Exam 1 Flashcards
(182 cards)
1
Q
PPCP: Collect
A
- Prominent symptoms & severity
- Onset & duration
- Any measures tried & their success
2
Q
QuEST
A
- Quickly assess
- Establish self-care appropriateness
- Suggest care
- Talk to the patient
3
Q
SCHOLAR
A
- Symptoms
- Characteristics
- History
- Onset
- Location
- Aggravating factors
- Remitting factors
4
Q
Influences of self-care medication
A
- Elderly pts
- Restricted access to prescribers through health management org
- Increasing health care $
- Emerging concept of non-rx drugs in disease mng
- Internet
- Pretax $
- Women > men
5
Q
FDA Drug labeling sections
A
- active ingredients
- uses
- warnings
- when to use
- directions
- inactive ingredients
6
Q
FDA drug labeling D/I has been changed to ___
A
Ask your physician or pharmacist
7
Q
When do we refer pts?
A
- Severe symptoms
- Minor but persistent symptoms
- Repeatedly returning symptoms w/ no readily recognizable cause
- pharmacist in doubt
8
Q
Risk factors of T2DM
A
Age, obesity, lack of physical activity, family hx, GDM hx, PCOS, HTN, dyslipidemia, prediabetes
9
Q
Preventative measures of diabetes
A
- Self monitoring BG: frequency
- Eye care
- Dental care
- Skin care
- Foot care
- Med adherence
- Sick day mng
- Immunization (influenza, hep B, pneumococcal)
10
Q
DM: limit daily intake to __ alcohol beverages for men & __ for women
A
Two; one
11
Q
ADA A1c goal
A
< 7%
12
Q
ADA pre-prandial goal
A
80 - 130 mg/dL
13
Q
ADA 2 hr postprandial goal
A
< 180 mg/dL
14
Q
HTN BP goal for DM
A
< 130/80 mmHg
15
Q
Aspirin for CV protection: secondary (hx of ASCVD)
A
Use aspirin
16
Q
Aspirin for CV protection: primary
A
- Age >= 50 : DM & 1 major risk factor –> aspirin
- Age < 50 or >= 70 : X
17
Q
Factors affecting insulin absorption- Site
A
Abdomen > arm > thigh > buttock
18
Q
Factors affecting insulin absorption- Depth of injection
A
IV > IM > SC
19
Q
Factors affecting insulin absorption- Other
A
- Exercise increases
- Skin temperature: cold decreases
- Massaging injection site: increases
- Smoking decreases
20
Q
Hypoglycemia S/S
A
- Sweating
- Tachycardia
- Palpitations
- Confusion
- Tiredness
21
Q
Treating hypoglycemia
A
Rule of 15
- 3 teaspoonful or 3 cubes of sugar
- 5 to 6 lifesavers
- 3 glucose tablets
- 4 oz juice
- 9 oz milk
22
Q
If glucose below 60 mg/dL after 15 mins of treating hypoglycemia
A
Repeat another 15 g of CHO
23
Q
SMBG frequency considerations:
A
- assess pt compliance
- vary timing of SMBG
- incorporate pt daily schedule and habits
- give ownership to the pt
24
Q
A1c reading frequency testing is recommended at least quarterly (Q 3 months) for:
A
- newly diagnosed
- therapy recently changed
- poorly controlled, unstable, or intensively managed
25
A1c reading frequency testing is recommended at least twice a year (Q 6 months) for:
stable glycemic control
26
Ketone testing is a marker of __ and __
insulin deprivation and subsequent hyperglycemia
27
Ketone level should be tested every 4 to 6 hrs when:
- Acute illness
- BG > 240 ng/dL
- Symptoms of DKA (fruity breath, thirst, frequent urination, Kussmaul breathing, abdominal pain/vomiting, flu-like symptoms, confusion, stupor, coma)
28
Use control solutions when:
- New monitor & test strips
- Improper storage for test strips
- Unusual results
- Symptoms do not match your results
29
Tips for using control solutions:
- Discard after 90 days or expired
- Check to see if there is more than one solution for your meter
- Know you model when you reorder
30
Do not use alternate testing sites when:
- Acutely/frequently hypoglycemic
- Within 2 hrs after a meal, insulin dose, or exercise
- Acutely ill
31
Fermentation process of prebiotics
1. Prebiotics must be fermented in the colon
2. Fiber can act as a prebiotic and are fermented by bifidobacteria and lactobacilli
3. Fermentation leads to short chain fatty acids and lactate production
32
What are the two common bacteria that ferment fiber in the colon?
