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PHARM_OTC Flashcards

1
Q

who decides if a drug is OTC or prescription?

A

FDA’s Non-prescription Drug Advisory Committee (NDAC)

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2
Q

what are some the labeling requirements for OTC drugs?

A 
product name
active ingredients
purpose
uses
warnings
directions
other info-storage
inactive ingredients
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3
Q

in general consumers should avoid mixing ______ or prescription meds acting on the CNS and OTC drugs.

A

alcohol

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4
Q

name hidden drug in some cough/cold and mouthwashes

A

alcohol

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5
Q

name hidden drug in these OTC classes: analgesics, menstrual products, sleep aids

A

antihistamines

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6
Q

name hidden drug in antidiarrheals, cold/allergy drugs

A

aspirin or other salicylates

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7
Q

name hidden drug often seen with analgesics

A

caffeine

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8
Q

name hidden drug with analgesics, antacids, cough/cold drugs, laxatives

A

sodium

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9
Q

what is a hidden drug class often found in asthma products, hemorrhoidal products, analgesics and cough/cold/allergy products?

A

sympathomimetics

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10
Q

name some of the antidiarrheal OTC drugs

A

bismuth subsalicylate

loperamide

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11
Q

which antihistamine is most sedating of the 1st generation agents?

A

diphenhydramine

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12
Q

name two antitussive agents

A

dextromethorphan

codeine

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13
Q

name two topical decongestants

A

oxymetalozine
xylometazoline
(long acting preferred)

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14
Q

which decongestant is a methamphetamine precursor?

A

pseudoephedrine

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15
Q

Sleep aids (diphenhydramine, doxylamine) should be used for how long?

A

less than 2 weeks

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16
Q

which laxative is safest?

A

bulk formers (citrucel)

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17
Q

what is an OTC weight loss aid that used as part of diet/exercise plan and has recent concern for liver toxicity

A

orlistat (alli)

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18
Q

how do NSAIDs contribute to renal failure?

A

they inhibit formation of prostaglandins which are needed to vasodilate the renal arteries, also exacerbate renal failure

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19
Q

how do NSAIDs worsen gout?

A

inhibiting elimination of uric acid

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20
Q

how do NSAIDs precipitate asthma attacks?

A

shunt metabolites of arachidonic acid into leukotriene synthesis which has pro-inflammatory and bronchoconstriction

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21
Q

what is the leading cause of liver failure in the us?

A

acetaminophen poisoning

  • dosing instructions based on weight
  • use dosing device
  • never give >1 medicine with acetaminophen at a time
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22
Q

which class of OTC drugs can be used for motion sickness?

A

1st generation antihistamines like diphenhydramine and dimenhydrinate: they inhibit transmission of sensation from inner ear to the cerebellum by blocking H1 and muscarinic receptors

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23
Q

what happens if you push the dose too high with antihistamines?

A

you are going to get CNS effects

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24
Q

what are the 4 components to coricidin?

