Self Care Final

Allergic Rhinitis Exclusions

- < 12 years old - P/L - Symptoms of other infections - Symptoms of asthma, COPD, lower respiratory disorders - Severe or unacceptable side effects of treatment

Diarrhea Exclusions

- < 6 months - < 17.5 lbs. - Severe dehydration - ≥ 6 months with persistent fever - Visible blood, mucus, pus in stool - Persistent vomiting - Severe abdominal pain - High output, frequent, substantial volume - Risk for significant complications - Pregnant - Chronic or persistant - Suboptimal response to ORS already administered

Protussive - Productive

Guaifenesin = 200-400 q4h NTE 2.4 g Need at least 1200 mg/day to make effective AEs = n/v, dizzy, headache, rash, diarrhea, drowsy, stomach pain Same benefit as staying hydrated

Tobacco Cessation Treatment

Gum, lozenge, patch, inhaler, nasal spray, Chantix, Zyban

Allergic Rhinitis Treatment

INCS, antihistamines, decongestants, mast cell stabilizers (take 1 week before)

Counterirritant

Icy Hot, Bengay, Tiger Balm, Capzasin (knee) Exclusions = damaged skin, < 2 years old, don't use tight bandages or thermotherapy C/I = warfarin w/ salicylates 3-4 times/day for 7 days

Sinus Headache

Inflammation or distention of sensitive sinus walls, caused be viral/bacteria infection or allergic rhinitis Face / forehead / periorbital area, pressure behind eyes or face, dull, bilateral, mild-severe, onset with sinus problems Difficult to discern between this and migrain w/o aura

Osteoarthritis

Joint stiffness for 20-30 minutes, relieved by rest Hip and Knee = NSAIDs and APAP (oral) Hand = NSAIDs only (topical) Back = NSAIDs and heat are first line, APAP second line Diclofenac = 4 times/day, 2 or 4 g, may take up to 1 week to work, stop use after 21 days and refer back to PCP

Topical Anesthetics

Lidocaine, Aspercreme, Salonpas NTE 7 days

Nicotine Patch

Light = 14 for 6 weeks, 7 for 2 weeks Heavy = 21 for 6 weeks, 14 for 2 weeks, 7 for 2 weeks

Hemorrhoids Treatment - Piles

Local Anesthetics (external), vasoconstrictors, protectants, astringents, keratolytics, analgesic / anesthetic / antipruritic, corticosteroids, laxatives Avoid NSAIDs and ASA Don't OTC for more than 7 days

Cromolyn Sodium

Mast cell stabilizer Low absorption ≥ 2 yo 1 spray 3-6 times/day May take 3-7 days to work and 2-4 weeks for max effect Good for P/L

Probiotics

May be effective in preventing and treating in kids Maintains natural GI flora

Analgesic, Anesthethic, Antipruritics

Menthol - can cause allergic reactions Juniper tar - has phenol so don't injest Camphor - stimulates CNS and readily absorbed For discomfort, itching, irrititation, pain, burning

Inhaler

4 mg 6 inhales min 6 for 3-6 weeks NTE 16 PRN q1-2h Gradually reduce dose in weeks 6-12

Heartburn Exclusions

- > 3 months - Still have it while taking H2RAs or PPIs - Continues after 2 weeks with treatment - Nocturnal heartburn - Severe Symptoms - Difficulty swallowing food - Chronic hoarsness, weezing, coughing, choking - GI bleeding - Unexplained weight loss - Continuous n/v and diarrhea - Chest pain with sweating or pain in shoulder, arm, neck, jaw - SOB - P/L - Children < 2 for antacids, < 12 for H2RAs, < 18 for PPIs - Adults over 45 with new onset dyspepsia

Hemorrhoids Exclusions

- Anorectal disorders < 12 - GI disease w/ colorectal bleeding (Crohn's) - Family history of colon cancer - Severe pain - Bleeding - Seepage - Prolapse - Tarry stool - Itchy - Inflammation - Burning - Discomfort - Not better after 7 days of treatment

