Term
Coenzyme Q10
Vitamin Q
Ubiquinone |
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Definition
2,3 dimethyl-6-decaprenyl benzoquinone
synthesized in mitochondria
Fat-soluble, vitamin-like compound |
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Term
| Dietary Sources of Coenzyme Q10 |
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Definition
| oily fish, organ meats, whole grains |
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Term
|
Definition
| Angina, CHF and Hypertension |
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Term
| Mechanism of Action of Coenzyme Q10 |
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Definition
1. Involved in ATP generation
2. Lipid-soluble antioxidant that is found in LDL-C to limit oxidation
3. Deficiency is related to CV and peridontal disease
-Statins can reduce Coenzyme Q levels by 20-40% |
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Term
| Adverse Effects of Coenzyme Q10 |
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Definition
| Abdominal discomfort, GI distress, headache, and loss of appetite |
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Term
| Drug interactions with Coenzyme Q10 |
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Definition
Warfarin
Drugs that reduce CoQ10 levels:
-HMG CoA Reductase Inhibitors
-Thiazide Diuretics
-Beta-blockers
-Tricyclic antidepressants
-Sulfonylureas
-Chemotherapy drugs |
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Term
| Dosing range of Coenzyme Q10 |
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Definition
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Term
| Clinical evidence for Coenzyme Q10 |
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Definition
Hypertension:
No evidence
Congestive Heart Failure:
300 mg daily for 3-6 months
Myocardial Infarction:
120 mg/day for one year - improved 24%
Ischemic Heart Disease:
Improved HDL and exercise tolerance |
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Term
| Dietary Sources of Fish Oil |
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Definition
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Term
|
Definition
Decreases inflammation:
Crohn's Disease, Rheumatoid Arthritis, Skin disorders, Cardiovascular disease
Lowers lipid levels:
Triglycerides 20-40% |
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Term
| Source of 2 important omega-3 FA |
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Definition
Docosahexaenoic Acid (DHA)
Eicosapentaenoic Acid (EPA) |
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Term
| Adverse Effects of Fish Oils |
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Definition
| Upset stomach, belching, fishy taste, diarrhea |
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Term
| Potential Drug interactions with Fish oil |
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Definition
| Anticoagulants, Aspirin, NSAIDS |
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Term
|
Definition
Triglycerides: 2-4 gm every day in divided doses
Heart disease: 1 gram every day |
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Term
|
Definition
Each 1 gram capsule contains 840 mg of omega-3 FA as ethyl esters.
-EPA 465 mg
-DHA 375 mg |
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Term
|
Definition
Coughs, colds, intestinal worms, digestive and Cardiovascular disorders
-Decreases lipid levels and blood pressure. |
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Term
|
Definition
Has sulfur containing active ingredients:
Alliin--> Allicin |
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Term
| Adverse Effects of Garlic |
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Definition
Mouth sores and irritation
GI distress and flatulence |
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Term
| Potential drug interactions with Garlic |
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Definition
Anticoagulants, aspirin, NSAIDs, Antiplatelet therapy
Anti-HIV therapy |
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Term
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Definition
Equivalent to 1-2 fresh cloves everyday
-1-2 cloves = 4 grams
-300 mg of dried tablet
-1.3% Alliin or 0.6% Allicin BID or TID
Enteric coated dried garlic capsules or tablets so that the active ingredients can survive the trip tot he small intestine where the conversion to allicin can take place. |
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Term
| Clinical Evidence for Garlic |
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Definition
Hypertension:
No consistent effect - 2-7% decrease in DBP and 3% decrease in SBP
Hyperlipidemia:
Decrease in TC, LDL, and TG
Antiplatelet: - modest |
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Term
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Definition
| Cardiovascular ailments, circulation disorders and insomnia |
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Term
| Mechanism of Action of Hawthorn |
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Definition
Dilation of blood vessels, especially coronary
Strengthens contractions of the heart muscle |
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Term
| Adverse Effects of Hawthorn |
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Definition
| Dizziness, headache and changes in BP |
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Term
| Potential Drug Interactions with Hawthorn |
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Definition
| Antiarrhythmics, antihypertensives, cardiac glycosides |
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Term
|
Definition
250 mg qd to TID
*will not stop angina attack*
May see extreme sedation and dangerous drops in BP at higher doses |
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Term
| Background of Horse Chestnut |
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Definition
Flavenoids:
-quercetin and kaempferol
Active constituent:
-triterpenoid-aescin or escin |
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Term
|
Definition
Circulatory disorders
Vericose veins, hemorrhoids, reductionof swelling in lower extremities |
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Term
|
Definition
300 mg qd to BID
Topical -apply 2% aescin gel qd to BID, may not absorb well |
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Term
|
Definition
Reduce the number and diameter of pores in capillaries, inhibit fluids
Increases the tone and elasticity of vessel walls. |
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Term
| Adverse Effects of Chestnut |
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Definition
| GI distress and bleeding, pseudolupus syndrome w/ venocuran |
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Term
| Potential Drug interactions with Horse Chestnut |
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Definition
| Aspirin, NSAIDs, and antiplatelets |
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Term
| Active ingredient in Goldenseal |
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Definition
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Term
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Definition
| Protects against APAP induced hepatotoxicity |
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Term
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Definition
Oral:
1.2-2 g daily for 8 weeks along with conventional therapy
IV:
0.2-0.7 mg/kg/min increase cardiac output |
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Term
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Definition
| Improves systemic and pulmonary vascular resistance, atrial and ventricular diastolic pressure and cardiac index. |
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Term
| Adverse Effects of Goldenseal |
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Definition
-Transient GI disturbances
-Constipation
-May decrease blood sugar and anticoagulative effect
-May decrease total & LDL cholesterol levels and TG
-Inhibits CYP3A4 |
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Term
| Potential Drug Interactions with Goldenseal |
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Definition
Decreased metabolism of Vitamin B12
Enhances tetracycline effect |
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Term
| Constituents of Horsetail |
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Definition
| Petrosin (onitin), flones, glycosides, sterols, tannins and caffeic acid derivatives |
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Term
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Definition
| Significant diuretic effects caused by flavonoids and equisetonin (saponin) |
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Term
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Definition
| 300 mg capsules TID, up to 6 g daily |
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Term
| Adverse Effects of Horsetail |
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Definition
Prolong use may cause B12 deficiency.
Decreases K+ and may cause hypokalemia
May cause low blood sugar in Type II DM patients. |
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Term
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Definition
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Term
|
Definition
| Contains flavonoids that are precursor of oxerutins. |
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Term
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Definition
Oxyrutins: Protect against edema by Na retention
Rutins: Protect against edema by fluid retention |
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Term
| Drug Interactions with Rutin |
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Definition
| May have enhanced effect with Vitamin C or other flavonoids |
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Term
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Definition
Venorutin:
500-1000 mg BID up to 6 months for patients with chronic venous insufficiency or relief of edema. |
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Term
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Definition
Absorption is <10% and distributed in blood, lungs, spleen and muscles.
