OTC drugs quick hits Flashcards by M K

how are OTC drugs regulated by the FDA?

via OTC drug monographs (a kind of “recipe book” covering acceptable ingrdients, doses, formulations, and labeling)

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5 risks of OTC drugs? (M I OS)

intentional and unintendend mis use

accidental ingestion

intentional OD

worsened outcome due to self-management

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FDA decides if drug is ________

safe for direct selling

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what are the 6 hidden drug/classes in OTC drugs? (AAACSS)

alcohol - cough/cold; mouthwashes

antihistamine - analgesics; menstrual products and sleep aides

aspirin or other salicyclates -antidiarrheals; cold/allergy, analgesics

caffeine - menstrual period stimulants

sodium - analgesics, antancids; cough/cold drugs, laxatives

sympathomimetis - analgesics, asthma products; cough/cold/allergy drugs; hemorrhoidal products

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acid reducers - H2 antagonits : which two drugs?

comment?

cimetidine + nizatinide

use< 2 weeks, not <12YOA

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PPIs: which drug

comment?

omeprazole

use < 2 weeks not <18 YOA

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antidiarrheals

which two drugs?

when do you not used the?

bismuth salicyclate

loperamide

not for use if diarrhea is accompanied by fever >101 degree F or blood or mucus in stool

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allergy/colds

which 4 dugs?

comment?

which one most sedating

drugs: chlorpheniarmine, cetrizine, diphenydramine, and loratidine
comment: hayfever responds to ant-histamine alone for colds, sympathomimeitc decogenstant co-formulated = 2nd gen = non-sedating

diphenhydramine = most sedaing of listed 1st gen agents

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analgesics and antipyretics

which 3 drugs?

comment

acetaminophen

apsirin

ibuprofen

acetaminophen available in liquid formulation; max doese <4g/day. caution with regular alcohol use (hepatotoxicity). long term use increases risk of stroke, MI

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antitussives

which two drugs?

comment

codieine and dextromethorphan

central suppression of cough relfex, codiene schedule V, restricted in some states

Dex is non-narcotic but is abused; hallucinongen

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expectorants

which drug?

comment

guaifenesin

often used with antihistamines + antitussive in combination

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decogenstants - topical + systemtic

which drug?

comment

phenyephrine

systemic(pseudoepherdien + phenlyephrine)

use for <3 days to avoid rebound congestion

often used with antihistamine + antitussive + analgeisc in combo. may cause systemic toxcitiy

note: pseudoephedrine has methamphetamine precursor

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stimulants

which drug?

comment

caffeine

toxicity in high doses

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weight loss aid?

which drug?

comment

orlistat

approved for >18YOA as part of diet/exercise plan, recent concern over liver tox. FDA monitors

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OTC pain meds

what is ADE of acetaminponen

which 2 drug classes does it interact with?

caution in what? (CAPA)

ADE: hepatotoxicity

intreractions: hepatotoxic drugs(azoles, macrolides, warafin) + CYP inducers
cautions: C-cirrhosis A-alcohol use A-anticoagulation P-poor nutrition >60yrd old

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OTC pain meds

NSAIDS

which ADE: (7)

interactions: bleed and cardio meds(4 catergories here)

cautions

>60 yr old man with renal failure, GI bleed and gastritis, Nausea, diarrhea, and tinnitus

ADE: GI bleed and gastrits, Nausea and diarrhea, tinnitus, renal failure

interactions: warfarin

antihypertensives

alpha and beta blockers

ACEI and ARBS

caution in: Renal failure(prostaglandin inhibition), CHF, gout(blocks elimination of uric acid) , cirrhosis, apsirin sensitive ashtma(shunts metabolites of arachidonic acid to pro-inflammatory pathway –>leukotriene syntehsis)

which drug must be labeled if contained in a product ? “hidden ingredient case”

acetaminophen

what are 2, 2nd gen antihistamines: what happens if you push dose too high?

loratidine and cetrizine

push dose too high and CNS effects WILL occur

what is an first gen anti-histamine used for motion sickness?

diphendyramine

recall: transmission of sensatin from the inner ear(motion) to the cerebellum occurs via H1 and muscarinic receptor function

coughs and colds:

3 drugs?

anticholineric anihistamines

pseudoephedrine

topical nasal decongestant

anticholinergic antihistamine ADE?

