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Final
| Question | Answer |
|---|---|
| Karl's Clover Root Tea is | cleanse your system, nervousness, sallow skin |
| Federal Food and Drug Act of 1906 | Drugs, defined in accordance with the standards of strength, quality, and purity in the United States Pharmacopoeia and the National Formulary, could not be sold in any other condition unless the specific variations plainly stated on the label |
| 1938 Food, Drug and Cosmetic Act contains | Prohibition of false therapeutic claims for drugs, product advertising Mandated pre-market approval of all new drugs (safe), Brought about drugs causing harm including Elixir Sulfanilamide a new sulfa wonder drug that was an analogue of antifreeze |
| Durham-Humphrey Amendment of 1951 | The FDA was given authority to determine which drugs could not be labeled for safe use directly by the patient. Developed prescription and nonprescription products. Brought about by increased abuse in the 40’s and 50’s of amphetamines and barbiturates |
| Kefauver-Harris Amendments of 1962 | Brought about by Thalidomide, The new law mandated efficacy as well as safety before a drug could be marketed, required FDA to assess the efficacy of drugs intro since 1938, stricter control over drug trials (patients must give informed consent) |
| Do you think direct-to-consumer advertising affects the way consumers buy? | Yes |
| A national survey by the National Council on Patient Information and Education on self-medicating behaviors of the American public revealed | Only 1/3 surveyed that had used a OTC product could ID the active ingredient.10% said they read about possible side effects, Only 7% read about possible interactions 1/3 surveyed said they had taken more than the recommended dose of an OTC medication. |
| Introduction to patient care OTC | Patient presents to pharmacy with complaint |
| Formulate a ------ ------- by asking what are the ------ | Differential Diagnosis, What are the possible diagnosis for this patient? |
| Obtain a quick medical ------ on the patient | history, Intensity Duration Underlying medical conditions Prior treatment Allergies Current medications |
| then a Physical Assessment | It may be necessary to perform physical assessments in formulating a diagnosis Take blood pressure Physical presentation Patient Responsiveness |
| create a ----- Diagnosis | Tentative, Formulate a tentative diagnosis from history and assessment. Ask additional questions to confirm or refute diagnosis. |
| Conclude with a Diagnosis | Diagnosis is formed based on findings |
| now you ask what can I do to treat this patient by looking at... | Overall health of patient Age of patient OTC treatment option Seriousness of illness or condition Duration of illness or condition Prior therapy |
| Treatment Recommendations | If not a self-treatable illness- refer to appropriate provider If it is a self-treatable illness- make appropriate recommendations |
| Patient Education | Educate patient on disease or illness and signs and symptoms to look for when further medical treatment is required. Counsel patient on medication use including Ingredients Dose and administration Interactions General treatment guidelines |
| NEVER, NEVER, NEVER | Make a recommendation to a patient where self-treatment may cause harm |
| NUTRACEUTICALS in the present market | “Nutraceuticals are in their formative years. But no mistake, the Nutraceuticals boom is coming it will be worth billions to the companies who define it” |
| WHAT ARE NUTRACEUTICALS? | “Food or part of food that provide medical or health benefits including the prevention and treatment of disease” |
| NUTRACEUTICALS are known alternatively as | “Diet supplement that delivers a concentrated form of a presumed bioactive agent from a food presented in a non-food matrix and used to enhance health in dosages that exceed those that could be obtained from normal food” |
| NON-FOOD MATRIX is | Capsules Liquids Tablets Emulsions Powders Suspensions Douches Dermal/Cosmetic Products |
| FUNCTIONAL FOODS are | Is a natural or formulated food that has enhanced physiological performance or prevents or treats a particular disease. This term was first used in Japan in 1998. |
| Curcumin is from | Tumeric and makes curry |
| Indirubin | active ingredient of Danggui Longhui Wan, a mixture of plants that is used in traditional Chinese medicine to treat chronic diseases, Indirubin-3'-monoxime inhibits the proliferation of a large range of cells |
| What natural herb is used in used in cancer treatment | Indirubin from Chinese medicine has been found to be potent inhibitor of cyclin-dependent kinases (CDKs) |
| what is the difference in nutraceuticals and funtional foods | Functional foods are defined as similar in appearance to conventional foods and consumed as part of usual diet; whereas, Nutraceutical is a product produced from food but sold as capsules, tablets, or other medicinal forms |
| More than half of the U.S. population report taking some sort of | dietary supplement. Over $20 billion spent annually on dietary supplements. > 1/3 spent in multivitamins (MVI) |
| Recommended Daily Allowance is | (RDA) or Daily Reference Intake (DRI), Labels will read: Quantity and % DV (percent daily value), Ex. 200 mg…….20%, Usually measured in milligrams (mg), micrograms (mcg) or international units (IU) IU is dependent on how potency of the substance |
| FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products (prescription and Over-the-Counter). Under the Dietary Supplement Health and Education Act of 1994 (DSHEA) | FDA takes action against any unsafe supplement product reaches the market. manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements. Manufacturers must make sure that not misleading |
| Dietary Supplements Labels must say | "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease" Look for USP verified products only has A Few good clinical trials |
| Manufacturers are expected to follow certain | good manufacturing practices" (GMPs) to ensure that dietary supplements are processed consistently and meet quality standards |
| Vitamins are | Vitamins are natural (organic) substances found in plants and animals Essential for proper growth and development Inappropriate intake = Deficiency diseases, Over-dose (hypervitaminosis) There are two types: water-soluble and fat-soluble |
| Water-soluble Vitamins | Water-soluble B complex and C, Water-soluble vitamins are absorbed by your body, The human body does not store large amounts of water-soluble vitamins, The water-soluble vitamins that are not needed are removed by the kidneys, Vitamin C is antioxidant |
| Fat-soluble Vitamins | Fat-soluble A, D, E, and K; Require bile acid for absorption, Once these vit are absorbed, the body stores them, When they are needed the body takes them out of storage and used, Absorb is compromised in liver disorders, Vitamins A, and E are antioxidants |
| Minerals are | Minerals are inorganic elements that come from the earth, Soil and water and are absorbed by plants Animals and humans absorb minerals from the plants they eat, Minerals include Potassium, calcium, phosphorous, magnesium, zinc, iodine and selenium |
| Minerals Comprise 4% of | total body weight, Are present in compounds such as, phospholipids, and hemoglobin; Involved in regulating cell membrane permeability, osmotic pressure, acid-base balance, and water balance |
| Who Needs Supplements? | They should NOT be sub for a healthy diet, Nutrients are absorbed come from food, Unless deficient, do not take more than 100% DV, elderly, 1000 calories/day or less, Smokers, Malabsorption diseases, Heavy drinks, Pregnancy, breast feeding, vegetarians |
| Vitamin A has | Different forms referred to as “retinoids” Retinol, retinal, retinoic acid, and retinyl ester Caroteniods (beta-carotene) dietary precursor to retinol ; A.k.a. Provitamin A; Body stops converting to vitamin A before levels are excessive |
| Vitamin A: Forms and Function | Carotenes From plant foods (abundant in yellow and orange vegetables and fruit) Antioxidants Retinyl esters From animal derived foods e.g. eggs, whole milk, meat Retinol Supports healthy skin |
| Vitamin A: Forms and Function | Retinal - Needed for vision Retinoic acid - Supports skin and epithelial tissue Retinyl palmitate - Storage form inside human liver |
| Vitamin A: Toxicity | Called hypervitaminosis A - Brittle nails, gingivitis, hair loss, reduced menstrual flow, spider angiomas, anemia, leukocytosis and thrombocytopenia |
| Vitamin A is transported through the blood bound to proteins-Toxicity appears when | binding proteins are full and retinol starts to damage cells, Occurs from long-term consumption of excessive doses of 10 times the RDA |
| Vitamin A May have negative effect on bone | Suppress osteoblast activity, stimulate osteoclast formation, and antagonize the ability of vitamin D to maintain serum calcium levels |
| Vitamin D | Several forms; 2 that are physiologically important Vitamin D2 (ergocalciferol) Comes from ergosterol, a plant sterol, and yeast Vitamin D3 (Cholecalciferol) |
| 80-90% of vitamin D is provided by | sunlight, Brief sunlight exposure (25% of the time it takes to cause pinkness to the skin) Light skin can take as little as 10 minutes, More exposure needed for darker skin |
| Vitamin D: Function | Regulate serum calcium and phosphorus concentrations Enhances the efficiency of the intestinal absorption of calcium (primarily in duodenum and jejunum) and phosphorus Researching effects in autoimmune diseases (seems to be immunosuppressive |
| Vitamin D: RDA | The National Osteoporosis Foundation recommends 400-800 IU daily for adults < 50 800-1000 IU daily for ≥ 50 The North American Menopause Society recommends 700-800 IU daily for women at risk for deficiency due to low sun exposure |
| Vitamin D: Deficiency | Children- Rickets- Bowing of the arms and legs Delayed closure of the fontanels - Soft spot” Severe cases affect nerves and cause seizures Estimated that 30% of teens and 50% of adults have deficiency |
| Adults With low vitamin D | ↓ amounts of calcium is absorbed → ↓ calcium in the blood stream, Parathyroid hormone then triggers release of calcium from bone to increase calcium in the blood stream→ soft bones (osteomalacia) |
| Vitamin D: Deficiency | Muscle pain, proximal muscle weakness sensation of heaviness in the legs, rapid fatigue and problems climbing stairs and getting up from a chair (some researchers think doses of 800-1000 IU daily in the elderly may help muscle strength and prevent falls) |
| Vitamin D: Toxicity | Reversible with discontinuation of vitamin D supplementation Hypercalcemia Azotemia (increased BUN) Anemia Kidney stones |
| Vitamin E is | Tocopherols Alpha, beta, gamma, delta and four tocotrienols Most vitamin E in food is gamma Supplemental vitamin E is alpha |
| Vitamin E Sources | Vegetable oils, cereal grains, animal fats, meat, poultry, eggs, fruits and vegetables |
| Vitamin E: Function | Does not appear to have a specific metabolic process Chain-breaking antioxidant preventing free radical formation |
| Vitamin E: Deficiency | Very rare Enough stored that it would take 4 years or more of deficient diet |
