Self-Care Exam 2 (REDO)

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1

Transient insomnia

Self-limiting

Lasting less than 1 week

2

Short term insomnia

1–3 weeks

3

Chronic insomnia

More than 3 weeks to years

4

Causes of Chronic insomnia

Medical problems

Psychiatric disorders

Substance abuse

5

Primary insomnia

Patients who have sleep difficulty that lasts at least 1 month

6

How is the pt impacted

Affects psychosocial functioning

Not caused by another sleep disorder, general medical disorder, psychiatric disorder, or medication (i.e., secondary insomnia)

7

Difficulty falling asleep is caused by

Acute life stresses

Medical illness

Anxiety

Poor sleep habits

8

Medications that cause insomnia

Antidepressants

Antihypertensive agents

Sympathomimetic amines

-pseudoephedrine

-phenylephrine

9

How long does it take a person with insomnia to fall asleep

How many hours of sleep do they get

More than 30 minutes to fall asleep

Their duration of sleep is less than 6–7 hours nightly.

10

Pts with insomnia characterized by frequent nighttime awakenings or early morning awakenings with difficulty going back to sleep should be referred to a PCP when

Those whose symptoms have lasted 4 weeks or longer

11

Non-Pharm Therapy first-line therapy

Cognitive behavioral therapy for insomnia (CBI)

12

Pharm Therapy

Antihistamines

Ethanol

13

MOA of Antihistamines:

Diphenhydramine

Doxylamine

Ethanolamines

Block histamine-1 + Muscarinic receptors

14

The primary indication for diphenhydramine

Symptomatic management of transient and short-term sleep difficulty

15

Which types of pt in particular

Individuals who complain of occasional problems falling asleep.

16

What causes additive sedation or anticholinergic effects

What enzyme is inhibited

Diphenhydramine + Anticholinergics

CYP2D6

17

Which population is particularly impacted

Women

18

Diphenhydramine + Diphenhydramine AE

Dry mouth

Dry throat

Constipation

Blurred vision

Urinary retention

Tinnitus

19

Contrasindications

Prostatic hyperplasia

Difficulty urinating

Angina

Arrhythmia

Angle-Closure glaucoma

20

Ethanol is typically used to induce sedation in which individuals

Chronic insomnia

21

Special populations

Pregnancy + breastfeeding

Children +

Geriatric

22

Treatment for individuals who have difficulty falling asleep or staying asleep

Medical referral

23

Treatment for pts who feel well rested in the morning + function throughout the day

Sleep hygiene measures

Follow up in 14 days

24

Treatment for patients that use stimulants

Nicotine, alcohol, caffeine

Decrease intake

Cessation

Avoid using in the evening

Follow up in 10 days

25

Problems related to lifestyle, poor sleep hygiene, or stress

Sleep hygiene + Diphenhydramine

Dose: 25-50mg

Days: 2-3 then skip

Max days: 7-10

26

Episodic Insomnia treatment

Sleep hygiene + Diphenhydramine

Dose: 25-50mg

Days: 2-3 then skip

Max days: 7-10

27

Exclusion Criteria

Less than 12 years old

65 and older

Pregnant + lactating

Frequent late at night/ early morning awakening

Chronic insomnia

Secondary sleep disturbances

-Meds

-Health issues

28

Contact Dermatitis

TOPIC

29

Types of Contact Dermatitis

Irritant contact dermatitis (ICD)

Allergic contact dermatitis (ACD)

30

What is Irritant contact dermatitis (ICD)

an inflammatory reaction of the skin caused by exposure to an irritant substance

31

What is Allergic contact dermatitis (ACD)

an immunologic reaction of the skin caused by exposure to an antigen

32

Causes of Irritant contact dermatitis (ICD)

Frequent hand washing

Handle food

Repeated contact with irritants

33

When does Irritant contact dermatitis occur

After 1 time

After multiple times

34

Clinical Presentation

Inflammation

Swelling

Dry, cracking, macerated skin

Rash: itching, stinging

Erythematous

35

Results of chronic exposure

Hyper/ Hypo-pigmentation

36

Non-pharm Therapy

Wash the exposed area with copious amounts of tepid water

Cleanse with mild or hypoallergenic soap -Cetaphil or Dove

37

Pharm Therapy

Emollients (moisture)

Colloidal oatmeal baths (itching)

Corticosteroids (inflammation)

