OTC Flashcards
1
Q
Antihistamines used for allergy treatment are divided into 2 categories
A
1st generation
2nd generation
2
Q
1st Generation Antihistamine. 4 examples
A
Dimetapp (brompheniramine)
Chlor-trimeton (chlorpheniramine)
Benadryl (diphenhydramine)
Tavist (clemastine)
the “amines”
3
Q
2nd Generation Antihistamine. 4 examples
A
Zyrtec (cetirizine)
Allegra (fexofenadine)
Xyzal (levocetirizine)
Claritin/Alavert (loratadine)
the “ines”
4
Q
1st Generation Antihistamine: Caution when used in patients with
A
narrow angle glaucoma, BPH and urinary retention
5
Q
2nd Generation Antihistamine: Caution use in patients with
A
renal impairment, hepatic impairment (loratadine), allergy to hydroxyzine (cetirizine) and urinary retention (levocetirizine)
6
Q
Diphenhydramine– the most
A
commonly used 1st generation OTC antihistamine; most sedating
7
Q
1st Generation Antihistamine: It’s a ___ depressant so may cause
A
CNS depressant - causes drowsiness and sedation
8
Q
1st Generation Antihistamine: Anticholinergic effects lead to
A
dry eyes, dry mouth, constipation, urinary retention
9
Q
1st Generation Antihistamine: Should not be used in children younger than
A
6 years of age (diphenhydramine)
10
Q
1st Generation Antihistamine: May cause ____ in children
A
excitability
11
Q
1st Generation Antihistamine: Overdose symptoms include:
A
worsening of common anticholinergic and CNS side effects
Patients may also present with cardiac arrhythmias and hallucinations
12
Q
1st Generation Antihistamine: Antidote for overdose
A
Physostigmine may be used for an anticholinergic overdose
13
Q
2nd Generation Antihistamine: 2nd generation antihistamines have less ___ _____ than 1st gen
A
CNS depression
14
Q
2nd Generation Antihistamine: 2nd generation antihistamines have less CNS depression however
A
higher dose may lead to sedation (loss of H1 specificity)
15
Q
2nd Generation Antihistamine: Oral Liquid/ chewable tablet available for
A
children 2 – 6 years of age
16
Q
2nd Generation Antihistamine: Toxicity with 2nd generation antihistamine is
A
unlikely
17
Q
2nd Generation Antihistamine: Overdose symptoms:
A
mild CNS effects, agitation, restlessness, tachycardia, myalgia
18
Q
Allergy Products: Combination medication available with a decongestant such as
A
pseudoephedrine
19
Q
Pseudoephedrine may cause
A
restlessness, insomnia
20
Q
Kept behind the pharmacy counter for patients ages 18 and up with identification due to potential for abuse. Pseudoephedrine has been used to manufacture
A
methamphetamine
21
Q
Nasal Decongestants: 2 examples
A
Oxymetazoline
Phenylephrine
22
Q
Nasal Decongestants: Phenylephrine: mechanism
A
constricts nasal blood vessels, decreases swelling in the nose to allow better inhalation
23
Q
Nasal Decongestants: Phenylephrine: receptor
A
Alpha adrenergic agonists
24
Q
Nasal Decongestants: Phenylephrine: Self treat for up to
A
3 days
25
Nasal Decongestants: Phenylephrine: Treatment for more than 3 days may cause
rebound congestion
26
Nasal Decongestants: Phenylephrine: Side effects include
increased BP, CNS stimulation such as insomnia/anxiety and rebound congestion
27
Allergic Rhinitis: 1st line treatment
Intranasal Steroids
28
Allergic Rhinitis: 1st line treatment is Intranasal Steroids such as
fluticasone
29
Allergic Rhinitis: 1st line treatment is Intranasal Steroids such as fluticasone. The effect is
Temporary relief of congestion, runny/itchy nose/ itchy and watery eyes
30
Allergic Rhinitis: Increased use of intranasal steroid may cause
slow growth rate in children (triamcinolone and budesonide)
31
Allergic Rhinitis: Patients with use of inhaled corticosteroid should also
consult MD before use
32
Allergic Rhinitis: fluticasone may be used for up to
6 months
33
Allergic Rhinitis: budesonide may take up to
1 week to show improvement
34
Allergic Rhinitis: budesonide can be used for up to
2 weeks
35
naphazoline
Ophthalmic Agent
| Decongestant
36
tetrahydrozoline
Ophthalmic Agent
| Decongestant
37
Oxymetazoline
Ophthalmic Agent
| Decongestant
38
Phenylephrine (ophtalmic formula)
Decongestant
| use for up to 3 days
39
Nasal Decongestants: Phenylephrine (topical formula), use it Q
4 hours (short acting)
40
Nasal Decongestants: Phenylephrine (topical formula) use for up to
3 days
41
Nasal Decongestants: Phenylephrine (topical formula) Treatment for more than 3 days may cause
rebound congestion
42
Nasal Decongestants: Phenylephrine (topical formula) side effects
increased BP, CNS stimulation such as insomnia/anxiety and rebound congestion
43
Coricidin HBP is for treating
Cold and Cough
44
Coricidin HBP for Cold and Cough is specifically recommended for individuals with
high blood pressure by eliminating decongestants from the main ingredients
45
Cough Expectorant
Guaifenesin
46
Cough Suppressant
Dextromethorphan
47
Guaifenesin (Cough Expectorant) allows for
thinning and loosening of the mucus in airways
48
Guaifenesin S.E.
