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  1. What is one of the top 25 reasons women seek medical care
    Vaginal discharge
  2. Three most common vaginal infections
    • Bacterial vaginosis - most common
    • Trichomoniasis
    • Vulvovaginal candidiasis
  3. What promotes the epitherlial cells lining the vagina
    Estrogen
  4. Stored in the epithelial cells promoted by estrogen is what
    glycogen
  5. Glycogen interacts with Lactobicillus to form what
    lactic acid
  6. The presence of this creates an acidic pH in the vagina that provides protection against infection
    lactic acid
  7. What event causes estrogen levels to fall having a direct influence on vaginal pH and Lactobacilli
    Menopause
  8. Six organisms that are normal flora in the vagina
    • Corynebacteria
    • Staphylococcus epidemidis
    • Gardnerella vaginalis
    • Peptostreptococcus
    • E. Coli
    • Lactobacillys
  9. Six factors affecting vaginal environment
    • Hormanal fluctuations
    • Aging
    • diseases
    • medications
    • douching
    • # of sex partners
  10. What is the amount of healthy, daily vaginal discharge
    • 1.5gm
    • clear/white
    • odorless
    • viscous/sticky
  11. What is the common name for Vulvovaginal Candidiasis
    yeast infection
  12. yeast infection - what percent of women by 25 will have one episode.
    50%
  13. what is the causative agent of yeast infection
    candida albicans (80-90%)
  14. Seven risk factors of yeast infection
    • Pregnancy
    • Menopause
    • menstruation
    • broad spectrum antibiotics
    • immunosuppressant drugs
    • IUD
    • vaginal sponge
  15. six s&s of yeast infection
    • thick, whitish "cottage cheese" discharge
    • no odor
    • dysuria
    • normal pH
    • will usually occur before menses and improve during menses
    • itching, redness, vulvar edema
  16. Treatment goals of VVC
    Relif of symptoms, eradication of infection, reestablishment of normal vaginal flora
  17. 4 Nonpharacologic therapy of VVC
    • Yogurt
    • discontinue broad spectrum antibiotic immunosuppressant
    • oral contraceptive drug free period
  18. What nonpharmacological therapy is used for resistant candida infections
    gentia violet
  19. What nonpharmacological therapy can be fatal if ingested and should not be used by pregnant women
    boric acid
  20. 3 candidates for self treatment of VVC
    • vaginal symptoms are infrequent (uncomplicated)
    • at least one previous episode of VVC was medically diagnosed
    • current symptoms are mild to moderate, nonmalodorous discharge
  21. 4 OTC medications that treat yeast infection.
    • butoconazole - gynazle
    • clotrimazole - clotrimax, atopalm
    • miconazole - alovest, baza
    • tioconazole - vagistat 1
  22. MOA of vaginal antifungals
    Imidazole compounds alter fungal membranes resulting in lyses
  23. Indications of vaginal antifungals
    FDA approved for local treatment and external itching/irritation associated with infection.
  24. what are three adverse reactions of antifungals
    • initial burning
    • itching/irritation
    • headache
  25. What could be a DI with vaginal antifungals
    coumadin
  26. What two treatment options are not advantageous over antifungals.
    • vagisil - benzocaine
    • yeast gard
  27. 6 situations when you would refer a patient with VVC
    • pregnancy
    • girls < 12 yo
    • concurrent symptoms; fever or in pain in the lower abdomen, back and shoulder
    • medications that can predispose to VVC: corticosteroids, angiplastics
    • medical disorders that predispose women to VVC: DM, HIV infection
    • recurrent VVC ( >3 vaginal infections pre year or vaginal infection in past 12 months)
  28. 7 nonpharmacologic therapies for VVC (not recommended)
    • Lactobacillus acidophilus preparations
    • douches
    • sodium bicarbonate sitz bath
    • garlic
    • tea tree oil
    • gentian violet
    • boric acid
  29. 3 counseling points for VVC
    limiting self treatment to appropriate circumstances (mild to moderate symptoms, infrequent vaginal symptoms, predicatble antibiotic associated VVC)

    seeking medical evaluation if symptoms persis beyond a week after treatment, recur within 2 months, or vaginal symptoms occur > 3 times in 12 months

