Self-Care II Exam 4: Scaly/Diaper/Diarrhea/Otic

• _____ → 1ST LINE for PSORIASIS, SD for associated ERYTHEMA

• _____ → 1ST LINE for SD can use for the rest 

• _____ → 1ST LINE for SD can use for the rest 

• _____ → 1ST LINE for SD can use for the rest LOWER IN DOSE than acute 

• _____ → 1ST LINE for SD can use for the rest 

• _____ → can use for all but limited use for DANDRUFF

Hydrocortisone, Ketoconazole, Pyrithione Zinc (acute), Pyrithione Zinc (chronic), Selenium, Coal Tar

Nonpharm for Dandruff

• Routine shampooing w/ NON-medicated shampoos (daily or every other day)

• Avoid shampoos with _____

sodium lauryl/laureth sulfate

Nonpharm for SD

• _____ to loosen scales

• Washing with _____

Mineral or olive oil, dishwater liquid

Nonpharm for Cradle cap

• _____ to soften and remove scales 

• Use _____

Non-medicated shampoos, baby oil

Nonpharm for Psoriasis

• Avoid _____ 

• Use _____ bath products _____

• Use _____ water for bathing 

• Non-medicated _____ AFTER bath/shower

triggers, lubrication, 2-3x/week, tepid, emollients

Prevention options for Scarly derm diaper derm

• Change diapers frequently (_____)

• Clean area with baby wipes or use soft cloth and warm water 

• Allow area to air dry before rediapering 

• Use skin protectants (make sure skin is clean first)

• Consider a diaper holiday 

• Use disposable diapers (some _____ in diapers can cause allergic reaction)

2 hours, dyes

Treatment options for Scarly derm diaper derm

• _____ 

  • Barrier between skin and external irritants

  • Lubricate areas of friction 

  • Prevent direct contact with moisture 

  • Allows body’s normal healing processes to work

• _____ and _____ formulations 

• Avoid _____, _____, and _____ 

• Skin protectants 

  • _____ → THICK paste so requires soap for removal

  • _____ → ointment base

  • _____ → reduce moisture and friction, inhalation warning, _____ possibly carcinogenic

Skin protectants, Semisolid, powder, topical antibiotics, antifungals, steroids, Zinc Oxide, Petrolatum, Talc and Cornstarch, Talc

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Pyrithione Zinc cytostatic

  • preferred over _____

1) Wash with nonmedicated/nonresidue shampoo 1st 

2) more effective with longer contact time 

3) massage on scalp and leave for 3-5 mins 

4) avoid contact with eyes to prevent stinging 

5) contact derm when used on broken or abraded skin 

Dandruff: use _____ then use _____ for _____ than _____ for maintenance 

SD: use _____ then _____ for _____ then _____ for maintenance

Selenium, qd 1 week, 2-3x/week, 2-3 weeks, every other week, qd 2 weeks, 2-3x/week for 4 weeks, qd 1 week

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Selenium Sulfide Cytostatic

  • ADRs: May _____ and Leaves _____

1) Wash with nonmedicated/nonresidue shampoo 1st 

2) more effective with longer contact time 

3) massage on scalp and leave for 3-5 mins (contact time is key)

4) rinse hair thoroughly (2-3 times) or discoloration of hair my result or residual odor/oil

5) avoid contact with eyes to prevent stinging 

6) freq use may leave a residual odor and an oily scalp 

Dandruff: use _____ then use _____ for _____ than _____ for maintenance 

SD: use _____ then _____ for _____ then _____ for maintenance 

discolor hair, oil/odor, qd 1 week, 2-3x/week, 2-3 weeks, every other week, qd 2 weeks, 2-3x/week, 4 weeks, qd 1 week

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Coal tar (creams, ointments, pastes, lotions, bath oils, shampoos, soaps and gel)

  • cytostatic → NOT preferred

  • ADRs: _____ (axilla + groin area), Staining of _____, _____, and _____

1) apply at _____ then _____ to remove residual coal tar and loosen scales 

2) may stain _____. Wash thoroughly 

3) avoid _____ application 

Folliculitis, skin, hair, and clothing, photosensitivity, contact dermatitis, bedtime, bathe in the morning, skin and clothing, sun exposure for 24 hours after

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Ketoconazole 1% (anti-malassezia/ antifungal)

