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OTC Theraputics > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is the general requirements/criteria to use anti-obesity medication?

A

BMI ≥27 kg/m2 with co-morbidity
OR
BMI ≥30 kg/m2

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2
Q

What is people-first language for obesity?

A

Do not say obese patient.
Use patient affected by obesity or patient with obesity

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3
Q

Which weight loss supplement was banned due to unreasonable risk of injury and illness?

A

Ephedra (ma huang)

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4
Q

What is the dietary supplement that is a fat absorption blocker?

A

Chitosan

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5
Q

Which dietary supplements are appetite suppressants and satiety promoters?

A

Glucomannan and Psyllium

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6
Q

Which dietary supplement is a fat and carbohydrate modulator?

A

Green tea

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7
Q

What are the dietary supplements that are stimulants, energy boosters, and thermogenic aids?

A

Bitter orange and caffeine

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8
Q

What 10 chronic diseases are associated with obesity?

A
  1. Arthritis
  2. Diabetes
  3. Hypertension
  4. Dyslipidemia
  5. Coronary Artery Disease
  6. Stroke
  7. Arrhythmias
  8. Sleep apnea
  9. Cancer
  10. GallBladder Disease
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9
Q

What are the two non-pharmacological recommendations for weight loss?

A
  1. Healthy eating with MyPlate
  2. Increased physical activity
  3. Reduce stress and control stimulators
  4. Monitor and identify triggers
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10
Q

What are some recommendations to give when advising health eating with MyPlate for weight loss?

A

Eat reduced-calorie meals
Reduce fast-food and frozen meal dinners
Eat smaller portions
Make small, gradual changes to diet and exercise
Maintain realistic goals for weight loss and activity levels
Eat a low-calorie balanced diet
Eat meals at the table
Do not have distractions while eating (phone etc)
Set a regular eating schedule and do not skip meals
Eat slowly and enjoy the food
Put down utensils between bits
Wait 5 minutes before going back for more food
Leave some food on plate each time you eat
5 servings of fruits and vegetables per day
Drink 8 glasses of non-caloric beverages per day
Avoid eating after dinner
Do not shop for food when hungry

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11
Q

What are physical activity recommendations?

A

Moderate Activity 200-300 minutes/week over 3-5 days or 75-150 minutes/week of vigorous intensity.
Resistance exercises 2-3 times per week

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12
Q

What are some physical activity recommendations for someone pursuing weight loss?

A

Gradually increase activity levels with the goal of engaging in 60 minutes of moderate-intensity physical activity most days of the week
Increase lifestyle activity like walking, standing, climbing stairs
Limit time spent watching TV, playing videos, or using internet
Keep a diary of weight loss, physical activity, and caloric intake

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13
Q

What is the recommended caloric deficit to lose 1-2 pounds per week?

A

500-750 kcal

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14
Q

When counseling a patient on Orlistat (Alli), what are the 6 main things to address?

A
  1. Take 1 hour before consuming food
  2. Take a multivitamins containing K, A, D, E, and beta-carotene at bedtime or more than 2 hours before or after taking medication
  3. Only take if consuming more than 30% of kcal from fat
  4. Side effects include abdominal pain, oily stool, fecal urgency, flatulence, and malabsorption of fat-soluble vitamins and medications
  5. Administer interacting drugs 4 hours between taking Orlistat like cyclosporine, fat-soluble vitamin, levothyroxine, warfarin, amiodarone, anti-epileptics, and anti-retrovirals
  6. Severe diarrhea may decrease the absorption of oral contraceptive pills (OCP)
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15
Q

What type of multivitamin should be taken with orlistat?

A

Vitamin containing K, A, D, E, and beta-carotene 2 hours before or after orlistat

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16
Q

What are the 7 potential drug-drug interactions with Orlistat?

A
  1. Cyclosporine- decreased concentrations
  2. Fat-soluble vitamins
  3. Levothyroxine- decreased concentrations
  4. Warfarin- malabsorption of vitamin K may lead to over anticoagulation
  5. Amiodarone- decreased concentrations
  6. Anti-epileptic drugs- decreased concentrations
  7. Anti-retroviral drugs- lowers effectiveness
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17
Q

How should potential drug-drug interactions with Orlistat be counseled on?

