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196 Cards in this Set

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what are 4 properties of aspirin?
antiinflammatory
antipyretic
antiplatelet
analgesic
Aspirin: digested where?
stomach & SI
Aspirin: digestion affected by food?
Yes, slowed by food & antacids
Aspirin: adverse effects?
Possible GI irritation, ulcer, allergy
Aspirin: drug interactions?
anticoags-increased bleeding
valproic acid: incr bld level
sulfonylurea: too much hypoglycemia
Alcohol: incr GI irritation
Aspirin:
What are the precautions?
1. Chronic ETOH use
2. Asthma/Nasal Polyps
3. Pregnancy!
4. Kids under 15 w/ flu or chickenpox
What is choline salicylate an alternative to?
Aspirin
What benefits does choline salicylate have over aspirin?
1. Doesn't give stomach irritation
2. For those who are allergic to ASA
What does aspirin treat that choline salicylate does NOT?
fever
What is a drawback of choline salicylate?
fishy odor!
What is the abbreviation for acetaminophen?
apap
Does apap cause GI irritation?
Is apap safe for use in pregnant/nursing?
It does NOT cause GI irritation.
It IS safe for use in pregnant/nursing.
What is the most common ingred in OTC prods?
Acetaminophen
What are acetaminophens 2 indications?
Its 2 indications are pain & fever. NOT inflammation!
What is the most common drug in acute overdoses?
apap
What is the concentration of the infant acetaminophen liquid?
80mg/0.8mL
What is the concentration of the child apap liquid?
125mg/5mL
Which one is more concentrated- the infant or child apap liquids?
The infants is more concentrated -> beware!
What are 3 Non-salicylate NSAIDS?
1. Ibuprofen (Motrin)
2. Naproxyn (Aleve)
3. Ketoprofen (Orudis, Actron)
Which HA OTC med is best & why?
Ibuprofen best:
safe, not many side effects, effective
What is an advantage of Naproxen?
low side effects like Ibuprofen, except longer acting (6-8 hrs)
Who is naproxen (Aleve) NOT recommended for?
Children under 12
What are the 3 indications for all of Ibuprofen, Naproxen, & ketoprofen (the non-salicylate NSAIDs)?
Analgesic
Antipyretic
Antiinflammatory
What effect does the non-salicylate NSAIDs NOT have that aspirin does?
Antiplatelet
Can a pregnancy women take non-salicylate NSAIDS?
Yes, but ONLY in Trimesters 1&2
What are the drug interactions w/ NSAIDs?
1. Anticoagulants- increased effect when taken w/ ASA, ibuprofen
2. Alcohol - Incr GI irritation
What analgesic works best for pain?
Each drug reacts differently to different types of pain-> so some are better for specific pain than others
What is the best OTC pain analgesic combo?
ASA, Ibuprofen, APAP, & caffiene
NSAIDs are particularly bad if have what medical condition?
Renal conditions
What are rec. kids doses for:
ASA?
APAP?
Ibuprofen?
ASA: NOTHING-> ASA not rec for kids!
APAP: 10-15mg/kg
Ibuprofen: 7.5mg/kg
What temp is a fever when taken by a:
rectal thermometer?
Oral Thermometer?
Axillary Thermometer?
Tympanic Thermometer?
Rectal >101.84
Oral >100.0
Axillary >99.0
Tympanic >100.4
Which type of thermometer is least reliable?
axillary
At above what Temp do kids have seizures?
105-106
What is muscle pain?
Dull, constant, aching pain which worsens when use muscle.
How do you treat muscle pain?
1. OTC analgesics
2. RICE therapy
What are joints?
Cartilage covering the articulating bone surfaces, the surrounding synovial membrane, & periarticular supporting structures incl ligaments (muscle to bone) & tendons (bone to bone).
What is a bursa?
A double layered collapsed sack that provides surface & lubrication; somewaht similar to a synovial membrane
What causes joint pain?
Can be caused by:
1. stress, tension
2. kinins, prostaglandins, lactic acid, histamine, uric acid
3. Joint degeneration from arthritis
What are the signs & symptoms of joint pain?
1. Injury had occurred
2. Redness, swelling, pain present
3. Pt complains of aching joints
How do you treat joint pain?
1. OTC analgesics
2. RICE therapy
What is Bursitis/Tendonitis?
