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102 Cards in this Set

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Herbal Remedy
Eye health/platelet aggregation inhibitor/Anthocyanins??
Bilberry
Herbal Remedy
Menopause/27 deoxyaceteine
Can potentiate effect of antihypertensives
Black Cohosh
Herbal Remedy
Premenstrual health/several "actives"/
May interfere with oral contraceptives, HRT, endocrine therapies
Chaste Tree Berry
Herbal Remedy
Immune stimulant/echinosides etc./
contraindicated with cyclosporine
Echinacea
Herbal Remedy
Anti-infective and supports cardiovascular health, dec. cholesterol/
sulfur comp.
High doses lead to GI irritation, inhibits platelet aggregation and increases fibrinolytic activity
Garlic
Herbal Remedy
Supports memory and concentration/improves brain circulation/ginkolides/
potent inhibitor of platelet activating factor
Ginkgo
Herbal Remedy
Adaptogen to stress/ginseno-sides
avoid with caffeine, MAOIs, NSAIDs, and antiplatelet agents
Ginseng
Herbal Remedy
Mild anti-depressant/hyperforin
increases cytochrome P450 which leads to decrease blood conc of many drugs
St. John's Wort
Herbal Remedy
decrease BPH/lipophilic agents
Not for females, has hormonal effects
Saw Palmetto
Herbal Remedy
Mild sedative/valapotrhates?/
May potentiate other CNS depressants
Valarian
What is the etiology of a headache?
The exact cause of a primary headache is unknown.
It may be associated with a variety of stimuli, such as stress, fatigue, sensitivity to certain foods and beverages, medications, acute illness
What is the pathophysiology of a headache?
Pain transmission in the central nervous system may be partly mediated by the serotonergic (new focus) and adrenergic systems. Peripheral pain transmission may be partly mediated by the neurotransmitter substance P and excitatory amino acids.
Describe a tension Headache
May be associated with prolonged contractions of head and neck muscles.
Usually BILATERAL and occur at the back of the head, in the forehead, or at the temples, but can change location during headache attack.
Some pts may experience neck or jaw discomfort.
May persist for 30 minutes to 7 days
Not associated with nausea and vomitting, and are not aggravated by routine physical activity.
How can you assess a headache?
P - provacative and palliative
Q - quality
R - radiation
S - severity
T - Temporal (does it persist?)
What are some clinical considerations concerning non-prescription analgesics for HA?
- indicated for the temporary relief of minor aches and pains associated with HA, the common cold, tootache, muscular aches, backache, for minor pain of arthritis, for the pain of menstrual cramps, and for reduction of fever.
Often used in the treatment of tension-type and migraine HA

Should not be used on a nonprescription basis for more than 10 days for pain unless directed by a physician
Products contain a warning that pts who consume more than 3 EtOh containing drinks per day to consult DR before use of an algesic
How do salicylates treat Headaches?
They produce analgesia by inhibiting prostaglandin synthesis and also exhibit anti-inflammatory activity.
What are some clinical considerations of salicylates?
CI in patients who are hypersensitive to salicylates or NSAIDs.
Cross-sensitivity may exist between ASA and other NSAIDs and between ASA and tartrazine. Cross-sensitivity may not necessarily occur with ASA and other salicylates.

The acetyl component of ASA is what causes stomach upset.
What are some adverse effects/precautions of salicylates?
Hypersensitivity reactions
GI effects - heartburn, nausea, vomitting, bleeding, ulercation
tinnitus
coagulation effects
renal effects (increase with longer use)
salicylism
Reye Syndrome
Pregnancy - avoid during 3rd trimester
What are some drug interaction of salicylates concerning drug concentrations changing as a result of salicylates?
May increase the action: acetazolamide, anticoagualants, antidiabetic agents, lithium, methotrexate, valproate

May decrease the action: probenecid, sulfinpyrazone, thiazide and loops, ACEi, beta blockers
What are some drug interactions causing salicyalte levels to be affected?
action of salicylate may be increased: alcohol, urinary acidifiers (if urine pH dec. then ASA more absorbed), SSRIs