A

Take them 4 hours before and after taking Orlistat

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18
Q

What the common side effects of Orlistat?

A

Side effects include abdominal pain, oily stool, fecal urgency, flatulence, and malabsorption of fat-soluble vitamins and medications.

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19
Q

What is the serious adverse effect of Orlistat?

A

Liver failure

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20
Q

What is the BMI formula?

A

Kg/m^2

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21
Q

What is the OTC and RX brand names for Orlistat?

A

OTC- Alli
RX- Xenical

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22
Q

What are the waist circumference obesity markers in men and women?

A

Men >40 inches
Women >35 inches

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22
Q

What are the 5 exclusions for self-treatment in regard to anti-obesity medications?

A
  1. Severe obesity (BMI > 40)
  2. Pregnant or breastfeeding
  3. Less than 18 or older than 65
  4. CVD, dyslipidemia, diabetes, or HTN
  5. Eating disorders
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23
Q

What is the standard goal for weight loss?

A

5-10% in 6 months

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24
Q

What is the BMI range for obesity?

A

30-34.9 BMI

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25
Q

What is the interaction between orlistat and cyclosporine?

A

Orlistat reduces the cyclosporine concentration.

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26
Q

What is the interaction between orlistat and fat-soluble vitamins?

A

Orlistat decreases the absorption of vitamins K, A, D, and E.

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27
Q

What is the interaction between Levothyroxine and orlistat?

A

Orlistat decreases concentrations of Levothyroxine leading to hypothyroidism.

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28
Q

What is the interaction between orlistat and warfarin?

A

Orlistat leads to the malabsorption of vitamin K which may lead to over coagulation of the blood with warfarin.

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29
Q

What is the interaction between orlistat and amiodarone?

A

Starting amiodarone during orlistat therapy may result in decreased concentrations of amiodarone.

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30
Q

What is the interaction between antiepileptic drugs and orlistat?

A

Orlistat decreases the concentration of various antiepileptic drugs. The exceptions to this include thiopental, fosphenytoin, and pentobarbital.

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31
Q

What is the interaction between orlistat and antiretroviral drugs?

A

Orlistat lowers the effectiveness of antiretroviral drugs used to treat HIV which may be due to inhibition of it absorption.

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32
Q

What are the 6 common side effects of orlistat?

A

Flatulence, oily spotting, loose and frequent stools, fatty stools, fecal urgency, and fecal incontinence

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33
Q

What is the dosing in Orlistat?

A

60 mg TID

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34
Q

What is the age cut-off for orlistat?

A

18 years and older with the cutoff at 65 years old.

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35
Q

At what BMI can patients take orlistat?

A
  1. BMI of 27 with a co-morbidity
    OR
  2. BMI of 30 or greater
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36
Q

What is the MOA of orlistat?

A

Orlistat is a pancreatic lipase inhibitor that covalently binds to the active site of gastric and pancreatic lipases reversibility inactiviting 91.4% of these enzymes. Inhibition of these enzymes partially inhibits the hydrolysis of triglycerides which reduces their absorption.

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37
Q

What are the 6 exclusions for self-treatment for allergic rhinitis?

A
  1. Children 12 and younger unless already diagnosed with allergic rhinitis and OTC approval from HCP
  2. Pregnant or lactating
  3. Symptoms of nonallergic rhititis
  4. Symptoms of otitis media, sinusitis, bronchitis, or another infection
  5. Symptoms of undiagnosed or uncontrolled asthma (wheeze, SOB), COPD, or lower respiratory disorder
  6. Severe or unacceptable side effects of treatment
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38
Q

What is the common dose of Claritin (loratadine) for allergic rhinitis?

A

5-10 mg daily

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39
Q

What is the common dose for Allegra (Fexofenadine) for allergic rhinitis?

A

30-60 mg BID or 180 mg daily

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40
Q

What is the common dose for Zyrtec (cetirizine) for allergic rhinitis?

A

5-10 mg daily

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41
Q

What is the common dose for Xyzal (Levocetirizine) for allergic rhinitis?

A

2.5-5 mg daily

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42
Q

What are the four 2nd generation antihistamines discussed?

