What nonpharmacological therapy is used for resistant candida infections
gentia violet
What nonpharmacological therapy can be fatal if ingested and should not be used by pregnant women
boric acid
3 candidates for self treatment of VVC
vaginal symptoms are infrequent (uncomplicated)
at least one previous episode of VVC was medically diagnosed
current symptoms are mild to moderate, nonmalodorous discharge
4 OTC medications that treat yeast infection.
butoconazole - gynazle
clotrimazole - clotrimax, atopalm
miconazole - alovest, baza
tioconazole - vagistat 1
MOA of vaginal antifungals
Imidazole compounds alter fungal membranes resulting in lyses
Indications of vaginal antifungals
FDA approved for local treatment and external itching/irritation associated with infection.
what are three adverse reactions of antifungals
initial burning
itching/irritation
headache
What could be a DI with vaginal antifungals
coumadin
What two treatment options are not advantageous over antifungals.
vagisil - benzocaine
yeast gard
6 situations when you would refer a patient with VVC
pregnancy
girls < 12 yo
concurrent symptoms; fever or in pain in the lower abdomen, back and shoulder
medications that can predispose to VVC: corticosteroids, angiplastics
medical disorders that predispose women to VVC: DM, HIV infection
recurrent VVC ( >3 vaginal infections pre year or vaginal infection in past 12 months)
7 nonpharmacologic therapies for VVC (not recommended)
Lactobacillus acidophilus preparations
douches
sodium bicarbonate sitz bath
garlic
tea tree oil
gentian violet
boric acid
3 counseling points for VVC
limiting self treatment to appropriate circumstances (mild to moderate symptoms, infrequent vaginal symptoms, predicatble antibiotic associated VVC)
seeking medical evaluation if symptoms persis beyond a week after treatment, recur within 2 months, or vaginal symptoms occur > 3 times in 12 months
symptoms should improve in 2-3 days and resolve within a week of treatment
Nonpharmacologic treatment used for non C. albicans infections
boric acid
What vaginal infection is caused by polymicrobic anaerobic organisms
Bacterial vaginosis (BV)
3 main signs and symptoms of BV
1/3 to 1/2 of women are asymtomatic
fishy odor
disharge - watery
- white, grey, yellow or green
- increased volume
The most common Tx for BV
antibiotic
3 situations when to refer for BV
pregnant or chance of becoming
history of vaginosis that was treated with prescription antibiotics
underlying medical conditions that may complicate therapy
epidemilogy of Trichomniasis -3
transmitted via sex
women are asymtomatic
men are asymtomatic resovoirs
4 S&S of Trichomniasis
frothy and foamy discharge
yellow-grey-green discharge
dysuria
vulvovaginal irritiation
Treatments options for Trichomoniasis
prescription only
treat sex partners also
REFER
What is the usefulness of OTC pH testing kits
reduces inappropriate use of antifungals
Inflammation of vagina due to atrophy of vaginal mucosa secondary to declining estrogen levels. post menopausal disorder
atrophic vaginitis
What disorder could present as a yeast infection
atrophic vaginitis
S&S of atrophic vaginitis
initially - dyspareunia, irritation, burning
watery, yellow (bloody), malodorous discharge
sexual activity may lead to bleeding or spotting, because of dryness
3 counciling points of atrophic vaginitis products
may apply as often as needed, use liberally
remind women who are postpartum or breast feedig that the dryness will be shor term
which products can be used with condoms and diaphragms - oil based
what days of the menstrual cycle is dysmenorrhea the greatest
first and second days, increased levels of prostaglandins and leukotrienes causing increased uterine contractions
what is the difference between primary and secondary dysmenorrhea and which one needs referal
Primary - idiopathic cramp-like pain at time of menstruation
Secondary - pain other than associated with menstruation. REFER
what otc is more preferred in women with dysmenorrhea
ibuprofen
etiology of PMS
due to fluctuating levels of estrogen/progesterone
patholphysiology of PMS
decrease in serotonin assiciated with irritability and food cravings
Nonpharmacologic treatments of PMS
exercise
diet - avoid alcohol and caffeine
- foods rich in tryptophan ( precursor to serotonin, help with mood.
