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Key Points(OTC DRUGS)

Cough, Cold, and Allergy


Non-prescription drug therapy for the common cold includes symptomatic management using decongestants (nasal congestion), antihistamines (excess nasal discharge), analgesics (headache), and local anesthetic lozenges or sprays (pharyngitis). Non-prescription treatment of allergies includes systematic antihistamines (sedating or nonsedating), ocular antihistamines, decongestants (if nasal congestion, and cromolyn (scheduled, not as needed). Cough can be relieved by a product containing a cough suppressant (dextromethorphan). An expectorant (guaifenesin) should be recommended to enhance clearance of mucus. Diet and lifestyle changes should always be recommended to prevent or treat constipation (increase in fiber and fluid intake, exercise). Bulk-forming laxatives and stool softeners are the safest product to prevent and treat constipation, and can be used chronically. Stimulant laxatives should be used only occasionally to avoid laxative dependence or other complications. Loperamide or bismuth subsalicylate may be recommended to treat diarrhea. Maintaining adequate hydration is very important, especially in young children and the elderly. Non-prescription drug treatment options for nausea and vomiting include antihistamines (meclizine, dimenhydrinate) and phosphorated carbohydrate solution (Emetrol) Histamine2-receptor antagonist (cimetidine, ranitidine), antacids, or bismuth salts (Pepto-Bismol) may relieve gastric discomfort or indigestion. Pain and fever may be treated with aspirin and other salicylates, non-steroidal antiinflammatory drugs (NSAIDS), or acetaminophen. Aspirin and NSAIDS inhibit platelet aggregation. Non-acetylated salicylates and acetaminophen do not have antiplatelet activity. Salicylates and NSAIDS can cause gastropathy, including gastritis, gastric ulcers and gastric bleeding. They may decrease the effectiveness of some antihypertensives, and may have deleterious effects on kidney function.

Constipation

Diarrhea

Nausea and Vomiting

Pain and Fever


THE APhA COMPLETE REVIEW FOR PHARMACY

Acetaminophen does not have anti-inflammatory bleeding, and can be hepatotoxic in excessive doses (>4g/d), or when used concurrently with alcohol. Dry eyes can be treated with artificial tears or ocular emollient. Ophthalmic vasoconstrictors ( ocular decongestants) cause vasoconstriction in the conjunctiva to treat redness. Naphazoline is the ocular decongestant of choice. Ocular decongestants are contraindicated in narrow-angle glaucoma, due to the potential to cause rebound. Combination products containing an ophthalmic vasoconstrictor and ocular antihistamine should be recommended for allergic conjunctivitis (naphazoline + pheniramine or antazoline). Impacted cerumen can be treated with cerumen softening agents (carbamide peroxide in anhydrous glycerin + alcohol; hydrogen peroxide + water). Water-clogged ears may be managed with commercial preparation of isopropyl alcohol + anhydrous glycerin, or compounded acetic acid + isopropyl alchocol. Home tests are available for: o Blood glucose monitoring (diabetes) o Fertility and ovulation o Pregnancy o Urinary tract infection o Colorectal cancer o Blood pressure monitoring o Acquired immunodeficiency syndrome(AIDS) o Illicit drug use o Hepatitis C Herbal products that should be discontinued prior to surgery: gingko, garlic, ginseng St. Johns wort: takes several weeks to see effect; potential for serious drug interactions.

Ophthalmic products

Otic products

Home monitoring and testing devices

Natural and herbal products


Sleeping aids
Ethanolamine antihistamines (diphenyhydramine, doxylamine) should be used for shortterm management of occasional insomnia in conjunction with good sleep hygiene.

THE APhA COMPLETE REVIEW FOR PHARMACY

Smoking cessation
First-line agents for pharmacotherapy in smoking cessation: * Nicotine gum (Nicorette, generic) OTC * Nicotine patch (Nicotrol, Nicoderm CQ) OTC * Nicotine inhaler (Nicotrol inhaler) * Nicotine nasal spray (Nicotrol NS) * Bupropion SR (Zyban) Contraindications/Precautions for nicotine replacament therapy: * Cardiovascular disease * <2 weeks post-MI * Serious arrhythmias * Serious/worsening angina * Esophagitis, peptic ulcer disease (gum) * Seek medical advice if pregnant or breastfeeding * Do not smoke while using NRT *Allergies, asthma, sinus conditions (nasal spray) Caffiene, a CNS stimulant, is the only FDA-approved non-prescription stimulant. The recommended dosage of 50-200 mg may increase alertness and decrease fatigue. Doses exceeding 200 mg may cause nervousness, insomnia, and/or irritability.

Stimulants

THE APhA COMPLETE REVIEW FOR PHARMACY