FINAL - Skin infections, Hemorrhoids, Supplements (73) Flashcards
Minor wounds - exclusions for self tx of minor wounds
-Bleeding > 5 minutes
-Wound from animal/human bite
-Deep/acute wounds
-Chronic wounds
-Immunocompromised
-Diabetes (foot wounds)
-Signs of infection
-Contain foreign matter
Skin Minor wounds: Self treatment
Irrigants
-Tap water +/- soap, chlorhexidine, hydrogen peroxide, saline
Topical Antibiotics
-Prevent infection
Bandage
-HUGE selection, important to not tear healing skin/scab; consider water-proofing
Monitoring
-Change dressing if needed for cleanliness or adherence
Sunburn
Cause: Excessive exposure to UV radiation
Resolution: typically <7 days
Prevention: sunscreen lotion, sunblock clothing or hats, limited sun exposure
Complications: Pain, redness, blistering, peeling, itching
Skin: Sunburn - Exclusion of self tx
Extensive Burns (>20% body surface affected w/blistering)
Infants
Severe blistering (swelling, pus, yellow/red blisters)
Intense Pain
Sunburn self tx
Clean with mild soap and water
Cool compresses
Consider use of aloe, calamine, silver gel, lotion
Blisters may require bandaging
Pain control with PO medications
Foot care - warts
Cause: HPV entrance through damaged skin
Resolution: Months to years w/o treatment
Prevention: Proper hygiene
Complications: Pain, impaired function social stigma
Exclusions for self-treatments of wart -IMPORTANT
-Suspicion growth is not wart
-Warts on face or genitalia
-Many warts
-Warts that hurt, itch burn, or bleed
-Weakened immune system
-Diabetes
Warts Tx
Salicylic Acid (Liquid or patch)
-Tape (usually over pad or acid)
-OTC “Cryotherapy”
Skin: Foot Care - Corns and Calluses
Cause: dead skin hardened by friction, often ill-fitting shoes
Callus: Can appear anywhere, larger area - typically involved
Corn: Commonly small, tops and sides of toes or balls of feet
Skin: Foot care - Corns and Calluses Tx
-Soak in warm water for 5-10 minutes
-File/scrape with pumice stone/scraper
-Lotion/ointment/cream to moisturize
-Shoes that fit properly
-Keep toenails clipped
Athletes foot
Cause: Fungal infection, direct contact with organism
Prevention: Good hygiene, moisture wicking shoes/socks, desiccating foot powders, tx of hyperhidrosis, proper footwear
Complications: Erosions, ulcers, malodor, secondary infections
Exclusions to self-treatment: recurrent, failed prior treatment; expansive infection, including genitalia
Athletes foot tx - Antifungals
-Zeasorb (miconzaole)
-Lotrimin (Clotrimazole)
-Lamisil (Terbinafine)
-Tinactin (Tolnafate)
Lice
Cause: The head louse (Pediculus humanus capitus), transmission requires direct contact
Presentation: Itching/scratching, redness, small wounds
Considerations:
-Often overtreated as diagnosis requires distinguishing between inactive and active forms of lice
-Low threshold for referral (recurrent, refractory, age <2 months, involvement of hair outside the scalp region)
Lice treatment
IMPORTANT
Rid = pyrethrin + Piperonyl butoxide
-Does not kill unhatched eggs (nits), tx MUST be repeated in 7-10 days
Age >2 YEARS
Nix = Permethrin
-Likely also needs repeated in 7-10 days, dependent on initial clinical response
Age, >2 MONTHS
Lice - post treatment
Wet combing
-With a fine comb that comes in most OTC lice tx packages
-Repeat Q2-3 days for up to 2-3 weeks, assess for dead lice
Other Considerations:
-Machine wash bedding, clothes
-Soak combs/brushes in hot water for 5-10 minutes
-Vacuum area where patient has been
-Children do not have to be kept out of school after undergoing tx
Which of the following is NOT an OTC tx for warts?