bifidobacteria and lactobacilli
33
Most common type of prebiotics is ____
inulin-type fructans
34
Benefits of prebiotics
1. Reduce duration and prevalence of infectious and antibiotic-associated diarrhea
2. Stool bulking and decreased constipation
3. Reduce inflammation and symptoms with IBD
4. Enhance absorption of minerals (Ca, Mg)
5. Promote satiety and weight loss
6. Increase bifidobacterium for digesting fiber and preventing infections
7. Enhancement by synbiotics
35
Protective effects of probiotics
1. GI barrier function
2. Antimicrobial activity
3. Alter EC inflammatory responses
4. Enhance antiviral activity
5. Increase CD4+ (regulatory) T cells
6. Activate MP
36
Safety considerations of probiotics
1. Minor GI AEs
2. Systemic infections
3. Avoid in immunocompromised
4. Probiotics via a jejunostomy tube increase risk of AEs
37
CoenzymeQ10 E/S, clinical pearls (CP)
- Likely effective for CoQ10 deficiency, mitochondrial dysfunction
- Likely safe
- Diarrhea, N/V, heartburn, vit K-like activity
38
Fish oil E/S, CP
- Effective for **hypertriglyceridemia**
- Likely safe
- Increase LDL 1%, fishy burps
39
Niacin dose, E/S, CP
- **500 mg PO, max 2 g daily**
- Likely effective for **dyslipidemia** & pellagra
- Likely safe
- **Flushing**, abdominal pain, increased LFTs
40
Red yeast rice E/S, CP
- Likely effective for **hyperlipidemia**
- Possibly safe
- X in preg, abdominal pain
41
Gingko Biloba E/S, CP
- Possibly effective for anxiety, dementia, hearing loss, PMS, schizophrenia, stroke, tardive dyskinsea, vertigo
- Likely safe
- **Caution w/ DTIs (dabigatran),** GI upset, N/V, dizziness
42
Garlic E/S, CP
- Possibly effective for atherosclerosis, diabetes, HTN, NAFLD, periodontitis, endometriosis
- Likely safe
- Body odor/bad breath
43
Melatonin E/S, CP
- Likely effective for delayed sleep phase syndrome, non 24 hr sleep wake disorder
- Likely safe
- Onset w/i 1 hr, **may increase VLDL & trig**, mood swings
44
St. John's Wort E/S, CP
- Likely effective for **depression**
- Likely safe
- Palpitations, sedation, insomnia, major DDI
45
Three major DDIs for St. John's Wort
Contraceptives, omeprazole, SSRIs
46
Alpha lipoic acid E/S, CP
- Possibly effective for **diabetic neuropathy, hyperlipidemia, obesity**
- Possibly safe
- Headache, heartburn, N/V
47
Echinacea E/S, CP
- Possibly effective for **common cold**
- Likely safe
- Severe allergic reactions < 12 yrs, N/V, abdominal pain
48
Elderberry E/S, CP
- Possibly effective for **influenza**
- Likely safe
- Unripe, raw = toxic -> severe NVD so cook
49
Cranberry E/S, CP
- Possibly effective for **recurrent UTIs**
- Likely safe
- GI upset or diarrhea
50
Turmeric/Curcumin E/S, CP
- Possibly effective for allergic rhinitis, depression, dyspepsia, hyperlipidemia, NAFLD, osteoarthritis, pruritus
- Likely safe
- Unsafe in preg & lac
51
Black Cohosh E/S, CP
- Possibly effective for **menopausal symptoms**
- Possibly safe
- Unsafe in preg & lac, breast tenderness, dizziness, GI upset, risk of liver damage if taken w/ other hepatotoxic drugs
52
Fenugreek E/S, CP
- Possibly effective for T2DM, dysmenorrhea, sexual arousal/dysfunction
- Likely safe
- Bloating, dyspepsia, GI upset, **hypoglycemia**
53
Glucosamine E/S, CP
- Possibly effective for osteoarthritis (only w/ chondroitin)
- Likely safe
- do NOT take if on **warfarin**, use caution in pts with asthma, beware of **shellfish** allergy
54
What is the only effective herbal?
