Lecture 20: Misuse of OTC Drugs & Poisonings Flashcards

Question

Pseudoephedrine/Ephedrine

Answer 1

Used/abused for stimulant properties ○ Increases heart rate and BP, elevates mood, appetite suppression ● Normal dose: 120mg daily ephedrine

Answer 2

1450mg daily ephedrine

Answer 3

○ Sympathomimetics | ○ Structurally similar to norepinephrine

Answer 4

``` ● ALSO - used to make methamphetamine ● 2005 Combat Methamphetamine Epidemic Act ○ Led to restrictions on pseudoephedrine purchases (daily and monthly) ```

Answer 5

Used/abused for weight loss ○ Rare in typical population (0.7-5.5%) ○ High rate in population with anorexia/bulimia diagnosis (3-70%) ○ Stimulants are most commonly abused class

Answer 6

○ Used to stimulate bowel movements (purging)

Answer 7

○ Electrolyte imbalance | ○ Nutritional deficiencies

Answer 8

``` ○ UK just passed a law limiting sales ■ Retail outlets can sell to 18 and older ■ Pharmacists can sell for use in 12 and older ■ Additional warnings about abuse potential added to labelling ```

Answer 9

``` ● Keep drugs out of sight ● Question purchase of the medication ● Refusal to sell ● Referral to physician ● Counseling about abuse/misuse potential ```

Answer 10

● Challenges in identifying drug related problems ○ Lack of record-keeping with OTC medications ● Lack of widespread tracking or tracking between pharmacies ○ Pseudoephedrine is the exception with the 2005 Combat Methamphetamine Epidemic Act ● Other pharmacist tasks ○ How can technicians help?

Answer 11

``` ● Drug take-back programs ○ Partner with local sheriff’s office ○ Sell drug disposal products ○ Advertise for local events ● Educate parents and grandparents ● Health literacy ```

Answer 12

● Drugs that are available only after consultation with a pharmacist ○ No prescription required, but cannot be purchased OTC ● Has been reviewed by the FDA in the past → not currently a formal category in the U.S. ● Would allow a pharmacist to assess safety, efficacy, appropriateness ● Requires more training for pharmacists and technicians in order to offer the required assessment ● Proposed medications: codeine products, pseudoephedrine, diphenhydramine, statins, insulin

Answer 13

``` ● Poisonings are the #1 cause of injury death in the United States and a significant cause of morbidity ● Poisoning tends to be accidental in children ● Poisoning may be accidental or intentional in adults ○ Suicide attempt ○ Substance abuse ○ Medication misuse ● Exposure: ○ Ingestion ○ Topical ○ Inhaled ○ Bites/envenomation ```

Answer 14

○ Misunderstandings/confusion about use/misuse ○ Accidental overdose from using multiple APAP containing products ○ Intentional misuse - easy access

Answer 15

○ Knowyourdose.org ○ Convert children/infant doses to same concentration to prevent math errors ○ Highlight APAP ingredient on product labels

Answer 16

``` ● 24 hours sources of: ○ Poison information ○ Clinical toxicology consultation ○ Poison prevention education ● Staffed by pharmacists, nurses, physicians, PAs who have additional tox training ● Available for public or healthcare provider consultation ● Contact for assessment/treatment of poisonings OR for educational material ```

Answer 17

1-800-222-1222

Answer 18

``` ● 47.7% of reported cases are in children <6 ● Common non-RX products: ○ Analgesics ○ Cough/cold ○ Topical preparations ○ Vitamins ○ Antihistamines ● 70% of calls to Poison Control Centers can be managed at home ```

Answer 19

● Purpose: Protect children under 5 from accidental poisoning and death ● Legislated requirement for child-resistant closures (CRC) on possible poisons ● This has reduced the fatalities due to both RX and non-RX exposure

Answer 20

● Mouthwash containing ≥3g ethanol ● Aspirin ● Prescription and controlled medications

Answer 21

``` ○ ≥1g acetaminophen ○ ≥1g ibuprofen ○ ≥66mg diphenhydramine base ○ ≥0.045mg loperamide ○ ≥250mg elemental iron ○ ≥250mg naproxen ○ ≥14mg minoxidil ```

