OTC 1 Flashcards
Max dose acet (adult and child)
4g- 10-15mg/kg q4-6h max 75 mg/kg/day
max dose ibu (adult and child)
1.2 (OTC), 3.2 Actual, 5-10mg/kg q6-8h max 40mg/kg/day
when to refer back pain
trauma from height, fever/chills/unexplained weight loss, worse lying down, numb in bum or radiating pain, bowel/bladder dysfunction,
dealing with burns
remove heat source, keep cool to remove heat (run under cold water, etc), keep moist, cover,
disorder helped by sun, and made worse by sun
psoriasis better, rosacea and sometimes cold sores can be worse
ceiling of sunscreen protection, apply ___ minutes before sun exposure
SPF 50, 30
minoxidil is used topically for ____ and works best for ____. Use for ___ months before results (__________). Side effects include
used for androgenic alopecia. Best if loss is from crown vs receding. Fine baby hair most likely to grow. D/c if new hair lost within 3 months, ad try for 8-12 to get results. Low systemic absorption, but used to be used for BP so small possibility of decreased BP
what is finasteride’s role in hair loss
type 2 alpha reductase inhibitor only for hair loss in med- dosed 1mg vs 5mg used for BPH. Works in about 3 months, can also slow hair loss
comedone types
open (black), closed (white)
what to tell a patient whose baby has milia
baby acne- self limiting, normal (about 1 in 2), disappears without treatment in about 2 weeks
salicylic acid for acne
keratolytic, mild therapy
BP for acne
5% most, antibacterial and exfollient, SE= red/peel/dry and bleach clothes, lotion better for dry or sensitive, gel is stronger acting. Start; slow in 1-2 hour intervals to decrease irritation (goal is 12 hours contact at least), worse before better as pull bacteria and dirt out of pores, lotion good adjunct but not immediately after BP (20-30 min)
retinoids for acne
-decrease stickiness of follicular wall and increase penetration of other agents (combined with BP is great- combo product okay to use together, if seperate products use one in AM and one HS as can inactivate retinoid), side effects same as BP so start low and go slow (work up to 12 hours on), best HS becuase photosensitizing,
compare the retinoids (adapalene, tretinoin, tazarotene)
adap= least irritating, tret=most photosensitizing, tazar=most potent, Cat X for preg. Other two okay in preg but not recommended
antibiotics in acne
must be used in combo to prevent resistance and increases efficacy (with BP or ret- for both oral and topical),
tetracycline administration differences:
avoid antacids in all, avoid food/dairy with tetra, less problems with mino but could still avoid, and give with good for doxy
isotretinoin
for acne, for severe acne, CI in women of childbearing age unless taking contraceptive measures (one month before and one after), 2 negative preg tests before starting, and they understand potential risks to fetus, monitor for dryness (esp eyes- can use drops, shold go away within 6 weeks in most) and depression
how long before see an improvement in acne?
about 8 weeks
when do you repeat lice application and why
7-10 days- to get full life cycle of adults and eggs
how long do lice live away from the scalp
2-3 days- washing items in hot water for 15 minutes or dryer on hottest setting for items with close contact, or in a sealed plastic bag for 2 weeks freeze.
side effects of nicotine gum
throat irritation, burping/hiccups, nausea esp if faster chewing
side effects of nicotine patch
local reaction, headache, insomnia, weird dreams/nightmares (can take off patch at night to avoid), nausea
coffee/acidic drinks with nicotine
slows absorption if drink it first- reverse order or educate to space
bupropion for smoking cessation
increase NA and DA (blocks uptake), SE=dry mouth, insomnia, seizure disorder if dose too high (separate by 12 hours to avoid), interacts with MAOI, “zyban”
varenicline for smoking cessation
partial nicotine agonist, SE-N, abnormal dreams, constipation, drowsiness, “champix:”
how much AHA (alpha ydroxy acid) is needed in dry skin lotion for effect
5-10% to soften (keratin softening agent)
calamine uses
first aid (insect bites, poison ivy, etc) and chicken pox maybe (kids might scratch off when dries crusted though) but NOT dry skin (will suck moisture out) or for blister lesions (draws fluid out)
how long is breastfeeding recommended
first year
only vitamins where synthetic is better than natural
B12 and folate
vitamin D supplementation in infants
breast fed- 400 IU, formula fed none OR in winter months increase both of those by 400IU
iron in infants, vitamins in kids
before 6 months stores are sufficient in iron, after choose multivitamin in kids that has minerals and vitamins as mix
prenatal vitamin requirements
Fe= 27mg (child bearing age- 18), 600ug folate (400 child b) (1mg in most products ie 1000ug), 1000mg Ca (no change), vitamin D important too
amounts of calcium in: carbonate,lactate, gluconate
carb (40%), lact (13), gluc (9)
iron products and amounts in each
fumarate (blue-33), sulfate (red-20), gluconate (green-12)
AREDs may do what for AMD, and what type is it maybe effective for?
