Pharmacology II Flashcards
What are non rx therapies for headache?
Acetaminophen, acetaminophen/cafeine/codeine
ASA
Ibuprofen
Naproxen sodium
What are treatments for pregnancy (headache)
Ibuprofen, ASA (safe in intermittent doses during 1st and 2nd trimesters)
Acetaminophen safe during all trimesters
What are Natural products for migraines
Butterbur, coenzyme Q10, melatonin, magnesium, vitamin b2
What are causes of fever?
Infection, heat exhaustion, inflammatory conditions (rheumatoid arthritis), cancerous and medications
Medications for treating fever and how they work
Acetaminophen, ASA, ibuprofen and naproxen sodium (reduce patient discomfort)
Naproxen and ASA should not be used in children
Antipyretics (Naproxen sodium, ASA) reduce body temperature by decreasing prostaglandin synthesis in the brain and reducing the thermoregulatory set-point. They do not lower normal body temperature.
Treatment for fever in kids
Naproxen and ASA (Reye disease) should not be used
Ibuprofen
Acetaminophen
What are Antihistamine classes
Second generation (bilastine, cetirizine, desloratadine, fexofenadine, loratadine, rupatadine) , : more selective for H1 receptor and less lipophilic
Do not cross the blood-brain barrier
First generation (chlorpheniramine, diphenhydramine) : dry mouth and nasal passages, difficulty voiding urine, constipation, CNS effects (sedation, psychomotor and cognitive impairment)
Side effects of topical decongestants
oral : (Mild CNS, nervousness, excitability, restlessness, dizziness, weakness, insomnia)
Increased Blood pressure, tachycardia or palpitation
Topical: local burning and stinging, sneezing, dryness of the nasal mucosa
Rhinitis medicamentosa used more than 3-5 days
Non pharm therapy for colds
Hydration with oral liquids and humidification of room air may be beneficial
Nasal saline irrigation can help nasal congestion
Avoid inhaled irritants such as smoke, dust, pollutant and allergens
Types of decongestants
Pseudoephedrine (oral)
Phenylephrine (oral)
Oxymetazoline (topical)
Phenylephrine (Topical)
Xylometazoline (topical)
What is a antitussive and what are examples?
Act centrally to suppress cough
Inhibit motor control of cough
If used by a patient with a productive cough, more mucus is retained
Dextromethorphan and codeine
Antitussives for kids
Dextromethorphan > 12 (6-11 years old)
Honey 1-18
Codeine not good for children
What is an expectorant?
The protussive agents act peripherally
Reduce sputum viscosity. Permitting more effective removal of secretions from the respiratory tract
What is a common type of expectorant?
Guaifenesin
What are expectorant used for?
Enhance cough effectiveness by promoting the clearance of airway secretions.
Natural health products for colds
Echinacea
Garlic
Ginseng
Vitamin C
Zinc
How to prevent swimmer’s ear
Avoid cotton-tipped swabs
Avoid water sports for at least 7-10 days during treatment
Earplugs and bathing caps
Avoid overzealous cleansing and scratching
After swimming or bathing, dry the external canal with a blow dryer set on low
Dimenhydrinate vs promethazine
Promethazine has a longer duration of action as compared with dimenhydrinate and may be an alternative in patients with refractory nausea or when dimenhydrinate is ineffective
Non pharm measures for nausea and vomiting
Smaller meals
Adequate hydration
Avoid smells and foods
Dietary interventions
Relaxation therapy
Acupressure wristbands
Aromatherapy
Maintaining fluid intake
Non pharm for constipation
Increase calories if low caloric intake
Have a regular bowel regimen
Consume a high-fiber diet
Fruit/ juice: natural laxative sorbitol
Restrict dairy: cow milk-free diet may improve constipation in kids
Exercise, weight loss,biofeedback/relaxation
Symptoms of dehydration
Feeling thirsty and lightheaded
A dry mouth
Tiredness
Having dark coloured, strong-smelling urine
Passing urine less often than usual
Types of laxatives
Bulk-forming (psyllium, bran): increase stool volume and are considered for long-term use.
