OTC drugs quick hits Flashcards
how are OTC drugs regulated by the FDA?
via OTC drug monographs (a kind of “recipe book” covering acceptable ingrdients, doses, formulations, and labeling)
5 risks of OTC drugs? (M I OS)
intentional and unintendend mis use
accidental ingestion
intentional OD
worsened outcome due to self-management
FDA decides if drug is ________
safe for direct selling
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
acid reducers - H2 antagonits : which two drugs?
comment?
cimetidine + nizatinide
use< 2 weeks, not <12YOA
PPIs: which drug
comment?
omeprazole
use < 2 weeks not <18 YOA
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
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
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
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
expectorants
which drug?
comment
guaifenesin
often used with antihistamines + antitussive in combination
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
stimulants
which drug?
comment
caffeine
toxicity in high doses
weight loss aid?
which drug?
comment
orlistat
approved for >18YOA as part of diet/exercise plan, recent concern over liver tox. FDA monitors
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
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?
- 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
