FNP Pharm overview

What are topical nasal decongestants and examples?

Topical nasal decongestants, such as Oxymetazoline (Afrin) and Phenylephrine (Neo-Synephrine), are used for short-term relief of nasal congestion.

What is the recommended usage duration for topical nasal decongestants?

Short-term use of topical nasal decongestants is considered safe at twice a day as needed for up to 3 days.

What condition is caused by chronic use of nasal decongestants?

Rhinitis medicamentosa is caused by the chronic use of nasal decongestants for more than 3 days.

List some common antihistamines.

Common antihistamines include Diphenhydramine (Benadryl), Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra), Doxylamine (Unisom), and Chlorpheniramine (ChlorTrimeton).

Which antihistamine is recommended for elderly patients?

Loratadine (Claritin) is recommended for elderly patients due to its lower incidence of sedation.

What is the use for Azelastine nasal spray?

Azelastine nasal spray is used to treat allergic rhinitis, seasonal allergic rhinitis, and vasomotor rhinitis.

What are the risks associated with Dextromethorphan?

Dextromethorphan can increase the risk of serotonin syndrome when used with monoamine oxidase inhibitors (MAOIs), selegiline, SSRIs, and SNRIs.

What is the purpose of the Combat Methamphetamine Epidemic Act?

The Combat Methamphetamine Epidemic Act restricts the amount of pseudoephedrine you can buy to prevent its use in the illicit manufacture of methamphetamine.

What are mucolytics?

Mucolytics, such as Guaifenesin, work by thinning mucus and aiding in hydration for better respiratory function.

Decongestants contraindicated in patients with what certain conditions?

Decongestants are contraindicated in patients with hypertension and coronary artery disease (CAD) because they can cause heart palpitations, tremors, and anxiety.

What are common over-the-counter Nonsteroidal Anti-inflammatory Drugs (NSAIDs)?

Common over-the-counter NSAIDs include Ibuprofen (Advil, Motrin) and Naproxen sodium (Aleve).

What are the prescription forms of Ibuprofen?

Ibuprofen is available by prescription in 600 mg and 800 mg dosages.

What are some prescription NSAIDs?

Prescription NSAIDs include Naproxen (Naprosyn, Anaprox), Diclofenac (Voltaren), Indomethacin (Indocin), Ketoprofen (Orudis), Ketorolac (Toradol), Etodolac (Lodine), Mefenamic acid (Ponstel), Diflunisal (Dolobid), and Nabumetone (Relafen).

What are COX-2 inhibitors, and give examples?

COX-2 inhibitors, such as Celecoxib (Celebrex) and Meloxicam (Mobic), have a lower risk of gastrointestinal bleeding compared to other NSAIDs.

What topical NSAIDs are used for joint pain?

Topical NSAIDs include Diclofenac gel 1% (Voltaren Gel), Diclofenac solution 1.5% (Pennsaid), and Flector patch 1.3%, used for joint pain from osteoarthritis and degenerative joint disease.

What are ophthalmic NSAIDs used for?

Ophthalmic NSAIDs like Ketorolac (Acular) and Diclofenac sodium (Voltaren ophthalmic) are used for seasonal allergic conjunctivitis and for pain after cataract surgery.

What are some important warnings about NSAIDs?

NSAIDs should be avoided in patients with heart failure, severe heart disease, GI bleeding, and during the last 3 months of pregnancy. Patients with nasal polyps and asthma can be sensitive to aspirin/NSAIDs.

What is the maximum duration for taking Ketorolac (Toradol)?

The maximum duration for taking Ketorolac (Toradol) is 5 days, and it should not be used before surgery or with concurrent acetylsalicylic acid (ASA).

How should long-term NSAID use be managed?

For long-term NSAID use, document informed consent regarding risks of serious MI, stroke, GI bleeding, and acute renal failure. Consider prescribing proton-pump inhibitors or H2 antagonists to reduce GI risk.

What is the purpose of acetaminophen (Tylenol), and what are its dosing guidelines?

Acetaminophen (Tylenol) is considered a first-line drug for pain from osteoarthritis, with maximum doses ranging from 3,000 mg to 3,900 mg per day, depending on the formulation. Regular strength is 325 mg, and maximum is 10 tablets in 24 hours.

Why should NSAIDs be avoided in certain patients?

