OTCs Flashcards
For common OTC drugs, you should be able to identify what 4 things?
1) Pathophysiology of diseases / disorders
2) MOA of drugs
3) Adverse effects
4) Drug interactions
For common vitamins, minerals, enzymes & herbs, you should be able to identify what 2 things?
1) Diseases / disorders and acceptable products
2) MOA (if noted in slides)
List the 2 main categories of headaches, and what headaches are in each category
1) Primary
-Tension (episodic or chronic)
-Migraine (without or with aura)
-Cluster
2) Secondary
-Stroke
-Substance abuse
-Infection
-Others…
1) Tension headaches involve what tissues & receptors?
2) What pt of the nervous system do episodic headaches involve?
3) What about chronic headaches? How often does it happen if it’s chronic?
1) Myofascial tissues & pericranial nociceptors
2) PNS
3) CNS; 5 or more days per month for at least 3 months
1) What pathway and molecules are involved w migraines w/o aura?
2) What is stimulated? What is released and activated?
1) Pain pathways are stimulated and messenger molecules are involved, including nitric oxide, serotonin, and calcitonin gene–related peptide
2) Stimulation (by an axon reflex) of trigeminal sensory fibers in the large cerebral and dural vessels causes neuropeptide release with concomitant neurogenic inflammation, vasodilation, and activation of platelets and mast cells
1) What happens in migraines without aura?
2) What deficiency may contribute to this state?
1) Neuronal depolarization that spreads slowly across the cerebral cortex
2) Magnesium
1) What type of headaches are common in people with allergies?
2) What is a cause of headaches specific to women?
1) Sinus headaches
2) Estrogen withdrawal headaches
Why do children start taking adult doses at age 12?
Your liver fully matures
1) What is the max adult dose of APAP per day?
2) What abt ibuprofen per day?
1) 4000mg
2) 200-400mg every 4-6 hours as needed (1200mg)
1) What is the MOA of Acetaminophen (Tylenol / APAP)?
2) FDA requires manufacturers to include a boxed warning on acetaminophen products that addresses its potential to cause __________________
1) Central inhibition of prostaglandin synthesis
2) hepatotoxicity
1) Why can acetaminophen cause hepatotoxicity?
2) How may it be treated?
1) Metabolized by the cytochrome P450 enzyme system to a hepatotoxic intermediate metabolite that is detoxified by glutathione (Phase II conjugation)
2) May be treated with activated charcoal or acetylcysteine to supplement glutathione
True or false: even incidents unrelated to a drug can end up on its monograph
True
1) MOA of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
2) Give 2 examples of NSAIDs
1) Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) with consequent inhibition of prostaglandin synthesis
2) Ibuprofen (Advil) and naproxen (Aleve)
Adverse effects of NSAIDs:
1) What are its side effects?
2) What is NSAID use associated with?
3) How can it cause edema?
4) What can it cause w chronic use?
1) GI ulceration, perforation, and bleeding
2) NSAID use is associated with increased risk for myocardial infarction (MI), heart failure, hypertension, and stroke
3) Sodium and water retention causing edema
4) Nephropathy with chronic use
How do NSAIDs interact with:
1) Methotrexate
2) P2Y12 inhibitors & SSRIs
3) Bisphosphonates?
1) Decreased methotrexate clearance
2) Increase risk of bleeding
3) Increased risk of GI bleeding / ulceration
How do NSAIDs interact with:
1) Digoxin
2) Phenytoin and ibuprofen
Specify what you should do for each
1) Decreased renal clearance; monitor
2) Displacement from protein-binding sites (albumin); monitor
1) Aspirin is a type of what?
2) What is its MOA
3) Is intolerance common? What are its two types?
1) Salicylates
2) Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both COX-1 and COX-2
3) Uncommon
-cutaneous (manifesting as urticaria and angioedema) and -respiratory (manifesting as bronchospasm, laryngospasm, and rhinorrhea)
1) What may aspirin (salicylates) produce a positive result for?
2) What pts should it be avoided in?
3) What pts is it contraindicated for?
1) May produce a positive result on fecal occult blood testing, so its use should be discontinued at least 3 days before testing
2) Should be avoided in patients with a history of gout or hyperuricemia because of dose-related effects on renal uric acid
3) W. hypoprothrombinemia, vitamin K deficiency, hemophilia, history of any bleeding disorder
The American Academy of Pediatrics, FDA, the Centers for Disease Control and Prevention, and the Surgeon General have issued warnings that aspirin and other salicylates (including bismuth subsalicylate and nonaspirin salicylates) should be avoided in children and teenagers who have ________________ or _______________ due to the risk of ___________ syndrome
influenza or chicken-pox; Reye’s syndrome.
