Exam 1 Spring 2025 Flashcards
Dental pain, vaginal issues, STDs, pregnancy (212 cards)
1
Q
What is the normal pH of the vagina?
A
4-4.5 pH
2
Q
Is douching recommended or not recommended?
A
No it is not
3
Q
What are the 3 most common vaginal infections?
A
Vulvovaginal Candidiasis (VVC/ yeast infection), bacterial vaginosis (BV), and trichomoniasis
4
Q
If the vaginal discharge has any odor, it is most likely NOT a _______ ____________.
A
Yeast infection
5
Q
What are the seven common risk factors for vulvovaginal candidiasis (VVC/ yeast infection)?
A
Pregnancy, high dose of oral contraceptives, antibiotics/immunosuppression, increased estrogen, diabetes, onset of sexual activity, clothes and food.
6
Q
Why is diabetes a risk factor for vulvovaginal candidiasis (yeast infection)?
A
Diabetes increases sugar excretion in the urine which feeds the fungi.
7
Q
What is the discharge like if someone have bacterial vaginosis?
A
The discharge is typically white and clear with a fishy odor.
8
Q
What is the typical vaginal pH value for someone who has bacterial vaginosis?
A
Greater than 4.5
9
Q
What is the typical vaginal pH value for someone with vulvovaginal candidiasis (yeast infection)?
A
4.0 (it is typically normal)
10
Q
What is the typical vaginal pH value for someone trichomoniasis?
A
5-6 pH
11
Q
What is the typical vaginal discharge for vulvovaginal candidiasis (yeast infection)?
A
The discharge is white, thick, creamy, and curdy while having no odor.
12
Q
What is the typical vaginal discharge for someone who has trichomoniasis?
A
The discharge is green and/or yellow and can be frothy.
13
Q
What is the main clinical symptom of vulvovaginal candidiasis (yeast infection)?
A
Vulvar itching
14
Q
What are the 7 exclusion factors for self-treatment for vuvlovaginal candidiasis (yeast infection)?
A
- Pregnancy
- Younger than 12 years
- Concurrent symptoms of fever, pain in pelvic area, lower abdomen, back and/or shoulder
- Medication that predisposes you to VVC (corticosteroids and antineoplastics)
- Medication disorders that can predispose to VVC (diabetes and HIV)
- More than 3 VVC in the past year and/or 1 in the past 2 months
- First VVC episode (must go to PCP)
15
Q
What is the generic name for AZO?
A
Phenazopyridine
16
Q
What are the 3 types of non-prescription antifungals for vulvovaginal candidiasis (yeast infection)?
A
Clotrimazole, miconazole, and tioconazole
17
Q
What is the dosing product for clotrimazole?
A
1% cream x7 days or 2% cream x3 days
18
Q
What is the typical course duration for clotrimazole?
A
7 or 3 days
19
Q
What are the two products that miconazole comes in?
A
Cream and vaginal suppository
20
Q
What is the dosing product for miconazole?
A
2% cream x7 days or 4% cream for x3 days
OR
Vaginal suppository:
100 mg x 7 days
200 mg x 3 days
1.2 g x 1 days
21
Q
What is the typical course duration for miconazole?
A
7, 3, and 1 days
22
Q
What is the product dosing for tioconazole?
A
Ointment 6.5% daily x 1 day
23
Q
What is the MOA of the 3 antifungals clotrimazole, miconazole, and tioconazole?
A
These antifungals alter the fungal cell membrane permeability
24
Q
What is the age cut-off for the use of antifungals to treat vulvovaginal candidiasis (yeast infection)?
A
12 years old
25
What are the common adverse effects of antifungals?
Dry skin, burning, rash, and hypersensitivity
26
What are the drug interactions with clotimazole?
None
27
What is the main drug interaction with miconazole?
Warfarin. This drug should be avoided or bleeding should be monitored.
28
What is the main drug interaction with tioconazole?
Progesterone. This drug should be avoided.
29
T or F: When applying vaginal antifungals, they should be applied in the morning.
False. These should be applied at night.
30
T or F: The vaginal applicator for antifungal application use can be reused.
