OTC Exam 1 Flashcards
What are special populations in OTC
Pregnant
Geriatric
Pediatric
Lactating
Who does the FDA recommend against self medicating with nonprescription products
Children less than 2 years old
What type of dosing is preferred
Weight based
What are exclusions for self treatment
- OTC not available or recommended for child’s age group
- disorder not self treatable because of age
- rarity condition
- could indicate more serious disorder
What are administration considerations
Taste and measuring device
What dosage forms are available for acetaminophen
Capsules
Tablets
Chewable tablets
Liquid
Suppositories
ODT
What dosage forms are available for ibuprofen
Capsules
Tablets
Chewable tablets
Liquid
What dose do acetaminophen chewable tablets come in
160 mg with score (80 mg sections)
What is the concentration of acetaminophen liquid
160 mg/5 mL
What is the infant concentration of ibuprofen
50 mg/1.25 mL (40 mg/mL)
What is the concentration of child’s ibuprofen
100 mg/5 mL
What pediatric antihistamines are available in chewable
Cetirizine
Diphenhydramine
Loratadine
What pediatric antihistamine is not available in a chewable tablet
Fexofenadine
What should miralax NOT be mixed in
Milk
What drugs are generally not recommended in pediatrics
Codeine
Promethazine
Quinolones
Tetracycline
Why is codeine not recommended in pediatrics
CYP2D6 enzyme converts it to morphine which could cause possible overdose for people who over-express this enzyme
Why is promethazine not recommended in pediatrics
Severe and potentially fatal respiratory depression
Why are quinolones not recommended in pediatric patients
Adverse effect on cartilage, bone, and muscle
Why are tetracyclines not recommended in children younger than 8
Stain teeth and weaken bones
What are the primary causes of accidental overdose in children
Iron and acetaminophen
What is the poison control number
1-800-222-1222
How does ABSORPTION change in the elderly population
- increased GI secretions and motility
- decreased surface area and blood flow
- increased pH
How does DISTRIBUTION change in the elderly population
- decreased total body water
- decreased muscle mass
- increased body fat
How does METABOLISM change in the elderly population
- decreased hepatic blood flow
- decreased enzyme activity
How does ELIMINATION change in the elderly population
Decreased renal function
What PK parameters change as you age
Absorption
Distribution
Metabolism
Elimination
What are the concerns with NSAID use in the elderly population
GI changes
Cardiovascular issues
Renal function concern
What are factors that pharmacists should consider in geriatric patients
- Polypharmacy
- Multiple chronic disorders
- Alteration in senses
- Cognition and memory changes
- Dysphagia
- Sensitivity to anticholinergic meds
- Blurred vision
- decreased Salivation
- decreased Lacrimation
- Urinary retention
- Constipation
(Pharmacy School Sucks, At Least Dumb Bitches Can’t Make Us Cry)
What resource contains meds that cause adverse effects in the elderly
Beer’s criteria
What are screening tools used to adjust medications in the elderly
STOPP/START criteria
What should pregnant patients try first
nondrug therapy
Most medications cross what
The placenta
Most medications cross what
The placenta
What should pregnant patients never presume about an OTC medication
That it is safe for use during pregnancy
When is the best time for a breastfeeding mother to take a medication
Immediately after feeding or right before infant’s longest sleeping period
What should breastfeeding mothers be advised
- use nonpharmacologic therapy if possible
- take medication immediately after nursing/before infant’s longest sleep
- counsel on potential side effects in the infant
What should a breastfeeding mother avoid
Extra strength/long acting products
Combination products
What resource is an A to Z searchable database that summarizes known/possible side effects in pregnancy and possibility of passage through breast milk
Briggs
What drugs are safe for pregnancy for allergic rhinitis
- chlorpheniramine
- diphenhydramine
- cromolyn
- saline NS
- flonase
- zyrtec/claritin/allegra (2nd gen)
(Zack Catches Cute Cats And Dogs [on] Friday, Saturday)
What drugs are unsafe during pregnancy for congestion
Phenylephrine
Pseudoephedrine
What drugs are UNSAFE during pregnancy for pain, fever, and headache
- aspirin (avoid high dose in 1st and 3rd trimesters)
- excedrin
- ibuprofen/naproxen (avoid in 1st and 3rd trimesters)
What drugs are UNSAFE during pregnancy for diarrhea
Loperamide
Pepto (bismuth subsalicylayte)
What drugs are UNSAFE during pregnancy for constipation
Castor oil
Mineral oil
What should be discouraged during lactation
Homeopathic and herbal remedies
What drugs are SAFE during pregnancy for constipation
Miralax