Fish oil
55
What are examples of likely effective herbals?
- Coenzyme Q10
- Niacin
- Red Yeast Rice
- Melatonin
- St. John’s Wort
**St. Red MeN 10**
56
What are examples of possibly safe herbals?
- Black cohosh
- Alpha lipoic acid
- Red yeast rice
**BAR**
57
Bacterial Vaginosis marked symptom
Unpleasant "fishy" odor
58
Bacterial Vaginosis treatment
- X self-treat
- Topical or oral clindamycin or metronidazole
- Sexual partners not warranted for routine tx
59
Trichomoniasis marked symptom
Copious, malodorous, yellow-green (discolored), frothy discharge
60
Trichomoniasis treatment
- X self-treat
- Metronidazole or tinidazole
- MUST treat partners
61
Vulvoganial Candidiasis marked symptoms
Thick, white "cottage cheese" discharge
62
Vulvoganial Candidiasis exclusions for self-treatment
1. Pregnancy
2. Girls < 12 yrs
3. Concurrent or systemic symptoms
4. Steroids, antineoplastic
5. Medical disorders (DM, HIV)
6. Recurrent infection
63
Vulvoganial Candidiasis nonpharmacologic therapy
- Decrease sugar, refined CHO consumption
- Increase yogurt containing live culture consumption
- D/C drugs that may predispose to infection
64
Vulvoganial Candidiasis pharmacological therapy
1. Non-rx imidazole antifungal
2. Butoconazole, clotrimazole, miconazole, tioconazole
65
Vulvoganial Candidiasis pharmacologic therapy pt counseling points
1. Start tx at night, before going to bed
2. Wash applicator with warm water and soap b/w uses
3. Complete tx to prevent recurrence
4. Continue using even during menstruation
5. Should improve w/i 24 - 72 hrs in 7 days
6. If > 7days, no improvement in 3 days -> PCP
7. Avoid sexual intercourse
66
Atrophic Vaginitis marked symptoms
Dyspareunia, vaginal dryness
67
Atrophic Vaginitis pharmacologic therapy
- Vaginal lubricants
- Water > Silicone-based
- Vaseline should NOT be used
68
Vaginal Disorder home test kit pH > 5.0
BV or trichomoniasis
69
Vaginal Disorder home test kit pH 4.5
Yeast infection (BVC)
70
Vaginal douching counseling points
- NOT recommended
- C/I during pregnancy
- Delay douching for 6 - 8 hrs after intercourse if vaginal spermicide was used
71
Cow's milk formula CHO, protein, fat
- CHO: lactose
- Protein: whey +/- casein
- Fat: vegetable oil > coconut, soy, palm olein, safflower, sunflower oil
72
Soy-based formula indication
Lactose deficiency/intolerance, galactosemia, cow's milk protein allergy, vegetarians
73
Soy-based C/I for:
Preterm infants < 1800 mg, CF, prevention of colic or allergic, infants who developed cow milk protein induced enterocolitis
74
Soy-based formula CHO, protein, fat
- CHO: sucrose or corn syrup solids
- Protein: soy and methionine
- Fat: vegetable oil
75
Premature formula indication
Preterm infant < 2-3 kg, < 36 wks gestational age
76
Compared to term infant formulas, premature formulas:
- More protein, MCT, Ca, phosphorous, Vit AED
- Less lactose
- More growth & cognitive functions
77
Premature formula CHO, protein, fat
- CHO: lactose
- Protein: whey +/- casein (6:4)
- Fat: MCT
78
DHA and ARA infant formula indication, CHO, protein, fat
- Indication: normal and healthy
- CHO: lactose
- Protein: whey
- Fat: vegetable oil + long chain FA
79
Casein Hydrolysate-based formula CHO, protein, fat
- CHO: corn syrup solids, modified corn/tapioca starch, sucrose, dextrose
- Protein: hydrolyzed casein, smaller peptides, AA
- Fat: long-chain fat & MCT
80
Disadvantage of casein hydrolysate-based formulas
High cost, bad taste, high osmolality (intolerance, diarrhea)
81
Amino acid-based formula indication
Extreme milk protein, soy, food allergies
82
Amino acid-based formula CHO, protein, fat
- CHO: corn syrup solids
- Protein: 100% synthetic free AA
- Fat: vegetable oils & MCT
- All iron-fortified
83
Infant formula preparation points
1. Always wash hands
2. Wash top of the can with hot water & detergent, rinse in hot water, dry
3. If ready to use formula, always shake well
4. If powdered formula, always read mixing directions
84
Modular nutrient component indication
Enhance a single nutrient component
