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Pharm 452: Self-Care > OTC drugs > Flashcards

Flashcards in OTC drugs Deck (98)
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1

α-galactosidase

Route: Oral

Category: Miscellaneous GI gas product

Uses: GI gas (due to producing food)

Key Points:

Take with first bite of food

Caution in diabetics

Avoid patients with galactosemia

Possible allergic reaction for patients with allergy to mold

2

Acetaminophen

Brand name: Tylenol

Route: Oral

Category: Analgesic Antipyretic

Uses: Cold and flu, Dysmenorrhea, Headache, Fever, Pain

Key Points:

FDA max of 4,000 mg per day (some manufactures 3,000 mg per day max)

Avoid in patients consuming 3 or more alcoholic beverages per day or with liver damage

May cause very serious skin rashes (rare)

Pregnancy: Human data suggests low risk

Breastfeeding: Compatible

Pediatric dosing 10 to 15 mg/kg/dose Q4H to Q6H PRN

*Do not exceed 5 doses in 24 hours (maximum daily dose 75mg/kg/day not to exceed 4 grams daily)

*If age less than 2 or weight less than 24 pounds, consult pediatrician

3

Activated charcoal

Route: Oral

Category: Miscellaneous GI gas product

Uses: GI gas

Key Points:

Questionable efficacy, may be better for reducing smell

May be alternative to simethicone

No dosing in children age less than 12

4

Adapalene

Route: Topcial

Category: Acne

Product Uses: Acne

Key Points:

Acne may worsen in 1st week May take 12 to 18 weeks for full effect Increases sun sensitivity, use sunscreen

Redness, scaling, and burning diminish after 1st month

5

Aluminum acetate

Route: Topical

Category: Astringent

Uses: Contact dermatitis (weeping)

Key Points:

Dries and constricts tissue

Has antimicrobial effects May be combined with antifungal for treatment of tinea pedis (athlete's foot)

6

Aluminum hydroxide

Route: Oral

Category: Antacid

Uses: Dyspepsia, GERD, Heartburn

Key Points:

Starts to work within 15 to 30 minutes (liquid faster than tablets)

Diarrhea

Avoid in acute kidney disease

7

Antazoline

Route: ophthalmic

Category: Antihistamine (1st gen)

Uses: Allergic conjunctivitis

Key Points:

Limit OTC use to 3 days

Contraindicated in patients with glaucoma

May be combined with ophthalmic decongestant for improved efficacy

8

Aspirin

Route: Oral

Category: Analgesic, Antipyretic Salicylate

Uses: Cold and flu, Dysmenorrhea, Headache, Fever, Pain

Key Points:

Avoid in children and teenagers due to risk of Reyes Syndrome

Take with food Risk of ulcer (increased in patients consuming 3 or more alcoholic beverages daily)

May cause upper GI discomfort

Do not use if patient has history of GI bleed

Avoid enteric coated version in patients wanting immediate relief

Watch dose: 81 mg is for heart protection only

9

Bacitracin, polymyxin B

Route: Topical

Category: Antiseptic

Uses: Atopic dermatitis Infection prevention

Key Points:

Preferred over neomycin since some patients are sensitive to neomycin

10

Benzocaine

Route: Topical

Category: Anesthetic

Uses: Canker sores Pain and itching due to vulvovaginal candidiasis

Key Points:

For canker sores, apply a small amount up to four times daily

FDA recommends AGAINST use for teething pain and in children under age 2 Rare but serious condition (methemoglobinemia)

Treatment of vulvovaginal candidiasis should be focused on curing the infection with vaginal antifungal rather than masking symptoms with benzocaine

11

Benzoyl peroxide

Route: Topical

Category: Acne product

Uses: Acne

Key Points:

Avoid in very sensitive skin Increases sun sensitivity, use sunscreen

Start low (2.5%) to minimize side effects; increase if desired results not achieved and patient tolerates treatment

Full benefit may take 4 to 6 weeks

Several potential drug interactions

12

Bisacodyl

Route: Oral

Category: Laxative (stimulant)

Uses: Constipation

Key Points:

May cause abdominal cramping due to mechanism of peristalsis stimulation

Often produces bowel movement in 6 to 12 hours

13

Bismuth

Route: Oral

Category: Salicylate

Uses: Diarrhea, Dyspepsia, Nausea

Key Points:

Avoid in children and in patients with renal failure

May cause stool and tongue to turn black

Risk of salicylate toxicity, neurotoxicity with extended use

Not recommended in children under 12

Drug interaction with warfarin

14

Budesonide

Route: Intranasal

Category: Corticosteroid

Uses: Allergic conjunctivitis, Allergic rhinitis 

Key Points:

