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Pharm 452: Self-Care > OTC Conditions > Flashcards

Flashcards in OTC Conditions Deck (221)
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1

What are the presenting symptoms of acne?

Open Comedones (blackheads) or closed comedones (whiteheads) Often found on face, chest, upper back and upper arms

2

When do you treat acne with OTCs?

Only when its mild acne Few erythematous papules and occasional pustules, no scarring

3

What is the goal of treating acne with an OTC?

Prevent new lesions and scarring Improve psychological effects and appearance Lower med side effects Educate patient on appropriate healthcare provider follow up

4

What are some complementary and non-pharmacologic treatment options for acne?

Eliminate causes Wash skin Adequate skin hydration Change diet Physical treatments

5

What are the OTC treatments for acne?

1. Benzoyl Peroxide 2. Alpha & beta - hydroxy acids 3. Sulfur and resorcinol 4. Adapalene

6

What are follow up recommendation for Acne?

Pt should follow up with PCP if symptoms worsen or if they do not improve within 6 weeks

7

What are the symptoms of Allergic Conjunctivitis?

1. Red eyes 2. Watery discharge 3. Itching eyes 4. Blurred vision due to excessive tearing

8

When do you not treat allergic conjunctivitis?

1. Thick yellow discharge or crusting (bacterial infection) 2. Light sensitivity 3. last longer than 72 hours 4. Age less than 2 5. History of glaucoma 6. Foreign object feeling 7. accompanied by fever

9

What is the goal of treating allergic conjunctivitis

1. Prevent corneal dmg 2. Remove and avoid allergen 3. alleviate bothersome symptoms 4. Minimize med side effects 5. educate pt about having follow up

10

What are some complementary and non-pharmacologic treatment options for allergic conjunctivitis?

1. Avoid the allergen (pollen count, close window) 2. Cool compresses 3-4 times a day 3. Do not wear contacts 4. good hygiene

11

What are some OTC treatments for allergic conjunctivitis?

1. Ophthalmic antihistamines 2. Ophthalmic decongestants 3. Artificial tears 4. Oral antihistamines

12

What are the follow up recommendations for allergic conjunctivitis?

Follow up with PCP if symptoms worsen or persist within 3 days

13

What are the symptoms of allergies?

1. Sneezing 2. Rhinorrhea 3. Itchy eyes, nose, or palate 4. Nasal obstruction 5. Conjunctivitis 6. Pain

14

When do you not treat allergies with an OTC?

1. Children less than 12 2. Pregnant or lactating women 3. Symptoms of infection 4. Shortness of breath 5. COPD 6. Uncontrolled asthma

15

What are the goals of therapy for treatment of allergies?

1. alleviate symptoms 2. Minimize med side effects 3. Educate pt to follow up with PCP

16

What are the best non-pharmacologic treatment options for allergies?

1. Avoid allergen (best) 2. Know what effects them most 3. Clean house 4. Air quality index 5. Use HEPA filters 6. nasal saline profucts

17

What are the OTC treatment options of allergies?

1. Antihistamines 2. Decongestants 3. Mast cell stabilizers 4. Intranasal corticosteroids

18

What are the follow up recommendations for someone with allergies?

Pt should follow up with PCP if symptoms do not get better within 2 weeks

19

What are the symptoms of alopecia?

1. Androgenetic Alopecia (men) : Receding front hair line, thinning at the vertex 2. Women: More diffuse hair loss, dec hair length and thickness Could come with concurrent acne, hirutism and infertility

20

When do you not treat Alopecia with an OTC?

1. less than 18 2. Pregnant or breast feeding 3. No family history of hair loss 4. Sudden or patchy hair loss 5. Loss of eyebrows or eyelashes

21

What are the goals of treatment for alopecia?

1. restore appearance 2. minimize medication side effects 3. educate pt

22

What are the non-pharmacologic treatment options for alopecia?

1. cosmetic camouflage : spray-on powders or wigs

23

What is the OTC treatment for alopecia?

Minoxidil (2% for women, 5% for men)

24

What are the follow-up recommendations for alopecia?

If symptoms worsen or persist and do not improve within 4 to 6 months see PCP ** if it works pt must use indefinitely

25

What are the symptoms of atopic dermatitis?

1. erythema 2. Scaling 3. May include crusts, pustules or plagues

26

When do you not treat atopic dermatitis with OTCs

1. Moderate‐severe condition with intense itching 2. Affected area covers large areas of the body 3. Affected area covers large areas of the body

27

What is the goal of therapy for atopic dermatitis?

1. Stop the itch‐scratch cycle 2. Restore skin hydration & barrier function (prevent secondary infection) 3. Educate the patient about prevention 4. Minimize medication side effects

28

What are some of the non-pharmacologic treatments for atopic dermatitis?

