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Self/Home Care > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

BMI Classification: Obesity

A

> 30 mg/kg2

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2
Q

BMI Classification: Overweight

A

25.0-29.9 mg/kg2

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3
Q

Treatment goal for obese: lose __% of total weight over _____. Average ____ lbs/wk.

A
  • 10%, 6 months
  • 1-2 lbs/wk
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4
Q

How many calories equal to 1 lb of weight gain?

A

3500 calories

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5
Q

Pharmacological therapy is appropriate if BMI ____, or ____ with ___ of co-morbid conditions

A
  • 30
  • 27 with 2 co-morbidities
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6
Q

OTC medication for weight loss: Name, dose, must take ____ when?

A
  • Alli
  • 60 mg with a fat containing meal, up to 3 doses daily
  • Multivitamin at bedtime or 2 hrs from Alli dose
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7
Q

Urinary incontinence type: stress

A
  • Involuntary leakage with sudden increase in abdominal pressure
  • Urine leakage triggered by physical activity: cough, exercise, laugh, sneeze
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8
Q

Urinary incontinence type: overflow

A
  • Over-distention of the bladder
  • Decreased or incomplete urine stream
  • Causes: obstruction (BPH) or dysfunctional bladder (diabetic/alcoholic)
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9
Q

Urinary incontinence type: urge (= overactive bladder)

A
  • Frequency >8 times/day
  • Nocturia
  • Inability to reach toilet following urge to void
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10
Q

Urinary incontinence type: functional

A
  • Urine loss due to physical or cognitive impairment
  • Interferes with a person’s ability to reach toilet facilities
  • Causes: stroke, diminished mobility
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11
Q

Urinary incontinence type: mixed

A
  • Overactive bladder + stress
  • More common in women
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12
Q

Urinary incontinence risk factors: medical disorders/procedures

A
  • BPH, TURP, prostatectomy
  • Diabetes
  • Obesity
  • Pregnancy
  • Stroke
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13
Q

Urinary incontinence risk factors: physiologic factors

A
  • Estrogen depletion
  • High/low fluid intake
  • Pelvic floor muscle weakness
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14
Q

Urinary incontinence risk factors: lifestyle factors

A
  • Smoking, high-impact physical activities (running, jumping jacks)
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15
Q

Urinary incontinence risk factors: others

A
  • Caucasian race
  • Environmental barriers
  • Medication
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16
Q

Medications that impact incontinence

A
  • Anticholinergics
  • Antidepressants (SSRIs, SNRIs)
  • Hypnotics/sedatives
  • Antipsychotics
  • Narcotics
  • Muscle relaxants
  • Antihypertensives (ACEi, ARBs)
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17
Q

Urinary incontinence: non-pharmacologic tx

A
  • Behavioral modification: toileting assistance, bladder training, pelvic floor muscle training
  • Supplies: urinary catheters, absorbent pads, undergarments for protection
  • Surgical = last line
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18
Q

Urinary incontinence: pharmacologic tx indication, SEs, DDIs, Counseling points

A

Oxybutynin transdermal patch
- Indication: overactive bladder/urge incontinence for women
- SEs: constipation, nausea, xerostomia
- DDIs: minor CYP3A4 substrate, acetylcholinesterase inhibitors
- Counsel: use when UI symptoms >3 months, do NOT cut the patch, rotate site of application, do NOT expose to sunlight, refer to HCP if no improvement after 2 weeks

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19
Q

Complementary therapies for UI

A
  • Pumpkin seed oil
  • Vitamin
  • Cranberry
  • Glycine
  • Acupuncture (limited data)
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20
Q

BP monitors: potential confounding factors

A
  • Stress
  • Tobacco use
  • Caffeine <60 mins prior to usage
  • Medications such as pseudoephedrine
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21
Q

BP monitors: wrist and finger monitors

A
  • Not as accurate
  • Finger: not recommended
  • Wrist: for obese patients
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22
Q

BP monitors: counseling points

A
  • Assess any physical impairments to use the machine
  • Importance of keeping track of BP values
  • Medication adherence and healthy lifestyle choices
  • Demonstrate proper technique to patients
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23
Q

Covid test if (+):

A
  • Highly reliable/accurate
  • Standard precautions to prevent spreading of disease (mask, social distancing)
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24
Q

Covid test if (-):

A
  • Cannot rule out infection
  • Need a PCR test or 2 (-) antigen tests that are 48 hrs apart
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25
Q

Covid test counseling points

A
  • Rotate the swab in the second well prior to closing the card
  • once the nasal swab sample is collected, immediately perform the test
  • Ensure the pt is putting an adequate amount of extraction buffer on the sample
  • Patient should be tested within the first 5-7 days of symptoms
  • Emphasize the importance of preventing the spread
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26
Q

HIV routes of transmission

A
  • Needle exchange
  • Sexual intercourse
  • Born to a mother infected with HIV
  • Blood transfusion between 1978 to 1985
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27
Q

HIV test possible confounders

A
  • Blood: inadequate blood sample
  • Saliva: inadequate swabbing of gums, eating/drinking/using oral care products 30 mins prior to starting test
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28
Q

HIV test if (+):

A
  • Contact HCP for confirmation
  • Counsel pt on precautions to avoid spreading infection
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29
Q

HIV test if (-):

A
  • Confirm sufficient time has passed since potential exposure (saliva: 30 mins)
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30
Q

HIV test counseling points

A
  • Determine if the elapsed time since possible exposure to the virus before recommending an HIV test
  • Blood: fragility of blood samples -> not to delay mailing the specimen card, apply enough blood
  • Saliva: adequate swabbing gums, 30 mins time frame
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31
Q

HCV: CDC recommends that all adults born _______ should be screened for HCV

A
  • between 1945 to 1965 (“baby boomers”)
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32
Q

HCV tests for the presence of HCV _____, not the ____

A
  • Antibodies; virus
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33
Q

HCV test results are typically available ____ days after the sample is received

A

2 to 7 days

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34
Q

HCV tests confounding factors

A
  • Inadequate blood samples
  • Immunosuppressant therapy: may not be able to produce sufficient levels of antibodies (ex., steroids)
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35
Q

HCV test if (+):

A
  • HCP for evaluation
  • Follow up with a HCV RNA test
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36
Q

HCV tests counseling points

A
  • Pt recently infected (<6 months) may receive a false(-) result -> retest
  • Fragility of blood samples -> not to delay mailing the specimen card
  • Medical disorders that might rule out the use of a fingerstick-based test or physical limitations that may interfere with performing the test
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37
Q

UTI risk factors

A
  • Diabetes
  • Urinary stones/obstructions
  • Pregnancy
  • Anatomical differences: females much shorter urethral (more inflammation possibility) than males
  • Presence of urinary catheters
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38
Q

UTI tests detect both ___ and ___

A
  • Nitrite; leukocyte esterase
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39
Q

