Unit 1: OTC Flashcards
(85 cards)
1
Q
OTC drugs are marketed about _____ the number of prescription medicines. Including multiple products like herbals, vitamins, and _____.
A
10 times
nutritional supplements
2
Q
There are greater than _______, with about 700 active ingredients, including those that were formerly available by prescription only and have been ______ to OTC status with FDA approval (e.g. non-drowsy antihistamines)
A
125,000 OTC products
“switched”
3
Q
The majority of illnesses are usually first _______ without advice of a health-care provider. Benefits include cost savings and convenience.
A
self-treated
4
Q
With the majority of illnesses usually being first self treated the role of the ____ becomes greater.
A
pharmacist
5
Q
Conditions commonly first self treated include headache, skin problems, common cold, chronic dandruff, _____, upset stomach, muscle/joint pain, fever, & sinus problems.
A
premenstrual/menstrual symptoms
6
Q
The major self treating categories include respiratory, feminine, pain, digestive, ______, skin, and general well being.
A
eye/ear/mouth
7
Q
Those with ________ are more likely to use OTC products, and those with chronic conditions tend to seek professional health care.
A
acute problems
8
Q
Need for consumer information: to avoid using an inappropriate medication or suffering _________, and need to recognize the recommended duration of OTC use and possibility of side effects.
A
drug-drug interactions
9
Q
_____ populations: may have increased risk of adverse effects with OTC drugs such as illiterate patients, blind or otherwise visually impaired, deaf or otherwise hearing-
impaired, elderly, children, those with comprehension deficits, and pregnant/nursing mothers.
A
Special
10
Q
Geriatric patients (> 65 years old) use more OTCs and have more ________ than the younger population.
A
drug-drug
interactions
11
Q
A potential problem with OTC drugs is _____ self diagnosis. i.e. chest pains construed as heartburn
A
improper
12
Q
A potential problem with OTC drugs is _____ to FDA label instructions.
A
noncompliance
13
Q
A potential problem with OTC drugs is some products contain _____ and individuals do not always take this into account.
A
multiple drugs
i.e. salicylate in product (such as Pepto and risk of Reye syndrome if given to child with viral GE
14
Q
A potential problem with OTC drugs is that patient comorbidities may enhance _____.
A
drug toxicity
15
Q
A potential problem with OTC drugs is the drug drug interactions. (i.e. salts - worsen heart failure and _____)
A
hypertension
16
Q
A potential problem with OTC drugs is that the dyes may cause an ______.
A
allergic reactions
17
Q
Take an OTC ______ along with the medication history, emphasize potency of these medications and the risk of adverse effects.
A
history
18
Q
When discussing OTC drugs advise patients to read labels, get _______ advice if unsure of directions or use
A
pharmacist
19
Q
Encourage patients to _____ the time limits for OTC use.
A
respect
20
Q
Explain that _______ with the use of OTCs may mask a serious underlying condition.
A
non-improvement
o Examples include a bacterial skin infection that doesn’t respond to an OTC dermatologic product, serious infection with continued fever despite antipyretic medication, headache that persists despite analgesic use
21
Q
Explain that \_\_\_\_\_\_\_\_ use of some OTC products may actually cause a separate additional problem (e.g. rebound rhinitis with the use of sympathomimetic OTC nasal sprays after 3 days of use).
A
prolonged
22
Q
OTC products (topical & systemic) can cause allergic reactions and may be the cause of _______ symptoms.
A
mysterious
23
Q
Don’t forget the OTC history (including _____ and supplement products, topical
products) when investigating unusual clinical presentations.
A
herbal
24
Q
_______ interfere with absorption of tetracyclines, fluoroquinolones, biphosphanates; & impair absorption of iron.
A
Antacids
25
___________ alkalinizes stomach pH, reducing absorption of keoconazole, increases renal clearance of Lithium & aspirin
sodium bicarbonate
26
ibuprofen & naproxen interfere with _________ effectiveness of beta-blockers, may also increase serum Lithium level, and interfere with the cardio-protection of low-dose aspirin
antihpertensive
27
_____ are natural remedies that include herbal medicine.
phytomedicine
28
________ includes botanicals recognized for medicinal effect – “phyto” means “plant”
Herbal medicine
29
Herbal medicine may be ingested, inhaled, or ______ into skin
massaged
30
There are culinary herbs (used in cooking) and ______ herbs.
medicinal
31
Almost every traditional drug was originally derived from a ______. Usually, purification & _____alteration of the original substance achieved the
desired physiological outcome without the adverse effects seen with the unmodified botanical.
botanical
| chemical
32
Phytobotanicals are available to buy _____.
