OTC Exam 2 Flashcards
(309 cards)
1
Q
_____ deficiency may be a result of anticonvulsants
A
Calcium
2
Q
Supplementation with ____ and ____ in most patients taking anticonvulsants
A
Calcium
Vitamin D
3
Q
Exclusively breastfed infants require ______ of vitamin D daily
A
400 IU
4
Q
Older children who do not drink ______ of ___________ require vitamin D supplementation
A
4 cups
Vitamin D fortified milk
5
Q
Folic acid is also called
A
Vitamin B9
6
Q
Infants drinking less than ____ of baby formula require ______ daily
A
1 liter
Vitamin D
7
Q
_______ or _______ vitamin D is allowed in infants
A
Poly-vi-sol or generic
8
Q
How much calcium is in a cup (8 oz) of milk
A
300 mg
9
Q
How much folic acid should all women of childbearing age obtain
A
400 mcg/day
10
Q
How much folic acid should a pregnant person obtain
A
600 mcg/day
11
Q
What does folic acid help in pregnancy
A
Decrease birth defects of the brain/spinal cord (neural tube defects)
12
Q
How long before expected pregnancy should folic acid be consumed
A
1 month
13
Q
Patients should not exceed ____ of vitamin E
A
400 IU daily
14
Q
What does excessive intake of vitamin E cause
A
Cardiovascular risk
15
Q
4-6 months iron requirement
A
1 mg/kg/day
*not recommended if formula contains adequate iron
16
Q
Vitamin E interacts with ____ and increases ______
A
Warfarin
Bleeding risk
17
Q
0-4 months iron recommendation
A
Not required
18
Q
6-12 months iron requirement
A
11 mg/day (preferred from food)
19
Q
1-3 years iron requirement
A
7 mg/day (food preferred)
20
Q
Optimal calcium absorption occurs at an individual dose at _____
Anything higher than ____ will be taken in ______
A
500 mg or less
1000 mg
Divided doses
21
Q
Fat soluble vitamins
A
ADEK
22
Q
When should fat soluble vitamins be taken
A
With food
23
Q
What controls calcium absorption
A
Small intestine
24
Q
Vitamin B7
A
Biotin
25
Vitamin B1
Thiamine
26
Vitamin B3
Niacin
27
Vitamin B6
Pyridoxine
28
Vitamin B5
Pantothenic acid
29
Vitamin B2
Riboflavin
30
Vitamin B9
Folic acid
31
Vitamin B12
Cobalamin
32
What foods contain vitamin B12 and this can be an issue for what type of patients
Meat
Liver
Poultry
Dairy
Oysters
Clams
Issue for vegans
(DOC, My Liver Please)
33
What foods is magnesium found in
Whole grain cereals
Tofu
Legumes
Green vegetables
(Way To Go, Loser)
34
What foods contain phosphorus
Milk
Meat
Poultry
Seeds
Nuts
Egg yolk
(My Mom’s PENS)
35
What nutrients does amphotericin B deplete
Magnesium
Potassium
36
What nutrients does acetazolmide deplete
Calcium
Potassium
37
What foods contain zinc
Oysters
Shellfish
Liver
Beef
Lamb
Pork
Legumes
Milk
Wheat bran
(Learning Pharmacy BLOWS Lots)
38
What nutrients do antiepileptic drugs deplete
Calcium
39
Loop diuretics deplete was nutrient
Potassium
40
What nutrients are depleted by isoniazid
Vitamin B6
41
What nutrients are recommended for alcohol use disorder
Vitamin B1
Folate
42
Sulfamethoxazole depletes what nutrients
Folate
43
Methotrexate depletes what nutrients
Folate
44
Metformin depletes what nutrient
Vitamin B12
45
PPIs deplete what nutrients
Magnesium
Vitamin B12
46
Orlistat depletes what nutrients
Fat soluble vitamins
Beta carotene
47
Alcohol use disorder is recommended what nutrient
Vitamin B1
Folate
48
Golfer is recommended what nutrient
Iodine
49
Macrocyclic anemia is recommended what nutrient
Vitamin B12
Folate
50
Microcytic anemia is recommended what nutrient
Ferrous sulfate
51
Scurvy is recommended what nutrient
Vitamin C
52
Crohn’s disease is recommended what nutrient
Patient specific
53
Osteopenia/osteoporosis is recommended what nutrient
Calcium
Vitamin D
54
What is the earliest symptom of vitamin A
Night blindness
55
Pregnancy is recommended what nutrients
Folate
Vitamin D
Calcium
Pyridoxine
(Flying Dogs Catch Prey)
56
With taking vitamin A, who may be at risk for toxicity
Chronic kidney disease
Chronic liver disease
Low body weight
57
Bariatric surgery is recommended what nutrient
Patient specific
58
Chronic kidney disease is recommended what nutrient
Vitamin D
59
Osteomalacia is recommended what nutrient
Calcium
Vitamin D
60
Vitamin K
Phytonadione
61
A vitamin K deficiency may be evidenced by:
- unusual bleeding
- elevated international normalized ratio (INR)
62
Vitamin A is also called
Retinoids
63
Vitamin D dosing
15-20 mcg (600-800 IU) daily
64
Vitamin K promotes the synthesis of what clotting factors
2
7
9
10
65
What vitamin should pregnant women avoid and why
