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OTC Theraputics > Exam 3 Fall 2024 > Flashcards

Exam 3 Fall 2024 Flashcards

Fever, Headache, Musculoskeletal pain, Insomnia, Eyes and Ears

1
Q

What are the 3 types of primary headaches?

A

Tension headache
Migraine headache with/out aura
Medication overuse headache

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2
Q

What is the one type of secondary headache?

A

Sinus headache

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3
Q

What is the course of action if a person presents with a cluster headache?

A

Automatic referral

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4
Q

How is a chronic tension headache defined?

A

Greater than 15 days per month for a least 3 months.

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5
Q

What is the presenting nature of a sinus headache?

A

Pressure behind the eyes or face with dull and bilateral pain

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6
Q

What is the presenting nature of a migraine headache?

A

Throbbing and pulsating and usually unilateral

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7
Q

What is the presenting nature of a tension-type headache?

A

Diffuse ache, tightening, pressure, and constricting. Typically bilateral

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8
Q

What is the onset of a migraine headache?

A

Sudden and can last 4-72 hours

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9
Q

What is the onset of a tension-type headache?

A

Gradual and can last for 30 minutes to 7 days

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10
Q

What causes medication overuse headaches?

A

Excessive use of analgesics. This means using it 3 times or more per week for 3 months or longer. The headache also presents on more than 15 days of the month.

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11
Q

What are some OTC agents that can cause medication overuse headaches?

A

Acetaminophen, aspirin, NSAIDs, and caffeine

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12
Q

What are the exclusions for self-treatment for headache?

A
  1. Severe head pain
  2. Rapid onset with maximum pain headache
  3. Concerning change in headache pattern
  4. Lasts 10 days with or without treatment
  5. Less than 8 years old
  6. High fever or signs of infection
  7. Neck stiffness (indication of meningitis)
  8. Neurologic change (seizure, mental status, vision)
  9. High-risk comorbid condition like cancer or HIV
  10. Last trimester of pregnancy
  11. New headaches during pregnancy
  12. Headache associated with underlying pathology that is NOT a sinus headache
  13. Migraine symptoms with NO diagnosis (can treat if they have been diagnosed)
  14. Liver disease or alcohol consumption of 3 or more drinks per day
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13
Q

What are some non-pharmacological treatments for tension headaches?

A

Relaxation exercises, physical therapy, keep a headache diary

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14
Q

What are some non-pharmacological treatments for migraine headaches?

A

Maintain regular schedule for sleep, eating, and exercise. Apply ice with pressure to forehead. Rest in a dark and quiet room. Manage stress. Do cognitive therapy, and avoid triggers.

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15
Q

What is the normal body temperature?

A

97.5-98.9

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16
Q

What are the fever-producing substances that activate that body’s host defense?

A

Pyrogens

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17
Q

In response to the release of pyrogens, what is produced that elevates the thermoregulatory set point in the hypothalamus?

A

Prostaglandins of the E2 (PGE2)

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18
Q

What area of the brain controls core body temperature?

A

Hypothalamus

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19
Q

What is the medical term used to describe “having or showing symptoms of a fever”?

A

Febrile

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20
Q

What is the result of an untreated fever?

A

Seizure, delirium, coma, then death

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21
Q

What body regulates thermometers?

A

FDA

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22
Q

What is the gold standard area to test body temperature?

A

Rectal

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23
Q

What temperature measured in the rectum signals a fever?

A

100.4 or greater

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24
Q

If temperature is taken orally, how many degrees are added to get to rectal equivalent?

A

+1 degree

Example: Oral was 99.8 then rectal would be 100.8 signifying a fever

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25
Q

If temperature is taken via the axillary, how many degrees are added to get to rectal equivalent?

A

+2 degree

Example: Axillary was 97.6 then rectal would be 99.6 which is not a fever

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26
Q

Through what age are rectal temperatures taken?

A

3 years

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27
Q

What is the celsius to fahrenheit conversion formula?

A

C= 5/9 (F-32)

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28
Q

What are the fever threshold exclusions for OTC treatment in those 3 months old and greater?

A

3 months or older with rectal temperature equal to or greater than 104F. If this is present they must be referred.

