What condition did people most commonly use alternative/complementary medicines for?
back pain
This alt med is a building block of tendons, cartilage, ligaments, synovial fluid, blood vessels and heart valves?
glucosamine/chondroitin
What is best indication for glucosamine/chondroiton?
mild to moderate OA, not severe
t/f: chondroitin or glucosamine are not effective when used alone
true
t/f: patients taking warfarin can also take glucosamine/chondroitin.
false: may increase bleeding
Do not recommend these alt meds for muscle or neuro pain, only for joint pain?
glucosamine/chondroitin
t/f: since glucosamine/chondroitin comes from marine exoskeletons and cow or shark cartilage, patients w/ shellfish allergy should not take them.
false, it's okay
What is the safe dosage and length of treatment for MSM?
2.6-6 grams per day for 12 weeks
This drug is thought to have a link to pain by sulfur deficiency but that is not proven?
MSM
Where is MSM found?
algae
plants
fruits
veggies
milk
urine
What is MSM thought to help?
OA pain
What natural anti-inflammatories have similar side effects to NSAIDs? (GI upset, caution with anticoags)
bromelian
cat's claw
devil's claw
ginger
This natural med thought to be comparable to diclofenac and reducing mild knee pain?
bromelian
This natural med thought to reduce knee pain?
cat's claw
This natural med thought to similar to Vioxx for back pain and has been validated for OA pain?
devil's claw
What is ginger thought to do for pain?
relieve OA pain
What are all of the natural anti-inflammatory meds?
willow bark
stinging nettles
turmeric
phellodendron
ginger
devil's claw
cat's claw
bromelian
Which natural anti-inflammatory might actually work for pain associated with RA (according to Onysko)?
turmeric
What are some anti-depressant-like natural meds?
L-tryptophan
5-HTP
St. John's Wort
SAMe
What natural med is thought to be good for fibromyalgia, but not headaches?
5-HTP
Which natural med is thought to be as effective as NSAIDs for pain, but is expensive and has poor product quality?
SAMe
These two natural meds look promising for helping with nerve pain in diabetics or for increasing blood flow?
Acetyl-L-carnitine
Alpha-lipoic acid
These two natural meds decrease substance P in the sensory nerves which decreases pain (also cause irritation and stimulation of nervous tissue)?
camphor
capsaicin (capsicum/cayenne pepper)
Patients should use these two natural meds for 3 days and multiple applications to see pain relief at fullness?
capsaicin
camphor
Which 4 natural meds are most safe AND effective to recommend for pain relief?
camphor
capsaicin
glucosamine sulfate
SAMe
Which 4 natural meds should not be recommended for pain relief?
St. John's wort
L-tryptophan
marijuana
5-HTP
How do non-selective NSAIDs cause GI bleeds?
inhibit protective prostaglandin PGE2 in endothelium
Inhibition of which COX causes GI bleeding?
COX 1
Inhibition of which COX increases cardio risk?
COX 2
Inhibition of which COX decreases inflammation?
COX2
What is the amount of risk when taking an NSAID and getting GI complications vs. someone who is not taking an NSAID?
50-100% increased risk
Which antihypertensive does NSAID not interfere with?
calcium channel blockers
If patient reports with an allergic reaction to both aspirin and naproxen, does patient have allergy or pseudoallergy?
pseudo which is related to COX 1 inhibition
What problems might a patient have that would make them be at higher risk for aspirin-induced asthma?
urticaria
nasal polyps
severe asthma
chronic rhinitis
Very low and high doses of aspirin do what in a gout patient?
help excretion of uric acid = good
Which OTC analgesic is only contraindicated in the 3rd trimester of pregnancy?
NSAIDs
Which analgesic should not be used in pregnancy or breastfeeding?
aspirin
Where do tension headaches occur?
over top of head
extend to base of head
both sides
Where do migraines occur?
one side usually
avoiding known triggers is the best way to avoid which type of headache?
migraine
At what temp should you treat a fever in an adult?
