OTC Conditions Flashcards
1
Q
What are the presenting symptoms of acne?
A
Open Comedones (blackheads) or closed comedones (whiteheads) Often found on face, chest, upper back and upper arms
2
Q
When do you treat acne with OTCs?
A
Only when its mild acne Few erythematous papules and occasional pustules, no scarring
3
Q
What is the goal of treating acne with an OTC?
A
Prevent new lesions and scarring Improve psychological effects and appearance Lower med side effects Educate patient on appropriate healthcare provider follow up
4
Q
What are some complementary and non-pharmacologic treatment options for acne?
A
Eliminate causes Wash skin Adequate skin hydration Change diet Physical treatments
5
Q
What are the OTC treatments for acne?
A
- Benzoyl Peroxide 2. Alpha & beta - hydroxy acids 3. Sulfur and resorcinol 4. Adapalene
6
Q
What are follow up recommendation for Acne?
A
Pt should follow up with PCP if symptoms worsen or if they do not improve within 6 weeks
7
Q
What are the symptoms of Allergic Conjunctivitis?
A
- Red eyes 2. Watery discharge 3. Itching eyes 4. Blurred vision due to excessive tearing
8
Q
When do you not treat allergic conjunctivitis?
A
- Thick yellow discharge or crusting (bacterial infection) 2. Light sensitivity 3. last longer than 72 hours 4. Age less than 2 5. History of glaucoma 6. Foreign object feeling 7. accompanied by fever
9
Q
What is the goal of treating allergic conjunctivitis
A
- Prevent corneal dmg 2. Remove and avoid allergen 3. alleviate bothersome symptoms 4. Minimize med side effects 5. educate pt about having follow up
10
Q
What are some complementary and non-pharmacologic treatment options for allergic conjunctivitis?
A
- Avoid the allergen (pollen count, close window) 2. Cool compresses 3-4 times a day 3. Do not wear contacts 4. good hygiene
11
Q
What are some OTC treatments for allergic conjunctivitis?
A
- Ophthalmic antihistamines 2. Ophthalmic decongestants 3. Artificial tears 4. Oral antihistamines
12
Q
What are the follow up recommendations for allergic conjunctivitis?
A
Follow up with PCP if symptoms worsen or persist within 3 days
13
Q
What are the symptoms of allergies?
A
- Sneezing 2. Rhinorrhea 3. Itchy eyes, nose, or palate 4. Nasal obstruction 5. Conjunctivitis 6. Pain
14
Q
When do you not treat allergies with an OTC?
A
- Children less than 12 2. Pregnant or lactating women 3. Symptoms of infection 4. Shortness of breath 5. COPD 6. Uncontrolled asthma
15
Q
What are the goals of therapy for treatment of allergies?
A
- alleviate symptoms 2. Minimize med side effects 3. Educate pt to follow up with PCP
16
Q
What are the best non-pharmacologic treatment options for allergies?
A
- Avoid allergen (best) 2. Know what effects them most 3. Clean house 4. Air quality index 5. Use HEPA filters 6. nasal saline profucts
17
Q
What are the OTC treatment options of allergies?
A
- Antihistamines 2. Decongestants 3. Mast cell stabilizers 4. Intranasal corticosteroids
18
Q
What are the follow up recommendations for someone with allergies?
A
Pt should follow up with PCP if symptoms do not get better within 2 weeks
19
Q
What are the symptoms of alopecia?
A
- Androgenetic Alopecia (men) : Receding front hair line, thinning at the vertex 2. Women: More diffuse hair loss, dec hair length and thickness Could come with concurrent acne, hirutism and infertility
20
Q
When do you not treat Alopecia with an OTC?
A
- less than 18 2. Pregnant or breast feeding 3. No family history of hair loss 4. Sudden or patchy hair loss 5. Loss of eyebrows or eyelashes
21
Q
What are the goals of treatment for alopecia?
A
- restore appearance 2. minimize medication side effects 3. educate pt
22
Q
What are the non-pharmacologic treatment options for alopecia?
A
- cosmetic camouflage : spray-on powders or wigs
23
Q
What is the OTC treatment for alopecia?
A
Minoxidil (2% for women, 5% for men)
24
Q
What are the follow-up recommendations for alopecia?
A
If symptoms worsen or persist and do not improve within 4 to 6 months see PCP ** if it works pt must use indefinitely
25
What are the symptoms of atopic dermatitis?
1. erythema 2. Scaling 3. May include crusts, pustules or plagues
26
When do you not treat atopic dermatitis with OTCs
1. Moderate‐severe condition with intense itching 2. Affected area covers large areas of the body 3. Affected area covers large areas of the body
27
What is the goal of therapy for atopic dermatitis?
1. Stop the itch‐scratch cycle 2. Restore skin hydration & barrier function (prevent secondary infection) 3. Educate the patient about prevention 4. Minimize medication side effects
28
What are some of the non-pharmacologic treatments for atopic dermatitis?