Describe the drug interactions (2) of salicylates (aspirin)
Similar to NSAIDs:
1) Valproic acid = displacement of valproic acid from protein-binding sites and inhibition of valproic acid metabolism
2) Sulfonylureas = increased risk of hypoglycemia
Combination products available that contain caffeine, nasal decongestants or diphenhydramine
Why might caffeine be problematic for headache use?
Can make a HA worse
1) What happens with concomitant EtOH and APAP or NSAIDs?
2) What should you caution the pt abt?
1) Hepatoxicity
2) Use of OTC analgesics for patients that use blood thinners or drink alcohol
If a pt is pregnant, what should you tell them to take for HA? Why?
APAP; NSAIDs contraindicated in third trimester, avoid aspirin
Why are NSAIDs contraindicated in third trimester?
1) Delayed parturition, prolonged labor, and increased postpartum bleeding
2) Premature closure of the ductus arteriosus
1) What should you recommend for HA for a lactating pt?2) What should you avoid?
1) Ibuprofen; relevant infant dose is 0.6 – 0.9%
-Acetaminophen; relevant infant dose is 3.98%
2) Avoid aspirin
What is the pediatric APAP recommendation?
APAP safe for all ages: 160 mg / 5 mL suspension
Rx max depends on age & weight
What is the pediatric ibuprofen recommendation? What does the Rx max depend on?
1) Ibuprofen approved >= 6 months:
100 mg / 5 mL suspension
2) Rx max depends on age & weight
For ibuprofen and acetaminophen, list their weight based dosing, schedule, and max daily dose
1) Ibuprofen: 5-10mg/kg, every 6-8 hours PRN, 300mg per dose up to 4 doses or 40mg/kg/day; not to exceed 1200mg max daily dose
2) Acetaminophen: 10-15mg/kg, every 4-6 hours PRN, 480mg per dose up to 5 doses or 75mg/kg/day; not to exceed 2400mg max daily dose
Test question:
7-month-old patient weighing 18 lbs.
What is an acceptable dose (X) of ibuprofen using 5 mg / kg?
41mg
Work:
18/2.2 = 8.2
8.2x5 = 41
Test question:
7-month-old patient weighing 18 lbs. Ibuprofen comes in a 100 mg / 5 mL standard concentration. How many mL will each dose be?
2.1mL
Eight-year-old patient weighing 62lbs with Periorbital cellulitis. Clindamycin (Cleocin) 75 mg / 5 mL
FDA-approved dose is 8 – 20 mg / kg / day divided into 3 – 4 doses. Prescriber used 20 mg / kg / day & TID dosing for 10 days
How many mL should you prescribe?
375mL
Core body temperature is controlled by the ________________ and regulated by a feedback system involving information transmitted between the thermoregulatory center in the ___________________________ and the thermosensitive neurons in the ________________________ and ____________________
hypothalamus; anterior hypothalamus; skin and central nervous system (CNS)
1) Somatic pain occurs when pain impulses are transmitted from _________________ to the central nervous system
2) Inflammatory response develops through participation of multiple mediators, including what?
1) peripheral nociceptors
2) Histamine, bradykinin, serotonin, leukotrienes, and prostaglandin E
List 8 topical medications for Musculoskeletal Injuries and Disorders
1) Menthol 2–16%
2) Camphor 3.2%
3) Capsaicin 0.1 – 0.15%
4) Histamine dihydrochloride 0.025%
5) Trolamine salicylate 10%
6) Methyl salicylate 10 – 30%
7) Lidocaine 4%
8) Diclofenac sodium 1%
1) What does topical menthol stimulate? What does it activate?
2) What does topical camphor stimulate? What does it produce?
3) What does capsaicin elicit? How?
1) Stimulates cutaneous receptor response (i.e., acts as a counterirritant)
-Activates the transient receptor potential (TRPM8) menthol receptor, triggering the sensation of cold
2) Stimulates nerves; produces cooling sensation
3) A transient feeling of warmth through stimulation of the TRPV1 receptor and ↑ depletion of substance P
1) Which topical for MSK disorders/ injuries is a vasodilator?
2) Which two inhibit prostaglandin synthesis?
1) Histamine dihydrochloride 0.025%
2) Trolamine salicylate 10%; & Methyl salicylate 10 – 30% (Rubefacient (increase blood flow))
1) What does topical lidocaine 4% do?
2) What type of medication is Diclofenac sodium 1% topical?
