Drug Quizz #1 OTC Flashcards
Acetaminophen
Trade Name:
Tylenol
Class:
Analgesic
Common Self-Care:
1. Pain, headache, fever
Self-Monitoring Parameters:
Decreased pain, fever. If fever does not resolve in 3 days or pain in 10 days, seek medical attention. Seek medical attention for severe skin rash, black tarry stools, and yellowing of eyes or skin.
Key Patient Counseling:
Do not exceed the maximum recommended daily dose; higher doses may result in hepatic injury, including severe hepatotoxicity and death. Avoid alcohol (<3 drinks/d), especially if use is chronic. Use the provided measuring device with individual products to reduce dosing errors. The infant and children’s formulation is the same strength (160 mg/5 mL).
Clinical Pearls:
Available in a wide range of prescription and OTC combination products; be aware of strength and total daily dose administered in various products. One of the most common agents in accidental and intentional overdoses and requires immediate medical attention. As little as 10 g of acetaminophen ingested can cause fatal hepatotoxicity. Activated charcoal is given to prevent absorption, and N-acetylcysteine, a sulfhydryl donor, is also used to replenish glutathione stores and reduce hepatotoxicity. FDA recommends HCP stop prescribing or dispensing prescription combination drug products that contain >325 mg acetaminophen per dosage unit.
Adapalene
Trade Names:
Differin
Class:
Retinoid
Antiacne
Common Self-Care Indication:
1. Acne vulgaris
Self-Monitoring Parameters:
Resolution of acne lesions and reduced redness of skin. If excessive dryness, irritation, or skin peeling occur, discontinue use temporarily (until symptoms resolve) and restart applying smaller amounts less often, or consider using a different formulation or select an alternative medication.
Key Patient Counseling:
Avoid contact with eyes, lips, angles of nose, and mucous membranes; do not apply on cuts, abrasions, eczematous, or sunburned skin. Wash, then dry hands and affected area prior to application. Other topical preparations/washes (sulfur, resorcinol, or salicylic acid) should not be used prior to using topical adapalene. A thin layer of product should be applied. Use of daily moisturizers may be necessary for relief of dry skin or irritation. Avoid products that can dry or irritate skin further. Adapalene causes sun-sensitivity. Avoid sun exposure and tanning beds. Protective clothing and application of sunscreen are recommended when sun exposure cannot be avoided. Cold temperatures or wind may also increase skin irritation during drug therapy. The redness, dryness, itching and burning associated with its use should diminish after the first month of therapy. Symptomatic improvement may not be seen for up to 12 wk.
Clinical Pearls:
Acne will worsen over first few weeks of use prior to improvement; continue use unless severe irritation occurs. Safety and efficacy have not been established in children <12 y of age. Other retinoic acid agents, both in topical (tretinoin) and oral (isotretinoin) formulations, are also available via prescription.
Alpha-d-galactosidase
Trade Name:
Beano
Class:
Antigas
Self Care Indication:
1. Intestinal gas, bloating, flatulens
Self-Monitoring Parameters:
Reduction in frequency and severity of bloating sensation and flatulence after meals containing legumes, fruit, and other products containing nondigestible complex carbohydrates.
Key Patient Counseling:
This product is most useful when used as a preventive measure for intestinal gas symptoms resulting from diets high in fiber or foods that contain oligosaccharides. Must administer dose before or with the first bite of food (up to 30 min after first bite) to ensure that the enzyme is present in the stomach before food is present. Do not cook or heat the product, as the enzyme will be deactivated. Can swallow, chew, or crumble the dose on food. Patients with diabetes should be aware of the increase in absorbable carbohydrates (additional 2-6 g of carbohydrates for every 100 g of food treated by Beano) that may raise blood glucose levels when taking this product with meals.
Clinical Pearls:
Evidence exists supporting the safety and efficacy of this product in children as young as 4 y of age. Consider nondrug options that may limit the amount of air swallowed (avoid smoking, carbonated beverages, gum chewing, sucking on hard candies). Use of a food diary may be helpful to pinpoint problematic foods, and avoid foods likely to increase intestinal gas such as onions, cabbage, bananas, whole grains, bran, dairy, etc. Use of simethicone is also an option, but limited evidence supports its efficacy.