1. Identify and avoid triggers 2. Extra rinse cycle on laundry 3. Lukewarm baths without additives followed by moisturizers 4. Good fingernail hygiene 5. Use of mild (hypoallergenic) cleansers & cosmetics
29
What are some of the OTC treatment options for atopic dermatitis?
1. Hydrocortisone 2. bactracin and polymyxin B 3. Oatmeal bath
30
What are the follow up recommendations for atopic dermatitis?
Patient should follow up with PCP if symptoms worsen or if they persist and do not improve despite treatment within: 3 days
31
What are the symptoms of Bites and stings?
May be painless or sharp intense pain, including itching May include wheal and flare reaction
32
When do you not treat a bite or sting with an OTC?
1. Severe reactions (including history of it) 2. Significant reaction away from site 3. Symptoms persist for a week or longer 4. Child less than 2 years of age – Refer to PCP
33
What are the goals of therapy for treatment of bites and stings?
1. Identify anaphylactic and other emergent and urgent symptoms 2. B Prevent secondary bacterial infections 3. alleviate symptoms
34
What are some of the non-pharmacologic treatments for bites and stings?
1. Prevention 2. Treatment (ice 10 min on, 10 off) Baking soda (mix with water to make paste)
35
What are some of the OTC treatment options for bites and stings?
1. Topical anesthetics and antihistamines 2. Topical counter irritants, and corticosteroids 3. Topical skin protectants 4. systemic analgesics and antihistamines
36
What are the follow up recommendations for bites and stings
Follow up within 1 week \*\*if very serious rxn call 911 and pt should go to ER
37
What are the symptoms of canker sores?
Round or oval shaped, gray or yellowish colored, flat or crater‐like ulcerations located on the tongue, floor of mouth, soft palate, or inside lining of lips or cheeks \*usually painful
38
When do you not treat canker sores with OTCs?
Toothache, bleeding gums, broken teeth, missing teeth, tooth pain, trauma to the mouth with bleeding, swelling, etc Mouth soreness due to poo-fitting dentures Presence of fever or swelling
39
What are the goals of therapy for canker sores?
1. Heal lesion and allow normal eating, drinking 2. Prevent secondary infection
40
What are the non-pharmacologic treatment options of canker sores?
1. Avoid irritation (sharp, acidic, or spicy foods) 2. Apply ice (10 mins at a time, not to exceed 20 minutes per hour) 3. Oral debriding wound cleansing agents
41
What are some of the OTC treatment options for canker sores?
1. Topical oral anesthetics and protectants 2. oral rinses
42
What is the follow-up recommendation for canker sores?
2 weeks if they dont get better or they worsen
43
What are the symptoms of cold and flu?
Cold: 1. onset within 3 day 2. Duration 7-14 days 3. low grade fever Flu: 1. Onset within 3 to 6 hours 2. Duration 3 days 3. fever greater than 100 4. Physical presentation: body ache, chills, fatigue
44
When do you not treat the clod and flu with OTCs?
1. less than 9 months \*9 to 2 years with fever over 100 for more than 24 hours \*9 to 2 years with temp over 104 at anytime 2. Frail older adults 3. Shortness of breath 4. Chronic immunosuppression (AIDS, suppressed from medications, etc 5. lasts longer than 7 days
45
What is the goal of therapy for the cold and flu?
1. prevent transmission 2. alleviate symptoms
46
What are some of the non-pharmacologic treatment options for cold and flu?
1. rest 2. hydration 3. cold mist humidifier 4. cost mist vaporizer
47
What are the OTC treatments for the cold and flu?
1. decongestants 2. antihistamines 3. local anesthetics 4. systemic analgesics
48
What are the follow-up recommendations for the cold and flu?
1 week
49
What are the symptoms of cold sores?
1. Patients may notice a tingling or itching during prodromal period 2. Small red papule often presents at junction of lips or nose 3. Lesions are often painful and irritating
50
When do you not treat cold sores with an OTC?
1. last longer than 14 days 2. Patients with compromised immunity 3. pts with signs of infection
51
What are the goals of therapy for cold sores?
1. Reduce healing time and duration of symptoms 2. Prevent spreading of lesions 3. Prevent secondary infection
52
What are the complementary therapies of cold sores?
1. Melaleuca (tea tree) oil has similar effect on healing time as acyclovir e 2. Lysine decreases frequency of outbreaks 3. Lemon balm reduces healing time and prevents spread of infection
53
What are the non-pharmacologic treatment for cold sores?
1. Lesions may be gently washed with mild soap and should be kept moist to prevent cracking 2. Wash hands frequently to avoid spreading the virus or contaminating the lesions 3. Use sunscreen if sun exposure is a trigger
54
What are the OTC treatment options for cold sores?
Docosanol
55
What is the follow up recommendation for cold sores?