False. Do not reuse these applicators
31
How long does it take to see improvement with the use of antifungals?
24-48 hours
32
T or F: Antifungal treatment can be discontinued once symptoms improve.
False. Finish out the dose of the medication even if the symptoms have improved.
33
T or F: Tampons and douching can be used during treatment with vaginal antifungals.
False. Tampons and douches should not be used during intravaginal treatment.
34
T or F: Patients should refrain from intercourse while undergoing intravaginal antifungal treatment for vulvovaginal candidiasis.
True!
35
What were the 3 medications discussed that do not directly treat vulvovaginal issues but do provide relief of itching?
Benzocaine, hydrocortisone, and AZO
36
What is the indication for AZO (phenazopyridine)?
AZO is indicated to relieve symptomatic urinary pain for adults and children 12 years and older.
37
What is the dosing protocol for OTC AZO (phenazopyridine)?
95mg or 99.5mg 1x PO TID
38
If symptoms are still present after ______ days of using AZO, the individual should be referred to a PCP.
2 days
39
T or F: AZO (phenazopyridine) changes the color of the urine to red/orange.
True
40
What are the common adverse effects seen with AZO use?
Headaches, rashes, and stomach cramps
41
In general, what is AZO used for?
It is mainly used to treat symptomatic urinary pain relief in UTIs.
42
What were the 5 main CAM products discussed that may improve vulvovaginal issues?
Lactobacillus
Boric acid
Sodium Bicarb Sitz Bath
Tea Tree Oil
Gentian Violet
43
T or F: Pregnant women can use boric acid as a CAM product for vaginal issues.
False. Pregnant people should not use boric acid
44
What are 5 common nonpharmacological therapies for vulvovaginal issues?
Yogurt with live cultures, sitz bath, decrease sucrose and refined carbs, discontinue aggravating drugs, and wearing loose clothing
45
T or F: Self-treatment of vulvovaginal issues during pregnancy is not acceptable.
True. The outlier to this is if they are diagnosed with vulvovaginal candidiasis (yeast infection) by a PCP and come back to the pharmacy to get a 7-day only OTC antifungal.
46
Is breastfeeding an exclusion for self-treatment of vulvovaginal candidiasis?
No
47
If the symptoms of vulvovaginal candidiasis do not improve within ______ days or persist beyond _______ days, then medical attention is needed.
3 days
7 days
48
What is atrophic vaginitis?
Vaginal dryness secondary to decreased estrogen levels.
49
What is the self-care product used to treat atrophic vaginitis?
Vaginal lubricants
50
What is the MOA of vaginal lubricants?
Temporarily moistens vaginal tissue
51
What are the 5 main causes for atrophic vaginitis?
Menopause, postpartum, breastfeeding, radiation, and chemotherapy.
52
How long does it take for symptom relief when using vaginal lubricants?
Typically works immediately
53
How much vaginal lubricant should be applied?
A liberal amount should be used
54
What is the most common STI?
HPV
55
T or F: Nearly half of new STIs occur in the youth from ages 15-24 years.
True
56
What are the two incurable but vaccine preventable STIs?
Genital warts (HPV) and Hepatitis B
57
What are the 5 curable STIs?
Chlamydia, Gonorrhea, Hep C, Syphilis, and Trichomoniasis
58
What are the two noncurable STIs?
AIDs and genital herpes
59
How is HPV transmitted?
It is transmitted through sexual contact (skin to skin contact during sex).
60
HPV is the major cause for _______ cancer and _______ __________.
Cervical and genital warts
61
What is the HPV vaccine called?
Gardasil
62
How is Hepatitis B transmitted?
Transmitted through blood typically occurring through high risk sexual behaviors. Transmits through bodily fluids like blood, semen, etc.
63
What can hepatitis B cause?
It may cause hepatitis, cirrhosis, hepatic carcinoma, and death.
64
T or F: The hepatitis B vaccine is recommended as a teenager.
False. This is recommended for all infants.
65
What are the 3 different hepatitis B vaccines?
Engerix-b, Recombivax B, and Heplisav-b
66
What is the only 100% effective contraceptive method?
Abstinence
67
What is the Opill?