1. Identify and avoid triggers 2. Extra rinse cycle on laundry 3. Lukewarm baths without additives followed by moisturizers 4. Good fingernail hygiene 5. Use of mild (hypoallergenic) cleansers & cosmetics

29

What are some of the OTC treatment options for atopic dermatitis?

1. Hydrocortisone 2. bactracin and polymyxin B 3. Oatmeal bath

30

What are the follow up recommendations for atopic dermatitis?

Patient should follow up with PCP if symptoms worsen or if they persist and do not improve despite treatment within: 3 days

31

What are the symptoms of Bites and stings?

May be painless or sharp intense pain, including itching May include wheal and flare reaction

32

When do you not treat a bite or sting with an OTC?

1. Severe reactions (including history of it) 2. Significant reaction away from site 3. Symptoms persist for a week or longer 4. Child less than 2 years of age – Refer to PCP

33

What are the goals of therapy for treatment of bites and stings?

1. Identify anaphylactic and other emergent and urgent symptoms 2. B Prevent secondary bacterial infections 3. alleviate symptoms

34

What are some of the non-pharmacologic treatments for bites and stings?

1. Prevention 2. Treatment (ice 10 min on, 10 off) Baking soda (mix with water to make paste)

35

What are some of the OTC treatment options for bites and stings?

1. Topical anesthetics and antihistamines 2. Topical counter irritants, and corticosteroids 3. Topical skin protectants 4. systemic analgesics and antihistamines

36

What are the follow up recommendations for bites and stings

Follow up within 1 week **if very serious rxn call 911 and pt should go to ER

37

What are the symptoms of canker sores?

Round or oval shaped, gray or yellowish colored, flat or crater‐like ulcerations located on the tongue, floor of mouth, soft palate, or inside lining of lips or cheeks *usually painful

38

When do you not treat canker sores with OTCs?

Toothache, bleeding gums, broken teeth, missing teeth, tooth pain, trauma to the mouth with bleeding, swelling, etc Mouth soreness due to poo-fitting dentures Presence of fever or swelling

39

What are the goals of therapy for canker sores?

1. Heal lesion and allow normal eating, drinking 2. Prevent secondary infection

40

What are the non-pharmacologic treatment options of canker sores?

1. Avoid irritation (sharp, acidic, or spicy foods) 2. Apply ice (10 mins at a time, not to exceed 20 minutes per hour) 3. Oral debriding wound cleansing agents

41

What are some of the OTC treatment options for canker sores?

1. Topical oral anesthetics and protectants 2. oral rinses

42

What is the follow-up recommendation for canker sores?

2 weeks if they dont get better or they worsen

43

What are the symptoms of cold and flu?

Cold: 1. onset within 3 day 2. Duration 7-14 days 3. low grade fever Flu: 1. Onset within 3 to 6 hours 2. Duration 3 days 3. fever greater than 100 4. Physical presentation: body ache, chills, fatigue

44

When do you not treat the clod and flu with OTCs?

1. less than 9 months *9 to 2 years with fever over 100 for more than 24 hours *9 to 2 years with temp over 104 at anytime 2. Frail older adults 3. Shortness of breath 4. Chronic immunosuppression (AIDS, suppressed from medications, etc 5. lasts longer than 7 days

45

What is the goal of therapy for the cold and flu?

1. prevent transmission 2. alleviate symptoms

46

What are some of the non-pharmacologic treatment options for cold and flu?

1. rest 2. hydration 3. cold mist humidifier 4. cost mist vaporizer

47

What are the OTC treatments for the cold and flu?

1. decongestants 2. antihistamines 3. local anesthetics 4. systemic analgesics

48

What are the follow-up recommendations for the cold and flu?

1 week

49

What are the symptoms of cold sores?

1. Patients may notice a tingling or itching during prodromal period 2. Small red papule often presents at junction of lips or nose 3. Lesions are often painful and irritating

50

When do you not treat cold sores with an OTC?

1. last longer than 14 days 2. Patients with compromised immunity 3. pts with signs of infection

51

What are the goals of therapy for cold sores?

1. Reduce healing time and duration of symptoms 2. Prevent spreading of lesions 3. Prevent secondary infection

52

What are the complementary therapies of cold sores?

1. Melaleuca (tea tree) oil has similar effect on healing time as acyclovir e 2. Lysine decreases frequency of outbreaks 3. Lemon balm reduces healing time and prevents spread of infection

53

What are the non-pharmacologic treatment for cold sores?

1. Lesions may be gently washed with mild soap and should be kept moist to prevent cracking 2. Wash hands frequently to avoid spreading the virus or contaminating the lesions 3. Use sunscreen if sun exposure is a trigger

54

What are the OTC treatment options for cold sores?

Docosanol

55

What is the follow up recommendation for cold sores?

2 weeks

56

What are the symptoms of constipation?

