Card Set Information
herbals, fungal infections, wounds, nicotine, pain relief, women's junk, acne
What is tinea corporis?
fungal infection on the body
What is the most common type of vaginal infection?
What is stored in the epithelial cells of the vagina?
What is glycogen's purpose in the vagina?
to interact w/ lactobacillus to make lactic acid
What does lactic acid do in the vagina?
makes the pH acidic
What are some of the normal flora in the vagina?
What are some factors that affect the vaginal environment?
# of sex partners
What is vulvovaginal candidiasis aka?
What is the most common cause of a yeast infection (VVC)?
use of antibiotics
What are the risk factors for VVC?
broad spectrum antibiotics
What does VVC discharge look like?
cottage cheese like
What are the S&S of VVC?
dysuria- painful urination
will occur before menses and get better during
What non-pharm treatment is there for VVC?
d/c antibiotics but probably not likely
stop oral contraceptives
Who would be a candidate to self treat VVC?
her vaginal symptoms are infrequent (less than 3 in a year's time)
she had at least one previous episode that was medically diagnosed
her symptoms are mild to moderate w/ non-malodorous discharge
The azoles are used to treat what?
What are some azoles for VVC?
T/F: all of the azoles for treating VVC are equally efficacious.
What is the MOA of azole antifungals?
imidazole compounds alter the fungal membranes resulting in lysis
These drugs are approved for local treatment and external itching/irritation associated w/ a VVC infection?
What are the most common side effects of the azole antifungals?
What drug interactions should you watch for when using an azole antifungal?
What are the dosage regimens for the vaginal antifungals?
1, 3, or 7 days
What are the pros and cons of Vagisil?
it has benzocaine in it
it is only for external use
it doesn't treat the infection
T/F: Yeast-gard (a homeopathic) is advantageous over azole antifungals.
T/F: yogurts or other lactobacillus preps are not effective against post-antibiotic VVCs.
Would you recommend a sodium bicarb sitz bath for someone with a VVC?
Would you recommend douching, like ever?
T/F: girls less than 12 can self treat w/ an azole antifungal.
Which drugs can predispose a woman to VVC?
What diseases can predispose a woman to VVC?
If a woman has had a vaginal infection in the past 2 months, can she self treat?
What are 2 herbal therapies for VVC?
tea tree oil
What is in garlic that makes it useful antibac or antifungal for VVC?
What is the problem w/ using gentian violet?
it has alcohol in it
Which product is useful for non Candida albicans VVC infections?
Which drug for VVC can be fatal if ingested orally and should not be used by preggo women?
What is the usual course of VVC w/ treatment?
should improve in 2-3 days and completely resolve within 1 week of treatment
Which infection is caused by more than one organism (is polymicrobic)?
bacterial vaginosis (BV)
Which organisms cause BV?
Which infection may be protected by oral contraceptives or condoms?
Who is predisposed to getting BV?
What does BV smell like?
What does BV look like?
white, gray, yellow or green
1/3 to 1/2 of women are asymptomatic who have this?
Can you treat BV w/ OTC agents?
no probably not
need RX antibiotics
You should almost always refer if a woman has what?
What are the s& s of trichomoniasis vaginalis?
yellow, gray, green discharge
This infection is transmitted via sex?
Can we treat trich with OTCs?
no, need an RX
Which virus do we need to treat the sex partners too?
T/F: we should always refer a woman with trich?
What happens if we don't treat BV and trich?
increased risk for:
preterm labor and premees
premature membrane rupture
transmit HIV or other STIs
What product might help reduce the inappropriate use of antifungals?
self-testing pH devices like Fem-V or Vagisil screening kit
What can lead to inacurrate results of a pH test kit?
too soon after sex
Which of the 3 vag infections can be treated OTC?
Do we need to treat sex partners of VVC or BV?
What is dyspareunia?
What are the 2 common ingredients in lubricants?
T/F: you should wait 6-8 hours after sex if you are going to douch, but you really shouldn't
What is the one most distinguishing factor b/w VVC and BV or trichomoniasis when diagnosing?
VVC does not have a bad odor
t/f: during menses and menopause the vaginal pH increases.
what does a pH greater than 4.5 in the vagina indicate?
not VVC, but BV or trich
t/f: you can use antifungal creams on your period.
When should we refer a woman w/ atrophic vaginitis (5 things)?
severe vaginal dryness
personal lubricants not helping
pain is not localized
t/f: daily intake of yogurt can help prevent VVC.
what two menstrual disorders can women treat for?
what 4 things can cause pain of primary dysmenorrhea?
Which two drugs are most recommended for treating dysmenorrhea?