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29
Q

What are the fever threshold exclusions for OTC treatment in those younger than 3 months old?

A

3 months or younger with rectal temperature greater than or equal to 100.4. If this is present they must be referred.

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30
Q

What are the fever duration exclusions for OTC treatment in those 2 years and older?

A

2 years or older with a fever (104F) that persists for 3 days with or without treatment must be reffered.

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31
Q

What are the fever duration exclusions for OTC treatment in those 2 years and younger?

A

2 years and younger with a fever that persists for 24 hours must be referred.

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32
Q

What are other exclusions for self-treatment for fevers?

A
  1. Fever over 104F at any age
  2. Impaired oxygen utilization (pulmonary diseases)
  3. Impaired immune fxn (cancer, HIV)
  4. CNS damage (stroke, head trauma)
  5. Severe symptoms of infection
  6. Children with any of the following- history of seizures, stiff neck, rash, refuses to drink liquids, irritable, sleepy, hard to wake, vomiting, cannot keep down fluids, and repeated diarrhea
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33
Q

What are some non-pharmacological treatments for a fever?

A

Adequate fluid intake, sponging or baths with tepid water (be careful as shivering with increase body temp), wear lightweight clothing, remove blankets, maintain comfortable room temperature

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34
Q

What is a non-opioid analgesic that can be used for headache and fever?

A

Acetaminophen (Tylenol)

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35
Q

What is the MOA of acetaminophen (Tylenol)?

A

Centrally inhibits COX enzymes to inhibit prostaglandin synthesis.

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36
Q

Where and how is acetaminophen metabolized?

A

In the liver to sulfate and glucuronide conjugates as well as CYP450s.

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37
Q

What is the duration of action of acetaminophen?

A

4 hrs with normal and 6-8 hours with extended release tablets

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38
Q

What is the toxic metabolite of acetaminophen metabolism produced via metabolism by CYP450?

A

NAPQI

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39
Q

In acetaminophen metabolism, what molecules detoxifies NAPQI?

A

Glutathione

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40
Q

Why should alcohol and acetaminophen not be used together?

A

Alcohol depletes glutathione stores which decreases the ability of the liver to detoxify NAPQI. Elevated levels of NAPQI lead to hepatotoxicity.

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41
Q

Elevated levels of NAPQI from acetaminophen metabolism leads to ___________________.

A

Heptatoxicity

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42
Q

Doses of acetaminophen at _______ grams or greater increases the risk for adverse effects.

A

4 grams (4000mg)

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43
Q

What are the two key drug interactions with acetaminophen?

A

Alcohol and warfarin

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44
Q

Acetaminophen is typically well tolerated. If there are side effects, they typically include __________.

A

Reddening of skin, rash, and blisters

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45
Q

What are the contraindications/ warnings for acetaminophen?

A

Hepatotoxicity (boxed warning)

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46
Q

What is the antidote for acetaminophen toxicity?

A

Acetylcysteine

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47
Q

What is the FDA determined maximum dose of acetaminophen?

A

4000mg/day

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48
Q

What is the acetaminophen dosing for those 12 years and older taking the immediate release 325mg tablet?

A

1-2 tablets PO Q4-6H PRN (max 3,250mg)

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49
Q

What is the acetaminophen dosing for those 12 years and older taking the extra strength 500mg tablet?

A

1-2 tablets PO Q4-6H PRN (max 3,000mg)

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50
Q

What is the acetaminophen dosing for those 12 years and older taking the extended release 650mg tablet?

A

1-2 tablets PO Q8H PRN (max 3,900mg)

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51
Q

What is the concentration of suspension acetaminphen?

A

160mg/5mL

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52
Q

What is the acetaminophen dosing for those younger than 12 years old taking the suspension version?

A

10-15mg/kg/dose PO Q4-6H PRN (max75mg/kg, 5 doses)

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53
Q

What is the acetaminophen dosing for those 2-11 years old taking the 160mg chewable tablet?

A

1-3 tablets PO Q4-6H (max 2,400mg or 5 doses/day)

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54
Q

Is acetaminophen appropriate to use during pregnancy and/or lactation?