Vitamin A due to teratogenic effects
(Vit A = retinoids; think accutane babies)
66
Vitamin A interactions
Cholestyramine (binds fat)
Orlistat (blocks fat)
Mineral oil (fecal loss)
Warfarin
Colestipol (binds fat)
(Calling Over My White Child)
67
Vitamin D strength for severe deficiency
50,000 IU
68
Vitamin D side effects
Anorexia
Hypercalcemia
69
How does vitamin D deficiency present in children
Rickets
Osteoporosis
70
Vitamin D main interaction
Corticosteroids
71
Calcium interactions
Corticosteroids
PPIs
Phenytoin
H2RAs
Levothyroxine
Iron
Magnesium
Phosphates
Aluminum antacids
Cholestyramine
Tetracyclines
Fluoroquinolones
Zinc
Phenobarbital
Carbamazepine
(Calling Pleasant People Has Lasting IMPACT For Zillions, Please Call)
72
Examples of drugs that interact w/ fat soluble vitamins and decrease their absorption
Cholestyramine
Orlistat
Mineral oil
Colestipol
(Calling Over My Child)
73
Vitamin K interactions
Warfarin
74
What does the FDA have a warning for in hair, skin, and nail supplements
High doses of biotin
75
What increases urinary excretion of thiamine, leading to a deficiency? What complications?
Diuretics
Cardiovascular complications
76
______ can cause yellow/orange fluorescence/discoloration of the urine
Riboflavin
77
Calcium in doses greater than ____ is harmful
3 g
78
What happens when tetracyclines and fluoroquinolones are taken with calcium
Reduced absorption
79
What interacts with calcium and causes inhibited nutrient absorption
Iron
Zinc
Magnesium
80
How can iron absorption be increased
Take with vitamin C on an empty stomach
81
What effect does food have on absorption
Decreases
82
Iron side effects
Constipation
Abdominal pain
Nausea
Tar like stool
(CAN’T)
83
Iron interactions
Fluoroquinolones
Levothyroxine
Antacids
Tetracyclines
(FLAT)
84
What happens when antacids are taken with iron
Decreased solubility and absorption
*separate doses by 2 hrs
85
What happens when levothyroxine is taken with iron
Decreased drug absorption
*separate doses by 4 hrs
86
What happens when tetracyclines and fluoroquinolones are taken with iron
Decreased iron and antibiotic absorption
*take 2 hrs before iron OR 6 hrs after iron
87
3 main categories of iron deficient people
- pregnant
- adolescents
- females beginning menstruation/have heavy periods
88
What should you NOT take if you are using a home testing kit
Vitamin C
89
Vitamin C interactions and what happens
Cholestyramine
Orlistat
Mineral oil
Colestipol
Decreased vitamin absorption
(Calling Over My Child)
90
Severe vitamin B6 deficiency in infants include
Irritability
Convulsive disorders
91
Signs of serious vitamin B6 deficiency
- Convulsions
- Peripheral neuritis
- Sideroblasic anemia (unable to produce RBCs)
(CPS)
92
______ and vitamin B6 should be taken together
Isoniazid
93
If vitamin B12 is unable to be absorbed in the gut, what is another option
Injection
94
Vitamin B12 interactions
Metformin
Antibiotics (long term)
95
Folic acid interactions
Trimethoprim
Phenytoin/Anticonvulsants
Methotrexate
Sulfasalazine
(TAP My Shoulder)
96
What happens when you take phenytoin/anticonvulsants with folic acid
Decreased folic acid absorption
97
What rare occurrence can happen when trimethoprim and folic acid interact
Megaloblastic anemia
98
Methotrexate when taken with folic acid should be monitored in patients with what disease states
Psoriasis
Rheumatoid arthritis
99
The ONLY described niacin deficiency state is ______
Pellagra
100
What is the dosing for niacin when treating pellagra and hypercholesterolemia/hyperlipidemia
Pellagra: 150-500 mg daily in divided doses
Hypercholesterolemia/hyperlipidemia: 1-2 g in 3 divided doses, up to 8 g daily
101
Niacin can be used to treat hypercholesterolemia and hyperlipidemia when a patient is unable to tolerate what kind of drug
Statins
102
Niacin effect on blood glucose
Increases
103
What is the most common side effect of niacin and how can it be fixed
Flushing
Aspirin
104
What dose of elemental iron is equivalent to ferrous sulfate
36-48 mg elemental iron = 325 mg ferrous sulfate
105
What type of iron is best for patients with iron deficiency
Ferrous sulfate
106
What is the function of fluorides
- reduce tooth decay
- increase enamel resistance to erosion
107
What does fluoride interact with and what happens
Magnesium
Aluminum
Calcium
(MAC)
Decreases the effect and absorption of fluoride
108
Fluoride is not recommended OTC for children under what age
2 years
109
