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243 FINAL > Heat Related Disorders, Sun Care/Skin Damage > Flashcards

Heat Related Disorders, Sun Care/Skin Damage Flashcards

1
Q

The hypothalamus maintains core body

temperature at ~______C .

A

~37 degree C

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2
Q

How does the body acquires heat?

A

by several mechanisms (shivering, physical activity, etc.

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3
Q

How does the body eliminates heat?

A

by several mechanisms (evaporation, radiation, conduction, and convection)

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4
Q

Causes of Heat illness (2)

A
  • from an imbalance of the body’s process of acquires heat and eliminates heat
  • as ambient temperature and humidity increase, heat
    dissipation becomes less efficient.
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5
Q

List Heat-related illnesses in order of severity:

A
  1. Heat Rash
  2. Heat Edema
  3. Heat Cramps
  4. Heat Syncope
  5. Heat Exhaustion
  6. Heat Stroke
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6
Q

Heat-related illnesses:

Risk Factors? (5)

A
  1. Age
  2. Outdoor labourers
  3. Competitive athletes
  4. Individuals in poor socioeconomic situations
  5. Other medical / demographic factors or medications
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7
Q

Heat-related illnesses:

What risk do Infants and young children have?

A

Due to physiologic and thirst-response differences, plus their dependence on caregivers

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8
Q

Heat-related illnesses:

What risk do Older adults have?

A

Due to comorbid illnesses, medications, poor thermoregulatory response, and social factors such as isolation and inability to provide self-care

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9
Q

Heat-related illnesses:

Examples of Other medical / demographic factors or medications:

A
  • alcoholism, dehydration, psychiatric or pulmonary
    disorders, hyperthyroidism, vascular diseases, lack of
    acclimatization, lack of breaks, strenuous activity, etc.
- drugs that increase heat production (thyroid drugs), 
  decrease sweating (anticholinergics), or cause 
  vasoconstriction (MAOIs)
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10
Q

Slide 24 - Medications as a Risk Factor???

A

Look at table

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11
Q

non-pharm for Heat-related illnesses:

1st 5 types of heat-related illnesses:

A

 Heat rash – small blisters or rash that appear as a
result of irritation from excessive sweating
* Keep cool and dry, avoid humidity

 Heat edema – in the extremities from vasodilation or
water / sodium retention
* Elevate hands and feet

 Heat cramps – common in the arms, legs, and
stomach due to water/sodium depletion
* Stop activity, rest, rehydrate, and stretch affected
muscles
- Seek attention if no improvement in ~1 hour

 Heat syncope – dizziness / fainting
* Stop activity, get up slowly (patients often recover
quickly)

 Heat exhaustion – weakness, dizziness, headache,
elevated core body temperature (~40C), tachycardia
/ hypotension
* Stop activity, rehydrate
- Seek attention with severe symptoms or if no
improvement in ~2-3 hours

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12
Q

non-pharm for Heat-related illnesses:

Heat Stroke:

A

 This is a medical emergency!
* Can lead to hepatic and renal failure, CNS injury,
coagulopathy, and CV collapse
- “Classic” heat stroke normally affects the elderly
and can develop over several days
- “Exertional” heat stroke normally affects younger,
active individuals after strenuous activity and
can develop rapidly

 Symptoms are similar to heat exhaustion plus…

* Hot, dry skin and >40C core body temperature
* Altered mental status / confusion / hallucinations
* Ataxia (lack of coordination)
* Seizures
* Coma

 Call 911, and …
* Stop activity, get in cool / shaded area with good
air circulation, remove excessive clothing,
rehydrate, and cool the body with ice water towels
applied to the groin, neck, head, and axillae

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13
Q

pharm for Heat-related illnesses:

What should NOT be used?

What CAN be used?

A

 Antipyretics should not be used

 Some medications can be used to treat complications
of heat stroke
* e.g., benzodiazepines to control seizures

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14
Q

Heat-related illnesses:

Prevention:

Which group of people may be at risk?

A

The elderly, athletes, homeless, infants/children, cognitive disabilities, those with risk factors

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15
Q

Heat-related illnesses:

Prevention:

If unable to control exposure, ways to prevent Heat-related illnesses?