A

Claritin (Loratadine)
Allegra (Fexofenadine)
Xyzal (Levocetirizine)
Zyrtec (Cetirizine)

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43
Q

What is the MOA of 2nd generation antihistamines?

A

These drugs compete with histamine at peripheral H1 receptor sites. They are less sedating than 1st generation drugs.

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44
Q

What is the preferred drug for moderate-severe intermittent allergic rhinitis?

A
  1. Oral antihistamine or intranasal antihistamine or
  2. Intranasal corticosteroid or
  3. Intranasal antihistamine and intranasal corticosteroid
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45
Q

What are the classifications of allergic rhinitis?

A
  1. Episodic- Due to contact
  2. Intermittent- 4 days or less /week or 4 weeks or less in total
  3. Persistent- 4 days or more/week or 4 weeks or more in total

A. Mild- do NOT impair sleep or daily activities
B. Moderate-severe- does impair sleep or daily activites

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46
Q

What is the drug class and MOA of diphenhydramine (Benadryl)?

A

This is a 1st generation antihistamine. It competes with histamine at central and peripheral H1 receptor sites. This drug has high sedation and strong anticholinergic properties.

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47
Q

What are the 2 herbal supplements that are ‘likely effective’ for allergic rhinitis?

A

Sweet vernal grass and timothy grass

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48
Q

What are the 3 main herbal supplements that are ‘possibly effective’ for allergic rhinitis?

A

Butterbur, turmeric, and vitamin D

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49
Q

What drug class is Azelastine (Astepro) in?

A

Azelastine (Astepro) is a 2nd generation topical nasal antihistamine

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50
Q

What is the preferred drug for mild persistent allergic rhinitis?

A
  1. intranasal corticosteroid
  2. Oral antihistamine or intranasal antihistamine
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51
Q

What is the most sedating 2nd generation antihistamine?

A

Zyrtec (Certirizine)

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52
Q

What are the 7 risk factors for allergic rhinitis?

A
  1. Family history of atopy (allergic disorders)
  2. Filaggrin gene mutation (skin barrier protein)
  3. Elevated serum IgE greater than 100 IU/mL before the age of 6 years
  4. Higher socioeconomic level
  5. Eczema
  6. Positive reaction to allergy skin tests
  7. Diet (3 or more fast-food meals/ week)
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53
Q

What are the signs and symptoms of allergic rhinitis seen with the nose?

A

Itchy and watery nose with sneezing and nasal congestion.

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54
Q

What are the signs and symptoms of allergic rhinitis seen in the eyes?

A

Watery, red, and irritated eyes. This is a common symptom. Conjunctivitis is also present.

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55
Q

What are the signs and symptoms of allergic rhinitis seen with the respiratory tract?

A

Cough and sneezing may be present. Would be due to nasal drip.

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56
Q

What are the signs and symptoms of allergic rhinitis seen in the throat?

A

Itchy and painful throat

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57
Q

Does allergic rhinitis present with a fever?

A

No

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58
Q

Is fatigue/malaise typically seen with allergic rhintis?

A

Not typically

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59
Q

Does allergic rhinitis present with shortness of breath?

A

No

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60
Q

Compared to non-allergic rhinitis, what is the typical presentation of allergic rhinitis?

A

Bilateral and worse upon waking and evening.

(Non-allergic rhinitis is unilateral and constant throughout the day)

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61
Q

What is the drug class for Mometasone (Nasonex) and MOA?

A

Mometasone (Nasonex) is an intranasal corticosteroid that stops the allergic cascade by inhibiting multiple cell types and mediators including histamine.

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62
Q

What is the highest sedating 1st generation antihistamine class?

A

The class of 1st generation antihistamines that is the most sedating is the ethanolamines which includes clemastine, diphenhydramine, and doxylamine.

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63
Q

What are the 1st generation antihistamines?

A

chlorpheniramine
diphenhydramine and doxylamine
hydroxyzine and meclizine

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64
Q

What are the 5 inhaled nasal corticosteroids?

A
  1. Fluticasone propionate (Flonase)
  2. Fluticasone furoate (Flonase sensimist)
  3. Triamcinolone acetonide (Nasacort)
  4. Budesonide (Rhinocort)
  5. Mometasone (Nasonex)
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65
Q

What is the 2nd generation antihistamine that interacts with amiodarone?

