OTC and Herbal Medications

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Merrittk
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210188
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OTC and Herbal Medications
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2013-03-29 17:17:07
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BC CRNA
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Flashcards over OTC and Herbal Medications
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  1. To be classified as an Over The Counter medication:

    [5 Things]
    • 1. Safe (benefits outweigh the risks)
    • 2. Low potential for misuse or abuse 
    • 3. Can be labeled
    • 4. Pt. must be able to self diagnose the condition for which the drug is being taken
    • 5. Must be for a condition the patient can manage without supervision by licensed health professional
  2. Tylenol is metabolized in the _______.
    Liver
  3. The maximum daily dose of Tylenol is:
    • 4000 mg
    • or
    • 4 g
  4. The Mechanism of Action for Aspirin is:
    COX1 and COX2 inhibition

    (bonus: COX stands for cyclooxygenase)
  5. What four pathways does aspirin work?
    • 1. antipyretic
    • 2. antiinflammation
    • 3. antiplatelet
    • 4. Analgesic
  6. What are some Adverse Reactions of Aspirin?
    GI irritation, bleeding problems (irreversible inhibition of platelet aggregation)
  7. True or False: When taking aspirin, take with food to decrease the risk of GI irritation.
    True.
  8. What are some contraindications for taking aspirin?
    Hemophilia, Peptic Ulcer Disease, Vit. K deficiency, and if you're a kid!

    ASA use not safe in children.
  9. What pregnancy categories is aspirin?
    • 1st/2nd Trimester: cat. C
    • 3rd Trimester: Cat. D
  10. What is an example of a trade name for aspirin?
    Bayer
  11. What is Acetaminophens trade name?
    Tylenol
  12. What is acetaminophen's mechanism of action?
    central inhibition of prostaglandin synthesis
  13. Does tylenol have anti-inflammatory activity?
    No!
  14. What condition should you use caution when prescribing tylenol?
    Liver disease.
  15. What pregnancy category is tylenol?
    Category B
  16. What is a trade name for Naproxen?
    Aleve
  17. What are trade names for Ibuprofen?
    Motrin and Advil
  18. What classification of drug are Ibuprofen and Naproxen?
    NSAIDs
  19. What does NSAID stand for?
    Non-steriodal anti-inflammatory
  20. What is the mechanism of action for NSAIDs?
    COX1 and COX2 inhibitors
  21. What is the mechanism of action for Ibuprofen?
    COX1 and COX2 inhibitors
  22. What is the mechanism of action for Naproxen?
    COX1 and COX2 inhibitors
  23. What four pathways do NSAIDs use to work?
    • 1. antipyretic
    • 2. antiplatelet
    • 3. anti-inflammatory
    • 4. analgesic
  24. What adverse reactions do NSAID's have?
    • GI Irritation
    • Bleeding problems (irreversible* inhibition of platelet aggregation)

    (* Emailed Tasmina about this... NSAIDS and ASA have everything the same except this reversible/irreversible discrepancy- I'll keep you updated on her response)
  25. What pregnancy category are NSAIDs?
    • 1st/2nd trimester: Category C
    • 3rd trimester: Category D
  26. Pediatric Dosing of Ibuprofen
    • 0-12 years old:
    • 5-10 mg/kg/dose every 6-8 hours
  27. Pediatric Dosing of Acetaminophen
    0-12 years old:
    10-15 mg/kg/dose every 4-6 hours
  28. True or False: Patient can be on Ibuprofen and Acetaminophen concurrently.
    True.

    Due to the different mechanisms of action, patients may get the most symptom relief by switching between the two meds.
  29. True or False: Patient can take Ibuprofen and Naproxen concurrently.
    False!

    These drugs have the same mechanisms of action- if given concurrently the risk of adverse reaction is increased.
  30. Antihistamines compete with _________.
    Histamine
  31. Histamines are the primary mediator for:
    Sneezing and itching
  32. _______ are the first line agents for prophylaxis and treatment of allergic symptoms.
    Antihistamines
  33. Urticaria means...
    itching
  34. Rhinitis means...
    irritation or inflammation of the mucosal lining of the nose
  35. What are two examples of first generation antihistamines?
    • diphenhydramine
    • and
    • chlorpheiramine
  36. What is a trade name of a first generation antihistamine?
    Benadryl
  37. True or False: First generation antihistamine drugs cross the blood brain barrier.
    True.

