Exam 3 Flashcards

Question

Do not self treat for oral pain

Answer 1

Toothache (first time and/or no history of toothache) Mouth soreness associated with dentures Fever or swelling Loose teeth Bleeding gums Broken teeth Severe tooth pain Trauma to mouth

Answer 2

1. Repair damaged tooth surface 2. Correct inappropriate tooth brushing tech

Answer 3

-Stop triggers -Avoid toothbrushing within 30-60 min of acidic foods and drinks -Correctly brushing teeth with fluoride toothpaste

Answer 4

Standard toothpaste with fluoride Desensitizing tooth paste Follow up: Standard toothpaste with fluoride and soft bristled brush Refer if no improvement after 14 days of desensitizing toothpaste

Answer 5

MOA: depolarizes nerves in tubules and pulp to block perception of stimuli; seals exposed dentin Indication: tooth hypersensitivity Dosing: brush with 1 in strip BID DI: Sodium or stannous fluoride Avoid: High abrasion toothpastes, whitening toothpastes No concern for preg and lact

Answer 6

MOA: depolarizes nerves in tubules and pulp to block perception of stimuli Indication: tooth sensitivity Avoid: using fluoride toothpaste at the same time Dosing: brush with 1 in strip BID

Answer 7

Canker sore or aphthous ulcer Etiology: genetic, food sensitivity, local trauma Signs and symptoms: Epithelial, circular ulcer on movable mouth surfaces Lasts 5 to 14 days, 0.5 to 2 cm

Answer 8

-If underlying cause -Lesions present for 2 weeks or more -Frequent recurrence -Sx of systemic illness -Self-care ineffective

Answer 9

1. Relieve pain and irritation 2. Heal lesions 3. Be able to eat/drink and do usual oral care 4. Prevent secondary infection 5. Prevent recurrence

Answer 10

-Correct any diagnosed nutritional deficiencies -Avoid food allergy triggers -Avoid spicy, acidic, textured foods -Apply ice to lesions x 10 min; max 20 min in an hour -DIY salt rinses

Answer 11

Topical 1.Oral debriding and wound cleansing agents (MOA: release of molecular oxygen) USE: up to 4x daily for 7 days AVOID: toothpastes containing sodium lauryl sulfate *DIY baking soda paste 2. Topical oral anesthetics 3. Topical oral protectants 4. Oral rinses Follow up: 7 days of treatment or 14 days since lesion/s first appeared SE of topical

Answer 12

MOA: protect, decrease friction, provide temp relief Coat ulcer with topical oral protectants Rinses: Listerine or saline rinse (1 to 3 tsp salt in 4 to 8 oz of tap water)

Answer 13

Etiology: dental procedures, accidental injury Do not self treat: same as tooth hx Goals of therapy: control discomfort, aid healing, prevent secondary bacterial infection Non-pharmacotherapy: Sodium bicarbonate Saline rinse (MOA: debride, clean wound, stimulate health) Ice x 10 min (max 20 min in an hour)

Answer 14

1. Topical analgesics 2. Oral protectants 3. Oral debriding/wound cleansing Astringents: tissue contraction, stop secretions When to refer? Sx persistent after 7 days treatment or 10 days of initial injury Sx worse during treatment Sx of infection develop

Answer 15

Infected for life Symptoms: burning itching numbness Visual: crusted or fluid filled lesions Spontaneous healing over 10 days

Answer 16

-lesions present more than 14 days -Increased outbreak frequency -Symptoms of infection -No prior cold sore

Answer 17

-Relieve pain and irritation -Prevent secondary infection -Prevent spread of lesions

Answer 18

Keep lesions clean Handwashing Avoid sharing utensils Moisture involving skin Avoid triggers that slow healing Facial/lip sunscreen (sun trigger) Tea tree oil, lysine, lemon balm

Answer 19

Topical skin protectants External analgesics/anesthetics Docosanol 10% Follow up if persist > 14 days

Answer 20

MOA: inhibits fusion of virus to cell membrane; prevents viral replication Indication: reduce duration and severity PD: decreases time to heal by ~1 day No SE AVOID: placing aspirin on lesions, hydrocortisone, astringents, zinc sulfate Dosing: Apply 5x/day max 10 days

Answer 21

Many health conditions Radiation therapy Medications: 1 gen antihistamines, decongestants, diuretics, TCAs, antipsychotics, sedatives Excessive alcohol, caffeine consumption Mouth breathing

Answer 22

Tooth erosion, or decay Candidiasis, gingivitis Decreased denture wearing time Mouth soreness due to dentures Fever or swelling Loose teeth Broken teeth Severe tooth pain Mouth trauma Sjogren syndrome

Answer 23

-relieve discomfort and any symptoms such as difficulty talking -reduce risk of dental decay -prevent and treat associated infections if any

Answer 24

Avoid tobacco, caffeine, hot spicy foods, alcohol Limit sugary and acidic food Increase water consumption Very soft bristle brushes

Answer 25

Severe dry skin on or around lips Etiology: -Dry or cold weather -Excessive sun exposure -Frequent licking of lips -Food sensitivity -Personal care products (lip balm, lipstick, etc.) -Meds: Retinoids -Health conditions: eczema, Crohn's disease

Answer 26

Artficial saliva products MOA: mimics natural saliva Indication: dry mouth SE: hx if preservatives DI: None Avoid: sodium based products if low salt

Answer 27

1. Avoid licking/peeling/biting/exfoliating lips or surrounding skin 2. Protect lips with quality lip balm -Best is beeswax or petro jelly -Dimethicone: seals off cracks in lips Apply 6-8 coats during day 3. Hydrate 4. Avoid irritants 5. Breathe through nose rather than mouth *Refer if severely cracked or swollen or doesn't improve with above steps

Answer 28

Intrinsic: within tooth structure Extrinsic: surface of tooth Do not self treat: Intrinsic (or 1 tooth) Goals of therapy: lighten color/whiten teeth OTC options: 1. Bleaching ingredients/products -Hydrogen peroxide, carbamide peroxide 2. Nonbleaching ingredients/products =whitening toothpastes -Ingredients: Bicarbonate, hydrated silica -Lightens stains and helps prevent new stains

Answer 29

Use of a substance harmful to the body Routes: Oral, inhaled, injected, topical

Answer 30

Medication used for medical purposes but used incorrectly -taking a dose or taking differently other than as directed -taking the medication for an effect it can cause -mixing OTC meds together to create new products

Answer 31

Use of OTC meds for non-med purposes

Answer 32

Most poison exposures are unintentional and/or in children so it's our responsibility as pharmacists to educate patients and parents on proper OTC administration

Answer 33

Call 911 or refer to hospital ED if person is: -Lethargic or comatose -Decreased resp. frequency -Abnormal BP or pulse -Has taken meds that may cause seizures or decrease in consciousness

Answer 34

Fumes: remove person from fumes to fresh air Skin/mucosal surfaces: water irrigation Eye: water irrigation

Answer 35

1-800-222-1222

Answer 36

Tooth discoloration and staining can occur in two different ways, only one of which is generally treatable with teeth whitening products.

