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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 cordvarious 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.
Created by: benmarler