two factors that cause fluid retention
redistribution
retention
3 FDA approved diuretics for PMS
ammonium chloride
caffeine
pamabrom
5 counciling points of PMS
stress the improtance of stress reduction techniques and diet
rule out other conditions with same symptoms that would warrant referral
recommend medicaions to treat symptoms of dysmenorrhea
recommend appropriate OTC therapy
refer to PCP if symptoms don't improve or worsen
Dysmenorrhea dosing for APAP, ASA, and ibuprofen, naproxen sodium
650-1000mg q4-6h (3000mg)
650-1000mg q4-6h (4000mg)
200-400mg q 4-6h (3200mg)(1200mg) OTC
220-440mg initially, then 220mg q8 - 12h (660mg)
PMS when to refer
severe symptoms
symptoms not timed with menstrual cycle
onset of symptoms coincide with use of OC's or HRT
contraindications to OTC products
previous unsuccessful OTC treatment
relative contraindications (age less than 18 years)
Main cause of toxic shock syndrome
high absorbency tampons
S&S of toxic shock syndrome - 6
malaise, myalgia, chills
high fever
decreased urine output
cardiac failure
skin dysquamination
hypotension and shock
what can reduce the risk of toxic shock syndrome to 0%
using pads instead of tampons
Predisposiing factors for toxic shock syndrome
elevated vaginal temperature and neutral pH
retention of blood by tampon serves as bacterial medium
tampons that inhibit lactobacillus and promote toxin production
menses and tampons cause micro trauma to baginal that may allow introduction of toxin into systemic circulation
What is the dosing of Ammonium chloride for PMS. and some adverse effects
Oral up to 3 g/day in divided doses, no more than 6 days in a row.
GI
nervous system
CI in patients with renal or liver impairment
What is the safe dosing range of Caffeine (Xanthine) for PMS
100 - 200mg q3-4h
What is the dosing of Pamabrom of PMS
up to 200mg/day (50mg QID)
What is in the combination product Pamprin, for PMS
pamabrom 25mg
magnesium salicylate 250mg
acetaminophen 250mg
What is in the combination product midol, for PMS
caffein 60mg
acetaminophen 500mg
pyrliamine maleate 15mg
During what period of pregnancy would drug exposure effect organ development
5 - 10 weeks
What is the dose of folic acid pre-pregnancy, and for high risk women
400mcg/day
4000mcg/day beginning 1-3 months prior to pregnancy and during 1st trimester
Very few drugs are teratogenic, but when is the critical exposure period
first trimester - physical transformation seen more frequently during weeks 2-8, and functional/behavioral changes seen during exposures late in pregnancy.
What is the safest OTC pain reliever in pregnancy and the dosing.
acetaminophen
< 4000mg/d
ex 500 bid - tid
Safest OTC antihistamine in pregnancy
loratadine or certrizine
< 10mg/d
Safest OTC decongestant in pregnancy, but avoid in first trimester
pseudoephedrine
<240mg/d
cough remedy that appears safe in pregnancy
dextromethorphan
<120mg/d
four lifestyle changes for cough/cold in pregnancy
humidifier
saline spray
fluids
vitamin c
Antidiarrheal probably safe in pregnancy
loperamide
< 16 mg/d
When do we REFER in pregnancy diarrhea cases
if > 24-48 hours
Antifungal that is probably safe in 2nd and 3rd trimester
clotrimazole
5g, 100mg, 200mg
data is lacking in antifungals avoid if possible especially in the 1st trimester
Three lifestyle modification for yeast infection
cranberry juice - prevenative health
sitz baths - soothing
yogurt
Lifestyle changes for acid reduction
elevate head of bed 6 inches
dietary changes
decrease weight
avoid smoking
eliminate alcohol
avoid tight clothes
avoid high fat meals/ eat small meals more frequently
avoid lying down until 3 hours after eating
concurrent medications
What antacid should you avoid in pregnancy
nizatidine - axid
Firs line antacid for pregnancy
famotidine - pepcid
< 80 mg/d
First line antacid for pregnancy
famotidine - pepcid
< 80 mg/d
Recommended antacids in pregnancy
AIOH/MgOH
simethicone
CaCO2
ranitidine
famotidine
First line supplemnetal defense of N/V in pregnancy
B6
25 mg QD - TID
What could B6 be combined with for N/V in pregnancy, 2nd line.
doxylamine
25 mg QD
Three treatments of N/V in pregnancy, general
sea bands
fluids
rest
Three general treatments of constipation in pregnancy
Increase dietary fiber
exercise
drink suficient fluid
Four main pregnancy complications that need to be refered
Gestational diabetes
preeclampsia
headache
UTI
Three main pregnancy complications that need refered
Deep vein thrombosis
pumonary embolism
incontinence
Are drugs that are safe in pregnancy safe in breast feeding?
