Practice 722 Final Flashcards
Required components of a telephone Prescription
Name of patient & DOB
Name of medication, strength, directions and quantity
Name of person calling in prescription
Initials of pharmacist/intern receiving prescription
Date (also recommended is the time and if it was a message or a live conversation)
Call back number
Species if animal (vet)
What are the pathophysiological reasons for tooth hypersensitivity?
Dentin Exposure through loss of enamel or gingival recession.
Dentin tubules open to oral cavity and pulp.
Stimuli (heat or cold or pressure) reach dentin or open tubule.
What non-pharmacologic treatment is there for tooth hypersensitivity?
Eliminate factors that cause sensitivity.
Avoid brushing teeth within 30-60min of consuming acidic foods/drinks
Avoid using highly abrasive toothpastes (teeth whitening properties)
What pharmacological treatment is there for tooth hypersensivity?
Potassium Nitrate - acts on dentin to block perception of stimuli (takes up to 2-4 weeks)
Arginine in combo w/ calcium carbonate to occlude exposed tubules (use max 4 weeks)
What are the symptoms of teething?
Pain, Irritation, reddening, drooling, mouth biting, gum rubbing, low fever, eruption cysts, loss of sleep
What non-pharmacologic treatment is there for teething discomfort?
massage gums around tooth area
Cold Teething Ring
Dry foods is old enough (avoid high sucrose)
What pharmacologic treatment is there for teething?
Topical Oral Analgesics (not recommended) - Benzocaine, Lidocaine
Systemic Analgesics - Children’s tylenol
what features characterize RAS?
Recurrent Aphthous Stomatitis (canker sore)
Lesions that affect only non-keratinized mucosa, occur on tongue, floor of mouth, soft palate, inside of lips/cheek. Ulcers usually round/oval and crater like w/ gray to yellow visible halo or inflamed tissue.
What non-pharm treatment options are there for RAS?
Fix Vitamin Deficiency (Iron, Folate, etc)
Reduce Stress, avoid irritating foods
What pharm treatment options are there for RAS?
Oral debriding agents/wound cleansing agents Topical Oral Anesthetics Topical Oral Protectants (inert) Oral Rinses Systemic Analgesics
What types of Topical Anesthetics are used for RAS, and what concentrations?
Benzocaine 5-20%, Benzyl Alcohol 0.05-0.1%, Butacaine sulfate 0.05-0.1%, Dyclonine 0.05-0.1%, Hexylresorcinol 0.05-01%, Salicylic Alcohol 1-6%
What information would you share with a patient regarding the timeline for RAS?
Most resolve within 14 days
Debriding agents may be used for 7 days.
What is HSL? and what causes it?
Herpes Simplex Labialis which is caused by
HSV-1 or HSV-2
1- oral and labial lesions
2- forms genital sores
How do HSL outbreaks generally occur?
It remainsin a latent state in trigeminal ganglia until reactivatino through exposure to a trigger (UV, Stress, fatigue, cold, wind burn, etc)
What non-pharm and Cam therapties can be recommended for HSL?
Non Pharm
keep lesions clean (wash mild soap)
Keep lesionsmoist
CAM
Tea Tree Oil, Lysine supplement, Lemon Balm
What Pharm therapy exists for HSL?
Docosonal - only if used during first signs of outbreak to reduce symptoms
Other externally applied analgesics or anesthetics to reduce pain
Skin Protectants
What is Xerostomia, and what/where is it often seen in?
Patients with Sjogren syndrom, diabetes mellitus, depression, Crohns, and older populations
Those on Anticholinergic drugs (antihistamines, decongestants, anti-hypertensives, diuretics, antidepressants, anti-psychotics, and sedatives)
What symptoms usually accompany Xerostomia?
Difficulty swallowing and/or talking, stomatitis, burning tongue or halitosis, hypersensitive teeth, lack of taste
What non-pharm or cam therapy is used to treat Xerostomia?
mild case: sugarless sweets, chewing gums (sugar alcohol) or suckin on ice chips
Avoid Spicy foods, avoid smoking, no caffeine or alcohol
Limit sugar intake/starchy and acidic foods
What pharm therapy is availble for those with xerostomia?