Answer 37

No because they are considered to be cosmetic products so the FDA doesn't regulate them

Answer 38

-18 in of floss and wrap around most of middle finger -Wrap remaining around the same finger of the opp hand (1 in floss between thumbs and forefingers) -Do not snap floss down between teeth (gentle sawing motion) -When reach gumline floss into a C shape against one tooth -Scrape side of tooth with an up-down motion -Advance floss with each tooth and repeat procedure

Answer 39

-Brush teeth after each meal or at least twice a day -Apply a small amount of paste to the toothbrush -Use a gentle scrubbing motion and hold brush at 45 degrees -No excessive force -Brush for at least 2 minutes, cleaning all tooth surfaces -Brush tongue -Rinse mouth and spit

Answer 40

Tooth Hx: Exposed and open dentin tubules Stimuli cause fluid in dentinal tubules to expand and shrink, which stimulates pulp nerve fibers and results in pain Caused by attrition, abrasion, erosion, etc. Sx is a quick, fleeting, sharp or stabbing pain Hx due to attrition, abrasion, or erosion is self treatable, and all others require dental referral Toothache: Bacterial invasion extending to the pulp Inflammatory response to invading bacteria stimulates free nerve endings in the pulp Caused by cavitation/decay present in tooth/teeth under existing restoration, etc. Pain that remains even in absence of stimulus Requires dental referral in all cases

Answer 41

Burning in the stomach or lower chest; may extend up toward neck and occasionally to the back -Main symptom of GERD -Occurs within 1 hour after eating; often after large meal; worsened by lying down

Answer 42

Chronic condition; Frequent reverse flow of stomach acid and content into the esophagus *Not for pharmacists to recommend therapy *Heartburn 2 or more times per week Complications: esophagitis, esophageal stricture, Barrett's esophagus (pre-cancerous condition)

Answer 43

Symptoms originate from gastroduodenal region and occur together *Early satiety, post prandial fullness, epigastric pain -Can also be known as indigestion Symptoms: Anorexia, belching, n/v, upper abdominal bloating, heartburn, regurgitation

Answer 44

Help to keep acid and stomach contents in stomach -LES contracting at rest

Answer 45

Alarm symptoms (dysphagia, odynophagia, vomiting, GI bleeding, unexplained weight loss) Atypical symptoms (noncardiac chest pain, asthma, voice changes, feeling of "lump in the throat", chronic cough, etc.)

Answer 46

-Acupuncture for reflux, GERD sx, dyspepsia -Melatonin -Weight loss -No food within 2-3 hours of bedtime -Sleep on left side -Elevate head -Stop tobacco use -Limit/stop alcoholic beverage intake -Mediterranean diet

Answer 47

Consider: Sx: Frequency, duration, severity Medication cost Drug-drug interactions Adverse effects Patient preference Medications: 1. Antacids (Rapid relief and short term) 2. Histamine 2 receptor antagonists (Slower relief 14 days max) 3. Proton pump inhibitors (Slower relief 14 days max) 4. Bismuth subsalicylate

Answer 48

1. If initial therapy with Antacid or combo or H2RA doesn't work try different agent or refer 2. If initial therapy is helpful then continue 3. If heartburn 2 or more days per week and take PPI once daily x 14 days or H2Ha as needed (May repeat PPI every 4 months if needed or continue H2HA PRN)

Answer 49

MOA: Neutralize gastric acid Indication: treatment of mild, infrequent heartburn, sour stomach, and acid indigestion Pharmacodynamics: Onset is within 5 min Duration can vary Pregnancy: Calcium and Magnesium ok (AL NOT) Lactation: Aluminum, calcium, magnesium ok

Answer 50

Aluminum: constipation (manage by taking AL + Mg), hypophosphatemia Magnesium: Diarrhea (manage by taking AL + Mg) Dosing: -Product recommended doses; don't exceed -Take dose at symptom onset -Repeat dose in 1-2 hours if needed *Reevaluate if -Using more than twice a week -Regularly for more than 2 weeks

Answer 51

Many Antifungals --> decreased absorb (separate by 2 hours) Amphetamines --> decreased excretion (AVOID) Rosuvastatin --> decreased absorption (separate by 2 hours) Enteric-coated meds --> Premature breakdown of meds (separate by 2 hours) Anything ending with -nib or -vir (separate by several hours) Levothyroxine (separate 4 hrs) Tetracyclines (separate 4 hours) Fluoroquinolones (2 hours prior or 6 hours after) Azizthromycin (separate by 2 hours)

Answer 52

Cimetidine, famotidine MOA: reduce acid secretion by inhibiting histamine at the H2 receptors on parietal cells in lining of stomach Indication: Mild to moderate HB Pharmacodynamics: Onset is within 30-45 min and lasts many hours SE: Infrequent (cimetidine can cause impotence or breast enlargement) Avoid: In older adults and children younger than 12 *Ok to use both for pregnancy but want to watch out for developing childhood asthma *Use famotidine for lactation

Answer 53

Iron sulfate and calcium carbonate (Decreased absorption; AVOID) Warfarin, clopidogrel, TCAs (Decreased metabolism; AVOID) Citalopram --> Max 20 mg per day or avoid (Increased citalopram concentration) Dosing: 200 mg CImetidine daily, 10-20 mg famotidine once or twice daily (max 40 mg) Take an hour prior to expected HB *Tolerance develops if used daily

Answer 54

Esomeprazole-DR Lansoprazole-DR Omeprazole-DR/IR MOA: Inhibit hydrogen potassium ATPase in stomach parietal cells Indication: HB symptoms 2 or more days per week Pharmacodynamics: -May need 1 to 4 days for full effect SE: Uncommon -Increased risk for travelers diarrhea, and CDIF Avoid: Crush/chew tablets and capsules Severe diarrhea Younger than 12 Older adults Pregnancy: lansoprazole and omeprazole is safe Lactation: low milk on omeprazole and esomeprazole

Answer 55

30-60 min prior to meal Max 14 days 1 course every 4 months max Iron sulfate, calcium carbonate --> decreased absorption; AVOID Warfarin --> Increased conc; AVOID Citalopram --> increased citalopram conc; Max 20 mg citalopram per day or AVOID Clopidogrel --> decreased conversion to active form; AVOID

Answer 56

MOA: protects gastric mucosa Indication: HB, upset stomach, indigestion, nausea, diarrhea Pharmacodynamics: Onset and duration is 30-60 min SE: Black tongue/stool, tinnitus DI: ABSOLUTELY AVOID WARFARIN, TETRACYCLINE, AND METHOTREXATE Avoid: children < 18, salicylate sensitivity/allergy, bleeding risks Dosing: -262-525 mg every 30/60 min PRN -Chew tablets thoroughly (if chewable) -Nonchew: full glass water *MAX 48 hours of use Use another drug if pregnant or lactating