A

During pregnancy, acetaminophen should be used at the lowest effective dose for the shortest amount of time. During lactation, acetaminophen is compatible. Overall, acetaminophen is the drug of choice during pregnancy and lactation.

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55
Q

What is the MOA of NSAIDs?

A

Reversible central and peripheral inhibitors of the COX enzyme preventing prostaglandin synthesis.

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56
Q

NSAIDs exert effects of _________, __________, and ___________________.

A

Analgesic
Antipyretic
Anti-inflammatory

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57
Q

What is the duration of action of ibuprofen (Advil/Motrin)?

A

6-8 hours

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58
Q

What is the duration of action of naproxen (Aleve)?

A

Up to 12 hours

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59
Q

If a drug is more COX1 selective, it increases the risk for _______________.

A

Stomach ulcers and bleeding.

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60
Q

If a drug is more COX2 selective, it increases the risk for _________________.

A

Cardiovascular events

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61
Q

What are the 4 key drug interactions with NSAIDs?

A

Aspirin
Anti-hypertensives
Anticoagulants
Alcohol

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62
Q

What is the age cutoff for ibuprofen use?

A

Under 6 months

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63
Q

What is the age cutoff for naproxen use?

A

Under 12 years

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64
Q

What is the boxed warning for COX-1 inhibitors?

A

Gastrointestinal events

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65
Q

What is the boxed warning for COX-2 inhibitors?

A

Cardiovascular events

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66
Q

What is the dosing for 200mg ibuprofen for those greater than 12 years old?

A

1-2 200mg tablets PO Q4-6H WF PRN (max 1,200mg)

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67
Q

What is the dosing for 220mg naproxen for those greater than 12 years old?

A

1 220mg tablet PO Q8-12H WF PRN (max 660mg)

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68
Q

What dose is the ibuprofen suspension come in?

A

100mg/5mL

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69
Q

What is the dosing for the ibuprofen suspension for those between 6 months and 12 years old?

A

5-10mg/kg/dose PO Q6-8H WF PRN (max 40mg/kg, 4 total doses)

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70
Q

What is the dosing for the chewable tablet ibuprofen for those between 2-11 years old?

A

1-3 100mg tablets PO Q6-8H WF PRN (max 1,200mg, 4 total doses/day)

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71
Q

Are NSAIDs safe to use during pregnancy and lactation?

A

Avoid NSAID use during pregnancy, especially in the 3rd trimester. NSAIDs are normally safe to use during lactation.

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72
Q

What is the MOA of salicylates?

A

Irreversible peripheral inhibition of COX enzymes inhibiting prostaglandin synthesis.

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73
Q

What are the 3 effects of salicylates?

A

Analgesic, antipyretic, and anti-inflammatory effects

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74
Q

Why are salicylates not typically used for their anti-inflammatory effects?

A

Salicylates need very high doses (4-6g) to exert any anti-inflammatory effects. At doses that high, it would increase the risk for side effects.

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75
Q

What is the duration of action of salicylates?

A

4-6 hours for immediate release and the platelet inhibition effects last up to 10 days before they die and need to be inhibited again.

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76
Q

The main salicylate discussed was aspirin. What are common adverse effects of this drug?

A

High risk for GI bleeds and a lower risk for cardiovascular events.

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77
Q

What is the age cutoff for salicylates/aspirin?

A

Do not use in patients under 18 years old due to risk of Reye’s syndrome in those recovering from viral infections.

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78
Q

Are salicylates/aspirin safe to used during pregnancy and/or lactation?

A

Avoid the use of these drugs during pregnancy and lactation.

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79
Q

Besides the pediatric and pregnant population, what are two other contraindications for the use of salicylates?

A

The elderly as they have increased risk for GI complications and those with gout as salicylates and uric acid compete for excretion.

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80
Q

What is the fatality rate for Reye’s syndrome which is associated with the pediatric use of salicylates?

A

50%

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81
Q

What are the symptoms of Reye’s syndrome?

A

Neurologic damage, fatty liver with encephalopathy, and hypoglycemia

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82
Q

What is AERD?

A

This is Aspirin exacerbated respiratory disease. It is basically aspirin induced asthma.

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83
Q

What is the formal aspirin challenge?

