Exam 3 Fall 2024 Flashcards
Fever, Headache, Musculoskeletal pain, Insomnia, Eyes and Ears
1
Q
What are the 3 types of primary headaches?
A
Tension headache
Migraine headache with/out aura
Medication overuse headache
2
Q
What is the one type of secondary headache?
A
Sinus headache
3
Q
What is the course of action if a person presents with a cluster headache?
A
Automatic referral
4
Q
How is a chronic tension headache defined?
A
Greater than 15 days per month for a least 3 months.
5
Q
What is the presenting nature of a sinus headache?
A
Pressure behind the eyes or face with dull and bilateral pain
6
Q
What is the presenting nature of a migraine headache?
A
Throbbing and pulsating and usually unilateral
7
Q
What is the presenting nature of a tension-type headache?
A
Diffuse ache, tightening, pressure, and constricting. Typically bilateral
8
Q
What is the onset of a migraine headache?
A
Sudden and can last 4-72 hours
9
Q
What is the onset of a tension-type headache?
A
Gradual and can last for 30 minutes to 7 days
10
Q
What causes medication overuse headaches?
A
Excessive use of analgesics. This means using it 3 times or more per week for 3 months or longer. The headache also presents on more than 15 days of the month.
11
Q
What are some OTC agents that can cause medication overuse headaches?
A
Acetaminophen, aspirin, NSAIDs, and caffeine
12
Q
What are the exclusions for self-treatment for headache?
A
- Severe head pain
- Rapid onset with maximum pain headache
- Concerning change in headache pattern
- Lasts 10 days with or without treatment
- Less than 8 years old
- High fever or signs of infection
- Neck stiffness (indication of meningitis)
- Neurologic change (seizure, mental status, vision)
- High-risk comorbid condition like cancer or HIV
- Last trimester of pregnancy
- New headaches during pregnancy
- Headache associated with underlying pathology that is NOT a sinus headache
- Migraine symptoms with NO diagnosis (can treat if they have been diagnosed)
- Liver disease or alcohol consumption of 3 or more drinks per day
13
Q
What are some non-pharmacological treatments for tension headaches?
A
Relaxation exercises, physical therapy, keep a headache diary
14
Q
What are some non-pharmacological treatments for migraine headaches?
A
Maintain regular schedule for sleep, eating, and exercise. Apply ice with pressure to forehead. Rest in a dark and quiet room. Manage stress. Do cognitive therapy, and avoid triggers.
15
Q
What is the normal body temperature?
A
97.5-98.9
16
Q
What are the fever-producing substances that activate that body’s host defense?
A
Pyrogens
17
Q
In response to the release of pyrogens, what is produced that elevates the thermoregulatory set point in the hypothalamus?
A
Prostaglandins of the E2 (PGE2)
18
Q
What area of the brain controls core body temperature?
A
Hypothalamus
19
Q
What is the medical term used to describe “having or showing symptoms of a fever”?
A
Febrile
20
Q
What is the result of an untreated fever?
A
Seizure, delirium, coma, then death
21
Q
What body regulates thermometers?
A
FDA
22
Q
What is the gold standard area to test body temperature?
A
Rectal
23
Q
What temperature measured in the rectum signals a fever?
A
100.4 or greater
24
Q
If temperature is taken orally, how many degrees are added to get to rectal equivalent?
A
+1 degree
Example: Oral was 99.8 then rectal would be 100.8 signifying a fever
25
If temperature is taken via the axillary, how many degrees are added to get to rectal equivalent?
+2 degree
Example: Axillary was 97.6 then rectal would be 99.6 which is not a fever
26
Through what age are rectal temperatures taken?
3 years
27
What is the celsius to fahrenheit conversion formula?
C= 5/9 (F-32)
28
What are the fever threshold exclusions for OTC treatment in those 3 months old and greater?
3 months or older with rectal temperature equal to or greater than 104F. If this is present they must be referred.
29
What are the fever threshold exclusions for OTC treatment in those younger than 3 months old?
3 months or younger with rectal temperature greater than or equal to 100.4. If this is present they must be referred.
30
What are the fever duration exclusions for OTC treatment in those 2 years and older?
2 years or older with a fever (104F) that persists for 3 days with or without treatment must be reffered.
31
What are the fever duration exclusions for OTC treatment in those 2 years and younger?