Which supplements could be used to treat dysmenorrhea?
sweet fennel extract
When does a woman experience PMS?
the 5 days prior to period
What is thought to be the cause of PMS?
low levels of serotonin caused by drops in estrogen and progesterone
What supplements can we take for PMS?
vitamin B6 (pyridoxine)
calcium and vitamin D
What OTC drugs can we take for PMS?
caffeine and other diuretics?
these are in things like Midol, Aquaban and Pamprin
Chastetree berry, ginkgo, saffron and St. John's Wort have been thought to be effective for what syndrome?
What adverse effect can ginkgo have?
increased bleeding due to antiplatelet activity
Which bacteria is most responsible for causing TSS?
t/f: you can use egg whites as lubrication for sex.
Why is the contraceptive sponge a trifecta?
t/f: spermicides can increase the risk of getting an STI.
t/f: aspirin is an NSAID
true, but it is a salicylate too
Name all of the Salicylates.
magnesium salicylate (Doan's/Percogesic)
bismuth salicylate (Pepto)- no analgesic props
What are COX-1 and COX-2 responsible for?
: protection/physio fxns
What is COX-1 protecting in the body?
What is COX-2 inducing in the body?
inflammation at inflammatory sites
In general which one is good and which one is bad out of COX-1 and COX-2?
What do NSAIDs and salicylates inhibit?
What does aspirin inhibit?
t/f: NSAIDs affect platelets but they bind them reversibly, so not much effect.
What binds platelets irreversibly?
You will need a much higher dose of what drug to relieve pain?
Aspirin has antiplatelet (cardio) activity at what dose?
81- 325 mg/day
What molecule does aspirin most strongly block?
What dose of aspirin would you take for pain relief?
325-650 mg/day or more
Are NSAIDs selective or non-selective at inhibiting COXs?
Why do NSAIDs have no cardio benefit?
b/c they reversibly inhibit TXA2
What are the 3 pharmacologic effects that NSAIDs have?
How do NSAIDs have an analgesic effect?
decrease prostaglandins that sensitize nociceptors to inflammatory mediators in the brain
cause vasoconstriction = decrease headache
How do NSAIDs have an anti-pyretic and anti-inflammatory effect?
decrease prostaglandins that are responsible for elevating hypothalamic set point for temperature
decrease vasodilator prostaglandins (PGE2) which means less vasodilation and less edema (swelling)
t/f: ibuprofen, aspirin, and naproxen are all non-selective for COX 1 and 2.
This drug is antipyretic and analgesic, but has little anti-inflammatory activity?
NSAIDs work to decrease pain in the ________, while APAP works to decrease pain in the _________?
: peripherally, all over
: in the brain
Which pain relief drug is available as a suppository?
What is the best pain reliever to use in someone who is taking warfarin?
APAP (even though it may enhance anticoag effect of warfarin) still the recommended one
What is the max dose of Tylenol in one day?
3-4 grams (FDA says 3)
1 gram q 6hrs okay
How many grams of tylenol at one time is considered non-toxic to the liver?
less than 6 g
How many grams of tylenol will cause severe liver necrosis?
more than 10 g
t/f: chronic alcoholics can take tylenol.
How much tylenol should a geriatric patient have in one day?
What toxic metabolite is tylenol made into?
t/f: NSAIDs are hepatotoxic just like tylenol.
t/f: NSAIDs should be avoided in alcoholics
What could happen if a patient w/ liver cirrhosis takes NSAIDs?
impaired renal function
diuretic resistant ascites
What is considered to be the toxic dose of tylenol?
more than 6 grams
If someone wants a recommendation about taking tylenol, what two questions should you ask first?
how much alcohol do you drink?
what other drugs are you taking (are they potentially hepatotoxic)?
What diseases do we need to watch if we are going to recommend NSAIDs?
chronic/recurrent GI ulcers
what is the #1 problem caused by aspirin and NSAIDs use?
What is misoprostol (Cytotec)?
for peptic ulcers
t/f: all NSAIDs and aspirin can hurt your gut.
t/f: NSAIDs can increase BP in normal and hypertensive people, but only by 2-3 mmHg
Which pain reliever is the safest to take if patient has high BP and might be taking anti-hypertensives?
tylenol (inconclusive data)
How do NSAIDs increase BP?
inhibit COX-2 in kidneys which reduces sodium excretion, which increases intravascular volume, which increases BP
Which pain reliever makes you retain water?
If a patient has heart failure, which drug should they take and which should they not take?
do not take
Which of the two NSAIDs is most likely safer for heart disease (even though neither should really be taken)?
naproxen safer than ibuprofen
What are the top 4 choices for pain relief in a patient whith cardio disease?
A patient with pain and asthma should take what drug?
An allergy is a _____ reaction, whereas a pseudoallergy is a _______ reaction?
t/f: allergies and pseudoallergies can have the same symptoms.
