OTC and Herbal Medications
Card Set Information
OTC and Herbal Medications
Flashcards over OTC and Herbal Medications
To be classified as an Over The Counter medication:
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
Tylenol is metabolized in the _______.
The maximum daily dose of Tylenol is:
The Mechanism of Action for Aspirin is:
COX1 and COX2 inhibition
(bonus: COX stands for cyclooxygenase)
What four pathways does aspirin work?
What are some Adverse Reactions of Aspirin?
GI irritation, bleeding problems (irreversible inhibition of platelet aggregation)
True or False: When taking aspirin, take with food to decrease the risk of GI irritation.
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.
What pregnancy categories is aspirin?
: cat. C
: Cat. D
What is an example of a trade name for aspirin?
What is Acetaminophens trade name?
What is acetaminophen's mechanism of action?
central inhibition of
Does tylenol have anti-inflammatory activity?
What condition should you use caution when prescribing tylenol?
What pregnancy category is tylenol?
What is a trade name for Naproxen?
What are trade names for Ibuprofen?
Motrin and Advil
What classification of drug are Ibuprofen and Naproxen?
What does NSAID stand for?
What is the mechanism of action for NSAIDs?
COX1 and COX2 inhibitors
What is the mechanism of action for Ibuprofen?
COX1 and COX2 inhibitors
What is the mechanism of action for Naproxen?
COX1 and COX2 inhibitors
What four pathways do NSAIDs use to work?
What adverse reactions do NSAID's have?
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)
What pregnancy category are NSAIDs?
: Category C
: Category D
Pediatric Dosing of Ibuprofen
0-12 years old:
5-10 mg/kg/dose every 6-8 hours
Pediatric Dosing of Acetaminophen
0-12 years old:
10-15 mg/kg/dose every 4-6 hours
True or False: Patient can be on Ibuprofen and Acetaminophen concurrently.
Due to the different mechanisms of action, patients may get the most symptom relief by switching between the two meds.
True or False: Patient can take Ibuprofen and Naproxen concurrently.
These drugs have the same mechanisms of action- if given concurrently the risk of adverse reaction is increased.
Antihistamines compete with _________.
Histamines are the primary mediator for:
Sneezing and itching
_______ are the first line agents for prophylaxis and treatment of allergic symptoms.
irritation or inflammation of the mucosal lining of the nose
What are two examples of first generation antihistamines?
What is a trade name of a first generation antihistamine?
True or False: First generation antihistamine drugs cross the blood brain barrier.
More lipophilic than second generation which allows it to cross the blood brain barrier
True or False: First generation antihistamines are MORE lipophilic than second-generation antihistamines.
Why they can cross the blood brain barrier and cause drowsiness.
Common adverse effect of First generation antihistamine:
Name three drug names of second generation antihistamines.
What is the trade name for Loratadine?
What is the trade name for Cetirizine?
What is the trade name for Fexofenadine?
True or False: Second generation antihistamines are less likely to cross the blood brain barrier.
Because they're less lipophilic than first generation antihistamines.
Pregnancy category of Fexofenadine.
Pregnancy Category of:
Chlorpheiramine, Diphenhydramine, Loratadine, Cetirizine
(Benadryl, Claritin, Zyrtec)
How often are second line antihistamines dosed?
Typically once a day!
What are two routes of decongestant administration?
oral & nasal
What are two ORAL decongestant medications?
phenylephrine and psuedoephedrine
What are two NASAL decongestant medications?
phenylephrine and oxymetazoline
What is an important consideration/teaching point for nasally administered decongestants?
Cannot be taken more than 5 days! otherwise: rebound congestion
What is the mechanism of action for decongestants?
-reduces nasal congestion
What are some adverse effects of decongestants?
Rapid heart rate, high blood pressure, insomnia
What patient populations would you use caution with when recommending decongestants? Why?
BPH- constriction of the urinary sphincter
Glaucoma- increases intraocular pressure
The only nasal decongestant approved for use in kids mentioned in our lecture:
Afrin Children's Pump Mist
For kids 6-12 years old.
Pediatric Phenylephrine dosing:
For 6-12 years old:
5 mg every 4 hours
Pediatric psuedoephedrine dosing:
For 6-12 year old:
30 mg every 4-6 hours
Per FDA guidelines, it is not recommended to give decongestants to children under ______.
5 years old!
Combat Methamphetamine Epidemic Act of ______.
Combat Methamphetamine Epidemic Act restricts sales of:
cough and cold medications that contain methamphetamine precursors:
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
Pt's will be required to show ______ to acquire decongestants with methamphetamine precursors.
Government issued ID
What two types of cough medicines were described in our lecture?
1. Systemic Antitussives
2. Chest congestion
What medication (drug name) is a systemic antitussive?
What is the trade name for dextromethorphan?
*extended release- dosed every 12 hours
What is the mechanism of action for dextromethorphan?
-centrally acting to decrease cough threshold
-Decreases the incidence of coughing
What is a (rare) adverse effect of systemic antitussives?
What pregnancy category are systemic antitussives?
What medication (drug name) is a drug used for chest congestion?
What is the trade name for Guafenesin?
What is the mechanism of action of Guafenesin?
Mechanism unknown, just know it loosens and thins secretions
What pregnancy category is guafenesin?