| Vitamin E: Toxicity | Increase risk of bleeding at high doses Can change from antioxidant to pro-oxidant when supplementing > 400 IU daily |
| Vitamin K | Needed for the synthesis and activation of clotting factors in the liver (factors II, VII, IX, X), K1-phytonadione from dietary sources (green leafy vegetables) K2-menaquinone made by the intestinal bacteria, K3-menadione, synthetic compound (3Xpotent) |
| Vitamin C | Involved in a variety of metabolic process Known for immune function Vitamin C seems to: regulate T-lymphocyte activity, phagocyte function, leukocyte mobility and possible antibody and increase interferon production, we need from diet |
| B Vitamins | Work closely together thus may be difficult to identify deficiency Taken together in food and supplements Referred to as B complex |
| B Vitamins provide | Energy production from carbs, fats, and protein Synthesis of neurotransmitters Conversion of amino acids Synthesis of fatty acids and hormones Antioxidant protection |
| Vitamin B1 (Thiamine) | Aids in carbohydrate metabolism Amount increases with increase with B vitamin when CHO consumption increases |
| Vitamin B1 (Thiamine)Deficiency | Beriberi Anorexia, abdominal pain, constipation, peripheral neurologic changes, sleep disturbances, poor memory Wernicke-Korsakoff Confusion, aphonia, ataxia, nystagmus, and coma |
| Vitamin B2 (Riboflavin) | Required for tissue respiration Vital for dermatologic and ophthalmic health |
| Deficiency in Vitamin B2 (Riboflavin) | Rare Mainly seen when animal protein is not in diet Sensitivity to light Cracks in corner of mouth |
| Vitamin B3 (Niacin) Two forms | Niacin=Nicotinic Acid Niacinamide=Nicotinamide Synthesized by dietary tryptophan Hundreds of enzymes require these coenzymes NAD and NADP |
| Vitamin B3 (Niacin) does | Enzymes mainly used to accept or donate electrons to make energy or build molecules NAD often used in reactions to release energy from carbs, fats, proteins and alcohol Used in high doses for lipid management |
| Sources Vitamin B3 (Niacin) | Cooked whole grains, legumes, seeds Enriched grains, mushrooms, leafy vegetables, pork, beef, fish and dairy products |
| Vitamin B3 (Niacin) Toxicity | Nicotinic acid can cause flushing of the face and skin and itching Liver damage, elevated blood glucose, PUD, elevated uric acid Contraindicated in active liver disease and PUD Caution use in diabetes and gout patients |
| Biotin | Needed to make energy in the mitochondria of the cell Synthesized by colonic flora in the large intestine Larges doses of pantothenic acid compete with biotin absorption due to similar structure |
| Vitamin B5 (Pantothenic Acid) | Required for metabolism of carbs, proteins and fats Forms a large part of coenzyme A |
| Vitamin B5 (Pantothenic Acid) Deficiency | Very rare and hard to detect Somnolence, fatigue, HA, GI complaints, muscle weakness in legs, paresthesia of hands and/or feet followed by hyperreflexia and increased susceptibility to infection |
| Vitamin B6 (Pyridoxine) | Involved in the metabolism of amino acids; as well as carbs and lipids Converted to the coenzyme Pyridoxal Phophate (PLP) in the body and used for many metabolic reactions Including converting tryptophan to niacin |
| Vitamin B6 (Pyridoxine) Toxicity | Severe neuropathy and shaky movements or unsteady gait (ataxia) |
| Folate (Folic Acid)is Reduced in the body to the active coenzyme tetrahydrofolate | Major role in intracellular metabolism Indirect role in the rate-limiting step of DNA synthesis, Reduces damage to DNA and prevents replication errors Deficiency disturbs cell cycle, induces cell death and increased rate of cell death |
| RDA of Folate (Folic Acid)is | 400 mcg 600 mcg during pregnancy Reduces incidences of neural tube defects when taken before and during pregnancy 500 mcg if breast feeding |
| Folate (Folic Acid) Sources | Found in nearly all natural foods,Leafy green vegetables, 1998 FDA required fortification of all enriched cereal grain products (bread, flour, corn meal, rice, pasta, etc.) Heat liable with >50% destroyed in canning process |
| Folate (Folic Acid) Deficiency | Seen in alcoholism, malabsorption, fad diets and associated with various drugs, Dihydrofolate reductase inhibitors (i.e. methotrexate, trimethoprim), Anemia resulting from abnormal cell division resulting in fewer and larger red blood cells,mimics b12 de |
| Vitamin B12 (Cyanocobalamin) is for | Required for nucleoprotein and myelin synthesis, cell reproduction, normal growth, Requires the glycoprotein, intrinsic factor (produced by the stomach), to be absorbed in the terminal ileum, Works with folate to convert homocysteine to methionine |
| Deficiency of B12 | Seen in strict vegetarians, alcoholics, those with pernicious anemia (an autoimmune disorder resulting in inability to produce intrinsic factor) and gastrectomy |
| Vitamin B12 (Cyanocobalamin) Neurologic symptoms | Neuropsychiatric disorders such as depression, paresthesias, ataxia, memory loss, weakness and personality and mood changes without anemia |
| Sodium | Electrolyte Important for maintaining blood pressure and fluid balance Absorbed directly from the GI tact Kidneys remove Na+ from the blood and put back the correct amount |
| Sodium Deficiency | Caused by excessive sweating, prolonged vomiting or diarrhea, use of diuretic sx: HA, muscle cramps, fainting, fatigue and disorientation |
| Potassium | Electrolyte High concentrations in the cell Involved in cell metabolism and determination of resting potential across the cell membrane Required for insulin secretion and relax heart muscle |
