OTC Final Exam Flashcards
(92 cards)
1
Q
Colds - Exclusions (Symptoms)
A
chest pain
SoB
2
Q
Colds - Exlcusions (Age)
A
frail older
infants <3 months
3
Q
Colds - Exclusions (Conditions)
A
cardiopulmonary disease
immunosuppression
4
Q
Colds - Exclusions (Persists)
A
worsening while self-treating
persisting 7-14 days
5
Q
Colds - Decongesants
A
First line
PO vs. Nasal depends on patient variables
6
Q
Cold/Cough - First generation antihistamines
A
Second line as adjuvant to decongestant for post-nasal drip (cough)
7
Q
Cough - Exclusions (Symptoms)
A
difficulty breathing
dyspnea
cyanosis
hemoptysis
weight loss
night sweats
signs of croup
sudden onset w/o URI
8
Q
Cough - Exclusions (Age)
A
Children <4 (no meds)
9
Q
Cough - Exclusions (Conditions)
A
Immunocompromised
TB exposure
risk of HIV
chronic illness
10
Q
Cough - Exclusions (Persists)
A
Worsens after 3-5 days
11
Q
Cough - Antitussives
A
Dextromethorphan
Topicals
Menthol
12
Q
Cough - Protussives
A
guaifenesin
don’t take at night
13
Q
Allergies - Exclusions (Symptoms)
A
nonallergic rhinitis (infection, epistaxis, obstruction)
symptoms of asthma/COPD
14
Q
Allergies - Exclusions (Age)
A
Children <12 years unless diagnosed
15
Q
Allergies - Exclusions (Conditions)
A
pregnancy or breastfeeding
16
Q
Allergies - Exclusions (Other)
A
treatment causes unacceptable side effects
17
Q
Allergies - Special populations
A
Older adults - avoid FGAs
Pregnancy - cromolyn first line, less effective; loratidine safest antihistamine
18
Q
Allergies - Intranasal corticosteroids
A
First line for mod-sev IAR
First line for all PER
19
Q
Allergies - Second generation antihistamines
A
First line for mild IAR or episodic AR
20
Q
Allergies - Other options
A
1st gen antihistamines: inexpensive, but many ADEs
Decongestants: adjuvant if experiencing congestion
21
Q
Headache - Exclusions (Symptoms)
A
severe pain
high fever
signs of infection
migraine symptoms with no diagnosis
new with sudden onset
22
Q
Headache - Exclusions (Age)
A
children < 8 years
23
Q
Headache - Exclusions (Conditions)
A
pregnancy (last trimester)
history of alcoholism or liver disease
24
Q
Headache - Exclusions (Persists)
A
Persists 10+ days
25
Acetaminophen
First line for headache
Does not help with inflammation
26
NSAIDs
27
Fever - Exclusions (Symptoms)
temp >104 (or 100.1 for infants <3 months)
severe/persistent infection
child with spots/rash, lethargy, or intractable vomiting/diarrhea
28
Fever - Exclusions (Age/Persists)
Children <2 (if fever lasts 24+ hours)
29
Fever - Exclusions (Conditions)
CV or pulmonary disease
Immunocompromised
CNS damage
History of febrile seizures
30
Fever - Exclusions (Other)
risk for hyperthermia
31
Musculoskeletal Pain - Exclusions (Symptoms)
Severe pain (>6)
Pelvic/abdominal pain
Fever, nausea, vomiting
Suspicion of serious injury
*Back pain and bladder/bowel incontinence
32
Musculoskeletal Pain - Exclusions (Age)
Children < 2 years
33
Musculoskeletal Pain - Exclusions (Conditions)
Pregnancy
34
Musculoskeletal Pain - Exclusions (Persists)
Increase in intensity
Marked change in character
Persists 10+ days
Persists 7+ days w/ treatment
35
Analgesics - Special populations
Older adults - avoid naproxen (long-acting)
Children - avoid naproxen and aspirin
36
Musculoskeletal Pain - Nonpharmacologic
Rest (1-2 days)
Ice (10-25 on, cycle off)
Compression
Elevation (above heart)
37
Vulvovaginal Candidiasis - Exclusions (Symptoms)
Fever
First infection ever
Referred pain (pelvic, etc.)