A

A test conducted to confirm diagnosis of an NSAID allergy.

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84
Q

What are the two main drug-drug interactions with aspirin?

A

NSAIDs and ibuprofen. Take ibuprofen 60 minutes before or 8 hours after taking aspirin.

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85
Q

What is the dosing for the immediate release 325-600mg aspirin for those 12 years and older?

A

325-1000mg PO Q4-6H with maximum dose of 4000mg/day for analgesic and antipyretic effects

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86
Q

What is the dosing for the immediate release 75-100mg aspirin for those 12 years and older?

A

1 tablet (typically 81mg) PO daily for secondary cardioprotection.

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87
Q

A 21 year old male presents with a headache characterized by tightness and pressure. They state they are juggling many assignments and exams right now. What type of headache is this?

A

Tension headache

(symptoms of tension headache: Diffuse ache, tightening, pressure, and constricting. Typically bilateral)

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88
Q

A 21 year old male presents with a headache characterized by tightness and pressure. They state they are juggling many assignments and exams right now. Is this patient an appropriate candidate for self-treatment?

A

Yes. Typically we would need to ask more questions to see if he has any exclusions factors but based on the information given, he is a candidate for OTC treatment.

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89
Q

A 21 year old male presents with a headache characterized by tightness and pressure. They state they are juggling many assignments and exams right now. What treatment could he receive?

A

He could start with acetaminophen (tylenol) at doses of 325-1000mg Q4-6H (max 4000mg). If that does not work, he could do an NSAID like ibuprofen or naproxen. If this headache continues to last for a total of 10 days, he will need to be referred.

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90
Q

A young woman calls the pharmacy stating her 8 month old has a rectal temperature of 104.4F and she will not eat or drink and has been very fussy. Does this child have a fever?

A

Yes. A rectal temperature greater than 100.4F is considered a fever.

3 months or older with rectal temperature equal to or greater than 104F must be referred.

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91
Q

A young woman calls the pharmacy stating her 8 month old has a rectal temperature of 104.4F and she will not eat or drink and has been very fussy. Is the child a candidate for self-treatment?

A

No. A child 3 months and older with a fever above 104F needs to be referred.

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92
Q

What is the pain scale classification from 1-3?

A

Mild pain

93
Q

What is the pain scale classification from 4-6?

A

Moderate pain

94
Q

What is the pain scale classification from 7-10?

A

Severe pain

95
Q

How long does acute pain last?

A

Less than 4 weeks

96
Q

How long does subacute pain last?

A

4 weeks to 3 months

97
Q

How long does chronic pain last?

A

At least 3 months

98
Q

__________ are pain sensing nerve fibers.

A

Nociceptors

99
Q

What is the location and symptoms of myalgia?

A

Occurs in the muscles and is a dull and constant ache. Swelling may be present.

100
Q

What is the location and symptoms of tendonitis?

A

Tendon areas due to injury or repetitive use. Presents with mild to severe pain occurring after us. Warmth, swelling, and erythema may be present.

101
Q

What is the location and symptoms of bursitis?

A

Inflammation of the bursae within joints. Presents as constant pain that worsens with movement. Warmth, swelling, and erythema may be present.

102
Q

What is the location and symptoms of a sprain?

A

Stretching or tearing of a ligament within a joint. Presents with initial severe pain following by moderate pain with joint use. There is a reduction in joint stability and function.

103
Q

What is the location and symptoms of a strain?

A

Hyperextension of a joint that results in overstretching or tearing. Presents with initial severe pain with continued pain with movement and rest. Some loss of function may be present.

104
Q

What is the location and symptoms of osteoarthritis?

A

Weight-bearing joints presenting with dull joint pain that is typically worse in the morning and improves with movement.

105
Q

Which of the following issues is acute with injury?

A. Myalgia
B. Tendonitis
C. Bursitis
D. Sprain
E. Strain
F. Osteoarthritis

A

C, D, and E

Bursitis, sprain, and strain

106
Q

What are the exclusion for self-treatment of pain?

