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Pharm 130 > Tx various minor ailments > Flashcards

Tx various minor ailments Flashcards

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1
Q

NonPharms prevention constipation (5)

A

Fibre

fluid -1.5L/day

toilet routine

  • bowel schedule
  • stool to put feet on

bowel retraining

exercise

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2
Q

nonpharms for tx of constipation (4)

A

increased fluid

bowel retraining

manual manipulation

prebiotics/probiotics

  • activia
  • bioGaia tabs
  • bisbiome
  • yakult liquid
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3
Q

5 classes of laxatives (nonRx pharm)

A

bulk forming

osmotic agents

stool softeners

saline laxatives

stimulant laxatives

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4
Q

bulk forming (nonRx pharm)

A

psyllium

  • Lax A day / metamucil
  • 70% soluble fibre 30% insoluble
  • DO NOT INHALE POWDER

wheat dextran vs inulin

  • (USA = wheat dextran CAN = inulin)
  • Benefiber
  • soluble fibre dissolves in liquid

Low level evidence

  • sterculia gum
  • polycorbophil
  • methylcellulose
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5
Q

osmotic agents (nonRx pharm)

  • MoA
  • evidence
  • 4 kinds
  • how use to avoid diarrhea
  • purgative/lavage
A

non-absorbed ions or mols break down gut flora –> acidic env osmotic gradients within intestinal lumen retaining water

ONLY laxative family with evidence shown to improve constipation

  • glycerin suppository (only works in last few inches of rectum)
  • lactulose (can use in diabetics bc no systemic abs)
  • sorbitol 70% solution (syrup)
  • PEG 3350 powder
    +restoralax, miralax, lax a day
    +good for pediatrics and adults
    +onset 3 days

TO AVOID DIARRHEA
-start low and work way up

Purgative/lavage

  • PEG with electrolytes
  • much higher dose
  • should be closely supervised by physician or caregiver
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6
Q

Stool softeners (nonRx pharm)

  • MoA
  • names 2
  • lubricant/purgative (2)

-EVIDENCE/EFICACIOUS?

A

act as surfactants and soften stool by allowing mixing of aq and fatty substances

docusate sodium
docusate calcium

LUbricant/purgative

  • mineral oil oral
  • mineral oil enema
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7
Q

Saline Laxatives (nonRx pharm)

  • MoA
  • avoid in who
  • oral (3)
  • enemas (6)
  • ENEMA NOTE
A

create osmotic gradient through electrolyte imbalance

avoid in children and elderly

Oral

  • Mg(OH)2
  • MgCitrate
  • NaPO4 oral

Enemas

  • tap water
  • soap suds
  • Mg enema
  • Phosphate soda
  • saline enema
  • mineral oil

ENEMA NOTE
-can damage rectum, only use as pretense to remove impaction

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8
Q

Stimulant laxatives (nonRx pharm)

  • MoA
  • concern
  • 4 types
  • how use
A

produce rhythmic contractions in intestines

dependency with overuse, talk about reduction in those using lot
DO NOT CAUSE MELANOSIS

senna tablets/suppository

  • can be used in children as liquid and may be used in pregnancy
  • herbal, tablet, liquid -> probs swallowing

Bisacodyl tablets/suppository

cascara sagrada
-NOT commonly used

Castor oil

HOW USE

  • take at night then shit for the next 12 days
  • some patients complain about cramping
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9
Q

Complimentary and homeopathic and herbal agents

  • evidence
  • found in OTC prep
  • 11 worthless hunks of plant
A

NO EVIDENCE, JUST EAT GRASS

senna and psillium –> use OTC bc thats where evidence

slippery elm
Fennei seed
aloe vera
papaya
acacia gum 
psyllium husk
pepermint leaves
triphala
buckthorn bark
senna leaves
ginger root
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10
Q

Oral forms for laxatives (acute)