85
Polycose provides additional ___
CHO
86
Beneprotein, Promod, Liquid protein fortifier provides additional ___
Protein
87
MCT oil and Microlipid provides additional ___
Fat
88
Enfamil HMF liquid, Prolact +4, Similac Special Care with Iron Fortifier provides additional ___
Human Milk Fortifier (HMF)
89
Benecalorie provides additional
Protein + Fat
90
Duocal provides additional
Carbohydrate + Fat
91
Dysmenorrhea S/S
Cramping pain, N/V, fatigue, nervousness, dizziness, diarrhea, headache
92
Dysmenorrhea exclusions for self-tx
1. Severe
2. Secondary
3. Hx of PID, infertility, irregular menstrual cycles, endometriosis, ovarian cysts
4. Presence of IUD
5. Aspirin or NSAID allergy
6. Warfarin, heparin, lithium
7. Active GI disease
8. Bleeding disorder
93
Dysmenorrhea: preferred agent
NSAIDs
- Ibuprofen, Naproxen
94
Dysmenorrhea mild cases are treated with
Acetaminophen and Aspirin
95
Dysmenorrhea: NSAIDs counseling point
- Difference in responses
- GI effects; take with food
- Anticoagulants, antiHTN, lithium
- Relative C/I with aspirin/NSAID allergy, active GI disease, bleeding disorders, CKD
- Take with water
96
Dysmenorrhea: APAP counseling point
- Avoid alcohol
- APAP containing rx drugs
97
Dysmenorrhea: ASA counseling point
- Take with food
- X for adolescents < 18 yrs
- DDI with anticoagulant, methotrexate, oral hypoglycemics, high doses of antacids
- Relative C/I with PUD, gastritis, asthma, bleeding disorders
- May increase menstrual flow
98
PMS exclusions for self-tx
1. Severe
2. Atypical timing of symptoms
3. Onset related to oral contraceptives or hormonal replacement
4. C/I to pharmacologic agents
99
PMS pharmacologic therapies
Vit B6/E, Calcium (with vit D), Mg, NSAIDs, Diuretics (caffeine and pamabrom)
100
PMS counseling points
1. Initial tx = Ca, Mg, pyridoxine
2. Caffeine/Pamabrom = relief of **bloating**
3. Xanthines C/I in pts with ulcer disease or taking MAOIs
4. NSAIDs reserved for women with **both PMS and dysmenorrhea**
101
Toxic Shock Syndrome (TSS) S/S
1. Occurs w/i 2 days of onset of menses
2. Prodromal phase: malaise, myalgias, chills (2-3 days) before severe symptoms
3. 5-12 days after onset = desquamation of the skin on face, trunk, extremities
102
TSS counseling points
1. Tampon use review
2. Change tampons at least every 6 hrs
3. Alternate use b/w sanitary pads and tampons
4. Seek medical attention appropriately
103
Male condom counseling point
1. Keep in sealed package and protect from light and heat
2. Expiration date
3. Discoloration, brittleness, stickiness
4. Decreased sensitivity and contact dermatitis
5. If dissatisfied with one brand/style, try another
104
Female condom counseling point
1. One-time use only
2. May insert **up to 8 hrs prior** to intercourse
3. Effective immediately
4. Store at room temp, unopened
5. do NOT use with male condom
6. Vaginal irritation, increased noise, decreased sensation, discomfort
105
Opill C/I
- Hx breast cancer
- Allergy to norgestrel or FD&C yellow No.5 (tartrazine)
- Current use of other birth control pill, vaginal ring, patch, implant, injection, IUD
- Known/suspected pregnancy
- Male
106
Opill counseling points
1. Not an emergency contraceptive
2. Does not protect against STIs
3. Use barrier method for first two days; not effective for the first 48 hrs
4. If >3 hrs late: take 1 ASAP, then return to taking a daily tablet at usual time and use barrier method for the next two days
107
LGBTQIA+ STIs screening guideline
1. Screen every 3 months (Chaperone trauma-informed approach, Self-collection of samples)
2. Transgender women undergone vaginoplasty do not have a cervix -> cervical HPV NOT appropriate
3. Infectious prostatitis should be included in sexually active transgender women
108
Heartburn and dyspepsia (HB/D) S/S
Burning feeling, acid regurgitation
109
HB/D treatment for mild, infrequent s/s
Antacids, H2RA
110
HB/D treatment for moderate, infrequent s/s
H2RA
111
HB/D treatment for frequent s/s
PPI
112
What is considered frequent s/s for HB/D?