Answer 57

Pregnancy: -Lifestyle/food changes first -First line OTC is antacid (calcium or magnesium) -Max calcium per day: 2500 mg Children older than 2 years with mild, transient, infrequent HB: Children's formulas of antacid Refer if frequent HB or antacid ineffective Older adults: -Triage carefully as HB can be symptom of more serious pathology -Consider drug-drug -Consider other health conditions and kidney function -Avoid H2RAs if high risk for delirium -Short course PPI ok but risk for SE sith long term use

Answer 58

GI -Stomach capacity doubles by 1 month old -Need more frequent feedings because human milk empties rapidly from the stomach -Shorter small intestine so nutrient absorption is affected Kidneys -Filtration begins early on in the fetus (week 9) -GFR reaches adult values in 3rd year of life Nutritive sucking -Depends on coordination of sucking, swallowing, and breathing -Swallowing develops by end of first trimester; sucking develops ~22-33 weeks gestation -Effective sucking = rhythmic alternation between suction and swallowing -Nutritive sucking develops very late in gestation and -Premature infants have an inefficient pattern for >1 month or more Gastric Motility is delayed in the first few days of life

Answer 59

AVERAGE BIRTH WEIGHT: 7 LBS 11 OZ Low birth weight: <2500 g (5 lbs 8 oz) Very low: less than 1500 g (3 lbs 4 oz) Extremely low: less than 1000 g (2 lbs 2 oz) Micropremies: less than 750 g (1 lb 10 oz) *Water weight loss immediately after birth: 6-10% Double by 4-6 months and triple by 12 months Normal values for length/height, weight and head circumference: expressed in percentile for age

Answer 60

Water Carbs Proteins and Amino Acids Fat and essential fatty acids Micronutrients

Answer 61

Holliday-Segar method First 10 kg: 100 mL/kg Second 10 kg: 50 mL/kg Each additional kg: 20 mL/kg *Greater needs for premature infants *Daily fluid losses: Urine, evaporation from skin/lungs, feces Ex: 22.8 kg child 1000 + 500 + 40 + 16 1556 mL water

Answer 62

40-50% of daily caloric needs *Primary source for infants is from lactose (human milk - or milk based formula) *Balance with fat intake for proper neurologic development *Fiber from cereals, green veggies, legumes (6-12 months)

Answer 63

Total body protein increases from 11 to 15% of body weight in 1st year Human milk protein content changes with growing infant needs *Preterm infants have higher protein needs Essential AA: His, Ile, Leu, Lys, Met, Phe, Thr, Trp, Val *Cys and Thr not essential Taurine is especially important -High amounts in human milk, and supplemented in all formulas -Not source of energy -Cell membrane protector, conjugates bile acids -Deficiency: affects vision, hearing, and fat absorption

Answer 64

*9 kcal/gram (vs 4 kcal/gram for protein/carb) 50% of non-protein energy in human milk/formula Fat is needed for proper growth and development *Do not restrict fat if younger than 2 years unless advised to do so Age 12 months to 2 years and at increased risk for CVD: reduced fat milk products as advised by medical professional 2 essential polyunsaturated fatty acids (PUFAs) Arachidonic Acid (ARA) Docosahexaenoic acid (DHA) *If you give DHA without ARA it can lead to growth suppression *Don't supplement while pregnant or lactating Essential fatty acid deficiency is rare in the US Linoleic acid = most of PUFAs in formulas

Answer 65

1. Formulas supplemented to meet daily needs 2. Human milk needs fortification to meet needs of premature infants

Answer 66

Human milk Animal milk Commercial infant formulas

Answer 67

Infants should be breast feed for first 6 months and through 12 months if appropriate

Answer 68

-optimal nutrient source for infant -improved bonding -decreased risk of infant infections -decreased risk of SIDs, diabetes, etc. -possible enhanced performance on cognitive development -decreased bleeding (menstrual and post partum) -decreased risk of cancer and other diseases

Answer 69

1. HIV infection 2. Infant galactosemia 3. Parental untreated TB 4. Parental human T cell lymphotropic virus type I or II 5. Presence of a herpes simplex lesion on the breast 6. Parental use of contraindicated meds

Answer 70

Cow: Don't use for infants < 1 yr Avoid evaporated milk Reduced fat NOT for < 2 years Source of commercially prepared, milk based infant formula Goat: Fat digested more easily than cow milk Must be fortified with folate iron and vitamin D

Answer 71

4 types: Premature, newborn, infant/toddler, or specific health condition Manufactured as: 3 basic types: milk-based, soy protein, or casein hydrolysate based 3 formulations: concentrated liquid, powder, or ready to feed *Standard, fortifier, therapeutic, and modular Varying compositions to best feed individual infant needs

Answer 72

Liquid formulations manufactured to be sterile -Powdered formulations not required or guaranteed to be sterile *Premature and immunocompromised infants should only receive liquid formulations STANDARD CALORIC DENSITY: 20 KCAL/OZ Can fortify or increased conc by altering amount of water added but only do so with medical advice

Answer 73

Can add to either human milk or infant formula; alternative to concentrated formula *Use macronutrients components only with medical advice **PROTEIN POWDER, carbohydrates, fat, combinations -More expensive and time-consuming than concentrating formula -Use modular when you only need to add a single ingredient or when you don't need to concentrate further

Answer 74

Parents who give birth to premature infants produce breast/chest milk that is higher in nutrients Need to supplement in addition to breast milk -All supplementation products are liquid (and sterile) -Mixed into 60-100 mL of human milk

Answer 75

For infants with health conditions that require a dietary adjustment *Used with medical supervision*

Answer 76

Younger the baby the more feedings you need need to do *avoid over and under feeding

Answer 77

Potential formula-related cause if incorrect dilution of concentrated product or incorrect addition of modular product Severe More than 72 hours Bloody stool Projectile vomiting or green, bilious vomiting

Answer 78

Loss of fluid by diarrhea or vomiting can produce severe dehydration within 24 hours *Signs and symptoms: Poor skin turgor (pinching a fold of skin and it returns to normal) -Rapid breathing -Increased heartrate -Restlessness and/or irritability -Sunken fontanelle/eyes -Lack of tears -Wants to drink a lot of water -Decreased urine output

Answer 79

1. Wash hands before handling feeding materials or preparing formula 2. Sterilize feeding equipment a. using tongs, place all equipment in a deep pan and cover with COLD water b. bring to a rolling boil and continue boiling for 5 minutes c. remove equipment from pan using tongs and place on clean towel d. OR sterilize in a dishwasher with a heated drying cycle

Answer 80

Sterilize tap or bottled water *allow to cool for 30 minutes Formulas *Wash top of can with hot water and detergent, rinse in hot water, dry Assemble equipment and feed baby Test temperature before feeding baby *Never microwave

Answer 81

Store up to 96 hours in glass or plastic airtight container in fridge -Ok to freeze human milk up to 6 months -Use thawed milk within 24 hours of thawing and never refreeze