What is iodine used for
- goiter (moderate deficiency)
- hypothyroidism (severe deficiency)
110
In most cases, iodine supplements are ______
Unwanted
111
What should be monitored when using iodine
Thyroid function
112
Zinc deficiency is ________
Not widespread
113
What are the signs/symptoms of zinc toxicity
Vomiting
Dehydration
Poor muscle coordination
Dizziness
Abdominal pain
114
What can be done if zinc causes GI upset
Take with food
115
Complementary medicine
Health practices used with conventional medicine
116
Alternative medicine
Used in place of conventional medicine
117
Natural medicine includes
Herbals
Vitamins
Minerals
118
The FDA must show a product is unsafe before they can do what
Restrict use or remove it
119
Searchable database of adverse events caused by dietary supplements, medications, devices, and tobacco products
FDAble
120
What claim can manufacturers NOT make about natural products
That it can treat or cure a condition/disease
121
What are the parts of a supplement facts label
Indication
Purpose
Uses
Warnings
Instructions
Excipients/allergic rxn alerts
Recommended daily intake (RDI)
Amount of each ingredient
(I Put Up With Idiots Everyday, Real Assholes)
122
What are the risks of natural products
- dose depended (higher dose = higher risk)
- can interact w/ Rx meds
- increase bleeding risks
- cause hepatotoxicity/cardiotoxicity
123
What supplements increase bleeding risk
5 Gs:
- garlic
- ginger
- ginkgo
- ginseng
- glucosamine
Fish oils (higher doses)
Dong quai
Vitamin E
Willow bark (salicylate)
(Finally Doing Very Well)
124
What supplements have liver toxicity risks
Comfrey
Kava
Black cohosh
Green tea extracts
Chaparral
(Cassie Kellogg Bakes Green Cookies)
125
What supplements have cardiac toxicity risks
Powdered supplement mixes
Licorice (glycyrrhizin)
Yohimbe
Bitter orange
Ephedra
DMAA
(PLY BED)
126
Bitter orange side effects
- increased BP & HR
- dose dependent cardiac toxicity
- heart attack, stroke, arrhythmia
127
What is DMAA used in
Body building/performance enhancers
128
Where is Gycyrrhizin found?
What does it lower?
What does it increase?
Found in licorice
Lowers potassium
Increases BP
129
What is yohimbe used for?
What does it increase?
What is the risk?
Used for increased libido/erectile dysfunction
Increases BP
Risk of seizures
130
How much caffeine is safe
Up to 400 mg
131
Supplements for ADHD
Omega-3 fatty acids
Polyunsaturated fats
EPA and DHA (in those fats)
(OPE)
132
Supplements for anxiety
5-HTP
Chamomile
Kava
Valerian
St John’s wort
Passionflower
(5 Cowards, Very Sad People on Ketamine)
133
Supplements for cold and flu
Probiotics
vitamin C
Zinc
Echinacea
Elderberry
(Panthers Chasing Zebras, Easy Eats)
134
What can zinc nasal products cause
Loss of smell
135
Supplements for dementia/memory
Ginkgo
vitamin E
vitamin D
Vinpocentine
Acetyl-L-carnitine
(GED, Very Academic)
136
Supplements for depression
St John’s wort
SAMe
Valerian
5-HTP
137
Supplements for diabetes
Ginseng
Alpha lipoic acid
Magnesium
Chromium
Cassia cinnamon
(Great AMC Cinema)
138
Supplements for dyslipidemia
Artichoke extract
Plant sterol
Fibers
Red yeast rice
Omega-3 fatty acids
Garlic
(A Purple FROG)
139
Supplements for dyspepsia
Calcium
Magnesium
Peppermint
Chamomile
(CMPC)
140
Supplements for energy/weight loss
Bitter oragne
Caffeine
Guarana
Green tea powder
141
Supplements for erectile dysfunction
Ginseng
L-arginine
Yohimbe
142
Supplements for heart health
CoQ10 (ubiquinone)
Hawthorne
Omega 3 fatty acids
143
Patients should not take L-arginine if they have experienced what medical event
Heart attack
144
What lab value may supplements for heart health increase
LDL
145
Supplements for HTN
CoQ10
Garlic
Fiber
L-arginine
Omega-3 fatty acids
Potassium
(Cassie’s Grades FLOP)
146
Supplements for GI health
Wheatgrass
Probiotics
Horehound
Fibers
Peppermint
Chamomile
(Wearing Party Hats From Party City)
147
Supplements for insomnia
Melatonin
Valerian
Lemon balm
Chamomile
5-HTP
Passionflower
L-tryptophan
CoQ10
(Making Virgin Losers Cry & Helping People Learn Chinese)
148
Supplements for inflammation
Flaxseed oil
Omega-3 fatty acids
Turmeric
Curcumin
(Fuck OTC)
149
Supplements for liver
Milk thistle
150
Supplement for menopause
Black cohosh
Evening primrose oil
Dong quai
Soy
Red clover
(BEDS+red clover)
151
Black cohosh should not be used with medications for what disease state
Heart failure
152
What should dong quai NOT be used with? What can it increase?
