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PHAR 398: Minor Ailments > Pharmacist Prescribing > Flashcards

Pharmacist Prescribing Flashcards

1
Q

What is the number one prescribing situation for pharmacists?

A

Cold Sores

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2
Q

What is useful to pharmacists regarding prescribing for cold sores?

A

50% if individuals will get prodromal symptoms –> Tingling

  • Helps us out a lot as far as prescribing
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3
Q

What is Lysine +? Efficacy in cold sores?

A

Amino Acid - Not very effective

Asterix on package - probably tested in test tube (cuts healing time in half)

Much more expensive compared to name brand chap stick

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4
Q

How is Lysine+ suppose to be used as indicated by the manufacturer?

A

For the relief of cold sores

Apply ointment every 2 hours until cold sore resolves

Up to 10 applications per day

Apply using a clean fingertip

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5
Q

Are cold sores always on the lip? What is another issue with cold sores?

A

Can deviate away from the lip

Can make diagnosis hard

Rare to see an MD; often MD comes into play when 5 to 6 cold sore a summer for a child

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6
Q

What are some benefits in cold sore prescribing regarding the individual?

A

Self-diagnosed –> Easy to do as has seen them before
–> legalistic approach, but we double check
–> not much can go wrong on thus front

Prodromal Symptoms may be present and helps with clueing into cold sore

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7
Q

What is cold-sore Fx? Efficacy?

A

Bee pollen/wax

  • A bit better than other agents but still not that great of an agent
  • Bee stuff has loads of good stuff in it
  • Still just a chapstick
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8
Q

When do people commonly get cold sores? Describe the pattern between age and cold sores?

A

Virus of cold sores can infect people of all ages

Exposure to the virus typically occurs in childhood

Many people catch HSV-1 by the time they are 5 years old

One can develop a cold sore at any age although having a chnacde of an outbreak decraeses after the age of 35

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9
Q

Describe the typical progression of a cold sore

A

Typical - 2 days in:
- Will crust over (keep it soft with some normal chapstick) and will have some leakage
- Takes about a week to be taken care of

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10
Q

Describe the stages of a cold sore? Differential?

A

Stage 1: Tingling, itching, or burning
Stage 2: Blister formation - 12-24 hours later (red, swollen, pain)
Stage 3: Blister bursts - Lasts 2-3 days
Stage 4: Scab formation (may crack and bleed)
Stage 5: Healing stage

Stages of a cold sore can help differentiate from angular chelitis

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11
Q

Differential of cold sores

A

ANgular Chelitis –> Tx is to keep it soft

Impetigo - Age is usually 2-5
- Tears in the skin can lead to a staph infection

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12
Q

Describe cold sores

A

Usually form an and around the mouth and lips

Genuinely look the same from person to person

Begin with a tingle or an itch, form a small fluid blister or cluster of blisters, then pop and scab over

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13
Q

Describe the difference between cold sores and impetigo regaridng presnetation

A

Distinguishing a visual difference between the non-bullous form of impetigo and cold sores cane be difficult

Some cases, non-bollus impetigo blisters form in much larger cluster and burst more quikcly than cold sores

Impetigo often looks worse than it feels

Non bollus impetigoo does not cause much, if any, pain ; however, can experience some itchiness once blisters burst and crust over

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14
Q

Describe the difference between cold sores and impetigo in regards to treatment and duration of disease

A

Impetigo can be treated with antibiotiics, and when identidfied early, heal within a week
- Once treated, child will not experience a recurrence unless they contact the bacteria again (bacteria will not stay in child’s system for a significnat length of time)

When a child suffers cold sores, they are more likely to develop pain and itchiness throughout the stages of an outbreak
- May ecome ill during their first cold sor eoutbreak
- No cure for HSV-1 or 2, children with cold sores are mor elikely to suffer recurring outbreaks

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15
Q

Do cold sores cause systemic symptoms?

A

Not usually

The symptoms are usually the most severe the first time yoy get cold sores

A first-time cold sore can make a child seriously ill

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16
Q

Cold sore vs angular chelitis

A

Cold sores typically begin as an itchy or painful area that turns into one or a group of small painful blisters

Over time, they may weep, scab over, and finally heal

Angular Chelitis - Begins as a patch of dry, irritated, or cracked skin at one or both corners of the mouth

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17
Q

Desribe some of the OTC cold sore medications that may be used? Efficacy?