Answer 82

Liquid formulate 1. Liquid concentrate -Refrigerate up to 48 hours 2. Ready to use formula Refrigerate up to 48 hours Powdered formula 1. Unused reconstituted liquid *refrigerate up to 24 hours 2. Unused powder *store at room temp up to 1 month

Answer 83

Activated charcoal MOA: adsorb substances Indication: emergency antidote for self-treatment of ingested poison SE: vomiting, black/tarry stools *SHAKE WELL BEFORE USE Avoid if GI tract not intact High risk for aspiration and for substances that won't be adsorbed Dosing: 1 dose at home only Round to nearest half or whole bottle

Answer 84

Confusion Irritability Agitation Anxiety Mood Changes

Answer 85

-Individual, group therapy -Mental health counseling -CBT -Inpatient, outpatient rehab programs

Answer 86

1st gen antihistamines -Benadryl challenge Dextromethorphan -Robotripping SE: N/V, Respiratory depression, death Stimulant laxatives (bisacodyl, sennosides, castor oil) -Abused to lose weight -SE: cardiac arrhythmias, physical and psychological dependence Loperamide -Abused to get high and lessen opioid withdrawal symptoms -Need very high doses SE: Cardiac arrhythmias and death Pseudoephedrine -Get high -Used to make meth -CV and CNS effects Propylhexedrine -Abused for stimulation SE: Lung damage, overheating, dehydration *Bad crash after wears off Dosing: removal of drug from inhaler, swallowed or injected

Answer 87

3.6 g per day 9 g per month 7.5 g a month via mail DXM age 18 restrictions in many states

Answer 88

Store browsing and purchasing vigilance OFFER CONSULTATIONS

Answer 89

Cannot be made by the body in sufficient amounts Compound

Answer 90

Necessary for body functions Element

Answer 91

Soluble in lipids - absorption facilitated by bile Stored in body tissues Deficiencies tend to occur when fat absorption is compromised

Answer 92

Function: Vision, immune system and cell division COD: Fat malabsorption, malnutrition SSD: Blindness, decreased immune function, skin effects, impaired appetite SST: Headache, double vision, N/V, vertigo, fatigue & drowsiness, bone fractures

Answer 93

Function: Calcium balance, bone structure COD: Malabsorption SSD: Rickets, osteopenia, fractures, falls SST: Anorexia, hypercalcemia, soft tissue calcification, kidney stones, renal failure, increased cancer risk

Answer 94

Function: Antioxidant, protects cell membranes COD: Fat malabsorption SSD: PERIPHERAL NEUROPATHY, MUSCLE WEAKNESS, hemolytic anemia SST: Associated with increased risk of congestive heart failure, hemorrhagic stroke, fetal loss when given for preeclampsia

Answer 95

Function: SYNTHESIS OF CLOTTING FACTORS COD: Fat malabsorption, liver disease, disruption of gut microflora SSD: IMPAIRED COAGULATION SST: Large amts over time have not produced toxicity

Answer 96

Not stored in the body If deficient in one probably deficient in all

Answer 97

Function: Cofactor for metabolism, MYOCARDIAL FUNCTION, NERVE CELL FUNCTION, carb metabolism COD: Alcoholism, Malabsorption SSD: ENCEPHALOPATHY, PERIPHERAL NEUROPATHY, CARDIAC FUNCTION SST: None

Answer 98

Function: CELLULAR GROWTH AND MAINTENANCE OF VISION, integrity of cell membranes COD: Alcoholism and malabsorption SSD: ocular symptoms: LIGHT SENSITIVITY, EYE FATIGUE SST: None

Answer 99

Function: COFACTOR FOR NADP RXNS COD: Alcoholism, poor nourishment SSD: PELLAGRA (DERAMATITIS, DIARRHEA, DEMENTIA), neuropathy, red/beefy tongue SST: GI symptoms, hepatotoxicity, skin lesions, tachycardia, hypertension

Answer 100

Function: PRECURSOR OF COENZYME A COD: malabsorption SSD: somnolence, FATIGUE, LEG MUSCLE WEAKNESS, HAD AND FEET PARETHESIA SST: Diarrhea, water retention

Answer 101

Function: FORMATION OF PROTEINS, AMINO ACIDS, AND NEUROTRANSMITTERS COD: Alcoholism, malabsorption SSD: Infants: irritability and convulsions Adults: dermatitis, oral lesions, peripheral neuropathy SST: Severe sensory neuropathy, prolactin inhibition

Answer 102

Function: CELL DIVISION, DNA production, BRAIN/SPINAL CORD DEVELOPMENT COD: Alcoholism, malabsorption SSD: IMPAIRED CELL DIVISION & PROTEIN SYNTHESIS, sore mouth, diarrhea, CNS SYMPTOMS, megaloblastic anemia SST: None

Answer 103

Function: RBC AND DNA SYNTHESIS COFACTOR, NEUROLOGIC FUNCTION COD: vegetarian diet SSD: MACROCYTIC ANEMIA, NEUROLOGIC SYMPTOMS SST: None

Answer 104

Function: antioxidant and cofactor for collagen and prostaglandin metabolism, REDUCES FERRIC IRONE TO FERROUS IRON COD: smoking, inadequate diet of fresh food SSD: scurvy, fatigue, IMPAIRED WOUND HEALING, CAPILLARY HEMORRHAGING/WEAKENING, COLLAGEN STRUCTURES SST: Nausea, stomach cramps, diarrhea, nephrolithiasis

Answer 105

Function: OXYGEN AND E TRANSPORT COD: inadequate diet, malabsorption, increased blood demand SSD: Pallor, FATIGUE, SPLIT NAILS, SOB with exertion, LOW HEMOGLOBIN SST: Shock, diarrhea, death

Answer 106

Function: Maintenance of nerve and muscle electrophysiology COD: Malabsorption syndromes SSD: Neuromuscular irritability SST: Diarrhea, muscle weakness, lethargy, sedation, diminished deep tendon reflexes, hypotension, dysrhythmia

Answer 107

Function: BONE STRUCTURE, phospholipids, DNA/RNA, buffer system COD: usually induced SSD: WEAKNESS, ANOREXIA, MALAISE, pain, BONE LOSS SST: Diarrhea, stomach pain

Answer 108

Function: Major component of bones and teeth, regulates muscle contraction and relaxation COD: malabsorption syndromes SSD: Convulsions, bone and tooth deformities SST: Kidney stones; anorexia; N/V, constipation Requirements: Males: <70 1000 mg/day >70 1200 mg/day Females: <50 1000 mg/daily >50 1200 mg/daily

Answer 109

Carbonate (40% elemental calcium) - Acidic environment Citrate (21% elemental calcium) - Less dependent on pH

Answer 110

-Infants and children -Pregnant -Older adults -Malabsorptive states -Alcoholism/drug abuse -Cystic Fibrosis -Medications Considerations: Infants and children--> Vitamin A/ Multivitamin Pregnancy-->Folic Acid, Vitamin D, Calcium, Iron Older Adults-->B12, vitamin D, Calcium Alcoholism/drug abuse--> Water soluble vitamins Cystic fibrosis--> Fat soluble vitamins

