OTC's herbals And Supplements

Question 1

Classification of an OTC

Answer 1

Safe, low potential for misuse, pt can self administer and diagnose w/o supervision

Question 2

Hazards of OTC

Answer 2

Acetaminophen toxcity
Do not give infants or anyone under 4 decongestants
May be masking a serious illness

Question 3

Adverse effects of OTC

Answer 3

GI upset, GI bleeding
Sedation with antihistamines
Impaired driving

Question 4

Pharm tx for URI

Answer 4

Treat based on TYPE of symptoms and FREQ of symptoms

Question 5

URI ( how to treat)

Answer 5

Mild and intermittent = antihistamine or decongestant

Moderate and freq and persistent = intranasal corticosteroid ( with or without antihistamine or decongestant)

Severe: intranasal corticosteroid with a antihistamine or decongestion ( consider oral steroid x 5)

Question 6

Nasal decongestants : class, MOA, benefits, adverse, precautions, contraindication, preg

Answer 6

Sympathomimetic amine ( class)

MOA: stimulates beta receptors of smooth muscle and stimulates alpha receptors causing vasoconstriction

Benefits: reduces tissue edema and nasal congestion, promotes sinus drainage, opens Eustachian tubes

Adverse effects: tachy, increases IOP, urinary retention

Precaution: peripheral HTN, CVD, prostatic hypertrophy

Contraindications: mitral value prolapse, cardiac palpitations , severe HTN, severe CAD

Preg: C, not for nursing mothers

Question 7

Types of nasal decongestants

Answer 7

Phenylinephrine ( Sudafed PÉ)
Pseudoephedrine ( Sudafed 12 hours)
Oxymetazoline ( Afrin)
Antihistamine + D ( AKA Allerga D, Claritin D)

Question 8

Oral Antihistamines

Answer 8

1st generation : Tavist, Chlor-Trimetor, Benadryl ( more side effects)

2nd generation: Zyrtec, Claritin, Allegra ( less sedative s/e)

MOA: compete for histamine receptor ( H1) site, antagonize effects of histamine

Benefits: treats rhinorrhea, watery eyes, postnasal drip, sneezing

Adverse effects: dizziness , confusion, dry mouth , constipation

Precautions: lower resp disease, sleep apnea, bladder neck obstruction, elderly , pedi

Preg: B or C , not for nursing mothers

Question 9

Intranasal corticosteroid

Answer 9

Examples: Flonase, Nasacort, Nasonex, Veramyst

No systemic side effects
Good for people who have had “ 6 weeks of hell”

Question 10

Intranasal Mast Cell stabilizers

Answer 10

Cromolyn *
MOA: preventative agent, inhibits sensitized and mast cell degranulation that occurs after exposure to specific antigens

Drawbacks: must be nebulized ( may take months to see effects) 4-6 times a day

Adverse effects: nasal irritation, stinging, sneezing

Preg: B, lactation unknown

Question 11

Antitussives ( Belsym)

Answer 11

Dextromethorphan

DO not supresses the cough during the day

MOA: centrally acting in medulla to elevate threshold for cough

Adverse: n/v dizziness
Precautions: pedi < 6
Contraindication: MAOI with 14 days
Preg: C

Question 12

Expectorants

Answer 12

Guaifenasin
MOA: increases resp tract fluid secretions, reduces surface tension, loosens bronchial secretion

Benefits: used in the presence of mucus and congestion

Precaution : not use in children less than 12
Preg: C

Question 13

Tylenol

Answer 13

MOA: no anti inflammatory activity , central inhibition of PG synthesis

Max dose of 4 g per day

Can use in pregnancy

Question 14

Sleep aids

Answer 14

Sominex and Unisom

MOA: same as antihistamine
Adverse: sedation, dry mouth, constipation, blurred vision

Preg: B not recommended in lactation

Question 15

Black Cohosh

Answer 15

Hot flashes and menopausal symptoms

Adverse: increased menstrual flow, GI upset, dizziness

Interaction: fertility agents, estrogens, oral contraceptives, progestin

Contraindication: abnormal fetal positioning, eclampsia

Preg: X

Question 16

Coenzyme Q10

Answer 16

Acute MI, chronic systolic heart failure, mitochondrial disease

Adverse: well-tolerated,

Interactions: antihypertensives, warfarin

Preg: unknown

Question 17

Cranberry

Answer 17

Recurrent UTI

Adverse : well tolerated

Preg: unknown

Question 18

Creatine

Answer 18

Non-hormonal performance enhancement

Adverse: weight gain from urinary retention

Interaction: cyclosporine

Contraindication: renal impairment

Question 19

Echinacea

Answer 19

Common cold or mild flu

Adverse: allergic reaction to plants ( sunflowers, daisies)