>106 or if they are uncomfortable
Which method of measuring temp is best in kids?
rectal, but others are okay if proper technique used
Combining NSAIDs or aspirin with alcohol increases risk of what?
GI bleed
What is RICE?
rest
ice
compression
elevate
What is the difference between fever and drug-induced hyperthermia?
fever= over 100 degrees
DIH= 102-104 sometimes as high as 108
Which usually causes a higher temp, bacteria or virus?
bacteria
t/f : a child less than 6 months old with a rectal temp of 101 or higher can be self treated.
false
t/f: magnesium salicylate is usually used to treat back pain
true
Which drug is used mostly for OA pain, fever, and mild to moderate pain?
tylenol
For a child older than 6 months what should we recommend for fever?
ibuprofen or tylenol
Tylenol + Alcohol =
increased hepatotoxicity
NSAIDs/aspirin + alcohol =
increased risk of GI bleed
tylenol/NSAIDs/aspirin + warfarin =
bleeding risk
aspirin + NSAID =
bleeding risk
decreased cardio benefit from aspirin
NSAIDs/salicylates + antihypertensives =
increased BP
hyperkalemia
What are some examples of complemetary medicine?
massage
support groups
biofeedback
hypnosis
What is alternative medicine?
no reimbursed by thirdparty payers
lacks evidence for effectiveness
therapy not provided in hospital or taught in American med schools
t/f: Homeopathic meds must be approved by FDA
true
t/f: homeopathic medicine is often compared to vaccines
true
Use of what meds usually requires vigorous shaking?
homeopathics
Dilutions of 1 to 10 are designated as ?
X
Dilutions of 1 to 100 are designated as ?
C
t/f: the more dilute a homeopathic med is, the stronger it is
true
1X=
1: 10
3X=
1:1000
6X=
1:1,000,000
1C=
1: 100
3C=
1:1,000,000
Dilutions of what strength have zero active ingredient molecules in them?
more than 24X or 12C
t/f: dietary supplements are required to be safe, but not effective
true
What is required to be on a natural medicine label?
product name + the word supplement
quantity
manu. name and location
directions for use
facts panel with serving size
plant-based product has to include scientific name
Which natural med product claim is not required by the FDA to be on the label?
structure-function claim
This group verifies that a product contains the labeled ingredients and that contaminants and unlisted ingredients are not present in a natural med?
NSF (national sanitation foundation intl)
This is an independent company that tests products?
consumer lab
Which population (race) uses CAM the most?
American Indians and Alaskans, then whites
What natural meds are used for cardio system?
garlic
hawthorn
CoQ10
omega-3
red yeast rice
what are the uses for CoQ10?
statin-induced myopathy
aids immune function in HIV
may lower BP
heart failure
This natural supp is a vitamin-like compound, acts as an antioxidant, membrane stabilizer, cofactor for ATP?
CoQ10
t/f: odorless garlic products are inactive
true
What is in garlic that makes it pharmaco effective?
allicin
ajoene
This natural supp may cause smooth muscle dilation by activating NO and reduces oxidative stress and inhibits LDL oxidation?
garlic
What would you use garlic for?
atherosclerosis
hypertension
tick bites
ringworm
jock itch
athlete's foot
Pregnant women or someone taking aspirin or warfarin should not take this cardio supp?
garlic
what type of fatty acids are omega 3 and omega 6?
polyunsaturated
Why do we want more omega 3 than 6?
b/c 6 has pro-inflammatory effects
Where do we get omega 3 fa from?
soy
canola oil
flaxseed
walnuts
nuts
fatty fish oils (long chain, EPA/DHA)
What type of omega 3 do we want for a cardio benefit?
long-chain polyunsaturated w/ EPA and DHA (but focus is on EPA)
What is a good protective dose of fish oil against cardiac events?
1 gram/day
What is a good treatment dose of fish oil for lowering TGs?
3-4 grams/day
What is a good dose of fish oil for decreasing atherosclerosis and antiarrhythmic?