| Potassium Deficiency | Results from prolonged vomiting, certain medications, and from some forms of kidney disease sx: fatigue muscle weakness, irregular/rapid heart beats (can be fatal) |
| Potassium Toxicity | Hyperkalemia From excessive supplementation S/sx: weakness and cardiac arrest |
| Calcium | 99% found in the bones and teeth Plays a role in nerve and muscle function Narrow range of concentration in the blood Will take calcium from bone if needed This is regulated by the parathyroid hormone Needs vitamin D to be absorbed |
| Calcium Deficiency | Can be due to malabsorption, vitamin D deficiency, renal disease Convulsions, tetany, behavioral and personality disorders, mental and growth retardation, bone deformities, osteromalacia, osteopenia, osterporosis |
| Calcium Toxicity/Excessive Intake | Calcium in urine and possibly renal stones Increased deposition of calcium in soft tissue Constipation |
| Calcium Carbonate is 40% elemental calcium | Tablet containing 1000 mg of calcium carbonate has 400 mg of elemental calcium Percent daily values refer to elemental calcium |
| Calcium forms need to be | Must be in a soluble, ionized form to be absorbed Solubility increased in an acidic ph Calcium citrate is the most soluble Recommended if taking H2 blockers or PPIs > 65 yo because stomach acidity decreases |
| Calcium salts | Carbonate (40%), Citrate (21%), Gluconate (9%) |
| Iron | Used to store and transport oxygen in the blood and store oxygen in the muscles |
| Iron RDA | Differs depending on age and conditions Males 19-50 yo 8 mg Females 19-50 yo 18 mg |
| Iron Deficiency and Toxicity | Results from inadequate intake, pregnancy, lactation or blood loss, Anemia, Pallor, fatigue, dizziness, SOB, HA, split or “spoon-shaped nails, sore tongue Irritate GI tract causing nausea, abdominal pain, Constipation, Black tarry stool |
| Supplementation of Iron | Supplementation Absorption increased by vitamin C Many drug interactions |
| Phosphorus is Needed in every cell of the body for | Cell membranes, used for energy production and storage of energy in the body, acid-base balance |
| Main use of Phosphorus is to strengthen bones; 85% of phosphorus in the body is in the bones and | Is Regulated along with calcium by the parathyroid hormone When calcium is low it is removed from the bone along with phosphorus; calcium is retained in the blood while phosphorus is excreted from the body |
| Magnesium | Strengthens bones, promotes muscle relaxation and stabilizes ATP Majority found in bones Needed for proper mineralization of bones with calcium and phosphorus |
| Magnesium Deficiency | Caused by malabsorption, kidney disease, alcoholism and malnutrition S/sx: muscle spasms, rapid heart beat, confusion, lack of appetite, N/V |
| Some use Magnesium for | headache, taking orally seems to reduce the frequency and severity of migraine headaches. However, other research suggests that magnesium doesn't have any effect. |
| Some use Magnesium for | Slowed breathing, coma, HoTN, dysrhythmia progressing to cardiac arrest |
| Zinc | Trace element Antioxidant Needed for activity of nearly 100 enzymes Plays important role in growth and development, neurological function, the immune system, reproduction and wound and burn healing |
| Deficiency Zinc | Growth retardation in children, slow wound healing and birth defects Impaired taste and smell |
| Toxicity of Zinc | Excessive consumption can lead to copper deficiency Diarrhea, abdominal pain, N/V Zinc nasal spray can cause permanent loss of smell, therefore, sprays and gels should be avoided |
| Toxicity of Iodine | Long term excessive intake may disturb thyroid utilization and result in goiter formation, unpleasant taste in mouth, burning of mouth and tongue, soreness of teeth and gums, increased salivation, sneezing, irritation of eyes and swelling of eye lids |
| Deficiency Selenium Toxicity Selenium | Decreased antioxidant activity and thyroid function (selenium needed to produce active form of thyroid hormone), Garlic breath, brittleness and loss of hair and nails, vomiting, diarrhea and skin abnormalities |
| Pharmacists Role in supplementation is | Stress a well balanced diet is the best source of vitamins and minerals Emphasis that vitamin/minerals are SUPPLEMENTS, not substitutions Counsel patients to inform all healthcare providers of vitamin/mineral use |
| Clinical Pearls | Avoid products that contain “megadoses” Chose products labeled USP or USP-verified Ignore claims such as special benefits for people on |
| Pain is Unpleasant sensory and emotional experience associated with | actual or potential tissue damage or described in terms of such damage |
| Damaged tissues release | prostaglandins, bradykinin, serotonin (5-HT), substance P, and histamine, which stimulate or sensitize nociceptive neurons |
| Nociceptors deliver | electrical impulses from site of injury spinal cordvarious centers of brain |
| In response, inhibitory transmitters (ie. | endorphins, norepinephrine, 5-HT) are released to block pain transmissions from periphery |
| > 90% of people report | experiencing HA at some time during their lives |
| classified as primary or secondary which is | Primary (approx 90% of HA)—not associated with underlying disease (ie. migraine, tension, medication overuse) Secondary—symptoms (sx) of an underlying disease (ie. head trauma |
| Tension HA is caused by | Stress, anxiety, depression, emotional conflicts, fatigue, repressed hostility |
| Migraine is caused by | Stress, fatigue, oversleeping, fasting or missing a meal, vasoactive substances in foods, caffeine, alcohol, menses, and medications |