Decrease in the frequency of fecal elimination to less than 3 times per week characterized by passage of hard dry stool, with straining, and the feeling of incomplete emptying

57

When do you not treat constipation with OTCs?

1. less than 2 2. severe abdominal pain 3. significant distention or cramping 4. nausea and vomiting 5. GI bleed 6. sudden change in stool 7. IBS or anorexia

58

What are the goals of therapy for constipation?

1. Relieve constipation and reestablish normal bowel function 2. Establish dietary and exercise habits that aid in preventing recurrences

59

What are some non-pharmacologic treatment options for treatment of constipation?

1. inc fiber 2. inc fluids 3. inc exercise 4. bowel routine development

60

What are some OTC treatments for constipation?

1. bulk forming laxatives (fiber) 2. emollient (stool softener) 3. hypersomotic laxatives 4. lubricant laxatives 5. saline laxatives 6. stimulant laxatives

61

What is the follow up recommendation for constipation?

1 week ** if really serious or painful seek intimidate care

62

What are the symptoms of contact dermatitis?

Irritant Contact Dermatitis: Inflamed erythematous rash that may be panful and cracked (most often hands and face due to occupational exposure Allergic Contact Dermatitis: Inflamed erythematous rash that generally includes papules, vesicles, or bullae, swollen skin and significant itching (limited to area of body exposed to allergic antigen contact site)

63

When do you not use OTC to treat contact dermatitis?

1. less than 2 2. lasts more than 2 weeks 3. eyes, mouth, nose or genitalia involved 4. signs of infection 5. extreme itching, redness, swelling

64

What are the goals of therapy for contact dermatitis?

1. remove the offending agent 2. treat inflammation, itching, oozing, crusting

65

What are some non-pharmacologic treatments of contact dermatits?

1. removal of irritant (cool showers, DO NOT BATHE) 2. preventative and protective measures (clothing, acoid irritant)

66

What are the OTC options for treating contact dermatitis?

1. Oral antihistamines 2. hydrocortisone 3. astringents

67

What is the follow up recommendations of contact dermatitis?

1 week

68

What are symptoms of a cough?

1. differentiate between a productive (wet cough) in which sputum is produced, and a non‐productive (dry cough) in which sputum is NOT produced 2. differentiate between an effective cough (in which sputum is effectively expelled) and an ineffective cough (in which sputum is NOT effectively expelled)

69

When do you not treat a cough with OTC?

1. less than 4 2. Last longer than 7 days 3. worsening cough 4. have fever (103 or higher for adult, 102 for child)

70

What are the goals of therapy for treating a cough?

1. prevent complications 2. alleviate bothersome symptoms

71

What are the non-pharmacologic treatments for a cough?

1. nonmedicated lozenges 2. cool-vapor humidifiers 3. body positioning 4. hydration 5. avoid honey in children less than 1

72

What are the OTC treatments for a cough?

1. oral antitussives 2. topical antitussives 3. expectorants 4. NSAID's

73

What is the follow-up recommendations for a cough?

1 week

74

What are the symptoms of diaper dermatitis?

1. Red, shiny, wet appearing patches of skin in and near the diaper area **can affect anyone what wears diapers

75

When to not treat diaper dermatitis with OTC?

1. possible secondary infection 2. frequent recurrence despite appropriate OTC treatment

76

What are the goals of therapy for diaper dermatitis?

1. eliminate rash 2. restore skin hydration and barrier function

77

What are the non-pharmacologic treatment options for diaper dermatitis?

1. increase diaper change frequency (min 6 times daily) 2. Use disposable diapers 3. DO NOT use hydrocortisone or clotrimazole

78

What are the OTC treatment for diaper dermatitis?

1. liberal use of protectants white petrolatum, zinc oxide, lanolin

79

What are the follow-up recommendations for diaper dermatitis?

1 week

80

What are the symptoms of diarrhea?

1. An abnormal increase in frequency and fluidity of bowel movements 2. more than 3 a day 3. sudden onset of nausea or vomiting 4. abdominal pain, fever chills 5. lower right quadrant pain and cramps

81

When do you not treat diarrhea with OTCs?

1. less than 6 months 2. greater than 6 months with fever> 102 3. sever dehydration 4.severe stomach pain 5. risk for complications 6. Pregnacy 7. lasts longer than 14 days

82

What are the goals of therapy for diarrhea?

1. prevent and correct fluid and electrolyte imbalance 2. identify and treat cause 3. prevent sudden morbidity and mortality

83

What are some of the non-pharmacologic treatments for diarrhea?

1. keep food journal to identify triggers 2. Oral re-hydration salt solution (ORS) *** pedialyte "has suger, salt, water" gatorade and those drinks do not have correct balance

84

What are the OTC treatment options for diarrhea?

1. loperamide 2. bismuth

85

What is the follow-up recommendations for diarrhea?

2 days *** if very serious go to ER

86

What are the symptoms of dry eye?

