OTC drugs Flashcards
α-galactosidase
Route: Oral
Category: Miscellaneous GI gas product
Uses: GI gas (due to producing food)
Key Points:
Take with first bite of food
Caution in diabetics
Avoid patients with galactosemia
Possible allergic reaction for patients with allergy to mold
Acetaminophen
Brand name: Tylenol
Route: Oral
Category: Analgesic Antipyretic
Uses: Cold and flu, Dysmenorrhea, Headache, Fever, Pain
Key Points:
FDA max of 4,000 mg per day (some manufactures 3,000 mg per day max)
Avoid in patients consuming 3 or more alcoholic beverages per day or with liver damage
May cause very serious skin rashes (rare)
Pregnancy: Human data suggests low risk
Breastfeeding: Compatible
Pediatric dosing 10 to 15 mg/kg/dose Q4H to Q6H PRN
*Do not exceed 5 doses in 24 hours (maximum daily dose 75mg/kg/day not to exceed 4 grams daily)
*If age less than 2 or weight less than 24 pounds, consult pediatrician
Activated charcoal
Route: Oral
Category: Miscellaneous GI gas product
Uses: GI gas
Key Points:
Questionable efficacy, may be better for reducing smell
May be alternative to simethicone
No dosing in children age less than 12
Adapalene
Route: Topcial
Category: Acne
Product Uses: Acne
Key Points:
Acne may worsen in 1st week May take 12 to 18 weeks for full effect Increases sun sensitivity, use sunscreen
Redness, scaling, and burning diminish after 1st month
Aluminum acetate
Route: Topical
Category: Astringent
Uses: Contact dermatitis (weeping)
Key Points:
Dries and constricts tissue
Has antimicrobial effects May be combined with antifungal for treatment of tinea pedis (athlete’s foot)
Aluminum hydroxide
Route: Oral
Category: Antacid
Uses: Dyspepsia, GERD, Heartburn
Key Points:
Starts to work within 15 to 30 minutes (liquid faster than tablets)
Diarrhea
Avoid in acute kidney disease
Antazoline
Route: ophthalmic
Category: Antihistamine (1st gen)
Uses: Allergic conjunctivitis
Key Points:
Limit OTC use to 3 days
Contraindicated in patients with glaucoma
May be combined with ophthalmic decongestant for improved efficacy
Aspirin
Route: Oral
Category: Analgesic, Antipyretic Salicylate
Uses: Cold and flu, Dysmenorrhea, Headache, Fever, Pain
Key Points:
Avoid in children and teenagers due to risk of Reyes Syndrome
Take with food Risk of ulcer (increased in patients consuming 3 or more alcoholic beverages daily)
May cause upper GI discomfort
Do not use if patient has history of GI bleed
Avoid enteric coated version in patients wanting immediate relief
Watch dose: 81 mg is for heart protection only
Bacitracin, polymyxin B
Route: Topical
Category: Antiseptic
Uses: Atopic dermatitis Infection prevention
Key Points:
Preferred over neomycin since some patients are sensitive to neomycin
Benzocaine
Route: Topical
Category: Anesthetic
Uses: Canker sores Pain and itching due to vulvovaginal candidiasis
Key Points:
For canker sores, apply a small amount up to four times daily
FDA recommends AGAINST use for teething pain and in children under age 2 Rare but serious condition (methemoglobinemia)
Treatment of vulvovaginal candidiasis should be focused on curing the infection with vaginal antifungal rather than masking symptoms with benzocaine
Benzoyl peroxide
Route: Topical
Category: Acne product
Uses: Acne
Key Points:
Avoid in very sensitive skin Increases sun sensitivity, use sunscreen
Start low (2.5%) to minimize side effects; increase if desired results not achieved and patient tolerates treatment
Full benefit may take 4 to 6 weeks
Several potential drug interactions
Bisacodyl
Route: Oral
Category: Laxative (stimulant)
Uses: Constipation
Key Points:
May cause abdominal cramping due to mechanism of peristalsis stimulation
Often produces bowel movement in 6 to 12 hours
Bismuth
Route: Oral
Category: Salicylate
Uses: Diarrhea, Dyspepsia, Nausea
Key Points:
Avoid in children and in patients with renal failure
May cause stool and tongue to turn black
Risk of salicylate toxicity, neurotoxicity with extended use
Not recommended in children under 12
Drug interaction with warfarin
Budesonide
Route: Intranasal
Category: Corticosteroid
Uses: Allergic conjunctivitis, Allergic rhinitis
Key Points:
May start at full dose and titrate down
Works best after at least 1 week of continued therapy
Budesonide, fluticasone, and triamcinolone may be used in children** but approved age varies by product
**Although OTC products for allergies exist for pediatric patients, patients under age 12 should first be evaluated by PCP (chance of having asthma)
Caffeine