2 years and younger with a fever that persists for 24 hours must be referred.
32
What are other exclusions for self-treatment for fevers?
1. Fever over 104F at any age
2. Impaired oxygen utilization (pulmonary diseases)
3. Impaired immune fxn (cancer, HIV)
4. CNS damage (stroke, head trauma)
5. Severe symptoms of infection
6. Children with any of the following- history of seizures, stiff neck, rash, refuses to drink liquids, irritable, sleepy, hard to wake, vomiting, cannot keep down fluids, and repeated diarrhea
33
What are some non-pharmacological treatments for a fever?
Adequate fluid intake, sponging or baths with tepid water (be careful as shivering with increase body temp), wear lightweight clothing, remove blankets, maintain comfortable room temperature
34
What is a non-opioid analgesic that can be used for headache and fever?
Acetaminophen (Tylenol)
35
What is the MOA of acetaminophen (Tylenol)?
Centrally inhibits COX enzymes to inhibit prostaglandin synthesis.
36
Where and how is acetaminophen metabolized?
In the liver to sulfate and glucuronide conjugates as well as CYP450s.
37
What is the duration of action of acetaminophen?
4 hrs with normal and 6-8 hours with extended release tablets
38
What is the toxic metabolite of acetaminophen metabolism produced via metabolism by CYP450?
NAPQI
39
In acetaminophen metabolism, what molecules detoxifies NAPQI?
Glutathione
40
Why should alcohol and acetaminophen not be used together?
Alcohol depletes glutathione stores which decreases the ability of the liver to detoxify NAPQI. Elevated levels of NAPQI lead to hepatotoxicity.
41
Elevated levels of NAPQI from acetaminophen metabolism leads to ___________________.
Heptatoxicity
42
Doses of acetaminophen at _______ grams or greater increases the risk for adverse effects.
4 grams (4000mg)
43
What are the two key drug interactions with acetaminophen?
Alcohol and warfarin
44
Acetaminophen is typically well tolerated. If there are side effects, they typically include __________.
Reddening of skin, rash, and blisters
45
What are the contraindications/ warnings for acetaminophen?
Hepatotoxicity (boxed warning)
46
What is the antidote for acetaminophen toxicity?
Acetylcysteine
47
What is the FDA determined maximum dose of acetaminophen?
4000mg/day
48
What is the acetaminophen dosing for those 12 years and older taking the immediate release 325mg tablet?
1-2 tablets PO Q4-6H PRN (max 3,250mg)
49
What is the acetaminophen dosing for those 12 years and older taking the extra strength 500mg tablet?
1-2 tablets PO Q4-6H PRN (max 3,000mg)
50
What is the acetaminophen dosing for those 12 years and older taking the extended release 650mg tablet?
1-2 tablets PO Q8H PRN (max 3,900mg)
51
What is the concentration of suspension acetaminphen?
160mg/5mL
52
What is the acetaminophen dosing for those younger than 12 years old taking the suspension version?
10-15mg/kg/dose PO Q4-6H PRN (max75mg/kg, 5 doses)
53
What is the acetaminophen dosing for those 2-11 years old taking the 160mg chewable tablet?
1-3 tablets PO Q4-6H (max 2,400mg or 5 doses/day)
54
Is acetaminophen appropriate to use during pregnancy and/or lactation?
During pregnancy, acetaminophen should be used at the lowest effective dose for the shortest amount of time. During lactation, acetaminophen is compatible. Overall, acetaminophen is the drug of choice during pregnancy and lactation.
55
What is the MOA of NSAIDs?
Reversible central and peripheral inhibitors of the COX enzyme preventing prostaglandin synthesis.
56
NSAIDs exert effects of _________, __________, and ___________________.
Analgesic
Antipyretic
Anti-inflammatory
57
What is the duration of action of ibuprofen (Advil/Motrin)?
6-8 hours
58
What is the duration of action of naproxen (Aleve)?
Up to 12 hours
59
If a drug is more COX1 selective, it increases the risk for _______________.
Stomach ulcers and bleeding.
60
If a drug is more COX2 selective, it increases the risk for _________________.
Cardiovascular events
61
What are the 4 key drug interactions with NSAIDs?
Aspirin
Anti-hypertensives
Anticoagulants
Alcohol
62
What is the age cutoff for ibuprofen use?