38

What products should be avoided

Caine's

PEG

Lactic Acid

Urea

Salicyclic Acid

39

Causes of Allergic Contact Dermatitis

Poison Ivy

Poison Oak

Poison Sumac

Jewelry (nickel)

40

When does ACD occur

Does not appear upon contact with allergen

41

When does type IV ACD appear

24h - 21d

42

When does ACD appear in sensitive people

24-48h after exposure

43

Where are ICD and ACD rashes limited to

Anywhere on the body

ICD: usually hands

ACD: hands/ legs/ feet

44

Presentation

Papules

Small vesicles

Bullae

Inflammation

Swollen

45

Mild ACD presentation

Linear streaks

Itching

46

Moderate ACD presentation

Erythema

Bullae

Papsules

Vesicles

Inflammation

Pruritus

47

Severe ACD presentation

Edema of the extremities/ face

Marked swelling

Closure of eyelids

Extreme itching, irritation

Formation of vesicles/ bullae

48

Medical referral presentation

Dermatitis or edema affecting

Face

Eyes

Genitalia

Face

Large BSA

Secondary infection is occurring

49

Non-Pharm therapy

Cold/ tepid soapless showers

Hypoallergenic soap

Trim nails

50

Pharm Therapy First line

Hydrocortisone 1%

51

Other pharm therapies:

Itching

Weeping

Inflammation

Itching:

First-generation oral antihistamines at night

Weeping/bleeding oozing/ discharge:

Astringent

Aluminum Acetate 5%

Inflammation:

Hydrocortisone 0.5% + 1%

-Without dressing/ bandages

52

What products should not be used

Topical Anesthetics (Caine's)

Antihistamines

Antibiotics (neomycin)

53

Open + weeping blisters, vesicles or bullae treatment

Topical hydrocortisone crease, not ointment

Aluminum Acetate compresses

Coldwater baths/ showers

Tepid showers

Colloidal oatmeal baths

54

No open + weeping blisters, vesicles or bullae treatment

Topical hydrocortisone cream or ointment

Tepid showers

Colloidal oatmeal baths

Calamine lotion

55

Exclusion criteria

Less than 2

Dermatitis more than 2 weeks

More than 20% BSA

Numerous bullae

Extreme itching, irritation, severe vesicles + bullae formation

Swelling of body/extremities

Swollen eyes

Genitalia exposure

Itching mucosa

Infection

Lasts more than 7 days

Low tolerance for pain or other symptoms

Impaired daily activities

56

Dandruff

Mild inflammatory scalp disorder

57

Characterization

Accelerated epidermal turnover

Abnormal keratinization

Malassezia yeast inflammation

58

Presentation

Itching

Flaking

Tightness

Irritation

59

Difference between dandruff/ psoriasis/ seborrheic dermatitis

Dandruff does not have inflammation or erythema

60

What shapoos should be avoided

Sodium lauryl sulfate

Sodium laureth sulfate

61

Pharm therapy

Cytostatic agent

Ketoconazole shampoo

Keratolytic shampoo

62

Cytostatic agents

Purpose + contact time

Pyrithione zinc or Selenium sulfide

Rid Malassezia

Leave on scalp for 3–5 minutes before rinsing

Rinse 2-3 times for products that contain Selenium sulfide (causes discoloration)

63

How long should this be sued

Daily for 1 week

Then 2–3 times weekly for 2–3 weeks

Then once weekly or every other week to control the disorder

64

Ketoconazole shampoo

Purpose

Anti-fungal with/ Anti-Malassezia activity

65

Keratolytic shampoo

Content

Disadvantage

Salicylic acid

Sulfur

Require longer duration of use due to limited efficacy

66

Coal Tar Shampoo

Use

MOA

AE

Limited use of second-line therapy

Reduce scaling by decreasing turnover rate for scalp cells

Discolors hair/ clothes/ jewelry

67

Seborrheic dermatitis

A chronic inflammatory disorder that occurs predominantly in the areas of greatest sebaceous gland activity:

Scalp, face, chest

68

Presentation

Red, scaly, itchy rash

Yellow-Brown, greasy scales/ plaques with erythema

Exudation (leaky fluid) + crust

69

Similarities between Dandruff and Seborrheic dermatitis

Malassezia species

Accelerated epidermal proliferation

70

Difference between Dandruff and Seborrheic dermatitis

Seborrheic dermatitis involves more inflammation than dandruff

Can occur in places other than the scalp

71

What increases the risk of Seborrheic dermatitis

Immunosuppressive disorders: HIV/AIDS

Organ transplants

Chronic neurologic disorders: PD

72

Pharm 1st-line of therapy

Topical antifungal agents

73

Shapoos used

Pyrithione zinc

Selenium sulfide

Coal Tar

Salicyclic Acid

Sulfur

Ketoconazole

74

Pyrithione zinc + Selenium sulfide MOA

anti-Malassezia activity = Reduces yeast

75

Salicylic acid MOA

Salicylic acid decreases skin pH

76

Non-shampoo products

Corticosteroids

Hydrocortisone ointment 2x/day

77

Use of shampoos

Leave on scalp for 3–5 minutes

Shampoo daily for the first week or 2

Then 2–3 times per week for the next 4 weeks.

Then once a week to prevent relapse

78

Treatment in infants

Self-limiting

Massage scalp with baby oil

Nonmedicated shampoo

79

How long should self treating last

No more than 7 days

80

Psoriasis triggers

  • Environmental factors such as physical, ultraviolet, and chemical injury
  • Various infections (streptococcal infection, HIV infections)
  • Prescription drug use (e.g., antimalarials, beta-blockers, interferons, lithium, nonsteroidal anti-inflammatory drugs) and withdrawal of systemic corticosteroids
  • Emotional and psychological stress
  • Obesity
  • Use of alcohol and tobacco
81

Mild case criteria

Few localized lesions no larger than a quarter,

82

Treatment

Topical agents such as hydrocortisone or emollients

Hydrocortisone 1% ointment

83

Non phar treatment

Lubricating baths 2-3x/ week in tepid water

Emollient moisturizers 4x/ day

-Lubriderm, Nivea

84

Self-treatment age limit

Can be no younger than 2 years old

85

Dry silver lesions located on elbows/ knees/ scalp + associated with bleeding when scales are removed

Psoriasis

No --> Refer

Yes--> Hydo ointment

86

Exclusion Factors: Dandruff + Seb Derm

Younger than 2

Worsen/ no improvement after 2 weeks

87

Exclusion Factors: Psoriasis

Larger than 5% BSA

88

Diaper Dermatitis

Acute inflammation of the skin occurring in the region of the perineum, buttocks, lower abdomen, and inner thighs

89

Presentation

Erythematous

Shiny, wet-looking patches/ lesions on the skin

90

What happens in severe cases

Spread outside the diaper area

Maceration

Papule formation

Vesicles or bullae

Oozing

Erosion of the skin

Ulceration

91

Non Pharm Treatment

Change the diaper immediately after the infant defecates or urinates

-Min. 6 changes /day

-Disposable diaper are preferred

A: Air/ Diaper Holiday

-Keep diaper off as much as possible

B: Barrier

C: Cleansing

D: Diaper

E: Education

92

Pharm Treatments

Lubricants:

Zinc Oxide

-DisAdv: Require soap for removal

Petrolatum and white petrolatum

Lanolin

Calamine

Mineral Oil

Dimethicone

Topical cornstarch and talc

93

What not to use

Topical nonprescription antibiotic

Antifungal agents

Hydrocortisone

Topical analgesics

Complementary therapies are not recommended

94

Exclusion Factors

Lesion present for more than 7 days

Lesion do not improve after 7 days

Secondary infection

Lesions are from another disease state

Diaper Dermatitis outside of the diaper

Broken skin

Onion-like or bullae appearance

Oozing, blood, vesicles, or pus

Chronic or concurrent lesions

Other symptoms

Behavioral changes

Comorbid health conditions

95

Prickly Heat

Heat rash, a transient inflammation of the skin that appears as a very fine, pinpoint, and usually red raised rash

96

Presentation

Pinpoint-sized lesions that are raised and red or maroon

Erythematous papules

97

Where do the lesions appear

  • Chest
  • Upper back
  • Back of neck
  • Abdomen
  • Inguinal area
  • Armpits
98

Non-Pharm Treatment

Decrease sweating

Increase airflow

Wearing loose, light-colored, and lightweight clothing

Cooling baths

AC

99

Pharm Therapy

Colloidal oatmeal bath

Powders

Hydrocortisone cream = less than 10% BSA

100

Exclusion criteria

Same as diaper rash

101

First-line of therapy for prickly heat

Allotoin

102

What should not be used

Fat based emollients (water-based only)

Ointments

103

When should powders be used

For prevention

104

What is used for wet oozing lesions

Aluminum acetate

105

Burns

Topic

106

What types of burns can be treated

Superficial burns (epidermis)

Nothing deeper in the skin

107

When should the burn be assessed

Within the first 3 hours then again in 24 hours

108

Non-pharm treatment

Run cool water over it for 20 minutes ASAP

Cleanse with mild soap

Apply non-adherent dressing/ protectant

109

What should be done is debris is visable

Refer

110

Pharm treatment

Moisturizer

Skin protectant

Emollients

Aloe Vera

APAP

NSAIDs

First aid antibiotics

Topical anestheics

-Caine's

111

What are the topical antibiotics

Bacitracin

Neomycin

Polymyxin B Sulfate

112

Which protects are preferred

Ointments

113

Do you want occlusion in the treatment of burns?

