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17
Q

What is the dosing product for clotrimazole?

A

1% cream x7 days or 2% cream x3 days

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18
Q

What is the typical course duration for clotrimazole?

A

7 or 3 days

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19
Q

What are the two products that miconazole comes in?

A

Cream and vaginal suppository

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20
Q

What is the dosing product for miconazole?

A

2% cream x7 days or 4% cream for x3 days

OR

Vaginal suppository:
100 mg x 7 days
200 mg x 3 days
1.2 g x 1 days

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21
Q

What is the typical course duration for miconazole?

A

7, 3, and 1 days

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22
Q

What is the product dosing for tioconazole?

A

Ointment 6.5% daily x 1 day

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23
Q

What is the MOA of the 3 antifungals clotrimazole, miconazole, and tioconazole?

A

These antifungals alter the fungal cell membrane permeability

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24
Q

What is the age cut-off for the use of antifungals to treat vulvovaginal candidiasis (yeast infection)?

A

12 years old

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25
Q

What are the common adverse effects of antifungals?

A

Dry skin, burning, rash, and hypersensitivity

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26
Q

What are the drug interactions with clotimazole?

A

None

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27
Q

What is the main drug interaction with miconazole?

A

Warfarin. This drug should be avoided or bleeding should be monitored.

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28
Q

What is the main drug interaction with tioconazole?

A

Progesterone. This drug should be avoided.

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29
Q

T or F: When applying vaginal antifungals, they should be applied in the morning.

A

False. These should be applied at night.

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30
Q

T or F: The vaginal applicator for antifungal application use can be reused.

A

False. Do not reuse these applicators

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31
Q

How long does it take to see improvement with the use of antifungals?

A

24-48 hours

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32
Q

T or F: Antifungal treatment can be discontinued once symptoms improve.

A

False. Finish out the dose of the medication even if the symptoms have improved.

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33
Q

T or F: Tampons and douching can be used during treatment with vaginal antifungals.

A

False. Tampons and douches should not be used during intravaginal treatment.

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34
Q

T or F: Patients should refrain from intercourse while undergoing intravaginal antifungal treatment for vulvovaginal candidiasis.

A

True!

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35
Q

What were the 3 medications discussed that do not directly treat vulvovaginal issues but do provide relief of itching?

A

Benzocaine, hydrocortisone, and AZO

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36
Q

What is the indication for AZO (phenazopyridine)?

A

AZO is indicated to relieve symptomatic urinary pain for adults and children 12 years and older.

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37
Q

What is the dosing protocol for OTC AZO (phenazopyridine)?

A

95mg or 99.5mg 1x PO TID

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38
Q

If symptoms are still present are ______ days of using AZO, the individual should be referred to a PCP.

A

2 days

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39
Q

T or F: AZO (phenazopyridine) changes the color of the urine to red/orange.

A

True

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40
Q

What are the common adverse effects seen with AZO use?

A

Headaches, rashes, and stomach cramps

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41
Q

In general, what is AZO used for?

A

It is mainly used to treat symptomatic urinary pain relief in UTIs.

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42
Q

What were the 5 main CAM products discussed that may improve vulvovaginal issues?

A

Lactobacillus
Boric acid
Sodium Bicarb Sitz Bath
Tea Tree Oil
Gentian Violet

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43
Q

T or F: Pregnant women can use boric acid as a CAM product for vaginal issues.

A

False. Pregnant people should not use boric acid

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44
Q

What are 5 common nonpharmacological therapies for vulvovaginal issues?

A

Yogurt with live cultures, sitz bath, decrease sucrose and refined carbs, discontinue aggravating drugs, and wearing loose clothing

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45
Q

T or F: Self-treatment of vulvovaginal issues during pregnancy is not acceptable.

A

True. The outlier to this is if they are diagnosed with vulvovaginal candidiasis (yeast infection) by a PCP and come back to the pharmacy to get a 7-day only OTC antifungal.

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46
Q

Is breastfeeding an exclusion for self-treatment of vulvovaginal candidiasis?

A

No

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47
Q

If the symptoms of vulvovaginal candidiasis do not improve within ______ days or persist beyond _______ days, then medical attention is needed.

A

3 days
7 days

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48
Q

What is atrophic vaginitis?

A

Vaginal dryness secondary to decreased estrogen levels.

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49
Q

What is the self-care product used to treat atrophic vaginitis?

A

Vaginal lubricants

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50
Q

What is the MOA of vaginal lubricants?

A

Temporarily moistens vaginal tissue

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51
Q

What are the 5 main causes for atrophic vaginitis?

A

Menopause, postpartum, breastfeeding, radiation, and chemotherapy.