1. Excessive tearing due to abnormal lubrication 2. White‐red eyes 3. Sandy, gritty feeling 4. Foreign body feeling

87

When do you not treat dry eye with an OTC?

1. Blurred vision 2. Pain in the eye 3. Chemical exposure 4. Contact lens wearer 5. Blunt trauma to the eye 6. Symptoms lasting greater than 72 hours

88

What is the goal of therapy for dry eyes?

1. Prevent corneal damage 2. Alleviate bothersome symptoms

89

What are the non-pharmacologic treatment options for dry eyes?

1. Avoid dry, dusty, and windy environments including airflow from air vents 2. Use cool mist humidifiers to improve air humidity 3. Wear eye protection (sunglasses or goggles) 4. Avoid allergens and other eye irritants 5. Avoid prolonged computer use 6. Use warm water eyelid compresses

90

What are the OTC treatment options for dry eyes?

Ophthalmic solutions (artificial tears) Non‐medicated ophthalmic ointments

91

What is follow-up for dry eyes?

2 weeks

92

What are the symptoms for dry mouth?

minimal or no salivary flow

93

When do you not treat dry mouth with OTCs?

1. Tooth erosion, decalcification, or decay Candidiasis, gingivitis, or periodontitis 2. Oral trauma, missing teeth, swelling, soreness, tooth pain 3. Sjogren's syndrome

94

What is the goal of therapy for dry mouth?

1. Prevent oral infections and dental caries 2. Alleviate bothersome symptoms

95

What are some of the non-pharmacologic treatment options for dry mouth?

1. Eliminate offending agents when possible (ethanol, tobacco, antihistamines, CNS stimulants) 2. Change medication schedules 3. Limit sugar and acidic foods 4. Use hard candy or xylitol based gum 5. Increase dietary water intake

96

What are the OTC treatment options of dry mouth?

1. artificial saliva 2. dry mouth oral rinses, sprays, and toothpastes

97

What is the follow-up recommendation for dry mouth?

2 weeks

98

What are the symptoms of dry skin?

1. Rough skin 2. Scaling skin 3. Loss of skin flexibility 4. Fissures 5. Inflammation 6. Pruritus

99

When do you not treat dry skin with an OTC?

1. severe condition 2. signs of infection (yellow crusting)

100

What are the goals of therapy for dry skin?

1. Restore skin hydration & barrier function 2. Prevent secondary infections

101

What are the non-pharmacologic treatments for dry skin?

1. Short baths (3‐5 minutes), 2‐3 times per week in tepid water immediately followed by moisturizer 2. Cool‐mist humidifiers 3. Emollients (creams, lotions, ointments, butters) Humectants (glycerin, propylene glycol, phospholipids)

102

What are the OTC treatment options for dry skin?

1. Urea 2. Lactic acid 3. Allantion 4. Hydrocortisone (short term)

103

What is the follow up recommendations for dry skin?

2 weeks

104

What are the symptoms of Dysmenorrhea?

1. Cramping 2. Bloating 3. Headache 4. Fatigue 5. Lower back pain 6. Nausea

105

When do you not treat dysmenorrhea with an OTC?

1. Severe dysmenorrhea or severe blood loss 2. Secondary dysmenorrhea 3. History of pelvic inflammatory disease 4. Irregular menstrual cycles 5. Endometriosis 6. Ovarian cysts 7. Use of intrauterine contraception 8. Use of warfarin, heparin, lithium, or bleeding disorder 9. Active GI disease

106

What is the goal of therapy for treating dysmenorrhea?

alleviate bothersome symptoms

107

What are some non-pharmacologic treatment options for dysmenorrhea?

1. topical heat 2. Exercise 3. Complementary therapies: Vit B1, E, MG acupressure Omega-3 fatty acids

108

What are the OTC treatment options for dysmenorrhea?

1. diuretics 2. NSAID's 3. Aspirin

109

What is the follow up recommendations for dysmenorrhea?

2 weeks

110

What are the symptoms of ear wax?

1. Sense of fullness in the ear 2. Pressure in the ear 3. Gradual hearing loss 4. Vertigo 5. Tinnitus 6. Chronic cough

111

When do you not treat ear wax with an OTC?

1. Signs of infection 2. Pain associated with ear discharge 3. Abrupt hearing loss 4. Presence of ruptured eardrum 5. Ear surgery within the prior 6 months 6. Tubes in ears 7. Age less than 12

112

What is the goal of therapy for treatment of ear wax?

1. Soften and remove excessive or impacted cerumen 2. Alleviate associated symptoms

113

What are the non-pharmacologic treatments of ear wax?

1. Use wet wrung‐out washcloth draped over finger to remove cerumen from the outermost portion of the external auditory canal 2. Do NOT use cotton tipped applicators (Q‐tips) 3. FDA warns against use of ear candles ax (dangerous and not effective)

114

What are the OTC treatment options for ear wax?

carbamide peroxide

115

What is the follow up recommendations for ear wax?

