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196 Cards in this Set
- Front
- Back
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what are 4 properties of aspirin?
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antiinflammatory
antipyretic antiplatelet analgesic |
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Aspirin: digested where?
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stomach & SI
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Aspirin: digestion affected by food?
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Yes, slowed by food & antacids
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Aspirin: adverse effects?
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Possible GI irritation, ulcer, allergy
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Aspirin: drug interactions?
|
anticoags-increased bleeding
valproic acid: incr bld level sulfonylurea: too much hypoglycemia Alcohol: incr GI irritation |
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Aspirin:
What are the precautions? |
1. Chronic ETOH use
2. Asthma/Nasal Polyps 3. Pregnancy! 4. Kids under 15 w/ flu or chickenpox |
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What is choline salicylate an alternative to?
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Aspirin
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What benefits does choline salicylate have over aspirin?
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1. Doesn't give stomach irritation
2. For those who are allergic to ASA |
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What does aspirin treat that choline salicylate does NOT?
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fever
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What is a drawback of choline salicylate?
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fishy odor!
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What is the abbreviation for acetaminophen?
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apap
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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. |
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What is the most common ingred in OTC prods?
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Acetaminophen
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What are acetaminophens 2 indications?
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Its 2 indications are pain & fever. NOT inflammation!
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What is the most common drug in acute overdoses?
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apap
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What is the concentration of the infant acetaminophen liquid?
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80mg/0.8mL
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What is the concentration of the child apap liquid?
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125mg/5mL
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Which one is more concentrated- the infant or child apap liquids?
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The infants is more concentrated -> beware!
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What are 3 Non-salicylate NSAIDS?
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1. Ibuprofen (Motrin)
2. Naproxyn (Aleve) 3. Ketoprofen (Orudis, Actron) |
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Which HA OTC med is best & why?
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Ibuprofen best:
safe, not many side effects, effective |
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What is an advantage of Naproxen?
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low side effects like Ibuprofen, except longer acting (6-8 hrs)
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Who is naproxen (Aleve) NOT recommended for?
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Children under 12
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What are the 3 indications for all of Ibuprofen, Naproxen, & ketoprofen (the non-salicylate NSAIDs)?
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Analgesic
Antipyretic Antiinflammatory |
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What effect does the non-salicylate NSAIDs NOT have that aspirin does?
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Antiplatelet
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Can a pregnancy women take non-salicylate NSAIDS?
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Yes, but ONLY in Trimesters 1&2
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What are the drug interactions w/ NSAIDs?
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1. Anticoagulants- increased effect when taken w/ ASA, ibuprofen
2. Alcohol - Incr GI irritation |
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What analgesic works best for pain?
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Each drug reacts differently to different types of pain-> so some are better for specific pain than others
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What is the best OTC pain analgesic combo?
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ASA, Ibuprofen, APAP, & caffiene
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NSAIDs are particularly bad if have what medical condition?
|
Renal conditions
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What are rec. kids doses for:
ASA? APAP? Ibuprofen? |
ASA: NOTHING-> ASA not rec for kids!
APAP: 10-15mg/kg Ibuprofen: 7.5mg/kg |
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|
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 |
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Which type of thermometer is least reliable?
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axillary
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At above what Temp do kids have seizures?
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105-106
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What is muscle pain?
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Dull, constant, aching pain which worsens when use muscle.
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How do you treat muscle pain?
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1. OTC analgesics
2. RICE therapy |
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What are joints?
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Cartilage covering the articulating bone surfaces, the surrounding synovial membrane, & periarticular supporting structures incl ligaments (muscle to bone) & tendons (bone to bone).
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What is a bursa?
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A double layered collapsed sack that provides surface & lubrication; somewaht similar to a synovial membrane
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What causes joint pain?
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Can be caused by:
1. stress, tension 2. kinins, prostaglandins, lactic acid, histamine, uric acid 3. Joint degeneration from arthritis |
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What are the signs & symptoms of joint pain?
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1. Injury had occurred
2. Redness, swelling, pain present 3. Pt complains of aching joints |
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How do you treat joint pain?
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1. OTC analgesics
2. RICE therapy |
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What is Bursitis/Tendonitis?
|
Pain/Inflammation in joint area:
Commonly shoulder, elbow, knee Characterized by swelling, pain and TENDERNESS |
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What should pts on fluoroquinolone Abx (FLOXIN, CIPRO, LEVAQUIN) be warned about?
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Increased risk of tendon rupture
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Treatment for bursitis/tendonitis?
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RICE therapy
OTC analgesics topicals massages/exercise/PT |
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Define: strain?
Treatment: strain? |
Excess stretching of a tendon or a muscle causing limited muscle fiber tears.
Treat w/ RICE & OTC analgesics |
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Define: sprain?
