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Phm Sci 438: OTC > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Caries symptoms

A

No initial symptoms
Progressive lesion on tooth
*can progress to abscess and tooth loss
*sensitive
*continuous pain +/- difficulty chewing if lesion invades dental pulp

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2
Q

Caries etiology

A

Carbs in diet
Oral bacteria
Host resistance altercations
*Xerostomia
*Orthodontic appliances
*Radiation therapy
*Alcohol use

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3
Q

When to not self treat for Caries

A

Symptoms of toothache
Visualized lesion
Entire tooth discoloration
Bleeding, swelling, reddened gums
Persistent mouth odor despite regular fluoride toothpaste

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4
Q

Plaque

A

fresh/soft deposit
removed by brushing of teeth

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5
Q

Calculus

A

harder form of plaque
removed by professional cleaning

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6
Q

Gingivitis symptoms

A

Inflamed gingiva
May progress to periodontal disease

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7
Q

Gingivitis entiology

A

Accumulation of supragingival bacterial plaque
Medications (calcium channel blocker, cyclosporine, phenytoin)
Reduced saliva flow (anticholinergic, antidepressants)
Tobacco
Pregnancy

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8
Q

When to not self treat gingivitis

A

Swollen gums
Gums that bleed with brushing or flossing
Receding gums
Gums that are darker red

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9
Q

Goals of therapy - gingivitis prevention

A

Prevent calculus formation
Remove and control supragingival plaque

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10
Q

Nonpharmacologic for caries and gingivitis

A

Dietary: Avoid highly cariogenic foods and drink water
Plaque remove:
-Chewing sugarless gum
-Brushing and flossing
-Toothbrushes
-Floss once daily

*activated charcoal
*Probiotics (possible benefit)
*Vitamin D
*Xylitol (no benefit)

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11
Q

OTC for caries and gingivitis

A

Chemical plague management (fluoride, dentifrices, and mouth rinses)

*Professional dental cleanings every 6 months

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12
Q

Toothpaste use

A

Adults: size of pea twice daily
Children: age to start brushing? When teeth erupt
Amount:
<3 : size of rice grain
>3 : size of pea

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13
Q

Dentrifices

A

MOA: act directly on oral bacteria or disrupt plaque components to aid in mechanical removal
3 functions:
1. Help remove plaque, stain
2. Reduce mouth odors
3. Enhance personal appearance

Categories of ingredients
Abrasive
Humectant
Sweetener
Surfactant

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14
Q

Dentifrice abrasive categories and ingredients

A

Low abrasion –> Silica abrasives
Mild abrasion –> Baking soda
High abrasion –> Dicalcium phosphate, calcium pyrophosphate, Alumina trihydrate

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15
Q

Fluoride: anticaries agent

A

Sodium fluoride, Sodium monofluorophophate (remineralize, strengthen weakened enamel, reduce gingivitis, reduce sensitivity)
Stannous Fluoride (Stann = slight tooth staining)

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16
Q

Other dentifrice ingredients

A

Whitening detrifrices
-Not tooth bleaching products

Chemotherapeutic agents may be combined in a whitening dentifrice
-Fluoride
-Potassium nitrate
-Stannous fluoride
-Metal salts
-Essential oils
-Hydrogen peroxide
-Sodium bicarbonate

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17
Q

Plaque control mouth rinses

A

Ingredients: Aromatic oils, antimicrobials, phenol
MOA:
Aromatic oils: antibacterial, local anesthesia
Antimicrobials: bactericidal activity
Phenol: local anesthetic, antiseptic, bactericidal activity

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18
Q

Mouth rinse cautions

A

Adverse effects: burning, irritation
Cautions: Mouth ulcers or irritation, keep out of reach of children, supervise use in children, Alcohol content issues

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19
Q

Mouth rinse use

A
  1. 1-2 tablespoonsfrul
  2. Swish 30 seconds
  3. Spit
    *before brushing
    *1 to 2 times per day
    * supervise children < 12 years
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20
Q