Mile GI effects, dry mouth, diarrhea, constipation |
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Term
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Definition
Used with warfarin dur to anti-erythrocyte aggregation effects
Effective treatment of venous insufficiency, edema and cramps.
Breast cancer patients to counteract docetaxel-induced fluid retention. |
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Term
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Definition
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Term
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Definition
| Support when cholesterol-lowering is needed |
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Term
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Definition
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Term
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Definition
| Used to lower total cholesterol and TG |
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Term
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Definition
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Term
| Adverse Effects of Red Yeast Rice |
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Definition
Hepatotoxicity/hepatitis.
May affect liver function when used long-term |
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Term
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Definition
22 million people affected
0.5 million hospitalized/year
1.4/100,000 Death rate |
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Term
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Definition
Chronic, inflammatory lung disease.
Air passages get swollen, restricting the amount of air that can pass through. |
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Term
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Definition
| non-invasive way to measure air capacity of lungs |
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Term
| Clinical Symptoms of Asthma |
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Definition
-Coughing
-Bronchospasm
-Wheezing or whistling sound when exhaling
-Shortness of breath or rapid breathing
-Chest tightness and pain
-Fatigue
-GERD |
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Term
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Definition
1. Allergic
2. Non-allergic
3. Exercise-induced
4. Cough-variant
5. Occupational |
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Term
| COPD - Chronic Obstructive Pulmonary Disease |
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Definition
Damage or obstruction of airway
Chronic bronchitis, emphysema, asthmatic bronchitis. |
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Term
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Definition
| Body produces abnomally thick and sticky mucus, saliva, sweat and digestive enzymes. |
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Term
Uses for Borage
Gamma-linolenic acid (GLA) |
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Definition
| Immunosuppressant activity that is helpful in reducing asthma |
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Term
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Definition
1. GLA is broken down into di-homo-GLA (DGLA)
2. DGLA is then converted into PGE1 (protaglandin)
3. Prostaglandins inhibit gastric acid and increase bicarbonate secretion and fat and nutrient absorption.
Also, suppresses Leukotriene B4 (LTB4) which induces bronchoconstriction. |
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Term
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Definition
| 25 grams daily for asthma |
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Term
| Adverse Effects of Borage |
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Definition
May cause diarrhea, bloating, and my lower seizure threshold.
May lower blood pressure and reduce WBC. |
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Term
| Potential Drug Interactions with Borage |
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Definition
| May potentiate the bleeding risk of warfarin |
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Term
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Definition
Potential chronic asthma therapy.
Contains multiple pentacyclic triterpenic acids including boswellic acid which is a major anti-inflammatory agent. (acetyl-11-keto-beta-boswellic acid)
Inhibits LTB4 and HLE involved in CF, CB and emphysema |
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Term
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Definition
300-1200 mg daily
Half-life of 5.9 hours and is excreted in the urine. |
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Term
| Adverse Effects of Boswellia |
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Definition
-Mild GI effects
-Inhibits CYP1A2, 2C8, 2C9, 2C19, 2D6 and 3A4
-Fat may increase Boswellia concentration
-High doses may cause hepatomegaly and steatosis (abnormal retention of lipids w/in a cell)
-Exhibits sedative effects |
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Term
| Major active ingredient in Coleus |
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Definition
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Term
| Mechanism of Coleus (forskolin) |
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Definition
-Inhibits histamine release from mast cells that have been exposed to IgE
-Increases cAMP
-inhibits lung parenchyma contractions induced by histamine and LTD4
-Relieved bronchocontriction in patients with asthma |
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Term
| Dose for Coleus (forskolin) |
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Definition
| 10 mg powder inhaled from spinhaler. 10-18% |
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Term
| Adverse Effects of Coleus (forskolin) |
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Definition
-Inhibits platelet aggregation
-Increased risk of bleeding if taken with NSAIDs or anticoagulating agents
-Lower blood pressure through vasodilation |
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Term
|
Definition
-Decongestant and to treat asthma
-Allergic rhinitis |
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Term
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Definition
Ephedrine and pseudoephedrine
-plant alkaloids |
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Term
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Definition
| Relaxes bronchial smooth muscles through stimulation of beta 2 receptor. |
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Term
| Adverse Effects of Ephedra |
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Definition
-List adverse effects if dose is >8 mg/serving for 7 days.
-Prolonged use results in:
Weight loss, insomnia, rapid heartbeat, anxiety and hypertension
-Diuretic, can increase ALT/AST and thyroid hormones (T3/T4) |
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Term
| Potential Drug Interactions |
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Definition
| Course with Theophylline or caffeine results in additive neurological, cardiovascular and psychiatric toxicity. |
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Term
| Active ingredients in Butterbur |
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Definition
Sesquiterpines:
-iosopetain, oxopetasin, and petasin |
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Term
|
Definition
1. Petasin - anti-inflammatory due to inhibition of LOX activity resulting in reduced leukotriene synthesis
2. Isopetasin and oxopetasin - inhibits leukotrienes, COX-2 and PGE2
-used for allergic rhinitis |
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Term
|
Definition
50 mg qd to TID
max - 150 mg |
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Term
| Adverse Effects of Butterbur |
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Definition
Generally well tolerated
Should not be used in acute asthma
Possible hepatotoxicity and carcinogen
Prolong use increase liver enzymes |
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Term
| Active ingredients of Pychogenol |
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Definition
Oligomeric proanthocyanidins (OPCs)
Other bioflavonoids |
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Term
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Definition
| Antioxidant and Anti-inflammatory agent |
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Term
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Definition
When used in combination with conventional therapy it may reduce mild to moderate asthma symptoms
-Has protective effects against doxorubicin-induced cardiotoxicity
-Elevates GSH
-Inhibits thymus DNA synthesis induced by cyclophosphamide |
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Term
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Definition
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Term
| Active Ingredient of Ginseng |
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Definition
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Term
|
Definition
-Nitric Oxide (NO)-mediated relaxation in bronchial smooth muscles.