UTI tests possible confounders

A
  • Strict vegetarian diet = false (-)
  • Phenoazopyridine = false (+)
  • Tetracyclines
  • Vitamin C >250 mg
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40
Q

UTI test if (+):

A

Contact HCP immediately for assessment & treatment

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41
Q

UTI test if (-):

A

Contact HCP if symptoms persist

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42
Q

UTI counseling points

A
  • Collect clean sample
  • If symptoms present, contact HCP
  • Diet and medications may potentially interfere with results
  • OTC UTI detect only ~90% of infections
  • Visual difficulties should be advised to seek assistance in interpreting test results
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43
Q

Substance abuse tests: clinical presentation

A

Fatigue, red eyes, drowsiness, slurred speech, chronic cough, withdrawal from normal acticities

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44
Q

Substance abuse tests: urine test detects ____ vs hair test detects ____

A
  • Urine: low level, casual drug use (+: absence of line, -: presence of line)
  • Hair: longer-term drug use
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45
Q

Substance abuse tests potential confounders

A

Codeine, poppy seeds, decongestants, dextromethorphan, anti-diarrheal agents

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46
Q

Substance abuse tests if (+)

A

Consider if any potential problems with test used

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47
Q

Substance abuse test if (-)

A

Cannot assume accuracy

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48
Q

Substance abuse test counseling points

A
  • Limitations of the tests for confirming drug use and for identifying anything other than intended use
  • Length of time of suspected drug and type of drug used
  • Seek HCP advice and family counseling services
  • Potential confounders such as legal rx or non-rx medications that the pt may already be taking
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49
Q

Pregnancy tests detect ____, which may be present as early as ____ after conception

A

human chorionic gonadotropin (hCG); day 7

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50
Q

Pregnancy test accuracy and when to use

A
  • Will detect 95% of pregnancies
  • Use first morning urine bc that’s when hCG is the most concentrated
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51
Q

Pregnancy tests: false (+) may be a result of

A
  • Miscarriage or birth within previous 8 weeks
  • Ovarian cysts
  • Ectopic pregnancy
  • Perimenopausal
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52
Q

Pregnancy tests if (+)

A
  • Contact HCP ASAP
  • Check if pt is on teratogenic medication (ex., methotrexate)
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53
Q

Pregnancy tests if (-)

A

Review procedure to ensure appropriate testing; test again in 1 week

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54
Q

Pregnancy tests counseling points

A
  • Emphasize how and when to use the test: wait at least 1 week after the date of the expected period, morning urine, avoid getting up during the night to urinate
  • Potential confounding factors can cause inaccurate results
  • Seek medical attention if the 2nd test is (-) & menstruation has not begun
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55
Q

Insomnia exclusions for self-tx

A
  • <12 yo
  • > = 65 yo
  • Pregnant or breastfeeding
  • Frequent nocturnal awakenings or early morning awakenings
  • Chronic insomnia (>=3 months)
  • Sleep disorder secondary to psychiatric or general medical disorders
  • Significant sleep disturbances as defined by sleep-onset latency, WASO, sleep efficiency, &/or total sleep time
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56
Q

Insomnia nonpharmacologic therapy

A

Good sleep hygiene
- Only use bed for sleeping
- Regular sleep pattern (including weekends)
- Make the bedroom comfortable for sleeping: cooler temp, minimum/white noise, minimum light
- Engage in relaxing activities before bedtime
- Avoid daytime napping or limit to 20-30 mins
- If unable to fall asleep after more than 20 mins, do not continue to try to sleep -> get out of bed and perform a relaxing activity until you feel tired
- Do not watch the clock at night

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57
Q

Insomnia pharmacologic therapy: diphenhydramine effects, recommended uses

A
  • Effects: decrease time to fall asleep, improves quality of sleep
  • Uses: transient insomnia, occasional sleep problems, NOT for chronic bc may develop tolerance
  • Preferred agent
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58
Q

Insomnia pharmacologic therapy: doxylamine effects, recommended uses

A
  • Effects: decrease time to fall asleep, improves quality of sleep
  • Use: same as diphenhydramine; transient insomnia, occasional sleep problems, NOT for chronic bc may develop tolerance
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59
Q

Insomnia pharmacologic therapy: antihistamine warnings/precautions

A
  • Benign Prostatic Hyperplasia (BPH): may cause urinary retention
  • Glaucoma: may increase intraocular pressure
  • Dementia/Cognitive impairment: may increase confusion, decrease cognition
  • Cardiovascular disease: may increase HR
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60
Q

Insomnia pharmacologic therapy: antihistamine AEs

A
  • Sedation
  • “Hang over” effect
  • Anticholinergic effects: dry mouth, constipation, blurred vision, dizziness, urinary retention
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61
Q

Insomnia pharmacologic therapy: antihistamine use in special populations (elderly, pregnant/lactating women, children)

A
  • Elderly: sleep changes with age, avoid due to increased risk of falls & cognitive impairment
  • Pregnant: category B for safety
  • Lactating women: continuous use increases CNS effects in infants
  • Children: paradoxical rxn
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62
Q

Insomnia pharmacologic therapy: ethanol effects, AEs

A
  • Effects: decrease time to fall asleep
  • AEs: tolerance, restless sleep (nocturnal awakenings and reduction in overall sleep duration), rebound insomnia with cessation
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63
Q

Insomnia complementary therapies: melatonin effects, uses, beneficial for ___

A
  • Effects: helps with falling asleep
  • Use: chronic insomnia, jet lag
  • Beneficial for elderly & depressed pts
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64
Q

Insomnia complementary therapies: valerian effects, use, warnings/precautions

A
  • Effect: decrease time to fall asleep by increasing GABA
  • Use: chronic insomnia
  • Should tapered off with regular use to avoid benzodiazepine-like withdrawal syndrome, cardiac, hepatotoxicity risk with chronic use
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65
Q

Insomnia complementary therapies: kava effects, use, AEs

A
  • Effects: decreases time to fall asleep by increasing GABA, inhibit MAO, NE, DP
  • Use: chronic insomnia
  • AE: significant drowsiness and dizziness, hepatotoxicity, blood dyscrasias
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66
Q

Insomnia complementary therapies in special populations (elderly, pregnant/lactating women, children)

A
  • Elderly: limited data, melatonin OK
  • Pregnancy: avoid melatonin, valerian
  • Lactating: limited data
  • Children: melatonin may cause changes in hormonal levels
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67
Q

Drowsiness and Fatigue (DF) symptoms

A
  • Feeling foggy or woozy
  • Being responsive but not fully alert
  • Having dream like thoughts
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68
Q

DF exclusions for self-tx

A
  • <12 yrs
  • Pregnant or breastfeeding
  • Heart disease
  • Anxiety disorders
  • Medication induced drowsiness
  • Chronic fatigue defined as >=6 months of fatigue
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69
Q