Under 6 months
63
What is the age cutoff for naproxen use?
Under 12 years
64
What is the boxed warning for COX-1 inhibitors?
Gastrointestinal events
65
What is the boxed warning for COX-2 inhibitors?
Cardiovascular events
66
What is the dosing for 200mg ibuprofen for those greater than 12 years old?
1-2 200mg tablets PO Q4-6H WF PRN (max 1,200mg)
67
What is the dosing for 220mg naproxen for those greater than 12 years old?
1 220mg tablet PO Q8-12H WF PRN (max 660mg)
68
What dose is the ibuprofen suspension come in?
100mg/5mL
69
What is the dosing for the ibuprofen suspension for those between 6 months and 12 years old?
5-10mg/kg/dose PO Q6-8H WF PRN (max 40mg/kg, 4 total doses)
70
What is the dosing for the chewable tablet ibuprofen for those between 2-11 years old?
1-3 100mg tablets PO Q6-8H WF PRN (max 1,200mg, 4 total doses/day)
71
Are NSAIDs safe to use during pregnancy and lactation?
Avoid NSAID use during pregnancy, especially in the 3rd trimester. NSAIDs are normally safe to use during lactation.
72
What is the MOA of salicylates?
Irreversible peripheral inhibition of COX enzymes inhibiting prostaglandin synthesis.
73
What are the 3 effects of salicylates?
Analgesic, antipyretic, and anti-inflammatory effects
74
Why are salicylates not typically used for their anti-inflammatory effects?
Salicylates need very high doses (4-6g) to exert any anti-inflammatory effects. At doses that high, it would increase the risk for side effects.
75
What is the duration of action of salicylates?
4-6 hours for immediate release and the platelet inhibition effects last up to 10 days before they die and need to be inhibited again.
76
The main salicylate discussed was aspirin. What are common adverse effects of this drug?
High risk for GI bleeds and a lower risk for cardiovascular events.
77
What is the age cutoff for salicylates/aspirin?
Do not use in patients under 18 years old due to risk of Reye's syndrome in those recovering from viral infections.
78
Are salicylates/aspirin safe to used during pregnancy and/or lactation?
Avoid the use of these drugs during pregnancy and lactation.
79
Besides the pediatric and pregnant population, what are two other contraindications for the use of salicylates?
The elderly as they have increased risk for GI complications and those with gout as salicylates and uric acid compete for excretion.
80
What is the fatality rate for Reye's syndrome which is associated with the pediatric use of salicylates?
50%
81
What are the symptoms of Reye's syndrome?
Neurologic damage, fatty liver with encephalopathy, and hypoglycemia
82
What is AERD?
This is Aspirin exacerbated respiratory disease. It is basically aspirin induced asthma.
83
What is the formal aspirin challenge?
A test conducted to confirm diagnosis of an NSAID allergy.
84
What are the two main drug-drug interactions with aspirin?
NSAIDs and ibuprofen. Take ibuprofen 60 minutes before or 8 hours after taking aspirin.
85
What is the dosing for the immediate release 325-600mg aspirin for those 12 years and older?
325-1000mg PO Q4-6H with maximum dose of 4000mg/day for analgesic and antipyretic effects
86
What is the dosing for the immediate release 75-100mg aspirin for those 12 years and older?
1 tablet (typically 81mg) PO daily for secondary cardioprotection.
87
A 21 year old male presents with a headache characterized by tightness and pressure. They state they are juggling many assignments and exams right now. What type of headache is this?
Tension headache
(symptoms of tension headache: Diffuse ache, tightening, pressure, and constricting. Typically bilateral)
88
A 21 year old male presents with a headache characterized by tightness and pressure. They state they are juggling many assignments and exams right now. Is this patient an appropriate candidate for self-treatment?
Yes. Typically we would need to ask more questions to see if he has any exclusions factors but based on the information given, he is a candidate for OTC treatment.
89
A 21 year old male presents with a headache characterized by tightness and pressure. They state they are juggling many assignments and exams right now. What treatment could he receive?
He could start with acetaminophen (tylenol) at doses of 325-1000mg Q4-6H (max 4000mg). If that does not work, he could do an NSAID like ibuprofen or naproxen. If this headache continues to last for a total of 10 days, he will need to be referred.
90
A young woman calls the pharmacy stating her 8 month old has a rectal temperature of 104.4F and she will not eat or drink and has been very fussy. Does this child have a fever?