1-2 grams/day
t/f: there is enteric coated fish oil
true
t/f: contaminants like mercury in fish oil are a major concern
false
t/f: Eating a diet with 1-2 servings of oily fish per week is enough to have cardiac protection
true
Is flaxseed a long or short-chain omega 3?
short
What is found in short chain omega 3?
alpha-linolenic acid
Why do we not recommend flaxseed as a supplement?
has too many calories
can increase TGs by 10%
Which cardiac supp is absolutely contraindicated in pregnancy?
red yeast rice
What prescription drug is red yeast rice similar to?
statins
This supp has cholesterol lowering effects?
red yeast rice
How does hawthorn work?
increases membrane perm for calcium and inhibits PDEs, increases cAMP, increases coronary blood flow, increases vasodilation
t/f: it is best not to recommend hawthorn
true
the flowers and leaves of this cardiac supp contain chlorgenic acid and flavonoids?
hawthorn
What supps might we use for the nervous system?
ginkgo
melatonin
SJW
valerian
5-HTP
chamomile
riboflavin (B2)
CoQ10
Which nervous system supp contains flavonoids, terpenoids, and organic acids?
ginkgo
This NS supp has antioxidant props and neural and retinal protective effects?
ginkgo
t/f: ginkgo is only recommended for folks who already have dementia or memory loss.
true
t/f: healthy elderly patients probably should not take ginkgo
true
What uses does ginkgo have other than for dementia?
intermittent claudication
PMS
diabetic retinopathy
vertigo
glaucoma
t/f: roasted or fresh ginkgo seeds are safe to use
false
What drug should you not take with ginkgo?
warfarin (bleeding)
Which supp naturally regulates circadian rhythm, endocrine secretions, an sleep patterns?
melatonin
_______ inhibits melatonin secretion?
light
This supp is effective for jet lag, the blind, mentally retarded, autistic, or other CNS disorders?
melatonin
What dose of melatonin should you take for eastbound jet lag?
0.5-5 mg at local bedtime
Women who are trying to get prego should not take this NS supp b/c will inhibit ovulation or decrease gonadal development?
melatonin
What does 'wort' mean?
plant
t/f: SJW may contain melatonin
true
Hyperforin and adhyperforin are found in which NS supp and these modulate the effects of serotonin, dopamine, and NE?
SJW
This supp can be considered a good option for mild, short-term depression?
SJW
This supp is often used in conjunction with SJW for menopausal women?
black cohosh
This NS supp is used for insomnia, sedative-hypnotic, anxiolytic, antidepressant, anticonvulsant and antispasmodic effects?
valerian
This NS supp may bind directly to GABA receptors?
valerian
What is the typical dose of valerian when used for insomnia?
400-900mg 2 hours before bedtime
This NS supp can reduce time to sleep onset and improve sleep quality?
valerian
T/F: some people may not see sedative effects from valerian (flippers) and may actually get excited
true
This NS supp seems to be effective for depression and fibromyalgia, but can also cause EMS (eosinophilia myalgia syndrome)?
5-HTP
What is chamomile used for?
oral mucositis
dyspepsia
anti-inflammatory
anti-bacterial
depression?
This NS supp contains a flavonoid called apigenin which is similar to BZD ligand?
chamomile
Which NS supp which is a vitamin might help ameliorate migraines?
riboflavin (B2)
What NS effect would CoQ10 potentially have?
helps migraines
What supps would we use for digestive health?
B6
ginger
milk thistle
peppermint
senna
probiotics
chamomile
What digestive supp is considered the first line treatment for N/V in prego women?
B6 (pyridoxine)
What is the dose of B6 for N/V in prego women?
25 mg q 8 hours
Which digestive supp is similar to Zofran and may increase GI motility and act on serotonin receptors?
ginger root
What is the dose of ginger to be used for N/V/morning sickness in prego?