| Migraine HA is defined by | Neuronal dys of NV5 vs vascular disturbance, Neuronal hyperexcitability has been proposed as trigger for aura, Stimulation of trigeminal sensory fibers causes neuropeptide release with inflammation, vasodilation, and platelet and mast cell activation |
| Goals of Treatment for HA | Alleviate acute pain Restore normal functioning Prevent relapse Minimize side effects Reduce frequency of headaches (if pt has chronic HA) |
| Refer to physician for persistent HA | Medication Overuse Refer to physician for tapering Use episodically not chronically (no more than 3 days per week) Need to refer to clinician if headache persists over 6-12 weeks or gets worse |
| Who should NOT self-treat? | Headaches that persist for 10 days w/ or w/o treatment Last trimester of pregnancy ≤ 7 years of age High fever or signs of serious infection History of liver disease or consumption of ≥3 alcoholic drinks per day Sx -no diagnosis of migraine headaches |
| Degree of sprain | 1st degree—excessive straining 2nd degree—partial tear 3rd degree—complete tear |
| Exclusions for Self-Treatment for muscle treatment | Moderate to severe pain (pain score >6), Pain that lasts >2 weeks, Pain that continues >7 days after treatment, Increased intensity or change in character of pain, Pelvic or abdominal pain (other than dysmennorhea), Accompanying nausea, |
| Exclusions for Self-Treatment for muscle treatment | vomiting, fever or other signs of systemic infection or disorder, Visually deformed joint, abnormal movement, weakness in any limb, or suspected fracture, 3rd trimester of pregnancy, <2 yo (FDA minimum age) |
| Acute Treatment of Musculoskeletal Injuries: | RICE |
| General Treatment Approach of Musculoskeletal Injuries | Nonprescription analgesics +/- external analgesics during 1st 1-3 days following injury Heat therapy, massage with traction Mobilization with exercise |
| Cryotherapy is for | Use should be limited to 20-30 minutes twice daily Best results if used within first 24-48 hours |
| Cryotherapy is cautioned for | –Avoid use in patients with Raynaud’s disease –Avoid use in patients with lack of sensation (neuropathy) |
| Thermotherapy cautions | Always use heating pad covers Avoid use on skin devoid of feeling Do not sit or lay on heating product Do not use in conjunction with counterirritants Do not use while sleeping |
| Avoid use of heat therapy for | Fresh contusion Tumors Patient with fevers Eyes Brown recluse bites Abdomen of pregnant patients Patients with rheumatoid arthritis |
| Counterirritants are | Approved for treatment of minor aches and pains of muscles and joints Recommended as adjuncts to pharmacologic and nonpharmacologic therapy of musculoskeletal injuries and disorders |
| Types of Counterirritants | Rubefacients (cause redness) Methyl salicylate Cooling sensation agents Camphor Menthol Cause vasodilation Methyl nicotinate Incite irritation without rubefaction Capsaicin |
| General Patient Counseling on Counterirritants | Should be applied no more than 4 times daily Should avoid using heating pads or other heating devices in conjunction with any external analgesic Avoid application to wounds or broken skin Do not bandage after application Use for no longer than 7 days |
| Camphor is a | counter irritant, Produces cooling sensation Available in concentrations from 3%-11% Found in many combination products JointFlex Cream (3.1% camphor) Mentholatum Ointment (9% camphor with menthol) |
| Menthol is a counter irritant | Also known as peppermint oil Concentrations range from 1.25-16% Lethal oral dose is 2 grams Flexall 454 (7% menthol with additives) Eucalyptamint (16% menthol with additives) BenGay SPA (10% menthol with additives) |
| Methyl Salicylate is a | Counterirritant, known as wintergreen or teaberry oil, Rubefacient,is combined with menthol and/or camphor, Topical, CAUTION in aspirin allergic patients, Watch for adverse reactions, Lethal doses:4 mL in children, 30 mL in adults |
| Lice are | Human lice are wingless parasites that require frequent blood feedings, they do not fly, |
| Pediculus humanus capitis | Head Lice , Most cases are between the ages 3-12 years old Common places for outbreaks (typically between August and November) Affects all classes; less common in African Americans due to oval hair shaft |
| Body Lice a.k.a. “cooties” | P. humanus corporis, Live, hide and lay eggs in folds under clothes and periodically attack body for blood feeding Body lice are twice the size of head lice and lay more eggs (up to 300 in a lifetime) |
| Pubic Lice a.k.a. “crabs | Phthirus pubis, Transmitted through high risk sexual activity, Mostly found in pubic area, but may infest armpits, eyelashes, mustaches, beards and eyebrows, Smaller than head lice, |
| Nits Glued near the base of the | hair shafts, close to body heat, Hatch in 5-10 days, Begin feeding process within 24 hours of hatching or will die |
| Nymph is | Newly hatched nit; empty nit shell becomes more visible, Matures in 8-9 days, adults are less active, cycle repeats every 3 weeks |
| Mature Lice are | Pierces skin with jaws,injecting saliva (contains hyaluronidase)that thins the blood,and sucks blood about 5 times a day. |
| Signs and symptoms of lice | Seen around the crown of the head, near the ears and base of neck, Evidence of lice feces in the form of dark powder stains on linens or clothes |
| How to treat the infestation of lice within home | If cannot be washed, seal in a plastic bag for 2 weeks, Wash combs and brushes in very hot water, ≥130° F for 10 minutes, |