Yes. A rectal temperature greater than 100.4F is considered a fever.
3 months or older with rectal temperature equal to or greater than 104F must be referred.
91
A young woman calls the pharmacy stating her 8 month old has a rectal temperature of 104.4F and she will not eat or drink and has been very fussy. Is the child a candidate for self-treatment?
No. A child 3 months and older with a fever above 104F needs to be referred.
92
What is the pain scale classification from 1-3?
Mild pain
93
What is the pain scale classification from 4-6?
Moderate pain
94
What is the pain scale classification from 7-10?
Severe pain
95
How long does acute pain last?
Less than 4 weeks
96
How long does subacute pain last?
4 weeks to 3 months
97
How long does chronic pain last?
At least 3 months
98
__________ are pain sensing nerve fibers.
Nociceptors
99
What is the location and symptoms of myalgia?
Occurs in the muscles and is a dull and constant ache. Swelling may be present.
100
What is the location and symptoms of tendonitis?
Tendon areas due to injury or repetitive use. Presents with mild to severe pain occurring after us. Warmth, swelling, and erythema may be present.
101
What is the location and symptoms of bursitis?
Inflammation of the bursae within joints. Presents as constant pain that worsens with movement. Warmth, swelling, and erythema may be present.
102
What is the location and symptoms of a sprain?
Stretching or tearing of a ligament within a joint. Presents with initial severe pain following by moderate pain with joint use. There is a reduction in joint stability and function.
103
What is the location and symptoms of a strain?
Hyperextension of a joint that results in overstretching or tearing. Presents with initial severe pain with continued pain with movement and rest. Some loss of function may be present.
104
What is the location and symptoms of osteoarthritis?
Weight-bearing joints presenting with dull joint pain that is typically worse in the morning and improves with movement.
105
Which of the following issues is acute with injury?
A. Myalgia
B. Tendonitis
C. Bursitis
D. Sprain
E. Strain
F. Osteoarthritis
C, D, and E
Bursitis, sprain, and strain
106
What are the exclusion for self-treatment of pain?
1. Severe pain (score of 6 or more)
2. Pain lasting more than 10 days
3. Pain that continues for 7 days after treatment with topical analgesic
4. Increased intensity or change in the character of pain
5. Pelvic or abdominal pain (not dysmenorrhea)
6. Nausea, vomiting, fever, signs of infection
7. Visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture
8. Pregnancy
9. Younger than 2 years
10. Back pain and loss of excretion control
11. Arthritis pain requiring use of topical NSAIDs for longer than 21 days
12. Arthritis pain that has not improved after 7 days of using topical NSAID
107
Can osteoarthritis be treated with OTC products?
Yes, but only if that individual has an osteoarthritis diagnosis
108
What are the non-pharmacologic treatment for pain?
RICE (Rest, Ice, Compression, Elevation), heat for those with non-inflammatory pain, and TENS therapy, epsom salts, massages, acupuncture, and more.
109
T or F: Heat or ice treatment non-pharmacologic treatments should be used for 15-20 minutes 3-4x per day.
True
110
T or F: TENS therapy is highly recommended for osteoarthritis.
False. TENS therapy is recommended against in osteoarthritis
111
What is the maximum duration of time that systemic analgesics like acetaminophen, ibuprofen, naproxen, etc should be used?
10 days maximum
112
What is the maximum duration of time that topical analgesics should be used?
7 days (exception is diclofenac/voltaren which is a 21 day maximum)
113
For minor-moderate aches and pain of the muscles and joints, what is the 1st line therapy?
Systemic analgesics like acetaminophen or NSAIDs. Typically start with acetaminophen but if inflammation is present, use an NSAID. Topical analgesics can be used as adjunct therapy
114
For osteoarthritis, what is the 1st line therapy?
Acetaminophen or NSAIDs paired with a topical analgesic like diclofenac gel or capsicum.
115
What is the 1st line therapy for nerve pain?
Lidocaine as a topical anesthetic
116
What is the MOA for diclofenac (voltaren) gel?
Same as NSAIDs, it inhibits COZ enzymes to stop prostaglandin synthesis.
117
Compare absorption between systemic NSAIDs and topical NSAIDs like diclofenac.
