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Guaifenesin Dextromethorphan Pseudoephedrine Doxylamine Dexbrompheniramine Brompheniramine Diphenhydramine Chlorpheniramine Naproxen APAP Cold and Allergy Products Available Over-the-Counter Ibuprofen Cold and Allergy COMMENTS Tylenols: (APAP, chlorpheniramine, diphenhydramine, doxylamine, pseudoephedrine, dextromethorphan, guaifenesin) Tylenol sinus non-drowsy Tylenol sinus night time Tylenol allergy sinus multi Sx Tylenol allergy sinus night time Tylenol flu non-drowsy Tylenol flu night time Tylenol cold non-drowsy Tylenol cold complete formula Tylenol cold severe congestion non-drowsy X X X X X X X X X X X X X X X X X X X X X X X X X X X X Benadryls: (APAP, diphenhydramine, pseudoephedrine) Benadryl allergy Benadryl dye-free allergy Benadryl allergy/congestion Benadryl allergy and sinus fast melt Benadryl allergy/sinus headache Benadryl allergy/cold Benadryl maximum strength severe allergy/sinus HA X X X X X X X X X X X X X X X As diphencitrate Sudafeds: (APAP, pseudoephedrine, dextromethorphan, guaifenesin) Sudafed nasal decongestant Sudafed 12 hour Sudafed 24 hour Sudafed non-drying sinus Sudafed sinus headache Sudafed multi Sx cold and sinus Sudafed severe cold formula Sudafed multi Sx cold and cough X X X X X X X X X X X X X X X Drixorals: (APAP, dexbrompheniramine, pseudoephedrine) Drixoral nasal decongestant Drixoral cold and allergy Drixoral cold and flu X X X X X X Alka-seltzers: (APAP, chlorpheniramine, doxylamine, pseudoephedrine, dextromethrophan) Alka-seltzer plus cold and sinus Alka-seltzer plus cold Alka-seltzer plus cold and cough Alka-seltzer plus nighttime cold X X X X X X X X X X X X X X Guaifenesin Dextromethorphan Pseudoephedrine Doxylamine Dexbrompheniramine Brompheniramine Diphenhydramine Chlorpheniramine Naproxen APAP Cold and Allergy Products Available Over-the-Counter Ibuprofen Cold and Allergy (cont’d)…. COMMENTS Robitussins: (APAP, chlorpheniramine, pseudoephedrine, dextromethorphan, guaifenesin) Robitussin cold severe congestion Robitussin cold cold and cough Robitussin cold cold and congestion Robitussin cold sinus and congestion Robitussin cold multi Sx cold and flu Robitussin cold cold, cough, and flu Robitussin honey flu nondrowsy Robitussin honey flu night time X X X X X X X X X X X X X X X X X X X X X X X X Coricidins: (APAP, chlorpheniramine, pseudoephedrine, dextromethorphan) Coricidin HBP cough and cold Coricidin HBP maximum strength flu Coricidin HBP cold and flu Coricidin ‘D’ cold, flu, and sinus X X X X X X X X X X Theraflus: (APAP, chlorpheniramine, pseudoephedrine, dextromethorphan, guaifenesin) Theraflu maximum strength severe cold and congestion nondrowsy (caplets) Theraflu maximum strength severe cold and congestion nighttime (caplets) Theraflu maximum strength severe cold and congestion nondrowsy liquid Theraflu maximum strength severe cold and congestion night time liquid Theraflu regular strength cold and cough nighttime Theraflu regular strength cold and sore throat night time liquid Theraflu maximum strength flu and sore throat night time liquid Theraflu maximum strength flu and cough night time liquid X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Same as above Dextromethorphan Guaifenesin X X X X X X X X X X X APAP Doxylamine X Brompheniramine X Diphenhydramine X Chlorpheniramine X Naproxen X Cold and Allergy Products Available Over-the-Counter Ibuprofen Pseudoephedrine Dexbrompheniramine Cold and Allergy (cont’d)…. COMMENTS Theraflus (cont’d): Theraflu maximum strength flu and congestion non-drowsy liquid Theraflu maximum strength flu, cold, and cough non-drowsy chest congestion and cough Vicks: (APAP, doxylamine, pseudoephedrine, dextromethorphan) Vicks Dayquil, liquicaps Vicks Dayquil, liquid Vicks Nyquil, liquicaps Vicks Nyquil, liquid X X X X X X 10% alcohol NSAIDs: (ibuprofen/naproxen, pseudoephedrine) Motrin sinus/headache Advil cold and sinus Advil flu and bodyache Aleve cold and sinus X X X X X X X X Comtrexs: (APAP, chlorpheniramine, brompheniramine, pseudoephedrine, dextromethorphan, guaifenesin) Comtrex cold and cough relief Comtrex day and night cold/cough relief Comtrex multi-Sx maximum X X X X X X X X X X X Contacs: (APAP, pseudoephedrine, diphenhydramine, dextromethorphan) Contac severe cold and flu nondrowsy Contac cold/flu day and night (DAY) Contac cold/flu day and night (NIGHT) Contac allergy/sinus day and night X X X X X X X X X X X X Chlor-trimetons: (chlorpheniramine, pseudoephedrine) Chlor-trimeton allergy 4 hour Chlor-trimeton allergy 8 hour Chlor-trimeton allergy 12 hour Chlor-trimeton D 12 hour X X X X X Actifeds: (APAP, pseudoephedrine, chlorpheniramine, triprolidine) Actifed cold and sinus Actifed cold and allergy X X X X Triprolidine Guaifenesin Dextromethorphan Pseudoephedrine Doxylamine Dexbrompheniramine Brompheniramine Diphenhydramine Chlorpheniramine Naproxen APAP Cold and Allergy Products Available Over-the-Counter Ibuprofen Cold and Allergy (cont’d)…. COMMENTS Tavists: (APAP, pseudoephedrine, clemastine) Tavist sinus Maximum strength Tavist sinus Tavist allergy X X X X Clemastine Sinutabs: (APAP, pseudoephedrine, guaifenesin) Sinutab sinus Sinutab non-drying X X X X Other remedies Sine-off Allerest Nasalcrom allergy prevention Dristan cold Aprodine Actagen Nolahist Novahistine DMX Airborne Arizona Sun natural cold medicine hot liquid formula X X X X X X X Cromolyn sodium Phenylephrine Triprolidine Triprolidine Phenindamine tartrate X X X X X Vitamins and herbals Zinc and herbals Cold symptoms - starts with sore throat - progresses to include nasal/allergy Sx’s including: sneezing, rhinorrhea (nasal discharge), postnasal drip, nasal stuffiness, watery eyes - lastly, cough develops - possible constitutional Sx’s: tiredness, fever, shivering - susceptibility increases with smoking and psychological stress (as it impairs the immune system) - REFER to MD if… • fever persists for longer than 24 hours • cold Sx’s do not improve in about a week • high fever, rash or persistent HA present Cold vs. Allergies Characteristic Nasal discharge Sneezes Nasal itching Onset of Sx’s Congestion Duration Occurrence Contagious? Cold Purulent One Little Gradual Yes 5-7 days 1-2 times/year Can be spread Allergies Clear Multiple (paroxysmal) Itchy Sudden Yes As long as allergy season >1-2 times/year No Cold Gradual Not usually present – ltd to nose area Non-productive at first, later productive 5-7 days May occur in children Flu Sudden onset of fever Present Cold vs. Flu Characteristic Onset Systemic constitutional Sx’s (malaise, myalgias, chills) Cough Duration Fever Usually non-productive Longer than cold Present Cold vs. Bacterial sore throat (Strep throat) Characteristic Onset Throat Constitutional Sx’s (aches/pains) Respiratory Sx’s Lymph node involvement Fever Cold Gradual Sore Present More None May occur in children Bacterial sore throat More rapid More sore More prevalent Less Often present Present OTC cold and allergy products consist of….. Antipyretics/analgesics - includes: APAP, ibuprofen, naproxen - to be discussed in another section Antihistamines: block histamine-1 receptors to decrease mucus production, vascular permeabilitly, smooth muscle contraction - examples: brompheniramine, diphenhydramine, chlorpheniramine, clemastine, triprolidine, dexbrompheniramine, doxylamine - can be used to relieve runny nose, sneezing (allergy Sx’s) associated with the common cold - all are sedating…. • least sedating (alkylamines): brompheniramine, chlorpheniramine • most sedating (ethanolamines): diphenhydramine, doxylamine - SE’s: anticholinergic – dryness of eyes, mouth, nose; blurry vision; urinary retention; tachycardia; drowsiness DDI’s with MAOI’s, TCA’s: increases the anticholinergic effects Pediatric: CI in children <6 y/o – paradoxical excitement may occur Pregnancy: use only if benefits outweigh risks Lactation: not recommended Systemic decongestants: vasoconstrictive drugs (α-agonists) that reduce blood flow to the nose thus decreasing mucosal edema - systemic: pseudoephedrine, phenylephrine (although no OTC products contain this ingredient) - CI with MAOI as it prevents breakdown of NE causing sympathomimetic response (arrhythmias, etc.) - May worsen: HTN, heart disease, DM (alter B-G), hyperthyroidism, BPH - SE’s: CNS (nervousness, irritability, restlessness, insomnia) – d/t stimulation of CNS; ↑BP, ↑HR, irregular HR, palpitations – d/t constriction of all vascular beds; may also induce urinary sphincter constriction; increase intraocular pressure in the eye by narrowing chamber angle; HA - Don’t use for >7 days - Remember decongestants are considered stimulants! (will show up on drug test) - Pediatric: do not administer to children <2 y/o - Pregnancy/lactation: use with caution (Pregnancy category C) Cough suppressant - dextromethorphan - to be discussed in another section Expectorant - guaifenesin - to be discussed in another