1. Neurotransmitters involved in vomiting
    acetylcholine, serotonin, domine and histamine
  2. Antiemetic classifications
    antihistamines, anticholinergics, domamine antagonists, benzo, serotonin antagonists, glucocoticoids, cannabinoids
  3. Why not to use dopamine antagonist in parkinson's disease
    will decrease dopamine already don't have enough
  4. Antihistamines and anticholinergics
    antagonist to histamine 1 receptors
  5. diphenhydramine (benadryl)
  6. hydroxyzine (vistaril, Atarax)
  7. Pheneragan (Promethazine)
  8. scopolamine (Transderm-Scop)
  9. Dopamine Antagonists (4)
    • block dopamine 2 receptors in the CTZ and vomit center
    • Avoid in children
    • SE: EPS, sedation and anticholinergic
    • Not really for preop but help with prego
    • some don't cross placenta
  10. CTZ
    chemoreceptor trigger zone-near the medulla and the vomiting center is in the medulla
  11. prochlorperazine (Compazine)
    dopamine antagonist
  12. chlopromazine (Thorazine)
    dopamine antagonist
  13. metoclopramide (Reglan)
    dopamine antagonist
  14. Benzodiazepines
    • indirectly control N/V
    • generally given with antiemetic
    • sometimes help with anxiety
  15. which benzo can be used to prevent symptoms of chemo
    lorazepam (Ativan)
  16. lorazepam (Ativan)
  17. serotonin (5-HT3) receptor antagonist (4)
    • supress N/V by blocking the serotonin receptors in the CTZ and vagal nerve terminal in the upper GI tract
    • very effective and very expensive
    • SE: HA, diarrhea, dizziness, fatigue
    • used postop and chemo
  18. odansetron (Zofran)
    serotonin (5-HT3) receptor antagonists
  19. granisetron (Kytril)
    serotonin (3-HT3) receptor antagonist
  20. dolasetron (Anzemet)
    serotonin (3-HT3) receptor antagonist
  21. palonosetron (Emend)
    serotonin (3-HT3) receptor antagonist
  22. Glucocorticoids (Corticosteroids)
    • MOA is unknown
    • used alone or with other agents to help N/V with chemo tx
  23. cannabinoids
    • avoid with ETOH and CNS depressants
    • SE: drowsiness, dry mouth, impaired thinking, euphoria
    • used in CA pts for vomiting and appetite stimulant in AIDS pts
  24. Causes of diarrhea
    foods, fecal impaction, bacteria, virus, IBD, IBS, toxins, drug reactions, laxative abuse, malabortion syndrome, bowel tumor, etc
  25. Antidiarrheals
    slow or inhibit GI motility by acting on nerve endings of the intestinal wall to reduce volume of stools, increase viscosity and decrease fluid and lyte loss
  26. Classifications of antidiarrheals
    • opiates and opitate-related agents
    • somatostatin analog
    • adsorbents
    • misc.
  27. Opiate and opiate-related agents
    • avoid in CNS depressands, slight risk of dependence with prolonged use
    • SE:anticholenergic SE of atropine and opiate SE
    • decrease intestinal motility and are frequently combined with atropine
    • does enter breast milk
  28. difenoxin and atropine (Motofen)
    opiate and opiate-related agents
  29. dipenoxylate with atropine (Lomotil)
    opiate and opiate-related agents
  30. loperamide HCL (Imodium)
    opiate and opiate-related agents
  31. why opiates mixed with atropine
    atropine is a potent anticholinergic
  32. Somatostatin Analog
    • inhibits gastric acid, pepsinogen, gastrin, cholecystokinin and serotonin secretion in the intestinal fluid as well as decreases smooth muscle contractility
    • Used for severe diarrhea and metastic Ca
  33. octreotide (Sandostatin)
    somatostatin analog
  34. Active ingerdient in dronabinol (Marinol)
    cannibus-just like mary
  35. Adsorbents
    • coat the GI and absorb the bacteria or toxins causing the diarrhea
    • Avoid with MAOIs
    • can cause greyish black stools
  36. bismuth salts (Pepto-Bismol)
    special considerations
    • Adsorbent
    • do not give to kids (has ASA)
  37. kaopectate (Kaolin-pectin)
  38. Laxatives classifications
    osmotic (saline), stimulants, bulk forming, emollients (stool softeners), opioid antagonist, cloride channel activator (Amitiza)