  • it _____ 

  • ADRs: _____, _____, abnormal _____, _____, _____ sensation, _____

1) apply _____ for _____ with at least _____ each treatment → once controlled use _____ to prevent relapse 

2) avoid contact with _____ due to irritation

kills it, hair loss, skin irritation, hair texture, dry skin, burning, pruritus, 2x/week, 4 weeks, 3 days inbtwn, qd 1 week, eyes

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Salicylic Acid keratolytic

• ADRs: _____ sensation, _____, _____, _____

1) Do not apply over _____ bc potential systemic toxicity 

2) For body: soak area in _____ water for _____ before application to enhance keratolytic activity 

3) extended use can alter _____

4) avoid drug exposure to eyes, nose, mouth, or broken/injured skin 

5) keratolytic effect begin in _____

burning, erythema, pruritus, stinging, extensive areas, warm, 10-20 mins before, hair appearance, 7-10 days

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Sulfur Keratolytic

  • ADRs: _____, _____ of skin, _____

  • May be combined with _____ to treat SD but NOT FDA approved

skin irritation, drying/peeling, odor, salicylic acid,

Counseling for OTC prods, how to use/admin schedule, duration, DDI, ADR, CI for scaly derm and diaper derm

• Hydrocortisone 1%

• ADRs: Local _____ after prolonged use, aggravation of certain cutaneous _____, impaired _____

• Apply _____

atrophy, infection, skin healing, BID x 7 days

Exclusion Criteria For dandruff, seborrheic derm, psoriasis

• < _____ 

• Worsening of Sxs or no improvement after _____ of self-care treatment  

2 y/o, 2 weeks

Exclusion Criteria For only psoriasis

• > _____

• Involvement of _____

• _____ (possible psoriatic arthritis)

• More than a few _____

• Lesions greater than size of a _____

5% BSA, face, joint pain, lesions, quarter

Exclusion Criteria For Diaper 

• Lesions > _____ or lack of improvement

• s/sx of secondary infection 

• Diaper dermatitis _____

• Possible _____ 

• Broken _____, _____, _____, or _____

• Comorbid conditions

• Severe or systemic Sxs

• Chron, freq, or recurrent Sxs 

• Significant behavior changes with _____ (incessant crying, lethargy)

7 days, outside of diaper area, UTI, skin, blood, vesicles, pus, rash

Nonpharm for Oral rehydration therapy

• Can be used for _____ by managing fluids and electrolytes

• Premized solutions and powders w. Electrolytes and carbs

  • _____, _____, _____, and _____

  • _____, _____, _____

• Products osmolarity should be ~ 200 to 300 mOsm/L

  • Higher conc may worsen diarrhea

  • Improves Na and water reabsorption

• Products Na+ conc should be 45-90 mEq/L 

  • Lower Na conc may limit water reabsorption 

mild to moderate diarrhea, Na, Cl, K, citrate, glucose, fructose, dextrose

Nonpharm for Dietary recc for Diarrhea

• Generally, age-appropriate eating w/ slight restrictions should be encouraged

• Certain foods should be AVOIDED → 

  • _____ (children) → banana, rice, apple sauce, toast

  • Products w/ _____ content, _____ conc, _____, _____ products

  • Other foods that might ordinarily upset the stomach (_____, _____ etc)

Traditional BRAT diet, high sugar, low Na, caffeine, dairy, spicy, fatty

Loperamide for Diarrhea

• > _____

• Tabs/Caps: MAX: _____, _____ initially → _____ after each subsequent loose stool

• Liquid: MAX _____, _____initially → _____ after each subsequent loose stool

• Max duration of use → _____

• ADRs: _____, _____

• C/I: hypersensitivity

• Counseling

  • May cause _____ and/or _____

  • Will NOT significantly interact with other meds but may incr _____ or _____ w/ other CNS medications

6 y/o, 8 mg/day, 4 mg, 2 mg, 8 mg/day, 30 mL, 15 mL, 2 days, dizziness, constipation, dizziness, constipation, dizziness, sedation

Bismuth Subsaliculate for Diarrhea

• > _____

• Tabs/Caps: MAX _____, _____ q_____

• Liquid: MAX _____, _____ (262mg/mL or 525mg/15mL) q_____

• Max duration of use → _____

• ADRs: _____ and _____, _____

• C/I: Hypersensitivity to pro, _____, _____, _____

• Counseling

  • May cause _____ with excessive use → DNE _____

  • May cause _____ or discoloration of the _____

  • Must separate BSS use with other antibiotics if both are to be taken concurrently by _____