250 mg QID
What two conditions is ginger likely effective for and what condition is it likely ineffective for?
effective: morning sick, post op N/V
ineffective: motion sick
t/f: pyridoxine may be safer than ginger for prego women
true
What is most commonly used part of milk thistle used?
seeds
What do we use milk thistle for?
dyspepsia
diabetes
alcohol related liver disease
laxative?
this digestive supp has silymarin in it, which is a potent inhibitor of TNF, blocks cytotoxicity, inflammation and apoptosis, is an antioxidant, and is especially selective for liver cells?
milk thistle
This digestive supp may inhibit histamine release, is an antispasmodic due to direct relaxing effects on GI smooth muscle, and if applied topically can inhibit pain receptors b/c it contains menthol?
peppermint
What do we use peppermint for?
dyspepsia
enema related colon spasms
tension headaches
This digestive product can be used orally, topically or rectally?
peppermint
Since peppermint can cause heartburn, what should we tell the patient?
take enteric coated
This digestive supp is used for patients on long term opioid therapy.
senna
What do we use senna for?
constipation (esp w/ opioids)
bowel preparation before colonoscopy
These digestive supps are prodrugs that get activated by bacterial enzymes in the colon.
senna
t/f: prego women can use senna
true
This digestive supp can cause ab pain, cramps, bloating and depletion of electrolytes?
senna
What supps do we use for the endocrine system?
alpha lipoic acid
ginseng
DHEA
What do we use alpha lipoic acid for?
diabetic neuropathy
peripheral neuropathy (pain, numbness, burning)
What do we use ginseng for?
diabetes to reduce post prandial glucose in Type 2 DM
resp tract infections (colds, flu)
Should we use ginseng with warfarin?
no
What do we use DHEA for?
adrenal insufficiency
ED
aging skin
osteoporosis
schizophrenia
SLE
What are some side effects of DHEA?
hirsutism
acne
hair loss
insomnia
voice deepening
This supp was banned by NCAA for stimulant-like activity?
DHEA
This supp has had quality control problems and is endogenously produced from our adrenal glands and liver?
DHEA
t/f: DHEA is possibly unsafe when taken orally in high doses for a long time
true
Name some immune stimulants/performance enhancers.
echinacea
green tea
probiotics
What is the most commonly used natural supplement?
echinacea
What do we use echinacea for?
reducing symptoms of cold
not prophylaxis
What substances does green tea contain?
caffeine
flavonoids, flavonols
What do we use green tea for?
anti-inflammatory in airway
diuretic effect
mental alertness
genital warts
hyperlipidemia (lowers TG and cholesterol)
What 3 strains of bacteria do we have the most evidence of probiotic effectiveness for?
lactobacillus
bifidobacteria
saccharomyces boulardi
What functions does the flora in our GI have?
prevent overgrowth of bad bacteria
produces vitamins B and K
break down food
absorb nutrients
Which probiotic found in Activia helps improve slow intestinal transit?
bifidobacteria
Which probiotic is the most effective?
lactobacillus (Acidophillus) (Culturelle)
Which probiotic is most effective at treating C. diff?
saccharomyces boulardi (Florastor)
t/f: probiotics are safe in pregnancy and breastfeeding
true
t/f: probiotics are safe to use in the immunocompromised
false
Which supp may decrease symptoms of the flu by 0.28 days?
oscillo
What are the potential harms of cleansing?
dehydration
electrolyte imbalances
fecal incontinence
bowel perforation
N/V
cramps
infection
Who should absolutely avoid cleansing?
diverticulitis
ulcerative colitis
Crohn's
hemorrhoids
recent bowel sx
What 2 supps do we use for kidney, urinary and prostate health?
salicylic acid: anti-inflammatory and anti-platelet
t/f: cranberry can be used to treat UTIs
false; only to prevent
t/f: cranberry can interact with warfarin
true
Which product was thought to decrease prostate growth/inflammation?
saw palmetto
What 2 supps do we use for skin and mucous membrane health?
aloe vera
tea tree oil
What do we use tea tree oil for (in relation to skin)?
acne (less irritating even though slower acting)
onychomycosis (fungal toenail infection)
What 2 non-herbal OTCs is tea tree oil comparable to?