DF nonpharmacologic therapy

A

Good sleep hygiene

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70
Q

DF pharmacologic tx: caffeine effects, AEs, warnings/Precautions

A
  • Effects: improves wakefulness by inhibiting adenosine A1 and A2A receptors -> adenosine promotes sleep
  • AEs: HTN, tolerance, withdrawal, sleep disturbances
  • W/P: CV
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71
Q

DF pharmacologic tx: caffeine dose-related SEs (low, moderate, high dose)

A
  • Low: increased arousal, decreased fatigue, elevates mood
  • Moderate: increased HR, BP
  • High: anxiety, nausea, jitteriness, nervousness
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72
Q

DF complementary therapy: ginseng effects

A
  • Boosts physical and mental energy
  • Decreases impotence
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73
Q

DF therapies in special populations (elderly, pregnant/lactating women, children)

A
  • Elderly: prolonged t1/2
  • P/LW: limit to <200mg/day to decrease risk of preterm birth or infant irritability
  • Children: more susceptible to CV and CNS effects
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74
Q

Insomnia & DF: refer to PCP if symptoms persist ____ days

A

> 7-10 days

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75
Q

Adult Nutrition (AN): causes of deficiency -> inadequate intake

A
  • Alcohol absorption
  • Vegetarian diet
  • Eating disorders
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76
Q

AN: causes of deficiency -> disease conditions

A
  • Crohn’s disease
  • Surgical resection
  • Bacterial overgrowth
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77
Q

AN: causes of deficiency -> malabsorption

A
  • From food
  • Lack of intrinsic factor
  • Lack of parietal cells
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78
Q

AN: Estimated Average Requirement (EAR) is

A

Average intake level estimated to meet the nutrient requirements of 50% of healthy people

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79
Q

AN: Recommended Dietary Allowance (RDA) is

A

Average daily level of intake sufficient to meet the nutrient requirements of nearly all 97.5% healthy people

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80
Q

AN: Adequate Intake (AI) is

A

Established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy based on observation

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81
Q

AN: Tolerance Upper Intake Level (UL) is

A

Maximum daily intake unlikely to cause adverse effects

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82
Q

AN: Stages of vitamin deficiency

A
  1. Inadequate nutrient delivery or absorption
  2. Depletion of nutrient stores
  3. Biochemical changes
  4. Physical manifestation of deficiency
  5. Morbidity and death
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83
Q

AN: vitamin and mineral deficiency clinical presentation of nails, hair, mouth, other

A
  • Nails: lack of luster to nail surfaces
  • Hair: loss and thin texture
  • Mouth: stomatitis, glossitis, pale gums, poor dentition
  • Other: visible goiter, poor skin color/texture, obesity/thinness, edema
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84
Q

AN: deficiency lifestyle modification

A
  • Consuming a balanced diet with food from all energy sources
  • Variety of nutrient-dense foods in moderate portion sizes
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85
Q

AN: purpose of supplementation and what supplements are NOT intended for

A
  • Prevent nutritional deficiencies
  • Replenish compromised nutrient stores
  • Maintain present nutritional status
  • NOT intended for self-tx for deficiency
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86
Q

AN: what are vitamins?

A
  • Nutrients that cannot be synthesized in the body in sufficient quantities and must be obtained through diet
  • Used as dietary supplements and therapeutic agents to treat deficiencies or other conditions
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87
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin A

A
  • F: visual adaptation to darkness, maintenance of epithelial cells, immune function, embryonic development, skin health
  • SD: night blindness, loss of appetite, impaired taste/smell
  • SC: hepatotoxicity, hypervitaminosis A, retinol (teratogenic at high doses)
  • FS: carotenoids (carrots, leafy greens, apricots, peaches), retinol (fatty fish, liver, meats, dairy, egg yolk)
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88
Q

AN: Function, signs of deficiency, safety considerations, sources of Vitamin D

A
  • F: bone formation and mineral homeostasis
  • SD: fatigue, bone pain, muscle weakness, rickets in children, osteoporosis in adults
  • SC: hyperCa, soft tissue calcification, kidney stones
  • S: red meat, egg yolks, fatty fish (tuna, salmon), sun exposure
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89
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin E (tocopherol)

A
  • F: antioxidant that protects cellular membranes from oxidative damage
  • SD: peripheral neuropathy, intermittent claudication, muscle weakness
  • SC: risk of bleeding/hemorrhagic stroke, increased risk of mortality (elderly with CVD)
  • FS: vegetable oils, nuts, seeds, leafy greens, fortified cereals
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90
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin K (phytonadione)

A
  • F: synthesis of clotting factors 2, 7, 9, 10 & anticoagulation proteins C, S
  • SD: increased/prolonged bleeding, elevated INR
  • SC: consistent dietary intake should not interfere with warfarin activity, changes to supplemental intake can significantly alter INR
  • FS: leafy greens (spinach, kale, swiss chard, brussel sprouts, broccoli)
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91
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin C (ascorbic acid)

A
  • F: precursor of collagen/osteoid/dentin, aids in wound healing, absorption of iron, immune function, common cold symptoms
  • SD: scurvy, fatigue, petechiae, swollen gums, may impair wound healing
  • SC: nausea, cramps, diarrhea, kidney stones, may interact with continuous glucose monitor if >500mg/day
  • FS: citrus, tomatoes, strawberries, broccoli, potatoes, kiwi, brussel sprouts, red/green peppers
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92
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B12 (cyanacobalamin)

A
  • F: RBC formation, cell metabolism, nerve function and the production of DNA
  • SD: neuropathy, mental confusion, agitation, poor muscular coordination, pernicious anemia
  • SC: excessive doses have not resulted in toxicity
  • FS: beef, fish, milk, cheese, eggs
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93
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B9 (folic acid)

A
  • F: cell devision/DNA production/brain & spinal cord development, women of child-bearing age should consume daily (prevent neural tube defects)
  • SD: soreness/ulcerations in mouth, diarrhea, irritability, forgetfulness
  • SC: excessive doses have not resulted in toxicity; may reduce efficacy of methotrexate used for cancer
  • FS: broccoli, brussel sprouts, leafy greens, chickpeas, kidney beans
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94
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B6 (pyridoxine)

A
  • F: heme & GABA production, heals with pregnancy-induced N/V
  • SD: peripheral neuropathy, oral lesions, scaliness of skin, dulled mentation
  • SC: may be toxic at high doses, causes sensory neuropathy
  • FS: pork, chicken, turkey, peanuts, oats, bananas
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95
Q

AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B1 (thiamine)

A
  • F: necessary for myocardial function, nerve cell function, CHO metabolism
  • SD: peripheral neuritis, weakness, Wernicke’s encephalopathy
  • SC: X toxicity
  • FS: whole grains, pork, fish, beans, lentils, green peas, sunflower seeds
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96
Q

AN: Function, signs of deficiency, safety considerations, food sources of Calcium

A
  • F: muscle contraction/relaxation, catalyze activation of plasma clotting factors, supplementation often used in osteoporosis
  • SD: bone deformities, behavioral disorders, growth deficiencies
  • SC: renal stones, permanent renal damage, N/V, constipation, polyuria
  • FS: milk, cheese, dairy products, leafy green
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97
Q

AN: which calcium formulation is acid-dependent?