Severe symptoms
38
Vulvovaginal Candidiasis - Exclusions (Age)
Age < 12 years
39
Vulvovaginal Candidiasis - Exclusions (Conditions)
Pregnancy
Predisposing condition (diabetes, HIV)
Predisposing medications (ABX, CHCs, corticosteroids, immunosuppressants, chemo)
40
Vulvovaginal Candidiasis - Exclusions (Persists)
Last infection <2 months ago
4+ infections in the last year
No improvement in 3 days
Persists at 7 days
41
Vulvovaginal Candidiasis - Antifungals
clotrimazole (3 or 7)
miconazole (1, 3, or 7)
tioconazole (1)
42
Vulvovaginal Candidiasis - Antipruritics
Cannot be used as monotherapy
Topical only
43
Vulvovaginal Candidiasis - Nonpharmacological
yogurt cultures, loose clothing, d/c predisposing meds, sodium bicarbonate sitz bath
44
Atrophic Vaginitis - Exclusions (Symptoms)
Severe symptoms
Vaginal bleeding
Symptoms not localized
Not relieved by lubricants
45
Atrophic Vaginitis - Exclusions (Persists)
Symptoms worsen
Persists 1+ week with treatment
46
Atrophic Vaginitis - Nonpharmacological
Causes:
postpartum/lactating: usually resolves
peri- or post-menopausal: usually long term
47
Primary Dysmenorrhea - Exclusions (Symptoms)
Symptoms inconsistent with primary (e.g. pain other than at onset of menses)
Severe symptoms
Menorrhagia
48
Primary Dysmenorrhea - Exclusions (Age)
Age < ~20 (inconsistent with primary)
49
Primary Dysmenorrhea - Exclusions (Conditions)
History of: PID, infertility, irregular cycles, endo, ovarian cyst
IUD
Active GI disease
Bleeding disorder
Taking warfarin, DOAC, or lithium
Allergy to NSAIDs or aspirin
50
Primary Dysmenorrhea - NSAIDs
First line since they target prostaglandins
Can cause fluid retention
51
Primary Dysmenorrhea - Nonpharmacological
Sleep
Topical heat
Exercise
Smoking cessatin
Supplements: fish oil, vitamin D3
52
Premenstrual Syndrome - Exclusions (Symptoms)
Severe PMS or PMDD
Uncertain pattern of timing
Coincide with start of oral contraceptives or hormone therapy
53
Premenstrual Syndrome - Exclusions (Persists)
Symptoms worsen or do not improve
54
Premenstrual Syndrome - Special populations
If lactating: no herbs
55
Premenstrual Syndrome - Supplements
Better option than diuretics
Calcium
Vitamin D
Pyridoxine (B6)
-concern for neuropathy (tingling, weakness, bone pain)
Vitamin E
56
Premenstrual Syndrome - Nonpharmacological
Exercise
Acupuncture
Light therapy
Diet
CBT
57
Heartburn/GERD - Exclusions (Symptoms)
Alarm symptoms: dysphagia, odynophagia, upper GI bleed, weight loss
Severe or nocturnal symptoms
Continuous n/v/d
Signs of heart attack
58
Heartburn/GERD - Exclusions (Age)
Children <2 (no meds)
<12 years (antacids only)
<18 years (no PPIs)
59
Heartburn/GERD - Exclusions (Persists)
Persists after 2+ weeks
Frequent for >3 months
60
Heartburn/GERD - Special populations
Older adults: avoid aspirin and H2RAs
Pregnancy: if mild nonpharm, can use antacids or H2RAs (famotidine preferred)
Children: can treat 2-11 if mild (antacid, then refer)
61
Heartburn/GERD - Antacids
First line for mild
Alginic acid: only used together with MgCO3 or AlOH
62
Heartburn/GERD - H2 Blockers
First line for mild-mod (low or high dose)
Cimetidine strong inhibitor; many interactions (e.g. blood thinners, clopidogrel, phenytoin, nifedipine, metronidazole, propranolol, chlordiazepoxide, lidocaine, diazepam, theophylline, depression or anxiety medications)
