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OTC > OTC Exam 2 > Flashcards

OTC Exam 2 Flashcards

1
Q

_____ deficiency may be a result of anticonvulsants

A

Calcium

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2
Q

Supplementation with ____ and ____ in most patients taking anticonvulsants

A

Calcium
Vitamin D

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3
Q

Exclusively breastfed infants require ______ of vitamin D daily

A

400 IU

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4
Q

Older children who do not drink ______ of ___________ require vitamin D supplementation

A

4 cups
Vitamin D fortified milk

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5
Q

Folic acid is also called

A

Vitamin B9

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6
Q

Infants drinking less than ____ of baby formula require ______ daily

A

1 liter
Vitamin D

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7
Q

_______ or _______ vitamin D is allowed in infants

A

Poly-vi-sol or generic

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8
Q

How much calcium is in a cup (8 oz) of milk

A

300 mg

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9
Q

How much folic acid should all women of childbearing age obtain

A

400 mcg/day

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10
Q

How much folic acid should a pregnant person obtain

A

600 mcg/day

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11
Q

What does folic acid help in pregnancy

A

Decrease birth defects of the brain/spinal cord (neural tube defects)

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12
Q

How long before expected pregnancy should folic acid be consumed

A

1 month

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13
Q

Patients should not exceed ____ of vitamin E

A

400 IU daily

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14
Q

What does excessive intake of vitamin E cause

A

Cardiovascular risk

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15
Q

4-6 months iron requirement

A

1 mg/kg/day

*not recommended if formula contains adequate iron

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16
Q

Vitamin E interacts with ____ and increases ______

A

Warfarin
Bleeding risk

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17
Q

0-4 months iron recommendation

A

Not required

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18
Q

6-12 months iron requirement

A

11 mg/day (preferred from food)

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19
Q

1-3 years iron requirement

A

7 mg/day (food preferred)

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20
Q

Optimal calcium absorption occurs at an individual dose at _____

Anything higher than ____ will be taken in ______

A

500 mg or less
1000 mg
Divided doses

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21
Q

Fat soluble vitamins

A

ADEK

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22
Q

When should fat soluble vitamins be taken

A

With food

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23
Q

What controls calcium absorption

A

Small intestine

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24
Q

Vitamin B7

A

Biotin

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25
Q

Vitamin B1

A

Thiamine

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26
Q

Vitamin B3

A

Niacin

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27
Q

Vitamin B6

A

Pyridoxine

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28
Q

Vitamin B5

A

Pantothenic acid

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29
Q

Vitamin B2

A

Riboflavin

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30
Q

Vitamin B9

A

Folic acid

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31
Q

Vitamin B12

A

Cobalamin

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32
Q

What foods contain vitamin B12 and this can be an issue for what type of patients

A

Meat
Liver
Poultry
Dairy
Oysters
Clams

Issue for vegans

(DOC, My Liver Please)

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33
Q

What foods is magnesium found in

A

Whole grain cereals
Tofu
Legumes
Green vegetables

(Way To Go, Loser)

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34
Q

What foods contain phosphorus

A

Milk
Meat
Poultry
Seeds
Nuts
Egg yolk

(My Mom’s PENS)

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35
Q

What nutrients does amphotericin B deplete

A

Magnesium
Potassium

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36
Q

What nutrients does acetazolmide deplete

A

Calcium
Potassium

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37
Q

What foods contain zinc

A

Oysters
Shellfish
Liver
Beef
Lamb
Pork
Legumes
Milk
Wheat bran

(Learning Pharmacy BLOWS Lots)

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38
Q

What nutrients do antiepileptic drugs deplete

A

Calcium

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39
Q

Loop diuretics deplete was nutrient

A

Potassium

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40
Q

What nutrients are depleted by isoniazid

A

Vitamin B6

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41
Q

What nutrients are recommended for alcohol use disorder

A

Vitamin B1
Folate

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42
Q

Sulfamethoxazole depletes what nutrients

A

Folate

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43
Q

Methotrexate depletes what nutrients

A

Folate

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44
Q

Metformin depletes what nutrient

A

Vitamin B12

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45
Q

PPIs deplete what nutrients

A

Magnesium
Vitamin B12

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46
Q

Orlistat depletes what nutrients

A

Fat soluble vitamins
Beta carotene

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47
Q

Alcohol use disorder is recommended what nutrient

A

Vitamin B1
Folate

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48
Q

Golfer is recommended what nutrient

A

Iodine

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49
Q

Macrocyclic anemia is recommended what nutrient

A

Vitamin B12
Folate

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50
Q

Microcytic anemia is recommended what nutrient

A

Ferrous sulfate

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51
Q

Scurvy is recommended what nutrient

A

Vitamin C

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52
Q

Crohn’s disease is recommended what nutrient

A

Patient specific

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53
Q

Osteopenia/osteoporosis is recommended what nutrient

A

Calcium
Vitamin D

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54
Q

What is the earliest symptom of vitamin A

A

Night blindness

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55
Q

Pregnancy is recommended what nutrients

A

Folate
Vitamin D
Calcium
Pyridoxine

(Flying Dogs Catch Prey)