action may be decreased by NSAIDs (cardioprotective strength of ASA), urinary alkalinizers, and certain antacids
What is the maximum adult dosage of ASA?
4000 mg in a 24 hour period
What is the usual adult dosage of ASA?
325mg, 500mg, or 650mg every 4 hours as needed
Which form of ASA irritates the stomach less? Buffered or enteric coated?
Enteric coated
Downside is that they don't release quickly
What are the nonacetylated salicylates?
These are powers?
Choline salicylate - powder is hygroscopic, liquid is 870 mg/5ml
Magnesium salicylate - 325 and 500 mg caplets, used in caution with pts with renal impairment
Sodium salicylate and Salicylamide are less likely to cause GI upset
What are some facts about APAP?
Exact MOA is unknown
Similiar to ASA in analgesic and antipyretic activity
WEAK anti-inflammatory action
less likely than salicylates and NSAIDs to cause adverse drug events and drug interacitons
Used for mild-moderate pain
What are some clinical considerations with APAP?
Overdose may result in hepatic toxicity
Chronic consumption of EtOH or long-term use of enzyme-inducing agents may increase the risk of hepatic toxicity
What is the usual dosage of APAP?
Adult - 325mg, 500mg, or 650mg every 4 hours, 1000mg every 6 hours, or 1300 mg(ER) every 8 hours
Max dose is 4000mg in a 24 hour period
How do NSAIDs work?
They act by inhibiting cyclooxygenase activity and inhibiting prostaglandin synthesis.
Exhibit anti-inflammatory activity in higher dosages but this effect is not seen in doses used as non-prescription.
What are some clinical considerations of NSAIDs?
Contraindicated in pts who are hypersensitive to any NSAID, including ASA
What are some adverse reactions to NSAIDs?
GI effects - heartburn, nausea, vomiting, bleeding
renal effects, CI 3rd trimester
Skin reactions are rare
What are some drug interactions of NSAIDs?
NSAIDs may increase the action of: anticoagulants, lithium, and methotrexate
NSAIDS may decrease the action of: ASA(cardio-protect dose), thiazide and loops, ACEi, beta-blockers,

EtOH and SSRIs may increase effect of NSAIDs
What is usual non-prescription adult dose of Ibuprofen?
200mg every 4-6 hours;
If response with the 200mg dose is not adequate, a 400mg dose may be used;
max dose is 1200mg in a 24 hour period
What is the min age for ibuprofen?
6 months or older
What are some facts about naproxen sodium?
Has a longer duration of action that other nonprescription analgesics.
NOT indicated for nonprescription use in children under 12 y/o
What is the usual dosage for nonprescription?
220mg every 12 hours.