  39. osmotic (saline) laxitives
    • hyperosmotic salt pulls H2O into the colon, small amt is absorbed systemically watch for CHF, good renal function is needed
    • SE:hypermagnesemia, diarrhea, abd cramps, N/V
  40. magnesium citrate
    special considerations
    • osmotic laxative
    • will blow out the side of a barn
  41. Mg hydroxide (Milk of mag)
    osmotic laxative
  42. Na (PO4)2 (fleet phosopho-soda)
    osmotic laxative
  43. lactulose (Enulose)
    special consideration
    • osmotic laxative
    • given with liver disease lowers one of the enzymes
  44. Stimulants
    • stimulate peristalisi via mucosal irritatation, SE: mild crampind, diarrhea, fluid/lyte imblances
    • good for narcotic induced constipation
  45. bisacodyl (Dulcolax)
  46. castor oil (Purge)
    special considerations
    • stimulant
    • dont give to prego can stimulate uterine contractions
  47. senokot (Senna)
    special consideration
    • stilmulant
    • prolonged use can damage nerves resulting in loss of intestinal muscle tone
  48. Bulk-forming laxatives
    abosrb water into intestine to increase bulk and peristalsis, non absorbable, do not cause dependence, poor fluid intake can cause agent to solidify in tract and cause obstruction, don't give to pts on fluid restriction
  49. calcium polycarbophil (Fibercon)
    special consideration
    • bulk-forming lax
    • dont' give if hypercalcemia
  50. methylculllulose (citrucel)
    bulk-forming lax
  51. psyllium hydrophilic mucilloid (metamucil)
    bulk forming lax
  52. Emollients
    stool softeners, promote water accumulation in intestine and stool, can be toxic in kids, avoid in pts at risk for aspiration
  53. docusate calcium (surfak)
  54. docusate sodium (Colace)
    special consideration
    • emollient
    • cautious in pts with CHF
  55. opioid antagonist
    ability to cross BBB is restricted by structure, helps GI without analgesic effects on CNS, given SQ everyother day, expensive, usually only in hospital
  56. methylnaltrexone (Relistor)
    • opioid antagonist
    • approved by FDA to tx opioid induced constipation in palliative pts.
  57. factors that can cause GERD
    high fat foods, yellow onions, choc, peppermint, cigs, ETOH, caffeine
  58. TX for GERD
    lifestyle mods, antacids, H2 receptor antagoinst, proton pump inhibitor, promotility drugs, surgery
  59. antacids
    neutralize gastric acid, also used in peptic ulcer disease, may bind with other drus or increase gastric pH to decrease absorbtion of other drugs
  60. magnesium trisilicate (Gaviscon)
  61. calcium carbonate (Tums)
  62. magnesium hydroxide
  63. aluminum hydroxide
  64. H2 receptor antagonist
    • block H2 receptors of the parietal cells in the stomach--reducing gastric secretions and concentration along with prevention of reflus into esophagus.
    • used to tx peptic ulcer disease
    • do not give with antacids
    • SE: HA, dizziness, constipation, pruritus
  65. nizatidine (Axid)
    H2 receptor antagonist
  66. famotidine (pepsid)
    H2 receptor antagoinist
  67. cimetidine (Tagamet)
    H2 receptor antagonist
  68. ranitidine (Zantac)
    H2 receptor antagonist
  69. Proton pump inhibitors
    blocks the formation of gastric acid by inhibiting the H+ and K+ ATPase at the secretory surface of the gastric parietal cells, inhibits secretion by 90% more than H2 blockers, can reduce Ca+ absorbtion and in hospital saw more respiratory pneumonia, inc risk of C. diff
  70. lansoprazole (prevacid)
    proton pump inhibitor
  71. omeprazole (Prilosec)
    proton pump inhibitor
  72. pantoprazole (Protonix)
    proton pump inhibitor
  73. esomeprazole (Nexium)
    proton pump inhibitor
  74. rebeprazole sodium (Aciphex)
    proton pump inhibitor
  75. dexlansoprazole (Kapidex)
    proton pump inhibitor
  76. why more risk of pneumonia with PPI
    decreases fluid in gut and respiratory tract which promote bacterial colonization
  77. Two major forms of peptic ulcer disease
    • duodenal
    • gastric
  78. Peptic Ulcer Disease