    symptoms should improve in 2-3 days and resolve within a week of treatment
  30. Nonpharmacologic treatment used for non C. albicans infections
    boric acid
  31. What vaginal infection is caused by polymicrobic anaerobic organisms
    Bacterial vaginosis (BV)
  32. 3 main signs and symptoms of BV
    • 1/3 to 1/2 of women are asymtomatic
    • fishy odor
    • disharge - watery
    • - white, grey, yellow or green
    • - increased volume
  33. The most common Tx for BV
    antibiotic
  34. 3 situations when to refer for BV
    • pregnant or chance of becoming
    • history of vaginosis that was treated with prescription antibiotics
    • underlying medical conditions that may complicate therapy
  35. epidemilogy of Trichomniasis -3
    • transmitted via sex
    • women are asymtomatic
    • men are asymtomatic resovoirs
  36. 4 S&S of Trichomniasis
    • frothy and foamy discharge
    • yellow-grey-green discharge
    • dysuria
    • vulvovaginal irritiation
  37. Treatments options for Trichomoniasis
    • prescription only
    • treat sex partners also
    • REFER
  38. What is the usefulness of OTC pH testing kits
    reduces inappropriate use of antifungals
  39. Inflammation of vagina due to atrophy of vaginal mucosa secondary to declining estrogen levels. post menopausal disorder
    atrophic vaginitis
  40. What disorder could present as a yeast infection
    atrophic vaginitis
  41. S&S of atrophic vaginitis
    • initially - dyspareunia, irritation, burning
    • watery, yellow (bloody), malodorous discharge
    • sexual activity may lead to bleeding or spotting, because of dryness
  42. 3 counciling points of atrophic vaginitis products
    • may apply as often as needed, use liberally
    • remind women who are postpartum or breast feedig that the dryness will be shor term
    • which products can be used with condoms and diaphragms - oil based
  43. what days of the menstrual cycle is dysmenorrhea the greatest
    first and second days, increased levels of prostaglandins and leukotrienes causing increased uterine contractions
  44. what is the difference between primary and secondary dysmenorrhea and which one needs referal
    • Primary - idiopathic cramp-like pain at time of menstruation
    • Secondary - pain other than associated with menstruation. REFER
  45. what otc is more preferred in women with dysmenorrhea
    ibuprofen
  46. etiology of PMS
    due to fluctuating levels of estrogen/progesterone
  47. patholphysiology of PMS
    decrease in serotonin assiciated with irritability and food cravings
  48. Nonpharmacologic treatments of PMS
    • exercise
    • diet - avoid alcohol and caffeine
    • - foods rich in tryptophan ( precursor to serotonin, help with mood.
  49. two factors that cause fluid retention
    • redistribution
    • retention
  50. 3 FDA approved diuretics for PMS
    • ammonium chloride
    • caffeine
    • pamabrom
  51. 5 counciling points of PMS
    • stress the improtance of stress reduction techniques and diet
    • rule out other conditions with same symptoms that would warrant referral
    • recommend medicaions to treat symptoms of dysmenorrhea
    • recommend appropriate OTC therapy
    • refer to PCP if symptoms don't improve or worsen
  52. Dysmenorrhea dosing for APAP, ASA, and ibuprofen, naproxen sodium
    • 650-1000mg q4-6h (3000mg)
    • 650-1000mg q4-6h (4000mg)
    • 200-400mg q 4-6h (3200mg)(1200mg) OTC
    • 220-440mg initially, then 220mg q8 - 12h (660mg)
  53. PMS when to refer
    • severe symptoms
    • symptoms not timed with menstrual cycle
    • onset of symptoms coincide with use of OC's or HRT
    • contraindications to OTC products
    • previous unsuccessful OTC treatment
    • relative contraindications (age less than 18 years)
  54. Main cause of toxic shock syndrome
    high absorbency tampons
  55. S&S of toxic shock syndrome - 6
    • malaise, myalgia, chills
    • high fever
    • decreased urine output
    • cardiac failure
    • skin dysquamination
    • hypotension and shock
  56. what can reduce the risk of toxic shock syndrome to 0%
    using pads instead of tampons
  57. Predisposiing factors for toxic shock syndrome
    • elevated vaginal temperature and neutral pH
    • retention of blood by tampon serves as bacterial medium
    • tampons that inhibit lactobacillus and promote toxin production
    • menses and tampons cause micro trauma to baginal that may allow introduction of toxin into systemic circulation
  58. What is the dosing of Ammonium chloride for PMS. and some adverse effects
    • Oral up to 3 g/day in divided doses, no more than 6 days in a row.
    • GI
    • nervous system
    • CI in patients with renal or liver impairment
  59. What is the safe dosing range of Caffeine (Xanthine) for PMS
    100 - 200mg q3-4h
  60. What is the dosing of Pamabrom of PMS
    up to 200mg/day (50mg QID)
  61. What is in the combination product Pamprin, for PMS
    • pamabrom 25mg
    • magnesium salicylate 250mg
    • acetaminophen 250mg
  62. What is in the combination product midol, for PMS
    • caffein 60mg
    • acetaminophen 500mg
    • pyrliamine maleate 15mg
  63. During what period of pregnancy would drug exposure effect organ development
    5 - 10 weeks
  64. What is the dose of folic acid pre-pregnancy, and for high risk women
    • 400mcg/day
    • 4000mcg/day beginning 1-3 months prior to pregnancy and during 1st trimester
  65. Very few drugs are teratogenic, but when is the critical exposure period
    first trimester - physical transformation seen more frequently during weeks 2-8, and functional/behavioral changes seen during exposures late in pregnancy.
  66. What is the safest OTC pain reliever in pregnancy and the dosing.
    • acetaminophen
    • < 4000mg/d
    • ex 500 bid - tid
  67. Safest OTC antihistamine in pregnancy
    • loratadine or certrizine
    • < 10mg/d
  68. Safest OTC decongestant in pregnancy, but avoid in first trimester
    • pseudoephedrine
    • <240mg/d
  69. cough remedy that appears safe in pregnancy
    • dextromethorphan
    • <120mg/d
  70. four lifestyle changes for cough/cold in pregnancy
    • humidifier
    • saline spray
    • fluids
    • vitamin c
  71. Antidiarrheal probably safe in pregnancy
    • loperamide
    • < 16 mg/d