Artificial salivary products
What are the differences in energy between UVA, UVB and UVC?
UVA - (320-400) penetrates glass, involved in DNA damage and immune suppression
UVB - (290-320) most active, called sunburn radiation, highest from 10am-4pm
UVC - (200-299) screened out by ozone, absorbed by SC.
What are the ABCs of Melanomas and skin cancer risks?
Asymmetric shape Border irregularities Color Variation Diameter larger than 6mm Evolution (change over time)
What can excess UVR exposure lead to?
Sunburn, Premature Aging, Skin Cancer, Sweet Tan
What prevention methods should be taken to minimize risk of excess UVR?
Avoidance (hat w/ 4in brim, long sleeved shirt)
Sunscreens SPF 15+
What are some Types of Sunscreens and what do they block best?
Aminobenzoic Acid - UVB, good for sweat, not water
Anthranilates - UVB/UVA, often used in combo products
Benzophenones - UVB/UVA, significant sensitizing agent
Cinnamates - UVB/UVA dont adhere well to skin
Dibenzoyl Methane Derivatives - Avobenzone (UVA)
Physical - Zinc Oxide, can be used with anything but Avobenzone.
What directions should you give someone in applying sunscreen?
apply 15-30min before UV exposure and at least every 2 hours thereafter, or immediately after swimming, sweating, etc.
If Water resistant, still reapply 40-80min after swimming/sweating.
What are the three stages of wound healing?
- Inflammatory (3-4 days) consists of hemostasis
- Proliferative (3days - 3 weeks) fills wound with new connective tissue
- Maturation (3 weeks+) wound completely closed and solidly healed.
What components are essential for wound healing?
Vitamin C and E, as well as protein, carbohydrates, and trace elements required for collagen production.
What are the different stages of wound/burn?
Stage 1 - only epidermis, no loss of skin layers
Stage 2 - Blistering or partial thickness skin loss (break)
Stage 3 - Full thickness loss w/ damage to entire epidermis, dermis and dermal appendages
Stage 4 - Stage 3 plus damage to underlying subcutaneous tissue, muscle tendon or bone
How would you treat a patient whose burn is 2% of BSA or possess a stage 3 or 4 burn?
Immediately refer/medical attention
What non-pharm treatment should be used for stage 1 or 2 burns?
leave open, soak in soapy water for 30min at least 3 times a day, avoid application of ice/ice water.
What are the different types of wound dressings?
Gauze - minor wounds/burns that are draining/need debridement (change often)
Antimicrobial - contain products like silver/iodine
Speciality - absorb excess moisture
Adhesive - often waterproof, no needles for wound closure.
Surgical tape - for those that dont require changing
What pharmacologic therapties may be useful in the treatment of burns?
Systemic Analgesics Skin Protectants Topical Anesthetics First Aid Antiseptics Antibiotics
What is the role of protectants against burns? What products are there?
Prevent drying of stratum corneum, further injury and make area less painful.
Allantoin, Cocoa butter, petrolatum, shark liver oil, white petrolatum.
How might first-aid antiseptics be used to treat burns or wounds? Products available?
in wound after it has been rinsed to completely clean out.
Hydrogen peroxide, Ethyl Alcohol, Isopropyl Alcohol, Iodine, Povidine/Iodine, Camphorated phenol
What first aid antibiotics may be used on burned/broken skin?
Bacitracin
Neomycin
Polymyxin B Sulfate
What natural products are often used for burns?
Aloe Vera (meh) Calendula Oficinalis (meh) Honey (good)
What are the symptoms of irritant contact dermatitis?
dry or macereated, painful cracking and inflamed skin that is generally itching,m burning and stinging.
Late stage: ulcers and necrosis.
What are non-pharm therapy options for ICD?
wash with tepid water
cleanse w/ hypoallergenic soap
preventative measures
non medicated emollients/moisturizers and barrier creams
Pharm therapy for ICD?
Emolients applied liberally to SC, or colloidal ointment baths to relieve itching.
What usually occurs in allergic contact dermatitis to create a reaction?
Related to exposure of an allergen that activates sensitized T cells, does not typically appear on first contact.
What plant product/chemical is most commonly responsible for ACD?