Plaque control with gum

A

MOA: increased saliva flow, mechanical removal of debris
Use: Chew after eating as well as other times of day, sugarless only

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21
Q

Halitosis

A

Bad breath

Causes:
Systemic, and oral causes

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22
Q

Halitosis when to not self treat

A

Medical conditions associated with halitosis
Persistent halitosis despite good oral hygiene

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23
Q

Halitosis prevention

A

Remove cause if possible
Mechanical
Chemical
MOA:
Zinc salts –> reduce receptor binding for VSCs
Chlorine dioxide: breaks disulfide bonds

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24
Q

Oral pain causes

A

Etiologies
1. Exposure of dentin
2. Injury to mouth or lips
3. Nerve pain of face
Dentin/tooth hypersensitivity
2 aspects for development: Exposed dentin, dentin tubules open to the oral cavity and tooth pulp
Symptoms: Short stabbing pain
Tubule fluid flow increase–> nerve stimulation -> pain

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25
Q

Do not self treat for oral pain

A

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

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26
Q

Goals of therapy for tooth pain

A
  1. Repair damaged tooth surface
  2. Correct inappropriate tooth brushing tech
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27
Q

Complementary options for tooth pain

A

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

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28
Q

OTC options for tooth pain

A

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

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29
Q

Potassium nitrate + fluoride

A

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

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30
Q

Arginine + calcium carbonate

A

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

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31
Q

Recurrent aphthous stomatitis

A

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

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32
Q

When to not self treat for RAS

A

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

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33
Q

Goals of therapy RAS

A
  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
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34
Q

RAS non-OTC options

A

-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

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35
Q

RAS OTC options

A

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

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36
Q

Barrier protectants and rinses for RAS

A

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)

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37
Q

Minor oral mucosal injury/irritation

A

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)

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38
Q

Pharmacotherapy for Minor Oral Mucosal Injury/Irritation

A
  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

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39
Q

HSL causes and presenting symptoms

A

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

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40
Q

When to not self treat HSL

A

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

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41
Q

Goals of therapy for HSL

A

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

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42
Q

Complementary and non-pharm options for HSL

A

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

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43
Q

OTC treatment for HSL

A

Topical skin protectants
External analgesics/anesthetics
Docosanol 10%

Follow up if persist > 14 days

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44
Q

Docosanol 10% cream

A

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

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45
Q

Xerostomia etiologies

A

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

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46
Q

Do not self treat Xerostomia

A

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

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47
Q

Goals of therapy - xerostomia

A

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

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48
Q

Complementary and non-pharmacologic options for xerostomia

A

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

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49
Q

Cheilitis

A

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

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50
Q

OTC options for xerostomia

A

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

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51
Q

Prevention and treatment of Cheilitis

A
  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
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52
Q

Tooth discoloration and staining

A

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

  1. Nonbleaching ingredients/products =whitening toothpastes
    -Ingredients: Bicarbonate, hydrated silica
    -Lightens stains and helps prevent new stains
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53
Q

Poisoning

A

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

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54
Q

Misuse

A

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

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55
Q

Abuse

A

Use of OTC meds for non-med purposes

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56
Q

Role of a pharmacist in abuse

A

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

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57
Q

When to not self treat for poisoning

A

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

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58
Q

Non-pharmacologic therapy for poison

A

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

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59
Q

Poison control helpline

A

1-800-222-1222

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60
Q

Teeth whitening article main point

A

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

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61
Q

Does the FDA regulate OTC teeth whitening agents?

A

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

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62
Q

guidelines for using dental floss

A

-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

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63
Q

Guidelines for brushing teeth

A

-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

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64
Q

Differentiation of Tooth Hx and Toothache

A

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

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65
Q

Heart burn

A

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

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66
Q

GERD

A

Chronic condition; Frequent reverse flow of stomach acid and content into the esophagus
*Not for pharmacists to recommend therapy

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67
Q

Dyspepsia

A

Symptoms originate from gastroduodenal region and occur together
*Early satiety, post prandial fullness, epigastric pain