1) Inhibits the conduction of nerve impulses
2) NSAID
BV:
1) What are the classic signs and symptoms?
2) Differentials?
3) Etiology?
1) Thick white discharge w. odor, high pH, dysuria, etc
2) VVC, trichomoniasis
3) Polymicrobial infection
Trichomoniasis
1) Describe symptoms in women and men.
2) Etiology and risk factors?
1) Frothy, malodorous, discolored vaginal discharge (sometimes w pruritis). Sometimes no symptoms in women, men act as infection reservoirs.
2) STI; multiple partners, new partner, no protection, and other stis.
1) What is Vulvovaginal Candidiasis (VVC) treated with? How is it administered? When is 7 day therapy preferred?
4) Give examples of this category
1) Azoles; topical; 1 to 7 days of therapy
-7-day if pregnant
4) Clotrimazole, miconazole, and tioconazole
What is the MOA of Vulvovaginal Candidiasis (VVC)
Inhibit cytochrome P450 (CYP) enzymes in the cell membrane of the infecting pathogen, decreasing synthesis of the fungal sterol ergosterol.
(Ultimately causes structural damage to fungal membranes.)
What medications can treat vaginal itching and irritation? What risk is one associated with?
1) Hydrocortisone 1%
2) Benzocaine 5 – 10% / resorcinol 2 – 3%
-Rare risk of methemoglobinemia associated with benzocaine-containing products
3) Others
1) What is the typical presentation of Atrophic vaginitis?
2) How can it be treated?
1) Vaginal dryness, burning, itching, and dyspareunia (if vaginal dryness is the cause of painful sexual intercourse)
2) Lubricants like: glycerin, propylene glycol, mineral oil, others
1) What medication treats an overactive bladder?
2) What’s its MOA?
1) Oxybutynin patches (Oxytrol)
2) MOA: antimuscarinic
1) Give examples of colds
2) What receptors does a virus bind to? On what cells where?
1) Rhinoviruses, coronaviruses, parainfluenza, respiratory syncytial virus, adenoviruses, and human metapneumovirus
2) Intercellular adhesion molecule-1 receptors on respiratory epithelial cells in the nose and nasopharynx
1) When you have a cold, what are your infected cells releasing? What do these things then activate? (2 things)
2) What two things cause hypersecretion of watery nasal fluid with a cold?
1) Chemokine “distress signals,”; inflammatory mediators and neurogenic reflexes
2) Inflammatory mediators + parasympathetic nervous system reflex mechanisms
List and describe the 4 phases of allergic rhinitis
1) Sensitization phase: Allergen stimulates beta-lymphocyte–mediated IgE production
2) Early phase: Rapid release of preformed mast cell mediators (e.g., histamine, proteases), as well as the production of additional mediators (e.g., prostaglandins, kinins, leukotrienes, neuropeptides)
3) Cellular recruitment: Leukocytes, especially eosinophils, are attracted to the nasal mucosa and release more inflammatory mediators
4) Late phase: Mucus hypersecretion secondary to submucosal gland hypertrophy and congestion
List some drugs that can cause non-allergic rhinitis
Cocaine, beta blockers, ACEIs, chlorpromazine, hydralazine, oral contraceptives, aspirin or other NSAIDs, overuse of topical decongestants
1) What initiates a cough?
2) What are the two main types?
3) What are the further classifications (next slide)
1) Stimulation of chemically and mechanically sensitive, vagally mediated bronchopulmonary and extrapulmonary sensory nerves in the pharynx, larynx, esophagus, and tracheobronchial airway epithelium
2) Productive and nonproductive
3) Acute, subacute, and chronic
Productive coughs:
1) What usually causes a clear productive cough?
2) What usually causes a purulent productive cough?
3) What usually causes a productive cough with a putrid malodor?
4) How would you describe a smoker’s cough? What usually causes it?
1) Acute bronchitis
2) Bacteria
3) Anerobic bacteria
4) Purulent; chronic bronchitis (from smoking)
Nonproductive cough may be associated with what?
1) Viral and atypical bacterial infections
2) Gastroesophageal reflux disease (GERD)
3) Cardiac disease (e.g., congestive heart failure),
4) Medications (some)
1) Colds, allergic rhinitis & cough can be treated with adrenergic agonists (sympathomimetics), which are what kind of drug?
2) What is the MOA?