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56
Q

With taking vitamin A, who may be at risk for toxicity

A

Chronic kidney disease
Chronic liver disease
Low body weight

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57
Q

Bariatric surgery is recommended what nutrient

A

Patient specific

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58
Q

Chronic kidney disease is recommended what nutrient

A

Vitamin D

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59
Q

Osteomalacia is recommended what nutrient

A

Calcium
Vitamin D

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60
Q

Vitamin K

A

Phytonadione

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61
Q

A vitamin K deficiency may be evidenced by:

A
  • unusual bleeding
  • elevated international normalized ratio (INR)
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62
Q

Vitamin A is also called

A

Retinoids

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63
Q

Vitamin D dosing

A

15-20 mcg (600-800 IU) daily

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64
Q

Vitamin K promotes the synthesis of what clotting factors

A

2
7
9
10

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65
Q

What vitamin should pregnant women avoid and why

A

Vitamin A due to teratogenic effects

(Vit A = retinoids; think accutane babies)

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66
Q

Vitamin A interactions

A

Cholestyramine (binds fat)
Orlistat (blocks fat)
Mineral oil (fecal loss)
Warfarin
Colestipol (binds fat)

(Calling Over My White Child)

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67
Q

Vitamin D strength for severe deficiency

A

50,000 IU

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68
Q

Vitamin D side effects

A

Anorexia
Hypercalcemia

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69
Q

How does vitamin D deficiency present in children

A

Rickets
Osteoporosis

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70
Q

Vitamin D main interaction

A

Corticosteroids

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71
Q

Calcium interactions

A

Corticosteroids
PPIs
Phenytoin
H2RAs
Levothyroxine
Iron
Magnesium
Phosphates
Aluminum antacids
Cholestyramine
Tetracyclines
Fluoroquinolones
Zinc
Phenobarbital
Carbamazepine

(Calling Pleasant People Has Lasting IMPACT For Zillions, Please Call)

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72
Q

Examples of drugs that interact w/ fat soluble vitamins and decrease their absorption

A

Cholestyramine
Orlistat
Mineral oil
Colestipol

(Calling Over My Child)

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73
Q

Vitamin K interactions

A

Warfarin

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74
Q

What does the FDA have a warning for in hair, skin, and nail supplements

A

High doses of biotin

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75
Q

What increases urinary excretion of thiamine, leading to a deficiency? What complications?

A

Diuretics
Cardiovascular complications

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76
Q

______ can cause yellow/orange fluorescence/discoloration of the urine

A

Riboflavin

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77
Q

Calcium in doses greater than ____ is harmful

A

3 g

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78
Q

What happens when tetracyclines and fluoroquinolones are taken with calcium

A

Reduced absorption

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79
Q

What interacts with calcium and causes inhibited nutrient absorption

A

Iron
Zinc
Magnesium

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80
Q

How can iron absorption be increased

A

Take with vitamin C on an empty stomach

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81
Q

What effect does food have on absorption

A

Decreases

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82
Q

Iron side effects

A

Constipation
Abdominal pain
Nausea
Tar like stool

(CAN’T)

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83
Q

Iron interactions

A

Fluoroquinolones
Levothyroxine
Antacids
Tetracyclines

(FLAT)

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84
Q

What happens when antacids are taken with iron

A

Decreased solubility and absorption

*separate doses by 2 hrs

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85
Q

What happens when levothyroxine is taken with iron

A

Decreased drug absorption

*separate doses by 4 hrs

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86
Q

What happens when tetracyclines and fluoroquinolones are taken with iron

A

Decreased iron and antibiotic absorption

*take 2 hrs before iron OR 6 hrs after iron

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87
Q

3 main categories of iron deficient people

A
  • pregnant
  • adolescents
  • females beginning menstruation/have heavy periods
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88
Q

What should you NOT take if you are using a home testing kit

A

Vitamin C

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89
Q

Vitamin C interactions and what happens

A

Cholestyramine
Orlistat
Mineral oil
Colestipol

Decreased vitamin absorption

(Calling Over My Child)

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90
Q

Severe vitamin B6 deficiency in infants include

A

Irritability
Convulsive disorders

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91
Q

Signs of serious vitamin B6 deficiency

A
  • Convulsions
  • Peripheral neuritis
  • Sideroblasic anemia (unable to produce RBCs)

(CPS)

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92
Q

______ and vitamin B6 should be taken together

A

Isoniazid

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93
Q

If vitamin B12 is unable to be absorbed in the gut, what is another option

A

Injection

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94
Q

Vitamin B12 interactions

A

Metformin
Antibiotics (long term)

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95
Q

Folic acid interactions

A

Trimethoprim
Phenytoin/Anticonvulsants
Methotrexate
Sulfasalazine

(TAP My Shoulder)

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96
Q

What happens when you take phenytoin/anticonvulsants with folic acid

A

Decreased folic acid absorption

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97
Q

What rare occurrence can happen when trimethoprim and folic acid interact

A

Megaloblastic anemia

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98
Q

Methotrexate when taken with folic acid should be monitored in patients with what disease states

A

Psoriasis
Rheumatoid arthritis

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99
Q

The ONLY described niacin deficiency state is ______

A

Pellagra

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100
Q

What is the dosing for niacin when treating pellagra and hypercholesterolemia/hyperlipidemia