Answer 111

Vitamins A, D, E, K, and C (Cholestyramine, colestipol, orlistat, or mineral oil can lead to decreased vitamin absorption) Warfarin cause vitamin K to decrease Methotrexate causes decreased Folic acid absorption

Answer 112

Calcium prevents absorptions of iron, zinc, magnesium, levothyroxine and antibiotics (separate by 2-4 hours) Magnesium also affects levothyroxine and antibiotics (separate by 2-4 hours) Iron affects Antacids, levothyroxine, and antibiotics (separate by 2-4 hours)

Answer 113

Swallowing Smoking Gum chewing Sucking on hard candy Carbonated beverages Anxiety and hyperventilating Sugar alcohols in food Fiber in diet Some medical conditions Genetics Altered gut bacteria Food intolerances Medications

Answer 114

Meds that affect gut biome Agents that affect metabolism of glucose & dietary substances Drugs that affect GI motility Meds that contain or release gas

Answer 115

Eructation: belching of swallowed air Bloating: uncomfortable fullness, may/may not have abdominal distension Indigestion Abdominal pain/cramping Borboygmi: audible bowel sounds Flatulence: passage of air out through the rectum

Answer 116

-Symptoms persist for more than a few days or occur several times a month -Symptoms so severe they are debilitating -Sudden change in the location of abdominal pain -New onset of symptoms in people older than 40 years -Significant discomfort -Conjunction with other symptoms such as severe or persistant diarrhea

Answer 117

Prevention of gas -Alpha Galactosidase -Lactase enzyme Treatment of gas -Simethicone -Activated charcoal Follow up recommendations: Follow up in 7 days or with their PCP

Answer 118

*Food Product* MOA: hydrolyzes oligosaccharides into component parts Indication: prevention of intestinal gas Pharmacodynamics: Quick onset and long duration SE: possible allergic reaction DI: None Avoid: in people with galactosemia, mold allergies Likely ok with pregnancy and lactation

Answer 119

*Food product* MOA: replacement enzyme that breaks down lactose into glucose + galactose Indication: dairy intolerance Pharmacodynamics: Onset is immediate and duration is while digesting dairy product No DI or Avoid Dosing for all ages: Org strength: 3 caplets Extra strength: 2 caplets Ultra strength: 1 caplet Safe for preg and lact

Answer 120

MOA: defoaming agent; reduces surface tension of gas bubbles in GI tract mucus --> eliminated more easily Indication: intestinal gas Pharmacodynamics: onset is fast and duration is long NO SE DI or AVOID Safe to use in pregnancy and lactation Dosing after meals + bedtime

Answer 121

MOA: Unknown but thought to adsorb gas given charcoal large surface area Indication: promoted for relief of intestinal gas Pharmacodynamics: Onset and duration unknown SE: poor palatability and constipation DI: May decrease drug absorption Avoid: taking charcoal within 1 hour after meds *Ok for pregnancy and lactation

Answer 122

Inflamed, swollen blood vessels in the rectum and anus that protrude during bowel movements Internal: inside, can't see or feel, no Sx External: under skin around anus, usually have Sx

Answer 123

Younger than 12 yrs Ulcerative colitis or Crohn's Disease Family history colon cancer Anorectal disorder previously dx by medical provider Acute onset severe pain; bleeding, black tarry stools, severe symptoms Minor symptoms not responding to 7 days of self care

Answer 124

Dietary modification Avoid alcohol, caffeine, fatty foods -Adequate fiber Avoid lifting heavy objects Proper bowel habits *Defecation (don't suppress urge) *Toilet sitting time = 2-5 minutes *Avoid excessive cleaning *Sitz baths Severe hemorrhoids may require surgery

Answer 125

Local anesthetics Vasoconstrictors Protectants Astringents Keratolytics Analgesics, anesthetics, antipruritics Corticosteroids Follow up after 1 week if no change

Answer 126

MOA: block transmission of nerve impulses Indication temporary relief of external anal symptoms Pharmacodynamics: onset is very fast and duration is long SE: allergic reactions, dermatitis DI: no significant interactions Avoid: more severe anorectal disorders; open lesions *Ok with pregnancy and lactation Dosing: Applied 3-6 times/day; check label

Answer 127

*Ephedrine, phenylephrine (internal or external) Epinephrine (EXTERNAL ONLY) MOA: stimulation of alpha receptors to constrict arterioles and decrease swelling Pharmacodynamics: Quick onset and very long duration SE: mild pain, sting/pain if raw/bleeding skin DI: unknown Avoid: talk to provider before use if cardiac history, diabetes, BPH, thyroid conditions *Likely ok for pregnancy and lactation Dosing: Applied 4 times/day; check label

Answer 128

Lots of options GLYCERIN is EXTERNAL only MOA: provide physical protective barrier Indication: temporarily relief of discomfort, irritation, burning Pharmadynamics: Onset is unknown and duration is long SE: uncommon; lanolin caution DI: unknown Avoid: applying other meds after protectants *Ok with pregnancy and lactation Dosing: -Petrolatum: PRN or no limit -Other up to 6x/day or after each bowel movement

Answer 129

Calamine, zinc oxide (Int or Ext) Witch hazel EXTERNAL only MOA: help coagulate surface proteins to protect lower tissue; decrease cell volume, provide thin protective layer Indication: temporary relief of itching, burning, irritation or anorectal d/o Pharmacodynamics: Onset is unknown and duration is long SE: Slight tinging with witch hazel No DI or Avoid *Ok with pregnancy and lactation Dosing: apply up to 6 times per day

Answer 130

Alcloxa and resorcinol MOA: cause sloughing of epidermal surface cells Indication: treat pain and itching caused by minor skin irritations Pharmacodynamics: Onset is unknown and duration is long SE: Allergy to resorcinol No DI Avoid: using with harsh soaps *ok for pregnancy and lactation Dosing: apply up to 6 times per day

Answer 131

Menthol, Juniper tar, camphor Indication: temporary relief of burning, pain or itching; EXTERNAL Pharmacodynamics: Onset is unknown, duration is long SE: allergic reactions NO DI Avoid using on damaged or irritated skin *ok for pregnancy and lactation Dosing: Up to 6 times daily

Answer 132

Hydrocortisone 0.25-1% MOA: lysosomal membrane stabilization + antimitotic activity Indication: temporary relief of minor EXTERNAL anal itching Pharmacodynamics: Onset is unknown and duration is very long SE: thins the skin if used too much No DI Avoid prolonged use (max 7 days) *Ok with pregnancy and lactation Dosing: apply up to 3-4 times/day

Answer 133

Brain senses disconnect = eyes and inner ear sense movement but body is still Highest risk: Women and children 2-12 yrs

Answer 134

Someone who feels motion sickness but isn't traveling

Answer 135

Sit in specific areas of the vehicle you're traveling in (window, upper deck, front seat) or where motion is least experienced -Look at horizon, avoid books or electronics -Lay back and close eyes -Drink water -Eat low-fat, bland, starchy food prior to travel -Fresh air/air vents toward you -Ginger -Avoid Alcohol -Avoid strong odors -Drive the vehicle if possible