4 drug interactions? (TAP O)

cautions(2)

anti- DUMBELLS

interactions: TCA, antiparkinson, phenothiazine, oxybutin
cautions: Closed angle glaucoma and dementia

pseudoephedrine

9 ADEs?

3 intreactions: BDM

cautions: 7

ADE: HTN + vasopasm

arrhythmia + stroke

seizures + hallucincations

chronic headaches

insomnia + tremor

interactions: Beta blockers, digoxin, Monoamine oxidase inhibotrs;

CAutions: CHD + HTN

Thyroid disase + diabetes mellitus

prostatic hypertrophy + urinary retention

closed-angle glaucoma

topical nasal decongestants: 2 ADEs

rhinitis medicamentosa

HTN

MOA of dextromethorphan:

what demethylates this drug? consequences?

has effects like?

what is it combined with to discourage abuse?

MOA: non-opiate blocker in cough center (normally no sedative, analgesic or additive properties)

demethylated by CYP2D6; enzyme deficient is some individuals(5-10% white europeans)–>rapid acute toxicity and in excess, side effects include: dry mouth and throat, tachycardia, warm feeling, inability to concentrate

>2mg/kg —>phenycylcinde-like effects

combination of products contain ingredients that limit dosing(guaifenesin) or have toxicity(chlorpheniramine)

in kids \<6 years old, what should you use for cough and colds?

1. honey just as good as dextromethorphan, but increased risk of transmitting botulism to infants \<1

3 common OTC that may affect BP: PIP

phenylephrine pseudoephedrine ibuprofen

which medications most commonly abused by persons 12-25? which age = more girls abusing? which age = more boys abusing?

cough and cold medicines others: doxylamine, dimenphyarinate, diphendyramne caffience nicotine replacement 12-17 = females more likely to abuse 18-25= males

OTC and dyspesia + heart burn: which three drug classes

antacids H2 antagonists- PPIs

OTC and dyspepsia antacids: which ADE (DECK)? inreactions? 6 cautions (CHRK)

ADE: DECK = diarrhea, electrolyte imbalance, constipation, kidney stones interactions: ibuprofen, sulfonyluera, ferrous sulfate, tetracycline, ciprofloxacin, isoniazid cautions: kidney stones, hypercalcemia, renal failure, CHF

H2 antagonist: cimetidine, nizetinide ADE: HDDC interaction: 2 cautions: think GI

ADE: headache, dizziness, constipation, diarrhea interactions: Cimetidine is CYP2C19 inhibitor; interaction w/fluozetine, diazepma, phenytoin, ALL H2 blockers change gastric pH and can affect bioavailability of drugs Cautions: Cirrhosis, GI bleed, renal failure

PPIs: omepraxole ADE: interactions: caution

PPIs: ADE: headache, dizziness, constipation, diarrhea interactions: both CYP2C19 inhibitors All PPIs change gastric pH and and affect bioavailability of drugs ADE: cirrhosis, GI bleeding, renal failure

antidiarrheals: bismuth subsalicylate( peptobismol and kaopectate) ADE:TFF interactions: cautions:

ADE: discolored feces, discolored tongue, fecal impaction Interactions: warfarin, tetracycline, steroids, valproic acid, uricosuric acid, antacids cautions: anticoagulation, infections, diarrhea

medication: loperamide ADE: FEDuP interactions: cautions: DIC

ADE: FEDuP- fluid loss, electrolyte imabalance, Dehydration, Paralytic ileus interactions: none Cautions: diarrhea, infections, cirrhosis

OTC constipation products which two drugs?

bisacodyl senna magnesium hydroxide, magnesium sulfate

bisacodyl senna ADE: interactions cautions

ADE: electrolyte imbalance, cathartic action interactions: none cautions: none

magnesium hydroxide ADE: EE why? interactions: 4 cautions:

ADE: electrolyte imbalance and edema (potential for chelation of concurrent drugs and alteration of bioavailability by neutralization of pH) interactions: quinolones, azoles, thyroid drugs, digoxin cautions: renal failure, bone disease

children: what is the DOC for pain relief? when should you avoid aspirin? decongestants for whom? what about H2 blockers?

DOC: acetaminophen Aspirin(use in Kawasaki's diseas)- don't use --\> Reye syndrome (encephalopathy, microvesicular fatty chnages, transaminase elevation) decongestants are ok for kids \>6 BUT safety not established H2 blcokers are safe, but liquid formulations (easier for admin) are not OTC.

5 considerations in the elderly? NGPAG

increase risk NSAIDs and kidney disease/GI bleeding increase risk glaucoma/UT block w/pseudopehedrine Pseudopehedrien interaction(beta-blockers, antidepressants, insulin, MAOIs\_ interaction w/antihistamine may be significant (worsen asthma, narrow angle-glaucoma, prostatic enlargment, confusion, delirium, dizziness, -falls and fractures) more susceptible to ADE of GI drugs(diarrhea/dehydration (Mg) or constipation(AI) - mg antacids if no renal impairment; drug interaction w/cimetidine most likely

sleep aids: 2 drugs? comment