Exam 1

Card Set Information

Exam 1
2012-02-12 18:45:40
Self Care

otic, dyspepsia, patient counseling, N/V, respiratory.....
Show Answers:

  1. What % of people read an OTC label when buying?
  2. What % would rather self treat than go to Dr?
  3. What % of people take an OTC at the first sign of a problem?
  4. When a problem is 'minor' what % of people ask a pharmacist about it?
    only 7%
  5. What is the #1 reason why more people don't talk to a pharmacist?
    they are "hidden"
  6. 40% of OTCs are purchased by what group?
    elderly (>65)
  7. T/F: women access OTCs more than men.
  8. What is the fastest growing population of medication users?
  9. T/F: compared to Rx drugs, there are ten times more OTC drugs.
  10. Name two drug classes that have gone Rx to OTC.
    • antihistamines
    • PPIs
  11. T/F: More than 80 drugs have been switched from Rx to OTC.
  12. Which act did not require any mandate for safety?
    Pure Food and Drug Act 1906
  13. Which act required that drugs be safe?
    Federal Food, Drug and Cosmetic Act 1938
  14. Which act required that drugs be safe AND effective?
    1962 amendment to FFDCA
  15. Which act separated the Rx medications (legend) from the non-legend medications?
    Durham-Humphrey Amendment 1951
  16. Do manufacturers or the FDA have the final say on what category a drug belongs?
  17. What did the Drug Efficacy Study Implementation (DESI) do?
    • reviewed all drugs between 1938-1962
    • determined effectiveness and safety
  18. What is the ongoin process called that determines safety and effectiveness?
    OTC Drug Review
  19. What are the 3 questions that the FDA uses to decided if a drug should be OTC or legend?
    • Can patient adequately self-diagnose the problem?
    • Can problem be successfully treated with an OTC?
    • Is the self-treatment OTC safe and effective for the consumer to use?
  20. What are the four categories of non-prescription products?
    • OTC
    • dietary supplements
    • homeopathics
    • drug cosmetics
  21. T/F: dietary supplements are considered drugs.
  22. T/F: homeopathics are considered drugs.
  23. Who regulates dietary supplements?
    DSHEA (dietary supplement health and education act)
  24. Who regulates advertising of non-prescription drugs?
    FTC (federal trade commission)
  25. What class of drugs is OTC but requires counseling by a pharmacist?
  26. T/F: OTC drugs are required by FDA to be much more detailed than Rx drugs.
  27. What two things absolutely must be on an OTC label?
    • active ingredients
    • inactive ingredients
  28. What 8 key points have to be on an OTC label?
    • description of tamper resistant features
    • exp date and lot #/batch code
    • directions for use
    • name/location of manufacturer
    • warnings
    • uses
    • product name
    • active ingredients (purpose, dosage, dosage form, quantity) and inactive ingredients
  29. Are there any exceptions to the labeling requirements for an OTC? If so, what are they?
    • When product does not have a dosage limit
    • If product is considered to be stable for at least 3 years or more
  30. In 2006, the FDA proposed new standards for OTC labels. What are they (4)?
    • bigger font
    • purpose of each active ing
    • layman language
    • more organized layout
  31. What is the most common drug reclassification?
    Product line extension (new dose, formulation, combination of ingredients)
  32. T/F: there are no efficacy requirements for dietary supplements.
  33. T/F: there are no safety requirements for dietary supplements
    false; must be safe
  34. Why are dietary supplements not considered as drugs?
    b/c they are not intended to treat, cure or diagnose a disease or condition
  35. What two things are typically on a dietary supplement label?
    • Must state the part of the plant used!
    • Structure/function claim, but not a disease claim
  36. What % of dietary supplements are legitamite?
  37. What is the theory surrounding homeopathic drugs?
    that potency increases with dilution
  38. Which subset of non-rx products are exempt from GNP and are not required to have an NDA?
  39. Which drugs could have a high alcohol content?
  40. What is required in the labeling for a homeopathic product?
    • ingredients
    • instructions for safe use
    • at least one major indication
    • dilution instructions
  41. What are some cosmetic drug products that would require a valid OTC label?
    • toothpaste w/ fluoride
    • antidandruff shampoo
    • makeup with sunscreen in it
    • antiperspirant deoderant
  42. What are the classes of drug recalls?
    • class I (worst)
    • class II
    • class III
  43. Which recall class are we required to tell patients about?
    class I
  44. What is OBRA '90?
    law that requires us to offer to counsel on prescriptions dispensed to medicaid patients
  45. What are some causes of med errors?
    • patients can't see or can't read
    • language barrier
    • inadequate lighting in retail area
    • uneducated on proper use
    • handle and store improperly
  46. What level does the average consumer read at?
    8th grade level
  47. What 3 things does triage consist of ?
    • recommend no treatment
    • recommend self-care (OTC)
    • refer
  48. T/F: leading questions should be avoided.
  49. What are the open ended questions?
    • what
    • when
    • who
    • why
    • where
  50. What is quest?
    • Qu: QUickly and accurately assess the patient
    • E: Establish that patient is an appropriate candidate for self care
    • S: Suggest appropriate treatment strategies
    • T: Talk with patient
  51. What should you do in Qu of quest?
    • introduce yourself
    • 1st open ended question "What can I help you w/ today?"