A

Pellagra: 150-500 mg daily in divided doses

Hypercholesterolemia/hyperlipidemia: 1-2 g in 3 divided doses, up to 8 g daily

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101
Q

Niacin can be used to treat hypercholesterolemia and hyperlipidemia when a patient is unable to tolerate what kind of drug

A

Statins

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102
Q

Niacin effect on blood glucose

A

Increases

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103
Q

What is the most common side effect of niacin and how can it be fixed

A

Flushing
Aspirin

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104
Q

What dose of elemental iron is equivalent to ferrous sulfate

A

36-48 mg elemental iron = 325 mg ferrous sulfate

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105
Q

What type of iron is best for patients with iron deficiency

A

Ferrous sulfate

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106
Q

What is the function of fluorides

A
  • reduce tooth decay
  • increase enamel resistance to erosion
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107
Q

What does fluoride interact with and what happens

A

Magnesium
Aluminum
Calcium
(MAC)

Decreases the effect and absorption of fluoride

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108
Q

Fluoride is not recommended OTC for children under what age

A

2 years

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109
Q

What is iodine used for

A
  • goiter (moderate deficiency)
  • hypothyroidism (severe deficiency)
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110
Q

In most cases, iodine supplements are ______

A

Unwanted

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111
Q

What should be monitored when using iodine

A

Thyroid function

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112
Q

Zinc deficiency is ________

A

Not widespread

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113
Q

What are the signs/symptoms of zinc toxicity

A

Vomiting
Dehydration
Poor muscle coordination
Dizziness
Abdominal pain

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114
Q

What can be done if zinc causes GI upset

A

Take with food

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115
Q

Complementary medicine

A

Health practices used with conventional medicine

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116
Q

Alternative medicine

A

Used in place of conventional medicine

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117
Q

Natural medicine includes

A

Herbals
Vitamins
Minerals

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118
Q

The FDA must show a product is unsafe before they can do what

A

Restrict use or remove it

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119
Q

Searchable database of adverse events caused by dietary supplements, medications, devices, and tobacco products

A

FDAble

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120
Q

What claim can manufacturers NOT make about natural products

A

That it can treat or cure a condition/disease

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121
Q

What are the parts of a supplement facts label

A

Indication
Purpose
Uses
Warnings
Instructions
Excipients/allergic rxn alerts
Recommended daily intake (RDI)
Amount of each ingredient

(I Put Up With Idiots Everyday, Real Assholes)

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122
Q

What are the risks of natural products

A
  • dose depended (higher dose = higher risk)
  • can interact w/ Rx meds
  • increase bleeding risks
  • cause hepatotoxicity/cardiotoxicity
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123
Q

What supplements increase bleeding risk

A

5 Gs:
- garlic
- ginger
- ginkgo
- ginseng
- glucosamine

Fish oils (higher doses)
Dong quai
Vitamin E
Willow bark (salicylate)
(Finally Doing Very Well)

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124
Q

What supplements have liver toxicity risks

A

Comfrey
Kava
Black cohosh
Green tea extracts
Chaparral

(Cassie Kellogg Bakes Green Cookies)

125
Q

What supplements have cardiac toxicity risks

A

Powdered supplement mixes
Licorice (glycyrrhizin)
Yohimbe
Bitter orange
Ephedra
DMAA

(PLY BED)

126
Q

Bitter orange side effects

A
  • increased BP & HR
  • dose dependent cardiac toxicity
  • heart attack, stroke, arrhythmia
127
Q

What is DMAA used in

A

Body building/performance enhancers

128
Q

Where is Gycyrrhizin found?
What does it lower?
What does it increase?

A

Found in licorice
Lowers potassium
Increases BP

129
Q

What is yohimbe used for?
What does it increase?
What is the risk?

A

Used for increased libido/erectile dysfunction

Increases BP

Risk of seizures

130
Q

How much caffeine is safe

A

Up to 400 mg

131
Q

Supplements for ADHD

A

Omega-3 fatty acids
Polyunsaturated fats
EPA and DHA (in those fats)

(OPE)

132
Q

Supplements for anxiety

A

5-HTP
Chamomile
Kava
Valerian
St John’s wort
Passionflower

(5 Cowards, Very Sad People on Ketamine)

133
Q

Supplements for cold and flu

A

Probiotics
vitamin C
Zinc
Echinacea
Elderberry

(Panthers Chasing Zebras, Easy Eats)

134
Q

What can zinc nasal products cause

A

Loss of smell

135
Q

Supplements for dementia/memory

A

Ginkgo
vitamin E
vitamin D
Vinpocentine
Acetyl-L-carnitine

(GED, Very Academic)

136
Q

Supplements for depression

A

St John’s wort
SAMe
Valerian
5-HTP

137
Q

Supplements for diabetes

A

Ginseng
Alpha lipoic acid
Magnesium
Chromium
Cassia cinnamon

(Great AMC Cinema)

138
Q

Supplements for dyslipidemia

A

Artichoke extract
Plant sterol
Fibers
Red yeast rice
Omega-3 fatty acids
Garlic

(A Purple FROG)

139
Q

Supplements for dyspepsia

A

Calcium
Magnesium
Peppermint
Chamomile

(CMPC)