What are some symptoms of an allergic reaction to NSAIDs?
angioedema (lips, throat)
t/f: aspirin induced
is an allergic reaction
false: it is a pseudoallergy (type 1)
How does aspirin cause an allergic reaction like asthma?
it inhibits PGE2 which increases the amount of leukotrienes
t/f: NSAID induced urticaria/angioedema is an allergic reaction
false: it is a type 2 pseudoallergy
Patients with an allergy to NSAIDs should avoid which NSAIDs?
How long does it take for an aspirin allergy to manifest?
How long does it take for an NSAID allergy to manifest?
Patients with a pseudoallergic reaction should avoid _______, while patients with a true allergic reaction should avoid ________?
: take a weak COX-1 or just take a COX-2 or tylenol
: avoid specific drug and same chemical group
Who is likely to get a medication overuse headache?
use analgesics for more than 2-3 days a week
Which drugs can cause rebound headaches?
aspirin/APAP/caffeine combos (excedrin)
Which drug has the lowest potential for causing rebound headaches?
t/f: you should not take aspirin and NSAID together
false, you can
t/f: people can become resistant from taking aspirin too long
true, may need to switch to plavix
If a patient must take both aspirin and NSAIDs together, how should they do it?
take aspirin first, then take NSAID 2 hours later (to avoid platelet interactions)
t/f: patients can take warfarin and aspirin or an NSAID together
true, but increases risk of bleeding
which pain reliever can cause or exacerbate gout?
Is a low, moderate, or high dose of aspirin more likely to exacerbate gout?
moderate (therapeutic doses) -- strange
t/f: a patient can take an ACE inhibitor and an NSAID together.
true, but need to monitor kidney function
How do NSAIDs cause acute interstitial nephritis?
inhibiting COX converts arachidonic acid to leukotrienes which activate T helper cells, which could attack kineys
How do NSAIDs + ACE inhibitors cause renal failure?
ACEs dilate the vessels going OUT of kidney, but NSAIDs constrict vessels going INTO kidney = problem
drops glomerular pressure
Which problems caused by NSAIDs are reversible?
hemodynamically mediated acute renal failure
acute interstitial nephritis
Which problems caused by long term, high doses of NSAIDs (or tylenol) are irreversible?
damage to vascular endothelial cells = tubular necrosis
In relation to the kidney, which pain reliever is considered safest to take long term in therapeutic doses?
Use of what 2 drugs together greatly increases the risk for nephrotoxicity?
aspirin + tylenol
What is the best advice for a pregnant or breastfeeding woman for a pain reliever?
tylenol > NSAID > aspirin
what problems might a prego woman see if she takes NSAIDs?
: premature contraction of the ductus arteriosus
hypertension in baby
may inhibit labor
t/f: enteric coated aspirin prevents GI bleeding
false, only prevents nausea
If taking a fecal occult blood test, when should you stop aspirin?
3 days prior
If having surgery, when should you stop aspirin?
7 days (2-7)
What are the best pain relievers for kiddos?
tylenol and ibuprofen
What is the typical dose of tylenol for a child?
What is the typical dose of ibuprofen for a child?
7.5 mg/kg (half the dose of tylenol)
who is not recommended to take naproxen?
kids less than 12
Why can kids not take aspirin?
What is the leading cause of acute liver failure in the U.S?
Which pain reliever can/should you take with food, milk or antacids?
What are the symptoms of tylenol toxicity?
or nothing at all in some people
What is overdose of aspirin aka?
What are symptoms of salicylism?
tinnitus, vertigo, N/V, headache, confusion, decreased hearing
What are the signs of salicylate poisoning?
What condition did people most commonly use alternative/complementary medicines for?
This alt med is a building block of tendons, cartilage, ligaments, synovial fluid, blood vessels and heart valves?
What is best indication for glucosamine/chondroiton?
mild to moderate OA, not severe
t/f: chondroitin or glucosamine are not effective when used alone
t/f: patients taking warfarin can also take glucosamine/chondroitin.
false: may increase bleeding
Do not recommend these alt meds for muscle or neuro pain, only for joint pain?
t/f: since glucosamine/chondroitin comes from marine exoskeletons and cow or shark cartilage, patients w/ shellfish allergy should not take them.
false, it's okay
What is the safe dosage and length of treatment for MSM?
2.6-6 grams per day for 12 weeks
This drug is thought to have a link to pain by sulfur deficiency but that is not proven?
Where is MSM found?
What is MSM thought to help?
What natural anti-inflammatories have similar side effects to NSAIDs? (GI upset, caution with anticoags)
This natural med thought to be comparable to diclofenac and reducing mild knee pain?
This natural med thought to reduce knee pain?
This natural med thought to similar to Vioxx for back pain and has been validated for OA pain?