NSAIDs should be avoided in patients with heart failure (HF), severe heart disease, GI bleeding, severe renal disease, and during the last 3 months of pregnancy, as they can block prostaglandins.

What conditions can increase sensitivity to aspirin/NSAIDs?

Patients with nasal polyps and asthma can be sensitive to aspirin and NSAIDs.

What is the recommended duration of use for Ketorolac (Toradol)?

Ketorolac (Toradol) is recommended for short-term use only, limited to 5 days per episode.

How should Ketorolac be administered initially?

The first dose of Ketorolac should be given intramuscularly or intravenously, followed by oral administration.

When should Ketorolac be avoided?

Ketorolac should not be used before surgery, with concurrent acetylsalicylic acid (ASA), in pediatric patients, or in individuals at high risk of bleeding or with active/recent GI bleeds.

What should be documented for long-term NSAID use?

For long-term NSAID use, document informed consent regarding the higher risk of serious myocardial infarction (MI), stroke, emboli, GI bleeds, and acute renal failure.

How do COX-2 inhibitors compare to traditional NSAIDs regarding GI bleeding?

COX-2 inhibitors, such as Celecoxib, have a lower risk of gastrointestinal bleeding compared to traditional NSAIDs, but are not considered first-line treatment except for patients at high risk for GI bleeding.

What medications or substances increase bleeding risk when combined with NSAIDs?

Increased risk of bleeding occurs when NSAIDs are combined with warfarin, dabigatran (Pradaxa), steroids, alcohol, and some alternative herbs such as ginkgo biloba.

What should be considered for long-term NSAID therapy?

For long-term NSAID therapy, consider prescribing concurrent proton-pump inhibitors (PPIs), H2 antagonists, or misoprostol (Cytotec) to mitigate gastrointestinal risks.

How can NSAIDs affect hypertension in patients?

NSAIDS caused worsen hypertension by inhibiting prostaglandin synthesis, which can lead to sodium retention and increased blood pressure.

NSAIDs may worsen hypertension in patients who were previously well-controlled.

What is the dosing regimen for Aspirin (Bayer)?

Aspirin (Bayer) is typically dosed at 325 mg to 650 mg every 4 to 6 hours as needed.

What is the dosing for enteric-coated aspirin?

Enteric-coated aspirin can be dosed at 650 to 1,300 mg every 8 hours, with a maximum of 3.9 g per day.

What is the recommended aspirin dosage for acute coronary syndrome?

For acute coronary syndrome, aspirin is recommended at 160 to 325 mg orally; a nonenteric-coated tablet should be chewed as soon as possible (within minutes of symptoms).

What is the aspirin dosage for secondary prevention of MI and stroke?

For secondary prevention of myocardial infarction (MI) and stroke, aspirin is dosed at 75 to 81 mg orally daily, up to a maximum of 325 mg per day.

What is the dosing for Aspirin 845 mg with caffeine (BC Powder)?

For Aspirin 845 mg with caffeine (BC Powder), take one powder sublingually every 6 hours as needed, mixed with a full glass of water.

What are common topical therapies containing salicylate?

Common topical therapies include methyl salicylate and menthol products, such as BENGAY gel/cream.

What are nonacetylated salicylates?

Nonacetylated salicylates include medications such as salsalate (Disalcid) and nabumetone (Relafen).

What should be administered for thromboembolic stroke?

For thromboembolic stroke, immediate-release aspirin should be taken as soon as possible.

Why should aspirin not be given to children under 12 years of age?

Aspirin should not be given to children under the age of 12 years due to the risk of Reye’s syndrome.

What age should Aspirin be avoided

12 years and younger

How long does aspirin irreversibly suppress platelet function?

Aspirin irreversibly suppresses platelet function for up to 4 days due to irreversible acetylation.

What is the lifespan of platelets?

The lifespan of platelets is about 10 days.

What should be done if a patient complains of tinnitus while taking aspirin?

Discontinue aspirin (ASA) if the patient complains of tinnitus, as this may indicate possible aspirin toxicity.

What are the uses of capsaicin topical cream and patches?

Capsaicin topical cream (Zostrix HP) and patches are used for temporary relief of muscle and joint pain, as well as neuropathic pain such as postherpetic neuralgia (PHN) and trigeminal neuralgia.

How long might it take for capsaicin cream to work?

Capsaicin cream may take up to 4 weeks to work.

What precautions should be taken when using capsaicin cream?