3 days

116

What are the symptoms of emergency contraception?

Girls and women of reproductive age up to 3 to 5 days after unprotected intercourse

117

When do you not treat Emergency Contraception with an OTC?

Patients presenting between 5 and 7 days after unprotected intercourse should be referred to a primary care provider for possible insertion of a copper intrauterine contraceptive device

118

What is the goal of therapy for emergency contraception?

prevent pregnancy

119

What are some of the non-pharmacologic treatment options for emergency contraception?

Non-hormonal copper IUC (inserted by PCP)

120

What are the OTC treatment options for emergency contraception?

Levonorgestrel

121

What are the follow up recommendations for emergency contraception?

Works best the sooner it is taken, may still be effective up to 5 days post‐coitus

122

What are the symptoms of a fever?

Temperature of approximately 100°F (37.8 °C) or higher and discomfort

123

When do you not treat a fever with an OTC?

*Age less than 3 months with a temp of 100°F (37.8°C) or higher for any time *Age 3 months to 2 years with a temp of 100°F (37.8°C) or higher for more than 24 hours *Age 3 months to 2 years with a temp of 104°F (40°C) or higher for any time *Although self care of fever may be initiated in appropriate patients less than age 2, parents should be advised to contact PCP for all patients under age 2 Age 2 years or older with a temp of 100°F(37.8°C) or higher for 3 days or more

124

What is the goal of therapy for treating fever?

alleviate bothersome symptoms

125

What are the non-pharmacologic treatments for a fever?

1. Tepid bath 2. Light clothing 3. No blankets 4. 68° F room 5. Adequate hydration 6. NO rubbing alcohol baths (may cause fever to rebound) NO Ice water baths

126

What are the OTC treatments for a fever?

1. NSAID's 2. Acetaminophen 3. Aspirin

127

What is the follow up recommendations for fever?

3 days for all pts over 2 **if under 2 years of age you should talk with PCP before starting treatment

128

What are the symptoms of fungal skin infections?

1. Tinea Corporis (ringworm of the body): Ring shaped lesions with clear centers and red‐scaly borders 2. Tinea Cruris (jock itch): Found in medial and upper thighs and groin Pain when sweating 3. Tinea Pedis (athletes foot): Malodorous, pruritic, stinging, itching fissures, ulcers or vesicles on the feet

129

When do you not treat fungal skin infections with an OTC?

1. Tinea unguium (nail fungus) 2. Tinea capatis (ringworm of the scalp) 3. Patients with diabetes, immune deficiency, asthma, systemic infections 4. Face, mucus membrane, or genitalia involvement 5. Extensive involvement Pus‐like discharge 6. Less than 2 years of age

130

What are the goals of therapy for treatment of fungal skin infections?

1. Eradicate existing fungal infection 2. Prevent future fungal infections 3. provide symptomatic relief

131

What are the non-pharmacologic treatment options for treating fungal skin infections

prevention

132

What are the OTC treatment options for fungal skin infections?

1. Pedis only: Tolnaftate and aluminum acetate 2. Pedis and cruris: Undecylenic acid 3. Pedis, cruris, corporis: Clotrimazole, terbinafine, tolnaftate *Do NOT treat unguium or capatis OTC

133

What is the follow up recommendations for fungal skin infections?

2 weeks (cruris) 4 weeks (corporis or pedis)

134

When do you not treat a headache with an OTC?

Severe head pain Pain for more than 10 days Last trimester of pregnancy Less than 8 years of age Infection with high fever History of liver disease or more than 3 alcoholic drinks daily Secondary headache (except diagnosed sinus headache) Symptoms of migraine in previously undiagnosed patient

135

What is the goal of therapy for treatment of a headache?

Alleviate bothersome symptoms

136

What are the non-pharmacologic treatments of headaches

1. Migraine HA: Avoid triggers (diet, exercise, stress, etc) Dark room Cool compress/ice on head and neck 2. Tension HA: Stretching neck muscles Relaxation exercises Physical therapy 3. Sinus HA: Hot shower Adequate hydration

137

What are the OTC treatment options for headaches?

1. Acetaminophen 2. NSAID's 3. Aspirin

138

What are the follow up recommendations for headaches?

1 week

139

What are the symptoms of heartburn?

1. Pain behind sternum 2. Sour taste in the mouth 3. Belching 4. Sore throat 5. Cough *Typically occurs after meals and at bedtime

140

When do you not treat heartburn with an OTC?