    • 2nd open ended question "Tell me more about...."
    • **Use SCHOLAR** here
  52. What is scholar?
    • S: symptoms
    • C: characteristics
    • H: history
    • O: onset
    • L: location
    • A: aggravating factors
    • R: remitting factors (what makes it better?)
  53. What part of quest does scholar fit into?
  54. What should you do in "E" of quest?
    • establish that patient can do self-care
    • refer if:
    • you're unsure
    • symptoms are too severe
    • symptoms are result of unidentifiable cause
    • patient is elderly, prego, or under 2 (not always though)
  55. What should you do in "S" of quest?
    • suggest: medication, alternative options, non-pharmacologic txt, general care measures
    • prevent future problems
    • Advise patient on: reason for self txt, describe drug/txt, administration of txt, what to expect from txt (side effects, precautions)
  56. What should you do in "T" of quest?
    • Talk to patient
    • explain why you chose particular drug
    • advise patient of when to expect results from txt
    • discuss what to do if no results
    • decide if follow up is necessary
  57. What is MTMS?
    medication therapy management services
  58. What allows pharmacists codes to bill for cognitive services?
    CPT (current procedural terminology)
  59. T/F: OTCs are rarely labeled for <2 yo.
  60. Premature
    <36 months
  61. Neonate
    <1 month old
  62. Infant
    1-12 months old
  63. Toddler
    1-3 yo
  64. Preschool
    3-6 yo
  65. Child
    6-12 yo
  66. Adolescent
    13-18 yo
  67. What is a common rule when dispensing medication to prego women?
    use the oldest drug first (b/c there is more research available on effects)
  68. T/F: herbals and homeopathics should be discouraged when counseling prego women.
  69. Which group of people should avoid taking long-acting, maximum strength, multi-ingredient products?
    nursing mothers
  70. What group believes that health is a matter of luck (fatalism)
  71. What group believes in alternative medicine and herbs?
  72. What group distrusts the american health system?
    african americans
  73. What group believes in sweat lodges and prayer for healing/cure?
    native americans
  74. What type of disorders account for 1.2% of ambulatory care visits per year?
  75. T/F: otic OTCs can be given to children <12 yo.
  76. Why do children often get more ear infections than adults?
    b/c their eustacian tubes are more flat whereas adults slope upward
  77. T/F: if a person has tubes in their ears they can use OTC products.
  78. What are some of the exclusions to self-treatment w/ ear OTCs?
    • sign of infection (pus, fever)
    • pain associated w/ ear discharge
    • bleeding or signs of trauma
    • ruptured tympanic membrane
    • ear sx in the past 6 weeks
    • tubes present
    • incapable of following instructions
    • hypersensitivity to product
    • <12 yo
  79. What is the only FDA approved OTC cerumen softening agent?
    carbamide peroxide 6.5% in anhydrous glycerin
  80. What are the 3 components of carbamide peroxide 6.5% wax softener and what does each one do?
    • Urea: breaks down and loosens earwax
    • Hydrogen Peroxide: effervescence breaks down earwax and acts as an antimicrobial
    • Anhydrous Glycerin: softens earwax
  81. What are the 2 brands of OTCs that contain carbamide peroxide 6.5% for softening earwax?
    • Auro Ear drops: CP 6.5% w/ anhydrous glycerin
    • Debrox Earwax Removal Aid Kit: CP 6.5% w/ glycerin; comes with a syringe
  82. What are the instructions and dosing for carbamide peroxide 6.5%?
    • place 5-10 drops into ear canal and leave in ear for 15 min; flush with bulb/syringe
