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OTC - Test 2
| Question | Answer |
|---|---|
| clinical presentation of common cold (6 symptoms) | 1.sore throat 2.nasal symptoms 3.watery eyes 4.sneezing 5.cough 6.malaise |
| complications of the common cold (4) | spread to sinuses, spread to eustachian tubes, spread to lower respiratory tract, aggravate COPD & asthma |
| which condition that mimics the common cold presents with thick yellow sputum and/or nasal discharge | bacterial infection |
| which condition that mimics the common cold presents with a rapid onset and significant fever? | bacterial infection |
| which condition that mimics the common cold presents with more systemic symptoms and fewer nasal symptoms? | influenza |
| which condition presents similarly to the common cold, but involves more allergic rhinitis and opthalmic symptoms? (esp. opthalmic) | allergic rhinitis |
| Rx for influenza only - NOT common cold | tamiflu, relenza, symmetrel, flumadin |
| what symptom are OTC decongestants used for? | NASAL congestion |
| what symptom are antihistamines used for? | excess nasal discharge (runny nose) |
| what is quickvue | influenza test |
| what "herbal" supplement should NEVER be recommended for cold treatment | echinacea |
| what are the two types of allergic rhinitis? | perennial and seasonal |
| how does someone develop allergic rhinitis? (i.e. what are the mitigating factors) | exposure to allergens |
| what is the in vivo early response in allergic rhinitis? | immediate release of mediators from mast cells |
| what is the in vivo late response in allergic rhinitis? | chemotactic factors released |
| which response (late or early) do antihistamines help to block? | late response |
| what are the nasal symptoms associated with allergic rhinitis? | congestion, rhinorrhea, pruritis, sneezing |
| what are the ocular symptoms of allergic rhinitis? | itching, lacrimation, soreness, puffiness |
| what are the general symptoms of allergic rhinitis? | headache, malaise |
| what is the primary complication associated with allergic rhinitis? | secondary infection |
| name 3 conditions that mimic allergic rhinitis | infectious rhinitis, vasomotor rhinitis, and rhinitis medicamentosa |
| what are some non-pharmacologic therapies/prevention of allergic rhinitis? | limit outside exposure, air filtration, keep pets outside |
| name a non-OTC therapy for allergic rhinitis | allergy shots |
| what do antihistamines do in vivo? | block H-1 receptors |
| what are the major side effects of antihistamines? | sedation and anti-cholinergic effects |
| what is the best pharmacotherapy for mild allergic rhinitis? | H-1 antagonists |
| what is the best pharmacotherapy for moderate allergic rhinitis? | H-1 antagonist PLUS decongestant |
| what is the best pharmacotherapy for chronic allergic rhinitis? | cromolyn |
| what severity of allergic rhinitis should be treated with Rx products? | Sever and very severe only |
| what are the precautions/contraindicaitons for 1st gen antihistamines? | 1.do not drive/operate machinery2.do not drink alcohol w/ med3.prostatic hypertrophy4.narrow angle glaucoma |
| what effect do 1st gen antihistamines have on BP? | NONE - not contraindicated in hypertension |
| name 5 1st gen antihistamines | chlorpheniramine, brompheniramine, diphenhydramine, clemastine, triprolidine |
| name 1 2nd gen antihistamine | loratadine |
| what is the MOA of oral decongestants? | block alpha-adrenergic receptors |
| what in vivo effects do oral decongestants have? | vasoconstriction - decreases blood supply to nose |
| what effect do oral decongestants have on allergic mediated reactions? | NONE - no effect on histamine |
| common side effects of oral decongestants | CNS stimulation, nervousness, increased HR, increased BP |
| can oral decongestants be taken long term? | yes |
| can oral decongestants be used during pregnancy? | they can, but should only use if necessary |
| precautions associated with oral decongestants | hypertension, heart disease, diabetes, hyperthyroidism, enlarged prostate, narrow angle glaucoma, pregnancy |
| true contraindication for oral decongestant | MAOIs - may produce hypertensive crisis leading to death |
| what are the effects of an overdose of oral decongestants? | CV collapse, shock, coma |
| name 4 oral decongestants | phenylephrine, pseudoephedrine, phenylpropanolamine, ephedrine |
