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Exam 2 Flashcards

1
Q

BMI Classification: Obesity

A

> 30 mg/kg2

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2
Q

BMI Classification: Overweight

A

25.0-29.9 mg/kg2

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3
Q

Treatment goal for obese: lose __% of total weight over _____. Average ____ lbs/wk.

A
  • 10%, 6 months
  • 1-2 lbs/wk
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4
Q

How many calories equal to 1 lb of weight gain?

A

3500 calories

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5
Q

Pharmacological therapy is appropriate if BMI ____, or ____ with ___ of co-morbid conditions

A
  • 30
  • 27 with 2 co-morbidities
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6
Q

OTC medication for weight loss: Name, dose, must take ____ when?

A
  • Alli
  • 60 mg with a fat containing meal, up to 3 doses daily
  • Multivitamin at bedtime or 2 hrs from Alli dose
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7
Q

Urinary incontinence type: stress

A
  • Involuntary leakage with sudden increase in abdominal pressure
  • Urine leakage triggered by physical activity: cough, exercise, laugh, sneeze
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8
Q

Urinary incontinence type: overflow

A
  • Over-distention of the bladder
  • Decreased or incomplete urine stream
  • Causes: obstruction (BPH) or dysfunctional bladder (diabetic/alcoholic)
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9
Q

Urinary incontinence type: urge (= overactive bladder)

A
  • Frequency >8 times/day
  • Nocturia
  • Inability to reach toilet following urge to void
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10
Q

Urinary incontinence type: functional

A
  • Urine loss due to physical or cognitive impairment
  • Interferes with a person’s ability to reach toilet facilities
  • Causes: stroke, diminished mobility
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11
Q

Urinary incontinence type: mixed

A
  • Overactive bladder + stress
  • More common in women
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12
Q

Urinary incontinence risk factors: medical disorders/procedures

A
  • BPH, TURP, prostatectomy
  • Diabetes
  • Obesity
  • Pregnancy
  • Stroke
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13
Q

Urinary incontinence risk factors: physiologic factors

A
  • Estrogen depletion
  • High/low fluid intake
  • Pelvic floor muscle weakness
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14
Q

Urinary incontinence risk factors: lifestyle factors

A
  • Smoking, high-impact physical activities (running, jumping jacks)
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15
Q

Urinary incontinence risk factors: others

A
  • Caucasian race
  • Environmental barriers
  • Medication
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16
Q

Medications that impact incontinence

A
  • Anticholinergics
  • Antidepressants (SSRIs, SNRIs)
  • Hypnotics/sedatives
  • Antipsychotics
  • Narcotics
  • Muscle relaxants
  • Antihypertensives (ACEi, ARBs)
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17
Q

Urinary incontinence: non-pharmacologic tx

A
  • Behavioral modification: toileting assistance, bladder training, pelvic floor muscle training
  • Supplies: urinary catheters, absorbent pads, undergarments for protection
  • Surgical = last line
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18
Q

Urinary incontinence: pharmacologic tx indication, SEs, DDIs, Counseling points

A

Oxybutynin transdermal patch
- Indication: overactive bladder/urge incontinence for women
- SEs: constipation, nausea, xerostomia
- DDIs: minor CYP3A4 substrate, acetylcholinesterase inhibitors
- Counsel: use when UI symptoms >3 months, do NOT cut the patch, rotate site of application, do NOT expose to sunlight, refer to HCP if no improvement after 2 weeks

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19
Q

Complementary therapies for UI

A
  • Pumpkin seed oil
  • Vitamin
  • Cranberry
  • Glycine
  • Acupuncture (limited data)
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20
Q

BP monitors: potential confounding factors

A
  • Stress
  • Tobacco use
  • Caffeine <60 mins prior to usage
  • Medications such as pseudoephedrine
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21
Q

BP monitors: wrist and finger monitors

A
  • Not as accurate
  • Finger: not recommended
  • Wrist: for obese patients
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22
Q

BP monitors: counseling points

A
  • Assess any physical impairments to use the machine
  • Importance of keeping track of BP values
  • Medication adherence and healthy lifestyle choices
  • Demonstrate proper technique to patients
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23
Q

Covid test if (+):

A
  • Highly reliable/accurate
  • Standard precautions to prevent spreading of disease (mask, social distancing)
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24
Q

Covid test if (-):