  72. When do we REFER in pregnancy diarrhea cases
    if > 24-48 hours
  73. Antifungal that is probably safe in 2nd and 3rd trimester
    • clotrimazole
    • 5g, 100mg, 200mg
    • data is lacking in antifungals avoid if possible especially in the 1st trimester
  74. Three lifestyle modification for yeast infection
    • cranberry juice - prevenative health
    • sitz baths - soothing
    • yogurt
  75. Lifestyle changes for acid reduction
    • elevate head of bed 6 inches
    • dietary changes
    • decrease weight
    • avoid smoking
    • eliminate alcohol
    • avoid tight clothes
    • avoid high fat meals/ eat small meals more frequently
    • avoid lying down until 3 hours after eating
    • concurrent medications
  76. What antacid should you avoid in pregnancy
    nizatidine - axid
  77. Firs line antacid for pregnancy
    • famotidine - pepcid
    • < 80 mg/d
  78. First line antacid for pregnancy
    • famotidine - pepcid
    • < 80 mg/d
  79. Recommended antacids in pregnancy
    • AIOH/MgOH
    • simethicone
    • CaCO2
    • ranitidine
    • famotidine
  80. First line supplemnetal defense of N/V in pregnancy
    • B6
    • 25 mg QD - TID
  81. What could B6 be combined with for N/V in pregnancy, 2nd line.
    • doxylamine
    • 25 mg QD
  82. Three treatments of N/V in pregnancy, general
    • sea bands
    • fluids
    • rest
  83. Three general treatments of constipation in pregnancy
    • Increase dietary fiber
    • exercise
    • drink suficient fluid
  84. Four main pregnancy complications that need to be refered
    • Gestational diabetes
    • preeclampsia
    • headache
    • UTI
  85. Three main pregnancy complications that need refered
    • Deep vein thrombosis
    • pumonary embolism
    • incontinence
  86. Are drugs that are safe in pregnancy safe in breast feeding?
    No
  87. Which lactation rating of OTC medications is the safest?
    L1
  88. Which home pregnancy test can detect lower levels of hCG (15mIU/ml)
    Lifesign1
  89. Two times when meds could be taken when breastfeeding
    • Immediately following nursing session
    • Right before infant's longest nap of the day
  90. Two methods to determine efficacy of contraceptives
    • accidental pregnancy rate in the first year of perfect use
    • accidntal pregnancy rate in the first year of typical use
  91. Which composition of male condoms is not as snug of a fit
    polyurethane
  92. which composition of male condoms is porous and conducts heat better
    lamb cecum
  93. which composition of male condoms can cause allergic reactions
    latex
  94. male condoms effectiveness; failure rates
    • typical use 15%
    • perfect use 2%
  95. seven couseling points for male condoms
    • polyurethane condoms not as elastic as latex, space must be left at the tip
    • use proper lubrication
    • average shelf life 3-5 years
    • protect from heat, overexposure to ozone
    • discard if discolored, brittle, sticky
    • counsel on alternative polyurethane condoms if latex sensitivity exists
    • try different products (patients may be sensitive to spermicide)
  96. What is the only female condom FDA approved
    • FC by reality
    • polyurethane
  97. What is the failure rate for female condoms
    12.4%
  98. Is conjunction of male and female condoms recommended
    no
  99. Largest complaint of female condoms
    increased vaginal irritation and noise
  100. Main vaginal spermicides
    nonoxynol-9
  101. Doses of nonoxynol-9 in gels, foams,suppositories, and film
    • 12.5%
    • 12.5%
    • 3%
    • 28%
  102. What is a big counseling point of the vaginal contraceptive film
    there is a cleansing film that is very similar
  103. What is the FDA issued warning label for nonoxynol-9
    spermacides irritate mucosa and increases possibility of transmission of infections, HIV/AIDS
  104. are vaginal spermacied effective in prevneting STI's
    No
  105. Three available contraceptive sponge products
    • today
    • protectaid
    • pharmatex
  106. Three MOA of contraceptive sponge
    • serves as a physical barrier
    • contains spermicide
    • absorbs semen
  107. Failure rate of first use contraceptive sponge use
    17.4-24.5%, higher in women who have had children previously
  108. a safety concern with the contraceptive sponge
    associated with increased risk of toxic shock syndrome
  109. six natural contraceptives
    • natural family planning
    • standard days method
    • lactational amenorrhea method
    • home tests for ovulation prediction
    • withdrawal
    • douching
  110. four natural family planning techniques for oral contraceptive
    • calendar method
    • basal body temperature method
    • cervical mucus method
    • symptothermal method
  111. What is the emergency contraceptive product available and doses
    • Plan B one step, next step
    • 1.5 and 0.75 mg tablets levonorgestrel
  112. Three points to know of Plan B
    • must be 18 yo to purchase
    • kept behind the pharmacy counter
    • side effects N/V, if this happens within one hour then repeat the process
  113. What does the dilution of 1X of a homeopathic agent mean
    The ration of active to nonactive molecules, 1:10
  114. What does the dilution of 1C of homeopathic agents mean
    The ratio of active to nonactive agents, 1:100
  115. What dilutions in X and C of homeopathic agents contain 0 molecules of the original acitve ingredients
    24X, 12C
  116. What organizaion regulates natural medicines
    DSHEA - dietary supplement and health education - 1994
  117. Dietary supplements are regulated by the FDA under what
    CFSAN - center for food safety and applied nutrition
  118. Natural medicines must have proof of efficacy and safety prior to marketing
    no, only safety
  119. are products sold prior to October 15, 1994 required to be reviewed for safety
    no
  120. who could possibly be exempt from natural medicine good manufactoring practice's
    small manufacturers, because they don't have the resources to meet compliance guidlines
  121. four label requirements for natural medicines
    • name of product as well as word supplement
    • quantity of contents
    • manufacturer's, packers, or distributers's name and place of business
    • directions for use