A

Calcium carbonate

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98
Q

AN: Function, signs of deficiency, safety considerations, food sources, interactions of Iron

A
  • F: oxygen and electron transport
  • SD: blood loss, spoon shaped nails, sore tongue, dyspnea on exertion
  • SC: abdominal cramps, N/V, constipation, dark colored stools
  • FS: heme (beef, chicken, organ meats, oysters, clams, mussels), non-heme (beans, lentils, spinach, nuts, fortified cereals
  • I: separate 2-4 hrs from tetracyclines, fluoroquinolones, bisphosphonates, levothyroxine
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99
Q

AN: Function, signs of deficiency, safety considerations, food sources of Magnesium

A
  • F: bone structure formation, maintenance of nerve and muscle electrical potentials
  • SD: neuromuscular irritability, increased CNS stimulation, delirium, convulsions
  • SC: diarrhea may occur with large doses, muscle weakness, lethargy
  • FS: almonds, cashews, peanuts, spinach, pumpkin seeds
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100
Q

AN: what are functional foods (FF)?

A
  • Foods claimed to have additional function by adding new ingredients or increasing amount of existing ingredients
  • Foods in which concentration of one or more ingredients has been altered to enhance the nutrient content
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101
Q

AN: FF claim categories - Authorized Health Claims

A
  • Require publication of FDA regulation after extensive review of literature
  • Undergo the most thorough review by the FDA and meets significant scientific agreement
  • Cannot quantify degree of risk reduction and the terms “may” or “might” must be used
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102
Q

AN: FF claim categories - Qualified Health Claims

A
  • Level of evidence does not achieve “significant scientific agreement” but evidence of health benefits is still emerging
  • Require specific “qualifying terms” by the FDA
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103
Q

AN: FF claim categories - Structure-Function Claims

A
  • FDA authorization is not required before use
  • Prior notification of FDA regarding the claim is required
  • Cannot claim to reduce risk or cure disease
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104
Q

AN: exclusions for self-care enteral formulas

A
  • Organ dysfunciton
  • GI dysfunction
  • Significant unintended weight loss
  • Disease states affected by diet (DM, COPD)
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105
Q

Oral: Caries - nonpharmacologic therapy -> dietary measures

A
  • Avoid cariogenic foods: >15% sugar, clings to teeth, remain in mouth after chewed
  • Replace with non-cariogenic foods: high water content, stimulate saliva flow, high protein
106
Q

Oral: Caries - nonpharmacologic therapy -> toothbrush

A
  • Brush for 2 mins, 2 times daily
  • Soft
  • Replace every 3 months
107
Q

Oral: Caries - nonpharmacologic therapy -> dental floss

A
  • At least once daily
  • Requires finger dexterity and practice
  • Waxed, unwaxed forms
  • Removes interdental plaque
  • Reduce gingival inflammation
  • Prevents caries
108
Q

Oral: Caries - nonpharmacologic therapy -> oral irrigating devices

A
  • Direct high-pressure stream of water to the tooth surface
  • Remove minimal amount of plaque
  • Not a substitute for brushing or flossing
  • Will remove loose debris
109
Q

Oral: Caries - pharmacologic therapy -> Fluoride Dentifrices

A
  • Preventing and treating carious lesions
  • Children at risk of dental fluorosis ( <6: only by dentist, 6-12: supervise usage)
110
Q

Oral: Caries - pharmacologic therapy -> Astringent

A

Neutralize odoriferous sulfur compounds produced in the oral cavity

111
Q

Oral: Caries - pharmacologic therapy -> Demulcent

A

Provide protective film coating soothing to oral mucosa

112
Q

Oral: Caries - pharmacologic therapy -> Antibacterial

A

Fight pathogenic bacteria

113
Q

Oral: Caries - Listerine usage

A
  • Prevent and reduce plaque and gingivitis
  • Rinse with 1-2 tablespoons BID for about 30 secs after brushing
  • Avoid smoking, eating, or drinking for 30 mins after use
114
Q

Oral: Caries - Mouth rinse safety

A
  • May cause oral epithelium sloughing if containing: phenol oils, methyl salicylate, alcohol
  • Do not use in children <6 yrs
  • C/I: unsupervised use in mouth irritation or ulcerations
115
Q

Oral: What is Xerostomia?

A

Salivary flow limited or lacking = dry mouth

116
Q

Oral: Xerostomia - causes (medications, conditions, other)

A
  • Anticholinergics (antihistamines, antidepressants, antipsychotics), reduced salivary flow volume (antiHTN, diuretics), dries secretions (decongestants)
  • Sjogren syndrome, DM, depression, Crohn’s disease, radiation therapy of head/neck
  • Alcohol, tobacco, caffeine, spicy foods, mouth breathing
117
Q

Oral: Xerostomia - clinical presentations

A
  • Difficulty talking and swallowing
  • Stomatitis and burning tongue
  • Halitosis
  • Loss of appetite
  • Tooth hypersensitivity and caries, gingivitis, candidiasis
118
Q

Oral: Xerostomia - nonpharmacologic therapy

A
  • Avoid “drying” substances
  • Take culprit medications before meals (natural saliva stimulation)
  • Limit sugary, starchy, acidic foods
  • Chewing gum with sugar alcohols
  • Increase water intake
  • Cool mist humidifiers
119
Q

Oral: Xerostomia - primary pharmacologic therapy

A

Artificial saliva
- Mimics natural saliva
- Does not stimulate saliva secretion
- Can be used as needed

120
Q

Oral: Xerostomia - counseling and referral

A

Counseling:
- Practice good oral hygiene
- All populations can use artificial saliva
- Caution for sodium and preservatives (HTN)
Referral
- Self treat for up to 7 days: refer if no improvement
- Candidiasis, gingivitis, periodontitis
- Loose, broken, knocked out teeth
- Fever, swelling, severe pain
- Sjogren syndrome

121
Q

Oral: what is gingivitis?

A

Reversible inflammation of the gums

122
Q

Oral: Gingivitis - causes

A
  • CCBs, cyclosporine, phenytoin
  • Medications contributing to xerostomia
  • Tobacco use
  • Pregnancy
123
Q

Oral: Gingivitis - prevention

A
  • Antiplaque products and good oral hygiene
  • Can be cured with regular brushing and flossing: can return with poor care
124
Q

Oral: Gingivitis - patient counseling

A
  • Mild, reversible form of periodontal disease
  • Proper oral care is important for prevention and treatment
  • Can lead to worse periodontal disease and tooth loss if untreated
125
Q

Oral: what is tooth or dentin hypersensitivity?