| which oral decongestant has the least side effects and the least PO therapeutic effect? | phenylephrine |
| which oral decongestant is the only one that has unrestricted sale in the US? | phenylephrine |
| which oral decongestant has MODERATE side effects and good therapeutic effect? | pseudoephedrine |
| which oral decongestant is also available in combination asthma agents? | ephedrine |
| what is the MOA of topical decongestants? | alpha adrenergic agonism that constricts blood supply to the nose |
| are the side effects more or fewer in decongestants when applied topically as opposed to orally? | fewer side effects when applied topically (esp. systemically) |
| what is the FDA recommended maximum length of use of topical decongestants? | 3 days |
| what are the 3 main adverse effects of topical decongestants? | 1. dependence2. rhinitis medicamentosa3. systemic effects (only w/ wrong admin.) |
| what is the shortest acting topical decongestant? | phenylephrine |
| what is an intermediate acting topical decongestant? | naphazoline |
| what is a long acting topical decongestant? | xylometazoline |
| what is the longest acting topical decongestant? | oxymetazoline |
| what is a good alternative to topical decongestants in children? | saline solution |
| what is a major concern with home-made saline solution? | lack of preservation - can harbor bacterial/mold growth |
| how long should home-made saline solution be kept? | 5 days |
| name two nasal inhalers that may be used as alternatives to topical decongestants | propylhexadrine (Benzedrex)levodosoxyephedrine (vick's) |
| what is a major side effect concern for zinc sprays? | can produce loss of taste |
| what should cromolyn be used for? | PREVENTION of allergic symptoms (good med for chronic allergic rhinitis) |
| how long does it take to see onset of action of cromolyn? | 2-3 weeks MINIMUM |
| what do manufacturers add to otc products that are labeled as night time formulas? | diphenhydramine OR doxylamine |
| what type of product do daytime/non-drowsy products NOT contain? | antihistamines |
| what two drugs makeup coricidin cold & flu? | chlorpheniramine and APAP |
| what drugs make up advil sinus and dristan sinus? | pseudoephedrine and ibuprofen |
| what two drugs are present in sine-aid max strength and sine off? | pseduoephedrine and APAP |
| what two drugs are in sunutab non-drowsy? | pseudoephedrine and APAP |
| what drugs are in sinulin? | chlorpheniramine, pseudoephedrine, and APAP |
| what drugs are in alkaseltzer plus cold | chlorpheniramine, pseudoephedrine, ASA |
| what drugs are in tylenol allergy sinus max | chlorpheniramine, pseudoephedrine, APAP |
| what drugs are in dristan cold multi-symptom | chlorpheniramine, phenylephrine, APAP |
| what drugs are in actifed? | triprolidine, pseudoephedrine |
| what drugs are in benadryl allergy decongestant? | diphenhydramine, pseudoephedrine |
| what drugs are in dimetapp 4hr tabs? | brompheniramine, pseudoephedrine |
| what drugs are in novahistine? | chlorpheniramine, phenylephrine |
| what drugs are in chlor-trimeton 12-hr? | chlorpheniramine, pseudoephedrine |
| what drugs are in contac 12 hr? | chlorpheniramine, pseudoephedrine |
| what drugs are in cimetapp 12 hr max strength? | brompheniramine, pseudoephedrine |
| what drugs are in drixoral cold & allergy? | dextrobrompheniramine & pseudoephedrine |
| what drugs are in tavist D? | clemastine and pseudoephedrine |
| what drugs are in teldrin? | chlorpheniramine and pseudoephedrine |
| what drugs are in claritin d 12 hr? | loratidine & pseudoephedrine |
| what drugs are in DayQuil? | brompheniramine and pseudoephedrine |
| what are 3 causes of cough? | 1. defense mechanism to expel foreign material2. postnasal drip/throat irritation (common w/ smokers)3. some drugs (e.g. ACE inhibitors) |
| what are the 3 types of cough? | congested & productive, congested & non-productive, dry & non-productive |
| what type of cough is indicative of chest congestion? | congeste & productive |
| what type of cough is similar to smoker's cough? | dry & non-productive |
| what are the two main treatments for cough? | anti-tussives and expectorants |
| what is the only OTC narcotic? | codeine |
| what is the primary use of codeine? | night-time cough |
| what are the main SEs of codeine? | sedation, nausea, constipation |
| what is the ONLY non-narcotic OTC anti-tussive? | dextromethorphan |
| what product has had the anti-tussive class removed by the FDA? | diphenhydramine |