section Other products - Vitamin C: may help decrease duration and severity of Sx’s • no proof it can PREVENT colds • MOA: antioxidant which neutralizes oxidizing compounds released by neutrophils - Echinacea: possibly effective in shortening duration of cold • no proof it can PREVENT colds • MOA: stimulates immune system • Don’t use >6 wks • Pediatric: not recommended • Pregnancy/lactation: not recommended • caution: if immunosuppressed, DON’T USE! Guaifenesin Dextromethorphan Pseudoephedrine Doxylamine Dexbrompheniramine Brompheniramine Diphenhydramine Chlorpheniramine Naproxen APAP Cold and Allergy Products Available for Children Over-the-Counter Ibuprofen Child products for cold/allergy COMMENTS Tylenols: (APAP, chlorpheniramine, pseudoephedrine, dextromethorphan) Infant Tylenol cold concentrated drops decongestant and fever reducer Infant Tylenol cold concentrated drops decongestant and fever reducer plus cough Children's Tylenol Children's Tylenol sinus Children's Tylenol cold (susp/chews) Children's Tylenol cold plus cough (susp/chews) Children's Tylenol flu X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Dimetapps: (APAP, brompheniramine, pseudoephedrine, dextromethorphan) Dimetapp infant drops decongestant Dimetapp infant drops decongestant plus cough Dimetapp cold and allergy Dimetapp DM cold and cough Dimetapp non-drowsy flu Dimetapp nighttime flu Dimetapp freezer pops Dimetapp get better bear sore throat pops Dimetapp cold & congestion caplets Dimetapp cold & allergy tablets X X X X X Pectin Pectin X X X X X phenylephrine Triaminics: (APAP, chlorpheniramine, pseudoephedrine, dextromethorphan, guaifenesin) Triaminic vapor patch cough Triaminic softchews cough Triaminic softchews cold/allergy Triaminic softchews cold/cough Triaminic softchews throat pain/cough Triaminic cough Triaminic cold and allergy Triaminic cold and cough Triaminic cold and night time cough Triaminic cold, cough, and fever Triaminic cough and sore throat Triaminic chest congestion Triaminic allergy congestion Triaminic night time maximum strength Camphor, menthol X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Guaifenesin Dextromethorphan Pseudoephedrine Doxylamine Dexbrompheniramine Brompheniramine Diphenhydramine Chlorpheniramine Naproxen APAP Cold and Allergy Products Available for Children Over-the-Counter Ibuprofen Child products for cold/allergy (cont’d)…. COMMENTS Benadryls: (diphenhydramine, pseudoephedrine) Benadryl allergy chewables Children's Benadryl allergy Children's Benadryl dye-free allergy Children's Benadryl allergy and sinus Children's Benadryl allergy/cold fastmelt X X X X X X X Robitussins: (pseudoephedrine, dextromethorphan, guaifenesin) Robitussin DM infant drops Robitussin cough and cold infant drops Robitussin pediatric cough Robitussin pediatric cough and cold X X X X X X X X Alcohol-free Alcohol-free Alcohol-free Alcohol-free Sudafeds: (pseudoephedrine, dextromethorphan) Children's Sudafed nasal decongestant chewables Children's Sudafed nasal decongestant Children's Sudafed cold and cough X X X X X X X X X X X Pediacares: (chlorpheniramine, pseudoephedrine, dextromethorphan) Pediacare infant drops decongestant Pediacare infant drops decongestant plus cough Pediacare cough/cold Pediacare night rest cough/cold X X Vicks: (chlorpheniramine, pseudoephedrine, dextromethorphan, guaifenesin) Pediatric Vicks 44e cough and chest congestion relief Pediatric Vicks 44m cough and cold relief Children’s Vicks Nyquil cold/cough relief X X X X X X X X Other cold products: Children’s Motrin cold Children’s Advil Breathe right children's colds X X X No medication General pain relief: Excedrin ES Excedrin migraine Excedrin PM Excedrin ES ASA-free Anacin Anacin extra strength Anacin ASA-free Vanquish Percogesic original Extra strength Percogesic Alka-seltzer PM Alka-seltzer original fast relief Alka seltzer extra strength fast relief Bromoseltzer antacid/pain relief Aspirins: Genuine Bayer Bayer adult low strength entericcoated Bayer adult low strength with calcium Children's Bayer (chewable) Extra strength Bayer Extra strength Bayer arthritis pain regimen Extra strength Bayer Plus Extra strength Bayer PM (w/ diphenhydramine) Bufferin X X X X X X X X X Chondroitin Glucosamine Salicylamide Mg salicylate Ketoporfen Naproxen Ibuprofen X X X X Diphenhydramine X X Caffeine APAP Systemic Antipyretic/Analgesic Products Available Over-theCounter Aspirin Systemic Antipyretics / Analgesics COMMENTS X X X X X X X AlOH, MgOH Phenyltoloxamine - antihistamine X X citric acid, NaHCO3 citric acid, NaHCO3 X citric acid, NaHCO3 X X X X X X X X X Extra strength Bufferin X Ecotrin adult low strength Ecotrin regular strength Ecotrin maximum strength Ecotrin arthritis relief Ascriptin regular strength X X X X X Ascriptin maximum strength X Ascriptin arthritis pain X buffered with CaCO3 X buffered with CaCO3, MgO2, MgCO3 buffered with CaCO3, MgO2, MgCO3 buffered with Maalox, CaCO3 buffered with Maalox, CaCO3 buffered with Maalox, CaCO3 Tylenols: Tylenol Regular strength Tylenol Extra strength Women's Tylenol menstrual relief Tylenol arthritis pain Tylenol PM Headache: Therapatch HA cool gel patch Stanback HA powder BC fast pain relief (HA powder) Goody's HA powder Excedrin tension HA cooling pads Back / Leg pain: Maximum strength Backaid Doan's extra strength Doan's extra strength PM Momentum backache relief DeWitt's Pills backache and joint pain relief Legatrin PM Hyland's leg cramps w/ quinine Chondroitin Glucosamine Salicylamide Mg salicylate Ketoporfen Naproxen X X X COMMENTS Pamabrom X X X NSAID’s: Advil Motrin Nuprin Aleve Orudis KT Migraine pain: Excedrin migraine Advil migraine Motrin migraine pain Migraine ice cooling HA pads Ibuprofen Diphenhydramine Caffeine APAP Systemic Antipyretic/Analgesic Products Available Over-theCounter Aspirin Systemic Antipyretics / Analgesics (cont’d)…. X X X X X X X Do not use in <16 y/o X X X (solubilized ibuprofen) Mentholatum Drug-free X X X X X X X X X X X X Drug-free X Pamabrom X X X X X X X K nitrate, caffeine X Homeopathic Arthritis pain: Tylenol arthritis pain BC arthritis strength (analgesic powder) Ultra strength Arthriten Arthri-solution Aflexa Dr. Art Ulene's joint health formula Cosamin DS Glucoflex glucosamine drink mix Sundown advanced glucosamine complex Osteojoint Flexagen Arthx DS Osteo bi-flex regular strength Osteo bi-flex maximum strength Osteo bi-flex double strength Maximum strength Flex-A-Min Schiff pain-free Amenfit glucosamine and chondroitin drink mix Flexable chewables Flexable sugar-free drink mix Osteo bi-flex triple strength COMMENTS Chondroitin Glucosamine Salicylamide Mg salicylate Ketoporfen Naproxen Ibuprofen Diphenhydramine Caffeine APAP Systemic Antipyretic/Analgesic Products Available Over-theCounter Aspirin Systemic Antipyretics / Analgesics (cont’d)…. X X X X X X X X X X Niacin, herbs…. X X Vit C, Zn, Cu, Mn X X X X X X X X X X X X X X X X X X X X X X X Antipyretics / Analgesics - in general, OTC pain therapy is ltd to 10 days for adults, 5 days for children - antipyretic therapy is ltd to 3 days in adults and children - synergistic agents to analgesics: caffeine, antihistamines Pediatric concerns - do not recommend…. • ASA in <15-18 y/o • APAP in < 2y/o • ibuprofen in < 2y/o • naproxen in <12 y/o • ketoprofen in <16 y/o Mn, Na, Vit C Gelatin, Vit A, etc… MSM Vit C MSM Children's Antipyretic / Analgesic formulations Infant Pediatric NSAIDS: Q6-8H – NMT 4 times/day Infant Motrin drops (50/1.25 mL) Infant Advil drops (50/1.25 mL) Pediatric Advil drops (100/2.5 mL) Tylenol oral: Q4H – NMT 5 times/day Infant Tylenol drops (80/0.8 mL) Childrens Junior strength Children's Motrin (100/5 mL; 50mg chews) JS Motrin (100mg caplets/chews) Children's Advil (100/5 mL; 50mg chews) JS Advil (100mg caplets/chews) Children's Tylenol (160/5 mL; 80mg chews) JS Tylenol (160mg chews) Tylenol rectal: Q4H – NMT 6 times/day Feverall (120mg suppositories) Classification of children Infant: 6-23 months Pediatric: 2-3 years Children: 2-11 years Junior: 6-11 years Other methods to control fever - tepid water sponge bath (use when high fever) • at risk for seizure when >105oC - light clothing or covering - adequate fluids Aspirin - effective antipyretic and analgesic, but important to avoid in children <15 y/o - Reyes’s syndrome: rare, life-threatening condition that occurs primarily in children or teens in the course of or while recovering from a mild RTI, flu, chicken pox, or other viral illness • Early Sx’s: excessive, repeated vomiting • Other Sx’s: cold, clammy hands and feet; negative, irritable, belligerent attitude • Average time from vomiting to death is 3-5 days Alcohol (%) APAP Chlorpheniramine Pyrilamine Pseudoephedrine Dextromethorphan Cough syrups Available Over-the-Counter Guaifenesin Cough syrups COMMENTS Robitussins: Robitussin Robitussin DM Robitussin CF Robitussin PE Robitussin sugar-free cough Robitussin cough and