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WRAP UP > PHARM_OTC > Flashcards

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
Q

list all the side effects of anticholinergic antihistamines?

A 
cognitive dysfunction
hallucinations
insomnia
xerostomia
constipation
increased thirst
pupillary dilatation
seizures
heat stroke
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26
Q

list all the side effects you can think of for pseudoephedrine?

A 
hypertension
vasospasm
arrhythmia
stroke
seizures
hallucinations
insomnia
tremor
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27
Q

list the side effects for topical nasal decongestants like afrin, neosynephrine

A 
rhinitis medicamentosa (rebound congestion that happens after about 5-7 days of continuous use)
HTN
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28
Q

what are cautions/contra- for anticholinergic antihistamines?

A

closed-angle glaucoma

dementia

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29
Q

what are the drug interactions with the anticholinergic antihistamines?

A

antiparkinsonian drugs
TCA phenothiazines
oxybutynin (drug for urinary incontinence)

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30
Q

what are the drug interactions with pseudoephedrine?

A

beta blockers
digoxin
MAOIs

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31
Q

what are the cautions/contra- for pseudoephedrine?

A

CHD
HTN
DM
BPH (adrenergic stimulation causes contraction of urethral smooth muscle)
urinary retention
closed-angle glaucoma (adrenergic stimulation produces mydriasis)

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32
Q

what kind of drug is pseudoephedrine?

A

alpha adrenergic agonist that produces vasoconstriction

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33
Q

what is the recommended way to use topical decongestants?

A

use for less than 3 days to avoid rebound congestion ( turbinate hyperplasia may require surgical treatment), the long acting form is preferred

34
Q

how long should you use the acid reducers (H2 blockers) for?

A

less than 2 wks, not for pts under 12 y/o

35
Q

how long should you use acid reducers like PPIs?

A

less than 2 wks, not for pts under 18 y/o

36
Q

antidiarrheals are not for use if the diarrhea is accompanied by what or has blood or mucus in stool?

A

fever

37
Q

hayfever responds to _______ alone

A

antihistamine

38
Q

pts taking dextromethorphan that are deficient in CYP2D6 may experience what adverse effects?

A

rapid acute toxicity

In excess: dry mouth & throat, tachycardia, warm feeling, inability to concentrate

39
Q

what happens to pts who abuse dextromethorphan at about 5-10x normal dose?

A

PCP-like effects including depersonalization, disorientation, confusion, possibly addiction

40
Q

dextromethorphan combination products have ingredients that limit dosing like __________ or have toxicity like _____________

A

guaifenesin-oral expectorant that produces N/V/D & abd. pain in high doses
chlorpheniramine

41
Q

today cough and cold products are labeled only for those above what age?

A

6 y/o

42
Q

the majority of toxicity with cough and cold products in children occurs as a result of what?

A

unsupervised ingestion

43
Q

name some OTC products that contain ephedrine?

A

bronkotabs, primatene tabs

44
Q

name some OTC products that have epinephrine in them?

A

bronkaid, primatene mist

45
Q

name 6 common OTC products that affect blood pressure?

A 
ephedrine
epinephrine
ibuprofen
phenylephrine
pseudoephedrine
theophylline
46
Q

name some OTC products that contain theophylline?

A

asthmalixir

bronkotabs

47
Q

what are the 3 pharmacologic ways to modify stomach pH?

A
  1. neutralize pH with antacid
  2. use H2 blocker
  3. use PPI
48
Q

what are some of the adverse effects of antacids?

A

electrolyte imbalance
diarrhea
constipation
kidney stones

49
Q

what are some of the cautions/contraindications with antacids?

A

kidney stones
hypercalcemia
renal failure
CHF

50
Q

which h2 blocker is a CYP2C19 inhibitor?

A

cimetidine

51
Q

what are some of the adverse effects of h2 antagonists and PPIs?

A

headache
dizziness
constipation
diarrhea

52
Q

what are the cautions/contra- with use of H2 antagonists and PPIs?

A

cirrhosis
GI bleeding
renal failure

53
Q

omeprazole and lansoprazole both inhibit which CYP enzyme?