63
Heartburn/GERD - Proton Pump Inhibitors
First line for frequent (2+ episodes/week)
64
Heartburn/GERD - Nonpharmacological
Food diary, avoid trigger foods, smaller meals, avoid bedtime eating, weight loss, smoking cessation
65
Constipation - Exclusions (Symptoms)
Abdominal pain or cramping
Marked/unexplained flatulence
Fever, nausea, vomiting
Unexplained changes or weight loss
Blood in stool
Marked change in character of stool
66
Constipation - Exclusions (Age)
Children <2 years old
67
Constipation - Exclusions (Conditions)
Paralysis, IBD, colostomy
Daily laxative use (except fiber)
Anorexia
68
Constipation - Exclusions (Persists)
Persists >2 weeks
Recur over 3+ months
Recur after treatment
69
Constipation - Special populations
First line: check med list and nonpharmacological
Older adults: bulk-forming (or PEG)
Pregnancy: bulk-forming (or PEG), short-term stimulants are ok
Children: MgOH, senna, PEG
70
Constipation - Bulk-forming
First line
May be more effective in low fiber intake, postpartum, or GI disease
Onset:
71
Constipation - Hyperosmotics
First line
72
Constipation - Stimulants
First line for opioid-induced (+emollient)
Otherwise second line
73
Constipation - Emollients
Second line
does not treat
docusate
74
Constipation - Lubricants
Not preferred
75
Constipation - Saline
Not preferred
76
Constipation - Duration of treatment
7 days
Avoid laxatives within 2 hours of other meds
77
Constipation - Nonpharmacological
Insoluble fiber, hydration, exercise, bowel habits
78
Diarrhea- Exclusions (Symptoms)
Fever (102.2, or 100.4 if <3 months)
Visible blood/pus/mucus in stool
Extremely high output
Persistent vomiting
Severe dehydration (e.g. AMS, anuric, no tears)
Severe abdominal pain
79
Diarrhea- Exclusions (Age)
Infants <6 months or <8 kg
Frail patients 65+
80
Diarrhea- Exclusions (Conditions)
Pregnancy
Diabetes
Severe CVD
Renal disease
Immunosuppression
81
Diarrhea- Exclusions (Persists)
Chronic (>4 weeks)
Poor response to ORS
Persists 72+ hours with treatment
82
Diarrhea- Oral Rehydration Solution
First line for mild-mod
Adults: 2-4 L over 3h
83
Diarrhea- Loperamide
Can be used if afebrile, no signs of bacterial/protozoal infection
84
Diarrhea- Bismuth subsalicylate
Preferred if vomiting
85
Diarrhea- Severity
Mild dehydration: <3% loss, virtually no symptoms, <3 stools/day
Moderate: 3-9%, some symptoms, e.g. thirst, 3-5 stools/day
Severe: >9%, serious symptoms, 6-9 stools/day
86
Intestinal Gas - Simethicone
safe in pregnancy
safe in children, questionable efficacy in colic
87
Nausua/Vomiting - Exclusions
Infants <6 months or <8 kg (Same as diarrhea), signs of serious condition
88
Nausua/Vomiting - Pregnancy
Pyridoxine (B6) +/- doxylamine
BF: no antihistamines or bismuth
89
Nausua/Vomiting - Children
dimenhydrinate 2+
diphenhydramine 6+
cyclizine 6+
meclizine 12+
90
Anorectal Disorders - Exclusions
Children <12 years
GI disease or abnormality
91
Anorectal Disorders - Special populations
If >40, refer for cancer eval
If pregnant, avoid internal products
92
Anorectal Disorders - Internal products
Corticosteroids
Vasoconstrictors
Protectants (except glycerin)
Astringents (calamine and ZnO)