congestion Robitussin night relief cough, cold, and flu Robitussin maximum strength cough Robitussin maximum strength cough and cold Robitussin honey cough Robitussin honey cold Robitussin honey flu X X X X X X X X X X X X X X X X 0 0 0 0 X X X X X 0 0 1.4 1.4 0 0 0 X 5 5 5 10 X X X X Vicks: Vicks 44 cough relief Vicks 44D cough and head congestion relief Vicks 44E cough and chest congestion relief Vicks 44M cough, cold, and flu relief X X X X X X X X Others: Creomulsion cough medicine Delsym 12 hour cough relief Buckley’s DM X X 0 0.26 X X X 0 Diabetic cough syrups: Benylin expectorant Robitussin sugar-free cough Diabetic Tussin DM Diabetic Tussin allergy relief X X X X 0 0 Dextromethorphan polistirex OTC cough syrups consist of…. Expectorants: thins mucus and helps clear it from respiratory tract (for productive coughs) - includes: guaifenesin - CI: chronic bronchitis, cystic fibrosis - Pediatric: not recommended for children <2 y/o - Pregnancy/lactation: Systemic antitussives: cough suppressant for dry, hacking, non-productive coughs - acts by depressing the medullary centers of the brain, decreasing the sensitivity of respiratory cough receptors, or interrupting the transmission of cough impulses - includes: dextromethorphan, diphenhydramine (antihistamine too) – most commonly dex! - codeine is OTC antitussive in some states (NOT CA!) - SE’s (dex): mild – drowsiness, GI upset - CI (dex): MAOI inhibitors – has caused death, hypertensive rxns, bleeding…. - Pediatric (dex): not recommended in children <2 y/o - Pregnancy/lactation: Possible additive ingredients - decongestants (pseudoephedrine) - antihistamines (chlorpheniramine, pyrilamine) - antipyretics / analgesics (APAP) - alcohol Nonpharmacologic therapies - fluids: helps thin mucus and clear it from the respiratory tract Eucalyptus oil Menthol Camphor Normal saline Oxymetazoline Xylometazoline Propylhexedrine Topical Decongestants / Antitussives Available Over-the-Counter Phenylephrine Topical Decongestants / Antitussives COMMENTS Short-acting nasal decongestants: (phenylephrine, propylhexedrine) Afrin childrens nasal decongestant Neo-synephrine regular strength NS Neo-synephrine extra strength NS 4-way NS Little noses for infants and children decongestant nose drops Vicks sinex nasal spray Benzedrex nasal inhaler X X X X X X X Intermediate/Long-Acting nasal decongestants: (xylometazoline, oxymetazoline) Natruvent fine nasal mist Afrin original nasal decongestant Afrin extra moisturizing nasal decongestant Afrin severe congestion nasal decongestant Afrin sinus nasal decongestant Afrin no-drip nasal decongestant Afrin no-drip extra moisturizing nasal decongestant Afrin no-drip severe congestion nasal decongestant Afrin no-drip sinus nasal decongestant Neo-synephrine extra moisturizing 12 hour NS Nostrilla 12 hour nasal decongestant Duration 12 hour NS Vicks sinex 12 hour nasal spray Dristan 12 hour nasal spray X X X X X X X With Microthix - no drip from nose to throat X X X X X X X Normal saline decongestants: Ocean Afrin non-medicated saline Breathe right saline NS Baby Ayr for infants and children (spray/drops) Little noses for all ages (spray/drops) Natruvent saline X X X X X X Rub decongestants/cough suppressants via vapors: (camphor, menthol, eucalyptus oil) Vicks vaporub Vicks vaporub cream Vicks vapo steam Metholatum ointment decongestant analgesic Vaporizer in a bottle portable cough suppressant X X X X X X X X X X X Eucalyptus oil Menthol Camphor Normal saline Oxymetazoline Xylometazoline Propylhexedrine Topical Decongestants / Antitussives Available Over-the-Counter Phenylephrine Topical Decongestants / Antitussives (cont’d)…. COMMENTS Other nasal decongestants/cold products: Breathe right nasal congestion Breathe right colds Breathe right children's nasal congestion Breathe right children's colds Ayr herbal inhaler Ayr saline nasal mist Ayr saline nasal gel Nose better Vicks vapor inhaler Zicam cold remedy Zicam allergy relief Nasalcrom allergy prevention No medication No medication No medication No medication Herbals X X X X Allantoin Levmetamfetamine Zincum gluconium Homeopathic Cromolyn sodium Childrens decongestants: Breathe right children's nasal congestion Baby Ayr for infants and children (spray/drops) Little noses for all ages (spray/drops) Little noses for infants and children decongestant nose drops Afrin childrens nasal decongestant No medication X X X X Topical decongestants: vasoconstrictive drugs that reduce nasal congestion - topical intranasal: ephedrine, naphazoline, phenylephrine, tetrahydrozoline, xylometazoline (intermediate acting), oxymetazoline (long acting) - inhalers: propylhexedrine - SE: rebound congestion when used >3-5 days (stuffy nose despite using decongestant) • occurs esp with short-acting decongestants • returns to normal in 1-2 weeks - depending on ingredient, don’t want to use in children <6-12 y/o - Pediatric: isotonic nasal drops and gentle aspiration of secretions may help infants and young children - Patient counseling: blow nose before using product; wait few minutes after giving dose before blowing nose again Topical antitussives: soothes by stopping the cough reflex - includes: camphor, menthol - dosing: rub thick layer on chest and throat NMT TID - Pediatric: not recommended in children <2 y/o Asthma Products - Bronkaid dual action formula caplets (ephedrine, guaifenesin) Primatine mist (epinephrine inhalation aerosol) Primatine tablets (ephedrine, guaifenesin) OTC asthma products consist of…. Epinephrine: bronchodilator - causes rebound congestion - Do not recommend unless asthma has been diagnosed by a MD - Airway obstruction may be confused with widespread bronchial infection or bronchitis - Seek medical assistance if Sx’s not relieved within 20 min - Pediatric: do not recommend in <4 y/o Ephedrine: bronchodilator - SE’s: chest pain, MI, hepatitis, stroke, seizures, psychosis, death - Do not recommend unless asthma has been diagnosed by a MD - Airway obstruction may be confused with widespread bronchial infection or bronchitis - Seek medical assistance if Sx’s not relieved within 1 hour - Pediatric: do not recommend in <12 y/o Guaifenesin: expectorant - unapproved ingredient in asthma products COMMENTS ASA APAP Phenol Dyclonine Zinc Menthol Sore throat Products Available Over-theCounter Benzocaine Sore throat Lozenges: Cepacol sore throat lozenges Sugar-free Cepacol sore throat lozenges Vicks chloraseptic lozenges Vicks cough drops Ricola herb throat drops Robitussin cough drops Robitussin honey cough drops Celestial seasonings herbal throat drops Herbal quincers Halls Halls plus Halls sugar-free Halls defense Vitamin C supplement drops Halls defense multi-blend Naturemade Zinc lozenges Cold-eeze Kids-eeze Nature’s Bounty Zinc lozenges Sucrets regular strength Sucrets maximum strength Sucrets children formula Cepastat fast acting sore throat relief Luden’s throat drops X X X X X X X X X X X X X X X Pectin Pectin Vitamin C Vitamin C, Echinacea X X X X X Zinc gluconate Zinc gluconate Zinc gluconate X X X X Pectin Diabetic lozenges: Sugar-free NICE lozenges X Throat sprays: Cepacol sore throat spray Vicks chloraseptic spray X X Other: Runny Rhino cold relief pops Comtrex sore throat liquid Tylenol sore throat liquid Aspergum X Chelated Zinc X X X OTC sore throat products consist of…. Lozenges: soothing demulecent via anesthetic action – helps relieve Sx’s - only provides temporary relief - includes: benzyl alcohol, butacaine, phenol, sodium phenolate, dyclonine, hexylresorcinol, menthol, benzocaine - dosing: Q2H - Pediatric: not recommended in children <2 y/o (or 6 y/o for phenol products) Zinc (gluconate): may help boost immune system - may also help reduce severity of cold if started within hours of onset of Sx’s - MOA (proposed): prevents rhinovirus particles from entering cells - dosing: Q2H for no more than one week - SE’s: metallic taste, dry mouth, N/V - administer on empty stomach - Pregnancy/lactation: contraindicated Sprays/washes - apply to affected area QID - Pediatric: under 12 y/o must be supervised Others methods - hard candy: stimulate salivary flow and act as soothing demulecent - warm saline gargle (1-3 tsp salt per 8-12 oz water) and fruit juices - humidifiers: soothes and hydrates airways - vaporizers: steam inhalation to soothe irritated membranes Octyl methoxycinnamate Octyl salicylate Oxybenzone Allantoin Dimethicone Petrolatum Phenol Camphor Methol Tetracaine Lidocaine Oral Sore Products Available Over-the-Counter Benzocaine Oral Sore Products COMMENTS Cold sores/fever blisters: Abreva Orajel mouth sore medicine Orabase-B gel/paste Zilactin Zilactin-B Zilactin-L Zilactin-lip Banadyne-3 Cepacol Viractin V cream/gel Carmex Blistex lip medex Softlips secret healer Tanac medicated gel Herpecin L Campho-phenique original cold sore gel Purelip remedy Purelip prevention Lip clear lysine plus Docosanol Benzalkonium Cl, Zn Cl X X Benzyl alcohol