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68
Q

LES and Diaphragm

A

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

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69
Q

Do not self treat heartburn when

A

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

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70
Q

Complementary and non-pharmacologic options for Heartburn/GERD

A

-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

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71
Q

OTC treatment for Heartburn/GERD

A

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

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72
Q

Follow up recommendations Heartburn and GERD

A
  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)
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72
Q

Antacid

A

MOA: Neutralize gastric acid
Indication: treatment of mild, infrequent heartburn, sour stomach, and acid indigestion
Pharmacodynamics:
Onset is within 5 min
Duration can vary

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73
Q

Antacid SE

A

Aluminum: constipation (manage by taking AL + Mg), hypophosphatemia
Magnesium: Diarrhea (manage by taking AL + Mg)

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74
Q

Antiacid DI

A

Many
Antifungals –> decreased absorb
Amphetamines –> decreased excretion
Rosuvastatin –> decreased absorption
Enteric-coated meds –> Premature breakdown of meds
Levothyroxine
Tetracyclines
Fluoroquinolones
Azizthromycin

*How to many these?
Separate by a few hours

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75
Q

H2RA

A

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
Avoid: In older adults and children younger than 12
Both ok with pregnancy and lactation

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76
Q

H2RA DI

A

Iron sulfate and calcium carbonate
(Decreased absorption)
Warfarin, clopidogrel, TCAs (Decreased metabolism)
Citalopram
(Increased citalopram concentration)
Dosing:
Take an hour prior to expected HB
*Tolerance develops if used daily

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77
Q

Proton pump inhibitors

A

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

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78
Q

PPIs dosing and DI

A

30-60 min prior to meal
Max 14 days
1 course every 4 months max

Iron sulfate, calcium carbonate –> decreased absorption
Warfarin –> Increased conc
Citalopram –> increased citalopram conc
Clopidogrel –> decreased conversion to active form

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79
Q

Bismuth salicylate

A

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: Tetracycline, Methotrexate, Warfarin
Avoid: children < 18, salicylate sensitivity/allergy, bleeding risks

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80
Q

Special pop HB and GERD

A

Pregnancy:
-Lifestyle/food changes first
-First line OTC is antacid

Children older than 2 years with mild, transient, infrequent HB:
Children’s formulas of antacid

Older adults:
-Triage carefully as HB can be symptom of more serious pathology

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81
Q

Infant Organ Maturity

A

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

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

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82
Q

When does birth weight double

A

By 4-6 months and triple by 12 months

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83
Q

Basic requirements for a healthy diet

A

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

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84
Q

Water requirements

A

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

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85
Q

Carbs requirements

A

*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

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86
Q

Proteins and amino acid requirments

A

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

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87
Q

Fat and Essential Fatty Acids Requirements

A

Fat is needed for proper growth and development
*Do not restrict fat if younger than 2 years unless advised to do so

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

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88
Q

Micronutrients requirements

A

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

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89
Q

Infant Food Sources

A

Human milk
Animal milk
Commercial infant formulas

90
Q

Human milk

A

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

91
Q

Benefits of breast feeding

A

-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

92
Q

Contraindications to breast and chest feeding

A
  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
93
Q

Animal Milk

A

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

94
Q

Commercial infant formulas

A

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

95
Q

Standard formula considerations

A

Liquid formulations manufactured to be sterile
-Powdered formulations not required or guaranteed to be sterile
*Premature and immunocompromised infants should only receive liquid formulations

Can fortify or increased conc by altering amount of water added but only do so with medical advice

96
Q

Modular macronutrient components

A

Can add to either human milk or infant formula; alternative to concentrated formula

*Use macronutrients components only with medical advice
**Protein powder

97
Q

Human milk fortifiers

A

Parents who give birth to premature infants produce breast/chest milk that is higher in nutrients

Need to supplement in addition to breast milk
-Mixed into 60-100 mL of human milk

98
Q

Therapeutic formulas

A

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

99
Q

Number of daily feedings

A

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

100
Q

When to call a medical provider for diarrhea and vomiting

A

Severe
More than 72 hours
Blood stool
Vomiting projectile or green

101
Q

Diarrhea or vomiting in infants

A

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)