    More lipophilic than second generation which allows it to cross the blood brain barrier
  38. True or False: First generation antihistamines are MORE lipophilic than second-generation antihistamines.
    True.

    Why they can cross the blood brain barrier and cause drowsiness.
  39. Common adverse effect of First generation antihistamine:
    Drowsiness
  40. Name three drug names of second generation antihistamines.
    • 1.Loratadine
    • 2. Cetirizine
    • 3. Fexofenadine
  41. What is the trade name for Loratadine?
    Claritin
  42. What is the trade name for Cetirizine?
    Zyrtec
  43. What is the trade name for Fexofenadine?
    Allegra
  44. True or False: Second generation antihistamines are less likely to cross the blood brain barrier.
    True!

    Because they're less lipophilic than first generation antihistamines.
  45. Pregnancy category of Fexofenadine.
    • (Allegra)
    • Category C
  46. Pregnancy Category of:
    Chlorpheiramine, Diphenhydramine, Loratadine, Cetirizine
    (Benadryl, Claritin, Zyrtec)

    Category B
  47. How often are second line antihistamines dosed?
    Typically once a day!
  48. What are two routes of decongestant administration?
    oral & nasal
  49. What are two ORAL decongestant medications?
    phenylephrine and psuedoephedrine
  50. What are two NASAL decongestant medications?
    phenylephrine and oxymetazoline
  51. What is an important consideration/teaching point for nasally administered decongestants?
    Cannot be taken more than 5 days! otherwise: rebound congestion
  52. What is the mechanism of action for decongestants?
    • -vasconstrictive
    • -reduces nasal congestion
    • -sympathomimetic
  53. What are some adverse effects of decongestants?
    Rapid heart rate, high blood pressure, insomnia
  54. What patient populations would you use caution with when recommending decongestants? Why?
    • BPH- constriction of the urinary sphincter
    • Glaucoma- increases intraocular pressure
  55. The only nasal decongestant approved for use in kids mentioned in our lecture:
    Afrin Children's Pump Mist

    For kids 6-12 years old.
  56. Pediatric Phenylephrine dosing:
    • For 6-12 years old:
    • 5 mg every 4 hours
  57. Pediatric psuedoephedrine dosing:
    • For 6-12 year old:
    • 30 mg every 4-6 hours
  58. Per FDA guidelines, it is not recommended to give decongestants to children under ______.
    5 years old!
  59. Combat Methamphetamine Epidemic Act of ______.
    2006
  60. Combat Methamphetamine Epidemic Act restricts sales of:
    • cough and cold medications that contain methamphetamine precursors:
    • 1. ephedrine
    • 2. psuedoephedrine
    • 3. phenylpropanolamine
  61. According to the Combat Methamphetamine Epidemic Act: Psuedoephedrine sales are limited to: 
    ______ per day 
    ______ per month
    • 3.6 g per day
    • 9 g per month

    *if you go above this, you will be refused
  62. Pt's will be required to show ______ to acquire decongestants with methamphetamine precursors.
    Government issued ID
  63. What two types of cough medicines were described in our lecture?
    • 1. Systemic Antitussives
    • 2. Chest congestion
  64. What medication (drug name) is a systemic antitussive?
    Dextromethorphan
  65. What is the trade name for dextromethorphan?
    • Delsym
    • *extended release- dosed every 12 hours

    -citrus.grape flavoring
  66. What is the mechanism of action for dextromethorphan?
    • -centrally acting to decrease cough threshold
    • -Decreases the incidence of coughing
  67. What is a (rare) adverse effect of systemic antitussives?
    Drowsiness
  68. What pregnancy category are systemic antitussives?
    Category C.
  69. What medication (drug name) is a drug used for chest congestion?
    Guafenesin
  70. What is the trade name for Guafenesin?
    Robitussin
  71. What is the mechanism of action of Guafenesin?
    Mechanism unknown, just know it loosens and thins secretions
  72. What pregnancy category is guafenesin?
    Category C
  73. Name the two OTC sleep aids described in class. (drug names)
    • 1. Diphenhydramine
    • 2. Doxylamine
  74. What is the trade name for diphenhydramine? (hint: the one sold with the SLEEP AIDS)
    Sominex
  75. What is the trade name for doxylamine?
    Unisom
  76. What is the mechanism of action of the sleep aids diphendyramine and doxylamine?
    Act like antihistamines
  77. Adverse Effects of OTC sleep aids
    Drowsiness & Anticholinergic effects (dry mouth, constipation, blurred vision, tinnitus)
  78. What is the pregnancy category for diphenhydramine and doxylamine?
    Category B! (for bedtime!)
  79. In a 2005 study of the US population, ___% reported they used herbs or supplements during the previous 12 months.
    57.3%
  80. In 1987, ___% of medications were derived from plants.