-Vasodilation and prevention of oxygen free radial injury in pulmonary endothelium. |
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Term
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Definition
Extract containing 4-7% total ginsenoids content
For COPD:
200 mg extract capsules |
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Term
| Uses for Ginseng in Respiratory Disorders |
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Definition
-Enhances bacterial clearance of sputum in bacterial bronchitis treated with antibiotics
-Reduces blood alcohol concentration
-Cholesterol lowering effects
-Attenuates cisplatin-induced nausea |
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Term
| Adverse Effects of Ginseng |
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Definition
-Inhibit platelet activity and potentiate the effects of NSAIDS (aspirin)
-Inhibits CYP2D6 and CYP3A4
-Enhance the effects of caffeine, cause headache and insomnia
-Increase testosterone level
-May increase the effects of digoxin in CHF |
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Term
| Seasonal/Intermittent allergic rhinitis |
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Definition
| Symptoms occur during a certain period of the year. Predictable |
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Term
| Perennial/Persistent allergic rhinitis |
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Definition
| Symptoms occur throughout the year and my wax and wane in intensity. |
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Term
| Triggers by Aeroallergens |
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Definition
Outdoor:
-Pollen
-Mold spores
Indoor:
-Dust mites
-Cockroaches
-Mold spores
-Cigarette smoke
-Pet dander
Occupational:
-Latex
-Resins
-Chemicals
-Dusts |
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Term
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Definition
1. Sensitization phase: Allergen exposure stimulates immune system stimulation (e.g. IgE). No symptoms. First exposure
2. Early phase: Further allergen exposure causes fast release of pre-formed mast cell mediators: Can cause itching / sneezing in minutes of exposure
3. Cellular recruitment phase: mast cells and granulocytes infiltrate mucosa and set up shop
4. Late phase: Several hours after exposure. Mucus hypersecretion from congestion and submucosal gland hypertrophy. With continued allergen exposure, tissue has lower threshold to allergy triggers (hypersensitivity). |
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Term
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Definition
Suborbital edema causing dark area under eyelids
Secondary to venous congestion |
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Term
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Definition
| Upward stroking of the nose with palm |
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Term
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Definition
| secondary to the allergic salute |
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Term
| Other signs of Allergic Rhinitis |
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Definition
| Open-mouth breathing, Nasal voice, and Engorged nasal mucosa |
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Term
| Complications with Allergic Rhinitis |
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Definition
Sinusitis
Conjunctivitis
Otitis media
Sleep apnea
Asthma exacerbations
Anosmia (loss of smell)
Loss of taste or taste perversion
Nasal polyps |
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Term
| Self-Care Exclusions for Allergic Rhinitis |
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Definition
Children < 12 years
Pregnant or lactating women
Symptoms of nonallergic rhinitis
Symptoms of otitis media (OM), sinusitis, bronchitis, or other infection
Symptoms of undiagnosed or uncontrolled asthma, COPD, or other lower respiratory disorder
Moderate to severe PAR or symptoms unresponsive to treatment
Severe or unacceptable ADEs to treatment |
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Term
Treatment:
Environmental Control/Avoidance |
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Definition
| First step in treatment aimed at reducing sensitization and IgE production. |
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Term
| Ways to control Indoor Allergens |
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Definition
1. Control humidity
2. Encase/wash household items
3. HEPA filters
4. Find a new home for family pet |
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Term
| Ways to control outdoor allergens |
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Definition
1. Avoid activities that increase exposure
2. Avoid outdoor activities when allergen counts are high - a low Air Quality Index |
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Term
| Pharmacologic options for allergic rhinitis |
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Definition
First Generation Antihistamine
Second Generation Antihistamine
Decongestants
Intranasal anti-inflammatory |
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Term
| First-generation Antihistamines |
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Definition
Chlorpheniramine:
-4 mg Immediate Release QID
-8 mg Slow Release TID
-12 mg Slow Release BID
-max: 24 mg daily
Dexbropheniramine:
-2 mg q 4-6 hrs (max: 12 mg daily
Diphenhydramine:
-25-50 mg q 6-8 hr (max: 300 mg daily)
Doxylamine (insomnia drug too)
-7.5-12.5 mg q 4-6 hr (max: 75 mg daily) |
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Term
| Second generation antihistamines |
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Definition
Claritin (loratadine):
-5-10 mg daily
Zyrtec (cetririzine):
-5-10 mg daily
Allegra (fexofenadine):
-60 mg BID or 180 mg daily |
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Term
| Intranasal anti-inflammatory |
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Definition
Cromolyn Sodium:
-1 spray in each nostril 3-6 times daily
-give as a prevention for next time |
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Term
|
Definition
Saline/Propylene/Polyethylene glycol
-May reduce allergic rhinitis symptoms by decreasing irritation and dryness of nasal mucosa. |
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Term
| Herbals that may be used to treat/prevent allergic rhinitis |
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Definition
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Term
| Treatment options for Pregnancy |
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Definition
1. Cromolyn Sodium - first line option
2. Loratadine - pregnancy category B
3. Chlorpheniramine, clemastine, diphenhydramine - pregnancy category B |
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Term
| Treatment options for Lactation |
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Definition
1. Cromolyn Sodium - first line option
2. First-generation Antihistamines are contraindicated in lactating women and if needed use chlorpheniramine under primacy care physician supervision
3. Loratadine may pass into breastmilk |
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Term
| Treatment options for Children |
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Definition
1. Cromolyn Sodium - first line option
2. First generation AH - contraindicated in newborns and premature infants
3. Loratadine - ages 2 and up
4. Cetirizine - ages 2 and up
5. Fexofenadine - ages 2 and up and is a suspension |
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Term
| Treatment options for Elderly |
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Definition
First generation AH - Beers' list
-anticholinergic properties |
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Term
|
Definition
| Late August to early April |
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Term
| Viral Causes of Common cold |
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Definition
| up to 60% are caused by Rhinovirus |
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Term
| Modes of Transmission of Common cold |
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Definition
1. Viruses differ in the ways they are transmitted between hosts
2. Hand contact with viral secretions
-Infected person
-Environmental surfaces
3. Aerosolized particles lingering for an extended period
4. Direct contact of viral particles from infected person |
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Term
| Most common cause of the cold |
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Definition
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Term
|
Definition
1. Pharyngitis
2. Nasal congestion, rhinorrhea, sneezing
-appears day 2-3
-nasal discharge starts out thin-->purulent/thick
3. Cough
-appears day 4-5 and can last up to 3 weeks
4. Fever
-rarely exceeds 100 F
5. Other - headache, myalgia, malaise, hoarseness |
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Term
| Cold symptoms share symptoms with more serious respiratory illnesses |
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Definition
Allergic rhinitis
Asthma
Influenza
Otitis media
Sinusitis |
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Term
| Complications with the common cold |
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Definition
Otitis media
Most common complication in children (20%)
Sinusitis
Pneumonia
Asthma/COPD exacerbations
Rhinoviruses linked as a trigger
Bronchitis
Eustachian tube obstruction |
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Term
|
Definition
Only symptomatic care.