X X X X X X X X Homosalate Alcohol X X X X X X X X Salicylic acid X X X X X X X X Dyclonine X X X X (camphorated phenol) Zinc oxide Zinc oxide L-lysine Canker sores: Zilactin-B Orabase-B gel/paste Miradyne-3 Orajel mouth sore medicine Regular strength Anbesol liquid Maximum strength Anbesol gel Tanac no-sting liquid Blistex Kanka Zilactin X X X X X X X X Benzalkonium Benzoin tincture compound Benzyl alcohol Cold sore vs. Canker sore Factor Origin Contagious? Symptoms Duration Treatment Cold sore (fever blister) Viral (herpes virus) Yes Lesions on corner of lip, etc… Up to 2 weeks Protectants; topical anesthetics; systemic pain relievers Canker sore Not viral – often d/t dirt, abrasions, etc… No Lesions on tongue, floor or side of mouth 1-2 weeks Rinse with saline, then apply orabase or benzoin tincutre (oral protectants) - can use systemic pain relievers too OTC Oral Sore Products consist of…. Oral mucosal analgesics: provide temporary relief of pain caused by minor irritation or injury of the mouth and gums - includes: benzocaine, benzyl alcohol, camphor, dibucaine, diphenhydramine, dyclonine, lidocaine, menthol, phenol, pramoxine, resorcinol, tetracaine - use limited to 1 week - dosing: NMT QID - Pediatric: do not use in children <2 y/o (benzocaine okay in pts > 4 months) Protectants: help soften skin to prevent cracking and relieve dryness - includes: allantoin, calamine, petrolatum, Zn oxide, cocoa butter Sunscreens: help prevent fever blisters and prevent sun-induced damage - includes: octocrylene, octyl methoxycinnamate, oxybenzone, octyl salicylate, homosalate, padimate O, titanium dioxide Other products - docosanol - salicylic acid - L-lysine - benzalkonium – quarternary ammonium surfactants X X X COMMENTS Octocrylene X X Octyl salicylate Octyl methoxycinnamate X X Padimate O Oxybenzone Phenol Camphor Menthol Allantoin Dimethicone Lip Products Available Overthe-Counter Petrolatum Lip Products Blistex: Blistex herbal answer Blistex medicated DCT Blistex lip revitalizer Blistex complete moisture Blistex medicated lip balm Blistex lip tone Medicated Blistex lip ointment X X X X X X X X X X X X X X X menthyl anthranilate Chapstick: Chapstick medicated lip balm Chapstick lip moisturizer Chapstick lipsations Chapstick lip balm X X X X Chapstick ultra 30 Chapstick overnight lip treatment X X X X X X lanolin, isopropyl myristate, cetyl alcohol X X X X X X X X X Others: Vaseline lip therapy Soft lips Natural Ice X X X X Antiseptic oral cleansers OTC products include…. - Colgate Peroxyl (hydrogen peroxide) Gly-Oxide (carbamide peroxide, glycerin) General Information - includes: sodium perborate monohydrate, carbamide peroxide, hydrogen peroxde, sodium bicarbonate - cleansing products which help with treatment of gingival and intraoral tissue discomfort such as minor wounds and recurrent aphthous stomatitis (RAU), otherwise known as canker sores - medications are swished and spit out - do not use >1 week - Pediatric: not recommended in <6 y/o; children <12 y/o should be supervised COMMENTS Glycerin Mineral oil Magnesium Calcium polycarbophil Fiber Psyllium Methylcellulose Docusate Cascara Casanthranol Bisacodyl Laxatives Available Over-theCounter Senna (sennosides) Laxatives Stimulant laxatives: Senokot – liquid/tabs Ex-lax Black Draught Swiss Kriss herbal laxative Agoral -- chews/liquid X-prep bowel evacuant Fleet maximum strength senna laxative Fleet natural vegetable senna laxative Nature’s remedy stimulant laxative Correctol bisacodyl stimulant laxative Feen-a-mint Dulcolax – tabs/supp Alophen Carter's laxative Fleet stimulant laxative Fleet women's gentle laxative Purge X X X X X X X Alcohol-free X X X X X X X X X Castor oil Stool softeners: Correctol stool softener Surfak Colace Phillips liqui-gels stool softener laxative X X X X DSS 100 mg DS Ca 240 mg DSS 100 mg DSS 100 mg X X X X DSS DSS DSS DSS Combination laxatives: Correctol 50 plus Doxidan Peri-colace Senokot-S Perdiem overnight relief X X X X X X Bulk laxatives: Citrucel Fiberease Ultrafiber Fiberchoice Six-way cleanse dietary supplement X X X X X X Cellulose, prune X Blended herb/fiber Glycerin Mineral oil COMMENTS Magnesium Calcium polycarbophil Fiber Psyllium Methylcellulose Docusate Cascara Casanthranol Bisacodyl Laxatives Available Over-theCounter Senna (sennosides) Laxatives (cont’d)…. Bulk laxatives (cont’d): Metamucil Hydrocil instant natural fiber laxative Perdiem fiber therapy Konsyl natural fiber supplement Konsyl easy mix formula X X X X X Bulk laxatives for IBS (alternating diarrhea and constipation): Phillips fibercaps bulk-forming fiber laxative Equalactin Konsyl Fibercon X X X X Saline laxatives: Citroma Fleet phospho-soda Fleet enema Epsom salts Phillips MOM (also antacid) Fleet MOM (also antacid) X Mg Citrate Sodium phosphate Sodium phosphate Mg Sulfate Mg Hydroxide Mg Hydroxide X X X Lubricant laxatives: Mineral oil Fleet mineral oil enema Phillips lubricant laxative X X X MgOH Other: Fleet glycerin suppositories Fleet liquid glycerin suppositories X X (2 y/o-adult) X (2-6 y/o) X (2-5 y/o) Children’s laxatives: Fleet glycerin suppositories (pediatric size) Fleet babylax – liquid suppositories Senokot childrens syrup Fletcher's castoria Fleet enema for children X X (2-12 y/o) alcohol-free (2-15 y/o) Sodium phosphate (>2 y/o) Contents of Fleet Prep Kits Kit 1 - fleet phosphosoda 1.5 fl oz. - 4 fleet bisacodyl tabs (5 mg each) - 1 fleet bisacodyl suppository (10 mg) Kit 2 - fleet phosphosoda 1.5 fl oz. - 4 fleet bisacodyl tabs (5 mg each) - 1 fleet bag enema Classifications of OTC laxatives…. Stimulant: bowel evacuation d/t irritation causing increased peristalsis - includes: anthraquinones (senna, aloe, cascara, casanthranol – active component of cascara), diphenylmethanes (bisacodyl, phenolphthalein), castor oil - CI with appendicitis - Don’t use > 1 week - SE’s: severe cramping, colic, increased mucus secretion, increased fluid loss - Pregnancy: NOT recommended (esp. castor oil – may cause premature uterine contractions) - Lactation: NO – can be absorbed and transferred to breast milk - Patient counseling: anthraquinone laxatives may discolor urine; bisacodyl oral tabs should not be chewed or taken with an antacid, milk, or H2 blocker - NOTE: phenolphthalein was removed from laxative products d/t carcinogenicity risks Stool softeners: increase wetting efficiency and softens the fecal mass for prevention of constipation; can be used long-term - onset: 6-12 hours (tablets); 15 min to 1 hour (supp) - CI with mineral oil, drugs with narrow therapeutic index – may become toxic (e.g. digoxin) - Don’t use > 1 week - CHF, HTN CI with sodium-containing products – calcium products okay - Pregnancy: preferred laxative (if laxatives are absolutely necessary) Bulk formers: often 1st choice; can be used long-term - onset: 12-24 hours; DOA: 3 days - Pregnancy: preferred laxative (if laxatives are absolutely necessary) - Diabetics: sugar or sugar-free - Patient counseling: take with at least 8 oz. water; take Rx meds 2 hours before or after laxative as it may reduce effectiveness of medication Saline: highly osmotic, therefore draws water into intestine – increased pressure causes BM - CI with decreased renal fxn, decreased CNS activity - SE’s: abdominal cramping, diuresis, N/V, DH - Pediatric: not recommended in < 6 y/o Lubricant: coats feces and prevents water absorption thus prevents straining - onset: few-8 hours - SE: may have leakage from rectum; lipid pneumonia (d/t aspiration) - CI with stool softeners - Pregnancy: NO! – causes decreased absorption of Vitamin K - Pediatric: not recommended in < 6 y/o - Patient counseling: do not take at bedtime Glycerin: lower bowel evacuation d/t osmotic effect and local irritation - onset: 15-60 minutes - SE’s: rectal discomfort, irritation, burning or griping, cramping pain - Patient counseling: suppositories should be inserted high and retained as long as possible Enemas - saline laxatives, mineral oil, and stool softeners can be given as enemas - onset: 2-15 minutes - Pediatric: use pediatric enemas for children - Patient counseling: pt must retain enema until abdominal cramping is felt (507 min) Other methods - ↑ fiber - ↑ fluid - exercise - heed the urge Bismuth subsalicylate Ca Polycarbophil Loperamide Anti-diarrheal Products Available Over-theCounter Attapulgite Anti-diarrheals COMMENTS Adsorbents: Diasorb – liquid Donnagel – liquid Kaopectate – caplets/liquid X X X 1.4% alcohol Alcohol-free Opioid-like agents: Immodium A-D – caplets/liquid Immodium advanced chewable tabs X X 0.5% alcohol (in liquid) Simethicone Hydrophilic Polyacrylic Resin for Irritable Bowel Syndrome: Phillips fibercaps bulk-forming fiber laxative Equalactin Konsyl fiber tabs Fibercon X X X X Adsorbent and Astringent for Traveler’s Diarrhea: Pepto Bismol – liquid/chews/tabs/caplets X Not recommended in <3 y/o (Reye’s syndrome) Children’s Anti-diarrheals: Childrens Kaopectate (3-12 