Term
|
Definition
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Term
|
Definition
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|
Term
| Allergic rhinitis (increases/decreases) with increase age. |
|
Definition
Decreases
*as you age, your immune system is weaker |
|
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Term
|
Definition
| seasonal allergic rhinitis |
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Term
|
Definition
| Intermittent Allergic rhinitis |
|
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Term
| Perrenial/persistent allergic rhinitis |
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Definition
| symptoms persist throughout the year |
|
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Term
| Immune mediators are from..... |
|
Definition
| mast cells and granulocytes |
|
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Term
| Histamine, Kinins, PGs, adn leukotrienes are what?? |
|
Definition
| immune mediators that cause allergic reaction |
|
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Term
| Histamine causes which symptoms of allergic rhinitis? |
|
Definition
itching
pain
vasodilation
sneezing |
|
|
Term
| What are the phases of allergic rhinitis? |
|
Definition
Sensitization
Early
cellular Recruitment - cells set up shop and pump out mucus
Late |
|
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Term
| Diagnosis for allergy via ______ |
|
Definition
|
|
Term
| Complications/comorbidities of allergic |
|
Definition
Sinusitis
Conjunctivitis
Otitis media
Sleep apnea
Asthma exacerbations
Anosmia (loss of smell)
Loss of taste or taste
Nasal polyps
Taste perversion |
|
|
Term
| Exclusions for self care for allergic rhinitis?? |
|
Definition
Children < 12 years*
Pregnant or lactating women*
Symptoms of nonallergic rhinitis
Symptoms of otitis media (OM), sinusitis, bronchitis, or other infection
Symptoms of undiagnosed or uncontrolled asthma, COPD, or other lower respiratory disorder
Moderate-to-severe PAR or symptoms unresponsive to treatment
Severe or unacceptable ADEs to treatment |
|
|
Term
|
Definition
air quality index
**usually worse inside your house than outside |
|
|
Term
| Describe aspects of Asthma. |
|
Definition
Chronic, inflammatory lung disease
Air passage within lungs get swollen, restricting the amount of air that can pass through trachea
Lung: exchange oxygen and carbon dioxide between inspired air and blood
Spirometry-non invasive way to measure air capacity of lungs
Immunoglobulin E (IgE): activation cause shortness of breath, allergic reaction, inflammation and airway obstruction
Mast cells: inflammation triggered by IgE
Mast cells release chemotactic factors- basophils, neutrophils and eosinophils.
Inflammatory mediators: histamine, leukotrienes and prostaglandins
Edema and increase in mucus causing airway obstruction |
|
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Term
| What are the Asthma clinical symptoms? |
|
Definition
Coughing (constant or intermittant)
Bronchospasm (contraction of the bronchi resulting in the obstruction of airway)
Wheezing or whistling sound while exhaling
Shortness of breath or rapid breathing
Chest tightness and pain
Fatigue
GERD (77%) |
|
|
Term
| What are the options for asthma? |
|
Definition
Bronchodilators
Antihistamines-diphenhydramine
Beta agonists-short acting (albuterol)
Corticosteroids-long term (fluticasone)
Acid blockers-PPI
NSAIDs-Warning-could be fatal due to aspirin sensitivity
Food Allergy: egg, milk, peanut, fish, legumes
Smoke free environment |
|
|
Term
| What are the different types of Asthma? |
|
Definition
Allergic (extrinsic): dust mites, mold spores, pollen, pets
Non allergic (intrinsic): anxiety, stress, cold air, dry air, hyperventilation
Exercise-induced: airway constricted during vigorous physical activity
Cough-variant: chronic, persistent cough without shortness of breath
Occupational: poor air quality or other unknown factors at workplace |
|
|
Term
|
Definition
COPD=Chronic Obstructive Pulmonary Disease
Damage or obstruction of airway to lungs
COPD: chronic bronchitis, emphysema, asthmatic bronchitis
Smoking major cause of COPD
Chronic bronchitis (CB): chronic cough, increased mucus, wheezing, shortness of breath, fatigue
Emphysema: shortness of breath (even at rest), fatigue |
|
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Term
| Describe Cystic Fibrosis. |
|
Definition
Mucoviscidosis: inherited disorder-life threatening
Severe lung damage and nutritional deficiencies
Common among Caucasians- 1/3500 (life expectancy-35yrs)
Body produce abnormally thick & sticky mucus, saliva, sweat & digestive enzymes
Lungs and pancreas affected
CFTR gene mutation at F508 |
|
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Term
|
Definition
Seed oil: γ-linolenic acid (GLA)
GLA: immunosuppressant activity-helpful in reducing asthma
GLA broken down into di-homo-GLA (DGLA) which is converted into PGE1
Prostaglandins inhibit gastric acid, increase bicarbonate secretion and fat and nutrient absorption-CF
Leukotriene B4 (LTB4)-(inducer of bronchoconstriction) suppressed |
|
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Term
| Describe the dosing and adverse effects for Borage. |
|
Definition
2g GLA daily for asthma
GLA metabolites excreted in urine
May cause diarrhea, bloating and may lower seizure threshold
Potentiate effect of warfarin-bleeding risk
May lower blood pressure and reduce WBC |
|
|
Term
|
Definition
Ayurvedic medicine: salai guggul
Potential chronic asthma therapy
Multiple pentacyclic triterpenic acids-boswellic acid: major antiinflammatory
Major triterpiene: acetyl-11-keto-β-boswellic acid
Animal studies: inhibits LTB4
Human studies: human leukocyte elastase (HLE)-involved in CF, CB, emphysema
Antibacterial; cholesterol & triglyceride levels |
|
|
Term
| What are the doses and side effects for Boswellia? |
|
Definition
Doses: 300-1200 mg daily, half life-5.9h, excreted in urine
Generally safe
Mild GI effects (epigastric pain, GERD, diarrhea, nausea reported in 3-42 patients)
Inhibits CYP450 (1A2, 2C8, 2C9, 2C19, 2D6 and 3A4)
Fat increase boswellia concentration
High doses cause hepatomegaly &steatosis
Exhibit sedative effects comparable to 7.5mg/kg chlorpromazine in animals |
|
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Term
|
Definition
Forskolin: major active ingredient present
Conc-dependent inhibit histamine release from mast cells exposed to IgE
Increase cAMP
Modulate release of hypersensitivity mediators by adenylate cyclase activation
IV/intratracheal forskolin prevented bronchospasm in guinea pigs
In vitro: inhibitslung parenchyma contractions induced by histamine, LTD4
RCT: forskolin relieved bronchoconstriction in patients with asthma
Prohylactic treatment positive
Doses: 10mg forskolin powder inhaled from Spinhaler. Products standardized to 10-18%
Inhibits platelet aggregation.
Increase risk of bleeding if atken with NSAIDs or anticoagulating agents
Colenol isolated from coleus stimulate insulin release in rats
Lower blood pressure through vasodilation |
|
|
Term
|
Definition
Generally used as decongestant and to treat asthma
Components: ephedrine & pseudoephedrine are plant alkaloids
Relaxes bronchial smooth muscles through stimulation of beta-2-receptor
Pseudoephedrine (Sudafed) FDA approve
Several CT reported efficacy as bronchodilator (1927)
Allergic rhinitis: RCT showed promising results with 1% ephedrine nasal wash |
|
|
Term
| What are the adverse effects of Ephedra? |
|
Definition
Half life-3-6h, excreted in urine within 24h
FDA: 800 toxicity reports & 22 deaths
FDA: Over 8mg ephedrine/serving for 7 days should list adverse effects
Prolonged use: weight loss, insomnia, rapid heartbeat, anxiety, hypertension
Couse with theophylline or caffeine results in additive neurological, cardiovascular and psychiatric toxicity
Diuretic, increase ALT/AST & thyroid hormones T3/T4 |
|
|
Term
|
Definition
Extract prepared from rhizomes, roots and leaves
Active ingredients: sesquiterpines (isopetasin, oxopetasin and petasin)
Petasin most active component
Petasin: antiinflammatory due to inhibition of lipoxygenase activity resulting in reduced leukotriene synthesis
Isopetasin & oxopetasin: inhibits leukotrienes, COX-2 and PGE2
Clinical studies: compared butterbur with allegra and zyrtec and reported similar efficacy for allergic rhinitis (small trial??)