- Gas formation. Increased osmotic load, water retention and wall stress
Emollient: Stool softeners (docusate sodium or docusate calcium) act as surfactants to often the stool by allowing the mixing of aqueous and fatty substances.
Osmotic: increased pressure on the lumen wall induces gastric motility
(Polyethylene, glycol, lactulose)
Stimulant: Bisacodyl, senna, sodium picosulfate
- increases colonic peristalsis by producing rhythmic muscle contractions in the intestines
Special considerations for bulk forming laxatives
Given > 250 ml water/juice to prevent fecal impaction and or esophageal obstruction
Do not use in patients dehydrated,fluid restricted, opioids
Require 12-72 hours for onset of effect
Psyllium improves stool frequency and consistency
Bran reduces use of laxatives in the elderly
Signs and symptoms of constipation
Infrequent defecation
Abdominal distention
Flatulence
Nausea
Vomiting
Anorexia
Early satiety
Stools that are small, hard and or difficult to evacuate
Incomplete rectal emptying
Rectal bleeding due to fissures or hemorrhoids
Weight loss
What is ORT
Can treat the majority of patients with diarrhea as well as prevent most diarrhea-related complications
Rehydration and maintaining electrolyte balance
Examples of ORT?
Gastrolyte, pedialyte and hydralyte
Non rx therapy for gerd and dyspepsia
Alginic acid (Gavision), aluminum (Alugel), aluminum hydroxide (Diovol), calcium carbonate (tums), magnesium salts (Milk of magnesia)
Famotidine (Pepcid) ranitidine (Zantac)
Hemorrhoid products and dosage forms
Anesthetics: dibucaine (ointment/cream, suppository), pramoxine (ointment, suppository)
Anti-infectives: framycetin (ointment, suppositories)
Anti-inflammatory agents: hydrocortisone (ointment, suppositories)
Astringents: hamamelis (gel, pads, wipes), zinc sulfate (ointment/cream, suppository)
Phlebotonics: diosmin (tablet), citrus bioflavonoids (Tablets)
Protectants: glycerin (ointment), petrolatum (ointment)
Vasoconstrictors: phenylephrine (gel)
Yeast derivatives: yeast (ointment/cream, suppository)
Monitoring blood glucose why it is important?
Helps to determine if you are meeting your glucose targets which helps to reduce the unpleasant symptoms of high and low blood sugar and avoid long-term diabetes complications.
Proper use of lancing device and lancet
Apply device to skin, exert gentle pressure and press the trigger
Site rotation is important
Frequent users will rotate between fingers, right-handed users might prefer lacing the left hand and vice versa
Urine glucose monitoring
Less expensive however does not reflect current BG levels and will not detect hypoglycemia (low glucose)
Not appropriate for most patients using insulin
Iron deficiency and risks
Increased requirements (pregnancy, infancy, adolescence)
Decreased intake (vegetarian)
Diminished absorption (elderly)
Excessive or regular blood loss (menstruation)
Can lead to anemia, decreased energy, impaired immunity
Various forms of calcium salts
Calcium carbonate should be taken with or after meals as it needs an acidic medium for best absorption
Calcium citrate is better absorbed in patients with higher gastric pH, and can be take on an empty stomach but less elemental calcium
How to increase iron absorption
Vitamin C can also improve non-heme iron absorption by improving its solubility
Glass of orange juice can increased vitamin absorption
RICE
Rest, Ice, Compression, Elevation (After 48 hours) then can be replaced by heat
Muscle relaxants and sports injuries
Methocarbamol not considered first-line in acute musculoskeletal injuries because they provide limited pain relief
Intended to provide pain relief when muscle spasm is a component of an acute injury
External analgesics (sports injury)
Methyl salicylate,menthol, camphor, capsaicin
Treat general aches and pains
Useful during rehabilitation as cooling or heating rubs or massage therapy
Cause skin skin reactions such as a rash or blisters
Applied to acute injuries
Not be used more than 3-4 times a day
Used concurrently with thermotherapy devices as burns
Athletes foot
How it’s transmitted
Directly via contact with infected person or indirectly through contaminated surfaces
Spread to other parts of body by autoinoculation
How do you treat Athletes foot?
