Exam4 reduced Flashcards
What are the pathophysiological wound healing phases?
I. Inflammatory II. Proliferation III. Maturation or remodeling
What are some delayed healing disease states?
-DIABETES - Severe anemia - Hypotension - PVD - CHF
What are the delayed wound healing medications?
Antiplatelets Glucocorticosteroids Systemic steroids (these interfere with the inflammation phase) Chemotherapeutic drugs (cell division)
What are some causes of delayed wounds healing?
- Inadequate nutrition
- Advanced age
- Obesity
What is the goal for treatment of minor wounds? Stepwise self treatment approach?
CSC
Self care vs. referral Relieve symptoms, promote healing by protecting the wound from infection and further trauma and minimize scarring 1) Cleanse damaged area 2) Selectivity use antiseptics and antibiotics 3) Close or cover with appropriate dressing
What are the exclusions for self care for a wound?
-Wound containing foreign matter after irrigation
- Chronic wound
- Wound secondary to an animal or human bite
- Signs of infection
- Involvement of face, mucous membrane, or genitalia
- Deep, acute wound
- Patients with diabetes
What are the pharmacological recommendations for wound care?
Systemic Analgesics - NSAIDS - anti-inflammatory - Acetaminophen Topical Analgesics - Inhibit transmission of pain signals from pain receptors: duration 15-45 minutes - Common ones are lidocaine and benzocaine High concentration when skin is intact Low when skin surface is not intact
Talk about First-Aid antibiotics what if you use it for too long?
It is a triple antibiotic cream or ointment containing - Bacitracin - Neomycin - Polymyxin If use is prolonged bacterial resistance may be developed and may cause secondary fungal infection
If sign of improvement are not seen within how many days? what should you do?
Constipations i think
If not improved within 7 days then refer to the doc
What are the exclusions for self treatment when treating corns or calluses?
- Diabetes - PVD - Lesions hemorrhaging or oozing purulent material - Anatomic defect - Extensive or painful - Unsuccessful self treatment attempt - History of RA
What is the pharmalogical therapy of corns and calluses?
Salicylic Acids
Callodion and Liquid forms of salicylic acids are in what concentration?
12-17.6%
Plaster and disk, pads forms of salicylic acids come in what concentration?
12-40%
What is the difference between a callus and a corn how would you be able to tell?
- Corns have a core - Corns are smaller than calluses - Corns have a clear border - Corns are hard or soft
What are the treatment goals pertaining to corns and calluses
- Provide symptomatic relief - Remove corns and calluses - Prevent their recurrence by correcting underlying causes Eliminate the source
What is some non-pharm treatment for corns and calluses?
- Soaking your feet - Removing dead tissue - Callus file - Pumice stone - no knives ore razor blades - cushioning pads - silicone toe sleeve - proper fitting footwear
What are the goals for treatment of bunions?
- Decrease irritation of the affected area - Prevent it from getting worse by fixing the cause
What are exclusions to self treatment with bunions?
DM patient Bunions with bleeding or discharge proper but unsuccessful self-treatment attempt
What is the pharmacological treatment for bunions?
OTC anti-inflammatory meds - limit to short term of use
When do you refer a bunion patient to the doc?
First adjust shoes size after 2-3 weeks if symptoms persist If not fixed by 2-3 weeks using larger footwear refer
Ingrown toenails treatment goals
Relieve pressure on the toenails relieve pain prevent recurrence
What are the exclusions for self treatment with ingrown toenails
DM, PVD, arthritis - malformation of foot - physical or mental impairment that makes self treatment hard
Refer patient with ingrown toenails if symptoms dont improve after?
3-4 weeks
What is the pharm treatment for ingrown toenail?
Sodium sulfide gel 1% topical BID x 7 days - oral NSAIDS
What are the different types of ostomies?
- Ileostomy (liquid–>semisoft)
- Colostomy (semisoft to fully formed)
- Urostomy
The ideal pouch system in ostomies should be?
- Leak proof
- odor proof
- Easy to manipulate
- unseen
- safe
- cheap
What are the goals for pouch management?
- Want to resume normal life as soon as possible
- Avoid complications from improper use
- Reduce risk of other complications
What are the self care skills a patient needs to avoid complications with an ostomy pouch?
- Sizing
- Cutting barriers to fit
- selecting correct precut products
- Pouch application, removal, and emptying
What kinds of medications do you want to avoid if you have an ostomy?
