OTC Drugs Flashcards by Sara Sverker

What is different about today’s consumer?

They are empowered, motivated, and knowledgeable

They want more control of their care

They are less reliant on healthcare providers

Shifting towards “self-care”

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What did healthcare reform do?

1) Increased health care access but in turn caused a supply vs. demand of providers problem
2) Focused on cost savings through self-care wellness programs and misc. incentives; OTC meds have saved 102$ billion/year
3) High deductibles mean that the patient is going to try self-care first and if no relief, then they will see provider

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What are the benefits of more prescription drugs becoming OTC?

More choice
Enhanced access
Decreased frequency of PCP visits
Increased independence
Increased savings

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What are the risk of more prescription drugs becoming OTC?

ADRs
Delay in seeking medical care for serious health conditions
Delayed diagnosis
Gains from the pharmaceutical companies

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Do patients typically perceive OTCs as safe?

Yes

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What drugs can have serious DDIs with OTC ingredients?

NSAIDs

Antacids/Acid supressant therapies

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What are the two mechanisms for DDIs with NSAIDs?

Inhibition of renal prostaglandin synthesis leading to decreased renal clearance and increased accumulation

Inhibition of platelet aggregation and function

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What Rx’s have DDI’s with NSAIDs due to renal prostaglandin synthesis?

Lithium Carbonate

High dose methotrexate

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What Rx’s have DDIs with NSAIDs due to inhibition of platelet aggregation and function?

SSRIs

Warfarin

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What are the symptoms of an NSAID/Lithium carbonate DDI?

Stupor
Ataxia
Confusion
Renal failure

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What is recommended to do if there is a DDI with NSAIDs and Lithium carbonate?

Upon initiation and d/c, check level every 3-5 days

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What are the symptoms of NSAID/high dose methotrexate DDI?

Thrombocytopenia
Neutropenia
Mucositis
Acute renal failure

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What are the risks of SSRI/NSAID DDI?

increased risk of bleeding

monitor for signs and symptoms

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What are the risk of Warfarin/NSAID DDI?

Increased risk of bleeding

Monitori for signs and symptoms and INR

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What are the mechanisms for interactions with Antacids/acid suppressive therapies like H2RA and PPIs?

Alteration of dissolution
Chelation
Alteration of GI motility

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What drugs have a DDI with antacids/acid suppressive therapies because of alteration of dissolution?

Itraconazole
Ketoconazole
Atazanavir

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What drugs have a DDI with antacids/acid supressive therapies because of chelation?

Tetracycline
Doxycycline
Fluoroquinolones
Bisphosphonates

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What does Al3+ containing meds cause?

Decrease in gastric emptying

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What does Mg2+ containing meds cause?

increase gastric motility

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What should be done to avoid interactions between Rx and OTC antacids/acid suppressive therapies?

Separate administration either 4 hours prior or 2 hours after

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What herbs have significant herb-drug interactions with OTC ingredients?

G herbs:
Ginger
Garlic
Gingko
Grapefruit

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What NSAIDS are commonly available OTC?

Ibuprofen
Naproxen
Aspirin

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What are the safety risks of OTC NSAIDs?

1) GI = ulcers (duodenal or gastric), perforations, and bleeding
2) Renal = sodium and fluid retention, hyperkalemia, AKI, and hypertension
3) Platelets = inhibits aggregation causing increased risk of bleeds

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Who is at a risk of GI bleeds?

History of prior bleed
Concomitant anticoagulant, antiplatelet, or corticosteroid use
NSAID use especially high dose and aspirin
70-80 years of age

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What is Dextromethorpan (DXM) abuse?