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52
Q

How long does it take for symptom relief when using vaginal lubricants?

A

Typically works immediately

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53
Q

How much vaginal lubricant should be applied?

A

A liberal amount should be used

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54
Q

What is the most common STI?

A

HPV

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55
Q

T or F: Nearly half of new STIs occur in the youth from ages 15-24 years.

A

True

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56
Q

What are the two incurable but vaccine preventable STIs?

A

Genital warts (HPV) and Hepatitis B

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57
Q

What are the 5 curable STIs?

A

Chlamydia, Gonorrhea, Hep C, Syphilis, and Trichomoniasis

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58
Q

What are the two noncurable STIs?

A

AIDs and genital herpes

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59
Q

How is HPV transmitted?

A

It is transmitted through sexual contact (skin to skin contact during sex).

60
Q

HPV is the major cause for _______ cancer and _______ __________.

A

Cervical and genital warts

61
Q

What is the HPV vaccine called?

A

Gardasil

62
Q

How is Hepatitis B transmitted?

A

Transmitted through blood typically occurring through high risk sexual behaviors. Transmits through bodily fluids like blood, semen, etc.

63
Q

What can hepatitis B cause?

A

It may cause hepatitis, cirrhosis, hepatic carcinoma, and death.

64
Q

T or F: The hepatitis B vaccine is recommended as a teenager.

A

False. This is recommended for all infants.

65
Q

What are the 3 different hepatitis B vaccines?

A

Engerix-b, Recombivax B, and Heplisav-b

66
Q

What is the only 100% effective contraceptive method?

A

Abstinence

67
Q

What is the Opill?

A

This is the first OTC birth control that is progesterone only.

68
Q

What is the mechanism of action of progesterone only birth control pills like the Opill?

A

it inhibits ovulation by suppressing of luteinizing hormone, inhibiting sperm migration, and slowing ovum transport.

69
Q

What are the drug interactions with the Opill?

A

CYP3A4 inducer
CYP3A4 inhibitors
Warfarin

70
Q

What are the side effects if the Opill?

A

Fatigue, hypermenorrhea, nausea, and abdominal pain.

71
Q

What do you do if you miss a dose of the Opill birth control?

A

A missed dose is anything more than 3 hours from when you normally take it. If late, immediately take the dose and use a condom. or other barrier methods for 48 hours after. Make sure to take a pregnancy test if period your period is late.

72
Q

Will the OPill work if the egg is already fertilized?

A

No it will not work.

73
Q

Who are not candidates for the OPill?

A

Those with history of breast cancer
Allergy to ingredients in the OPill
Currently using another birth control
Known or suspected pregnancy
Males

74
Q

T or F: Condoms are not FDA regulated.

A

False. Condoms are FDA regulated

75
Q

Which type of condom does not protect against STIs?

A

Natural membrane condom

76
Q

For latex condoms, _________ based lubricants need to be used.

A

Water. Do not use oil as it may cause friction and lead to breakage.

77
Q

Are female condoms an effective barrier for STIs?

A

Yes

78
Q

What is the only FDA approved spermicides?

A

Nonoxynol-9

79
Q

What is the MOA of spermicides?

A

These are surface agents that immobilize and kill sperm.

80
Q

T or F: Spermicides does not protect against the STIs and may increase the risk.

A

True!

81
Q

Is the calendar method effective for women with irregular cycles?

A

No. This only works if a cycle is between 26-32 days in length.

82
Q

What is the symptothermal method?

A

This tracks cervical mucus with basal body temperature to look at fertile days.

83
Q

What is a home ovulation prediction test?

A

This is a test that detects a surge in luteinizing hormone.

84
Q

What is coitus interruptus?

A

Pulling out

85
Q

What is the MOA of emergency contraceptives?

A

They delay ovulation via suppression of luteinizing hormone and prevent fertilization by inhibiting sperm migration.

86
Q

Within what time frame must emergency contraceptives be used to be effective?

A

72 hours after sex and 120 hours

87
Q

What is the class for the only OTC emergency contraceptive?

A

Progestin (Levonorgestrel)

88
Q

What are the directions for use for emergency contraceptive?

A

Take 1.5mg PO as soon as possible within 72 hours of unprotected sex. Can be used 120 hours after unprotected sex.

89
Q

T or F: Emergency contraceptive disrupts implanted fertilized eggs.

A

False. If a fertilized egg is already implanted into the uterine wall, emergency contraceptive will not work.

90
Q

What are the drug interactions with the OTC emergency contraceptive progestin (Levonorgestrel)?

A

CYP3A4 inducers, inhibitors, and warfarin

91
Q

What are the side effects of the OTC emergency contraceptive progestin (Levonorgestrel)?