3) Give 2 examples of drugs in this category
1) Decongestants
2) Stimulation of alpha-adrenergic receptors constricts blood vessels, thereby decreasing sinusoid vessel engorgement and mucosal edema
-Directly bind to adrenergic receptors
3) Phenylephrine (Sudafed PE) and Oxymetazoline (afrin)
Limit use of ____________________ to three consecutive days due to rhinitis medicamentosa (RM)
Oxymetazoline (Afrin nasal spray)
Pseudoephedrine (Sudafed D):
1) MOA
2) Why are there purchase limits on this drug?
1) Direct binding and displacement of norepinephrine from storage vesicles in prejunctional nerve terminals (tachyphylaxis can develop as stored neurotransmitter is depleted)
2) Reduce illegal methamphetamine manufacturing
1) True or false: pseudoephedrine (Sudafed D) is found in solo and combination products
2) Who should the use of pseudoephedrine be limited in? What’s the exception?
1) True
2) Pts w. hypertension (HTN); if blood pressure is under control, may use 30 mg tablets at lowest frequency possible for 3 days
1) Pseudoephedrine (Sudafed D) causes increased risk of HTN when combined w what 3 types of drugs?
2) Pseudoephedrine (Sudafed D) can increase risk of tachycardia when combined w what drugs?
1) Linezolid, MAOIs & ergot derivatives
2) SNRIs (bc they increase adrenergic activity)
1) What do antihistamines compete with? What does this prevent?
2) What is the MOA of second-generation antihistamines?
1) Histamine at central and peripheral histamine type 1 (H1) receptor sites, preventing the histamine receptor interaction and subsequent mediator release
2) Inhibit the release of mast cell mediators; may decrease cellular recruitment
Give 3 examples of first gen antibiotics
1) Diphenhydramine (Benadryl)
2) Chlorphenamine
3) Doxylamine (Unisom)
1) Why are first gen antihistamines more sedating? Explain.
2) Adverse effects associated with cholinergic blockage (like by 1st gen antihistamines) include what?
1) More anticholinergic, antiserotonin, and anti–alpha-adrenergic effects
-Highly lipophilic molecules that readily cross the blood–brain barrier
2) Dryness of the eyes and mucous membranes (mouth, nose, vagina), blurred vision, urinary hesitancy and retention, constipation, and reflex tachycardia
Diphenhydramine muscarinic receptor antagonism will cause anticholinergic effects such as what?
1) Dry mouth
2) Blurry vision
3) Constipation
4) Urinary retention (rarely)
Clozapine is a _____________ agonist and produces lots of __________.
muscarinic; saliva
1) What is the MOA of Intranasal corticosteroids to aid in symptoms of colds, allergic rhinitis and cough?
2) Give 3 examples of medications in this group
1) Inhibit multiple cell types and mediators (i.e. phospholipase A), including histamine, and effectively stop the “allergic cascade”
2) Budesonide (Rhinocort), fluticasone (Flonase), triamcinolone (Nasacort)
Describe the adverse effects of intranasal corticosteroids (short term and long term)
1) Epistaxis
2) Long-term use has been linked to: changes in vision, glaucoma, cataract formation, increased risk of fungal infections, and growth inhibition in children
Why should you avoid concomitant use of intranasal corticosteroids with protease inhibitors?
May lead to Cushing’s syndrome (rapid weight gain, obesity, facial hirsutism and swelling)
1) Colds, allergic rhinitis and cough can be treated with cromolyn sodium, which is a ____________ stabilizer
2) This blocks the influx of calcium into mast cells, thereby preventing _____________ and ________________ release
1) mast cell
2) degranulation; leukotriene
What medication must be administered one week prior to exposure of allergens and takes two weeks to work for perennial rhinitis?
Cromolyn sodium
Give 2 examples of antitussives
1) Codeine (Cheratussin AC [codeine 10mg / guaifenesin 100 mg / 5 mL])
2) Dextromethorphan (Robitussin or Delsym)
Codeine (Cheratussin AC [codeine 10mg / guaifenesin 100 mg / 5 mL]):
1) Describe its MOA
2) Why can it be unpredictable? Explain the risks assoc. w this.
3) Why is there a black box warning?
1) Acts centrally on the medulla to increase the cough threshold
2) CYP 2D6 polymorphisms lead to unpredictable clinical response and potential toxicity in affected persons. Poor metabolizers may not benefit from codeine. Extensive metabolizers are at increased risk for sedation and respiratory depression.