Avoid using capsaicin on broken skin, wash hands with soap and water immediately after use, and avoid touching the eyes, nose, mouth, and genitals.

What important condition can capsaicin cream be use for?

Capsaicin cream can be used to treat pain in trigeminal neuralgia and postherpetic neuralgia (PHN).

What are glucocorticoids used for in medicine?

Glucocorticoids are used as adjunct treatment for rheumatoid arthritis, lupus, autoimmune disorders, anaphylaxis, and septic shock.

What is the first-line treatment for polymyalgia rheumatica?

Oral corticosteroids, particularly high-dose corticosteroids, are the first-line treatment for polymyalgia rheumatica.

What is the role of inhaled corticosteroids?

Inhaled corticosteroids are the first-line treatment for asthma and are used in short-term bursts to treat exacerbations.

What should be done if uveitis is suspected?

If uveitis is suspected, it should ideally be treated within 24 hours to reduce the risk of blindness.

What are the different groups of topical steroids?

Topical steroids are classified from Group 1 (superpotent) to Group 7 (least potent).

What are the potential side effects of chronic glucocorticoid use?

Chronic use can lead to HPA axis suppression, secondary Cushing’s disease, osteoporosis, immunosuppression, and skin changes.

Why should low-potency steroids be used for facial treatment?

Low-potency steroids are advised for the face, intertriginous areas, and genitals due to the thinner skin in these regions.

What is occlusion in the context of topical steroids?

Occlusion involves applying a topical steroid and covering it with a dressing or plastic wrap to increase absorption.

What is the risk of using ultrapotent steroids under occlusion?

Ultrapotent steroids should not be occluded for more than 2 weeks to avoid the risk of HPA suppression.

What is advised for patients on long-term corticosteroids to prevent osteoporosis?

Patients should engage in weight-bearing exercises and intake adequate vitamin D and calcium.

What is the first-line treatment for asthma?

Inhaled corticosteroids are the first-line treatment for asthma and help to control chronic inflammation in the lungs.

When are short-term bursts of oral steroids used?

Short-term bursts of oral steroids are used to treat exacerbations of asthma or other inflammatory conditions.

What should be done if uveitis is suspected?

Uveitis should be referred to the emergency department and treated ideally within 24 hours to prevent blindness.

What autoimmune diseases can lead to uveitis?

Uveitis can be a complication of autoimmune diseases such as rheumatoid arthritis, lupus, and polymyalgia rheumatica.

How is uveitis treated?

Uveitis is treated with topical steroid eye drops and/or systemic steroids to reduce inflammation.

What conditions are treated with topical steroids?

Topical steroids are first-line or adjunct treatment for inflammatory skin diseases, including acute cases of dermatitis like contact dermatitis.

What is the recommended dosage of Prednisone for short-term treatment?

Prednisone is prescribed at 40 to 60 mg/day for 3 to 4 days for short-term treatment, such as for asthma exacerbations.

What is the dosing guideline for Methylprednisolone (Medrol Dose Pack)?

Methylprednisolone is typically administered in a Dose Pack for 7 days and does not need to be weaned.

What are the dosage recommendations for infants and children regarding corticosteroids?

Children 2 years and younger: 20 mg/day; 3 to 5 years: 30 mg/day; 6 to 11 years: 40 mg/day; 12 years and older: 1 mg/kg/day, max 50 mg/day for 5 to 7 days.

What is the classification of topical steroids based on potency?

Topical steroids are classified from Group 1 (superpotent) to Group 7 (least potent), each indicating varying degrees of strength and usage.

Why should ointments be preferred over creams for topical steroids?

Ointments are usually more potent than creams and lotions, enhancing absorption and efficacy in treatment.

What is a potential risk when using topical steroids on thinner skin areas like eyelids?

Topical steroids can leach into the eyes, potentially causing secondary glaucoma if used near the eye area.

What are the side effects of chronic glucocorticoid use?

Chronic use can lead to HPA axis suppression, secondary Cushing’s disease, osteoporosis, immunosuppression, and skin changes.

What does HPA axis suppression result in?

HPA axis suppression can lead to decreased adrenal function and increased risk of adrenal crisis.

Decreaseadrenal function leads to various metabolic disorders and hormone imbalances.

What is secondary Cushing’s disease caused symptoms?

Secondary Cushing’s disease can manifest as a dorsal hump, rounded face, and other symptoms related to excess corticosteroids.