A
  • Cannot rule out infection
  • Need a PCR test or 2 (-) antigen tests that are 48 hrs apart
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25
Covid test counseling points
- Rotate the swab in the second well prior to closing the card - once the nasal swab sample is collected, immediately perform the test - Ensure the pt is putting an adequate amount of extraction buffer on the sample - Patient should be tested within the first 5-7 days of symptoms - Emphasize the importance of preventing the spread
26
HIV routes of transmission
- Needle exchange - Sexual intercourse - Born to a mother infected with HIV - Blood transfusion between 1978 to 1985
27
HIV test possible confounders
- Blood: inadequate blood sample - Saliva: inadequate swabbing of gums, eating/drinking/using oral care products 30 mins prior to starting test
28
HIV test if (+):
- Contact HCP for confirmation - Counsel pt on precautions to avoid spreading infection
29
HIV test if (-):
- Confirm **sufficient time** has passed since potential exposure (saliva: 30 mins)
30
HIV test counseling points
- Determine if the elapsed time since possible exposure to the virus before recommending an HIV test - Blood: fragility of blood samples -> **not to delay** mailing the specimen card, apply enough blood - Saliva: adequate swabbing gums, 30 mins time frame
31
HCV: CDC recommends that all adults born _______ should be screened for HCV
- between 1945 to 1965 ("baby boomers")
32
HCV tests for the presence of HCV _____, not the ____
- Antibodies; virus
33
HCV test results are typically available ____ days after the sample is received
2 to 7 days
34
HCV tests confounding factors
- Inadequate blood samples - Immunosuppressant therapy: may not be able to produce sufficient levels of antibodies (ex., steroids)
35
HCV test if (+):
- HCP for evaluation - Follow up with a HCV RNA test
36
HCV tests counseling points
- Pt recently infected (<6 months) may receive a false(-) result -> retest - Fragility of blood samples -> **not to delay** mailing the specimen card - Medical disorders that might rule out the use of a fingerstick-based test or physical limitations that may interfere with performing the test
37
UTI risk factors
- Diabetes - Urinary stones/obstructions - Pregnancy - Anatomical differences: females much shorter urethral (more inflammation possibility) than males - Presence of urinary catheters
38
UTI tests detect both ___ and ___
- Nitrite; leukocyte esterase
39
UTI tests possible confounders
- Strict vegetarian diet = false (-) - Phenoazopyridine = false (+) - Tetracyclines - Vitamin C >250 mg
40
UTI test if (+):
Contact HCP immediately for assessment & treatment
41
UTI test if (-):
Contact HCP if symptoms persist
42
UTI counseling points
- Collect clean sample - If symptoms present, contact HCP - Diet and medications may potentially interfere with results - OTC UTI detect only ~90% of infections - Visual difficulties should be advised to seek assistance in interpreting test results
43
Substance abuse tests: clinical presentation
Fatigue, red eyes, drowsiness, slurred speech, chronic cough, withdrawal from normal acticities
44
Substance abuse tests: urine test detects ____ vs hair test detects ____
- Urine: low level, casual drug use (+: absence of line, -: presence of line) - Hair: longer-term drug use
45
Substance abuse tests potential confounders
Codeine, poppy seeds, decongestants, dextromethorphan, anti-diarrheal agents
46
Substance abuse tests if (+)
Consider if any potential problems with test used
47
Substance abuse test if (-)
Cannot assume accuracy
48
Substance abuse test counseling points
- Limitations of the tests for confirming drug use and for identifying anything other than intended use - Length of time of suspected drug and type of drug used - Seek HCP advice and family counseling services - Potential confounders such as legal rx or non-rx medications that the pt may already be taking
49
Pregnancy tests detect ____, which may be present as early as ____ after conception
human chorionic gonadotropin (hCG); day 7
50
Pregnancy test accuracy and when to use
- Will detect 95% of pregnancies - Use first morning urine bc that's when hCG is the most concentrated
51
Pregnancy tests: false (+) may be a result of
- Miscarriage or birth within previous 8 weeks - Ovarian cysts - Ectopic pregnancy - Perimenopausal
52
Pregnancy tests if (+)
- Contact HCP ASAP - Check if pt is on teratogenic medication (ex., methotrexate)
53
Pregnancy tests if (-)
Review procedure to ensure appropriate testing; test again in 1 week
54
Pregnancy tests counseling points
- Emphasize **how and when to use** the test: wait at least 1 week after the date of the expected period, morning urine, avoid getting up during the night to urinate - Potential confounding factors can cause inaccurate results - Seek medical attention if the 2nd test is (-) & menstruation has not begun
55
Insomnia exclusions for self-tx
- <12 yo - >= 65 yo - Pregnant or breastfeeding - Frequent nocturnal awakenings or early morning awakenings - Chronic insomnia (>=3 months) - Sleep disorder secondary to psychiatric or general medical disorders - Significant sleep disturbances as defined by sleep-onset latency, WASO, sleep efficiency, &/or total sleep time
56
Insomnia nonpharmacologic therapy
**Good sleep hygiene** - Only use bed for sleeping - Regular sleep pattern (including weekends) - Make the bedroom comfortable for sleeping: cooler temp, minimum/white noise, minimum light - Engage in relaxing activities before bedtime - Avoid daytime napping or limit to 20-30 mins - If unable to fall asleep after more than 20 mins, do not continue to try to sleep -> get out of bed and perform a relaxing activity until you feel tired - Do not watch the clock at night
57
Insomnia pharmacologic therapy: diphenhydramine effects, recommended uses
- Effects: decrease time to fall asleep, improves quality of sleep - Uses: transient insomnia, occasional sleep problems, NOT for chronic bc may develop tolerance - Preferred agent
58
Insomnia pharmacologic therapy: doxylamine effects, recommended uses
- Effects: decrease time to fall asleep, improves quality of sleep - Use: same as diphenhydramine; transient insomnia, occasional sleep problems, NOT for chronic bc may develop tolerance
59
Insomnia pharmacologic therapy: antihistamine warnings/precautions