No

114

Exclusion Criteria

Burn to 2% or more of body surface area

Burns involving eyes, ears, face, hands, feet perineum, genitals

Chemical burns- use 1st aid measures then seek medical attention

Electrical or inhalation burns

Persons of advanced age

Diabetics or persons with multiple medical disorders

Immunocompromised patients

Medically refer if not getting better after 7 days

115

What should not be used

Ointments if the skin is broken

116

After treatment has started when should the pt be reassessed

7 days

117

Acne

...

118

Mild

Few erythematous papules and occasional pustules mixed with comedones

119

Moderate

Many erythematous papules and pustules and prominent scarring

120

Severe

Extensive pustules, erythematous papules, and multiple nodules in an inflamed background

121

First-line of treatment for acne

Adapalene and Benzoyl Peroxide

122

Other pharm therapies

Salicylic Acid

Sulfur

a-hydroxy acids

Resorcinol with sulfur 3%-8%

Resorcinol Monoacetate with sulfur 3%-8%

123

SE of Salicylic Acid

Stains clothes

124

Adapalene

MOA

SE

When does it become effective

Special population

Inflammation + Keratinization

Makes pt sensitive to the sun, use sunscreen

Takes 8-12 weeks to be effective

Not approved for pregnant women or those trying to ger pregnant

125

Benzoyl peroxide

Preferred form

SE

When does it become effective

Gel is preferred

Bleaches clothes + hair

Causes photosensitivity, wear sunscreen

Try small amount + use once daily + increase prn

126

What vitamins can be used

Vitamin A (Retinol)

B3

Tea tree oil

Zinc

Nicotinamide

127

What are the most effective dosage form + why

Gels

They are astringents that remain on the skin

They dry out the skin

128

What dosage forms are less irritating than gels

Lotions

Creams

129

When are ointments used

They are not used

They keep moisture in

We do not want an occlusion

130

How effective are medicated cleaners

They arent because they wash off

131

Application instructions

Once a day then move up to twice a day

Start with the lowest dose and move up

132

What population should not use acne medication

Pregnant

133

Exclusion factors

  1. Moderate to severe acne
  2. Exacerbating factors (comedogenic drugs, mechanical irritation)
  3. Possible Rosacea **Red butterfly pattern across nose and cheeks
134

Insect Bites

...

135

Non-pharm Treatment

Avoid Insects

Wear Repellents

Ice packs

Topical analgeics

136

Bug repellents

DEET

Picaridin

Lemon eucalyptus oil

Permethrin

Soybean oil

Citronella

Different essential oils

Garlic

Scented moisturizers (skin so soft)

137

Pharm Therapy

Local Anesthetics

  • Benzocaine
  • Pramoxine
  • benzyl alcohol
  • Lidocaine
  • Dibucaine

Topical Antihistamines

Hydrocortisone 1%

Counterirritants

Camphor

Menthol

Skin protectants

Zinc Oxide

Calamine

Titanium dioxide

138

Exclusion Criteria

  • Hypersensitive to bites resulting in systemic effects
  • <2 years old
  • Spider bite
  • Signs of secondary infection
  • History of tick bite and systemic infection
  • Seek medical attention if the condition worsens during treatment or if symptoms persist after 7 days of topical treatment
139

Insect Stings

...

140

Non-pharm Therapy

  • Remove stinger using credit card or fingernail
  • Use antiseptic like hydrogen peroxide or alcohol after stinger removal
  • Apply ice packs for 10-minute intervals
141

Pharm Therapy

  • local anesthetics
  • topical antihistamines
  • Counterirritants
  • Hydrocortisone
  • skin protectants
142

Complementary Therapy

  • Meat tenderizer
143

Exclusion Factors

  • Hives, excessive swelling, dizziness, weakness, n/v, difficulty breathing
  • Significant allergic response away from sting area
  • Previous sting
  • Previous severe reaction
  • Family history of severe allergic reactions
  • <2 years old
144

Fungal Infections

...