-should be started early to control nasal build-up
Antibiotics have NO role in helping and can increase antibiotic resistance |
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Term
| Non-pharmacologic treatment |
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Definition
1. Rest
2. Fluids
3. Humidification
-can provide antitussive action
4. Saline nasal spray/drops
-loosens mucus
5. Nasal strips - enlarges nasal passage
6. Saline gargle or hard candies to relieve pharyngitis
7. Natural Demulcent - substance that relieves irritation of the mucus membranes in the mouth by forming a protective film. |
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Term
| Symptom Specific pharmacologic treatment - Pharyngitis (sore throat) |
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Definition
1. Acetaminophen
2. NSAIDs
-ASA – avoid in children and teenagers
-Non-ASA NSAIDs – some options in children/teens
3. Lozenges / Sprays
-Anesthetic action
-Phenol / Benzocaine sprays
-Menthol / Diclonine lozenges
-Use q 3-4 hr
4. Refer to PCP when sore throat persists after several days or it is associated with fever, headache, or N/V |
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Term
| Symptom Specific pharmacologic treatment - Fever/Myalgia |
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Definition
| Analgesics (same as for sore throat) |
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Term
| Symptom Specific pharmacologic treatment - Nasal Congestion (Decongestants) |
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Definition
-Sympathomimetic: Constricts blood vessels to reduce the blood supply to nose
-Direct acting (bind directly to adrenergic receptors)
-Phenylephrine, oxymetazoline, tetrahydrozoline
-Indirect-acting (displaces NE from storage vesicles) - slower onset
-Mixed (direct and indirect)
-pseudoephedrine |
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Term
| Side effects of Pseudoephedrine |
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Definition
| Cardiovascular stimulation and may increase BP, CNS stimulation |
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Term
|
Definition
|
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Term
| Drug interactions with Pseudoephedrine |
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Definition
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Term
| Contraindication for Pseudoephedrine |
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Definition
| Hypertension, Benign prostatic hyperplasia (BPH), Coronary Heart Disease, elevated intraocular pressure, lactation |
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Term
|
Definition
10 mg q 4-6 hr
-1 tablet, shouldn't take more than 2. |
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Term
|
Definition
Oxymetazoline, xylometazoline, naphazoline, phenylephrine
-Afrin and Dristan |
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Term
| Dose for Topical Nasal Decongestants (oxymetazoline) |
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Definition
| 2-3 sprays in each nostril q 12 hours |
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Term
| Do NOT use topical nasal decongestants... |
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Definition
|
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Term
| Rhinitis Medicamentosa (rebound congestion) |
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Definition
| Body has become accustomed to the topical nasal decongestant and will mimic the problem that you are trying to fix. To fix, taper it down or trade off nostrils |
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Term
| Symptom Specific pharmacologic treatment - Rhinorrhea (runny nose)/Sneezing |
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Definition
First Generation Antihistamines:
-effective secondary to anticholinergic effects rather than antihistaminic effects. |
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Term
| Cough associated with common cold |
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Definition
Acute <3 weeks, Chronic >3 weeks (send to PCP)
Defense mechanism to remove mucus or foreign debris from respiratory tract |
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Term
| Symptom Specific pharmacologic treatment - Wet Cough |
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Definition
Productive (i.e. Phlegm-producing)
Expectorant: guaifenesin
MOA: decreases the mucus viscosity to aid in its removal from the respiratory tract
Efficacy has been questioned
Fluid/water intake aids in its efficacy
Available in single-source or combination products
SE (mild): Drowsiness / GI upset / HA
Dose: 600-1200 mg po BID (maximum daily 2400 mg)
Mucinex (guaifenesin ER tablets)
-Only OTC extended-release formulation available
-600 mg per tablet |
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Term
| Symptom Specific pharmacologic treatment - Dry Cough |
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Definition
Non-productive
Antitussives: codeine, dextromethorphan (DM)
MOA: Suppress cough reflex; therefore counter-productive in a phlegm-producing cough
Codeine (Rx in Texas)
Increases the cough threshold at the respiratory center in the medulla
Antitussive doses have low risk for addiction
SE: nausea, vomiting, sedation, constipation
DI: additive sedative effects with other CNS depressants
Available in many states without a prescription (Rx only in Texas) |
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Term
| Dose for Dextromethorphan use for Dry Cough |
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Definition
|
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Term
| Adverse Effects to Dextromethorphan |
|
Definition
| GI, sedation and "robo-tripping" at high doses |
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|
Term
| Drug interactions to Dextromethorphan |
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Definition
| MAOIs, CNS depresants, Alzheimers' medications |
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Term
| Topical Antitussives/Expectorants |
|
Definition
Camphor/Menthol
Thought to increase sensation of better airflow through nasal passage by stimulating sensory nerve endings.
May be used up to TID.
Not for children under 2 |
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Term
| Use of Zinc for common cold |
|
Definition
believed to block the rhinovirus from adhering to the nasal epithelium.
There may be nausea or taste abnormalities.
Citrus juices may chelate reducing effectiveness |
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Term
| Vitamin C for common cold |
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Definition
| >1g daily may reduced duration and severity of cold. |
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Term
| Echinacea purpurea for common cold |
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Definition
| believed to have antiviral and immune-stimulating effects. May decrease duration and severity of cold symptoms. |
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|
Term