Aluminum Acetate
Trade Name:
Domeboro powder
Burow solution
Certain-Dri
Class:
Astrigent
Self-Care Indication:
1. Pruritus
Self-Monitoring Parameters:
Improvement in skin irritation, pruritus, rash and other dermatologic symptoms. Seek medical attention for signs of severe dryness.
Key Patient Counseling:
Dissolve 1-3 packets of powder in 16 oz of warm water and stir to dissolve all powder. If Burow’s solution is used, provide instructions on dilution to 0.14-0.42%. Do not use diluents other than water. Soak clean, soft cloth in solution to create compress, or soak affected area in diluted solution. Discard unused solution, used compresses, and solution after use. A cream can be used following the solution to create an emollient effect if used for softening of the skin. Unlikely to cause any systemic adverse effects unless applied to large area of skin. Avoid contact with eyes and do not ingest by mouth. Do not use for >7 d. Roll-on: Do not use immediately after showering or bathing, or on irritated or broken skin. Use at bedtime under the arms and apply sparingly; 1-2 strokes to begin with. Use daily until perspiration is controlled, then every other day or as needed.
Clinical Pearls:
Should not be used on chicken pox, measles, or shingles. Avoid contact with eyes; if contact occurs, flush with copious amounts of clean water until irritation subsides. Do not ingest; contact poison control center if swallowed. Do not soak for >30 min to avoid overdrying. Do not cover wet compresses. Using commercial powder products, dissolving packets in 16 oz of water, 1 packet creates 0.14% solution, 2 packets create 0.28% solution, and 3 packets create 0.42% solution. Use least concentrated solution to achieve desired therapeutic effect. Roll-on: Allow skin to dry completely (5-10 min) to avoid discoloring clothing. May take several days for perspiration to stop. Keep away from eyes and out of the reach of children. Discontinue if rash develops or worsens.
Artificial Saliva
Trade Name:
Biotene
Salivart
Class:
Oral Lubricant
Self-Care indication:
1. Xerostomia (dry mouth)
Self-Monitoring Parameters:
Decreased symptoms and sensation if dry mouth. If any adverse effects occur, discontinue use and report concern to HCP.
Key Patient Counseling:
Patients should be advised to read the label of specific products to determine if the product is safe to ingest (vs “swish and spit” only). Appropriate dental care should be recommended if using acidic products and those containing sugars. Note some products including toothpaste may contain fluoride. Some liquid products and sprays must be shaken before use.
Clinical Pearls:
A recent Cochrane review finds that no topical therapy is clinically effective for the treatment of xerostomia, but individual patients may find temporary relief from the use of some products. These products do not cure xerostomia but can provide symptomatic relief. It is important that the patient maintain good oral hygiene. Some products have significant amounts of electrolytes including sodium, potassium, and magnesium, and should be used with caution in some patients (renal failure, low-sodium diet, etc). Patients requesting this product, particularly older adults, would benefit from a complete medical history and current med list to determine anticholinergic burden and opportunities for deprescribing.
Artificial Tears
Trade Name:
Systane
Isopto tears
Class:
Ocular lubricant
Self-Care indication:
Ocular dryness
Self-Monitoring Parameters:
Decreased symptoms and sensation of dry eyes. If any adverse effects occur, discontinue use and report concern to HCP. Contact HCP if changes in vision, eye pain, continued redness or irritation occur, or if the condition worsens.
Key Patient Counseling:
Patients should be instructed on the appropriate administration technique as it is estimated that >50% of patients have inappropriate administration technique. To avoid contamination, do not touch tip of container to any surface. Replace cap after using. Do not use if solution is cloudy or changes color. Patients using preservative-free products should be advised to discard unused portions of unit-dose packages. Some products contain preservatives such as benzalkonium, which may produce adverse reactions in some patients, but can extend the dosing interval. Contact lens wearers should avoid products containing preservatives.
