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OTC Flashcards

1
Q

Which patients are most likely to abuse OTC drugs?

A

Cough syrup:
females 12-17,
males 18-25

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2
Q

Which OTC agents are most commonly abused?

A

cough and cold syrups, doxylamine (1st gen antihistamines), cyclizine, caffeine, nicotine replacement

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3
Q

Are OTCs regulated by FDA?

A

regulated by FDA via OTC drug monographs. “recipe books”

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4
Q

Do OTCs make up a large portion of healthcare costs?

A

no, only 2%

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5
Q

What is the most sedating of 1st gen allergy cold meds?

A

diphenhydramine

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6
Q

How do OTC pain meds cause asthmatic attacks?

A

shunting the metabolic products of arachidonic acid down the pro-inflammatory pathway of leukotriene synthesis

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7
Q

What are toxicities of OTC pain meds?

A 
hepatotoxicy
renal toxicity
Worsening of gout
asthmatic atatcks
prostaglandin effects
increase leukotrienes
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8
Q

What is leading cause of liver failure in US?

A

acetaminophen poisoning

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9
Q

MOA of loratadine (claritin, alaver, zyrtec)?

A

antihistamine

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10
Q

Which antihistamine is marketed as non-sedating?

A

cetirizine

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11
Q

Which 1st gens are used for motion sickness?

A

diphenhydramine, dimenhydrinate. Because they have anticholinergic effects. Transmission of sensation from inner ear to cerebellum occurs via H1 and muscarinic receptors.

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12
Q

MOA of coricidin?

A

chlorpheniramine (1st gen antihistamine with antimuscarinic) + pseudoephedrine (vasoconstrictive) + acetaminophen + dextromethorphan (antitussive)

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13
Q

What type of coricidin should be given to a patient with HTN?

A

Coricidin HPB (one that does not contain an sympathomimetic like pseudoephedrine)

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14
Q

MOA of pseudoephedrine?

A

alpha adrenergic agonist for vasoconstriction

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15
Q

ADE of pseudoephedrine?

A 
cardiovascular interactions (HTN), mydriasis, urethral smooth muscle contraction. Rhinitis medicamentosa, insomnia, tremor.
Interacts iwth BBs, digoxin, MOAIs
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16
Q

What can happen in extreme cases of rhinitis medicamentosa?

A

turbinate hyperplasia that requires surgery

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17
Q

ADE of anticholinergic antihistamines?

A

cognitive dysfunction, halucinations, insomnia, xerostomia, constipation, impaired sweating, thirst, mydriasis, anuresis, seizures, arrhythmia, heat stroke.
Interacts with antiparkisonian drugs, TCAs, oxybutynin

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18
Q

MOA of dextromethorphan?

A

non-opiate blocker of cough center.

Normally no sedation, analgesic or addictive props

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19
Q

ADE of dextromethorphan?

A

demethylated by CYP2D6, if deficient (white 5% white euros) will cause acute toxicity of dry mouth, throat and tachycardia.

High doses will cause phenyclidine effects- out of body state, disorientation, anesthesia, addiction.

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20
Q

What is included with DM to prevent abuse?

A

guaifenesin (oral expectorant) that will produce N/V, diarrhea, and abdominal pain in high doses.
Could also include chlorpheniramine

21
Q

What is best treatment for infant coughs? What are its risks?

A

plain honey. Usually not pasteurized so risking botulism

22
Q

How do majority cough and cold med intoxications occur?

A

unsupervised child ingestion

23
Q

What OTCs affect BP?

A

ibuprofen
phenylephrine
pseudoephedrine

24
Q

What age group is likely to abuse OTCs? What is usually the main target drug?

A

under 20s.

No specific product but most are using something containing DM

25
Q

Why are 1st gen antihistamines sometimes abused?

A

they can access CNS in higher concentrations so cause hallucinations and euphoria.
Anticholinergic effects lead to tachycardia, warm, dry flushed skin and dry mucosa, mydriasis, delirium, urinary retention and arrhythmia

26
Q

What is usually fatal about huffing?

A

fatal cardiac arrthymias.

cause apathy, malaise, loss of appetite, wiehgt loss, fatigue, chemical breath, perioral dermatitis

27
Q

Concerning things that can be huffed/inhaled, what substance will require methylene blue treatment?

A

volatile alkyl nitrites from room odorizers or videotape head cleaners because they will cause methemoglobinemia

28
Q

What are 3 OTC treatment choices for dyspepsia and heartburn?

A

antacids - mylanta, rolaids/tums
H2 antagonists - cimetidine, faotidine, ranitidine, nizatidine
PPIs - omeprazole, lansoprazole

29
Q

What are ADE of antacids?

A

electrolyte imbalance, diarrhea, constipation, kidney stones.
Interactions with ibuprofen, sulfa drugs, ferrous sulfate, tetracycline, ciprofloxacin and isoniazid

30
Q

ADE of H2 antagonists like cimetidine?

A

headache, dizzy, constipation, diarrhea.
Cimetidine is a CYP2C19 inhibitor.
interactions with fluoxetine, diazepam, phenytoin.
All H2 blockers change bioavailability by pH changes.
Caution in cirrhosis, GI bleeds or renal failure

31
Q

ADE of PPIs like omeprazole?

A

headache, dizzy, consip/diarrh.
Both inhibt CYP2C19. All PPIs change pH and can affect drug bioavail.
Caution in cirrhosis, GI bleeds or renal failure

32
Q

ADE of bismuth subsalicylate (pepto or kaopectate)?

A

discolored feces and tongue. fecal impaction.
Interaction with warfarin, tetracycline, steroids, valproic acid, uricosuric drugs and antacids.
Caution in anticoagulation or infectious diarrhea

33
Q

MOA of loperamide?

A

opiate-like product. anti-diarrhetic

34
Q

ADE of loperamide?

A

electrolyte imablance, fluid loss, dehydration, paralytic ileus.
Caution in cirrhosis or infections diarrh

35
Q

What are OTCs for constipation?

A

bisacodyl, senna, magnesium hydroxide or magnesium sulfate (epsom salts)

36
Q

What are ADE of bisacodyl and senna?

A

electrolyte imbalance, cathartic colon

37
Q

What are ADE of magnesium hydroxide and epsom salts?

A

electrolyte imbalance, edema
Interactions with quinolones, azoles, thyroid drugs and digoxin
Caution in renal failure or bone disease.

38
Q

What is DOC for children pain relief?

A

acetaminophen.

Avoid aspirin to prevent risk of Reye’s

39
Q

In elderly, what are some concerns for antihistamines?

A

worsen asthma, glaucoma, prostatic enlargment, confusion and delirium

40
Q

In elderly what are some common risks for taking pseudoephedrine?

A

interacts with their BBs, antidepressants, insulin and MOAIs

41
Q

What hidden drug is often in cough meds?

A

alcohol

42
Q

What hidden drug is often in menstrual products?

A

antihistamines and caffeine

43
Q

What hidden drug is often in antidiarrheals?

A

aspirin or salicylates

44
Q

What hidden drug is often in analgesics?

A

antihistamines, caffeine, sympathomimetics

45
Q

Which OTCs contain sodium?

A

analgesics, antacids, cough/colds, laxatives

46
Q

What hidden drug is in hemorrhoidal products?

A

sympathomimetics

47
Q

MOA of orlistat?

A

weight loss aid. Can cause liver toxicty

48
Q

MOA of doxylamine

A

1st gen antihistamine

49
Q

Who approves OTCs?

A

FDA NDAC

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