| Treatment options for Pregnancy |
|
Definition
Decongestant - Topical oxymetazoline
Cough suppressant -guaifenesin, DM |
|
|
Term
| Treatment options for Lactation |
|
Definition
Decongestant - topical phenylephrine
Cough suppressant - DM |
|
|
Term
| Treatment options for Children under 2 |
|
Definition
-Saline nasal drops
-bulb suction of nose
-humidification of inspired air |
|
|
Term
| Treatment options for Children 2-6 |
|
Definition
| Combination products available |
|
|
Term
| Treatment options for Children 6-11 |
|
Definition
| Combination products available |
|
|
Term
| Self-Care Exclusions for common cold |
|
Definition
Fever > 101.5°F* (38.6°C)
Chest pain (CP)
Shortness of breath (SOB)
Significant worsening of symptoms beyond normal duration
Significant underlying comorbidity (CHF / COPD / Severe Asthma)
Immunosuppressed (HIV / AIDS / Transplant patients)
Frail patients of advanced age
Infants under 9 months
Hypersensitivity to recommended OTC medications |
|
|
Term
| American Heart Association definition for Hypertension |
|
Definition
|
|
Term
| Lipid Panel for Hyperlipidemia |
|
Definition
Total cholesterol - <200mg/dL
Triglycerides (TG) - <150 mg/dL |
|
|
Term
|
Definition
| the heart cannot pump enough blood through the body |
|
|
Term
| Home monitoring of blood pressure |
|
Definition
1. manual blood pressure cuf with sphygmomanometer
2. Semi-automatic
3. fully automatic
4. wrist |
|
|
Term
| Home monitoring of Cholesterol |
|
Definition
monitor:
-Total cholesterol
-HDL
-Costs ~$4/strip |
|
|
Term
| Natural Products for Cardiovascular |
|
Definition
Flaxseed oil
Krill oil
Niacin
Plant Sterols
Blond Psyllium |
|
|
Term
|
Definition
Dose: 1-3 g/day
Contains lower concentration of EPA and DHA than fish oil |
|
|
Term
| Vitamin that is used to help manage hyperlipidemia |
|
Definition
|
|
Term
| Dose of Niacin for Hyperlidemia |
|
Definition
|
|
Term
| Effectiveness of Niacin for Hyperlipidemia |
|
Definition
Decreases LDL 5-25%
Increases HDL 15-35%
Decreases TG 20-50% |
|
|
Term
| Counseling points for Niacin |
|
Definition
| Take aspirin 325 mg or ibuprofen 200 mg 30 minutes before dose and do not take with hot drink |
|
|
Term
| Dose of Flaxseed for Hyperlipidemia |
|
Definition
|
|
Term
| Effectiveness of Flaxseed for Hyperlipidemia |
|
Definition
Decreases TC 5-9%
Decreases LDL 8-18&
Increases TG 10% |
|
|
Term
| Counseling points for Flaxseed |
|
Definition
|
|
Term
| Dose of Psyllium for Hyperlipidemia |
|
Definition
| 10-12 grams daily in 2-3 divided doses |
|
|
Term
| Effectiveness of Psyllium for hyperlipidemia |
|
Definition
Decreases TC 3-14%
Decreases LDL 5-10% |
|
|
Term
|
Definition
| Flatulence, bloating, choking, bowel obstruction |
|
|
Term
| Counseling points for Psyllium |
|
Definition
Take with 8oz of fluid
Take 30-60 minutes after food and medicine
It is less effective in >60 |
|
|
Term
| Dose of Plant Sterols for Hyperlipidemia |
|
Definition
| 800-6000 mg daily in divided doses before meals |
|
|
Term
| Effectiveness of Plant Sterols |
|
Definition
| Likely effective for lowering TC and LDL but little effect on HDL |
|
|
Term
| Side Effects of Plant Sterols |
|
Definition
| GI effects, sexual dysfunction |
|
|
Term
| Counseling points for Plant Sterols |
|
Definition
Take 30-90 minutes before meals
Caution to patients on immunosuppressive agents. |
|
|
Term
| 5 Basic Functions of skin |
|
Definition
1. Protection
2. Sensation
3. Thermoregulation
4. Immunomodulation
5. Production of Vitamin D |
|
|
Term
| 3 Stages of Wound Healing |
|
Definition
1. Inflammatory Phase
2. Proliferative Phase
3. Maturation (Remodeling) Phase |
|
|
Term
|
Definition
-immediate response
-characterize by redness, swelling, pain and fever
-lasts 3-4 days
-prepares wound for tissue development |
|
|
Term
|
Definition
-Wound is filled with connective tissue and covered with new epithelium
-begins on day 3 and continues for 3 weeks |
|
|
Term
|
Definition
-Final phase of healing
-last ~3 weeks once wound is completely closed by connective tissue and resurfaced by epithelium
-may continue for ~2 years after injury |
|
|
Term
| Factors influencing wound healing |
|
Definition
Tissue perfusion and oxygenation
Nutrition
Age and weight
Infection
Coexisting diabetes mellitus
Medications |
|
|
Term
| Wound Classification by Depth |
|
Definition
Stage I
-Erythema of intact skin
Stage II
-Partial-thickness skin loss; epidermis +/- dermis
Stage III
-Full thickness skin loss; damage to subcutaneous tissue
Stage IV
-Tissue necrosis; damage to underlying muscle, tendon, bone |
|
|
Term
| Wound Classification by Acuity |
|
Definition
Acute Wounds
Chronic Wounds |
|
|
Term
|
Definition
Abrasions, punctures, lacerations, burns
Take ~1 month to heal |
|
|
Term
|
Definition
Superficial wounds
Injury to epidermis and may extend to upper layer of dermis
Results from friction or rubbing |
|
|
Term
|
Definition
| Injury to dermis or deeper tissue |
|
|
Term
|
Definition
| Injury to various layers of skin |
|
|
Term
|
Definition
Pressure ulcers, Venus ulcers, Arterial ulcers
Do NOT proceed through 3 stages of wound healing in a timely manner |
|
|
Term
|
Definition
Result from unrelieved pressure
Injury to skin and underlying tissue, usually over bony prominences |
|
|
Term
| 4 Factors involved in skin breakdown |
|
Definition
1. Pressure
2. Shearing forces
3. Friction
4. Moisture |
|
|
Term
| Self-Care Exclusions for Wounds |
|
Definition
Wound containing foreign matter after irrigation
Chronic wound
Wound secondary to an animal or human bite
Signs of infection
Location of wound-involvement of face, mucous membrane, or genitalia
Deep, acute wound-extending beyond dermis
No signs of healing after 5 days of self-treatment |
|
|
Term
| Treatment goals for all wounds |
|
Definition
-Facilitate wound healing
-Prevent scarring
-Prevent secondary skin infections and further trauma |
|
|
Term
| General Treatment Approach |
|
Definition
1. Cleansing wound
2. Selectively using antiseptics and antibiotics
3. Create closure with an appropriate dressing |
|
|
Term
|
Definition
Remove excess exudate
Be permeable to oxygen
Thermally insulate wound
Protect wound from infection
Be easy to remove without disrupting delicate new tissue
Maintain a moist environment |
|
|
Term
|
Definition
Gauze dressing
Nonadherent (gauze-type) dressing
Foams
Alginates
Carbon-impregnated (Odor control)
Composite/island dressing
Hydrocolloids
Transparent adhesive film
Hydrogels/gels |
|
|
Term
| Wound Dressing that Absorb Moisture |
|
Definition
Foam
Alginate
Carbon impregnated
Composite |
|
|
Term
| Wound Dressings that Maintain moisture |
|
Definition
hydrocolloid
Transparent adhesive film |
|
|
Term
| Wound Dressing that provide Moisture |
|
Definition
|
|
Term
| Wound Dressings for Abrasions and Lacerations |
|
Definition
Gauze dressing
Non-adherent gauze-type bandage
Adherent gauze-type bandage (Band-Aid®)
Hydrocolloid (New Skin®) |
|
|
Term
|
Definition
1. Cleanse
2. Leave open
3. Soak with soapy water for 30 min QID
4. Apply Wound Dressing
-Hydrocolloid or Hydrogel dressing |
|
|
Term
| Treatment of Pressure Ulcers |
|
Definition
Need to be closely supervised by physician.