A
  1. Severe pain (score of 6 or more)
  2. Pain lasting more than 10 days
  3. Pain that continues for 7 days after treatment with topical analgesic
  4. Increased intensity or change in the character of pain
  5. Pelvic or abdominal pain (not dysmenorrhea)
  6. Nausea, vomiting, fever, signs of infection
  7. Visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture
  8. Pregnancy
  9. Younger than 2 years
  10. Back pain and loss of excretion control
  11. Arthritis pain requiring use of topical NSAIDs for longer than 21 days
  12. Arthritis pain that has not improved after 7 days of using topical NSAID
107
Q

Can osteoarthritis be treated with OTC products?

A

Yes, but only if that individual has an osteoarthritis diagnosis

108
Q

What are the non-pharmacologic treatment for pain?

A

RICE (Rest, Ice, Compression, Elevation), heat for those with non-inflammatory pain, and TENS therapy, epsom salts, massages, acupuncture, and more.

109
Q

T or F: Heat or ice treatment non-pharmacologic treatments should be used for 15-20 minutes 3-4x per day.

A

True

110
Q

T or F: TENS therapy is highly recommended for osteoarthritis.

A

False. TENS therapy is recommended against in osteoarthritis

111
Q

What is the maximum duration of time that systemic analgesics like acetaminophen, ibuprofen, naproxen, etc should be used?

A

10 days maximum

112
Q

What is the maximum duration of time that topical analgesics should be used?

A

7 days (exception is diclofenac/voltaren which is a 21 day maximum)

113
Q

For minor-moderate aches and pain of the muscles and joints, what is the 1st line therapy?

A

Systemic analgesics like acetaminophen or NSAIDs. Typically start with acetaminophen but if inflammation is present, use an NSAID. Topical analgesics can be used as adjunct therapy

114
Q

For osteoarthritis, what is the 1st line therapy?

A

Acetaminophen or NSAIDs paired with a topical analgesic like diclofenac gel or capsicum.

115
Q

What is the 1st line therapy for nerve pain?

A

Lidocaine as a topical anesthetic

116
Q

What is the MOA for diclofenac (voltaren) gel?

A

Same as NSAIDs, it inhibits COZ enzymes to stop prostaglandin synthesis.

117
Q

Compare absorption between systemic NSAIDs and topical NSAIDs like diclofenac.

A

Diclofenac only has 6% absorption from the skin which is 17x less than systemic NSAIDs

118
Q

What issue is diclofenac approved for?

A

Osteoarthritis in those 18 and older

119
Q

Diclofenac may take up to _____ days to work.

A

7

120
Q

What is the dosing for diclofenac gel?

A

Upper body areas- 2 grams/dose
Lower body areas- 4 grams/dose

Apply 4 times per day. Maximum of 16 grams per joint and 32 grams for the whole body per day.

121
Q

It is known that counterirritants are drugs that exert a paradoxical pain-relieving effect achieved by producing less severe pain to counter the more intense one. What is the typical dosing for most counterirritant topical products?

A

Apply no more than 3-4x per day for up to 7 days. If chronic pain, use for the duration of the pain.

122
Q

Topical counterirritants are safe for use in adults and children older than ______ years of age.

A

2

123
Q

What is a possible side effect when using topical counterirritants?

A

Chemical burns

124
Q

What is the MOA of the counterirritant methyl salicylate?

A

This is a rubefacient that causes vasodilation increasing blood flow and skin temperature. It also inhibits central and peripheral prostaglandin synthesis.

125
Q

What is the MOA of the topical counterirritant camphor?

A

It produces a cooling sensation

126
Q

At concentration of 0.1-3% for camphor products, what is the effect?

A

Depresses cutaneous receptors

127
Q

At concentrations greater than 3% for camphor products, what is the effect?

A

Stimulates nerve ending in the skin and masks the pain

128
Q

For safety reasons, camphor cntrentrations can not exceed ______%.

A

11%

129
Q

What is the MOA of counterirritant menthol?

A

Produces a cooling sensation

130
Q

At concentration less than 1%, what are the effects of menthol?

A

Depresses cutaneous receptors to act as an anesthetic.

131
Q

At concentrations greater than 1.25%, what are the effects of menthol?

A

Stimulates cutaneous receptors to act as a counterirritant.