A

Short, sharp pain arising from exposed dentin

126
Q

Oral: tooth or dentin hypersensitivity - predisposing factors

A
  • Periodontitis patients
  • Post dental procedures
  • Whitening treatments
  • Clenching or grinding teeth
127
Q

Oral: tooth hypersensitivity exclusions for self-treatment

A
  • Toothache
  • Mouth soreness associated with poor-fitting dentures
  • Fever or swelling
  • Loose teeth
  • Bleeding gums in the absence of trauma
  • Broken or knocked-out teeth
  • Severe tooth pain triggered or worsened by hot, cold, or chewing
  • Trauma to the mouth with bleeding, swelling, and soreness
128
Q

Oral: tooth hypersensitivity - nonpharmacologic therapy

A
  • Identify and eliminate predisposing factors (acid exposure, improper brushing technique)
  • Avoid brushing teeth within 30-60 mins of consuming acidic foods or drinks
  • Use soft bristle toothbrush
129
Q

Oral: tooth hypersensitivity - pharmacologic therapy

A
  • Brush with fluoride toothpaste for 7 days
  • if unresolved: desensitizing dentrifrices
130
Q

Oral: tooth hypersensitivity - desensitizing dentrifrices patient education

A
  • Use plaque removal brushing practices
  • Relief of sensitivity will not occur with single application
  • Use for 2-4 weeks may be needed
  • Avoid in children <12 yo
  • Do not use high-abrasion toothpastes
131
Q

Oral: What is Recurrent Aphthous Stomatitis (RAS)?

A
  • “Canker sore”
  • Female predominance
  • Affects nonkeratinized mucosa
  • Self-limiting 10-14 days
132
Q

Oral: RAS causes

A
  • Stress
  • Local trauma: smoking, chemical irritation, biting inside of cheeks/lips, injury caused by tooth brushing or braces
  • Genetic
  • Gluten food allergy
  • Hormonal changes
  • Medical conditions: Lupus, Neutrophil dysfunction, nutritional deficiencies (B1,2,6,12, folic acid, iron), IBD, HIV/AIDS
133
Q

Oral: RAS clinical presentation

A
  • Epithelial ulceration: movable oral mucosa
  • Common in tongue, floor of the mouth, soft palate, inside lining of the lips or cheeks
134
Q

Oral: RAS nonpharmacologic therapy

A
  • Food allergy: avoid
  • Supplement nutritional deficiencies
  • Apply ice in 10 min increments for max 20 mins/hr
  • Avoid: spicy/acidic foods, food activities that can cause trauma, heat
135
Q

Oral: RAS pharmacologic therapy - cleansing

A
  • Oral debriding and wound cleansing agents
  • No FDA approved product
  • Apply directly up to QID =<7 days, for 1 min
136
Q

Oral: RAS pharmacologic therapy - cleansing products and safety

A
  • Carbamide peroxide, hydrogen peroxide
  • Soft tissue irritation, enamel decalcification, cellular changes, black/hairy tongues
137
Q

Oral: RAS pharmacologic therapy - pain relief

A
  • Topical oral anesthetics
  • Benzocaine: temporary pain relief, caution hypersensitivity
138
Q

Oral: RAS pharmacologic therapy - oral rinses

A
  • Saline rinses: soothe discomfort, help prepare for topical medication
  • Baking soda paste: sooth discomfort, apply to area for a few mins
139
Q

Oral: RAS pharmacologic therapy - product selection

A
  • Hypersensitive pts avoid anesthetics (benzocaine)
  • Gel products = preferred
  • Debriding agents + anesthetics = help with pain and heal the lesion quicker
  • 7 days or until lesion is gone
  • Proper dental hygiene care
140
Q

Oral: teething - symptoms

A
  • Irritability
  • Sleep disturbances
  • Excessive drooling
  • Reddening
  • Low-grade fever
  • Slight swelling of gums
141
Q

Oral: teething - nonpharmacologic therapy

A
  • Massage the gum around the erupting tooth
  • Chew on: cold teething ring, cold wet cloth, dry toast, teething cookies
  • Plan dental check-up within 6 months of teething event + no later when child turns 1 yo
142
Q

Oral: teething - pharmacologic therapy

A
  • Avoid topical teething products in peds: no benzocaine in <2 yo
  • OTC topical anesthetic: APAP 10-15 mg/kg Q4-6H PRN, max 5 doses
143
Q

Oral: teething - when to seek medical attention

A
  • N/V
  • Diarrhea
  • Fever
  • Nasal congestion
  • Malaise
  • Symptoms not relieved with 2 days
144
Q

Oral: what is Herpes Simplex Labialis (HSL)?

A
  • Cold sores or fever blisters
  • Typically caused by HSV-1
  • Self-limiting 10-14 days
145
Q

Oral: HSL - triggers

A

UV radiation, stress, fatigue, cold, windburn, fever, injury, menstruation, dental work, infectious disease, immune suppression

146
Q

Oral: HSL - clinical presentation

A
  • Recurrent, painful, cosmetically objectionable
  • Prodromal phase
  • Initially: small, red, fluid filled papule
  • Lesion -> Crust forms
  • Pus under the crust: refer if secondary bacterial infection
147
Q

Oral: HSL - nonpharmacologic therapy

A
  • Wash hands
  • Maintain clean lesions: gently wash with mild soap solutions
  • Keep lesions moist to prevent drying
  • Avoid triggers
  • Use lip balm with SPF
148
Q

Oral: HSL - topical skin protectants

A
  • Relieve discomfort + dryness
  • Protect lesions from infection
  • Keep lesions soft
  • TID-QID after meals
  • No reduction of symptom duration
149
Q

Oral: HSL - topical anesthetic/analgesics

A
  • Symptomatic discomfort relief (burning, itching pain)
  • Does NOT reduce duration of symptoms
150
Q

Oral: HSL - Docosanol (Abreva)

A
  • Only FDA approved product to reduce duration + symptom severity
  • Apply at 1st sign of outbreak for 5 days until lesion is healed
151
Q

Oral: HSL - patient education

A
  • Secondary bacterial infection prevention: apply thin layer of topical triple-antibiotic ointment TID-QID
  • C/I: do not use topical steroids for HSL
152
Q

Acne cosmetica is

A

Noninflammatory, cosmetics, moisturizers, pomades, health/beauty products

153
Q

Acne excoriee is

A

Constant picking, squeezing, scratching at the skin

154
Q

Acne mechanica is

A

Local irritation from clothing, headbands, helmets, other devices

155
Q

Chloracne is

A

Acneiform eruption caused by exposure to chlorine compounds

156
Q

Drug-induced acne is

A

Anabolic steroids, bromides, corticosteroids, corticotrophin, isoniazid, lithium, phenytoin