Urishiol (oil found in toxicodendron plants, poison ivy/oak/sumac)
What are similarities/differences for ACD and ICD in presentation?
Both can occur anywhere on body (ICD usually limited to hands/forearms)
ACD limited to area of antigen contact, generally linear
Symptoms of Urushiol induced ACD?
Intense itching, vesicles, and bullae (may break open and release fluid), papules or plaques, oozing vesicular fluid, crusting and drying
What pharm agents are most successful in treating ACD?
Hydrocortisone, Calamine, Colloidal Oatmeals, or Astringents
Zanfel wash
Tecnu skin cleanser
What non-pharm therapy successful for ICD/ACD?
Protective clothing
Barrier products
Immediate removal of antigen at time of exposure.
What products might be successful in reducing itching of ACD?
Topical ointments/creams containing anesthetics, antihistamines or antibiotics
First gen antihistamines for at night
What products might be successful in treating weeping of ACD?
Astringents
Aluminum Acetate solution USP
Isotonic Saline Solution
Hydrocortisone cream
What product is most successful for treating inflammation in ACD?
Hydrocortisone cream
What is the pathophysiology of Acne Vulgaris?
Problems of the pilosebaceous unit within the dermis.
The sebaceous gland produces sebum, and is influenced by Corticotrophin-releasing hormone.
What are the 5 pathological factors in acne development?
- Androgenic hormonal triggers
- Excessive sebum production
- Alteration in keratinization process
- Proliferation of propionbacterium acnes
- Inflammatory response
What is a Closed Comedo?
White Head, a precursor to other acne lesions
What is an open Comedo?
Blackhead, characterized by presence of melanin and oxidation of lipids upon air exposure.
What factors may attribute to Acne?
Age, Gender, Genetics, Western Diet (high-glycemic load/milk)
What are the levels of the Acne Grade scale?
0 = clear skin 1 = almost clear w/ no more than 1 inflammatory lesion 2 = mild w/ only a few inflammatory lesions (no nodules) 3 = 1 nodule 4 = a few Nodules
Non pharm therapy for treatment of Acne
Eliminate Exacerbating factors
Cleanse skin twice daily
Stay well hydrated
Light
What Pharm therapies are used for treatment of Acne?
Benzoyl Peroxide Hydroxy Acid Salicylic Acid Sulfur Sulfur/Resorcinol
How does Benzoyl Peroxide work against Acne?
Keratolytic, comedolytic and antibacterial properties against p. acnes. (may bleach clothing)
How do hydroxy acids work against acne?
Keratolytic, they are naturally exfoliating (dont penetrate pilosebaceous unit to cause comedolytic effect)
How do Salicylic acids work against acne?
Comedolytic that is lipid soluble and able to pass through pilosebaceous unit to produce comedolytic effect. (may cause nausea, vomitting, dizziness, tinnitus)
How does sulfur or Sulfur/Resorcinol work against Acne
Sulfur = keratolytic and antibacterial to resolve alreaedy formed comedomes
Resorcinol enhances effect of sulfur, functions as keratolytic, increasing cell turnover rate. (not effective monotherapy)
What formulation is most effective in acne medications?
Gels (serve as astringents that stay on skin long)
What Cam therapies are often used for Acne?
Tea Tree Oil
Oral Zinc
Vitamin A (retinol)
Nicotinamide (B3)
What features characterize Atopic Dermatitis?
Episodic flares and periods of remission
Genetic inheritance
typically develops in first year of childhood
What non-pharm treatment options exist for Atopic Dermatitis?
Skin Hydration
ID and elimination of triggers
Baths only 3-5min every other day (tepid water)
Keep fingernails short/clean
Moisturize w/ emolients at least x2 a day
Creams/ointments over lotions for skin hydration
What Pharm therapy exists for Atopic Dermatitis? when should it be avoided?
Hydrocortisone (go to) Cream - preferred Ointment - thick/lichenified skin No ointments if weeping Dont use on cracked skin
What are some CAMs for Atopic Dermatitis?
Probiotics (delay presentation)
Phototherapy
Coal tar
Wet Wraps
What is the cause of dry skin?
disruption of keratinization or desquamation, can result from a systemic disorder such as hypothyroidism or dehydration
What are the symptoms/presentation of dry skin?