2 weeks
56
What are the symptoms of constipation?
Decrease in the frequency of fecal elimination to less than 3 times per week characterized by passage of hard dry stool, with straining, and the feeling of incomplete emptying
57
When do you not treat constipation with OTCs?
1. less than 2 2. severe abdominal pain 3. significant distention or cramping 4. nausea and vomiting 5. GI bleed 6. sudden change in stool 7. IBS or anorexia
58
What are the goals of therapy for constipation?
1. Relieve constipation and reestablish normal bowel function 2. Establish dietary and exercise habits that aid in preventing recurrences
59
What are some non-pharmacologic treatment options for treatment of constipation?
1. inc fiber 2. inc fluids 3. inc exercise 4. bowel routine development
60
What are some OTC treatments for constipation?
1. bulk forming laxatives (fiber) 2. emollient (stool softener) 3. hypersomotic laxatives 4. lubricant laxatives 5. saline laxatives 6. stimulant laxatives
61
What is the follow up recommendation for constipation?
1 week \*\* if really serious or painful seek intimidate care
62
What are the symptoms of contact dermatitis?
Irritant Contact Dermatitis: Inflamed erythematous rash that may be panful and cracked (most often hands and face due to occupational exposure Allergic Contact Dermatitis: Inflamed erythematous rash that generally includes papules, vesicles, or bullae, swollen skin and significant itching (limited to area of body exposed to allergic antigen contact site)
63
When do you not use OTC to treat contact dermatitis?
1. less than 2 2. lasts more than 2 weeks 3. eyes, mouth, nose or genitalia involved 4. signs of infection 5. extreme itching, redness, swelling
64
What are the goals of therapy for contact dermatitis?
1. remove the offending agent 2. treat inflammation, itching, oozing, crusting
65
What are some non-pharmacologic treatments of contact dermatits?
1. removal of irritant (cool showers, DO NOT BATHE) 2. preventative and protective measures (clothing, acoid irritant)
66
What are the OTC options for treating contact dermatitis?
1. Oral antihistamines 2. hydrocortisone 3. astringents
67
What is the follow up recommendations of contact dermatitis?
1 week
68
What are symptoms of a cough?
1. differentiate between a productive (wet cough) in which sputum is produced, and a non‐productive (dry cough) in which sputum is NOT produced 2. differentiate between an effective cough (in which sputum is effectively expelled) and an ineffective cough (in which sputum is NOT effectively expelled)
69
When do you not treat a cough with OTC?
1. less than 4 2. Last longer than 7 days 3. worsening cough 4. have fever (103 or higher for adult, 102 for child)
70
What are the goals of therapy for treating a cough?
1. prevent complications 2. alleviate bothersome symptoms
71
What are the non-pharmacologic treatments for a cough?
1. nonmedicated lozenges 2. cool-vapor humidifiers 3. body positioning 4. hydration 5. avoid honey in children less than 1
72
What are the OTC treatments for a cough?
1. oral antitussives 2. topical antitussives 3. expectorants 4. NSAID's
73
What is the follow-up recommendations for a cough?
1 week
74
What are the symptoms of diaper dermatitis?
1. Red, shiny, wet appearing patches of skin in and near the diaper area \*\*can affect anyone what wears diapers
75
When to not treat diaper dermatitis with OTC?
1. possible secondary infection 2. frequent recurrence despite appropriate OTC treatment
76
What are the goals of therapy for diaper dermatitis?
1. eliminate rash 2. restore skin hydration and barrier function
77
What are the non-pharmacologic treatment options for diaper dermatitis?
1. increase diaper change frequency (min 6 times daily) 2. Use disposable diapers 3. DO NOT use hydrocortisone or clotrimazole
78
What are the OTC treatment for diaper dermatitis?
1. liberal use of protectants white petrolatum, zinc oxide, lanolin
79
What are the follow-up recommendations for diaper dermatitis?
1 week
80
What are the symptoms of diarrhea?
1. An abnormal increase in frequency and fluidity of bowel movements 2. more than 3 a day 3. sudden onset of nausea or vomiting 4. abdominal pain, fever chills 5. lower right quadrant pain and cramps
81
When do you not treat diarrhea with OTCs?
1. less than 6 months 2. greater than 6 months with fever\> 102 3. sever dehydration 4.severe stomach pain 5. risk for complications 6. Pregnacy 7. lasts longer than 14 days
82
What are the goals of therapy for diarrhea?
1. prevent and correct fluid and electrolyte imbalance 2. identify and treat cause 3. prevent sudden morbidity and mortality
83
What are some of the non-pharmacologic treatments for diarrhea?
1. keep food journal to identify triggers 2. Oral re-hydration salt solution (ORS) \*\*\* pedialyte "has suger, salt, water" gatorade and those drinks do not have correct balance
84
What are the OTC treatment options for diarrhea?
1. loperamide 2. bismuth
85
What is the follow-up recommendations for diarrhea?