interactions: AID’s drugs, corticosteroids

Preg: unknown

Question 20

Garlic

Answer 20

Hypercholesterolemia

Adverse: GI

Preg: safe but data lacking

Question 21

Gingko Biloba

Answer 21

Dementia, memory impairment

Adverse: inhibits platelet aggregation

Interaction: anticoagulants

Preg: not reccomended

Question 22

Ginseng

Answer 22

Immune system enhancement, mental performace

Adverse: mild overdose : excitation, fidgeting, headache, inhibits platelet aggregation

Interactions: anticoagulants , anti-platelets
Preg:avoid

Question 23

Melatonin

Answer 23

Mild insomnia, jet lag

Adverse: headache, depression, tachy

Preg: should be avoided

Question 24

Saw Palmetto

Answer 24

Adjunct for BPH

well tolerated

Interactions: androgens, 5-alpha reductase

Contra: UTI, prostate CA

Preg: avoid in preg

Question 25

St. John's Wort

Answer 25

Adjunct for depression and seasonal affective disorder Adverse: GI irritation, sexual dysfunction Interaction: induces CYP34A, MAOI, warfarin, SSRI;s Contra: AIDS/HIV, MAOI, SI Preg: not reccomended

Question 26

Valerian

Answer 26

Occasional treatment mild insomnia or anxiety die to restlessness or nervousness of non-psychotic origin Adverse: paradoxical reaction (agitation) Interaction: sedatives, hypnotics, ethanol, anxiolytics

Question 27

Nutrient - Drug interactions

Answer 27

Food may effect - drug absorption, metabolism, excretion, Drug may affect nutrient status

Question 28

Influence of Diet on Drug Absorption

Answer 28

Drug absorption can be decreased, delayed, accelerated or increased by food Food changes gastric ph Food may bind with medication, decreasing absorption

Question 29

Influence of diet on drug metabolism

Answer 29

The rate of the drug metabolism is affected by nutrient intake - low carb high protein diet may increase drug -metabolizing enzymes - antioxidant vegetables may increase the activity of drug - metabolizing enzymes Grapefruit and P450 - inhibits CYP 3A4 - increases levels of ccb, statins, tacrolimus Food and P450: - Veggies, caffeine, charcoal broiling may lead to therapeutic failure

Question 30

Influence of Diet on Drug Excretion

Answer 30

Some food can change urinary PH Foods that alkalinize the urine - milk, veggies, citrus fruits Foods that Acidify the urine - meat, fish, cheese, eggs

Question 31

Drug - food incompatibilities

Answer 31

Warfarin - Vit K containing foods MAOI- tyramine-containing foods ( fermented pickles) Metronidazole: alcohol Caffeine : accelerates absorption up to 20X Alcohol: enhances drug solubility

Question 32

Influence of drugs on nutrients

Answer 32

Drug induced nutrient depletion - antacid therapy or potassium therapy can decrease folic acid, iron, vit B Phenytoin reduces folic acid Loop diuretics affect sodium, calcium, potassium

Question 33

Fiber

Answer 33

Decreased constipation, CAD, better glucose control , improved lipid levels

Question 34

Vitamins A, C, D, K

Answer 34

A= vision, bone growth, immune, reproduction C ( ascorbic acid) = humans cant synthesize vitamin C, inadequate intake may lead to scurvy , smokers are at risk, does not decrease URI's, D = Bone health , need 400 IU day K= need for blood clotting

Question 35

Vitamin B

Answer 35

B1= thiamine = alcoholics are at high risk for Wernicke's encephalopathy B2 ( riboflavin) = may decrease headache B3 ( niacin) : used to treat hyperlipidemia B12 : could lead to megablastic anemia

Question 36

Folate

Answer 36

Critical to the production of new cells Found in green leafy veggies, fruits, dried legumes Deficiency Occurs in pregnancy Preg: 600mcg day

Question 37

Minerals

Answer 37

Calcium = need for muscle contraction, bone health, heat health Iron = need for oxygen transport, pt will develop microcytic-hypochromic anemia

Question 38

Fatty acids

Answer 38

Must be consumed ( nuts) Heart health Children with autism or ADD may benefit to omega three

Question 39

Plant sterols

Answer 39

Compete with cholesterol in the intestine Can lower LDL

Question 40

Pre / Pro / Symbiotics

Answer 40

Reduces antibtiocs associated diarrhea May improve IBD and necrotizing enterocolitis