Long term safety (12-16 weeks) not clear
Small trial of 16 asthma patients reported significant positive outcome
Petadolax: bigger trial of 80 asthma patients (64 adults, 16 children) for 2 months-50% patients reported reduced asthma attacks (no placebo group??)
Petadolax: 50mg tab contains 7.5mg each of petasin and isopetasin
Dose: 50mg qd to tid-maximum 150mg
Half life: 4-6h
Generally well tolerated
Raw/unprocessed: hepatotoxicity
Long term use: possible carcinogen
Acute asthma: should not be used
Prolong use increase liver enzyme levels
Inhibits COX-2 by binding-other inhibitor |
|
|
Term
|
Definition
Active ingredients: oligomeric proanthocyanidins (OPCs) & other bioflavonoids
Confused with grape seed extract (GSE)-same generic name (pycnogenol)
MOA: antioxidant & antiinflammatory effect
RCT (children & adults): combination with conventional therapy reduces mild to moderate asthma symptoms
Dose: 1mg/lb body weight daily
Astringent taste-can be taken with meal
PK: rapidly absorbed; metabolites (catechin, caffeic acid, ferulic acid, taxifolin); excreted in urine
Protective effects against doxorubicin-induced cardiotoxicity
Elevates GSH and related enzymes
Inhibits thymus DNA synthesis induced by cyclophosphamide |
|
|
Term
|
Definition
Active ingredient: ginsenoside
MOA: nitric oxide (NO)-mediated relaxation in bronchial smooth muscles
Vasodilation & prevention of oxygen free radical injury in pulmonary endothelium
RCT: improved pulmonary functions over placebo in patients with COPD
Dose: extract containing 4-7% total ginsenoids content
For COPD: 200mg extract capsules (Ginsana)
Synergistically enhances bacterial clearance of sputum in bacterial bronchitis treated with antibiotics
Reduces blood alcohol concentration by enhanced clearance
Cholesterol lowering effects
Attenuate cisplatin-induced nausea |
|
|
Term
| What are the side effects of Ginseng? |
|
Definition
Inhibit platelet activity and potentiate the effects of NSAIDS (aspirin)
Inhibits CYP2D6 and CYP3A4
Enhance the effects of caffeine, cause headache and insomnia
Increase testosterone level
May increase the effects of digoxin in CHF |
|
|
Term
| What are the exclusions to self treatment for allergic rhinitis? |
|
Definition
Children < 12 years*
Pregnant or lactating women*-cleft palate possible
Symptoms of nonallergic rhinitis
Symptoms of otitis media (OM), sinusitis, bronchitis, or other infection
Symptoms of undiagnosed or uncontrolled asthma, COPD, or other lower respiratory disorder
Moderate-to-severe PAR or symptoms unresponsive to treatment
Severe or unacceptable ADEs to treatment
* exclusion from self-care unless already diagnosed with allergic rhinitis and OTC therapy approved by a PCP |
|
|
Term
| What are the first generation AHs? And dosing? |
|
Definition
Chlorpheniramine *least sedating
4 mg IR qid; 8 mg SR tid; 12 mg SR bid
(max: 24 mg daily)
Diphenhydramine *more sedating
25-50 mg q 6-8 hr (max: 300 mg daily) |
|
|
Term
| What are some of the second generation AHs? Dosing? MOA? |
|
Definition
Claritin (loratadine): 5-10 mg daily
Zyrtec (cetirizine): 5-10 mg daily
More sedating than loratadine
Allegra (fexofenadine): BID or daily dosing
60 mg BID or 180 mg daily |
|
|
Term
| What is the difference between first and second generation AHs? |
|
Definition
First - sedative
Second - non-sedative |
|
|
Term
|
Definition
Reduce nasal congestion
Often combined with antihistamines
See “Common Cold” lecture for more information
Topical versus Systemic
same concept as with common cold
Topical: nasal AND ophthalmic |
|
|
Term
| What is intranasal anti-inflammatory? |
|
Definition
Cromolyn sodium (intranasal)
Dosing: 1 spray in each nostril 3-6 times daily
Expect benefit to begin in 3-7 days and to peak at 2-4 weeks of continued use
Not BEST for current symptoms if not used w/ AH |
|
|
Term
| Describe nasal wetting sprays. |
|
Definition
May reduce allergic rhinitis symptoms by decreasing irritation and dryness of nasal mucosa
decreased rhinorrhea / sneezing
Saline / propylene / polyethylene glycol
No major side effects |
|
|
Term
Which of the following products has potential evidence for use in treating/preventing allergic rhinitis?
Boswellia
Ephedra
Ginseng
Pyconogenol |
|
Definition
|
|
Term
| What do we need to know about allergic rhinitis treatments and pregnancy/lactation? |
|
Definition
Pregnancy
Cromolyn sodium – first line option
Loratadine – Pregnancy Category B
Chlorpheniramine, clemastine, diphenhydramine – Pregnancy Category B
Category B means less likely to cause problems; still may have consequences
Lactation
Cromolyn sodium – first line option (but does NOT work immediately)
First-generation AH – contraindicated in lactating women
If needed, chlorpheniramine under PCP supervision
Loratadine – may pass into breast milk |
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|
Term
| Allergic rhinitis treatment for children? |
|
Definition
Children
Cromolyn sodium – first line option
First-generation AH – contraindicated in newborns, premature infants
Loratadine – age 2 and up*
Cetirizine – age 2 and up*
Fexofenadine – age 2 and up*
only approved form is liquid. This is a suspension and must be shaken!! ($1/day) |
|
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Term
| Allergic rhinitis treatment for elderly? |
|
Definition
Elderly
First-generation AH – Beers’ List (inappropriate in elderly children) medications (anticholinergic properties)
OPPOSITE Effects of SLUDGE….
Also….
Dry as a bone
Mad as a hatter
Red as a beet
Blind as a bat |
|
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Term
| Self care exclusions for allergic rhinitis. |
|
Definition
Children < 12 years*
Pregnant or lactating women*
Symptoms of nonallergic rhinitis
Symptoms of otitis media (OM), sinusitis, bronchitis, or other infection
Symptoms of undiagnosed or uncontrolled asthma, COPD, or other lower respiratory disorder
Moderate-to-severe PAR or symptoms unresponsive to treatment
Severe or unacceptable ADEs to treatment
* exclusion from self-care unless already diagnosed with allergic rhinitis and OTC therapy approved by a PCP |
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
| late august to early april |
|
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Term
|
Definition
|
|
Term
| which is most common cold virus |
|
Definition
|
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Term
| Describe symptom progression. |
|
Definition
Pharyngitis: short lived, early sign
Nasal congestion, rhinorrhea, sneezing: day 2-3; thin discharge, purulent/thick
Cough: day 4-5, lasts up to 3 wks
Fever?:rarely exceeds 100degF; more common in children |
|
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Term
| What are some complications of common cold? |
|
Definition
otitis media
sinusitis
pneumonia
ashtma/copd
Bronchitis
Eustachian tube obstruction |
|
|
Term
| Treatment of common cold generally is for what? |
|
Definition
|
|
Term
| Nonpharmacologic treatments for common cold |
|
Definition
rest
fluids
humidification(humidifier, vaporizer)
saline nasal spray/drops
nasal strips
saline gargle(1/2tsp of salt per8oz H2O)
natural demulcent(honey) |
|
|
Term
| Cold treatment for pharyngitis |
|
Definition
acetaminophen
NSAIDs
lozenges and sprays
(chloriseptic-phenol) |
|
|
Term
| Decongestants are ____________ causing increase ____ |
|
Definition
|
|
Term
| Direct acting decongestants are (more/less) effective. |
|
Definition
|
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Term
| Describe direct acting decongestants. |
|
Definition
bind directly to adrenergic rec
faster onset/shorter duration
Exs:phenylephrine,oxymetazoline,tetrahydrozoline |
|
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Term
| Describe indirect acting decongestants. |
|
Definition
displace NE from storage vesicles
slower onset/longer duration of action |
|
|
Term
| Describe mixed decongestants. |
|
Definition
both direct and indirect actions
Ex: pseudoephedrine |
|
|
Term
|
Definition
60mg q 4-6 hours (2 pills)
DI: MAOIs, TCAs, methyldopa