    Today, __% of medications derived from plants due to advancements in synthetic production.
    • 1987- 85%
    • Today- 15%
  81. True or False:
    Many herbals are being used concurrently with other therapies.
    TRUE!
  82. What is the evidence grading system?
    Provides clinicians wit methods to understand the mechanism, use, and potential harmful effects of herbal therapy using an evidence based system
  83. What is an example of an evidence grading system for herbals?
    Natural Standard

    -complimentary medicine grading system
  84. According to Natural Standard, Herbals are graded on a scale of __ to __.
    • A to F
    • A: indicates strong scientific evidence of benefit
    • F: Indicates strong negative scientific evidence
  85. True or False:
    Patients need a prescription to take an herbal supplement.
    FALSE!
  86. What is Senna used for? What is its classification?
    Senna is used to treat constipation. Technically, senna is an herbal medication.
  87. What FOUR preparations can herbals come in?
    1. Oils (concentrated and extracted for massaging into the body)

    2. Capsules/Pills (mimic western medicine)

    3. Teas (taken as a beverage)

    4. Tinctures (preserved in alcohol, taken orally)
  88. What is Kava used to treat?
    Anxiety
  89. What is the mechanism of action of Kava?
    acts on the GABA receptors (like benzos)
  90. What is the purpose of Kava?
    Sedation
  91. What are the adverse effects of Kava?
    • because it acts on GABA receptors:
    • decreased motor reflexes, diminished judgement, visual disturbances

    with long term use: decreased platelet count, shortness of breath, pulmonary HTN, weight loss
  92. What things can Kava interact with?
    Alcohol, sedatives, other GABA-ergic drugs (like phenobarbitol)
  93. What is melatonin indicated for?
    Insomnia
  94. What is the mechanism of action of melatonin?
    • -Mimics the sleep wake cycle
    • -exemplar of a hormone produced by pineal gland to reset sleep-wake cycle
  95. What are some adverse reactions to melatonin?
    altered sleep patterns, confusion, headache, tachycardia, hypothermia
  96. Melatonin potentiates:
    Benzodiazepines
  97. What is valerian root indicated for?
    Insomnia
  98. What is the mechanism of action for valerian?
    Inhibits uptake and presynaptic release of GABA
  99. What does valerian potentiate?
    alcohol, other CNS depressants if taken in large amounts
  100. True or False: When taking Ambien, Benadryl, or Sominex you shouldn't take herbals indicated for insomnia.
    True. The herbals can potentiate the effects of or interact with the other drugs.
  101. What's the #1 indication for St John's Wort?
    Depression
  102. What are other indications for St. John's Wort?
    Gastritis, HIV, Kaposi Sarcoma, wound healing, hypothyroidism
  103. What are the three main mechanisms of action for St. John's Wort?
    • 1. blocks serotonin reuptake
    • 2. blocks norepinephrine re-uptake
    • 3. antiviral activity
  104. What are some side effects of St. John's Wort?
    *side effects are directly related to the effect of the herbal on serotonin and norepinephrine

    Constipation, dry mouth, GI upset
  105. What does St. John's Wort Interact with?
    Tricyclic Antidepressants (TCA's), MAO Inhibitors, Sympathomimetics
  106. If a patient is already on antidepressants and begins taking St. John's Wort what are they putting themselves at risk for?
    Serotonin Syndrome
  107. What is main indication of DHEA ?
    Hormone Enhancement
  108. What is the mechanism of action of DHEA?
    Steroid precursor- later converted into androgen and estrogen
  109. What are other indications for DHEA?
    Immune enhancement, Prevention of Osteoperosis, Prevention of development of malignant cells
  110. What are the adverse effects of DHEA?
    Hirstruism (overgrowth of hair), insomnia, irritability

    insomina and irritability directly related to increase in amount of steroids in body
  111. What is the main indication for Ginseng?
    Confusion and Memory Loss
  112. What is the mechanism of action of Ginseng?
    CNS stimulating