    • bid for up to 4 days
  83. T/F: you can run a bottle of eardrops under warm water to warm it up.
  84. Which direction do you pull the ear of child <3 yo?
    back and down
  85. Which direction do you pull the ear of an adult?
    back and up
  86. What are some alternative agents for softening earwax that are not recommended for self-care?
    • mineral oil
    • olive oil
    • glycerin
    • docusate sodium
    • dilute hydrogen peroxide
    • herbal remedies
    • ear candles
  87. T/F: water clogged ears are NOT swimmer's ear or external otitis.
  88. What are the S&S of water clogged ears?
    • feeling of fullness or wetness
    • hearing loss
    • tissue maceration (itching, pain, inflammation, infection)
  89. T/F: you can use a blowdryer to help dry out a wet ear.
    true; on low setting
  90. What is the only FDA approved OTC ear drying agent?
    isopropyl alcohol 95% in 5% anhydrous glycerin
  91. What is a drying agent that we can compound if we have the correct ingredients, but is not for sale?
    • 50:50 mix of 5% acetic acid with 95% isopropyl alcohol
    • has bactericidal and antifungal properties
  92. What is the dosing/instructions for isopropyl alcohol + anhydrous glycerin drying agent?
    Place 5-10 drops into ear canal and keep in ear 1-2 minutes
  93. What are the contraindications for using iso alcohol+anhydrous glycerin drying agent?
    ruptured ear drum or tubes
  94. What are the 2 ingredients in a drying agent and what do they do?
    • isopropyl alcohol: acts as drying agent and disinfectant
    • anhydrous glycerin: solvent and emollient to reduce moisture without overdrying the EAC (external auditory canal)
  95. What are the 2 brands of OTCs that contain isopropyl alcohol and anhydrous glycerin for drying ears?
    • Auro-Dri Drops
    • Swim Ear Drops
    • (both contain same thing)
  96. What are the 3 most common derm disorders of the ear?
    • psoriasis
    • seborrhea
    • contact dermatitis
  97. What is contact dermatitis?
    • an alleric reaction or an irritant
    • drugs (topical neomycin)
    • nickel in earrings
    • poison ivy
    • rubber or plastic
    • soaps/detergents
  98. What are the S&S of contact dermatitis?
    • maculopapular rash
    • formation of vesicles
    • pruritis (itch)
    • erythema
    • edema
  99. What are the non-pcol and pcol txts for contact derm on the ear?
    • non: minimize exposure to irritant
    • pcol: astringents
  100. What is a common astringent used to treat contact dermatitis on the ear?
    • Burrow's solution (1:40 aluminum acetate in water): antipruritic
    • anti-inflammatory
    • some antibacterial properties
  101. What is the MOA of Burrow's solution?
    precipitates proteins and dries the affected area by decreasing secretory function of the skin glands
  102. What are the instructions for Burrow's solution?
    apply wet compress of solution several times per day for 4 days
  103. What are the 2 CHRONIC derm disorders of the ear?
    • psoriasis
    • seborrhea
  104. Between psoriasis and seborrhea, which one can usually be treated with OTCs and which one requires further intervention?
    • seborrhea= OTC
    • psoriasis=inflammatory, needs derm txt
  105. _____ is characterized by itching (pruritis), flaking of the skin, and skin fissures?
  106. _______ is characterized by thickening, erythematous, silvery scaly lesions, mostly appears at pressure points (knee, elbow), and if on the scalp, can move to external ear?
  107. What are the pcol txts for seborrhea or psoriasis of the ear?
    • anti-seborrheic shampoos
    • emollients
    • topical hydrocortisone
  108. What is the prevalence of heartburn in the US?
  109. Where is stomach acid formed?
    parietal cells
  110. The secretion of stomach acid is stimulated by what 3 substances?
    • histamine (H2)
    • acetylcholine
    • gastrin
  111. What two things help to protect the stomach from its own acid?
    • 1. prostaglandins
    • 2. nitric oxide
    • stimulate secretion of bicarbonate and mucous
    • inhibit secretion of acid
  112. What are the 2 damaging forces in the stomach and what are the 5 protecting factors?
    • Damage: pepsin, acid
    • Protecting: surface mucous, bicarbonate, mucosal blood flow, epithelial regeneration, prostaglandins