CI:HTN, hyperthyroidism, BPH, CHD, elevated IOP(narrow angle glaucoma),lactation |
|
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Term
|
Definition
|
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Term
| Describe some of the topical decongestants. |
|
Definition
oxymetazoline, xylometazoline, naphazoline, phenylephrine
SE:local irritation, minimal systemic
DOSe: 2-3 sprays each nostril Q12hours
**NOT be used >3-5 days
this can cause Rhinitis medicamentosa aka rebound congestion...mimics what they were trying to treat it |
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|
Term
| First generation AH (do/donot) cross BBB? |
|
Definition
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|
Term
| ___________ are usuing DI in almost everything! |
|
Definition
|
|
Term
| Chronic cough lasts how long? acute? |
|
Definition
|
|
Term
|
Definition
| defense mechanism to remove mucus and foreing debris from the lower respiratory tract |
|
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Term
|
Definition
|
|
Term
| what is used for wet cough? |
|
Definition
drink lots of water!!(not good for heart failure patients)
Expectorant:guaifenesin |
|
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Term
|
Definition
| decreases the mucus viscosity to aid in its removal from the respiratory tract |
|
|
Term
| Side effects of guaifenesin? |
|
Definition
|
|
Term
|
Definition
| 600-1200mg PO BID (2400mg) |
|
|
Term
|
Definition
antitussives
codein
dextromethorphan(DM) |
|
|
Term
| Codeine in TX as Rx or OTC? |
|
Definition
|
|
Term
| goal for treatment of dry cough |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
GI
sedation
Robo-Tripping at high doses |
|
|
Term
|
Definition
MAOIs
CNS depressants
Alzheimers meds |
|
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Term
|
Definition
| increases cough threshold centrally |
|
|
Term
| what kind of topical cough releif? |
|
Definition
|
|
Term
| camphor/menthol (is/isnot) safe for children |
|
Definition
|
|
Term
| There is (plenty/little) evidence that cough OTC products work |
|
Definition
|
|
Term
| Combo cough product advantages/disadvantages? |
|
Definition
Advantages
Convenience
Cost
Treat multiple symptoms
Disadvantages
Increase potential for side effects/OD
Symptoms(smx) very from cold to cold |
|
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Term
|
Definition
*may reduce severity and/or duration of illness
*may block rhinovirus
*efficacy is conflicting
Side effects:nauseau,taste abnormalities
DI: citrus juices may chelate and then reduce effectiveness |
|
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Term
|
Definition
some evidence to reduce duration/severity of cold
>1g needed to benefit (4g daily)
Side Effects:GI,diarrhea
**data is conflicting! |
|
|
Term
| Echinacea purpurea for coughs? |
|
Definition
believed to have antiviral properties and immune-stimulating effects
*efficacy unproven
*may decrease severity and/or duration of cold |
|
|
Term
| decongestants and cough suppressants and pregnancy |
|
Definition
avoid systemic agents, topical oxymetazoline preferred
cough suppressants avoided!! |
|
|
Term
| Lactation and decongestants and cough suppressants?? |
|
Definition
Decongestants: topical phenylephrine preferred; avoid xylometazoline and naphazoline
Systemic agents may decrease milk production
Cough Suppressants: DM, etc. compatible |
|
|
Term
|
Definition
no OTC recommendations
*saline nasal drops
*bulb suction of nose
*humidification of inspired air |
|
|
Term
|
Definition
| combinations are iffy and may not be recommended |
|
|
Term
| 6-11 treatments for colds? |
|
Definition
|
|
Term
| Cold medications are generally a safe option for children under age 2. T/F |
|
Definition
|
|
Term
| Exclusions for self care for colds. |
|
Definition
Fever > 101.5°F* (38.6°C)
Chest pain (CP)
Shortness of breath (SOB)
Significant worsening of symptoms beyond normal duration
Significant underlying comorbidity (CHF / COPD / Severe Asthma)
Immunosuppressed (HIV / AIDS / Transplant patients)
Frail patients of advanced age
Infants under 9 months
Hypersensitivity to recommended OTC medications |
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|
Term
Hyperthermia vs fever vs hyperpyrexia??
Old man, mid of summer, found with 41 deg C
Hyperthermia
Fever
Hyperpyrexia
Normal |
|
Definition
|
|
Term
Hyperthermia vs fever vs hyperpyrexia???
Old man, mid of summer, sends wife for nausea
Hyperthermia
Fever
Hyperpyrexia
Normal |
|
Definition
|
|
Term
Cut off age for giving aspirin during viral illness?
2yo
12yo
15yo
20yo |
|
Definition
|
|
Term
Decongestant for patient with high BP??
1.DM (cough suppressant)
2. loratidine(2nd gen AH…not best for runny nose)
3. chlorpheniramine (1st gen AH)
4. guaifenesin (expectorant)
5. phenylephrine (topical is good for high BP)
6. acetaminaphen
7. honey |
|
Definition
| 5. phenylephrine (topical) |
|
|
Term
Runny nose due to common cold in an adult??
1.DM (cough suppressant)
2. loratidine(2nd gen AH…not best for runny nose)
3. chlorpheniramine (1st gen AH)
4. guaifenesin (expectorant)
5. phenylephrine
6. acetaminaphen
7. honey |
|
Definition
3. chlorpheniramine (1st gen AH)
5. phenylephrine (topically is good choice) |
|
|
Term
cholesterol goal
triglycerides goal |
|
Definition
|
|
Term
| Blood pressure monitor types? |
|
Definition
*manual blood pressure cuff with sphygmomanometer
*semi-automatic
*fully automatic
*wrist |
|
|
Term
|
Definition
total cholesterol
HDL
results in 30sec to 12min
cost roughly $4/strip |
|
|
Term
| What characterizes hyperlipidemia? |
|
Definition
total cholesterol >200 OR
HDL<40
see physician for full lipid panel and workup
do NOT self adjust medication! |
|
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Term
|
Definition
| from natural product (foxglove) |
|
|
Term
|
Definition
|
|
Term
RT 45 y/o male presenting to the pharmacy. He is currently taking Singulair 10mg, Prozac 20 mg, Crestor 20 mg(statin), and Tricor 145 mg PO daily. He has heard he should be taking a supplement because of a possible deficiency with his cholesterol medication. What product to you suspect RT is referring to?
A. Niacin
B. Hawthorn
C. Coenzyme Q10
D. Vitamin K |
|
Definition
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|
Term
RN is a 67 year old male, 186 lb, 6 ft 1 in
SH: retired building contractor, tries to eat a low-fat, low-cholesterol diet, sleeps 7-8 hours a night. Exercises three days a week for 45 minutes
PMH: Hypertension, osteoarthritis, hyperlipidemia
Medications:
Hydrochlorothiazide 25 mg daily
Naproxen 500 mg BID
Simvastatin 20 mg at bedtime
Centrum silver daily
Fish oil 1 gram TID
RN comes to the pharmacy counter with 2 products, red yeast rice and garlic. He wants to know which of these products would help his cholesterol come down a little lower.
Options
A. Take simvastatin and ADD garlic
B. Take simvastatin and ADD red yeast rice
C. Stop simvastatin and take red yeast rice
D. Talk to physician about increasing simvastatin |
|
Definition
| D. Talk to physician about increasing simvastatin |
|
|
Term
| How to avoid fishy burp with fish oil? |
|
Definition
Take with food
Try enteric coated product
Try freezing softgels
Vitamin E |
|
|
Term
|
Definition
dose:1-3 g/day
insufficient evidence
may reduce TC, LDL and increase HDL
Contains lower concentration of EPA and DHA than fish oil
Side effects: similar to fish oil |
|
|
Term
What vitamin is also used to help manage hyperlipidemia?
A. Vitamin D
B. Vitamin B3
C. Vitamin E
D. Vitamin A |
|
Definition
|
|
Term
|
Definition
dose:1200-3000 mg/day
effectiveness:LDL dcrd 5-25%
HDL incrs 15-35%
TG dcrs 20-50%
side effects:flushing, liver dysfunction
Counseling points:
*Take ASA 325mg or IBU 200mg 30 minutes before Niacin dose
*not with hot drink |
|
|
Term
PH is 56 y/o male returning to the pharmacy for a refill of his Niaspan®. He has changed jobs and has new insurance coverage that does not cover Niaspan®. Can he substitute nonprescription niacin for Niaspan®? If so, what product would you recommend?