This is the first OTC birth control that is progesterone only.
68
What is the mechanism of action of progesterone only birth control pills like the Opill?
it inhibits ovulation by suppressing of luteinizing hormone, inhibiting sperm migration, and slowing ovum transport.
69
What are the drug interactions with the Opill?
CYP3A4 inducer
CYP3A4 inhibitors
Warfarin
70
What are the side effects if the Opill?
Fatigue, hypermenorrhea, nausea, and abdominal pain.
71
What do you do if you miss a dose of the Opill birth control?
A missed dose is anything more than 3 hours from when you normally take it. If late, immediately take the dose and use a condom. or other barrier methods for 48 hours after. Make sure to take a pregnancy test if period your period is late.
72
Will the OPill work if the egg is already fertilized?
No it will not work.
73
Who are not candidates for the OPill?
Those with history of breast cancer
Allergy to ingredients in the OPill
Currently using another birth control
Known or suspected pregnancy
Males
74
T or F: Condoms are not FDA regulated.
False. Condoms are FDA regulated
75
Which type of condom does not protect against STIs?
Natural membrane condom
76
For latex condoms, _________ based lubricants need to be used.
Water. Do not use oil as it may cause friction and lead to breakage.
77
Are female condoms an effective barrier for STIs?
Yes
78
What is the only FDA approved spermicides?
Nonoxynol-9
79
What is the MOA of spermicides?
These are surface agents that immobilize and kill sperm.
80
T or F: Spermicides does not protect against the STIs and may increase the risk.
True!
81
Is the calendar method effective for women with irregular cycles?
No. This only works if a cycle is between 26-32 days in length.
82
What is the symptothermal method?
This tracks cervical mucus with basal body temperature to look at fertile days.
83
What is a home ovulation prediction test?
This is a test that detects a surge in luteinizing hormone.
84
What is coitus interruptus?
Pulling out
85
What is the MOA of emergency contraceptives?
They delay ovulation via suppression of luteinizing hormone and prevent fertilization by inhibiting sperm migration.
86
Within what time frame must emergency contraceptives be used to be effective?
72 hours after sex and 120 hours
87
What is the class for the only OTC emergency contraceptive?
Progestin (Levonorgestrel)
88
What are the directions for use for emergency contraceptive?
Take 1.5mg PO as soon as possible within 72 hours of unprotected sex. Can be used 120 hours after unprotected sex.
89
T or F: Emergency contraceptive disrupts implanted fertilized eggs.
False. If a fertilized egg is already implanted into the uterine wall, emergency contraceptive will not work.
90
What are the drug interactions with the OTC emergency contraceptive progestin (Levonorgestrel)?
CYP3A4 inducers, inhibitors, and warfarin
91
What are the side effects of the OTC emergency contraceptive progestin (Levonorgestrel)?
Fatigue, hypermenorrhea, nausea, and abdominal pain
92
Emergency contraceptive is less effective for women greater than ________ BMI.
26
93
After taking the EC pill, use a backup method during sex for ________ days.
7
94
If vomiting occurs within ______ hours of taking an EC dose, repeat the dose.
2
95
T or F: Breastfeeding women do not need to discard breast milk after taking EC.
False. Breastmilk should be discarded for 24 hours after taking EC.
96
What is the average blood loss during a cycle?
30 mL.
Anything greater than 80mL per cycle or a cycle lasting longer than 7 days is abnormal and is associated with severe anemia.
97
What is the menstrual cycle?
The start of menses (blood flow) to the start of the next menses.
98
The follicular phase is days _____to ______ and the luteal phase is days ______ to ________ in a cycle.
1-11
18-28
99
What is the definition of dysmenorrhea?
This is painful menstruation
100
What is the cause of primary dysmenorrhea?
This is normally idiopathic and likely caused by prostaglandins but it is not fully understood.
101
What is the cause of secondary dysmenorrhea?
It is likely caused by endometriosis and is associated with pelvic pathology.
102
What is menses like for primary dysmennorhea?
It is normally a regular 28 day cycle
103
What is menses like for secondary dysmennorhea?
It is highly irregular with menorrhagia and intermenstrual bleeding.
