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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
Q

When can a pharmacist prescribe preventative therapy for cold sores?

A

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
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26
Q

Describe why HSV-1 can lead to recurrences?

A

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

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27
Q

Describe pharmacist prescribing of birth control

A

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)

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28
Q

Describe a situation that may be an adverse effect bit also treatment with birth control

A

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

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29
Q

Describe why prescribing of birth control is considered safe for pharamcists?

A
  • 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
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30
Q

OTC Birth Control

A

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

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31
Q

What can be a diagnostic criteria for a migraine?

A

If an individual thinks they have a migraine, try a triptan

  • If it helps, diagnosis via treatment
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32
Q

Describ ethe difference between a tension headache and migraine

A

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

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33
Q

Why is it hard to differntiate a migraine and a tension headache? Mangement?

A

Enough overlap between the two that can make it hard to diagnose

Just try a triptan

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34
Q

Describe the phases of a migraine

A

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

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35
Q

Describe some concerns regarding migraines and a stroke

A

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

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36
Q

Describe the difference in symptoms between a stroke and a migraine/headache

A

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

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37
Q

Describe med-sask red flags for migraine? When to refer?

A
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38
Q

Symptoms of migraine in med-sask prescribing algorithm

A
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39
Q

TX recommendations of migraines MedSask

A

If tripatn helps, diatgnostic

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40
Q

Describe the benefit of pharamcists prescribing for migraines

A

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

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41
Q

When should acute medications for migraines be taken?

A

Take acute medications ASAP (within 30 mins of mild pain)

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42
Q

How should triptans be dosed?

A

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

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43
Q

What is considered an adequate trial of a triptan?

A

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
Q

Migraine and Combination Therapy

A

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
Q

Describe the speed of triptans in a migraine? Is it effective?

A

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
Q

Drug Interactions of Triptans

A

Triptans and Ergots (rarely used)

Risk of serotonin syndrome with triptans, even with triptans + SSRI’s, is low

47
Q

Describe the effcacy of migraine medications

A

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
Q

What are the best migraine medications regarding efficacy?

A

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
Q

Describe Ibuprofen usage in migraines

A

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
Q

Ibuprofen and Speed in mIgraines Tips

A

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
Q

What are some symptoms of cystitis?

A
52
Q

Symptoms of UTI in Men

A
53
Q

Is urine sterile?

A

Urine in healthy individuals naturally comtaines bacteria and urine is not a sterile substance

54
Q

Describe statistics of UTI in CAnada

A

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
Q

What are some key factors that support an uncomplicated UTI?

A
56
Q

What are some red flags of a UTI?

A
57
Q

red flag symptoms of UTI’s MedSask prescribing algorithm

A

Leaning more towards pyelonephritis here

58
Q

Symptoms of acute uncomplicated cystitis - Med Sask

A
59
Q

Standard therapy for UTI - MedSask

A
60
Q

Describe the main therapy for a UTI CI

A
61
Q

UTI’s in Elderly and Concern

A

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
Q

Counselling for a UTI Key Points

A

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
Q

Preventative Tips to COusnel a Patient on to prevent UTIs

A
64
Q

Is viral and bacterial conjuctivitis easily distinguishable?

A

NO - Hard to tell the difference

Will be right about 50% of the time

65
Q

Describe the diferrences between viral and bacterial conjuctivitis

A
66
Q

Describe the course of viral conjuctivitis? WHat does it commonly occur after?

A

starts in 1 eye – moves to 2nd eye in approx 1/3 of cases​

often follows a cold​
67
Q

Describe how to diffren6tiate betwen viral, bacterial and allergic conjuctivitis?

A
68
Q

Overall summary between viral and bacterial conjuctivitis?

A
69
Q

What type of conjuctivitis is most common in children?

A

Bacterial

70
Q

When is bacterial conjuctivit more likely?

A
71
Q

Conjuctivitis vs Blepharitis: Location opf exudate

A

Blepharitis - Older individuals - Seborhhea - Exudate from the lid margin

Bacterial Conjuctivitis - Exudate from the eye

72
Q

What is blephritis

A

Eyelid disorder

CAn lead to probelms with dry eyes

Crusting at the base of the eye lashes

REFER

73
Q

Describe the etyiology of Blepharitis

A
74
Q

Blepaharitis Symptoms

A
75
Q

Allergic Conjuctivitis Sx

A

ITCHING
Nasal Symptoms at play?