A

Fatigue, hypermenorrhea, nausea, and abdominal pain

92
Q

Emergency contraceptive is less effective for women greater than ________ BMI.

A

26

93
Q

After taking the EC pill, use a backup method during sex for ________ days.

A

7

94
Q

If vomiting occurs within ______ hours of taking an EC dose, repeat the dose.

A

2

95
Q

T or F: Breastfeeding women do not need to discard breast milk after taking EC.

A

False. Breastmilk should be discarded for 24 hours after taking EC.

96
Q

What is the average blood loss during a cycle?

A

30 mL.

Anything greater than 80mL per cycle or a cycle lasting longer than 7 days is abnormal and is associated with severe anemia.

97
Q

What is the menstrual cycle?

A

The start of menses (blood flow) to the start of the next menses.

98
Q

The follicular phase is days _____to ______ and the luteal phase is days ______ to ________ in a cycle.

A

1-11
18-28

99
Q

What is the definition of dysmenorrhea?

A

This is painful menstruation

100
Q

What is the cause of primary dysmenorrhea?

A

This is normally idiopathic and likely caused by prostaglandins but it is not fully understood.

101
Q

What is the cause of secondary dysmenorrhea?

A

It is likely caused by endometriosis and is associated with pelvic pathology.

102
Q

What is menses like for primary dysmennorhea?

A

It is normally a regular 28 day cycle

103
Q

What is menses like for secondary dysmennorhea?

A

It is highly irregular with menorrhagia and intermenstrual bleeding.

104
Q

When is the onset of pain for primary dysmennorhea?

A

Prior to or concurrent with menses (bleeding)

105
Q

When is the onset of pain for secondary dysmenorrhea?

A

It varies with cause but the pain is usually very severe.

106
Q

For primary dysmenorrhea, is there pain outside of the menstrual cycle?

A

No. However, in secondary dysmenorrhea there is pain present throughout.

107
Q

Does primary dysmenorrhea respond to NSAIDs for relief?

A

Yes. However, it secondary dysmenorrhea is unlikely to respond to NSAIDs.

108
Q

24 year old female presents with severe abdominal pain which she describes as menstrual cramps which started suddenly yesterday (day 3 of her period). Her last menstrual cycle was 6 weeks ago. Is she experiencing primary or secondary dysmenorrhea?

A

Secondary dysmenorrhea

109
Q

19 year old smoker presents with menstrual like cramps before and during her period. The cramps last about 1-2 days and gradually improve. In addition, she experiences nausea and fatigue during her menstrual cycle. Is she experiencing primary or secondary dysmenorrhea?

A

Primary dysmenorrhea

110
Q

What are the 8 exclusions for self-treatment for dysmenorrhea?

A
  • dysmenorrhea inconsistent with PRIMARY dysmenorrhea
  • HX of pelvic inflammatory disease, infertility, irregular cycles, endometriosis, and ovarian cysts
  • Severe dysmenorrhea
  • Change in pattern/intensity of pain
  • Allergy/intolerance to NSAIDs
  • Use of warfarin, heparin, or lithium
  • Active GI disease (PUD, GERD, UC)
  • Use of intrauterine devices
111
Q

What are the 7 risk factors for dysmenorrhea?

A
  1. Less than 30 years old
  2. Early menses
  3. Heavy menstrual flow
  4. Tobacco smoking
  5. BMI less than 20
  6. Premenstrual symptoms
  7. Low intake of fruits, veggies, etc
112
Q

What are some non-pharm treatments for dysmenorrhea?

A

Heating pads, smoking cessation, increasing fish intake, and some supplements like fish oil, ginger, vitamin B1 and D, and zinc sulfate

113
Q

What is the only OTC treatment for primary dysmenorrhea?

A

NSAIDs like acetaminophen, ibuprofen, and naproxen. Can be aspirin as well but no one uses it for pain relieve.

114
Q

What is the dosing for acetaminophen?

A

650-1000mg every 4-6 hours

115
Q

When taking NSAIDs for primary dysmenorrhea, should they be taken PRN or on a schedule?

A

On a schedule between the first 48 and 72 hours of menstrual flow.

116
Q

What are common adverse effects associated with NSAID use?

A

Nausea, vomiting, and diarrhea

117
Q

20 year old smoker presents with menstrual like cramps before and during her period. The cramps last about 1-2 days and gradually improve. In addition, she experiences nausea and fatigue during her menstrual cycle. She has not tried anything to make it better and she is allergic to motrin. Is she a candidate for self-treatment?

A

Technically she is not eligible for self-treatment as she has an allergy/intolerance to NSAIDs. However, you could still recommend tylenol.