Pain/Inflammation in joint area:
Commonly shoulder, elbow, knee
Characterized by swelling, pain and TENDERNESS
What should pts on fluoroquinolone Abx (FLOXIN, CIPRO, LEVAQUIN) be warned about?
Increased risk of tendon rupture
Treatment for bursitis/tendonitis?
RICE therapy
OTC analgesics
topicals
massages/exercise/PT
Define: strain?
Treatment: strain?
Excess stretching of a tendon or a muscle causing limited muscle fiber tears.
Treat w/ RICE & OTC analgesics
Define: sprain?
Most commonly referred to a injury of a ligament, has 3 degrees.
What are the 3 degrees of a sprain?
How do you treat each one?
1st degree: Xs stretching w/ pain/discomfot & swelling; Tx: OTC analgesics & RICE
2nd degree: Partial tear, pain, discomfort & swelling->if very inflamed
3rd degree: Complete rupture of ligament: trouble using!
TX for 2nd & 3rd: see MD!
Define: cramp
A painful spasmodic contraction of a muscle: self-limiting
What can cause a cramp?
Electrical imbalance
Low potassium
Treatment: cramp?
Massage/Heat
Rest
Electrolyte replenishment
Calcium supplements
What are the 4 categories of Topical OTC Counterirritant Analgesics?
A. Rubefacients: Methyl Salicylate/Allyl isothiocyanate/Ammonia water/Turpentine Oil
B. Cooling Agents: Camphor/Menthol
C. Topical vasodilators: Methyl Nicotinate/Histamine Dihydrochloride
D. Extracts Of Hot Pepper: Capsaicin/Capsicum oleoresin/Capsicum
What does a rubefacient require upon application?
Rubbing!
How do vasodilators help muscle & joint pain
Cause localized vasodilation->improve circulation->warmth
How do Extracts of Hot Pepper relieve muscle & Joint pain?
topical gets hot upon application, no rubbing required
What must one NOT do when using Extracts of Hot Peppers?
Wrap over it!
What formulations of OTC Counterirritant Analgesics are available?
1. Liniments
2. Gels
3. Lotions
4. Ointment/Creams
What is a liniment?
A solution or mix of oil/alcohol/soap -> leaves an oily residue
What is a gel?
A water based jelly that leaves NO residue
Define: lotion?
Suspension or emulsion usually containing water & oil.
Greasy scale:
Ointment&Creams>Liniment>Lotion>Gel
Define: Ointment/Cream?
Semi-solid that remains on the skin, and penetrates deeper into layers
Most greasy
What is trolamine Salicylate?
aka Aspercreme
A salicylate that is applied topically->
Gives salicylate level in synovial fluid lower than w/ oral dosing, but no GI side effect
Where can you get topical NSAIDs?
1. Europe
2. Specialty compounding pharmacies in US
What are the 3 most common respiratory ailsment treatable w/ OTC meds?
Cough
Cold
Allergic Rhinitis
How is a cough categorized?
Acute: 3 weeks or less
Chronic: 3+ weeks
What medical conditions can cause a chronic cough?
Asthma
Bronchitis
GERD
CHF
What medication can cause chronic cough
Lisinopril
What are 2 types of symptoms of a cough?
1. Productive/Nonproductive
2. Voluntary/Involuntary
Which type of cough is better clinically?
Productive
What are some complications of cough?
Insomnia (most common)/Exhaustion
Hoarseness/Sore throat
Muscle strain or chest pain
Perspiration
Urinary incontinence
Fainting (syncopy)
Stroke
What are the Exclusions for self care in cough?
1. Production of yellow or green phlegm -> infxn->see MD
2. Coughs w/ high fever
3. Coughs assoc w/ wt loss -> TB
4. Hemoptysis-> Coughing up blood
5. Worsening of symptoms despite treatment
What are the nonpharmacological treatments for cough?
1. Hydration
2. Increased humidity
3. Hard candy/lozenges
How do humidifiers & vaporizers differ?
Vaporizers: produce steam, can burn, less worry @ bacterial growth, can add topical antitussives to!

Humidifiers: Nothing more than atomizers, depend on power of fan
How do lozenges help cough?
By stimulating salivary fow: any hard candy can do this!
What types of pharmacologic treatments for cough are there?
1. Expectorants: stim resp. tract secretions, make mucus more watery
2. Antitussives: (Cough suppressant) deadens coughing nerve
Do expectorants and antitussives work systemically or locally?