A

1) Docosonal (Abreva)
- Medicated - use in prodromal symptoms
- If used after sores burst, use chapstick
- 20$

2) Propolis - COldSoreFX

3) Camphor/Phenol - CArmex
- Some people swear by it
- Anasthetic
- TLC

4) Heparin/ZN SO4 - Lipactin
- definetly heparin receptors in the body
- not therapeutic; not out go to

5) Lysine+

6) Benzyl Alcohol - Zilactin
- Anasthetic
- Drying agent

7) Benzocaine - Orajel
- Totatlly fine to use to numb the area

8) Ice cube in Facecloth
- Anti-inflammatory

9) Thin Colloid Patch - Not avai;able anymore
- Unmedicated silicone patch - cosmetic
- Great agents

Dogs and puppies chase chickens, catch happy little bugs, zooming by outside.

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18
Q

Describe Abreva and its efficcay

A

Docosonal
- Can be used if early enough (<48 hours) and have effect

Cold sore usually lasts around 7 days

Manufacturer claims to cleave off 3 days - –> Astronomical
Fake –> 4.1 vs 4.8 days in a lab –> 0.7 of a day

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19
Q

Describe cold sore patches

A

Abreva Conceal
- Non-medicated patch that covers your cold sore and provdies a smooth surface for applying makeup

Lip Clear - Cold Sore Banadage
- Hard to find in pharamcy
- Non-medical - Cosmetic agent -> Wear for 12 hours

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20
Q

Describe the prescrbing symptom history section of med-sask guidelines for cold sores? Issues?

A
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21
Q

Describe the treatment options of cold sores

A
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22
Q

Describe the issues associated with topical and oral therapy of cold sores?

A

Topical Agents - Hard to know where lesion will form and therefore can be hard to hit the prodromal phase

Oral Agnets –> Not an issue

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23
Q

What are the treatment options of a cold sore once prodromal phase is over?

A
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24
Q

Describe cold sores and the concern in elderly patients

A

After 35 and 50 years old, have titres to fight off cold sores and become rare-ish

Nervous about squamish cells or basal cell carcinoma
–> Guidelines say 14 days
- Basal - lowest invasive skin cancer
- Melanoma is the worry