157
Q

Hormone-induced acne is

A

Increased androgen levels

158
Q

Hydration-induced acne is

A

High-humidity environments and prolonged sweating

159
Q

Occupational acne is

A

Dirt, vaporized cooking oils, certain industrial chemicals

160
Q

Acne: nonpharmacologic therapy

A
  • Do: cleanse skin with non-abrasive, mild soap but no more than twice daily, hydrate, facial toners
  • AVOID: exacerbating factors, foods in high glycemic index
161
Q

Acne: pharmacologic therapy - Adapalene

A
  • > 12 yo, first-line, thin layer once daily, protect from sun exposure
  • Diminishes after 1st month, full effect up to 3 months
  • Refer to PCP: worsen in 3 months, pregnant, allergic rxn
162
Q

Acne: pharmacologic therapy - Benzoyl Peroxide

A
  • > 12 yo, 2-10% similar efficacy, avoid contact with clothes/hair due to bleaching
  • Results within 5 days to 3 weeks, up to 3 months, for adults and peds
163
Q

Acne: pharmacologic therapy - Sulfur

A
  • Natural glycolic, lactic, citric acids, less potent → longer duration (once every 15 days for 4-6 months)
  • For pts who cannot tolerate other topical acne products
  • Less AEs, have moisturizing and humectant properties
  • Provides protection from the sun, inhibits UVB radiation-induced formation of sunburn cells
164
Q

Acne: pharmacologic therapy - Hydroxic acids

A
  • For pts who cannot tolerate other topical acne products
  • Scarring and hyperpigmentation
165
Q

Acne: Product selection for mild acne oily vs dry skin

A
  • Oily: gel
  • Dry: cream and lotion
166
Q

Acne: Exclusion criteria for self-tx

A
  • Moderate-severe acne, exacerbating factors (comedogenic drugs, mechanical irritation), possible rosacea
167
Q

Fungal Infection (FI): Tinea pedis

A
  • Foot
  • Malodor pruritus/stinging sensation on feet, toe webs
  • Aggravation comes from warmth and humidity
168
Q

FI: Tinea unguium

A
  • Nail beds
  • Lose normal shiny luster → opaque
  • If left untreated, become thick, rough, yellow, opaque, friable
  • Can lose nail
169
Q

FI: Tinea corporis

A
  • Ringworm
  • Small, circular, erythematous scaly areas
  • Spread peripherally
170
Q

FI: Tinea cruris

A
  • Jock itch
  • More common in males
  • Bilateral, spare the penis and scrotum
  • Bright red, fine scaling
171
Q

FI: Tinea capitis

A
  • Scalp
  • Black dot
172
Q

Fungal skin infections: location, S/S, severity, onset, cause, modifying factors

A
  • L: areas of body where moisture is
  • S/S: soggy malodorous, thickened skin, cracks/fissures may be present, itching, pain
  • Severity: localized to single region, but could spread
  • Onset: variable
  • Cause: superficial fungal infection
  • MF: nonrx agents
173
Q

Fungal skin infection: general duration of treatment; when to refer to PCP

A
  • Can take bw 2 and 4 weeks or up to 6 weeks to resolve (long)
  • Refer: tinea unguium or capitis
174
Q

Fungal skin infection: Clotrimazole/Miconazole Nitrate

A
  • Damage fungal cell wall membrane
  • DDI: warfarin
175
Q

Fungal skin infection: Terbinafine hydrochloride

A
  • Relieves itching, burning, cracking, scaling
  • No DDI
176
Q

Fungal skin infection: Tolnaftate

A
  • Only OTC for both preventing and treating
  • Dry and scaly lesions
  • Relapse after discontinuation
  • No DDI
177
Q

Fungal skin infection: Clioquinol/Undecylenic acid

A
  • Adjunctive
  • Prevent fungal growth
  • Less effective on scalp or nails
  • AE: local skin irritation and burning
178
Q

Fungal skin infection: Salts of Aluminum

A
  • Adjunctive
  • External use only, should NOT be applied near eyes
179
Q

Fungal skin infection: Product Selection guidelines

A
  • Creams or solutions most effective
  • Patient adherence is important
180
Q

Warts are caused by

181
Q

Warts: risk factors

A
  • Existing/prior warts
  • Going barefoot
  • Nail-biting
  • Swimming pool and public shower use
  • Immunocompromised status
  • Chronic skin conditions
182
Q

Warts: hand - subtype(s) of HPV

A

2, 4, 27, 57

183
Q

Warts: foot - subtype(s) of HPV

184
Q

Common warts: location, population, description, self-tx?

A
  • L: hands
  • P: children
  • D: skin-colored/brown, dome-shaped, rough surface, typically painless
  • YES
185
Q

Flat warts: location, population, description, self-tx?

A
  • L: face
  • P: children
  • D: smooth, flat-topped, yellow-brown papules
  • No
186
Q

Plantar warts: location, population, description, self-tx?

A
  • L: feet
  • P: adolescents and young adults
  • D: skin-colored, flat, callus-like; can be painful
  • YES
187
Q

Mosaic warts: location, population, description, self-tx?

A
  • L: feet
  • P: adolescents and young adults
  • D: multiple, closely grouped plantar warts
  • No
188
Q

Periungual warts: location, population, description, self-tx?

A
  • L: nails
  • P: individuals that bite nails
  • D: thickened, fissured, cauliflower-textured skin around the nail plate
  • No
189
Q

Filiform warts: location, description, self-tx?

A
  • L: face
  • D: flesh-colored, rapidly growing, thread-like projections
  • No
190
Q

Warts treatment curable?

A

No cure for HPV infection

191
Q

Warts: nonpharmacologic tx

A
  • Prevent HPV spread: do not cut, shave, or pick at warts, use a designated towel to dry wart-affected areas, do not share towels, razors, socks, shoes, etc with others, keep the wart covered, avoid walking barefoot
  • Symptomatic relief: use lamb’s wool or moleskin on pressure points to relieve plantar wart discomfort
192
Q

Warts: pharmacologic tx - salicylic acid (MoA, indication, +/-, available products, counseling points)

A
  • Keratolytic agent: destroys infected cells
  • Only in common and plantar warts
  • (+): low $, readily available, few AEs, effective
  • (-): consistent and frequent application required, damages healthy skin, long duration of tx, irritating to skin
  • 17% for hand, 40% for foot
  • Refer when >12 weeks
  • Soak affected area in warm water for 5 mins
  • Wash and dry affected area thoroughly
193
Q

Warts: pharmacologic tx - cryotherapy (MoA, indication, office vs OTC formulation, efficacy, counseling points)

A
  • Liquid nitrogen destroy the lesion via freezing the tissue (office)
  • OTC: nitrous oxide or dimethyl ether and propane
  • Blister will form under the wart and cause it to fall off after 10 days
  • Soak affected area in warm water for 5 mins before use
  • Apply to the wart until a “halo” appears around it (20 secs for common, 40 secs for plantar)
194
Q