Treated with topical antifungal agents: ciclopirox, clotrimazole, ketoconazole, miconazole, terbinafine
Can be applied twice daily for up 4 weeks
Terbinafine higher cure rates
Anti-inflammatory (betamethasone and hydrocortisone)
Ointments remain in contact longer (but slowing healing)
Powders may be non medicated or medicated
Solutions, sprays or foams (allowed to air dry)
What is Corns and calluses
Overactive keratinization, attempt of body to protect food from excessive friction
Result of poorly fitting footwear, weight gain, abnormal gait or foot structure
Tough layer of compacted dead skin cells
Calluses tend to occur on soles of feet (heel or ball of the foot)
Not contagious
Treatment for dandruff and seborrhea
Antifungal agents (first line therapy for both), anti-inflammatory agents (creams used in moist areas) (lotions and solutions are best for the scalp and hairy areas) and keratolytics (Salicylic acid and sulfur)
Medicated shampoos
Associated anti-inflammatory and keratolytic action
Topical therapies are recommended first with oral treatment reserved for severe cases
Moisturizers (support role for softening): mineral oil or surfactant- containing bath oils
Ketoconazole, ciclopirox olamine, selenium sulfide, zinc pyrithione, propylene glycol 15% solution
Ketoconazole (fungistatic): can mediate inflammation through inhibition of leukotriene production
Topical calcineurin inhibitors ( tacrolimus, pimecrolimus) used in seborrheic dermatitis
Topical tacrolimus together with zinc pyrithione treat scalp seborrheic dermatitis.
Keratolytics: increase penetration of other topical medications and increase effectiveness
Coal tar side effects
Is mildly effective for seborrheic dermatitis as it reduces local swelling and inflammation, relieves itching is keratolytic and antiseptic and has minimal antifungal activity
Messy, can stain blond or gray hair and clothing, have an unpleasant odor, cause tar acne, contact dermatitis, photosensitivity and possible carcinogenicity
Acne What’s beneficial in treatment?
Management by evaluting psychological impact of acne, aid in detection of depression or need for psychological care and improve therapeutic outcomes.
- The longer acne countines, the greater the psychological harm and therefore the greater impact on personal/social life.
- The longer acne continues the greater the psycholgical harm and therfore the greater impact on personal/social life
Types of exfoliants
Rescorcinol
Salicylic acid
Sulfur
Glycolic acid
Azelaic acid
Topical retinoids
Benzoyl peroxide for acne
-Antibacterial most effective for inflammatory acne
- mild to moderate popular-pustular acne
- Derivative of coal tar
- absorbed through the stratum corneum
- useful in both inflammatory and noninflammatory acne
- produces powerful anaerobic antibacterial activity due to slow release of oxygen
- Combined with topical antibiotics or retinoids to improve efficacy, decrease irritation and reduce development of antibiotic resistance
- Irritation more likely in fair complexions (sunburn easily)
- irritation dependent on the concentration
- contact allergic dermatitis can occur
- Soap/wash, gel, lotions
- do not use if very sensitive skin
- apply the product and leave on for 15 miuntes the first evening each evening double the contact time until the product is left on overnight
How to self treat minor wounds
Cleanse Wound: Remove dirt and debris as soon as possible to prevent infection and promote healing. Wash with water
Stop the bleeding: Apply clean dressing or gauze for 10 minutes. seek attention if bledding does not stop.
Apply dressing that maintains moist wound bed to protect from possible infection and imporve healing process.
Debridement: Removal of foreign material performed only by trained health-care pracitioner under sterile conditions.
Topical antibiotics (wound therapy)
recommended only for prevention of complication in wounds at highter risk of infection or chronic wounds not healing
- Discontiuned as soon as signs and symtoms of infection are no longer present
Examples of topical antibiotics for wound care?