Worried in older individuals

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25
When can a pharmacist prescribe preventative therapy for cold sores?
4-6x times per year; can give prevention therapy a thought - If just in summer, only do prevention therapy in the summer - Agents are safe (no s/e) - If used all year, maybe worried about the liver
26
Describe why HSV-1 can lead to recurrences?
Virus remains in the body and lies dormant in a bundle of nerves called the trigeminal ganglion and stops causing infection The virus can become active agein and cause recurrent cold sores Cods sores typically recure three to four times a year, although some people may develop more than one cold sore per month
27
Describe pharmacist prescribing of birth control
Women pharmacist know this areas - Know your limits; especially of a man - Do you smoke, then try one. If side effects, try soemthing else Low level therapeutics - Estrogen levels are getting lower vs historically (50 mg historically increased side ffects)
28
Describe a situation that may be an adverse effect bit also treatment with birth control
Acne - Sometimes worsens intially but usually improves in the long term Acne as an adverse effect occurs with progesterone component Ethinyl Estradiol (estrogen) can help acne
29
Describe why prescribing of birth control is considered safe for pharamcists?
- Low level worries about prescribing birth control in a pharamcist setting Opill - Norgesterol Tablet --> OTC in USA - First ever OTC birth control - Progestin-only pills are safer compared to the combined birth control pills that contain both estrogen and progesting - Progestin only pills do not have the same risk of blood clots or stroke as combination pills
30
OTC Birth Control
LAtin America and Europe has been doing this for awhile Leading medical organizations have affirmed that a prescription is not clinically necessart for acess ro the pill No toxic, addictive and has no risk of oberdose, meeting FDA criteria for oTC acess Other OTC products such as cold, flu and allergy sumptoms carry higher risks
31
What can be a diagnostic criteria for a migraine?
If an individual thinks they have a migraine, try a triptan - If it helps, diagnosis via treatment
32
Describ ethe difference between a tension headache and migraine
Tension - Once or few times a week or continous for several days - Generalized Migraine - Svere, intense throbbing pain with pulsating charcter mostly localized on one side of the head --> Typically unilater
33
Why is it hard to differntiate a migraine and a tension headache? Mangement?
Enough overlap between the two that can make it hard to diagnose Just try a triptan
34
Describe the phases of a migraine
Prodorome Sx - 25% of people with migraines will have - Few hours to days Aura - 5-60 mins Migraine Attack - 4 to 72 hours - Nauseau, vomitting (still can occur in tension headaches) Post-drome - 24-48 hours - Can occur in a tension headache as well
35
Describe some concerns regarding migraines and a stroke
Although symptoms can overlap, if even the slightest chance of being a stroke, call 911 If you are over 40 and never had a migraine, assume its something more serious If you are young, more likely a migraine. If you. are older, more likely a stroke. People who get migraines typically have had them before; rare to get 1st one when older
36
Describe the difference in symptoms between a stroke and a migraine/headache
If grey hairs - it may be a stroke - if first migraine/headache, lean towards a stroke (usually exoerience early in life) Stroke - Lose (loss of function) --> Diminishes vision Migraine - Add on Sx --> Added on visual stimuli Its possible to have a firts migraine at any age, it's more typical to begin having them as a child - Most will also recognize their aura
37
Describe med-sask red flags for migraine? When to refer?
38
Symptoms of migraine in med-sask prescribing algorithm
39
TX recommendations of migraines MedSask
If tripatn helps, diatgnostic
40
Describe the benefit of pharamcists prescribing for migraines
Pharamcists can help to close the treatment gap - Not trying to be diagnosticians but can help decrease the tx gap Migraines remain underdiagnosed, undertreated and under-estimated
41
When should acute medications for migraines be taken?
Take acute medications ASAP (within 30 mins of mild pain)
42
How should triptans be dosed?
If needing repeat dosing over 24 hours, taking the max dose once is more effective than a low dose twice If prodrome phase, give high dose of triptan
43
What is considered an adequate trial of a triptan?
Ensure an adequate trial of a triptan Try a triptan over 3 attacks, with re-dosing if needed and/or increase dose If still fialure, try greater than or equal to other triptans
44
Migraine and Combination Therapy
More effective than monotherapy (e.g. triptan + NSAID vs triptan alone) but also consider potential for AE --> MAx of 9 days/month to prevent MOH (> 10 days)
45
Describe the speed of triptans in a migraine? Is it effective?
Onset of tablet and ODT formulations are similar, but ODT can be convienient and discreet ODT also useful if water exacetbates nauseau If require speed, use an ODT --> if faster relief is desired
46
Drug Interactions of Triptans
Triptans and Ergots (rarely used) Risk of serotonin syndrome with triptans, even with triptans + SSRI's, is low
47
Describe the effcacy of migraine medications
Triptans - 74% Ergots - 65% - Specialized meds - Strong vasoactive compound - Don't know if incraesed dilation or incraesed sensitivity in migraine Anti-emetics - 59% - Treating symptoms of migraines NSAID's - Give it a try
48
What are the best migraine medications regarding efficacy?
Triptans, ergots and entiemetics had the highest efficacy --> TRIPTANSSSSSS Individual medications with the highest patient-reported effectiveness were eletriptan, zolmitriptan and sumatriptan - Just try one
49
Describe Ibuprofen usage in migraines
400 mg - ceiling effect of analgesia Don't know if migraines have inflammatory effect - can try 800 mg but may be overkill Whatever works for patient Make sure someone is monitoring Make sure they try triptans
50
Ibuprofen and Speed in mIgraines Tips
Ibuprofen liquid gel and diclofenac K+ (expensive) often 10-20 min quicker onset Avoid enetric coated and slow release tabs Avoid taking NSAIDs with food in acute migraine (delays absorption) GI effect is low with NSAIDs
51