  113. What features does a person with a gastric ulcer present with?
    • thin
    • pain in the day
    • food may increase pain
    • antacids help pain
  114. What features does a person with a duodenal ulcer present with?
    • pain at night
    • pain 1-3 hours after meal
    • overweight
    • food or antacids can relieve pain
  115. What are the 2 ways that NSAIDS can cause an ulcer?
    • direct irritation
    • systemic inhibition of prostaglandin synthesis
  116. How does H. pylori cause ulcers?
    • direct mucosal damage
    • alters inflammatory response
    • increases gastric acid secretion
  117. What are some non-pcol txts for ulcers?
    • stop smoking
    • stop drinking
    • alter diet
  118. What is the most common upper GI disorder in the western world?
  119. What are some medications that can contribute to GERD?
    • alendronate
    • anticholinergics
    • aspirin
    • benzodiazepines
    • calcium channel blockers
    • estrogen
    • iron
    • nicotine
    • nitrates
    • NSAIDs
    • progesterone
    • potassium
    • theophylline
    • TCAs
  120. What are common S&S of GERD?
    • burning chest pain (heartburn)
    • regurgitation (sour taste in mouth)
    • belching
    • dysphagia
    • laryngitis, asthma, pulmonary aspiration
  121. What are lifestyle modifications for GERD?
    • eat smaller meals
    • lose weight
    • stop smoking
    • elevate head of bed
    • don't eat 3 hours before bedtime
    • avoid tight clothes
    • avoid caffeine, alcohol, citrus or tomato drinks
    • avoid causative foods
    • avoid lifting or straining
  122. What is the best remedy for occasional heartburn?
  123. What two products protect ulcerated tissue in the GI tract?
    • sucralfate
    • bismuth compounds (Pepto bismol)
  124. What two products increase GI motility?
    • dicyclomine (Bentyl)
    • metoclopramide (Reglan)
  125. What are the 5 therapeutic choices for GERD?
    • antacids
    • H2 antagonists
    • PPIs
    • Sucralfate
    • Antibiotics
  126. What is the MOA of antacids?
    they neutralize stomach acid
  127. What is the MOA of H2 antagonists?
    • they reduce acid secretions
    • block histamine at the receptors of parietal cells
    • reduce hydrogen ion production, which reduces HCl
  128. What are some common H2 antagonist?
    • cimetidine (Tagamet)
    • famotidine (Pepcid AC)
    • nizantidine (Axid)
    • ranitidine (Zantac)
  129. What hobby may decrease the effectiveness of H2 blockers?
  130. Which H2 blocker has the most side effects?
    cimetidine (Tagamet)
  131. Which drugs should be taken one hour before or after antacids?
    H2 antagonist
  132. Which therapeutic choice for GERD can last up to 24 hours?
  133. What is the MOA for PPIs?
    irreversibly bind to H/K ATPase enzyme to prevent the movement of hydrogen ions from the parietal cells into the stomach
  134. What are some common PPIs?
    • omeprazole (Prilosec)
    • lansoprazole (Prevacid)
    • rabeprazole (Aciphex)
    • pantoprazole (Protonix)
    • esomeprazole (Nexium)
  135. T/F: PPIs can be given with antacids.
  136. Which GERD drug class must be taken 30 min before meal?
  137. Which drug can cause a black tongue or stool?
    BSS (bismuth sub salicylate)
  138. What drug is indicated for nausea, diarrhea, heartburn, and upset stomach?
    • BSS (bismuth sub salicylate)
    • Maalox
  139. Which antacids usually have a constipating effect?
    • aluminum salts
    • ---phosphate, hydroxide, carbonate
  140. Which antacid commonly causes a laxative effect?
    magnesium salts
  141. What is an example of a common magnesium antacid?
    MOM (milk of mag)
  142. What is an example of a common aluminum antacid?
    aluminum carbonate (Basaljel)
  143. What is an example of a common combination antacid that has both laxative and constipating effects counteracting each other?
    • Maalox
    • Mylanta
  144. T/F: calcium carbonate (Tums) can cause constipation, gas and belching
  145. Excessive use of this antacid could cause kidney stones or hyperacidity rebound?
    Tums (calcium carbonate)
  146. Which antacid is highly soluble, fast acting, short duration, but may cause metabolic alkalosis?
    sodium bicarb (alka seltzer)
  147. Patients with CHF or hypertension should use which antacid products?
    • Riopan
    • Maalox
    • Mylanta
    • (low salt)