3) Black box warning for codeine includes the risk of serious, life-threatening, or fatal respiratory depression and the risk of opioid addiction, abuse, and misus
Codeine (Cheratussin AC [codeine 10mg / guaifenesin 100 mg / 5 mL])
1) Describe its drug interactions
2) Explain how it can be abused
1) CYP2D6 inhibitors bupropion, fluoxetine & paroxetine
-Reduce effect of codeine because codeine is a prodrug
2) Codeine syrup containing the antihistamine promethazine hydrochloride (Rx only), when mixed with soft drinks and/or alcohol and sometimes candy (common street names include “purple drank,” “sizzurp,” “syrup,” and “lean”)
1) Explain the MOA of Dextromethorphan (Robitussin or Delsym).
2) Is it addictive?
1) Noncompetitively antagonizes N-methyl-D-aspartate (NMDA) and glutamate-induced excitation and excitotoxicity in the CNS and spinal regions
2) D-isomer of the codeine analog of levorphanol – no analgesic or addictive properties
Dextromethorphan (Robitussin or Delsym):
1) CYP2D6 inhibitors bupropion, fluoxetine & paroxetine have what interaction?
2) What else does it interact with?
1) May decrease dextromethorphan metabolism, increasing the psychoactive effects of dextromethorphan
2) SSRIs & MAOIs: May increase the risk of serotonergic (psychoactive) effects of dextromethorphan
Give 3 examples of expectorants
1) Mucinex: Guaifenesin
2) Mucinex D: guaifenesin and pseudoephedrine
3) Mucinex DM: guaifenesin and dextromethorphan
Guaifenesin (Mucinex):
1) How does it work as an expectorant?
2) Large doses of this agent, either alone or in combination with _____________ or _____________, have been associated with development of ___________________.
1) Loosens and thins lower respiratory tract secretions, making minimally productive coughs more productive
2) ephedrine or pseudoephedrine; renal calculi
1) What is the first line of defense when treating colds, allergic rhinitis and cough during pregnancy?
2) What is the preferred first line nasal decongestant if there is severe congestion in pregnancy?
1) Intranasal cromolyn
2) Oxymetazoline
Colds, allergic rhinitis and cough during pregnancy:
1) ______________ during the first trimester has been associated with minor malformations (e.g., inguinal hernia, congenital hip dislocation)
2) Pseudoephedrine has been linked to what in newborns?
3) ACOG says do not use _______________ during the first trimester
1) Phenylephrine
2) abdominal wall defects (gastroschisis)
3) pseudoephedrine
1) What are the two preferred antihistamines for pregnant pts?
2) What else can be used in this scenario?
1) Diphenhydramine (severe symptoms + antitussive effect) and chlorpheniramine (mild/mod)
2) Second generation antihistamines (eg, loratadine and cetirizine)
INCS (intranasal corticosteroids) are considered compatible with pregnancy, but systemic use of these drugs is associated with what?
Cleft lip and palate and low birth weight
Colds, allergic rhinitis and cough during lactation:
1) Is pseudoephedrine compatible? Explain
2) What two things are probably compatible?
3) What’s contraindicated?
1) Yes, just may decrease milk production
2) Intranasal cromolyn and INCS (intranasal corticosteroids)
3) Antihistamines
Colds, allergic rhinitis and cough during pregnancy:
1) True or false: in general, avoid long-acting or max dose products
2) True or false: Dextromethorphan, guaifenesin, benzocaine, camphor (topical), and menthol (topical) each carry a low risk of birth defects and have been found to be compatible with breastfeeding
1) True
2) True
Differentiate between heartburn and dyspepsia
1) Hearburn: Acidic stomach contents regurgitate through lower esophageal sphincter and stimulates mucosal chemoreceptors
2) Dyspepsia: orginiating from stomach / duodenal area
1) What are some alarm symptoms in pts with heartburn?2) True or false: dyspepsia and heartburn are treated with the same things
1) Dysphagia, odynophagia, vomiting, GI bleeding, and unexplained weight loss
2) True
Dyspepsia & heartburn:
1) List symptoms of dyspepsia
2) What is the onset of antacids? What is their MOA?
3) What are they made of?
1) Persistent postprandial fullness, early satiation, epigastric pain, and epigastric burning
2) 5 minutes; buffering agents
3) Different mixtures of sodium bicarbonate, calcium carbonate, aluminum hydroxide, magnesium hydroxide & bismuth subsalicylate
Dyspepsia & heartburn; list the adverse effects of the following treatments and when to avoid each:
1) Magnesium
2) Aluminum
3) Calcium
4) Sodium bicarb
1) Diarrhea; avoid if CrCl < 60 mL / min
2) Constipation; avoid chronic use for patients with renal failure
3) Calcium; renal calculi possible if preexisting renal impairment
4) Sodium bicarbonate; alkalosis possible if preexisting renal impairment
Although drug interactions aren’t a major concern without renal issues for antacids, what are they?