104
When is the onset of pain for primary dysmennorhea?
Prior to or concurrent with menses (bleeding)
105
When is the onset of pain for secondary dysmenorrhea?
It varies with cause but the pain is usually very severe.
106
For primary dysmenorrhea, is there pain outside of the menstrual cycle?
No. However, in secondary dysmenorrhea there is pain present throughout.
107
Does primary dysmenorrhea respond to NSAIDs for relief?
Yes. However, it secondary dysmenorrhea is unlikely to respond to NSAIDs.
108
24 year old female presents with severe abdominal pain which she describes as menstrual cramps which started suddenly yesterday (day 3 of her period). Her last menstrual cycle was 6 weeks ago. Is she experiencing primary or secondary dysmenorrhea?
Secondary dysmenorrhea
109
19 year old smoker presents with menstrual like cramps before and during her period. The cramps last about 1-2 days and gradually improve. In addition, she experiences nausea and fatigue during her menstrual cycle. Is she experiencing primary or secondary dysmenorrhea?
Primary dysmenorrhea
110
What are the 8 exclusions for self-treatment for dysmenorrhea?
- dysmenorrhea inconsistent with PRIMARY dysmenorrhea
- HX of pelvic inflammatory disease, infertility, irregular cycles, endometriosis, and ovarian cysts
- Severe dysmenorrhea
- Change in pattern/intensity of pain
- Allergy/intolerance to NSAIDs
- Use of warfarin, heparin, or lithium
- Active GI disease (PUD, GERD, UC)
- Use of intrauterine devices
111
What are the 7 risk factors for dysmenorrhea?
1. Less than 30 years old
2. Early menses
3. Heavy menstrual flow
4. Tobacco smoking
5. BMI less than 20
6. Premenstrual symptoms
7. Low intake of fruits, veggies, etc
112
What are some non-pharm treatments for dysmenorrhea?
Heating pads, smoking cessation, increasing fish intake, and some supplements like fish oil, ginger, vitamin B1 and D, and zinc sulfate
113
What is the only OTC treatment for primary dysmenorrhea?
NSAIDs like acetaminophen, ibuprofen, and naproxen. Can be aspirin as well but no one uses it for pain relieve.
114
What is the dosing for acetaminophen?
650-1000mg every 4-6 hours
115
When taking NSAIDs for primary dysmenorrhea, should they be taken PRN or on a schedule?
On a schedule between the first 48 and 72 hours of menstrual flow.
116
What are common adverse effects associated with NSAID use?
Nausea, vomiting, and diarrhea
117
20 year old smoker presents with menstrual like cramps before and during her period. The cramps last about 1-2 days and gradually improve. In addition, she experiences nausea and fatigue during her menstrual cycle. She has not tried anything to make it better and she is allergic to motrin. Is she a candidate for self-treatment?
Technically she is not eligible for self-treatment as she has an allergy/intolerance to NSAIDs. However, you could still recommend tylenol.
118
What is premenstrual syndrome (PMS)?
This is a cyclic disorder that includes a combination of physical, emotional, mood, and behavioral symptoms during the luteal phase of the menstrual cycle.
119
T or F: The symptoms of PMS typically improve by the end of menses.
True
120
What are the diagnosis guidelines for premenstrual syndrome?
At least 1 mood or physical symptoms during the 5 days prior to menses with a mild-moderate negative effect on social functioning or lifestyle.
121
What are the diagnosis guidelines for moderate to severe premenstrual syndrome (PMS)?
At least 1 mood or physical symptom that results in significant impairment of daily activities or relationships.
122
What are the diagnosis guidelines for premenstrual dysphoric disorder (PMDD)?
5 or more symptoms are present the last week of the luteal phase with at least 1 symptom being significant depression, anxiety, lability, or anger. The symptoms interfere with life and the symptoms are absent the week after menses.
123
What is the diagnosis guidelines for premenstrual exacerbation?
Worsening of symptoms of typically psychiatric disorders.
124
What are the common side effects of PMS?
Fatigue, irritability, labile mood, abdominal bloating, breast tenderness, and headache.
125
What are the 4 exclusion for self-treatment for PMS?