years) – liquid X Alcohol-free General Information - REFER if diarrhea >2 days (adults) or >1 day (kids) - NOT recommended in <3 y/o, chronically ill • infants should eat BRAT diet (bananas, rice, apple sauce, toast); Pedialyte - Pregnancy: NO! Patient counseling: stay away from milk (dairy products); drink lots of fluids Anti-gas OTC products are all simethicone-containing and include…. - Maalox anti-gas extra strength Alka seltzer gas relief maximum strength Mylanta gas softgels maximum strength Mylanta gas chew tabs maximum strength Phazyme gas relief Phazyme gas relief ultra strength Gas-X regular strength chews Gas-X extra strength chews/softgels Gas-X maximum strength softgels GasAid maximum strength Childrens Anti-gas products…. - Little Tummy's gas relief drops (infants and kids) (simethicone) Infant's Mylicon drops (simethicone) Infant's Mylicon drops non-staining formula (simethicone) Gerber gas drops (simethicone) Gassygator tummy pops antacid/anti-gas (Ca glycinate, sugar) Gas Prevention OTC product contains alpha-galactosidase enzyme…. - Beano – drops/tabs Flatulence General Information - prevent passing gas with simethicone - prevent gas production with alpha-galactosidase - other methods: dietary interventions, remain upright for several hours after meal Infant Colic General Information - defn: trapped gas in bowel resulting in painful intestinal contractions - occurs within first 3 months of life - treat with simethicone drops - other methods: heat applied to abdomen, belly massage, altering baby’s posture during feeding, sedatives, dicyclomine Lactose intolerance OTC products consist of the lactase enzyme (unless otherwise noted) and include…. - Lactaid – drops Lactaid extra strength – caplets Lactaid ultra – caplets/chews Dairy Care (lactase and lactobacillus acidophilus enzyme) * drops and capsule contents – put in milk tabs/caps – for hard lactose products (ice cream, cheese, etc…) Healthy digestion promotion OTC products include…. - Omnigest EZ (plant source digestive enzymes) Probiotica (lactobacillus reuteri) X X X X Pramoxine X X X COMMENTS Cocoa butter X X X Anusols: Anusol suppositories Anusol HC-1 ointment Anusol hemorrhoidal ointment Other: Tucks medicated pads Tucks take alongs Tronolane anesthetic cream for hemorrhoids Hemorid maximum strength ointment Americaine hemorrhoidal ointment Nupercainal hemorrhoidal and anesthetic ointment Hydrocortisone X X Witch hazel X X Shark liver oil Glyverin Preparation-H’s: Preparation-H cream Preparation-H ointment Preparation-H suppositories Preparation-H cooling gel Preparation-H medication wipes Preparation-H anti-itch cream Petrolatum Hemorrhoid Products Available Over-theCounter Phenylephrine Hemorrhoids Topical starch X X Zn oxide, mineral oil X X X X X X Light mineral oil Benzocaine Dibucaine General information - hemorrhoids = conglomerates of hemorrhoidal vessels, supporting structure, skin, and other tissue that bulge into the anorectal area - caused by pregnancy (d/t pressure on abdomen), sitting/standing long-term, heavy lifting, straining, genetics, etc… - do not use OTC products for >7 days - Pediatric: should not be used in children <12 y/o - Pregnancy: ONLY petrolatum - Lactation: ONLY petrolatum - Patient counseling: use post-BM after thoroughly cleaning the area OTC hemorrhoidal products consist of…. Vasoconstrictors: reduce swelling and congestion of anorectal tissue - includes: phenylephrine, ephedrine, Epi - CI with heart dz, DM, HTN Protectants: relieves itchiness, burning, irritation by forming a protective coating over the skin - includes: lanolin, petrolatum, cocoa butter, mineral oil, shark liver oil, calamine, Zn oxide - makes wounds less painful by protecting from friction/rubbing Astringents: retards oozing, discharge, bleeding by coagulating proteins; shrinks swollen tissue to temporarily relieves irritation and burning - includes: hamamelis water (witch hazel), calamine, Zn oxide • suitable for internal use: calamine and Zn oxide • suitable for external use: witch hazel Corticosteroids: reduce swelling and inflammation; relieves anal itching - includes: hydrocortisone - onset: 12 hours – but produces longer lasting relief than other agents - CI: broken skin; bleeding Local anesthetics: temporarily relieves pain, burning, itching, irritation, soreness - includes: benzocaine, pramoxine, benzyl alcohol, dyclonine, lidocaine, tetracaine Keratolytics: relieve discomfort and itching by causing desquamation and debridement - include: alcloxa, resorcinol Non-pharmacologic therapies - sitz baths: ameliorates Sx’s by decreasing the pt’s resting anal pressure • sit in warm water B-TID for 15-30 min each bath - anal hygeine: may alleviate minor Sx’s • wash the anal area with soap and water after each BM Lifestyle modifications (for prevention) - eat diet high in fiber and fluid – avoid spicy foods - reduction of straining while attempting to defecate Pinworms OTC products all consist of pyrantel pamoate and include…. - Reese's pinworm medicine Pin-X suspension Pin-Rid suspension General Information - methods of transmission (of pinworms or eggs): finger-to-mouth; inhalation; retroinfection - Sx’s: perianal itching (more common at night when the worm is migrating), restless sleep, irritability, insomnia, abdominal pain - pinworm medications only kill adult worms and are ineffective for developing eggs & larvae - routine 2nd treatment is recommended after the initial treatment d/t possible reinfection - pyrantel pamoate is an anthelmintic which eradicates pinworms by depolarization of muscle, thereby paralyzing the pinworm’s contractile hold on the intestinal wall – worms then carried away in feces - Pregnancy: not recommended - Pediatric: not recommended in <2 y/o (or <25 lbs) Sodium acetylsalicylate Magaldrate Magnesium carbonate X Bismuth salicylate X X X X Activated charcoal X X Potassium citrate X X Sodium citrate Aluminum hydroxide Antacids – Tums: Tums regular strength Tums maximum strength Tums extra strength Tums extra strength sugar-free Tums ultra maximum strength Magnesium hydroxide Acid Products Available Overthe-Counter Calcium carbonate Acid Products COMMENTS X X X X X Antacids – Other CaCO3-containing: Titralac antacid instant relief X Titralac antacid extra strength X Alka-mints X Chooz antacid/calcium suppl. X Antacids – Maaloxs: Maalox regular strength quick dissolve chewable tabs Maalox maximum strength quick dissolve chewable tabs Maalox regular strength liquid Maalox therapeutic concentrate Antacids – Mylantas: Ultra Mylanta calci-tabs Mylanta antacid gelcaps/tabs Mylanta supreme antacid liquid Mylanta ultratabs Mylanta night time strength liquid X X X X X X Antacids – MOM: Phillips MOM laxative/antacid – liquid/chews Fleet MOM Antacids – Rolaids: Rolaids antacid Rolaids antacid extra strength Antacids – Gaviscons: Gaviscon regular strength – liquid/tabs Gaviscon extra strength – liquid/tabs X X X X X X X X Mg trisilicate; alginic acid X Alginic acid Antacids – Seltzers: Alka seltzer heart burn relief Alka seltzer original Alka seltzer extra strength Gold Alka-seltzer Bromoseltzer antacid/pain reliever Brioschi for upset stomach Charcocaps Pepto bismol – chews/caplets/liquid X X X X X Sodium acetylsalicylate Magaldrate Magnesium carbonate Bismuth salicylate Activated charcoal Potassium citrate Sodium citrate Aluminum hydroxide Magnesium hydroxide Acid Products Available Overthe-Counter Calcium carbonate Acid Products (cont’d)…. X X X Children’s Antacids: Childrens Mylanta Gassygator tummy pops antacid/anti-gas (citric acid + NaHCO3) (citric acid + NaHCO3 + ASA) (citric acid + NaHCO3 + ASA) (citric acid + NaHCO3 + KHCO3) (citric acid + NaHCO3 + APAP) (NaHCO3) X X H2 blockers: Axid AR – tabs Zantac 75 – tabs Pepcid AC – tabs/chews/gels Mylanta AR Tagamet HB 200 – liquid/tabs Antacid combinations: Titralac plus antacid instant relief Advanced formula di-gel Mylanta liquid antacid/anti-gas original strength Mylanta liquid antacid/anti-gas extra strength Maalox maximum strength fast relief antacid/anti-gas Gelusil Riopan plus Pepcid complete chews COMMENTS nizatidine 75 mg ranitidine 75 mg famotidine 10 mg famotidine 10 mg cimetidine 200 mg X X Simethicone X X X Simethicone Simethicone X X Simethicone X X Simethicone X X X X X X X Simethicone Simethicone Famotidine 10 mg (2-11 y/o) Ca glycinate General information - do not use OTC products for >2 weeks in the treatment of GERD - there are no OTC products labeled for PUD Antacids: work quickly to neutralize stomach acid - includes: CaCO3, AlOH, MgOH, Mg CO3, NaHCO3, magaldrate - potency: CaCO3 > NaHCO3 > MgOH > other Mg salts > Al salts - magaldrate = combination of Mg and Al hydroxides and sulfates - used for heart burn, stomach upset, indigestion - also helps with GERD (unlabeled use) as it decreases acidic damage from reflux, reduces the number of reflux episodes and quantity of refluxate, and may increase LES tone - take after meals to increase DOA (empty stomach: 20-30 min; after meals: 3-4 hrs) - Pediatric: don’t recommend in < 2 y/o - Patient counseling: if taking tablet form, make sure tablet is completely chewed to avoid any bowel obstruction H2 blockers: slow the secretion of acid into the stomach - used for relief or prevention of heart burn, indigestion - Pediatric: don’t recommend in <12 y/o - Patient counseling: for prevention, must be taken before eating (Pepto: 60 min; Axid: 0-60 min; Tagamet: 0-30 min; Zantac: not labeled for prevention) Bismuth subsalicylate (Pepto-Bismol) - used for heart burn and indigestion - NOT considered to be an antacid by the FDA - works by coating the GIT - Pediatric: not for use in children (aspirin-derivative à Reye’s) Antiemetics / prevention of motion sickness OTC products include…. - Dramamine original formula (dimenhydrinate) (>2 y/o) Dramamine chewable formula (dimenhydrinate) (>2 y/o) Dramamine less-drowsy formula (meclizine) (>12 y/o) Bonine (meclizine) (>12 y/o) Marezine (cyclizine) Travel Eze (wristband for travelers – pressure points) Anti-nausea / vomiting OTC products include…. - Emetrol (dextrose, levulose, phosphoric acid) (>2 y/o) Cola syrup (fructose, sucrose) (>2 y/o) Nauzene chewables (Na citrate dihydrate) (formulated for adults only) Emetics OTC products include…. - Ipecac syrup Activated charcoal General Information - used to induce vomiting in poisonings - activated charcoal: adsorbs toxins; often not readily available in pharmacies (sometimes with the laxatives) so will focus our discussion on ipecac syrup - ipecac: induces vomiting by causing irritation of GIT and activating the central vomiting center through stimulation of the chemoreceptor zone - given within 1 hour of ingestion, ipecac removes ~30-60% of stomach contents (15-30% after 1 hour has elapsed) – if ingestant is a liquid, time is shorter - SE’s: lethargy, diarrhea - Pediatric: not recommended in <6 months – all ages may repeat the initial dose if vomiting does not occur in 30 minutes - Patient counseling: pt should drink water or another clear fluid after taking ipecac to facilitate its action General – jock itch, ring worm, athlete’s foot Cruex X Cruex Lotrimin AF X Lotrimin AF Micatin Desenex Desenex max Lamisil AT Tinactin antifungal Quinsana plus Nail Fungi nail anti-fungal solution Extra strength fungi cure Dr. Scholl’s fungi nail revitalizer ProClearz brush-on Dr. Scholl’s fungi solution Undecylenic acid Tolnaftate Terbinafine Miconazole Anti-fungal Products Available Overthe-Counter Clotrimazole Anti-fungals COMMENTS Cream Spray powder Cream, solution Spray liquid, powder, spray powder, deodorant powder Cream, spray powder, spray liquid Powder, spray powder, liquid spray Cream Cream, solution dropper, spray pump, deodorant powder Cream, powder, spray, powder spray, liquid spray, sports wipes Powder X X X X X X X X X X CaCO3, urea, mineral oil, benzyl alcohol, dimethicone X X General Information - OTC fungal medications are effective only for Tinea pedis, corporis, and cruris - products should be used or 4 weeks for pedis or corporis, and 2 weeks for cruris - thin layer should be applied QAM and QPM - OTC medications labeled for the scalp or nails are generally not effective – Rx tx necessary Fungus classifications - Tinea pedis: athlete’s foot - Tinea corporis: ringworm of body - Tinea cruris: jock itch - Tinea capitis: ringworm of scalp - Tinea unguium: onychomycosis - Tinea versicolor: fungus that changes – depigments skin - Tinea nigra: black or brownish discoloration most often on the palm Warts OTC products all consist of salicylic acid and include…. - Compound W – cream/pads/strips DuoFilm – liquid/patch Dr. Scholl's clear away – pads/strips/gel Tinamed – liquid/patch Pedifix wart stick Wart-off wart remover Occlusal-HP topical wart remover Maxi-strength wart remover Corn and callus OTC products all consist of salicylic acid and include…. - ProClearz corn and callus remover Mosco callus and corn remover Freezone corn and callus remover Pedisilk corn and callus remover Dr. Scholl's corn/callus remover – liquid/pads Band-aid corn remover Other foot products - Out gro (benzocaine) -- for foot pain Tea tree for toes and feet (tea tree oil) -- spray-on antiseptic Podiacin soak and massage pain relieving gel (menthol, methyl salicylate) – for foot pain Sleep Aids Product Sominex original formula Sominex maximum strength formula Simply sleep Sleepinal maximum strength Nytol quickcaps Unisom sleep gels Unisom sleep tabs Alluna Calms Forte Diphenhydramine X X X X X X Doxylamine Comments X valerian root, hops extract natural General information - indication: insomnia – not to be used for narcolepsy, sleep apnea, restless leg syndrome - don’t use >1 week - Pediatric: not recommended for children <12 y/o - Patient counseling: there are many other combination sleep products available with the added diphenhydramine (e.g. Tylenol PM) or doxylamine (e.g. Nyquil) Non-traditional therapies - melatonin - valerian Stimulants OTC products all consist of caffeine and include…. - Vivarin No Doz Caffedrine Ultra Pep-back Eleveine General information - indication: fatigue and drowsiness - usual dose: 100-200 mg NMT Q3-4H - SE’s: nervousness, irritability, sleeplessness, occasional tachycardia, GI upset, tinnitus, tremor, HA - Patient counseling: recommended dose of each product contains about as much caffeine as a cup of coffee; caffeine is an addictive drug Fat binders Natrol absorbitol fat binder Chitosan-C with biozan Diet fuel Ma Huang free chitosan formula Other supplements Diet fuel Ma Huang free formula Dual action diet slim T-lite Fat burners X X X X X X X X X X X X X Chroma slim plus X L-arginine Creatine L-phenylalanine X X X Citrus aurantium X X X Chitosan Zinc X X X Vitamin E X COMMENTS sida cordifolia, vanadium X X X X Carb cutter Twin lab chromic fuel Drug-free Dexatrim natural ephedrine-free formula Drug-free Dexatrim green tea formula Ultra chroma slim plus Chroma slim for men Chroma slim plus water pill Twin Lab Ironman energy booster Twin lab fast burn diet formula Ripped Fuel Ma Huang free formula Twin lab amino fuel Twin lab creatine fuel Twin lab mega creatine fuel Advanced creatine Acutrim natural AM X Magnesium X X X X X X L-carnitine X X X X X Guarana Ephedra-containing supplements Ripped fuel Metab-o-lite caffeine-free Metabolife 356 Metaboless Diet Fuel Drug-free dexatrim natural no caffeine formula Chromium Dietary Supplements Available Over-the-Counter Ma Huang Dietary supplements X X X X X X X K X Multivitamins, K Grapefruit extract, kola nut extract Vit C, etc. X X Bitter orange peel extract, caffeine Sida cordifolia, Ca X Ca, Mn Vit B6, pantothenic acid, Ca, Mn Vit B6, Ca, Mn, K, pantothenic acid Vit B6, K X X X X X X X X St. John’s wort St. John’s wort X BCAA’s X X X X Acutrim natural PM Heart bar * all products listed above have additional ingredients not shown X X X Niacin, bitter orange extract Niacin OTC dietary supplements consist of…. Ephedrine: β-receptor stimulation à stimulates thermogenesis - acts as appetite suppressant - CNS stimulant which produces amphetamine-like action - SE’s: dizziness, flushing, nervousness, irritability, insomnia, anxiety, tachycardia - Patient counseling: should not be taken without medical supervision; ingestion above recommended amount may result in heart attack, seizure, stroke, or death Chromium: sensitizes insulin-sensitive glucoreceptors in brain to suppress appetite - used for weight loss; also for glycemic control in diabetes - SE’s: cognitive, perceptual, motor dysfunction Guarana: contains 2.5-7% caffeine, therefore acts as CNS stimulant - used for weight loss; also helps enhance athletic performance and reduce fatigue - SE’s: insomnia, nervousness, agitation, N/V, diuresis, tachycardia, ↑RR - Patient counseling: coffee contains 1-2% caffeine; can increase caffeine levels in body L-carnitine: seems to be needed to release energy from fat; can serve as precursor for ACh - helps enhance athletic performance Magnesium: involved in protein synthesis and carbohydrate metabolism - helps increase energy and endurance Vitamin E: antioxidant - helps treat and prevent CVD; also for ALZ, PD, night cramps Zinc - helps improve athletic performance; also treats common cold (gluconate form) Chitosan: monopolysacchardie component of marine organism exoskeletons - used for weight loss Citrus aurantium L-phenylalanine Creatine: in muscle tissue is utilized to convert ADP à ATP - for enhancement of short-term athletic performance - SE’s: dehydration, heat-related illnesses, cramps, weight gain - Patient counseling: do not use in renal dysfunction; concurrent use with NSAIDs may further compromise renal function Arginine: precursor for production of nitric oxide, the body’s natural vasodilator - helps vasodilate peripheral and coronary blood vessels Sodium chloride Chlorhexidine Iodine Triclosan