2 days \*\*\* if very serious go to ER
86
What are the symptoms of dry eye?
1. Excessive tearing due to abnormal lubrication 2. White‐red eyes 3. Sandy, gritty feeling 4. Foreign body feeling
87
When do you not treat dry eye with an OTC?
1. Blurred vision 2. Pain in the eye 3. Chemical exposure 4. Contact lens wearer 5. Blunt trauma to the eye 6. Symptoms lasting greater than 72 hours
88
What is the goal of therapy for dry eyes?
1. Prevent corneal damage 2. Alleviate bothersome symptoms
89
What are the non-pharmacologic treatment options for dry eyes?
1. Avoid dry, dusty, and windy environments including airflow from air vents 2. Use cool mist humidifiers to improve air humidity 3. Wear eye protection (sunglasses or goggles) 4. Avoid allergens and other eye irritants 5. Avoid prolonged computer use 6. Use warm water eyelid compresses
90
What are the OTC treatment options for dry eyes?
Ophthalmic solutions (artificial tears) Non‐medicated ophthalmic ointments
91
What is follow-up for dry eyes?
2 weeks
92
What are the symptoms for dry mouth?
minimal or no salivary flow
93
When do you not treat dry mouth with OTCs?
1. Tooth erosion, decalcification, or decay Candidiasis, gingivitis, or periodontitis 2. Oral trauma, missing teeth, swelling, soreness, tooth pain 3. Sjogren's syndrome
94
What is the goal of therapy for dry mouth?
1. Prevent oral infections and dental caries 2. Alleviate bothersome symptoms
95
What are some of the non-pharmacologic treatment options for dry mouth?
1. Eliminate offending agents when possible (ethanol, tobacco, antihistamines, CNS stimulants) 2. Change medication schedules 3. Limit sugar and acidic foods 4. Use hard candy or xylitol based gum 5. Increase dietary water intake
96
What are the OTC treatment options of dry mouth?
1. artificial saliva 2. dry mouth oral rinses, sprays, and toothpastes
97
What is the follow-up recommendation for dry mouth?
2 weeks
98
What are the symptoms of dry skin?
1. Rough skin 2. Scaling skin 3. Loss of skin flexibility 4. Fissures 5. Inflammation 6. Pruritus
99
When do you not treat dry skin with an OTC?
1. severe condition 2. signs of infection (yellow crusting)
100
What are the goals of therapy for dry skin?
1. Restore skin hydration & barrier function 2. Prevent secondary infections
101
What are the non-pharmacologic treatments for dry skin?
1. Short baths (3‐5 minutes), 2‐3 times per week in tepid water immediately followed by moisturizer 2. Cool‐mist humidifiers 3. Emollients (creams, lotions, ointments, butters) Humectants (glycerin, propylene glycol, phospholipids)
102
What are the OTC treatment options for dry skin?
1. Urea 2. Lactic acid 3. Allantion 4. Hydrocortisone (short term)
103
What is the follow up recommendations for dry skin?
2 weeks
104
What are the symptoms of Dysmenorrhea?
1. Cramping 2. Bloating 3. Headache 4. Fatigue 5. Lower back pain 6. Nausea
105
When do you not treat dysmenorrhea with an OTC?
1. Severe dysmenorrhea or severe blood loss 2. Secondary dysmenorrhea 3. History of pelvic inflammatory disease 4. Irregular menstrual cycles 5. Endometriosis 6. Ovarian cysts 7. Use of intrauterine contraception 8. Use of warfarin, heparin, lithium, or bleeding disorder 9. Active GI disease
106
What is the goal of therapy for treating dysmenorrhea?
alleviate bothersome symptoms
107
What are some non-pharmacologic treatment options for dysmenorrhea?
1. topical heat 2. Exercise 3. Complementary therapies: Vit B1, E, MG acupressure Omega-3 fatty acids
108
What are the OTC treatment options for dysmenorrhea?
1. diuretics 2. NSAID's 3. Aspirin
109
What is the follow up recommendations for dysmenorrhea?
2 weeks
110
What are the symptoms of ear wax?
1. Sense of fullness in the ear 2. Pressure in the ear 3. Gradual hearing loss 4. Vertigo 5. Tinnitus 6. Chronic cough
111
When do you not treat ear wax with an OTC?
1. Signs of infection 2. Pain associated with ear discharge 3. Abrupt hearing loss 4. Presence of ruptured eardrum 5. Ear surgery within the prior 6 months 6. Tubes in ears 7. Age less than 12
112
What is the goal of therapy for treatment of ear wax?
1. Soften and remove excessive or impacted cerumen 2. Alleviate associated symptoms
113
What are the non-pharmacologic treatments of ear wax?