1. Age less than 2 for antacids, less than 12 for H2RA’s, less than 18 for PPI’s 2. Age greater than 45 with symptoms of dyspepsia 3. Heartburn that continues after 2 weeks of OTC treatment 4. Frequent heartburn for 3 months or greater 5. Patients with severe symptoms 6. Heartburn symptoms that occur during the night 7. Patients with dysphagia 8. Signs of a GI bleed 9. Persistent hoarseness, wheezing, cough, choking Unexplained weight loss Signs of heart attack

141

What are the goals of therapy for the otc treatment of heartburn?

prevent symptoms

142

What are the non-pharmacologic treatment options of heartburn?

1. Keep food journal to identify triggers 2. Weight loss for overweight patients 3. Raise the head of the bed 4. BRAT diet Bananas Rice Applesauce Toast

143

What are the OTC treatment options for heartburn?

1. Antacids 2. H2 receptor antagonists (H2RA) 3. Proton pump Inhibitors (PPI)

144

What are the follow up recommendations for heartburn?

2 weeks

145

What are the symptoms of Hemorrhoids?

1. Hemorrhoids large bulging hemorrhoidal vessels, surrounding tissue, and overlying mucous membrane Itching, swelling, inflammation, discomfort, pain, bleeding, change in bowel pattern, seepage, prolapse, thrombosis 2. Internal Hemorrhoids: Above dentate line, lack sensory fibers leading to less or no pain 3. External Hemorrhoids: Below dentate line, bluish lump at the anal canal, wrapped in highly innervated epithelium, very painful

146

When do you not treat hemorrhoids with an OTC?

1. Age less than 12 2. Ulcerative colitis or Crohn’s disease 3. Family history of colon cancer 4. Signs of GI bleed, excessive pain, seepage, or prolapse 5. Persists after 7 days of OTC treatment

147

What are some non-pharmacologic treatment of hemorrhoids?

1. Improve constipation to reduce straining 2. Spend less time on the toilet 3. Cryotherapy (cooling): ice pack between buttock to sooth

148

What are the OTC treatments used for hemorrhoids?

1. Analgesics 2. Anesthetics 3. Vasoconstrictors 4. Protectants 5. Astringents 6. Keratolytics 7. Corticosteroids 8. Stool softeners

149

What is the follow up recommendation for hemorrhoids?

1 week ** if blood in stool see PCP sooner

150

What are the symptoms of insomnia?

1. Difficulty falling asleep 2. Awaking early with inability to fall back asleep 3. Unusual or troublesome dreams 4. Poor sleep 5. Fatigue, drowsiness, anxiety, irritability, depression, limited concentration and memory

151

When do you not treat insomnia with an OTC?

Age less than 12 1. Age greater than 65 2. Pregnant patients 3.Frequent nocturnal or morning wakeups 4. Chronic insomnia (lasts greater than 3 weeks) 5. Secondary insomnia (due to underlying condition)

152

What are some of the non-pharmacologic treatments for insomnia?

Sleep hygiene American Academy of Sleep Medicine recommends against dietary supplements for insomnia unless approved by a health care provider

153

What are the OTC treatments for insomnia?

1. diphenylhydramine 2. doxylamine ** 2nd generation antihistamines are NOT used for insomnia

154

What is the recommended follow up for insomnia?

1 week

155

What are the symptoms of intestinal gas?

1. Belching 2. Gas Pains 3. Bloating 4. Flatulence

156

When do you not treat intestinal gas with OTCs?

1. Symptoms that occur more than a few times per month or that last for more than a few days 2. Sudden onset or change in abdominal pain 3. Severe symptoms 4. Occurs with any of the following symptoms (Diarrhea, GI bleed, fatigue, unintentional weight loss, symptoms that frequently occur during the night)

157

What are the non-pharmacologic treatment for intestinal gas?

Limit gas producing foods eliminate dairy if lactose intolerant

158

What are the OTC treatments for intestinal gas?

1. Simethicone 2. Charcoal 3. alpha-galactosidase 4. Lactose replacement

159

What is the recommended follow up for intestinal gas?

3 days **see PCP if you get these symptoms more than a few times a month

160

What are the symptoms of musculoskeletal pain?

Pain (inflammation)

161

When do you not treat musculoskeletal pain with an OTC?

1. Less than 2 years of age 2. Pregnant (especially 3rd trimester) 3. Pain score great than 6 4. Increased intensity or change in pain 5. Pain for 10 or more days 6. Pelvic or abdominal pain (dysmenorrhea ok) 7. Nausea, vomiting, fever, or symptoms of infection 8. Visual deformity (broken bone, etc) 9. Abnormal movement or weakness 10. Back pain with loss of bowel or bladder control

162

What are the goals of therapy for musculoskeletal pain?

1. restore function and prevent re-injury 2. prevent acute pain from becoming chronic persistent pain

163

What are the non-pharmacologic treatment of musculoskeletal pain?

1. RICE 2. slpints, braces, and slings 3. Glucosamine and chondroitin

164

What are the OTC treatments for musculoskeletal pain?

