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Pharm301 Topics > OTC misuse > Flashcards

OTC misuse Flashcards

1
Q

What is misuse?

A
  • using medicine not as intended
  • using medicine for recreational purposes
  • overusing medicine
  • using medicine in a dependent way
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2
Q

What is the difference between intentional and unintentional misuse?

A
  • some misuses are unintentional e.g. taking higher than recommended doses to elicit beneficial medical effect
  • some misuse is intentional and relates to obtaining euphoric effects, laxative abuse, prevent withdrawal symptoms when drugs of choice are unavailable
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3
Q

What is the general spectrum of OTC misuse?

A

they usually start off unintentionally, then become intentional misuse

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4
Q

what are examples of unintentional misuse?

A
  • over use, use for too long, use in inappropriate patient, drug interactions
  • these can result in severe ADRs from other ingredients e.g. paracetamol toxicity, GI problems with ibuprofen
  • often arise due to lack of info to consumers
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5
Q

What are other causes for unintentional misuse?

A
  • advertising/labeling may ‘promote’ misuse
  • once informed, patients usualyl respond positively to making changes
  • can also lead to intentional misuse
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6
Q

What are the characteristics of intentional misuse?

A
  • often covert
  • may shop around to avoid suspicion
  • might be at a higher dose than recommended
  • may be fore recreational purposes
  • may be in conjunction with use of illicit drugs
  • maybe as a source of precursor
  • may lead to negative health outcomes
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7
Q

What are the consequences of misuse?

A

primary drug:

  • ADRs
  • electrolyte imbalance (laatives)
  • dependence
  • negative health consequences including death.

additional ingredient

  • GI irritation (NSAIDs)
  • rebound problems
  • hypokalaemia/acidosis (ibuprofen)
  • liver toxicity (paracetamol)
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8
Q

Why are OTC ‘herbal’ and alternative medicines not any safer to misuse?

A
  • they have a perception that they are natural
  • often lack clarity on contents
  • rarely evidence to back up any claims
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9
Q

What is Ma Huang?

A
  • contains ephedrine, misused as stimulant
  • sometimes also with norpseudoephedrine (more toxic)
  • there is no way of knowing how much ephedrine it contains
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10
Q

What are the resutls of taking Ma Huang?

A
  • heart disease
  • inflammation of liver and heart
  • unusual form of kidney stones that contain ephedrine
  • certain preparations of ephedra may be toxic to nervous system
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11
Q

What can occur with ephdra and MOAi?

A

serious drug interaction

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12
Q

What kinds of drugs can get abused?

A 
opiates
antihistamines
sympathomimetics
performance  enhancers
laxatives
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13
Q

What are opiates used for?

A

-included in compound analgesics as codeine
-homebake
-used for:
pain relief,
prevention of withdrawal when addicted to OTC,
euphoric effect,
prevent withdrawal symptoms when no morphine or heroin available

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14
Q

What are the effects of opiates?

A

euphoria, sedation, pinned pupils, respiratory depression

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15
Q

What are the effects of high doses of opiates?

A

respiratory depression

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16
Q

What other substances increase the overdose risk?

A

alcohol

other CNS depressants

17
Q

What are the problems with codiene overuse?

A

other ingredients in OTC products:
ibuprofen = GI haemorrhage, perforated duodenal ulers, acute renal failure, hypokalaemia

Paracetamol= toxicity, death

18
Q

Why is dextromephorphan misused?

A
  • primarily used in cough medicines and historically believed to have no euphoric effect
  • misused primarily by younger adolescnets
  • non opiod analogue of codiene
  • metabolised to dextrphan which antagonises NMDA receptors which might result in dissociative effects sought by abusers
19
Q

What are the effects of dextromephorphan?

A

initially stimulant effects
-feelings of dissociation, euphoria, ataxia, restlessness, loss of concentration at doses > 2mg/kg

  • antagonises 5-HT receptors may lead to serotonin syndrome?
  • co ingestion with pseudoephedrine and chlorpheniramine can cause tachycardia, hypertension, hyperthermia, mydriasis and urinary retention
20
Q

How are sedating antihistamines used?

A
  • included in many sleep aids e.g. diphenhydramine, cyclizine, dimenhydrinate
  • possibly used for antmuscarinic effects
  • nytol most misused in a scottish study,
  • often used in conjunction with alcohol
  • may be used to ‘come down’ from cocaine and other stimulants
21
Q

How are sympathomimetics used?

A

e. g. pseudoephedrine
- may be misused for psychoactive effect as it is a stimulant
- performance enhancer: found in sports people, long distance lorry drivers
- metamphetamine precursor
- has potential for dependence if used over long periods

22
Q

What are the effects of sympathomimetics?

A
  • peripheral vasoconsctriction,
  • cardiac stimulation
  • increased blood pressure
  • increased heart rate
23
Q

What are the adverse effects of sympathomimetics on the CNS?

A
  • nervousness
  • anxiety
  • tremor
  • weakness
  • irritability
  • insomnia

these increase with higher doses

24
Q

What are the effects of sympathomimetic overdose?

A
  • nausea
  • vomiting
  • fever
  • palpitations
  • tachycardia
  • hypertension
  • paranoid psychosis
  • respiratory depression
  • convulsions
  • comas
25
Q

What laxatives are usually misused?

A

stimulant laxatives like bicosadyl, senna

  • often misused by people with eating disorders
  • misconception that it will flush food through before calories are absorbed
26
Q

What are the implications with laxative use?

A
  • long term use can mask other conditions

- can cause serious electrolyte imbalance

27
Q

What alerts pharmacists with medicine misuse?

A 
customer appearance
customer behaviour
refusal of alternative product
requests for large quantities
frequent requests
excuses such as buying for someone else
customer very knowledgeable abut why they want the product
28
Q

What can pharmacists do about medicines misuse?

A
  • monitor trends
  • well trained staff
  • professional judgement
  • early warning systems
  • keep up to date

Pharm301 Topics (8 decks)

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