Doxycycline, ciprofloxacin, levofloxacin and others can cause chelation via divalent cations (e.g., Ca2+ or Mg2+):
List potential ways to treat dyspepsia/ heartburn and the onset times of each
1) Antacids: 5 mins
2) Histamine Type 2 Receptor Antagonist (H2RA): 30-45 mins
3) Proton Pump Inhibitors (PPI): 60 mins to several days for full effect
Histamine Type 2 Receptor Antagonist (H2RA) for dyspepsia/ heartburn:
1) Onset
2) MOA
3) Two examples
1) 30 – 45 minutes
2) Inhibiting histamine on the H2 receptor of the parietal cell (site of HCl production)
3) Cimetidine (Tagamet) & Famotidine (Pepcid)
Histamine Type 2 Receptor Antagonist (H2RA) for dyspepsia/ heartburn:
1) Which one of these was removed from marked due to N-nitrosodimethylamine (NDMA)?
2) Which one of these can have an antiandrogenic effect (decreased libido, impotence, or gynecomastia in men)?
3) What does Cimetidine inhibit? What does this cause an interaction with?
1) Ranitidine (Zantac)
2) Cimetidine
3) CYP450 1A2, 2C19
-Phenytoin, warfarin, amiodarone, clopidogrel, nifedipine, theophylline, tricyclic antidepressants, opioids and others
Proton Pump Inhibitors (PPI) for dyspepsia/ heartburn:
1) Onset
2) MOA
3) Examples
4) Example by Rx only
1) Onset – 60 minutes … make take several days for full efficacy
2) Inhibits hydrogen potassium ATPase (the proton pump), thereby irreversibly blocking the final step in gastric acid secretion
3) Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid)
4) Pantoprazole (Protonix), others
Proton Pump Inhibitors (PPI) for dyspepsia/ heartburn:
1) What infection is it associated with?
2) What are pts with ascites secondary to cirrhosis are at an increased risk of?
3) Long-term and multiple daily dose may be associated with an increased risk for what?
1) Clostridium difficile infection
2) Spontaneous bacterial peritonitis
3) Osteoporosis-related fractures of the hip, wrist or spine
Proton Pump Inhibitors (PPI) for dyspepsia/ heartburn:
1) What does omeprazole inhibit?
2) What does this cause interaction with?
1) CYP2C19
2) Citalopram, clopidogrel, warfarin, tacrolimus, mycophenolate and others
1) True or false: Take all heartburn / dyspepsia meds on an empty stomach
2) Explain your answer
1) True
2) Increasing the pH of the stomach will cause lots of drug interactions
-Azoles, protease inhibitors, fluoroquinolones, thyroxine, digoxin and others
What lifestyle modifications can help treat heartburn/ dyspepsia?
Weight loss, elevate head of bed 6 – 8 inches, avoid eating 2 – 3 hours before bed, Mediterranean diet, symptom diary and smoking cessation
1) What are the pediatric recommendations for treating heartburn/ dyspepsia?
2) Why is bismuth subsalicylate not recommended?
1) Age: 2–12: calcium carbonate
-Age: 12–17: antacids and H2RAs
2) Reye syndrome
1) What are the 3 steps to treating dyspepsia/ heartburn in pregnancy?
2) What should be avoided when treating these while pregnant?
1.Lifestyle modifications 2.Calcium antacids 3.H2RAs
2) Avoid PPIs – needs more safety data to recommend
List 5 & define ways to treat constipation
1) Polyethylene glycol 3350 (Miralax): Hyperosmotic
2) Wheat dextrin (Benefiber): Fiber supplement
3) Docusate (Colace): Emollient (aka stool softener)
-very effective
4) Magnesium citrate: Saline laxative
5) Bisacodyl (Dulcolax): Simulant laxative
Describe the MOA of Miralax
- Miralax will increase alimentary canal osmolality > 300 mOsm
- Water will diffuse into alimentary canal to equalize hyperosmotic state
- Results in relief of constipation
What is the first step to treating diarrhea?
Rehydration
How can you pharmacologically treat diarrhea? (2 ways, list each MOA).
Which one has potential for abuse?
1) Loperamide (Imodium): Peripheral mu opioid agonist
-Potential for abuse
2) Bismuth subsalicylate (Pepto-Bismol): Antisecretory antidiarrheal effects
1) What medication treats Pin worms (E. vermicularis)?
2) What’s its MOA? Describe.
3) How are the worms removed?