No
Which lactation rating of OTC medications is the safest?
L1
Which home pregnancy test can detect lower levels of hCG (15mIU/ml)
Lifesign1
Two times when meds could be taken when breastfeeding
Immediately following nursing session
Right before infant's longest nap of the day
Two methods to determine efficacy of contraceptives
accidental pregnancy rate in the first year of perfect use
accidntal pregnancy rate in the first year of typical use
Which composition of male condoms is not as snug of a fit
polyurethane
which composition of male condoms is porous and conducts heat better
lamb cecum
which composition of male condoms can cause allergic reactions
latex
male condoms effectiveness; failure rates
typical use 15%
perfect use 2%
seven couseling points for male condoms
polyurethane condoms not as elastic as latex, space must be left at the tip
use proper lubrication
average shelf life 3-5 years
protect from heat, overexposure to ozone
discard if discolored, brittle, sticky
counsel on alternative polyurethane condoms if latex sensitivity exists
try different products (patients may be sensitive to spermicide)
What is the only female condom FDA approved
FC by reality
polyurethane
What is the failure rate for female condoms
12.4%
Is conjunction of male and female condoms recommended
no
Largest complaint of female condoms
increased vaginal irritation and noise
Main vaginal spermicides
nonoxynol-9
Doses of nonoxynol-9 in gels, foams,suppositories, and film
12.5%
12.5%
3%
28%
What is a big counseling point of the vaginal contraceptive film
there is a cleansing film that is very similar
What is the FDA issued warning label for nonoxynol-9
spermacides irritate mucosa and increases possibility of transmission of infections, HIV/AIDS
are vaginal spermacied effective in prevneting STI's
No
Three available contraceptive sponge products
today
protectaid
pharmatex
Three MOA of contraceptive sponge
serves as a physical barrier
contains spermicide
absorbs semen
Failure rate of first use contraceptive sponge use
17.4-24.5%, higher in women who have had children previously
a safety concern with the contraceptive sponge
associated with increased risk of toxic shock syndrome
six natural contraceptives
natural family planning
standard days method
lactational amenorrhea method
home tests for ovulation prediction
withdrawal
douching
four natural family planning techniques for oral contraceptive
calendar method
basal body temperature method
cervical mucus method
symptothermal method
What is the emergency contraceptive product available and doses
Plan B one step, next step
1.5 and 0.75 mg tablets levonorgestrel
Three points to know of Plan B
must be 18 yo to purchase
kept behind the pharmacy counter
side effects N/V, if this happens within one hour then repeat the process
What does the dilution of 1X of a homeopathic agent mean
The ration of active to nonactive molecules, 1:10
What does the dilution of 1C of homeopathic agents mean
The ratio of active to nonactive agents, 1:100
What dilutions in X and C of homeopathic agents contain 0 molecules of the original acitve ingredients
24X, 12C
What organizaion regulates natural medicines
DSHEA - dietary supplement and health education - 1994
Dietary supplements are regulated by the FDA under what
CFSAN - center for food safety and applied nutrition
Natural medicines must have proof of efficacy and safety prior to marketing
no, only safety
are products sold prior to October 15, 1994 required to be reviewed for safety
no
who could possibly be exempt from natural medicine good manufactoring practice's
small manufacturers, because they don't have the resources to meet compliance guidlines
four label requirements for natural medicines
name of product as well as word supplement
quantity of contents
manufacturer's, packers, or distributers's name and place of business
directions for use
also if plant based must include scientific name
must contain facts panel that descrobes serving size
