PHRD5975 Self-Care - Anorectal Disorders

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  1. non-hemorrhoidal anorectal disorders (7)
    • abscesses
    • fistulas
    • fissures
    • neoplasms
    • polyps
    • pruritus ani
    • IBD
  2. 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
  3. 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
  4. MOA of local anesthetics for tx of anorectal disorders
    block transmission of nerve impulses
  5. why shouldn't local anesthetics be used internally?
    rectal mucosa does not contain pain receptors
  6. name 3 vasoconstrictors used for tx of anorectal disorders
    • 1) ephedrine
    • 2) phenylephrine
    • 3) epinephrine
  7. MOA of vasoconstrictors in tx of anorectal disorders
    • stimulate¬†Image Upload 1-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)
  8. benefit of choosing phenylephrine over ephedrine/epinephrine?
    has minimal effects on CNS & cardiac rhythm (doesn't cross BBB)
  9. DDI's in vasoconstrictors?
    rectally administered vasoconstrictors may attenuate effects of oral anti-hypertensives and increase BP
  10. 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
  11. name 3 protectants used in tx of anorectal disorders
    • aluminum hydroxide gel
    • glycerin (external only)
    • zinc oxide
  12. 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
  13. name 3 astringents used in tx of anorectal disorders
    • 1) witch hazel
    • 2) calamine
    • 3) zinc oxide
  14. 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)
  15. name a keratolytic
  16. MOA of keratolytics
    cause desquamation & debridement/sloughing of epidermal surface cells
  17. name 3 counterirritants used in tx of anorectal disorders
    • 1) menthol
    • 2) juniper tar
    • 3) camphor
  18. MOA of counterirritants as analgesics/anesthetics/antipruritics in tx of anorectal disorders
    produce a local sensation that distracts from the discomfort
  19. name 1 corticosteroid used for tx of anorectal disorders
    hydrocortisone (1%)
  20. MOA of CCS's (eg: hydrocortisone) in the tx of anorectal disorders
    act as vasoconstrictor & antipruritic by producing lysosomal membrane stabilization & antimitotic activity
  21. negative effect of using CCS's for tx of anorectal disorders
    may mask sx of bacterial/fungal infections
  22. onset of action for CCS's in tx of anorectal disorders
    up to 12 hours
  23. 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)
  24. 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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PHRD5975 Self-Care - Anorectal Disorders
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