Robo-tripping Acts as a dissociative anesthetic and causes euphoric high Occurs in doses of 150-1500 mg or more Administered usually through an alternative route

What are complications of DXM abuse?

``` Death Coma Seizure CV effects Respiratory depression Hyperthermia Liver failure ```

Who is most likely to abuse DXM?

teens

What are the street names for DXM?

Skittles Robo Triple C

What is loperamide?

Peripheral mu-opiate agonist with antisecretory and antimolitly activity

Why would loperamide be abused?

Accesible OTC, cheap, lack of social stigma Opioids are harder to access Self-treat withdrawal symptoms For euphoria

What is loperamide abuse?

Poor man's methadone Often used with other drugs to increaes its exposure/limit metabolism

What can loperamide abuse lead to?

Cardiac arrhythmias Syncope Cardiac arrest

When should you suspect loperamide abude?

When a patient is fainting, tachycardia, or unresponsive

When did fatal overdoses of loperamide occur?

4-100 times the recommended dose consumed

What occured in 2018 to help prevent loperamide abuse?

FDA asked manufacturers to limit quantities and repackage

What are laxatives abused for?

Weight loss by rushing food through GI tract before absorption

What can laxative abuse cause?

Loss of water, electrolytes, and minerals like Na+, K+, Mg++, and PO4 ``` Tremors Weakness Blurry vision fainting Kidney injury Meatbolic alkalosis Arrhythmias ```

What can laxative abuse lead to?

Dependence Lazy colon infection Increased risk of colon cancer

When should you suspect laxative abuse?

More common in women Concomitant eating disorder Complaints of alternating diarrhea and constipation Inconsistencies in medical history

Why is OTC Pseudoephedrine so controlled?

It has a stimulant effect and is highly abused It is a methamphetamine precursor

What must one do in order to obtain pseudoephedrine?

Purchase limitations: Daily = 3.6 grams Monthly mail orders = 7.5 grams Monthly retail sales = 9 grams ID Purchaser must sign

What are the OTC max daily doses for acetominophen for kids?

75 mg/kg/day

What are the OTC max daily doses for acetominophen for adults?

3000 mg/day for extra strength 3250 mg/day for regular strength 4000 mg/day under direction of healthcare provider

What are the considerations for Acetominophen?

Prevention of hepatotoxicity | Ingesting multiple products with it in it

What are the most common pediatric dosing errors?

Given medication twice Incorrect dose Confused units of measure Wrong medication

What are the common pediatric medications with dosing errors?

Analgesics Cough and cold preparations Antihistamines

What are the percentage of errors with liquids in pediatrics?

81.9%

What is the percentage of dosing errors that occurred in children < 1 year old?

25.2%

What did the experiment with parents and pediatric doses show?

84.4% of parents made greater than or equal to onedosing error 21% made greater than or equal to 1 large error More errors occurred with cups than syringes Teaspoon labels associated with more errors

What are the recommendations to avoid pediatric dosing errors?

ORAL SYRINGES should be used Recommend parents speak with pharmacist

What is the Beers criteria?

Listing of meds inappropriate to give to elderly

What are OTC examples of meds that shouldn't be given to older adults?

``` Anticholinergics = confusion, drowsiness, and falls NSAIDS = GI bleed, medication interaction Decongestants = hypertension, insomnia PPIs = osteoporosis, fractures ```

What is special about pediatrics and OTCs?

Weight based dosing = always double check mg/kg dosing and know to convert from pounds to kg Measurement friendly dose rounding Dosage form considerations: Oral liquid, oral tablet, suppository Avoid combo products

What are ADRs of pregnant and lactating women who use OTCs?

``` Birth defects Pregnancy loss Prematurity Infant death Developmental delays ```

What are some resources for pregnant and lactating mothers?

LactMed | Treating for Two

How many women use OTC medications?

9 in 10

What is the new Rx drug labeling used in pregnancy?

8. 1: pregnancy including labor and delivery 8. 2: lactation including nursing mothers 8. 3: females and males of reproductive potential

What do OTC drugs still have?

Pregnancy categories A, B, C, D, and X

What pregnancy categories are okay?

Category A, B, and C

What is wrong with using pregnancy categories?

They can be misinterpreted by patients

How should you talk with patients about OTC drugs?

Always provide non-pharmoligc options when possible Ask about OTC/herbal/CAM use as part of medication reconcilation Be open minded to OTC and CAM use Get familiar with what is out there Encourage use of single vs. multi ingredient products when possible Empower patients to be savvy customers Encourage patients to consult with pharmacist Be VERY specific in your recommendations = different types of Dulcolac and Maalox that do different things