How can osteoporosis be prevented in patients using glucocorticoids?

Prevent osteoporosis by advising weight-bearing exercises, adequate vitamin D, and calcium intake of 1,200 mg/day, and considering bisphosphonates.

What are some skin changes associated with long-term topical steroid therapy?

Long-term topical steroid therapy can cause skin atrophy, striae, telangiectasia, acne, and pigmentation changes.

Why should low-potency steroids be used for facial treatment?

Low-potency steroids are recommended for the face, intertriginous areas, and genitals due to the thinner skin in these regions.

Why should using topical steroids around the eye area be avoided?

Avoid topical steroids around the eye area as they can leach into the eyes, causing secondary glaucoma and potential blindness.

Why should potent-strength topical steroids be tapered?

Potent-strength topical steroids should be tapered to prevent rebound effects when treatment is discontinued.

Why are infants and young children at higher risk when using topical steroids?

Infants and young children have thinner stratum corneum than adults, leading to increased absorption and risk of adverse effects from topical steroids.

What is occlusion in the context of topical steroids?

Occlusion involves applying a topical steroid and covering it with a dressing or plastic wrap to enhance absorption.

How long should ultrapotent steroids be occluded?

Ultrapotent steroids should not be occluded for more than 2 weeks due to the risk of HPA suppression.

What duration of oral steroid may be required for severe poison ivy or poison oak rashes?

A severe case of poison ivy or poison oak rash may require 14 to 21 days of an oral steroid to clear.

What is the formulation of superpotent topical steroids?

Superpotent topical steroids are typically available in ointment forms for better absorption and efficacy.

What are common uses for high potency topical steroids?

High potency topical steroids are often used for thick skin areas and severe inflammatory skin conditions such as psoriasis and eczema.

Why is the correct classification of topical steroids important?

Correct classification prevents potential side effects and ensures appropriate treatment for various skin conditions.

How should medium potency topical steroids (Group 4) be applied?

Medium potency steroids should be used sparingly and in thin layers to avoid skin atrophy and other side effects.

What precautions should be taken when using lower-mid potency topical steroids?

Monitor for skin irritation and ensure not to exceed the recommended duration of treatment to prevent tolerance.

What is a common side effect of using low potency topical steroids?

While generally safer, low potency steroids can still cause local skin reactions, such as irritation or sensitization.

Who should ideally prescribe high potency topical steroids?

High potency topical steroids should be prescribed by a dermatologist or healthcare professional due to their potential for significant side effects.

What are examples of medications classified as superpotent topical steroids (Group 1)?

Examples include Clobetasol (Temovate) and halobetasol propionate (Ultravate).

What is an example of a medication in Group 2 (high potency)?

Halcinonide (Halog) is an example of a high potency topical steroid in Group 2.

What are examples of medications classified as high potency in Group 3?

Mometasone furoate (Elocon) is an example of a high potency topical steroid in Group 3.

What is an example of a medium potency topical steroid in Group 4?

Hydrocortisone valerate ointment (Westcort) is classified as a medium potency topical steroid in Group 4.

What are examples of medications classified as lower-mid potency topical steroids (Group 5)?

Desonide gel (Desonate) is an example of a lower-mid potency topical steroid in Group 5.

What are examples of low potency topical steroids (Group 6)?

Alclometasone dipropionate (Aclovate) is an example of a low potency topical steroid in Group 6.

What is an example of the least potent topical steroid (Group 7)?

Hydrocortisone base <2% (Cortaid, Cortizone 10) is classified as the least potent topical steroid in Group 7.

What should low-potency steroids be used for?

Low-potency steroids should be used for the face, intertriginous areas, and genitals due to the thinner skin in these regions.

What are examples of low-potency steroid strengths for topical use?

Hydrocortisone cream/ointment/lotion 0.5% to 1% (OTC) and prescription strength hydrocortisone 2.5% (Hytone Rx).

Why should topical steroids be avoided around the eye area?

Topical steroids can leach into the eye and cause secondary glaucoma and potential blindness in susceptible individuals.

When should you refer to a dermatologist with regards to steroid use?

Refer to a dermatologist if higher potency steroids are necessary, due to the high risk of suppression of the HPA axis.

What regions of the body are suitable for moderate- to high-potency steroids?

Moderate- to high-potency steroids are used for thicker skin areas like the scalp, soles of feet, palms of the hands, and for treating plaques like psoriasis.