Only instant release tablets because extended can not be dissolved all the way
What are the four main points of ostomies?
- Goals of self treatment, complications, reducing risk of complications, dietary considerations, low fiber diet for the first 6 weeks, want patient to resume normal life
- When to refer?- to irrigate, denuded skin, self treatment doesnt work, cant tolerate fluid or electrolytes, fungal infections, use of laxative, herbal agents need to be provided by doctor
- Medication considerations
- Pouches ideal system
Exclusions for self treatment for pinworms
- Liver disease
- pregnant
- Breastfeeding
- age
- Hypersensitivity to pyrantal pamoate
- Non-specific symptoms with negative visual aspects
- Helminth other than E. Vermicularis
- Treatment failure symptoms longer than 2 weeks
Treatment algo for pinworms
First ask about secondary causes, confirm pinworm, self treatment exclusions
- If appropriate recommend pyrantel pamoate in addition to strict hygiene
WHo do you treat with pyrantal pamoate if someone has pinworms?
Every member in the house hold
What are the adverse effects of pyrantal pamoate?
N/V, renesmus, anorexia, diarrhea, cramps, headaches, dizziness, drowsiness, insomnia , rash, fever, weakness
Albendazole is Rx only to treat?
Pinworms
What is the normal dose for pyrantel pamoate?
11 mg/kg once
Max 1 gram
shake suspension
What is GERD?
What are the symptoms?
Gastroesopheageal reflux disease
- Heartburn (buring sensation)
- Regurgitation
- Dysphagia
- Dyspepsia
What are some risk factors for GERD?
Diet
- Alcohol
- Caffiene/carbonated drinks
- Citrus or Spicy foods
Lifestyle
- Obesity
- smoking
- tight clothes
- stress
What are some medication related risk factors for GERD?
Anticholinergics
NSAIDS
Calcium blockers
What are the major exclusions to self care for GERD?
- Heartburn lasting more than 3 months
- It is severe
- Adults older than 45 with new onset dyspepsia
What are the treatment goals for GERD?
- Complete relief of symptoms within 14 days
- Reduce recurrence of symptoms
- Prevent complications
What is some non-pharm treatment for GERD?
- Diet (avoid trigger foods)
- Weight loss
- GERD pillow
- Eat small meals
- refrain from laying down 3 hours after eating
- Stop smoking
- limit alcohol
What is the pharm treatment for GERD?
Antacids
H2RA
Proton pump inhibitors (PPI)
What do antacids treat?
How frequent would it need to occur to suggest this medicine?
treatment mild infrequent heartburn or indigestions
3 times a month
When would you not use antacids?
Renal failure, heart failure, pregnancy
When do antacids show relief and how long do they last?
When would you reevaluate?
Relief within 5 minutes
last 60 minutes
Reeval- if using more than 2 times per week
What do H2RAs treat?
what do they relieve?
How many times per week would constitute use?
Less than what age?
Caution in?
Treat mild to moderate infrequent/episodic heart burn or preventions of indigestion
Cannot be used if less than 12
Relieve fasting and nocturnal symptoms
Caution in renal dysfunction, old
Symptoms less than 2 x per week
When do you take H2RAs?
How long do they last, when do they start working?
WHen do you refer?
Take H2RAs 30 minutes prior to a meal or at onset of symptoms
Relief within 1 hour
lasts 4-10 hours
Refer if use is needed past 14 days
What do PPIs treat? They are more potent than what?
Treat frequent heartburn great than or equal to 2 weeks
dont us in people under 18
More potent than H2RAs
Caution in hepatic impairment
When do you take PPIs?
For how many days can you take them?
When do you refer?
How long do they last?
30 to 60 minutes prior to meal, take for up to 4 days
Actions for 24 hours
Needed past 14 days refer
may repeat every 4 months
If someone has GERD and is pregnant what should you do?
Fisrt suggest lifestyle changes
Calcium and Magnesium antacids
ranitidine
When do you follow up for GERD?
Within 1 week you should ask about changes in frequency and severity, side effects, adequate response to treat meant
If not completely gone by 14 days refer
What are some factors that increas intestinal gas?
- Large meals
- stress and anxiety
- Increased swalling while eating and drinking
- Foods
- bean, veggies, high fiber cereal
What are exclusions for Intestinal gas?
