Exam 1 Flashcards
(112 cards)
1
Q
- PPCP step involving gathering both subjective (usually from the patient) and objective (measured or observed) information
- comprehensive gathering of this patient information includes things like chief complaint, past medical/family/personal/social history, physical examinations
- self-care encounters usually don’t involve full coverage of all parts of the patient’s health history
- patient-centered factors including lifestyle habits, preferences/beliefs, health and functional goals, socioeconomic factors are included in this step
A
collect
2
Q
- PPCP step that involve medication assessment, patient history and risk assessment, preventative care assessment
A
assess
3
Q
analyzing medications for appropriateness, effectiveness, safety, adherence
A
medication assessment
4
Q
analyzing patient health status, risk factors, health data, cultural factors, health literacy, access to medications/care
A
patient history and risk assessment
5
Q
focusing on the presenting disorder or problem, advise things to prevent the problem from happening again
A
preventative care assessment
6
Q
- PPCP step involving using the previous steps to give a recommendation for self care with pharmacologic, nonpharmacologic, alternative medicine, referring patient to another provider for treatment, recommending self-care until patient can be seen by provider, condition is self-resolving and nothing else needs to be done
- components of this include medication related problems, goals of therapy, patient engagement, care continuity
A
plan
7
Q
part of plan step in PPCP, results in recommending a therapeutic product (generally speaking), recommendation should be patient centered
A
medication-related problems
8
Q
part of plan step of PPCP, these serve as endpoints to measure outcomes and include practitioner and patient contributions, should include clinical parameters (signs and symptoms), desired value/observable change in each parameter, specific time frame for this to be met (establishes clear expectations)
A
goals of therapy
9
Q
part of plan step of PPCP, identify medication specific information that needs to be communicated to the patient
A
patient engagement
10
Q
part of plan step of PPCP, involves appropriate follow-up, referral, transitions of care
A
care continuity
11
Q
- PPCP step that involves execution of the developed plan
- involves gathering the recommended medication and giving it to the patient rather than having them find it themselves
- communication is key here
A
implement
12
Q
- PPCP step, may not be necessary in self-care encounters considering a lot of the time the problems are self-limiting
- if necessary, the PPCP process should start over at the next encounter
A
follow-up: monitor and evaluate
13
Q
quickly and accurately assess the patient
A
Qu in QuEST
14
Q
establish patient is appropriate self-care candidate
A
E in QuEST
15
Q
suggest appropriate self-care strategies
A
S in QuEST
16
Q
talk with the patient
A
T in QuEST
17
Q
S in SCHOLAR-MAC, what are the main and associated symptoms?
A
symptoms
18
Q
C in SCHOLAR-MAC, what is the situation like, is it changing?
A
characteristics
19
Q
H in SCHOLAR-MAC, what has been done so far, has this ever happened before and what was done then, what was successful and what wasn’t?
A
history
20
Q
O in SCHOLAR-MAC, when did it start?
A
onset
21
Q
L in SCHOLAR-MAC, where is the problem?
A
location
22
Q
A in SCHOLAR-MAC, what makes it worse?
A
aggravating factors
23
Q
R in SCHOLAR-MAC, what makes it better?
A
remitting factors
24
Q
M in SCHOLAR-MAC, prescription non-prescription, complementary/alternative products
A
medications
25
A in SCHOLAR-MAC, medications and other substances, reactions experienced
allergies
26
C in SCHOLAR-MAC, coexisting health problems
conditions
27
S in SCHOLAR-MAC, asking about alcohol, tobacco, diet, occupation, etc.
social history
28
- openness to alternative viewpoints and approaches
- use of inclusive language when gathering demographic information
- self-awareness of one's own prejudices and biases
- engagement to identify one's own barriers to care and individual social determinants of health
- understanding of how the patient's beliefs and attitudes may influence the treatment plan
- negotiating treatment that is acceptable to the patient
6 specialized communication skills to gather information about specific patient's health-related beliefs and circumstances
29
prohibited adulteration and misbranding of medicines, pushed a lot of patent medicines off market
Pure Food and Drugs Act (1906)
30
created safety standards for foods, drugs, and cosmetics
Food, Drug, and Cosmetic Act (1938)
31
created statutory basis for prescription and non-prescription classes of drugs
Durham-Humphrey Amendment (1951)
32
required that drugs had to have proven efficacy which includes non-prescription drugs
Kefauver-Harris Drug Amendments (1962)
33
both defined and regulated dietary supplements, dietary supplements essentially defined as substances that increase the dietary intake of the substance or form of the substance itself
Dietary Supplement Health and Education Act (DSHEA 1994)
34
established inactive ingredient labeling requirements
Food and Drug Modernization Act (1997)
35
required that serious ADRs need to be reported by dietary supplement and non-prescription drug manufacturers
Dietary Supplement and Nonprescription Drug Consumer Protection Act (2006)
36
allow a partial switch from prescription only to some nonprescription indications so there is still a prescription option for patients, beneficial because changes like this give more access to important medications and nonprescription drugs are often less expensive for patients
additional conditions for nonprescription use (ACNU)
37
when a drug product contains a substance that might make it harmful to consumers under normal conditions for use
adulteration
38
when the labeling of a drug is false or misleading, doesn't have the required labeling information, or container is made/filled in a deceptive way
misbranding
39
quantity limit of pseudoephedrine per person within 24 hours
one package not to exceed 3.5 grams
40
quantity limit of pseudoephedrine per person with 30 days
7,500mg
41
what scheduled class is pseudoephedrine?