102
Q

Preparing equipment for feeding

A
  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
103
Q

Preparing formula for feeding

A

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

104
Q

Feeding with expressed human milk

A

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

105
Q

Formula beyond use dating

A

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

106
Q

OTC treatment options for poison

A

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

107
Q

OTC Abuse Withdrawal symptoms

A

Confusion
Irritability
Agitation
Anxiety
Mood Changes

108
Q

OTC addiction treatment

A

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

109
Q

Common OTCs that are abused

A

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

110
Q

Federal PSE purchasing limits

A

3.6 g per day
9 g per month
7.5 g a month via mail

DXM age 18 restrictions in many states

111
Q

Pharmacist role in abuse

A

Store browsing and purchasing vigilance
OFFER CONSULTATIONS

112
Q

Vitamin

A

Cannot be made by the body in sufficient amounts

113
Q

Mineral

A

Necessary for body functions

114
Q

Fat Soluble Vitamins

A

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

115
Q

Vitamin A

A

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

116
Q

Vitamin D

A

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

116
Q

Vitamin E

A

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

117
Q

Vitamin K

A

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

118
Q

Water soluble vitamins

A

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

119
Q

Vitamin B1

A

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

120
Q

Vitamin B2

A

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

121
Q

Vitamin B3

A

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

122
Q

Vitamin B5

A

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

123
Q

Vitamin B6

A

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

124
Q

Vitamin B9

A

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

125
Q

Vitamin B12

A

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

126
Q

Vitamin C

A

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

127
Q

Iron

A

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

128
Q

Magnesium

A

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

129
Q

Phosphorous

A

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

130
Q

Calcium

A

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

131
Q

Calcium salt forms

A

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

132
Q

Populations at risk for deficiencies

A

-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

133
Q

What to not use a micronutrient with what med?

A

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

134
Q

Calcium Magnesium and Iron

A

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)

135
Q

Intestinal Gas causes

A

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

136
Q

Medications that contribute to intestinal gas

A

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

137
Q

Symptoms of intestinal gas

A

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

138
Q

Do not self-treat

A

-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

139
Q

OTC options for intestinal gas

A

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

140
Q

Alpha galactosidase

A

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

141
Q

Lactase enzyme

A

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

142
Q

Simethicone

A

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

143
Q

Activated charcoal for Intestinal gas

A

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

144
Q

Hemorrhoids

A

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

145
Q

Do not self-treat

A

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

146
Q

Non OTC treatments for hemorrhoids

A

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

147
Q

OTC options for hemorrhoids

A

Local anesthetics
Vasoconstrictors
Protectants
Astringents
Keratolytics
Analgesics, anesthetics, antipruritics
Corticosteroids

Follow up after 1 week if no change

148
Q

Local Anesthetics for hemorrhoids

A

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

149
Q

Vasoconstrictors for hemorrhoids

A

*Ephedrine, epinephrine, phenylephrine
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

150
Q

Protectants

A

Lots of options
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

151
Q

Astringents

A

Calamine, zinc oxide (Int or Ext)
Witch hazel (Ext)
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

152
Q

Keratolytics

A

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

153
Q

Analgesics, anesthetics, antipuritics

A

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

154
Q

Corticosteroid

A

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

155
Q

Motion sickness

A

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

156
Q

Exclusion to self treatment for motion sickness

A

Someone who feels motion sickness but isn’t traveling

157
Q

Non OTC options for motion sickness

A

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

158
Q

OTC options

A

First gen antihistamines

Follow up if OTC and non-OTC not helpful

159
Q

Antihistamines for motion sickness

A

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

160
Q

Gastroenteritis definition

A

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

161
Q

When to not self treat for gastroenteritis

A

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

161
Q

General treatment approach for gastroenteritis

A

Fluid and electrolyte replacement via Oral Rehydration Soln
-Antidiarrheal drugs in selected individuals