132
Q

Menthol activates the ______________ cation channels to trigger a cold sensation followed by a sensation of warmth.

A

Transient receptor potential

133
Q

What is the MOA of counterirritant capsicum?

A

It is a TRPV1 receptor stimulates that depletes substance P.

134
Q

What is unique about the dosing for capsicum?

A

Needs to be applied regularly to see any effects. This topical drug will not work if not applied regularly.

135
Q

What is the MOA of the topical analgesic trolamine salicylate?

A

This drug is absorbed through the skin and results in synovial fluid salicylate concentrations below those of oral aspirin. May be good for osteoarthritis in the hand.

136
Q

What was the only drug discussed that acts on nerve pain?

A

Lidocaine

137
Q

What is the dosing protocol for lidocaine patches?

A

Limit patching to 8-12 hours and leave off for at least 12 hours

138
Q

What is the dosing protocol for lidocaine creams?

A

Apply Q6-8H PRN and do not exceed 3 doses per day.

139
Q

Lidocaine use is approved for ________ days in those ______ years and older.

A

7
12

140
Q

What is the pathophysiology behind dry eye disease?

A
  1. Tear hyperosmolarity
  2. Decreased tear production
  3. Increased evaporation loss
  4. T-cell mediated inflammation with moderate to severe disease
141
Q

What are the main symptoms of dry eye disease?

A

Itchy or scratchy eye and/or a gritty sensation in the eye.

142
Q

What are the 4 classes of drugs that can induce dry eye disease?

A

Anticholinergics like antihistamines and antidepressants
Decongestants
Diuretics
Beta blockers

143
Q

A patient complains of grittiness in the eye. What is likely the problem?

A

Dry eye disease

144
Q

If the dry eye disease presents as mild, what is the 1st line treatment?

A

Ocular lubricants

145
Q

A patient complains of redness and matting of both eyes in the morning. What are they likely suffering from?

A

Bacterial conjunctivitis

146
Q

A patient complains of itchy eyes with redness and watery discharge. What is likely the problem?

A

Allergic conjunctivitis

147
Q

When should a person be switched from preservative containing to preservative free eye solutions?

A

If they are using them everyday they should switch the preservative free to limit damage to the epithelium of the eye.

148
Q

What are the 3 alarm symptoms of eye disease?

A
  1. Pain
  2. Photophobia
  3. Blurred vision
149
Q

What are the 2 indication for artificial tear use?

A
  1. Dry eye disease
  2. Allergic conjunctivitis
150
Q

What are the 3 main side effects of artificial tear use?

A

Blurred vision, crusting of eyelids, and stinging of eyes

151
Q

What are the side effects of ophthalmic ointments?

A

Blurred vision, eye discomfort, irritation, redness, and matting or sticking of eyelashes

152
Q

What are the exclusions for self-treatment for eye issues?

A
  1. Eye pain
  2. Blurred vision
  3. Light sensitivity
  4. History of contact lenses
  5. Blunt trauma to eye
  6. Chemical exposure to eye
  7. Eye exposes to heat
  8. Symptoms lasting longer than 72 hours.
153
Q

What are the signs and symptoms of allergic conjunctivitis?

A

Bilateral eye involvement, painless tearing (watery eyes), intense itching, diffuse redness, and watery discharge

154
Q

A good non-pharm treatment for dry eye is to use a warm compress. What is a similar good non-pharm treatment for allergic conjunctivits?

A

Cold compress

155
Q

What is the 1st line treatment for allergic conjunctivitis?

A

Artificial tears

156
Q

What is the 2nd line treatment for allergic conjunctivits?

A

Ophthalmic antihistamine/mast-cell stabilizers or just ophthalmic antihistamines.

157
Q

What were the 3 discussed ophthalmic antihistamines/mast cell stabilizers?

A

Olopatadine, ketotifen, and alcaftadine

158
Q

What drug class is alcaftadine in?

A

Antihistamine/ mast cell stabilizer

159
Q

What were the two discussed ophthalmic antihistamines only?

A

Pheniramine and antazoline

160
Q

What were the 5 ophthalmic decongestants discussed?

A

Naphazoline, tetrahydrozoline, phenylephrine, oxymetazoline, and brimonidine

161
Q

What two ophthalmic decongestants that have the highest risk for ocular rebound?