What is ginger thought to do for pain?
relieve OA pain
What are all of the natural anti-inflammatory meds?
Which natural anti-inflammatory might actually work for pain associated with RA (according to Onysko)?
What are some anti-depressant-like natural meds?
St. John's Wort
What natural med is thought to be good for fibromyalgia, but not headaches?
Which natural med is thought to be as effective as NSAIDs for pain, but is expensive and has poor product quality?
These two natural meds look promising for helping with nerve pain in diabetics or for increasing blood flow?
These two natural meds decrease substance P in the sensory nerves which decreases pain (also cause irritation and stimulation of nervous tissue)?
capsaicin (capsicum/cayenne pepper)
Patients should use these two natural meds for 3 days and multiple applications to see pain relief at fullness?
Which 4 natural meds are most safe AND effective to recommend for pain relief?
Which 4 natural meds should not be recommended for pain relief?
St. John's wort
How do non-selective NSAIDs cause GI bleeds?
inhibit protective prostaglandin PGE2 in endothelium
Inhibition of which COX causes GI bleeding?
Inhibition of which COX increases cardio risk?
Inhibition of which COX decreases inflammation?
What is the amount of risk when taking an NSAID and getting GI complications vs. someone who is not taking an NSAID?
50-100% increased risk
Which antihypertensive does NSAID not interfere with?
calcium channel blockers
If patient reports with an allergic reaction to both aspirin and naproxen, does patient have allergy or pseudoallergy?
pseudo which is related to COX 1 inhibition
What problems might a patient have that would make them be at higher risk for aspirin-induced asthma?
Very low and high doses of aspirin do what in a gout patient?
help excretion of uric acid = good
Which OTC analgesic is only contraindicated in the 3rd trimester of pregnancy?
Which analgesic should not be used in pregnancy or breastfeeding?
Where do tension headaches occur?
over top of head
extend to base of head
Where do migraines occur?
one side usually
avoiding known triggers is the best way to avoid which type of headache?
At what temp should you treat a fever in an adult?
>106 or if they are uncomfortable
Which method of measuring temp is best in kids?
rectal, but others are okay if proper technique used
Combining NSAIDs or aspirin with alcohol increases risk of what?
What is RICE?
What is the difference between fever and drug-induced hyperthermia?
fever= over 100 degrees
DIH= 102-104 sometimes as high as 108
Which usually causes a higher temp, bacteria or virus?
t/f : a child less than 6 months old with a rectal temp of 101 or higher can be self treated.
t/f: magnesium salicylate is usually used to treat back pain
Which drug is used mostly for OA pain, fever, and mild to moderate pain?
For a child older than 6 months what should we recommend for fever?
ibuprofen or tylenol
Tylenol + Alcohol =
NSAIDs/aspirin + alcohol =
increased risk of GI bleed
tylenol/NSAIDs/aspirin + warfarin =
aspirin + NSAID =
decreased cardio benefit from aspirin
NSAIDs/salicylates + antihypertensives =
What are some examples of complemetary medicine?
What is alternative medicine?
no reimbursed by thirdparty payers
lacks evidence for effectiveness
therapy not provided in hospital or taught in American med schools
t/f: Homeopathic meds must be approved by FDA
t/f: homeopathic medicine is often compared to vaccines
Use of what meds usually requires vigorous shaking?
Dilutions of 1 to 10 are designated as ?
Dilutions of 1 to 100 are designated as ?
t/f: the more dilute a homeopathic med is, the stronger it is
Dilutions of what strength have zero active ingredient molecules in them?
more than 24X or 12C
t/f: dietary supplements are required to be safe, but not effective
What is required to be on a natural medicine label?
product name + the word
manu. name and location
directions for use
facts panel with serving size
plant-based product has to include scientific name
Which natural med product claim is not required by the FDA to be on the label?
This group verifies that a product contains the labeled ingredients and that contaminants and unlisted ingredients are not present in a natural med?
NSF (national sanitation foundation intl)
This is an independent company that tests products?
Which population (race) uses CAM the most?
American Indians and Alaskans, then whites
What natural meds are used for cardio system?
red yeast rice
what are the uses for CoQ10?
aids immune function in HIV
may lower BP
This natural supp is a vitamin-like compound, acts as an antioxidant, membrane stabilizer, cofactor for ATP?
t/f: odorless garlic products are inactive
What is in garlic that makes it pharmaco effective?
This natural supp may cause smooth muscle dilation by activating NO and reduces oxidative stress and inhibits LDL oxidation?
What would you use garlic for?
Pregnant women or someone taking aspirin or warfarin should not take this cardio supp?
what type of fatty acids are omega 3 and omega 6?