    • also if plant based must include scientific name
    • must contain facts panel that descrobes serving size
  122. Three types of product claims for natural medicines and which ones requires FDA approval
    • health claim - relationship between ingredient and reduction of risk of disease or health-related condition
    • nutrient content claim - relative amount of substance in a product
    • structure-function claim - how a product may maintain the normal healthy structure of function of the body
  123. A big concern for product quality of natural medicines
    many brands do no contain the quantity of product listed on the label, contaminants vary
  124. What two programs evaluate supplements
    • US Pharmacopeia dietary supplement verification program - USP
    • National sanitation foundation international NSF
  125. Stated uses of coenzyme Q10, and cautions
    heart failure and lower blood pressure

    statin induced myopathy
  126. stated uses of garlic and cautions
    • atherosclerosis
    • hypertension
    • tick bites
    • ringworm, jock itch, athletes foot


    • GI - N/V, heartburn
    • avoid in pregnancy
    • topical can cause irritation/burn
    • possible antithrombotic effects - w/ NSAID & warfarin
  127. Do we supplement omega 6
    no
  128. stated uses of fish oil and cautions
    • dietary intake - lower risk of sudden cardiac death and CHD
    • low dose - decrease progression of coronary atheroscierosis
    • higher doses - lower TG levels, lowers BP, lower resting HR

    fishy burps, upset stomach, greasy stools
  129. protective dose of fish oil
    < 1 gram/day
  130. What dose of fish oil lowers TG levels by 25-30%
    3-4 grams/day
  131. Three facts about flaxseed
    • may increse TG's by 10%
    • not a substitute for fish oil, 40 grams contains 200 calories
    • best as part of a healthy diet, not as a supplement
  132. What medication does red rice yeast often contain and contraindicated in
    • statin (lovastatin)
    • pregnancy

    cholesterol lowering effects due to other constituents
  133. Stated use of Hawthorn and cautions
    heart failure

    • vertigo and dizziness
    • palpitations
  134. stated use of ginkgo and cautions
    age-related memory impairment