| what drug is the rx only cough suppressant? | benzonotate |
| what is the best remedy for a bad night-time cough? | 50 mg of diphenhydramine and max dose of dextromethorphan |
| what is the major expectorant used? | guaifenesin |
| what should be taken along with guaifenesin? | PLENTY OF FLUIDS |
| what are the three parts of the ear? | external ear, middle ear, internal ear |
| appendage attached to the side of the ear under the ear canal | auricle (or pinna) |
| tube running from the auricle into the temporal bone - protects the middle and internal ear | external acoustic meatus |
| reacts to sound waves, also known as the eardrum | tympanic membrane |
| three parts of the external ear | auricle, external acoustic meatus, tympanic membrane |
| components of the middle ear (2) | auditory ossicles and eustachian tube |
| links the middle ear with the nasopharynx and serves as a route for infections to reach the middle ear | eustachian tube |
| two components of the inner ear | bony labyrinth and membranous labyrinth |
| common ear disorde that may be due to overproduction of ear wax | cerumen impaction |
| only "pharmacologic" treatment for cerumen impaction | carbamide peroxide (debrox, auro, murine) |
| non-pharmacologic therapies for cerumen impaction | olive oil, baby oil, glycerin, hydrogen peroxide w/ water |
| Rx only treatment for cerumen impaction | cerumenex |
| cerumenex MOA | dissolves ear wax |
| technical name for swimmer's ear | external otitis |
| most likely cause of external otitis | bacterial or fungal infection |
| household product used for prevention of external otitis | acetic acid (vinegar in water) |
| a product used in external otitis but that is only labeled for use in "ear drying" | isopropyl alcohol in anhydrous glycerin |
| products containing isopropyl alcohol in anhydrous glycerin | swim ear, ear-dry |
| what is the reccomendation for external otitis prevention from the american academy of otolaryngology? | mix acetic acid 5% 50:50 w/ 95% isopropyl alcohol |
| what are the OTC products approved for treatment of external otitis? | there are NONE |
| non-pharmacologic therapies that may help with external otitis treatment | acetic acid 50/50 w/ water and domeboro's solution (aluminum acetate) |
| what is pain due to changes in altitude? | barotrauma/barotitis |
| what is the OTC DOC for barotrauma? | pseudoephedrine |
| what is the best way to remove foreign bodies from the ears of children? | use warm olive oil. esp. with insects |
| what are the two treatments for auricular boils? | 1. treat w/ hot compress followed by triple antibiotic oint.2. icthamol oint. (boil salve) |
| what two auricular disorders should be referred to PCP b/c there are no OTC treatments? | otitis media and tympanic membrane perforation |
| what flora predominates in a healthy vaginal ecosystem? | lactobacillus |
| 6 factors that may affect the vaginal ecosystem | 1.hormonal fluctuations2.aging3.disease (e.g. DM)4.medications (e.g. antibiotics)5.douching6.number of sex partners |
| how much discharge does a normal vagina produce daily? | 1.5 grams |
| 4 factors that may affect normal discharge | 1.feminine hygiene products2.douches3.contraceptive products4.tampons |
| LOOK AT TABLE 8.1!!! | AH-T SAID THERE WILL BE A QUESTION FROM 8.1!!! |
| what are the classifications for a recurrent VVC? | > 3 infections in one year or current infection w/ an infection in the past 2 months |
| list the precipitating factors for VVC | -pregnancy-HRT-vaginal pH (esp. w/ DM)-broad spec antibiotics-immunosuppressant drugs-onset of regular sexual activity-IUD or vaginal sponge |
| symptoms of VVC | thick, white discharge and erythema, itching or vulvular edema |
| treatment goals of VVC | relief of symptoms AND eradication of infectionre-establishment of normal flora |
| PCP referral w/ VVC | <12concurrent symptomsimmunosuppressantsmedical disorders that predisposerecurrent infectionsymptoms persisting >1wk |
| VVC self-treatment criteria | not considered recurrentat least one previous physician diagnosed episodecurrent symptoms mild to moderate |
| VVC - non-pharmacologic treatment | d/c meds that could causedecrease sucrose/refined carb intakeincrease yogurt intakesodium bicarb sitz bath |
| herbal treatments for VVC | garlic and tea tree oil |
| pharmacologic treatment for VVC | non-Rx topical imidazoles (clotrim, miconazole, butaconazole, tioconazole) |
