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102 Cards in this Set
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Herbal Remedy
Eye health/platelet aggregation inhibitor/Anthocyanins?? |
Bilberry
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Herbal Remedy
Menopause/27 deoxyaceteine Can potentiate effect of antihypertensives |
Black Cohosh
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Herbal Remedy
Premenstrual health/several "actives"/ May interfere with oral contraceptives, HRT, endocrine therapies |
Chaste Tree Berry
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Herbal Remedy
Immune stimulant/echinosides etc./ contraindicated with cyclosporine |
Echinacea
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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
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Herbal Remedy
Supports memory and concentration/improves brain circulation/ginkolides/ potent inhibitor of platelet activating factor |
Ginkgo
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Herbal Remedy
Adaptogen to stress/ginseno-sides avoid with caffeine, MAOIs, NSAIDs, and antiplatelet agents |
Ginseng
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Herbal Remedy
Mild anti-depressant/hyperforin increases cytochrome P450 which leads to decrease blood conc of many drugs |
St. John's Wort
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Herbal Remedy
decrease BPH/lipophilic agents Not for females, has hormonal effects |
Saw Palmetto
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Herbal Remedy
Mild sedative/valapotrhates?/ May potentiate other CNS depressants |
Valarian
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What is the etiology of a headache?
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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 |
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What is the pathophysiology of a headache?
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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.
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Describe a tension Headache
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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. |
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How can you assess a headache?
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P - provacative and palliative
Q - quality R - radiation S - severity T - Temporal (does it persist?) |
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What are some clinical considerations concerning non-prescription analgesics for HA?
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- 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 |
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How do salicylates treat Headaches?
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They produce analgesia by inhibiting prostaglandin synthesis and also exhibit anti-inflammatory activity.
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What are some clinical considerations of salicylates?
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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. |
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What are some adverse effects/precautions of salicylates?
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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 |
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What are some drug interaction of salicylates concerning drug concentrations changing as a result of salicylates?
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May increase the action: acetazolamide, anticoagualants, antidiabetic agents, lithium, methotrexate, valproate
May decrease the action: probenecid, sulfinpyrazone, thiazide and loops, ACEi, beta blockers |
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What are some drug interactions causing salicyalte levels to be affected?
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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 |
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What is the maximum adult dosage of ASA?
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4000 mg in a 24 hour period
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What is the usual adult dosage of ASA?
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325mg, 500mg, or 650mg every 4 hours as needed
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Which form of ASA irritates the stomach less? Buffered or enteric coated?
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Enteric coated
Downside is that they don't release quickly |
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What are the nonacetylated salicylates?
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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 |
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What are some facts about APAP?
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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 |
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What are some clinical considerations with APAP?
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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 |
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What is the usual dosage of APAP?
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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 |
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How do NSAIDs work?
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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. |
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What are some clinical considerations of NSAIDs?
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Contraindicated in pts who are hypersensitive to any NSAID, including ASA
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What are some adverse reactions to NSAIDs?
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GI effects - heartburn, nausea, vomiting, bleeding
renal effects, CI 3rd trimester Skin reactions are rare |
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What are some drug interactions of NSAIDs?
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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 |
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What is usual non-prescription adult dose of Ibuprofen?
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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 |
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What is the min age for ibuprofen?
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6 months or older
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What are some facts about naproxen sodium?
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Has a longer duration of action that other nonprescription analgesics.
NOT indicated for nonprescription use in children under 12 y/o |
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What is the usual dosage for nonprescription?
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220mg every 12 hours.
Max dose in a 24 hour period is 660mg. |
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What is the 3rd NSAID approved for OTC usage, but is no longer marketed because it is short acting and not used in children?
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Ketoprofen
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How should baby aspirin and ibuprofen be dosed together?
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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.
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Describe the pathophysiology of pain.
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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.
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What are some uses for topically applied analgesics?
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Pain of muscular aches, neuralgia, arthritis, sprains, and similiar conditions when the skin is intact.
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What are some clincial indications for topically applied analgesics?
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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 |
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What is Trolamine salicylate?
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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 |
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What is methyl salicylate?
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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 |
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What are counterirritants?
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They replace an unpleasant sensation with another sensation.
Menthol, camphor, eucalyptus oil, capsaicin, capsicum oleorsesin, and methlnicotinate |
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Did you look at the combination topical analgesics available?
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Yes
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What is the most common of all musculoskeletal pain?
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Lower back pain
causes: mechanical (poor posture, improper lifting, improper shoes), trauma, inflammation, infection etc. |
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What symptoms of lower back pain are needed for physician referral?
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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 |
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What is some non-drug therapies of lower back pain?
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moderate exercises, short term bed rest
thermotherapy cryotherapy massage acupuncture supportive belts, braces, corsets |
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What is myalgia?
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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 |
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What is some non-drug therapy for myalgia?
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Rest, localized heat, gentle massage, stretching exercises
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What is a sprain or strain?
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encompasses all acute, traumatic injuries that affect ligaments, tendons, and muscles.
Usually followed with fast inflammation. Healing process takes 4 weeks. |
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What is some non-drug therapy for sprains and strains?
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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 |
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What is some non-drug therapy of osteoarthritis?
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exercises, sit without slumping, sleep on a firm bed, application of heat or cold
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What is dysmenorrhea?
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Painful menstruation
primary - pain occurs in the absence of any pelvic pathology secondary - underlying pelvic pathology is present |
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What does primary dysmenorrhea result from?
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Abnormal uterine activity (increased intrauterine pressure, increased contractions) during normal menstruation
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What does secondary dysmenorrhea result from?
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Associated with pelvic pathology such as endometriosis, pelvic inflammatory disease (start as UTI), or uterine fibroids
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What are signs and symptoms of dysmenorrhea?