    signifies a circuscribed lesion existing in the mucosal membrane of GI tract, 5 million in US have it, two major forms
  79. Duodenal Ulcers
    upper portion of small intestine, 80% of PU, yonger pts (20-50), 5-10% develop complications needing surgery, usually chronic course of remissions and exacerbations
  80. Gastric Ulcers
    ulcers in stomach, 60-70 yo, often in ETOH users and chronic ASA users
  81. etiology of PUD
    NSAID use, H. pylori infection (usually in childhood lays dormant then bam!), hypersecretory states
  82. Tx for PUD
    antactids, H2 blockers, PPIs, antiboitics if H. pylori is present, cautery to control bleeding, can take mos to heal ulcers
  83. desired pH to heal ulcers
    • >4 for gastric
    • >3 for duodenal
  84. when not to use H2 blockers
    with GI bleed
  85. sulcarlfate(Carafate)
    other agents for PUD, short duration of action, binds to damaged mucosa to coat and protect gut, decreases absorbtion of other meds
  86. misoprostol (Cytotec)
    other agents for PUD, repalces prostaglandins that are diminished during NSAID therapy, prevention of NSAID induced ulcers, SE: nausea and diarrhea
  87. Octerotide
    initail tx for GI bleed, cytoprotective, inhibits gastric secretion, must be refrigerated, IV
  88. Sympathetic System on heart
    N-epi strimulates B1 receptors with cardiac excitatory effects:inc. SA node pacing rate, incr conduction rate, inc cotraction force,
  89. parasympathetic system on heart
    ach activates cardiac cholinergic receptor to produce and inhibitory effect of decreased: rate of SA node pacing, conduction rate and force, irritability of atrial and junctional foci
  90. why do people still live when they are brain dead?
    myocardium contains it's own conduction system without needing stimulation from the CNS.
  91. Contration of the heart
    Na+ and K+ switch places and this generates electricity
  92. Ca+ role in contraction
    Ca+ follow Na+ into the cardiac cell and increases contraction force.
  93. SA node
    dominate pace maker of the heart, in upper RA, sends out waves of electricity through the heart (depolorization)
  94. AV node
    depolorization slows when it gets here to allow blood in the Atria to enter ventricles
  95. Antidysrhythmics (4 classes)
    • I: sodium channel blockers
    • II: Beta-receptor blockers
    • III: Potassium channel blockers
    • IV: calcium channel blockers
    • other agents....
  96. Class I: Sodium channel blockers
    slows conduction and either prolongs/ shortens repolarization

    Changes the speed of Na+ channel
  97. quinidine
    Na+ channel blocker
  98. disopyramide (Norpace)
    Na+ channel blockers
  99. procainamide (pronestyl)
    special considerations
    • Na+ channel blocker
    • need to monitor levels
  100. phenytoin (Dilantin)
    Na+ channel blocker
  101. mexiletine (Mexitil)
    Na+ channel blocker
  102. tocainide (Tonocard)
    Na+ channel blocker
  103. flecainide (Tambocor)
    Na+ channel blocker
  104. propafenone (Rythmol)
    Na+ channel blocker
  105. Lidocaine
    special considerations
    Na+ channel blocker, used for ventricular arrythmias, SE: bradycardia, drowsiness, dizziness, nausea, hallucinations, IV use requires EKG monitoring
  106. II: Beta receptor blockers
    block sympathetice beta receptors decreasing HR, inhibit the stimulation of heart tissue by depressing depolarization and slowing SA and AV impulses. Impair Ca+ release (reduces strength of contraction)
  107. Importance of Beta blockers and respiratory
    don't use on brittle asthmatics will bronch constrict (non cardiac specific)
  108. propranolol (Inderal)
    • Beta blocker
    • non cardiac specific
  109. acebutolol (Sectral)
    • Beta blocker
    • non caridac specific
  110. sotalol (Betapace)
    • beta blocker
    • non cardiac specific
  111. esmolol (Brevibloc)
    • beta blocker
    • non cardiac specific
  112. atenolol ( Tenormin)
    • beta blocker
    • cardiac specific
  113. metoprolol (Lopressor)
    • beta blocker
    • cardiac specific
  114. nebivolol (Bystolic)
    • beta blocker
    • cardiac specific