A. Time-release niacin
B. Immediate release niacin
C. No-flush niacin
D. Do not substitute |
|
Definition
| B. Immediate release niacin |
|
|
Term
| From outside inward, what are the layers of the skin? |
|
Definition
Epidermis
Dermis
Hypodermis (subcutaneous tissue) |
|
|
Term
| What are the 3 stages of wound healing? |
|
Definition
inflammatory phase
proliferative phase
maturation phase (remodeling) |
|
|
Term
| Describe inflammatory phase of wound healing. |
|
Definition
immediate respone to injury
characterized by redness, swelling, fever, pain
lasts 3-4 days
prepares wound for tissue development
**know TGF-beta(transforming growth factor), PDGF(platelet derived growth factor) |
|
|
Term
| Describe proliferative phase of wound healing. |
|
Definition
Wound filled with new connective tissue and covered with new epithelium
starts after 3 days and lasts 3 weeks |
|
|
Term
| Describe maturation phase of wound healing. |
|
Definition
final phase
longest phase
Lasts ~ 3 weeks once wound is completely closed by connective tissue and resurfaced by epithelial cells
It can continue for ~ 2 years after injury |
|
|
Term
| What are the factors that influence wound healing. |
|
Definition
tissue perfusion and oxygenation
nutrition
age and weight
infection
coexisting diabetes mellitus
medications (cancer meds, corticosteroids, anticoagulants) |
|
|
Term
| Describe classification of wound by depth |
|
Definition
Stage I - erythema of intact skin
Stage II - partial, thickness skin loss; epidermis +/- dermis
Stage III - full thickness skin loss; damage to subcutaneous tissue
Stage IV - Tissue necrosis; damage to underlying muscle, tendon, bone |
|
|
Term
| Describe classification of wound by acuity. |
|
Definition
Acute Wounds
Usually result from injury
Chronic Wounds
Require triage and medical treatment |
|
|
Term
| What are the different acute wounds? |
|
Definition
Abrasions
Punctures
Lacerations
Burns
Take ~ 1 month to heal
Healthy individuals |
|
|
Term
| Describe abrasion wounds. |
|
Definition
Superficial wounds
Injury to epidermis
Extends to upper layer of the dermis
Results from friction or rubbing |
|
|
Term
|
Definition
Injury to dermis or deeper tissue
Results from piercing by foreign object |
|
|
Term
|
Definition
*injury to various layers of skin
*result from sharp objects cutting through the skin |
|
|
Term
|
Definition
Chronic Wounds
Pressure ulcers
Venus ulcers
Arterial ulcers
Do not proceed through the 3 phases of wound healing in a timely manner
Risk factors:
DM or other external factors contribute to poor wound healing
Older patients and those who are immobilized are at increased risk
Obesity, malnutrition, and incontinence |
|
|
Term
| Describe pressure ulcer wounds. |
|
Definition
Pressure Ulcers
Result from unrelieved pressure
Injury to skin & underlying tissue
Usually occur over bony prominences
4 factors involved in skin breakdown
Pressure
Shearing forces
Friction
Moisture |
|
|
Term
| What are the exclusions for self care of wounds? |
|
Definition
Wound containing foreign matter after irrigation
Chronic wound
Wound secondary to an animal or human bite
Signs of infection
Location of wound-involvement of face, mucous membrane, or genitalia
Deep, acute wound-extending beyond dermis
No signs of healing after 5 days of self-treatment |
|
|
Term
| What are the treatment goals for wounds? |
|
Definition
For all wounds:
Facilitate wound healing
Prevent scarring
Prevent secondary skin infections and further trauma |
|
|
Term
| What is the approach to treatment for wounds? |
|
Definition
Stepwise approach
Cleansing wound
Selectively using antiseptics and antibiotics
Create closure with an appropriate dressing |
|
|
Term
| Describe visual inspection of wounds. |
|
Definition
Visual inspection of wound
Type
Depth
Location
Degree of contamination
Signs of infection |
|
|
Term
|
Definition
Ideal dressing should:
Remove excess exudate
Be permeable to oxygen
Thermally insulate wound
Protect wound from infection
Be easy to remove without disrupting delicate new tissue
Maintain a moist environment |
|
|
Term
| What kinds of wound dressings are there? |
|
Definition
Gauze dressing
Nonadherent (gauze-type) dressing
Foams
Alginates
Carbon-impregnated (Odor control)
Composite/island dressing
Hydrocolloids
Transparent adhesive film
Hydrogels/gels |
|
|
Term
| Which dressings absorb moisture? |
|
Definition
Absorb moisture
Foam
Alginate
Carbon impregnated
Composite |
|
|
Term
| Which dressing provide moisture and which maintain moisture? |
|
Definition
Maintain moisture
Hydrocolloid
Transparent adhesive film
Provide moisture
Hydrogels |
|
|
Term
| What are the nonpharmacological treatments for abrasions and lacerations? |
|
Definition
Ensure no foreign bodies
Inquire about tetanus immunization status
Wound dressing
Gauze dressing
Non-adherent gauze-type bandage
Adherent gauze-type bandage (Band-Aid®)
Hydrocolloid (New Skin®)
Individuals with latex allergy:
May try products with natural rubber latex
Band-Aid ® Gentle Care
Curad ® Sensitive Skin
Individuals with hypersensitive skin:
Hypoallergenic tape
Latex-free tape
First-Aid Hurt Free tape |
|
|
Term
| What are the nonpharm treatments for punctures? |
|
Definition
Ensure no foreign bodies
Inquire about tetanus immunization status
If no debris present –
Cleanse with soap and water or sterile saline
Leave open
Soak with soapy water for 30 minutes at least QID
Wound dressing
Hydrocolloid dressings
Hydrogel dressings |
|
|
Term
| What are the nonpharm treatments for pressure ulcers? |
|
Definition
Pressure Ulcers
Often require intense supervision and professional aid to heal properly
Key Objective:
Remove dead tissue, debris, excess exudate to enable optimal wound healing
Relief of inciting pressure required for healing
Counsel patients that pressure ulcers should be closely supervised by physician or delegate |
|
|
Term
| What are the types of pharmacologic treatments for wounds? |
|
Definition
Irrigants
Antiseptics
Antibiotics |
|
|
Term
| Describe wound irrigants. |
|
Definition
OTC Products:
Normal saline
Sterile water
Purpose: clean wound by removing dirt/debris
Sterile saline is the preferred choice for wound irrigation |
|
|
Term
|
Definition
OTC Products:
Ethyl Alcohol 48-95%
Isopropyl alcohol 50-91.3%
Hydrogen peroxide topical solution USP
Iodine
Iodine topical solution USP
Iodine tincture USP
Povidone-iodine complex 5-10%
Phenol 0.5-1.5%
Purpose: disinfection of intact skin
Ethyl Alcohol
Direct application to wound can cause tissue irritation (use caution)
Highly flammable
May be used 1-3 times daily
Cover wound with sterile bandage after area has dried
Contains denaturants – which dehydrate skin at high concentrations
Isopropyl Alcohol
Stronger bactericidal activity than ethyl alcohol
Do not use to cleanse open wounds due to possible cytotoxic effects and higher reported infection rates
No denaturants (unlike ethyl alcohol)
Has a greater potential for drying the skin (astringent action)
Is flammable (like ethyl alcohol) |
|
|
Term
| Describe Ethyl Alcohol as use as antiseptic. |
|
Definition
Ethyl Alcohol
Direct application to wound can cause tissue irritation (use caution)
Highly flammable
May be used 1-3 times daily
Cover wound with sterile bandage after area has dried
Contains denaturants – which dehydrate skin at high concentrations |
|
|
Term
| Describe isopropyl alcohol as antiseptic for wounds. |
|
Definition
Isopropyl Alcohol
Stronger bactericidal activity than ethyl alcohol
Do not use to cleanse open wounds due to possible cytotoxic effects and higher reported infection rates
No denaturants (unlike ethyl alcohol)
Has a greater potential for drying the skin (astringent action)
Is flammable (like ethyl alcohol) |
|
|
Term
| Describe hydrogen peroxide as an antiseptic for wound. |
|
Definition
Hydrogen Peroxide
Enzymatic release of oxygen occurs when contacts skin causing effervescent cleansing action
Should only be used where releases gas can escape
Do not use in abscesses
Do not apply bandages until solution dries |