Fusidic acid, mupirocin or combination of bactracin/gramicidine/polymyxin B/neomycin
Treating thermal burns
Initial treatment includes removal of the causative agent to minimize further tissue damage. Cooling should be started as soon as possible as it can limit the extent of injury, decrease inflammation and provide some pain relief. Should be cooled for up to 30 minutes with cool-to-touch tap water irrigations, immersion in cool water or application of cool tap water compresses for 20 minutes.
Treatment for vaginal dryness
**Vaginal lubricants and moisturizers first-line options **
- Vaginal lubricants are short-acting and reqiure frequent re-application
- Suppository (Mae) and cream (Cleo) for symtomatic relief
- Mae also contains vitamin E and hyaluronic acid
- Moisturizers such as polycarbophil and hyaluronic acid gels attach vaginal epithelium and provide water and electrolytes
- longer duration of action than lubricants
- oil-based products should be avoided due to irritation, difficult to remove
**- Hormonal supplementation with estrogens and progestogens is an option **
-Estrogen replacement reverses vaginal changes seen with menopause and relieves symptoms
**Black cohosh used in managment of menopausal symtoms **
- can cause nausea and headache and contraindicated in pregnancy and breastfeeding
Antifungal treatment for candidiasis
Self treatment OTC is recommended
**Fluconazole is an effective option **
Clotrimazole, miconazole, terconazole,
Slection determined by length of therapy desired, dosage form preferred and women’s previous experience
Boric acid- inserted intravaginally
- option for women who do not respond to other therapies
Probiotics
- little success in decreasing vaginal candidiasis
Basal body temp
What it’s used for
Occurs prior to rising in the morning
Can be orally, rectally or vaginally but must be consistently measured same way same time each day
When ovulation occurs, corpus luteum releases progesterone, causing significant rise in temperature that is detectable and lasts for several days
Increases is about 0.5 or 0.28 and is measurable by a basal thermometer
**- More narrow range of temperature than a fever thermometer **
**Determine when most fertile and likely to conceive **
Cane fitting and measuring
**Distance from top of cane or walker handle to ground should equal distance from wrist crease to ground when arm is straight down **
Should be performed with the individual standing erect and wearing everyday shoes
- If cane too short user will lean forward or user will lean backwards if cane too long
Support stocking
Elastic compression stockings known as surgical or support stockings
**Intended to relieve tired, aching legs and prevent swelling of feet, ankles and legs **
- May be prescribed for medical conditions such as varicose veins, lymphedema, venous eczema and ulceration
- ranging from 12-20mm Hg at the ankle
- meausrements of nonedematous leg first thing in morning
Peak flow metre
how it is measured
**Measure peak expiratory flow rate, or speed of air forced out after the lungs are fullt inflated **
- help predict and prevent exacerbations in chronic pulmonary conditions
- Home monitoring may be suitable for adult patients who are poor perceivers of airway obstruction or with severe asthma
**- After a complete exhalation
- inhale as deeply as possible
- Place the meter in mouth and blow out as hard and fast as possible
- the final postition of indicator on the scale is the PEF measured in liters per minute
- 3 readings are taken the highest of the 3 are recorded
Agents for otitis externa
In uncomplicated cases, topical therapy options include acidifying agents, antibiotics alone or antibiotics with corticosteroid combinations
Acidifying Agents: acetic acid 2%, gramicdin/polymyxin B
Miscellaneous: antipyrine/benzocaine, isopropyl alcohol 95%/glycerin 5%
Bulk forming laxatives
What they are
**Increase stool volume,considered safest, suitable for long-term use **
Fermentation leags to gas formation, increased osmotic load, water retention and wall stress which stimulate motility
**Examples: Psyllium, Bran, inulin (chicory), fibre **
H2 receptor antagonists
cimetidine, famotidine, nizatidine & ranitidine
Reduce gastric acid by blocking histamine receptors
inhibits action proton pump and prevents hydrogen ioins into stomach
longer duration of action