Rougness, scaling, loss of flexibility, fissures, inflammation and pruritus, platelike scaling, especially on arms/legs, and may have a cracked appearance
What non-pharm treatments exist for dry skin?
Colloidal oatmeal or bath oil
Oil based emolients immediately after bathing
Stay well hydrated
What pharm therapy exists for dry skin?
Oil and water moisturizers
Severe cases = humecants: glycerin, urea, lactic acid
What do bath products generally consist of?
mineral oil or vegetable oil and a surfactant (mineral better absorbed than vege)
(make tub slippery, counsel)
Why might glycerin soaps help with dry skin?
they are more water soluble, have a higher oil content which makes them less drying than most traditional products
How do Emolients and moisturizers help treat dry skin?
they fill the space getween the desquamating skin cells, and prevent moisture from leaving skin surface
What are some emolients used to treat dry skin?
Ceramide (enhances skin protection) Petroleum Jelly (Very greasy, no open wounds)
What are Humectants? How do they act?
Hydrating agents often added to emolient bases
They draw water into SC and hydrate skin. Most effective at lower concentrations
What are some common humectants in products that treat dry skin?
Glycerin, Propylene glycol, Urea, Phospholipids, Alpha Hydroxy Acids, Allantoin, Hydrocortisone
Which OTC anesthetics and other agents are used as antipruritics in treatment of dry skin?
Pramoxine
Lidocaine
Benzocaine
Camphor
Menthol
What is the cause of dandruff? How is characterized?
Generally caused by Malassezia yeast species
Characterized by excessive epidermal cell turnover and an irregular keratin breakup pattern, 13-15 day turnover
How should dandruff be treated?
Washing hair every other day w/ non-medicated shampoo
Medicated Shampoos: Selenium Sulfide (leave 3-5min, then rinse repeatedly)
Sulfur:
Increases sloughing of cells/reduces corneocyte counts
How might coal tar be effective in treating Dandruff?
Decreases epidermal turnover rate (may discolor hair/clothing)
How does Seborrheic Dermatitis differ from Dandruff
SD: More inflammatory, yellow greasy scales, turnover is 9-10 days
Occurs in scalp, eyebrows, glabella, eyelid margins, cheeks, paranasal area, … etc
How might you treat Seborrheic Dermatitis? what about infants?
Just like Dandruff
Infants - Baby Oil
What is Psoriasis?
Chronic, inflammatory disease characterized by excessive scaling on raised plaques
How is Psoriasis generally presented?
Usually symmetrical scaling (plaque most common)
Most commonly located on elbows, knees, lower back, scalp, ear and penis
How is psoriasis generally treated non-pharm?
Avoid UV exposure and Skin trauma
Scale removal
Bathing w/ lubricating agents 2-3x a week
What Pharm treatments can be used to psoriasis?
Ketoconazole - 2x a week up to 4 wks, (3 days between each use)
Salicylic Acid - decrease skin pH, increases keratin hydration and facilitates loosening/removal of plaques (7-10 days)
What three pathogenic fungi are responsible for causing tinea infections?
Trichophyton
Microsporum
Epidermophyton
How can fungal transmission occur?
Environmental contact, either Social custom or Climate
Contact w/ infected people, animals, soil or fomites
What are the stages of Fungal Tinea Infection?
IERE
Incubation - grows into stratum corneum, minimals signs
Enlargement in which the fungal infection spreads (growth rate must exceed epidermal turnover rate)
Refractory period is when cell-mediated immunity has not fully developed, inflammation and pruritis at peak
Involution is when infection either clears, or presents with much less inflammation
Involution,
How do Tinea Infections generally present?
ranges from mild itching to scaling to a severe, exudative inflamatory process leading to denuded skin, fissuring, crusting, and or discoloration of skin.
What are the major forms of Tinea Infections?
Tinea Pedis (foot) Tinea Unguium (nails) Tinea Corporis (body) Tinea Cruris (jock) Tinea Capitis (scalp)
Can tinea infections be self treated?
Yes
What product(s) may be used to improve appearance of nail during tinea unguium infection?