Three types of product claims for natural medicines and which ones requires FDA approval
health claim - relationship between ingredient and reduction of risk of disease or health-related condition
nutrient content claim - relative amount of substance in a product
structure-function claim - how a product may maintain the normal healthy structure of function of the body
A big concern for product quality of natural medicines
many brands do no contain the quantity of product listed on the label, contaminants vary
What two programs evaluate supplements
US Pharmacopeia dietary supplement verification program - USP
National sanitation foundation international NSF
Stated uses of coenzyme Q10, and cautions
heart failure and lower blood pressure
statin induced myopathy
stated uses of garlic and cautions
atherosclerosis
hypertension
tick bites
ringworm, jock itch, athletes foot
GI - N/V, heartburn
avoid in pregnancy
topical can cause irritation/burn
possible antithrombotic effects - w/ NSAID & warfarin
Do we supplement omega 6
no
stated uses of fish oil and cautions
dietary intake - lower risk of sudden cardiac death and CHD
low dose - decrease progression of coronary atheroscierosis
not a substitute for fish oil, 40 grams contains 200 calories
best as part of a healthy diet, not as a supplement
What medication does red rice yeast often contain and contraindicated in
statin (lovastatin)
pregnancy
cholesterol lowering effects due to other constituents
Stated use of Hawthorn and cautions
heart failure
vertigo and dizziness
palpitations
stated use of ginkgo and cautions
age-related memory impairment
won't stop dimentia, if dimentia is already present, might help.
if healthy older person --> no effects
cases of minor to sever bleeding
What ginkgo seeds are toxic
roasted or fresh seed
What endogenous hormone regulates circadian rhythm
melatonin
stated use of melatonin and cautions
jet lag
circadian rhythm sleep disorder
unsafe for children and pregnant women
stated use of ST. John's wort and cautions
depression
menopausal symptoms
interacts with everything
2-4 grams/day increases risk of photosensitivity
stated use of valerian and cautions
insomnia (400-900mg 2 hours before bedtime)
headache, excitabilty, morning drowsiness
flippers
what natural medicine for sleep disorder, depression and anxiety do we not recommend
5-hydroxytryptophan
What oral rinse natural product may help prevent chemo-induced mucositis
chamomile
Which vitamin and the dose reduces the frequency of migraines
B2 (riboflavin)
400mg/day
what vitamin helps in pregnancy induced nause and vomiting, and the dose
B6 (pyridoxine)
25mg q 8 hours
stated use of ginger and cautions
morning sickness
post op N/V
controversial in pregnancy
stated use of milk thistle and cautions
antioxidant
diabetes
dyspepsia
laxative effect
allergic reactions may occur
stated use of pepperming and cautions
antispasmotic
dyspepsia
tension headache
heartburn
no long term safety data
stated use of senna and cautions
stimulant laxatives - long term opiate therapy (first choice)
long term use can lead to laxative dependency
safe when used appropriately in pregnancy
which natural product was approved in Germany for treatment of diabetic neuropathy
alpha-lipoic acid
stated use of ginseng and cautions
ginsensides
decreases glucose
estrogenic activity
immunomodulator
diabetes
respiratory tract infections
GI upset
insomnia mania
blood pressure changes
vaginal bleeding
stated uses of DHEA and cautions
adrenal insufficiency
aging skin
osteoporosis
acne
hair loss
voice deepening
unsafe long term in high doses - concern of increased risk of prostrate and breast cancer
Most common immune stimulant, natural.
echinacea
stated use of green tea and cautions
mental alertness
genital warts
may have antiinflammatory activity
contains significant amounts of caffeine
These are often taken to improve digestion, prevent vaginal yeast infection, treat infections or antibiotic diarrhea
probiotics
a probiotic, nonpathogenic yeast, that produces proteases that decrease toxicity of C. diff.