Answer 136

First gen antihistamines Follow up if OTC and non-OTC not helpful

Answer 137

Cyclizine, meclizine, dimenhydrinate, diphenhydramine, doxylamine MOA: blocks histamine 1 receptors Indication: Prevention of nausea, vomiting, or dizziness associated with motion sickness Pharmacodynamics: Onset is quick and duration depends SE: drowsiness, dry mouth, confusion, dizziness, constipation DI: SSRI Avoid: glaucoma, BPH; Alcohol *Check with PCP for lactation and pregnancy

Answer 138

Inflammation of the stomach and intestines due to viral infection or bacterial/protozoal toxins which causes vomiting and diarrhea Causes: Viral is major cause Symptoms: Nausea, vomiting, diarrhea, fever

Answer 139

Age < 6 months Persistent fever, vomiting, diarrhea Visible blood, pus or mucus in stool Severe dehydration Severe abdominal pain Risk for important complications Pregnancy *NO IMPROVEMENT AFTER 48 HRs

Answer 140

Fluid and electrolyte replacement via Oral Rehydration Soln -Antidiarrheal drugs in selected individuals Self-limiting condition Improvement 24-48 hours; normal bowel function 24-72 hours

Answer 141

Fluid and electrolyte management: rehydration + maintenance -Self care algorithms -Commercial products -Household products Adults: ORS recommended, but little evidence if otherwise healthy, mild diarrhea and can maintain adequate oral fluid intake

Answer 142

Children and Adults: -Do not withhold longer than 24 hours -Normal age appropriate diet once child is rehydrated -Children can tolerate breastmilk and cow milk -BRAT diet (bananas, rice, applesauce, toast) = not recommended because insufficient nutrition

Answer 143

Loperamide Bismuth subsalicylate Follow up if no improvement after 48 hours of drug therapy

Answer 144

Imodium MOA: stimulate peripheral micro-opoid receptors on intestinal circular muscles to slow motility so water and electrolytes can be absorbed Indication: symptomatic relief of acute, nonspecific diarrhea Pharmacodynamics: Onset is quick and duration is multiple days SE: occasional dizziness, constipation, euphoria if abused DI: quinidine, ketoconazole, ritonavir, protease inhibitors, cyclosporine, erthyromycin, clarithromycin, saquinovir, St. John's wort Avoid: high fever or blood/mucus in stool

Answer 145

Max 48 hours of use Adults --> Caplets and liquids: 4 mg initially, then 2 mg after each loose stool; max 8 mg in 24 hours Children: Younger than 6 seek medical advice 6-8 years: caplets and liquid --> 2 mg initially, 1 mg after each loose stool, max 4 mg in 24 hours 9-11 years: caplets and liquid--> 2 mg initially, 1 mg after each loose stool, max 6 mg in 24 hours

Answer 146

MOA: inhibition of prostaglandin synthesis, stimulation of sodium and potassium reabsorption Indication: management of acute diarrhea in people aged 12 or older Pharmacodynamics: Onset varies and duration is unknown SE: mild tinnitus, black tongue or stool DI: warfarin, valproic acid, methotrexate, tetracycline and fluoroquinolone antibiotics Avoid: gout or asthma associated bronchospasm, chicken pox or flu

Answer 147

max 48 hours of use Not recommended in children

Answer 148

Because the FDA considers OTC teeth whitening agents to be cosmetic products, the FDA doesn't regulate them. And the seal of the ADA doesn't guarantee that at home teeth whiteners are safe and effective

Answer 149

0-12 months = 10-25 g 1-12 yrs = 25-50 g > 12 yrs = 25-100 g

Answer 150

It is important that pharmacists remain aware of the potential physical, behavioral and psychological signs of abuse and new OTC products become potentials for abuse

Answer 151

1. Patient presents with heartburn 2. Determine if patient is a candidate for self care 3. If patient is then proceed with treatment if not then refer 4. If patient has EPISODIC heartburn then proceed with different strengths of Antacid and H2RA based on severity 5. If patient doesn't respond to treatment consider PPI or other treatment, if they do then continue treatment 6. If patient has FREQUENT heartburn treat with PPI for 14 days and a H2RA PRN 7. If after 14 days treatment is working then continue treatment every 4 months, if not then refer to PCP

Answer 152

-Concentrated liquid formula and Ready to use formula are already sterilized but you need to wash the containers/can with soap and water -Powdered formula is NOT sterilized so you need to sterilize the water used and wash the container/can Sterilization of equipment: 1. Wash hands before preparing formula 2. Sterilize bottles, equipment and formula container if not clean 3. Use tongs to place all equipment in a pan with cold tap water, bring to a boil for 5 minutes 4. Allow to boil for additional 1-2 minutes and cool for 30 minutes *Used sterilized water for preparation of formula

Answer 153

Cyclizine: > 12 yrs: 50 mg 30 MINUTES before travel, then 50 mg every 4-6 hours 6 to < 12 yrs: 25 mg every 6-8 hours Children 2 to < 6 yrs: NOT RECOMMENDED Meclizine: > 12 yrs: 25-50 mg 1 HOUR before travel 6 to < 12 yrs: NOT RECOMMENDED 2 to < 6 yrs: NOT RECOMMENDED Dimenhydrinate: > 12 yrs: 50 - 100 mg every 4-6 hrs 6 to < 12 yrs: 25-50 mg every 6-8 hours 2 to < 6 years: 12.5 - 25 mg every 6-8 hours Diphenhydramine: > 12 yrs: 25-50 mg every 6-8 hrs 6 to < 12 yrs: 12.5 - 25 mg every 6-8 hours 2 to < 6 yrs: NOT RECOMMENDED Doxylamine: > 12 yrs: In pregnancy, 10-12.5 mg w/wo pyridoxine every 8 hours 6 to < 12 yrs: NOT RECOMMENDED 2 to < 6 yrs: NOT RECOMMENDED

Answer 154

1. Patient has hemorrhoid symptoms 2. Determine if a candidate for self care, if not refer to PCP 3. Determine if patient is pregnant or breastfeeding, if they are only use external hemorrhoid agents 4. Determine if patient has CVD, HTN, Thyroid disease, difficulty urinating, or uses Antidepressants, if they do don't recommend a vasoconstrictor 5. Counsel patients on proper diet, hygiene, and bowel habits. Revaluate in 1 week 6. If symptoms resolve continue good diet, hygiene and bowel habits 7. If symptoms do not resolve refer to PCP

Answer 155

Eating habit suggestions -Eat slowly -Chew food thoroughly -Avoid washing down solids with beverage -Avoid gulping and sipping -No smoking, or chewing gum -Check denture fit -Don't induce belching or farting -Don't overload stomach Diet: -Keep journal -Avoid gas producing foods -Avoid air whipped foods -Avoid carbonated/caffeinated beverages Medication use and lifestyle habits: -Avoid long term use of meds -Avoid drugs that may affect GI motility, glucose metabolism, intestinal flora

Answer 156

Vegetables (beet, broccoli, brussel sprouts, etc.) Beans (peas, chickpeas, lima beans, red kidney beans) Grains (barley, oat bran, rice bran, rye, etc.)