A

CYP2C19: possible interactionwith fluoxetine, diazepam, phenytoin

54
Q

name the opiate-like product that is used as an antidiarrheal drug

A

lopramide

55
Q

what are the adverse effects of loperamide?

A

electrolyte imbalance
fluid loss
dehydration
paralytic ileus

56
Q

what are the contra-/cautions with using loperamide?

A

cirrhosis & infectious diarrhea

57
Q

explain how use of bismuth subsalicylate can impact coagulation status?

A

inhibition of prostaglandins and inhibits platelet aggregation

58
Q

what are the side effects of bismuth subsalicylate?

A

discolored feces, discolored tongue, fecal impaction

59
Q

what are some of the cautions/contra- for bismuth subsalicylate?

A

anticoagulation, don’t use for infectious diarrhea

60
Q

abusers of anticholinergic drugs will display what classic symptoms?

A

symptoms of anticholinergic toxicity: such as dry mouth, dry skin, tachycardia, mydriasis, urinary retention, delirium, arrhythmia

61
Q

pts may abuse dyscylamine, cyclizine, chlorpheniramine, dimenhydrinate, diphenhydramine for what clinical effect?

A

these drug produce hallucinations & euphoria

62
Q

what kind of solvents are typically abused?

A

toluene
acetone
methylene chloride
ethyl acetate

63
Q

what kind of fuels are often abused?

A

butane
propane
octane boosters

64
Q

what kind of anesthetics are abused?

A 
ether
halothane
enflurane
ethyl chloride
N2O
65
Q

what kind of volatile alkyl nitrites are abused?

A

room odorizers

videotape head cleaners

66
Q

inhaling nitrites can have what clinical effects?

A 
vasodilation & smooth muscle relaxation
flushing
blurred vision
syncope
methemoglobinemia
67
Q

describe the immediate effects of abusing inhalants?

A

similar to onset of unconsciousness

68
Q

what are the usual causes of death due to inhalants?

A

cardiac arrhythmia
suffocation
aspiration

69
Q

what are some of the signs/symptoms of inhalant abuse?

A

Perioral/perinasal dermatitis (may look like contact hypersensitivity)
apathy, malaise, poor appetite
poor hygeine, weight loss, chronic fatigue
chemical breath odor

70
Q

what is the antidote for methemoglobinemia with the use of nitrites?

A

methylene blue

71
Q

what are some of the side effects of OTC constipation products like bisacodyl (dulcolax), or senna?

A

electrolyte imbalance

cathartic colon

72
Q

what are some of the side effects of magnesium hydroxide as an OTC constipation product?

A

electrolyte imablance

edema

73
Q

what are some of the cautions/contra- of magnesium hydroxide use as OTC to treat constipation?

A

renal failure

bone disease

74
Q

name 4 drugs/drug classes which have interactions with magnesium hydroxide/magnesium sulfate?

A

quinolones
azoles
thyroid drux
digoxin

75
Q

what is drug of choice for analgesia in children?

A

acetaminophen (avoid aspirin for risk of reye’s syndrome)

76
Q

decongestants are safe in children of what age?

A

over 6 y/o at the appropriate dose

77
Q

geriatric pts have crappy renal function which means they are susceptible to accumulation of what OTC anti-inflammatory drugs?

A

NSAIDs (watch out for kidney function and GI bleeds)

78
Q

which drug can worsen glaucoma and urinary retention, particularly in the elderly?

A

pseudoephedrine

79
Q

whats risk of using 1st gen. antihistamines with old people?

A

falling & fractures

80
Q

elderly people taking antihistamines may have what problems?

A

worsen asthma, narrow-angle glaucoma
prostatic enlargement
confusion, delirium, dizziness-falls

81
Q

pseuoephedrine use in the elderly may have interaction with what drugs?

A

beta-blockers
antidepressants
insulin
MAOIs

82
Q

elderly pts are more susceptible to adverse effects of GI drugs which may cause what problems?

A

diarrhea (Mg) or constipation (Aluminum)

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