Max dose in a 24 hour period is 660mg.
What is the 3rd NSAID approved for OTC usage, but is no longer marketed because it is short acting and not used in children?
Ketoprofen
How should baby aspirin and ibuprofen be dosed together?
Patients who use immediate release ASA and take a single dose of ibuprofen 400mg should dose the ibuprofen at least 30 minutes or longer after ASA ingestion, or more than 8 hours before ASA to avoid decrease of ASA effect.
Describe the pathophysiology of pain.
One or more pathways through which pain is experienced may be involved. The threshold for pain decreases, and the intensity of pain increases with fatigue, anxiety, depression, fear, or anger.
What are some uses for topically applied analgesics?
Pain of muscular aches, neuralgia, arthritis, sprains, and similiar conditions when the skin is intact.
What are some clincial indications for topically applied analgesics?
May cause local irritation
Should not be used in conjunction with an external source of heat
tight bandages or wraps, should not be applied over areas where products are applied.
Products may be toxic if ingested
What is Trolamine salicylate?
Aspercreme, Mobisyl, Myoflex, Sportscreme
A salicylate analgesic that is applied topically.
If applied to large areas for prolonged time systemic adverse effects may result.
10% lotion and cream
What is methyl salicylate?
Oil of Wintergreen
a salicylate analgesic that is applied topically
Systemic effects seen if applied over a large area for prolonged periods
Toxic if ingested
Often used with menthol or camphor
10-30% concentrations
What are counterirritants?
They replace an unpleasant sensation with another sensation.
Menthol, camphor, eucalyptus oil, capsaicin, capsicum oleorsesin, and methlnicotinate
Did you look at the combination topical analgesics available?
Yes
What is the most common of all musculoskeletal pain?
Lower back pain
causes: mechanical (poor posture, improper lifting, improper shoes), trauma, inflammation, infection etc.
What symptoms of lower back pain are needed for physician referral?
Pain for more than 10 days
tingling, numbness, or weakness
radiating pain into buttocks, back of thigh and/or lower leg
pain worsens at night or when lying down
patient is under 20 or over 55
chronic pain is present
What is some non-drug therapies of lower back pain?
moderate exercises, short term bed rest
thermotherapy
cryotherapy
massage
acupuncture
supportive belts, braces, corsets
What is myalgia?
Muscle pain that may or may not be associated with fatigue or weakness;
Fibromyalgia is associated with pain and tenderness of the muscle and the adjacent connective tissue
What is some non-drug therapy for myalgia?
Rest, localized heat, gentle massage, stretching exercises
What is a sprain or strain?
encompasses all acute, traumatic injuries that affect ligaments, tendons, and muscles.
Usually followed with fast inflammation.
Healing process takes 4 weeks.
What is some non-drug therapy for sprains and strains?
Rest, ice, compression, and elevation (RICE) are useful during first 24-72 hours
Rest can include crutches
Application of ice 20 minutes on and 20 minutes off, several times a day may reduce pain and swelling
Compression may help swelling
What is some non-drug therapy of osteoarthritis?
exercises, sit without slumping, sleep on a firm bed, application of heat or cold
What is dysmenorrhea?
Painful menstruation
primary - pain occurs in the absence of any pelvic pathology
secondary - underlying pelvic pathology is present
What does primary dysmenorrhea result from?
Abnormal uterine activity (increased intrauterine pressure, increased contractions) during normal menstruation
What does secondary dysmenorrhea result from?
Associated with pelvic pathology such as endometriosis, pelvic inflammatory disease (start as UTI), or uterine fibroids
What are signs and symptoms of dysmenorrhea?
cramping lower abdominal pain that my radiate to the back and thighs;
many women also experience nausea, vomiting, constipation, diarrhea, fatigue, HA, or dizziness
What is some non-drug therapy of dysmenorrhea?
aerobic exercise
low-fat diet
smoking cessation when applicable
What are some non-RX therapies for dysmenorrhea?
NSAIDs are DOC
APAP
salicylates
A wide range of physiological and psychological symptoms that occur cyclically and consistently during the late luteal phase of the menstrual cycle and disappear within the 4 days after the onset of mensturation.
Premenstural syndrome
What are some symptoms of PMS?
generalized HA, breast swelling/tenderness, bloating, fatigue, anxiety, depression, irritability, mood swings, wt gain, and fluid retention
What is some non-drug therapy of PMS?
patient education and counseling
dietary modifications
aerobic exercise
relaxation training
What are some non-RX therapies for PMS?
NSAIDs
APAP
salicylates
The presence of microorganisms in the urinary tract or urine in association with clincical symptoms;
cystitis - inflammation occuring in the bladder (i.e. lower urinary tract)
UTI
What are most UTIs caused by?
gram-negative bacteria, of which E.Coli is the most common
What are some signs and symptoms of UTI?
Dysuria, frequent urination of small volumes.
lower abdominal discomfort, hematuria, nocturia, and fever may also occur

Upper UTIs are characterized by flank pain, suprapubic pain, fever, chills, HA, malaise, nausea, and vomiting.
What are some non-drug therapies of UTI?
increased fluid intake
Cranberry juice, extract, or concentrate (AZO cranberr) [may excert a bacteriostatic effect by inhibiting the adherence of microorganisms to the mucosal surface of the urinary bladder]
What are some non-RX therapies of UTI?
Phenazopyridine (AZO standard, Prodium) [reddish-organge dye that exerts topical analgesic effect on UT mucosa] provides relief of dysuria, urgency, frequency, burning, and other discomfort associated with UTI
can be used with antimicrobial
What are some considerations with AZO dye?
causes reddish-organge discoloration of urine, possible staining of contacts and undergarments.
What are some adverse reactions of AZO?
GI disturbances, HA, rash, pruritus.
What is the usual dosage of AZO?
190 mg TID after meals for no more than 2 days
How does levonorgestrel work?
MOA includes stopping the release of an egg from the ovary, preventing fertilization of an egg, and/or preventing attachment to the uterus;does not terminate existing pregnancy
What is the dosage of levonorgestrel?
0.75 mg tablets
take one tablet as soon as possible, within 72 hours of unprotected sex, and the second 12 hours after the first tablet
What are some adverse effects of levonorgestrel?
pregnancy greater than 10%
nausea, abdominal pain, fatigue, HA, heavier or lighter menstural bleeding, breast tenderness
An increase in body temperature greater than that seen in normal daily body temperature variations
Fever
When is body temperature highest and lowest?
Lowest in the morning hours (2-4AM)
Highest later in day (6-10PM)
What are some signs and symptoms of fever?
Elevation of body temp to more than 37.8C orally or 38.2C rectally
Tachycardia, hypervent, anemia, increase neutrophils
What is the treatment of fever?
Maintain hydration, rest, avoid strenuous tasks, bath with tepid (not cold) water