Lidocaine Benzocaine Benzalkonium Benzethonium Cl Pramoxine Bacitracin Polymyxin B First Aid Products Available Over-the-Counter Neomycin First Aid Products COMMENTS Topical antibiotics (triple) – ointments: Neosporin original ointment Band Aid first aid antibiotic X X X X X X Topical antibiotics (triple plus pain) -- ointments: Lanabiotic Neosporin maximum strength plus pain ointment Gold Bond triple antibiotic Band Aid plus first aid antibiotic/pain relief ointment X X X X X X X X X X X X X X X X X X Other topical antibiotics: Neosporin maximum strength plus pain cream Betadine plus clear antibiotic Polysporin ointment Bacitraycin plus X X X X X X X Aquaphor Antiseptics/anesthetics: Lanacane antibacterial first aid spray Lanacane plus antibacterial antiitch cream Lanacane maximum strength anti-itch cream Bactine first aid – spray/liquid Solarcaine medicated first aid spray X X X X X X X X X X Topical anesthetics: Dermoplast pain relieving spray Solarcaine aloe extra burn relief X Menthol Aloe X Antiseptics: Betadine – ointment/solution Hibiclens Campho-phenique – liquid/gel Liquid bandages: Skin shield liquid bandage with pain reliever New Skin liquid bandage Wound wash: Blairex wound wash saline X X Camphor, phenol X Dyclonine Pyroxylin, alcohol X OTC First Aid products consist of…. Antibiotics - includes: bacitracin, neomycin, polymyxin B - do not use >1 week - watch for allergic reactions! - Patient counseling: NOT to be used in already infected wounds 1. Bacitracin: active mostly against gram positive organisms 2. Neomycin: active against gram negatives, anaerobes, some gram positive organisms - high incidence of allergic contact dermatitis - produces cross-sensitivity to other aminoglycosides in some pts 3. Polymyxin: gram negative activity Antiseptics - helps prevent infection in minor cuts and scrapes - includes: alcohol, iodine, hydrogen peroxide, benzalkonium, chlorhexidine - apply small amount QD-TID - do not use >1 week - Patient counseling: NOT to be used in already infected wounds 1. Alcohol: have gram-positive, gram-negative, and antitubercular activity - includes: denatured ethyl alcohol 48-95% and isopropyl alcohol 50-91.3% 2. Hydrogen Peroxide: cleanses wound via effervescent action - should be used ONLY in initial care of a wound since it damages viable tissue and inhibits formation of granulation tissue - Patient counseling: NEVER use for deep wound or one with a cul-de-sac 3. Iodine: has bactericidal, sporicidal, tuberculocidal, fungicidal, and virucidal properties - watch for allergic reactions - Patient counseling: stains the skin a brownish color; colorless iodines are useless as antiseptics 4. Quaternary ammonium compounds: effective against gram-positive organisms - includes: benzalkonium chloride, benzethonium chloride, methylbenzethonium chloride 5. Chlorhexidine: effective against bacteria and fungi Anesthetics: provide temporary relief for pain of minor wounds - includes: benzocaine, butamben picrate, dibucaine, dyclonine, lidocaine, pramoxine, tetracaine, dimethisoquin Hydrocortisone-containing: Cortaid – ointment/cream Cortizone 10 – cream/ointment/spray Cortizone 5 – cream Cortizone kids – cream Corizone 10 plus – cream Corticool gel Lanacort maximum strength cool crème Sarnol-HC maximum strength lotion COMMENTS X X X X X X X X Others: Benadryl original strength itch stopping cream -- also gel, spray, stick Benadryl extra strength itch stopping cream -also gel, spray, stick Dermarest plus cooling anti-itch gel Band Aid anti-itch spray Band Aid calamine spray Band Aid anti-itch gel Aveeno anti-itch – cream/lotion Caladryl lotion Caladryl clear lotion Gold Bond medicated anti-itch cream Itch-X Therapatch anti-itch patches for kids Respite anti-itch lotion Sarna anti-itch lotion Natural Harmony fast itch relief X X X X X X X X X X X X X X Zn acetate benzocaine X X X Zn acetate X X X X X X X X X Benzethonium Cl Astringents: Pedi-boro soak pads (AlSO4 + Ca acetate à Al acetate) (AlSO4 + Ca acetate à Al acetate) Domeboro astringent solution Poison Ivy Itch: Corticool gel Blistex ivarest medicated cream Aveeno anti-itch – cream/lotion Tecnu Ivy block lotion Menthol Camphor Benzyl alcohol Pramoxine Calamine Diphenhydramine Topical anti-itch Products Available Over-theCounter Hydrocortisone Topical anti-itch X X X X X X Deodorized mineral spirits Bentoquatum OTC Topical Anti-itch products consist of…. Topical hydrocortisone: antipruritic and anti-inflammatory effects - for relief of itching associated with minor skin irritation, inflammation, rashes caused by eczema; poison ivy, oak, or sumac; detergents; cosmetics; and jewelry - doses available: 0.5%, 1% - use sparingly T-QID - do not use > 1 week - Pediatric: don’t use in children <2 y/o Topical antihistamines: depress cutaneous receptors for pain and itch - includes: diphenhydramine, tripelennamine Skin protectants: protect minor wounds from harmful or annoying stimuli - includes: allantoin, AlOH gel, cocoa butter, calamine, dimethicone, glycerin, kaolin, petrolatum, shark liver oil, sodium bicarbonate, Zn acetate, Zn carbonate, Zn oxide - dries the oozing and weeping of poison ivy, oak, and sumac (AlOH, calamine, kaolin, Zn acetate, Zn carbonate, Zn oxide) - Pediatric: don’t use AlOH gel in <6 months; Zn acetate in <2 y/o Topical anesthetics: temporarily relieves pain, burning, itching, irritation, soreness - includes: benzocaine, pramoxine, benzyl alcohol, dyclonine, lidocaine, tetracaine Counterirritants: external analgesics often used for insect bites - includes: camphor, menthol, allyl isothiocyanate, ammonia water, methyl salicylate, turpentine oil, histamine HCl, methyl nicotinate, capsaicin, capsicum products - camphor and menthol produce cooling sensation - Pediatric: don’t use in children <2 y/o Astringents: temporarily relieves rashes caused by soaps, detergents, cosmetics, and jewelry, as well as minor skin irritations d/t poison ivy - includes: Al acetate (Burow’s solution) - reduces weeping, aids in removal of crust, and soothes the skin - do not use >7 days General pain relief – Flexalls: Flexall 454 maximum strength pain relieving gel Flexall 454 pain relieving gel vitamin E enriched Flexall quik gel Flexall plus pain reliving gel General pain relief – Bengays: Bengay vanishing scent Bengay original formula Bengay greaseless pain relieving cream Bengay ultra strength General pain relief – Tiger Balms: Tiger Balm pain relieving ointment extra strength Tiger Balm pain relieving ointment ultra strength General pain relief – Others: Mineral Ice pain relieving gel Absorbine Jr pain relieving liquid Theragesic Pain Bust R II Icy Hot Deep heating pain relieving rub Lini-mist spray Perform cool pain relieving gel Camphophenique pain relieving antiseptic liquid/gel Dibucaine Benzocaine Trolamine Benzocaine Phenol Capsaicin Camphor Methyl nicotinate Methyl salicylate Topical Pain Relief Products Available Over-the-Counter Menthol Topical pain relief COMMENTS X X X X X X X X X X X X X X X X X X X X X X X X X X X General pain relief – anesthetic-containing: Dermoplast pain relieving spray X Aspercreme Mobisyl Myoflex Sportscreme Boil Ease pain relieving ointment Americaine hemorrhoidal ointment Nupercainal hemorrhoidal and anesthetic ointment Tronolane anesthetic cream for hemorrhoids X X X X X X X X X (camphorated phenol) X X X X X X X X Pramoxine General pain relief (patch): Durapatch topical analgesic Salon Pas pain relieving patch J&J back plaster Mentholatum pain patch Skin shield liquid bandage with pain reliever Arthritis pain relief: Joint-ritis arthritis pain relief ointment Benejoint Stopain spray Banalg arthritic pain reliever Arthritis hot pain relief crème Bengay arthritis formula Arthritic hot deep penetrating pain relief crème Osteo bi-flex arthritis pain relieving cream Ziks arthritis pain relief Arthicare for women multi action Arthicare for women quick-drying Stop pain extra strength topical analgesic spray Arth-Rx topical analgesic lotion Jointflex pain relieving crème Blue star ointment Glucoflex herbal pain relief rub Capsagesic-HP arthritis pain relief crème Capzasin-P arthritis pain relief Capzasin-HP arthritis pain relief Zostrix arthritis pain relief Zostrix-HP arthritis pain relief Ease arthritis pain relief Natrol MSM with glucosamine lipoceutical creme Arthroflex max X X X X X X X X X X X X X X X X X X X X Dibucaine Benzocaine Trolamine Benzocaine Phenol Capsaicin Camphor Methyl nicotinate Methyl salicylate Topical Pain Relief Products Available Over-the-Counter Menthol Topical pain relief (cont’d)… COMMENTS (oleoresin of capsicum) Mentholatum Dyclonine, benzethonium X X X X X X MSM, glucosamine X X X X X X Glucosamine X X X X X MSM, glucosamine histamine dihydrochloride OTC Topical Pain Relief products consist of…. Counterirritants: external analgesics often used for insect bites - includes: camphor, menthol, allyl isothiocyanate, ammonia water, methyl