Diclofenac only has 6% absorption from the skin which is 17x less than systemic NSAIDs
118
What issue is diclofenac approved for?
Osteoarthritis in those 18 and older
119
Diclofenac may take up to _____ days to work.
7
120
What is the dosing for diclofenac gel?
Upper body areas- 2 grams/dose
Lower body areas- 4 grams/dose
Apply 4 times per day. Maximum of 16 grams per joint and 32 grams for the whole body per day.
121
It is known that counterirritants are drugs that exert a paradoxical pain-relieving effect achieved by producing less severe pain to counter the more intense one. What is the typical dosing for most counterirritant topical products?
Apply no more than 3-4x per day for up to 7 days. If chronic pain, use for the duration of the pain.
122
Topical counterirritants are safe for use in adults and children older than ______ years of age.
2
123
What is a possible side effect when using topical counterirritants?
Chemical burns
124
What is the MOA of the counterirritant methyl salicylate?
This is a rubefacient that causes vasodilation increasing blood flow and skin temperature. It also inhibits central and peripheral prostaglandin synthesis.
125
What is the MOA of the topical counterirritant camphor?
It produces a cooling sensation
126
At concentration of 0.1-3% for camphor products, what is the effect?
Depresses cutaneous receptors
127
At concentrations greater than 3% for camphor products, what is the effect?
Stimulates nerve ending in the skin and masks the pain
128
For safety reasons, camphor cntrentrations can not exceed ______%.
11%
129
What is the MOA of counterirritant menthol?
Produces a cooling sensation
130
At concentration less than 1%, what are the effects of menthol?
Depresses cutaneous receptors to act as an anesthetic.
131
At concentrations greater than 1.25%, what are the effects of menthol?
Stimulates cutaneous receptors to act as a counterirritant.
132
Menthol activates the ______________ cation channels to trigger a cold sensation followed by a sensation of warmth.
Transient receptor potential
133
What is the MOA of counterirritant capsicum?
It is a TRPV1 receptor stimulates that depletes substance P.
134
What is unique about the dosing for capsicum?
Needs to be applied regularly to see any effects. This topical drug will not work if not applied regularly.
135
What is the MOA of the topical analgesic trolamine salicylate?
This drug is absorbed through the skin and results in synovial fluid salicylate concentrations below those of oral aspirin. May be good for osteoarthritis in the hand.
136
What was the only drug discussed that acts on nerve pain?
Lidocaine
137
What is the dosing protocol for lidocaine patches?
Limit patching to 8-12 hours and leave off for at least 12 hours
138
What is the dosing protocol for lidocaine creams?
Apply Q6-8H PRN and do not exceed 3 doses per day.
139
Lidocaine use is approved for ________ days in those ______ years and older.
7
12
140
What is the pathophysiology behind dry eye disease?
1. Tear hyperosmolarity
2. Decreased tear production
3. Increased evaporation loss
4. T-cell mediated inflammation with moderate to severe disease
141
What are the main symptoms of dry eye disease?
Itchy or scratchy eye and/or a gritty sensation in the eye.
142
What are the 4 classes of drugs that can induce dry eye disease?
Anticholinergics like antihistamines and antidepressants
Decongestants
Diuretics
Beta blockers
143
A patient complains of grittiness in the eye. What is likely the problem?
Dry eye disease
144
If the dry eye disease presents as mild, what is the 1st line treatment?
Ocular lubricants
145
A patient complains of redness and matting of both eyes in the morning. What are they likely suffering from?
Bacterial conjunctivitis
146
A patient complains of itchy eyes with redness and watery discharge. What is likely the problem?
Allergic conjunctivitis
147
When should a person be switched from preservative containing to preservative free eye solutions?
If they are using them everyday they should switch the preservative free to limit damage to the epithelium of the eye.
148
What are the 3 alarm symptoms of eye disease?
1. Pain
2. Photophobia
3. Blurred vision
149
What are the 2 indication for artificial tear use?
1. Dry eye disease
2. Allergic conjunctivitis
150
What are the 3 main side effects of artificial tear use?
Blurred vision, crusting of eyelids, and stinging of eyes
151
What are the side effects of ophthalmic ointments?
Blurred vision, eye discomfort, irritation, redness, and matting or sticking of eyelashes
152
What are the exclusions for self-treatment for eye issues?