Do not use with:
- anticoagulants
- antiplatelets
- salicylates
Increases bleeding risks
153
Supplements for migraines
Feverfew
Butterbur
Guarana
Magnesium
Riboflavin (B2)
CoQ10
(Fuck Bitches Get Money, Really Cool)
154
Supplement for motion sickness
Ginger
Peppermint
155
Supplements for osteoarthritis
Glucosamine
Chondroitin
SAMe
Turmeric
156
What is SAMe used for
Depression
Osteoarthritis
157
What does SAMe increase risk of
Bleeding
Manic behavior
158
Patients should not use SAMe if they have what disease state
Bipolar disorder
159
Using SAMe with serotonergic medications increases
Serotonergic risk
160
Supplements for prostate health
Saw palmetto
Lycopene
Pygeum
Pumpkin seed
(SLPP)
161
Supplements for osteoporosis
vitamin D
Ipriflavone
Soy
Calcium
(DISC)
162
Supplements for UTI
Cranberry
Yogurt
Probiotics
163
Supplement for weight loss
Garcinia cambogia
164
What reference has access to over 250,000 commercial products for ingredients, safety, effectiveness, etc
Natmed pro
165
What is herbal medicine
Using any part of a plant for healing or health purposes
166
What are counseling points fro dietary supplements
- recognize importance of respecting their beliefs and values
- ask pt to monitor for perceived benefit and adverse effects
- providers should not endorse supplements with no evidence of efficacy
- providers and pharmacists are in position to educate about safety and efficacy
- recommend purchasing products that have a seal of quality of the label (USP, NSF)
- recommend purchasing from large reputable companies
- once supplement is selected, continue to use the same brand and formulation
- recommend pt talk w/ HCP
- recommend pts report unusual and adverse effects
167
All herbals are considered what
Dietary supplements
168
What is a dietary supplement
Products (other than tobacco) intended to supplement the diet that contains one or more of the following:
- vitamin
- mineral
- herb
- botanical
- amino acid
- dietary substance
For use to increase the total dietary intake, or a:
- concentrate
- metabolite
- constituent
- extract
- combo
Of any of the ingredients
169
What did the 1994 DSHEA say
- government should not take any actions to impose unreasonable regulatory barriers limiting or slowing the flow of safe products and accurate info to consumers
- safety problems are relatively rare and legislative action that protects the right of access of consumers to safe dietary supplements is necessary
170
Who regulates the marketing of products with unsubstantiated “drug” claim
FDA or FTC
171
Who created the category of dietary supplements (not drugs)
DSHEA
172
Under the DHSEA, product ingredients can be what
Promoted with:
- print material
- lectures
- vocal broadcasts
- educational efforts
- internet
173
What can supplements NOT claim
Can’t make drug claims
Medical claims can NOT be on supplement label
174
What do drug claims include
- anything intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease
- articles (other than food)
Intended to affect the structure or function of the body
175
What can supplements claim
- health claims authorized by the FDA if it meets certain criteria
- make claims about products affecting structure, function of the body, or overall well-being (unregulated by FDA)
176
What disclaimer must supplements carry
That the product is not designed to treat or prevent a disease
177
How are supplements regulated
Under the same umbrella as food
178
What is NOT required of supplements
- safety not required to be proven
- not required to prove effectiveness/benefit
179
What must be said in product name for supplements
Dietary supplement
180
What products are manufacturers prohibited from marketing
Products that are adulterated or misbranded
181
How are OTCs regulated
- by the FDA in much the same way as rx items
- safety must be proven
- efficacy must be proven
- manufacturing facilities must be inspected
- lots are checked for quality control
- labeling requirements that are translated into lay language
182
What is the process of approval for rx drugs
- IND must be submitted (FDA decides if med is reasonably safe)
- clinical trials
183
What is an IRB
Panel of scientists and non-scientists in hospitals and research institutions that oversee clinical research
Ensure the least amount of harm possible from a clinical trial
184
What does an NDA or BLA (biologics license application) include
- drug test results (from clinical trials)
- manufacturing info
- proposed label
185
Where are drugs published after approval
Orange book
186
Where are biologics published after approval
Purple book
187
(T/F): there is no government agency that assures a manufacturer includes products listed on the label for dietary supplements
True
FDA does not verify dietary supplements or that there are impurities
188
(T/F): dietary supplements rely of manufacturers to prepare their products honestly