1% lotrimin
5% benzoyl peroxide
What do we use aloe vera for?
sunburn/other burns
constipation
psoriasis
this skin supp could cause menstruation and abortion if taken in too high of an oral dose?
aloe vera
What is the most common supp used for hot flashes?
black cohosh
Do not use this supp b/c of estrogen-like effects, possible liver damage and miscarriage of pregnancy?
black cohosh
Should we recommend phytoestrogens like soy, red clover isoflavonem, genistein, or daidzein?
no could cause breast cancer
Does soy work to treat hot flashes?
no
What are the 3 ways to evaluate the significance of drug-supplement interactions?
Criterion 1: severity
Criterion 2: likelihood
Criterion 3: level of evidence
Where does grapefruit inhibit CYP3A4?
in the gut
Which supplement has the most documented drug interactions?
SJW
What supplement increases the activity of all prodrugs?
SJW
What are the top 10 drugs that cause undesirable drug interactions?
grapefruit
SJW
garlic
calcium
pomegranate juice
ginkgo
bitter orange
noni juice
kava
If have to take calcium and levothyroxine what is the rule of thumb?
take 4 hours apart
Which supplement can lower the seizure threshold?
ginkgo
Use SJW with caution with what 3 drug classes?
Plavix
HIV protease inhibitors
oral contraceptives
Use calcium with caution with what 3 drug classes?
bisphosphonates
levothyroxine
antibiotics
Use ginkgo with caution with what 6 drug classes?
wellbutrin
antibiotics
narcotics
warfarin
plavix
aspirin
*seizures*
This supplement has replaced Ephedra as a weight loss supp?
bitter orange
Which supp should you not take with anti-arrythmics b/c might cause QT prolongation?
bitter orange
What supp could cause hyperkalemia if taken with ACE inhibitors or spironolactone or in patients with renal dysfunction?
noni juice
this supp is linked to hepatoxicity especially when combined with other hepatotoxic drugs like statins, ketoconazole, lamisil, methotrexate and tylenol?
kava
Which two supps should the elderly avoid if they are on warfarin or aspirin?
ginkgo
garlic
Why is black cohosh bad for inducing labor?
causes heart failure in neonates
What is the biggest opponent to the tobacco control efforts?
tobacco industry itself
Who has the highest rate of tobacco use?
American Indians
Alaskans
t/f : nicotine is the addictive component of tobacco products, but it does not cause the ill health effects
true
t/f: there are safer levels of second hand smoke
false
What are some major health consequences of smoking?
cancers
cardiovasc diseases
pulmonary diseases
reproductive effects
cataracts
osteoporosis
periodontis
poor surgical outcomes
t/f: separating smoking areas, cleaning the air, and using ventilation are effective at protecting non-smokers from second hand smoke
false
What are the major health consequences of using smokeless tobacco?
periodontal disease: bone attachment loss, dental caries, gum recession
Oral leukoplakia: white spots
cancer: oral, pharyngeal
t/f: there is no statewide law regarding smoke-free workplaces in wyoming
true
where is the lowest tax placed on cigarettes?
virginia
Where is the highest cost for one pack of cigarettes?
New York
About how much sooner do cigarette smokers die than non-smokers?
10 years earlier
What are the different types of tobacco?
cigarettes
cigars
bidis
cloves
hookah
pipes
chew, snuff
Among folks who continue to smoke, how many will die due to a tobacco-related disease?
about half
How many adults are current smokers?
1/5
What is the most common form of tobacco used in the U.S?
cigarettes
What is the amount of nicotine contained in each cigarette?
1-2 mg
t/f: snuff smokeless tobacco is on the rise
true
What does the risk of smoking tobacco look like for pipes, cigars, cigarettes?
cigarettes> cigars = pipes
Which form of tobacco has twice the tar and nicotine of a standard cigarette?
cloves
Which form of tobacco has three times higher levels of carbon monoxide and nicotine and five times higher levels of tar than a standard cigarette?
bidis
What does PREPs stand for?