Schedule V
42
how long should a seller of pseudoephedrine maintain a log regarding pseudoephedrine purchases?
24 months from date of last entry
43
minimum age to purchase pseudoephedrine
18
44
patient must sign and present what form of personal identification with them at the counter when purchasing pseudoephedrine?
government issued photo ID card
45
caused by rhinoviruses mostly, but also some other viruses like coronaviruses, parainfluenza, RSV, adenoviruses, viral infection that is limited to upper respiratory tract, will develop when virus binds to glycoprotein receptors on respiratory epithelial cells in nose/nasopharynx where it then replicates and infection will be spread to other cells, max viral concentrations will be seen 2-4 days after initial infection and can be present for 16-18 days
colds
46
no known cure so trying to reduce bothersome symptoms while trying to also prevent transmission of the virus to other people
treatment goals of a cold
47
adrenergic agonists used to treat sinus and nasal congestion, stimulate alpha-adrenergic receptors leading to constriction of blood vessels which decreases sinusoid vessel engorgement and edema, direct acting bind directly to adrenergic receptors, indirect acting displace NE from storage vesicles in prejunctional nerve terminals, mixed have direct and indirect activity
decongestants MOA
48
phenylephrine, oxymetazoline, tetrahydrozoline
examples of direct acting decongestants
49
_______ are sedating, nonselective drugs and _______ are nonsedating, peripherally selective drugs, they both compete with histamine at central and peripheral histamine type 1 (H1) receptors which stops the histamine-receptor interaction and mediator release
first generation antihistamines, second generation antihistamines
50
chlorpheniramine, brompheniramine, triprolidine
alkylamine antihistamines
51
diphenhydramine, doxylamine
ethanolamine antihistamines
52
pyrilamine, thonzylamine
ethylenediamine antihistamines
53
promethazine
phenothiazine antihistamine
54
fexofenadine, loratadine
piperidine antihistamines
55
cetirizine, hydroxyzine, meclizine
piperazine antihistamines
56
how do local anesthetics work for sore throat?
provide pain relief by stimulating the menthol receptor
57
why should we NOT recommend antitussives and expectorants in a cold?
have questionable efficacy in cough associated with cold so not recommended
58
are Vitamin C and Zinc effective in treatment of a cold?
little to no efficacy
59
fever greater than 100.4, chest pain, SOB, worsening symptoms or development of additional symptoms during self-treatment, underlying chronic cardiopulmonary diseases like COPD or CHF, AIDS, chronic immunosuppressant therapy, frail patients of advanced age, infants less than 3 months old, hypersensitivity to recommended OTC medications
exclusions for treatment for common cold
60
can't be cured so trying to reduce symptoms and improve patient wellbeing
allergic rhinitis goals for treatment
61
best non-pharmacologic therapy in allergic rhinitis
allergen avoidance
62
inhibit multiple cell types and mediators including histamine to stop the allergic cascade
intranasal corticosteroid MOA
63
symptoms that an intranasal corticosteroid can be used to treat
itching, rhinitis, sneezing, congestion related to allergic rhinitis
64
mast cell stabilizer, works by blocking influx of calcium into mast cells preventing mediator release
cromolyn sodium MOA
65
minimum age for triamcinolone nasal spray
2
66
minimum age for fluticasone nasal spray
4
67
minimum age for budesonide nasal spray
6
68
cough with a duration less than 3 weeks
acute
69
cough with a duration of 3-8 weeks
subacute
70
cough with a duration of greater than 8 weeks
chronic
71
trying to reduce the number and severity of coughing episodes and secondarily prevent complications
treatment goals for cough
72
Difficulty breathing, SOB, dyspnea, cyanosis, hemoptysis (coughing up blood/bloody mucus), weight loss, night sweats, cough that worsens after 3-5 days or lasts 2-3 weeks, children under 4, fever over 100.4 F or 100 F that lasts longer than 3 days, barking cough, whooping cough, immunocompromised, TB exposure, risk factors for HIV, chronic illness (asthma, COPD, CHF, diabetes)
exclusions for self-care for cough
73
nonopioid with no analgesic, sedative, respiratory depressant or addictive properties at usual antitussive dosages, acts centrally in the medulla to increase the cough threshold
dextromethorphan MOA
74
only FDA approved expectorant indicated for relief of acute, ineffective productive cough but not indicated for chronic cough associated with chronic lower respiratory diseases like COPD/asthma, loosens and thins lower respiratory tract secretions making coughs more productive
guaifenesin MOA
75
only 2 FDA approved topical antitussives, work through vapors that stimulate and then desensitize sensory neuron receptors in nose and mucosa, creates a local anesthetic sensation/sense of improved airflow, cough reflex may be suppressed with these agents but evidence of antitussive efficacy is limited
camphor and menthol
76
headaches not associated with an underlying illness, episodic and chronic tension-type, migraines with or without aura, cluster headaches
primary headaches