| Medications used for lice | Synergized Pyrethrins, which is synergized by the presence of piperonyl butoxide (a petroleum derivative), |
| Mechanism of Action of Synergized Pyrethrins | Blocks nerve impulse transmission, causing paralysis and death; piperonyl butoxide synergizes by inhibiting the breakdown of pyrethrins, used for head lice and crabs, repeat 7-10 days, do not use in eyes, may use in infants. no treatment for eyebrows. |
| Permethrin is used for | Head lice, scabies in prescription, Acts on nerve cell membrane by disrupting sodium channels, delaying polarization and causing paralysis, do not reapply. Do not used in children, do not use when in eyebrows. |
| Poison ivy, poison oak, and poison sumac are the most common cause of | allergic reactions in the United States (allergic contact dermatitis), |
| When to Refer for poison IV infxn | < 2 years old, Dermatitis persists for >2 weeks, > 25% BSA affected, Numerous bullae or vesicles, Extreme itching, Swollen eyes, Mucus membrane or genitalia involvement |
| Tecnu Outdoor Skin Cleanser | 1. No water needed 2. Apply vigorously and wipe off with towel |
| Zanfe Poison Ivy | 1. Used to wash away urushiol 2. Apply in shower |
| Urea is a | keratolytic and increase water uptake in the stratum corneum |
| Lactic Acid/ά-Hydroxy Acids | At low concentrations,increases hydration of skin and acts as a modulator of epidermal keratinization |
| Allantoin | Soften keratin by disrupting its structure |
| Astringents | Cause vasoconstriction in and reduce blood flow in inflamed tissue. |
| Hydrocortisone | Suppresses cytokines associated with the development of inflammation and itching |
| Pyrilamine maleate | Antihistamines, Compete with histamine at H1 receptor sites. |
| Antiseptics | Boric Acid, Oxyquinoline, Benzalkonium Cl, Isopropyl alcohol, Phenol, Menthol |
| Protectant | Physical barrier between skin and external irritants |
| Keratolytic | Salicylic acid, Sulfur, Remove scales, Loosen and lyse keratin aggregates |
| Emollient | Glycerin, Mineral oil, Castor oil, Lanolin Ammonium lactate, Colloidal oatmeal |
| Humectant | Glycerin, Propylene glycol, Phospholipids |
| a type of ------- | Astringents, Aluminum acetate, Witch hazel |
| Most sunburns are | 1st degree burns, |
| Sunburns with blisters.... | fever, chills, weakness and shock may indicate 2nd degree burn |
| Protection from the sun rays | UVA and UVB rays is ideal |
| SPF or Sun Protection Factor is the factor of time a person may stay out in the sun without burning. For instance, if a person can normally be in the sun for 1 hour before burning, a SPF factor of | 6 would allow them to stay out for 6 hours. |
| Burn patients that need a refferal | 2nd degree or higher burn, Burn to BSA of 2% or more, Burns involving eyes, ears, face, hands, feet, or perineum, Chemical burns, Electrical or inhalation burns, Persons of advanced age, Patients with DM or multiple medical conditions. |
| The difference between a cut and laceration is | how deep the incision is. If in the sub cutaneous then its a laceration. Lacerations need stitches, |
| Bacitracin- polypepticde bactericidal that fights gram | positive bacteria, minimal systemic absorption and low frequencies of allergies |
| Neomycin is a | aminoglycoside antibiotic, mostly gram negative bacteria, relatively high (3.5-6%) hypersensitivity |
| Polymixin is a | polypeptide antibiotic, mostly gram negative, rarely allergic |
| Sleep problems may | Affect quality of life Exacerbate medical conditions Exacerbate psychiatric conditions |
| Sleep is divided into two stages | Rem and Non Rem stages, non rem has 4 stages and last 70 to 120 min, Rem starts at 5-7 min then increase as stages progess through out the night. |
| The ability to tell night from day is based on the | suprachiasmatic nuclei in brain, the neurotransmitters are released and stim the release of melatonin. |
| Melatonin plays an important role in the | Circadian Rhythm, Melatonin secretion and synthesis are increased during dark periods, and decreased during light |
| Melatonin | Higher levels in children Decreasing levels in age Circulates in the blood, unbound Synthesized from seratonin |
| Sleep Hygiene | Use beds for sleeping/intimacy only Establish regular sleep patterns Make the bedroom “comfortable” Engage in relaxing activities prior to sleep Exercise regularly, but not within 2-4 hours of bedtime Avoid eating meals within 2 hours of bedtime |
| Good Sleep Hygiene is | Avoid daytime napping Avoid using caffeine, alcohol, or nicotine within 4-6 hours of bedtime If unable to sleep, perform a relaxing activity until tired Do not watch the clock at night |
| Insomnia is defined as | Trouble falling asleep, staying asleep, or returning to sleep Waking up to early Not feeling “refreshed” after sleep |
| Classification of insomnia is | Transient—self-limiting, lasting less than 1 week Short term—lasting 1 to 3 weeks Chronic—lasting from more than 3 weeks to years Often the result of medical problems |
| Those that are risk of insomnia | Female Elderly Lower socioeconomic status Psychiatric disorders Stressors (unemployed, widowed, or separated) |
| Classification (cause) of insomnia | Primary cause is Affects psycho-social functioning Not caused by another sleep disorder, medical disorder, psychiatric disorder or medication, Other types of insomnia caused by specific stresses |
| More severe stressors may allow insomnia to progress from | Transient to Short-Term to Chronic |