Potentially reduced exposure products
What are some noncombustible tobacco products?
ariva
marlboro snus
stonewall
camel snus
Do PREPs reduce the risk of developing tobacco-related disease?
no
Where do we get the highest absorption of tobacco?
in alkaline media
At what pH is nicotine readily absorbed?
physiological
What is the pH of the mouth?
7
What kind of effects does nicotine predominantly have?
stimulatory
t/f: nicotine is readily absorbed across skin and small intestine
true
how long does it take nicotine to get to the brain?
10-20 seconds
What is the half life of nicotine?
2 hours
How is nicotine excreted?
kidney
breast milk
What are the 3 main contributing factors to tobacco use?
physiology
pharmacology
environment
Which pathway in the brain does nicotine activate?
dopamine reward pathway
What drugs may have a decreased effect due to induction of CYP1A2?
bendamustine
caffeine
clozapine
erlotinib
fluvoxamine
olanzapine
ropinirole
tacrine
theophylline
irinotecan
Which drug will have an increased effect if used while smoking?
Plavix
t/f: smoking decreases the efficacy of oral contraceptives
false
Which women are at a significantly increased risk of stroke, MI, or thromboembolism?
35 or older AND
smoke at least 15 cigarettes per day
What are the 5 A's of smoking cessation?
Ask
Advise
Assess
Assist
Arrange
What are the most effective ways to quit smoking?
counseling + medications
What are the 3 FDA approved drugs for smoking cessation?
partial nicotinic receptor agonist
psychotropics
nicotine replacement therapy
What prego category are wellbutrin and chantix?
C
What prego category is NRT?
D
t/f: NRT should be recommended for smokeless tobacco user
false
How much does NRT affect quit rates?
doubles quit rates
t/f: patients should stop using all forms of tobacco upon initiation of the NRT regimen
true
Who needs to be supervised when using NRT?
cardio disease
Which NRT is most like smoking a cigarette?
Nicotrol NS nasal spray
What doses does nicotine gum come in?
2 and 4 mg
How many cigarettes would someone smoke if you are going to give a 2 mg nicorette gum?
less than 25/day
What dosage of nicorette gum would you recommend for someone smoking more than 25 cigs per day?
4 mg
What is in the resin complex of nicorette gum?
nicotine
polacrilin
What is max number of pieces of gum you can chew in a day?
24
Do not eat or drink for how long before using nicorette gum or a lozenge?
15 minutes
What is Commit and Nicotine Mini?
lozenges
Which NRT delivers ~25% more nicotine than the equivalent gum dose?
lozenge
What is the max number of lozenges to be taken per day?
20
When should you use a 2 mg lozenge?
if you smoke more than 30 minutes after waking up
To improve chances of quitting, how many pieces of gum or lozenges should you have daily during the first 6 weeks?
9
what are the dosages of nicotine patch (NicoDermCQ)?
7
14
21 mg
How do we decide what dose of a nicotine patch to give?
less than 10 cigs/day: 14mg for 6 weeks, 7 mg for 2 weeks
more than 10 cigs/day: 21mg for 6 weeks, 14 mg for 2 weeks, 7 mg for 2 weeks
What should we remove before an MRI?
nicotine patch
One dose of nicotrol NS nasal spray contains how much nicotine?
1 mg
How many doses are in a bottle of nicotine nasal spray?
100 per nostril so 200 sprays
How much nicotine does the nicotine inhaler have?
4 mg of vapor
What is the min and max amount of cartridges of the nicotine inhaler you should use?
6
16
t/f: the mouthpiece for the nicotine inhaler can be reused
true but wash it
How long is an open cartridge of nicotine inhaler good for?