OTC
33
Many phytomedicines are _____ specific botanicals used by various cultures for specific cures and results.
culture
34
The use of phytomedicine may result in may result in unwanted _____.
toxicity
in some Latino cultures, anise tea has been used to induce abortion in unwanted pregnancy (abortifacient) – but the therapeutic dose also causes renal failure.
35
Phytomedicines European availibility is _____.
extensive
36
One of the first compendiums of herbals was “_________” (Germany, 1994)
Commission E
37
Due to the recognition of herbal potency and potential for toxicity and drug-drug
interactions, many herbals are now ______ in Europe from OTC availability and must be prescribed
prohibited
38
USA availability of phytobotanicals is based on classification as a “supplement” and not as ____. These agents are sold as dietary supplements, under the 1994 Dietary
Supplement Health and Education Act. Therefore NOT under Food and Drug Administration (FDA) control. There is no guarantee of purity, dosage or even ______ as labeled
drugs
contents
Example: One brand of Dolomite, a calcium supplement, was found to have arsenic impurities on testing, since other metals are often found when gathering calcium from earth sources
39
The Center for Food Safety and Applied Nutrition (CFSAN) is part of the _____.
FDA
40
In the US, nutritional supplements only need to "promote" or "maintain" the normal
structure and/or ______ of the body. These are the only claims allowed by law.
functions
41
The FDA is very specific regarding the language that can be used in ______
of herbals and supplements. Many manufacturers use their brand-name recognition factor to emphasize
safety and standards. The FDA will allow language like “supports” or “promotes”
advertising
Example: "tension & mood" remedy containing St. John's wort. o FDA has allowed some claims for risk reduction or treatment of illness
Example: whole grain barley and barley-containing products that contain at least 0.75 grams of soluble fiber per serving qualify for the health claim on their labels as being able to reduce the risk of coronary heart disease (CHD)
42
National Institutes of Health (NIH) has established the National Center for
Complementary and Alternative Medicine (NCCAM), to facilitate basic biomedical _____ in this phytobotanical area.
research
43
Health consumers are encouraged to use their _________________ for
information, and not use information from this source as recommendations for personal care.
primary care provider
44
FDA Consumer Information for Foods & Dietary Supplements:
is to encourage makers of foods and dietary supplements to make ________
health claims about their products on their labels.
science-based
45
Major health-care concerns with supplements is the
| lack of knowledge regarding ______ & adverse drug effects (AEs, ADRs)(side effects).
dosage
46
Major health-care concerns with supplements is the sterility and _____ of the preparation.
purity
47
Major health-care concerns with supplements is the lack of RCT evidence base for ______, safety, dosing
efficacy
48
Major health-care concerns with supplements is the contamination with _______.
pesticides
49
One of the most common drug interactions is the potentiation of ____.
coumadin
50
(ANTICOAGULANT EFFECT) as a result of ______ with increased bleeding risk, reduced levels of co-administered therapeutic drugs (may cause failure of
therapeutic drug), increased levels of co-administered therapeutic drugs (may cause toxic levels
of therapeutic drug), and direct organ toxicity due to drug-herbal interactions.
coumadin
51
USP means there is at least ____ of the amount stated in each cap/tab, & minimal variability.
80%
52
GMP (Good Manufactured Product) indicates higher quality standards. _____ has issued final rule that manufacturing processes must meet this standard.
FDA
53
Some Herbalists may not endorse standardization: Many herbalists feel that purified product with only one chemical is less helpful than an extract of whole herb. Herbalists often feel that the plant source contains ______ substances that act synergistically to provide increased benefit to the primary ingredient.
therapeutic
54
A “qualified health claim” for foods by the FDA has rules regarding the claims that can be made for foods. Examples of current foods that have such claims are ______, tomatoes, etc.
green tea
55
Nutritional supplements: Term used to include herbals (plant derived) and vitamins.
Examples:
o Barley can claim a cardiac risk reduction if the food contains at least 0.75 gm of
fat-soluble fiber & is “part of a low saturated-fat and low cholesterol diet” o Omega-3 (PUFA) fatty acids can protect against retinopathy o Dietary fiber: high fiber intake not associated with reduced risk of colorectal
56
Cancer probiotics include naturally occurring bacteria & yeasts such as: Lactobacillus and Saccharomyces species
which are found in _____, buttermilk as well as supplements. This may prevent _____with antibiotics and may prevent yeast vaginitis and may improve symptoms of irritable bowel syndrome (IBS)
active-culture yogurt
| diarrhea
57
Some herbals & supplements have been used in traditional _____, and the use of herbal components in mainstream medical prescribing has occurred with FDA approval.
medicine
58
Botulinum Toxin A (botox) induces muscle _____ via blockade of Acetylcholine release.
paralysis
59
_____ is used in anal fissure therapy: injection with botulinum toxin helps heal chronic anal fissure & prevent recurrence.