  115. labetalol (Trandate)
    • beta blocker
    • alpha and beta (peripheral and heart vasodialation)
  116. III: K+ channel blockers
    block movement of K+ during 3rd phase of action potential (cell recovery), prolonging repolarization and refractory period
  117. amiodarone (Cordarone)
    • K+ channel blocker
    • older than dirt, great during v-fib (chance of living rises 30%), need PFT, if IV need telemetry
  118. bretylol(Bretylium)
    K+ channel blocker
  119. ibutilide (Covert)
    K+ channel blocker
  120. dofetilide (Tikosyn)
    K+ channel blockers
  121. dronedarone (Multaq)
    • K+ channel blocker
    • lots of rx interactions, contraindicated in CHF class IV, 2nd or 3rd degree AV block or sick sinus syndrome (unless have functioning pace maker), SE: diarrhea, asthenia, nausea
    • Only indicated for pt with A-fib and flutter in pts w/o CHF
  122. IV: Ca+ channel blocker
    • inhibit the movement of Ca+ through the slow ca channels of the SA and AV nodes during the 2nd phase of the action potential, prolong conductivity, increase refractory period of SA and AV nodes, decrease strength of contration
    • Used for dysrhthmiase, HTN and angina
    • do not use in 2nd or 3rd heart block
  123. diltiazem (Cardizem)
    Ca channel blocker
  124. verapamil (Isoptin, Calan)
    Ca channel blockers
  125. Atropine-cardio
    blocks effects of acetylcholine on the SA and AV nodes, used to tx bradycardia, avoid if hypothermia (when pt warms up with hit all at once and bottom out),
  126. Dopamine (cardiac)
    sitmulated beta and some alpha receptors increaseing HR and contractility, cause renal blood vessel dialation, can cause tachyarrhythmia, do not DC abruptly, NO IV central line caustic to tissue
  127. what is dopamine used for (cardiac)
    • low dose for renal blood vessel dialation
    • moderate dose for beta 1 to inc HR, contractility and conduction
    • CHF and Shock
  128. Digoxin
    special considerations
    watch K+ if you see pt will live don't and they die
  129. Adenosine
    • antidyshythmic
    • considered a chemical defibrillator
    • causes a brief period of asystole (flat line) up to 10 seconds
    • stops chaos so SA can restart
    • Natural occuring amino acid in body
    • wake up feeling like you had a heart attack (you did it to them)
  130. Magnesium (cardiac)
    • used for ventricular arrhythmias (mg def is usually the cause)
    • Essential for the Na-K pump
  131. Prehypertension numbers
    • 120-139 systolic
    • 80-89 diastolic
  132. Stage 1 HTN numbers
    • 140-159 systolic
    • 90-99 diastolic
  133. Stage 2 HTN numbers
    • >159 systolic
    • > 100 diastolic
  134. What if systolic and diastolic fall in different categories
    use the higher number for classification
  135. Primary HTN
    • uncommon before 20
    • no identifiable cause
    • changes when stressed or activity
    • white coat HTN
    • read in am (usually early morning when people have heart attacks)
  136. Secondary HTN
    transient and labile
    • caused by something
    • transient-r/t acute illness or meds (steroids ro OC)
    • labile-stressful events
    • often is severe, sudden and resisitant
  137. Angiotensin I
    converted to II by angiotensin converting enzyme
  138. Angiotensin II
    • potent vasoconstrictor
    • principal pressor of the renin-angiotensin system
    • stimulates aldosterone synthesis and secretion by the adrenal cortex, cardiac contraction, renal reabsorbtion of Na, activity of the sympathetic nervous system, and smooth muscle growth
  139. Exacerbating factors of HTN
    obesity, Na, ETOH, cig smoking, secondary lifestyle, polycythemia, hypokalemia, genetics
  140. Transient HTN
    • NSAIDS (raises by 5)
    • estrogen
    • prego
    • hypercalemia
    • thyroid disease
    • whatever causes ICP
  141. Consequenses of uncontrolled HTN
    CAD, L vent hypertrophy, heart failure, strokes and TIA, kidney fail, peripheral artery disease, retinopathy
  142. Meds for HTN (6)
    • diuretics
    • sympatholytics
    • ACE inhibitors