    • won't stop dimentia, if dimentia is already present, might help.
    • if healthy older person --> no effects
    • cases of minor to sever bleeding
  135. What ginkgo seeds are toxic
    roasted or fresh seed
  136. What endogenous hormone regulates circadian rhythm
    melatonin
  137. stated use of melatonin and cautions
    • jet lag
    • circadian rhythm sleep disorder


    unsafe for children and pregnant women
  138. stated use of ST. John's wort and cautions
    • depression
    • menopausal symptoms

    • interacts with everything
    • 2-4 grams/day increases risk of photosensitivity
  139. stated use of valerian and cautions
    insomnia (400-900mg 2 hours before bedtime)


    • headache, excitabilty, morning drowsiness
    • flippers
  140. what natural medicine for sleep disorder, depression and anxiety do we not recommend
    5-hydroxytryptophan
  141. What oral rinse natural product may help prevent chemo-induced mucositis
    chamomile
  142. Which vitamin and the dose reduces the frequency of migraines
    • B2 (riboflavin)
    • 400mg/day
  143. what vitamin helps in pregnancy induced nause and vomiting, and the dose
    • B6 (pyridoxine)
    • 25mg q 8 hours
  144. stated use of ginger and cautions
    • morning sickness
    • post op N/V


    controversial in pregnancy
  145. stated use of milk thistle and cautions
    • antioxidant
    • diabetes
    • dyspepsia

    • laxative effect
    • allergic reactions may occur
  146. stated use of pepperming and cautions
    • antispasmotic
    • dyspepsia
    • tension headache

    • heartburn
    • no long term safety data
  147. stated use of senna and cautions
    stimulant laxatives - long term opiate therapy (first choice)

    • long term use can lead to laxative dependency
    • safe when used appropriately in pregnancy
  148. which natural product was approved in Germany for treatment of diabetic neuropathy
    alpha-lipoic acid
  149. stated use of ginseng and cautions
    • ginsensides
    • decreases glucose
    • estrogenic activity
    • immunomodulator
    • diabetes
    • respiratory tract infections

    • GI upset
    • insomnia mania
    • blood pressure changes
    • vaginal bleeding
  150. stated uses of DHEA and cautions
    • adrenal insufficiency
    • aging skin
    • osteoporosis

    • acne
    • hair loss
    • voice deepening
    • unsafe long term in high doses - concern of increased risk of prostrate and breast cancer
  151. Most common immune stimulant, natural.
    echinacea
  152. stated use of green tea and cautions
    • mental alertness
    • genital warts
    • may have antiinflammatory activity

    contains significant amounts of caffeine
  153. These are often taken to improve digestion, prevent vaginal yeast infection, treat infections or antibiotic diarrhea
    probiotics
  154. a probiotic, nonpathogenic yeast, that produces proteases that decrease toxicity of C. diff.
    saccharomyces
  155. are probiotics used for immunocompromised patients or pregnancy
    • no immuno
    • yes pregnancy and lactation
  156. homeopathic product with no measurable amount of active ingredient, made of dilution of duck liver and heart extract
    oscillococcinum
  157. 4 skeptical points of cleansing
    • natural bacteria in the colon detoxify food wastes
    • liver neutralizes toxins
    • mucus membrane in colon help keep unwanted substances from reentering blood and tissues

    absolutely avoid
  158. stated uses of cranberry and cautions
    UTI infections - preventative not treatment

    • stick to juice, no proof on capsules
    • consuming > 1 liter/day increases risk for kidney stones
  159. stated use of saw palmetto and cautions
    antiinflammatory

    doesn't work
  160. stated use for tea tree oil and cautions
    • acne
    • onychomycosis (toenail infections)
  161. stated use of aloe vera and cautions
    • psoriasis
    • burns
    • constipation

    • safe to use topically
    • unsafe orally at high doses
  162. the most widely used alternative therapy for hot flashes
    black cohosh
  163. this nature women's health product contains soy products
    phytoestrogens