Headache Exclusions

- Consult PCP if < 8 years old - Cluster and secondary headaches - Severe pain - Start with rapid onset of max pain - Change in headache pattern - > 10 days w/ or w/o treatment - Undiagnosed migraines - Fever or sign of infection - Neck stiffness - Last trimester of pregnancy - New headache during pregnancy - Hisotry of liver disease - ≥ 3 drinks per day

Cough Exclusions

- Difficulty breathing - SOB - Dyspnea - Cyanosis - Weight loss - Night sweats - Cough worsens after 3-5 days - Cough doesn't stop after 2-3 weeks - < 4 yo with > 100.4 - > 100 for > 3 days - Begins suddenly w/o fever or URI symptoms - Immunocompromised - History of exposure to TB - Risk factors of HIV - Chronic illness - GERD

Cold Exclusions

- Fever > 100.4 - Chest pain - SOB - Worsening of symptoms during treatment - Concurrent cardiopulmonary diseases (COPD, etc.) - AIDS - Chronic immunosuppressant therapy - Frail elderly patients - infants < 3 months - Symptoms longer than 7-14 days - Sports with oral decongestants

Constipation Exclusions

- Marked abdominal pain - Significant distention or cramping - Marked or unexplained flatulence - Fever - N/V - Daily laxative use - Unexplained change in bowel habits - Unexplained weight loss - Bloody or tarry stool - Chronic medical condition - Marked change in character of stool - Sudden change in bowel habits that lasts longer than 2 weeks or recur over a period of at least 3 months - Symptoms recur after dietary or lifestyle changes - IBS - Anorexia - < 2 years old

Sprains and Strains Exclusions

- Severe pain or tenderness - > 10 days of pain - Changes in character of pain - Accompanying n/v, fever, signs of systemic infection - Pelvic or abdominal pain - Weakness or numbness in injurd area - Cannot put weight on injured joint - Pregnant - < 2 years old

Intestinal Gas Exclusions

- Symptoms for several days - Severe debilitating - Sudden change in location of pain - Significant increase in frequency or severity - Onset > 40 yo - Significant abdominal pain and change in BM - Accompanying symptoms (diarrhea, bleeding, etc.)

N/V Exclusions

- Urine ketone increases - Suspected food poisoning > 24 hours - Severe abdominal pain in middle or lower right quadrant - N/V with fever and/or diarrhea - Sever upper right quadrant pain - Blood in vomit - Yellow skin - Eye discoloration - Dark urine - Stiff neck w/ or w/o headache - Photosensitivity - Head injury with n/v - Blurry vision - Numbness - Tingling - Comorbidities - P/L - Drug induced - Psychogenic

Corticosteroids

0.5-1% Hydrocortisone For itching May mask symptoms of bacterial or fungal infections

Nasal Spray

10 mL bottle 1 dose is 1 mL with one 0.5 spray each q1-2h NTE 5/hour or 40 mg/day Don't excede 3 months

Antihistamines

1st Gen = sedating, -amine, runny nose, help sleep Diphenhydramine = benadryl, sedating, anticholinergic (opposite in kids), take at night 2nd Gen = non-sedating, not good for colds (less anticholinergic) Loratadine, cetrizine, fexofendadine, lecocetirizine - good for < 6 yo Less AEs C/I = fexofenadine (allegra) w/ fruit juice, MAOIs

Nicotine Gum

2 g or 4 g 9 pieces min 20 pieces max Chew and park

Nicotine Lozenge

2 g or 4 g 20 pieces pax Weeks 1-6 = 1 q1-2h Weeks 7-9 = 1 q2-4h Weeks 10-12 = 1 q4-8h

Children Allergic Rhinitis

> 2 = cromolyn, furoate, triamcinolone > 4 = propionate > 6 = budesonide Loratdadine > fexofenadine > levocetirizine > cetirizine C/I = INCS and sedatives

Tension Type Headache

APAP and NSAIDS, < 3 times/week or < 14 days/month Chronic = ≥ 15 days per month for at least three months Episodic = < 15 days Freqeunt Episodic = at least 10 on 1-14 days Bilateral, pressing, constricting, tightening, ache, mild-moderate, gradual onset, 30 min-7 days, scalp tenderness, neck pain, muscle tension