- Benign Prostatic Hyperplasia (BPH): may cause urinary retention - Glaucoma: may increase intraocular pressure - Dementia/Cognitive impairment: may increase confusion, decrease cognition - Cardiovascular disease: may increase HR
60
Insomnia pharmacologic therapy: antihistamine AEs
- Sedation - "Hang over" effect - Anticholinergic effects: dry mouth, constipation, blurred vision, dizziness, urinary retention
61
Insomnia pharmacologic therapy: antihistamine use in special populations (elderly, pregnant/lactating women, children)
- Elderly: sleep changes with age, avoid due to increased risk of falls & cognitive impairment - Pregnant: category B for safety - Lactating women: continuous use increases CNS effects in infants - Children: paradoxical rxn
62
Insomnia pharmacologic therapy: ethanol effects, AEs
- Effects: decrease time to fall asleep - AEs: tolerance, restless sleep (nocturnal awakenings and reduction in overall sleep duration), rebound insomnia with cessation
63
Insomnia complementary therapies: melatonin effects, uses, beneficial for ___
- Effects: helps with falling asleep - Use: chronic insomnia, jet lag - Beneficial for elderly & depressed pts
64
Insomnia complementary therapies: valerian effects, use, warnings/precautions
- Effect: decrease time to fall asleep by increasing GABA - Use: chronic insomnia - Should tapered off with regular use to avoid benzodiazepine-like withdrawal syndrome, cardiac, hepatotoxicity risk with chronic use
65
Insomnia complementary therapies: kava effects, use, AEs
- Effects: decreases time to fall asleep by increasing GABA, inhibit MAO, NE, DP - Use: chronic insomnia - AE: significant drowsiness and dizziness, hepatotoxicity, blood dyscrasias
66
Insomnia complementary therapies in special populations (elderly, pregnant/lactating women, children)
- Elderly: limited data, melatonin OK - Pregnancy: avoid melatonin, valerian - Lactating: limited data - Children: melatonin may cause changes in hormonal levels
67
Drowsiness and Fatigue (DF) symptoms
- Feeling foggy or woozy - Being responsive but not fully alert - Having dream like thoughts
68
DF exclusions for self-tx
- <12 yrs - Pregnant or breastfeeding - Heart disease - Anxiety disorders - Medication induced drowsiness - Chronic fatigue defined as >=6 months of fatigue
69
DF nonpharmacologic therapy
Good sleep hygiene
70
DF pharmacologic tx: caffeine effects, AEs, warnings/Precautions
- Effects: improves wakefulness by inhibiting adenosine A1 and A2A receptors -> adenosine promotes sleep - AEs: HTN, tolerance, withdrawal, sleep disturbances - W/P: CV
71
DF pharmacologic tx: caffeine dose-related SEs (low, moderate, high dose)
- Low: increased arousal, decreased fatigue, elevates mood - Moderate: increased HR, BP - High: anxiety, nausea, jitteriness, nervousness
72
DF complementary therapy: ginseng effects
- Boosts physical and mental energy - Decreases impotence
73
DF therapies in special populations (elderly, pregnant/lactating women, children)
- Elderly: prolonged t1/2 - P/LW: limit to <200mg/day to decrease risk of preterm birth or infant irritability - Children: more susceptible to CV and CNS effects
74
Insomnia & DF: refer to PCP if symptoms persist ____ days
>7-10 days
75
Adult Nutrition (AN): causes of deficiency -> inadequate intake
- Alcohol absorption - Vegetarian diet - Eating disorders
76
AN: causes of deficiency -> disease conditions
- Crohn's disease - Surgical resection - Bacterial overgrowth
77
AN: causes of deficiency -> malabsorption
- From food - Lack of intrinsic factor - Lack of parietal cells
78
AN: Estimated Average Requirement (EAR) is
Average intake level estimated to meet the nutrient requirements of 50% of healthy people
79
AN: Recommended Dietary Allowance (RDA) is
Average daily level of intake sufficient to meet the nutrient requirements of nearly all 97.5% healthy people
80
AN: Adequate Intake (AI) is
Established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy based on observation
81
AN: Tolerance Upper Intake Level (UL) is
Maximum daily intake unlikely to cause adverse effects
82
AN: Stages of vitamin deficiency
1. Inadequate nutrient delivery or absorption 2. Depletion of nutrient stores 3. Biochemical changes 4. Physical manifestation of deficiency 5. Morbidity and death
83
AN: vitamin and mineral deficiency clinical presentation of nails, hair, mouth, other
- Nails: lack of luster to nail surfaces - Hair: loss and thin texture - Mouth: stomatitis, glossitis, pale gums, poor dentition - Other: visible goiter, poor skin color/texture, obesity/thinness, edema
84
AN: deficiency lifestyle modification
- Consuming a **balanced diet** with food from all energy sources - Variety of **nutrient-dense foods** in moderate portion sizes
85
AN: purpose of supplementation and what supplements are **NOT** intended for
- Prevent nutritional deficiencies - Replenish compromised nutrient stores - Maintain present nutritional status - **NOT** intended for self-tx for deficiency
86
AN: what are vitamins?
- Nutrients that cannot be synthesized in the body in sufficient quantities and **must be obtained through diet** - Used as dietary supplements and therapeutic agents to **treat deficiencies** or other conditions
87
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin A**
- F: visual adaptation to darkness, maintenance of epithelial cells, immune function, embryonic development, skin health - SD: night blindness, loss of appetite, impaired taste/smell - SC: hepatotoxicity, hypervitaminosis A, retinol (teratogenic at high doses) - FS: _carotenoids_ (carrots, leafy greens, apricots, peaches), _retinol_ (fatty fish, liver, meats, dairy, egg yolk)
88
AN: Function, signs of deficiency, safety considerations, sources of **Vitamin D**
- F: bone formation and mineral homeostasis - SD: fatigue, bone pain, muscle weakness, rickets in children, osteoporosis in adults - SC: hyperCa, soft tissue calcification, kidney stones - S: red meat, egg yolks, fatty fish (tuna, salmon), sun exposure
89
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin E** (tocopherol)
- F: antioxidant that protects cellular membranes from oxidative damage - SD: peripheral neuropathy, intermittent claudication, muscle weakness - SC: risk of bleeding/hemorrhagic stroke, increased risk of mortality (elderly with CVD) - FS: vegetable oils, nuts, seeds, leafy greens, fortified cereals