Why do we want more omega 3 than 6?
b/c 6 has pro-inflammatory effects
Where do we get omega 3 fa from?
fatty fish oils (long chain, EPA/DHA)
What type of omega 3 do we want for a cardio benefit?
long-chain polyunsaturated w/ EPA and DHA (but focus is on EPA)
What is a good protective dose of fish oil against cardiac events?
What is a good treatment dose of fish oil for lowering TGs?
What is a good dose of fish oil for decreasing atherosclerosis and antiarrhythmic?
t/f: there is enteric coated fish oil
t/f: contaminants like mercury in fish oil are a major concern
t/f: Eating a diet with 1-2 servings of oily fish per week is enough to have cardiac protection
Is flaxseed a long or short-chain omega 3?
What is found in short chain omega 3?
Why do we not recommend flaxseed as a supplement?
has too many calories
can increase TGs by 10%
Which cardiac supp is absolutely contraindicated in pregnancy?
red yeast rice
What prescription drug is red yeast rice similar to?
This supp has cholesterol lowering effects?
red yeast rice
How does hawthorn work?
increases membrane perm for calcium and inhibits PDEs, increases cAMP, increases coronary blood flow, increases vasodilation
t/f: it is best not to recommend hawthorn
the flowers and leaves of this cardiac supp contain chlorgenic acid and flavonoids?
What supps might we use for the nervous system?
Which nervous system supp contains flavonoids, terpenoids, and organic acids?
This NS supp has antioxidant props and neural and retinal protective effects?
t/f: ginkgo is only recommended for folks who already have dementia or memory loss.
t/f: healthy elderly patients probably should not take ginkgo
What uses does ginkgo have other than for dementia?
t/f: roasted or fresh ginkgo seeds are safe to use
What drug should you not take with ginkgo?
Which supp naturally regulates circadian rhythm, endocrine secretions, an sleep patterns?
_______ inhibits melatonin secretion?
This supp is effective for jet lag, the blind, mentally retarded, autistic, or other CNS disorders?
What dose of melatonin should you take for eastbound jet lag?
0.5-5 mg at local bedtime
Women who are trying to get prego should not take this NS supp b/c will inhibit ovulation or decrease gonadal development?
What does 'wort' mean?
t/f: SJW may contain melatonin
Hyperforin and adhyperforin are found in which NS supp and these modulate the effects of serotonin, dopamine, and NE?
This supp can be considered a good option for mild, short-term depression?
This supp is often used in conjunction with SJW for menopausal women?
This NS supp is used for insomnia, sedative-hypnotic, anxiolytic, antidepressant, anticonvulsant and antispasmodic effects?
This NS supp may bind directly to GABA receptors?
What is the typical dose of valerian when used for insomnia?
400-900mg 2 hours before bedtime
This NS supp can reduce time to sleep onset and improve sleep quality?
T/F: some people may not see sedative effects from valerian (flippers) and may actually get excited
This NS supp seems to be effective for depression and fibromyalgia, but can also cause EMS (eosinophilia myalgia syndrome)?
What is chamomile used for?
This NS supp contains a flavonoid called apigenin which is similar to BZD ligand?
Which NS supp which is a vitamin might help ameliorate migraines?
What NS effect would CoQ10 potentially have?
What supps would we use for digestive health?
What digestive supp is considered the first line treatment for N/V in prego women?
What is the dose of B6 for N/V in prego women?
25 mg q 8 hours
Which digestive supp is similar to Zofran and may increase GI motility and act on serotonin receptors?
What is the dose of ginger to be used for N/V/morning sickness in prego?
250 mg QID
What two conditions is ginger likely effective for and what condition is it likely ineffective for?
: morning sick, post op N/V
: motion sick
t/f: pyridoxine may be safer than ginger for prego women
What is most commonly used part of milk thistle used?
What do we use milk thistle for?
alcohol related liver disease
this digestive supp has silymarin in it, which is a potent inhibitor of TNF, blocks cytotoxicity, inflammation and apoptosis, is an antioxidant, and is especially selective for liver cells?
This digestive supp may inhibit histamine release, is an antispasmodic due to direct relaxing effects on GI smooth muscle, and if applied topically can inhibit pain receptors b/c it contains menthol?
What do we use peppermint for?
enema related colon spasms
This digestive product can be used orally, topically or rectally?
Since peppermint can cause heartburn, what should we tell the patient?
take enteric coated
This digestive supp is used for patients on long term opioid therapy.
What do we use senna for?
constipation (esp w/ opioids)
bowel preparation before colonoscopy
These digestive supps are prodrugs that get activated by bacterial enzymes in the colon.
t/f: prego women can use senna
This digestive supp can cause ab pain, cramps, bloating and depletion of electrolytes?
What supps do we use for the endocrine system?
alpha lipoic acid
What do we use alpha lipoic acid for?
peripheral neuropathy (pain, numbness, burning)
What do we use ginseng for?
diabetes to reduce post prandial glucose in Type 2 DM
resp tract infections (colds, flu)
Should we use ginseng with warfarin?