1. Use wet wrung‐out washcloth draped over finger to remove cerumen from the outermost portion of the external auditory canal 2. Do NOT use cotton tipped applicators (Q‐tips) 3. FDA warns against use of ear candles ax (dangerous and not effective)
114
What are the OTC treatment options for ear wax?
carbamide peroxide
115
What is the follow up recommendations for ear wax?
3 days
116
What are the symptoms of emergency contraception?
Girls and women of reproductive age up to 3 to 5 days after unprotected intercourse
117
When do you not treat Emergency Contraception with an OTC?
Patients presenting between 5 and 7 days after unprotected intercourse should be referred to a primary care provider for possible insertion of a copper intrauterine contraceptive device
118
What is the goal of therapy for emergency contraception?
prevent pregnancy
119
What are some of the non-pharmacologic treatment options for emergency contraception?
Non-hormonal copper IUC (inserted by PCP)
120
What are the OTC treatment options for emergency contraception?
Levonorgestrel
121
What are the follow up recommendations for emergency contraception?
Works best the sooner it is taken, may still be effective up to 5 days post‐coitus
122
What are the symptoms of a fever?
Temperature of approximately 100°F (37.8 °C) or higher and discomfort
123
When do you not treat a fever with an OTC?
\*Age less than 3 months with a temp of 100°F (37.8°C) or higher for any time \*Age 3 months to 2 years with a temp of 100°F (37.8°C) or higher for more than 24 hours \*Age 3 months to 2 years with a temp of 104°F (40°C) or higher for any time \*Although self care of fever may be initiated in appropriate patients less than age 2, parents should be advised to contact PCP for all patients under age 2 Age 2 years or older with a temp of 100°F(37.8°C) or higher for 3 days or more
124
What is the goal of therapy for treating fever?
alleviate bothersome symptoms
125
What are the non-pharmacologic treatments for a fever?
1. Tepid bath 2. Light clothing 3. No blankets 4. 68° F room 5. Adequate hydration 6. NO rubbing alcohol baths (may cause fever to rebound) NO Ice water baths
126
What are the OTC treatments for a fever?
1. NSAID's 2. Acetaminophen 3. Aspirin
127
What is the follow up recommendations for fever?
3 days for all pts over 2 \*\*if under 2 years of age you should talk with PCP before starting treatment
128
What are the symptoms of fungal skin infections?
1. Tinea Corporis (ringworm of the body): Ring shaped lesions with clear centers and red‐scaly borders 2. Tinea Cruris (jock itch): Found in medial and upper thighs and groin Pain when sweating 3. Tinea Pedis (athletes foot): Malodorous, pruritic, stinging, itching fissures, ulcers or vesicles on the feet
129
When do you not treat fungal skin infections with an OTC?
1. Tinea unguium (nail fungus) 2. Tinea capatis (ringworm of the scalp) 3. Patients with diabetes, immune deficiency, asthma, systemic infections 4. Face, mucus membrane, or genitalia involvement 5. Extensive involvement Pus‐like discharge 6. Less than 2 years of age
130
What are the goals of therapy for treatment of fungal skin infections?
1. Eradicate existing fungal infection 2. Prevent future fungal infections 3. provide symptomatic relief
131
What are the non-pharmacologic treatment options for treating fungal skin infections
prevention
132
What are the OTC treatment options for fungal skin infections?
1. Pedis only: Tolnaftate and aluminum acetate 2. Pedis and cruris: Undecylenic acid 3. Pedis, cruris, corporis: Clotrimazole, terbinafine, tolnaftate \*Do NOT treat unguium or capatis OTC
133
What is the follow up recommendations for fungal skin infections?
2 weeks (cruris) 4 weeks (corporis or pedis)
134
When do you not treat a headache with an OTC?
Severe head pain Pain for more than 10 days Last trimester of pregnancy Less than 8 years of age Infection with high fever History of liver disease or more than 3 alcoholic drinks daily Secondary headache (except diagnosed sinus headache) Symptoms of migraine in previously undiagnosed patient
135
What is the goal of therapy for treatment of a headache?
Alleviate bothersome symptoms
136
What are the non-pharmacologic treatments of headaches
1. Migraine HA: Avoid triggers (diet, exercise, stress, etc) Dark room Cool compress/ice on head and neck 2. Tension HA: Stretching neck muscles Relaxation exercises Physical therapy 3. Sinus HA: Hot shower Adequate hydration
137
What are the OTC treatment options for headaches?
1. Acetaminophen 2. NSAID's 3. Aspirin
138
What are the follow up recommendations for headaches?
1 week
139
What are the symptoms of heartburn?
1. Pain behind sternum 2. Sour taste in the mouth 3. Belching 4. Sore throat 5. Cough \*Typically occurs after meals and at bedtime
140
When do you not treat heartburn with an OTC?