-Severe PMS or PMDD
- Uncertain patterns of symptoms
- onset of symptoms coincide with start of oral contraceptives
- contraindications to specific agents
126
What are the 7 different 'supplements' that can worsen PMS symptoms?
Caffeine/Pamabrom, ammonium chloride, chastetree berry, black cohosh, st. John Wort, and ginkgo
127
What are some non-pharm treatments for PMS?
Dietary modification, exercise, stress management, light therapy, cognitive behavioral therapy, and acupuncture
128
What are supplements that may work in improving PMS symptoms?
Calcium, vitamin D, pyridoxine (vitamin b6), magnesium, and vitamin E
129
Why may calcium aid in improving PMS symptoms?
It may prevent fluctuation
130
Why may vitamin D aid in improving PMS symptoms?
It may prevent the development of PMS symptoms
131
Why may Pyridoxine (Vitamin B6) aid in improving PMS symptoms?
It may provide a therapeutic benefit
132
Why may magnesium aid in improving PMS symptoms?
It may improve affective symptoms
133
Why may Vitamin E aid in improving PMS symptoms?
It may reduce physical and mental symptoms
134
What is the OTC treatment for PMS?
It depends but it could include OTC NSAIDs like naproxen, ibuprofen, and acetaminophen as well as OTC diuretics like caffiene, ammonium chloride, and pamabrom. Combo products are also avaliable like Midol and Pamprin which contain analgesics, antihistamines, and diuertics.
135
Why might NSAIDs help with pain associated with PMS?
NSAIDs reduce headaches and muscle pain associated with PMS
136
Why might diuretics help with PMS?
OTC diuretics like ammonium chloride, caffeine, and pamabrom may help reduce bloating/swelling, water retention, and weight gain
137
What is the dosing for ammonium chloride (OTC diuretic supplement)?
1 g TID for no more than 6 days
138
What is the dosing for caffeine?
100-200 mg every 3-4 hours
139
What is the dosing for Pamabrom (OTC diuretic)?
50mg 4 times per day
140
A patient presents with PMS symptoms including muscle pain, irritability, breast tenderness, anxiety, and food cravings. The symptoms are moderate but affect her productivity at work and last about a week. She has not tried anything and has no known drug allergies. What menstrual disorder is she experiencing and is she a candidate for self-treatment?
She is experiencing PMDD and is therefore not a candidate and needs to be referred to a PCP.
141
What is toxic shock syndrome?
This is a bacterial infection caused by S. aureus characterized by high fever, profound hypotension, severe diarrhea, mental confusion, renal failure, erythroderma, and skin desquamation. It is overall an inflammatory immune response mounted against the bacteria.
142
Does black cohosh work for symptoms of menopause?
It might work as it may reduce circulating levels of luteinizing hormone and stimulate dopamine receptors that in turn oppose prolactin.
143
What is the dosing for black cohosh?
6.5-160 mg PO daily
144
What are the adverse effects of black cohosh?
GI distress is the big one. Other adverse effects include headache and dizziness.
145
The root of the tooth is right below the gum line and is covered in _______________.
Cementum. Cementum is calcified CT covering the root of the tooth and it attaches the tooth to the periodontal ligament.
146
The crown of the tooth is above the gum line and is covered it ___________.
Enamel
147
What is enamel made of?
Enamel is made up of calcium phosphate also called hydroxyapatite.
148
What is the pulp?
The pulp is the innermost layer of the tooth that contains the blood supply and nerve.
149
Do the dentin tubules interact with the tooth pulp?
Dentin tubules contain fluid and travel through the dentin and connect the pulp to the exterior cementum.
150
What are the keratinized surfaces of the oral cavity?
Gingiva, hard palate, and lips
151
What are the non-keratinized surfaces of the oral cavity?
Buccal mucosa, soft palate, floor of the mouth, and tongue
152
What are the main presenting features of a toothache?
Throbbing and constant pain that can become worse when chewing. Toothaches need to be referred to dentist and/or PCP.
153
What is the main cause of tooth hypersensitivity?
Loss of enamel and gingival recession
154
What is the pathophysiology behind tooth hypersensitivity?