>= 2 days/week
113
HB/D exclusions for self-tx
1. More than 3 months or 2 weeks while taking OTC acid suppressive
2. Severe
3. Nocturnal HB
4. Difficulty or pain swallowing
5. > 45 yrs with new onset
6. Vomiting blood or black tarry stools
7. Chronic hoarseness, wheezing, coughing, choking
8. Continuous NV, diarrhea
9. Chest pain or weight loss
10. Preg or nursing
11. Children < 12 yrs
114
HB exclusions
Dysphagia, GI bleeding, odynophagia, unexplained iron-deficiency anemia, unintended weight loss
115
Dyspepsia exclusions
> 45 yrs with new onset, family hx of upper GI cancer, GI bleeding, jaundice, odynophagia, palpable mass or lymphadenopathy, persistent vomiting, progressive dysphagia, unexplained iron-deficiency anemia, unintended weight loss
116
HB/G: Antacid
- MoA
- Neutralize acid
- Cytoprotective effect
- Simethicone (decrease surface tension of gas bubbles)
- Alginic acid (symptomatic relief of GERD)
117
HB/G Sodium bicarbonate AEs
- Metabolic alkalosis
- Milk-alkali syndrome
- Sodium overload: fluid retention, weight gain
118
HB/G Calcium carbonate AEs
- Hypercalcemia
- Milk-alkali syndrome
119
HB/G Aluminum salts AEs
- Constipation
- Hyperaluminemia
- Hypophosphatemia
120
HB/G Magnesium salts AEs
- Diarrhea
- Hypermagnesemia
121
HB/G antacids DDI
- Binding of drugs in the gut; decreased oral absorption
- Decreased absorption of ketoconazole, itraconazole, iron, atazanavir
- Decreased efficacy of enteric coatings
- Increased urinary pH
122
HB/G antacids FDA warnings
- Combination with antacid-aspirin containing products
- Serious bleeding can occur
- Greatest risk: > 60 yrs, hx of stomach ulcers/bleeding problems, anticoagulant, systemic, steroids, NSAIDs, > 3 alcoholic
123
HB/D H2RA MoA
- Competitive inhibition of histamine at H2 receptors on parietal cells
- Decrease volume of secreted acid
124
HB/D H2RA AEs
- Common: headache, diarrhea, nausea
- Rare: confusion, hallucinations, anemia, leukopenia, thrombocytopenia, elevated liver enzymes, impotence, gynecomastia
125
HB/D H2RA D/I
- Inhibition of CYP450: Cimetidine, theophylline, phenytoin, warfarin, amiodarone, clopidogrel, TCAs
- Reduced absorption due to increased pH: ketoconazole, itraconazole, iron, Ca
- decreased tubular secretion: procainamide
126
HB/D PPI MoA
- Irreversibly inhibit H/K ATPase in parietal cells
127
HB/D PPI AEs
- Common: abdominal pain, headache, diarrhea, vomiting, dizziness
- Rare: skin rash, anemia, neutropenia, thrombocytopenia, hematuria, hepatotoxicity, peripheral neuropathy
128
HB/D PPI D/I
- Inhibit CYP450: warfarin, phenytoin, diazepam, tacrolimus, methotrexate
- Decreased oral absorption: ketoconazole, itraconazole, iron, Ca, mycophenolate mofetil
- Clopidegrel: omeprazole, esomeprazole may decrease antiplatelet effects -> inhibit CYP2C19
129
HB/G Bismuth Subsalicylate MoA
- Topical effect on gastric mucosa
- Binds bacterial toxins in GI tract -> suppress H. pylori growth
- Antisecretory effect
130
HB/G Bismuth Subsalicylate maximum dose
8 doses/day
131
HB/G Bismuth Subsalicylate AEs
- Darkening of the tongue and stool
- Bismuth toxicity: headache, confusion, ataxia, seizures
- Salicylate toxicity: tinnitus, hypersensitivity, bleeding disorders
- Reye's syndrome in children
132
Gas exclusions for self-tx
- S/S persisting for more than several days×/month
- severe