Calcium Carbonate and Urea
How long does therapy against Tinea infections generally last?
2-4 weeks
What non-pharm advice would you offer a patient regarding their Tinea infection?
Use a seperate towel for your infection
Dont share towels, wash immediately
Cleanse skin daily w/ soap and water, pat dry
Used foot powder to keep foot dry
What drugs are effective against tinea infections?
Butenafine Hydrochloride Clioquinol Clotrimazole Haloprogin Miconazole Nitrate Terbinafine Hydrochlorde Tolnaftate
What is the mechanism of action for Clotrimazole and Miconazole Nitrate? How is it dosed?
inhibit biosynthesis of ergosterol, damaging fungal cell wall and altering its permeability. Dosed once per day
What is Tolnaftate’s mechanism of action? How is dosed? What formulation? What makes it special?
Distorts Hyphae and shunts mycelial growth of fungi species
applied 2x a day for 2-4 weeks
Formulated as solution
Only product for prevention and treatment
Why might astringents be helpful against Tinea Pedis? Example?
Dries out the foot, high enough concentrations might be antibacterial.
Salts of Aluminum -
Aluminum Acetate/Chloride
What CAM therapies exist for Tinea infections?
Tea Tree Oil
Bitter Orange
Garlic
What are the preferred formulations for Tinea infections?
Creams and solutions (first)
Powders
What causes warts? What is the most common cause of warts on feet?
Human Papilloma Virus
HPV-1 most common for foot warts
How do common warts generally present
generally skin-colored or brown, they are hyperkeratotic dome shaped papules with a rough cauliflower like appearance.
Often painless
Is there a cure for HPV infection?
No but a vaccine exists
Are warts contagious? How, non-pharmacologically, might you reduce spreading?
Yes, washing hands often, avoid cutting, shaving or pickin wart, keep clean and dry, use designated towels, and avoid sharing anything that may serve as a vector for transmission
What self-pharmacologic drug therapy exist for warts?
Salicylic Acid (12-40%)
Cryotherapy (dimethyl-ether)
What Cam therpaies may help against warts?
Vitamin A Dietary Zinc Garlic Essential Oils Occlusion w/ Duct Tape
What are Corns?
Small raised sharply demarcated hyperkeratotic lesion with a central core that is caused by pressure from underlying bone
Often seen from tight fitting shoes
How are calluses different from Corns?
Indefinite borders
Have a broad base w/ relatively thick skin and are generally found on bottom of foot and sides of big toe
How are corns/calluses treated non-pharm?
Daily soaking of affected area for at least 5min in warm water
Cushioning pads to relieve painful pressure
Silicon toe sleeves infused with mineral oil
Foam spacer or lamb wool
Proper footwear
How are Corns/Calluses treated pharmacologically?
Salicylic Acid (0.5-40%)
usually applied in a collodion or collodion like vehicle w/ pyroxylin.
What test is important in differentiation of different common vaginal infections?
pH
3.5-4.5 = Normal
> 4.5 = bacterial or trichomonal genital infection
What factors may increase the likelihood of vaginal infections?
Race Diabetes Antibiotics Transplant recipient Tight fitting clothes
Recurrent VVCs are generally referred to as…? when does this usually occur?
Complicated
when a women experieces at least 4 documented infections in 1 year
What non-pharm treatments exist for women with VVC?
Dietary/clothing/lifestyle changes (3-4 months)
- Decreased consumption of sucrose and refined carbs
- increased consumption of yogurts with live cultures
- Avoid meds or contraceptives that cause fungal infection
What pharm therapy exists for VVC?
Vaginal Antifungals
- Butoconazole
- Clotrimazole
- Miconazole
- Tioconazole
ADR: burning, itching, irritation more likely with first application
When is self treatment not appropriate for those with VVC?
What CAM therapies exist for VVC?
Lactobacillus Preparations Sodium Bicarbonate sitz bath Tea Tree Oil Gentian Violet Boric Acid (No pregos)
What characterized Atrophic Vaginitis?
Inflammation of the vagina related to atrophy of vaginal mucosa secondary to decreased estrogen levels
What are the proposed causes of Atrophic Vaginitis?
