Gas/hemorrhoids/motion sickness/gastroenteritis Flashcards

1
Q

What are the causes of intestinal gas

A

-swallowing food/air/saliva
-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

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2
Q

What are some medical conditions that are associated with increased intestinal gas

A

-irritable bowel syndrome
-lactose intolerance/ malabsorption
-celiac disease
-pancreatic insufficiency

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3
Q

What are some medications that contribute to intestinal gas

A

-meds that affect the gut biome(lactulose, antibiotics)
-agents that affect metabolism of glucose and dietary supplements(acarbose, metformin, orlistat)
-drugs that can affect GI motility (narcotics, anticholinergics, calcium channel blockers, psyllium, cholestyramine)

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4
Q

What are the presenting symptoms of intestinal gas

A

eructation(belching of swallowed air)
bloating(uncomfortable fullness)
indigestion
abdominal pain/cramping
borborygmi(audible bowel sounds)
flatulence

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5
Q

When should you not self-treat for intestinal gas

A

-symptoms persist for more than a few days
-symptoms occur several times a month
-symptoms so severe they are debilitating
-sudden change in the location of abdominal pain or significant increase in frequency or severity of symptoms
-New onset of symptoms in people older the age of 40
-significant discomfort or sudden bowel function change(diarrhea or constipation)
-gas occurs in conjunction with other symptoms such as severe or persistent diarrhea or constipation, GI bleeding, fatigue , fatigue, unintentional weight loss, or frequent symptoms at night

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6
Q

Why is it especially important for people over the age of 40 experiencing a new onset of symptoms of intestinal gas to not self-treat

A

incidence of colon cancer increases after the age of 40

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7
Q

What are our goals of therapy when treating intestinal gas

A

reduce symptoms (frequency/intensity/duration)
minimize gas impact on persons lifestyle
NOT eliminate gas since it’s a normal part of GI tract function

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8
Q

What are some complementary/non-pharmacologic options that can be suggested to help with intestinal gas

A

probiotics(14-day trial)
fermented foods with live active cultures
herbal carminatives (fennel seed, japanese mint, peppermint, spearmint)
*Insufficient evidence, no gurantee

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9
Q

Why should pt with GERD avoid carminatives

A

Lower the LES tone and pressure and can cause an increase of acid reflux

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10
Q

Who should avoid fennel seed

A

those that are pregnant or lactating

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11
Q

What are some OTC options to prevent gas

A

alpha-galactosidase
lactase enzyme
*follow up in a week to see if MD visit is needed

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12
Q

What are some OTC options for the treatment of gas

A

simethicone
activated charcoal
*follow up in a week to see if MD visit is needed

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13
Q

What is the MOA of alpha-galactosidase (beano)

A

hydrolyzes oligosaccharides into component parts

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14
Q

What is the indication of beano

A

prevention of intestinal gas

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15
Q

How long does it take for beano to start working and how long do the effects last for

A

onset within 30 minutes of taking
duration: at least 5 hours

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16
Q

What is a possible side effect

A

allergic reaction is possible(rash, swelling, hives, etc…)

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17
Q

Who should avoid taking beano

A

people with galactosemia(don’t have the enzyme to break down galactose into glucose)
people who have mold allergies

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18
Q

What is the dosing for beano in adults

A

300-450 units per food serving
*should ask HCP for child usage

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19
Q

What is the MOA of the lactase enzyme (lactaid)

A

replacement enzyme that breaks down lactose into glucose and galactose

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20
Q

What is lactaid indicated for

A

dairy intolerance

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21
Q

How fast lactaid start working and how long does it last

A

onset is immediate
lasts the entire time dairy product is being digested

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22
Q

Who should avoid taking lactaid

A

people with galactosemia

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23
Q

What is the dosing for lactaid

A

*dosing for all ages
Original strength: 3 caplets at first bite
Extra strength: 2 caplets””
Ultra strength: 1 caplet (max of 2) “”

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24
Q

What is the MOA of simethicone (gas-x)

A

defoaming agent
reduces the surface tension of gas bubbles in GI tract mucus
makes it so it is eliminated more easily

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25
Q

What is the onset of action and the duration of Gas-X

A

onset is within 30 minutes
the duration is up to 4 hours

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26
Q

What is the dosing of Gas-X

A

*after meals and at bedtime
-Adults and adolescents: 40-125 mg qid prn
-Children 2-12 yr: 40-50mg qid prn
-children younger than 2: 20mg qid prn

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27
Q

What is the suspected MOA of activated charcoal

A

adsorb gas given charcoal large surface area

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28
Q

What drug interactions exist with activated charcoal

A

it may decrease drug absorption so avoid taking within one hour of medications

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29
Q

What is the dosing of activated charcoal

A

500-520mg after meals as needed
may repeat hourly

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30
Q

What is a hemorrhoid

A

-inflamed, swollen blood vessels in the rectum and anus that protrude during bowel movements
-can be internal(can’t see or feel and almost never any discomfort)
-can be external(under skin around the anus, usually have symptoms)

