over the counter medications for common ailments and possible overdoses rhynn malloy, cynthia...
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Over the Counter Medications for common ailments and possible overdosesRhynn Malloy, Cynthia Herrera, Katrina KarpowitchPGY-1 Pharmacy ResidentsNorthwestern Memorial Hospital
The speaker has no potential or actual conflicts of interest with this presentation
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What can be treated?
• Pain
• The common Flu/Cold
• Heartburn/Upset stomach
Pain
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Ibuprofen (Advil, Motrin)•Naproxen (Naprosyn, Aleve)•Aspirin
•Uses:- Fevers- Rheumatoid arthritis/Gout/Osteoarthritis
pain/inflammation - Musculoskeletal pain/Bone pain - Dysmenorrhea pain- Migraines
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
•Contraindications:- Peptic Ulcer Disease- Renal/Kidney Disease- Hypertension/Heart Failure- Coronary Artery Disease (CAD)- Cardiovascular Disease (CVD)
•Alternative if you have Peptic Ulcer Disease or increased bleeding risk: Celebrex
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
•Doses:- Ibuprofen: 200mg every 4-6 hours as needed•Max dose: 1,200mg in 24 hours• Treatment >10 days not recommended
- Aspirin: 325mg every 4-6 hours as needed•Max dose: 4,000mg in 24 hours
- Naproxen (sodium): 220 mg every 8-12 hours•Max dose: 660mg in 24 hours
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Side Effects:- Dyspepsia (indigestion)- Ulcers- Nausea- Gastrointestinal bleeding- Rash/Itching- Kidney damage
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Acetaminophen (Tylenol)
•Uses: - Fevers- Injury/Trauma pain- Cramping, aches
•Contraindications: liver disease
•Doses: 325mg every 4-6 hours - Max dose: 4,000mg in 24 hours- Overdose = #1 cause of acute liver failure in the US
Insomnia
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Melatonin
•Uses: - Insomnia- Limited evidence that it is effective
•Dose: 0.3mg to 5mg at bedtime
• Side effects: largely unknown
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Valerian Root
•Uses: - Insomnia- Limited evidence that it is effective- May take weeks of nightly use to be effective
•Dose: 400 -900mg at night
• Side effects: if withdrawn abruptly, may cause heart complications and withdrawal sympmtoms
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Antihistamines
•Diphenhydramine
•Uses- Insomnia- Allergic reactions (skin rashes, hives)- Congestion
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Antihistamines
•Contraindications:- Urinary retention- Prostate enlargement- Angle closure glaucoma- Cardiovascular disease- Patients of advanced age- may interact with
medications and will increase fall risk
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Antihistamines
•Doses:- Diphenhydramine: 25-50mg before bed•Max use: do not exceed 14 days of nightly use
•May develop tolerance in 2-3 nights
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Antihistamines
• Side effects:- Sedation – extending into morning after- Dry mucous membranes- Elevated body temperature- Constipation- Blurred vision- Urinary retention
Cold/Flu Management
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Antihistamines
•Diphenhydramine•Doxylamine
•Uses: - Sinus and nasal congestion, allergy relief - Insomnia
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Decongestants
•Contraindications:- Hypertension/Heart Failure- Coronary Artery Disease (CAD)- Cardiovascular Disease (CVD)- Asthma - Chronic Obstructive Pulmonary Disease (COPD)
•Alternative agents to use in hypertension:- Antihistamines: desloratadine (Clarinex),
fexofenadine (Allegra), cetirizine (Zyrtec)
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Decongestants
•Doses:- Phenylephrine HCl: 10mg every 4 hours as needed•Max dose: 60mg in 24 hours
- Pseudoephedrine: 60mg every 4-6 hours as needed•Max dose: 240mg in 24 hours
•Nasal sprays:- Ephedrine 0.5%: 2-3 drops not more often than
every 4 hours
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Decongestants
• Side effects:- Elevated blood pressure- Palpitations, arrhythmias, fast heart beat- Restlessness, insomnia- Anxiety- “Rebound congestion”•Occurs within 3-5 days of continuous use
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Antitussives and Protussives (Expectorants)
•Dextromethorphan (antitussive)•Guaifenasin (expectorant)
•Uses: - Cough related to post-nasal drip- Chest congestion
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•Contraindications:- Hypertension/Heart Failure- Coronary Artery Disease (CAD)- Cardiovascular Disease (CVD)- Asthma, chronic bronchitis - Chronic Obstructive Pulmonary Disease (COPD)
Antitussives and Protussives (Expectorants)
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Antitussives and Protussives (Expectorants)
•Doses:- Dextromethorphan: 10-20mg every 4 hours or
30mg every 6-8 hours•Max dose: 120mg in 24 hours
- Guaifenasin (expectorant): 200-400mg every 4 hours•Max dose: 2,400mg (2.4g) in 24 hours
•CAUTION: beware of combination products!
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Antitussives and Protussives (Expectorants)
• Side effects:- Drowsiness OR excitation, nervousness- Dizziness- Headache- Stomach discomfort, nausea, constipation- Respiratory depression in high doses
Heartburn
Heartburn-antacids• Symptomatic treatment of heartburn and indigestion- Tums©, Milk of Magnesia©, Maalox©, Mylanta©,
Rolaids©
Heartburn-antacids
• Things to watch out for:- Drug interactions- Constipation or diarrhea- Nausea and/or vomiting- Muscle twitching- Confusion- Irregular heartbeat
Heartburn-H2RAs• Symptomatic Prevention or Treatment of acid
reflux/peptic ulcer disease:- Pepcid© (famotidine), Zantac© (ranitidine), Tagamet©
(cimetidine), Axid© (nizatidine)
Heartburn-H2RAs
• Things to look out for:- Drug interactions [Cimetidine]- Diarrhea- Abnormal heartbeat- Flushing and/or sweating- Nausea and/or vomiting- Slurred speech• Dosing:- Famotidine: 10-20mg once to twice daily- Ranitidine: 75-150mg once to twice daily- Cimetidine: 200-400mg once to twice daily- Nizatidine: 75mg once to twice daily
**CAUTION in patients with kidney dysfunction**
Heartburn-PPIs
• Treatment for chronic acid reflux, GERD, and PUD- Prilosec© (omeprazole), Prevacid© (lansoprazole)
Heartburn-PPIs
• Things to look out for:- Nausea and/or vomiting- Bone pain- Sedation- Muscle twitching- Abnormal heart beats- Diarrhea• Dosing:- Omeprazole: 20mg once daily- Lansoprazole: 15mg once daily
**CAUTION in patients with osteoporosis**
Nausea
Nausea
• Pepto-Bismol© (bismuth subsalicylate)- Symptomatic relief of upset stomach, nausea,
indigestion, diarrhea• Dramamine© (meclizine)- Symptomatic and preventive treatment of motion
sickness
Nausea
• Things to watch out for with Pepto-Bismol©- Breathing problems- Stomach bleed- Hearing loss- Aspirin allergy• Dosing- 30 mL every 30-60 minutes for maximum of 8
doses/day
**DO NOT USE WITH STOMACH ULCERS**
Nausea
• Things to watch out for with meclizine:- Urinary retention- Closed angle glaucoma- Dry mouth- Drowsiness- Flushing• Dosing:- 25-50mg one hour prior to traveling. Maximum dose of
50mg in 24 hours.
QUESTIONS?