4) Describe who it’s appropriate for and dosing
1) Pyrantel pamoate (Pin-X)
2) Depolarizing neuromuscular agent that stimulates the release of acetylcholine and inhibits cholinesterase, thereby paralyzing adult worms in the gastrointestinal (GI) tract
3) Paralyzed adult worms loosen their hold on the intestinal wall and are subsequently passed out in the stool
4) OTC labeled for two years and up, 2 kinds based on weight
Ophthalmic meds:
1) List 5 decongestant products
2) List 2 second generation/ mast cell stabilizing products
1) Phenylephrine, naphazoline, oxymetazoline, tetryzoline, brimonidine
2) Olopatadine, Ketotifen
1) What medication treats excess cerumen?
2) What are two ways to treat excess water in ear?
3) What do both have in common
1) Carbamide peroxide 6.5% in anhydrous glycerin (Debrox)
2) Isopropyl alcohol 95%; anhydrous glycerin 5% (Swim-Ear Drops)
3) Glycerin
Atopic dermatitis
1) Define and describe this condition
2) What is going on in the body to cause this?
3) What medication treats it? What should you counsel pts about this med?
1) Eczema in which the skin is chronically scaly, erythematous, edematous, papular, and crusty
2) Atopic skin is inflamed owing to overexpression of cytokines (the interleukins IL-4 and IL-13) and chemokines produced by T-helper 2 cells
3) Hydrocortisone 1%: topical corticosteroid
-Limit use to two weeks with a week off
1) Define xerosis
2) How is it treated?
1) Dry skin
2) Moisturizers: creams, ointments and lotions
Define acne
Multifactorial disorder of pilosebaceous glands
List 4 medications to treat acne and their MOAs
1) Adapalene (Differin Gel): Retinoid
2) Benzoyl peroxide 2.5 – 10%: Keratolytic and antibacterial properties
3) Salicylic acid 0.5 – 2%: Comedolytic, inhibits ultraviolet B (UVB) radiation–induced formation of “sunburn cells”
4) Sulfur 3 – 10%: Keratolytic and antibacterial properties
Acne medications:
1) Which may cause irritation at first and takes 6 – 12 weeks for results?
2) Which can bleach clothing?
3) What concentration of salicylic acid is used?
1) Adapalene (Differin Gel)
2) Benzoyl peroxide
3) 0.5 – 2%
List and define the two medications to treat photoaging
1) Glycolic acid: Alpha hydroxy acid
2) Retinol: Vitamin A derivative
-Can use Differin Gel, however efficacy studies are based on tretinoin 0.5% cream
What are the two ways to minimize scarring? Specify which is preferred
1) Silicon sheets or gels: preferred
2) Vitamin E liquid: Can find as a liquid or can puncture a vitamin E capsule
1) What is another name for Tinea pedis? Describe this condition
2) Name, define, and describe a dermatologic disorder involving the hands/ feet that likely needs an Rx to treat
1) Athlete’s foot; fissuring, scaling, or maceration in the interdigital spaces; malodor; pruritus; and/or a stinging sensation on the feet
2) Tinea unguium: nail infection
Thick, rough, yellow, opaque, and friable nails
-Terbinafine (Rx)
1) What is another name for tinea corporis? Describe its presentation
2) What is tinea capitis? Does it need an Rx to treat?
1) Ring worm; most often, lesions which involve glabrous (smooth and bare) skin, begin as small, circular, erythematous, scaly areas
2) Four clinically different fungal infections of the head
-Yes, griseofulvin (Rx)
List the 3 OTC medications that can be used to treat tinea pedis/ tinea corporis. Describe their MOAs.
1) Clotrimazole & miconazole: Inhibits the biosynthesis of ergosterol and other sterols and by damaging the fungal cell wall membrane, thereby altering its permeability and resulting in the loss of essential intracellular elements
2) Tolnaftate: Allylamine antifungal agent that inhibits squalene epoxidase, a key enzyme in fungal sterol biosynthesis
Which drug formulation would you recommend for tinea pedis? Cream or spray?
Spray
1) What are warts?
2) What are 2 ways to treat them? Describe each.
1) HPV infection of the basal keratinocytes
2) -Salicylic acid: 17 – 40%
-Cryotherapy: nitrous oxide, dimethyl ether and propane
Alopecia:
1) How is it treated topically?
2) What is this med’s MOA?
3) Explain how it works
4) Does it affect hemodynamics? Explain.