Clinical Pearls:
While artificial tears are a mainstay of treatment of dry eyes, they do not address underlying causes of the symptom. Nonpharmacological interventions for dry eye (eg, warm compresses, good eyelid hygiene, punctal plugs, etc) are important for managing dry eye symptoms. Long-term contact lens wear and Lasik can contribute to dry eyes. Omega-3 fatty acids were shown to improve dry eye symptoms with oral supplementation. Patients should be advised to eliminate common environmental causes of dry eye (eg, use humidifier, stay out of dry, dusty conditions, wear eye protection, etc). Many prescription products (anti-inflammatory agents, cyclosporine, etc) are also available to treat dry eyes.
Aspirin
Trade Name: Baeyer
Class: Salicylate
Self-Care indication:
1. Fever, aches, pains, headaches
Self-Monitoring Parameters:
Decreased pain, fever. If fever does not resolve in 3 day or pain in 10 day, seek medical attention. Seek medical attention if severe skin rash, hematemesis, chest pain, yellowing of eyes or skin, or change in urination occur. Monitor for any signs of stomach bleeding including black tarry stools, vomiting of blood, or stomach pain that does not resolve.
Key Patient Counseling:
Avoid additional aspirin, NSAIDs, or aspirin-containing products during drug therapy, unless approved by HCP, particularly if history of GI disease. Avoid ≥3 alcoholic drinks/d, as risk of GI bleeds increases. Use should be discontinued temporarily in advance of dental procedures.
Clinical Pearls:
Aspirin is not recommended for children <16 y of age with a viral illness due to an increased risk of Reye syndrome and is generally not the treatment of choice in children. Low-dose aspirin reduces cardiovascular mortality and cancer incidence but increases the risk of major bleeding. Use of aspirin for primary prevention of myocardial infarctions or cancer is not typical self-care indications—use for these indications should be individualized and weighed against the risk of bleeding.
Bacitracin, Neomycin, Polymyxin B
Trade Name:
Neosporin
Class:
Topical Antibiotic
Self-Care indication:
1.Prevent infections in minor cuts, scrapes, and burns
Self-Monitoring Parameters:
For skin infections, improvement in erythema and pruritus usually occurs within 1-2 days. Seek medical attention if no improvement is seen after 1 wk of treatment. Discontinue use and seek medical attention if severe skin irritation or rash.
Key Patient Counseling:
For skin application, wash and dry area. Apply thin layer (size of fingertip) to affected area. May cover with sterile bandage. For external use only.
Clinical Pearls:
Read package labeling; dozens of products are named “Neosporin” and contain active ingredients other than bacitracin, neomycin, and polymyxin B. Assess patient for allergies; neomycin allergies are common. Recommend bacitracin and polymyxin B combination product in patients allergic to neomycin or if using for an extended period of time to reduce likelihood of contact dermatitis related to neomycin use.
Benzocaine Topical
Trade Names:
Anbesol
Cepacol
Class:
Local Anesthetic
Self-Care indication:
1. skin, mouth, throat, or gum pain, and throat pain.
Self-Monitoring Parameters:
Relief from pain. Seek medical attention if symptoms worsen after 2 days or not resolved after 7 days, if severe skin reaction, irregular heartbeat, symptoms of methemoglobinemia (shortness of breath, cyanosis, mental status changes) occur.
Key Patient Counseling:
Shake sprays well prior to use. Hold spray about 6 in from skin and spray for 1-3 s. Do not apply to broken skin or ingest topical products, may lead to systemic absorption and toxicity, particularly cardiac effects. Some formulations contain alcohol and are flammable. Caution on warnings and use on combination products that may contain other ingredients such as cough suppressants. Since topical anesthetics work for up to 1 h and can only be used 4 times/d, pain relief is not continuous and oral pain relievers such as acetaminophen or ibuprofen should be considered.
Clinical Pearls:
Methemoglobinemia and subsequent tissue hypoxia have been reported with higher concentrations, use in large areas of the body, children <6 mo of age, those with G6PD deficiency, those with COPD, asthma, and heart disease. Use lowest effective dose or consider topical lidocaine that does not have this effect. For children who are teething or have canker sores, try a refrigerated teething toy, massaging the gums with fingers, or a cold washcloth.