non-RX: APAP, NSAIDs, salicylates

pts with temps higher than 102F or who have had a fever for longer than 24 hours should be referred to a physician
Difficulty falling asleep, difficulty maintaining sleep, lack of restful sleep.
Insomnia
What are some non-drug therapies for treating insomnia?
Eliminate precipitating factors
Advise pts to sleep only amount of time to feel rested
Advise pts to determine specific times to sleep and wake up
Advise pts to avoid watching TV or reading in bed
Avoid taking naps during the day
ADjust temp, light, sound
Avoid drinking large vol. fluid before bed
What is diphenhydramine used for with insomnia?
helps to reduce difficulty falling asleep and for occasional sleeplessness
What is the dosage of diphenhydramine for insomnia?
50mg at bedtime
What OTC antihistamine is even more sedating than diphenhydramine?
Doxylamine succinate

50mg HS
What are some herbal remedies for insomnia?
Valerian and melatonin
How should a stye be treated?
Use a hot compress for 10 minutes, 3 to 4 times a day and the stye should rupture on its own.

If it is still there after a few days, see an opthalmologist
What should be recommended for red eyes and excessive tearing?
Cool compress and avoid rubbing
Antihistamine drops
Vasoconstrictor drops
What drugs cause dry eye as an ADE?
diuretics
antihistaimes
anticholinergics
phenothiazines
TCAs
preservative containing eye drops
hormone replacement therapy
radiation therapy
Accutane, cimetidine, clonidine
What are the OTC ophthalmic decongestant agents containing tetrahydolozine?
Collyrium Fresh
Eye Drops (B and L)
Murine Plus
Visine moisturizing
Visine allergy releif
What are the OTC ophthalmic decongestant agents containing phenylephrine?
AK-nephrin
Relief
Prefrin Liquifilm
Zincfrin
What are the OTC ophthalmic decongestant agents containing oxymetazoline?
Ocuclear
Visine LR
What are the OTC ophthalmic decongestant agents containing naphazoline?
20/20 Eye Drops
Allerest Eye Drops
Clear Eyes
Clear Eyes ACR
Naphcon
Allergy Drops
Vasoclear
What are the ophthalmic decongestant/antihistamine combination drops?
Naphcon
Opcon
Vasocon
they contain naphazoline/pheniramine or
naphazoline/antazoline
What are the different artificial tear solution?
Artificial tears
AquaSite
Bion Tears
Celluvisc
Comfort Tears
Dry Eyes
GenTeal
Hypo Tears
Hypo Tears PF
Isopto Tears
Liquifilm tears
LubriTears
a lot more
What are the OTC ocular lubricant ointments?
Dry Eyes
Duratears Naturale
LubriTears
HypoTears (CibaVision)
Stye
Lacri-Lub SOP
LacriLube NP
Preservative free Moisture eyes PM
Refresh PM
What are some non-drug treatments of hemorrhoids?
High fiber diet
hydration
avoid prolonged sitting at stool
sitz bath
What are some OTC treatments for hemorrhoids?
bulk laxatives, stool softeners
topical anorectal products: local anesthetics (best), witch hazel, vasoconstrictors, ,protectants
suppositories
OTC hemorrhoid Treatment
Local anesthetic
MOA: block transmission of nerve impulses
Benzocaine, benzyl alcohol, dibucaine, dyclonine, lidocaine, pramoxine, tetracaine
OTC hemorrhoid Treatment
Vasoconstrictors
MOA: result in modest and transient reduction in swelling
ephedrine, epinephrine, phenylephrine
OTC hemorrhoid Treatment
protectant
MOA: form physical barrier to protect against irritation
AlOH3 gel, cocoa butter, glycerin, kaolin, lanolin, mineral oil, white petrolatum, shark liver oil, cod liver oil, zinc oxide, calamine, starch
OTC hemorrhoid Treatment
Astringents
MOA: promote drying by decreasing mucus and other secretions; relieve local anorectal irritation
calamine, zinc oxide, witch hazel
OTC hemorrhoid Treatment
Antipruritic agents
MOA: depress cutaneous sensory receptors
menthol, juniper tar, camphor
OTC hemorrhoid Treatment
corticosteroids
MOA: vasoconstrictor and antipruritic-reduce itching and pain
hydrocortisone
What are the OTC drugs used for motion sickness?
meclizine, dimenhydrinate, adn cyclizine