Self-Care/PPCP/Legal & Regulatory and Fungal (PHR 913 Block I)

What is self-care?

What people do for themselves to establish and maintain health, and to prevent and deal with illness.

Why do consumers prefer self-care?

Trust, convenience, cost-effectiveness, and control.

What are the 3 categories of products for self-medication?

Nonprescription medications (OTC), dietary supplements, complementary/integrative therapies.

What is an OTC/nonprescription medication?

A medication available without a prescription for consumer self-care.

What is a dietary supplement?

A product intended to supplement the diet, such as vitamins, minerals, herbs, and botanicals.

What are complementary/integrative health therapies?

Non-mainstream products/practices used with conventional healthcare, such as meditation, yoga, chiropractic care, and massage.

Why are pharmacists important in self-care?

They are accessible, trusted medication experts.

What are the pharmacist's major roles in self-care?

Triage, product selection, checking interactions, dosing/administration, identifying adverse effects/safety issues, recommending non-drug measures, and determining when medical care is needed.

What are the 5 steps of the PPCP?

Collect → Assess → Plan → Implement → Follow-up

What is the purpose of PPCP?

To provide consistent, patient-centered care.

How long are self-care encounters typically?

Under 10 minutes.

What is QuEST/SCHOLAR-MAC?

A tool that helps pharmacists efficiently perform the PPCP

What does QuEST stand for?

Q = Quickly and accurately assess

E = Establish patient as appropriate for self-care

S = Suggest self-care strategies

T = Talk with the patient

What does SCHOLAR stand for?

S = Symptoms

C = Characteristics

H = History

O = Onset

L = Location

A = Aggravating factors

R = Remitting factors

What does MAC stand for?

M = Medications

A = Allergies

C = Co-existing conditions

How does QuEST map to PPCP?

Quickly assess → Collect

Establish → Assess

Suggest → Plan

Talk → Implement

Then → Follow-up

Unnecessary drug therapy

The patient is taking a medication that they do not need

Example: A patient has a viral cold but is taking an antibiotic.

Ineffective drug therapy

The patient is taking a medication, but it is not effective for their condition

Example: A patient has a fungal skin infection but is using triple antibiotic ointment

What is health literacy?

The ability to obtain, process, and understand basic health information/services needed to make appropriate health decisions.

What percentage of U.S. adults have low health literacy?

30%

How should pharmacists communicate with patients?

Put important information first, use simple language, evaluate understanding, and show and tell.

How should pharmacists provide culturally appropriate self-care?

Be respectful, knowledgeable, empathetic, and linguistically sensitive.

What organization determines whether an OTC medicine is safe/effective for direct consumer sale?

FDA — Food and Drug Administration

How does the required safety margin of OTC drugs compare with prescription drugs?

OTC medications require a wider margin of safety and low potential for abuse/misuse.

What does CDER stand for and what does it do?

Center for Drug Evaluation and Research — handles review of OTC medicines.

What does CPSC regulate regarding OTC medications?

Child-resistant closures

What is the Drug Facts Label?

The standardized label that provides the information an ordinary consumer needs for safe and effective OTC use.

What does "behind-the-counter" mean?

The consumer must ask the pharmacist/pharmacy employee to obtain the product.

Why are some nonprescription medications behind the counter?

Because of their potential for misuse/abuse.

What are examples of restricted-access products?

Pseudoephedrine, Schedule V codeine combination cough suppressants, insulin syringes/needles, and dextromethorphan in some states

What are examples of medications/services pharmacists may initiate without a traditional prescription?

Naloxone, vaccines, Kentucky BOP-approved protocols, and oral contraceptives in some states.

The United States self-care marketplace currently includes three categories of products available for self-care use. Which of the following is NOT one of those categories of products?

A. Prescription medications

B. Dietary Supplements

C. Nonprescription medications

D. Complementary Health Therapies

A. Prescription medications

In a 2015 study (noted in your text reading), pharmacists reported they often assisted in patient initiated self-care. The most frequent counseling activity they provided for patient's seeking self-care with nonprescription medications was:

A. Dosing information about a product

B. Product side effects and safety considerations

C. Product selection based on patient symptoms

D. Information on when to seek medical care

C. Product selection based on patient symptoms

QuEST/SCHOLAR-MAC is a tool that helps pharmacist utilize the Pharmacists Patient Care Process (PPCP) efficiently during self-care encounters. The SCHOLAR mnemonic corresponds to this step of the PPCP:

Collect

This core step of the Pharmacists Patient Care Process includes presentation of a selected nonprescription product to the patient to use and providing education regarding its use:

Implement

Specific information in outlined sections is required on a Drug Facts Label. Which of the following is NOT a required section?

A. Directions

B. Inactive ingredients

C. Uses

D. Drug Pregnancy Category

D. Drug Pregnancy Category

What are the major types of fungal skin infections?

Dermatophyte, Non-dermatophyte, Candidal infections

What is tinea pedis?

Fungal infection of the feet = athlete's foot (most common)

What is tinea corporis?

Fungal infection of the body = ringworm of the body

What is tinea cruris?

Fungal infection of the groin = jock itch

What is tinea capitis?

Fungal infection of the scalp

What is Tinea unguium?

Fungal infection of the nails

Onychomycosis or

"ringworm of the nail"

Which tinea infections are identified as self-treatable?