  • Caution if using _____ or other anticoagulants such as _____

  • Caution in those under _____ or in those w/ _____

12 y/o, 4200 mg/day, 525 mg, 30-60 mins, 4200 mg/day, 15-30 mL, 30-60 mins, 2 days, black tarry stools, tongue, tinnitus, ASA allergy, viral infections, preggo, ringing in ears, 4200 mg/day, black tarry stools, tongue, 2 hours, ASA, Warfarin, 18 y/o, Hx of GI bleeding

Lactase for Diarrhea

• Take _____ prior to meals containing dairy

Zinc for Diarrhea

• _____ and _____ with ORS

• For ages <_____ y/o

1-3 caps 30 mins, 5-20 mg QD, 10-14 days, 5

Exclusion For Diarrrhea

• < _____, weight < _____

• Persistent or high _____

• Blood, mucus, pus present in stool

• High volume output or freq of diarrhea

• Persistent _____

• Severe or persistent _____ 

• Abdominal pain, distention, tenderness

• At risk of significant complications

  • _____, _____, _____ disease

  • _____ 

• _____

• Chronic _____

• Suboptimal response to _____ (oral rehydration solution)

• Sxs worsening after _____ of onset

6 months, 17.5 lbs, fevers, vomiting, dehydration, DM, CVD, renal, immunosuppression, Preggo, diarrhea, ORS, 48 hours

Water clogged →  fullness or dull _____ in ear + some hearing impairment

• Recommend D/C of _____ or wardrobes and refer to local urgent care or make app with PCP ASAP

• Avoid other water activities until Sxs have resolved

• _____ is dry agent for _____ of water-clogged ears → DO NOT USE FOR _____

pain/discomfort, Auro-Dri, prevention, infection

Impacted cerumen → Sensation of _____, _____ or _____, Discomfort, _____, Sometimes _____ and _____ may be present

• _____ in anhydrous glycerin is FDA APPROVED FOR SELF CARE

ADMINISTRATION: from APHA

• Instil _____ of the solution into the affected ear(s) and allow the solution to remain in EAS for _____ for effective softening of excess earwax

• Administer _____ for up to _____ 

  • Prevent the applicator tip from entering the EAC

  • Prevent contact with eyes during administration

ADMINISTRATION FROM CASE 

• Instill _____ in the affected ear and let sit for _____. Use OTIC bulb syringe to gently rinse out afterwards, follow up PCP after _____ or if Sxs continue or are worse. Can be used _____ 

ear fullness, dull pain, itching, tinnitus, ear discharge, odor, Carbamide Peroxide 6.5%, 5-10 drops, several minutes, BID, 4 days, 5-10 drops, 15 mins, 4 days, BID

Impacted cerumen

• If Sxs persist after _____or _____ develop REFER to PCP

• Can be used _____ or w/ _____ irrigation to remove the loosened cerumen 

• Can be use in children >_____

4 days, ADR, alone, warm water, 12 y/o

Exclusion for Cerumen

• Signs of infection (_____) 

• Pain associated with _____

• _____ or signs of _____ 

• Presence of ruptured _____

• Ear surgery within prior _____

• _____ present

• Hypersensitivity to recommended agents 

• < _____ 

• Worsening of condition after attempted self-treatment

irritation or rash, ear discharge, bleeding, trauma, tympanic membrane, 6 weeks, tympanostomy tubes, 12 y/o

Exclusion for Water-Clogged Ears

• Signs of _____ (_____) 

• Pain associated with _____

• _____ or signs of _____ 

• Presence of _____

• Ear surgery within prior _____

• _____ present

• Hypersensitivity to recommended agents 

• Worsening of condition after attempted self-treatment

infection, irritation or rash, ear discharge, bleeding, trauma, ruptured tympanic membrane, 6 weeks, Tympanostomy tubes

Cerumen

• Sensation of _____, _____ or _____ 

• Discomfort, _____

• Sometimes _____ and _____ may be present

ear fullness, dull pain, itching, tinnitus, ear discharge, odor

Water-clogged ears

• _____ within the EAC

• _____

• Localized discomfort or sensation of fullness in ear canal

retention of water, hearing impairment