What are some symptoms of cystitis?
52
Symptoms of UTI in Men
53
Is urine sterile?
Urine in healthy individuals naturally comtaines bacteria and urine is not a sterile substance
54
Describe statistics of UTI in CAnada
A UTI is the 8th most common cause of ambulatory care visists Almost half of all women will experience a UTI before the age of 33 Uncomplicated UTIs can be empiraclly treated with oral natibiotics
55
What are some key factors that support an uncomplicated UTI?
56
What are some red flags of a UTI?
57
red flag symptoms of UTI's MedSask prescribing algorithm
Leaning more towards pyelonephritis here
58
Symptoms of acute uncomplicated cystitis - Med Sask
59
Standard therapy for UTI - MedSask
60
Describe the main therapy for a UTI CI
61
UTI's in Elderly and Concern
UTI is one of the most common infections in odler aduts - Constitues approximately 25% of all infx in older audlts - Would need to be worried about creatinine clearence at this age
62
Counselling for a UTI Key Points
recurrence happens in about 25% of patients The ppainful urination should resolve within a few hours of starting the medication Sx should improve within 48-72 hours and resolve within 7 days
63
Preventative Tips to COusnel a Patient on to prevent UTIs
64
Is viral and bacterial conjuctivitis easily distinguishable?
NO - Hard to tell the difference Will be right about 50% of the time
65
Describe the diferrences between viral and bacterial conjuctivitis
66
Describe the course of viral conjuctivitis? WHat does it commonly occur after?
starts in 1 eye – moves to 2nd eye in approx 1/3 of cases​ often follows a cold​
67
Describe how to diffren6tiate betwen viral, bacterial and allergic conjuctivitis?
68
Overall summary between viral and bacterial conjuctivitis?
69
What type of conjuctivitis is most common in children?
Bacterial
70
When is bacterial conjuctivit more likely?
71
Conjuctivitis vs Blepharitis: Location opf exudate
Blepharitis - Older individuals - Seborhhea - Exudate from the lid margin Bacterial Conjuctivitis - Exudate from the eye
72
What is blephritis
Eyelid disorder CAn lead to probelms with dry eyes Crusting at the base of the eye lashes REFER
73
Describe the etyiology of Blepharitis
74
Blepaharitis Symptoms
75
Allergic Conjuctivitis Sx
ITCHING Nasal Symptoms at play?
76
Agents for Allergic COnjuctivitis
Agent of Choice - PAtaday OD Murine can help to wash stuff out of the eyes Visine for allergic eyes - Not a good idea
77
Describe Infectious conjuctivitis in adults
Viral causes are more common - 7 days of sx Both are slef limiting heree MDS correct 50% of the time
78
Describe the effect of an antibiotic in bacvteria conjuuctivitis
Antibiotic shortens the course by 1-3 days Decreased spreading Should see improvement within 2 days
79
What is another strategy that can used for infectious conjuctiviytis?
Watchful Wiating - If not better 3 days after sx begin, consider an antibiotic
80
Treatment of Viral COnjuctivitis
Most references suggest symptomatic care Lubricating eye drops - None of them are better than the otehr one Just go with one here
81
Are presverative sin eye drops toxic? How often to apply?
NOOO QID - Should go presverative free May be irritating but not toxic Most wi;ll become preservative free
82
Hylo Eye Drops
Bacteria cannot get back into the bottle Expensive with no special ingredients Still a trial and error
83
Homeopathic {Pink Eye Relief
NOOOOO
84
Bacterial Conjutcivitis Treatment
3 day Windo - Watchful waiting Use an antibiotic Polysporin Eye Drops (totally fine to use)
85
Polysporin Eeye Drop Usage Directions
Great agent 1-2 Drops QID
86
Is treatment necessary for bacterial conjuctivitis?
Almost all cases of bacterial conjuctivitis are self limiting and will clear within 10 days without treatment
87
TX of Subconjuctival hemorrhage
Visine decongestant is not effective here ACnnot decongestant a broken vessel Greater the size may be worrying but not worried on this front More so worried if it occured due to trauma
88
Whn does BP work best for acne?
BP works best for acne if ther eis inflammation occuring
89
Differentails Acne
PCOS - HAirs, wacky p-eriods and acne - Worried Roscea/Perioral Derm -
90
Roscea Diffrential pof Acne
Acne-like lesions at same stage Starts at 30 years of age Facial Flushing, Teleangiectasis, Eye Druness No black heads or white heads and older womken - Roscea
91
Describe the age of Acne and its prevalence
80% of teenagers; can last till early 30's 20% tennager and stops at w0 and comes back later - More conerned - Adult onset
92
peri-oral Dermatitis Differntail
- Dermatitis that occurs around the. mouth Lesions clustered around the mouth and nasal fold Women > Men History of topical steroid use No blackheads
93
TX of peri-oral Dermatitis
Low level antibiotics here - Inherrent antiflammatory
94
What combination therapy for acne is recommended?
BP + Retinoi d BP + antibio retinoid + Antibio Does not matter which one we choose
95
Describe when ceratin acne agents sghould he used regarding lesisons?
Pimps - Inflammatory Response - BP White/Blackheads - No anti-inflammatory - Retinoids stop the inflammation from starting
96
How to apply retinoid?
1 pea sized dab spread over 4 spots - not the more the merrier here
97
prescribing for Acne
TActuo - Adapalen BP Clindoxyl - Clindamycoin 1% OD
98
RX Prescribing and COmbination Products
Pharamcists cannot prescribe for antibio and BP combination prpducts Not indicated for mild acne e.g. TActupump
99
Other age nt for acne? Efficacy?
Not a listed benefit of the Saskatchewan Drug Plan. Pharmacists may prescribe ​ & assessment fee may be claimed. Dapsone gel 5% - Aczone TRASHHHH
100
Describe ongoing care of Acne and agents
Topical antibiotics (if being used) should be d/c after​ resolution of inflammatory symptoms​ Drop down to retinoid monotx
101
Referall Situation Acne
Acne ofn the back
102
Rare Agent for Acne and Its indication
Aklief Trifarotene 0.005% Indicated for chest, shoudkers and back - MD only Targeted trunkal acne - Not going to pentrate retinoid market Still a standard retinoid that also works on the face
103
Tinea Capitis
Common infection in childrem Not topical monotthearpy here Scalp is hard to pentrate - Need oral tx
104
Descrobe the ytreatment of tinea
105
Diaper Rash Applicatuon
1/2 FTU should be enough HC 0.5-1%
106
Treatment of Diaper RAsh Fungal

PHAR 398: Minor Ailments (9 decks)

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