A

PEG 3350 1.5g/kg/day
- evidence for disimpaction

NO EVIDENCE BUt USED IN PRACTICE
Mg(OH)2
MgCitrate
lactulose
sorbitol
senna
bisacodyl
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11
Q

Rectal laxatives (acute)

A 
EVIDENCE FOR DISIMPACTION
-phosphate soda enema
- saline enema
- mineral oil enema followed by phasphate
\+ need medical supervision

MOST EVIDENCE IN ELDERLY

  • bisacodyl suppository
  • glycerin suppository

NOT RECOMMENDED tox and irrit

  • soap suds enema
  • tap water enema
  • Mg enema
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12
Q

glycerin suppository (acute)

A

fastest onset

less effective if stool dry and hard

fast acting in nec to get relief before oral osmotic agent works in 48 hours

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13
Q

saline laxatives (acute)

  • evidence
  • onset
  • admin with what
  • taste
  • concern
  • CI
A

lack evidence to supp effectiveness

fast acting and effective

administer with enough fluid avoid dehydration

tastes v chalky

electrolyte disturbances

  • esp in LT use
  • -> diarrhea

CONTRAINDICATIONS

  • renal failure
  • CHF worse due to Mg
  • Neg mortality at 3 yrs
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14
Q

bulk laxatives (acute)

  • when do not use
  • how administer
  • good for what constipation
  • bad in what constipations
A

do not use if patient is

  • dehydrated
  • fluid restricted
  • impacted

administer with at least 250mL water or juice to prevent impaction

improves normal transit constipation

poor in slow colonic transit or pelvic floor disorder

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15
Q

stool softeners

  • chronic constipation use?
  • AEs?
  • mineral oil risk
  • AVOID IN WHO
A

insufficient data to use in chronic

AEs equal to placebo

mineral oil risk of lipid aspiration and binding fat soluble drugs

Avoid in pediatric and elderly

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16
Q

timeframe to eliminate cramping and bloating

A

1 day

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17
Q

timeframe to reduce pain

A

1-2 hours

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18
Q

timeframe to prevent future constipation

A

3-4 days

-get >3shits/wk

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19
Q

bulk laxatives for chronic

  • safety LT use
  • avoid in who
  • admin with what
A

safest drug for LT use

avoid in dehydrated or fluid restricted

admin with 250mL water or juice to prevent impaction

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20
Q

osmotic laxatives (chronic)

  • what one use in children
  • lactulose and PEG
  • low dose
A

FIRST LINE in pediatric = PEG

lactulose

  • abdominal pain
  • 80% effective

PEG
-least straining and greatest efficacy and tolerability

low dose
- stops bloating, cramping, flatulence, and electrolyte imbalance

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21
Q

saline laxatives (chronic)

  • evidence
  • onset
  • admin with what
  • compliance consideration
  • risks
A
  • lack evidence to supp effectiveness

fast acting and effective

admin withe nough fluid prevent dehydration

compliance prob: chalky taste

RISKS

  • multiple electrolyte disturbances esp in LT use
  • diarrhea
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22
Q

Stimulant laxatives (chronic)

  • evidence
  • opioid induced
  • when admin/onset
  • RISKS
A
  • insufficient evidence
  • best with opioid induced constipation (combo with osmotic agent may work better)
  • admin at bedtime
  • onset 6-12hr
RISKS
-concern dependence
\+ limit use when possible
\+use if other classes innefective
-abdominal discomfort and some electrolyte imbalance
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23
Q

for an acute episode of constipation

A

saline laxative, glycerin suppository, and/or enemas if no BM for 3 consecutive days

