Week 3 - Medicaments and Clinical Processes

Question 1

How are pharmaceutical preparations names

Answer 1

• According to TYPE OF BASE
• According to the way they are APPLIED
• According to their use

Question 2

Scheduling of medicines and posions

Answer 2

• National classification systme that controls how medicines and chemicals are made available to public
• classified into schedules according to level of regulatory control over the availability of the medicine - to protect public
• states have different regulations

Question 3

Schedule 2 medicines

Answer 3

Schedule 2: pharmacy medicines - available of the shelf at pharmacies

Question 4

Schedule 3 medicines

Answer 4

(can be prescribed by Pod): Pharmacy only medicines - available without a prescription but behind the counter to elicit health advise before purchasing

Question 5

Complementary medicines

Answer 5

Unscheduled, registered or listed
Fully evaluated by the TBA for quality, safety and efficiency, having a higher risk than listed medicines

Question 6

Listed medicines

Answer 6

unscheduled medicines with well-known low risk ingredients - assessed by TGA for quality and safety but not efficiency

Question 7

Can podiatrists dispense prescription medicines

Answer 7

No - requires a prescription from a dr or authorised HC professional

Question 8

What medicines can podiatrists suggest

Answer 8

OTC medicines - for self treatment from pharmacies, available from supermarket, health food stores and other retailers

Complementary medicines - listed or registered depending on their ingredient and claims made

Question 9

When recommending OTC medicines:

Answer 9

1. Diagnose the condition
2. decide on desired therapeutic objective (what Is the point of the medicine being recommended)
3. select the medicine based on
   - efficacy
   - safety
   - patient suitability
   - cost

Question 10

What is antimicrobial

Answer 10

Broad term for substances that act on bacteria, fungi, viruses and parasites. more specifically classified as antibiotics/antibacterials, antifungals etc

Question 11

what is a haemostatics, examples and what they do

Answer 11

• agent that arrests or diminishes the flow of blood
  Hydrogen peroxide - reduce capillary bleeding time by increasing the contractility and resistance and decreasing the permeability of the capillary wall

Styptic - arrest bleeding by contracting tissues to seal blood vessels

Question 12

Anaesthetics

Answer 12

preparations that lessen sensitivity to pain by acting directly on nerve ending

block the action potention of pain sensing nerve fibres

general, local or topical

Question 13

Analgesics and classified as:

Answer 13

lessen and relieve pain by removing the cause (e.g. inflammation) or changing response/percpetion of pain

Classified as:
-opiates
-non-opiated
-non-steroidal anti-inflam drugs (NSAIDS)
-Corticosteriods

Question 14

Anti-inflammatory agents and classified as:

Answer 14

reduce inflammation

Classifed as:
- rubefacients
- heat and cold
- non steriodal anti- inflam drugs (nsaids)
Corticosteriods - glucocorticoids

Question 15

Rubefacient

Answer 15

Produces mild local inflammation when apploed to skin

increases blood flow that flushes metabolites from area of chromic inflammation and relieves congestoins and stasis

Contradicted in acute inflam: acute inflam usually due to infection hence don’t want to increase blood flow to that area as it will make the infection spread further

Examples; deep heat

Question 16

NSAIDS

Answer 16

reduce inflammation by inhibiting the synthesis of prostaglandins at a variety of points in the metabolic pathway, used to treat MSK pain

Contradictions
- severe hepatic impairment
- GI bleeds
- Drug interactions

Question 17

Corticosteriods - glucosteriods

Answer 17

act on cells to reduce arachidonic acid and hence prostaglandin production

have immunosuppressive effects

anti-inflammatory and vasocontrictive

cream - useful for ezcema reactions

can lead to atrophy of the skin and surrounding tissues and contradicted where infection is present

CONSIDER A REFFERAL TO DERMATOLOGIST
- diagnosis unclear
- repeated infections
condition is not controlled with topical treatment

Question 18

Astringents and modes of actions

Answer 18

shrink cells or mucous membranes, decrease sweat and arrest discharge

2 modes of actions
- PROTIENT PRECIPITANT : shrink the cells of mucous membranes, destroy organic tissue, harden skin
-PHYSICAL CHANGES : evaporate quickly on the skin whilst causing constriction of the tissues, evaporating –> cooling