D. Aloe
What causes Athlete’s foot
B. Fungal infections
Hemorrhoids - Exclusions for self tx
No relief after one week of OTC tx
Severe pain
Bleeding
Sensitivity to OTC meds
Change in bowel patterns
Family history of IBD
Hemorrhoids - Self tx nonpharmacologic
-Eat high-fiber foods
-Stool softener or fiber supplement
-Increase water consumption
-Use topical tx
-Soak regularly in warm bath/sitz bath
-Take oral pain relievers
Hemorrhoids self tx - Pharmacologic
Anesthetics
-Dibucaine or pamoxine; often in combo products like “Preparation H”
Astringents
-Witch Hazel (TUCKS Pads), dries, soothes, relieves irritation
Corticosteroids
-Hydrocortisone 1% in cream or suppository; relieves itching
Vasoactive Agents
-Phenylephrine topical ointment or suppository; shrinks tissues to relieve discomfort
Which of the following recommendations would be most helpful for managing symptoms of hemorrhoids?
A. Soak in cold sitz water
B. Consume a clear liquid diet
C. Apply Lamisil (terbinafine) cream
D. Take a stool softener
D - Take a stool softener
Supplements - Fish oil
Uses:
-Hypertriglyceridemia
Considerations:
-GI upset, heartburn, indigestion, “fishy” taste
-Caution with anticoagulants/platelets, active bleed, or PUD
Supplements - Niacin
IMPORTANT - FLUSHING
Uses:
-Dyslipidemia (will increase HDL and decrease TG); not commonly used
Considerations:
Flushing occurs with ~80% of patients, but improves after two weeks of continued use
-To mitigate flushing, slowly increase dose, patients can pretreat w/aspirin, take with meals, use ER formulation, or take at bedtime
Supplements - Ginger
Uses:
-Typically used for nausea and vomiting (especially pregnancy)
-No use in CINV or motion sickness
Considerations:
-Generally well tolerated, ADRs with doses > 3 g/day
-Can increase bleeding risk
G’s make you bleed
Supplements - St. John’s Wort
Uses:
-Tx of mild-moderate depression, NOT MAJOR
-Extensive use some efficacy
Considerations:
-Vivid dreams, HA, dizziness
-GI upset, dry mouth, photodermatitis
-Significant medication interactions: CYP inducer, PGP inducer, Digoxin, HIV meds, Warfarin - clotting
-Interacts with A LOT of things
Supplements - Cranberry
Uses
-Thought to interfere w/bacteria’s ability to adhere to urinary tract wall
-Used for prevention, no role in treatment of UTI
Considerations:
-Caution w/aspirin allergy, has small amount of salicylic acid
-Can cause kidney stones
-Some patients will use cranberry juice, low cranberry concentration, but high sugar concentration
Supplements - Saw Palmetto
Uses:
-BPH
-Medication inhibits 5-alpha reductase
-Does NOT decrease prostate size or PSA
Considerations
-Can cause GI upset
Supplements - Echinacea
Uses:
-Some evidence that it can decrease URTI by 1 day
-Must be started at onset of symptoms, taken for 7 days
-No antibacterial or antiviral properties
Considerations:
-GI upset, rash, allergic rxn (ragweed, marigold, daises)
Supplements - Melatonin
Use:
-Insomnia
-Shift disorder
-Jet lag
Considerations
-Should be taken 2 hours prior to bed time
Which supplement and use pair is INCORRECT?
A. Melatonin - Insomnia
B. Niacin - Dyslipidemia
C - AZO cranberry Upper RTI
D. Saw Palmetto - BPH
C - Azo Cranberry - Upper RTI
Which supplement and potential adverse effect is INCORRECT?
A. Echinacea - Allergic rxn
B. Niacin - Flushing
C. Saw Palmetto - Gi Upset
D. Ginger - Nausea
D . Ginger - Nausea