May start at full dose and titrate down

Works best after at least 1 week of continued therapy

Budesonide, fluticasone, and triamcinolone may be used in children** but approved age varies by product

**Although OTC products for allergies exist for pediatric patients, patients under age 12 should first be evaluated by PCP (chance of having asthma) 

15

Caffeine

Route: Oral

Category: Diuretic

Uses: Water retention (due to menses)

Key Points:

Most women do not experience any true sodium or water retention and do not experience weight gain

Swelling and bloating are caused by a fluid shift

May cause nervousness, tachycardia, insomnia

16

Camphor

Route: Oral

Category: Antitussive, Counterirritant

Uses: Cough

Key Points:

Vapors stimulate sensory nerve endings causing local anesthetic sensation

Little clinical evidence

Toxic if swallowed (4 tsp of 5% camphor)

For topical formulations, use on intact skin only, wash hands after applying, and do not apply heat

Do not use in patients age less than 2

17

Capsaicin

Route: Topical

Category: Counterirritant

Uses: Musculoskeletal pain

Key Points:

Decreases nerve impulses by depleting substance P

Use on intact skin only, wash hands after applying, and do not apply heat

18

Carbamide peroxide

Route: Otic

Category: Effervescent debriding agent

Uses: Excessive cerumen (ear wax)

Key Points:

Place 5 to 10 drops in ear canal, allow it to remain for several minutes

Cerumen remaining after treatment may be removed with gentle, warm water irrigation, administered with otic bulb syringe

May be repeated daily for up to 4 days

19

Cetirizine

Route: Oral

Category: Antihistamine

Uses: Allergic conjunctivitis, Allergic rhinitis Congestion (due to cold or flu)

Key Points:

Less sedation and less anticholinergic than 1st generation antihistamine

Cetirizine still causes some drowsiness (~10% of patients)

Should not be used OTC in pregnant or lactating patients

Brand Name: Zyrtec

20

Chlorpheniramine

Route: Oral

Category: Antihistamine (first generation)

Uses: Allergic conjunctivitis, Allergic rhinitis, Allergic dermatitis, Congestion (due to cold or flu) Contact dermatitis

Key Points:

Highly lipophilic molecule that readily crosses the blood‐brain barrier (causing sedation)

Side effects include drowsiness, dizziness, urinary retention, constipation, blurred vision, tachycardia, dry eyes, dry mouth, dry nose, dry vagina

Do not use in pregnancy, lactation, premature infants, glaucoma, geriatric patients, patients with enlarged prostate, and patients on MAOI’s

21

Cimetidine

Route: Oral

Category: H2 Histamine receptor antagonist (H2RA)

Uses: Dyspepsia, GERD, Heartburn

Key Points:

Onset within 1 hour and lasts 6 to 12 hours May cause drowsiness, dizziness, headache, nausea May take PRN prior to known food triggers

Only for use in age 12 or older

Limit continual use to 14 days OTC Many drug interactions and may cause gynecomastia and impotence

22

Codeine

Route: Oral

Category: Cough (non-productive)

Uses: Works centrally on the medulla to increase the cough threshold

Key Points:

Schedule V controlled substance

Available behind the counter without a prescription in some states

Avoid with benzos, opiates, alcohol, and sedating products

Usually in combination products: review active ingredients

Risk for abuse

23

Cromolyn

Route: Oral

Category: Mast cell stabilizer

Uses: Allergic conjunctivitis, Allergic rhinitis

Key Points:

Mast cell stabilizer

Approved for age 2 and older as well as pregnant patients

Works best if started 3 to 7 days prior to allergen exposure

Works best after 2 to 4 weeks of continued therapy

24

Cyclizine

Route: Oral

Category: Antihistamine (first generation)

Uses: Motion sickness, Nausea

Key Points:

May cause drowsiness (or paradoxical stimulation)

Avoid other sedating agents (meds, alcohol, etc)

Products are approved for children, but approved age varies by product

Do not use OTC for pregnant patients

25

Dextromethorphan

Route: Oral

Category: Antitussive

Uses: Cough (non-productive)

Key Points:

Safety and efficacy not established in children

Should not be taken within 14 days of a MAOI

Risk for abuse (phencyclidine‐like euphoric effect)

Overdose: confusion, excitation, nervousness, restlessness, drowsiness, and severe nausea and vomiting