Answer 22

● “Designed or constructed to be significantly difficult for children under 5 to open or obtain a harmful amount of the contents within a reasonable amount of time” ● 80% of the children tested must not be able to open the package within 10 minutes ● Also tested in adults to make sure it can be opened: 90% of adults must be able to open within 5 minutes

Answer 23

● OTC brands may package one size with non-child resistant packaging ○ Must offer other sizes that are child resistant ● OTC exempted products must label: ○ “This package for households without young children” ○ “Package not child resistant” ● Individuals may request that prescriptions are not placed in child resistant packaging

Answer 24

● Presentation may vary depending on the drug ● May mimic side effect profile with normal use ○ Ibuprofen → nausea, vomiting, abdominal pain ○ Diphenhydramine → sedation, stimulation, tachycardia, hypertension, dry mouth, dilated pupils ● Others may have more widespread organ effects ○ Aspirin → GI, CNS, metabolic, CV, pulmonary, hematologic ● Signs/symptoms may be delayed ○ ER or enteric coated products may have delayed absorption ○ Delayed gastric emptying or slowed GI motility (diphenhydramine) ○ Metabolism to toxic metabolites (APAP)

Answer 25

First step: Determine if the patient has symptoms and if the exposure puts the patient at risk of toxicity ● Self-care treatment is ONLY appropriate if: ○ Exposure was unintentional ○ Toxicity risk is assessed to be minor

Answer 26

``` ● Intentional exposure/substance abuse ● Expected suicide or homicide ● Inadvertent exposure with moderate/severe toxicity risk ● Exhibiting life-threatening clinical effects (coma, convulsion, syncope) ○ Call 911 and transport to ER ● Suspected child abuse or elder abuse ● Debilitated or advanced age ● Absent or poor gag reflex ● CNS depression ```

Answer 27

``` ● Supportive care ○ Keep airway open ○ Fluids ● Prevent absorption ● Increase elimination ● Utilize antidotes ```

Answer 28

remove from source to fresh air

Answer 29

irrigation ○ Wash skin with soap and water (pay attention to nail beds and hair) ○ Use water/saline solution to irrigate eyes

Answer 30

○ Administering large amounts of fluids → may cause spontaneous vomiting ○ Some drugs may require fluid dosing ■ Bisphosphonates + esophageal irritation ■ Ibuprofen + renal injury ○ Avoid stimulating the gag reflex manually

Answer 31

○ Adsorbent | ○ Controversial use

Answer 32

Ipecac syrup ○ Emetic ○ Does not improve outcomes → avoid ○ Also not easily purchased

Answer 33

● Tasteless, gritty, fine, black, insoluble powder ● Large surface area so it’s a highly effective adsorbent ● As the ratio of activated charcoal to toxin increases, the proportion of bound toxin increases

Answer 34

``` ○ Lithium, potassium (highly ionized) ○ Alcohols ○ Hydrocarbons ○ Mineral acids ○ Heavy metals ○ Cyanide ``` ● Food in GI tract may effect efficacy

Answer 35

● Approved by the FDA for use as emergency antidote for ingested poison ● Home use should only include ONE DOSE ● Usual dose: 1g/kg

Answer 36

○ Premixed with water ○ Premixed with water + carboxymethylcellulose ○ Premixed with sorbitol (decreases GI transit time)

Answer 37

○ GI tract not anatomically or functionally intact ○ Bariatric surgery may require dose adjustments ○ High risk of aspiration ○ If the toxin does not adsorb to charcoal

Answer 38

● Products should be shaken vigorously prior to administration ● Some products may have flavoring agents to improve palatability ● Common ADRs: ○ Vomiting (12-20%) ○ Black stool

Answer 39

● Works best if administered quickly (works best within one hour) ● It is available as a non-RX drug ● Not typically found in most homes ● Not routinely recommended by a poison center ● Conclusion: it is relatively safe, but it is probably not something that people need or should be recommended to keep around their house due to its controversial place in practice and possibly limited efficacy (especially in selfcare situations)

Lecture 20: Misuse of OTC Drugs & Poisonings Flashcards

(63 cards)