24 hours
Which NRT avoids food/drink problems?
the patch
Patients should begin therapy of what drug 1 to 2 weeks prior to quit date?
wellbutrin
Patients should begin therapy of what drug 1 week prior to quit date?
chantix
Dry mouth and insomnia are common side effects of what cessation drug?
wellbutrin
Seizure risk is increased when taking what cessation agent?
wellbutrin
What is the half-life of chantix?
24 hours
Patients might become agitated, depressed, hostile or have changes in behavior when taking which cessation agent?
chantix
Patients taking this cessation drug might give you GI upset or vivid dreams or insomnia?
chantix
What natural herbal could be used for smoking cessation?
lobeline
How does lobeline work?
like chantix
partial nicotinic agonist
What grade of acne can patients self-treat for?
grade 1
What are the 5 main causes of acne?
proliferation of P. acnes
excessive sebum production
inflammatory response
hormones
abnormal follicular desquamation
What medications can cause acne?
phenytoin
isoniazid
moisturizers
phenobarbital
lithium
ethionamide
steroids
What are the pharmacological treatments for acne?
benzoyl peroxide
salicylic acids (beta-hydroxy acids)
alpha-hydroxy acids
sulfur products
tea tree oil
oral zinc
tinea capitis
scalp infection
tinea corporis
any where on body
under fat folds
tinea pedis
athlete's foot
tinea unguium (onychomycosis)
toenail fungus
tinea cruris
jock itch
What is an immediate exclusion to self care of treating fungal infections?
Candida or other yeasts
What is the most common type of tinea pedis?
chronic intertriginous
What is favus?
patchy areas of hair loss, yellow crusts and scales
can lead to scalp scarring and permanent hair loss
(seen in tinea capitis)
What are the most common agents used to treat fungal infections?
butenafine
clotrimazole
miconazole
terbinafine
tolnaftate
Which antifungal can be used as a preventative measure?
Tuff Actin Tinactin (Tolnaftate)
What is a salt of aluminum that is used to treat fungal infections? (also can also be used for ears)
Burrow's solution
t/f: you can apply tolnaftate to broken skin
true
What does fungistatic mean?
prevents bacterial growth
Which antifungal medication is not fungicidal?
Tolnaftate
What are the 3 phases of wound healing?
inflammation
proliferation
maturation/remodeling
How many stages of wound depth are there?
4
What is another term for whitehead?
closed comedone
What is another term for blackhead?
open comedone
Can we self treat papules, pustules or cysts on the skin?
no (unless they are not inflamed)
What is grade 1 acne?
closed and open comedones
less than 10 on the face
none on rest of body
no scarring
no inflammation
t/f: acne medications often make our skin worse before they make our skin better and can take 6-8 weeks to work
true
What does mild acne look like?
non-inflammatory papules or pustules
What are some exacerbating factors for acne (not causes)?
local irritation/friction
oil based beauty products
exposures to dirt, chemicals, cooking oil, tar
stress/emotional extremes
high humidity
prolonged sweating
increased androgen levels (PCOS, preg, meds)
Does chocolate cause acne?
no, nor do any other foods
What are some exclusions for self treating acne?
moderate to severe acne present
drug induced acne
contributing disease state present
rosacea
What are the adverse side effects of benzoyl peroxide?
bleaching
photosensitivity
contact allergy
over-drys skin
What are the OTC strengths of benzoyl peroxide?
2.5-10%
What are the Rx strengths of benzoyl peroxide?
10-20%
This acne treatment can be bactericidal and keratolytic?
benzoyl peroxide
This acne treatment is comedolytic and keratolytic.
salicylic acid (beta hydroxy)
Who is contraindicated to take salicylic acid?
diabetics
poor circulation
small children
What are the OTC strengths of salicylic acid?
0.5%- 2%
This acne treatment exfoliates and tingles?
alpha-hydroxy acids
What are the OTC concentrations of alpha-hydroxy acid?