saccharomyces
are probiotics used for immunocompromised patients or pregnancy
no immuno
yes pregnancy and lactation
homeopathic product with no measurable amount of active ingredient, made of dilution of duck liver and heart extract
oscillococcinum
4 skeptical points of cleansing
natural bacteria in the colon detoxify food wastes
liver neutralizes toxins
mucus membrane in colon help keep unwanted substances from reentering blood and tissues
absolutely avoid
stated uses of cranberry and cautions
UTI infections - preventative not treatment
stick to juice, no proof on capsules
consuming > 1 liter/day increases risk for kidney stones
stated use of saw palmetto and cautions
antiinflammatory
doesn't work
stated use for tea tree oil and cautions
acne
onychomycosis (toenail infections)
stated use of aloe vera and cautions
psoriasis
burns
constipation
safe to use topically
unsafe orally at high doses
the most widely used alternative therapy for hot flashes
black cohosh
this nature women's health product contains soy products
phytoestrogens
doen't work and can have higher rate of hot flashes
a main concern when supplements are used for a particular indication
can interact with drugs that are also used for that indication
grapefruit inhibits enzymes where, resulting in what
gut wall, but not hepatically
increased drug peak levels
what product in garlic has an effect on the likely of an interaction
allicin - decreases drug levels
this supplement binds to drugs in the gut decreasing levels and should be taken 4 hours apart from lovethyroxine
calcium
this supplement lowers seizure threshholds in patients with or without seizure history
ginkgo
a big caution point with ginkgo
increased bleeding
this supplement is generally harmful, prolonged QT with other stimulants, and could cause ventricular arrhythmias. ingredient of choice in weight loss supplements
bitter orange
supplement that could causse increased potassium in patients with renal dysfunction
noni juice
supplement linked to many reports of hepatotoxicity
kava
four special population patients that need our attention
elderly
pediatrics
pregnancy
chronic renal disease
What is the new OTC pediatric liquid product standardiszed dose
160mg/5ml
what is the range of toxicity of acetaminophen
> 10 grams --> severe hpatic necrosis
< 6 grams considered non toxic
what group of people should use cautio with acetominophen
alcoholics - can't clear the toxic metabolite produced
443,595 deaths annually are attributed to what
smoking
three health consequences of smokelss tobacco
periodontal effects
gingivla recession
bone attachment loss
dental caries
oral leukoplakia
cancer
oral cancer
pharyngeal cancer
4 major conclusions of smoking, 2004 surgeon general report
smoking harms nearly every organ of the body
quitting smoking has immediate as well as long-term benefits
smoking cigarettes with lower machine measured yields of tar and nicotine provides no clear health benefit
the list of diseases caused by smoking has been expanded
2006 surgeon general report on second hand smoke. 5 points
second hand smoke causes premature death and disease in nonsmokers (children & adults)
at what stage of quitting smoking do you see benefits
any stage
six forms of tobacco mentioned
cigarettes
smokeless tobacco
pipes
cigars
clove cigarette
bidis
hookah
most common form of tobacco used in the US
cigarettes
what three groups is smokeless tobacco most prevelant
18-25 yo
american indians and alaskan natives
residents of the southern US and rural areas
ratio of related deaths comparing cigarettes, pipes and cigars
cigarettes > pipes = cigars
this can deliver enough nicotine to establish and maintain dependence
cigar
in 2010 an estimated 4.6% of 12th graders in the US reported to smoking what in the past year
kreteks
These have two times the tar and nicotine as standard cigarettes
kreteks
What was the main point in the 1988 surgeon generals report
nicotine is the drug in tobacco products that causes addiction
what is nicotine absorption dependet upon
pH - readilly absorbed at physiologic pH
Is nicotine absorbed more readily through intact skin or the small intestine
intact skin, low gi availability because of first pass effect.