Decreased ovarian estrogen from chemo or radiation
Anti-estrogenic drugs
Low-estrogen oral contraceptives also been known to cause AV
What Condition is characterized by decreased vaginal lubrication as well as irritation, dryness, burning, itching, leukorrhea and dyspareunia associated with thin watery yellow malordorous vaginal discharge?
Atrophic Vaginitis
What condition is characterized by white clumpy cottage cheese-like vaginal discharge assocated with redness, itching and burning?
VVC
Yeast Infection
What condition is characterized by yellow/green frothy vaginal discharge associated with foul/fishy odor and increase in pH?
Trichomoniasis
What non-pharm therapies can be used to treat AV?
Sexual arousal and Intercourse
What pharm therapies can be used to treat AV?
Water soluble lubricants
What factors may contribute to Dysmenorrhea?
Menarche prior to 12 Heavy menstrual flow Tobacco Low fish consumption BMI 30 Stress Anxiety Depression
What is Primary Dysmenorrhea?
cramp like lower abdominal pain that typically occurs before menstruation
most seen between age 13-17 aged girls
affects 93% of young women
What general treatment is recommended for Primary dysmenorrhea?
Vitamin D3 supplement
Fish Oil Supplement
Sleep, Hot baths, heating pads, Excercise
No smoking
What systemic analgesics are most effective for treatment of primary Dysmenorrhea?
NSAIDS:
- IBuprofen
- Naproxen
switch to see which patient responds best to
What factors characterize secondary dysmenorrhea?
Age: late 20s and Up
Menses: irregular, menorrhagia and metrorrhagia and change in pattern/duration
Pain: before, during or after menses, doesnt respond to NSAIDs
Describe Premenstrual Syndrome and its symptoms
cyclic disorder composed of a combo between physical, emotional/mood, and behavioral symptoms that occur during luteal phase of menstrual cycle.
Symtpoms include:
Food cravings, emotional lability, irritability, lowered mood, breast tenderness, bloating, lower backache,
What is PMDD?
Premenstrual dysphoric disorder, a severe form of PMS in which symptoms disrupt social or occupational function. (school, work, social activities and relationships)
What Non-pharm therapy may help PMS?
Aerobic Exercise
Diet modification
Cognitive/behavioral therapy
Light therapy/accupuncture/massage
What pharm therapy may help PMS?
Pyridoxine - limit to 100mg daily
Calcium & Vitamin D - 600mg bid
Magnesium - 360mg qd during luteal phase
NSAIDs - to reduce heache/muscle joint aches
Diuretics - Alumnium Chloride, Caffeine, Pamabrom
What is Toxic Shock Syndrom? what causes it? associated symptoms?
Caused by buildup Staph Aureus, it is from the proliferation of toxin producing bacteria and the release of TSST-1 toxin from use with high absorbency tampons, or uninterrupted use of tampons for at least a day.
symptoms: High fever, profound hyptension, severe diarrhea, mental confusion, renal failure, erythroderma, skin desquamation, malaise, myalgia, chills, vomitting
What conditions promote toxin production by staph aureus?
Elevated protein levels
Neutral pH
elevated carbon dioxide levels
elevated oxygen levels
How are most STIs spread? who is more at risk?
Contact with infected genital tissues, mucous membranes or body fluids
Both men and women at risk, women more likely to develop reproductive consequences.
What vaccines are available for protection from HPV?
Gardasil
Cervarix
How does the Hep B vaccine work?
inactivated injectable formulation with administration at months 0, 1 and 6.
What are the most common general contraceptive methods?
Condoms (male > female) Fertility awareness Coitus interruptus Spermicides Contraceptive Sponge Oral contraceptives Sterilization
What are the differences in male vs female condoms
Price (females greater) Satisfaction (females lower) structure (duh) Noise (females squeak) Material (male = latex, polyurethane, polyisoprene, lamb cecum; female = nitrile)
What lubricants are safe to use with latex condoms?
Contraceptive foams/gels Water based lube Egg whites Glycerin Replens Inserts Saliva Water
What are some different fertility awareness methods for contraception?
Calendar method
Cervical Mucus Method
Symptothermal method
What is Lactational Amenorrhea method?