For most, there is no assurance that the ingredients on the label are in the bottle
True
189
What 3 companies verify herbals
Consumer lab
NSF
USP
190
What does consumer lab do
Establishes the standards of quality for each product
Then selects popular brands for testing against these standards including:
- identity
- potency
- purity
- bioavailability
- consistency
191
What criteria does NSF use for GMPs
Same as NNFA/NPA (natural products association)
192
What is the difference in NNFA’s and NSF certification program
NNFA is only available to NNFA members
BUT
Any dietary supplement can apply for certification by NSF international
193
What is considered the gold standard for quality of supplements by pharmacists
USP seal
194
What is used to confirm that dietary supplements continue to meed USP’s strict standards
Off the shelf testing of randomly samples dietary supplements
195
(T/F): the USP is a voluntary system
True
196
What are the differences in complementary, conventional, alternative, and integrative health
Complementary: non-mainstream approaches
Conventional: mainstream
Alternative: used in place of conventional therapies
Integrative: combines conventional and complementary approaches
197
What prohibits many small companies from submitting to USP
The cost is substantial to the manufacturer
198
Example of psychological and nutritional complementary health approaches
Mindful eating
199
What does CAM represent
All complimentary and alternative medicine
200
What does the USP seal say to consumers
- that the product on the label is in the bottle, in the amount labeled, and that the product should not dissolve as expected
- does not assure effectiveness
201
How is CAM/CIM defined
- medical products and practices that are not part of standard care (modern medicine)
- any healthcare technique w/ a history of beginnings outside of mainstream medicine
- encompasses dietary supplements, yoga, acupuncture, etc
202
What population is CAM usage higher in
Patients with chronic diseases
203
Why do people turn to CAM
- aligns w/ their philosophy or they want to expand their options
- helps patients feel better or reduce adverse events
- to feel in control or looking for a cure
- most use it to supplement traditional medicine
204
What are examples of complementary health approaches
Massage
Magnets
Spinal manipulation
205
What are examples of nutritional complementary health approaches
Vitamins and minerals
Dietary supplements
Aromatherapy
Diets
(VDAD)
206
(T/F): herbals are OTC medications
False
They are not regulated the same and safety is not established
207
What are examples of psychological complementary health approaches
Mindfulness
Medication & biofeedback
208
What did Dr. Samuel Hahnemann do
- developed homeopathy in the early 1800s
- coined the term allopathy (means conventional medicine)
209
What are the benefits of CIM
- considered preventative medicine
- used to maintain health and reduce disease risk
- potential to treat diseases that have no therapies
- increased sense of empowerment and participation
- considered safe and natural
- some practices are supported by basic science and evidence
210
What are the risks of CIM
Not all have undergone rigorous testing
Drug interactions with foods, rx/OTC products, vitamins, etc
211
What are examples of combination (psychological and physical) complementary health approaches
Healing touch
Acupuncture
Reiki
Dance
Tai chi
Art therapies
Yoga
(HARD Tests All Year)
212
What is homeopathy often compared to
- vaccination
- not entirely accurate because homeopathic preparations are only used to treat existing illnesses, not prevention
- oscillococcinum is an exception because it’s used to treat and prevent flu
213
What is homeopathy based on
- like cures like, law of similars
- idea that if a substance produces symptoms of an illness, then that substance can cure it when given in small doses
- more dilute = greater potency
- efficacy believed to depend on dilution factor as well as vigorous shaking (or succession) which is performed w/ each dilution
214
How much active ingredient is contained in homeopathic preparations
So dilute that they only contain negligible amounts of AI
215
What are homeopathic products NOT considered by the FDA
Not considered dietary supplements even though they are generally meant to be ingested
216
Who regulates and recognizes homeopathic medicines
USP
HPUS
NF
217
What must a homeopathic drug have to be included in the HPUS
Must be manufactured with cGMP determined by the HPUS to be safe and effective
218
What determines safety and efficacy of homeopathic drugs
- process called “provings” (or research procedures in the HPUS)
- determines the dosage needed to induce symptoms in healthy people
219
What is a huge distinction w/ approval process for homeopathic drugs