Key objective: Remove dead tissue, debris, excess exudate |
|
|
Term
| Pharmacologic Treatment for Wounds |
|
Definition
Irrigants
Antiseptics
Antibiotics - topical to prevent infection from occurring |
|
|
Term
|
Definition
Normal Saline
Sterile water
Used to clean wound of dirt/debris |
|
|
Term
|
Definition
Ethyl Alcohol 48-95%
Isopropyl Alcohol 50-91.3%
Hydrogen Peroxide topical solution
Iodine
Phenol 0.5-1.5% |
|
|
Term
|
Definition
Direct application to wound can cause tissue irritation (use caution)
Highly flammable
May be used 1-3 times daily
Cover wound with sterile bandage after area has dried
Contains denaturants – which dehydrate skin at high concentrations |
|
|
Term
|
Definition
Stronger bactericidal activity than ethyl alcohol
Do not use to cleanse open wounds due to possible cytotoxic effects and higher reported infection rates
No denaturants (unlike ethyl alcohol)
Has a greater potential for drying the skin (astringent action)
Is flammable (like ethyl alcohol) |
|
|
Term
|
Definition
| Effervescent cleansing action by enzymatic release of oxygen on contact on skin. |
|
|
Term
|
Definition
Broad antimicrobial activity
Iodine is preferred over iodine tincture (which contains alcohol)
Stains the skin
Can Irritate tissues
Bandaging should be discouraged to avoid tissue irritation
Recommended if patients have chlorhexidine allergy |
|
|
Term
|
Definition
Non-irritating to skin and mucous membranes
May be absorbed systemically
-use caution in renal dysfunction, may cause thyroid dysfunction |
|
|
Term
|
Definition
Only apply to dry skin and do not bandage
Moisture will result in skin damage |
|
|
Term
|
Definition
Bacitracin
Neomycin
Polymixin B sulfate
Combination products |
|
|
Term
|
Definition
Polypeptide bactericidal antibiotic that inhibits cell wall synthesis in bacteria
Apply 1-3 times daily |
|
|
Term
|
Definition
Aminoglycoside antibiotic that inhibits protein synthesis by irreversibly binding to the 30S ribosomal subunit
Relatively high rate of hypersensitivity (3.5-6%)
Usually used in combination with polymixin & bacitracin
Apply 1-3 times daily |
|
|
Term
|
Definition
Polypeptide antibiotic
Alters bacterial cell wall permeability
Effects on healing are unknown
Apply 1-3 times daily |
|
|
Term
| Pharmacists Role in Wound Healing |
|
Definition
1. Visually inspect wound
-Type, depth, location of wound
-Presence of contamination
-Presence of infection
2. Evaluate for potential drug-induced eruption
3. Recommend antimicrobial agent when secondary infection is present or probable
4. Recommend appropriate cleansing agent, antiseptic, and wound dressing |
|
|
Term
|
Definition
Breed in water, active during evening
Attracted by exhaled carbon dioxide
Transmission of diseases
-West Nile virus
-Malaria |
|
|
Term
| Clinical Presentation of Mosquito bites |
|
Definition
Welts
Erythematous papules on exposed areas
Pruritis |
|
|
Term
|
Definition
Attracted by body warmth and exhaled carbon dioxide
Tiny, bloodsucking, wingless
Transmission of diseases
-Bubonic plague
-Endemic typhus |
|
|
Term
| Clinical Presentation of Flea Bites |
|
Definition
Bites multiple/grouped
-Ankles/legs
Papules with erythema
Intense pruritis |
|
|
Term
|
Definition
Mouth parts hold firmly to skin when skin pierced
Transmission of diseases
-Rocky Mountain spotted fever
-Lyme disease |
|
|
Term
| Clinical Presentation of Tick Bites |
|
Definition
| Pruritic papules that disappear in 1 week |
|
|
Term
| Clinical Presentation of Lyme Disease from Deer Tick |
|
Definition
"Bull's-eye" Rash and flu like symptoms
-Fever, muscle/joint pain
Neurologic
-Headache, stiff neck
Cardiovascular / musculoskeletal symptoms |
|
|
Term
|
Definition
Microscopic, live in shrubs, trees, grass
Larvae attach
-Do not burrow in skin
Secrete digestive fluid
-Causes cellular disintegration of affected area
Drops off and becomes adult |
|
|
Term
| Clinical Presentation of Chigger Bites |
|
Definition
| Erythematous, Pruritic papule |
|
|
Term
|
Definition
Black widow
-Delayed intense pain, stiffness/joint pain, abdominal disturbances, fever/chills, dyspnea
Brown recluse
-Same as above
-Plus ulcerated wound at bite site that may lead to tissue necrosis |
|
|
Term
| Self-Care Exclusions for Insect Bites |
|
Definition
Age < 2 years
Hypersensitivity or systemic reaction
Bites from ticks or spiders
-Brown recluse or black widow spider bite need immediate referral
Infection present |
|
|
Term
| OTC pharmacologic treatment of insect bites |
|
Definition
Local anesthetics
Topical antihistamines
Counterirritants
Topical corticosteroids
Skin protectants |
|
|
Term
| Bees, Wasps, Yellow Jackets and Hornets |
|
Definition
| Local reaction elicited by injection of venom by stinger. |
|
|
Term
| Clinical Presentation of Bee, Wasp, yellow jacket and hornet sting |
|
Definition
| Pain, itching, burning and irritation at the site of the sting |
|
|
Term
| Anaphylaxis may occur as a result Bee, Wasp, etc Sting |
|
Definition
Hypersensitivity or "allergic reaction"
Treat with Epipen and/or antihistamines |
|
|
Term
| Clinical presentation of Fire Ant stings |
|
Definition
| Pain, itching, burning and irritation at the site of the sting |
|
|
Term
| Self-Care Exclusions for Stings |
|
Definition
Age < 2 years of age
Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing
Significant allergic response away from sting
Previous sting by honeybee, wasp, or hornet
-Need to evaluate for possible hypersensitivity
Previous severe reaction to insect bites
Personal or family history of severe allergic reactions |
|
|
Term
| OTC pharmacologic treatment for Stings |
|
Definition
Local anesthetics
Topical/Oral antihistamines
Counterirritants
Skin protectants |
|
|
Term
| Three main categories of Treatment for Insect bites/stings |
|
Definition
External analgesics/antipruritics
-Counterirritants
-Anesthetics & antihistamines
-Hydrocortisone
Skin protectants
Antibacterials |
|
|
Term
|
Definition
Benzocaine
Pramoxine
Benzyl alcohol
Lidocaine
Dibucaine
Phenol |
|
|
Term
| Mechanism of Action of local anesthetics |
|
Definition
| Depress cutaneous sensory receptors, resulting in relief of pain/itching |
|
|
Term
| Administration of local anesthetics |
|
Definition
| apply to area 3-4 times daily for 7 days |
|
|
Term
|
Definition
Diphenhydramine HCl
0.5-2% cream, spray, stick |
|
|
Term
|
Definition
Reduces pain and itching by stimulating cutaneous sensory receptors
Camphor 0.1-3%
Menthol 0.1-1%
Combination products |
|
|
Term
|
Definition
Do NOT use for >7 days
Very dangerous if ingested.