What do we use DHEA for?
What are some side effects of DHEA?
This supp was banned by NCAA for stimulant-like activity?
This supp has had quality control problems and is endogenously produced from our adrenal glands and liver?
t/f: DHEA is possibly unsafe when taken orally in high doses for a long time
Name some immune stimulants/performance enhancers.
What is the most commonly used natural supplement?
What do we use echinacea for?
reducing symptoms of cold
What substances does green tea contain?
What do we use green tea for?
anti-inflammatory in airway
hyperlipidemia (lowers TG and cholesterol)
What 3 strains of bacteria do we have the most evidence of probiotic effectiveness for?
What functions does the flora in our GI have?
prevent overgrowth of bad bacteria
produces vitamins B and K
break down food
Which probiotic found in Activia helps improve slow intestinal transit?
Which probiotic is the most effective?
lactobacillus (Acidophillus) (Culturelle)
Which probiotic is most effective at treating C. diff?
saccharomyces boulardi (Florastor)
t/f: probiotics are safe in pregnancy and breastfeeding
t/f: probiotics are safe to use in the immunocompromised
Which supp may decrease symptoms of the flu by 0.28 days?
What are the potential harms of cleansing?
Who should absolutely avoid cleansing?
recent bowel sx
What 2 supps do we use for kidney, urinary and prostate health?
t/f: cranberry acidifies the urine
t/f: cranberry capsules are effective
false; use juice
What chemicals does cranberry contain?
: interfere w/ bacterial adherence to urinary tract epithelial cells
: anti-inflammatory and anti-platelet
t/f: cranberry can be used to
false; only to prevent
t/f: cranberry can interact with warfarin
Which product was thought to decrease prostate growth/inflammation?
What 2 supps do we use for skin and mucous membrane health?
tea tree oil
What do we use tea tree oil for (in relation to skin)?
acne (less irritating even though slower acting)
onychomycosis (fungal toenail infection)
What 2 non-herbal OTCs is tea tree oil comparable to?
5% benzoyl peroxide
What do we use aloe vera for?
this skin supp could cause menstruation and abortion if taken in too high of an oral dose?
What is the most common supp used for hot flashes?
Do not use this supp b/c of estrogen-like effects, possible liver damage and miscarriage of pregnancy?
Should we recommend phytoestrogens like soy, red clover isoflavonem, genistein, or daidzein?
no could cause breast cancer
Does soy work to treat hot flashes?
What are the 3 ways to evaluate the significance of drug-supplement interactions?
: level of evidence
Where does grapefruit inhibit CYP3A4?
in the gut
Which supplement has the most documented drug interactions?
What supplement increases the activity of all prodrugs?
What are the top 10 drugs that cause undesirable drug interactions?
If have to take calcium and levothyroxine what is the rule of thumb?
take 4 hours apart
Which supplement can lower the seizure threshold?
Use SJW with caution with what 3 drug classes?
HIV protease inhibitors
Use calcium with caution with what 3 drug classes?
Use ginkgo with caution with what 6 drug classes?
This supplement has replaced Ephedra as a weight loss supp?
Which supp should you not take with anti-arrythmics b/c might cause QT prolongation?
What supp could cause hyperkalemia if taken with ACE inhibitors or spironolactone or in patients with renal dysfunction?
this supp is linked to hepatoxicity especially when combined with other hepatotoxic drugs like statins, ketoconazole, lamisil, methotrexate and tylenol?
Which two supps should the elderly avoid if they are on warfarin or aspirin?
Why is black cohosh bad for inducing labor?
causes heart failure in neonates
What is the biggest opponent to the tobacco control efforts?
tobacco industry itself
Who has the highest rate of tobacco use?
t/f : nicotine is the addictive component of tobacco products, but it does not cause the ill health effects
t/f: there are safer levels of second hand smoke
What are some major health consequences of smoking?
poor surgical outcomes
t/f: separating smoking areas, cleaning the air, and using ventilation are effective at protecting non-smokers from second hand smoke
What are the major health consequences of using smokeless tobacco?
: bone attachment loss, dental caries, gum recession
: white spots
: oral, pharyngeal
t/f: there is no statewide law regarding smoke-free workplaces in wyoming
where is the lowest tax placed on cigarettes?
Where is the highest cost for one pack of cigarettes?
About how much sooner do cigarette smokers die than non-smokers?
10 years earlier
What are the different types of tobacco?
Among folks who continue to smoke, how many will die due to a tobacco-related disease?
How many adults are current smokers?
What is the most common form of tobacco used in the U.S?