How does the affect the pts ability to drink water
Centrally, so ok to drink water!
What is the active ingredient in Expectorants?
Guaifenesin: the ONLY FDA approved active ingredient for this category
What are some active ingredients in oral Antitussives?
1. Codeine
2. Dextromethorphan
3. Diphenhydramine
Which ingredient is the GOLD STANDARD for antitussive?
Is it OTC?
Codeine
It is OTC some places, but not MA
How does Codeine work in an antitussive?
Centrally on cough center
What is the common strength and dosage of Codeine in an antitussive?
10mg/5mL is common strength
Dose is 1-2 tsp q4-6
Who is codeine (ie in antitussive) NOT recommended for?
1. Under 6yo
2. Pregnant (Category C=questionable)
What are the 5 pregnancy risk categories for meds & what do they each mean?
A: OK for all trimesters
B: OK for all trimesters, studies less conclusive
C: Questionable: Animal studies only showed adverse effects
D: BAD! Evidence of fetal risk, some may still use based on ben/risk ratio
E: BAD! Evidence of fetal risk & no benefits to outweigh risk
What is dextromethorphan commonly abbreviated as on products?
"DM"
DM (dextromethorphan) is slightly _______-acting than codeine.
shorter
What antitussive med has minimal side effects but may cause nausea, stomach cramps, dissiness, HA or drowsiness?
Dextromethorphan
Is dextromethorphan a narcotic?
No, but it IS a narcotic derivative so it is a popular abuse drug w/ kids due to its hallucinogen effect (as seen in Corisidan HBP abuse)
What is a popular brand name for diphenhydramine?
Benadryl
What Pregnancy Risk Category does diphenhydramine fall under?
Cat. B
When should a RPh recommend a pt take diphenhydramine?
bedtime!
What additional affect does diphenhydramine have?
Antihistamine
Which antitussives act centrally to raise the cough threshold?
Codeine and Diphenhydramine
Which is the most sedating antitussive?
Diphenhydramine
Which antitussive can make some kids go off the wall?
Diphenhydramine
What are the topical antitussives?
Camphor & Menthol (& possibly eucalyptol)
How do topical antitussives work?
Stim mucosal receptors to create soothing sensation & increase secretions, easier breathing
How are topical antitussives used?
1. Rub on neck & chest up to TID, esp b4 bed
2. Can be used in vaporizers or placed in hot water basin
What is an NSAID?
Ibuprofen, Ketoprofen, Naproxen (technically aspirin, but normally it is not included when people are referencing NSAIDs)
What causes @ 50% of all illness in adults & nearly 75% in kids?
Common cold
What viruses cause the common cold?
Many different, but most commonly:
Rhinovirus (RV)
Respiratory Syncytial Virus (RSV)
When is peak season for the common cold?
August - May!
What other viruses are common for the cold?
adenovirus, echovirus, cocksackievirus
What is 1st cold symptom?
What are 3 main symptoms?
1. Sore throat
2. Nasal congestion, rhinorrhea, sneezing
Is cough a primary symptom of cold?
NO
How long do nasal symptoms of a cold last?
10-14 days
What is nonpharmacological Tx for a cold?
rest, incr fluid intake, vap/humidifier, steamy showers, saline gargle, lozenges, soup etc
What is pharmacological tx for cold? Best approach?
Treat symptoms as they occur
What are types of pharmacological Tx for common cold?
Oral Decongestants / Topical Decongestant
Antihistamines
Systemic Analgesics
Local Anesthetics
Antiseptics Agents
What are the 2 types of oral decongestant?
1. pseudoephedrine
2. Phenylephrine
What time of day should pts NOT take decongestants?
Before bed!
Elevated BP, tachycardia, palpitations, restlessness, insomnia, anxiety & tremors are side effects of which type of common cold treatment?
Decongestants
WHat is the max amt of time one should use topical decongestants?
3-5 days to avoid rebound nasal congestion
What is a problem w/ nasal decongestants?
Irritating to mucous membranes which can cause some rebound nasal congestion
Are Topical decongestants ok in preg women?
Usually b/c limited systemic effect
How are topical decongestants taken?
Intranasal or opthalmic
What are antihistamines used for?
Primarily allergies but also may reduce rhinorrea/sneezing seen in cold
What type of Tx for the common cold has side effects including: sedation and dry mouth/eyes/mucosa?