    doen't work and can have higher rate of hot flashes
  164. a main concern when supplements are used for a particular indication
    can interact with drugs that are also used for that indication
  165. grapefruit inhibits enzymes where, resulting in what
    • gut wall, but not hepatically
    • increased drug peak levels
  166. what product in garlic has an effect on the likely of an interaction
    allicin - decreases drug levels
  167. this supplement binds to drugs in the gut decreasing levels and should be taken 4 hours apart from lovethyroxine
    calcium
  168. this supplement lowers seizure threshholds in patients with or without seizure history
    ginkgo
  169. a big caution point with ginkgo
    increased bleeding
  170. this supplement is generally harmful, prolonged QT with other stimulants, and could cause ventricular arrhythmias. ingredient of choice in weight loss supplements
    bitter orange
  171. supplement that could causse increased potassium in patients with renal dysfunction
    noni juice
  172. supplement linked to many reports of hepatotoxicity
    kava
  173. four special population patients that need our attention
    • elderly
    • pediatrics
    • pregnancy
    • chronic renal disease
  174. What is the new OTC pediatric liquid product standardiszed dose
    160mg/5ml
  175. what is the range of toxicity of acetaminophen
    • > 10 grams --> severe hpatic necrosis
    • < 6 grams considered non toxic
  176. what group of people should use cautio with acetominophen
    alcoholics - can't clear the toxic metabolite produced
  177. 443,595 deaths annually are attributed to what
    smoking
  178. three health consequences of smokelss tobacco
    • periodontal effects
    • gingivla recession
    • bone attachment loss
    • dental caries
    • oral leukoplakia
    • cancer
    • oral cancer
    • pharyngeal cancer
  179. 4 major conclusions of smoking, 2004 surgeon general report
    • smoking harms nearly every organ of the body
    • quitting smoking has immediate as well as long-term benefits
    • smoking cigarettes with lower machine measured yields of tar and nicotine provides no clear health benefit
    • the list of diseases caused by smoking has been expanded
  180. 2006 surgeon general report on second hand smoke. 5 points
    • second hand smoke causes premature death and disease in nonsmokers (children & adults)
    • children - increase risk of SIDS
    • adult - immediate adverse cardiovascular effects, increased risk for coronary heart disease
    • millions of americans are exposed to smoke in their homes/workplaces
    • indoor spaces, eliminating smoking fully protects nonsmokers
  181. four main consequences of smoking
    • cancers
    • cardiovascular diseases
    • pulmonary diseases
    • reproductive effects
  182. at what stage of quitting smoking do you see benefits
    any stage
  183. six forms of tobacco mentioned
    • cigarettes
    • smokeless tobacco
    • pipes
    • cigars
    • clove cigarette
    • bidis
    • hookah
  184. most common form of tobacco used in the US
    cigarettes
  185. what three groups is smokeless tobacco most prevelant
    • 18-25 yo
    • american indians and alaskan natives
    • residents of the southern US and rural areas
  186. ratio of related deaths comparing cigarettes, pipes and cigars
    cigarettes > pipes = cigars
  187. this can deliver enough nicotine to establish and maintain dependence
    cigar
  188. in 2010 an estimated 4.6% of 12th graders in the US reported to smoking what in the past year
    kreteks
  189. These have two times the tar and nicotine as standard cigarettes
    kreteks
  190. What was the main point in the 1988 surgeon generals report
    nicotine is the drug in tobacco products that causes addiction
  191. what is nicotine absorption dependet upon
    pH - readilly absorbed at physiologic pH
  192. Is nicotine absorbed more readily through intact skin or the small intestine
    intact skin, low gi availability because of first pass effect.
  193. is nicotine readily absorbed across respiratory epithelium
    yes, pH 7.4, large surface area, extensive capillary system in lung
  194. how many mg of nicotine is absorbed from each cigarette
    1
  195. time line of nicotine withdrawal effects
    • manifest 1-2 days
    • peak within first week
    • subside within 2-4 weeks
  196. what test is used to assess nicotine dependence
    fagerstrom test - higher scores indicate higher levels of dependence. 1-10, 5 meaning substantial dependence
  197. what two aspects need to be addressed when dealing with tobacco dependence
    • physiological - addiction to nicotine
    • behavioral - habit of using
  198. smokers who use combined hormonal contraceptives have an increased risk of what
    serious cardiovascular adverse effects
  199. what are the odds of quitting smoking with the use of a clinician
    doubled
  200. why should clinicians address tobacco
    failure to address tobacco use tacitly implies that quitting is not important
  201. the five A's of quitting tobacco
    • ask - about tobacco use
    • advise - tobacco users to quit
    • assess - readiness to make a quit attempt
    • assist - with the quit attempt
    • arrange - follow up care
  202. seven nonpharmacological methods to help quit tobacco
    • cold turkey
    • unassisted tapering
    • assisted tapering
    • formal cessation programs
    • acupuncture
    • hypnotherapy
    • massage therapy
  203. three general classes of FDA approved drugs for smoking cessation
    • nicotine replacement therapy
    • psychotropics
    • partial nicotinic receptor therapy
  204. nicorette gum dosing
    • > 25 cigarettes/day -- > 4mg
    • < 25 cigarettes/day --> 2mg
  205. nicorette gum recommended usage schedule
    • weeks 1-6 --> 1 piece q 1-2h
    • 7-9 --> 1 piece q 2-4h
    • 10-12 --> 1 piece q 4-8h
  206. six direction points for nicotine gum
    • chew slowly severaly times
    • stop at first sign of peppery taste
    • park
    • resume chewing when taste fades
    • stop upon arrival of tingle
    • repeat chew/park until most of nicotine is gone generally 30 minutes