Respiratory depression possible with high doses

26

Dimenhydrinate

Route: Oral

Category: Antihistamine (first generation)

Uses: Motion sickness, Nausea

Key Points:

May cause drowsiness (or paradoxical stimulation)

Avoid other sedating agents (meds, alcohol, etc)

Products are approved for children, but approved age varies by product

Do not use OTC for pregnant patients

27

Diphenhydramine

Route: Oral

Category: Antihistamine (first generation) Antitussive Sedative

Uses: Allergic conjunctivitis, Allergic rhinitis, Congestion (due to cold or flu), Cough (due to post nasal drip), Insomnia

Key Points:

Brand Name: Benadryl Highly

lipophilic molecule that readily crosses the blood‐brain barrier (causing sedation)

Side effects include drowsiness, dizziness, urinary retention, constipation, blurred vision, tachycardia, dry eyes, dry mouth, dry nose, dry vagina

Do not use in pregnancy, lactation, premature infants, glaucoma, geriatric patients, patients with enlarged prostate, and patients on MAOI’s

For cough, works centrally on the medulla to increase cough threshold

28

Docosanol

Route: Topical perioral

Category: Antiviral

Uses: Cold sores

Key Points:

Apply at the first sign of an outbreak, 5 times a day until lesion is healed, max 10 days

Reduces healing time by 1 day over placebo

Systemic treatment (prescription acyclovir) is superior to OTC docosanol

Apriva 

29

Docusate

Route: Oral

Category: Emollient (stool softener)

Uses: Constipation

Key Points:

Lubricates and softens the stool

Available as docusate sodium or docusate calcium (no clinical difference)

Do not use under 6 years old

Used with stimulant for long term opiate use (pushy with the mushy for OIC)

Slow acting (may take several days for effect)

30

Doxylamine

Route: Oral

Category: Antihistamine (first generation), Sedative

Uses: Insomnia

Key Points:

Highly lipophilic molecule that readily crosses the blood‐brain barrier (causing sedation)

Side effects include drowsiness, dizziness, urinary retention, constipation, blurred vision, tachycardia, dry eyes, dry mouth, dry nose, dry vagina

Do not use in pregnancy, lactation, premature infants, glaucoma, geriatric patients, patients with enlarged prostate, and patients on MAOI’s

31

Esomeprazole

Route: Oral

Category: Proton pump inhibitor (PPI)

Uses: GERD, Heartburn

Key Points:

Take 30 minutes before morning meal

Limit duration of OTC treatment to 14 days Long term use, especially in higher doses, may increase risk for GI infections and may increase risk for lower bone density

32

Famotidine

Route: Oral

Category: H2 Histamine receptor antagonist (H2RA)

Uses: Dyspepsia, GERD, Heartburn

Key Points:

Onset within 1 hour and lasts 6 to 12 hours

May cause drowsiness, dizziness, headache, nausea

May take PRN prior to known food triggers Only for use in age 12 or older

Limit continual use to 14 days OTC

33

Fexofenadine

Route: Oral

Category: Antihistamine (second generation)

Uses: Allergic conjunctiviti,s Allergic rhinitis, Congestion (due to cold or flu)

Key Points:

Less sedation and less anticholinergic than 1st generation antihistamines

Should not be used OTC in pregnant or lactating patients

Brand name: Allegra

34

Fluticasone

Route: Intranasal

Category: Corticosteroid

Uses: Allergic conjunctivitis, Allergic rhinitis

Key Points:

May start at full dose and titrate down

Works best after at least 1 week of continued therapy Budesonide, fluticasone, and triamcinolone

may be used in children** but approved age varies by product

**Although OTC products for allergies exist for pediatric patients,

patients under age 12 should first be evaluated by PCP

35

Glycolic acid

Route: Topical

Category: Acne product

Uses: Acne

Key Points:

Less effective than benzoyl peroxide

There are several contraindications to glycolic acid peels including open wounds (cold sores, acne cysts, etc) and history of dermatologic conditions (psoriasis, atopic dermatitis, rosacea, etc)

36

Glycerin

Route: rectal suppository

Category: Laxative (hyperosmotic)

Uses: Constipation

Key Points:

In addition to hyperosmotic effect, also works through direct rectal irritation

Available for all age groups

Often produces bowel movement in 15 to 30 minutes

37

Glycerin, Xylitol, Sorbitol

Route: Oral Rinse

Category: Artificial saliva Use as needed

Uses: Xerostomia (dry mouth)

Key Points:

Use as needed Often needed at least after meals and at bedtime

Brand name: Biotene

38

Guaifenesin

Route: Oral

Category: Expectorant (protussive)

Uses: Cough (productive)

Key Points:

Loosens and thins lower respiratory secretions making cough more productive

FDA approved for symptomatic relief of acute, ineffective, productive cough; but, use is NOT endorsed by American College of Chest Physicians (ACCP)‐2006 Guidelines

NOT indicated for chronic cough associated with COPD, emphysema, smoking

39

Hydrocortisone

Route: Topical

Category: Corticosteroid

Uses: Allergic dermatitis, Atopic dermatitis, Dry skin, Scaly dermatoses, Hemorrhoids

Key Points:

Vasoconstrictor and antipruritic

Avoid on cracked or open skin

Do not apply to face

Avoid use on large areas

May cause skin discoloration

40

Ibuprofen

Route: Oral

Category: Analgesic, Antipyretic, Nonsteroidal anti-inflammatory drug (NSAID)

Uses: Cold and flu, Dysmenorrhea, Headache, Fever, Pain

Key Points:

Brand Names: Motrin, Advil

Take with food Risk of ulcer (increased in patients consuming 3 or more alcoholic beverages daily)

May cause GI discomfort Do not use if pt has history of GI bleed

Adult max OTC dose = 400mg per dose

Pediatric dosing = 5 to 10 mg/kg/dose Q8H PRN

If age less than 2 years or weight less than 24 pounds, consult pediatrician

Not recommend for: Pts > 75 years; pts with HTN or on BP medication

41

Isopropyl alcohol in anhydrous glycerin

Route: Otic

Category: Drying agent

Uses: Water clogged ear

Key Points:

Combination of alcohol and glycerin reduces moisture in the ear without over drying

42

Ketotifen

Route: Ophthalmic

Category: Antihistamine, Mast cell stabilizer

Uses: Allergic conjunctivitis

Key Points:

OTC use to 3 days

Contraindicated in patients with glaucoma

Action is improved because it also has mast cell stabilizer functions

43

Lactase enzyme

Route: Oral

Category: Lactase replacement

Uses: GI gas (due to lactose intolerance)

Key Points:

Indicated for use by patients with lactose intolerance when they are consuming dairy products

Symptoms of lactose intolerance include pain, diarrhea, or flatulence after consuming dairy

Take with dairy containing foods to prevent gas formation

44

Lansoprazole

Route: Oral

Category: Proton pump inhibitor (PPI)

Uses: GERD, Heartburn

Key Points:

Take 30 minutes before morning meal

Limit duration of OTC treatment to 14 days

Long term use, especially in higher doses, may increase risk for GI infections and may increase risk for lower bone density

45

Levocetirizine

Route: Oral

Category: Antihistamine (second generation)

Uses: Allergic conjunctivitis, Allergic rhinitis, Congestion (due to cold or flu)

Key Points:

Less sedation and less anticholinergic than 1st generation antihistamines

Should not be used OTC in pregnant or lactating patients

46

Levonorgestrel

Route: Oral

Category: Emergency contraception

Uses: Emergency contraception

Key Points:

OTC available for all ages

Take within 72 hours of intercourse (may recommend up to 120 hours ) 1 tablet method (1.5 mg) preferred for compliance and simplicity 2 tablet method (0.75 mg per tab) may be taken 2 tabs at once or spaced apart by 12 hours

If patient vomits within 1 to 2 hours of taking the dose, she should repeat the dose (nausea common side effect)

Will not affect an implanted embryo or increase the risk of malformations

47

Lidocaine

Route: Topical

Category: Anesthetic

Uses: Musculoskeletal pain, Sunburn

Key Points:

American Academy of Dermatology recommends against use of lidocaine for sunburn

Apply to less than 1% of body surface area (size of a hand)

Rare but serious condition (methemoglobinemia)

48

Loperamide

Route: Oral

Category: Synthetic opioid agonist

Uses: Diarrhea

Key Points:

Instructions: 2 caplets at onset followed by 1 caplet after each loose bowel movement (max 8 caplets daily)

Do not use when abdominal distention is present

Occasional dizziness and constipation may occur

Not approved in children under 6 due to risk of toxic megacolon

Do not use OTC for more the 2 days

49

Loratadine

Route: Oral

Category: Antihistamine (second generation)

Uses: Allergic conjunctivitis, Allergic rhinitis, Congestion (due to cold or flu)

Key Points:

Less sedation and less anticholinergic than 1st generation antihistamines

Should not be used OTC in pregnant or lactating patients

Brand name: Claritin

50

Magnesium citrate

Route: Oral

Category: Laxative (saline)

Uses: Constipation

Key Points:

Causes rapid bowel evacuation

Do not use rectal products in children under age 2

Do not use oral products in children under age 5

Caution in renal disease

Contraindicated in patients with ostomy or congestive heart failure

51

Magnesium hydroxide

Route: Oral

Category: Antacid, Saline laxative

Uses: Constipation, Dyspepsia, GERD, Heartburn

Key Points:

Starts to work within 15 to 30 minutes (liquid faster than tablets)

Diarrhea

Caution in renal disease

52

Meclizine

Route: Oral

Category: Antihistamine (first generation)

Uses: Motion sickness, Nausea

Key Points:

May cause drowsiness (or paradoxical stimulation)

Avoid other sedating agents (meds, alcohol, etc)

Products are approved for children, but approved age varies by product

Do not use OTC for pregnant patients

53

Menthol

Route: Topical

Category: Antitussive, Counterirritant

Uses: Cough, Musculoskeletal pain

Key Points:

Vapors stimulate sensory nerve endings causing local anesthetic sensation

Little clinical evidence

Menthol may decrease effects of warfarin

For topical formulations, use on intact skin only, wash hands after applying, and do not apply heat

Do not use in patients age less than 2

54

Methenamine & sodium salicylate

Route: Oral

Category: Antimicrobial and analgesic

Uses: Urinary tract infection

Key Points:

Decreases pain associated with urination

Patients with UTI may not be treated OTC

Urinary analgesics may be started OTC for no more than 2 days, while patient is concurrently seeking primary care

Methenamine is an antimicrobial, but does not have sufficient evidence for use in UTI

55

Mineral oil

Route: Oral or enema

Category: Laxative (lubricant)

Uses: Constipation

Key Points:

Do not use under 6 years old

Avoid oral formulation in elderly and pediatric patients due to risk for aspiration pneumonia

Oral formulation may inhibit nutrient absorption resulting in vitamin deficiency

56

Moisturizers

Route: Topical

Category: Moisturizer

Uses: Dry Skin

Key Points:

Ingredients include: urea, lactic acid, and alpha- hydroxy acids

Helps skin retain moisture

Apply frequently and within 1-3 minutes of bathing

57

Minoxidil

Route: Topical

Category: Vasodilator

Uses: Androgenetic alopecia

Key Points:

2% strength for women

5% strength for men

Does not cure alopecia, needs to be used indefinitely

May take several months to show improvement

If no improvement after 4 to 6 months, stop using

AVOID: Pregnant women should not handle

58

Naphazoline

Route: Ophthalmic

Category: Decongestant

Uses: Allergic conjunctivitis

Key Points:

Limit OTC use to 72 hours

Extended use may cause rebound congestion and may cause drying of eyes resulting in ocular irritation

59

Naproxen

Route: Oral

Category: Analgesic, Antipyretic, Antitussive, Nonsteroidal anti-inflammatory drug (NSAID)

Uses: Cold and flu Cough (due to post nasal drip), Dysmenorrhea, Fever, Headache, Pain

Key Points:

Brand Name: Aleve

Take with food

Risk of ulcer (increased in patients consuming 3 or more alcoholic beverages daily)

May cause GI discomfort

Do not use if patient has history of GI bleed

Not recommend for: Pts > 75 years; pts with HTN or on BP medication

60

Nicotine (gum)

Route: Gum

Category: Nicotine Replacement Therapy

Uses: Smoking cessation

Key Points:

Dosed based off time in the morning until first cigarette If first cigarette less than 30 minutes after waking, start with 4 mg. If first cigarette greater than 30 minutes after waking, start with 2mg

Chew piece of gum very slowly several times, stop chewing at first sign of peppery taste or tingling; park gum between cheek and gum; resume chewing when taste or tingle fades, repeat process until taste or tingle does not return

Do NOT eat or drink for 15 minutes before or while using nicotine gum

May be combined with nicotine patch

 

Call 1-(800)-QUIT-NOW for referal, ASK, ADVISE, REFER 

61

Nicotine (lozenge)

Route: Lozenge

Category: Nicotine replacement therapy

Uses: Smoking cessation

Key Points:

Dosed based off time in the morning until first cigarette If first cigarette less than 30 minutes after waking, start with 4 mg. If first cigarette greater than 30 minutes after waking, start with 2mg

Place in mouth and allow to dissolve slowly;

Do not chew or swallow lozenge; rotate to different areas of the mouth

Do NOT eat or drink for 15 minutes before or while using nicotine lozenge

May be combined with nicotine patch

1 Pack of cigs = 20 cigs

62

Nicotine (patch)

Route: Patch

Category: Nicotine replacement therapy

Uses: Smoking cessation

Key Points:

Dosed based off number of cigarettes smoked per day If patient smokes 10 or more cigarettes per day, start with step 1 (21mg patch).