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Most commonly referred to a injury of a ligament, has 3 degrees.
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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! |
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Define: cramp
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A painful spasmodic contraction of a muscle: self-limiting
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What can cause a cramp?
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Electrical imbalance
Low potassium |
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Treatment: cramp?
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Massage/Heat
Rest Electrolyte replenishment Calcium supplements |
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What are the 4 categories of Topical OTC Counterirritant Analgesics?
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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 |
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What does a rubefacient require upon application?
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Rubbing!
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How do vasodilators help muscle & joint pain
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Cause localized vasodilation->improve circulation->warmth
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How do Extracts of Hot Pepper relieve muscle & Joint pain?
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topical gets hot upon application, no rubbing required
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What must one NOT do when using Extracts of Hot Peppers?
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Wrap over it!
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What formulations of OTC Counterirritant Analgesics are available?
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1. Liniments
2. Gels 3. Lotions 4. Ointment/Creams |
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What is a liniment?
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A solution or mix of oil/alcohol/soap -> leaves an oily residue
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What is a gel?
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A water based jelly that leaves NO residue
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Define: lotion?
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Suspension or emulsion usually containing water & oil.
Greasy scale: Ointment&Creams>Liniment>Lotion>Gel |
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Define: Ointment/Cream?
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Semi-solid that remains on the skin, and penetrates deeper into layers
Most greasy |
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What is trolamine Salicylate?
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aka Aspercreme
A salicylate that is applied topically-> Gives salicylate level in synovial fluid lower than w/ oral dosing, but no GI side effect |
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Where can you get topical NSAIDs?
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1. Europe
2. Specialty compounding pharmacies in US |
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What are the 3 most common respiratory ailsment treatable w/ OTC meds?
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Cough
Cold Allergic Rhinitis |
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How is a cough categorized?
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Acute: 3 weeks or less
Chronic: 3+ weeks |
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What medical conditions can cause a chronic cough?
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Asthma
Bronchitis GERD CHF |
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What medication can cause chronic cough
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Lisinopril
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What are 2 types of symptoms of a cough?
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1. Productive/Nonproductive
2. Voluntary/Involuntary |
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Which type of cough is better clinically?
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Productive
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What are some complications of cough?
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Insomnia (most common)/Exhaustion
Hoarseness/Sore throat Muscle strain or chest pain Perspiration Urinary incontinence Fainting (syncopy) Stroke |
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What are the Exclusions for self care in cough?
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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 |
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What are the nonpharmacological treatments for cough?
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1. Hydration
2. Increased humidity 3. Hard candy/lozenges |
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How do humidifiers & vaporizers differ?
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Vaporizers: produce steam, can burn, less worry @ bacterial growth, can add topical antitussives to!
Humidifiers: Nothing more than atomizers, depend on power of fan |
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How do lozenges help cough?
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By stimulating salivary fow: any hard candy can do this!
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What types of pharmacologic treatments for cough are there?
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1. Expectorants: stim resp. tract secretions, make mucus more watery
2. Antitussives: (Cough suppressant) deadens coughing nerve |
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Do expectorants and antitussives work systemically or locally?
How does the affect the pts ability to drink water |
Centrally, so ok to drink water!
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What is the active ingredient in Expectorants?
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Guaifenesin: the ONLY FDA approved active ingredient for this category
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What are some active ingredients in oral Antitussives?
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1. Codeine
2. Dextromethorphan 3. Diphenhydramine |
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Which ingredient is the GOLD STANDARD for antitussive?
Is it OTC? |
Codeine
It is OTC some places, but not MA |
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How does Codeine work in an antitussive?
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Centrally on cough center
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What is the common strength and dosage of Codeine in an antitussive?
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10mg/5mL is common strength
Dose is 1-2 tsp q4-6 |
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Who is codeine (ie in antitussive) NOT recommended for?
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1. Under 6yo
2. Pregnant (Category C=questionable) |
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What are the 5 pregnancy risk categories for meds & what do they each mean?
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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 |
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What is dextromethorphan commonly abbreviated as on products?
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"DM"
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DM (dextromethorphan) is slightly _______-acting than codeine.
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shorter
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What antitussive med has minimal side effects but may cause nausea, stomach cramps, dissiness, HA or drowsiness?
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Dextromethorphan
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Is dextromethorphan a narcotic?
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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)
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What is a popular brand name for diphenhydramine?
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Benadryl
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What Pregnancy Risk Category does diphenhydramine fall under?
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Cat. B
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When should a RPh recommend a pt take diphenhydramine?
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bedtime!
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What additional affect does diphenhydramine have?
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Antihistamine
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Which antitussives act centrally to raise the cough threshold?
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Codeine and Diphenhydramine
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Which is the most sedating antitussive?
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Diphenhydramine
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Which antitussive can make some kids go off the wall?