Warts: pharmacologic tx selection in special populations C/I

A
  • Pregnant and lactating women
  • Children <3 or those recovering from flu-like conditions should not use salicylic acid (children <4 avoid cryotherapy)
  • Diabetes or poor circulation
195
Q

Most common cause of corns

A

Inappropriate, tight-fitting shoes

196
Q

Common causes of calluses

A

Friction, walking barefoot, structural biochemical problems

197
Q

Types of calluses: Discrete-nucleated vs Diffuse-shearing

A
  • D-N: small, translucent, localized center, painful with applied pressure
  • D-S: large surface area, no central core
198
Q

Corns and Calluses (CC): nonpharmacologic therapy

A
  • Gentle, daily soaking in warm water for at least 5 mins
  • Circular foam cushioning pads
  • Well-fitting, non binding footwear
  • Orthopedic corrections
199
Q

CC: pharmacologic therapy - salicylic acid formulas and caution

A
  • Collodion-like vehicle: (+)- adhere, prevent moisture evaporation, (-)- flammable & volatile -> inhale & abuse, occlusion of water transport -> systemic absorption
  • Plaster/Disk/Pad: direct, prolonged contact of drug, quick resolution
  • Inflammation or ulcer formation: suboptimal technique, hazardous in pregnancy, breastfeeding pts
200
Q

CC: patient counseling

A
  • Remission: days- months
  • Footwear with adequate width and length
  • Only apply medication to corn or callus bc it is corrosive
  • No improvement or resolution in 14 days -> PCP
201
Q

CC: exclusions for self-tx

A
  • DM, peripheral circulatory disease
  • Hemorrhaging or oozing purulent
  • Anatomic defect or fault in body weight distribution
  • Extensive or painful, debilitating corns/calluses on foot
  • Proper, but unsuccessful self-med attempt
  • Hx of rheumatoid arthritis and complaint of painful metatarsal heads or deviation of great toe
202
Q

Cause of ingrown toenails (IngT)

A

Incorrect trimming of nails

203
Q

IngT: nonpharmacologic therapy

A
  • Educate on prevention of ingrown toenail formation
  • Adequate room for nail to revert to normal position
  • Soak affected area for 10-20 mins in warm water multiple times/day
204
Q

IngT: pharmacologic therapy

A
  • Topical anesthetics (benzocaine): prevent opportunistic infections
  • Sodium sulfide 1% topical gel + retainer ring: softens nail or hardens nail bed
  • Oral NSAIDs: aspirin, ibuprofen, naproxen
205
Q

IngT: exclusions to self-tx

A
  • DM, peripheral circulatory disease, arthritis
  • Foot malformations
  • Physical or mental impairment
  • Pus or oozing discharge at the affected site or inflammation, redness, or pain beyond site of IngT
206
Q

IngT: medical referral

A

3-4 weeks w/o relief or condition worsens

207
Q

Alopecia phases (ACTE)

A
  • Anagen: active hair growth
  • Catagen: end of active hair growth
  • Telogen: resting period
  • Exogen: hair strands released
208
Q

Causes of Alopecia

A
  • Physiological stress
  • Chronic illnesses: rheumatoid arthritis, lupus, eating disorders
  • Medications: ACEi, allopurinol, androgenic, anticonvulsants, anticoagulants, antidepressants, BB, cholesterol-lowering, chemotherapeutic
  • Dietary changes: protein restriction/deficiency, rapid weight loss, Zinc, biotin or iron deficiency
209
Q

Alopecia: androgenetic alopecia (AGA) cause & clinical presentation

A
  • Hereditary hair loss
  • Gradual onset with progression of gender-specific hair loss
  • Most common
  • Only self-treatable
210
Q

Alopecia: exclusions for self-tx

A
  • <18 yo
  • Postpartum, pregnant, breastfeeding
  • Hair loss related to endocrine dysfunction or medical tx
  • No family hx of hair loss
211
Q

Alopecia: nonpharmacologic therapy

A
  • Wigs/hair weaves
  • Scalp-camouflaging
  • Surgical transplantation
212
Q

Alopecia: pharmacologic therapy agent, indication, direction, AEs, counseling points

A

Minoxidil
- Only FDA approved for self tx AGA
- Men: 2%, 5% solution, 5% foam
- Women: 2% solution, 5% foam
- Allow 2-4 hrs for drug to penetrate the scalp
- AEs: itching, irritation, dryness, hypertrichosis (excess hair growth)
- Avoid pregnancy
- D/C if no improvement in 4-6 months
- Increase in hair loss may occur w/i first few wks of use
- Must continue to use product indefinitely to maintain new growth
- Avoid use day of and for 24 hrs after using permanent hair color products

213
Q

Allergic Rhinitis (AR): risk factors

A
  • Family history
  • Elevated serum IgE >100 IU/mL (<6 yo)
  • Eczema or AREA triad
  • Higher socioeconomic level
  • Positive rxn to allergy skin tests
  • Diet?
214
Q

AR classification based on duration

A
  • Intermittent: =<4 days per week or =<4 weeks
  • Persistent: >4 days per week and >4 weeks
215
Q

AR classification based on severity

A
  • Mild: do not impair sleep or daily activities
  • Moderate-severe: impairment of sleep/daily activities, troublesome symptoms
216
Q

AR treatment algorithm

A
  1. Allergen avoidance
  2. Pharmacotherapy
  3. Immunotherapy
217
Q

AR assessment and management approach

A
  • Assess in 2-4 weeks
  • Controlled symp: intermittent = continue prn, persistent = continue for 1 month
  • Uncontrolled: adherent = increase dose or switch to alternative, nonadherent = pt education
218
Q

AR exclusions for self-tx

A
  • <12 yo
  • Pregnant or lactating
  • Symptoms of infection: otitis media, sinusitis, bronchitis, other infection, asthma, COPD
  • Severe or unacceptable SEs of tx
219
Q

AR pharmacologic tx for mild intermittent

A

Oral antihistamine

220
Q

AR pharmacologic tx for moderate-severe intermittent

A

Intranasal corticosteroids or oral antihistamine

221
Q

AR pharmacologic tx for mild persistent

A

Intranasal corticosteroids or oral antihistamine

222
Q

AR pharmacologic tx for moderate-severe persistent

A

Intranasal corticosteroids preferred

223
Q

AR pharmacologic tx with congestion

A

Add oral or topical decongestant

224
Q

AR pharmacologic tx with conjunctivitis

A

Add oral antihistamine, intraocular antihistamine or saline

225
Q

AR: 1st gen antihistamines caution

A
  • Beers criteria: avoid in elderly
  • CNS: depression, anxiety, sedation (Lipophilic)
  • Anticholinergic: blurred vision, urinary retention, tachy, constipation
226
Q