1) Minoxidil 2 – 5% (Rogaine)
2) Vasodilator
3) Increases cutaneous blood flow, promotes and maintain vascularization of hair follicles, and directly stimulates follicular hypertrophy
4) No effect on hemodynamics reported in clinical trials due to limited absorption into systemic circulation
Pediculosis humanus capitis (Lice):
What two medications kill lice? What are their MOAs?
1) Permethrin 1% (Nix): acts on the nerve cell membrane to disrupt the sodium channel current by which the polarization of the membrane is regulated
2) Ivermectin 0.5% (Sklice): opens glutamate-sensitive chloride channel currents in helminths
-Approved OTC in 2020
1) What is cyanocobalamin also called? What two things can it treat?
2) Reduction of neural tube defects is associated with what?
3) Calcium and vitamin D both aid in the prevention of what condition?
1) Vitamin B12; macrocytic anemia and decreased intrinsic factor (age > 50 or taking metformin)
2) B12 (folic acid)
3) Osteoporosis
1) True or false: Vitamin D should no longer be dosed in IU (international units) … but it still is
2) What form of vitamin D is Rx? Which is OTC?
1) True
2) Ergocalciferol (D2) is Rx and cholecalciferol (D3) is OTC
1) What is iron also called? What does it treat?
2) What is vitamin E used topically for?
1) Iron ferrous sulfate; microcytic anemia
2) Scar minimization
What two OTC heart meds can aid in hypercholesteremia? Describe their MOAs
1) Red yeast rice: molecular structure similar to statins
2) Niacin (Vitamin B3): NAD & NADP precursor for mitochondrial redux reactions
OTC heart meds:
1) What is the MOA of Coenzyme Q10? What is it used for?
2) What is fish oil? What is it used for?
1) Rate-limiting cofactor in mitochondrial adenosine triphosphate (ATP) formation
-Reduction of statin-associated adverse effects
2) Omega-3 fatty acids DHA / EPA
-Hypertriglyceridemia and inflammatory conditions
OTC brain meds:
1) Gingko biloba has what kind of properties? What is it used for?
2) What is melatonin? What can it treat?
1) Neuroprotective properties
-Alzheimer’s disease (AD), vascular dementia, attention-deficit/hyperactivity disorder (ADHD), tardive dyskinesia, intermittent claudication, tinnitus, acute mountain sickness, and age-related macular degeneration
2) Hormone and potent antioxidant produced by the pineal gland
-Insomnia and jetlag
OTC brain meds:
1) Hypericum perforatum flower is also called what? What is it used for?
2) Valeriana officinalis (Valarian root) is used for what two things?
1) St. John’s wort; depression, anxiety and OCD
2) Insomnia and anxiety
OTCs of abuse:
1) What is Kava? What may it cause?
2) What is Kratom? What properties does it have?
3) Cannabis sativa is used for what? Why?
1) Piper methysticum, a ceremonial tranquilizer for Pacific Islanders
-Severe liver damage
2) Mitragyna speciosa: psychoactive with both stimulant and opioid-like effects
3) Everything??? Use proliferated after passage of the 2018 Farm Bill
What 4 OTCs are used to prevent and treat colds & may decrease duration of infection?
1) Echinacea
2) Sambucus nigra (elderberry)
3) Vitamin C (ascorbic acid)
4) Zinc
1) What are probiotics used for?
2) What is preferred by gastroenterologist? Name 2.
1) GI flora restorations
2) Refrigerated products; Florajen (≈$30) and VSL (≈$60)
1) What are the many things glucosamine and chondroitin do?
2) What condition do they help with?
1) Stimulates chondrocytes to produce cartilage and synoviocytes to produce synovial fluid and hyaluronic acid, inhibits matrix metalloproteinase, and modulates activities of inflammatory cytokines; also serves as “building blocks” for cartilage
2) Osteoarthritis
OTC genitourinary:
1) What is the MOA of saw palmetto? What is it used for?
2) What is Black cohosh? What 3 things is it used for?
1) Inhibits 5-alpha-reductase and cytosolic androgen receptor
2) Cimicifuga racemose; premenstrual syndrome, dysmenorrhea, and menopause
1) Evening primrose oil is also called what? What’s it used for?
2) Drug interactions are mostly likely to occur with ________________ and ________________
1) Oenothera biennis; PMS and menopause
2) Antidepressants and blood thinners
United States Pharmacopeia is responsible for what standards?
Sterile and non-sterile compounding standards
-USP 795, 797, 800 guidelines
Can cranberry juice treat or prevent a urinary tract infection?
Possibly, has antibiotic properties
True or false: Narcan and Opill were approved for OTC use in 2023
True