140
Q

Supplements for energy/weight loss

A

Bitter oragne
Caffeine
Guarana
Green tea powder

141
Q

Supplements for erectile dysfunction

A

Ginseng
L-arginine
Yohimbe

142
Q

Supplements for heart health

A

CoQ10 (ubiquinone)
Hawthorne
Omega 3 fatty acids

143
Q

Patients should not take L-arginine if they have experienced what medical event

A

Heart attack

144
Q

What lab value may supplements for heart health increase

A

LDL

145
Q

Supplements for HTN

A

CoQ10
Garlic
Fiber
L-arginine
Omega-3 fatty acids
Potassium

(Cassie’s Grades FLOP)

146
Q

Supplements for GI health

A

Wheatgrass
Probiotics
Horehound
Fibers
Peppermint
Chamomile

(Wearing Party Hats From Party City)

147
Q

Supplements for insomnia

A

Melatonin
Valerian
Lemon balm
Chamomile
5-HTP
Passionflower
L-tryptophan
CoQ10

(Making Virgin Losers Cry & Helping People Learn Chinese)

148
Q

Supplements for inflammation

A

Flaxseed oil
Omega-3 fatty acids
Turmeric
Curcumin

(Fuck OTC)

149
Q

Supplements for liver

A

Milk thistle

150
Q

Supplement for menopause

A

Black cohosh
Evening primrose oil
Dong quai
Soy
Red clover

(BEDS+red clover)

151
Q

Black cohosh should not be used with medications for what disease state

A

Heart failure

152
Q

What should dong quai NOT be used with? What can it increase?

A

Do not use with:
- anticoagulants
- antiplatelets
- salicylates

Increases bleeding risks

153
Q

Supplements for migraines

A

Feverfew
Butterbur
Guarana
Magnesium
Riboflavin (B2)
CoQ10

(Fuck Bitches Get Money, Really Cool)

154
Q

Supplement for motion sickness

A

Ginger
Peppermint

155
Q

Supplements for osteoarthritis

A

Glucosamine
Chondroitin
SAMe
Turmeric

156
Q

What is SAMe used for

A

Depression
Osteoarthritis

157
Q

What does SAMe increase risk of

A

Bleeding
Manic behavior

158
Q

Patients should not use SAMe if they have what disease state

A

Bipolar disorder

159
Q

Using SAMe with serotonergic medications increases

A

Serotonergic risk

160
Q

Supplements for prostate health

A

Saw palmetto
Lycopene
Pygeum
Pumpkin seed

(SLPP)

161
Q

Supplements for osteoporosis

A

vitamin D
Ipriflavone
Soy
Calcium

(DISC)

162
Q

Supplements for UTI

A

Cranberry
Yogurt
Probiotics

163
Q

Supplement for weight loss

A

Garcinia cambogia

164
Q

What reference has access to over 250,000 commercial products for ingredients, safety, effectiveness, etc

A

Natmed pro

165
Q

What is herbal medicine

A

Using any part of a plant for healing or health purposes

166
Q

What are counseling points fro dietary supplements

A
  • recognize importance of respecting their beliefs and values
  • ask pt to monitor for perceived benefit and adverse effects
  • providers should not endorse supplements with no evidence of efficacy
  • providers and pharmacists are in position to educate about safety and efficacy
  • recommend purchasing products that have a seal of quality of the label (USP, NSF)
  • recommend purchasing from large reputable companies
  • once supplement is selected, continue to use the same brand and formulation
  • recommend pt talk w/ HCP
  • recommend pts report unusual and adverse effects
167
Q

All herbals are considered what

A

Dietary supplements

168
Q

What is a dietary supplement

A

Products (other than tobacco) intended to supplement the diet that contains one or more of the following:

  • vitamin
  • mineral
  • herb
  • botanical
  • amino acid
  • dietary substance

For use to increase the total dietary intake, or a:

  • concentrate
  • metabolite
  • constituent
  • extract
  • combo

Of any of the ingredients

169
Q

What did the 1994 DSHEA say

A
  • government should not take any actions to impose unreasonable regulatory barriers limiting or slowing the flow of safe products and accurate info to consumers
  • safety problems are relatively rare and legislative action that protects the right of access of consumers to safe dietary supplements is necessary
170
Q

Who regulates the marketing of products with unsubstantiated “drug” claim

A

FDA or FTC

171
Q

Who created the category of dietary supplements (not drugs)

A

DSHEA

172
Q

Under the DHSEA, product ingredients can be what

A

Promoted with:

  • print material
  • lectures
  • vocal broadcasts
  • educational efforts
  • internet
173
Q

What can supplements NOT claim

A

Can’t make drug claims

Medical claims can NOT be on supplement label

174
Q

What do drug claims include

A
  • anything intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease
  • articles (other than food)
    Intended to affect the structure or function of the body
175
Q

What can supplements claim

A
  • health claims authorized by the FDA if it meets certain criteria
  • make claims about products affecting structure, function of the body, or overall well-being (unregulated by FDA)
176
Q

What disclaimer must supplements carry

A

That the product is not designed to treat or prevent a disease

177
Q

How are supplements regulated

A

Under the same umbrella as food

178
Q

What is NOT required of supplements

A
  • safety not required to be proven
  • not required to prove effectiveness/benefit
179
Q