145

Types:

Tinea capitis

Tinea Corporis

Tinea Pedis

Tinea Cruris

Tinea Unguium

Scalp

Body

Feet

Groin

Nails

146

Predisposing factors for fungal skin infections

  1. Trauma to skin
  2. Diabetes mellitus
  3. Diseases and medications associated with immune system depression
  4. Impaired circulation
  5. Poor nutrition and hygiene
  6. Occlusion of skin
  7. Warm, humid climates
147

Which kinds can be self-treated

Tinea pedis

Tinea corporis

Tinea cruris

148

Pharm Treatment

Butenafine hydrochloride 1%

Clioquinol 3%

Clotrimazole 1% - Lotrimin AF Cream

Haloprogin 1%

Miconazole/ Miconazole nitrate 2% - Cruex Antifungal Spray Powder, Cures Jock Itch/ Micatin Cream

Terbinafine hydrochloride 1% - Lamisil AT Antifungal Gel, Nighttime AF Therapy

Tolnaftate 1% - Tinactin Antifungal Cream / Aerosol Powder Spray

Povidone/iodine 10%

Undecylenic acid and its salts 10% - 25%

149

Salt of Aluminum Use

Not included in FDA final monograph for topical antifungal drug products

–Approved for relief of inflammatory conditions of skin (i.e. athlete’s foot)

–Useful when combined with other topical anti-fungal agents

–Act as astringents, and antibacterial activity (in concentration > 20%) –Concentrated solutions contraindicated on severely eroded or deeply fissured skin

150

Special Populations

Diabetes

Immune deficiency

Systemic infection

151

Exclusion Factors

  • Causative factor unclear
  • Unsuccessful initial treatment, or worsening of the condition
  • Nails or scalp involved
  • Face, mucous membranes, or genitalia involved
  • Signs of possible secondary bacterial infections (oozing purulent material)
  • Excessive and continuous exudation
  • Condition extensive, seriously inflamed, or debilitating
  • Diabetes, systemic infection, immune deficiency
  • Fever, malaise, or both
152

Poor Demarcated

Well-demarcated

Refer

Treat

153

Hair Loss

...

154

Forms of non-scarring alopecia

androgenetic alopecia (AGA, or pattern hereditary hair loss)

alopecia areata (rapid onset, patchy hair loss)

anagen effluvium (rapid shedding of growing hairs)

telogen effluvium (rapid shedding of resting hairs)

trichotillomania (a compulsive pulling out of one’s hair)

tinea capitis

155

Scarring alopecia

Related to:

Syphilis

Aacoidosis

Discoid lupus erythematosus

Psoriasis

Seborrheic dermatitis

156

Hair loss in Men

Thinning at

Vertex

Frontal hairline

Occipital regions

157

Hair loss in women

Diffuse thinning over entire crown

Hairs will be thinner than normal

Suspect hyperandrogegism

158

Non-pharm

Camouflaging thinning hair with wigs and hair weaves

Hair sprays, gels, colorants, permanents, and scalp camouflaging products

159

What not to use

Oily hair products that can cause folliculitis

Hairstyles that pull on the hair, such as tight braids

Heat from hair dryers and curling/flat irons

160

Pharm Treatment

Men

Women

Minoxidil 2% + 5% solutions, and 5% foam

Minoxidil 2% solution + 5% foam

161

Pharm treatment Use

Men

Women

Baldness at the crown of the head

Thinning in the frontoparietal area in women

162

Exclusion factors

  1. < 18 years of age
  2. Pregnancy of breastfeeding
  3. Recent discontinuation of oral contraceptives
  4. Hair loss in a patient with no family history of hair loss
  5. Hair loss in a patient with positive hair-pull test
  6. Hair loss related to a history of endocrine dysfunction, medical treatments (e.g, chemotherapy, medication use), and dietary deficiencies
  7. Sudden or patchy hair loss
  8. Evidence of fever or inflammation (3-6 months before hair loss begins)
  9. Skin lesions that indicate autoimmune disease or infection
  10. Scaling, sunburn, or other damage to the scalp
  11. Broken-off hair shaft that resembles those caused by fungal infection or trichotillomania
  12. Loss of eyebrows or eyelashes
  13. Changes in nails
  14. Women with sudden or severe hair loss
  15. Postpartum women with hair loss.
163

How long should a pt use hair growth products before seeing a doctor

4 months

164

Warts

...