|
|
Term
| Describe iodine as antiseptic for wounds. |
|
Definition
Iodine
Broad antimicrobial activity
Iodine is preferred over iodine tincture (which contains alcohol)
Stains the skin
Can Irritate tissues
Bandaging should be discouraged to avoid tissue irritation
Recommended if patients have
chlorhexidine allergy |
|
|
Term
| Describe Povidone-iodine use as antiseptic in wounds |
|
Definition
Povidone-iodine
Non-irritating to skin and mucous membranes
Can be absorbed systemically (related to concentration and frequency)
Use caution in renal dysfunction (can cause thyroid dysfunction) - CONTROVERSIAL |
|
|
Term
| Describe camphophenique as antiseptic for wounds. |
|
Definition
Camphorated phenol
Only apply to dry skin
Do not bandage
Moisture will result in skin damage
KEEP OUT OF REACH OF CHILDREN |
|
|
Term
| Describe bacitracin as antibiotic for wounds. |
|
Definition
Bacitracin
Polypeptide bactericidal antibiotic that inhibits cell wall synthesis in bacteria
Apply 1-3 times daily
~2% pts experience allergic contact dermatitis |
|
|
Term
| Describe neomycin as antibiotic for wounds. |
|
Definition
Neomycin
Aminoglycoside antibiotic that inhibits protein synthesis by irreversibly binding to the 30S ribosomal subunit
Relatively high rate of hypersensitivity (3.5-6%)
Usually used in combination with polymixin & bacitracin
Apply 1-3 times daily |
|
|
Term
| Describe polymixin b sulfate as an antibiotic for wounds. |
|
Definition
Polymixin B Sulfate
Polypeptide antibiotic
Alters bacterial cell wall permeability
Effects on healing are unknown
Apply 1-3 times daily |
|
|
Term
| What are some of the complementary therapy for wounds? |
|
Definition
Used without substantial evidence of benefit
Vitamin A
Vitamin C
Vitamin E
Zinc
Others
Honey
Aloe vera |
|
|
Term
| What are the patient counseling points of wounds? |
|
Definition
To relieve throbbing pain and slow bleeding, position wound above level of heart
If wound is dirty-
Irrigate with normal saline
Use antiseptic solutions
When cleaning with soapy water –
Wash hands apply mild liquid soap to wet cotton ball gently wash wound rinse under running warm water and pat dry
Cover with wound dressing to ensure wound site will stay moist
Continue wound dressings until –
Wound bed has firmly closed AND
Signs of inflammation have subsided
Avoid disrupting dressing
Change only if dirty, not intact, or excessive fluid released
Use mild analgesic to control pain
Store wound dressings in original packaging and away from moisture
Observe for signs of infection
i.e. foul odor
Consult a primary care provider if –
Infection suspected
Wound does not show signs of healing after 5 days of self-treatment |
|
|
Term
|
Definition
Attracted by exhaled carbon dioxide
Transmission of diseases
West Nile virus
Malaria
Clinical Presentation:
Welts
Erythematous papules on exposed areas
Pruritis |
|
|
Term
|
Definition
Attracted by body warmth and exhaled carbon dioxide
Tiny, bloodsucking, wingless
Transmission of diseases
Bubonic plague
Endemic typhus
Clinical Presentation:
Bites multiple/grouped
Ankles/legs
Papules with erythema
Intense pruritis |
|
|
Term
|
Definition
Mouth parts hold firmly to skin when skin pierced
Transmission of diseases
Rocky Mountain spotted fever
Lyme disease
Clinical Presentation:
Pruritic papules
Disappear in 1 week
Lyme disease
Transmitted by deer tick
Clinical Presentation:
Rash and flu like symptoms
Fever, muscle/joint pain
Neurologic
Headache, stiff neck
Cardiovascular / musculoskeletal symptoms |
|
|
Term
|
Definition
Microscopic, live in shrubs, trees, grass
Larvae attach
Do not burrow in skin
Secrete digestive fluid
Causes cellular disintegration of affected area
Drops off and becomes adult
Clinical Presentation:
Erythematous, pruritic papule |
|
|
Term
|
Definition
Seldom fatal
At risk = infants, elderly, allergic persons
Brown recluse and black widow bites warrant immediate medical attention
Clinical Presentation:
Black widow
Delayed intense pain, stiffness/joint pain, abdominal disturbances, fever/chills, dyspnea
Brown recluse
Same as above
Plus ulcerated wound at bite site |
|
|
Term
| Exclusion for self care treatment of insect bites? |
|
Definition
Age < 2 years
Hypersensitivity or systemic reaction
Bites from ticks or spiders
Brown recluse or black widow spider bite need immediate referral
Infection present |
|
|
Term
| Treatment goals for insect bites. |
|
Definition
Relieve swelling/pain/itching
Prevent scratching
Monitor for infections transmitted by ticks
Prevent future insect bites
i.e. Repellants |
|
|
Term
| General treatment for insect bites. |
|
Definition
Apply ice promptly to bite area
Remove ticks if necessary
Avoid scratching area
Do not wear rough, irritating clothing over bite area
Use of OTC pharmacologic treatment:
Local anesthetics
Topical antihistamines
Counterirritants
Topical corticosteroids
Skin protectants |
|
|
Term
|
Definition
TICK REMOVAL
Grasp the tick close to head using fine tweezers
Gently pull to facilitate complete removal of head
Goal = removal of head
Avoid use of petrolatum, mineral oil, gasoline, etc.
Induces salivation and can contribute to infection |
|
|
Term
| Describe epidemiology and etiology of insect stings. |
|
Definition
Epidemiology
Risk = work or spend time outside
~0.5% with signs of systemic allergic reactions to stings
99% have only local reactions
Etiology
Bees, wasps, hornets, yellow jackets, fire ants
Attack to defend selves or kill other insects |
|
|
Term
| Describe local reaction and clinical presentation of insect stings. |
|
Definition
Local reaction
Elicited by injection of venom by stinger
Stinger of honeybee is embedded in victim and must be removed
Clinical Presentation:
Pain, itching, burning and irritation at the site of the sting
No systemic effects |
|
|
Term
|
Definition
Fire ants in same order as other venomous insects
Bees, wasps, yellow jackets, hornets
Clinical Presentation:
Pain, itching, burning and irritation at the site of the sting
No systemic effects |
|
|
Term
| Exclusion to self care of insect stings. |
|
Definition
Age < 2 years of age
Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing
Significant allergic response away from sting
Previous sting by honeybee, wasp, or hornet
Need to evaluate for possible hypersensitivity
Previous severe reaction to insect bites
Personal or family history of severe allergic reactions |
|
|
Term
| Treatment goals for insect stings. |
|
Definition
Relieve pain/swelling/itching
Monitor reaction to sting
To determine if allergic reaction
Prevent future insect stings
Repellants not effective! |
|
|
Term
| General treatment for insect stings. |
|
Definition
Apply ice promptly to area of sting
10 minute-intervals
Removal of stinger if necessary
Avoid scratching affected area
Use of OTC pharmacologic treatment:
Local anesthetics
Topical antihistamines
Oral antihistamines
Counterirritants
Hydrocortisone
Skin protectants |
|
|
Term
| Describe removal of stinger. |
|
Definition
Removal of stinger
Important to prevent further venom injection
Use credit card or fingernail
Apply antiseptic
Apply ice |
|
|
Term
| What are the 3 pharmacological treatments for insect bites/stings? |
|
Definition
Three main categories
External analgesics/antipruritics
Counterirritants
Anesthetics & antihistamines
Hydrocortisone
Skin protectants
Antibacterials |
|
|
Term
| List some local anesthetics for insect bites/stings |
|
Definition
Benzocaine
Pramoxine
Benzyl alcohol
Lidocaine
Dibucaine
Phenol |
|
|
Term
|
Definition
MOA: depress cutaneous sensory receptors, resulting in relief of pain/itching
Administration: apply to area 3-4 times daily for up to 7 days
Adverse effects: may cause allergic contact dermatitis
Other:
Pramoxine and benzyl alcohol among safest
Avoid using large quantities of phenol and dibucaine
Dibucaine – systemic toxicity excessive absorption
Phenol >2% - irritating/sloughing/necrosis |
|
|
Term
| Describe topical antihistamines. |
|
Definition
Diphenhydramine HCl
0.5% to 2%
Cream, spray, stick, etc.