Placing camphor in infant's nostrils will cause immediate respiratory collapse and may cause pediatric seizures |
|
|
Term
|
Definition
0.5-1%
Anti-inflammatory agent that prevents/suppresses development of edema, capillary dilation, swelling, and tenderness
Prolonged use may cause epidermal atrophy, acne eruptions, irritation, inflammation of follicles and tightening/cracking of the skin |
|
|
Term
|
Definition
Zinc Oxide
Calamine 1-25%
Titanium dioxide
Reduces inflammation/irritation by providing mechanical barrier against stimuli |
|
|
Term
|
Definition
Head lice
Most common - 10-12 million/yr
Children - Mostly ages 3-12
Body lice
Pubic lice - “crabs” |
|
|
Term
|
Definition
Itching
Erythema around bites
Presence of nit and nit casings
-Wet combing
Presence of lice feces |
|
|
Term
| Self-Care Exclusions for Pediculosis |
|
Definition
Age < 2 years
Hypersensitivity to chrysanthemums, ragweed, or pediculicide ingredients
Secondary skin infection
Lice infestation of eyelids or brows
Pregnancy or breastfeeding
Presence of active tumors |
|
|
Term
| General Treatment of Pediculosis |
|
Definition
Application of pediculicide
Combing hair with lice/nit comb to remove nits from hair shaft
Removing dead lice
Application of products to loosen eggs & facilitate removal
Preventing future infestations |
|
|
Term
| OTC pharmacologic Treatment of Pediculosis |
|
Definition
Synergized pyrethrins (pyrethrin + piperonyl butoxide)
Permethrin |
|
|
Term
|
Definition
Block neurotransmission leading to paralysis/death
-Apply for 10 minutes then rinse/shampoo |
|
|
Term
|
Definition
Induces paralysis of parasite by disruption Na channels of neurons
HEAD LICE ONLY! |
|
|
Term
|
Definition
Thermal - Contact with flames, scalding liquids, hot objects or inhalation
Electrical
-Contact electrical – contact with high voltage
-Electrical burns – heat up to 9000°F (5000° C)
Chemical - Contact with acids or alkalis (household products, workplace)
Sunburn - Caused by UV radiation |
|
|
Term
|
Definition
1. Superficial
-Self-treatable
2. Superficial partial thickness
-Self-treatable if < 2%BSA
3. Deep partial thickness
4. Full thickness |
|
|
Term
|
Definition
Brief exposure to low heat
Effects only epidermis
Erythema, warmth, slight edema, mildly painful with NO blisters
Blanches with pressure and heals w/in 3-10 days with no scarring |
|
|
Term
| Superficial Partial Thickness Burns |
|
Definition
High levels of heat or longer exposure
Epidermis
Erythema, blistered, moist, weeping, painful, and sensitive to stimuli
Blanches w/ pressure
Heals within 2-3 weeks w/ little or no scarring
>2% BSA refer to physician |
|
|
Term
| Deep Partial Thickness Burns |
|
Definition
More extensive heat exposure
Epidermis & dermis
Blanched, patchy white to red +/- blisters
Some areas painful while other areas are not
Up to 6 weeks to heal and will have thick scarring
Prone to infection
Refer |
|
|
Term
|
Definition
Epidermis, dermis & subcutaneous tissue
Pearly white, gray, or brown
Dry and leathery
No pain
Does not blanch
Usually requires skin graft and PT
Refer |
|
|
Term
| Self-Care Exclusions for Burns |
|
Definition
Burns to BSA of 2% or more (see figure 41-3)
Burns to the eye, ear, face, genitalia
Immunocompromised patients
Patients with diabetes or patients with multiple disease states
Elderly patients
Chemical burns (use 1st aid, then refer)
Electrical or inhalation burns |
|
|
Term
| First Aid to Superficial and Superficial Partial Thickness Burns |
|
Definition
Soak area in cool tap water 10-30 min
Systemic analgesics |
|
|
Term
|
Definition
Cool compresses or bath
Consider NSAID's during first 24 hrs
Avoid further exposure to the sun |
|
|
Term
| First Aid to Chemical Burns |
|
Definition
Remove contaminated clothing
Rinse area with H2O 15 min -2hrs
Do not delay transport to the ER or physician |
|
|
Term
| First Aid to Chemical Burns to the Eye |
|
Definition
Eye irrigated for 15 – 30 mins
Wash from nasal side to outside corner to prevent contaminating other eye |
|
|
Term
| Cleaning and protecting a burn |
|
Definition
Water and bland soap
Non-adherent dressing
Weeping- cool water soak for 15-30 min 3-9 times a day
cleanse area 1-2 x a day to remove dead skin. |
|
|
Term
|
Definition
Protect from irritation and drying of the stratum corneum
Pain relief |
|
|
Term
| Examples of Skin Protectants |
|
Definition
| Allantoin, cocoa butter, petrolatum, shark liver oil |
|
|
Term
|
Definition
NSAIDs - decreases erythema and edema
Acetaminophen - only pain relief |
|
|
Term
|
Definition
| Benzocaine, lidocaine, dibucaine, tetracaine, butamben, pramoxine |
|
|
Term
|
Definition
Not recommended unless skin is broken
Apply QD to QID max 5 days |
|
|
Term
| Other Therapies for Burns |
|
Definition
Topical Hydrocortisone
Topical Antibiotics
Counterirritants
Vitamins
Aloe Vera - may inhibit bradykinin, thromboxane and prostaglandins
Arnica montana
Calendula
Honey
Zinc
Ornithine Ketoglutarate |
|
|
Term
|
Definition
| Dried flower used for antimicrobial, antiedema and anti-inflammatory properties |
|
|
Term
|
Definition
| flower used for wound healing and anti-inflammatory properties |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3 major band of UV spectrum |
|
Definition
UVC (200-290 nm)
-Germicidal radiation
-Little reaches earth (screened out by ozone)
-Absorbed by the dead skin layer (stratum corneum)
UVB (290-320 nm)
-Sunburn radiation (erythema)
-Most active during 10am to 4pm
UVA (320-400 nm)
-Deeper penetration than UVB
-Weak erythema activity
-Greater effect on dermis |
|
|
Term
|
Definition
Induces erythema - "sunburn radiation"
Primary cause of skin cancer
Responsible for wrinkling, epidermal hyperplasia, elastosis and collagen damage |
|
|
Term
|
Definition
Deeper penetration can cause tissue and vascular damage
May augment the carcinogenic effects of UVB radiation
What tanning beds use |
|
|
Term
|
Definition
1. Superficial burn
- Mild erythema to tenterness, pain and edema
2. Superficial partial thickness burn
- blisters, fever, chills, weakness and shock |
|
|
Term
|
Definition
2 types:
1. Drug photoallergy - immunologic
2. Phototoxicity - chemically induced |
|
|
Term
| Some drugs that are involved in photosensitivity |
|
Definition
| Diuretics, sulfonamides, tetracyclines, benzoyl peroxide |
|
|
Term
|
Definition
Solar urticaria
Photo aggravated disorders:
-acne, systemic lupus erythematousus, herpes and rosacea |
|
|
Term
|
Definition
1. Basal cell carcinoma (BCC)
-Effects the epidermis and dermis
-Rarely metastasizes
2. Squamous cell carcinoma (SCC)
-Epithelial keratinocytes – grows slowly
3. Melanoma
-Highly metastatic
-Can be fatal - 70% of skin-cancer related deaths |
|
|
Term
|
Definition
Asymmetry
Border
Color
Diameter |
|
|
Term
| Exclusions to use of sunscreen |
|
Definition
Xeroderma pigmentosum
< 6 months
Allergy to all available sunscreen |
|
|
Term
|
Definition