162
Q

Non otc options for gastroenteritis

A

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

163
Q

Dietary management for gastroenteritis

A

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

164
Q

OTC options for gastroenteritis

A

Loperamide
Bismuth subsalicylate

Follow up if no improvement after 48 hours of drug therapy

165
Q

Loperamide

A

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

166
Q

loperamide dosing

A

Max 48 hours of use

167
Q

Bismuth subsalicyclate

A

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

168
Q

Bismuth subsalicylate dosing

A

max 48 hours of use

169
Q

Teeth whitening article main point

A

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

170
Q

Activated charcoal dosing for poisoning

A

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

171
Q

OTC abuse article main points

A

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

172
Q

Self care for heartburn algorithm

A
  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
173
Q

Sterilization method for infant formula preparation

A

-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

174
Q

Dose guidelines for 1st Gen Antihistamines for Motion Sickness

A

Cyclizine:
> 12 yrs: 50 mg 30 in 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
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
Meclizine:
> 12 yrs: 25-50 mg 1 hour before travel
6 to < 12 yrs: NOT RECOMMENDED
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

175
Q

Self care algorithm for hemorrhoids

A
  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
176
Q

Useful info to support patient self management of intestinal gas symptoms

A

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

177
Q

Oligosaccharide containing foods

A

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

178
Q

Gas producing foods

A

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

179
Q

Algorithm for intestinal gas

A
  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
180
Q

Self care algorithm for diarrhea in children 6 months to 5 yrs

A
  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
181
Q

Self care algorithm for diarrhea in children older than 5 yrs, adolescents, and adults

A
  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
182
Q

Types of UVR

A

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
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

183
Q

Sunburn

A

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

184
Q

Suntan

A

UVR stimulates melanocytes in skin to generate and distribute melanin

185
Q

Phototoxicity

A

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

186
Q

Photoallergy

A

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

187
Q

Skin cancer

A

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

188
Q

Goals for preventing UVR induced skin disorders

A

Short term:
Avoid or minimize: Sunburn, Drug photoallergy, phototoxicity

Long term:
Prevent skin cancer
Prevent premature skin aging

189
Q

Non drug prevention for sun burn

A

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

190
Q

Minimal Erythema Dose (MED)

A

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

191
Q

What SPF is the sweet spot?

A

30
*To decrease possible toxicities

192
Q

Broad spectrum

A

High protection against UVA and UVB

193
Q

Types of sunscreens

A

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

194
Q

Sunscreen dosing

A

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

195
Q

Sunscreen safety

A

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

196
Q

Photoaging

A

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

197
Q

Exclusions for self care of photoaging

A

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

198
Q

Photoaging prevention

A

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

199
Q

Photoaging treatment

A

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

200
Q

AHAs and BHA

A

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

201
Q

Vitamin A, vitamin C, Coenzyme Q10

A

Vitamin A
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

202
Q

1995 Dietary Supplement Health and Education Act

A

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

203
Q

Herbal sales by channel

A

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

204
Q

Herbal dietary supplements

A

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

205
Q

Mandates for Dietary supplements quality control and safety

A

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

206
Q

Elderberry

A

Used for influenza

207
Q

Fenugreek

A

used lactation

208
Q

Supplement vs DI

A

Most interactions between are likely to be pharmacodynamic
*Increasing or decreasing the effect of a drug
*Few established pharmacokinetic interactions

209
Q

Anticoagulants increased risk

A

-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

210
Q

Licorice root

A

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

211
Q

Cancer patients with DS

A

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

212
Q

Antioxidants

A

decrease activation steps of apoptosis which prevents cell death

213
Q

Functional foods

A

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

214
Q

Drug

A

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

215
Q

Health claims subtypes

A

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

216
Q

Fiber

A

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

217
Q

Fiber intake

A

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)

218
Q

Fiber benefits

A
  1. Improved bowel function
  2. Lipid effects
  3. Blood glucose effects
  4. Weight loss/maintenance
    (delayed gastric emptying, and prolonged small intestine travel time)
219
Q

Enteral formula

A

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)
Modular (single macro nutrient)
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

220
Q

Fluoride and personal care

A

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

Phm Sci 438: OTC (4 decks)

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