Question 19

Antipruritics

Answer 19

Preparations that relieve itching (puritis)

Used in conditions associated with itching - tinea, ezcema, psoriasis, allergic reactions, xerosis

Question 20

Anydrotics (antiperspirants)

Answer 20

reduce the flow of sweat
cooling action
invokes heat-regulating mechanisms
astringent action

Question 21

Antopruritics examples

Answer 21

Local/topical anaesthetics
rubefacients
tar cream/solutions - coal tar, pinetarsal solution
cooling agents - calamine
antihistamines

Question 22

Anhydrotic examples

Answer 22

Alcohol
Antiperspirants

Question 23

Emollients vs moisturisers

Answer 23

Emollient = product used to soften skin
moisturiser = add moisture

Question 24

Moisturiser and emollient preparaition

Answer 24

oil - least occlusive, thin layer deposited on skin
lotions - more occlusive than oils, higher water content
creams - more occlusive than lotions, higher water content
ointments - most occlusivem higher oil content

Question 25

Emollients and moisturisers are contraindicated for:

Answer 25

hyperhidrosis
infection

Question 26

Active ingredients in emollients and moisturisers

Answer 26

occlusives - insoluble in water, prevent evaporation by forming a waterproof barrier

humectants - increase the water holding capacity of the stratum corneum, attract trans-epidermal water to the stratum corneum and retain it

paraffin - liquid and soft

Question 27

antiseptics

Answer 27

preparations that kill or inhibit micro-organisms on living tissue such as skin

Question 28

disinfectants

Answer 28

agents that kill micro-organisms but they are applied to inanimate objects

Question 29

types of antiseptics

Answer 29

cetrimide - presence of organic matter, low tissue toxicity
chlorhexidine - low toxicity, useful alternative to iodine
providing-iodine - may be inactivated by several compounds
TBCOs
Hydrogen peroxide

Question 30

Antimycotic (antifungals)

Answer 30

act by inhibiting the growth of or killing the fungal pathogen

Question 31

what are fungal skin and nail infections caused by

Answer 31

Dermatophytes
yeasts
moulds

Question 32

caustics and keratolytics

Answer 32

Caustics - destroy organic tissue
keratolytic’s - special sub-group of a caustic - allows h20 to cause maceration they will affect underlying tissue if there is prolonged contact

Question 33

Caustics examples

Answer 33

silver nitrate
salicylic acid
potassium hydroxide
monochloroacetic and trichloroacetic acid
hydrogen peroxide

Question 34

Clinical Applications for caustics and keratolytics

Answer 34

heloma molle
onychophosis
heloma durum

Question 35

method of application and care of caustics and keratolytics

Answer 35

• mask the area: use appropriate padding/tapping to localise treatment and reduce degradation of health tissue
• patient compliance with the treatment program

Question 36

Asprin powder treatment in sulcus

Answer 36

• occluded for 7 days
• shows keratolytic effects of salicylic acid on onychophosis

Question 37

Salicylic acid treatment on HD

Answer 37

occluded for 5-7 days
- shows keratolytic effects of salicylic acid on callus

Question 38

Keratolytics examples

Answer 38

eulactol
dermal therapy heel bal,
NS8

Question 39

General principles for choosing emollient/moisturiser

Answer 39

penetration and effectivement is influenced by:
- amount of skin damage - increased permeability and reduced permeability by scale and crust
- permeability due to skin thickness and age
- skin hydration
- application
- adverse reactions - preservatices and fragrances

Question 40

Tinea

Answer 40

Caused by dermatophytes which can infect the skin, scalp and hair or nails
Dermatophystces that require keratin to grow
Typical skin rash is annular
tinea can be difficult to distinguish from ezcema and other patchy conditions

Question 41

Onychomycosis

Answer 41

Distal subungual OM
Total dystrophic OM
White superficial OM
Diagnosis confirmed with nail scrapings - diafactory fungal test, mycology