Botulinum Toxin A (botox)
60
Botulinum Toxin A (botox) is used in cosmetic dermatology to reduce ____.
frown lines
61
Botulinum Toxin A is used to treat hyperhidrosis which results in excessive _____.
sweating
62
Botulinum Toxin A injection is used to prevent head & ______. Relief of contractures (e.g. in stroke and multiple sclerosis patients). Relief of hyperhidrosis (excesssive sweating) with intradermal injections, and recently approved to treat ______
voice tremors
| chronic migraine headache
63
_____ is from white willow bark as well as meadowsweet (Spirea)
Spirea = gave us the name ____- from the "spir" of "spirea"
aspirin
| aspirin
64
Opium poppy yields _____. The culinary poppy seed will cause a positive drug screen (i.e. poppy seed muffins or Jewish hamentashen
cookies!!)
opiates
65
```
The _____ (Dioscorea villosa) yielded the ORIGINAL hormonal components of the first tested oral contraceptives
This is NOT the food yam sold in the USA
```
Mexican yam
66
Vinca (periwinkle): vincristine & vinblastine are used in the treatment of ______).
breast cancer
67
Yew tree: taxol (both the rare Pacific yew and the more common hedge yew) are used in the treatment of ______.
cancer
68
_______ (Digitalis): "cardiac tonic" for heart failure (in the past) & cardiac arrhythmias
Foxglove
69
_____ (Cayenne) ______ (Capsaicin)(Zostrix cream):
are naturally derived plant product depletes substance P from skin nerve endings, causing reduced pain & inflammation. The usefulness of small areas of ______ in small joints. Some other applications include post-herpetic neuralgia (PHN), RA, DJD (osteoarthritis),
diabetic neuropathy.
Chili
peppers
inflammation
70
Commonly used herbal and potential clinical implications:
St. John's wort:
Claimed usefulness: ______ & for premenstrual syndrome (PMS)
Active ingredient is removed by alcohol extraction of the above-ground part of
the plant (just before or during flowering) to obtain USP Hypericum perforatum L
Active ingredient is hypericin
MOA: This has SSRI effects, thus is a serotonergic agent
Considerations:
sold as a food supplement; no FDA quality assurance or label approval for us
•Warnings: This is a good example of drug-drug concern
mild SSRI-type antidepressant
71
Commonly used herbal and potential clinical implications:
St. John's wort:
Claimed usefulness: ______ & for premenstrual syndrome (PMS)
Active ingredient is removed by alcohol extraction of the above-ground part of
the plant (just before or during flowering) to obtain USP Hypericum perforatum L
Active ingredient is hypericin
MOA: This has SSRI effects, thus is a serotonergic agent
Considerations:
sold as a food supplement; no FDA quality assurance or label approval for us
•Warnings: This is a good example of drug-drug concern
mild SSRI-type antidepressant
72
Possibility of serotonin syndrome occurs with excessive activation of serotonin receptors due to combination of two serotonergic drugs (e.g. St. John’s wort plus SSRI med or other serotonergic agent)
DO NOT use with _____ inhibitors or othr SSRI agents and also some TCA antidepressants Induction of CYP3A4 biotransformation pathway:
▪ This causes REDUCED efficacy of drugs that also use this pathway
▪ Examples of reduced efficacy of other primary therapeutic drugs:
• protease inhibitors (for HIV – develop complications of AIDS)
• oral contraceptives (OCs, OCPs — unplanned pregnancy)
• cyclosporine (organ transplant rejection)
• theophylline
• reduced digoxin level
• reduced warfarin levels (clotting) o Glycoprotein transporter interactions:
▪ Affects the GP transporter, needed to absorb many drugs and also affects hepatic absorption of many drugs
▪ Many drug interaction possibilities, including critical dose AIDS drugs
• Other Cautions:
o Photosensitivity – recommend sunblock & avoid UVR o Cataracts – recommend avoid UVR & wear dark sunglasses
MAO
73
UNLESS you are an expert in herbal medicine, if a patient asks your advice regarding the use of these products ALWAYS warn:
1) may have ______ with prescribed and OTC drugs (e.g. warfarin
anticoagulant and many herbals, grapefruit/pomegranate juice & many drugs) 2) may have issues with purity and dosing variability 3) may have issues with long-term (e.g. zinc) use AS WELL as short-term use (e.g.