A

Phenylephrine and oxymetazoline

162
Q

What is the indication for the drug Ketotifen?

A

Allergic conjunctivits

163
Q

What is the indication for the drug olopatadine?

A

Allergic conjunctivits

164
Q

What is the indication for brimonidine?

A

It reduces redness in the eye

165
Q

What is the MOA for the drug brimonidine?

A

Selective alpha-2 agonist. It binds and activates alpha 2 adrenergic receptors in the vascular endothelium of the eye vessels causing vasoconstriction reducing blood flow to the eys.

166
Q

What is a side effect common with the use of Pheniramine?

A

Tingling sensation in the eye

167
Q

What drug class does Pheniramine belong to?

A

Anithistamine

168
Q

What are the 4 common side effects of ophthalmic decongestants?

A

Blurred vision, eye discomfort, irritation, and redness

169
Q

What drug class does oxymetazoline belong to?

A

Decongestant (can be nasal or ophthalmic)

170
Q

What drug class does tetrahydrozoline belong to?

A

Decongestant

171
Q

What drug class does Naphazoline belong to?

A

Decongestant

172
Q

What drug class does phenylephrine belong to?

A

Decongestant (can be nasal or ophthalmic)

173
Q

What is the MOA of phenylephrine?

A

Selective alpha 1 agonist

174
Q

What are the 2 common side effects of the drug Ketotifen?

A

Headache and rhinitis

175
Q

What are the 5 common side effects of ophthalmic ointment use?

A

Blurred vision, eye discomfort, irritation, redness, and matting or sticking of eyelashes

176
Q

What are the 3 common side effects of artificial tear use?

A

Blurred vision, crusting of eyelid, and stinging of the eyes.

177
Q

What drug class does Olopatadine belong to?

A

Ophthalmic antihistamine and mast cell stabilizer

178
Q

What drug class does Ketotifen belong to?

A

Ophthalmic antihistamine and mast cell stabilizer

179
Q

What is stabilized oxychloro complex (Purite, OcuPure)?

A

This is an ophthalmic preservative that evaporates when it hits the eye.

180
Q

What is sodium perboate?

A

This is an ophthalmic preservative that evaporates when it hits the eye.

181
Q

What is benzethonium chloride?

A

This is an ophthalmic preservative

182
Q

What is lanolin?

A

This is an ophthalmic lubricant ointment

183
Q

What is mineral oil 40% used for?

A

It is used as an ophthalmic lubricant ointment

184
Q

What is petrolatum used for?

A

It is used as an ophthalmic lubricant ointment

185
Q

What is glycerin 0.5-1% used for?

A

This is an ocular lubricant

186
Q

What is polyethylene glycol 400 used for?

A

This is an ocular lubricant

187
Q

What is Povidone 0.6-2% used for?

A

This is an ocular lubricant

188
Q

What is polyvinyl alcohol used for?

A

This is an ocular lubricant

189
Q

What is Hydroxypropyl methylcellulose used for?

A

It is an ocular lubricant

190
Q

What are the symptoms of impacted cerumen (earwax) in the ear?

A

Decreased hearing, dizziness, ringing in ear, and itching

191
Q

What drug class does carbamide peroxide belong to?

A

Cerumen softening agent

192
Q

What is the age cut-off for the medication called Debrox? It is an earwax removal kit?

A

12 years old

193
Q

What are the exclusions for self-treatment for otic issues like impacted cerumen or swimmer’s ear?

A
  1. Signs of infection
  2. Pain with ear discharge
  3. Bleeding or signs of trauma
  4. Ruptured tympanic membrane
  5. Ear surgery within last 6 weeks
  6. Tympanostomy tubes
  7. Cannot follow instructions
  8. Hypersensitivity to recommended products
  9. Younger than 12 years
  10. Worsening of condition after self-treatment
194
Q

Is dizziness an exclusion for self-treatment for impacted cerumen?

A

No. This is typically a symptom of impact cerumen.

195
Q

Is decreased hearing an exclusion for self-treatment for impacted cerumen?