90
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin K** (phytonadione)
- F: synthesis of clotting factors 2, 7, 9, 10 & anticoagulation proteins C, S - SD: increased/prolonged bleeding, elevated INR - SC: consistent dietary intake should not interfere with warfarin activity, changes to supplemental intake can significantly alter INR - FS: leafy greens (spinach, kale, swiss chard, brussel sprouts, broccoli)
91
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin C** (ascorbic acid)
- F: precursor of collagen/osteoid/dentin, aids in wound healing, absorption of iron, immune function, common cold symptoms - SD: scurvy, fatigue, petechiae, swollen gums, may impair wound healing - SC: nausea, cramps, diarrhea, kidney stones, may interact with continuous glucose monitor if >500mg/day - FS: citrus, tomatoes, strawberries, broccoli, potatoes, kiwi, brussel sprouts, red/green peppers
92
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin B12** (cyanacobalamin)
- F: RBC formation, cell metabolism, nerve function and the production of DNA - SD: neuropathy, mental confusion, agitation, poor muscular coordination, pernicious anemia - SC: excessive doses have not resulted in toxicity - FS: beef, fish, milk, cheese, eggs
93
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin B9** (folic acid)
- F: cell devision/DNA production/brain & spinal cord development, women of child-bearing age should consume daily (prevent neural tube defects) - SD: soreness/ulcerations in mouth, diarrhea, irritability, forgetfulness - SC: excessive doses have not resulted in toxicity; may reduce efficacy of methotrexate used for cancer - FS: broccoli, brussel sprouts, leafy greens, chickpeas, kidney beans
94
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin B6** (pyridoxine)
- F: heme & GABA production, heals with pregnancy-induced N/V - SD: peripheral neuropathy, oral lesions, scaliness of skin, dulled mentation - SC: may be toxic at high doses, causes sensory neuropathy - FS: pork, chicken, turkey, peanuts, oats, bananas
95
AN: Function, signs of deficiency, safety considerations, food sources of **Vitamin B1** (thiamine)
- F: necessary for myocardial function, nerve cell function, CHO metabolism - SD: peripheral neuritis, weakness, Wernicke's encephalopathy - SC: X toxicity - FS: whole grains, pork, fish, beans, lentils, green peas, sunflower seeds
96
AN: Function, signs of deficiency, safety considerations, food sources of **Calcium**
- F: muscle contraction/relaxation, catalyze activation of plasma clotting factors, supplementation often used in osteoporosis - SD: bone deformities, behavioral disorders, growth deficiencies - SC: renal stones, permanent renal damage, N/V, constipation, polyuria - FS: milk, cheese, dairy products, leafy green
97
AN: which calcium formulation is acid-dependent?
Calcium carbonate
98
AN: Function, signs of deficiency, safety considerations, food sources, interactions of **Iron**
- F: oxygen and electron transport - SD: blood loss, spoon shaped nails, sore tongue, dyspnea on exertion - SC: abdominal cramps, N/V, constipation, dark colored stools - FS: _heme_ (beef, chicken, organ meats, oysters, clams, mussels), _non-heme_ (beans, lentils, spinach, nuts, fortified cereals - I: separate 2-4 hrs from tetracyclines, fluoroquinolones, bisphosphonates, levothyroxine
99
AN: Function, signs of deficiency, safety considerations, food sources of **Magnesium**
- F: bone structure formation, maintenance of nerve and muscle electrical potentials - SD: neuromuscular irritability, increased CNS stimulation, delirium, convulsions - SC: diarrhea may occur with large doses, muscle weakness, lethargy - FS: almonds, cashews, peanuts, spinach, pumpkin seeds
100
AN: what are functional foods (FF)?
- Foods claimed to have **additional function** by adding new ingredients or increasing amount of existing ingredients - Foods in which concentration of one or more ingredients has been altered to **enhance the nutrient content**
101
AN: FF claim categories - Authorized Health Claims
- Require publication of FDA regulation after extensive review of literature - Undergo the most thorough review by the FDA and meets **significant scientific agreement** - Cannot quantify degree of risk reduction and the terms **"may"** or **"might"** **must** be used
102
AN: FF claim categories - Qualified Health Claims
- Level of evidence does **not** achieve **"significant scientific agreement"** but evidence of health benefits is still emerging - Require specific "qualifying terms" by the FDA
103
AN: FF claim categories - Structure-Function Claims
- FDA authorization is **not** required before use - Prior notification of FDA regarding the claim **is** required - **Cannot** claim to reduce risk or cure disease
104
AN: exclusions for self-care enteral formulas
- Organ dysfunciton - GI dysfunction - Significant unintended weight loss - Disease states affected by diet (DM, COPD)
105
Oral: Caries - nonpharmacologic therapy -> dietary measures
- Avoid cariogenic foods: >15% sugar, clings to teeth, remain in mouth after chewed - Replace with non-cariogenic foods: high water content, stimulate saliva flow, high protein
106
Oral: Caries - nonpharmacologic therapy -> toothbrush
- Brush for **2** mins, **2** times daily - **Soft** - Replace every **3 months**
107
Oral: Caries - nonpharmacologic therapy -> dental floss
- At least **once** daily - Requires finger dexterity and practice - Waxed, unwaxed forms - Removes interdental plaque - Reduce gingival inflammation - Prevents caries
108
Oral: Caries - nonpharmacologic therapy -> oral irrigating devices
- Direct high-pressure stream of water to the tooth surface - Remove minimal amount of plaque - **Not** a substitute for brushing or flossing - Will remove loose debris
109
Oral: Caries - pharmacologic therapy -> Fluoride Dentifrices
- Preventing and treating carious lesions - Children at risk of dental fluorosis ( <6: only by dentist, 6-12: supervise usage)
110
Oral: Caries - pharmacologic therapy -> Astringent
Neutralize odoriferous sulfur compounds produced in the oral cavity
111
Oral: Caries - pharmacologic therapy -> Demulcent
Provide protective film coating soothing to oral mucosa
112
Oral: Caries - pharmacologic therapy -> Antibacterial
Fight pathogenic bacteria
113
Oral: Caries - Listerine usage