A

Loratadine (Claritin) interacts with amiodarone by increasing QT prolongation when used together.

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66
Q

What is the preferred drug for mild intermittent allergic rhinitis?

A
  1. Oral antihistamine or Intranasal antihistamine or
  2. Intranasal corticosteriod
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67
Q

What are the 3 common side effects of inhaled corticosteroids?

A

Nasal discomfort, bleeding, and sneezing

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68
Q

What are the 3 side effects of Cromolyn (Nasalcrom)?

A

Sneezing, nasal stinging, and burning

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69
Q

What is the preferred drug for moderate-severe persistent allergic rhinitis?

A

Inhaled corticosteroid + inhaled antihistamine

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70
Q

What are some of the nonpharmacologic methods to manage allergic rhinitis?

A
  1. Avoid allergens
  2. Check local pollen counts and shut house/car windows
  3. Remove symptoms triggers (cats, tobacco, smoke, etc)
  4. Lower humidity in home to remove mold
  5. Wash bedding in hot water every week
  6. Nasal saline solutions
  7. Neti pot irrigation
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71
Q

If the symptoms of allergic rhinitis occur >4 days per week AND for 4 or more weeks, what is this categorized as?

A

Persistent

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72
Q

If the symptoms of allergic rhinitis occur less than or equal to 4 days per week OR less than or equal to 4 weeks, what is this categorized as?

A

Intermittent

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73
Q

What is the categorization for allergic rhinitis that impairs sleep and daily activities and are troublesome?

A

Moderate-severe allergic rhinitis

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74
Q

What is the categorization for allergic rhinitis if the individual is in contact with an exposure that is not normally a part of that individual’s environment?

A

Episodic

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75
Q

What is the drug class and MOA for budesonide (Rhinocort)?

A

Budesonide (Rhinocort) is an inhaled nasal corticosteroid glucocorticoid. It stops the allergic cascade by inhibiting multiple cell types and mediators, including histamine.

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76
Q

What is the drug class and MOA for Cetirizine (Zyrtec)?

A

2nd Generation antihistamine. It is a peripherally selective, non-sedating, H1 receptor blocker.

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77
Q

What is the drug class and MOA for chlorpheniramine (Chlor-Trimeton)?

A

1st generation antihistamine. It competes with histamine at central and peripheral H1 receptor sites.

77
Q

What are the common side effects of 1st generation antihistamines?

A
  1. Drowsiness
  2. Impaired cognition
  3. Anticholinergic effects include dry mouth, dry eyes, constipation, and urinary retention
78
Q

What is the drug class and MOA of cromolyn (Nasalcrom)

A

Mast cell stabilizer. It prevents the influx of calcium into mast cells therefore preventing mediator release.

79
Q

What is the drug class and MOA for fexofenadine (Allegra)?

A

2nd generation antihistamine. Peripherally selective and non-sedating H1 receptor blocker.

79
Q

What are the 3 drug/disease interactions with 1st generation antihistamines?

A
  1. Enlarged prostate- increase urinary retention
  2. Angle closure glaucoma- worsens angle closure
  3. Bronchitis/COPD- mucus plug
80
Q

What is the drug class and MOA for fluticasone (Flonase)?

A

Inhaled nasal corticosteroid (glucocorticoid). It stops the allergic cascade by inhibiting multiple cells types and mediators including histamine.

81
Q

What is the drug class and MOA for hydroxyzine (Atarax)?

A

1st generation antihistamine. Competes with histamine at central and peripheral H1 receptor sites.

82
Q

What is the drug class and MOA of levocetirizine (Xyzal)?

A

2nd generation antihistamine. Peripherally selective and non-sedating H1 receptor blockers. Active isomer of cetirizine.

83
Q

What is the drug class and MOA of loratadine (Claritin)?

A

2nd generation antihistamine. Peripherally selective and non-sedating H1 receptor blocker.

84
Q

What is the drug class and MOA of Meclizine?

A

1st generation antihistamine. Competes with histamine at central and peripheral H1 receptor sites.

85
Q

What is the drug class and MOA of mometasone (Nasonex)?