is nicotine readily absorbed across respiratory epithelium
yes, pH 7.4, large surface area, extensive capillary system in lung
how many mg of nicotine is absorbed from each cigarette
1
time line of nicotine withdrawal effects
manifest 1-2 days
peak within first week
subside within 2-4 weeks
what test is used to assess nicotine dependence
fagerstrom test - higher scores indicate higher levels of dependence. 1-10, 5 meaning substantial dependence
what two aspects need to be addressed when dealing with tobacco dependence
physiological - addiction to nicotine
behavioral - habit of using
smokers who use combined hormonal contraceptives have an increased risk of what
serious cardiovascular adverse effects
what are the odds of quitting smoking with the use of a clinician
doubled
why should clinicians address tobacco
failure to address tobacco use tacitly implies that quitting is not important
the five A's of quitting tobacco
ask - about tobacco use
advise - tobacco users to quit
assess - readiness to make a quit attempt
assist - with the quit attempt
arrange - follow up care
seven nonpharmacological methods to help quit tobacco
cold turkey
unassisted tapering
assisted tapering
formal cessation programs
acupuncture
hypnotherapy
massage therapy
three general classes of FDA approved drugs for smoking cessation
nicotine replacement therapy
psychotropics
partial nicotinic receptor therapy
nicorette gum dosing
> 25 cigarettes/day -- > 4mg
< 25 cigarettes/day --> 2mg
nicorette gum recommended usage schedule
weeks 1-6 --> 1 piece q 1-2h
7-9 --> 1 piece q 2-4h
10-12 --> 1 piece q 4-8h
six direction points for nicotine gum
chew slowly severaly times
stop at first sign of peppery taste
park
resume chewing when taste fades
stop upon arrival of tingle
repeat chew/park until most of nicotine is gone generally 30 minutes
to improve chance of quitting use at least nine pieces of gum a day
general dosing guidlines for nicotine lozenges
smoke your first cigarette with in 30 minutes of waking - 4mg
smoke your firts cigarette more than 30 minutes after waking - 2mg
nicotine lozenge recommended usage schedule
weeks 1-6, 1 lozenge q 1-2h
7-9, 1 lozenge q 2-4h
10-12, 1 lozenge q 4-8h
Transdermal nicotine patch dosing for a light smoker (<10 cigarettes/day)
step 2 (14mg x 6 wks.)
step 3 (1mg x 2 wks.)
Trandermal nicotine patch dosing for a heavy smoker (>10 cigarettes/day)
step 1 (21mg x 6 wks)
step 2 (14mg x 2 wks)
step 3 (7mg x 2wks)
transdermal nicotine patch side effects in the first hour
mild itching
burning
tingling
transdermal nicotine patch additional side effects
vivid dreams or sleep disturbances
headache
after patch is removed skin may appear red for 24 hours
local skin reactions
Is water harmful to the nicotine patch
no
nicotine nasal spray dosing
one dose = 1mg nicotine = 2 sprays
start with 1-2doses/hour
increase prn to max dosage of 5 doses/hour or 40mg
best results = 8 doses/day for first 6-8 weeks
nicotine inhaler dosing
6 cartridges/day during the firs 3-6 weeks
increase prn to max. 16 cartridges/day
general use 1 cartridge every 1-2 hours
gradually reduce daily dosage over the following 6-12 weeks
how long should you not eat or drink before or while using the nicotine inhaler
15 minutes
a nonnarcotic cessation aid, sustained release antidepressant, & oral formulation
zyban - bupropion SR
bupropion contraindications
patinets with seizure disorders
patines taking - wellbutrin or MAO inhibitors in the preceding 14 days
patients with a corrent or prior diagnosis of anorexia or bulimia nervosa
patients undergoing abrupt discontinuation of alcohol or sedaties
bupropion SR dosing
initial - 150 mg po q am x 3 days
then - 150 mg po bid, duration 7-12 weeks
varenicline (chantix)dosing
day 1-3 - 05mg qd
day 4-7 - 0.5mg bid
day 8 to end of treatment - 1mg bid
4 patient education points about chantix (varenicline)
take after eating, with a full glass of water
nausea and insomnia temp side effects
vivid, unusual or strange dreams
caution driving machinery
what has the best quit rate for tobacco cessatin long term
nicotine nasal spray 23.9%
proposed herbal drug for smoking cessation
lobeling
where can you find out how to treat acne if you don't have your textbook
academy of dermatology
which form of acne is a closed comedone
whitehead
what grade of acne can be self treated
grade 1
what severity classification of acne can be self treated
mild acne
four main causes of acne
sweat
puberty
hair follicles hat aren't able to shed properly
increased number of bacteria that is present in the body
Do not restrict diet for anybody to lower acne, there is no supporting evidence
true
exclusions to self treatment of acne
moderate to sever acne
rosacia
exasperating factors - drug induced acne, contributing disease state present