- Prevent and reduce plaque and gingivitis - Rinse with 1-2 tablespoons BID for about 30 secs after brushing - Avoid smoking, eating, or drinking for 30 mins after use
114
Oral: Caries - Mouth rinse safety
- May cause oral epithelium sloughing if containing: phenol oils, methyl salicylate, alcohol - Do not use in children <6 yrs - C/I: unsupervised use in mouth irritation or ulcerations
115
Oral: What is Xerostomia?
Salivary flow limited or lacking = dry mouth
116
Oral: Xerostomia - causes (medications, conditions, other)
- Anticholinergics (antihistamines, antidepressants, antipsychotics), reduced salivary flow volume (antiHTN, diuretics), dries secretions (decongestants) - Sjogren syndrome, DM, depression, Crohn's disease, radiation therapy of head/neck - Alcohol, tobacco, caffeine, spicy foods, mouth breathing
117
Oral: Xerostomia - clinical presentations
- Difficulty talking and swallowing - Stomatitis and burning tongue - Halitosis - Loss of appetite - Tooth hypersensitivity and caries, gingivitis, candidiasis
118
Oral: Xerostomia - nonpharmacologic therapy
- Avoid "drying" substances - Take culprit medications before meals (natural saliva stimulation) - Limit sugary, starchy, acidic foods - Chewing gum with sugar alcohols - Increase water intake - Cool mist humidifiers
119
Oral: Xerostomia - primary pharmacologic therapy
Artificial saliva - Mimics natural saliva - Does not stimulate saliva secretion - Can be used as needed
120
Oral: Xerostomia - counseling and referral
Counseling: - Practice good oral hygiene - All populations can use artificial saliva - Caution for sodium and preservatives (HTN) Referral - Self treat for up to 7 days: refer if no improvement - Candidiasis, gingivitis, periodontitis - Loose, broken, knocked out teeth - Fever, swelling, severe pain - Sjogren syndrome
121
Oral: what is gingivitis?
Reversible inflammation of the gums
122
Oral: Gingivitis - causes
- CCBs, cyclosporine, phenytoin - Medications contributing to xerostomia - Tobacco use - Pregnancy
123
Oral: Gingivitis - prevention
- Antiplaque products and good oral hygiene - Can be cured with regular brushing and flossing: can return with poor care
124
Oral: Gingivitis - patient counseling
- Mild, reversible form of periodontal disease - Proper oral care is important for prevention and treatment - Can lead to worse periodontal disease and tooth loss if untreated
125
Oral: what is tooth or dentin hypersensitivity?
Short, sharp pain arising from exposed dentin
126
Oral: tooth or dentin hypersensitivity - predisposing factors
- Periodontitis patients - Post dental procedures - Whitening treatments - Clenching or grinding teeth
127
Oral: tooth hypersensitivity exclusions for self-treatment
- Toothache - Mouth soreness associated with poor-fitting dentures - Fever or swelling - Loose teeth - Bleeding gums in the absence of trauma - Broken or knocked-out teeth - Severe tooth pain triggered or worsened by hot, cold, or chewing - Trauma to the mouth with bleeding, swelling, and soreness
128
Oral: tooth hypersensitivity - nonpharmacologic therapy
- Identify and eliminate predisposing factors (acid exposure, improper brushing technique) - Avoid brushing teeth within 30-60 mins of consuming acidic foods or drinks - Use soft bristle toothbrush
129
Oral: tooth hypersensitivity - pharmacologic therapy
- Brush with fluoride toothpaste for 7 days - if unresolved: desensitizing dentrifrices
130
Oral: tooth hypersensitivity - desensitizing dentrifrices patient education
- Use plaque removal brushing practices - Relief of sensitivity will not occur with single application - Use for 2-4 weeks may be needed - Avoid in children <12 yo - Do not use high-abrasion toothpastes
131
Oral: What is Recurrent Aphthous Stomatitis (RAS)?
- "Canker sore" - Female predominance - Affects nonkeratinized mucosa - Self-limiting 10-14 days
132
Oral: RAS causes
- Stress - Local trauma: smoking, chemical irritation, biting inside of cheeks/lips, injury caused by tooth brushing or braces - Genetic - Gluten food allergy - Hormonal changes - Medical conditions: Lupus, Neutrophil dysfunction, nutritional deficiencies (B1,2,6,12, folic acid, iron), IBD, HIV/AIDS
133
Oral: RAS clinical presentation
- Epithelial ulceration: movable oral mucosa - Common in tongue, floor of the mouth, soft palate, inside lining of the lips or cheeks
134
Oral: RAS nonpharmacologic therapy
- Food allergy: avoid - Supplement nutritional deficiencies - Apply ice in 10 min increments for max 20 mins/hr - Avoid: spicy/acidic foods, food activities that can cause trauma, heat
135
Oral: RAS pharmacologic therapy - cleansing
- Oral debriding and wound cleansing agents - No FDA approved product - Apply directly up to QID =<7 days, for 1 min
136
Oral: RAS pharmacologic therapy - cleansing products and safety
- Carbamide peroxide, hydrogen peroxide - Soft tissue irritation, enamel decalcification, cellular changes, black/hairy tongues
137
Oral: RAS pharmacologic therapy - pain relief
- Topical oral anesthetics - Benzocaine: temporary pain relief, caution hypersensitivity
138
Oral: RAS pharmacologic therapy - oral rinses
- Saline rinses: soothe discomfort, help prepare for topical medication - Baking soda paste: sooth discomfort, apply to area for a few mins
139
Oral: RAS pharmacologic therapy - product selection
- Hypersensitive pts avoid anesthetics (benzocaine) - Gel products = preferred - Debriding agents + anesthetics = help with pain and heal the lesion quicker - 7 days or until lesion is gone - Proper dental hygiene care
140
Oral: teething - symptoms
- Irritability - Sleep disturbances - Excessive drooling - Reddening - Low-grade fever - Slight swelling of gums
141
Oral: teething - nonpharmacologic therapy
- Massage the gum around the erupting tooth - Chew on: cold teething ring, cold wet cloth, dry toast, teething cookies - Plan dental check-up within 6 months of teething event + no later when child turns 1 yo
142
Oral: teething - pharmacologic therapy
- Avoid topical teething products in peds: no benzocaine in <2 yo - OTC topical anesthetic: APAP 10-15 mg/kg Q4-6H PRN, max 5 doses
143
Oral: teething - when to seek medical attention
- N/V - Diarrhea - Fever - Nasal congestion - Malaise - Symptoms not relieved with 2 days
144
Oral: what is Herpes Simplex Labialis (HSL)?
