Drug Quiz 2_Pearls
- BM w/in 15-60 min after rectal admin and 6-12 h of oral admin
- Not for chronic use (PEG 3350 is preferred for chronic bc better safety).
- Due to MOA may not be effective in patients with SC damage/paralysis from polio
- one type of drop or cerumen removal method is not better than others
- Cerumenolytics are the trtmt of choice for earwax impaction
- Avoid ear candeling
- Avoid confusion: similar products for the trtmt of swimmer’s ear contain isopropyl alcohol.
- Available in 10% solution (Gly-Oxide) for oral rinse for mouth, gum, or dental irritation.
- Multiple products available, often in combo w/ other AI
- Can cause varying degrees of euphoria, hallucinations (usually 100-400 mg), temporary psychosis, alterations in consciousness, and out-of-body experiences (usually >600 mg) = potential to abuse
- Many pharmacies voluntarily only allow purchases by adults >18 y of age to reduce abuse
- Not for persistent or chronic cough or for self-care in children <4 yo
- serotonin syndrome w/ use of proserotonergic drugs.
- Available OTC in many different products
- some brand name products w/ same name contain meclizine instead of dimenhydrinate
- Read product labeling carefully to confirm A
- Take 30-60 min before, and continuously during activities producing nausea;
- More effective as prevention than for treatment.
- Parenteral formulation available for IM or IV admin by HCP if symptoms severe
Evening Primrose Oil
- No difference in efficacy between placebo and evening primrose oil for eczema
- AE more common in the evening primrose group (mild GI distress)
- Used for breast pain, menstrual symptoms, diabetic nephropathy, and rheumatoid arthritis, despite the lack of evidence as to its efficacy
- No evidence for use of this drug for any health condition.
- Decreasing dose = decrease GI distress
- Sustained-release products may reduce AE bc lower iron absorption as iron is absorbed proximal to the jejunum.
- Vitamin C enhances absorption, but avoid orange juice containing calcium.
- Various prescription and OTC products, as well as other iron salts that contain different amounts of elemental iron, are available; confirm appropriate elemental iron for dosing purposes.
- Contraindicated in patients with iron overload, such as those with hereditary hemochromatosis or transfusion-dependent anemias.
- Plant source of Omega 3
- Reduces LDL and TG; further study needed before flaxseed oil can be routinely recommended.
- Contains fiber used for constipation
- Being studied as a treatment for cancer, diabetes, dry skin, constipation, and various other conditions; no conclusive evidence of efficacy yet
- Little evidence for effectiveness for acute coughs in adults or children
- few AE; may be beneficial in some patients
- Multiple combo products available, including guaifenesin/codeine syrup that can be dispensed OTC by pharmacists in a majority of states
- Double-check for therapeutic duplication.
- Labeling of various OTC products list varying minimum age limits for this product, many manufacturers voluntarily relabeled products to state “do not use in children <4 years of age,” but data exist for dosing down to 2 y of age.
Human Papilloma Virus
- Data in children is limited but has been used safely in many trials (eg, for mild acute diarrhea associated with rotavirus infection).
- Has been studied for radiation-induced diarrhea
- Individual effects vary by strain
- If one product fails to produce desired effect, alternative product with different mix of strains may still be beneficial
- For antibiotic-assoc. diarrhea, take at least 2 h after the antibiotic dose to ensure survival, and continue 7-14 d after completion of antibiotic
- Refrigeration requirements vary by product
- If refrigeration required, can be stored at room temperature for up to 1 wk.
- Treats symptoms, not cause, of diarrhea.
- This drug, w/ or w/o antibiotic, is preferred trtmt of traveler’s diarrhea
- Not to be used as primary therapy for bacterial enterocolitis, dysentery, pseudomembranous colitis associated with the use of broad-spectrum antibiotics, or acute ulcerative colitis (other primary therapy required).
- High doses (up to 60 mg) have been used w/o med supervision for opioid withdrawal, leading to CNS depression and intestinal blockage, and should not be recommended for OTC use.
- Special alert issued June 2016: cardiac events caused by use of higher than recommended doses, including through abuse or misuse of the product.
Measles, Mumps, & Rubella
- All topical imidazole antifungals are considered equivalent to one another, but more effective than nystatin
- Oral product available via prescription for oropharyngeal candidiasis.
Omega-3-Acid Ethyl Esters
- Rx fish oil concentrate capsules (Lovaza) are more concentrated than OTC product = fewer capsules per dose
- Trtmt of hypertriglyceridemia with this drug offers a better tolerability profile for patients as compared with other drugs, such as gemfibrozil and niacin
- equivalent to gemfibrozil in efficacy
- Different formulations contain variable amounts of EPA and DHA
- Typically, a 1-g capsule contains between 200 and 950 mg of EPA and DHA
- fishy aftertaste and fishy burps
- Enteric-coated product, taking the product with meals or at bedtime, or refrigerating or freezing the product may improve palatability and reduce aftertaste
- Beta-blockers, thiazides, and estrogens increase triglycerides, DC if possible
- Use the same brand to complete series
- Adacel not for children <11 yo
- Daptacel not for children <6 wk or >6 yo of age
- Avoid confusing Tdap and DTaP products
- Vaccination with DTaP may need to be delayed in children with known or suspected neurological conditions until the condition is evaluated, treated, and stable.
- Local reactions may be more frequent after the 4th or 5th dose of the series.
St John's Wort