MOA: relieve pain and itching by depressing cutaneous sensory receptors
Administration: apply to area 3-4 times daily for up to 7 days
Adverse effects: possible hypersensitivity reactions; contact dermatitis if used > 3-4 weeks
Other:
Avoid using over large body areas, especially in young children |
|
|
Term
| Describe counterirritants. |
|
Definition
Camphor 0.1-3%
Menthol 0.1-1%
Combination products
MOA: reduce pain and itching by stimulating cutaneous sensory receptors
Administration: apply no more than 3-4 times/day for up to 7 days
Adverse effects: lower concentrations well tolerated
Other:
DO NOT use for > 7 days
Camphor containing products - VERY DANGEROUS if ingested
Inappropriate choice in children
NEVER put camphor into infant’s nostrils – immediate respiratory collapse
Camphor and pediatric seizures |
|
|
Term
| Describe topical hydorcortisone. |
|
Definition
Hydrocortisone 0.5-1.0%
Combination products with aloe vera
MOA: anti-inflammatory agent prevents/suppresses development of edema, capillary dilation, swelling, and tenderness which relieves pain and itching
Administration: apply as directed to area 3-4 times daily for up to 7 days
Adverse effects: prolonged use may cause epidermal atrophy, acne eruptions, irritation, inflammation of follicles, and tightening/cracking of skin
Other:
Systemic absorption increases with occlusion and break in skin |
|
|
Term
| Describe and list skin protectants. |
|
Definition
Zinc oxide
Calamine 1-25%
Titanium dioxide
Available lotions, ointments, creams
MOA: reduce inflammation/irritation by providing mechanical barrier against harmful or annoying stimuli; calamine and zinc oxide absorb fluids from weeping lesions
Administration: apply to affected area PRN up to 4 times per day
Adverse effects: minimal
Other:
Recommended for adults, children, and infants |
|
|
Term
| List different names/types of pediculosis. |
|
Definition
Head lice
Most common
10-12 million/yr
Children
Mostly ages 3-12
Body lice
“cooties”
Pubic lice
“crabs” |
|
|
Term
|
Definition
Symptoms
Itching
Erythema around bites
Presence of nit and nit casings
Wet combing
Presence of lice feces |
|
|
Term
| Exclusions to self treatment of pediculosis. |
|
Definition
Age < 2 years
Hypersensitivity to chrysanthemums, ragweed, or pediculicide ingredients
Secondary skin infection
Lice infestation of eyelids or brows
Pregnancy or breastfeeding
Presence of active tumors |
|
|
Term
| Treatment goals for pediculosis. |
|
Definition
Rid of lice
Kill adult and lice
Removal of nits from hair |
|
|
Term
| General treatment of pediculosis |
|
Definition
Application of pediculicide
Combing hair with lice/nit comb to remove nits from hair shaft
Removing dead lice
Application of products to loosen eggs & facilitate removal
Preventing future infestations |
|
|
Term
| Nonpharm treatment of pediculosis |
|
Definition
Inspecting hair & combing with nit comb to remove nits
Clothing, bedding, towels, hairbrushes, combs, etc. should be washed
10 minutes at ≥130 deg F
DO NOT share
Seal unwashable objects in a plastic bag for 2 weeks to prevent lice from feeding
Vacuum living space frequently during treatment |
|
|
Term
| What are the 2 different pharm treatments for pediculosis? |
|
Definition
Synergized pyrethrins (pyrethrin + piperonyl butoxide)
Permethrin |
|
|
Term
| Described synergized pyrethrins as treatment for pediculosis. |
|
Definition
Synergized pyrethrins
MOA:block neurotransmission leading to paralysis/death
ADR: itching, redness, irritation
Indication: treatment of head and pubic lice
Administration: apply for 10 minutes followed by rinsing/ shampooing; repeat in 7-10 days
Other: use of lice comb |
|
|
Term
| Describe permethrin as treatment for pediculosis. |
|
Definition
Permethrin
MOA: induces paralysis of parasite by disrupting Na+ channels of neurons
ADR: itching, burning, irritation
Indication: head lice only
Administration: apply for 10 minutes, rinse, comb
Other: Rx available for scabies |
|
|
Term
| Differences between permethrin and pyrethrin. |
|
Definition
Permethrin more effective after single application
Pyrethrin indicated for pubic lice
Preference for particular dosage form
Cream rinse, shampoo, liquid, mousse foam |
|
|
Term
| What are the different kinds of burns? |
|
Definition
Electrical
Thermal
Chemical
Sunburn |
|
|
Term
| Only __________ burns are self treatable. |
|
Definition
|
|
Term
| Describe superficial burns. |
|
Definition
Only brief exposure to low heat
Epidermis only
Erythema, warmth, slight edema, mildly painful without blisters
Blanches w/ pressure Heals w/in 3-10 days with no scarring |
|
|
Term
| Describe superficial partial thickness burns. |
|
Definition
High levels of heat or longer exposure
Epidermis
Erythema, blistered, moist, weeping, painful, and sensitive to stimuli
Blanches w/ pressure
Heals within 2-3 weeks w/ little or no scarring
>2% BSA refer to physician |
|
|
Term
| Describe deep partial thickness burns. |
|
Definition
More extensive heat exposure
Epidermis & dermis
Blanched, patchy white to red +/- blisters
Some areas painful while other areas are not
Up to 6 weeks to heal and will have thick scarring
Prone to infection
Refer |
|
|
Term
| Describe full thickness burns. |
|
Definition
Epidermis, dermis & subcutaneous tissue
Pearly white, gray, or brown
Dry and leathery
No pain
Does not blanch
Usually requires skin graft and PT
Refer |
|
|
Term
While driving to school you spill hot coffee on your lap. You try to wipe it off as quickly as you can. You pull over to a restroom to inspect the area. It is red, blistering, sensitive to touch, and blanches with pressure. What classification of burn is this?
A.Deep Partial thickness
B.Superficial
C.Full thickness
D.Superficial Partial thickness |
|
Definition
D.Superficial Partial thickness
**blisters with this and NOT superficial |
|
|
Term
| What are the goals of treatment for minor burns and sunburns? |
|
Definition
Pain relief
Physical protection
Healing of wound with minimal complications (infection or scarring) |
|
|
Term
| Describe burns requiring referral |
|
Definition
Exclusions for self treatment
Burns to BSA of 2% or more (see figure 41-3)
Burns to the eye, ear, face, genitalia
Immunocompromised patients
Patients with diabetes or patients with multiple disease states
Elderly patients
Chemical burns (use 1st aid, then refer)
Electrical or inhalation burns |
|
|
Term
| Describe first aid for superficial and superficial partial thickness burns. |
|
Definition
Superficial and superficial partial thickness burns (<2%BSA)
Soak area in cool tap water 10-30 min
Systemic analgesics |
|
|
Term
|
Definition
Sunburn
Cool compresses or bath
Consider NSAID's during first 24 hrs
Avoid further exposure to the sun |
|
|
Term
| Describe first aid for chemical burns. |
|
Definition
Chemical burns
Remove contaminated clothing
Rinse area with H2O 15 min -2hrs
Do not delay transport to the ER or physician |
|
|
Term
| Describe first aid for eye burns. |
|
Definition
Eye
Eye irrigated for 15 – 30 mins
Wash from nasal side to outside corner to prevent contaminating other eye
Refer |
|
|
Term
| Describe cleaning and protecting burns. |
|
Definition
Water & bland soap
Avoid alcohol and hydrogen peroxide
Apply non-adherent dressing+/- skin protectant
If weeping, cool H2O soak 15-30 min 3-6x/ day
If blisters are broken, cleanse area 1-2 x daily to remove dead skin
Advise patient not to pull at loose skin
Absorbent dressings |
|
|
Term
| What are the skin protectants for burns? |
|
Definition
Allantoin, cocoa butter, petrolatum, shark liver oil
Protects from irritation (friction/rubbing) and drying of the stratum corneum
Pain relief
Apply prn |
|
|
Term
True or False? Applying butter to a burn will help protect it and speed healing?