  148. What conditions might prohibit the use of antacids?
    • CHF
    • GI obstruction
    • renal disease
    • pregnancy
    • fluid imbalances
  149. How long after taking an antacid can a patient take his/her other regular medications?
    1-2 hours after
  150. T/F: antacids can dissolve enteric-coated medications.
  151. What are some exclusions for self-treating heartburn?
    • younger than 12 for antacids/H2
    • younger than 18 for PPIs
    • pregnant/nursing
    • chest pain
    • difficulty swallowing or breathing
    • heartburn at night
    • longer than 3 months
    • unexplained weight loss
    • etc
  152. What are some herbal products for heartburn/dyspepsia?
    • artichoke
    • caraway oil
    • chamomile
    • ginger
    • licorice
    • peppermint
    • sage
    • carrageenan
  153. What are some of the exclusions for self-treating poisoning?
    • CNS depression
    • seizures
    • unknown substance
    • pregnancy
    • older age
    • suspected suicide
    • suspected child abuse
    • substance abuse
    • a child <6 months old
  154. What is vomiting controlled by in the brain?
    the vomiting center
  155. What are some treatments for nausea?
    • antacids(upset stomach)
    • H2 antagonists
    • omeprazole
    • bismuth salts (Pepto Bismol): cytoprotective, enhances secretion of mucus and bicarb, inhibit pepsin
    • phosphorylated carbohydrate solutions: fructose, glucose and phosphoric acid
  156. Which antiemetic is not recommended for use in children?
  157. What are the 2 brands of antiemetic liquids?
    • Emetrol
    • Rekematol
  158. What are 3 non pcol agents for N/V?
    • ginger ale or ginger root
    • peppermint
    • chamomile
  159. T/F: antihistamines can be used to treat N/V.
  160. What is AD for meclizine?
    • 25-50mg 1 hour before travel
    • NTE 50 mg
  161. What is AD for cyclizine?
    • 50mg 30 minutes before travel
    • 50mg Q4-6 hours
    • NTE 200mg
  162. What is the CD for cyclizine?
    • 25mg Q6-8 hours
    • NTE 75 mg
  163. What is the AD for diphenhydramine for N/V?
    • 25-50mg Q4 hours
    • NTE 300mg
  164. What is the CD for diphenhydramine for N/V?
    • 12.5-25mg Q4 hours
    • NTE 150mg

    • for a child 2-6 yo: 6.25mg Q4 hours
    • NTE 25mg
  165. What is the AD for dimenhydrinate?
    • 50-100mg Q4-6 hours
    • NTE 400mg
  166. What is the CD for dimenhydrinate?
    • 25-50mg Q6-8 hours
    • NTE 150mg

    • for a child 2-6 yo: 12.5-25mg Q6-8 hours
    • NTE 75mg
  167. Which antiemetic can decrease a mother's milk supply?
    diphenhydramine (Benadryl)
  168. What are some treatments for prego women with N/V?
    • Doxylamine: 12.5mg TID or QID - category A
    • Pyridoxine: 10-25mg TID or QID- category A water-soluble B complex
    • Antihistamines: reserved for severe N/V- category B
  169. What 2 drugs are used to treat N/V associated with chemo?
    • Ondansetron
    • Zofran
  170. What are signs of dehydration in children?
    • sunken or dry eyes
    • dry mouth
    • decreased urine
    • fast heart beat
    • minimal tears
    • decreased skin turgor
    • unusual sleepiness
    • weight loss
  171. Dilation of this will result in internal hemorrhoids?
    superior hemorrhoidal plexus
  172. Dilation of this will result in external hemorrhoids?
    internal sphincter
  173. Which hemorrhoids are generally asymptomatic?
    internal hemorrhoids (of the superior hemorrhoidal plexus)
  174. What are the causes of hemorrhoids?
    • erect posture
    • genetic
    • pregnancy
    • anal infection
    • traveller's diarrhea
    • diet
    • prolonged diarrhea
    • prolonged constipation
    • CHF
    • rectal cancer
  175. What are the S&S of hemorrhoids?
    • pain: with external hem, a steady aching discomfort
    • bleeding: with internal hem, occurs intermittently with BM
    • prolapse: with straining
    • burning: warm to intense heat
    • itching: due to inflammation
    • thrombosis: acute onset of constant pain
  176. What is a local anesthetic used for hemorrhoidal pain, itching or burning?
  177. What is a vasoconstrictor used for hemorrhoidal itching, shrinkage or swelling?
  178. What is a protectant for treating hemorrhoids and relieves pain, itching, irritation associated w/ internal hemorrhoids?
    • mineral oil
    • zinc oxide
    • petrolatum
  179. What is an astringent used to temporarily relieve hemorrhoid symptoms and rid itching?
    • witch hazel
    • calamine
    • zinc oxide
  180. What is a keratolytic for hemorrhoids?
    resorcinol-not used anymore
  181. What is an analgesic/anesthetic/antipyretic for hemorrhoid relief?
    • menthol
    • camphor
  182. What is a corticosteroid for treating hemorrhoids?
    hydrocortisone cream
  183. What are the only 2 herbal products that have support for safety and efficacy for treating hemorrhoids?
    • aloe
    • witch hazel
  184. What are some non pcol treatments for hemorrhoids?
    • diet
    • avoid lifting heavy objects
    • increase exercise
    • avoid NSAIDs and aspirin
    • sitz baths
    • do not ignore urge
  185. What are the best choices for treating itching/burning with hemorrhoids?
    • petrolatum
    • hydrocortisone ointment