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31
Q

What are the presenting symptoms for internal hemorrhoids

A

rare discomfort
stool passage may cause painless bleeding

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32
Q

What are the presenting symptoms for an external hemorrhoid

A

itching
general discomfort/irritation
burning
inflammation
swelling

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33
Q

When should you not self-treat hemorrhoids

A

-pt younger than 12 years
-UC or Crohn’s
-family history of colon cancer
-anorectal disorder previously diagnosed by MD
-acute onset of severe pain
-bleeding, seepage, black tarry stools
-severe symptoms
-minor symptoms not responding to 7 days of self-care

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34
Q

What are the goals of therapy with hemorrhoid treatment

A

resolve symptoms
keep stool soft to prevent straining
maintain remission of symptoms
prevent complications

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35
Q

What are some complementary and non-pharmacologic options available for someone with hemorrhoids

A

-avoid alcohol, caffeine, citrus foods, fatty foods
-ensure adequate fiber intake
-avoid lifting heavy objects
-ensure proper bowel habits

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36
Q

What OTC treatments are available for hemorrhoids

A

-local anesthetics
-vasoconstrictors
-protectants
-astringents
-keratolytics
-analgesics, anesthetics, antipruritics
-corticosteroids

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37
Q

What is the general follow up recommendations when trying an OTC treatment option for hemorrhoids

A

try something and if not better after 7 days of self-treatment then refer to MD

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38
Q

What is the MOA of local anesthetics such as benzocaine, lidocaine, dyclonine

A

they block the transmission of nerve impulses

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39
Q

What is the indication for local anesthetics

A

temporary relief of EXTERNAL anal symptoms

40
Q

How long do local anesthetics last for

A

depends on the agent
usually 4 hours

41
Q

what are the side effects that can occur with local anesthetics

A

allergic reaction
dermatitis

42
Q

What is the dosing of local anesthetics

A

apply 3-6 times a day depending on the agent
*check label for specific directions

43
Q

Who should avoid local anesthetics

A

those with severe anorectal disorders
those with open lesions

44
Q

What is the MOA of vasoconstrictors such as ephedrine, epinephrine, and phenylephrine

A

stimulation of alpha-receptors to constrict arterioles and decrease swelling

45
Q

What is the indication for vasocnstrictors

A

relief of discomfort, itching and reduction of swelling
*ephedrine and phenylephrine: internal and external relief
*epinephrine: external relief only

46
Q

How long does it usually take for vasoconstrictors to start working

A

within 5-10 minutes

47
Q

How long do vasoconstrictors last for

A

approximately 6 hours

48
Q

What are the side effects of vasoconstrictors

A

mild pain
stinging if skin is raw or bleeding

49
Q

Who should talk with their HCP before using vasoconstrictors

A

pt has history of cardiac events, diabetes, BPH, pr thyroid conditions

50
Q

What is the dosing of vasoconstrictors

A

can be applied 4 times a day but check label for specific instructions

51
Q

What is the MOA of protectants

A

provide a physical protective barrier

52
Q

What is the indication of protectants

A

temporary relief of discomfort, irritation and burning
*glycerin is only externally

53
Q

How long do protectants usually last for

A

4 hours or longer

54
Q

What is the dosing for protectants

A

petrolatum is as needed
all others is up to 6 times a day or after each bowel movement

55
Q

What is the MOA of astringents such as calamine, zinc oxide, witch hazel

A

help coagulate surface proteins to protect lower tissue
decrease cell volume and provide thin protective layer

56
Q

What is the indication for astringents

A

temporary relief of itching , burning, irritation or anorectal d/o

57
Q

What is the dosing of astringents

A

apply up to 6 times a day

58
Q

What is the MOA of keratolytics such as alcloxa

A

cause sloughing of epidermal surface cells via the breaking down of keratin

59
Q

What is the indication of keratolytics

A

treat pain and itching caused by minor skin irritations

59
Q

What is the dosing for keratolytics

A

apply up to 6 times a day

59
Q

What should you avoid using with keratolytics

A

harsh soaps

60
Q

What is the MOA of analgesics, anesthetics, and antipruritics(menthol, juniper tar, camphor)