HPUS determines that the manufacturing process is safe and effective, NOT the product itself
220
What is naturopathy
- philosophy of life and an approach to living that encourages lifestyles and therapies as close to nature as possible
- employs natural forces such as light, heat, air, water, and massage
- focuses primarily on building health rather than on treating disease
221
Most remedies do NOT need what
A prescription
Most are used for self-limiting conditions
222
What is attenuation or potentization
Process when homeopathic substances are serially dilueted and succussed (triturated), which is thought to increase potency
223
What are the 6 principles of naturopathy
Healing power of nature
Identify and treat the causes
Doctor as teacher
First do no harm
Prevention
Treat the whole person
(HID From Ponn Today)
224
What is meant by “the healing power of nature)
The body has the inherent ability to maintain and restore health
225
What is meant by “identify and treat the causes”
Implies that the naturopathic healthcare providers aim is to ID and treat the cause, rather than the symptoms, of a disease
226
What is meant by “first do no harm”
Emphasizes use of less toxic natural therapies
227
What is meant by “doctor as teacher”
Naturopath educates and encourages patients to take responsibility for their own health
228
What is aromatherapy
Therapeutic use of natural fragrances from:
- essential oils
- hydrosols
- carrier oils
To help improve whole persons mind, body, and spiritual well being
Used through inhalation or application to skin
229
What is meant by “treat the whole person”
HCP treats the whole person, taking into account their aspects that are:
- physical
- spiritual
- mental
- social
230
What is meant by “prevention”
Requires the naturopath to access risk factors and hereditary susceptibility to disease and to make appropriate interventions to prevent further harm or risk to patients
231
What are the characteristics of naturopathy providers
- believe mental attitude and emotions may influence physical illness
- include nutritional counseling and support as major components
232
What ailments has naturopathy been found to be MORE effective in treating
Anxiety
233
What ailments has naturopathy been proven to be LESS effective in treating
Extreme pain
Surgery
234
What are different delivery forms of aroma therapy
Massaging intended site
Foot and sitz bath
Adding to bath
(MFA)
235
What are safety concerns w/ aromatherapy
- essential oils are highly potent
- topical use can cause skin irritation
- avoid contact w/ eye
- avoid in children
- wintergreen oil contains menthol and methyl salicylate (5 mL = 4 g of aspirin)
236
What are therapeutic uses of aromatherapy
Support healing/wellbeing
Reduce stress
Reduce pain
Strengthen immunity
237
What specific issues can aromatherapy be used for
Reduce BP
Childbirth pain
Depression
Dysmenorrhea pain
Promote good sleep
(Really Cool Dudes Drive Porsches)
238
What is the common cold
Upper respiratory tract disorder due to virus infection
Most common w/ the rhinovirus
239
What is the pathophysiology of the common cold
- rhinovirus attached to respiratory epithelia and macrophages
- virus infiltrates the host cells via endocytosis, then replicates and infection spreads to other cells
- infection stimulates host cell release of inflammatory mediators (bradykinins, prostaglandins, histamine, vasodilators), which causes hypersecretion of watery nasal fluid
- viral infection ends once enough neutralizing IgA or or IgG enters the mucosa to end viral replication
240
What is a protective function for human airways and lungs that can also be induced by medication
Cough
241
What is the pathophysiology of a cough
- cough reflex is triggered by stimulation of sensory nerve receptors, which are stimulated by both chemical (cytokines, histamine) and mechanical (dust, growth/cancer) stimuli
- action potential is then sent to the “cough center” in the medulla
242
What is allergic rhinitis
- hay fever
- systemic disease w/ prominent nasal symptoms and effects the upper respiratory system
- immune response to antigenic environmental allergens
- reactions typically limited to nasal cavity without systemic allergies leading to conditions such as bronchoconstriction
243
What is type I hypersensitivity
Immediate reactions that occur within minutes of allergen exposure
IgE mediated
244
What is the pathophysiology of allergic rhinitis
Allergenic particles contact nasal mucous membranes, then inducing an IgE mediated inflammatory immune response
245
What is the process of the immune response causing allergic rhinitis
1. Airborne allergies inhaled that produce antigen specific IgE, causing sensitivity
2. Second exposure, mast cells trigger release of inflammatory mediators (histamine, leukotrienes, prostaglandins, bradykinins)
3. Inflammatory mediators cause vasodilation that increases vascular permeability and production of nasal secretion