76
Q

Agents for Allergic COnjuctivitis

A

Agent of Choice - PAtaday OD

Murine can help to wash stuff out of the eyes

Visine for allergic eyes - Not a good idea

77
Q

Describe Infectious conjuctivitis in adults

A

Viral causes are more common - 7 days of sx

Both are slef limiting heree

MDS correct 50% of the time

78
Q

Describe the effect of an antibiotic in bacvteria conjuuctivitis

A

Antibiotic shortens the course by 1-3 days

Decreased spreading

Should see improvement within 2 days

79
Q

What is another strategy that can used for infectious conjuctiviytis?

A

Watchful Wiating - If not better 3 days after sx begin, consider an antibiotic

80
Q

Treatment of Viral COnjuctivitis

A

Most references suggest symptomatic care

Lubricating eye drops - None of them are better than the otehr one

Just go with one here

81
Q

Are presverative sin eye drops toxic? How often to apply?

A

NOOO

QID - Should go presverative free

May be irritating but not toxic

Most wi;ll become preservative free

82
Q

Hylo Eye Drops

A

Bacteria cannot get back into the bottle

Expensive with no special ingredients

Still a trial and error

83
Q

Homeopathic {Pink Eye Relief

A

NOOOOO

84
Q

Bacterial Conjutcivitis Treatment

A

3 day Windo - Watchful waiting
Use an antibiotic
Polysporin Eye Drops (totally fine to use)

85
Q

Polysporin Eeye Drop Usage Directions

A

Great agent

1-2 Drops QID

86
Q

Is treatment necessary for bacterial conjuctivitis?

A

Almost all cases of bacterial conjuctivitis are self limiting and will clear within 10 days without treatment

87
Q

TX of Subconjuctival hemorrhage

A

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
Q

Whn does BP work best for acne?

A

BP works best for acne if ther eis inflammation occuring

89
Q

Differentails Acne

A

PCOS - HAirs, wacky p-eriods and acne - Worried

Roscea/Perioral Derm -

90
Q

Roscea Diffrential pof Acne

A

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
Q

Describe the age of Acne and its prevalence

A

80% of teenagers; can last till early 30’s

20% tennager and stops at w0 and comes back later - More conerned - Adult onset

92
Q

peri-oral Dermatitis Differntail

A
  • Dermatitis that occurs around the. mouth

Lesions clustered around the mouth and nasal fold

Women > Men

History of topical steroid use

No blackheads

93
Q

TX of peri-oral Dermatitis

A

Low level antibiotics here - Inherrent antiflammatory

94
Q

What combination therapy for acne is recommended?

A

BP + Retinoi d
BP + antibio
retinoid + Antibio

Does not matter which one we choose

95
Q

Describe when ceratin acne agents sghould he used regarding lesisons?

A

Pimps - Inflammatory Response - BP

White/Blackheads - No anti-inflammatory - Retinoids stop the inflammation from starting

96
Q

How to apply retinoid?

A

1 pea sized dab spread over 4 spots - not the more the merrier here

97
Q

prescribing for Acne

A

TActuo - Adapalen BP
Clindoxyl - Clindamycoin 1% OD

98
Q

RX Prescribing and COmbination Products

A

Pharamcists cannot prescribe for antibio and BP combination prpducts

Not indicated for mild acne

e.g. TActupump

99
Q

Other age nt for acne? Efficacy?

A

Not a listed benefit of the Saskatchewan Drug Plan. Pharmacists may prescribe ​
& assessment fee may be claimed.

Dapsone gel 5% - Aczone

TRASHHHH

100
Q

Describe ongoing care of Acne and agents

A

Topical antibiotics (if being used) should be d/c after​ resolution of inflammatory symptoms​

Drop down to retinoid monotx

101
Q

Referall Situation Acne

A

Acne ofn the back

102
Q

Rare Agent for Acne and Its indication

A

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
Q

Tinea Capitis

A

Common infection in childrem
Not topical monotthearpy here
Scalp is hard to pentrate - Need oral tx

104
Q

Descrobe the ytreatment of tinea

A
105
Q

Diaper Rash Applicatuon

A

1/2 FTU should be enough HC 0.5-1%

106
Q

Treatment of Diaper RAsh Fungal

A

PHAR 398: Minor Ailments (9 decks)

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