- Onset of symptoms occur when older than 40
- Symptoms are accompanied by significant ab pain or suddent change in bowel function
- Presence of severe diarrhea/constipation, GI bleeding, fatigue, weight loss
What are the treatment goals for Intestinal Gas
- Reduce frequency, intensity, duration, of symptoms
- Reduce impact of symptoms on patients lifestyle
What is the non-pharm treatment for Intestinal Gas
- Change eating habits , eat and drink slowly
- Stop tabacco
- Avoid gum
- Find trigger foods
What are the 4 pharmaologic treatments for intestinal gas?
- Alpha-galactoside
- Simethicone
- Lactase Enzymes (lactose intolerance only)
- Probiotics
WHat is the dose for Simethicone?
40-360 mg after meals
You should not use Alpha-galactosidase medications in patients with ______ and you should use caution in patients with ______ and allergy to _____
Galasctosemia
Caution in Diabetic patients and Allergy to mold
WHat is the dosing for Alpha-galactosidase
300-450 units per serving of food
What do probiotics do?
Help maintain bacterial population in the intestinal flora
When do you follow up for a patient with intestinal gas?
When would you discontinue?
follow up within 7 days to see if symptoms are relieved (refer if not)
Discontinue product if relief is not provided in 24 hours (specific to simethicone)
What are the 5 As in smoking cessation?
Ask, Advise, Assess, Assist, Arrange
In the first A-Ask what would you possibly say to the patient?
Do you ever smoke or use other types of tabacco or nicotine, like e-cigs?
What would you say in the second A-Advise?
Its important that you quit as soon as possible, and I can help you
3rd A assess what to say?
You are assessing the readiness to make a quit attempt
If they arent ready to quit you should enhance their motivation if they are ready to quit you should design a treatment plan, If they quit recently try and prevent relapse
How to you assess someones readiness to quit tabacco? What are the stages? What are the goals of each stage?
There are many stages to assessing how someone feels about quiting smoking
- Stage 1) Not ready to quit in the next month (start thinking about quitting)
- Ready to quit in the next month (achieve cessation, set quit date, find triggers)
- Recent quitter quit within the past 6 months (remain tabacco-free for at least 6 months)
- Former tabacco user quit longer than 6 months ago (remain tabacco free forever)
When performing brief counseling what could you refer the patient to to get more information about quitting?
1-800- quit- now
What are the non-pharm options to stop smoking?
Counseling and other non-drug approaches
- Like quitting cold turkey
- Tapering off of it, reduced frequency and lower nicotine cigs
- Assited tapering (QuitKey)
- Message therapy
- Hypnotherapy
- Acupunture
What are the first line pharmaclogical therapies for quitting smoking?
- Nicotine replacement therapy (NRT)
- Gum, lozenges, patches, lozenge, nasal spray, inhaler
- Psychotropics
- Sustained-release bupropion
- Partial nicotinic receptor agonist
- Varenicline
If you smoke less than 10 cigs a day should you use pharmacotherapy?
Nope
Use precautions when treating who pharmacologically for smoking?
- Patients with underlying cardiovascular disease
- MI within the past 2 weeks
- Serious arrhythmias
- Serious or worsening angina
Nicotine gum (nicorette) comes in what doses?
2, and 4 mg
When would you use the 2 mg dose of nicotine gum?
If the patient smokes their first cig more than 30 minutes after waking up
When would you use the 4 mg dose of nicorette?
If patient smoke first cig within 30 minutes of waking up
Going from Weeks 1-6, 7-9, 10-12
What should the frequency of nicotine gum be?
- 1 piece every 1-2 hours
- 1 piece every 2-4 hours
- 1 piece every 4-8 hours
How would you tell someone to use nicorette?
- Chew the pieces very slowly many times
- pepper stop chewing
- Put the gum between cheeck and gum (for absorption)
- When taste or tingle fades chew again
- Repeat
How many pieces should a patient use daily?
at least nine
WHat can reduce the effects of nicotine gum?
Coffee, wine, juice, soda
Do not eat or drink 15 minutes before or while using the gum
What are the side effects of nicotine gum?
- Mouth soreness
- Hiccups
- Dyspepsia
- Jaw ache
How do you use nicotine lozenges?