Dizziness, stomach pain, decreased uric acid, vomiting, rash, headache, and kidney stones
49
Guaifenesin signs of toxicity
vomiting, nausea
50
Dextromethorphan S.E.
increased heart rate, stomach pain, faint, dizzy, sedation, nervousness
51
Dextromethorphan signs of toxicity
sedation, hallucinations, detachment, euphoria
| think mental status changes
52
Dextromethorphan: do not use with
MAOI’s
53
Guaifenesin and Dextromethorphan not for use in
Children under 4
54
Acetaminophen 2 main uses
Pain reliever/fever reducer
55
Acetaminophen: Metabolism and transport is in the
liver
56
Acetaminophen: MDD: for adults
4g in observational setting/3g limit OTC
57
Acetaminophen: Acetaminophen: MDD: for kids
50-75 mg/kg/day
58
Acetaminophen: bioavailability
88%
59
Acetaminophen: reaches highest plasma peak within
90 minutes
60
Acetaminophen: duration of effect
1.5-2.5 hours
61
You can use Decongestants for how long before seeing a PCP
7 days
62
congestion is caused by
Dilation of blood vessels
63
What are the two types of decongestants
Phenylephrine and Pseudoephedrine
64
Phenylephrine and Pseudoephedrine should be used with caution for people with HTN because
it raises BP
65
Phenylephrine has low oral
bioavailability
66
Phenylephrine S.E.
Restlessness, sleeping trouble, extreme nervousness, dizziness
67
Phenylephrine: Children dose vary depending on
form of medication: saline nasal spray is used more often
68
Pseudoephedrine biovailability is
very high, almost 100%
69
Pseudoephedrine S.E.
Restlessness, vomiting, nervousness, stomach pain, fast heartrate, dizziness
70
Analgesics and Antipyretics. 2 main uses
Treatment of acute pain and temporary fever relief
71
Acetaminophen carries a black box warning for
hepatotoxicity if daily limit dose is exceeded
72
Acetaminophen toxicity symptoms include
nausea, vomiting, hepatotoxicity and renal impairment
73
Acetaminophen toxicity is due to
increased formation of reactive intermediate NAPQI
74
Acetaminophen toxicity is due to increased formation of reactive intermediate NAPQI. NAPQI is detoxified by
glutathione at therapeutic doses
75
Acetaminophen toxicity: ____ may be given as an antidote within 8 hours of ingestion
N-acetylcysteine (NAC)
76
Naproxen group
NSAID
77
Ibuprofen group
NSAID
78
Ibuprofen: Children dosing based on
weight and age
79
NSAIDs carry a boxed warning for
GI bleeding, ulceration, perforation as well as MI and stroke
80
NSAID: Avoid use in patients with
renal disease (CrCl less than 30ml/min)
81
NSAID: signs of overdose include
stomach pain, nausea and vomiting
82
NSAID: increased risk for bleeding with a___
age over 60
83
NSAID: increased risk for bleeding with P___
PUD
84
NSAID: increased risk for bleeding with c____
corticosteroids
85
NSAID: increased risk for bleeding with more than
3 alcoholic drinks a day
86
NSAID Long-term use may increase risk of
MI or stroke
87
Aspirin has a unique property:
antiplatelet
88
Aspirin is mainly used as
heart protectant in patients with MI risk
89
Aspirin: Should not be used in
patient less than 18 years of age who are recovering from chicken pox or flu (Reye’s syndrome – progressive encephalopathy)
90
Aspirin Toxicity presents with
hyperventilation, tachypnea, nausea and vomiting, tachycardia
91
Aspirin: Phase 1 Toxicity
Tachypnea and hyperventilation
92
Aspirin: Phase 2 Toxicity –
Adults may experience increased metabolic acidosis, children may experience pure metabolic acidosis
93
Aspirin: Phase 3 Toxicity –
potassium and bicarbonate depletion, dehydration, cerebral/non-cardiogenic pulmonary edema
94
Aspirin: Toxicity treatment includes
correcting life threatening complications, allowing patient to hyperventilate to maintain alkemia as well as activated charcoal within 1 hour of ingestion
95
Combination Pain Medication: Limit no more than 2 days per week use to prevent
medication induced rebound headache
96
Antacids work by
neutralizing stomach acid
97
Antacids SE
Constipation, calcium in antacids can lead to nausea, vomiting, mental status changes, kidney stones, plus alkalosis
98
Certain antacids like, Alka-Seltzer, contain
aspirin which can lead to bleeding or formation of ulcers; be aware of salicylate allergy
99
if taken in excess, Magnesium containing antacids-can lead to
confusion, low blood pressure and irregular heartbeat
100
Antacids: Aluminum is an ingredient in certain formulations. Excess consumption can result in
muscle weakness, pain in stomach, bloody or tarry stools.