APAP

Analgesic and antipyretic NOT ANTI-INFLAMMATORY > 2 years old unless medical referral Best onset rectally Inhibit COX in CNS only 10-15 mg/kg/dose q4-6h PRN NTE 2400 MAX IS 4000 MG DAILY B/C HEPATOTOXICITY 160 mg / 5 mL suspension AEs = hepatotoxicity, common accidental OD, bad concurrent with liver disease / ≥ 3 drinks / poor nutrition, skin problems C/I = warfarin, alcohol

Headache and Fever Treatment

Analgesics - APAP (headache only), NSAIDs, Asprin,

Musculoskeletal Treatment

Analgesics, counterirritants, topical anesthetics, diclofenac

Heartburn and Dyspepsia Treatment

Antacids, H2RAs, PPIs, Bismuth Subsalicylate

N/V Treatment

Antihistamines, antacids, H2RAs, BSS, phosphorated carbohydrate solution (PCS) - similar to heartburn ORS Acupressure = > 2

NSAIDs

Antipiretic, analgesic, anti-inflammatory, inhibit COX in CNS and PNS Ibuprofen = 5-10 mg/kg/dose q6-8h NTE 1200 mg > 2 yo for headache > 6 months for fever Naproxen = 220 mg/dose q12h NTE 660 > 12 yo Aspirin = 4-6 g > 18 yo AEs - GO, > 60 yo, Reye's syndrome

Alpha-galactosidase

Beano FDA approved Classified as food Avoid with mold allergy and galactosemia Wait until food is cooled down

Chantix

Begin 1 week before quitting Days 1-3 = 0.5 QD Days 4-7 = 0.5 BID Days 8+ = 1 BID for up to 12 weeks

Zyban

Begin 1-2 weeks before quitting 150 mg BID Don't need to taper off

Local Anesthetics

Benzocaine and dyclonine hydrochloride, pramoxine Menthol and camphor - rub on chest and throat, relief of nasal congestion and coughs - strong smell Antiseptics not antivirals May mask more sever anorectal disorders if used for hemorrhoids

Stimulant

Bisacodyl and Senna Oral = 6-10 hours Rectal = 15-60 min (bisacodyl) Good with docusate in opiate-induced Second line in occasional constipation after bulk forming and hyperosmotics More AEs

Constipation Treatment

Bulk forming, Hyperosmotics, Emollients, Lubricants, Saline, Stimulants For < 3 BMs / week

Topical Antitussives

Camphor and Menthol C/I = warfarin

H2RAs

Cimetidine (many d-d interactions), Famotidine, Ranitidine (discontinued), Nizatidine (not in US) - reduce acid secretion by inhibiting histamine on H2 receptor or parietal cells Tagamet, pepcid, zantac For fast and nocturnal symptoms Slower onset but longer duration Take PRN not daily Renal > hepatic metabolism OTC should not excede BID AEs = headache, diarrhea, constipation, dizziness, drowsiness, thrombocytopenia, male sex decrease Recommended Ca intake = 700 in 2-3 yo, 1000 in 4-8 yo, 1300 in > 9

Protectants

Cocoa butter, glycerin, lanolin, petrolatum, AlOH gel and kaolin (for moist - avoid greasy drugs) For discomfort, itching, irritation, burning

Oral Antitussives - Nonproductive

Codeine = 5 narcotic, 10-20 mg q4-6h NTE 120 AEs = n/v, sedation, dizzy, constipation, RR depression, opioid misuse C/I = CNS depressants, CYP2D5-I Dextromethorphan = non-opioid, safe for pregnancy AEs = drowsy, n/v, Gi, constipation, confusion, irritability C/I = MAOIs Diphenhydramine = commonly used in pregnancy, bad for breastfeeding / children / old C/I = MAOIs Citrate = 38-228, 19-75, 9.5-57 HCl = 25-150, 12.5-75, 6.25-37.5