1. Age less than 2 for antacids, less than 12 for H2RA’s, less than 18 for PPI’s 2. Age greater than 45 with symptoms of dyspepsia 3. Heartburn that continues after 2 weeks of OTC treatment 4. Frequent heartburn for 3 months or greater 5. Patients with severe symptoms 6. Heartburn symptoms that occur during the night 7. Patients with dysphagia 8. Signs of a GI bleed 9. Persistent hoarseness, wheezing, cough, choking Unexplained weight loss Signs of heart attack
141
What are the goals of therapy for the otc treatment of heartburn?
prevent symptoms
142
What are the non-pharmacologic treatment options of heartburn?
1. Keep food journal to identify triggers 2. Weight loss for overweight patients 3. Raise the head of the bed 4. BRAT diet Bananas Rice Applesauce Toast
143
What are the OTC treatment options for heartburn?
1. Antacids 2. H2 receptor antagonists (H2RA) 3. Proton pump Inhibitors (PPI)
144
What are the follow up recommendations for heartburn?
2 weeks
145
What are the symptoms of Hemorrhoids?
1. Hemorrhoids large bulging hemorrhoidal vessels, surrounding tissue, and overlying mucous membrane Itching, swelling, inflammation, discomfort, pain, bleeding, change in bowel pattern, seepage, prolapse, thrombosis 2. Internal Hemorrhoids: Above dentate line, lack sensory fibers leading to less or no pain 3. External Hemorrhoids: Below dentate line, bluish lump at the anal canal, wrapped in highly innervated epithelium, very painful
146
When do you not treat hemorrhoids with an OTC?
1. Age less than 12 2. Ulcerative colitis or Crohn’s disease 3. Family history of colon cancer 4. Signs of GI bleed, excessive pain, seepage, or prolapse 5. Persists after 7 days of OTC treatment
147
What are some non-pharmacologic treatment of hemorrhoids?
1. Improve constipation to reduce straining 2. Spend less time on the toilet 3. Cryotherapy (cooling): ice pack between buttock to sooth
148
What are the OTC treatments used for hemorrhoids?
1. Analgesics 2. Anesthetics 3. Vasoconstrictors 4. Protectants 5. Astringents 6. Keratolytics 7. Corticosteroids 8. Stool softeners
149
What is the follow up recommendation for hemorrhoids?
1 week \*\* if blood in stool see PCP sooner
150
What are the symptoms of insomnia?
1. Difficulty falling asleep 2. Awaking early with inability to fall back asleep 3. Unusual or troublesome dreams 4. Poor sleep 5. Fatigue, drowsiness, anxiety, irritability, depression, limited concentration and memory
151
When do you not treat insomnia with an OTC?
Age less than 12 1. Age greater than 65 2. Pregnant patients 3.Frequent nocturnal or morning wakeups 4. Chronic insomnia (lasts greater than 3 weeks) 5. Secondary insomnia (due to underlying condition)
152
What are some of the non-pharmacologic treatments for insomnia?
Sleep hygiene American Academy of Sleep Medicine recommends against dietary supplements for insomnia unless approved by a health care provider
153
What are the OTC treatments for insomnia?
1. diphenylhydramine 2. doxylamine \*\* 2nd generation antihistamines are NOT used for insomnia
154
What is the recommended follow up for insomnia?
1 week
155
What are the symptoms of intestinal gas?
1. Belching 2. Gas Pains 3. Bloating 4. Flatulence
156
When do you not treat intestinal gas with OTCs?
1. Symptoms that occur more than a few times per month or that last for more than a few days 2. Sudden onset or change in abdominal pain 3. Severe symptoms 4. Occurs with any of the following symptoms (Diarrhea, GI bleed, fatigue, unintentional weight loss, symptoms that frequently occur during the night)
157
What are the non-pharmacologic treatment for intestinal gas?
Limit gas producing foods eliminate dairy if lactose intolerant
158
What are the OTC treatments for intestinal gas?
1. Simethicone 2. Charcoal 3. alpha-galactosidase 4. Lactose replacement
159
What is the recommended follow up for intestinal gas?
3 days \*\*see PCP if you get these symptoms more than a few times a month
160
What are the symptoms of musculoskeletal pain?
Pain (inflammation)
161
When do you not treat musculoskeletal pain with an OTC?
1. Less than 2 years of age 2. Pregnant (especially 3rd trimester) 3. Pain score great than 6 4. Increased intensity or change in pain 5. Pain for 10 or more days 6. Pelvic or abdominal pain (dysmenorrhea ok) 7. Nausea, vomiting, fever, or symptoms of infection 8. Visual deformity (broken bone, etc) 9. Abnormal movement or weakness 10. Back pain with loss of bowel or bladder control
162
What are the goals of therapy for musculoskeletal pain?
1. restore function and prevent re-injury 2. prevent acute pain from becoming chronic persistent pain
163
What are the non-pharmacologic treatment of musculoskeletal pain?
1. RICE 2. slpints, braces, and slings 3. Glucosamine and chondroitin
164
What are the OTC treatments for musculoskeletal pain?