- Sudden change in abdominal pain location
- increased severity or frequency
- > 40 yrs
133
Gas: Simethicone MoA
- Defoaming agent = reduce surface tension of gas bubbles
134
Gas: alpha-D-galactosidase MoA & dosage
- MoA: degrades insoluble oligosaccharides into digestible sugars
- Take 2-3 tablets with first bit of food
135
Gas: lactase replacement MoA
- Breaks down lactose into glucose and galactose
136
Gas: first choice agent
Simethicone
137
N/V motion sickness tx
antihistamine
138
N/V antihistamine is safe to use during pregnancy: T/F
False
139
N/V phosphorylate carbonate solution C/I
DM, hereditary fructose intolerance
140
Constipation S/S
- Decreased frequency of bowel movements
- Abdominal discomfort
- Straining
- Passing hard, dry, small stools
- Bowel evacuation not complete
- NOT defined by number of bowel movements per day or week
141
Constipation exclusions for self-tx
- Abdominal pain, distension, cramping
- Unexplained flatulence
- Fever, N/V
- Para- or quadriplegia
- Daily laxative use
- Blood in stool, dark tarry stool
- Persisting > 2 weeks
142
Constipation nonpharmacologic therapy
- Gradually increase daily fiber intake
- Drink non-caffeinated
- Exercise
143
Constipation: order of pharmacological therapy
1. Bulk-forming laxatives
2. Hyperosmotic laxatives
3. Stimulant laxatives
- Straining: stool softeners: emmolients, lubricants
144
Constipation: bulk forming laxatives MoA
Retain water, increase bulk volume, stimulate peristalsis
145
Constipation bulk forming laxatives AEs
abdominal cramping, bloating, flatulence
146
Constipation bulk forming laxatives C/I
fluid-restriction, partial intestinal obstruction, fecal impaction, diff swallowing
147
Constipation: bulk forming laxatives ex
psyllium, methylcellulose, Ca polycarbophil
148
Constipation: hyperosmotic laxatives 3 classes
1. Saline laxatives
2. Lactulose
3. Polymer-type
149
Constipation: Saline laxatives MoA
Osmotic effect draws fluid into intestine
150
Constipation: saline laxatives AEs
abdominal cramping, excessive diuresis, dehydration, electrolyte disturbances
151
Constipation: saline laxative C/I
- Mg-containing
- Na-containing
- Mg: ileus of GI obstruction, heart block, renal failure
- Na: fluid restriction, CHF, cirrhosis
152
Constipation: saline laxative ex
Mg citrate, Mg hydroxide, Dibasic sodium phosphate
153
Constipation: sodium phosphate caution
- BBW: acute kidney injury
- Non-rx NOT for bowel cleansing
154
Constipation: polymer-type laxatives MoA
form H bonds with water, increase bulk, stimulate peristalsis, large molecular weight, create osmotic effect
155
Constipation: polymer-type AEs
abdominal cramping, bloating, flatulence
156
Constipation: polymer-type ex
Polyethylene glycol 3350
157
Constipation: stimulant laxative MoA
- Stimulate peristalsis by local mucosal irritation
- Stimulate fluid and electrolyte secretion
158
Constipation: stimulant AEs
severe cramping, fluid and electrolyte imbalance, malabsorption
159
Constipation: stimulant ex
1. Senna
2. Bisacodyl
3. Glycerin suppositories
4. Castor oil
160
Constipation: stimulant Senna AEs
- Can discolor urine (pink/red)
- chronic use cause brown pigment of the colon wall
161
Constipation: stimulant Bisacodyl AEs
Chronic use can cause metabolic acidosis/alkalosis, hypocalcemia, malabsorption
162
Constipation: stool softner emollient MoA