What must be said in product name for supplements

A

Dietary supplement

180
Q

What products are manufacturers prohibited from marketing

A

Products that are adulterated or misbranded

181
Q

How are OTCs regulated

A
  • by the FDA in much the same way as rx items
  • safety must be proven
  • efficacy must be proven
  • manufacturing facilities must be inspected
  • lots are checked for quality control
  • labeling requirements that are translated into lay language
182
Q

What is the process of approval for rx drugs

A
  • IND must be submitted (FDA decides if med is reasonably safe)
  • clinical trials
183
Q

What is an IRB

A

Panel of scientists and non-scientists in hospitals and research institutions that oversee clinical research

Ensure the least amount of harm possible from a clinical trial

184
Q

What does an NDA or BLA (biologics license application) include

A
  • drug test results (from clinical trials)
  • manufacturing info
  • proposed label
185
Q

Where are drugs published after approval

A

Orange book

186
Q

Where are biologics published after approval

A

Purple book

187
Q

(T/F): there is no government agency that assures a manufacturer includes products listed on the label for dietary supplements

A

True

FDA does not verify dietary supplements or that there are impurities

188
Q

(T/F): dietary supplements rely of manufacturers to prepare their products honestly

For most, there is no assurance that the ingredients on the label are in the bottle

A

True

189
Q

What 3 companies verify herbals

A

Consumer lab
NSF
USP

190
Q

What does consumer lab do

A

Establishes the standards of quality for each product

Then selects popular brands for testing against these standards including:
- identity
- potency
- purity
- bioavailability
- consistency

191
Q

What criteria does NSF use for GMPs

A

Same as NNFA/NPA (natural products association)

192
Q

What is the difference in NNFA’s and NSF certification program

A

NNFA is only available to NNFA members

BUT

Any dietary supplement can apply for certification by NSF international

193
Q

What is considered the gold standard for quality of supplements by pharmacists

A

USP seal

194
Q

What is used to confirm that dietary supplements continue to meed USP’s strict standards

A

Off the shelf testing of randomly samples dietary supplements

195
Q

(T/F): the USP is a voluntary system

A

True

196
Q

What are the differences in complementary, conventional, alternative, and integrative health

A

Complementary: non-mainstream approaches

Conventional: mainstream

Alternative: used in place of conventional therapies

Integrative: combines conventional and complementary approaches

197
Q

What prohibits many small companies from submitting to USP

A

The cost is substantial to the manufacturer

198
Q

Example of psychological and nutritional complementary health approaches

A

Mindful eating

199
Q

What does CAM represent

A

All complimentary and alternative medicine

200
Q

What does the USP seal say to consumers

A
  • that the product on the label is in the bottle, in the amount labeled, and that the product should not dissolve as expected
  • does not assure effectiveness
201
Q

How is CAM/CIM defined

A
  • medical products and practices that are not part of standard care (modern medicine)
  • any healthcare technique w/ a history of beginnings outside of mainstream medicine
  • encompasses dietary supplements, yoga, acupuncture, etc
202
Q

What population is CAM usage higher in

A

Patients with chronic diseases

203
Q

Why do people turn to CAM

A
  • aligns w/ their philosophy or they want to expand their options
  • helps patients feel better or reduce adverse events
  • to feel in control or looking for a cure
  • most use it to supplement traditional medicine
204
Q

What are examples of complementary health approaches

A

Massage
Magnets
Spinal manipulation

205
Q

What are examples of nutritional complementary health approaches

A

Vitamins and minerals
Dietary supplements
Aromatherapy
Diets

(VDAD)

206
Q

(T/F): herbals are OTC medications

A

False

They are not regulated the same and safety is not established

207
Q

What are examples of psychological complementary health approaches

A

Mindfulness
Medication & biofeedback

208
Q

What did Dr. Samuel Hahnemann do

A
  • developed homeopathy in the early 1800s
  • coined the term allopathy (means conventional medicine)
209
Q

What are the benefits of CIM

A
  • considered preventative medicine
  • used to maintain health and reduce disease risk
  • potential to treat diseases that have no therapies
  • increased sense of empowerment and participation
  • considered safe and natural
  • some practices are supported by basic science and evidence
210
Q

What are the risks of CIM

A

Not all have undergone rigorous testing

Drug interactions with foods, rx/OTC products, vitamins, etc

211
Q

What are examples of combination (psychological and physical) complementary health approaches

A

Healing touch
Acupuncture
Reiki
Dance
Tai chi
Art therapies
Yoga

(HARD Tests All Year)

212
Q

What is homeopathy often compared to

A
  • vaccination
  • not entirely accurate because homeopathic preparations are only used to treat existing illnesses, not prevention
  • oscillococcinum is an exception because it’s used to treat and prevent flu
213
Q

What is homeopathy based on

A
  • like cures like, law of similars
  • idea that if a substance produces symptoms of an illness, then that substance can cure it when given in small doses
  • more dilute = greater potency
  • efficacy believed to depend on dilution factor as well as vigorous shaking (or succession) which is performed w/ each dilution
214
Q

How much active ingredient is contained in homeopathic preparations

A

So dilute that they only contain negligible amounts of AI

215
Q

What are homeopathic products NOT considered by the FDA

A

Not considered dietary supplements even though they are generally meant to be ingested