101
For antacids with Aluminum and sodium, watch out for
renal impairment
102
For antacids with sodium, watch out for
hypertension, heart failure
103
Antacids: Prolonged use may cause
acid rebound
104
Antacids: can significantly reduce the absorption of
many prescription medication
105
H2 receptor blockers work by
decrease excess acid /reversibly bind histamine and gastric parietal cells- decrease acid secretion when eating and when not eating in dose-dependent manner
106
H2 receptor blockers time of onset
30 - 90 minutes
107
H2 receptor blockers duration
several hours
108
H2 receptor blockers: when is it taken
first meal of the day, may take before evening meal, or even at bedtime
109
Four main H2 receptor blockers:
Cimetidine, Famotidine, Nizatidine, and Ranitidine
tidines are H2 blockers
110
H2 Blocker: Famotidine: SE
Headache
111
H2 Blocker: Ranitidine: SE
headache
112
H2 Blocker: Nizatidine: SE
rare but bleeding can happen along with abdominal pain
113
H2 Blocker: Cimetidine: SE
dizziness, rashes, and rarely gynecomastia
114
Proton Pump Inhibitors work by
Blocks gastric H,K ATPase which leads to inhibition of acid secretion
115
Proton Pump Inhibitors are used for
GERD, ulcers, NSAID induced ulcers
116
Proton Pump Inhibitors: SE:
fever, headache, diarrhea, constipation, and vomiting
117
Proton Pump Inhibitors: Excess use can lead to:
sweating, blurred vision, fast heartbeat, vomiting, confusion
118
Proton Pump Inhibitors: how much should you use the OTC
usually 14 day course treatment at a max of 3 times a year
119
Proton Pump Inhibitors end in
prazole
120
Laxatives SE:
electrolyte imbalance, diarrhea, abdominal discomfort and cramping
121
Loperamide SE:
drowsiness, dizziness, fatigue, and constipations
122
Pepto-Bismol (Bismuth) has Salicylate in adult version, can lead to
bleeding
123
Children’s Pepto (Bismuth) =____ is only active ingredient
calcium
124
Children’s Pepto (Bismuth) SE
constipation, bleeding issue
125
Children’s Pepto (Bismuth) : excess leads to
nausea, vomiting, mental changes
126
Bismuth: Avoid concomitant use with
salicylate containing products, PUD, bleeding disorders, aspirin allergies
127
Bismuth SE
black stools and black tongue
128
Bismuth: high doses can cause
tinnitus
129
Bismuth may be used for ___ eradication regimen
H. pylori
130
Metamucil Fiber- SE
gas/cramping
131
Epsom salt+Magnesium Citrate- helps soften stool however, excess magnesium can lead to
vomiting, flushing, and pain
132
Methyl Salicylate with menthol
Topical!
| pain killer
133
benzocaine
Topical!
| pain killer for mouth
134
benzocaine: Risk of
methemoglobinemia with use in infants
135
Clotrimazole and Miconazole are in what group and what do they treat
Topical Antifungals (tinea pedis, tinea cruris, tinea corporis, candidiasis (vaginal yeast infections))
136
Clotrimazole directions
Athletes foot apply to affected areas twice daily for 4 weeks
Vaginal yeast infection apply daily for 7 days
Ringworm apply to affected areas twice daily for 4 weeks
137
Miconazole directions
Athletes foot apply to affected areas twice daily for 4 weeks
Ringworm apply to affected areas twice daily for 4 weeks
Vaginal yeast infection : Cream - 2% apply for 7 days, 4% apply for 3 days
Vaginal yeast infection : Suppository – 100 mg for 7 days, 200mg for 3 days and 1,200mg for 1 day
Vaginal products may compromise condom and diaphragm integrity and make them ineffective
138
Selenium Sulfide is in what group
Topical Antifungal
139
Terbinafine
Topical Antifungal
140
Selenium Sulfide, uses
*think S for Scalp*
Anti-infective agent of scalp and skin
Used to relieve itching and flaking of the scalp with dandruff
Used to treat tinea versicolor (fungal infection of the skin resulting in discolored patches)
141
Neosporin, what group?