A

 Ensure proper hydration and continuously consume
fluids during exertion. Oral rehydration solutions are
helpful, but be mindful of sugar / salt content in these
products.
* Thirst should not be relied upon as a reason to drink
 Stay out of the sun
 Avoid strenuous activity / take breaks
 Wear light coloured / lightweight clothing
 Acclimatize to the environment

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16
Q

Heat-related illnesses:

Monitoring and Follow-Up:

A

 In terms of hydration, can monitor for light-yellow
coloured urine
 heat exhaustion should resolve within hours, but the
individual should avoid repeated heat exposure for 1-
2 days. Those requiring hospitalization may require
longer- term monitoring due to possible complications

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17
Q

Sun Care and Skin Damage:

What are the 3 Ultraviolet Radiations:

A
  • UVA (320-400nm)
  • UVB (290-320nm)
  • UVC (270-290nm)
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18
Q

Sun Care and Skin Damage:

Characteristics of UVA:

A
  • is responsible for photoaging, skin cancers, and
    reactions from photosensitizing drugs
  • although less potent than other UV radiation, is a
    significant contributor to skin cancer risk because it
    readily reaches the Earth’s surface
  • is present all day and can penetrate clouds
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19
Q

Sun Care and Skin Damage:

Characteristics of UVB:

A
  • is the main cause of sunburns (B = burn!) and plays a
    role in cancers and photoaging…but is required for
    vitamin D synthesis
  • is the strongest between 10am and 4pm and is
    intensified by conditions such as high temperatures
    and reflective surfaces
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20
Q

Sun Care and Skin Damage:

Characteristics of UVC:

A
  • usually filtered by the ozone layer and does not reach

the Earth’s surface

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21
Q

Sun Care and Skin Damage:

How many in Fitzpatrick Skin Type?

A

6

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22
Q

Sun Care and Skin Damage:

Describe Fitzpatrick Skin Type I, skin colour/features before and after sun:

A

Before Sun:
Ivory

After Sun:
Always freckles, always burn/peels, never tans

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23
Q

Sun Care and Skin Damage:

Describe Fitzpatrick Skin Type II, skin colour/features before and after sun:

A

Before Sun:
Fair or pale

After Sun:
Usually freckles, often burn/peels, rarely tans

24
Q

Sun Care and Skin Damage:

Describe Fitzpatrick Skin Type III, skin colour/features before and after sun:

A

Before Sun:
Fair to beige, with golden undertones

After Sun:
Might freckles, burn on occasion, sometimes tans

25
Q

Sun Care and Skin Damage:

Describe Fitzpatrick Skin Type IV, skin colour/features before and after sun:

A

Before Sun:
Olive or light brown

After Sun:
Doesn’t really freckle, rarely burns, often tans

26
Q

Sun Care and Skin Damage:

Describe Fitzpatrick Skin Type V, skin colour/features before and after sun:

A

Before Sun:
Dark brown

After Sun:
Rarely freckles, almost never burns, always tans

27
Q

Sun Care and Skin Damage:

Describe Fitzpatrick Skin Type VI, skin colour/features before and after sun:

A

Before Sun:
Deeply pigmented dark brown to darkest brown

After Sun:
Never freckles, never burns, always tans

28
Q

Sun-Induced Skin Damage:

Describe Sunburn -

A

an inflammatory process in response to UV radiation

29
Q

Sun-Induced Skin Damage:

Describe Photoaging -

A

results in rough, dull skin with fine and deep wrinkles that may eventually appear yellowed and leathery

30
Q

Sun-Induced Skin Damage:

Describe Pigmentary changes -

A

commonly referred to as “age spots,” these are irregular areas on the skin ranging from light to dark brown. Freckles are in this category as well.

31
Q

Sun-Induced Skin Damage:

Describe Phototoxic Reaction -

A

dose-related sunburn that occur within minutes to hours of exposure to sunlight in patients taking a relevant medication.

32
Q

Sun-Induced Skin Damage:

What are the 5 classes of medication that causes Phototoxic Reaction?

A
  1. Antimicrobials
  2. NSAIDs
  3. Retinoids (systemic and topical)
  4. Diuretics
  5. Psychiatric medications
33
Q

Sun-Induced Skin Damage:

Phototoxic Reaction:

List medications in the Antimicrobials class:

A

Azole antifungals (itraconazole, voriconazole),
ceftazidime, quinolones (ciprofloxacin, norfloxacin),
sulfonamides, tetracyclines (doxycycline,
tetracycline), trimethoprim

34
Q

Sun-Induced Skin Damage:

Phototoxic Reaction:

List medications in the NSAIDs class:

A

Diclofenac, ibuprofen, indomethacin, ketoprofen,

naproxen, piroxicam, sulindac, tiaprofenic acid

35
Q

Sun-Induced Skin Damage:

Phototoxic Reaction:

List medications in the Retinoids (systemic and topical) class:

A

Acitretin, alitretinoin, isotretinoin

Adapalene, tazarotene, tretinoin

36
Q

Sun-Induced Skin Damage:

Phototoxic Reaction:

List medications in the Diuretics class:

A

Furosemide, hydrochlorothiazide

37
Q

Sun-Induced Skin Damage:

Phototoxic Reaction:

List medications in the Psychiatric Medications class:

A

Alprazolam, chlordiazepoxide, chlorpromazine,

desipramine

38
Q

Sun-Induced Skin Damage:

What are the 3 types of Sun-Induced Skin Damaged skins?