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Diphenhydramine
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What are the topical antitussives?
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Camphor & Menthol (& possibly eucalyptol)
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How do topical antitussives work?
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Stim mucosal receptors to create soothing sensation & increase secretions, easier breathing
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How are topical antitussives used?
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1. Rub on neck & chest up to TID, esp b4 bed
2. Can be used in vaporizers or placed in hot water basin |
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What is an NSAID?
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Ibuprofen, Ketoprofen, Naproxen (technically aspirin, but normally it is not included when people are referencing NSAIDs)
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What causes @ 50% of all illness in adults & nearly 75% in kids?
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Common cold
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What viruses cause the common cold?
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Many different, but most commonly:
Rhinovirus (RV) Respiratory Syncytial Virus (RSV) |
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When is peak season for the common cold?
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August - May!
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What other viruses are common for the cold?
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adenovirus, echovirus, cocksackievirus
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What is 1st cold symptom?
What are 3 main symptoms? |
1. Sore throat
2. Nasal congestion, rhinorrhea, sneezing |
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Is cough a primary symptom of cold?
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NO
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How long do nasal symptoms of a cold last?
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10-14 days
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What is nonpharmacological Tx for a cold?
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rest, incr fluid intake, vap/humidifier, steamy showers, saline gargle, lozenges, soup etc
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What is pharmacological tx for cold? Best approach?
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Treat symptoms as they occur
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What are types of pharmacological Tx for common cold?
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Oral Decongestants / Topical Decongestant
Antihistamines Systemic Analgesics Local Anesthetics Antiseptics Agents |
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What are the 2 types of oral decongestant?
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1. pseudoephedrine
2. Phenylephrine |
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What time of day should pts NOT take decongestants?
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Before bed!
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Elevated BP, tachycardia, palpitations, restlessness, insomnia, anxiety & tremors are side effects of which type of common cold treatment?
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Decongestants
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WHat is the max amt of time one should use topical decongestants?
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3-5 days to avoid rebound nasal congestion
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What is a problem w/ nasal decongestants?
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Irritating to mucous membranes which can cause some rebound nasal congestion
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Are Topical decongestants ok in preg women?
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Usually b/c limited systemic effect
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How are topical decongestants taken?
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Intranasal or opthalmic
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What are antihistamines used for?
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Primarily allergies but also may reduce rhinorrea/sneezing seen in cold
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What type of Tx for the common cold has side effects including: sedation and dry mouth/eyes/mucosa?
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Antihistamines
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In treating a cold, is a decongestant or antihistamine better to use for a pt w/ HBP?
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An antihistamine b/c it doesnt raise BP
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Should pts take systemic analgesics for cold?
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If needed, but beware often in cold txs already!
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What are some local anesthetics used for common colds?
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lozenges/troches/mouthwashes/sprays
Benzocaine, dyclonine, phenol |
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Is zinc FDA approved for colds?
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No, but evidence that helps if take at onset of symptoms
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Does Vit C help a cold?
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Doesnt prevent
May decrease duration Too much causes problems! |
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What are some diffs b/w cold & allergies?
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Cold has sore throat & HA
Allergies doesn't |
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What are the nonpharmacological tx for allergic rhinitis?
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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 |
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What are some types of pharmacologic treatments for Allergic Rhinitis?
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1. Antihistamines
2. Decongestant 3. Cromolyn (NOT a decongestant) 4. Nasal Wetting Agents |
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Should pts take allergic rhinitis meds prn or reg sched doses?
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reg sched doses are better
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What is the most effective combo for all. rhinitis sx incl itching, sneezing, rhinorrhea, & congestion?
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Decongestant & antihistamine
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What are some diffs b/w cold & allergies?
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Cold has sore throat & HA
Allergies doesn't |
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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 |
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What are some types of pharmacologic treatments for Allergic Rhinitis?
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1. Antihistamines
2. Decongestant 3. Cromolyn (NOT a decongestant) 4. Nasal Wetting Agents |
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Should pts take allergic rhinitis meds prn or reg sched doses?
|
reg sched doses are better
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What is the most effective combo for all. rhinitis sx incl itching, sneezing, rhinorrhea, & congestion?
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Decongestant & antihistamine
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What are some diffs b/w cold & allergies?
|
Cold has sore throat & HA
Allergies doesn't |
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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 |
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What are some types of pharmacologic treatments for Allergic Rhinitis?
|
1. Antihistamines
2. Decongestant 3. Cromolyn (NOT a decongestant) 4. Nasal Wetting Agents |
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Should pts take allergic rhinitis meds prn or reg sched doses?
|
reg sched doses are better
|
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What is the most effective combo for all. rhinitis sx incl itching, sneezing, rhinorrhea, & congestion?
|
Decongestant & antihistamine
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What are the most commonly purchased and prescribed med for All. Rhinitis?
|
Antihistamines (diphenhydramine aka Benadryl)
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Name the available antihistamines
|
1st gen:
Diphyenhydramine,Doxylamine, Brompheniramine, Chlorpheniramine 2nd gen: Loratadine (Claritin,Alavert, etc) |
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What is diff b/w 1st and 2nd generation antihistamines?