Name the two OTC sleep aids described in class. (drug names)
What is the trade name for diphenhydramine? (hint: the one sold with the SLEEP AIDS)
What is the trade name for doxylamine?
What is the mechanism of action of the sleep aids diphendyramine and doxylamine?
Act like antihistamines
Adverse Effects of OTC sleep aids
Drowsiness & Anticholinergic effects (dry mouth, constipation, blurred vision, tinnitus)
What is the pregnancy category for diphenhydramine and doxylamine?
Category B! (for bedtime!)
In a 2005 study of the US population, ___% reported they used herbs or supplements during the previous 12 months.
In 1987, ___% of medications were derived from plants.
Today, __% of medications derived from plants due to advancements in synthetic production.
True or False:
Many herbals are being used concurrently with other therapies.
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
What is an example of an evidence grading system for herbals?
-complimentary medicine grading system
According to Natural Standard, Herbals are graded on a scale of __ to __.
A to F
: indicates strong scientific evidence of benefit
: Indicates strong negative scientific evidence
True or False:
Patients need a prescription to take an herbal supplement.
What is Senna used for? What is its classification?
Senna is used to treat constipation. Technically, senna is an herbal medication.
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)
What is Kava used to treat?
What is the mechanism of action of Kava?
acts on the GABA receptors (like benzos)
What is the purpose of Kava?
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
What things can Kava interact with?
Alcohol, sedatives, other GABA-ergic drugs (like phenobarbitol)
What is melatonin indicated for?
What is the mechanism of action of melatonin?
-Mimics the sleep wake cycle
-exemplar of a hormone produced by
gland to reset sleep-wake cycle
What are some adverse reactions to melatonin?
altered sleep patterns, confusion, headache, tachycardia, hypothermia
What is valerian root indicated for?
What is the mechanism of action for valerian?
Inhibits uptake and presynaptic release of GABA
What does valerian potentiate?
alcohol, other CNS depressants if taken in large amounts
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.
What's the #1 indication for St John's Wort?
What are other indications for St. John's Wort?
Gastritis, HIV, Kaposi Sarcoma, wound healing, hypothyroidism
What are the three main mechanisms of action for St. John's Wort?
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
What does St. John's Wort Interact with?
Tricyclic Antidepressants (TCA's), MAO Inhibitors, Sympathomimetics
If a patient is already on antidepressants and begins taking St. John's Wort what are they putting themselves at risk for?
What is main indication of DHEA ?
What is the mechanism of action of DHEA?
Steroid precursor- later converted into androgen and estrogen
What are other indications for DHEA?
Immune enhancement, Prevention of Osteoperosis, Prevention of development of malignant cells
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
What is the main indication for Ginseng?
Confusion and Memory Loss
What is the mechanism of action of Ginseng?
-different effects depending on active component
What does Ginseng work to improve?
Concentration, Stamina, stress resistance, work efficiency, mental performance
What are the adverse effects of Ginseng?
drowsiness, dizziness, headache, insomnia, chest pain, HTN, impotence, nervousness, agitation, palpitations
What does Ginseng interact with?
What is the primary indication for Gingko?
Confusion and Memory Loss
What is the mechanism of Gingko? (3 things)
1. stimulates prostaglandin synthesis
2. stimulates vasodilation
3.increases cerebral blood flow
What does Gingko improve?
Concentration, Memory, thinking ability
What are the adverse effects of Gingko?
Bleeding, Seizures, diarrhea, HA, nausea, bruising
What does Gingko interact with?
What population should Ginkgo be used cautiously in?
Elderly: risk for falls, if on ASA or Warfarin- could pose huge risk to patient
What is the main indication for Licorice?
* not the candy!
What are other indications for licorice?
mild expectorant, laxative, antispasmodic
What is the mechanism of action of licorice? (2 things)
Potentiates endogenous steroids
2. Stimulates gastric mucous production
What are some adverse effects to Licorice?
HA, lethargy, Sodium/Water Retention
(all related to mineralcorticoid effects)
What does licorice interact with?
antihypertensives, diuretics, digoxin, quinidine, spironolactone
Licorice candy contains flavoring from:
What is glucosamine indicated for?
What is glucosamine derived from?
Amino acids found in
mucopolysaccharides and chitin
What is the mechanism of action for Glucosamine?
1. stimulates cartilage production
2. enhances rebuilding of damaged cartilage
What are the adverse effects of Glucosamine?
GI, heartburn, rash
True or False: Patients should combine Glucosamine and chondroitin for better efficacy.
What is the primary indication for chondroitin?
What is chondroitin derived from?
Extracted from the cartilage of cow trachea
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
What are the adverse reaction to chondroitin?
dyspepsia, motor restlessness, risk of internal bleeding
What can chondroitin potentiate?
True or False: Glucosamine and Chondroitin are available in combinations.
Available in double and triple strength depending on how many pills the patient wants to take
What is feverfew indicated for?
joint pain, menstrual problems
What is the mechanism of action for Feverfew?
What are the adverse reactions to feverfew?
mouth ulcerations, hypersensitivity
Can experience withdrawal syndrome from Feverfew: pain+ stiffness
True or False: Herbal medicine is not isolated as a single remedy, but typically combined with other therapies.
Examples of other therapies: acupuncture, manipulative therapy, movement
CoEnzyme Q10 (antioxidant)
Red Yeast Rice
True or False: Natural Standard is a reference tool for herbal supplements.