Keep having kid suck tits, long as tits gettin sucked, can keep gettin fucked
What is the 100% guaranteed contraceptive technique that is also 100% effective in preventing STIs?
Abstinence lol
What are some effective emergency contraceptives and how should you counsel them?
Plan B
Levonogestrel containing tablets
Copper IUC
- Take up to 120 hours following intercourse
- Might not work if overweight
- repeat dose if throwing up within 1-2 hours of taking
What are the different types of Ostomy?
Ileostomy
Colostomy
Urostomy
What is the location/discharge and reasons for Ileostomy?
Location: Ileum
Discharge: Liquid first, then semisoft
Reason: Ulcerative colitis, Crohns disease
What is the location/discharge and reasons for Colostomy?
Location: Colon
Discharge: semi-soft to semi-solid
Reason: Cancer (colon/rectum), diverticulitis, trauma
What is the location/discharge and reasons for urostomy?
Location: Ureters
Discharge: liquid… literally urine
Reason: diversion due to bladder loss/dysfunction, cancer, neurogenic bladder, genetic malformation, interstitial cystitis
What non-pharm things should those with an ostomy be doing?
Cleaning of stoma/peristomal skin with plain water
remain on low fiber diet for first 6 weeks
normal diet otherwise
What equipment is necessary for those with an ostomy?
Adhesives skin barriers skin powders skin pastes irrigating sets deodorizers
What does a normal healthy stoma look like? What is number one concern in keeping a health stoma?
bright shiny pink stoma, regular looking peristomal skin
hygiene of stoma/peristoma
What drugs may affect absorption and cause a change in stomal discharge?
Antibiotics Sulfa Drugs Diuretics Laxatives Antacids Herbal Agents
What is the Dentate line? what does this line control?
a line that separates squamous epitherlium from columnar epithelium
Below line = pain
Above line = no discomfort
What are the grades of Hemorrhoid Severity?
1st - enlarged but no prolapse
2nd - protrude but return spontaneously on defecation
3rd - protrude into anal canal, but must be returned to original position manually
4th - permanently prolapsed, cannot be reintroduced
What symptoms accompany hemorrhoids?
Itching, discomfort, irritation, burning, soreness, inflammation, pain, dry anal tissue, swelling of perianal area
When would you refer a hemorrhoid patient for medical attention?
Abdominal Pain Bleeding Seepage Change in bowel pattern Prolapse thrombosis
What non-pharm recommendations should you make for someone with hemorrhoids?
Maintain fluid intake and well balanced high-fiber diet
Practice good perineal hygiene,
Practice proper bowel habits avoid prolonged sitting on toilet
Avoid lifting heavy objects, discontinue foods/substances that aggravate symptoms (caffeine, alcohol, citrus, spicy foods)
What pharmacologic agents are effective in treating hemorrhoids?
Local Anesthetics Vasoconstrictors Protectants Astringents Keratolytics Analgesics Corticosteroids
What local anesthetics may be used to treat hemorrhoids?
Benzocaine, Benzyl Alcohol, Dibucaine, Dyclonine HCL, Lidocaine, Pramoxine HCL, Tetracaine
May mask more severe anorectal disorders
What Vasoconstrictors may be used to treat hemorrhoids?
Ephedrine Sulfate
Phenylephrine
many poor side effects however
How do protectants help treat hemorrhoids?
What products?
physical protective layer that softens anal canal and prevents fecal matter from irritating the perianal mucosa
AlOH gel, cocoa butter, glycerin, hard fat, kaolin, lanolin, mineral oil, white petrolatum, calamine, petrolatum, shark liver oil, zinc oxide, topical starch, cod liver oil
How might astringents help hermorrhoids? ADR?
decrease cell volume, making area drier, relieving itch, irritation and burning
Witch Hazel may sting or cause contact dermatitis due to alcohol and oil in formulation
How can Keratolytics treat Hemorrhoids? ADR?
Cause desquamation and debridement of epidermal surface cells, which reduces itching and inflammation
Repeated use may lead to: Methemoglobinemia Exfoliative dermatitis Death in infants Myxedeme in adults Tinnitus
What external Analgesics/Antipruritics may be useful against hemorrhoids?