    • ARBS
    • Ca channel blockers
    • direct renin inhibitors
  143. Diuretics
    • used in HTN to decrease edema (pulmonary and peripheral) associated with CHF and renal disease
    • inhibits Na and H2O from reabsorbing in the renal tubules
    • Reduction of blood volume by voiding
  144. classes of diuretics
    • Thiazide
    • Loop
    • Osmotic
    • Carbonic anhydrase inhibitors
    • Potassium sparing
  145. furosemide (Lasix)
    • Loop diuretic
    • look at K level
    • NSAIDS can blunt the diuretic effect
    • often in CHF and less often in HTN
    • can cause irreversible hearing loss
    • monitor for dehydration, lytes, constipation and tinnitis
  146. Beta blockers-HTN
    • reduce HR, contractility, and renin release
    • first line post MI, also used in CHF, angina and A-fib
    • SE: bradycardias, depression, nightmares, sexual dysfunction, and possibly hypoglycemia
  147. Have a heart attack? Take what the rest of your life
    Beta blocker
  148. Alpha 1 Adrenergic Blockers
    • venous and arterial dialation
    • relax muscles in bladder, neck and prostate
    • tx of HTN and BPH
    • mtr for otho hypotension and urinary incont
  149. doxazosin (Cardura)
    Alpha 1 Adrenergic Blocker
  150. prazosin (Minipress)
    alpha 1 adrenergic blocker
  151. alpha 2 agonists
    • decrease symphathetic outflow of norepi
    • wont actually cause slud
    • decrease CO and HR
    • causes vasodialation
  152. clonidine (Catapres)
    • alpha 2 agonists
    • patch can be applied q7d to hairless area
    • SE: sedation, rebound HTN with abrupt DC
  153. ACE inhibitors
    • inhibits the formation of angiotension II and block the release of aldosterone
    • "prils"
    • primary and second CV prevention
    • decrease vasoconstrion, aldosterone and BP
  154. captopril (capoten)
    ACE inhibitor
  155. enalepril (vasotec)
    ACE inhibitor
  156. lisinopril (zestril)
    ACE inhibitor
  157. quinapril (Accupril)
    ACE inhibitor
  158. Angiotensin II receptor blockers (ARBS)
    • act on renin agiotensis wystem and block angiotensinII from AT1
    • "sartans"
    • work earlier in system than ACE
    • primary and secondary prevent of stroke
    • Tx for heart fail
    • protection against nephropathy (DMII)
    • used when cough ACE gets annoying
  159. losartan (Cozaar)
  160. valsartan (Diovan)
  161. irbesartan (Avapro)
  162. eprosartan (Teveten)
  163. Free Calcium
    • found in myocarium
    • increases muscle contractility, peripheral resistance and increases BP
  164. SE of Ca channel blockers
    • peripheral edema
    • flushing
    • ha
    • nausea
    • palpitations
  165. amiodipine (Norvasc)
    ca channel blocker
  166. felodipine (Plendil)
    ca channel blocker
  167. nifedipine (Procardia)
    ca channel blocker
  168. diltiazem (cardizem)
    ca channel blocker
  169. verapamil (Calan SR)
    ca channel blocker
  170. clevidipine (Cleviprex)
    new IV ca channel blocker- onset is 2-4 minutes
  171. HTN crises considerations
    • give slowly and mtr BP and ECG
    • avoid use >3 days
    • cautious in liver and kidney disease
    • dont want hanging around too long
  172. nitroprusside
    direct vasodialator used in HTN emergency
  173. Direct Renin Inhibitors
    • newest classes
    • inhibits renin (renin decreases angio II)
    • SE: angioedema, cough, diarrhea, ha, hyperkalemia
    • mtr lytes
  174. aliskiren (Tekturna)
    direct renin inhibitor
  175. Cultural considerations
    native americans
    • w-generally high-renin HTN respond well to all meds
    • b-low-renin HTN respond better to CCB, alpha blockers and diuretics
    • A-twice as sensitive to BB as whits
    • N-reduced response to BB
  176. Angina Pectoris
    other symptoms
    typically SOA and panic feeling with diaphoresis, HTN and tachycardia
  177. Initital tx for angina
    • m-morphine
    • O- oxygen
    • N-nitro
    • A-Aspirin
  178. Anti-anginals
    what does
    • used to terminate attack or decrease attacks
    • classes: BB, CCB and organic nitrates
  179. Nitrates