    -different effects depending on active component
  113. What does Ginseng work to improve?
    Concentration, Stamina, stress resistance, work efficiency, mental performance
  114. What are the adverse effects of Ginseng?
    drowsiness, dizziness, headache, insomnia, chest pain, HTN, impotence, nervousness, agitation, palpitations
  115. What does Ginseng interact with?
    Insulin, hypoglycemics, MAO inhibitors
  116. What is the primary indication for Gingko?
    Confusion and Memory Loss
  117. What is the mechanism of Gingko? (3 things)
    • 1. stimulates prostaglandin synthesis
    • 2. stimulates vasodilation
    • 3.increases cerebral blood flow
  118. What does Gingko improve?
    Concentration, Memory, thinking ability
  119. What are the adverse effects of Gingko?
    Bleeding, Seizures, diarrhea, HA, nausea, bruising
  120. What does Gingko interact with?
    Antiplatelets and anticoagulants
  121. What population should Ginkgo be used cautiously in?
    Elderly: risk for falls, if on ASA or Warfarin- could pose huge risk to patient
  122. What is the main indication for Licorice?
    * not the candy!
    GI Health
  123. What are other indications for licorice?
    mild expectorant, laxative, antispasmodic
  124. What is the mechanism of action of licorice? (2 things)
    • 1. Potentiates endogenous steroids
    • 2. Stimulates gastric mucous production
  125. What are some adverse effects to Licorice?
    • HA, lethargy, Sodium/Water Retention
    • (all related to mineralcorticoid effects)
  126. What does licorice interact with?
    antihypertensives, diuretics, digoxin, quinidine, spironolactone
  127. Licorice candy contains flavoring from:
    Anise Oil
  128. What is glucosamine indicated for?
    Joint Pain
  129. What is glucosamine derived from?
    Amino acids found in mucopolysaccharides and chitin
  130. What is the mechanism of action for Glucosamine?
    • 1. stimulates cartilage production
    • 2. enhances rebuilding of damaged cartilage
  131. What are the adverse effects of Glucosamine?
    GI, heartburn, rash
  132. True or False: Patients should combine Glucosamine and chondroitin for better efficacy.
    TRUE!
  133. What is the primary indication for chondroitin?
    Joint pain
  134. What is chondroitin derived from?
    Extracted from the cartilage of cow trachea
  135. What is the mechanism of action of chondroitin?
    • 1. stimulation of chondrocyte metabolism
    • 2. stimualtion of collagen synthesis
    • 3. stimulation of hyluronic acid


    *all to improve joint fluidity
  136. What are the adverse reaction to chondroitin?
    dyspepsia, motor restlessness, risk of internal bleeding
  137. What can chondroitin potentiate?
    Anticoagulants
  138. True or False: Glucosamine and Chondroitin are available in combinations.
    TRUE!

    Available in double and triple strength depending on how many pills the patient wants to take
  139. What is feverfew indicated for?
    Headache, migraine, joint pain, menstrual problems
  140. What is the mechanism of action for Feverfew?
    inhibition of serotonin release from platelets
  141. What are the adverse reactions to feverfew?
    mouth ulcerations, hypersensitivity

    Can experience withdrawal syndrome from Feverfew: pain+ stiffness
  142. True or False: Herbal medicine is not isolated as a single remedy, but typically combined with other therapies.
    True!

    Examples of other therapies: acupuncture, manipulative therapy, movement
  143. CoEnzyme Q10 (antioxidant)
    INDICATION:
    RATING:
    • INDICATION: Hypertension
    • RATING:B
  144. Fish Oil:
    INDICATION:
    RATING:
    • INDICATION: Hypertension
    • RATING: A
  145. Calcium
    INDICATION:
    RATING:
    • INDICATION: Hypertension
    • RATING: B
  146. Psyllium Husk
    INDICATION:
    RATING:
    • INDICATION: hyperlipidemia
    • RATING: A
  147. Fish Oil:
    INDICATION:
    RATING:
    • INDICATION: Hyperlipidemia
    • RATING: A
  148. Red Yeast Rice
    INDICATION:
    RATING:
    • INDICATION: Hyperlipidemia
    • RATING: A
  149. Garlic
    INDICATION:
    RATING:
    • INDICATION: Hyperlipidemia
    • RATING: B
  150. True or False: Natural Standard is a reference tool for herbal supplements.
    True.

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