1. Acetaminophen 2. Aspirin 3. NSAIDs 4. Counterirritants

165

What is the follow up recommendation for musculoskeletal pain?

1 week

166

What are the symptoms of Nausea and Vomiting?

1. Nausea (subjective feeling of need to vomit) 2. Retching (Involuntary unsuccessful attempt to vomit) 3. Vomiting (Forceful expulsion of GI contents thro mouth)

167

When do you not treat nausea and vomiting with an OTC?

1. dehydration 2. Cannot be cared for at home 3. Yellowing of the eyes 4. Severe pain in upper right or lower quadrant (including pain after fatty meal) 5. Severe symptoms 6. Stiff neck 7. Not drinking fluids or lack of urination for 8 or more hours 8. Repeated vomiting after meals 9. Signs of GI bleed m 10. Fever present in children under age 3 11. Head injury and vomiting

168

What are the goals of therapy for nausea and vomiting?

1. Prevent/correct fluid and electrolyte imbalance 2. prevent other complications (aspiration, etc)

169

What are complementary and non-pharmacologic treatments for nausea and vomiting?

1. Acupressure: wrist bands 2. ORS Complementary Therapies: 1. Ginger 2. pyridoxine

170

What are the OTC treatments for nausea and vomiting?

1. Antihistamines 2. Antacids 3. H2RA's 4. Phophorylated carbohydrate solutions 5. Bismuth Subsalicylate

171

What are the follow up recommendations for nausea and vomiting?

24 hours ** should go to ER if symptoms are very bad

172

What are the symptoms of pediculosis?

1. Head lice: Pediculus capitis 2. Body lice: pediculus humanus or corporis 3. Pubic lice (crabs): Phthirus pubis 4. itching

173

When do you not treat someone with an OTC who has pediculosis?

1. Children age less than 2 2. Affected eyes or eyelids 3. Patients with secondary bacterial infections 4. Pregnancy or breastfeeding 5. Patients with active tumors 6. Patients with allergies to ragweed or chrysanthemums

174

What are non-pharmacologic treatments of pediculosis?

1. Nuvo method: cetaphil cleanser, apply to dry hair and blow dry to "shrink wrap" lice 2. Tree oil and lavender 3. mayonnaise and petroleum NOT shown to be effective

175

What is the OTC treatment for pediculosis?

1. Head lice: Permethrin 2. Head lice, pubic lice: Pyrethrin

176

What is the recommended follow up for pediculosis?

2 weeks

177

What are the symptoms of pinworm?

1. Perianal itch (increased in the evening) 2. Worms seen in feces, in perianal area, or on cellophane tape or paddle 3. Major infestations can lead to abdominal pain, nausea, nervousness, loss of appetite, insomnia

178

When do we not treat pinworm with OTCs?

1. Less than 2 2. Weight less than 25 pounds 3. Pregnancy or breatfeeding

179

What non-pharmacologic treatment should be used in conjunction for pinworm?

1. Washing lines, clothing, etc 2. Dont walk barefoot 3. avoid sweeping 4. vacuum daily

180

What should NOT be used when treating pinworm?

1. garlic paste, vaseline, caster oil, green team, yellow bark, and turmeric **dont show any evidence and high risk of pinworm infection transmission

181

What are the OTC treatment options for pinworm?

Pyrantel pamoate

182

What is the recommended follow up time for pinworm?

2 weeks

183

What are the symptoms of scaly dermatoses?

1. Dandruff 2. Seborrheic Dermatitis: dull, yellowish, oily, scaly areas on red skin may include scales in eyelids and ears 3. Psoriasis

184

When do you not treat scaly dermatoses?

1. Less than 2 years of age 2. c Psoriasis involving greater than 5% of body surface area, face, or if presence of joint pain

185

What are the non-pharmacologic treatments of scaly dermatoses?

Baby oil scalp massage and non-medicated shampoo

186

What are the OTC treatments for scaly dermatoses?

1. coar tar 2. Hydrocortisone (not for dandruff) 3. Ketoconazole 4. Pyrithione zinc 5. Salicylic acid 6. Selenium sulfide 7. sulfur

187

What is the follow up recommendation for scaly dermatoses?

2 weeks

188

What are they symptoms of smoking cessation?

Cigarette use

189

When do you not treat smoking cessation with an OTC?

1. Less than 18 years old 2. Active peptic ulcer disease 3. High blood pressure not controlled with medication 4. Serious heart disease **for pregnancy or breastfeeding or use of smokers tobacco, cigars or pipes: should use behavioral counseling

190

What are the non-pharmacologic treatment options for smoking cessation?

1. 5 a's :Ask, advise, assess, assist, arrange 2. 5 r's : Relevance, Risk, Rewards, Roadblocks, Repetition Have a counseling center

191

What are the OTC treatments for smoking cessation?

Nicotine gum, patches and lozenges

192

What are the symptoms of a sunbrun?