how many times should you cleanse your skin daily
twice, unless you work out then splash water on your face
medications - PIMPLES
phenytoin
isonazid
moisturizers
phenobarbital
lithium
ethionamide
steroids
Three examples of mild soaps that can be used to cleanse your face
dove, cetaphil, aveeno
four pharmacological treatments for acne
benzyl peroxide
salicylic acids
alpha-hydroxy acids
sulfur products
Three factors we should be looking at when a patient wants advice on acne products
number of pimples
shape of skin
when they break out
if applying acne medication and it is working, can you apply more to get a better effect
no
which acne product is keratolytic and can prevent and eliminate development of P. acnes resistance
benzyl peroxides
OTC - 2.5-10%
Rx up to 20 %
which acne product is both comedolytic and keratolytic
contraindicated in patients with diabetes or poor skin circulation
limit use to affected area to avoid toxicity
beta-hydroxy acids
This acne product has exfoliating acids
maybe helpful after acne controlled to reduce scarring
OTC concentrations of 4-10%
alpha-hydroxy acids
this acne product had kerotylic and maybe bactercidal effects
drawbacks include, smell and colored skin spots
sulphur products
how long before my acne clears up
up to 3 weeks to see improvements
max effect, 50-75% imporvement 8-12 weeks
Of the main acne products which one has more of a drying effect
gels and solutions
four criteria to determine if it is fungal rather than contact dermatitis
location - area with excessive moisture
presentation - soggy, malodorous, thick vs. scaly, fine with inflammation
symptoms - itching pain
quantity/severity - typically localized but can spread
five classifications of fungal and location, tinea ____
pedis - athletes foot
unguim - onychomycosis
corporis - body
cruris - jock itch
capitis - scalp
most prevelant fungal infection
tinea pedis
four types of fungal infection
chronic intertriginous
chronic papulosquamous
vesicular
acute ulcerative
which type of fungal infection is the most common
chronic intertriginous
which type of fungal infection presents bilaterally
chronic papulosquamous
which fungal infection, is not the most common, but gets people into the doctor more often because of the nasty odor (bleu cheese x 20)
acute ulcerative
which classification of fungal infections is commonly found unde skin folds, under breasts or in armpits
tinea corporis
which classification of fungal infection is represented by "black dots"
tinea capitis
eight exclusions to self care for fungal infections
No clear causative factor
Unsuccessful initial treatment or condition worsens
Nails or scalp involved
Face, mucous membranes or genitalia involved
Signs of possible secondary bacterial infection
Condition is debilitating, extensive or very inflamed
Diabetes, systemic infection, asthma, or immune deficiency
Fever, malaise or both…yikes it might be systemic!
five most common pharmacological treatment for fungals
Butenafine
Clotrimazole
Miconazole
Terbinafine
Tolnaftate
which fungal treatment is for treatment and prevention
tolnaftate (tuff actn tinactin)
three phases of wound healing
Inflammatory - first 3 days
Proliferative -days 3-21
Maturation or remodeling - begins approximately three weeks
which disease state attributes to poor wound healing
4 - deeper than 3 may involve muscle, tendon or bone
what is the most important factor for wound healing
moisture
exclusion for treatment of wounds
Wound containing foreign matter after irrigation
Chronic wound
Wound secondary to animal or human bite
Signs of infection
Redness, warmth, edema, purulent exudate
Involvement of face, mucous membranes or genitalia
Deep, acute wound
four products that absorb moisture for wound healing
foams
alginates
carbon-impregnated
composite dressing
two producst for wound healing that maintain moisture
hydrocolloids
transparent film
a product for wound healing that provides moisture
hydogels
three general pharacological treatments for wounds
Irrigants
Antiseptics
Topical antibiotics
what is iodine effective for in wounds
against bacteria, fungi, virus, spores, protozoa and yeast
three topical antibiotics for wound healing
Bacitracin
Neomycin
Polymyxin B sulfate
which topical antibiotic works against gram postitve bacteria
bacitracin
which topical antibiotic can increase hypersensitivity
neomycin
what is the preferred choice for irrigation of wounds
sterile saline
Visual inspection of wound is important for proper assessment
If wound worsens or does not improve in 5 days, seek advice from PCP
Change wound dressing only when dirty or not intact
If clinical picture is muddy, refer to PCP
Phone a friend: know your local wound care clinic professionals!!