anionic surfactant
- Soften feces by increasing the wetting efficiency of water in the intestine to soften the fecal mass
163
Constipation: emollient AEs
- Minimally absorbed
- Mild abdominal cramps
- Can increase digoxin, warfarin, mineral oil absorption
164
Constipation: emollient ex
docusate sodium/calcium
165
Constipation: lubricant MoA
Soften feces by coating stool and preventing water loss
166
Constipation: lubricant AEs
Foreign body reactions, aspiration
167
Anorectal Disorders: exclusions for self-tx
1. <12 yrs
2. UC or Crohn's disease
3. Family hx of colon cancer
4. Abscess, fistula/fissures, malignancy, diagnosed by PCP
5. black tarry stools
6. no response to 7 days of self-tx
168
Anorectal disorder: external application
- Local anesthetics warnings & ex
- Benzocaine, pramoxine hydrochloride, lidocaine
- allergic rxn, avoid on open sores
169
Anorectal disorder: external application
- Keratolytics MoA & ex
- MoA: Desquamation and debridement of epidermal surface cells leading to cell turnover
- resorcinol, alcloxa
170
Anorectal disorder: external application
- analgesics, anesthetics, antipruritis MoA & ex
- MoA: temporary relief of burning, pain, itching by producing cool, warm, or tingling sensation
- menthol, juniper tar, camphor
171
Anorectal disorder: internal application
- Astringents MoA & ex
- MoA: promote coagulation of surface protein in the anorectal skin cells to protect underlying tissue
- Calamine, zinc oxide, witch hazel
172
Anorectal disorder: internal application
- Protectants MoA, ex
- MoA: create physical protective barrier over inflamed anal tissue and soften the lining of the anal canal
- Cocoa butter, glycerin, kaolin, calamine, shark/cod liver oil, zinc oxide
173
What two agents are both astringents and protectants?
Calamine and zinc oxide
174
Anorectal disorder: internal application
- Vasoconstrictors MoA & AEs & ex
- MoA: relief of itching, discomfort, and irritation and to shrink and decrease swelling of the hemorrhoidal tissues
- AE: cardiac arrhythmias if absorbed systemically
- Phenylephrine, ephedrine, EP
175
Diarrhea S/S
- loose, watery stool
- more frequent bowel movements >=3
- acute: >=3 for =<14 days
- persistent: 14 days - 4 wks
- chronic: >= 4 wks
176
Diarrhea exclusions for self-tx
- Children ( < 6 months, severe dehydration, >= 6 months with high fever)
- Blood, mucus, pus in stool
- Severe abdominal pain
- Substantial volumes of diarrhea
- Severe dehydration/suboptimal response to rehydration
- Protracted vomiting
- DM, CVD, CKD, immunosuppressed
- Pregnancy
- Chronic or persistent > 14 days
177
Diarrhea: BRAT method
Banana, Rice, Apple sauce, Toast
178
Diarrhea: Loperamide MoA
Selective mu-opioid receptor agonist on gut wall
- Decrease GI motility
- Decrease secretion of fluid and electrolytes
179
Diarrhea: Loperamide AEs
- Headache, drowsiness, abdominal pain
- CV risks
180
Diarrhea: loperamide recommended dose
- 4 mg po initially, then 2 mg after each loose stool
- Max dose 8 mg/day
- Max duration 48 hrs
181
Diarrhea: Bismuth Subsalicylate MoA
- Bismuth increase water absorption
- Salicylate decrease prostaglandin formation -> induce inflammation & HYPERmotility
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Diarrhea: Bismuth Subsalicylate AEs
- black hairy tongue and black stools, N, bitter taste