| Other causes of insomnia are | Shift work: excessive daytime sleepiness Sleep apnea (obstructive/central): obstruction of the airway during sleep Stimulants: sensitivity to caffeine or nicotine, Medications: antidepressants, antihypertensives, sympathomimetics |
| Clinical Presentation of insomnia are | going and staying asleep. This can be very dangerous for the patient. |
| Treatment for insomnia is | Principles of good sleep hygiene Management of Stressors Pharmacologic Therapy (OTC) Diphenhydramine Doxylamine Complimentary Therapies Prescription Drugs (If self care excluded) |
| Exclusions for self care for insomnia | Frequent nocturnal awakenings Chronic insomnia Sleep disturbances nightly for >7 days Sleep disturbances secondary to psychiatric or general medical disorders |
| Complimentary Therapies for insomnia are | Melatonin 5-hydroxytryptophan (5-HTP) Valerian Kava |
| Melatonin is | Still considered a “standard of care” for JLD and Shift-work disorders Should not use more than 2 weeks without prescriber consultation |
| 5-HTP for insomnia | Efficacy not proven in sleep disorders Risk of Eosinophilia-myalgia syndrome (EMS), which is potentially fatal Should NOT be recommended as a sleep aid |
| Valerian is | Optimum dose: unknown, clinical trials used 400 to 900mg nightly for several weeks (only chronic insomnia) Patients may experience benzodiazepine-like withdrawal after years of use Limited evidence show that it works |
| Kava is | From the South Pacific plant, Piper methysticum Similar to Valerian, may have a benzodiazepine-like mechanism of action Recent reports show various drug interactions and hepatotoxicity Should NOT be recommended as a sleep aid |
| Jet lag is | A sleep disorder that occurs when the body’s biological clock does not correspond to local time Changes in normal sleep stimuli (light/dark) |
| American Academy of Sleep Medicine Guidelines If travel is of | short duration (2 or less days), keep home-based sleep hours For eastward travel, shift sleep schedule one hour earlier each day for 3 days Melatonin (standard) Short-term use of a benzodiazepine-receptor agonist, and Caffeine |
| Prepare for travel by adjusting sleep habits to | Westward: Stay up later and wake up later for several days prior to trip Eastward: Go to bed 1-2 hours early for several days prior to trip |
| Daytime drowsiness most often results from | Inadequate sleep Insufficient duration of sleep Fragmented sleep |
| Treatment for drowsiness is | Identify and eliminate underlying cause Good Sleep Hygiene Caffeine Prescription Stimulants |
| Caffeine Xanthine derivative Mechanism of action | Adenosine receptor antagonist Decreases levels of adenosine accumulated in the morning Also stimulates the sympathetic NS Stimulates release of epinephrine, norepinephrine, and renin Increases cardiac force and output Dosing should be 200mg 3-4 hrs |
| Tinea is the common term for “dermatophyte” infections:Dermatophytes are: | Species of fungi known for causing skin disease in animals and humans |
| Infections and lesions are usually | superficial Hair Nails Skin |
| Fungal skin infections are among the most common... | cutaneous disorders 10-20% of US suffer from Tinea at any given time |
| Tinea Pedis is | Most prevalent form of Tinea Adults > children Whites > blacks (increases in urban/tropical areas) 70% lifetime risk for everyone 45% have episodic infections for 10 years |
| Tinea Unguium | Tinea infection of the nails, Loss of nail luster Nails become opaque Nails may progress to: Yellow, Thick, Rough, Friable Possible separation from nail bed |
| Tinea Corporis is | 3rd most common, Affected population: pre-pubescents Increased risk: Hot/humid climate, Under stress, Over weight... common place is the day care for little kids. |
| Tinea Capitis is | Tinea of the scalp Affected population: Children > Adults Black females > black males > white children thought due to hair products, braiding of hair etc... the spread is by fomites |
| Tinea include 3 genera of pathogenic fungi that spread by 3 ways | Trichophyton, Microsporum, Epidermophyton Fungal transmission may occur via contact with: Infected animals and people, Soil, Fomites |
| Exclusions for Self Care of Tinea is | Cause unclear, Unsuccessful therapy, Nails or scalp need systemic meds, Face, mucous membranes, or genitals involved, 2ary infxn (oozing), serious inflammation, Diabetes, systemic infection, ashtma, immune deficiency and fever |
| Treatment of Fungal Infections with hygiene | Use separate towels to dry the area, Do not share towels, Cleanse skin daily with soap/water Avoid keeping area wet, Dust shoes with powders, Avoid contact with people who have fungal infections |
| Tolnaftate is Tinactin and | Introduced in 1965 for athlete’s foot Standard for comparison of antifungals Approved for treatment and prevention of athlete’s foot Apply to clean skin twice daily for 2-4 weeks |
| Clotrimazole and Miconazole mechanism is | Inhibit biosynthesis of ergosterol and other sterols Damage fungal cell wall-fungistatic/fungicidal |
| Clotrimazole and Miconazole is | Approved for: Tinea Pedis, Tinea Cruris, Tinea Corporis Clotrimazole—Lotrimin AF Miconazole—Desenex Apply twice daily for up to 4 weeks |
| Terbinafine and Butenafine mechanism and class are | Squalene epoxidase inhibitors Mechanism: Inhibits squalene epoxidase, key enzyme in fungi sterol synthesis—leads to fungal cell death |
| Terbinafine and Butenafine is approved for | Interdigital Tinea Pedis, Tinea Cruris, Tinea Corporis, Terbinafine: Apply 2X to area for up to 4 weeks or 2X for 1 wk for AF, Butenafine: Apply 2X for 1 week, or 1X for 4 weeks Tinea cruris or Tinea corporis: apply 1X daily for 2 wks |