Benzoyl Peroxide
Trade Name:
Proactive
Class:
Antiacne
Self-Care indication:
Acne vulgaris
Self-Monitoring Parameters:
Resolution of acne lesions and reduced redness of skin. If excessive dryness, irritation, or skin peeling occurs, discontinue use temporarily (until symptoms resolve) and restart applying smaller amounts less often. If adverse symptoms continue, consider using a different benzoyl peroxide product (different manufacturer), a different formulation (cream, lotion, gel, etc), a lower concentration product, or discontinue use and select an alternative antiacne medication. Excessive irritation may be more common when using a combination product.
Key Patient Counseling:
Avoid sun exposure or use sunscreen. If using once daily, apply at bedtime. Wash affected area and/or shave 20 min before applying topical product to minimize irritation. Avoid contact with hair or clothing as bleaching may occur. If possible, eliminate mechanical causes of acne (contact with sports equipment such as headbands, chin straps, etc). Avoid application of cosmetics and other topical products that are comedogenic. Start treatment with lowest effective concentration (2.5% or 5%) and increase higher concentrations, if needed, to control acne.
Clinical Pearls:
Available in a wide range of OTC products with different excipients and inactive ingredients. Gel products are typically the most drying and produce the most skin irritation. If acne is not resolved with OTC products, various prescription antiacne products are available. Advise patients to use daily moisturizer and sunscreen as they may be more susceptible to sunburn.
Budesonide Nasal
Trade Name:
Rhinocort Allergy
Class:
Inhaled Corticosteroid
Self-Care indication:
Upper respiratory allergies
Self-Monitoring Parameters;
Improvement in nasal rhinitis symptoms. Seek medical attention for signs of severe fatigue, fast or irregular heartbeat, rash, or shortness of breath. While only small amounts of budesonide reach systemic circulation, bone mineral density and growth and rate of development in children should be monitored with long-term use. Routine ophthalmologic examinations should be performed. Monitor for signs and symptoms of adrenal suppression and infection.
Key Patient Counseling:
Avoid allergic triggers. Adults ≥12 y of age may reduce dose to 1 spray/nostril daily if symptoms improve. Children ≤12 y of age should be supervised by an adult. For administration, bottle must be primed and shaken well prior to first use or if it has not been used in >2 d; avoid spraying in face. Patients should clear nasal passages by blowing nose prior to use. Press against outside of 1 nostril to close off. Employ the “nose to the toes” technique of tilting the head slightly downward to avoid overspray into the esophagus while inhaling to avoid bad taste. Aiming the spray away from the nasal septum toward the ears slightly inserted into the nostril can help minimize irritation and nosebleeds. Medication may take 24-72 h to take full effect. Sniff gently as you pump the bottle. Do not blow nose for at least 15 min after use. Brief stinging or sneezing may occur immediately after use. Wipe nozzle with tissue and replace cap. Nozzle only can be cleaned with tap water if pump does not spray properly; follow included instructions. Should not be shared between multiple people to reduce spread of infection.
Clinical Pearls:
Injectable, oral inhalation, and topical dosage forms of budesonide also available by prescription for treatment of other allergic disorders. While oral antihistamines (either OTC or prescription) remain the mainstay for treatment of rhinitis, nasal steroids are a recommended option if symptoms are severe, unresolved with oral antihistamines, or if oral antihistamines cause undesirable adverse effects. Do not use for common cold.
Bisacodyl
Trade Name:
Dulcolax
Class:
Stimulant Laxative
Self-Care indication:
Constipation
Self-Monitoring Parameters:
Relief from constipation, or successful bowel evacuation in preparation for surgical or diagnostic procedure. Cramps and abdominal pain may occur; if severe, seek medical attention.
Key Patient Counseling:
To protect the enteric coating, do not chew, split, or crush tablet and do not administer within 1 hour of milk, any dairy product, or antacid-containing product. Neither formulation should be administered more than once daily. Lifestyle interventions (increasing exercise, intake of water [6-8 glasses/d] and dietary fiber, and toileting habits) are first-line management of constipation and should be tried before stimulant laxatives for chronic constipation.