Antihistamines
In treating a cold, is a decongestant or antihistamine better to use for a pt w/ HBP?
An antihistamine b/c it doesnt raise BP
Should pts take systemic analgesics for cold?
If needed, but beware often in cold txs already!
What are some local anesthetics used for common colds?
lozenges/troches/mouthwashes/sprays
Benzocaine, dyclonine, phenol
Is zinc FDA approved for colds?
No, but evidence that helps if take at onset of symptoms
Does Vit C help a cold?
Doesnt prevent
May decrease duration
Too much causes problems!
What are some diffs b/w cold & allergies?
Cold has sore throat & HA
Allergies doesn't
What are the nonpharmacological tx for allergic rhinitis?
1. Remove or reduce allergen exposure
2. Change Furnace/Air filters, use Air Purifiers
3. Use bacterial/fungal control in humidifiers
4. Use HEPA vacuum
5. Control pets, pollen exposure
What are some types of pharmacologic treatments for Allergic Rhinitis?
1. Antihistamines
2. Decongestant
3. Cromolyn (NOT a decongestant)
4. Nasal Wetting Agents
Should pts take allergic rhinitis meds prn or reg sched doses?
reg sched doses are better
What is the most effective combo for all. rhinitis sx incl itching, sneezing, rhinorrhea, & congestion?
Decongestant & antihistamine
What are some diffs b/w cold & allergies?
Cold has sore throat & HA
Allergies doesn't
What are the nonpharmacological tx for allergic rhinitis?
1. Remove or reduce allergen exposure
2. Change Furnace/Air filters, use Air Purifiers
3. Use bacterial/fungal control in humidifiers
4. Use HEPA vacuum
5. Control pets, pollen exposure
What are some types of pharmacologic treatments for Allergic Rhinitis?
1. Antihistamines
2. Decongestant
3. Cromolyn (NOT a decongestant)
4. Nasal Wetting Agents
Should pts take allergic rhinitis meds prn or reg sched doses?
reg sched doses are better
What is the most effective combo for all. rhinitis sx incl itching, sneezing, rhinorrhea, & congestion?
Decongestant & antihistamine
What are some diffs b/w cold & allergies?
Cold has sore throat & HA
Allergies doesn't
What are the nonpharmacological tx for allergic rhinitis?
1. Remove or reduce allergen exposure
2. Change Furnace/Air filters, use Air Purifiers
3. Use bacterial/fungal control in humidifiers
4. Use HEPA vacuum
5. Control pets, pollen exposure
What are some types of pharmacologic treatments for Allergic Rhinitis?
1. Antihistamines
2. Decongestant
3. Cromolyn (NOT a decongestant)
4. Nasal Wetting Agents
Should pts take allergic rhinitis meds prn or reg sched doses?
reg sched doses are better
What is the most effective combo for all. rhinitis sx incl itching, sneezing, rhinorrhea, & congestion?
Decongestant & antihistamine
What are the most commonly purchased and prescribed med for All. Rhinitis?
Antihistamines (diphenhydramine aka Benadryl)
Name the available antihistamines
1st gen:
Diphyenhydramine,Doxylamine, Brompheniramine, Chlorpheniramine
2nd gen: Loratadine (Claritin,Alavert, etc)
What is diff b/w 1st and 2nd generation antihistamines?
1st gen: sedating
2nd gen: non-sedating
Of the 1st gen antihistamines, which are the most sedating? Least sedating?
Most sedating: diphenhydramine & doxylamine
Least sedating: brompheniramine & chlorpheniramine
Drawback of 2nd gen antihistamine?
Don't work as well, & no guarantee re the non-sedating characteristic
What 2 types of decongestants are used for All. Rhinitis?
Systemic or Topical
How do decongestants work?
Vasoconstrictors: Decrease leaking fluid out of swollen vessels, shrink membranes back.
What is a concern with decongestants?
Increased BP, Heart strain, insomnia
How does cromolyn work?
It's a mast cell inhibitor, for both immune related & non-immune-related triggers, to prevent & treat All. Rhinits, must take in advance ON REG BASIS
Is Cromolyn an antihistamine?
NOOOOO
What are Cromolyn's side effects?
Side effects are minimal as only 7% absorbed; most common are sneezing, nasal stinging or burning
Can pregnant women use cromolyn?
YES
Is cromolyn for long or short term use?
long term
What is a Nasal Wetting agent used for?