    to improve chance of quitting use at least nine pieces of gum a day
  207. general dosing guidlines for nicotine lozenges
    • smoke your first cigarette with in 30 minutes of waking - 4mg
    • smoke your firts cigarette more than 30 minutes after waking - 2mg
  208. nicotine lozenge recommended usage schedule
    • weeks 1-6, 1 lozenge q 1-2h
    • 7-9, 1 lozenge q 2-4h
    • 10-12, 1 lozenge q 4-8h
  209. Transdermal nicotine patch dosing for a light smoker (<10 cigarettes/day)
    • step 2 (14mg x 6 wks.)
    • step 3 (1mg x 2 wks.)
  210. Trandermal nicotine patch dosing for a heavy smoker (>10 cigarettes/day)
    • step 1 (21mg x 6 wks)
    • step 2 (14mg x 2 wks)
    • step 3 (7mg x 2wks)
  211. transdermal nicotine patch side effects in the first hour
    • mild itching
    • burning
    • tingling
  212. transdermal nicotine patch additional side effects
    • vivid dreams or sleep disturbances
    • headache
    • after patch is removed skin may appear red for 24 hours
    • local skin reactions
  213. Is water harmful to the nicotine patch
    no
  214. nicotine nasal spray dosing
    • one dose = 1mg nicotine = 2 sprays
    • start with 1-2doses/hour
    • increase prn to max dosage of 5 doses/hour or 40mg
    • best results = 8 doses/day for first 6-8 weeks
  215. nicotine inhaler dosing
    • 6 cartridges/day during the firs 3-6 weeks
    • increase prn to max. 16 cartridges/day
    • general use 1 cartridge every 1-2 hours
    • gradually reduce daily dosage over the following 6-12 weeks
  216. how long should you not eat or drink before or while using the nicotine inhaler
    15 minutes
  217. a nonnarcotic cessation aid, sustained release antidepressant, & oral formulation
    zyban - bupropion SR
  218. bupropion contraindications
    • patinets with seizure disorders
    • patines taking - wellbutrin or MAO inhibitors in the preceding 14 days
    • patients with a corrent or prior diagnosis of anorexia or bulimia nervosa
    • patients undergoing abrupt discontinuation of alcohol or sedaties
  219. bupropion SR dosing
    • initial - 150 mg po q am x 3 days
    • then - 150 mg po bid, duration 7-12 weeks
  220. varenicline (chantix)dosing
    • day 1-3 - 05mg qd
    • day 4-7 - 0.5mg bid
    • day 8 to end of treatment - 1mg bid
  221. 4 patient education points about chantix (varenicline)
    • take after eating, with a full glass of water
    • nausea and insomnia temp side effects
    • vivid, unusual or strange dreams
    • caution driving machinery
  222. what has the best quit rate for tobacco cessatin long term
    nicotine nasal spray 23.9%
  223. proposed herbal drug for smoking cessation
    lobeling
  224. where can you find out how to treat acne if you don't have your textbook
    academy of dermatology
  225. which form of acne is a closed comedone
    whitehead
  226. what grade of acne can be self treated
    grade 1
  227. what severity classification of acne can be self treated
    mild acne
  228. four main causes of acne
    • sweat
    • puberty
    • hair follicles hat aren't able to shed properly
    • increased number of bacteria that is present in the body
  229. Do not restrict diet for anybody to lower acne, there is no supporting evidence
    true
  230. exclusions to self treatment of acne
    • moderate to sever acne
    • rosacia
    • exasperating factors - drug induced acne, contributing disease state present
  231. how many times should you cleanse your skin daily
    twice, unless you work out then splash water on your face
  232. medications - PIMPLES
    • phenytoin
    • isonazid
    • moisturizers
    • phenobarbital
    • lithium
    • ethionamide
    • steroids
  233. Three examples of mild soaps that can be used to cleanse your face
    dove, cetaphil, aveeno
  234. four pharmacological treatments for acne
    • benzyl peroxide
    • salicylic acids
    • alpha-hydroxy acids
    • sulfur products
  235. Three factors we should be looking at when a patient wants advice on acne products
    • number of pimples
    • shape of skin
    • when they break out
  236. if applying acne medication and it is working, can you apply more to get a better effect
    no
  237. which acne product is keratolytic and can prevent and eliminate development of P. acnes resistance
    • benzyl peroxides
    • OTC - 2.5-10%
    • Rx up to 20 %
  238. which acne product is both comedolytic and keratolytic
    contraindicated in patients with diabetes or poor skin circulation
    limit use to affected area to avoid toxicity
    beta-hydroxy acids
  239. This acne product has exfoliating acids
    maybe helpful after acne controlled to reduce scarring