    • relax smooth muscle to produce vasodialation
    • SE: ha, hypotension, lightheadedness, nausea
    • tolerance is an issue, patches removed at night
  180. isorbide
  181. ismo
  182. imdur
  183. isordil
  184. Niitroglycerin
    • vasodialator (primarily veins)
    • drug of choice for angina
    • SE: ha, ortho hypotension, relex tachycardia
    • Rx interactions: antihypertensives, viagra (severe hypotension)
  185. dont give nitro to who
    person having stroke--want as much blood flow to brain as possible
  186. Pt Ed for Nitro
    • avoid ETOH
    • rotate patch sites
    • if SL allow to disolve and sit/lie down
    • cover iv bottle from sunlight
    • mtr for hypotension
  187. 5 drugs for circulatory disorders
    • anticoags
    • antiplatlets
    • thrombolytics
    • antilipemics
    • peripheral vasodialators
  188. dabigatran (Pradaxa)
    special considerations
    • anticoag
    • new no antidote
    • no need for lab mtr
  189. daltepairin sodium (Fragmin)
  190. Throbolytics
    • acitvates fibrinolytic system
    • give w/in 6 hrs of MI
    • 3 hrs of CVA
    • IV only and mtr for cerebral hemm
    • amacar-antidote
  191. alteplase (Activase)
  192. anistreplase (Eminase)
  193. retaplase (Retavase)
  194. streptokinase (Streptase)
  195. urokinase (Abbokinase Open-Cath)
  196. contraindications for thromblytics
    • prior IC hemmorage
    • ischemic stroke w/in 3 mos
    • suspected aortic dissection
    • active bleeding
    • significant head trauma w/in 3 mos
  197. Statins
    • primary and secondary CV prevention
    • lower cholesterol
  198. Bile acid seqestrants
    lower LDL by binding to bile--lead liver cells to send cholesterol to rid bad
  199. cholestramine (Questran)
    bile acid seq
  200. colestipol (colestid)
    bile acid seq
  201. colesevelam (Welchol)
    bile acid seq
  202. fibric acid derivatives
    • affect lipoproteins (triglyc and VLDL)
    • give 30 min ac
    • contraindicated in gallbladder disease, renal or liver probs, billary cirrhosis
    • avoid if prego or nursing
  203. cemfibrozil (Lopid)
    fibric acid der
  204. fenofibrate (Tricor)
    fibric acid der
  205. clofibrate (Abitrate)
    fibric acid der
  206. Nicotinic Acid
    • acitve form of vit B3 (niacin)
    • very effective but few can tolerate SE
    • ETOH and spicy food can make SE worse
    • SE: flushing from vasodialtor properties can be reduced with ASA
    • Not as harsh on liver as statins
  207. peripheral vacular disease
    • numbness and cooling of extremeties
    • intermittent claudication
    • possible leg ulcers
  208. scabicides
    used to kill mites and lice
  209. methrin (Nix)
  210. pyrethrin (Rid)
  211. permethrin (Elimite)
  212. keratolytics
    • reduce thickness of skin
    • used to tx warts and other conditions
    • applied as cream lotion or get
  213. benzoly peroxide
  214. resorcinol
  215. slicylic acid
  216. sulfur
  217. sodium sulfacetamid (Klaron)
    topical antibiotic
  218. benzoyl peroxide
    topical antibiotic
  219. Retinoids
    • vit A derivative
    • some also used for wrinkles
    • acne
  220. tretinoin (Retin A)
  221. adapalen (Differin)
  222. isotretinoin (Accutane)
    • retinoid
    • highly toxic--mtr lipids, glucose, sed rate, CBC
  223. dapsone (Aczone)
    • topical gel
    • believed to interfere with neutrophils
    • orla used in past for leprosy and other skin conditions.
  224. atopic dermatitis hallmark sign
    hyperirritable skin with key symptom pruritus
  225. skin findings with atopic dermatitis
    • usually symmetrical
    • location changes with age
    • infants-face, scalp, neck
    • post infant child- folds of arms and legs
    • adults- may be localized to eyelids hands or nipples
  226. tx for atopic dermatitis
    • decrease stress
    • avoid irritants
    • lukewarm baths
    • min use of soap
    • thick creams
    • topical steroids
  227. emollient creams
    • within 2 min of bath
    • crisco, eucerin
    • avoid lotions with ETOH
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