What is the amount of nicotine contained in each cigarette?
t/f: snuff smokeless tobacco is on the rise
What does the risk of smoking tobacco look like for pipes, cigars, cigarettes?
cigarettes> cigars = pipes
Which form of tobacco has twice the tar and nicotine of a standard cigarette?
Which form of tobacco has three times higher levels of carbon monoxide and nicotine and five times higher levels of tar than a standard cigarette?
What does PREPs stand for?
Potentially reduced exposure products
What are some noncombustible tobacco products?
Do PREPs reduce the risk of developing tobacco-related disease?
Where do we get the highest absorption of tobacco?
in alkaline media
At what pH is nicotine readily absorbed?
What is the pH of the mouth?
What kind of effects does nicotine predominantly have?
t/f: nicotine is readily absorbed across skin and small intestine
how long does it take nicotine to get to the brain?
What is the half life of nicotine?
How is nicotine excreted?
What are the 3 main contributing factors to tobacco use?
Which pathway in the brain does nicotine activate?
dopamine reward pathway
What drugs may have a decreased effect due to induction of CYP1A2?
Which drug will have an increased effect if used while smoking?
t/f: smoking decreases the efficacy of oral contraceptives
Which women are at a significantly increased risk of stroke, MI, or thromboembolism?
35 or older AND
smoke at least 15 cigarettes per day
What are the 5 A's of smoking cessation?
What are the most effective ways to quit smoking?
counseling + medications
What are the 3 FDA approved drugs for smoking cessation?
partial nicotinic receptor agonist
nicotine replacement therapy
What prego category are wellbutrin and chantix?
What prego category is NRT?
t/f: NRT should be recommended for smokeless tobacco user
How much does NRT affect quit rates?
doubles quit rates
t/f: patients should stop using all forms of tobacco upon initiation of the NRT regimen
Who needs to be supervised when using NRT?
Which NRT is most like smoking a cigarette?
Nicotrol NS nasal spray
What doses does nicotine gum come in?
2 and 4 mg
How many cigarettes would someone smoke if you are going to give a 2 mg nicorette gum?
less than 25/day
What dosage of nicorette gum would you recommend for someone smoking more than 25 cigs per day?
What is in the resin complex of nicorette gum?
What is max number of pieces of gum you can chew in a day?
Do not eat or drink for how long before using nicorette gum or a lozenge?
What is Commit and Nicotine Mini?
Which NRT delivers ~25% more nicotine than the equivalent gum dose?
What is the max number of lozenges to be taken per day?
When should you use a 2 mg lozenge?
if you smoke more than 30 minutes after waking up
To improve chances of quitting, how many pieces of gum or lozenges should you have daily during the first 6 weeks?
what are the dosages of nicotine patch (NicoDermCQ)?
How do we decide what dose of a nicotine patch to give?
less than 10 cigs/day
: 14mg for 6 weeks, 7 mg for 2 weeks
more than 10 cigs/day
: 21mg for 6 weeks, 14 mg for 2 weeks, 7 mg for 2 weeks
What should we remove before an MRI?
One dose of nicotrol NS nasal spray contains how much nicotine?
How many doses are in a bottle of nicotine nasal spray?
100 per nostril so 200 sprays
How much nicotine does the nicotine inhaler have?
4 mg of vapor
What is the min and max amount of cartridges of the nicotine inhaler you should use?
t/f: the mouthpiece for the nicotine inhaler can be reused
true but wash it
How long is an open cartridge of nicotine inhaler good for?
Which NRT avoids food/drink problems?
Patients should begin therapy of what drug 1 to 2 weeks prior to quit date?
Patients should begin therapy of what drug 1 week prior to quit date?
Dry mouth and insomnia are common side effects of what cessation drug?
Seizure risk is increased when taking what cessation agent?
What is the half-life of chantix?
Patients might become agitated, depressed, hostile or have changes in behavior when taking which cessation agent?
Patients taking this cessation drug might give you GI upset or vivid dreams or insomnia?
What natural herbal could be used for smoking cessation?
How does lobeline work?
partial nicotinic agonist
What grade of acne can patients self-treat for?
What are the 5 main causes of acne?
excessive sebum production
abnormal follicular desquamation
What medications can cause acne?
What are the pharmacological treatments for acne?
salicylic acids (beta-hydroxy acids)
tea tree oil
any where on body
under fat folds
tinea unguium (onychomycosis)
What is an immediate exclusion to self care of treating fungal infections?
Candida or other yeasts
What is the most common type of tinea pedis?
What is favus?
patchy areas of hair loss, yellow crusts and scales
can lead to scalp scarring and permanent hair loss
(seen in tinea capitis)
What are the most common agents used to treat fungal infections?
Which antifungal can be used as a preventative measure?