A. True
B. False |
|
Definition
|
|
Term
| How soon should NSAIDs be used after a sunburn? |
|
Definition
| within the first 24 hours |
|
|
Term
| Describe topical anesthetics for skin burns. |
|
Definition
Benzocaine, lidocaine, dibucaine, tetracaine, butamben, pramoxine
Inhibits pain transmission
Relief is short - 15-45 min
Use lower concentrations if skin is broken
Apply no more than 3-4 times/day |
|
|
Term
| Describe topical antibiotics for skin burns. |
|
Definition
Topical antibiotics – not recommended unless skin is broken
Bacitracin, neomycin, polymixin B sulfate, tetracyclines
For small burns w/ broken skin
Applied 1-3x/day; max 5 days use |
|
|
Term
| Describe topical hydrocortisone for skin burns. |
|
Definition
Topical hydrocortisone
Not FDA approved
May be useful in small burns without broken skin |
|
|
Term
|
Definition
Aloe Vera
Efficacy not substantiated
May inhibit bradykinin, thromboxane, prostaglandins
Contraindicated with allergy to garlic, onions, tulips, or other plants in the Liliaceae family |
|
|
Term
Counterirritants and burns??
Vitamins and burns?? |
|
Definition
Counterirritants
Camphor, menthol, ichthammol
Avoid in burns
Vitamins
Not necessary if good nutritional status |
|
|
Term
| What is arnica montana and what is it used for? |
|
Definition
Arnica montana: the dried flower head is used to compound creams
Antimicrobial, antiedema, and anti-inflammatory properties
Approved for use in Germany but not by the FDA
Contraindicated if allergic to marigolds, ragweed |
|
|
Term
| What is calendula and what is it used for? |
|
Definition
Calendula: the flower head is used to make topical preparations
Has wound healing and anti-inflammatory properties, may have antibacterial properties as well
Contraindicated if allergic to marigolds, ragweed |
|
|
Term
|
Definition
Honey: One trial of honey applied directly in gauze applications resulted in faster healing than silver sulfadiazine in partial thickness burns.
Not advocated by burn centers |
|
|
Term
|
Definition
| Zinc: Given IV with other nutrients may improve outcomes in burn patients |
|
|
Term
| Ornithine ketoglutarate and burns?? |
|
Definition
Ornithine Ketoglutarate: taken 30mg orally may improve wound healing in burns.
Not a lot of info regarding the safety of oral use |
|
|
Term
|
Definition
Ointment- use on intact skin
Cream- use on broken skin
Lotions- good for large areas
Aerosol and pumps- $$ but less painful application
Refer to Table 41-4 for examples |
|
|
Term
|
Definition
Reassess burn after 24-48 hrs
Refer if worse
Reassess in 7 days: refer if burn not improved
Refer if pain, redness, or swelling extends beyond original burn
Refer if contact dermatitis develops during burn treatment |
|
|
Term
A 19 y/o college student is playing with a cigarette lighter and lights her pajamas on fire. She quickly puts out the fire but is left with a 2inch area on her thigh that is reddened, painful, and blanches to touch. No blisters or weeping areas. No open skin. What should be the first thing she does to treat this burn?
A.Change her pajamas
B.Take a cool bath
C.Cover it with a band aide
D.Go to the emergency room |
|
Definition
|
|
Term
What would you recommend for her pain?
Ibuprofen
Aloe Vera
Bacitracin
Camphor |
|
Definition
|
|
Term
When should you tell the college girl that burned her pants to change the dressing?
Daily
Only when it gets wet or soiled
Every 5 days |
|
Definition
|
|
Term
When should you first re-assess the burn of the college girl?
A. one week
B. one day
C. one month |
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Definition
|
|
Term
One arm = ? BSA
One leg = ? BSA
Genital area = ? BSA
Face area = ? BSA
Chest or back = ? BSA |
|
Definition
|
|
Term
| Acne age for males vs females. |
|
Definition
|
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Term
| Papular lesions of acne vs nodular lesions of acne time period? |
|
Definition
mid-teens: papular
late-teens: nodular |
|
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Term
| ____% of people get acne over age of 25 |
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Definition
|
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Term
| What are the causes of acne? |
|
Definition
Hormonal triggers
Abnormal keratinization of cells in infundibulum
Increased sebum production
Growth of Propionibacterium acnes
Inflammation
Heredity |
|
|
Term
| What are the hormonal factors that cause acne? |
|
Definition
Hormonal
Menarche
High androgenic progestins |
|
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Term
| Which medications cause acne? |
|
Definition
Medication use
P – Phenytoin
I – Isoniazid
M – Moisturizers
P – Phenobarbital
L – Lithium
E – Ethionamide
S – Steroids |
|
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Term
| What are the main myths of acne? |
|
Definition
*Acne is NOT contagious
*Acne sufferers may wear cosmetics
*Certain hairstyles do NOT affect acne (i.e. bangs)
*Acne can occur at any age
*There is no evidence that acne is triggered or worsened by diet (i.e. chocolate, pizza)
*Acne is NOT caused by “dirty skin” – excessive scrubbing may actually worsen the condition
*There is no evidence that acne is triggered or worsened by sexual activity
*Sun exposure will NOT dry out acne and may worsen it |
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Term
| Microcomedo formation due to _________________ of cells in infundibulum |
|
Definition
| Microcomedo formation due to hyperkeratinization of cells in infundibulum |
|
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Term
|
Definition
Open comedo (blackhead)
Desquamated epithelial cells and sebum accumulate behind the plug
The orifice of the follicular canal becomes distended
Protrusion of plug occurs
The tip of the plug may darken due to melanin deposition |
|
|
Term
| What are the two types of acne? |
|
Definition
1. Noninflammatory
Open (blackhead) or closed (whitehead) comedones
2. Inflammatory
Papule
Larger inflamed, reddened, raised lesions
May enlarge to form pustules
Pustule
Raised lesions filled with pus
Nodule
Inflammatory lesions >5mm in diameter
Found on face, chest, back, neck, upper arms |
|
|
Term
| What is the goal self treatment for acne? |
|
Definition
Goals of self-treatment
Primary goal: Prevent lesions
Consistent, long term use of methods to unblock pilosebaceous ducts (keeps the orifice open)
Avoid exacerbating factors
Relief of physical and social discomfort |
|
|
Term
| Treatment of non-inflammatory acne? |
|
Definition
Non-inflammatory acne
Pharmacologic and non-pharmaclogic therapy
cleansing the skin to remove excess sebum
Avoiding factors that may cause acne |
|
|
Term
| Treatment for inflammatory acne? |
|
Definition
Inflammatory acne
Both non-prescription and prescription medication
Oral & topical antibiotics to suppress bacteria
Retinoids
Possible excision/drainage of lesions
Cleansing skin, avoiding factors |
|
|
Term
| Exclusions for self-treatment for acne? |
|
Definition
Grade II-IV (moderate-severe) acne
Papules, pustules, nodules, cysts and/or scarring
Severe, recalcitrant acne (extensive nodules/cysts)
Exacerbating factors (ex: comedogenic drugs, mechanical irritation)
Possible Rosacea |
|
|
Term
| Skin cleansing as nonpharm treatment for acne? |
|
Definition
Skin cleansing
Remove excess sebum produces mild skin drying/mild erythema
Instructions
Wash area twice daily using fingertips or washcloth gently
not excessively vigorous; pat dry
Warm water with soap (medicated or non medicated)
Use soaps with no moisturizing oils
Salicylic acid, sulfur, and sulfur-resorcinol combo soaps – effectiveness questionable?
Avoid abrasive cleaners |
|
|
Term
| Other ways besides skin cleansing as nonpharm treatment?? |
|
Definition
Avoidance of exacerbating factors
Avoid clothing which causes friction
Avoid resting face/chin on hand
Use water-based non-comedogenic cosmetics
Wash oily hair frequently with water-based shampoo
Minimize exposure to environmental factors (e.g., dirt, dust, oil)
Avoid “popping” pimples
Stay hydrated |
|
|
Term
| What are the pharmacological and herbal treatments for acne? |
|
Definition
Pharmacologic
Benzoyl peroxide
Salicylic acid
Sulfur
Sulfur-resorcinol combinations
Herbal Remedies
Tea Tree Oil
Glycolic Acid
Witch Hazel |
|
|
Term
| How do you choose treatments for acne? |
|
Definition
Product Selection
Cleansing products have questionable value because they leave little active ingredient on the skin
Gels most effective, but drying
Lotion/cream better for dry, sensitive skin
Some products may leave visible residue
Cream > gel for fair complexion
Gel > cream for dark complexion |
|
|
Term
| Describe benzoyl peroxide for acne treatment. |
|
Definition
Benzoyl peroxide
Available in 2.5 – 10% formulations
gel, lotion, cream, cleanser, etc.
