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non-hemorrhoidal anorectal disorders (7)
- abscesses
- fistulas
- fissures
- neoplasms
- polyps
- pruritus ani
- IBD
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exclusions for treatment of anorectal disorders
- <12yo
- UC, CD
- family hx of colon cancer
- severe pain, bleeding, seepage, prolapse, black tarry stools
- minor sx that didn't respond to 7 days of self-tx
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4 points for non-pharm therapy
- 1) avoid heavy-lifting
- 2) d/c foods that irritate sx (caffeine, citrus, spicy)
- 3) increase dietary fiber
- 4) avoid NSAIDs/ASA
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MOA of local anesthetics for tx of anorectal disorders
block transmission of nerve impulses
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why shouldn't local anesthetics be used internally?
rectal mucosa does not contain pain receptors
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name 3 vasoconstrictors used for tx of anorectal disorders
- 1) ephedrine
- 2) phenylephrine
- 3) epinephrine
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MOA of vasoconstrictors in tx of anorectal disorders
- stimulate
 -adrenergic R's in the vascular beds, causing constriction of arterioles, producing a modest, transient reduction of swelling - also relieves discomfort by producing a slight anesthetic effect (unknown mech)
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benefit of choosing phenylephrine over ephedrine/epinephrine?
has minimal effects on CNS & cardiac rhythm (doesn't cross BBB)
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DDI's in vasoconstrictors?
rectally administered vasoconstrictors may attenuate effects of oral anti-hypertensives and increase BP
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populations contraindicated in use of vasoconstrictors (8)
- 1) diabetes
- 2) thyroid disease
- 3) HTN
- 4) angina
- 5) enlarged prostate
- 6) on antidepressants
- 7) on anti-hypertensives
- 8) on cardiac meds
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name 3 protectants used in tx of anorectal disorders
- aluminum hydroxide gel
- glycerin (external only)
- zinc oxide
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MOA of protectants in tx of anorectal disorders
- prevent fecal matter from causing perianal irritation by forming a physical protective barrier over affected skin
- also softens the dry anal canal by decreasing water loss
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name 3 astringents used in tx of anorectal disorders
- 1) witch hazel
- 2) calamine
- 3) zinc oxide
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MOAs of astringents in the tx of anorectal disorders (4)
- 1) promote coagulation of skin cells, protecting underlying tissue while decreasing cell volume & making affected area drier
- 2) forms thin layer to protect underlying tissue from further irritation
- 3) cleans area (from class notes)
- 4) provides counterirritant effect (from class notes)
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name a keratolytic
resorcinol
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MOA of keratolytics
cause desquamation & debridement/sloughing of epidermal surface cells
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name 3 counterirritants used in tx of anorectal disorders
- 1) menthol
- 2) juniper tar
- 3) camphor
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MOA of counterirritants as analgesics/anesthetics/antipruritics in tx of anorectal disorders
produce a local sensation that distracts from the discomfort
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name 1 corticosteroid used for tx of anorectal disorders
hydrocortisone (1%)
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MOA of CCS's (eg: hydrocortisone) in the tx of anorectal disorders
act as vasoconstrictor & antipruritic by producing lysosomal membrane stabilization & antimitotic activity
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negative effect of using CCS's for tx of anorectal disorders
may mask sx of bacterial/fungal infections
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onset of action for CCS's in tx of anorectal disorders
up to 12 hours
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types of agents pregnant women may use for tx of anorectal disorders
only products recommended for external use, except for protectants, which can be used internallyu (except glycerin)
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why shouldn't suppositories be recommended as the initial dosage form?
they may leave the affected anal region & ascend up without distributing over the anal mucosa
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