- Cold sores or fever blisters - Typically caused by HSV-1 - Self-limiting 10-14 days
145
Oral: HSL - triggers
UV radiation, stress, fatigue, cold, windburn, fever, injury, menstruation, dental work, infectious disease, immune suppression
146
Oral: HSL - clinical presentation
- Recurrent, painful, cosmetically objectionable - Prodromal phase - Initially: small, red, fluid filled papule - Lesion -> Crust forms - Pus under the crust: refer if secondary bacterial infection
147
Oral: HSL - nonpharmacologic therapy
- Wash hands - Maintain clean lesions: gently wash with mild soap solutions - Keep lesions moist to prevent drying - Avoid triggers - Use lip balm with SPF
148
Oral: HSL - topical skin protectants
- Relieve discomfort + dryness - Protect lesions from infection - Keep lesions soft - TID-QID after meals - No reduction of symptom duration
149
Oral: HSL - topical anesthetic/analgesics
- Symptomatic discomfort relief (burning, itching pain) - Does **NOT** reduce duration of symptoms
150
Oral: HSL - Docosanol (Abreva)
- Only FDA approved product to reduce duration + symptom severity - Apply at 1st sign of outbreak for 5 days until lesion is healed
151
Oral: HSL - patient education
- Secondary bacterial infection prevention: apply thin layer of topical triple-antibiotic ointment TID-QID - C/I: do **not** use topical steroids for HSL
152
Acne cosmetica is
Noninflammatory, cosmetics, moisturizers, pomades, health/beauty products
153
Acne excoriee is
Constant picking, squeezing, scratching at the skin
154
Acne mechanica is
Local irritation from clothing, headbands, helmets, other devices
155
Chloracne is
Acneiform eruption caused by exposure to chlorine compounds
156
Drug-induced acne is
Anabolic steroids, bromides, corticosteroids, corticotrophin, isoniazid, lithium, phenytoin
157
Hormone-induced acne is
Increased androgen levels
158
Hydration-induced acne is
High-humidity environments and prolonged sweating
159
Occupational acne is
Dirt, vaporized cooking oils, certain industrial chemicals
160
Acne: nonpharmacologic therapy
- **Do**: cleanse skin with non-abrasive, mild soap but no more than twice daily, hydrate, facial toners - **AVOID**: exacerbating factors, foods in high glycemic index
161
Acne: pharmacologic therapy - Adapalene
- >12 yo, first-line, thin layer once daily, protect from sun exposure - Diminishes after 1st month, full effect up to 3 months - Refer to PCP: worsen in 3 months, pregnant, allergic rxn
162
Acne: pharmacologic therapy - Benzoyl Peroxide
- >12 yo, 2-10% similar efficacy, avoid contact with clothes/hair due to bleaching - Results within 5 days to 3 weeks, up to 3 months, for adults and peds
163
Acne: pharmacologic therapy - Sulfur
- Natural glycolic, lactic, citric acids, less potent → longer duration (once every 15 days for 4-6 months) - For pts who cannot tolerate other topical acne products - Less AEs, have moisturizing and humectant properties - Provides protection from the sun, inhibits UVB radiation-induced formation of sunburn cells
164
Acne: pharmacologic therapy - Hydroxic acids
- For pts who cannot tolerate other topical acne products - Scarring and hyperpigmentation
165
Acne: Product selection for mild acne oily vs dry skin
- Oily: gel - Dry: cream and lotion
166
Acne: Exclusion criteria for self-tx
- Moderate-severe acne, exacerbating factors (comedogenic drugs, mechanical irritation), possible rosacea
167
Fungal Infection (FI): Tinea pedis
- Foot - Malodor pruritus/stinging sensation on feet, toe webs - Aggravation comes from warmth and humidity
168
FI: Tinea unguium
- Nail beds - Lose normal shiny luster → opaque - If left untreated, become thick, rough, yellow, opaque, friable - Can lose nail
169
FI: Tinea corporis
- Ringworm - Small, circular, erythematous scaly areas - Spread peripherally
170
FI: Tinea cruris
- Jock itch - More common in males - Bilateral, spare the penis and scrotum - Bright red, fine scaling
171
FI: Tinea capitis
- Scalp - Black dot
172
Fungal skin infections: location, S/S, severity, onset, cause, modifying factors
- L: areas of body where moisture is - S/S: soggy malodorous, thickened skin, cracks/fissures may be present, itching, pain - Severity: localized to single region, but could spread - Onset: variable - Cause: superficial fungal infection - MF: nonrx agents
173
Fungal skin infection: general duration of treatment; when to refer to PCP
- Can take bw 2 and 4 weeks or up to 6 weeks to resolve (long) - Refer: tinea unguium or capitis
174
Fungal skin infection: Clotrimazole/Miconazole Nitrate
- Damage fungal cell wall membrane - DDI: warfarin
175
Fungal skin infection: Terbinafine hydrochloride
- Relieves itching, burning, cracking, scaling - No DDI
176
Fungal skin infection: Tolnaftate
- Only OTC for both preventing and treating - Dry and scaly lesions - Relapse after discontinuation - No DDI
177
Fungal skin infection: Clioquinol/Undecylenic acid
- Adjunctive - Prevent fungal growth - Less effective on scalp or nails - AE: local skin irritation and burning
178
Fungal skin infection: Salts of Aluminum
- Adjunctive - External use only, should NOT be applied near eyes
179
Fungal skin infection: Product Selection guidelines
- Creams or solutions most effective - Patient adherence is important
180
Warts are caused by
HPV
181
Warts: risk factors
- Existing/prior warts - Going barefoot - Nail-biting - Swimming pool and public shower use - Immunocompromised status - Chronic skin conditions
182
Warts: hand - subtype(s) of HPV
2, 4, 27, 57
183
Warts: foot - subtype(s) of HPV
1
184
Common warts: location, population, description, self-tx?
- L: hands - P: children - D: skin-colored/brown, dome-shaped, rough surface, typically painless - **YES**
185
Flat warts: location, population, description, self-tx?
- L: face - P: children - D: smooth, flat-topped, yellow-brown papules - No
186
Plantar warts: location, population, description, self-tx?
- L: feet - P: adolescents and young adults - D: skin-colored, flat, callus-like; can be painful - **YES**
187
Mosaic warts: location, population, description, self-tx?
- L: feet - P: adolescents and young adults - D: multiple, closely grouped plantar warts - No
188
Periungual warts: location, population, description, self-tx?
- L: nails - P: individuals that bite nails - D: thickened, fissured, cauliflower-textured skin around the nail plate - No
189
Filiform warts: location, description, self-tx?