1. Acetaminophen 2. Aspirin 3. NSAIDs 4. Counterirritants
165
What is the follow up recommendation for musculoskeletal pain?
1 week
166
What are the symptoms of Nausea and Vomiting?
1. Nausea (subjective feeling of need to vomit) 2. Retching (Involuntary unsuccessful attempt to vomit) 3. Vomiting (Forceful expulsion of GI contents thro mouth)
167
When do you not treat nausea and vomiting with an OTC?
1. dehydration 2. Cannot be cared for at home 3. Yellowing of the eyes 4. Severe pain in upper right or lower quadrant (including pain after fatty meal) 5. Severe symptoms 6. Stiff neck 7. Not drinking fluids or lack of urination for 8 or more hours 8. Repeated vomiting after meals 9. Signs of GI bleed m 10. Fever present in children under age 3 11. Head injury and vomiting
168
What are the goals of therapy for nausea and vomiting?
1. Prevent/correct fluid and electrolyte imbalance 2. prevent other complications (aspiration, etc)
169
What are complementary and non-pharmacologic treatments for nausea and vomiting?
1. Acupressure: wrist bands 2. ORS Complementary Therapies: 1. Ginger 2. pyridoxine
170
What are the OTC treatments for nausea and vomiting?
1. Antihistamines 2. Antacids 3. H2RA's 4. Phophorylated carbohydrate solutions 5. Bismuth Subsalicylate
171
What are the follow up recommendations for nausea and vomiting?
24 hours \*\* should go to ER if symptoms are very bad
172
What are the symptoms of pediculosis?
1. Head lice: Pediculus capitis 2. Body lice: pediculus humanus or corporis 3. Pubic lice (crabs): Phthirus pubis 4. itching
173
When do you not treat someone with an OTC who has pediculosis?
1. Children age less than 2 2. Affected eyes or eyelids 3. Patients with secondary bacterial infections 4. Pregnancy or breastfeeding 5. Patients with active tumors 6. Patients with allergies to ragweed or chrysanthemums
174
What are non-pharmacologic treatments of pediculosis?
1. Nuvo method: cetaphil cleanser, apply to dry hair and blow dry to "shrink wrap" lice 2. Tree oil and lavender 3. mayonnaise and petroleum NOT shown to be effective
175
What is the OTC treatment for pediculosis?
1. Head lice: Permethrin 2. Head lice, pubic lice: Pyrethrin
176
What is the recommended follow up for pediculosis?
2 weeks
177
What are the symptoms of pinworm?
1. Perianal itch (increased in the evening) 2. Worms seen in feces, in perianal area, or on cellophane tape or paddle 3. Major infestations can lead to abdominal pain, nausea, nervousness, loss of appetite, insomnia
178
When do we not treat pinworm with OTCs?
1. Less than 2 2. Weight less than 25 pounds 3. Pregnancy or breatfeeding
179
What non-pharmacologic treatment should be used in conjunction for pinworm?
1. Washing lines, clothing, etc 2. Dont walk barefoot 3. avoid sweeping 4. vacuum daily
180
What should NOT be used when treating pinworm?
1. garlic paste, vaseline, caster oil, green team, yellow bark, and turmeric \*\*dont show any evidence and high risk of pinworm infection transmission
181
What are the OTC treatment options for pinworm?
Pyrantel pamoate
182
What is the recommended follow up time for pinworm?
2 weeks
183
What are the symptoms of scaly dermatoses?
1. Dandruff 2. Seborrheic Dermatitis: dull, yellowish, oily, scaly areas on red skin may include scales in eyelids and ears 3. Psoriasis
184
When do you not treat scaly dermatoses?
1. Less than 2 years of age 2. c Psoriasis involving greater than 5% of body surface area, face, or if presence of joint pain
185
What are the non-pharmacologic treatments of scaly dermatoses?
Baby oil scalp massage and non-medicated shampoo
186
What are the OTC treatments for scaly dermatoses?
1. coar tar 2. Hydrocortisone (not for dandruff) 3. Ketoconazole 4. Pyrithione zinc 5. Salicylic acid 6. Selenium sulfide 7. sulfur
187
What is the follow up recommendation for scaly dermatoses?
2 weeks
188
What are they symptoms of smoking cessation?
Cigarette use
189
When do you not treat smoking cessation with an OTC?
1. Less than 18 years old 2. Active peptic ulcer disease 3. High blood pressure not controlled with medication 4. Serious heart disease \*\*for pregnancy or breastfeeding or use of smokers tobacco, cigars or pipes: should use behavioral counseling
190
What are the non-pharmacologic treatment options for smoking cessation?
1. 5 a's :Ask, advise, assess, assist, arrange 2. 5 r's : Relevance, Risk, Rewards, Roadblocks, Repetition Have a counseling center
191
What are the OTC treatments for smoking cessation?
Nicotine gum, patches and lozenges
192
What are the symptoms of a sunbrun?