1. Eye pain
2. Blurred vision
3. Light sensitivity
4. History of contact lenses
5. Blunt trauma to eye
6. Chemical exposure to eye
7. Eye exposes to heat
8. Symptoms lasting longer than 72 hours.
153
What are the signs and symptoms of allergic conjunctivitis?
Bilateral eye involvement, painless tearing (watery eyes), intense itching, diffuse redness, and watery discharge
154
A good non-pharm treatment for dry eye is to use a warm compress. What is a similar good non-pharm treatment for allergic conjunctivits?
Cold compress
155
What is the 1st line treatment for allergic conjunctivitis?
Artificial tears
156
What is the 2nd line treatment for allergic conjunctivits?
Ophthalmic antihistamine/mast-cell stabilizers or just ophthalmic antihistamines.
157
What were the 3 discussed ophthalmic antihistamines/mast cell stabilizers?
Olopatadine, ketotifen, and alcaftadine
158
What drug class is alcaftadine in?
Antihistamine/ mast cell stabilizer
159
What were the two discussed ophthalmic antihistamines only?
Pheniramine and antazoline
160
What were the 5 ophthalmic decongestants discussed?
Naphazoline, tetrahydrozoline, phenylephrine, oxymetazoline, and brimonidine
161
What two ophthalmic decongestants that have the highest risk for ocular rebound?
Phenylephrine and oxymetazoline
162
What is the indication for the drug Ketotifen?
Allergic conjunctivits
163
What is the indication for the drug olopatadine?
Allergic conjunctivits
164
What is the indication for brimonidine?
It reduces redness in the eye
165
What is the MOA for the drug brimonidine?
Selective alpha-2 agonist. It binds and activates alpha 2 adrenergic receptors in the vascular endothelium of the eye vessels causing vasoconstriction reducing blood flow to the eys.
166
What is a side effect common with the use of Pheniramine?
Tingling sensation in the eye
167
What drug class does Pheniramine belong to?
Anithistamine
168
What are the 4 common side effects of ophthalmic decongestants?
Blurred vision, eye discomfort, irritation, and redness
169
What drug class does oxymetazoline belong to?
Decongestant (can be nasal or ophthalmic)
170
What drug class does tetrahydrozoline belong to?
Decongestant
171
What drug class does Naphazoline belong to?
Decongestant
172
What drug class does phenylephrine belong to?
Decongestant (can be nasal or ophthalmic)
173
What is the MOA of phenylephrine?
Selective alpha 1 agonist
174
What are the 2 common side effects of the drug Ketotifen?
Headache and rhinitis
175
What are the 5 common side effects of ophthalmic ointment use?
Blurred vision, eye discomfort, irritation, redness, and matting or sticking of eyelashes
176
What are the 3 common side effects of artificial tear use?
Blurred vision, crusting of eyelid, and stinging of the eyes.
177
What drug class does Olopatadine belong to?
Ophthalmic antihistamine and mast cell stabilizer
178
What drug class does Ketotifen belong to?
Ophthalmic antihistamine and mast cell stabilizer
179
What is stabilized oxychloro complex (Purite, OcuPure)?
This is an ophthalmic preservative that evaporates when it hits the eye.
180
What is sodium perboate?
This is an ophthalmic preservative that evaporates when it hits the eye.
181
What is benzethonium chloride?
This is an ophthalmic preservative
182
What is lanolin?
This is an ophthalmic lubricant ointment
183
What is mineral oil 40% used for?
It is used as an ophthalmic lubricant ointment
184
What is petrolatum used for?
It is used as an ophthalmic lubricant ointment
185
What is glycerin 0.5-1% used for?
This is an ocular lubricant
186
What is polyethylene glycol 400 used for?
This is an ocular lubricant
187
What is Povidone 0.6-2% used for?
This is an ocular lubricant
188
What is polyvinyl alcohol used for?
This is an ocular lubricant
189
What is Hydroxypropyl methylcellulose used for?
It is an ocular lubricant
190
What are the symptoms of impacted cerumen (earwax) in the ear?
Decreased hearing, dizziness, ringing in ear, and itching
191
What drug class does carbamide peroxide belong to?
Cerumen softening agent
192
What is the age cut-off for the medication called Debrox? It is an earwax removal kit?
12 years old
193
What are the exclusions for self-treatment for otic issues like impacted cerumen or swimmer's ear?