216
Q

Who regulates and recognizes homeopathic medicines

A

USP
HPUS
NF

217
Q

What must a homeopathic drug have to be included in the HPUS

A

Must be manufactured with cGMP determined by the HPUS to be safe and effective

218
Q

What determines safety and efficacy of homeopathic drugs

A
  • process called “provings” (or research procedures in the HPUS)
  • determines the dosage needed to induce symptoms in healthy people
219
Q

What is a huge distinction w/ approval process for homeopathic drugs

A

HPUS determines that the manufacturing process is safe and effective, NOT the product itself

220
Q

What is naturopathy

A
  • philosophy of life and an approach to living that encourages lifestyles and therapies as close to nature as possible
  • employs natural forces such as light, heat, air, water, and massage
  • focuses primarily on building health rather than on treating disease
221
Q

Most remedies do NOT need what

A

A prescription

Most are used for self-limiting conditions

222
Q

What is attenuation or potentization

A

Process when homeopathic substances are serially dilueted and succussed (triturated), which is thought to increase potency

223
Q

What are the 6 principles of naturopathy

A

Healing power of nature
Identify and treat the causes
Doctor as teacher
First do no harm
Prevention
Treat the whole person

(HID From Ponn Today)

224
Q

What is meant by “the healing power of nature)

A

The body has the inherent ability to maintain and restore health

225
Q

What is meant by “identify and treat the causes”

A

Implies that the naturopathic healthcare providers aim is to ID and treat the cause, rather than the symptoms, of a disease

226
Q

What is meant by “first do no harm”

A

Emphasizes use of less toxic natural therapies

227
Q

What is meant by “doctor as teacher”

A

Naturopath educates and encourages patients to take responsibility for their own health

228
Q

What is aromatherapy

A

Therapeutic use of natural fragrances from:

  • essential oils
  • hydrosols
  • carrier oils

To help improve whole persons mind, body, and spiritual well being

Used through inhalation or application to skin

229
Q

What is meant by “treat the whole person”

A

HCP treats the whole person, taking into account their aspects that are:

  • physical
  • spiritual
  • mental
  • social
230
Q

What is meant by “prevention”

A

Requires the naturopath to access risk factors and hereditary susceptibility to disease and to make appropriate interventions to prevent further harm or risk to patients

231
Q

What are the characteristics of naturopathy providers

A
  • believe mental attitude and emotions may influence physical illness
  • include nutritional counseling and support as major components
232
Q

What ailments has naturopathy been found to be MORE effective in treating

A

Anxiety

233
Q

What ailments has naturopathy been proven to be LESS effective in treating

A

Extreme pain
Surgery

234
Q

What are different delivery forms of aroma therapy

A

Massaging intended site
Foot and sitz bath
Adding to bath

(MFA)

235
Q

What are safety concerns w/ aromatherapy

A
  • essential oils are highly potent
  • topical use can cause skin irritation
  • avoid contact w/ eye
  • avoid in children
  • wintergreen oil contains menthol and methyl salicylate (5 mL = 4 g of aspirin)
236
Q

What are therapeutic uses of aromatherapy

A

Support healing/wellbeing
Reduce stress
Reduce pain
Strengthen immunity

237
Q

What specific issues can aromatherapy be used for

A

Reduce BP
Childbirth pain
Depression
Dysmenorrhea pain
Promote good sleep

(Really Cool Dudes Drive Porsches)

238
Q

What is the common cold

A

Upper respiratory tract disorder due to virus infection

Most common w/ the rhinovirus

239
Q

What is the pathophysiology of the common cold

A
  • rhinovirus attached to respiratory epithelia and macrophages
  • virus infiltrates the host cells via endocytosis, then replicates and infection spreads to other cells
  • infection stimulates host cell release of inflammatory mediators (bradykinins, prostaglandins, histamine, vasodilators), which causes hypersecretion of watery nasal fluid
  • viral infection ends once enough neutralizing IgA or or IgG enters the mucosa to end viral replication
240
Q

What is a protective function for human airways and lungs that can also be induced by medication

A

Cough

241
Q

What is the pathophysiology of a cough

A
  • cough reflex is triggered by stimulation of sensory nerve receptors, which are stimulated by both chemical (cytokines, histamine) and mechanical (dust, growth/cancer) stimuli
  • action potential is then sent to the “cough center” in the medulla
242
Q

What is allergic rhinitis

A
  • hay fever
  • systemic disease w/ prominent nasal symptoms and effects the upper respiratory system
  • immune response to antigenic environmental allergens
  • reactions typically limited to nasal cavity without systemic allergies leading to conditions such as bronchoconstriction
243
Q

What is type I hypersensitivity

A

Immediate reactions that occur within minutes of allergen exposure

IgE mediated

244
Q

What is the pathophysiology of allergic rhinitis

A

Allergenic particles contact nasal mucous membranes, then inducing an IgE mediated inflammatory immune response

245
Q

What is the process of the immune response causing allergic rhinitis

A
  1. Airborne allergies inhaled that produce antigen specific IgE, causing sensitivity
  2. Second exposure, mast cells trigger release of inflammatory mediators (histamine, leukotrienes, prostaglandins, bradykinins)
  3. Inflammatory mediators cause vasodilation that increases vascular permeability and production of nasal secretion
  4. Histamine produces rhinorrhea, itching, sneezing, and nasal obstruction
  5. Chemokines attract allergen-destroying WBCs that increase inflammation and leads to congestion
246
Q