A

Inhaled nasal corticosteroid (glucocorticoid). It stops the allergic cascade by inhibiting cell types and mediators including histamine.

86
Q

What is the drug class and MOA for Promethazine?

A

1st generation antihistamine. Competes with histamine at central and peripheral H1 receptor sites.

87
Q

What is the drug class and MOA for Pyrilamine?

A

1st generation antihistamine. Competes with histamine at central and peripheral H1 receptor sites.

88
Q

What is the drug class and MOA for triamcinolone acetonide (Nasacort)?

A

Inhaled nasal corticosteroid (glucocorticoid). Stops the allergic cascade by inhibiting multiple cells types and mediators include histamine.

89
Q

What are the benefits of quitting smoking that can be seen with 2 weeks to 3 months?

A

Circulation improvement and walking becomes easier. Lung function increases

90
Q

What are the benefits of quitting smoking that can be seen within 1-9 months?

A

Lung cilia regain normal function and clearing mucus in lungs becomes easier. Coughing, fatigue, and SOB decrease.

91
Q

What are the benefits of quitting smoking that can be seen with 1 year?

A

The risk for coronary heart disease decreases the half that of those who continue to smoke.

92
Q

What are the benefits of quitting smoke that can be seen within 5 years?

A

The risk of stroke is reduced to that of people who have never smoked.

93
Q

What are the benefits of quitting smoking that can be seen within 10 years?

A

The lung cancer death rate is similar to half of those who continue to smoke. Risk of cancer in the mouth, throat, esophagus, bladder, kidney, and pancreas decrease.

94
Q

What is the benefits of quitting smoking that can be seen within 15 years and more?

A

Risk of coronary heart disease is similar to those who have never smoked.

95
Q

What is the difference in combination nicotine therapy replacement (NRT) and monotherapy?

A

Combination NRT is more effective than monotherapy NRT with an odds ratio of 2.7:2

96
Q

Constituents of tobacco ______ induce the CYP1A2 enzymes causing potential drug interactions.

A

smoke

97
Q

What effects does nicotine have on dopamine?

A

Nicotine increases pleasure and suppresses appetite with its effects on dopamine.

98
Q

What are the 10 exclusions for self-treatment for tobacco cessation?

A
  1. Active peptic ulcer disease (PUD). Stomach, esophageal, and duodenal ulcers
  2. Younger than 18
  3. Arrhythmia
  4. CVD
  5. Breastfeeding/pregnant
  6. Diabetes
  7. Uncontrolled hypertension
  8. Medications use for asthma, depression, or prescription tobacco cessation
  9. Recent MI
  10. Sodium-restricted diet

DUMB CRAYSA

99
Q

What are the effects that nicotine has on GABA?

A

Nicotine via GABA reduces anxiety and tension

100
Q

How does smoking cessation affect caffeine levels?

A

Caffeine levels increase in body after smoking cessation as CYP1A2 is no longer induced. Counsel patients to reduce caffeine intake by half.

101
Q

What effect does nicotine have on NE?

A

Nicotine via NE stimulates arousal and appetite supression

102
Q

What effect does nicotine have on ACh?

A

Nicotine via ACh increase arousal and cognitive imporvement.

103
Q

What effect does nicotine have on glutamate?

A

Nicotine via glutamate improves learning and memory enhancement.

104
Q

What effect does nicotine have on serotonin?

A

Nicotine via serotonin improves modulation and appetite suppression.

105
Q

How long should a nicotine lozenge be in the mouth?

A

Dissolve slowly in mouth for 20-30 minutes and rotate to different areas in mouth.

106
Q

T or F: Nicotine lozenges should be chewed and swallowed.

A

False. Do not chew and swallow nicotine lozenges

107
Q

Do not eat or drink ________ minutes before and during use of a nicotine lozenge as it will decrease its absorption.

A

15 minutes

108
Q

The maximum number of nicotine lozenges is __________ per day.

A

20 nicotine lozenges

109
Q

What are the 6 common side effects of nicotine gum?

A
  1. Unpleasant taste in mouth
  2. Mouth irritation
  3. Jaw soreness
  4. Hypersalivation
  5. Hiccups
  6. Dyspepsia (upset stomach)
110
Q

Nicotine gum and nicotine lozenge dosing is based on ________. What is this dosing cutoff?