echinacea) 4) may affect a _____ (e.g. cinnamon & glucosamine and blood sugar
levels in diabetes 5) may have organ toxicity (e.g. hepatitis with black cohosh) 6) may have allergic reaction (e.g. echinacea, chamomile and daisy allergy)
INTERACTIONS
| clinical condition
74
FOOD ALLERGIES:
Are reactions to herbal products may be due to _____, combination with carrier proteins, dyes, preservatives
• may also be due to cross-reactions to food allergies
processing
75
Types of Food Reactions (Allergies):
* Food hypersensitivity & food anaphylaxis: Common reactions to strawberries, wine, egg whites, tomatoes, citrus
* Food intolerance: (not immunological) such as malabsorption syndromes (e.g. gluten sensitive enteropathy of celiac sprue and lacose intolerance)
* Food toxicity: (poisoning -- food, additive, toxins from microbes)
76
Common reactions to ethanol & caffeine or reaction to food additives.
• Food idiosyncrasy: (e.g. reaction to monosodium glutamate, MSG, in Chinese Restaurant Syndrome).
77
Clinical Testing For Allergies:
* For allergy testing to specific antigens, using skin tests are gold standard.
* Oral challenges only done if foods cannot be avoided easily.
78
Food allergen labeling now required by the FDA:
* Passage of Food Allergen Labeling and Consumer Protection Act (FALCPA) in 2004
* Will label with scientific as well as common names (e.g. use “casein” and “milk”) so that consumers (especially children) can read labels and avoid allergens
* Will include the 8 major food allergens that account for 90
79
Clinical Findings in food or herbal allergy:
• Early: itchy swollen lips/mouth/tongue, rhinorrhea, itchy eyes.
• Progression: dysphagia, abdominal cramps, diarrhea, hives, angioedema.
• Severe: stridor, bronchospasm, nausea, vomiting, hypotension, death.
• Treatment:
o symptomatic relief & respiratory/cardiovascular support. o Pharmacologic treatment includes high-dose antihistamines, bronchodilators,
corticosteroids, fluid bolus, epinephrine, vasopressor support.
80
_____ allergy can be life-threatening when severe – this an allergy to natural rubber and there is cross-reactivity with some foods!
Latex
81
_______ means that if you are allergic to one thing, there is a very good
chance you will be allergic to other, related chemicals. Latex is from sap from the rubber plant, thus chemically related to other plants. ______ exposure: If you are repeatedly exposed to ANY of the related items, it will increase the allergic response to ALL of them!
Cross-reactivity
Repeated
82
Real life: in a recent hospital stay, the nurse asked me about latex allergy and she then went on to ask me about four other FOODS and if I ever had an allergic reaction to them? o Cleveland Clinic website -- which foods did the nurse ask me about?
People with known food allergies to banana, avocado, kiwi or chestnuts
83
No more pre-powdered latex medical gloves because when you remove the gloves, the powder aerosolizes and someone nearby
may _____ in the powder which has latex particles from the gloves and the gloves also ____ and there is increased latex particle exposure when powdered gloves are worn
• The science behind cross-reactivity:
o The same protein that initiates the allergic response in latex is found in these
plant foods – protein is called "_____" o Interesting stuff on latex allergy (e.g., why don't latex-allergic individuals have
reactions all the time in the natural world?), from the World Allergy Organization
breathe
“leak”
profilin
84
Reactions to Food Additives: COMMON OFFENDERS →
• _______:
o Bacterial inhibitors, anti-fermentors, preservatives, anti-browning for vegetables
o vast majority of reactions are asthmatic in nature.
o Mechanism: sulfur dioxide may be released and cause bronchospasm (like an
asthma attack)
o Diagnostic: Reactions confirmed with oral challenge in supervised setting only
(ready to administer life-saving treatment for acute anaphylaxis)
o Treatment: avoidance.
Sulfites
85
________:
o Chinese Restaurant Syndrome o Symptoms: within 15-20 minutes after ingestion headache, occipital burning;
note that asthmatics more susceptible & reaction may be more severe.
• Food dyes: azo- and non-azo- groups
o Urticaria: azo dyes with an (-N=N-) group, e.g. tartrazine o non-Azo don't cause urticaria.
MSG (monosodium glutamate)