Exposed dentin tubules
155
What are some things that can cause loss of enamel?
Excessive brushing, acidic foods and drinks, intrinsic acid (GERD, eating disorders), whitening strips, and teeth grinding (Bruxism)
156
What are the two things that can cause gingival recession?
Excessive brushing and periodontal disease
157
What is the referral criteria for tooth hypersensiviity?
-Toothache
-Fever or swelling
- Loose/broken teeth
-Dental restoration
- Bleeding/receding gums
158
What is the only toothbrush that should be used?
Soft bristle toothbrush
159
What is the only OTC treatment option for tooth hypersensitivity?
Desensitizing dentifrices (toothpaste)
160
What is the active ingredient in desensitizing dentifrices (toothpaste)?
Potassium Nitrate.
They can also contain fluoride.
161
What is the MOA for desensitizing dentifrices (toothpaste)?
The potassium nitrate enters dental tubules and decreases the excitability of nerves in the pulp. It also remineralizes open dentin tubules.
162
How long can someone use desensitizing dentifrices (toothpaste) before they need to be referred if there is no relief?
14 days. If no relief, refer to dentist
163
What is the age cutoff for use of desensitizing dentifrices (toothpaste)?
12 years and up.
164
Canker sores appear on ____________ tissue.
Non-keratinized
165
What is the pathophysiology behind canker sores?
It can be caused by genetics, stress, trauma, allergies, systemic disease like HIV, lupus, and vitamin deficiencies.
166
What do canker sores look like?
They are round/oval shapes with a flat/crater like appearance as well as a gray/yellow border on non-keratinzed tissue.
167
When should someone with tooth hypersensitivity be referred?
-Symptoms consistent with toothache
- fever, swelling (systemic symptoms)
- broken teeth
-dental restoration
- bleeding/receding gum line
168
When should someone be referred for a canker sore?
-Canker sore is associated with underlying pathology (HIV, etc)
- lesions are present for 14 days or more
- fever, swelling (systemic symptoms)
169
Do canker sores naturally heal by themselves?
Yes. They will naturally heal in 10-14 days.
170
What are some non-pharamcological recommendations for canker sores?
Avoid spicy, acidic, and sharp foods. Avoid toothpaste containing sodium lauryl sulfate.
171
What are the 5 different OTC treatment options of canker sores?
1. Oral debriding/wound cleansing agents
2. Topical oral protectants
3. Topical oral anesthetics
4. Oral rinses
5. Systemic analgesics
172
Why do we not give benozaine to children?
It can cause methemoglobinemia.
173
What are the 3 options for oral debriding/ wound cleansing agents for canker sore care?
Carbamide peroxide 10% (Cankaid)
Hydrogen peroxide 1.5% (peroxyl mouth rinse)
Listermine
174
What is the MOA for the oral debriding/ wound cleansing agents for canker sore care?
Release oxygen on tissue contact and foams to clean away debris and mucus.
175
What are the application guidelines for oral debriding/ wound cleansing agents for canker sore care?
Apply a few drops to AA area and let it sit for 1 minute or rinse and swish with product for 1 minute. Always use after a meal to wash out food.
176
What is the maximum time period to use oral debriding/ wound cleansing agents for canker sore care?
4 times per day for a maximum of 7 days.
177
What are the two products for canker sores that are topical oral protectants?
Canker cover and Canker melts. These are both bioadhesive patches/ dissolving disks that adhere and stick to the canker sore to protect it and they may increase healing time.
178
What is the MOA for topical oral protectants for canker sores?
There is no pharmacological activity here even though some contain anesthetics. They only cover and protect the canker sore.
179
These canker cover brands like Canker Cover and CankerMelts say they may increase ______________ time for a canker sore.
Recovery
180
What is the maximum amount of time for the use of topical oral protectants for canker sores?
2-3 times daily for maximum 7 days.
181
What is the main option for topical oral anesthetics to reduce pain from a canker sore?
Benzocaine (can also use phenol, camphor, or menthol)
182
A downside to the use of a topical oral anesthetic like benzocaine is that the pain relief is ___________________.