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cramping lower abdominal pain that my radiate to the back and thighs;
many women also experience nausea, vomiting, constipation, diarrhea, fatigue, HA, or dizziness |
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What is some non-drug therapy of dysmenorrhea?
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aerobic exercise
low-fat diet smoking cessation when applicable |
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What are some non-RX therapies for dysmenorrhea?
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NSAIDs are DOC
APAP salicylates |
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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.
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Premenstural syndrome
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What are some symptoms of PMS?
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generalized HA, breast swelling/tenderness, bloating, fatigue, anxiety, depression, irritability, mood swings, wt gain, and fluid retention
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What is some non-drug therapy of PMS?
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patient education and counseling
dietary modifications aerobic exercise relaxation training |
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What are some non-RX therapies for PMS?
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NSAIDs
APAP salicylates |
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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
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What are most UTIs caused by?
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gram-negative bacteria, of which E.Coli is the most common
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What are some signs and symptoms of UTI?
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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. |
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What are some non-drug therapies of UTI?
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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] |
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What are some non-RX therapies of UTI?
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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 |
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What are some considerations with AZO dye?
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causes reddish-organge discoloration of urine, possible staining of contacts and undergarments.
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What are some adverse reactions of AZO?
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GI disturbances, HA, rash, pruritus.
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What is the usual dosage of AZO?
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190 mg TID after meals for no more than 2 days
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How does levonorgestrel work?
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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
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What is the dosage of levonorgestrel?
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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 |
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What are some adverse effects of levonorgestrel?
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pregnancy greater than 10%
nausea, abdominal pain, fatigue, HA, heavier or lighter menstural bleeding, breast tenderness |
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An increase in body temperature greater than that seen in normal daily body temperature variations
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Fever
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When is body temperature highest and lowest?
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Lowest in the morning hours (2-4AM)
Highest later in day (6-10PM) |
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What are some signs and symptoms of fever?
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Elevation of body temp to more than 37.8C orally or 38.2C rectally
Tachycardia, hypervent, anemia, increase neutrophils |
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What is the treatment of fever?
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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 |
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Difficulty falling asleep, difficulty maintaining sleep, lack of restful sleep.
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Insomnia
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What are some non-drug therapies for treating insomnia?
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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 |
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What is diphenhydramine used for with insomnia?
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helps to reduce difficulty falling asleep and for occasional sleeplessness
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What is the dosage of diphenhydramine for insomnia?
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50mg at bedtime
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What OTC antihistamine is even more sedating than diphenhydramine?
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Doxylamine succinate
50mg HS |
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What are some herbal remedies for insomnia?
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Valerian and melatonin
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How should a stye be treated?
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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 |
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What should be recommended for red eyes and excessive tearing?
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Cool compress and avoid rubbing
Antihistamine drops Vasoconstrictor drops |
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What drugs cause dry eye as an ADE?
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diuretics
antihistaimes anticholinergics phenothiazines TCAs preservative containing eye drops hormone replacement therapy radiation therapy Accutane, cimetidine, clonidine |
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What are the OTC ophthalmic decongestant agents containing tetrahydolozine?
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Collyrium Fresh
Eye Drops (B and L) Murine Plus Visine moisturizing Visine allergy releif |
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What are the OTC ophthalmic decongestant agents containing phenylephrine?
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AK-nephrin
Relief Prefrin Liquifilm Zincfrin |
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What are the OTC ophthalmic decongestant agents containing oxymetazoline?
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Ocuclear
Visine LR |
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What are the OTC ophthalmic decongestant agents containing naphazoline?
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20/20 Eye Drops
Allerest Eye Drops Clear Eyes Clear Eyes ACR Naphcon Allergy Drops Vasoclear |
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What are the ophthalmic decongestant/antihistamine combination drops?
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Naphcon
Opcon Vasocon they contain naphazoline/pheniramine or naphazoline/antazoline |
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What are the different artificial tear solution?
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Artificial tears
AquaSite Bion Tears Celluvisc Comfort Tears Dry Eyes GenTeal Hypo Tears Hypo Tears PF Isopto Tears Liquifilm tears LubriTears a lot more |
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What are the OTC ocular lubricant ointments?
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Dry Eyes
Duratears Naturale LubriTears HypoTears (CibaVision) Stye Lacri-Lub SOP LacriLube NP Preservative free Moisture eyes PM Refresh PM |
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What are some non-drug treatments of hemorrhoids?
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High fiber diet
hydration avoid prolonged sitting at stool sitz bath |
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What are some OTC treatments for hemorrhoids?
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bulk laxatives, stool softeners
topical anorectal products: local anesthetics (best), witch hazel, vasoconstrictors, ,protectants suppositories |
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OTC hemorrhoid Treatment
Local anesthetic |
MOA: block transmission of nerve impulses
Benzocaine, benzyl alcohol, dibucaine, dyclonine, lidocaine, pramoxine, tetracaine |
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OTC hemorrhoid Treatment
Vasoconstrictors |
MOA: result in modest and transient reduction in swelling
ephedrine, epinephrine, phenylephrine |
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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 |
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OTC hemorrhoid Treatment
Astringents |
MOA: promote drying by decreasing mucus and other secretions; relieve local anorectal irritation
calamine, zinc oxide, witch hazel |
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OTC hemorrhoid Treatment
Antipruritic agents |
MOA: depress cutaneous sensory receptors
menthol, juniper tar, camphor |
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OTC hemorrhoid Treatment
corticosteroids |
MOA: vasoconstrictor and antipruritic-reduce itching and pain
hydrocortisone |
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What are the OTC drugs used for motion sickness?
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meclizine, dimenhydrinate, adn cyclizine
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