| Amount of time it takes you to burn with sunscreen/Amount of time it takes you to burn without it |
|
|
Term
|
Definition
2 to ≤ 12: Minimal sunburn protection
12 to ≤ 30: Moderate sunburn protection
30+: High sunburn protection |
|
|
Term
|
Definition
SPF 15 – block 93% UVB
SPF 30 – increases to 96.7%
SPF 40 – blocks 97.5 |
|
|
Term
|
Definition
1. Chemical - absorbs and blocks transmission of UVR
2. Physical - Reflects and scatters all UVR |
|
|
Term
Chemical sunscreens
Aminobenzoic Acid (PABA) |
|
Definition
UVB coverage
Advantages:
Penetrates horny layer of skin and provides long lasting coverage
Disadvantages:
Contact dermatitis, photosensitivity, stinging/drying of skin, yellow staining of clothes |
|
|
Term
|
Definition
Weak sunscreens
Do NOT adhere to skin well
UVB only |
|
|
Term
| Phenylbenzimidazole sulfonic acid |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
UVB with little UVA
Does not adhere to skin well |
|
|
Term
|
Definition
|
|
Term
|
Definition
mid-range UVA converage
usually combined with Avobenzone for increased UVA protection |
|
|
Term
Physical Sunscreens
Zinc Oxide, Titanium Oxide, Iron Oxide |
|
Definition
| Opaque and used for those who cannot limit sun exposure |
|
|
Term
|
Definition
| Each active ingredient must contribute an SPF of at least 2 |
|
|
Term
| Dosage and Administration of Sunscreen |
|
Definition
4.5 tsp
Re-apply every 40 min for water-resistant and 80 for very water-resistant |
|
|
Term
| Pilosebaceous units of the skin |
|
Definition
Consists of hair follicle, sebaceous gland, connected to the skin by a duct.
Where acne vulgaris originates |
|
|
Term
|
Definition
Hormonal triggers
Abnormal keratinization of cells in infundibulum
Increased sebum production
Growth of Propionibacterium acnes
Inflammation
Heredity |
|
|
Term
| Exacerbating factors of Acne |
|
Definition
Environmental - Humidity and Sweating
Physical - Friction
Cosmetic use - Oil based
Emotional - Stress
Hormonal |
|
|
Term
| Medications that can cause acne |
|
Definition
P – Phenytoin
I – Isoniazid
M – Moisturizers
P – Phenobarbital
L – Lithium
E – Ethionamide
S – Steroids |
|
|
Term
|
Definition
Hyperkeratinization of cells results in increased cohesiveness, obstruction of follicle. - forms microcomedo
More cells accumulate microcomedo enlarges to become closed comedo (Whitehead) |
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Term
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Definition
Desquamated epithelial cells and sebum accumulate behind the plug
The orifice of the follicular canal becomes distended
Protrusion of plug occurs
The tip of the plug may darken due to melanin deposition |
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Term
| Non-inflammatory presentation of Acne |
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Definition
| Open (blackhead) or closed (whitehead) comedo |
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Term
| Inflammatory presentation of Acne |
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Definition
Papule - larger inflamed, reddened, raised lesions
Pustule - Raised lesions filled with pus
Nodule - Inflammatory lesion >5mm in diameter |
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Term
Grade I Acne (Mild)
Comedonal Acne |
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Definition
| Comedones only, <10 on face, none trunk, no scars; noninflammatory lesions only |
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Term
Grade II (Moderate) Acne
Papular Acne |
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Definition
| 10-25 papules (face/trunk), mild scars; inflammatory lesions <5mm |
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Term
Grade III (Moderately severe) Acne
Pustular Acne |
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Definition
| >25 pustules, moderate scars; size <5mm but with visible, purulent core |
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Term
Grade IV (severe) Acne
Severe Pustulocystic Acne |
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Definition
Nodules/cysts, extensive scaring; inflammatory lesions >5mm diameter
Recalcitrant severe cystic acne with extensive nodules/cysts |
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Term
| Treatment for non-inflammatory acne |
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Definition
| Cleansing the skin to remove excess sebum and avoiding factors that may cause acne |
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Term
| Treatment for inflammatory acne |
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Definition
Oral & topical antibiotics to suppress bacteria
Retinoids
Possible excision/drainage of lesions
Cleansing skin, avoiding factors |
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Term
| Self-Care Exclusions for Acne |
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Definition
Grade II-IV (moderate-severe) acne
-Papules, pustules, nodules, cysts and/or scarring
Severe, recalcitrant acne (extensive nodules/cysts)
Exacerbating factors (ex: comedogenic drugs, mechanical irritation)
Possible Rosacea |
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Term
| Pharmacologic Treatment of Acne |
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Definition
Benzoyl peroxide
Salicylic acid
Sulfur
Sulfur-resorcinol combinations |
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Term
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Definition
Tea Tree Oil
Glycolic Acid
Witch Hazel |
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Term
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Definition
Antibacterial and keratolytic
Releases free radicals and reduces hyperkeratosis
Use QD or BID |
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Term
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Definition
| Keratolytic - causes desquatmation by dissolution of intercellular cement |
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Term
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Definition
Keratolytic with possible antibacterial effects.
Apply 1-3 times daily |
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Term
| Sulfur-Resorcinol combinations |
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Definition
| Irritant that may cause hyper pigmentation |
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Term
| Glycolic acid: Alpha hydroxy acid |
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Definition
| used in face peels and reduces acne scars |
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Term
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Definition
Reduces the number of inflammatory lesions and comedones
Fewer side effects than benzoyl peroxide |
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Term
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Definition
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