A
  1. Actinic keratosis
  2. Non-melanoma cancers
  3. Melanoma
39
Q

Sun-Induced Skin Damage:

Sun-Induced Skin Damaged skins

Describe Actinic keratosis -

A

a common sun-induced lesion that can progress to squamous cell carcinoma

40
Q

Sun-Induced Skin Damage:

Sun-Induced Skin Damaged skins

Describe Non-melanoma cancers -

A

may appear as abnormal scaling that bleeds or erodes over time – or – as “pimples” that do not heal and develop ulcerations

41
Q

Sun-Induced Skin Damage:

Sun-Induced Skin Damaged skins

Describe Melanoma -

A

rare but deadly, often presenting as flat brown or black spots (moles) that change over time

42
Q

Skin Cancer Surveillance

Individuals with ________ moles are at greater risk of developing skin cancers

A

> 100

43
Q

Skin Cancer Surveillance

What is ABCDEs of Moles?

A 
 A – asymmetry
 B – border (uneven, scalloped, or notched)
 C – colour (variety or changing)
 D – diameter ( > 6 mm)
 E – evolving (changing over time)
44
Q

Skin Cancer Surveillance

Skin cancer is uncommon in people of colour or Caucasian?

A

People of colour - BUT -

 At time of diagnosis, associated with increased
morbidity and mortality

 Diagnosis at late stage may be due to a variety of
factors (e.g. socioeconomic)

Lesions present in atypical fashion.

45
Q

Skin Cancer Surveillance

What are the 3 skin/cell conditions in Skin Cancer?

A
  • Basal Cell Carcinoma
  • Squamous Cell
  • Melanoma
46
Q

Skin Cancer Surveillance

Describe Basal Cell Carcinoma -

A

 Less common in black skin

 Might not appear as classic translucent papule with
telangiectasia

47
Q

Skin Cancer Surveillance

Describe Squamous Cell -

A

 Squamous Cell Carcinoma is the most common

 Skin cancer in blacks and SE Asians, even though UV
dependent, not sure why in coloured, chronic
inflammation and scarring?

48
Q

Skin Cancer Surveillance

Describe Melanoma -

A

 Deadliest, better prognosis if caught early but in
coloured skin, being diagnosed late resulted in
poorer outcomes and decreased survival rates

 A lot of these cancers can appear in non sun
exposed areas, examine mucosal membranes

49
Q

non-Pharm Sun-induced Skin Cancer

Prevention (3)

A

 Avoid the following:

  • Direct sun exposure
  • Tanning beds (Just don’t please!!!)

 Wear the following:

  • Protective clothing
  • Wide-brimmed hats
  • Sunglasses

 Educate patients at risk of drug-induced reactions
- Phototoxicity – dose-related sunburn-like reactions
- Photoallergies – delayed reactions after light
exposure, often extending beyond the area exposed
to light

50
Q

Sunscreens

is SPF 15-16 effective?

what features should sunscreens have (4)

A

 limited available evidence using moderate SPF ( ~15–
16) sunscreen suggests that “real world” application
of sunscreen does not affect vitamin D production
significantly.

Should have the following features:
 SPF of at least 30
 Be non-irritating, non-comedogenic, and
hypoallergenic
 Be minimally or non-perfumed
 Offer broad-spectrum UVA/UVB protection
* Look for this wording on the label

51
Q

Application of Sunscreens

How do you apply Sunscreens? (3)

A

 Apply 15-30 minutes before exposure, then reapply in
15-30 minutes to maximize protection
 Should also reapply after swimming, sweating, or
toweling-off
 Apply uniformly and liberally
* Include lips, ears, and feet
* “Teaspoon Rule”

52
Q

Application of Sunscreens

What is the “Teaspoon Rule”?

A

 1⁄2 – 1 teaspoonfuls on face and neck
 1 – 1 1⁄2 teaspoonfuls to arms, shoulders, and torso
 2 – 2 1⁄2 teaspoonfuls to legs and feet

53
Q

Sunscreens vs. Sunblocks

What is the difference?

A

Chemical vs. physical barriers

- Absorb vs. reflect and scatter UV radiation

54
Q

What ingredients in Sunscreend?

A

e.g., oxybenzone (UVB), mexoryl (UVA)

55
Q

What ingredients in Sunblocks?

A

e. g., titanium dioxide, zinc oxide

- Can be used by all ages > 6 months

243 FINAL (24 decks)

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