Refer or Treat
Below what patient age should always be referred?
2 years old
What is the approved dosage range for children under 12 years of age for Tylenol?
10-15 mg/kg/DOSE q4-6 hours
Children under what age should be excluded from self-care of allergic rhinitis?
Children under 12 years old (due to potential cases of undiagnosed asthma)
This herbal product is found to have a major drug interaction with warfarin
Ginseng
Using moisturizer, soak and seal, and hypoallergenic cleansers are non-pharmacological approaches to treating what condition?
Atopic dermatitis
A 25-year-old pregnant patient (first trimester) asking for something for mild nausea. What combo product is first-line?
Doxylamine and Pyridoxine (vitamin B6)
What is the maximum recommended daily dose for Prilosec OTC that can be used in a 17 year old patient?
None! PPI’s should not be used in patients under 18 years of age
A patient has a pain score of 5/10 that has lasted over 5 days and has accompanying nausea, vomiting, and a fever. Which of the following symptoms is an exclusion criteria for self-treatment?
Nausea, vomiting, and fever → signs of systemic infection
Pain >6/10 is an exclusion
Pain lasting >10 days is an exclusion
This herbal product is FDA approved and marketed as Veregen and Polyphenon E ointment and is used for genital warts
Green Tea
What is a nonpharmacological option for treatment of joint pain or muscle pain?
Heat or cold therapy (whatever patient prefers)
TENS unit depending on location of pain up to TID for 15-30 min (contraindicated in osteoarthritis of knee or hip)
Name 2 comorbidities that generally suggest referral instead of self- treatment
Uncontrolled HTN/heart failure, Uncontrolled diabetes, COPD, Severe renal impairment
What is the recommended adult dosing for Emetrol?
15-30 mLs q15 minutes → do not exceed 5 doses in 1 hour
Name 2 exclusion criteria for self-treatment of diarrhea
Young age (<6 months)
Visible blood, pus or mucus in stool
Chronic medical conditions (DM, CVD, immunosuppressed, frail patients >65 YO)
Severe abdominal pain, tenderness, distention
Pregnancy
Persistent fever
High output of diarrhea, chronic diarrhea
Signs of severe dehydration
Persistent vomiting
Suboptimal response to ORS
This nasal spray product has been withdrawn from the US market due to an associated loss of smell with certain products
Zinc
Name at least 1 nonpharmacological recommendations for constipation
Balanced diet (25 grams fiber for women, 38 grams for men)
Improve intake of insoluble fiber
Bowel training (going when feeling the urge, attempting BM 30 min after meal)
Increase physical activity
Postural modifications (Squatty Potty)
A 70-year-old taking lisinopril and acetaminophen asks for something for mild cold symptoms, including runny nose and sneezing.
What would you recommend and why?
What would you avoid and why?
2nd Gen, oral antihistamine - Zyrtec, Claritin, Allegra
Nasal corticosteroid- Flonase, Nasacort
Avoid first generation oral options like Benadryl or Dimenhydrinate- Beer’s List, drowsiness, risk of falls/injury
Name the adult and children’s dosing for Diminhydrinate (Dramamine)
Adult: 50-100mg q4-6 h
Children 6- under 12 yrs: 25-50mg q6-8 h
Children under 6-2 yrs: 12.5-25mg q6-8 h
Name 1 exclusion criteria for atopic dermatitis self-care
Moderate to severe condition (involving >10% BSA, intense pruritus affecting QOL, skin appears infected)
< 1 YO
Involving face or intertriginous area (where skin touches skin)
This herbal product has a proposed mechanism of action that includes the prevention of hemagglutination of release of viral particles for influenza A and B strains
Elderberry
Name at least 2 nonpharmacological recommendations for the common cold
- Adequate rest
- increase fluid intake
- saline nasal spray/drops
- warm liquids and salt gargles
- nasal strips
- Vicks VapoRub
- position body upright
- nasal suctioning for children <4
- proper hand hygiene
- coughing/sneezing into elbow
- disinfect surfaces to reduce transmission
A patient comes to the pharmacy with complaints of nausea and vomiting, and asks you for a recommendation on something OTC that they can take to help resolve their symptoms. Upon a quick patient interview, you discover the patient would describe their symptoms as mild to moderate, and has a PMH of asthma. The patient has no drug allergies. Should you refer or treat this patient?
Refer! Slide 10 of 5.5 has patients with glaucoma, BPH, chronic bronchitis, emphysema, or asthma as exclusion criteria
What is the recommended dose (in mL) of APAP for a child weighing 25kg?
10 mg/kg: 7.8 mL q4-6 h
10mg x 25kg = 250mg → 160mg/5ml = 250mg/XmL → x= 7.8 mL
15mg/kg: 11.7 mL q4-6 h
15mg x 25kg = 375mg → 160mg/5mL = 375mg/XmL → x = 11.7 mL
Name 2 exclusion criterias for self treatment of dermatophyte infections
Causative factor unclear
Unsuccessful treatment or worsening of condition
Nail or scalp involved
Face, mucous membranes, or genitalia involved
Signs of possible secondary infection
Excessive exudation
Diabetes, systemic infection, immune deficiency
Fever, malaise or both
This herbal product requires counseling on the prior use of chamomile or calendula due to the possibility of an asteraceae allergy
Echinacea
Name at least 3 nonpharmacologic measures to prevent nausea and vomiting during pregnancy.
Eat dry crackers before getting out of bed in the morning
Get out of bed slowly
Start with small amount of dry toast/crackers before breakfast
Eat small meals every 1-2 hours
Avoid excessive heat, humidity, strong smells
Try small sips of carbonated beverages or fruit juice
Avoid greasy, fatty, spicy, acidic foods
Eat dry, bland high protein foods
Avoid iron containing supplements