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OTC II > Hemorrhoids > Flashcards

Hemorrhoids Flashcards

1
Q

What is the line separating the Internal from the external hemorrhoids?

A

Dentate Lane

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2
Q

What is a significant difference between Internal and External hemorrhoids?

A

Internal: less pain and pressure receptors
patients with external hemorrhoids are more likely to suffer from pain

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3
Q

Pathophysiology of Hemorrhoids

A

-Vascular cushions slide -> Congested -> Bleed and Protrude

-Originate from superior hemorrhoidal vein

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4
Q

What are the risk factors of Hemorrhoids?

A

-Diet/lifestyle
-Prolonged sitting or standing
-Erect posture

-Bowel habits
-Constipation

-Diarrhea
-Pregnancy (may be alleviated after delivery)
-Heavy lifting with straining

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5
Q

Difference between Internal and External Hemorrhoids?

A

-Pain in external hemorrhoids (due to lack/presence of sensory nerve)

Internal: Covered by anal canal
mucous membrane
External: Covered by squamous
epithelium
Thrombosis common in extern Hemorrhoids

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6
Q

Non-Hemorrhoidal Anorectal Disorders

A

-REFER
-Abscesses
-Fistulas
-Fissures
-Neoplasms
-Polyps
-Pruritus ani
-Inflammatory bowel disease (IBD)

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7
Q

What are symptoms indicate Hemorrhoids or Non-hemorrhoids?

A

-Hemorrhoids: Itching, Irritation, Inflammation, Burning Discomfort, Swelling; could be some bleeding and pain too

-Non-hemorrhoidal: Pain, Bleeding, Seepage, Change in bowel patterns, Prolapse (rectal)
-> REFER

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8
Q

Symptoms of GI Bleeding

A

-shortness of breath (SOB)
-Dizziness
-Fatigue
-Orthostasis
-Hypotension
-Lab change -> anemia

-> REFER to ER

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9
Q

Non-pharmacologic Therapy

A

-Diet: add 25-30 g of fiber to a low-fiber diet
-Bowel habits: less than 10 min, reduce straining, do not hold BM
-Hygiene: Mild unscented soap, Sitz bath
-Surgery: internal hemorrhoids

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10
Q

What are the types of Hemorrhoidal drugs?

A

-Local anesthetics
– Vasoconstrictors
– Protectants
– Astringents
– Keratolytics
– Corticosteroids
– Analgesics/anesthetics/antipruritics

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11
Q

MOA for local Anesthetics

A

-blockade of nerve impulse transmission
-Use in only perianal areas or areas below the dentate line

-Reliefs pain QUICKLY!

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12
Q

Types of Local Anesthetics

A

-Amide group (-caines)
-Pramoxine

EXTERNAL hemorrhoids USE ONLY! -> rectal absorption -> systemic effects (CV and CNS)

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13
Q

Example of a local Anesthetic

A

-TUCKS Hemorrhoidal Ointment
-> Pramoxine 1%; zinc oxide 12.5%; mineral oil 46.6%; cocoa
butter; kaolin

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14
Q

How do vasoconstrictors help with Hemorrhoids?

A

-Stimulates alpha-adrenergic = constriction of
arterioles = transient reduction of swelling
-Relieve Itching, discomfort, irritation

-Caution: May increase cardiac contractility, HR, and
bronchodilation
-Phenylephrine with less systemic effects

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15
Q

API of Vasoconstrictors

A

-Phenylephrine (related to Epinephrine and norepinephrine)

-Example: Preparation H Cooling Gel
Witch hazel 50%; phenylephrine 0.25%

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16
Q

Which Patient population should not use Vasocontrictors?

A

-patients on Anti-hypertensive bc vasoconstrictors increase BP
-patients on MOAIs (depression, psychiatric illness)
-patients on TCAs

-> due to some systemic absorption -> DDI

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17
Q

Adverse effects of Vasoconstrictors

A

Nervousness, tremor (shaking), sleeplessness, nausea, and loss of appetite

18
Q

Protectants

A

-OILY
-Protective barrier and softens the dry anal area
-prevents irritation caused by fecal matter
-itching, irritation, and burning associated with
external and internal hemorrhoids
-Minimal systemic absorption

19
Q

Protectant with EXTERNAL USE only

A

Glycerin

could affect bowel movement (seen in constipation meds), so better for external hemorrhoids

20
Q

MOA Astringents

A

-Contracting, wrinkling, blanching of the affected area, and decreasing secretions = become drier

-targets: itching, irritation, and burning

21
Q

Which API is appropriate for external and internal Hemorrhoids?

A

External: Witch hazel
Internal and external: Calamine and zinc oxide

Example: Preparation H Cooling Gel
-> Witch hazel 50%; phenylephrine 0.25% (vasoconstrictor)

22
Q

Keratolytics

A

Desquamation and debridement/sloughing (removal of damaged tissue) of epidermal cells

-AVOID: Adverse effects outweigh potential benefits
especially in children

23
Q

Examples of Keratolytics

A

– Alcloxa, Resorcinol

24
Q

What are the effects of Hydrocortison-containing products?

A

-Local anti-inflammatory effects
-> Antipruritic (Anti-itching), Analgesia/vasoconstictor

  • Long-term use should be avoided
    ->Permanent damage and thinning of perianal skin/mucosa
25
Q

Onset and max concentration of Hydrocortisone?

A

Onset: may take 12 hours

Max conc: 1%

For itching and pain

26
Q

Example of Hydrocortisone

A

Preparation H Anti-Itch Cream
-Hydrocortisone 1%; glycerin (also in protectant - external use only); lanolin;
methylparaben,; petrolatum

27
Q

What is the API in Analgesics/Anesthetics/Antipruritics (Counterirritants)?

A

-contain Menthol (need a WARNING)
-never recommended by Dr. Gray
-Distracting local sensation (cool, warm, or tingling)
-> targets Pain, itching, burning

-Example ingredients:
– Menthol, Juniper tar, Camphor

28
Q

Combination Product Example

A

TUCKS Medicated Pads
Witch Hazel 50% (Vasoconstrictor - external); glycerin (protectant -External use only)

29
Q

Special populations to look out for

A

-Pregnant women, breast-feeding
-children under 12y

30
Q

Which dosage form is not recommended as the initial form?

A

Suppositories

31
Q

CAM Therapy

A

-Horse chestnut seed extract
targets: Itching, N/V; Caution poorly compounded preps -> poisonous

-have not been assessed for safety or efficacy

32
Q

Chief complaint: Pain

A

Local Anesthetics - TUCKS Hemorrhoidal Ointment
-> API for pain relief: Pramoxine 1%

-contact dermatitis doesn’t happen often (there is a lot of mucosal acting as a barrier)

33
Q

Chief complaint: Itching, Irritation

A

-Vasoconstrictor (API: Phenylephrine) - reduce swelling due to vasoconstriction
-Protectant (API: Glycerin)
-Astringent
-Hydrocortisone

34
Q

Chief complaint: Itching and Pain

A

Hydrocortisone

35
Q

Role of Phenylephrine

A

Vasoconstriction
-has some systemic absorption

36
Q

The most common Astringent API

A

-Witch Hazel
-drying component

37
Q

Protectant API

A

-Oily substances
-Glycerin

38
Q

Corticosteroids

A

Hydrocortisone
-> Itching and PAIN
-Onset: 20-30 minutes, can take up to 12h
-best benefit: application over a period of time

38
Q

Which drugs help immediately with Pain?

A

Phenylephrine (Vasoconstrictor) and Analgesics (Pramoxine -> External Use only, some systemic absorption)

39
Q
A

OTC II (17 decks)

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