Clinical Pearls:
Generally produces bowel movement within 15-60 min after rectal administration and within 6-12 h of oral administration. Not recommended for chronic use (PEG 3350 is preferred for chronic constipation due to more favorable safety profile). Due to mechanism of action, bisacodyl may not be effective in patients with spinal cord damage or paralysis due to polio infection.
Brimonidine
Trade Name:
Lumify
Class:
Adrenergic Agonist
Antiglaucoma Agent
Self-Care indication
Ocular redness
Self-Monitoring Parameters:
Resolution of ocular redness. Seek medical attention if symptoms not improved after 3 days, increased redness, or if changes in vision or eye pain occur.
Key Patient Counseling:
Ophthalmic use only. Do not use if solution is discolored or has particulates. Remove contacts prior to use; soft contact lens wearers should wait at least 10 min before putting their lenses in. Do not contaminate dropper tip or solution when placing drops in eyes; replace cap after each use. Wash hands before use. To administer, tilt your head back, pull down the lower eyelid to make a pouch, and place 1-2 drops in corner of eye without touching the bottle tip to your eye; look downward and gently close your eyes and hold for 1-2 min.
Clinical Pearls:
Higher concentrations are available by prescription for the treatment of open-angle glaucoma and ocular hypertension. Note that Lumify contains the preservative benzalkonium (BAK) chloride, and if patients require preservative-free eye drops, consider alternative treatment for ocular redness. Patients using multiple ocular products should wait at least 5 min between products. Other redness relievers (alpha-1 or alpha-1/alpha-2 agonists) commonly have rebound redness and tachyphylaxis, which is uncommon with Lumify (alpha-2 agonist).
Bismuth Subsalicylate
Trade Name:
Pepto-Bismol
Kaopectate
Class:
Antidiarrheal
Antacid
Self-Care indication:
1. Diarrhea, heartburn, nausea
Self-Monitoring Parameters:
Relief from diarrhea or heartburn. Constipation and abdominal pain may occur; if severe, seek medical attention.
Key Patient Counseling:
Oral rehydration therapy for mild, uncomplicated diarrhea must accompany treatment with bismuth subsalicylate. Shake suspension before use. Use measuring device provided with individual packaging. Tablets should be taken with 120-240 mL of water and can be chewed or dissolve in mouth. May experience tongue discoloration or stool discoloration. If tinnitus occurs, inform an HCP immediately.
Clinical Pearls:
Loperamide, with or without antibiotics, is preferred for treatment of traveler’s diarrhea. Limited evidence supports use of bismuth subsalicylate for prevention of traveler’s diarrhea. Included as a component of multiple-drug combinations as a treatment for Helicobacter pylori–associated peptic ulcer disease. Use with caution in patients with renal dysfunction, gout, diabetes, bleeding ulcers, hemorrhagic conditions (due to salicylate component). May precipitate gout attacks in patients with gout.
Black Cohoosh
Trade Name: Cimicifuga Racemosa Bugbane Black Snakeroot Rattle Weed Remifemin CimiPure
Class:
Hormonal Modulator
Self-Care indications:
Menopausal Symptoms
Self-Monitoring Parameters:
Seek medical attention if symptoms are severe or no improvement after 8 wk, signs of hepatotoxicity (eg, abdominal pain, dark urine, jaundice) or seizures.
Key Patient Counseling:
Advise patient that weight loss, smoking cessation, stress management, and avoiding alcohol can reduce frequency of vasomotor symptoms. Dress in layers. Lower the thermostat if possible and avoid spicy or hot (temperature) foods.
Clinical Pearls:
A recent Cochrane review concludes that no difference exists in efficacy or toxicity between placebo and black cohosh for the treatment of menopausal symptoms. Certain products have been shown to contain other ingredients or ingredients not listed on the label; use with caution. Short-term estrogen is the treatment of choice for management of menopausal symptoms. SSRIs and gabapentin are options in women with contraindications to estrogen (breast cancer or cardiovascular disease).