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24
Q

when follow up to check if shit

25
when follow up again after initial shit check
1mo
26
steps to care
educate patient, lifestyle modification, diet fibre supplement and/or bulk forming laxatives osmotic laxatives or saline laxatives orally emolients and stimulants - limit to st use - use if fail other agents/narcotic load
27
opioid induced constipation: methylnaltrexone
methylnaltrexone - blocks miu receptor in gut - used for opioid induced constipation laxatives covered on ODB and most private plans on Rx Relistor (brandname) not covered oxycodone and naloxone
28
opioid induced constipation: naloxegol (movantik BN)
oral tablet indication - opioid induced, non-cancer pain in adults - do not use if risk GI obstruction dose - 25mg daily if cramp and pain restart at 12.5mg - hod regular laxatives for 3 days administration - take on empty stomach - avoid grapefruit juice
29
Chronic idiopathic constipation: linaclotide (constella BN)
class secretagogue: guanylate cyclase C agonist 2C good for chronic idiopathic constipation and Irritable bowel disease activates c-GMP to activate chloride channels in cells of luminal surface of intestine drives water into intestinal lumen not effective if ++ diarrhea
30
prokinetic agents
increase peristaltic movement
31
prokinetic: prucalopride
Class prokinetic: seretonin 5=HT4 receptor indication: - trials, mainly women - chronic idiopathic constipation, secondary to parkinsons, opioids - ileus - refractory gastroparesis - intestinal pseudo-obstruction prev drugs in this class removed from market but no safety risk vs placebo for CV risks
32
``` mild-moderate acute infections diarrhea - resolution? - What therapy +what type +reverse what +replenish what +as effective as what +when CI ``` WHEN RECOMMEND
- mild to moderate acute infectious diarrhea should be self limiting to 7-10 days Oral rehydration therapy (ORT) +inexpensive sugar salt solution +reverses secretory diarrhea +replenishes fluid and electrolyte losses - glucose enhances Na Abs + as effective as IV rehydration for mild to moderate dehydration +contraindicated in protracted vomiting RECOMMEND BEFORE DEHYDRATION
33
why homemade ORS typically not recommended
measurement errors
34
what avoid as ORS (4) - why - what risks (2) - what CAN substiture
plain water, fruit juice, sports drinks, carbonated beverages - plain water can cause hyponatremia - others may worsen osmotic diarrhea apple juice half diluted with water is reasonable alt until suitable ORS can be obtained
35
ORS administration - dosage - what if vomiting - what if unpalatable (3) - how long use
15mL/kg/hr OR 60mL/kg for 4hr if vomiting give small volumes frequently until vomiting resolves -ex. 15mL q10min if unpalatable give by spoon or oral syringe or administer frozen cts until diarrhea resolves
36
should patients use BRAT for diarrhea
NO - eat whatever (so long as not trigger)
37
acute diarrhea in breast fed children
breast / bottle feeding cts (+ORS) | - some patients with giardia lamblia will dev temp Lactose intolerance so temp milk avoidance may help
38
what food portions during diarrhea
small food protions until diarrhea improves
39
When should you use zinc in diarrhea tx - how long - infant dose <6mo - infant dose >6mo
for children at risk - use for 10-14 days - 10mg daily for infants <6mo - 20mg daily for infants >6mo
40
when use pharm options in addition to ORT (diarrhea)
when needed for QoL or if sx's not improved in 48hrs
41
what diarrhea pharm tx d/c in can
attapulgite
42
what do if patient does not improve from ORT + bismuth subsalicylate OR psylium +time frame +what do
if do not improve in 48 hours try loperamide for 24 hours | - if no imp refer
43
if improvement with ORT +/- Pharm tx what do (diarrhea)
cts until resolves then consider stop
44
Psylium (metamucil) [DIARRHEA tx] - used for what - action - safety (SE/guidance) - adherance (dosage forms) - dosing
- used for mild diarrhea - Bulking agent + abs fluid to make stool less watery -cramping and flatulence + take sep from other meds by 2hrs +give with enough water - powder avail in mult flavours as well as capsules DOSE TID to QID