Decongestants

Cold > 4 years old for manufacturers > 2 years old for FDA Acute overdose common - get dose right Limit 3-7 days to prevent RM Sudafed is ok for occasional use in HTN AEs = excessive CNS stimulation (insomnia, anxiety, tremors), CV collapse, shock, coma, n/v, drooling, hypotension, lethargy, sedation, coma, skin issues for topical, may exacerbate comorbidities C/I = MAOIs Sudafed = 3.6 g daily, 9 g per month Systemic = Pseudoephedrine (60-30-15 q4-6h) and Phenylephrine Topical = Ephedrine, Oxymetazoline (P/L), Xylo, Lev Limited AEs and fast onset

Cold Treatment

Decongestants, saline nasal sprays, antihistamines, expectorants, cough suppressant, analgesics, lozenges, throay sprays Vitamin C - early use may be beneficial but not really

Emollient

Docusate (colace) and calcium 240 mg Stool softener 12-72 hour onset and 3-5 day duration For occasional constipation, prevents straining, long-term for opiate-induced w/ stimulant (senna) C/I = mineral oil, < 12 for docusate sodium unless Rx

Vasoconstrictors - external

Ephedrine, phenylephrine, epinephrine For discomfort, itching, swelling, shrinkage AEs and C/I = antihypertensives, tremor, nausea, loss of appetite, sleepless, consult HCP with comorbidities

Bismuth Subsalicylate

For heartburn, upset stomahc, indigestion, nausea, diarrhea C/I = children, Reye's, bleeding risk, salicylate sensitivities 262-525 mg q30-60min PRN

Antihistamines - N/V

For motion sickness Meclizine > 12 Cyclizine > 6 Benadryl causes hyper kids - > 6 Dimenhydrinate = ≥ 2

Intranasal Corticosteroids

For nasal itching, rhinitis, sneezing, congestion - more severe These are nasal sprays Budesonide, Fluticasone Furoate, Fluticasone Propionate, Triamcinolone AEs = nasal discomfort, bleeding, sneezing, coughing, pharyyngitis, headache, dizziness, n/v, vision, glaucoma, cataract Don't use budesonide or triamcinolone in pregnant

Digestive Enzymes

For people with lactose intolerance Prevent osmotic diarrhea Lactaid and Lactrase

Simethicone

Gas x, Mylicon, Phazyme Adult = 40-125 mg 4 times Infants = 40 mg/0.6 mL Reduce surface tension of gas bubbles - defoaming Mixing with Loperamide for acute diarrhea results in better effect than either alone

Bulk Forming - first line

Methylcellulose, Polycarbophil, Psyllium (metamucil) Take with 8 oz. of warer 12-24 hour onset, 72 hour duration For short term relief, postpartum, colostomies, IBS AEs = not good for fluid restricted diets, avoid hypersensitivity, abdominal cramping, flatulence, choking, alter absorption of drugs Wait 2 hours between meds Not for opioid-induced

Saline

Mg citrate, Mg hydroxide, dibasic Na phosphate, monobasic Na phosphate, Mg sulfate Oral = 1/2-3 hours Rectal = 2-15 min For occasional relief of constipation (MgOH), bowel preparing for colonoscopies (MgOH), not for long-term management Not first line, only reason to take these is for fast onset Many AEs Separate dosing of meds by a couple hours

Antacids

Mg hydroxide, Mg carbonate, Mg trisilicate, Al hydroxide, Al phosphate, Ca carbonate (kids pepto-bismol), Na bicardonate - neutralize gastric acid Alka-seltzer, Pepto-bismol, Tums (Ca), Rolaids Liquid > Tablet for onset For mild and infrequent heartburn Dosing can be repeated every 1-2 hours PRN AEs = diarrhea (Mg), bad for renally impaired, constipation (Al and Ca), belching, flatulence, fluid overload in people with comorbidities Can take with alginic acid - only works in upright position and doesn't work alone

Lubricant

Mineral oil (liquid petrolatum) Oral = 6-8 hours Rectal = 5-15 min Same indications as docusate but not recommended for routine use AEs = d-d interactions with ADEK vitamins and docusate, don't use within 2 hours of eating, lipid pneumonia, bedridden patients c/i, < 6 yo unless Rx

PCS - Emetrol

Mixture of fructose, dextrose, phosphoric acid For nausea caused by infection, dietary indiscretion, NVP, motion sickness Emetrol - 5-12 = 5-10 mL every 15 min Adults = 15-30 mL every 15 min NVP = 15-30 mL at rise, repeat every three hours PRN Don't exceed 5 doses, do not dilute, do not consume other liquids for 15 min after > 2