| Before making recommendations, get an | accurate history and look for exclusion criteria, Always recommend practices for future prevention |
| If infection is oozing, oily, or has thickened skin, use | keratolytics and astringents prior to antifungal use |
| All antifungals available have been proven effective | differences lie in the delivery vehicle or time to cure |
| What is the pathology of acne | Sebaceous gland disorder that is caused by Androgenic triggers, Excess sebum, follicular desquamation, Proliferation of Proprionibacterium acnes, Inflammatory responses |
| Acne begins with | Abnormal desquamation that clogs the pore, Sebum is trapped, Comedone then forms |
| Comedones are | Whiteheads: closed Blackheads: open |
| Pustules- | Pustules-elevated, superficial cavity filled with purulent fluid |
| Papules- | well-defined, elevated, palpable distinct area of the skin in epidermis or dermis |
| Nodules- | elevated, firm, round or oval lesion in the dermis or hypodermis |
| Cysts- | deep nodules |
| Treatment Targets for Androgenic hormonal triggers | OCPs, Yaz, Yasmin, sprionolactone |
| Treatment Targets for Excess sebum production | Oral isotretinoin |
| Treatment Targets for Abnormal follicular desquamation | Benzoyl peroxide, Salicylic acid, Topical retinoids |
| Treatment Targets for Proliferation of Proprionibacterium | Topical and oral antimicrobials |
| Treatment Targets for Inflammatory responses | Oral antibiotics |
| Cleanser is used for | Clears sebum and bacteria from the skin |
| acne Lotion May be used for | dry skin |
| Decongestants are both | topical and oral. |
| oral decongestants are | phenlyefrine and psuedoephedrine |
| Topical decongestants are | ephedrine, naphazoline, oxymetazoline, phenylephrine and xylometazoline |
| Direct acting decongestants are | phenylephrine, oxymetazoline and tetrahydrazoline |
| Indirect acting decongestants are | able to displace norepinephrine |
| Mixed acting deocgestants are | psuedoephrine |
| systemic decongestants are metabolized by the MAO and catacholmethyl transferase pathway in the ___, the half life for psuedo/phenylephrine is | Liver, psuedo is 6 hrs and phenyl is 2.5 hrs. |
| Decongestants are used for | temp relief of the ear tubes and the sinus pressure/PNdrip. |
| Dosing of psuedo/phenyl is | Pseudo is 240mg/day, phenyl is 40mg/day. |
| SE of decongestants are | anxiety, insomnia, tremors, hallucinations and restlesness, the hear is affected by increase in action leading to over stim. |
| Cardiac disease pts need to watch for | hyperthyroidism and diabetes |
| Pregnancy class of psuedo/phenyl is | Class C. |
| Dristan is known as ___, Afrin is known as ___, Benzedrex is known as ___ and tyzine is known as | Oxymetazoline, Phenlyephrine, propylhexedrine and tetrahydrozoline. |
| Cromlyn Na works on the | surface of mast cells preventing the release of histamine mediators |
| NaCl Ocean works by providing | moisture to remove mucus that is built up in the sinuses |
| Topical advantages are | Minimal absorption systemically, fast onset of action, less SE. |
| what are some 1st gen antihistimines | chlorpheniramine and diphenhydramine and dexbromiramine |
| what are some 2nd gen antihistamines | Loratidine and certrizadine |
| Antihistamines are used for | allergic rhinitis, other hypersensitive rxns and some as a sleep aid. |
| Some SE of antihistamines are | drowsiness, dry mouth, constipation, urinary retention and hallucinations |
| Cautions when taking the antihistamines when pregnant take | Chlorpheniramine, loratidine, certirizine and diphenhydramine |
| Caution with glacoma in taking antihistamines | of 1st generations |
| Breast feeding women should not take | antihistamines due to the drug passing into the milk. |
| Pregnancy A,B and C means | Well documented studies failed at showing there is damage done to the fetus, Animal reproductive studies have failed showing any damage to fetus, C is animal studies have shown some damage but risk evaluation need to be |
| Pregnancy D and X means | D means that there is evidence that show fetal damage, X means that there is tremendous risk to human fetal risk and patient consent has to be provided. |
| A cough is stimulated by the | Medulla through cough receptors in the airway from irratant receptors. Its a reflexive action and can be acute to chronic. |
| Chronic types of cough come from | PNdrip |
| Subacute coughs come from | bacterial infxns and asthma |
| Acute coughs tend to come from | Viral upper resp. infxns and the common cold. |
| Exclusions for cough OTC is | Yellow/green sputum, Fever over 101.5, weight loss, COPD, Asthma, drug cough, lasting longer than 7 days or gets worse with self treatment |
| Irritation receptors lined in the airway can be slowed by OTC | Lozenges, Humidification and hydration |
| Cough suppressant is | Dextromethorphan, codiene and Diphenhydramine which act on the medulla to increase the reflex thresh hold. Used for non productive cough |
| Dextro, Diphen dosing is | Dextro is 15mg q 4hrs, Diphen is 25mg q 4 hrs. |
| Mucinex is used for | productive cough, max dose is 2400mg/day, Preg C, dont use if have COPD |
| Menthol and camphor used for coughs show | little clinical relevance. |
| Common cold on set and behavior is | shows up with low fever, mucus appears and tends to resolve by day 7. may lead to bacterial infxn as time passes. |
| Common cold treatment is | Rest, fluid intake, humidification, and treat symptoms. |
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benmarler
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