Colace/docusate
Fiber
Sennosides
Bisacodyl
What treatment options should lactating patients chose
Those with the shortest half life
What is a major cause of poisoning (drug)
Acetaminophen
What nonprescription products are most reported for potentially toxic exposures
Analgesics
Dietary supplements
Topical preparations
Vitamins
Antihistamines
(A TAD Vicious)
What patient info does poison control ask for
Age
Weight
Medical history
Ongoing clinical effects
Why have pediatric poisonings increased
- use on nonstandard liquid measuring devices
- caregiver misinterpretation on nonprescription medication labels
What information about the toxin does poison control ask for
Name of drug/substance
Dose
Route of exposure
Time since exposure
What information about treatment does poison control ask for
- has the pt or caregiver offered anything to reverse poisoning
- ask about excess water, forced vomiting, activated charcoal
- if so, when and how long after the poison was ingested
Even though ipecac syrup is approved for self treatment of ingested poisons, is does NOT
Improve outcomes for poisoned patients and use should be avoided
What are approved agents for self treatment for ingested poisons
Activated charcoal and ipecac syrup
What is activated charcoal mixed with to sweeten
Water/sorbitol
What are adverse effects of activated charcoal
Vomiting
Black stools
What should be done with activated charcoal before administering
Mix with water and shake vigorously
Activated charcoal is sold as an OTC drug but is not available where
Not available in most homes, nor is it routinely recommended for home use by poison control centers
What is the antidote for acetaminophen overdose
Acetylcysteine
What is the antidote for several medications and poisons
Charcoal
What is the antidote for scorpion poison
Centruroides antivenin
What is the antidote for North American pit vipers (rattlesnake, copperhead, water moccasin, cottonmouth)
Crotalidae poluvalent immune fab, ovine
What is the antidote for North American coral snake (eastern and texas)
Micrurus fulvius antivenin
What is the antidote for opioids
Naloxone
What is the antidote for iron
Deforxamine mesylate (desferal)
What is the antidote for black widow spider
Latrodectus mactans antivenin (LMA)
What is the antidote to tricyclic antidepressants, cocaine, local anesthetic, and salicylates
Sodium bicarbonate
What first aid antibiotic cream is used to prevent infection for minor cuts, scrapes, or burns than can be used for kids and adults 1-3x daily; greater than 7 days is not recommended unless directed by doctor
Bacitracin
What is the chewable tablet strength for ibuprofen
100 mg
What chewable antipyretic is 240 mg for 1.5 tablets
Tylenol
What organization provides resources for the geriatric population
American Geriatric Society (AGS)
What class of medication is generally avoided in geriatrics because it can increase BP, impair renal function, etc
NSAIDs
What medications are called anticholinergic drugs and are used to treat allergic rhinitis but can cause confusion, urinary retention, and constipation in the elderly
Antihistamines
What medication is used for gas and bloating and is rare since it can be dosed for 2 and under
Simethicone
What is the drug of choice for pain, fever, and headache in all trimesters of pregnancy
Tylenol
What is meant by nonpharmacologic
Treatment that is not medication
What are the most frequent self care counseling topics by pharmacists
- product selection for specific symptoms
- potential drug-drug interactions
- dosing/admin info
- signs/symptoms that indicate when to seek medical advice
- side effects and safety considerations
What are key sections of a drug facts label
Active ingredient
Purpose
Uses
Warnings
Directions
Other information
Inactive ingredients
What is meant by nonprescription
OTC
What are most self care nonprescription products limited to
Mild illness and short duration
Define self care
Independent act of preventing, diagnosing, and treating one’s own illness without seeking professional advice
What are barriers to pharmacist assisted self care and barriers to patient engagement for self care
- pt is seeking recommendation when medical care is needed
- pt in a hurry to leave
- pt erroneously considered nonprescription products to be overly safe
What are self medication categories
- nonprescription medications
- nutritional dietary supplements
- complementary and integrative health therapies and approaches
(CNN)
What is required for prescription drugs
- proof of Effectiveness
- proof of Safety
- Warnings about side effects or drug interactions
(SEW)
What is allowed for prescription drugs
Disease treatment claims
What is required for nonprescription drugs
- proof of Effectiveness
- proof of Safety
- Warnings about side effects of drug interactions