Menthol, Juniper Tar, Camphor
Corticosteroids may take up to how long to produce what effect against hemorrhoids?
up to 12 hours to produce vasoconstriction and antipruritic action
What are the symptoms indicating a pinworm infection?
perianal/perineal itch especially at night
severe symptoms:
ab pain, insomnia, anorexia, diarrhea, intractable local itching
What is the most common route of pinworm infection?
direct anus to mouth transfer by fingers or fomites
- re-infection can happen a lot if eggs under fingernails
what Non pharm therapy exists for treatment of pinworms?
Hygiene (fingernails, washing) UV and sunlight Washing Linens/Clothes Bathing/showering daily Change underwear, nightclothes and bedsheets daily for several days Clean pets Clean/Vacuum reduce overcrowding
What is the only non-Rx pharm treatment for pinworm infections?
Pyrantel Pamoate, which has a 90-100% cure rate when used for enterbiasis, it paralyzes adult worms causing them to be passed in stool before then can lay their eggs.
11mg/kg dose
repeat dose in 2 weeks if unresolved.
What should be done if helminthic infection occurs?
medical referral
What is the pregnancy risk for Pyrtantel Pamoate
Risk C, only use when benefit outweighs risk
What are general non-pharm treatment for insect bites?
Avoid insects
Use insect repellant
What effective ingredient is within most insect repellants?
N,N-diethyl-m-Toluamide (DEET)
What natural products may be useful as insect repellants?
Citronella, Lemon Eucalyptus Oil, Soybean oil, cedar oil, lavendar oil, tea Tree Oil, Garlic Thiamin
What pharmacologic products may be useful for treating an insect bite/sting?
Local Anesthetics Topical Antihistamines Counterirritants Hydrocortisone Skin Protectants
What is the general treatment approach in treating insect stings?
Remove stinger and apply ice in 10min intervals followed by application of local anesthetic, skin protecant, antiseptic or counterirritant
Injectable epinephrine if severe hypersensitivity
What are the different types of lice?
Head Lice Body Lice (Cooties) Pub Lice (Crabs)
What non-pharm therapy is affective for treating lice?
Combing, avoid direct physical contact, clean literally everything ever
Shave
How would Pyrethrin be applied to treat Lice?
Use on dry hair once per day then rinse after 10min for 7-10 days
How would Permethrin be applied to treat lice?
Used on recently wet hair for 10min then comb for lice
What Cam therapies are effective for treatment of lice?
Tea tree oil and Lavendar applied 2x a day
What conditions may contribute to Urinary Incontinence?
Lack of estrogen Prostatic enlargement Obesity Chronic Cough Jarring Exercise
What is Transient UI?
Sudden onset of UI usually due to acute illness or disease that causes acute confusion or immobility which prevents people from reaching toilet
What is Chronic UI?
neurological or other chronic condition that obscures intrinsic sphincter such as BPH or cystocele.
what is OAB?
Overactive Bladder, is characterized by sudden and profound urinary urgency accompanied by urge incontinence due to detrusor muscle instability
What is Stress Incontinence?
Characterized by involuntary leakage of urine with sudden increase in abdominal pressure associated with sneezing, laughing, coughing, exercising, lifting, etc.
What is Overflow incontinence?
Over distention of bladder, due to either outlet obstruction or under active bladder detrusor muscle.
What is mixed incontinence?
Consists of combination of OAB and stress incontinence
What is functional incontinence?
when a person lacks physical or cognitive ability to reach a toilet in time or perform toileting tasks
What non-Pharm treatments are useful in decreasing frequency of UI?
Behavior Techniques:
Toileting assistance
Bladder Training
Pelvic Floor Muscle training
What pelvic floor muscle training techniques/tools are used in inhibiting UI?
Knack Maneuver Kegels Radiofrequency treatment Neocontrol Pelvic therapy Mechanical Pressure
What pharm options may be used for reducing UI?
Anticholinergics - oxytrol patch Alpha Agonists - Pseudoephedrine Topical Vaginal Estrogen Duloxetine or Imipramine Alpha 1 - Antagonists (BPH)
When would an ointment formulation be preferred?
When a moist wound environment is required (unbroken skin)
What formulation would work best on weeping/broken skin?
Gels (astringents)