A

TTFC- time to first cigarette and the cut off is 30 minutes.

111
Q

What is the nicotine gum and nicotine lozenge dosing schedule?

A

Week 1-6: 1 piece Q1-2H
Week 7-9: 1 piece Q2-4H
Week 10-12 1 piece Q4-8H

112
Q

What is the maximum pieces of nicotine gum that can be used per day?

A

24 pieces/24 hours

113
Q

What are the directions for use for nicotine gum?

A
  1. CHEW slowly and wait till sign of peppery, minty, fruity, or tingling sensation
  2. PARK in gums between cheek (rotate each side for each piece)
    Repeat until the taste/tingle is gone
114
Q

Do not eat or drink __________ minutes before or during use for nicotine gum as it will decrease its absorption.

A

15

115
Q

What are the 8 common side effects of nicotine lozenge?

A
  1. Mouth irritation
  2. Nausea
  3. Hiccups
  4. Cough
  5. Heartburn
  6. Headache
  7. Flatulence
  8. Insomnia
116
Q

What is the maximum number of nicotine lozenges that can be consumed per day?

A

20 lozenges/ 24 hours

117
Q

What are the 4 common side effects of the nicotine patch?

A
  1. Local skin reactions
  2. Vivid dreams
  3. Insomnia
  4. Headache
118
Q

What is the dosing for nicotine patches for someone smoking less than 10 cigarettes per day?

A

14mg for 6 weeks
7 mg for 2 weeks

118
Q

The nicotine patch dosing is based on __________. The cut-off is ________ cigarettes?

A

Number of cigarettes.
10

119
Q

What is the dosing for nicotine patches for someone who is smoking more than 10 cigarettes per day?

A

21 mg for 4-6 weeks
14 mg for 2 weeks
7 mg for 2 weeks

120
Q

What are the directions for use for nicotine patches?

A
  1. PLACE on a clean, dry, and hairless spot on upper body or upper outer arm
  2. ROTATE site each day (wait 1 week to use same spot again)
  3. PRESS firmly for 10 seconds during application
  4. WASH hands after applications or removal
  5. DO NOT CUT
  6. Remove at bedtime if insomnia and vivid dreams become problematic
  7. Careful with lotions and creams as it can reduce adhesiveness
  8. Fold patch to discard
121
Q

How should nicotine patches be discarded?

A

Fold them in half

122
Q

Can nicotine patches be cut?

A

No

123
Q

T or F: A person can you the same spot everyday for nicotine patch application.

A

False. Use different spots on upper body and arms. Do not repeat same spot until 1 weeks after that spot’s use.

124
Q

_______% is the prevalence of smoking in adults.

A

11%

125
Q

Are e-cigarettes approved from smoking cessation?

A

No. Traditional NRT should be tried first.

126
Q

What did the Cochrane Review conclude?

A

E-cigarettes with nicotine increase quit rates compared to NRT and some evidence stated that E-cigarettes with nicotine increase quit rates compared to e-cigarettes without nicotine.

127
Q

What is the interaction between smoking and oral contraceptives?

A

Increased cardiovascular risks are seen with in women who smoke and use oral contraceptives.

128
Q

The risk for cardiovascular disease increases between smoking and oral contraceptives when women are ________ years and older and smoke more than _________ cigarettes per day.

A

35 years and older
15 or more cigarettes per day

129
Q

When do withdrawal symptoms for nicotine occur?

A

Most symptoms manifest within the first 1-2 weeks and peak within the 1st week and subside during weeks 2-4.

130
Q

What are the 10 common nicotine withdrawal symptoms?

A
  1. Irritability/ frustration/ anger
  2. Anxiety
  3. Difficulty concentrating
  4. Restlessness/ impatience
  5. Depressed mood
  6. Insomnia
  7. Impaired task performance
  8. Increased appetite
  9. Weight gain
  10. Cravings
131
Q

What are the likely effective complementary and alternative medications (CAMs) that can be used for a cough?

A

Topical Camphor

132
Q

What are the possibly effective complementary and alternative medications (CAMs) that can be used for a cough?