118
Q

What is premenstrual syndrome (PMS)?

A

This is a cyclic disorder that includes a combination of physical, emotional, mood, and behavioral symptoms during the luteal phase of the menstrual cycle.

119
Q

T or F: The symptoms of PMS typically improve by the end of menses.

A

True

120
Q

What are the diagnosis guidelines for premenstrual syndrome?

A

At least 1 mood or physical symptoms during the 5 days prior to menses with a mild-moderate negative effect on social functioning or lifestyle.

121
Q

What are the diagnosis guidelines for moderate to severe premenstrual syndrome (PMS)?

A

At least 1 mood or physical symptom that results in significant impairment of daily activities or relationships.

122
Q

What are the diagnosis guidelines for premenstrual dysphoric disorder (PMDD)?

A

5 or more symptoms are present the last week of the luteal phase with at least 1 symptom being significant depression, anxiety, lability, or anger. The symptoms interfere with life and the symptoms are absent the week after menses.

123
Q

What is the diagnosis guidelines for premenstrual exacerbation?

A

Worsening of symptoms of typically psychiatric disorders.

124
Q

What are the common side effects of PMS?

A

Fatigue, irritability, labile mood, abdominal bloating, breast tenderness, and headache.

125
Q

What are the 4 exclusion for self-treatment for PMS?

A

-Severe PMS or PMDD
- Uncertain patterns of symptoms
- onset of symptoms coincide with start of oral contraceptives
- contraindications to specific agents

126
Q

What are the 8 different ‘supplements’ that can worsen PMS symptoms?

A

Caffeine/Pamabrom, ammonium chloride, chastetree verry, black cohosh, st. John Wort, and ginkgo

127
Q

What are some non-pharm treatments for PMS?

A

Dietary modification, exercise, stress management, light therapy, cognitive behavioral therapy, and acupuncture

128
Q

What are supplements that may work in improving PMS symptoms?

A

Calcium, vitamin D, pyridoxine (vitamin b6), magnesium, and vitamin E

129
Q

Why may calcium aid in improving PMS symptoms?

A

It may prevent fluctuation

130
Q

Why may vitamin D aid in improving PMS symptoms?

A

It may prevent the development of PMS symptoms

131
Q

Why may Pyridoxine (Vitamin B6) aid in improving PMS symptoms?

A

It may provide a therapeutic benefit

132
Q

Why may magnesium aid in improving PMS symptoms?

A

It may improve affective symptoms

133
Q

Why may Vitamin E aid in improving PMS symptoms?

A

It may reduce physical and mental symptoms

134
Q

What is the OTC treatment for PMS?

A

It depends but it could include OTC NSAIDs like naproxen, ibuprofen, and acetaminophen as well as OTC diuretics like caffiene, ammonium chloride, and pamabrom. Combo products are also avaliable like Midol and Pamprin which contain analgesics, antihistamines, and diuertics.

135
Q

Why might NSAIDs help with pain associated with PMS?

A

NSAIDs reduce headaches and muscle pain associated with PMS

136
Q

Why might diuretics help with PMS?

A

OTC diuretics like ammonium chloride, caffeine, and pamabrom may help reduce bloating/swelling, water retention, and weight gain

137
Q

What is the dosing for ammonium chloride (OTC diuretic supplement)?

A

1 g TID for no more than 6 days

138
Q

What is the dosing for caffeine?

A

100-200 mg every 3-4 hours

139
Q

What is the dosing for Pamabrom (OTC diuretic)?

A

50mg 4 times per day

140
Q

A patient presents with PMS symptoms including muscle pain, irritability, breast tenderness, anxiety, and food cravings. The symptoms are moderate but affect her productivity at work and last about a week. She has not tried anything and has no known drug allergies. What menstrual disorder is she experiencing and is she a candidate for self-treatment?

A

She is experiencing PMDD and is therefore not a candidate and needs to be referred to a PCP.

141
Q

What is toxic shock syndrome?

A

This is a bacterial infection caused by S. aureus characterized by high fever, profound hypotension, severe diarrhea, mental confusion, renal failure, erythroderma, and skin desquamation. It is overall an inflammatory immune response mounted against the bacteria.

142
Q

Does black cohosh work for symptoms of menopause?

A

It might work as it may reduce circulating lelvels of luteinizing hormone and stimulate dopamine receptors that in turn oppose prolactin.

143
Q

What is the dosing for black cohosh?

A

6.5-160 mg PO daily

144
Q

What are the adverse effects of black cohosh?

A

GI distress is the big one. Other adverse effects include headache and dizziness.

145
Q
A

OTC Theraputics (5 decks)

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