Gel formulation more effective due to alcohol (astringent effect), but also more irritating
OTC product of choice
Benzoyl peroxide
MOA: Antibacterial, keratolytic
Releases oxygen free radicals which destroy bacterial proteins
Reduces follicular hyperkeratosis
Administration: Once or twice daily |
|
|
Term
| Describe benzoyl peroxide application. |
|
Definition
Benzoyl peroxide application
Avoid use with other topical products
Use lower concentration or wear time if excess irritation or dryness occur
Avoid inadvertent application to hair/clothing since product may bleach
Continue treatment regimen for 4-6 weeks to obtain maximum benefit |
|
|
Term
|
Definition
Benzoyl peroxide
ADRs
Dryness, erythema or edema
Peeling, skin sloughing
Stinging, burning
Above worse with exposure to sunlight
Use lower concentration/shorter periods if above occurs
May bleach hair, clothing, bed linens |
|
|
Term
| Describe salicylic acid for acne treatment, MOA, ADRs. |
|
Definition
Salicylic Acid
Available in concentrations of 0.5 – 2%
products include gels, pads and wipes, creams, etc.
MOA: Keratolytic; Causes desquamation by dissolution of intercellular cement
Administration dependent upon product chosen (generally 1 – 3 times daily)
ADRs: burning, stinging, erythema, pruritis, sun sensitivity |
|
|
Term
| Describe sulfur for acne medication, MOA, ADRs. |
|
Definition
Sulfur
Available in concentrations of 3 – 10%
MOA: Keratolytic; Possible antibacterial effect
Administration generally 1 – 3 times daily
ADRs: contact dermatitis, irritation
Possibly more effective when combined; has distinct odor and color |
|
|
Term
| Describe Sulfur-Resorcinol combinations for acne treatment. |
|
Definition
Sulfur-Resorcinol combinations
MOA: Irritant
May cause hyper pigmentation of dark skin
Should not be used for prolonged periods or over large surface areas of skin (thyroid dysfunction or methemoglobinemia) |
|
|
Term
| What are the herbal treatments for acne? |
|
Definition
Glycolic Acid: Alpha Hydroxy Acid
Used in face peels
Significantly reduces acne scars
Tea Tree Oil
Reduces the number of inflammatory lesions and comedones
Fewer side effects than Benzoyl Peroxide
Witch Hazel
Used as an astringent in herbal acne products |
|
|
Term
| __________ is the OTC product of choice to treat acne. |
|
Definition
| Benzoyl peroxide is the OTC product of choice to treat acne. |
|
|
Term
| <______ open and/or closed comedones qualifies a patient for self-treatment of acne |
|
Definition
|
|
Term
| Eating chocolate can exacerbate acne; True or False? |
|
Definition
|
|
Term
| Phenytoin can cause acne; True or False? |
|
Definition
|
|
Term
| What are the different kinds of respiratory disorders? |
|
Definition
Asthma
Chronic Obstructive Pulmonary Disease
Allergic Rhinitis
Cystic Fibrosis
Pulmonary Fibrosis
Pulmonary Hypertension |
|
|
Term
True or False?
Butterbur has been shown to inhibit lipoxygenase activity to decrease leukotriene synthesis |
|
Definition
|
|
Term
True or false?
Potential antiinflammatory properties of butterbur have been attributed to ephedrine content |
|
Definition
|
|
Term
True or False?
Butterbur was used in ancient Greece to treat asthma |
|
Definition
|
|
Term
True or False?
Raw, unprocessed butterbur plant should not be ingested because of the potential hepatotoxicity. |
|
Definition
|
|
Term
Based on what potential mechanism has boswellia been proposed as a potential therapy for asthma?
A. Blocking the physiological action of acetylcholine
B. Inhibiting the release of leukotrienes
C. Stimulating β2-adrenergic receptors
D. All of the above
E. None of the above |
|
Definition
|
|
Term
| Describe 1st gen AHs and their SE,DI,CI |
|
Definition
*more likely to cross BBB
May or may not relieve the symptoms of common cold
Effective secondary to anticholinergic effects rather than antihistaminic effects
Newer “non-sedating” antihistamines (Claritin) not as effective
SE: drowsiness (may have paradoxical effect in children/elderly), dryness of mucus membranes, urinary retention
DI: alcohol or other sedating medications, MAOIs, phenytoin
CI: newborns, narrow-angle glaucoma, BPH
Examples: diphenhydramine, clemastine, chlorpheniramine (least-sedating) |
|
|
Term
| Describe topical antitussives and expectorants. MOA and cautions. |
|
Definition
Topical antitussives / expectorants
camphor, menthol
MOA: Unproven: Thought to increase sensation of better airflow through the nasal passages by stimulating sensory nerve endings
TOXIC IF INGESTED
Not for direct application to the nose or upper lip!
Not for children under 2
Application or inhalation may be repeated up to three times daily |
|
|
Term
| Describe the American College of Chest Physicians' Guidelines for diagnosis and management of coughs. |
|
Definition
Diagnosis and Management of Cough Executive Summary: ACCP Evidence –Based Clinical Practice Guidelines Chest 2006;129:1-23.
Summary: there is little evidence that OTC products for coughs actually work
“… acute cough due to the common cold, OTC combinations cold medications, with the exception of an older antihistamine-decongestant, are not recommended until randomized controlled trials prove they are effective cough suppressants.”
NOT likely to have much of an impact on the general public in multi-million dollar business |
|
|
Term
Describe common pharmacologic measures for symptom progression for each of the following:
Pharyngitis
Nasal congestion, rhinorrhea, sneezing
Cough
Fever,etc. |
|
Definition
*Analgesics, lozenges
*Congestion: decongestants (systemic or topical)
*Rhinorrhea, sneezing: 1st generation antihistamines
*Dry/non-productive: antitussive
*Wet/productive: expectorant +/- antitussive
*Antipyretics/analgesics |
|
|
Term
| What is hypertension and how is it defined? |
|
Definition
Hypertension = elevated blood pressure
The American Heart Association defines hypertension for adults as 140 mm Hg or higher systolic and/or 90mm Hg or higher diastolic
Normal is < 120/80 mm Hg |
|
|
Term
|
Definition
| Blood pressure = the force of the blood pushing against artery walls from your heart pumping blood through your arteries |
|
|
Term
| What is congestive heart failure? |
|
Definition
Congestive heart failure = the heart cannot pump enough blood through the body
Blood backs up in one side of the heart causing the other side to work harder
Fluid buildup occurs in tissues and organs |
|
|
Term
| What are the treatment goals for CHF? |
|
Definition
Treatment goals
Improve cardiac function when possible
Reduce mortality rate
Improve patient's quality of life |
|
|
Term
| What are sebaceous glands? |
|
Definition
Sebaceous gland
Produce sebum (retards water loss and maintains hydration) |
|
|
Term
| Where does acne vulgaris originate? |
|
Definition
Acne vulgaris originates in pilosebaceous units of the skin
Consist of a hair follicle, sebaceous glands, connected to skin by a duct (infundibulum) |
|
|
Term
|
Definition
mild
Comedones only, <10 on face, none trunk, no scars; noninflammatory lesions only |
|
|
Term
|
Definition
moderate
10-25 papules (face/trunk), mild scars; inflammatory lesions <5mm |
|
|
Term
|
Definition
moderately-severe
>25 pustules, moderate scars; size <5mm but with visible, purulent core |
|
|
Term
| Describe Severe pustulocystic acne. |
|
Definition
severe
Nodules/cysts, extensive scaring; inflammatory lesions >5mm diameter |
|
|
Term
| Describe Recalcitrant severe cystic acne |
|
Definition
severe
Extensive nodules/cysts |
|
|
Term
| Describe benzoyl peroxide and its MOA and administration. |
|
Definition
Benzoyl peroxide
MOA: Antibacterial, keratolytic
Releases oxygen free radicals which destroy bacterial proteins
Reduces follicular hyperkeratosis
Administration: Once or twice daily |
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