1. Signs of infection
2. Pain with ear discharge
3. Bleeding or signs of trauma
4. Ruptured tympanic membrane
5. Ear surgery within last 6 weeks
6. Tympanostomy tubes
7. Cannot follow instructions
8. Hypersensitivity to recommended products
9. Younger than 12 years
10. Worsening of condition after self-treatment
194
Is dizziness an exclusion for self-treatment for impacted cerumen?
No. This is typically a symptom of impact cerumen.
195
Is decreased hearing an exclusion for self-treatment for impacted cerumen?
No. This is typically a side effect of impacted cerumen
196
Are the symptoms of pain, redness, and warmth exclusions for self-treatment for impacted cerumen?
Yes. These may be signs of an infection
197
Are the symptoms of pain associated with ear discharge a self-exclusion for impacted cerumen treatment?
Yes
198
Are tympanostomy tubes an exclusion factor for self-treatment for impact cerumen?
Yes
199
What are the exclusions for self-treatment with insomnia?
1. Younger than 12 years old
2. 65 years and older
3. Pregnant or breastfeeding
4. Frequent nocturnal or early morning awakenings
5. Chronic insomnia (3 months or more)
6. Sleep disturbances secondary to psychiatric or general medical disorders
200
What is chronic insomnia?
Insomnia that has lasted for at least 3 months and occurs 3 or more times per week.
201
What is short-term insomnia?
Insomnia that has lasted less than 3 months
202
What is the MOA of melatonin?
Melatonin regulates the circadian rhythm. It may shorten time to fall asleep (improves sleep latency)
203
What is the MOA of caffeine?
Caffeine is an adenosine antagonist at the A1 and A2 receptors. Adenosine naturally works to centrally promote sleep.
204
What is the typical dose of melatonin for insomnia?
2-10mg
205
What is the usual dose for diphenhydramine for insomnia?
25-50mg taken 30-60 minutes before bedtime
206
Is pregnancy and/or breastfeeding an exclusion for self-treatment for insomnia?
Yes
207
Is being 65 or older an exclusion for self-treatment for insomnia?
Yes
208
What is the only FDA approved OTC TX for insomnia?
Diphenhydramine
209
For the TX of short-term insomnia, use diphenhydramine for _________ days with an "off" night to assess sleep quality without the medication.
3 days. Do not use for more than 7-10 days.
210
What is the age cutoff for OTC TX for insomnia?
12 and 65
211
What does SLUDGE stand for?
Salivation, lacrimation, urination, defecation, GI distress, and emesis
212
How effective is the CAM known as valerian?
300-600 mg daily modestly improves subjective sleep quality.
213
What are the US population nutrients of concern?
Potassium, calcium, iron, and vitamin D
214
What form of iron has the highest % of elemental iron?
Iron fumarate
215
What form of calcium is best in the elderly population and those on anti-ulcer medications?
Calcium citrate as it does not need an acidic environment to be absorbed.
216
What is the indication for St. John's Wart?
Depression
217
What is the indication for Kava?
Anxiety
218
What is the indication for ginkgo?
Anxiety and dementia
219
What is the indication for asian gingseng?
Cognitive function
220
What are the 4 main 2nd generation antihistamines?
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Levocetirizine (Xyzal)
Loratadine (claritin)
221
What is Cromolyn (NasalCrom)?
This is a mast cell stabilizer drug
222
What is the time period for intermittent allergic rhinitis?
4 days or less per week OR less than 4 weeks
223
What is the time period for persistent allergic rhinitis?
4 days a week or more AND lasting at least 4 weeks.
224
What is the TX for mild intermittent allergic rhinitis?
1. Oral antihistamine or intranasal antihistamine
2. Intranasal corticosteroid
225
What is the TX for moderate-severe intermittent allergic rhinitis?
1. Oral antihistamine or intranasal antihistamine
2. Intranasal corticosteroid
3. IAH and ICS
226
What is the TX for mild persistent allergic rhinitis?
1. Inhaled corticosteroid
2. Oral antihistamine or intranasal antihistamine
227
What is the TX for moderate-severe persistent allergic rhinitis?
1. ICS and IAH
228
What type of drug is budesonide (Rhinocort)?
Intranasal corticosteroid
229
What is the dosing for the oral decongestant pseudoephedrine?
60mg Q4-6H (max 240 mg)