4. Histamine produces rhinorrhea, itching, sneezing, and nasal obstruction
5. Chemokines attract allergen-destroying WBCs that increase inflammation and leads to congestion
246
What are some manifestations of allergies due to
- Histamine release
- Activation of H1 receptors on smooth muscles
247
Examples of vasoconstrictors
- NSAIDs
- Epinephrine and norepinephrine
- Antihistamines
- Decongestants
(NEAD)
248
What are vasoconstrictors used for
To counteract the pathophysiological effects of histamine in colds and allergies by narrowing blood vessels and increasing BP
249
What do decongestants do
Decrease vascular congestion in the nose
250
What is the pharmacology of decongestants
- alpha 1 andrenoceptor agonists
- NE released from sympathetic nerves bind to alpha-androceptors on smooth muscle, stimulating vasoconstriction
- vasoconstriction of blood vessels in nose, throat, and paranasal sinuses results in reduced inflammation and mucosal edema (rhinorrhea, congestion)
251
What does it mean if a product has a D after its same
It contains pseudoephedrine
252
Why is pseudoephedrine more effective than phenylephrine
Phenylephrine has lower bioavailability
253
What are the warnings w/ systemic decongestants
- uncontrolled HTN (increases BP = vasoconstriction
- glaucoma (increased intraocular pressure)
254
What are longer acting intranasal decongestants
Xylometazoline
Oxymetazoline
255
What are antitussives
Cough suppressants
256
What is the pharmacology of dextromethorphan (DM)
- acts on the medulla cough center to increase the cough threshold
- robitussin is an example
257
What happens at high doses of dextromethorphan
Converted into a psychoactive metabolite dextrorphan
Produces hallucinogenic effects similar to PCP
258
What is the pharmacology of codeine (methyl morphine)
- acts on medulla cough center to increase cough threshold
- usual dosages have low toxicity and little risk of addiction
259
Who should avoid taking codeine
Those w/ CYP2D6 polymorphism
This makes them an ultra rapid metabolizer of codeine
Can cause respiratory depression and death
260
What is diphenhydramine and where does it act
- nonselective (1st gen) antihistamine w/ significant sedating and anticholinergic properties
- acts on medulla to raise the cough threshold
261
What do expectorants (protussives) do
Decrease phlegm viscosity
262
What does guaifenesin (mucinex) do
Loosens and thins lower respiratory tract secretions
263
What effects do NSAIDs have
Analgesic
Antipyretic
Anti-inflammatory
264
What effects does acetaminophen NOT have
Anti-inflammatory
Anti-thrombotic
*because it is inactivated outside the CNS
265
What is the MOA of most NSAIDs
- COX inhibitors causing decreased prostaglandin (PGE2, PGI1) synthesis
- blocks thromboxane A2 (TXA2) synthesis, which increases bleeding (anti-thrombotic)
- block prostacyclin (PGI2) synthesis, which increases gastric acid secretion, causing gastric erosion (ulcers) and bleeding
266
What does pectin do and what is it in
- relieves irritation of the mucous membranes in the throat by forming a protective film (demulcent)
- component of Halls throat lozenges
267
What do menthol and phenol do, and what are they in
- depress cutaneous receptor response, creating analgesic effects
- used in: chloraseptic sore throat spray, Vicks VapoDrops
268
What does benzocaine do
Numbing agent
Blocks Na+ channels on neuronal cell membranes, decreasing conductance
269
What do antihistamines do
Compete w/ histamine for H1 receptors, blocking vasodilation
2nd gen inhibit release of mast cell mediators
270
What are the characteristics of 1st generation antihistamines and what are examples
Lipophilic (nonpolar)
Cross BBB
Shorter acting
Benadryl (diphenhydramine)
Unisom (doxylamine)
271
What are characteristics of 2 generation antihistamines and what are examples
More hydrophilic (polar)
Protein bound
Do NOT cross BBB
Longer acting
Charged side chains
Loratadine
Cetirizine
272
What are the effects of 1st generation antihistamines
- somnolence (caution for excessive sedation)
- anticholinergic effects (dry mouth)
273
What is the pharmacology of mast cell stabilizers and what is an example
Blocks influx of Ca2+ into mast cell preventing histamine release
Cromolyn (NasalCrom)
274
What is the pharmacology of intranasal corticosteroids and what are some examples
Blocks allergic cascade
Rhinocort (budesonide)
Flonase (fluticasone)
Nasacort (triamcinolone)
275
What is rare in the US
Mineral and vitamin deficiencies
276
What can thiamine deficiency cause
Wernicke’s encephalopathy (mental confusion, ataxia, tremor, vision changes)
277
When is thiamine deficiency commonly seen
- alcoholism
- malabsorptive states (crohn’s, bariatric surgery, advanced HIV
278
What occurs as symptoms of Wernickes fade
Korsakoff syndrome (permanent neurological damage)
279