45
bismuth subsalicylate (pepto-bismol) {Diarrhea] - what kind diarrhea - action - safety (avoid in [4], SE) - adherance - dose
- used for mild to moderate diarrhea - antisecretory agent +stimulates reabsorption of electrolytes and water ``` - SAFETY +black tongue and stools + causes tinnitus + AVOID IN: -children -anticoagulants -subcylates - history of ulcer ``` liquid available in mult flavours chewable tablets easy to swallow capsules DOSE 130-60min PRN with daily maximum
46
loperamide - what types diarrhea - action - safety (4SE, 1CI, avoid[2]) - adherence - dosing
- used for moderate to severe diarrhea - antimotility agent + binds to opioid receptor to slow peristalsis - cramping, drowsiness, dizziness, dry mouth - contraindicated in children <3yrs - avoid in patients with fever or bloody diarrhea capsule, liquid, tablet initial dose followed by dose after each BM with daily max
47
PEP in children younger than 12yrs pregnant or lactating, evidence of active lyme disease - what drug/dose - endpoint/time period
doxycycline 200mg x 1 dose 0.4% incidence (relative to 3.2% placebo) of (endpoint) development of erythema migrans at site of tick bite (at 3wks and 6wks)
48
doxycycline drug interactions (3)
oral anticoagulants hepatic enzyme inducers isotretinoin
49
doxycycline MoA | -what consideration/counsil point
binds to divalent cations (ex. Ca, Fe) forms non-absorbable complex - wait 2hrs before/after dosing doxy with Ca and Fe (and other divalent cation) supplements
50
doxycycline AEs
allergy superinfection photosensitivity (LD higher in summer --> photosensitivity inconvenient) N/V esophagitis and esophageal ulcer (only if LT use) NOT HUGE DEAL BC ONLY ONE DOSE DOXY FOR LD
51
Rx doxycycline 200mg po x 1 dose | -what about in children
in children | - 4mg/kg po x 1 dose (maximum 200mg)
52
Non-pharm strategies NBI (3)
reduce symptoms - gently remove crusts with warm water or mild soap and water - warm saline compress x 10-15min TID-QID (dec itch) prevent spread (other areas of body and other ppl) - no scratch - wash b4/aft touch - cover draining lesion w/ clean/dry bandage - no share towel - wash linens sep from other ppl - discard used compress/bandages imm OR wash in hot water - stay home from school until 24hrs antimicrobial therapy OR lesions dry prevent recurrence - trim fingernails - manage pruritis appropriately - wash cuts, scrapes, and insect bites ASAP and cover w/ bandage
53
Topical antimicrobial therapy for mild uncomplicated non-bullous impetigo (3)
mupirocin 2% fusidic acid 2% ozenoxacin 1%
54
mupirocin 2% (4) - effectiveness - dose - type of topical (problematic?) - expense
impetigo - as effective as oral antibiotics with fewer SEs - TID x 5-7 days ointment or cream available - ointment + not good for oozing lesions + kids touch a lot and fingerprint all you shit - least expensive
55
Fusidic acid 2% - effectiveness - dose - type of topical - expense
NBI - as effective as oral antibiotics with fewer side effects TID x 5-7 days - ointment or CREAM (use cream bc ointment probs) - intermediate in price range to ozenoxacin 1%, mupirocin 2%
56
Ozenoxacin 1% - effectiveness - dose - type of topical - cost
Superior to placebo, hasnt been studies vs other antibiotics (drawback) BID x 5-7 days cream most expensive
57
What are the non-pharmacologic options for the treatment of dermatitis? (6)
- keep environment temperate (mild) with moderate humidity - choose swimming as a sport - wear loose-fitting cotton or cotton blend clothing - bathe using lukewarm water and a mild soap/soapless cleanser - do NOT restrict diet in absence of a confirmed food allergy - use wet dressings
58
What are the 3 types of wet dressings that can be used to treat dermatitis and when are they indicated?
1. Compresses --> when oozing and crusting is present 2. Soaks --> when hardened crusts and scaling are present (chronic) 3. Wraps --> moderate to severe AD and/or resistant cases

Pharm 130 (13 decks)

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