A
  1. chlorpheniramine (1st gen. antihistamine with mod. anti-muscrinic activity)
  2. pseudoephedrine (vasoconstriction)
  3. acetaminophen
  4. dextromethorphan (antitussive)
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25
list all the side effects of anticholinergic antihistamines?
``` cognitive dysfunction hallucinations insomnia xerostomia constipation increased thirst pupillary dilatation seizures heat stroke ```
26
list all the side effects you can think of for pseudoephedrine?
``` hypertension vasospasm arrhythmia stroke seizures hallucinations insomnia tremor ```
27
list the side effects for topical nasal decongestants like afrin, neosynephrine
``` rhinitis medicamentosa (rebound congestion that happens after about 5-7 days of continuous use) HTN ```
28
what are cautions/contra- for anticholinergic antihistamines?
closed-angle glaucoma | dementia
29
what are the drug interactions with the anticholinergic antihistamines?
antiparkinsonian drugs TCA phenothiazines oxybutynin (drug for urinary incontinence)
30
what are the drug interactions with pseudoephedrine?
beta blockers digoxin MAOIs
31
what are the cautions/contra- for pseudoephedrine?
CHD HTN DM BPH (adrenergic stimulation causes contraction of urethral smooth muscle) urinary retention closed-angle glaucoma (adrenergic stimulation produces mydriasis)
32
what kind of drug is pseudoephedrine?
alpha adrenergic agonist that produces vasoconstriction
33
what is the recommended way to use topical decongestants?
use for less than 3 days to avoid rebound congestion ( turbinate hyperplasia may require surgical treatment), the long acting form is preferred
34
how long should you use the acid reducers (H2 blockers) for?
less than 2 wks, not for pts under 12 y/o
35
how long should you use acid reducers like PPIs?
less than 2 wks, not for pts under 18 y/o
36
antidiarrheals are not for use if the diarrhea is accompanied by what or has blood or mucus in stool?
fever
37
hayfever responds to _______ alone
antihistamine
38
pts taking dextromethorphan that are deficient in CYP2D6 may experience what adverse effects?
rapid acute toxicity | In excess: dry mouth & throat, tachycardia, warm feeling, inability to concentrate
39
what happens to pts who abuse dextromethorphan at about 5-10x normal dose?
PCP-like effects including depersonalization, disorientation, confusion, possibly addiction
40
dextromethorphan combination products have ingredients that limit dosing like __________ or have toxicity like _____________
guaifenesin-oral expectorant that produces N/V/D & abd. pain in high doses chlorpheniramine
41
today cough and cold products are labeled only for those above what age?
6 y/o
42
the majority of toxicity with cough and cold products in children occurs as a result of what?
unsupervised ingestion
43
name some OTC products that contain ephedrine?
bronkotabs, primatene tabs
44
name some OTC products that have epinephrine in them?
bronkaid, primatene mist
45
name 6 common OTC products that affect blood pressure?
``` ephedrine epinephrine ibuprofen phenylephrine pseudoephedrine theophylline ```
46
name some OTC products that contain theophylline?
asthmalixir | bronkotabs
47
what are the 3 pharmacologic ways to modify stomach pH?
1. neutralize pH with antacid 2. use H2 blocker 3. use PPI
48
what are some of the adverse effects of antacids?
electrolyte imbalance diarrhea constipation kidney stones
49
what are some of the cautions/contraindications with antacids?
kidney stones hypercalcemia renal failure CHF
50
which h2 blocker is a CYP2C19 inhibitor?
cimetidine
51
what are some of the adverse effects of h2 antagonists and PPIs?
headache dizziness constipation diarrhea
52
what are the cautions/contra- with use of H2 antagonists and PPIs?
cirrhosis GI bleeding renal failure
53
omeprazole and lansoprazole both inhibit which CYP enzyme?
CYP2C19: possible interactionwith fluoxetine, diazepam, phenytoin
54
name the opiate-like product that is used as an antidiarrheal drug
lopramide
55
what are the adverse effects of loperamide?
electrolyte imbalance fluid loss dehydration paralytic ileus
56
what are the contra-/cautions with using loperamide?
cirrhosis & infectious diarrhea
57
explain how use of bismuth subsalicylate can impact coagulation status?
inhibition of prostaglandins and inhibits platelet aggregation
58
what are the side effects of bismuth subsalicylate?
discolored feces, discolored tongue, fecal impaction
59
what are some of the cautions/contra- for bismuth subsalicylate?
anticoagulation, don't use for infectious diarrhea
60
abusers of anticholinergic drugs will display what classic symptoms?
symptoms of anticholinergic toxicity: such as dry mouth, dry skin, tachycardia, mydriasis, urinary retention, delirium, arrhythmia
61
pts may abuse dyscylamine, cyclizine, chlorpheniramine, dimenhydrinate, diphenhydramine for what clinical effect?
these drug produce hallucinations & euphoria
62
what kind of solvents are typically abused?
toluene acetone methylene chloride ethyl acetate
63
what kind of fuels are often abused?
butane propane octane boosters
64
what kind of anesthetics are abused?
``` ether halothane enflurane ethyl chloride N2O ```
65
what kind of volatile alkyl nitrites are abused?
room odorizers | videotape head cleaners
66
inhaling nitrites can have what clinical effects?
``` vasodilation & smooth muscle relaxation flushing blurred vision syncope methemoglobinemia ```
67
describe the immediate effects of abusing inhalants?
similar to onset of unconsciousness
68
what are the usual causes of death due to inhalants?
cardiac arrhythmia suffocation aspiration
69
what are some of the signs/symptoms of inhalant abuse?
Perioral/perinasal dermatitis (may look like contact hypersensitivity) apathy, malaise, poor appetite poor hygeine, weight loss, chronic fatigue chemical breath odor
70
what is the antidote for methemoglobinemia with the use of nitrites?
methylene blue
71
what are some of the side effects of OTC constipation products like bisacodyl (dulcolax), or senna?
electrolyte imbalance | cathartic colon
72
what are some of the side effects of magnesium hydroxide as an OTC constipation product?
electrolyte imablance | edema
73
what are some of the cautions/contra- of magnesium hydroxide use as OTC to treat constipation?
renal failure | bone disease
74
name 4 drugs/drug classes which have interactions with magnesium hydroxide/magnesium sulfate?
quinolones azoles thyroid drux digoxin
75
what is drug of choice for analgesia in children?
acetaminophen (avoid aspirin for risk of reye's syndrome)
76
decongestants are safe in children of what age?
over 6 y/o at the appropriate dose
77
geriatric pts have crappy renal function which means they are susceptible to accumulation of what OTC anti-inflammatory drugs?
NSAIDs (watch out for kidney function and GI bleeds)
78
which drug can worsen glaucoma and urinary retention, particularly in the elderly?
pseudoephedrine
79
whats risk of using 1st gen. antihistamines with old people?
falling & fractures
80
elderly people taking antihistamines may have what problems?
worsen asthma, narrow-angle glaucoma prostatic enlargement confusion, delirium, dizziness-falls
81
pseuoephedrine use in the elderly may have interaction with what drugs?
beta-blockers antidepressants insulin MAOIs
82
elderly pts are more susceptible to adverse effects of GI drugs which may cause what problems?
diarrhea (Mg) or constipation (Aluminum)

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