165

Cause of warts

HPV

166

Most common are caused by

HPV-2, HPV-4, HPV-27, HPV-29

167

Planter warts are caused by

HPV-1

168

Presentation

  1. Rough, cauliflower-like appearance
  2. B) Slightly scaly, rough papules or nodules that appear alone or grouped
  3. C) Most often appear on hands
  4. D) Begin as minute, smooth-surfaced, skin-colored lesions that enlarge over time
  5. E) Repeated irritation causes them to continue enlarging
169

Defined according to locations:

-Common warts (verruca vulgaris): on hands and fingers
-Plantar warts (verruca plantaris): on soles of feet
-Juvenile (or flat) warts: on face, neck, and dorsa of hands, wrists, and knees of children

170

Non-pharm

  • Wash hand before & after treating/touching wart tissue
  • Use specific towel for drying only affected area after cleaning
  • Do not probe, poke, or cut wart tissue
  • If wart on sole of food, do not walk in bare feet unless wart is securely covered
  • Avoid sharing personal materials
171

Pharm Therapy

Salicylic acid

Cryotherapy

172

When is improvement of Salicylic acid seen

1-2 weeks: visible improvement

6-12 weeks: complete removal

173

When should pt be referred to PCP

After 12 weeks

174

(3) different vehicles

12 - 40% in plaster

5 - 17% in collodion-like

15% in a karaya gum-glycol plaster

175

What type of warts is Cryotherapy used for

Common & Plantar warts

176

When will wart fall off

After 10 days

177

When can it be repeated/ max treatment weeks

How many treatments

After 2 weeks/ up tp 12 weeks

3 treatments

178

Exclusion Factors

< 4 years of age

pregnancy or breastfeeding

  1. C) Mental or physical conditions that limit or prevent the patient from following the product directions
  2. D) Chronic, debilitating conditions that affect sensitivity and/or poor blood circulation to hand and/or feet (e.g., diabetes, PVD, or neuropathy)
  3. E) Immunocompromised patients
  4. F) Large or multiple warts located on one area of the body
  5. G) Painful plantar warts
  6. H) Warts located on the face, breasts, armpits, fingernails, toenails, anus, genitalia, or mucous membranes.
  7. I) Salicylic acid products* Immunosuppressive medications or medications that contradict the use of salicyclic acid
  8. J) Salicylic acid products* Salicylate allergy
  9. Db/ poor circulation
179

Special Populations: Children

  • Children:
    • Salicylic acid Not for children <3 years old
    • Cryotherapy Not for children <4 years old
    • Children/teenagers recovering from chicken pox or Influenza
180

Because of the GI SE associated with iron, what is the UL for irons

45 days

Rest of 118

181

Vaginal Candidiasis:

...

182

Signs

vulvar edema,

fissures,

excoriations,

thick curdy vaginal discharge

183

BV

Fishy smell

Off-white (green, grey, tan)

Fishy odor immediately after sex

elevated pH

184

Trich

Malodorous

Yellow-green

Itching

Dysuria (difficulty urinating)

Elevated pH

No symptoms in 50% of women

185

Exclusion factors

  1. A) Pregnancy
  2. B) Girls < 12 years of age
  3. C) Concurrent symptoms: fever or pain in the pelvic area, lower abdomen, back, or shoulder
  4. D) Medications that can predispose to VVC (vulvovaginal candidiasis): corticosteroids, Antineoplastic.
  5. E) Medical disorders that can predispose to VVC: diabetes, HIV infection
  6. F) Recurrent VVC (i.e., >3 vaginal infections per year or vaginal infection in past 2 months
  7. G) First vulvovaginal episode
  8. Symptoms unresolved after 1 week
186

Antifungal agents

Clotrimazole

Miconazole nitrate

Ticonazole

187

Itching/ irritation

Benzocaine E

Hydrocortisone E

Povidone/Iodine Products I

Homeopathic Products I

Feminine Powder E

188

Atrophic Vaginitis

Cancer,

radiation,

taking gonadotrophin receptor hormone agonist,

antiestrogen drugs,

aromatase inhibitor

189

Exclusion factors

  1. Symptoms of severe vaginal dryness, dyspareunia, or bleeding
  2. B) symptoms that are not localized
  3. C) Vaginal dryness or dyspareunia not relieved by use of personal lubricants
190

Dysmenorrhea

Painful/ cramping menses

191

Primary

Secondary