A

temporary relief of burning, pain or itching
EXTERNAL ONLY

61
Q

What is the dosing of analgesics, anesthetics, and antipruritics

A

apply up to 6 times daily

61
Q

Where should you avoid the use of analgesics, anesthetics, and antipruritics

A

irritated or damaged skin

62
Q

What is the MOA of corticosteroids

A

lysosomal membrane stabilization and antimitotic activity

62
Q

What is one of he main side effects of corticosteroid use

A

skin atrophy
thinning of the skin

63
Q

What is the indication for corticosteroids

A

temporary relief of minor external anal itching

63
Q

What is the onset and duration of corticosteroids

A

onset within 30-60 minutes
duration is up to 6-8 hours

63
Q

What should you avoid doing with corticosteroids

A

prolonged use
use for max of 7 days

63
Q

What is motion sickness

A

when eyes see movement, inner ear senses movement but the body is still

63
Q

what is the dosing for corticosteroids

A

apply up to 3-4 times a day

64
Q

Who is at the highest risk of experiencing motion sickness

A

women and children ages 2-12

65
Q

What factors increase the risk of experiencing motion sickness

A

family history
hormonal birth control
inner ear conditions
menstrual periods
migraines
parkinson’s disease
pregnancy

66
Q

What are the presenting symptoms for motion sickness

A

cold sweats
dizziness
headache
inability to concentrate
increased salivation, nausea, vomitting
rapid breathing

67
Q

When would you not self-treat motion sickness

A

when a person feels “motion sickness” but isn’t traveling

68
Q

What are the goals of therapy

A

provide symptom relief
prevent episodes/ recurrence

69
Q

What are some non-pharmacologic/ complementary options to prevent and/or treat motion sickness

A

looks at the horizon
avoid phone/tablet/book
lay back and close eyes
drink water slowly
eat low-fat, bland, starchy foods prior to travel
fresh air/air vents toward you
accupressure wristband
ginger
avoid alcohol

70
Q

What OTC treatment options are available

A

1st gen antihistamines

71
Q

What is the MOA of 1st gen antihistamines

A

blockage of H1 receptors

72
Q

What is the indication of 1st gen antihistamines

A

prevention or nausea, vomiting, or dizziness associated with motion sickness

73
Q

What is the onset and duration of 1st gen antihistamines

A

onset is 30-60 minutes
duration depends on the agent

74
Q

What are the side effects associated with 1st gen antihistamines

A

drowsiness
dry mouth
confusion
dizziness
constipation

75
Q

Who should avoid taking 1st gen antihistamines

A

those with glaucoma, BPH and older adults

76
Q

What is gastroenteritis

A

inflammation of the stomach and intestines due to viral, bacterial or protozoan infection which causes vomiting and diarrhea

77
Q

What are the most common symptoms that present with gastroenteritis

A

nausea
vomiting
fever
acute, watery diarrhea

78
Q

When should someone be referred if they have gastroenteritis

A

-less than 6 months of age
-less than 17.5 pounds in weight
-persistent fever
-visible blood, pus or mucus in stool
-persistent vomiting
-signs of sever dehydration
-severe abdominal pain/distress such as tenderness or distention
-risk for important complications
-pregnancy
-chronic or persistent diarrhea
-suboptimal response to ORS already administered
-no improvement or worsening after 48 hours of self-care

79
Q

What is the general treatment approach when it comes to gastroenteritis

A

fluid and electrolyte replacement via ORS
antidiarrheal drugs in selected individuals

80
Q

What is the MOA of loperamide

A

stimulates peripheral micro-opioid receptors on intestinal circular muscles to slow motility so water and electrolytes can be absorbed
*reduces peristalsis, lengthens intestinal transit time

81
Q

What is the indication for loperamide

A

symptomatic relief of acute, nonspecific diarrhea

82
Q

What is the onset and duration of loperamide

A

onset is within 1 hour
duration is up to 3 days

83
Q

What are the side effects of loperamide

A

occasional dizziness, constipation and euphoria is misused/abused

84
Q

What are the drug interactions that exist with loperamide

A

quinidine
ketoconazole
ritonavir
protease inhibitors
cyclosporine
erythromycin
clarithromycin
saquinavir
st. john’s wort

85
Q

What is the adult dosing of loperamide

A

Caplets: 4mg initially, then 2 mg after each loose stool. MDD of 8mg/24 hours
Liquid: 4mg(30mL) initially, then 2mg(15mL) after each loose stool. MDD 8mg/24 hours

86
Q

What is the loperamide dosing for children aged 6-8 years

A

caplets: 2 mg initially, then 1 mg after each loos stool. MDD 4mg in 24 hours
liquid: 2 mg(15mL) initially, then 1mg(7.5mL) after each loose stool. MDD 4mg in 24 hours

87
Q

What is the loperamide dosing for children 9-11 years of age

A

caplets: 2 mg initially, then 1 mg after each loos stool. MDD 6mg in 24 hours
liquid: 2 mg(15mL) initially, then 1mg(7.5mL) after each loose stool. MDD 6mg in 24 hours

88
Q

What is the adult dosing of pepto

A

tablet/caplet: take 525mg every 30-60 minutes. MDD 4200mg/day
liquid(262mg/15mL): take 30mL every 60 minutes. MDD 240mL/day
liquid(525mg/15mL): take 30mL every 60 minutes. MDD 120mL/day

89
Q

What is the max amount of time you can take pepto

A

48 hours of use