| drug interactions associated with miconazole | warfarin (both CYP2C9 substrates) |
| side effects of topical imidazoles | burning, itchingabdominal crampspenile irritationheadache |
| what type of prep is preferred in pts w/ VVC w/ significant vulvular symptoms? | cream OR cream combo w/ suppository |
| Alternative treatment for VVC | Gentian violet |
| how long should it take for symptomatic relief from VVC once treatment is initiated? | 2-3 days |
| how long should it take for complete symptomatic resolution from VVC once treatment is initiated? | at least a week |
| should treatment for a VVC be continued during a woman's period? | YES |
| should a woman refrain from having intercourse while treating a VVC? | YES - imidazole creams break condoms |
| what is the condition characterized by inflammation of the vagina related to atrophy of the vaginal mucosa secondary to decreased estrogen levels? | atrophic vaginitis |
| what are some things that may precipitate atrophic vaginitis? | menopausepost-partum breastfeedingdecreased estrogen productionmedications |
| symptoms of atrophic vaginitis | -vaginal irritation-dryness-burning-itching-leukorrhea-dyspareunia |
| what are the treatment goals of AV? | reduce/eliminate symptoms of vaginal dryness, burning, and itchingeliminate dyspareunia |
| what is the main treatment for AV? | topical lubricants |
| what should be avoided in a woman w/ AV? | anything that may aggravate symptoms (e.g. powders, perfumes, spermicides, panty liners) |
| what symptoms when associated w/ AV signify the need for PCP referral? | severe vaginal dryness or dyspareuniasymptoms are not localizedno relief from lubricants |
| what type of lubricants should be used w/ AV? | water soluble lubricants - vaseline should NOT be used (difficult to remove and damages latex) |
| adverse effects associated with vaginal douching | -mechanically irritate the vagina-disrupt normal flora-increased risk for many adverse conditions |
| what douche ingredients should not be used because they inhibit normal flora growth? | antiseptics and povidone-iodine |
| what douche ingredient has no effect on normal flora? | water-vinegar |
| is douching necessary for cleansing? | NO |
| is douching contraindicated during pregnancy? | YES |
| when should douches NOT be used? | as contraceptives AND during pregnancy |
| how long hsould douching be delayed after spermicide is used? | 6-8 hours |
| how long should a woman wait after taking the last dose of anti-fungal meds before douching? | 3 days |
| how long before an OBGYN appointment should a woman avoid douching? | 48 hours |
| what are the functions of the skin? | -protection-sensation-homeostasis (including temp and hydration)-vitamin synthesis |
| what are the layers of the skin? | epidermis, dermis, and hypodermis |
| what layer of the skin contains nerve endings vasculature and hair follicles? | dermis |
| what layer of the skin is responsible for nourishment and cushioning? | hypodermis |
| which layer of the skin regulates water content and controls drug transport? | epidermis |
| what is the fibrous, insoluble peptide that is present in the stratum corneum? | keratin |
| passive diffusion process dependent upon numerous factors | percutaneous absorption |
| factors that affect percutaneous absorption | -physical-chemical relationship b/w drug and vehicle-hydration of stratum corneum-temperature-skin integrity |
| chronic relapsing skin disorder that begins in infancy/early childhood and follows a remitting/flaring course throughout adulthood | atopic dermatitis |
| common exacerbating factors associated w/ atopic dermatitis | -foods-soaps/detergents and other chemicals-fragrances-temp and humidity changes-dust/pollen-emotional changes |
| what is the presentation of atopic dermatitis in infants? | facial and generalized body eczema |
| what is the presentation of atopic dermatitis in children? | flexural areas |
| what is the presentation of atopic dermatitis in adolescents and adults? | hands, flexural areas, and upper eyelids |
| pruritis and erythema are indicative of what phase of atopic dermatitis? | acute |
| what is the itch/scratch cycle referred to as? | pruritis |
| what phase of atopic dermatitis has crusting/plaques associated with it? | subacute |
| what phase of atopic dermatitis is associated with fibrotic papules and lichenification? | chronic phase |