A

Honey

133
Q

What are the two topical antitussives that can be used for a cough?

A

Camphor and Menthol. These are FDA approved. Has no known MOA.

134
Q

What is chlophedianol?

A

This is an antitussive/ cough suppressant.

135
Q

What is the MOA for chlophedianol?

A

It increases the cough threshold.

136
Q

What is codeine?

A

This is an antitussive/ cough suppressant.

137
Q

Codeine is a schedule _______ narcotic.

A

V (five)

138
Q

What is the MOA of codeine?

A

Increases the cough threshold.

139
Q

What are the 5 common side effects of codeine?

A

Nausea, vomiting, sedation, dizziness, and constipation

140
Q

What are the two cough products that are safe to use in pregnancy?

A

Guaifenesin and dextromethorphan. Avoid products that contain alcohol in them.

141
Q

What is the definition of an acute cough?

A

Less than 3 weeks.

142
Q

What is the definition of a chronic cough?

A

Greater than 8 weeks

143
Q

What is the definition of a subacute cough?

A

3-8 weeks

144
Q

What is dextromethorphan?

A

This is an antitussive/ cough suppressant

145
Q

What is the MOA of dextromethorphan?

A

This increases the cough threshold.

146
Q

What is the interaction between dextromethorphan and SSRIs like citalopram, escitalopram, fluoxetine, sertraline, etc?

A

Serotonin modulators may increase the risk of serotonergic (psychoactive) effects of dextromethorphan.

147
Q

What is the interaction between dextromethorphan and CYP2D6 inhibitors like bupropion, fluoxetine, paroxetine, quinidine, terbinafine, and dacomitinib?

A

Strong CYP2D6 inhibitors may decrease the metabolism of dextromethorphan therefore increasing the psychoactive effects of it.

148
Q

What are the three drug classes that interact with dextromethorphan?

A

Serotonin modulators, CYP2D6 inhibitors, and MAO inhibitors

149
Q

What are the 5 common side effects of dextromethorphan?

A

Drowsiness, nausea, vomiting, stomach discomfort, and constipation

150
Q

What is the drug class of choice for a non-productive cough?

A

Antitussives like dextromethorphan, diphenhydramine, or codeine.

151
Q

What is the drug of choice for a productive cough?

A

Guaifenesin

152
Q

What are the 12 exclusions for self-treatment for a cough?

A
  1. Difficulty breathing or SOB or dyspnea (feeling short of breath)
  2. Cyanosis- blue/purple color due to decreased oxygen in blood
  3. Hemoptysis- coughing up blood
  4. Weight loss unexpected
  5. Night sweats
  6. Cough worsens after 3-5 days or cough does not improve after 2-3 weeks
  7. 4 years and younger
  8. Temperature greater than 100.4F or temperature greater than 100F that last for more than 3 days
  9. Barking cough or ‘whooping’ cough
  10. Cough that begins suddenly without a fever or upper respiratory infection
  11. Immunocompromised or HIV risk factors or chronic illness
  12. TB exposure
153
Q

What type of drug is guaifenesin?

A

Expectorant

154
Q

What is the MOA of guaifenesin?

A

It loosens and thins the lower respiratory tract secretions

155
Q

Is diphenhydramine an antitussive and a 1st generation antihistamine?

A

Yes! It is both. It acts to increase the cough threshold as an antitussive.

156
Q

What are some nonpharmacologic methods to manage a cough?

A
  1. Non-medicated lozenges or hard candy
  2. Humidification
  3. Interventions to promote nasal drainage
  4. Hydration
157
Q

Why should someone not use dextromethorphan if they are taking an MAOI or within 2 weeks of stopping the MAOI?

A

MAO inhibitors may increase the serotonergic adverse effects of dextromethorphan.

158
Q

What two drugs/ classes of drugs cannot be used/contraindicated with MAOIs?

A

Dextromethorphan and decongestants

159
Q

What are the 4 cardiovascular side effects of decongestants?

A

Elevated blood pressure, tachycardia, palpitations, and arrhythmias. This makes sense as they typically act on a1 and a2 adrenergic receptors.

160
Q

What are the 4 CNS side effects of decongestants?