slow progression in dry type (ie 90% of cases)
interactions with Fe
coffee/tea/wine/antacids decrease absorption, tetracyclines, any drug with potential for constipation or GI issues
interactions with Ca
tetracyclines, CSs, chronic PPI use, potential for constipation
simethicone for colic
defoaming agent (ovol), gets rid of trapped gas and may help, really no side effects and very safe
gripe water for colic
sodium bicarbonate, almost no SE, more for gerd vs colic
cocyntal for colic
homeopathic, no benefit
difference between dandruff and seborrhea
dand= dry powdery scales with minimal inflammation, seb= yellow, oily greasy scales with inflammation. Dand=OTC, seb= rx
for derm conditions, when to see a doc if not getting better generally
7 days
OTC dandruff options
tar, tar solution, selenium, zinc, ketoconazole (*AF most common)
products for seborrheic dermatitis
apply to body; tar, antifungal (*most common), topical steroids, picrolimus if very bad and more chronic
how to treat cradle cap
common, disappears about 8 months, unknown why, treat with baby oil and vaseline to soften scales
different between irritant and allergic contact dermatitis
amount of exposure: is not important for allergic (poison ivy, nickel, cosmetic, metals, latex, glue, topical meds) (concentration not important), is for irritant (ie more is worse- usually chemicals-dish soap, detergents, diaper rash, etc)
how to treat contact dermatitis
acute- cool/wet dressing QID x20 minutes when gross blisters, sub acute means blisters are gone so d/c wet dressings and use steroid lotion/cream, for chronic use warm water soaks to soften and dry skin or steroid creams prn)
describe the properties of coal tar, sulfur/salicyclic acid, and selenium/zinc/ketoconazole
coal tar= anti proliferative and anti pruritic (not for broken or hairy areas as can clog pores), sulfur/sal acid have mild keratolytic properties, selenium/zinc/keto slow cell turnover and have antifungal effects (keto most)
length of diaper rash time and likelihood of infection
if allowing air time, keeping clean and using barrier products and has been over 3 days fungal more likely
rash in skin folds for diaper likely means
fungal- if just irritant, fold will protect area
how to treat fungal diaper rash
2 weeks max plus one week after clearing applied BID - if not better in 3 weeks, may be bacterial. Try mupirocin
if using canestan vag cream to treat diaper rash, which kit/what duration/strength?