Pyrantel Pamoate

No effect on larvae and eggs, reinfection common, rely on good hygeine 11 mg/kg NTE 1 g for single dose Consult PCP for < 2yo or < 25 lbs. Not recommended for 2nd and 3rd semesters of pregnancy Repeat dose in 2 weeks if not better

Activated Charcoal

Not approved or shown to work 500-520 mg orally after meals PRN, may repeat hourly

Diarrhea Treatment

ORS - fluid and electrolye management, Loperamide, Bismuth Subsalicylate, Digestive Enzymes, Probiotics ≥ 3 BM/day Acute = < 14 days Persistent = 14 days - 4 weeks Chronic = > 4 weeks

Cold Symptoms

Often caused by rhinovirus, sore throat around 1-3 days, cough by 4-5 days, postnasal drip, nasal obstruction, tender sinuses, clear / thin / watery nasal secretions in early stages (green and thick later), low grade fever, sneeizing, rhinorrhea, chills, headache, malaise, myalgia

PPIs

Omeprazole, Isomeprazole, Lansoprazole Prilosec, Zegerid, Nexium, Prevacid For mild-moderate and frequent (≥ 2 days/week), good for hiatal hernias Decrease gastric acid secretion by inhibiting hydrogen potassium ATPase Onset of 1-3 hours, 4 day duration AEs = headache, abdominal pain, diarrhea, constipation, flatuense, acute intestinal nephritis, C. diff Ome / lans / iso are good for renal impairment

Cough Treatment

Oral and topical antitussive, protussives

Hyperosmotic

PEG-3350 and glycerin Good for occasional simple constipation Glycerin = 15-30 min onset rectally PEG-3350 = 12-72 hours, last 96 hours Take one capful with 4-8 oz. of fluid, only ≥ 17

ORS

Preffered for mild-moderate dehydration 3-4 hours Not recommended for 6 months-5 years Vomiting is not c/i

Pinworm Treatment

Pyrantel Pamoate Treat whole household Education, scrub hands, sunlight for eggs, wash linens in hot water daily, daily shower in morning - no bath, vacuum around bed / curtain / bedroom, reduce overcrowding

Fever Exclusions

REFER BUT DON'T DENY THERAPY - < 3 months old when ≥ 100.4 - Pregnant - Old - HTN - HF - Renal failure - Impaired immune function - Children w/ history of febril seizure - > 2 years old for > 3 days - Child with spots or rash - Child that is irritable, sleepy, ward to wake up, refuses to drink, vomiting, strong diarrhea, stiff neck, repeatedly > 104 - < 2 years old for > 24 hours - Pharm for > 3 days w/o referral

Keratolytics

Resorcinol and Alcloxa - don't apply to abraded skin For discomfort and itching Sloughing

Intestinal Gas Treatment

Simethicone, activated charcoal, alpha-galactoside, dietary enzymes, probiotics Avoid Orlistat (OTC for weight loss)

Loperamide

Synthetic opioid, anticholinergic effects For non-specific acute diarrhea, traveler's diarrhea w/ antibiotics, chronic w/ IBS Adult = 4 initially, 2 per loose stool after NTE 8 mg 9-11 = 2 initially, 2 per NTE 6 mg 6-8 = 2 mg initially, 2 per NTE 4 mg Max of 48 hours AEs = < 6, dizzy, constipation, 3A4 and 2C8, p-glycoprotein Can be abused, cardiotoxicity

Migraine

Triptan, NSAIDs, combo of triptan with APAP or NSAIDs NEED MEDICAL DIAGNOSIS BEFORE OTC moderate to severe head pain, unilateral, pulsating, aggravation with PA, n/v or photo/phonophobia, 4-72 hours Aura = ocular perceptions, one-sided muscle weakness, slurring, 5-60 minutes

Astringents

Witch hazel, calamine, zinc oxide For itching, irritation, burning Promote coagulation of skin cells, lowers cell volume and shrinks tissues by making them drier Possible toxicity with long-term calamine or ZO use