AR: 2nd gen antihistamine caution

A
  • Renal dose-adjust
  • Non-sedation (Lipophobic)
227
Q

AR: diphenhydramine - gen, brand, consideration

A
  • 1st
  • Benadryl
  • Use: Allergic rx combination products
228
Q

AR: doxylamine - gen, brand, consideration

A
  • 1st
  • Unisom
  • Use: Insomnia
229
Q

AR: chlorpheniramine - gen, brand, consideration

A
  • 1st
  • ChlorTrimeton
  • Also used for motion sickness
230
Q

AR: 2nd gen antihistamines from least sedative to most sedative

A

Loratidine < desloratadine < fexofenadine < levocetirizine < cetirizine

231
Q

AR: loratidine - brand, gen, OTC/Rx, age, consideration

A
  • Claritin
  • 2nd
  • OTC
  • > = 2yrs
  • Least sedative 2nd gen
232
Q

AR: desloratadine - brand, gen, OTC/Rx, age, consideration

A
  • Clarinex
  • 2nd
  • Rx
  • > = 6 months
  • ADR: headache
  • Infants: diarrhea, upepr respiratory infection, fever
  • Dose adjust for hepatic impairment
233
Q

AR: fexofenadine - brand, gen, OTC/Rx, age, consideration

A
  • Allegra
  • 2nd
  • OTC
  • > 2 yrs
  • Avoid fruit juice/antacids
234
Q

AR: levocetirizine - brand, gen, OTC/Rx, age, consideration

A
  • Xyzal
  • 2nd
  • OTC
  • > = 6 months
  • ADR: diarrhea
235
Q

AR: cetirizine - brand, gen, OTC/Rx, age, consideration

A
  • Zyrtec
  • 2nd
  • OTC
  • > = 6 months
  • Most sedative 2nd gen
  • Food decreases absorption
236
Q

AR: intranasal antihistamines - indication, ADR, agents (generic, brand, OTC/Rx, age, misc)

A
  • More effective for congestion
  • ADRs: bitter taste, headache, epistaxis
  • Azelastine (Astepro), OTC, >= 6 yrs, avoid alcohol
  • Olopatadine (Patanase), Rx, >= 6 yrs, mast cell stabilizer
237
Q

Allergic conjunctivitis (AC) symptoms, nonpharmacologic tx

A
  • Watery, itchy, red eyes
  • Allergen avoidance, avoid rubbing eyes, cold compress
238
Q

AC treatment algorithm

A
  1. Artificial tears
  2. Dual-acting antihistamine & Mast cell stabilizers
  3. Decongestants or other antihistamines
239
Q

AC Olopatadine - MoA, viscosity trend, age

A
  • Antihistamine + MCS
  • Higher %, more viscous
  • > =2 yo
240
Q

AC Ketotifen - MoA, AEs, counseling tips, age

A
  • H1 receptor antagonist & MCS
  • AE: headache
  • Do not use solution if it is cloudy, remove contact lens prior to administration and wait 10 mins before reinserting them
  • > = 3 yo
241
Q

AC Intraocular decongestant MoA, AEs, examples

A
  • Alpha1 agonist: vasoconstriction of conjuctival vessels
  • AEs: burning, stinging, local dryness
  • Naphazoline, tetrahydrozoline
242
Q

AC Antihistamine MoA, AEs, example

A
  • Histamine1 antagonist
  • AEs: burning, stinging, pupil dilation
  • Pheniramine
243
Q

AC Intranasal corticosteroids (INCS) indication, MoA, counseling tips

A
  • Itching, rhinitis, sneezing & congestion
  • Anti-inflammatory
  • Shake well
244
Q

AC: INCS ADRs, DDIs, C/Is

A
  • ADRs: local irritation, pharyngitis, epistaxis
  • DDIs: Avoid strong CYP3A4 inhibitors (Ketoconzaole, Ritonavir, Clarithromycin) -> systemic effects (headache, dizziness, N/V)
  • C/I: hypersensitivity
245
Q

AC: INCS OTC products

A

Nasacort, Flonase, Rhinocort, Nasonex

246
Q

AC: INCS Budesonide - brand, do not use in children ___

A
  • Rhinocort Allergy Spray
  • <6 yo
247
Q

AC: INCS Fluticasone furoate - brand, do not use in children ___

A
  • Flonase Sensimist
  • < 2 yo
248
Q

AC: INCS Fluticasone propionate - brand, do not use in children ___

A
  • Flonase Allergy Relief
  • < 4 yo
249
Q

AC: INCS Triamcinolone acetonide - brand, do not use in children ___

A
  • Nasacort Allergy 24 HR
  • < 2 yo
250
Q

AC: INCS Mometasone - brand, do not use in children ___

A
  • Nasonex
  • <2 yo
251
Q

AC: INCS considerations

A
  • More effective than oral antihistamines for nasal congestion
  • Avoid use if nasal trauma
  • Onset in 3-5 hrs, reach efficacy within 1 week
  • Proper nasal spray usage
252
Q

AC: Decongestants MoA, indication

A
  • alpha-adrenergic agonist: constrict blood vessels to decrease mucosal swelling
  • temporary symptomatic relief of intermittent allergic rhinitis with signs of congestion
253
Q

AC: types of decongestants and example

A
  • Direct-acting: oxymetazoline
  • Indirect-acting: ephedrine
  • Mixed: pseudoephedrine
254
Q

AC: decongestant counseling

A
  • May exacerbate diseases sensitive to adrenergic stimulation (HTN, cardiac, diabetes)
255
Q

AC: decongestant DDIs, C/Is

A
  • DDIs: Linezolid (HTN), SNRI (duloxetine, venlafaxine -> tachycardic), MAOIs (HTN), Ergot derivatives (HTN, vasoconstriction)
  • C/Is: MAOIs, ergot derivatives
256
Q

AC: oral decongestant example, age

A
  • Pseudoephedrine (Sudafed)
  • Adults and children >=12 yo
257
Q

AC: topical decongestants ADRs, OTC agent examples

A
  • ADRs: burning, stinging, sneezing, local dryness
  • Rhinitis medicamentosa: rebound congestion -> limit use to 3-7 days
  • Oxymetazoline (Afrin, Vicks, Zicam), Phenylephrine (Neo-Synephrine)
258
Q

AC: cromolyn sodium indication, OTC/Rx products, Considerations

A
  • Allergic rhinitis prevention (safe for children & pregnancy)
  • OTC: Nasalcrom
  • Rx: Crolom for conjunctivitis
  • C/I: hypersensitivity
  • Administer 3-4 times/day, initiate prior to allergen exposure/symptoms
  • Symptomatic relief takes 1-2 weeks
259
Q

AC: combination therapy considerations indication, combinations

A
  • Indic: inadequate response to monotherapy, moderate-severe AR
  • INCS + Intranasal antihistamine or Intranasal Decongestant
  • Oral antihistamine + Oral decongestant
260
Q

AC: combination therapy to avoid

A
  • Oral antihistamine + INCS -> Lack efficacy
  • Leukotriene Antagonists + INCS or oral antihistamine -> No benefit
  • Multiple agents from the same class

Self/Home Care (3 decks)

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