Tinea pedis, tinea corporis, and tinea cruris

What conditions encourage fungal skin infections?

Warm, moist environments

What are major risk factors for fungal skin infections?

Skin trauma, tight/occlusive clothing or shoes, sweating/wet clothing, public pools/showers, warm climates, high-impact sports/chronic foot trauma, poor hygiene/nutrition, diabetes, immunocompromise, and impaired circulation.

What can tinea pedis look like?

Wet/thick/soggy and possibly malodorous skin, rash or small vesicles, scaling/inflammation, cracks, or fissures

What factors are especially associated with tinea pedis?

Tight/occlusive shoes, high-impact sports/chronic foot trauma, and public pools/showers, occurs more in men, caucasians

What does tinea corporis typically look like?

Small, circular, red, scaly lesions that may have vesicles/pustules and itching

What factors are especially associated with tinea corporis?

Prepubescent (day care centers), high-contact sports, hot, humid climates, stress, overweight, immunocompromised

What does tinea cruris typically look like?

Slightly raised, well-defined, itchy red rash, possibly with vesicles at the margins

What factors are especially associated with tinea cruris?

Adults, males, Warm conditions, sweating, prolonged

contact with wet clothing

Where does tinea cruris usually occur, and what area does it usually spare?

Usually bilateral upper thighs/pubic area and typically spares the genitalia

When should a fungal infection NOT be self-treated?

* Cause is unknown/unclear

* Appropriate self-treatment failed

* Condition worsens

* Nail, scalp, genitalia, face, or mucous membranes are involved

* Secondary/systemic infection is suspected

* Excessive/continuous oozing

* Widespread, seriously inflamed, or debilitating

* Patient has diabetes or immune deficiency

What is the most important general non-drug advice for fungal infections?

Keep the affected skin clean and dry

How should a patient prevent spreading/reinfecting themselves with fungus?

Don't share personal items, avoid infected people/fomites, and wash/dry contaminated towels and clothing on hot settings

What clothing/footwear advice should be given?

Avoid wet and occlusive clothing/shoes and wear protective footwear in common/public areas.

What can be used in shoes to help with fungal infections?

Medicated/nonmedicated powder and odor-controlling insoles.

What should a patient do if an antifungal causes irritation, sensitization, or worsening?

Discontinue it

Why is adherence especially important with antifungals?

Patients must use the treatment correctly and for the full recommended duration, even if symptoms begin improving.

What are the 4 classes/types of pharmacologic therapy for fungal skin infections?

Azoles

Allylamines

Benzylamine

Tolnaftate

What are the formulations and dosing for miconazole 2% for tinea infections?

Formulations: Spray, powder, cream, ointment, liquid

Tinea pedis/corporis: BID × 4 weeks

Powder for ringworm: 2 weeks

Tinea cruris: BID × 2 weeks

What are the formulations and dosing for terbinafine 1% for tinea infections? (best option)

Formulations: Gel, cream, spray

Tinea pedis:

Between toes: BID × at least 1 week (gel/spray)

Bottom/sides of feet: BID × 2 weeks (gel/spray)

Cream: Daily × 1 week

Tinea cruris: Daily × 1 week (gel/cream/spray)

What are the formulations and dosing for tolnaftate 1% for tinea infections?

Formulations: Cream, gel, solution, powder, spray powder, spray liquid

Tinea pedis/corporis:

Cream: Daily × 4 weeks

Spray: BID × 4 weeks

Tinea pedis prevention: Daily to BID

Tinea cruris: Daily × 2 weeks (cream/spray)

Which two aluminum salts are discussed as astringents?

Aluminum chloride and aluminum acetate (Burow's solution)

When might an astringent be used before an antifungal?

When there is significant inflammation with oozing/weeping lesions

What is important to remember about aluminum acetate (Burow's solution)?

It must be diluted, is for short-term use, and should be used cautiously on deeply fissured skin

When should the patient start noticing symptom relief?

Within about 1 week

How long does it usually take to cure a tinea infection?

Usually 2-4 weeks, although some cases require 4-6 weeks

When should a patient be referred after beginning treatment?

If there is no improvement within 1 week, symptoms persist beyond treatment, symptoms worsen, or significant itching/swelling occurs

A typical treatment time for resolution of most fungal skin infections should be expected to take:

A. 2-4 months

B. 7-10 days

C. 3-5 days

D. 2-4 weeks

D. 2-4 weeks

A patient with the following fungal skin infection should be referred to a primary care provider for treatment:

A. Tinea unguium (nail)

B. Tinea pedis (foot)

C. Tinea cruris (groin)

D. Tinea corporis (body)

A. Tinea unguium (nail)

To prevent the spread of a fungal skin infection to other parts of the body, one should:

A. consult a primary care provider.

B. not wear clothing or shoes that cause the skin to stay wet.

C. wear protective footwear.

D. use a separate towel to dry the affected area or dry affected area last.

D. use a separate towel to dry the affected area or dry affected area last.

What is the most common symptom a patient with a cutaneous fungal infection experiences?

A. odor

B. hyperhidrosis

C. erythema

D. pruritus

D. pruritus

An astringent may be used to treat tinea pedis prior to an anti-fungal product in the following situation:

A. weeping lesions are present

B. scaling is present

C. significant itching is present

D. nail involvement is present

A. weeping lesions are present