Route: Oral
Category: Diuretic
Uses: Water retention (due to menses)
Key Points:
Most women do not experience any true sodium or water retention and do not experience weight gain
Swelling and bloating are caused by a fluid shift
May cause nervousness, tachycardia, insomnia
Camphor
Route: Oral
Category: Antitussive, Counterirritant
Uses: Cough
Key Points:
Vapors stimulate sensory nerve endings causing local anesthetic sensation
Little clinical evidence
Toxic if swallowed (4 tsp of 5% camphor)
For topical formulations, use on intact skin only, wash hands after applying, and do not apply heat
Do not use in patients age less than 2
Capsaicin
Route: Topical
Category: Counterirritant
Uses: Musculoskeletal pain
Key Points:
Decreases nerve impulses by depleting substance P
Use on intact skin only, wash hands after applying, and do not apply heat
Carbamide peroxide
Route: Otic
Category: Effervescent debriding agent
Uses: Excessive cerumen (ear wax)
Key Points:
Place 5 to 10 drops in ear canal, allow it to remain for several minutes
Cerumen remaining after treatment may be removed with gentle, warm water irrigation, administered with otic bulb syringe
May be repeated daily for up to 4 days
Cetirizine
Route: Oral
Category: Antihistamine
Uses: Allergic conjunctivitis, Allergic rhinitis Congestion (due to cold or flu)
Key Points:
Less sedation and less anticholinergic than 1st generation antihistamine
Cetirizine still causes some drowsiness (~10% of patients)
Should not be used OTC in pregnant or lactating patients
Brand Name: Zyrtec
Chlorpheniramine
Route: Oral
Category: Antihistamine (first generation)
Uses: Allergic conjunctivitis, Allergic rhinitis, Allergic dermatitis, Congestion (due to cold or flu) Contact dermatitis
Key Points:
Highly lipophilic molecule that readily crosses the blood‐brain barrier (causing sedation)
Side effects include drowsiness, dizziness, urinary retention, constipation, blurred vision, tachycardia, dry eyes, dry mouth, dry nose, dry vagina
Do not use in pregnancy, lactation, premature infants, glaucoma, geriatric patients, patients with enlarged prostate, and patients on MAOI’s
Cimetidine
Route: Oral
Category: H2 Histamine receptor antagonist (H2RA)
Uses: Dyspepsia, GERD, Heartburn
Key Points:
Onset within 1 hour and lasts 6 to 12 hours May cause drowsiness, dizziness, headache, nausea May take PRN prior to known food triggers
Only for use in age 12 or older
Limit continual use to 14 days OTC Many drug interactions and may cause gynecomastia and impotence
Codeine
Route: Oral
Category: Cough (non-productive)
Uses: Works centrally on the medulla to increase the cough threshold
Key Points:
Schedule V controlled substance
Available behind the counter without a prescription in some states
Avoid with benzos, opiates, alcohol, and sedating products
Usually in combination products: review active ingredients
Risk for abuse
Cromolyn
Route: Oral
Category: Mast cell stabilizer
Uses: Allergic conjunctivitis, Allergic rhinitis
Key Points:
Mast cell stabilizer
Approved for age 2 and older as well as pregnant patients
Works best if started 3 to 7 days prior to allergen exposure
Works best after 2 to 4 weeks of continued therapy
Cyclizine
Route: Oral
Category: Antihistamine (first generation)
Uses: Motion sickness, Nausea
Key Points:
May cause drowsiness (or paradoxical stimulation)
Avoid other sedating agents (meds, alcohol, etc)
Products are approved for children, but approved age varies by product
Do not use OTC for pregnant patients
Dextromethorphan
Route: Oral
Category: Antitussive
Uses: Cough (non-productive)
Key Points:
Safety and efficacy not established in children
Should not be taken within 14 days of a MAOI
Risk for abuse (phencyclidine‐like euphoric effect)
Overdose: confusion, excitation, nervousness, restlessness, drowsiness, and severe nausea and vomiting
Respiratory depression possible with high doses
Dimenhydrinate
Route: Oral
Category: Antihistamine (first generation)
Uses: Motion sickness, Nausea
Key Points:
May cause drowsiness (or paradoxical stimulation)
Avoid other sedating agents (meds, alcohol, etc)
Products are approved for children, but approved age varies by product
Do not use OTC for pregnant patients
Diphenhydramine
Route: Oral
Category: Antihistamine (first generation) Antitussive Sedative
Uses: Allergic conjunctivitis, Allergic rhinitis, Congestion (due to cold or flu), Cough (due to post nasal drip), Insomnia