- Place in mouth and allow to disolve slowly
- Dont chew or swallow
- Rotate occasionally
- With dissolve in 20-30 minutes
What are some side effects of nicotine lozenges?
- Nausea
- CCough
- Heartburn
- Headache
- Fart
- Insomnia
Are the advantage of Nicotine lozenge the same as gum?
yes
How would you tell a patient to use a Nicotine patch?
- Choose an area of skin on the upper body or upper outer part of arm
- Dry, hairless, clean
- Different area every day
- Dont use same area agian for at least one week
- Dont leave patch on for more than 24 hours
What are some side effects of nicotine patch?
- Mild itching, burning, tingling (first hour)
- Possible crazy dreams
- Headache
What is bupropion?
- Nonnicotine cessation aid
- A sustained release antidepressant
- Oral
What are bupropions clinical effects?
Decreases cig cravings
Decreases withdrawal symptoms
When should you not use bupropion?
- Patients with siezure disorder
- Current or prior diagnosis of bulimia or anorexia
- Patients undergoing abrupt discontinuation of alcohol, benzos, barbiturates, antiepileptic drugs
- Patient taking MAO inhbitors within 14 days of initiating or discontinuing therapy
What is a serious precaution for bupropion?
Neuropsychiatric symptoms and suicide risks
When should patients start using bupropion?
1 to 2 weeks before their quit date!
Varenicline is a?
nonnicotine cessation aid, Partial nicotine receptor agonist
What are the clinical effects of Varenicline?
Reduces symptoms of nicotine withdrawal
Blocks reward of smoking
What can Varenicline cause?
- Seizures
- Effects of alcohol increased
*
When should you start Varenicline?
1 weeks prior to quit day
What are some of the causes of constipation?
- Low fiber diets
- high diet in red meats, dairy and processed foods
What are the treatment goals for constipation
Relieve constipations and return to normal bowel movement within 7 days
What are some exclusions to self treatment for constipations
- Less than 2 years old
- Fever
- Bloody stool
- Symptoms for longer than 2 weeks or recur over 3 months
What are some non-pharm treatments for constipation
- Dietary fiber intake
- Increase intake over 1-2 weeks gradually
- Take with plenty of water
- Increase fluid intake (64-68 oz)
- Bowel training
- Exercise
What would the ideal laxative be like?
- Ninirritation and nontoxic
- Acts on descending/sigmoid colon
- Normal stool within a few hours
This doesnt exsist though
What are the 6 types of laxitive?
- Bulk-forming
- Hyperosmotic
- Emollient
- Lubricant
- Saline
- Stimulants
Bulking forming laxative are similar to what mechanism?
Physiologic Evacuation mechanism
Hyperosmotic laxative contain large ions/molecules that draw water in the _____ causing what?
draw water into colon, lead to osmosis and a bowel movement
Peg 3350 (hyperosmotic) has the most evidence for?
Efficacy and Safety
What is usually used in combination with a stimulant?
Emolients
YOu should watch overuse of laxative in?
The elderly, anorexia/bulimia, misconception of normal BM
Bulk-forming and hyperosmotic are what in therapy?
1st choice in therapy
What do stimulants do in the colon?
They empty it completely
With non-pharm measure for constipation what should you do after a normal BM returns?
Continue the implimentation
If a patient has diarrhea when should you refer them?
Persistent occurs for more than 14 days but less than 4 weeks
Chronic longer than 2 weeks
Giardia, Crpyosporidium, Entamoeba histolytica, isospora belli
WHat do you do?
Refer
What makes diarrhea severe?
Unable to drink, Deeply sunken eyes, Parched, Cold, 6-9 unformed stools and day
What are diarrhea exclusions for self care?
less than 6 months old
High fever greater than 102.2
Severe vomiting, pain, distress
Chronic or persistent diarrhea
What are the goals for self treating diarrhea?
- Prevent or corrent fluid and electrolyte loss
- Control symptoms within 24-48 hours
- Identify and treat the cause
What is the most important non pharm treatment for diarrhea?
Good hygiene
Loperamide is indicated for?
Acute diarrhea
Loperamide should not be used in?
Patients with high fever
What are the side effects of BSS?
Black or grey stool
Avoid if allergic to aspirin
Dont use in children who have recently had flu like symptoms or chicken pox because it can cause reyes syndrome
Digestive Enzymes are indicated for what type of patient?
Lactose intolerant