Allergic Rhinitis
What are the 3 Nasal Wetting agents?
Saline
Propylene Glycol
Polyethylene Glycol
(glycol-> makes thicker & helps retain moisture)
What do Nasal wetting agents relieve?
nasal stuffiness, rhinorrhea, sneezing by reducing nasal irritation
Who are Nasal wetting agents safe for?
EVERYONE
No therapeutic agents
What is primary symptom of asthma?
wheezing
what % of population is atopic (susceptible to allergens, not nec get asthma)
30-50%
Is everyone who is atopic going to get asthma
NO
Define atopy
a genetically determined state of hypersensitivity to environmental allergens
________ atopy predisposes children to asthma
Parental
Asthma affects ___ million people incl ___ mil kids
15; 5
Sx of asthma often ____ w/ age
decrease
What % of people have temp or perm remission from asthma by adulthood?
50-70%
____ hospitalizations annually from asthma
500,000
___ deaths in 1998 from asthma
5438
Increase in asthma is greater in ____ & ____ populations
Elderly & Urban
Sx of asthma?
wheezing, dyspnea, chronic nonproductive cough, excessive thick sputum
Good to ___ humidity for asthma b/c _____
increase
they have dry membranes
Asthma triggers:
Most common: smoke, dust mites, pet dander, mold
How many OTC ingred approved by FDA for asthma?
two: Epinephrine & ephedrine
How long should OTC meds be used for asthmatics?
temp -> all asthmatics s/b treated by MD
What are the side effects of ephedrine?
Nausea, insomnia, tremors, tachycardia, anorexia, urinary retention
How can a name of an antihistamine be recognized?
They all end in -amine except for loratidine, triprolidine, & clemastine
The 3 types of antihistamine activity are:
Antihistamine, sedative, anticholinergic
What does anticholinergic effect =
Dry mouth
What level activities does diphenhydramine have?
low antihist, high sed, high antichol.
-> not a great antihistamine
Which antihistamines are best based on their activity levels?
Brompheniramine & dexbrompheniramine:
High Antihistamine
Low Sedative
Moderate Anticholinergic
What is the active ingred in Delsym?
DM
What drug is in Primatene Mist?
Epinephrine
DM is equiv to ____ on mg-to-mg basis; codeine works ___
codeine
better
What are the 5 categories for regulatory standards in drugs vs. supplements?
1. Proof of SAfety
2. Proof of Effectiveness
3. Post-marketing Surveillance
4. GMPs
5. Disease Treatment Claims
Of the 5 categories compared for regulatory standard in comparing drugs vs supplements, what are the only constraints placed on supplements
1. Dietary supplements must comply to food GMPs as of 2007
2. Disease-Treatment claims are not allowed
What is a nutrient content label claim?
Excellent source of....
What is a health claims on a label?
"diets high in Ca may reduce the risk of osteoporosis"
What is a structure/function claim?
"Antioxidants maintain cell integrity" followed by FDA hasn't evaluated disclaimer
What are the key labeling requirements?
1. Descriptive name of product, stating its a supplement
2. Structure/function ONLY
3. Disclaimer
4. Net qty of contents, Mfg name & address
5. Facts panel: supplement facts w/ a list of ea ingred.
For herbal prods must state which part of plant was used.
There are a lot of antiinflammatory/CNS agents which induce ___.
Hyperthermia
What ingredients are in Excedrim Migraine?
Apap 250, asa 250, caffiene 65mg
Adult rec dose for ASA?
650-1000mg q4-6 (4000mg max)
Adult rec dose for APAP?
325-1000mg q4-6 (4000mg max)
Adult rec dose for ibuprofen?
200-400 q4-6 (1200mg max)
Adult rec dose for naproxen?
220 mg q8-12 (660mg max)
Adult rec dose for ketoprofen?
12.5-25mg q4-6 (75mg max)
Adult rec dose for ASA?
650-1000mg q4-6 (4000mg max)
Adult rec dose for APAP?
325-1000mg q4-6 (4000mg max)
Adult rec dose for ibuprofen?
200-400 q4-6 (1200mg max)
Adult rec dose for naproxen?
220 mg q8-12 (660mg max)
Adult rec dose for ketoprofen?
12.5-25mg q4-6 (75mg max)
what is magnesium salicylate used for? What is its primary benefit? Brand names?
Analgesic
for those allergic to aspirin
Doans
377mg=325mg ASA