Topical Antibiotics
142
Bacitracin, what groups?
Topical Antibiotics
143
Neosporin is made up of 3 things
Polymyxin B, neomycin, bacitracin
144
Neosporin and Bacitracin (topical abx) 3 facts
Self treat up to 7 days
1-3 applications a day
application size: tip of your finger
145
Neosporin is different from Bacitracin because
it kills bacteria instead of just stopping the growth
146
Topical Corticosteroids: Properties:
anti-inflammatory, immunosuppressive, and vasoconstrictive
147
Low potency Topical Corticosteroids
Desonide, fluocinolone acetonide, hydrocortisone
148
Mid-potency Topical Corticosteroids
Triamcinolone acetonide, mometasone furoate
149
High potency Topical Corticosteroids
| C____, d____, f___, f____,h____, h____
Clobetasol, desoximetasone, fluocinonide, flurandrenolide, halcinonide, halobetasol propprionate
150
Topical Corticosteroids directions
Apply a thin layer to skin 1-4 times daily depending on specific agent
Generally should not be used for more than 4 weeks (Halobetasol, flurandrenolide tape, Clobetasol is only 2 weeks)
151
2 Topical Antihistamine
Diphenhydramine topical
| Calamine Lotion
152
Diphenhydramine topical- application and SE
Apply 3-4 times a day
| S.E.: skin rash, sunburn, sensitivity to sunlight and sunlamps
153
Calamine Lotion- application and SE
3-4 times a day
| S.E.: skin irritation
154
Levonorgestrel, what group
Emergency Contraceptives
155
Levonorgestrel: Indication: to prevent pregnancy following unprotected intercourse within
72 hours
156
Levonorgestrel: Avoid use if
pregnancy is confirmed
157
Levonorgestrel: Available only by prescription for
women <17 years old
158
Levonorgestrel: If vomiting occurs within 2 hours,
repeat dose
159
Levonorgestrel: Adverse effects:
heavier menstrual bleeding, nausea, lower abdominal pain, fatigue, headache, breast tenderness, dizziness
160
Oxytrol: Indication: treatment of
overactive bladder in women with symptoms of urinary urgency and frequency for at least 3 months
161
Oxytrol: This is NOT intended for
men, women < 18 years of age, UTI, stress incontinence (urine loss due to cough, laugh, sneeze).
162
Oxytrol: ____ should be consulted prior to use
Physician
163
Oxytrol: Directions:
apply one patch to abdomen, hips or buttocks every 4 days; rotate site
164
Oxytrol: Adverse reactions:
(anticholinergic effects) sleepiness, confusion, dry mouth, constipation, blurred vision
165
Pediculides: Indication:
treatment of head, pubic, and body lice
166
Pediculides: Active ingredients:
permethrin (NIX); pyrethrins combined with piperonyl butoxide (RID)
167
Pediculides: Avoid: if
allergic to ragweed
children <2 years
near eyes, nose, mouth, or vagina
168
Pediculides: Adverse effects:
itchiness and redness at application sites
169
Nicotine Transdermal Patches: Dose initiated usually mimics number of cigarettes smoked /day
1 pack/day - > 21mg patch for 6 weeks, then step down to next dose every 2 weeks
170
Nicotine Transdermal Patches
Adverse effects include: local skin reactions (erythema, itching, burning), headache, and sleep disturbances (insomnia, abnormal/vivid dreams).
171
Nicotine Gum and Lozenges: Do not use lozenge if
allergic to soya (soy beans)
172
Nicotine Gum and Lozenges: Avoid nicotine products if
less than 18 years old
173
Nicotine Gum and Lozenges: directions
Gum and lozenge should be “parked” between cheek and gums and allowed to dissolve slowly to minimize swallowing the nicotine.
174
Nicotine Gum: adverse effect
jaw soreness, hiccups, dyspepsia, throat and mouth irritation, nausea, vomiting, lightheadedness
175
Nicotine Lozenge: adverse effect
mouth irritation, nausea, hiccups, cough, heartburn, headache, sore throat, dizziness.
176
Nicotine Gum and Lozenge MDD
24 pieces
177
Clobetasol, what group
High potency Topical Corticosteroids
178
desoximetasone, what group
High potency Topical Corticosteroids
179
fluocinonide, what group
High potency Topical Corticosteroids
180
flurandrenolide, what group
High potency Topical Corticosteroids
181
halcinonide, what group
High potency Topical Corticosteroids
182
halobetasol propprionate, what group
High potency Topical Corticosteroids