A

Restlessness, insomnia, anxiety, and tremors

161
Q

What is the most common viral cause of colds?

A

Rhinovirus

162
Q

What are the 5 disease/drug interactions wtih decongestants?

A
  1. Hypertension
  2. Heart disease
  3. Hyperthyroidism
  4. Enlarged prostate
  5. Diabetes
163
Q

How do decongestants interact with hypertension?

A

Decongestants increase blood pressure through activation of alpha 1 receptors. Therefore in those with hypertension, this would further increase their blood pressure.

164
Q

How do decongestants interact with heart disease?

A

Decongestants can increase heart rate as some are non-selective and interact with beta 1 and can increase heart rate putting more stress on the heart in heart disease.

165
Q

How do decongestants interact with hyperthyroidism?

A

Decongestants can increase the symptoms related to hyperthyroidism.

166
Q

How do decongestants interact with an enlarged prostate?

A

Decongestants will increase the urinary retention already seen with an enlarged prostate.

167
Q

What drug class is dyclonine in?

A

Topical anesthetic

168
Q

How do decongestants interact with diabetes?

A

Decongestants may increase blood glucose levels.

169
Q

What drug class is ephedrine in?

A

Topical nasal decongestant

170
Q

What are the 9 exclusions for self-treatment for a cold?

A
  1. Temperature greater than 100.4F
  2. Chest pain
  3. SOB
  4. Worsening of symptoms of development of additional symptoms during self-treatment
  5. Concurrent underlying chronic cardiopulmonary diseases like asthma, COPD, congestive heart failure
  6. Aids or chronics immunosuppressant therapy
  7. Frail patients of advanced age
  8. Infants 3 months old or younger
  9. Hypersensitivity to recommended OTC medications.
171
Q

What is the herbal supplement that may be effective in preventing colds?

A

Echinacea

172
Q

What are the two supplements that may help ease cold symptoms?

A

Zinc and Vitamin C

173
Q

What drug class is Levmetamfetamine in?

A

Topical nasal decongestant

174
Q

What are the two long-acting topical decongestants?

A

Xylometazoline and oxymetazoline

175
Q

What drug class is menthol in?

A

This is a topical anesthetic that produces a cooling sensation. It is also a topical antitussive.

176
Q

What are some nonpharmacologic treatments for a cold?

A
  1. Increased fluid intake
  2. Adequate rest
  3. Nutritious diet
  4. Increased humidification with steamy showers, vaporizers, or humidifiers
  5. Proper hand hygiene for prevention
  6. Nasal strips
  7. Saline nasal spray for nasal symptoms
177
Q

What drug class is pseudoephedrine in?

A

Oral decongestant

178
Q

Per the drugs fact label, do not use the long-acting nasal decongestant oxymetazoline for more than ________ days.

A

3

179
Q

What drug class is phenol in?

A

Topical anesthetic

180
Q

What is the MOA for phenylephrine?

A

This is an alpha-1 agonist that causes vasocontrsiction.

181
Q

What drug class is propylhexedrine in?

A

Topical nasal decongestant

182
Q

What is the MOA of pseudoephedrine?

A

This is an alpha-1 agonist and beta agonist that produces vasoconstriction

183
Q

What it rhinitis medicamentosa?

A

This is rebound congestion

184
Q

What are the 5 short-acting topical decongestants?

A

NELPP

Naphazoline
Ephedrine
Levmetamfetamine
Phenylephrine
Propylhexedrine

185
Q

What are the 4 common side effects of topical decongestants?

A

Burning, stinging, sneezing, and local dryness

186
Q

What are the 5 typical symptoms of a cold?

A
  1. Sore throat
  2. Runny nose
  3. Congestion
  4. Cough
  5. Sometimes headache, malaise, fatigue, and myalgia (muscle pain)
187
Q

When is the usual cold season?

A

Winter months

188
Q

What are some ways to prevent getting the common cold?

A

Wash hands often
Cover mouth and nose when coughing or sneezing
Avoid close contact with sick people
Do not touch face with unwashed hands
Use hand sanitizer

189
Q

What drug class is xylometazoline in?

A

Topical nasal decongestant (long-acting)

OTC Theraputics (2 decks)

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