What are some manifestations of allergies due to

A
  • Histamine release
  • Activation of H1 receptors on smooth muscles
247
Q

Examples of vasoconstrictors

A
  • NSAIDs
  • Epinephrine and norepinephrine
  • Antihistamines
  • Decongestants

(NEAD)

248
Q

What are vasoconstrictors used for

A

To counteract the pathophysiological effects of histamine in colds and allergies by narrowing blood vessels and increasing BP

249
Q

What do decongestants do

A

Decrease vascular congestion in the nose

250
Q

What is the pharmacology of decongestants

A
  • alpha 1 andrenoceptor agonists
  • NE released from sympathetic nerves bind to alpha-androceptors on smooth muscle, stimulating vasoconstriction
  • vasoconstriction of blood vessels in nose, throat, and paranasal sinuses results in reduced inflammation and mucosal edema (rhinorrhea, congestion)
251
Q

What does it mean if a product has a D after its same

A

It contains pseudoephedrine

252
Q

Why is pseudoephedrine more effective than phenylephrine

A

Phenylephrine has lower bioavailability

253
Q

What are the warnings w/ systemic decongestants

A
  • uncontrolled HTN (increases BP = vasoconstriction
  • glaucoma (increased intraocular pressure)
254
Q

What are longer acting intranasal decongestants

A

Xylometazoline
Oxymetazoline

255
Q

What are antitussives

A

Cough suppressants

256
Q

What is the pharmacology of dextromethorphan (DM)

A
  • acts on the medulla cough center to increase the cough threshold
  • robitussin is an example
257
Q

What happens at high doses of dextromethorphan

A

Converted into a psychoactive metabolite dextrorphan

Produces hallucinogenic effects similar to PCP

258
Q

What is the pharmacology of codeine (methyl morphine)

A
  • acts on medulla cough center to increase cough threshold
  • usual dosages have low toxicity and little risk of addiction
259
Q

Who should avoid taking codeine

A

Those w/ CYP2D6 polymorphism

This makes them an ultra rapid metabolizer of codeine

Can cause respiratory depression and death

260
Q

What is diphenhydramine and where does it act

A
  • nonselective (1st gen) antihistamine w/ significant sedating and anticholinergic properties
  • acts on medulla to raise the cough threshold
261
Q

What do expectorants (protussives) do

A

Decrease phlegm viscosity

262
Q

What does guaifenesin (mucinex) do

A

Loosens and thins lower respiratory tract secretions

263
Q

What effects do NSAIDs have

A

Analgesic
Antipyretic
Anti-inflammatory

264
Q

What effects does acetaminophen NOT have

A

Anti-inflammatory
Anti-thrombotic

*because it is inactivated outside the CNS

265
Q

What is the MOA of most NSAIDs

A
  • COX inhibitors causing decreased prostaglandin (PGE2, PGI1) synthesis
  • blocks thromboxane A2 (TXA2) synthesis, which increases bleeding (anti-thrombotic)
  • block prostacyclin (PGI2) synthesis, which increases gastric acid secretion, causing gastric erosion (ulcers) and bleeding
266
Q

What does pectin do and what is it in

A
  • relieves irritation of the mucous membranes in the throat by forming a protective film (demulcent)
  • component of Halls throat lozenges
267
Q

What do menthol and phenol do, and what are they in

A
  • depress cutaneous receptor response, creating analgesic effects
  • used in: chloraseptic sore throat spray, Vicks VapoDrops
268
Q

What does benzocaine do

A

Numbing agent

Blocks Na+ channels on neuronal cell membranes, decreasing conductance

269
Q

What do antihistamines do

A

Compete w/ histamine for H1 receptors, blocking vasodilation

2nd gen inhibit release of mast cell mediators

270
Q

What are the characteristics of 1st generation antihistamines and what are examples

A

Lipophilic (nonpolar)
Cross BBB
Shorter acting

Benadryl (diphenhydramine)
Unisom (doxylamine)

271
Q

What are characteristics of 2 generation antihistamines and what are examples

A

More hydrophilic (polar)
Protein bound
Do NOT cross BBB
Longer acting
Charged side chains

Loratadine
Cetirizine

272
Q

What are the effects of 1st generation antihistamines

A
  • somnolence (caution for excessive sedation)
  • anticholinergic effects (dry mouth)
273
Q

What is the pharmacology of mast cell stabilizers and what is an example

A

Blocks influx of Ca2+ into mast cell preventing histamine release

Cromolyn (NasalCrom)

274
Q

What is the pharmacology of intranasal corticosteroids and what are some examples

A

Blocks allergic cascade

Rhinocort (budesonide)
Flonase (fluticasone)
Nasacort (triamcinolone)

275
Q

What is rare in the US

A

Mineral and vitamin deficiencies

276
Q

What can thiamine deficiency cause

A

Wernicke’s encephalopathy (mental confusion, ataxia, tremor, vision changes)