4-10%
This acne treatment may only be good for reducing scarring and uses glycolic, lactic and citric acids?
alpha-hydroxy acids
Which acne treatment should African Americans avoid?
sulfur products
Which acne product seems to be most efficacious (dosage form)?
gels
t/f: if baby has acne, we can treat it with drug products
false; use soap and water BID
What are the organisms most commonly involved in causing funal infections?
trichophyton
microsporum
epidermophyton
Candida
other yeasts
What is the most prevalent fungal infection?
tinea pedis
When should you change a wound dressing?
when it is dirty or no longer intact
t/f: antiseptic is recommended when self treating a wound
false
What should we use to irrigate wounds?
sterile saline
soap and water
bottled water
What are some examples of antiseptics?
hydrogen peroxide
ethyl alcohol
iodine
isopropyl alcohol
camphorated phenol
Which topical antibiotic works against gram negative bacteria?
Polymyxin B Sulfate
Which topical antibiotic might get resistance to develop?
Neomycin
This topical antibiotic could potentially cause ototoxicity or nephrotoxicity if too much is used?
neomycin
this topical antibiotic increases rate of hypersensitivity and allergies?
neomycin
T/F: both neomycin and polymyxin B sulfate work against gram negative bacteria
true, but neo also on staph
This fungal infection must be treated w/ systemic antifungals or pro nail removal?
tinea unguium
In general, should we recommend hydrogen peroxide?
no
Which antiseptic can be used as a douche or wound irrigant and is not irritating?
povidone/iodine
This antiseptic is effective against protozoa, fungi, bacteria, spores, viruses and yeast?
iodine
Which topical antibiotic is used to fight gram positive bacteria?
bacitracin
How many days should you give a wound to heal before you call your PCP?
5
This type of tinea pedis has fissuring, scaling, or maceration in the inter-digital spaces, bad odor, itching and stinging sensation?
chronic intertriginous
This type of tinea pedis usually involves the lateral toe webs and typically spreads to the sole or instep of the foot and gets worse in warm, humid environments?
chronic intertriginous
This type of tinea pedis usually presents on both feet and has mild inflammation, diffuse moccasin-like scaling on the soles of the feet?
chronic papulosquamous
If patient has tinea pedis and tinea onychomycosis/unguium, what do you treat first?
onychomycosis
this type of tinea pedis shows small vesicles near the instep or mid-anterior plantar surface and has skin scaling in the toe webs?
vesicular
This type of tinea pedis is aggravated in summer and dormant in cooler months?
vesicular
This type of tinea pedis is complicated by bacteria such as proteus and pseudomonas, gives a pungent odor, white hyperkeratosis, maceration, weeping ulcerations on the sole, and may be painful?
acute ulcerative
This type of fungal infection is not really a medical emergency but shows symptoms like opaque, yellow, thick nails, nail separation, or nail falls off?
tinea unguium/onychomycosis
What are the symptoms of tinea capitis?
lesions around hair shaft
hairs turns dull gray, breaks off at scalp
pustules
kerion
itching
fever
pain
enlarged lymph nodes
black dot
hair loss
favus
t/f: we can self treat a nail or scalp fungus
false
What is the typical duration of therapy for antifungals?
2-4 weeks
Terbinafine
Lamisil AT
Clotrimazole and Miconazole
Cruex
Desenex
Micatin
Lotrimin
Butenafine
Lotrimin Ultra
Tolnaftate
Tinactin
Salts of Aluminum
Burrow's solution
t/f: salts of aluminum have antifungal properties
false
What are salts of aluminum approved and most useful for?
astringent and antiinflammatory properties
dry out soggy tinea pedis'
What dosage form is the most effective antifungally?
cream
How long does the inflammatory wound healing phase take?
3-4 days
How long does the proliferative wound healing phase take?
3-21 days
How long does the maturation wound healing phase take?
a long time
happens after 3 weeks
What are some disease states that have poor vascularization and may take longer to heal a wound?
diabetes
hypotension
PAD
CHF
obesity
What are some meds that will slow wound healing?
corticosteroids
anticoagulants
chemo
radiation
What factors contribute to good or poor wound healing?