- L: face - D: flesh-colored, rapidly growing, thread-like projections - No
190
Warts treatment curable?
No cure for HPV infection
191
Warts: nonpharmacologic tx
- Prevent HPV spread: do not cut, shave, or pick at warts, use a designated towel to dry wart-affected areas, do not share towels, razors, socks, shoes, etc with others, keep the wart covered, avoid walking barefoot - Symptomatic relief: use lamb's wool or moleskin on pressure points to relieve plantar wart discomfort
192
Warts: pharmacologic tx - salicylic acid (MoA, indication, +/-, available products, counseling points)
- Keratolytic agent: destroys infected cells - **Only in common and plantar warts** - (+): low $, readily available, few AEs, effective - (-): consistent and frequent application required, damages healthy skin, long duration of tx, irritating to skin - 17% for hand, 40% for foot - Refer when >12 weeks - Soak affected area in warm water for 5 mins - Wash and dry affected area thoroughly
193
Warts: pharmacologic tx - cryotherapy (MoA, indication, office vs OTC formulation, efficacy, counseling points)
- Liquid nitrogen destroy the lesion via freezing the tissue (office) - OTC: nitrous oxide or dimethyl ether and propane - Blister will form under the wart and cause it to fall off after 10 days - Soak affected area in warm water for 5 mins before use - Apply to the wart until a "halo" appears around it (20 secs for common, 40 secs for plantar)
194
Warts: pharmacologic tx selection in special populations C/I
- Pregnant and lactating women - Children <3 or those recovering from flu-like conditions should not use salicylic acid (children <4 avoid cryotherapy) - Diabetes or poor circulation
195
Most common cause of corns
Inappropriate, tight-fitting shoes
196
Common causes of calluses
Friction, walking barefoot, structural biochemical problems
197
Types of calluses: Discrete-nucleated vs Diffuse-shearing
- D-N: small, translucent, localized center, painful with applied pressure - D-S: large surface area, no central core
198
Corns and Calluses (CC): nonpharmacologic therapy
- Gentle, daily soaking in warm water for at least 5 mins - Circular foam cushioning pads - Well-fitting, non binding footwear - Orthopedic corrections
199
CC: pharmacologic therapy - salicylic acid formulas and caution
- Collodion-like vehicle: (+)- adhere, prevent moisture evaporation, (-)- flammable & volatile -> inhale & abuse, occlusion of water transport -> systemic absorption - Plaster/Disk/Pad: direct, prolonged contact of drug, quick resolution - Inflammation or ulcer formation: suboptimal technique, hazardous in pregnancy, breastfeeding pts
200
CC: patient counseling
- Remission: days- months - Footwear with adequate width and length - **Only** apply medication to corn or callus bc it is corrosive - No improvement or resolution in 14 days -> PCP
201
CC: exclusions for self-tx
- DM, peripheral circulatory disease - Hemorrhaging or oozing purulent - Anatomic defect or fault in body weight distribution - Extensive or painful, debilitating corns/calluses on foot - Proper, but unsuccessful self-med attempt - Hx of rheumatoid arthritis and complaint of painful metatarsal heads or deviation of great toe
202
Cause of ingrown toenails (IngT)
Incorrect trimming of nails
203
IngT: nonpharmacologic therapy
- Educate on prevention of ingrown toenail formation - Adequate room for nail to revert to normal position - Soak affected area for 10-20 mins in warm water multiple times/day
204
IngT: pharmacologic therapy
- Topical anesthetics (benzocaine): prevent opportunistic infections - Sodium sulfide 1% topical gel + retainer ring: softens nail or hardens nail bed - Oral NSAIDs: aspirin, ibuprofen, naproxen
205
IngT: exclusions to self-tx
- DM, peripheral circulatory disease, arthritis - Foot malformations - Physical or mental impairment - Pus or oozing discharge at the affected site or inflammation, redness, or pain beyond site of IngT
206
IngT: medical referral
3-4 weeks w/o relief or condition worsens
207
Alopecia phases (ACTE)
- Anagen: active hair growth - Catagen: end of active hair growth - Telogen: resting period - Exogen: hair strands released
208
Causes of Alopecia
- Physiological stress - Chronic illnesses: rheumatoid arthritis, lupus, eating disorders - Medications: ACEi, allopurinol, androgenic, anticonvulsants, anticoagulants, antidepressants, BB, cholesterol-lowering, chemotherapeutic - Dietary changes: protein restriction/deficiency, rapid weight loss, Zinc, biotin or iron deficiency
209
Alopecia: androgenetic alopecia (AGA) cause & clinical presentation
- Hereditary hair loss - Gradual onset with progression of gender-specific hair loss - Most common - **Only** self-treatable
210
Alopecia: exclusions for self-tx
- <18 yo - Postpartum, pregnant, breastfeeding - Hair loss related to endocrine dysfunction or medical tx - No family hx of hair loss
211
Alopecia: nonpharmacologic therapy
- Wigs/hair weaves - Scalp-camouflaging - Surgical transplantation
212
Alopecia: pharmacologic therapy agent, indication, direction, AEs, counseling points
**Minoxidil** - Only FDA approved for self tx AGA - Men: 2%, 5% solution, 5% foam - Women: 2% solution, 5% foam - Allow 2-4 hrs for drug to penetrate the scalp - AEs: itching, irritation, dryness, hypertrichosis (excess hair growth) - Avoid pregnancy - D/C if no improvement in 4-6 months - Increase in hair loss may occur w/i first few wks of use - Must continue to use product indefinitely to maintain new growth - Avoid use day of and for 24 hrs after using permanent hair color products
213
Allergic Rhinitis (AR): risk factors
- Family history - Elevated serum IgE >100 IU/mL (<6 yo) - Eczema or AREA triad - Higher socioeconomic level - Positive rxn to allergy skin tests - Diet?
214
AR classification based on duration
- Intermittent: =<4 days per week or =<4 weeks - Persistent: >4 days per week **and** >4 weeks
215
AR classification based on severity
- Mild: do not impair sleep or daily activities - Moderate-severe: impairment of sleep/daily activities, troublesome symptoms
216
AR treatment algorithm
1. Allergen avoidance 2. Pharmacotherapy 3. Immunotherapy
217
AR assessment and management approach
- Assess in 2-4 weeks - Controlled symp: intermittent = continue prn, persistent = continue for 1 month - Uncontrolled: adherent = increase dose or switch to alternative, nonadherent = pt education