Answer 157

Minor gas production: Meat, Vegetables like zuccini and peppers, Fuits like Melons, Carbs (white flour), Nuts, eggs Moderate: Citrus, apples, white flour Major: Oligosaccharide containing foods

Answer 158

1. Determine if patient is a candidate for self-care, if they are proceed, if not then refer to PCP 2. If symptoms associated with food/beverages recommend simethicone 3. If symptoms associated with lactose then recommend avoidance and/or use of a lactase enzyme 4. If symptoms associated with Oligosaccharide containing foods then recommend avoidance and/or use of alpha-galactosidase 5. Symptoms with any other food/beverage, then recommend avoidance, if not then simethicone 6. If symptoms resolved then continue dietary modifications and/or use OTC, if not then refer to PCP

Answer 159

1. Determine if patient is candidate for self care, if not hospitalize 2. If 3-9% dehydrated then start ORS 3. If < 3% dehydrated then continue regular diet, consider adding dextrose-electrolyte solution to replace stool loss, or increase intake of usual dietary fluids 4. If diarrhea is resolved after 48 hrs than discontinue treatment 5. If not resolved then refer to PCP

Answer 160

1. Determine if patient is candidate for self care, if not refer to PCP 2. If >10% dehydrated refer to PCP 3. If 3-9% dehydrated, begin ORS at 2-4 L over 3 hours 4. If <3% dehydrated then continue regular diet, consider adding dextrose-electrolyte solution to replace stool loss, or increase intake of usual dietary fluids 5. If diarrhea resolved after 48 hours then discontinue treatment, if not then refer to PCP

Answer 161

UVA: HIGHEST range suppress immune system and damages DNA Premature photoaging and skin cancers Enhances effects of UVB UVB: MIDDLE range most active UVR for causing erythema & sunburn radiation Primary cause of skin cancer and responsible for photoaging Synthesis of vitamin D in skin *Can penetrate windows UVC: LOWEST range Mostly screened out by ozone layer but some is emitted by artificial sources of UVR Absorbed by dead cells in the stratum corneum

Answer 162

acute reaction to excessive UVR exposure --> inflammation of the skin Sx: redness, swelling, pain 3-5 hours after exposure, usually resolved by 72 hrs

Answer 163

UVR stimulates melanocytes in skin to generate and distribute melanin

Answer 164

More common Exaggerated sunburn (burning +/- painful redness, edema, vesicles) *30 min to 24 hrs after sun exposure Immune based --> No Prior exposure --> No; usually first exposure Not dose related

Answer 165

Pruritic (itching), swollen/raised lesions, welts *1-3 days after exposure Immune based: UVA triggers an antigen based reaction in the skin because the drug is in the person's body Prior exposure: Yes, usually at least 1 prior exposure to the drug Not dose related

Answer 166

Nonmelanoma skin cancer (NMSC): Sun exposed areas (face, head, neck, backs of hands) 2 types: Basal cell carcinoma and squamous cell carcinoma Melanoma: Origingates in the melanocytes Less common but more aggressive 30% come from existing moles Risk factors for Melanoma: Prior history of excessive sun exposure or sunburns

Answer 167

Short term: Avoid or minimize: Sunburn, Drug photoallergy, phototoxicity Long term: Prevent skin cancer Prevent premature skin aging

Answer 168

Avoid sun from 10 am to 4 pm Avoid tanning beds Protective clothing - darker color, tighter fabric weave -Hat with 4 in brim -Long pants -Long sleeved shirt -Sun glasses *protect eyes from cataract formation

Answer 169

Used to calculate sunscreen's SPF Minimum UVR dose that produces sunburn as a single exposure 2 MEDs = bright skin reddening 4 MEDs = painful sunburn 8 MEDs = blistering sunburn Sun protection factor (SPF): an indication of how long a sunscreen remains effective when applied to the skin

Answer 170

30 *To decrease possible toxicities

Answer 171

High protection against UVA and UVB

Answer 172

Chemical sunscreens MOA: absorb UVR = block rays from going into epidermis Concerns: skin irritation, possible hormone disruption Physical sunscreens Zinc oxide and Titanium dioxide MOA: reflect and scatter UVR Broad spectrum

Answer 173

Amounts: -Face and neck, arms and shoulders, torso: 1/2 tsp -Legs and top of ft: 1 tsp Frequency: 15 min before going outside At least every 2 hours afterward + after each episode of swimming, towel drying or excessive sweating Water resistant: after 40 - 80 minutes

Answer 174

Children: Only use on children older than 6 months of age Keep little ones out of sun and use non drug methods To minimize chemical exposure, use SPF 15 on younger children Teens and adults: follow the dosing guidelines carefully Pregnancy/lactation or Older Adults: no special guidelines; sunscreens generally safe

Answer 175

Causes: Genetic/intrinsic Environmental/extrinsic -UV light, smoking, wind, chemical exposure, Medications

Answer 176

Lesions that change in size shape and color Severe irritation from AHA product Lesions close to the eye, nose or mouth

Answer 177

Sun protection (spf 30) Cleansing to remove: dirt, desquamated keratinocytes, cosmetics, oil/sebum, perspiration Moisturizing: Dry skin: cream Normal skin: lotion Oily skin: gel or solution

Answer 178

Alpha and beta hydroxy acid products Alpha: lactic and glycolic acids 2-20% OTC -Most "non peeling" cosmeceuticals -Most common; often sunscreen in product or advise to use with sunscreen -Lower pH product more effective but possibly increased IRRITATION MOA: anti-inflammatory, keratolytic, antioxidant effects *Time to benefit: 1-3 months Beta: salicylic acid -Less water soluble than AHA; may be helpful with more acne prone skin MOA: keratolytic *Time to benefit 1-2 months

Answer 179

Exfoliant effects How to apply -Apply to dry skin 10-15 min after washing/dry face; start every other night x 7 days then max BID -Careful not to use more than one product with similar ingredients -Start with a small area for first use to see how skin reacts *Avoid in pregnancy or lactation

Answer 180

Vitamin A (topical retinoids) MOA: increase collagen production and increase cell size in epidermis SE: scaling, redness, burning, skin irritation Time to benefit: Usually at least 4 MONTHS Vitamin C MOA: neutralizes free radicals in epidermis (antioxidant) SE: pruritis, redness, irriation, tingling when applied Time to benefit: 12 weeks Coenzyme Q10 MOA: Neutralizes free radicals in epidermis (antioxidant) SE: Worse vitiligo Time to benefit: 4 -12 weeks

Answer 181

Includes herbal medicines in the definition of a dietary supplement, assures consumers access to all supplements on the market as long as they are not determined to be unsafe