6 day (1%)
treating uninfected diaper rash
HC 1%, wait five minutes, apply barrier product. Can do this with antifungal too- always apply med before barrier product
when to refer diaper rash
pimples/ulcers form, fever,rash spreads to other areas, doesn’t get better in 7 days with treatment
red flags of dental pain
fever, pus, swelling, headaches
topical benzocaine is not recommended in
kids under 2 due to risk of methemoglobinemia (can lead to death as blood less efficient at O2 transport) (can also disable infant’s gag reflex if swallowed)- for teething, best is cold washcloth, rubbing gums, acet, teething rings, etc
effectiveness of abreva for cold sores
docosonal- heals 1-2 days faster maybe if used at onset of tingling 5x/day. If too late (past prodromal), keep moist to promote healing but abreva no longer has benefit and is more expensive
how to differentiate oral candidiasis
white creamy lesions on tongue or cheek that don’t easily wipe off and may bleed a little if scraped, painful or burning possible
comment on nystatin in infant and children
infant swirl in mouth on q tip, child/adult swish and hold in mouth as long as possible then swallow, well tolerated with minimal systemic absorption so no DI, short contact time limits efficacy
symptoms of hemmorhoids
bleeding (streaks, bright red), itching, swelling, seepage, pain
red flags of hemmorhoids
over 50 should be screened, change in bowel habits all of the sudden (C/D), blood in stool (bright red not as worrisome-always ask about amount, and tell if blood should get assessed by dr if over 50 especially), stool narrower than usual, unexplained weight loss, increased pain and cramps, mucous/discharge
treatment of hemmorhoids (non pharm too)
post BM cleanliness, lotion prn, astringents ingredients (haemmophilis or zinc), base ointment in suppository or cream does most of work (ensure replacement post BM), nothing will “heal” just buys enough time for body to heal itself (self limiting condition) and treat sx; anusol or prep H
MSM
gives no added value to products such as glucosamine and chondroitin
corns
hyper keratonic growth from increased friction or trauma. Treat with SA- for ahrd corns, soak first, if soft don’t need to. apply OD-BID for about 6 days. Remove cause and protect
best treatment for ingrown toenail
get cotton underneath, file edge down. Don’t want to soften because will make clipping more difficult
treating warts with salicylic acid
soak first x5min, rub off dead skin, vaseline around surrounding skin optional for protection, apply drops, cover, do for 8-12 weeks. With lactic acid added gives no additional benefit and is increased cost
when to not use freezing products for warts? patches?
diabetes- may not feel. Patches macerate skin around
treating warts with freezing products
still soak first and pare, contact time about 20s-40s (ie may need more than one application if don’t feel freezing anymore after about 20)
T/F- plantar warts may clear up on their own
T
when to start COC
most effective if started on day 1, but can start any day up to day 6. Starting on first sunday after period starts avoids weekend period. If don’t start day 1, back up 7 days
benefits of COC
improve menstrual symptoms and regularity, decrease PMS, improve acne, decrease endometriosis + endometrial/ovarian cancer + ovarian cyst + OP + hirsutism
what amount of estrogen is more likely to have contraceptive failure if pills are missed
<20ug estrogen
risks with COC
VTE (increased with age over 35, smoke, increased estrogen), MI and stroke, breast cancer, cervical cancer
early warning signs of COC risks/danger acronym
ACHES- severe: abdominal pain, chest pain, headaches, eye problems, leg pain in calf or thigh
drugs that induce metabolism of COC
anticonvulsants (carba and pheny esp), rifampin, ritonavir, some herbals
drugs that have levels reduced by COC
lamotrigine, anticoagulants (may increase clotting factors therefore decrease efficacy), potential to increase sugars with antidiabetic drugs (monitor- maybe insig)
how long wait post partum to restart COC
at least 3 weeks due to increased risk VTE
how big is the window for POP admin
3 hours- if later, backup x48 hours
can the POP be used in breastfeeding
yes
AE of POP
irregular bleeding, HA, bloating, ance, breast tenderness
depo-provera- when to use back up with admin?
day 1-5 no backup, after day 5 backup for 7 days
which contraceptive delays return to fertility and by how long?
depo provera- 9 months
which contraceptive decreases BMD and increases OP risk
depo provera- esp in first 2 years
how long an nuvaring be out before concern
less than three hours
how long is nuvaring stable at room temp
4 months
the patch contraceptive is applied for ___ week and then removed
3 weeks
fever is anything greater than ___‘c at any time of day. Neurologic damage happens greater than ___‘c
37.5, 41.7
temperature cycles (highs and lows)
highest in late afternoon, lowest 12 hours later
after what length of time is fever worrisome?
more than three days
when is the oral route preferred for measuring temperature
ages 5 and up (watch out for drinking hot/cold or smoking beforehand)
what is the preferred route for temperature measurement under five
rectum. Can’t? less than two use armpit, over two use ear then armpit
red flags with fever
under 2 months, temp over 40.5, stiff neck or seizures, chemotherapy, confusion/delerium, child appears very ill or inconsolable crying
what is the maximum number of times fever needs to be taken in a day
2-3 (unless recent chemo)
MOA ASA
inhibit PG synthesis through irreversible acetylation and inhibition of COX
MOA acet
central inhibition of PG synthesis
MOA ibuprofen
reversible acetylation of COX
max dose naproxen and dosing
440 mg per day OTC (220 q8-12h)