Erythema, tenderness, pain, and edema following sun exposure May include blisters, fever, weakness, shock, peeling and itching
193
When do you not treat a sunburn with an OTC?
Only treat 1st degree burns \*\* no blisters, fever, chills, shock)
194
What are the goals of therapy for treating a sunburn?
1. prevent scarring 2. restore skin hydration & barrier function 3. Prevent secondary infections
195
What are the non-pharmacologic treatments for sunburns?
1. Prevention 2. Treatment: cold bath, moisturizing skin and hydration
196
What are the OTC treatment options for a sunburn?
1. NSAID's 2. Topical anesthetics (applied to less than 1% of the body = the size of the back of the hand)
197
What is the follow-up recommendations for a sunburn?
1 week \*\* seek immediate emergency help if you have extreme dry mouth, oliguria, confusion or signs of infection
198
What are the symptoms of Urinary incontinence?
Urge urinary Incontinence: Frequent urgency (more than 8 times daily) often with inability to reach toilet Stress Urinary Incontinence: Urine leakage during physical activity
199
When do you not treat urinary incontinence with OTC?
1. In men 2. Pt with symptoms of overflow urinary incontinence (straining to void, decreased urine stream, sense of bladder fullness despite voiding)
200
What are the non-pharmacologic treatments for urinary incontinence?
1. toileting assistance 2. bladder training 3. Pelvic floor muscle training 4. absorbent garments and pads
201
What is the OTC treatment for urinary incontinence?
Oxybutynin
202
What is the follow up recommendation for urinary incontnence?
2 weeks
203
What are the symptoms of urinary tract infections?
1. fever 2. chills 3. Urinary frequency and urgency 4. pyuria 5. dysuria 6. low back pain 7. cloudy urine 8. strong urine odor
204
What are the goals of therapy for urinary tract infections?
Make sure the pt goes to their PCP reduce pain associated with UTI
205
What are the non-pharmacologic treatment options for UTI?
prevention
206
What are the treatment options for UTI?
OTC do not treat the injection they control symptoms 1. Phenazopyridine 2. NSAID's 3. Acetaminophen
207
What are the symptoms of vulvovaginal candidiasis?
1. intense itching 2. burning sensation 3. Clumpy white discharge 4. Characteristic odor of yeast
208
When do you not treat vulvovaginal candidiasis with an OTC?
1. Suspected bacterial vaginosis or trichomoniasis 2. Pregnant women 3. Children under age 12 4. Recurrent VVC (more than 3 in the past year) 5. Non‐VVC vaginal infection in the past 2 months 6. Patients with diabetes or HIV (predisposing diagnosis) 7. Patients on corticosteroids or anti-neoplastics
209
What are the non-pharmacologic treatment options for vulvovaginal candidiasis?
1. decrease sugar consumption 2. increase yogurt containting live cultures 3. avoid tight fitting clothing 4. sitz bath
210
What are the OTC treatments for vulvovaginal candidiasis?
Imidazole antifungals Bezocaine (this can reduce pain but focus should be on imidazole antifungals to cure the underlying problem
211
What is the recommended follow up time with vulvovaginal candidasis?
1 week \*\* pt should see PCP if getting recurrent infections
212
What are the symptoms of warts?
Common warts: Skin-colored or brown, dome-shaped papules with a rough cauliflower-like appearance (found on hands, fingers, or face) Plantar warts: Skin-colored callous-like lesions on the feet which may be painful
213
When do you not treat warts with an OTC?
Face, nails, genitals or anus involved Extensive spread Painful plantar warts Chronic disease (diabetes, peripheral vascular disease, etc) Poor blood circulation Physical or mental impairment Immunosuppressive meds Less than 4 years of age Pregnancy or breastfeeding
214
What are the non-pharmacologic treatment options for warts?
1. wash hands after touching or treating wart 2. Do not pick or aggravate wart 3. Lambs wool, moleskin, or shoe inserts for painful warts 4. Cryotherapy
215
What are the OTC treatment options for warts?
1. 17% salicylic acid for common warts 2. 40% for plantar warts
216
What are the follow up recommendations for warts?
12 weeks
217
What are the symptoms of water-clogged ears?
1. feeling of wetness in the ear 2. feeling of fullness in the ear 3. gradual hearing loss
218
When do you not treat water-clogged ears with an OTC?
Signs of infection Pain associated with ear discharge Presence of ruptured ear drum Abrupt hearing loss Ear surgery within the prior 6 months Tubes in ears Age less than 12
219
What are the non-pharmacologic treatment for water-clogged ears
1. tilt affected ear downward and gently manipulate auricle 2. blow-dryer on low heat and speed 3. single use water-absorbing ear plugs
220
What are the OTC treatment options for water-clogged ears?
Isopropyl alcohol in anhydrous glycerin
221
When should a pt follow up with PCP when they have water-clogged ears?
3 days