Answer 182

Mass market: Food/grocery, drug, mass merchandise, club and convenience stores Natural retail: Supplement and specialty retail outlets Direct sales: direct to consumer

Answer 183

Elder berry - Prevent/treat colds and flu Psyllium - diarrhea, constipation, LDL Apple cider vinegar - COVID-19, obesity; diabetes; performance Horehound: component of oral lozenges Tumeric: joint/muscle pain Cranberry: Anti-bacterial Ashwagandha: Immune enhancement St. Johns Wort: Anti-depression/Mood Ivy leaf extract: Component of oral lozenges Fenugreek: Decrease blood glucose; increase milk production Ginger: Anti-emetic Enchinacea: immune enhancement

Answer 184

No safety data required for products available No mandatory reporting *Unsafe botanicals are the exception: Drug herb interactions appear to have a far greater potential for unintended harm Ashwagandha, Kratom

Answer 185

Used for influenza

Answer 186

Increase lactation; decrease blood glucose

Answer 187

Most interactions between are likely to be pharmacodynamic ST JOHNS WORT DECREASES DRUG CONC BERBERINE INCREASES DRUG CONC *Few established pharmacokinetic interactions Statins --> garlic, vitamin E, policosanol Metformin--> chromium, vanadium, cinnamon, alpha-lipoic acid Warfarin--> danshen, ginkgo, feverfew, coumarin containing

Answer 188

-Decreased platelet function -Several supplements have been associated with this in a convincing manner -Combining anticoagulation anticoagulation with herbs containing coumarins will increased risk of bleeding *Warfarin anticoagulation with herbs containing coumarins will increase effect (Dong QUAI, PAPAYA, RED CLOVER)

Answer 189

Licorice root has aldosterone like effects -Sodium water retention a problem in heart failure -Potassium loss Expect antagonism of diuretics and antihypertensives *Theoretical interaction with lithium

Answer 190

Take DS to -Prevent or slow growth of disease -Increase their immune response -Decease the toxic effects of the treatment *Changes in diet and exercise are typically not a concern Concerned about -Institution of antioxidants -Institution of immunostimulants

Answer 191

decrease activation steps of apoptosis which prevents cell death Vitamin C, E, K3

Answer 192

Part food + part drug "provides health benefits in addition to basic nutrition" 5 categories based on legal definitions and regulatory guidelines Categories 1: Health claims -reduction of disease risk -not allowed anything related to the def of a drug (authorized, authoritative, qualified) Category 2: Structure/function claim: effect that food has on body structure or function Category 3: Special dietary use: -Does not meet general dietary needs Category 4: Medical foods: Prescribed/recommended by medical provider Category 5: Specified conventional foods: catch all for what doesn't fit in categories 1-4

Answer 193

Agent used in diagnosis, cure, mitigation or treatment of disease

Answer 194

Authorized -publication of FDA regulation -reduction of diease risk and required to use may or might -label must state that condition depends on many factors -Limits for components -Not allowed in children <2 Authoritative: Protect public health or the US gov't body does research related to human nutrition Qualified: Emerging evidence, claim wording indicates very limited evidence *Disclaimer about level of scientific evidence

Answer 195

Indigestible components of diet Soluble: slows digestion, and prolongs time to absorbs glucose from foods Insoluble: hydrates and helps move waste through intestines Dietary fiber: intact carb + lignins from plants Functional fiber: carb extracted from plant or animal sources then added to supplement foods/drinks

Answer 196

14 g per 1000 cal consumed *Increase daily fiber slowly (add 1-2 servings every few days) Main SE: bloating, gas, diarrhea Caution: poor gi motility/dysfunction (including narcotic induced dysmotility)

Answer 197

1. Improved bowel function 2. Lipid effects 3. Blood glucose effects 4. Weight loss/maintenance (delayed gastric emptying, and prolonged small intestine travel time)

Answer 198

Semisynthetic liquid formulas for oral consumption or provision through feeding tube Types: Polymeric (normal digestive capability, contains MACRONUTRIENTs and you can drink them) Oligomeric (require minimal digestion, taste bad) --> AMINO ACIDS Modular (single macro nutrient) --> PROTEIN POWDER Specialty (polymeric or oligomeric) Use: Discard after 24 hours Withhold tube feed for 1-2 hours before/after giving med Check formula for Vitamin K and Warfarin

Answer 199

Personal oral hygiene in the absence of fluorides has failed to show a benefit in terms of reducing the incidence of dental caries

Answer 200

-Alcohol -Acidic factors -Caffeine -Carbonation -Exercise (stomach crunches, abdominal presses, high-impact exercise)

Answer 201

1. Provide complete symptom relief 2. Reduce symptom recurrence 3. Prevent/manage OTC medication side effects

Answer 202

Mild/moderate, infrequent HB or dyspepsia & only need short-term relief 1. Antacid: (Rapid sx relief, short-term relief if take without food, interchangeable at recommended doses, antacid/alginic acid more effective in combo 2. H2RA: slower relief Mild/moderate, infrequent HB or dyspepsia but need longer-lasting relief 1. H2RA: slower relief, can use with antacid or to prevent HB if taken 30-60 min prior to symptoms, take a lower dose for mild symptoms and a higher dose for moderate symptoms HB 2 or more days per week: 1. PPI or H2RA: PPI daily x 14 days ONLY and H2RA PRN

Answer 203

Antacids: Within 5 minutes (liquid formulations is fastest) Duration: 20-30 min on empty stomach, 3 hours with food H2RAs: 30-45 minutes relief Duration: 4-8 hours (cimetidine), 4-10 hours (famotidine) Combo: H2RA + Antacid --> Within 5 minutes Duration: 8 to 10 hours PPI (single dose): 1-3 hours start of relief (may need 1 to 4 days for full effect) Duration: 12-24 hours (single dose)

Answer 204

-Dyspepsia -Aluminum or calcium if kidney dysfunction -Calcium: exceeding max daily intake (2500 mg below 50, 2000 mg above 50) -Magnesium if CrCl less than 30 mL/min -Sodium bicarbonate *Sodium restriction *Heart/kidney failure, cirrhosis, pregnancy *Concomitant aspirin therapy (decreased aspirin effects - concerned for CV event)

Answer 205

1. Reduce symptoms (frequency, intensity, duration) 2. Minimize gas impact on lifestyle 3. NOT eliminate gas since it's a normal part of GI tract function

Answer 206

1. Resolve symptoms 2. Keep stool soft; prevent straining with bowel movements 3. Maintain remission of symptoms 4. Prevent complications

Answer 207

1. Prevent or correct fluid and electrolyte loss and acid-base disturbance 2. Control symptoms 3. Identify and treat cause 4. Prevent acute morbidity and mortality

Answer 208

1. Caused by redistribution of pigment-producing organelles in skin cells 2. Visible soon after UVR exposure lasts 3-4 days

Answer 209

-Protective mechanism -Does NOT protect against skin cancer, photodermatoses, photoaging or future sunburns -Due to increase in number of melanocytes visible in 3-4 days and lasts 10-30 days