(SEW)
What is not allowed for nonprescription drugs
Disease treatment claims
What is NOT required for supplements
- proof of Effectiveness
- proof of Safety
- Warnings about side effects or drug interactions
(SEW)
What is not allowed for supplements
Disease treatment claims
OTCs do not _____ but they do_____
- Treat/cure anything
- Lessen symptoms
What are the characteristics of nonprescription drugs
- Low potential for misuse and abuse
- can be used for Self diagnosed conditions
- Adequately labeled
- Do not require access to PCP for safe and effective use
- Sales are not limited to pharmacies
(SAD Little Shit)
Dietary supplements contain one or more of what ingredients
Vitamin
Mineral
Herb
Amino acid
(Very Much Hoeing Around)
Dietary supplement claims are limited to what
- function/structure
- nutrition content
Ex. Good source of vit C, maintains bowel regularity, supports healthy immune system, builds strong bones
What are concerns with supplements
- may not contain ingredients on the label
- may contain other ingredients NOT on the label
- may be contaminated with rx drugs, heavy metals, other adulterants
What is complementary medicine
Can be used WITH standard medical care
Ex. Acupuncture to help cancer treatment side effects
What is alternative medicine
Used in place of standard medical care
Ex. Herbals, special teas, massage
What is an RX to OTC switch
OTC marketing of a drug that was once an rx drug for the same indication with the same:
- strength
- dose
- duration of use
- dosage form
- route of admin
What are the benefits of OTC switch
- cost (save consumers money on dr visits)
- beneficial to drug companies who are about to lost patent rights and generic competition
Why do patients most often seek OTCs
- Pain
- Cough, cold, flu, sore throat
- Allergies/sinus problems
- Heartburn/indigestion
- Constipation, diarrhea, gas
- Minor infection
- Skin problems
(Some Hoe Called Mia A Cat Person)
Why are patients utilizing self care at an increasing rate
- cost to see PCP
- aging population uses more OTCs
- more women in population (more likely to use OTC)
What are the concerns with OTC labeling
- Inappropriate use when patients have limited reading skills or language barriers
- part of label covered by anti-theft tags
- small font type
- drug product reformulation (Kaopectate example)
(Please, I Suck Dick)
What does QuEST stand for
Qu: quickly and accurately assess the patient
E: Establish that a pt is an appropriate self care candidate
S: Suggest appropriate self care strategies (plan)
T: Talk w/ the patient (key info about lifestyle and OTC therapy)
SCHOLAR MAC
Symptoms
Characteristics
History
Onset
Location
Aggravating factors
Remitting factors
Medications
Allergies
Conditions
What are exclusions to self care
- symptoms Require medical referral
- pt Not appropriate candidate
- Symptoms too severe/long lasting
- Effective OTC therapy N/A
- OTC Dosages/duration is inadequate to treat the condition
- Previous OTC treatment was ineffective after adequate trial
(Please SEND Rach)
How should a pharmacist make a recommendation when we cannot help the patient
- determine who to refer to and urgency
- be specific about where and when the treatment should take place
What patients would not be appropriate self care candidates
- OTC meds not indicated
- Previous OTC therapy ineffective
- Minor but persistent symptoms, cause not easily identifiable
- Symptom specific exclusions
- Health status/history
- Pharmacist in doubt of medical condition
(Maybe Put Some New People Here)
What are self care strategies
Nondrug therapy
OTC
Refer to PCP or ED
No treatment
What are counseling points for self treating patients
- Reason for self treatment
- Description of medication or treatment
- proper Admin
- what to Expect
- How soon to see results
- Precautions
- Adverse effects/management of them
- General treatment guidelines
- appropriate Follow up
- Other important info (storage)
- When to seek medical attention
(Went And FORAGED Plenty Herbs)
What are the 5 core components of PPCP
Collect
Assess
Plan
Implement
Follow up: monitor and evaluate
What PPCP step correlates w/ each part of QuEST
Qu - collect/assess
E - assess
S - plan
T - implement/follow up
What are nonverbal cues to demonstrate good listening
S - squarely face the pt
O - open posture
L - lean toward pt
E - eye contact
R - relax
What are patient barriers to communication
Education level
Health literacy level
Misconceptions of pharmacist role
In a hurry
Aging
Visual/hearing difficulties
(How Many Elephants In A Van)
What are pharmacist barriers to communication
- attitude towards counseling
- lack of pt communication training
What are pharmacy/corporate barriers to communication
Lack of privacy
Low financial resources
Large # of patients per pharmacist