Short lived. Only about 15-30 minutes of relief.
183
T or F: Benzocaine is recommended for teething pain.
False. It is NOT recommended for teething pain.
184
What is the maximum amount of time that benzocaine can be used for pain relief in canker sores?
Maximum 3-4 times per day for 7 days.
185
What is benzalkonium chloride?
It is an antiseptic agent that is used in some canker sore products to clean the area. It is more likely to be used for cold sores though.
186
If someone presents with a ____________, they always need to be referred.
Toothache. Toothache presents with a dull, throbbing, and constant pain.
Can recommend OTC systemic analgesic or OTC topical anesthetic while they wait for dentist though.
187
A patient presents with a canker sore, what are you recommending to them?
First a debriding agent to clean it after meals and an oral protectant for in between meals. Could also suggest a topical anesthetic.
188
What is the pathophysiology behind a minor oral mucosal injury?
It is a wound in the mouth caused by dental procedures, and accidental injuries like biting your cheek or eating sharp foods.
189
When should a person with a minor oral mucosal injury be referred?
-severe pain
- fever, swelling (systemic signs of infection)
- Symptoms persist for 7 or more days or the symptoms get worse
190
What is the OTC treatment for a minor oral mucosal injury?
The same treatment as a canker sore. Offer oral debriding agents, possible canker sore covers, and topical anesthetics.
191
Cold sores appear on ______________ tissue.
Keratinized
192
T or F: Canker sores are contagious but cold sores are not.
False. Cold sores are very contagious while canker sores are not contagious.
193
What virus causes cold sores?
Herpes simplex labialis (HSV-1 typically)
194
How are cold sores spread?
Via direct contact. They can stay active on surfaces for several hours too.
195
Where does the dormant herpes simplex labialis hang out in the body?
Trigeminal ganglia
196
What are some common reactivation triggers for herpes simplex labialis?
UV light, stress, fever, menstruation, anything decreasing immune system function.
197
T or F: Canker sores are often preceded by a prodromal period. This period is typically 1-2 days before the canker sore appears.
False. Cold sores are often preceded by a prodrome period, not canker sores.
198
What is the average duration of a cold sore?
They are self-limiting and typically go away after 10-14 days.
199
Are secondary infections possible with cold sores?
Yes. Pus might fill the inside of the lesion. Neosporin can be used to control the local infection.
200
When should someone with a cold sore be referred to a PCP?
-Lesions present for 14 days or more
- Compromised immunity (HIV, immunosuppressant therapy)
- Signs of systemic infection (fever, swelling, malaise)
201
What are some non-pharmacological recommendations for someone with a cold sore?
Avoid cold sore trigger, keep it clean, wash hands, do not share glasses, food, kisses, and keep it moist.
202
What is the only medication that can be used for cold sores if started during the prodromal period?
Abreva
203
For the use of protectants and topical analgesics for cold sores (benzocaine and lidocaine products basically), what is the age cut-off?
2 years and older can use.
204
How often should protectants and topical analgesics for cold sores be applied?
3-4 times daily PRN
205
What is the only topical antiseptic for cold sores?
Benzalkonium 0.13% (Just Bactin)
206
What are the application guidelines for the benzalkonium for cold sores?
Apply 1-3 times per day for up to 7 days. Use in those 2 years and older.
207
What is the only real pharmacological therapy for a cold sore that is FDA approved to shorten duration and severity of symptoms?
Docosanol 10% (Abreva)
208
What is the MOA for docosanol 10% (Abreva)?
It inhibits the fusion of HS to human cell membranes so it stays under the surface of the skin.
209
What are the application guidelines for Docosanol 10% (Abreva)?
Apply 5 times daily for up to 10 days or until healed. Do not use in those 12 and younger.
210
T or F: Hydrocortisone cream is a good option for cold sores as it relieves symptoms like itching and burning.
False. NEVER USE HYDROCORTISONE FOR COLD SORES!!!!!! It suppress the immune system even more.
211
What ointment can be used for a secondary infection of a cold sore?
Neosporin (polysporin if there is an allergy)
212
Which supplement day helps to decrease the frequency of cold sore outbreaks?
Lysine
