Nonmedical use of OTC products

Question 1

What is Loperamide misused for?

Answer 1

-Opioid withdrawal
-feelings of euphoria
-used as an analgesic

Question 2

What is the recommended max dose for Loperamide?

Answer 2

OTC: 8 mg per day
Rx: 16 mg per day

Question 3

MOA of Lorepamide

Answer 3

binding to opioid receptors in the circular and longitudinal intestinal muscles that slow peristalsis and increase gastrointestinal transit time

Indication: to treat Diarrhea

Question 4

Symptoms of toxicity

Answer 4

-cause QTc prolongation, oftentimes leading to Torsades de Pointes -> death
-mechanism unknown

Question 5

Nonmedical Use Definiton

Answer 5

“Intentional use of a commercially available substance to experience its psychoactive effects; instead of its intended purpose”

-by Williams, JF and Kokotailo

Question 6

MISUSE vs ABUSE

Answer 6

Misuse: taking a medication other than as
directed, is usually ACCIDENTAL or
UNINTENTIONAL, and can happen for many
reasons.

Abuse: INTENTIONALLY using medications
that are not medically necessary or for the
experience or feeling a drug causes

Question 7

What are factors indicating incorrect use of OTC products ON PURPOSE?

Answer 7

-More medicine than prescribed
-More often than prescribed
-Without medical reason
-To delay traditional medical care
-Or mixes medicine with alcohol or illegal drug

Question 8

Dispensing OTC products containing opioids
LAW

Answer 8

-only by the pharmacist (transaction and delivery can be done by a non-pharmacist)

-max 240cc or 8 oz (or 48 dosage units) for controlled substances containing opium
-max 120cc or 4 oz (or 24 dosage units) any controlled substances

-the purchaser is at least 18 yo

Question 9

What is the indication for misuse of Dextromethorphan?

Answer 9

-Sense of floating and dissociation

-the response is highly variable
-dose-related
-tolerance factor (after time a need an additional product is needed to get the same experience)

Question 10

Signs of toxicity for Dextromethorphan?

Answer 10

-Anxiety
-memory loss
-impaired motor function
-tremor
-numbness

Question 11

What is the recommended dose for Dextromethorphan?

Answer 11

-recommended dose (antitussive): 15-30 mg 3-4x daily
-fatal dose: 2500/day
-signs of toxicity may start at 4 ounces

-Onset: 30-60min
-Peak: after 1-4 hours
-Duration: 6 hours

Question 12

Toxicities for Diphenhydramine

Answer 12

Mild: somnolence, anticholinergic signs, tachycardia, nausea/vomiting

Moderate (typically > 300mg) - isolated and
spontaneously resolving agitation, confusion,
hallucinations and ECG disturbances

Severe (typically >1G ingested): delirium/psychosis, seizures, coma

Question 13

What is the maximum amount of Pseudoephedrine that is allowed to be dispensed by the law?

Answer 13

Anti-meth law
-24 daylong tablets a month
-120 daylong tablets a year

-Tenn. Code: not more than 5.76 g/30 days

-for more than 28.8 g per year a prescription is needed

Question 14

Options of Laxatives

Answer 14

-Stimulating agents (often)
-saline and osmotic products
-bulking agents
-surfactants

Motivation - Wt Loss (high school, athletics, young females)

Question 15

ADE for Laxatives

Answer 15

-Bowel desensitization
-Electrolyte and acid/base changes that can
involve the renal and cardiovascular systems

Question 16

Other OTC products of misuse

Answer 16

-Hand sanitizer (due to alcohol)
-NSAIDs
-Caffeine
-Topical antibiotics (people refusing to go to the hospital for proper treatment (stitches on wounds)
-Nasal decongestants (Afrin)
-CBD