Key Points:
Brand Name: Benadryl Highly
lipophilic molecule that readily crosses the blood‐brain barrier (causing sedation)
Side effects include drowsiness, dizziness, urinary retention, constipation, blurred vision, tachycardia, dry eyes, dry mouth, dry nose, dry vagina
Do not use in pregnancy, lactation, premature infants, glaucoma, geriatric patients, patients with enlarged prostate, and patients on MAOI’s
For cough, works centrally on the medulla to increase cough threshold
Docosanol
Route: Topical perioral
Category: Antiviral
Uses: Cold sores
Key Points:
Apply at the first sign of an outbreak, 5 times a day until lesion is healed, max 10 days
Reduces healing time by 1 day over placebo
Systemic treatment (prescription acyclovir) is superior to OTC docosanol
Apriva
Docusate
Route: Oral
Category: Emollient (stool softener)
Uses: Constipation
Key Points:
Lubricates and softens the stool
Available as docusate sodium or docusate calcium (no clinical difference)
Do not use under 6 years old
Used with stimulant for long term opiate use (pushy with the mushy for OIC)
Slow acting (may take several days for effect)
Doxylamine
Route: Oral
Category: Antihistamine (first generation), Sedative
Uses: Insomnia
Key Points:
Highly lipophilic molecule that readily crosses the blood‐brain barrier (causing sedation)
Side effects include drowsiness, dizziness, urinary retention, constipation, blurred vision, tachycardia, dry eyes, dry mouth, dry nose, dry vagina
Do not use in pregnancy, lactation, premature infants, glaucoma, geriatric patients, patients with enlarged prostate, and patients on MAOI’s
Esomeprazole
Route: Oral
Category: Proton pump inhibitor (PPI)
Uses: GERD, Heartburn
Key Points:
Take 30 minutes before morning meal
Limit duration of OTC treatment to 14 days Long term use, especially in higher doses, may increase risk for GI infections and may increase risk for lower bone density
Famotidine
Route: Oral
Category: H2 Histamine receptor antagonist (H2RA)
Uses: Dyspepsia, GERD, Heartburn
Key Points:
Onset within 1 hour and lasts 6 to 12 hours
May cause drowsiness, dizziness, headache, nausea
May take PRN prior to known food triggers Only for use in age 12 or older
Limit continual use to 14 days OTC
Fexofenadine
Route: Oral
Category: Antihistamine (second generation)
Uses: Allergic conjunctiviti,s Allergic rhinitis, Congestion (due to cold or flu)
Key Points:
Less sedation and less anticholinergic than 1st generation antihistamines
Should not be used OTC in pregnant or lactating patients
Brand name: Allegra
Fluticasone
Route: Intranasal
Category: Corticosteroid
Uses: Allergic conjunctivitis, Allergic rhinitis
Key Points:
May start at full dose and titrate down
Works best after at least 1 week of continued therapy Budesonide, fluticasone, and triamcinolone
may be used in children** but approved age varies by product
**Although OTC products for allergies exist for pediatric patients,
patients under age 12 should first be evaluated by PCP
Glycolic acid
Route: Topical
Category: Acne product
Uses: Acne
Key Points:
Less effective than benzoyl peroxide
There are several contraindications to glycolic acid peels including open wounds (cold sores, acne cysts, etc) and history of dermatologic conditions (psoriasis, atopic dermatitis, rosacea, etc)
Glycerin
Route: rectal suppository
Category: Laxative (hyperosmotic)
Uses: Constipation
Key Points:
In addition to hyperosmotic effect, also works through direct rectal irritation
Available for all age groups
Often produces bowel movement in 15 to 30 minutes
Glycerin, Xylitol, Sorbitol
Route: Oral Rinse
Category: Artificial saliva Use as needed
Uses: Xerostomia (dry mouth)
Key Points:
Use as needed Often needed at least after meals and at bedtime
Brand name: Biotene
Guaifenesin
Route: Oral
Category: Expectorant (protussive)
Uses: Cough (productive)
Key Points:
Loosens and thins lower respiratory secretions making cough more productive
FDA approved for symptomatic relief of acute, ineffective, productive cough; but, use is NOT endorsed by American College of Chest Physicians (ACCP)‐2006 Guidelines
NOT indicated for chronic cough associated with COPD, emphysema, smoking
Hydrocortisone
Route: Topical
Category: Corticosteroid
Uses: Allergic dermatitis, Atopic dermatitis, Dry skin, Scaly dermatoses, Hemorrhoids
Key Points:
Vasoconstrictor and antipruritic
Avoid on cracked or open skin
Do not apply to face
Avoid use on large areas
May cause skin discoloration