77
headaches that occur 15+ days per month for at least 3 months
chronic tension type
78
headaches that happen less than 15 days per month
episodic tension type
79
moderate to severe head pain, unilateral pain, pulsating quality of pain, aggravation of pain by routine physical activity
migraine without aura
80
moderate to severe head pain, unilateral pain, pulsating quality of pain, aggravation of pain by routine physical activity, neurologic signs/symptoms that precede or coincide with onset of head pain and subsequently resolve, could be visual, sensory, speech, language, or motor manifestations
migraine with aura
81
headache in response to stress, anxiety, depression, emotional conflicts, etc., episodic thought to come from pain sensed by the peripheral nervous system whereas chronic thought to come from stimuli to central nervous system
tension type headaches
82
headaches from activation of trigeminal nerve, changes in central nervous system rather than the vascular system, can be triggered by stress, fatigue, irregular sleep patterns, fasting, caffeine, alcohol, changes in female hormones, bright lights, odors, neck pain
migraine headaches
83
headaches that come from excessive use of analgesics, onset of the headache occurs within hours of stopping the agent and re-administration of the agent relieves the headache
medication overuse headaches
84
headaches that happen when infection or blockage of the paranasal sinuses causes inflammation or distension of the sensitive sinus walls
sinus headaches
85
maximum amount of time that you should use OTC analgesics without medical supervision
2 days per week (multiple doses during a single day are allowed)
86
- reduce severity and alleviate acute pain
- restore normal functioning
- prevent relapses
- minimize adverse effects
treatment goals for headaches
87
works through central inhibition of prostaglandin synthesis
acetaminophen MOA
88
inhibition of COX with subsequent inhibition of prostaglandin synthesis
NSAIDs mechanism of action
89
inhibit prostaglandin synthesis from arachidonic acid by inhibiting both COX-1 and COX-2, results in decrease in prostaglandins
salicylates MOA
90
which medication for headache should NOT be used in children due to risk of Reye Syndrome?
aspirin
91
caused by a regulated rise in body temperature that is maintained by the hypothalamus in response to pyrogen
fever
92
malfunctioning of the normal thermoregulatory process at the hypothalamic level caused by excessive heat exposure or production
hyperthermia
93
body temperature greater than 106 F that is typically associated with mental and physical signs and symptoms
hyperpyrexia
94
Core body temperature is controlled by hypothalamus and regulated by feedback system involving information transmitted between the thermoregulatory center in the anterior hypothalamus and the thermosensitive neurons in the skin and central nervous system, prostaglandins are produced in response to circulating pyrogens and elevate the thermoregulatory set point in the hypothalamus, body temperature reaches new set point
fever pathophysiology
95
microbial origin or plant toxins, do not independently increase the hypothalamic set point but stimulate the release of endogenous pyrogens which increase core temperature
exogenous pyrogens
96
products released in response to or from damaged tissue like interleukins, interferons, tumor necrosis factor, immune cytokines
endogenous pyrogens
97
which 2 forms of temperature measurement devices are most accurate?
rectal and tympanic
98
should focus on the primary cause, not so much the temperature reading itself, alleviate the discomfort rather than trying to achieve a certain temperature
therapy goals for fever
99
maximum amount of time that you should use OTC antipyretics without medical supervision
3 days
100
- Patients greater than 3 months with rectal temperature greater than 104 F or equivalent
- Children less than 3 months with rectal temperature greater than 100.4 F or equivalent
- Children less than 2 years with fever that persist for longer than 24 hours
- Patients greater than 2 years with fever that persist for longer than 3 days with or without treatment
- Fever that repeatedly rises above 104 F in a child of any age
- Risk for hyperthermia
- Impaired oxygen utilization (CV or pulmonary disease)
- Impaired immune function (cancer, HIV)
- CNS damage (head trauma, stroke)
- Severe symptoms of infection that are not self-limiting
- Children with history of febrile seizures or seizures or stiff neck
exclusions for self-treatment of fever
101
common dosing of acetaminophen
500 or 650 - 1000 mg q4-6h prn
102
max daily OTC dose of acetaminophen
3000mg
103
common dosing of ibuprofen
400 mg q4-6h prn
104
max daily OTC dose of ibuprofen
1200 mg
105
common dosing of naproxen
220 mg q12h prn
106
max daily OTC dose of naproxen
660 mg
107
common dosing of aspirin
650 mg q4-6h prn
108
max daily OTC dose of aspirin
4000 mg
109
common dosing of magnesium salicylate
1160 mg q6h prn
110
max daily OTC dose of magnesium salicylate
4640 mg
111
dose, frequency, and mg/kg dose for pediatric acetaminophen
10-15 mg/kg every 4-6 hours prn
112
dose, frequency, and mg/kg dose for pediatric ibuprofen
5-10 mg/kg every 6-8 hours prn