218
AR exclusions for self-tx
- <12 yo - Pregnant or lactating - Symptoms of infection: otitis media, sinusitis, bronchitis, other infection, asthma, COPD - Severe or unacceptable SEs of tx
219
AR pharmacologic tx for mild intermittent
Oral antihistamine
220
AR pharmacologic tx for moderate-severe intermittent
Intranasal corticosteroids or oral antihistamine
221
AR pharmacologic tx for mild persistent
Intranasal corticosteroids or oral antihistamine
222
AR pharmacologic tx for moderate-severe persistent
Intranasal corticosteroids preferred
223
AR pharmacologic tx with congestion
Add oral or topical decongestant
224
AR pharmacologic tx with conjunctivitis
Add oral antihistamine, intraocular antihistamine or saline
225
AR: 1st gen antihistamines caution
- Beers criteria: avoid in elderly - CNS: depression, anxiety, sedation (Lipophilic) - Anticholinergic: blurred vision, urinary retention, tachy, constipation
226
AR: 2nd gen antihistamine caution
- Renal dose-adjust - Non-sedation (Lipophobic)
227
AR: diphenhydramine - gen, brand, consideration
- 1st - Benadryl - Use: Allergic rx combination products
228
AR: doxylamine - gen, brand, consideration
- 1st - Unisom - Use: Insomnia
229
AR: chlorpheniramine - gen, brand, consideration
- 1st - ChlorTrimeton - Also used for motion sickness
230
AR: 2nd gen antihistamines from least sedative to most sedative
Loratidine < desloratadine < fexofenadine < levocetirizine < cetirizine
231
AR: loratidine - brand, gen, OTC/Rx, age, consideration
- Claritin - 2nd - OTC - >= 2yrs - Least sedative 2nd gen
232
AR: desloratadine - brand, gen, OTC/Rx, age, consideration
- Clarinex - 2nd - Rx - >= 6 months - ADR: headache - Infants: diarrhea, upepr respiratory infection, fever - Dose adjust for hepatic impairment
233
AR: fexofenadine - brand, gen, OTC/Rx, age, consideration
- Allegra - 2nd - OTC - >2 yrs - Avoid fruit juice/antacids
234
AR: levocetirizine - brand, gen, OTC/Rx, age, consideration
- Xyzal - 2nd - OTC - >= 6 months - ADR: diarrhea
235
AR: cetirizine - brand, gen, OTC/Rx, age, consideration
- Zyrtec - 2nd - OTC - >= 6 months - Most sedative 2nd gen - Food decreases absorption
236
AR: intranasal antihistamines - indication, ADR, agents (generic, brand, OTC/Rx, age, misc)
- More effective for congestion - ADRs: bitter taste, headache, epistaxis - Azelastine (Astepro), OTC, >= 6 yrs, avoid alcohol - Olopatadine (Patanase), Rx, >= 6 yrs, mast cell stabilizer
237
Allergic conjunctivitis (AC) symptoms, nonpharmacologic tx
- Watery, itchy, red eyes - Allergen avoidance, avoid rubbing eyes, **cold** compress
238
AC treatment algorithm
1. Artificial tears 2. Dual-acting antihistamine & Mast cell stabilizers 3. Decongestants or other antihistamines
239
AC Olopatadine - MoA, viscosity trend, age
- Antihistamine + MCS - Higher %, more viscous - >=2 yo
240
AC Ketotifen - MoA, AEs, counseling tips, age
- H1 receptor antagonist & MCS - AE: headache - Do not use solution if it is cloudy, remove contact lens prior to administration and wait 10 mins before reinserting them - >= 3 yo
241
AC Intraocular decongestant MoA, AEs, examples
- Alpha1 agonist: vasoconstriction of conjuctival vessels - AEs: burning, stinging, local dryness - Naphazoline, tetrahydrozoline
242
AC Antihistamine MoA, AEs, example
- Histamine1 antagonist - AEs: burning, stinging, pupil dilation - Pheniramine
243
AC Intranasal corticosteroids (INCS) indication, MoA, counseling tips
- Itching, rhinitis, sneezing & congestion - Anti-inflammatory - Shake well
244
AC: INCS ADRs, DDIs, C/Is
- ADRs: local irritation, pharyngitis, epistaxis - DDIs: Avoid strong CYP3A4 inhibitors (Ketoconzaole, Ritonavir, Clarithromycin) -> systemic effects (headache, dizziness, N/V) - C/I: hypersensitivity
245
AC: INCS OTC products
Nasacort, Flonase, Rhinocort, Nasonex
246
AC: INCS Budesonide - brand, do not use in children ___
- Rhinocort Allergy Spray - <6 yo
247
AC: INCS Fluticasone furoate - brand, do not use in children ___
- Flonase Sensimist - < 2 yo
248
AC: INCS Fluticasone propionate - brand, do not use in children ___
- Flonase Allergy Relief - < 4 yo
249
AC: INCS Triamcinolone acetonide - brand, do not use in children ___
- Nasacort Allergy 24 HR - < 2 yo
250
AC: INCS Mometasone - brand, do not use in children ___
- Nasonex - <2 yo
251
AC: INCS considerations
- More effective than oral antihistamines for nasal congestion - Avoid use if nasal trauma - Onset in 3-5 hrs, reach efficacy within 1 week - Proper nasal spray usage
252
AC: Decongestants MoA, indication
- alpha-adrenergic agonist: constrict blood vessels to decrease mucosal swelling - temporary symptomatic relief of intermittent allergic rhinitis with signs of congestion
253
AC: types of decongestants and example
- Direct-acting: oxymetazoline - Indirect-acting: ephedrine - Mixed: pseudoephedrine
254
AC: decongestant counseling
- May exacerbate diseases sensitive to adrenergic stimulation (HTN, cardiac, diabetes)
255
AC: decongestant DDIs, C/Is
- DDIs: Linezolid (HTN), **SNRI (duloxetine, venlafaxine -> tachycardic)**, MAOIs (HTN), Ergot derivatives (HTN, vasoconstriction) - C/Is: MAOIs, ergot derivatives
256
AC: oral decongestant example, age
- Pseudoephedrine (Sudafed) - Adults and children >=12 yo
257
AC: topical decongestants ADRs, OTC agent examples
- ADRs: burning, stinging, sneezing, local dryness - Rhinitis medicamentosa: rebound congestion -> limit use to 3-7 days - Oxymetazoline (Afrin, Vicks, Zicam), Phenylephrine (Neo-Synephrine)
258
AC: cromolyn sodium indication, OTC/Rx products, Considerations
- Allergic rhinitis prevention (safe for children & pregnancy) - OTC: Nasalcrom - Rx: Crolom for conjunctivitis - C/I: hypersensitivity - Administer 3-4 times/day, initiate prior to allergen exposure/symptoms - Symptomatic relief takes 1-2 weeks
259
AC: combination therapy considerations indication, combinations
- Indic: inadequate response to monotherapy, moderate-severe AR - INCS + Intranasal antihistamine or Intranasal Decongestant - Oral antihistamine + Oral decongestant
260
AC: combination therapy to avoid
- Oral antihistamine + INCS -> Lack efficacy - Leukotriene Antagonists + INCS or oral antihistamine -> No benefit - Multiple agents from the same class

Self/Home Care (3 decks)

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