Final: H, D, G - Drug Info Flashcards
Hemorrhoids: Referral Criteria
Severe symptoms
- Pain
- Bleeding
- Prolapse
- Seepage
- Thrombosis
- OTC treatment failure (> 7 days)
High risk patients
- Children < 12 yo
- History of GI disease
- Family history of colon cancer
Hemorrhoids: Non-Pharmacologic Treatment
• Bowel modifications
– Act on the urge (don’t hold it in)
– Limit sitting time, don’t strain
– Anal hygiene
• Dietary modifications
– Increase fiber
– Increase fluids
• Non-pharmacologic treatments
– Sitz baths
– Surgery (laser, banding, sclerosis, etc)
Hemorrhoids: OTC, external vs. internal use
- Local anesthetics (Lidocaine, pramoxine): External only
- Astringents: External only
- Keratolytics: External only
- Analgesics (Witch hazel): External only
- Corticosteroids (Hydrocortisone): Both
- Vasoconstrictors (Phenylephrine): Both
- Protectants (Glycerin, petrolatum, mineral oil, cocoa butter): Both
Internal = Mucosal tissue
-No somatic innervation
(no pain)
-Not keratinized
External = Epidermal tissue
- Somatic innervation (pain)
- Keratinized
Hemorrhoids: OTC Adverse Effects
- Local anesthetics
Allergy, contact dermatitis - Vasoconstrictors
HTN, heart disease, urinary retention - Protectants
Rare, poorly absorbed - Astringents
Irritation, contact dermatitis - Keratolytics
Resorcinol: circulatory failure - Analgesics
Irritation, central nervous effects - Corticosteroids
Skin atrophy, ↑ risk of infection
Hemorrhoids: OTC Max Dosing
- Local anesthetics: 6x (pramoxine: 5x) (dibucaine: 4x)
- Vasoconstrictors: 4x
- Protectants: 6x, or after each bowel movement
- Astringents: 6x, or after each bowel movement
- Keratolytics: 6x
- Analgesics: 6x
- Corticosteroids: 3-4x
Diarrhea: Referral Criteria
Severe dehydration
- Dizziness
- Lethargy
- Confusion
- Low blood pressure
- Tachycardia
- Decreased urination
Systemic illness
- Fever
- Severe pain
- Blood or pus in stool
- Prolonged vomiting
- OTC treatment failure (> 2 days)
High risk patients
- Infants < 6 months
- Pregnancy
- Diabetes
- Kidney disease
- Heart disease
- Immunosuppression
Diarrhea: Non-Pharmacologic Treatment
– Avoid: High fat, sugar, spice, or caffeine content
– Not recommended: “BRAT diet” (bananas, rice, applesauce, toast), bowel rest
• Prevention
– Sanitation (hand washing, food handling)
– Avoid sick contacts
• Fluid & electrolyte replacement
Diarrhea: Oral Rehydration
• Solutions of sodium and glucose are most effective (Pedialyte)
- NaCl = 2.6 g/L
- Glucose = 13.5 g/L
- KCl = 1.5 g/L
- Sodium citrate = 2.9 g/L
• Immediate treatment: 2-4 L over 4 hours
– Children ≤ 5yo: 50-100 mL/kg over 4 hours
• Maintenance: As needed to replace ongoing losses
– Children ≤ 5yo: 10 mL/kg or 1⁄2 - 1 cup per loose stool
Diarrhea: MOA
Loperamide
- Decreases intestinal motility and secretion
Bismuth subsalicylate
- Bismuth -> Antibacterial
- Salicylate -> Antisecretory
Loperamide: Use & AEs
• Use: Acute treatment of diarrhea in adults & children
– Decreases stool frequency, volume, and liquidity
• AE’s: Rare (low systemic absorption)
– Abdominal pain, constipation, paralytic ileus
– Risk of arrhythmias if max doses are exceeded (abuse)
– May worsen underlying infections
Bismuth Subsalicylate: Uses & AEs
• Uses: Acute treatment of diarrhea in adults > 12 yo
– Treatment of nausea or upset stomach
– Prevention of travelers’ diarrhea
• AE’s:
– Black stained stools & tongue (harmless)
– Salicylate toxicity: tinnitus, Reye’s syndrome in children
– Bismuth toxicity: encephalopathy
Gas: Referral Criteria
Severe symptoms
- Pain
- Frequency
- Duration
Signs of another problem
- Other accompanying symptoms: fatigue, weight loss, bleeding
- Sudden changes in symptoms: bowel habits, pain location, frequency or duration, new onset if age > 40 yo
Gas: Non-Pharmacologic Treatment
• Behavioral modifications
– Eat slowly, don’t gulp air
– Mild exercise after meals
• Dietary modifications
– Avoid carbonated drinks, gum
– Decrease carbohydrates (beans, starch, lactose, fiber)
• Bowel modifications
– Avoid constipation
Gas: Brands, MOA
- Simethicone: Decreases gas bubble surface tension
- Lactase: Breaks down lactose into simpler sugars
- α-galactosidase: Breaks down some 3-5 saccharides into simpler sugars
Simethicone: Use & AEs
• Use: Relief of gas pain or bloating
• AE’s: Rare (not absorbed systemically)
– May increase flatus or belching