    OTC concentrations of 4-10%
    alpha-hydroxy acids
  240. this acne product had kerotylic and maybe bactercidal effects
    drawbacks include, smell and colored skin spots
    sulphur products
  241. how long before my acne clears up
    • up to 3 weeks to see improvements
    • max effect, 50-75% imporvement 8-12 weeks
  242. Of the main acne products which one has more of a drying effect
    gels and solutions
  243. four criteria to determine if it is fungal rather than contact dermatitis
    • location - area with excessive moisture
    • presentation - soggy, malodorous, thick vs. scaly, fine with inflammation
    • symptoms - itching pain
    • quantity/severity - typically localized but can spread
  244. five classifications of fungal and location, tinea ____
    • pedis - athletes foot
    • unguim - onychomycosis
    • corporis - body
    • cruris - jock itch
    • capitis - scalp
  245. most prevelant fungal infection
    tinea pedis
  246. four types of fungal infection
    • chronic intertriginous
    • chronic papulosquamous
    • vesicular
    • acute ulcerative
  247. which type of fungal infection is the most common
    chronic intertriginous
  248. which type of fungal infection presents bilaterally
    chronic papulosquamous
  249. which fungal infection, is not the most common, but gets people into the doctor more often because of the nasty odor (bleu cheese x 20)
    acute ulcerative
  250. which classification of fungal infections is commonly found unde skin folds, under breasts or in armpits
    tinea corporis
  251. which classification of fungal infection is represented by "black dots"
    tinea capitis
  252. eight exclusions to self care for fungal infections
  253. No clear causative factor
    • Unsuccessful initial treatment or condition worsens
    • Nails or scalp involved
    • Face, mucous membranes or genitalia involved
    • Signs of possible secondary bacterial infection
    • Condition is debilitating, extensive or very inflamed
    • Diabetes, systemic infection, asthma, or immune deficiency
    • Fever, malaise or both…yikes it might be systemic!
  254. five most common pharmacological treatment for fungals
    • Butenafine
    • Clotrimazole
    • Miconazole
    • Terbinafine
    • Tolnaftate
  255. which fungal treatment is for treatment and prevention
    tolnaftate (tuff actn tinactin)
  256. three phases of wound healing
    • Inflammatory - first 3 days
    • Proliferative -days 3-21
    • Maturation or remodeling - begins approximately three weeks
  257. which disease state attributes to poor wound healing
    Diabetes, hypotension, peripheral vascular disease, congestive heart failure, obesity
  258. two system for classifying wounds
    • acuity - abrasion, puncture, laceration
    • depth - stage 1 -4
  259. describe the four stages of wound depths
    • 1 - redness
    • 2 - blister
    • 3 - full thickness, skin loss
    • 4 - deeper than 3 may involve muscle, tendon or bone
  260. what is the most important factor for wound healing
    moisture
  261. exclusion for treatment of wounds
    • Wound containing foreign matter after irrigation
    • Chronic wound
    • Wound secondary to animal or human bite
    • Signs of infection
    • Redness, warmth, edema, purulent exudate
    • Involvement of face, mucous membranes or genitalia
    • Deep, acute wound
  262. four products that absorb moisture for wound healing
    • foams
    • alginates
    • carbon-impregnated
    • composite dressing
  263. two producst for wound healing that maintain moisture
    • hydrocolloids
    • transparent film
  264. a product for wound healing that provides moisture
    hydogels
  265. three general pharacological treatments for wounds
    • Irrigants
    • Antiseptics
    • Topical antibiotics
  266. what is iodine effective for in wounds
    against bacteria, fungi, virus, spores, protozoa and yeast
  267. three topical antibiotics for wound healing
    • Bacitracin
    • Neomycin
    • Polymyxin B sulfate
  268. which topical antibiotic works against gram postitve bacteria
    bacitracin
  269. which topical antibiotic can increase hypersensitivity
    neomycin
  270. what is the preferred choice for irrigation of wounds
    sterile saline
  271. Visual inspection of wound is important for proper assessment
    If wound worsens or does not improve in 5 days, seek advice from PCP
    Change wound dressing only when dirty or not intact
    If clinical picture is muddy, refer to PCP
    Phone a friend: know your local wound care clinic professionals!!

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