A

No. This is typically a side effect of impacted cerumen

196
Q

Are the symptoms of pain, redness, and warmth exclusions for self-treatment for impacted cerumen?

A

Yes. These may be signs of an infection

197
Q

Are the symptoms of pain associated with ear discharge a self-exclusion for impacted cerumen treatment?

A

Yes

198
Q

Are tympanostomy tubes an exclusion factor for self-treatment for impact cerumen?

A

Yes

199
Q

What are the exclusions for self-treatment with insomnia?

A
  1. Younger than 12 years old
  2. 65 years and older
  3. Pregnant or breastfeeding
  4. Frequent nocturnal or early morning awakenings
  5. Chronic insomnia (3 months or more)
  6. Sleep disturbances secondary to psychiatric or general medical disorders
200
Q

What is chronic insomnia?

A

Insomnia that has lasted for at least 3 months and occurs 3 or more times per week.

201
Q

What is short-term insomnia?

A

Insomnia that has lasted less than 3 months

202
Q

What is the MOA of melatonin?

A

Melatonin regulates the circadian rhythm. It may shorten time to fall asleep (improves sleep latency)

203
Q

What is the MOA of caffeine?

A

Caffeine is an adenosine antagonist at the A1 and A2 receptors. Adenosine naturally works to centrally promote sleep.

204
Q

What is the typical dose of melatonin for insomnia?

A

2-10mg

205
Q

What is the usual dose for diphenhydramine for insomnia?

A

25-50mg taken 30-60 minutes before bedtime

206
Q

Is pregnancy and/or breastfeeding an exclusion for self-treatment for insomnia?

A

Yes

207
Q

Is being 65 or older an exclusion for self-treatment for insomnia?

A

Yes

208
Q

What is the only FDA approved OTC TX for insomnia?

A

Diphenhydramine

209
Q

For the TX of short-term insomnia, use diphenhydramine for _________ days with an “off” night to assess sleep quality without the medication.

A

3 days. Do not use for more than 7-10 days.

210
Q

What is the age cutoff for OTC TX for insomnia?

A

12 and 65

211
Q

What does SLUDGE stand for?

A

Salivation, lacrimation, urination, defecation, GI distress, and emesis

212
Q

How effective is the CAM known as valerian?

A

300-600 mg daily modestly improves subjective sleep quality.

213
Q

What are the US population nutrients of concern?

A

Potassium, calcium, iron, and vitamin D

214
Q

What form of iron has the highest % of elemental iron?

A

Iron fumarate

215
Q

What form of calcium is best in the elderly population and those on anti-ulcer medications?

A

Calcium citrate as it does not need an acidic environment to be absorbed.

216
Q

What is the indication for St. John’s Wart?

A

Depression

217
Q

What is the indication for Kava?

A

Anxiety

218
Q

What is the indication for ginkgo?

A

Anxiety and dementia

219
Q

What is the indication for asian gingseng?

A

Cognitive function

220
Q

What are the 4 main 2nd generation antihistamines?

A

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

221
Q

What is Cromolyn (NasalCrom)?

A

This is a mast cell stabilizer drug

222
Q

What is the time period for intermittent allergic rhinitis?

A

4 days or less per week OR less than 4 weeks

223
Q

What is the time period for persistent allergic rhinitis?

A

4 days a week or more AND lasting at least 4 weeks.

224
Q

What is the TX for mild intermittent allergic rhinitis?

A
  1. Oral antihistamine or intranasal antihistamine
  2. Intranasal corticosteroid
225
Q

What is the TX for moderate-severe intermittent allergic rhinitis?

A
  1. Oral antihistamine or intranasal antihistamine
  2. Intranasal corticosteroid
  3. IAH and ICS
226
Q

What is the TX for mild persistent allergic rhinitis?

A
  1. Inhaled corticosteroid
  2. Oral antihistamine or intranasal antihistamine
227
Q

What is the TX for moderate-severe persistent allergic rhinitis?

A
  1. ICS and IAH
228
Q

What type of drug is budesonide (Rhinocort)?

A

Intranasal corticosteroid

229
Q

What is the dosing for the oral decongestant pseudoephedrine?

A

60mg Q4-6H (max 240 mg)

OTC Theraputics (5 decks)

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