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1st gen: sedating
2nd gen: non-sedating |
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Of the 1st gen antihistamines, which are the most sedating? Least sedating?
|
Most sedating: diphenhydramine & doxylamine
Least sedating: brompheniramine & chlorpheniramine |
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Drawback of 2nd gen antihistamine?
|
Don't work as well, & no guarantee re the non-sedating characteristic
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What 2 types of decongestants are used for All. Rhinitis?
|
Systemic or Topical
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How do decongestants work?
|
Vasoconstrictors: Decrease leaking fluid out of swollen vessels, shrink membranes back.
|
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What is a concern with decongestants?
|
Increased BP, Heart strain, insomnia
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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
|
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Is Cromolyn an antihistamine?
|
NOOOOO
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What are Cromolyn's side effects?
|
Side effects are minimal as only 7% absorbed; most common are sneezing, nasal stinging or burning
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Can pregnant women use cromolyn?
|
YES
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Is cromolyn for long or short term use?
|
long term
|
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What is a Nasal Wetting agent used for?
|
Allergic Rhinitis
|
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What are the 3 Nasal Wetting agents?
|
Saline
Propylene Glycol Polyethylene Glycol (glycol-> makes thicker & helps retain moisture) |
|
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What do Nasal wetting agents relieve?
|
nasal stuffiness, rhinorrhea, sneezing by reducing nasal irritation
|
|
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Who are Nasal wetting agents safe for?
|
EVERYONE
No therapeutic agents |
|
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What is primary symptom of asthma?
|
wheezing
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what % of population is atopic (susceptible to allergens, not nec get asthma)
|
30-50%
|
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Is everyone who is atopic going to get asthma
|
NO
|
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Define atopy
|
a genetically determined state of hypersensitivity to environmental allergens
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________ atopy predisposes children to asthma
|
Parental
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Asthma affects ___ million people incl ___ mil kids
|
15; 5
|
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Sx of asthma often ____ w/ age
|
decrease
|
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What % of people have temp or perm remission from asthma by adulthood?
|
50-70%
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____ hospitalizations annually from asthma
|
500,000
|
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___ deaths in 1998 from asthma
|
5438
|
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Increase in asthma is greater in ____ & ____ populations
|
Elderly & Urban
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Sx of asthma?
|
wheezing, dyspnea, chronic nonproductive cough, excessive thick sputum
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Good to ___ humidity for asthma b/c _____
|
increase
they have dry membranes |
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|
Asthma triggers:
|
Most common: smoke, dust mites, pet dander, mold
|
|
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How many OTC ingred approved by FDA for asthma?
|
two: Epinephrine & ephedrine
|
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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
|
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|
How can a name of an antihistamine be recognized?
|
They all end in -amine except for loratidine, triprolidine, & clemastine
|
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The 3 types of antihistamine activity are:
|
Antihistamine, sedative, anticholinergic
|
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What does anticholinergic effect =
|
Dry mouth
|
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What level activities does diphenhydramine have?
|
low antihist, high sed, high antichol.
-> not a great antihistamine |
|
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Which antihistamines are best based on their activity levels?
|
Brompheniramine & dexbrompheniramine:
High Antihistamine Low Sedative Moderate Anticholinergic |
|
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What is the active ingred in Delsym?
|
DM
|
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What drug is in Primatene Mist?
|
Epinephrine
|
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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 |
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|
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 |
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What is a nutrient content label claim?
|
Excellent source of....
|
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What is a health claims on a label?
|
"diets high in Ca may reduce the risk of osteoporosis"
|
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What is a structure/function claim?
|
"Antioxidants maintain cell integrity" followed by FDA hasn't evaluated disclaimer
|
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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. |
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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)
|
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Adult rec dose for ketoprofen?
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12.5-25mg q4-6 (75mg max)
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Adult rec dose for ASA?
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650-1000mg q4-6 (4000mg max)
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Adult rec dose for APAP?
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325-1000mg q4-6 (4000mg max)
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Adult rec dose for ibuprofen?
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200-400 q4-6 (1200mg max)
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Adult rec dose for naproxen?
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220 mg q8-12 (660mg max)
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Adult rec dose for ketoprofen?
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12.5-25mg q4-6 (75mg max)
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what is magnesium salicylate used for? What is its primary benefit? Brand names?
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Analgesic
for those allergic to aspirin Doans 377mg=325mg ASA |