How can some vitamin and mineral deficiencies be determined
Patients can be tested like blood draw for iron studies or initial hemoglobin on CBC
280
Examples of anticonvulsant/epileptic drugs
Phenobarbital
Phenytoin
Oxcarbazepine
Pregabalin
Carbamazepine
Levetiracetam
Valproate
Valproic acid
Divaloproex sodium
Topiramate
Zonisamide
(Pulling Pranks On People Can Lead to Very Very Dangerous Things + Z)
281
What are the functions of vitamin A in the body
- growth and reproduction
- skeletal and tooth development
- proper organ functioning of most organs (most notably the eyes)
282
What is the upper limit of vitamin A and what happens if this is exceeded
3 mg daily
Congenital birth defect risks
Liver abnormalities
283
What vitamins can be toxic
Fat soluble because they are stored in the body
284
What adverse effects can taking more than the upper limit of vitamin D cause
Hypercalcemia
Anorexia
Renal failure
Increased risk of certain cancers
Soft tissue calcification
Kidney stones
(Has A RISK)
285
What amounts of electrolytes requires the OTC label to state the amount of electrolyte per dosage unit in the “other information” section
Greater than or equal to:
20 mg calcium
8 mg magnesium
5 mg potassium
5 mg sodium
286
What warning must be on the label if a product contains greater than 3.2 g of calcium
As a dr before use if you have kidney stones or a reduced calcium diet
287
What warning must be on the label if a product contains greater than 600 mg of magnesium
Ask a dr before use if you have kidney disease or a magnesium reduced diet
288
What warning must be on the label if a product contains greater than 975 mg of potassium
Ask a dr before use if you have kidney disease or a reduced potassium diet
289
What term must be on the label if the product contains less than or equal to 5 mg sodium
Sodium free
290
What term must be on the label if the product contains less than or equal to 35 mg of sodium
Very low sodium
291
What term must be on the label if the product contains less than or equal to 140 mg of sodium
Low sodium
292
What warning must be on the label if the product contains greater than 140 mg of sodium
Ask a dr before use if you have kidney stones or a sodium reduced diet
293
What does federal law state about CBD in dietary supplements
That CBD can NOT be used as a dietary supplement or food additive
This is because CBD is technically an rx drug
294
How is CBD used in topical preparations (oils, sprays, creams, etc)
Extracted from hemp since hemp is legal and no longer considered schedule 1
295
In states where it is legal, what can cannabis be used for
Certain medical uses
Patients must obtain a medical card/certificate to get product from dispensary
State authorizes prescribers to recommended it for “approved indication for use”
States my allow recreational use
296
What laws must pharmacies follow regarding marijuana
Federal because pharmacies are registered w/ the DEA
297
What are pharmacies NOT permitted to do in regards to marijuana and what does this mean in WV
- be a dispensary
- sell marijuana or paraphernalia
WV: no pharmacies/pharmacist may be involved, no prescriptions permitted
298
What are the special warning requirements for OTC drugs for minor sore throat
Must state: “for temporary relief of minor sore throats”
Must include: “warning: severe or persistent sore throat and sore throat accompanied by high fever, headache, nausea, and vomiting may be serious. Contact physician promptly. Do not use more than 2 day or administer to children under 3 years of age unless directed by a physician”
299
What are the record keeping requirements of PSE
Name of purchaser
Address of purchaser
Signature of purchaser
Name of product
Qty including # of packages
Total weight of PSE in g
Date and time of purchase
Type of ID and ID #
299
What is the limit on dihydrocodeine, ethylmorphine, or opium preparations that can be sold OTC
100 mg/mL OR 100 g
299
What is the limitation on diphenoxylate preparations that can be sold OTC
25 mg/25 mcg atropine sulfate
300
What is the limit on codeine preparations that can be sold OTC
200 mg/100 mL OR 100 g
301
What is the limit on diphenoxin preparations that can be sold OTC
0.5 mg/25 mcg atropine sulfate
301
How much can be dispensed for all other controlled substances (robitussin ac, cheratussin ac) to any one purchaser in a 48 hr period
Not more than 120 mL of any other controlled substance
Not more than 24 dosage units of any other CS
302
How much opium can be dispensed to any one purchaser in a 48 hr period
Not more than 240 mL of anything containing opium
Not more than 48 dosage units of anything that contains opium
303
What is the DAILY limit of PSE in WV
3.6 g
303
What is the schedule of PSE in WV
C5 but still OTC
304
What is the limit per MONTH of PSE in WV
7.2 g per 30 days
305
What is the YEARLY limit of PSE in WV (updated)
84.6 g