If patient smokes less than 10 cigarettes per day, start with step 2 (14 mg)

Apply to a clean, dry, hairless area of skin on the upper body or upper outer part of arm

Apply to different area each day and do not use same area again for at least 1 week

Remove patch after 24 hours, wash hands after applying, do not cut patch

May remove at night if patient experiences nightmares

63

Nizatidine

Route: Oral

Category: H2 Histamine receptor antagonist (H2RA)

Uses: Dyspepsia, GERD, Heartburn

Key Points:

Onset within 1 hour and lasts 6 to 12 hours

May cause drowsiness, dizziness, headache, nausea

May take PRN prior to known food triggers

Only for use in age 12 or older

Limit continual use to 14 days OTC

64

Non-medicated ophthalmic gels, ointments &; solutions

Route: Oral

Category: Ophthalmic lubricant

Uses: Dry eye

Key Points:

Viscosity comparison (Ointments > Gels > Solutions)

Blurred vision comparison (Ointments > Gels > Solutions)

Dosing frequency comparison (Solutions > Gels > Ointments)

Ophthalmic Solutions: Preservative free versions are more expensive and easily contaminated, but may cause less burning and irritation

Also known as "Artificial Tears"

65

Omeprazole

Route: Oral

Category: Proton pump inhibitor (PPI)

Uses: GERD, Heartburn

Key Points:

Take 30 minutes before morning meal Limit duration of OTC treatment to 14 days Long term use, especially in higher doses, may increase risk for GI infections and may increase risk for lower bone density

66

Oxymetazoline

Route: ophthalmic; intranasal

Category: Decongestant

Uses: Allergic conjunctivitis (ophthalmic), Allergic rhinitis (intranasal), Congestion due to cold or flu (intranasal)

Key Points:

Limit OTC use to 3 days

May be used in combination with antihistamines

Extended use may cause rebound congestion and may cause drying of eyes resulting in ocular irritation

Use with caution in children, older adults, and patients with cardiovascular history

Contraindicated in patients using MAOI’s

67

Pamabrom

Route: Oral

Category: Diuretic

Uses: Water retention (due to menses)

Key Points:

Most women do not experience any true sodium or water retention and do not experience weight gain.

Swelling and bloating are caused by a fluid shift

68

Permethrin

Route: Topical

Category: Pediculicide

Uses: Head lice

Key Points:

Apply after shampooing hair with warm water and towel drying Leave on for 10 minutes and then rinse out

Retreatment in 7 to 10 days is only required if active lice are still detected

69

Phenazopyridine

Route: Oral

Category: Urinary analgesic

Uses: Urinary tract discomfort (due to UTI)

Key Points:

Decreases pain associated with urination

Patients with UTI may not be treated OTC Urinary analgesics may be started OTC for no more than 2 days, while patient is concurrently seeking primary care

May turn urine redish in color

70

Pheniramine

Route: Ophthalmic

Category: Antihistamine

Uses: Allergic conjunctivitis

Key Points:

Limit OTC use to 3 days Contraindicated in patients with glaucoma

May be combined with ophthalmic decongestant for improved efficacy

71

Phenylephrine

Route: intranasal and ophthalmic

Category: Decongestant

Uses: Allergic conjunctivitis (ophthalmic), Allergic rhinitis (intranasal), Congestion due to cold or flu (intranasal)

Key Points:

Limit OTC use to 3 days

May be used in combination with antihistamines Use with caution in children, older adults, and patients with cardiovascular history

Contraindicated in patients using MAOI’s May cause stimulant effects (increased HR, increased BP, insomnia)

Nasal and ophthalmic decongestants have less systemic absorption and less systemic side effects than oral

72

Phosphorylated carbohydrate solution

Route: Oral

Category: Hyperosmotic

Uses: Dyspepsia

Key Points:

Reduces smooth muscle contraction

Max of 5 doses

Higher doses my cause diarrhea

73

Polyethylene glycol 3350

Route: Oral

Category: Laxative (hyperosmotic)

Uses: Constipation

Key Points:

Not absorbed via GI tract

Approved for adults only

74

Protectants

Route: Topical

Category: Protectants

Uses: Diaper dermatitis, Dry skin, Eczema

Key Points:

Ingredients include: white petrolatum, zinc oxide, lanolin, cornstarch

Apply liberally (too much is just enough)

Avoid "double dipping" (Don't contaminate)

75

Pseudoephedrine

Route: Oral

Category: Decongestant

Uses: Allergic rhinitis, Congestion (due to cold or flu)

Key Points:

May cause stimulant effects (increased HR, increased BP, insomnia)

Use with caution in children, older adults, and patients with cardiovascular history

May be used in combination with antihistamines

Contraindicated in patients using MAOI’s

Brand Name: Sudafed

76

Bulk Forming Laxatives

Route: Oral

Category: Bulk Forming Laxatives

Uses: Constipation, Diarrhea

 Key Points:

Ingredients include: psyllium, calcium polycarbophil, methylcellulose, wheat dextran

ADA recommends 25 grams per day for women and 38 grams per day for men

Increase fiber slowly to avoid stomach upset, flatulence, and diarrhea

Usually takes 3 to 5 days to relieve constipation

Psyllium fiber may work best for both constipation and diarrhea

77

Pyrantel pamoate

Route: Oral

Category: Antihelminthic

Uses: Pin Worm

Key Points:

90% to 100% cure rate

Dose is 5mg/lb (max dose is 1000mg)

Treat all family members age 2 and up OTC

Patients and family members under age 2 require treatment by PCP

If still symptomatic after 2 weeks, retreatment required by PCP

78

Pyrethrins

Route: Topical

Category: Pediculicide

Uses: Head lice, Pubic lice Key

Points:

Apply to dry hair, leave on for 10 minutes and then rinse out

Repeat application after 9 days

Do not use if allergic to pyrethrin's, chrysanthemums, or ragweed

79

Ranitidine

Route: Oral

Category: H2 Histamine receptor antagonist (H2RA)

Uses: Dyspepsia, GERD, Heartburn

Key Points:

Onset within 1 hour and lasts 6 to 12 hours

May cause drowsiness, dizziness, headache, nausea

May take PRN prior to known food triggers

Only for use in age 12 or older Limit continual use to 14 days OTC

80

Resorcinol

Route: Topical

Category: Acne product

Uses: Acne

Key Points:

May cause reversible, dark spots on darker skinned individuals

81

Salicylic acid

Route: Topical

Category: Acne product

Uses: Acne

Key Points:

Used for hyperpigmentation

Contraindicated in patient with diabetes and in patients with poor blood circulation

Potential hypersensitivity reactions

Several potential drug interactions

82

Salicylic acid 17% and 40%

Route: Topical

Category: Miscellaneous

Uses: Warts

Key Points:

Common warts 17% Plantar warts 40%

Apply petrolatum (protectant) on non-wart area to protect healthy skin

Treatment Duration: 12 weeks

83

Scaly Dermatoses Treatment

Route: shampoo

Category: Scaly dermatoses treatment

Uses: Scaly dermatoses

Key Points:

Ingredients include: pyrithione zinc, selenium sulfide, ketoconazole, salicylic acid, sulfur, coal tar

Frequently formulated as medicated shampoo’s

Apply and leave on for 3 to 5 minutes before rinsing

Coal tar may discolor hair and clothing

84

Sennosides

Route: Oral

Category: Laxative (stimulant)

Uses: Constipation

Key Points:

May cause abdominal cramping due to mechanism of peristalsis stimulation

Often produces bowel movement in 6 to 12 hours

May discolor urine (pink) Contraindicated with rectal bleeding or pregnancy

85

Simethicone

Route: Oral

Category: Miscellaneous GI gas product

Uses: GI gas

Key Points:

Reduces surface tension of gas bubbles causing them to coalesce and be eliminated

Take if symptoms of gas to aid in gas removal

Not absorbed, no known side effects or interactions

Brand name product Mylicon approved for use in infants

GAS-X

86

Sodium phosphate

Route: Oral or Enema

Category: Laxative (saline)

Uses: Constipation

Key Points:

Causes rapid bowel evacuation

Do not use rectal products in children under age 2

Do not use oral products in children under age 5

Caution in renal disease

Contraindicated in patients with ostomy or congestive heart failure

87

Sulfur

Route: Topical

Category: Acne Product

Uses: Acne

Key Points:

Drying to skin Slight odor

88

Sunscreen

Route: Topical

Category: Protectant

Uses: Sunburn prevention

Key Points:

Sunscreen NOT Sunblock Apply 30 minutes prior to sun exposure and reapply every 2 hours

Encourage patients to use generously SPF 50+ is the max (Does not provide significantly more coverage than SPF 30) SPF 15 or higher can claim to reduce skin cancer

Physical sunscreen: Zinc oxide and/or titanium dioxide (better for pts with sensitive skin)

Chemical sunscreen: Oxybenzone, avobenzone, octisalate, octocrylene, homosalate and octinoxate (easier to spread)

89

Tetrahydrozoline

Route: Ophthalmic

Category: Decongestant

Uses: Allergic conjunctivitis

Key Points:

Limit OTC use to 72 hours

Extended use may cause rebound congestion and may cause drying of eyes resulting in ocular irritation

90

Topical Antifungals

Route: Topical 

Category: Anti Fungal

Uses: Clotrimazole, Miconazole, Terbinafine Tinea corporis (ringworm) Tinea cruris (jock itch) Tinea pedis (athlete's foot) Tolnaftate Tinea pedis (athlete's foot) Undecylenic Acid Tinea corporis (ringworm) Tinea pedis (athlete's foot)

Key Points:

Clotrimazole, Miconazole

Apply sparingly, twice daily for 2 to 4 weeks Terbinafine

Apply sparingly, twice daily for 1 to 4 weeks Tolnaftate

Apply sparinging, twice daily for 2 to 6 weeks.

May be used for treatment or prevention.

May cause stinging sensation when applied.

Undecylenic Acid Apply sparinging, twice daily for 4 weeks.

May be used for treatment or prevention

91

Topical Rectal Anesthetics

Category: Anesthetic (topical rectal)

Uses: Hemorrhoids

Key Points:

Ingredients include: benzyl alcohol, dyclonine, pramoxine, benzocaine, dibucaine, lidocaine, tetracaine

Block nerve transmission and decrease itching irritation, burning, and pain

Do not use on open wounds May cause allergic reactions

92

Topical Rectal Analgesics, Anesthetics, Antipruritics

Category: Analgesic, anesthetic, antipruritic

Uses: Hemorrhoids

Key Points:

Ingredients include: menthol, juniper tar, camphor

Counterirritants provide alternative stimulus (tingling, cool, warm etc)

Not indicated for internal hemorrhoids

93

Topical Rectal Vasoconstrictors

Category: Vasoconstrictor

Uses: Hemorrhoids

Key Points:

Ingredients include: ephedrine, epinephrine, phenylephrine

Shrink hemorrhoids and decrease swelling and irritation

May increase blood pressure (avoid OTC use in patients with cardiovascular diseases)

Do not use OTC in patients taking MAOIs or TCAs

Epinephrine is approved for external use only (not for internal use)

94

Topical Rectal Keratolytic

Category: Keratolytic

Uses: Hemorrhoids

Key Points:

Ingredients include: alcloxa, resorcinol Debriding agents

95

Topical Rectal Protectants

Category: Protectant

Uses: Hemorrhoids

Key Points:

Ingredients include: aluminum hydroxide gel, cocoa butter, glycerin, hard fat, kaolin, lanolin, mineral oil, white petrolatum, calamine, petrolatum, petrolatum, shark liver oil, zinc oxide, topical starch, cod liver oil

Provides a physical barrier to prevent irritation and promote healing

96

Triamcinolone

Route: intranasal

Category: Corticosteroid

Uses: Allergic conjunctivitis, Allergic rhinitis

Key Points:

May start at full dose and titrate down

Works best after at least 1 week of continued therapy Budesonide, fluticasone, and triamcinolone may be used in childre

** but approved age varies by product

**Although OTC products for allergies exist for pediatric patients, patients under age 12 should first be evaluated by PCP

97

Trolamine

Route: Topical

Category: Counterirritant

Uses: Musculoskeletal pain

Key Points: Vasodilates increasing blood flow

Use on intact skin only, wash hands after applying, and do not apply heat

98

Vaginal Antifungals

Category: Antifungal

Uses: Vulvovaginal candidiasis (yeast infection)

Key Points:

Products include clotrimazole, miconazole, and tioconazole Imidazole antifungals are equally effective between active ingredients (1 day, 3 day, and 7 day) 1 day formulation may shorten symptoms, but overall cure rate is the same as 3 day and 7 day May cause burning, itching and irritation when applied Tioconazole is more expensive than clotrimazole and miconazole