Tuff Actin Tinactin (Tolnaftate)
What is a salt of aluminum that is used to treat fungal infections? (also can also be used for ears)
t/f: you can apply tolnaftate to broken skin
What does fungistatic mean?
prevents bacterial growth
Which antifungal medication is not fungicidal?
What are the 3 phases of wound healing?
How many stages of wound depth are there?
What is another term for whitehead?
What is another term for blackhead?
Can we self treat papules, pustules or cysts on the skin?
no (unless they are not inflamed)
What is grade 1 acne?
closed and open comedones
less than 10 on the face
none on rest of body
t/f: acne medications often make our skin worse before they make our skin better and can take 6-8 weeks to work
What does mild acne look like?
non-inflammatory papules or pustules
What are some exacerbating factors for acne (not causes)?
oil based beauty products
exposures to dirt, chemicals, cooking oil, tar
increased androgen levels (PCOS, preg, meds)
Does chocolate cause acne?
no, nor do any other foods
What are some exclusions for self treating acne?
moderate to severe acne present
drug induced acne
contributing disease state present
What are the adverse side effects of benzoyl peroxide?
What are the OTC strengths of benzoyl peroxide?
What are the Rx strengths of benzoyl peroxide?
This acne treatment can be bactericidal and keratolytic?
This acne treatment is comedolytic and keratolytic.
salicylic acid (beta hydroxy)
Who is contraindicated to take salicylic acid?
What are the OTC strengths of salicylic acid?
This acne treatment exfoliates and tingles?
What are the OTC concentrations of alpha-hydroxy acid?
This acne treatment may only be good for reducing scarring and uses glycolic, lactic and citric acids?
Which acne treatment should African Americans avoid?
Which acne product seems to be most efficacious (dosage form)?
t/f: if baby has acne, we can treat it with drug products
false; use soap and water BID
What are the organisms most commonly involved in causing funal infections?
What is the most prevalent fungal infection?
When should you change a wound dressing?
when it is dirty or no longer intact
t/f: antiseptic is recommended when self treating a wound
What should we use to irrigate wounds?
soap and water
What are some examples of antiseptics?
Which topical antibiotic works against gram negative bacteria?
Polymyxin B Sulfate
Which topical antibiotic might get resistance to develop?
This topical antibiotic could potentially cause ototoxicity or nephrotoxicity if too much is used?
this topical antibiotic increases rate of hypersensitivity and allergies?
T/F: both neomycin and polymyxin B sulfate work against gram negative bacteria
true, but neo also on staph
This fungal infection must be treated w/ systemic antifungals or pro nail removal?
In general, should we recommend hydrogen peroxide?
Which antiseptic can be used as a douche or wound irrigant and is not irritating?
This antiseptic is effective against protozoa, fungi, bacteria, spores, viruses and yeast?
Which topical antibiotic is used to fight gram positive bacteria?
How many days should you give a wound to heal before you call your PCP?
This type of tinea pedis has fissuring, scaling, or maceration in the inter-digital spaces, bad odor, itching and stinging sensation?
This type of tinea pedis usually involves the lateral toe webs and typically spreads to the sole or instep of the foot and gets worse in warm, humid environments?
This type of tinea pedis usually presents on both feet and has mild inflammation, diffuse moccasin-like scaling on the soles of the feet?
If patient has tinea pedis and tinea onychomycosis/unguium, what do you treat first?
this type of tinea pedis shows small vesicles near the instep or mid-anterior plantar surface and has skin scaling in the toe webs?
This type of tinea pedis is aggravated in summer and dormant in cooler months?
This type of tinea pedis is complicated by bacteria such as proteus and pseudomonas, gives a pungent odor, white hyperkeratosis, maceration, weeping ulcerations on the sole, and may be painful?
This type of fungal infection is not really a medical emergency but shows symptoms like opaque, yellow, thick nails, nail separation, or nail falls off?
What are the symptoms of tinea capitis?
lesions around hair shaft
hairs turns dull gray, breaks off at scalp
enlarged lymph nodes
t/f: we can self treat a nail or scalp fungus
What is the typical duration of therapy for antifungals?
Clotrimazole and Miconazole
Salts of Aluminum
t/f: salts of aluminum have antifungal properties
What are salts of aluminum approved and most useful for?
astringent and antiinflammatory properties
dry out soggy tinea pedis'
What dosage form is the most effective antifungally?
How long does the inflammatory wound healing phase take?
How long does the proliferative wound healing phase take?
How long does the maturation wound healing phase take?
a long time
happens after 3 weeks
What are some disease states that have poor vascularization and may take longer to heal a wound?
What are some meds that will slow wound healing?
What factors contribute to good or poor wound healing?
What two factors do we use to classify a wound?
What are the main goals of wound care (3)?
moisture of wounds?
moisture of wounds?
moisture to a wound?
t/f: we should ace this test