Erythema, tenderness, pain, and edema following sun exposure May include blisters, fever, weakness, shock, peeling and itching

193

When do you not treat a sunburn with an OTC?

Only treat 1st degree burns ** no blisters, fever, chills, shock)

194

What are the goals of therapy for treating a sunburn?

1. prevent scarring 2. restore skin hydration & barrier function 3. Prevent secondary infections

195

What are the non-pharmacologic treatments for sunburns?

1. Prevention 2. Treatment: cold bath, moisturizing skin and hydration

196

What are the OTC treatment options for a sunburn?

1. NSAID's 2. Topical anesthetics (applied to less than 1% of the body = the size of the back of the hand)

197

What is the follow-up recommendations for a sunburn?

1 week ** seek immediate emergency help if you have extreme dry mouth, oliguria, confusion or signs of infection

198

What are the symptoms of Urinary incontinence?

Urge urinary Incontinence: Frequent urgency (more than 8 times daily) often with inability to reach toilet Stress Urinary Incontinence: Urine leakage during physical activity

199

When do you not treat urinary incontinence with OTC?

1. In men 2. Pt with symptoms of overflow urinary incontinence (straining to void, decreased urine stream, sense of bladder fullness despite voiding)

200

What are the non-pharmacologic treatments for urinary incontinence?

1. toileting assistance 2. bladder training 3. Pelvic floor muscle training 4. absorbent garments and pads

201

What is the OTC treatment for urinary incontinence?

Oxybutynin

202

What is the follow up recommendation for urinary incontnence?

2 weeks

203

What are the symptoms of urinary tract infections?

1. fever 2. chills 3. Urinary frequency and urgency 4. pyuria 5. dysuria 6. low back pain 7. cloudy urine 8. strong urine odor

204

What are the goals of therapy for urinary tract infections?

Make sure the pt goes to their PCP reduce pain associated with UTI

205

What are the non-pharmacologic treatment options for UTI?

prevention

206

What are the treatment options for UTI?

OTC do not treat the injection they control symptoms 1. Phenazopyridine 2. NSAID's 3. Acetaminophen

207

What are the symptoms of vulvovaginal candidiasis?

1. intense itching 2. burning sensation 3. Clumpy white discharge 4. Characteristic odor of yeast

208

When do you not treat vulvovaginal candidiasis with an OTC?

1. Suspected bacterial vaginosis or trichomoniasis 2. Pregnant women 3. Children under age 12 4. Recurrent VVC (more than 3 in the past year) 5. Non‐VVC vaginal infection in the past 2 months 6. Patients with diabetes or HIV (predisposing diagnosis) 7. Patients on corticosteroids or anti-neoplastics

209

What are the non-pharmacologic treatment options for vulvovaginal candidiasis?

1. decrease sugar consumption 2. increase yogurt containting live cultures 3. avoid tight fitting clothing 4. sitz bath

210

What are the OTC treatments for vulvovaginal candidiasis?

Imidazole antifungals Bezocaine (this can reduce pain but focus should be on imidazole antifungals to cure the underlying problem

211

What is the recommended follow up time with vulvovaginal candidasis?

1 week ** pt should see PCP if getting recurrent infections

212

What are the symptoms of warts?

Common warts: Skin-colored or brown, dome-shaped papules with a rough cauliflower-like appearance (found on hands, fingers, or face) Plantar warts: Skin-colored callous-like lesions on the feet which may be painful

213

When do you not treat warts with an OTC?

Face, nails, genitals or anus involved Extensive spread Painful plantar warts Chronic disease (diabetes, peripheral vascular disease, etc) Poor blood circulation Physical or mental impairment Immunosuppressive meds Less than 4 years of age Pregnancy or breastfeeding

214

What are the non-pharmacologic treatment options for warts?

1. wash hands after touching or treating wart 2. Do not pick or aggravate wart 3. Lambs wool, moleskin, or shoe inserts for painful warts 4. Cryotherapy

215

What are the OTC treatment options for warts?

1. 17% salicylic acid for common warts 2. 40% for plantar warts

216

What are the follow up recommendations for warts?

12 weeks

217

What are the symptoms of water-clogged ears?

1. feeling of wetness in the ear 2. feeling of fullness in the ear 3. gradual hearing loss

218

When do you not treat water-clogged ears with an OTC?

Signs of infection Pain associated with ear discharge Presence of ruptured ear drum Abrupt hearing loss Ear surgery within the prior 6 months Tubes in ears Age less than 12

219

What are the non-pharmacologic treatment for water-clogged ears

1. tilt affected ear downward and gently manipulate auricle 2. blow-dryer on low heat and speed 3. single use water-absorbing ear plugs

220

What are the OTC treatment options for water-clogged ears?

Isopropyl alcohol in anhydrous glycerin

221

When should a pt follow up with PCP when they have water-clogged ears?

3 days