277
Q

When is thiamine deficiency commonly seen

A
  • alcoholism
  • malabsorptive states (crohn’s, bariatric surgery, advanced HIV
278
Q

What occurs as symptoms of Wernickes fade

A

Korsakoff syndrome (permanent neurological damage)

279
Q

How can some vitamin and mineral deficiencies be determined

A

Patients can be tested like blood draw for iron studies or initial hemoglobin on CBC

280
Q

Examples of anticonvulsant/epileptic drugs

A

Phenobarbital
Phenytoin
Oxcarbazepine
Pregabalin
Carbamazepine
Levetiracetam
Valproate
Valproic acid
Divaloproex sodium
Topiramate
Zonisamide

(Pulling Pranks On People Can Lead to Very Very Dangerous Things + Z)

281
Q

What are the functions of vitamin A in the body

A
  • growth and reproduction
  • skeletal and tooth development
  • proper organ functioning of most organs (most notably the eyes)
282
Q

What is the upper limit of vitamin A and what happens if this is exceeded

A

3 mg daily

Congenital birth defect risks
Liver abnormalities

283
Q

What vitamins can be toxic

A

Fat soluble because they are stored in the body

284
Q

What adverse effects can taking more than the upper limit of vitamin D cause

A

Hypercalcemia
Anorexia
Renal failure
Increased risk of certain cancers
Soft tissue calcification
Kidney stones

(Has A RISK)

285
Q

What amounts of electrolytes requires the OTC label to state the amount of electrolyte per dosage unit in the “other information” section

A

Greater than or equal to:

20 mg calcium
8 mg magnesium
5 mg potassium
5 mg sodium

286
Q

What warning must be on the label if a product contains greater than 3.2 g of calcium

A

As a dr before use if you have kidney stones or a reduced calcium diet

287
Q

What warning must be on the label if a product contains greater than 600 mg of magnesium

A

Ask a dr before use if you have kidney disease or a magnesium reduced diet

288
Q

What warning must be on the label if a product contains greater than 975 mg of potassium

A

Ask a dr before use if you have kidney disease or a reduced potassium diet

289
Q

What term must be on the label if the product contains less than or equal to 5 mg sodium

A

Sodium free

290
Q

What term must be on the label if the product contains less than or equal to 35 mg of sodium

A

Very low sodium

291
Q

What term must be on the label if the product contains less than or equal to 140 mg of sodium

A

Low sodium

292
Q

What warning must be on the label if the product contains greater than 140 mg of sodium

A

Ask a dr before use if you have kidney stones or a sodium reduced diet

293
Q

What does federal law state about CBD in dietary supplements

A

That CBD can NOT be used as a dietary supplement or food additive

This is because CBD is technically an rx drug

294
Q

How is CBD used in topical preparations (oils, sprays, creams, etc)

A

Extracted from hemp since hemp is legal and no longer considered schedule 1

295
Q

In states where it is legal, what can cannabis be used for

A

Certain medical uses

Patients must obtain a medical card/certificate to get product from dispensary

State authorizes prescribers to recommended it for “approved indication for use”

States my allow recreational use

296
Q

What laws must pharmacies follow regarding marijuana

A

Federal because pharmacies are registered w/ the DEA

297
Q

What are pharmacies NOT permitted to do in regards to marijuana and what does this mean in WV

A
  • be a dispensary
  • sell marijuana or paraphernalia

WV: no pharmacies/pharmacist may be involved, no prescriptions permitted

298
Q

What are the special warning requirements for OTC drugs for minor sore throat

A

Must state: “for temporary relief of minor sore throats”

Must include: “warning: severe or persistent sore throat and sore throat accompanied by high fever, headache, nausea, and vomiting may be serious. Contact physician promptly. Do not use more than 2 day or administer to children under 3 years of age unless directed by a physician”

299
Q

What are the record keeping requirements of PSE

A

Name of purchaser
Address of purchaser
Signature of purchaser
Name of product
Qty including # of packages
Total weight of PSE in g
Date and time of purchase
Type of ID and ID #

299
Q

What is the limit on dihydrocodeine, ethylmorphine, or opium preparations that can be sold OTC

A

100 mg/mL OR 100 g

299
Q

What is the limitation on diphenoxylate preparations that can be sold OTC

A

25 mg/25 mcg atropine sulfate

300
Q

What is the limit on codeine preparations that can be sold OTC

A

200 mg/100 mL OR 100 g

301
Q

What is the limit on diphenoxin preparations that can be sold OTC

A

0.5 mg/25 mcg atropine sulfate

301
Q

How much can be dispensed for all other controlled substances (robitussin ac, cheratussin ac) to any one purchaser in a 48 hr period

A

Not more than 120 mL of any other controlled substance

Not more than 24 dosage units of any other CS

302
Q

How much opium can be dispensed to any one purchaser in a 48 hr period

A

Not more than 240 mL of anything containing opium

Not more than 48 dosage units of anything that contains opium

303
Q

What is the DAILY limit of PSE in WV

A

3.6 g

303
Q

What is the schedule of PSE in WV

A

C5 but still OTC

304
Q

What is the limit per MONTH of PSE in WV

A

7.2 g per 30 days

305
Q

What is the YEARLY limit of PSE in WV (updated)

A

84.6 g

OTC (31 decks)

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