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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

What type of infection are cold sores? When do people commonly get 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

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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? 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)

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

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
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

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
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

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

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

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

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

37
Q

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

A
38
Q

Symptoms of migraine in med-sask prescribing algorithm

A
39
Q

TX recommendations of migraines MedSask

A

If tripatn helps, diatgnostic

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

41
Q

When should acute medications for migraines be taken?

A

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

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

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

MOH (RX Files Definition)

A
48
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

49
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

50
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

51
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

52
Q

What are some symptoms of cystitis?

A
53
Q

Symptoms of UTI in Men

A
54
Q

Is urine sterile?

A

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

55
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

56
Q

What are some key factors that support an uncomplicated UTI?

A
57
Q

What are some red flags of a UTI?

A
58
Q

red flag symptoms of UTI’s MedSask prescribing algorithm

A

Leaning more towards pyelonephritis here

59
Q

Symptoms of acute uncomplicated cystitis - Med Sask

A
60
Q

Standard therapy for UTI - MedSask

A
61
Q

Describe the main therapy for a UTI

A
62
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
63
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

64
Q

Preventative Tips to COusnel a Patient on to prevent UTIs

A
65
Q

How can

A

PHAR 398: Minor Ailments (9 decks)

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