| what 3 things do cutaneous infection present with? | pustules, vesicles, and crusting |
| what recommendation should be made to patients presenting with cutaneous infections? | seek medical attention |
| PCP referral w/ atopic dermatitis | -involvement of large areas of the body-<2 yrs-sever condition w/ intense pruritis-skin appears to be infected |
| what are the goals of self treatment with atopic dermatitis? | -stop itch-scratch cycle-maintain skin hydration-avoid/minimize causative factors |
| what are some non-pharmacologic therapies to relieve/minimize itching? | -avoid tight, occlusive clothing-moderate temp/humidity settings-gloves and/or socks to bed-short, smooth, clean fingernails |
| how long does "appropriate bathing" last? | 3 to 5 minutes (in tepid water) |
| what types of soaps are recommended in appropriate bathing for people w/ atopic dermatitis? | glycerin soaps |
| what should be applied w/in 3 minutes after bathing to a person w/ atopic dermatitis? | moisturizer |
| why do glycerin soaps work better than other soaps? | -more water soluble-higher oil content-neutral pH |
| what products can be used to allay itching? | -hydrocortisone cream-oral antihistamines-calamine lotion-topical anasthetics |
| what products can be used to hydrate skin? | -emollients-colloidal oatmeal-bath oils |
| what products can be used for oozing/weeping wounds? | astringents |
| what are the primary ingredients in emollients/moisturizers? | -water-oils-humectants |
| what is the purpose of humectants in moisturizers? | helps skin retain water |
| what are the MOAs of emollients/moisturizers? | -occlusive (leave thin, oily film)-fill spaces b/w dewquamating skin scales w/ oil droplets - re-establishes integrity of stratum corneum |
| how many times are moisturizers/emollients applied daily? | 3 to 4 times |
| what type of vehicle is inappropriate to apply to weeping lesions? | ointments |
| what is the most common cause of pruritis? | xerosis |
| what factors can precipitate xerosis? | -environmental factors-excessive use of soap-inadequate water intake-increased age-physical damage to stratum corneum-hormonal changes |
| what are the treatment goals of xerosis? | -restore skin hydration-restore skin's barrier function |
| pharmacologic treatment of xerosis? | -topical hydrocortisone-urea or lactic acid containing products-ammonium lactate 12% and AHAs |
| how long should hydrocortisone be used in xerosis treatment? | no more than 7 days |
| how long should self treatment be continued before a PCP is contacted in xerosis? | 1 - 2 weeks |
| name 3 common keratin softening agents | -urea-lactic acid-allantoin |
| what are the effects of keratin softening agents? | hydration of the stratum corneum |
| what formulations are best for removal of scales and crusts associated with xerosis? | lotion and cream |
| what formulation is best for rehydrating dry skin associated w/ xerosis? | emollient ointment |
| name 3 common humectants | -glycerin-propylene glycol-phospholipids |
| prolonged and/or excessive uterine bleeding at regular intervals | menorrhagia |
| uterine bleeding occurring between menses | metrorrhagia |
| prolonged uterine bleeding occurring at irregular intervals | menometrorrhagia |
| cycle intervals of <21 days | polymenorrhea |
| cycle intervals ranging from 35 days to 6 months | oligomenorrhea |
| absence of menstrual bleeding for at lease 6 months | amenorrhea |
| how is progesterone indirectly responsible for primary dysmenorrhea? | stimulates arachadonic acid which is a precursor to prostaglandins |
| what effect do prostaglandins have on the uterus? | cause uterine contractions/ cervical narrowing AND release vasopressin |
| what effect does vasopressin have on the uterus? | vasoconstriction causing uterine ischemia and pain |
| what effect do leukotrienes have on the uterus? | increase sensitivity of uterine pain fibers |
| GI symptoms of primary dysmenorrhea | nausea, vomiting, AND diarrhea |
| CNS symptoms of primary dysmenorrhea | fatigue, dizziness, headache, weakness, nervousness |
| treatment goals of primary dysmenorrhea | provide relief of symptoms, limit discomfort, AND limit disruption of usual activities |
| non-pharmacologic therapy of primary dysmenorrhea | rest, wearing loose clothing, exercising, massage, heat pads, smoking cessation |
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zdelaney
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