salicylate, turpentine oil, histamine HCl, methyl nicotinate, capsaicin, capsicum products - Pediatric: don’t use in children <2 y/o 1. Menthol: produces cooling sensation - NMT 3-4x/day in adults - May cause sensitization 2. Camphor: produces cooling sensation - can be toxic if ingested 3. Methyl salicylate: produces redness by activating nerve endings – distracts you from pain - other irritants that produce redness: allyl isothiocyanate, strong ammonia, turpentine oil - occurs naturally as wintergreen oil or sweet birch oil - Patient counseling: use caution in pts who are aspirin sensitive, have severe asthma, nasal polyps, or other conditions associated with ASA sensitivity - NMT 3-4x/day in adults 4. Methyl nicotinate: vasodilator - other vasodilators: histamine - may induce drop in BP and pulse rate with possible syncope d/t vascular dilation - NMT 3-4x/day in adults 5. Capsicum preparations: depletes substance P - gives burning sensation therefore not recommended in kids - NMT 3-4x/day in adults Phenol: external analgesic that depresses cutaneous receptors - caution: can cause sloughing of the tissue in certain conditions Topical anesthetics: temporarily relieves pain, burning, itching, irritation, soreness - includes: benzocaine, pramoxine, benzyl alcohol, dyclonine, lidocaine, tetracaine Scar management OTC scar management products include…. - Speco 2nd skin scar management pad (silicone with breathable polyurethane membrane) Mederma (water, PEG-4, onion extract, xanthan gum, methyl paraben, sorbic acid) Curad scar therapy cosmetic pad (polyurethane) Cica-Care gel sheet Drawing ointment (salve) - Ichthammol ointment Diaper rash Product Balmex diaper rash ointment Desitin – ointment/creamy ointment DRC diaper rash crème Johnson’s diaper rash ointment A+D ointment with zinc oxide Aveeno diaper rash cream Blistex ultra dyprotex Vaseline nursery jelly A+D original ointment Diaper guard therapeutic skin rash ointment Gerber diaper rash lotion Zinc oxide X X X X X X X Petrolatum X X X X Dimethicone X X X lanolin X X OTC Diaper Rash products consist of…. Protectants: helps protect skin from moisture (exclude wetness, prevent dryness) - includes: Zn oxide, petrolatum, dimethicone, allantoin, calamine, cod liver oil, kaolin, lanolin, mineral oil, talc, corn starch Lifestyle modifications - frequent diaper changes – clean with water - keep as dry and clean as possible - cornstarch dusting powder Electrolyte Replacements OTC products include…. - ReVital oral electrolyte freezer pops ReVital oral electrolyte liquid squeezes ReVital oral electrolyte jell cups Kaolectrolyte electrolyte replenisher Pedialyte oral electrolyte maintenance solution Pedialyte freezer pops oral electrolyte maintenance solution Oralyte oral electrolytesolution Gerber pediatric electrolyte oral electrolyte maintenance solution Comments Teething OTC products include…. - Zilactin baby (benzocaine 10%) Baby Orajel teething pain medicine (benzocaine 7.5%) Orabase baby (benzocaine) - Hyland’s homeopathic teething tabs Humphrey’s “3” (homeopathic) General information - teething pain is d/t pressure of teeth erupting through gum surfaces - first teeth come in at 6-10 months (central incisors); last teeth in adulthood (wisdom teeth) - approved agents: benzocaine, phenol - should not be applied >QID - Pediatric: don’t use in <4 months of age Other remedies - crushed ice or bottle of cool water applied to child’s gums - chewing on clean, damp, or frozen washcloth Formulas OTC products include…. - Similac with iron infant formula Similac low iron infant formula Similac NeoSure infant formula with iron Similac lactose-free infant formula with iron Similac 2 infant and toddler formula with iron Isomil DF soy formula for diarrhea Isomil soy formula with iron Isomil 2 infant and toddler soy formula with iron Enfamil with iron infant formula Enfamil low iron infant formula Enfamil ProSobee soy formula Enfamil A.R. thickened formula with Added Rice Starch Enfamil lacto-free Enfamil nutramigen hypoallergenic formula Enfamil next step toddler formula Enfamil pregestimil hypoallergenic formula with MCT oil Carnation good start infant formula Carnation follow up infant formula Carnation Al soy infant formula Multi-vitamins - Centrum – lquid/tabs Centrum Silver – tabs One a day womens formula One a day mens formula One a day 50+ formula One a day maximum Theragram M advanced Theragram M with minerals Geritol extend Geritol complete Geritol tonic SSS Tonic Myadec Unicap M Unicap SR Nature made essential daily complete Nature made essential 50+ complete (with high levels Ca, Se) Nature made essential mega Theragran heart right Dr. Art Ulene’s optimal vitamin formula for men Dr. Art Ulene’s optimal vitamin formula for women Dr. Art Ulene’s nutrition boost formula for men and women Radiance Natrol my favorite multiple Multi-vitamins plus - Nature made essential multi plus energy (with korean ginseng) Nature made essential multi plus heart health (with garlic, soy, Vit E) Nature made essential multi plus stress relief (with kava, Vit B) Nature made essential multi plus memory (with gingko) One a day bedtime and rest (valerian, kava) One a day cholesterol health (garlic, soy extracts) One a day energy formula (ginseng, B vitamins) One a day joint health (glucosamine, Vit C, Vit E) One a day memory and concentration (ginkgo, B vitamins) One a day menopause health (black cohosh, natural soy extracts) One a day prostate health (saw palmetto, Zn) One a day tension and mood (St. John’s wort, kava) Centrum focused formulas bone health (Vit D, Ca citrate, Mg, Zn, Cu, Mn, boron) Centrum focused formulas energy (B complex, ginseng) Centrum focused formulas heart (garlic, coQ10, Vit E, Se, Mn, B6, B12, folic acid) Centrum focused formulas mental clarity (ginkgo, B-complex, Vit E, Zn, folic acid) Centrum focused formulas prostate (saw palmetto, Vit A) Centrum focused formulas stress (ginseng, Vit C, E, B-complex, Zn, Cu) Eye vitamins - I Caps plus formula I Caps lutein and zeaxanthin fomrula Ocuvite Ocuvite lutein Prenatal vitamins - Stuart prenatal Enfamil Natalins Natrol for women prenatal care B-complex combination vitamins - Stresstabs high potency B-complex (B complex with Vit C, Vit E, folic acid) - Stresstabs high potency B-complex + iron (B complex with Vit C, Vit E, folic acid, iron) - Stresstabs high potency B-complex + zinc (B complex with Vit C, Vit E, folic acid, zinc) - All BEE plus Vitamin C (B complex, Vit C) - All BEE plus Vitamin C, iron, Vitamin E (B complex, Vit C, Vit E, iron) - Z-BEC plus Zn, Vitamin E, Vitamin C (B complex, Zn, Vit E, Vit C) - Surbex-T (B complex, Vit C) - Nature made super B complex Antioxidants - Nature made antioxidant formula with minerals One a day antioxidant (Vit A, Vit C, Vit E, Zn, Se, Cu, Mn) Protegra antioxidant (Vit A, Vit C, Vit E, Zn, Se, Cu, Mn) Vitamin Packs - Nature made antioxidant pack (multi plus vitamins and minerals, Vit C, Vit E, Zn, βcarotene) Nature made men’s pack (multi plus vitamins and minerals, Vit C, Vit E, B-complex) Nature made stress pack (multi plus vitamins and minerals, Vit C, Ca, super B-complex) Nature made maximin pack (multi plus vitamins and minerals, Vit C, E, B-100, A, D, Ca) Your life memory body benefits pak (ginkgo, gotu kola, phosphatidylserine, lecithin) Your life circulatory and heart body benefits pak (coQ10, garlic, Vit E, folic acid, B vitamins) Your life energy body benefits pak (siberian ginseng, B-100 complex, ginseng, gotu kola, guarana) Your life daily pak maximum (multivitamin, Vit C, Vit E, siberian ginseng, chromium) General Information on Oil-soluble Vitamins - includes: A, D, E, K - held in body much longer than water-soluble vitamins – elevated potential for toxicity - involved for the most part in maintaining the structure of cell membranes and possibly responsible for synthesis of certain enzymes 1. Vitamin A: oil-soluble - essential for proper vision, growth, cellular differentiation and proliferation, reproduction, and immune system integrity - naturally-occurring compounds: retinol, retinaldehyde, retinoic acid - pre-vitamin A carotenoids: -carotene, -carotene, cryptoxanthin 2. Vitamin D: oil-soluble - essential for calcium metabolism in animals therefore important for normal mineralization of bone and cartilage - skin forms Vitamin D3 from a precursor when exposed to sunlight • 7-dehydrocholecalciferol à cholecalciferol (D3) - vitamin D3 is extensively metabolized, forming metabolites such as: • 25-hydroxyvitamin D (calcidiol), formed in the liver and further metabolized to... • 1,25-dihydroxyvitamin D (calcitriol) and 24,25-dihydroxyvitamin D in the kidneys - calcitriol is the active form of Calcium Pediatric: large doses of Vitamin D is potentially toxic 3. Vitamin E: oil-soluble; antioxidant - deficiency results in reproductive failure, muscular atrophy, wasting, neurologic deficits - compounds exhibiting Vit E activity: , , , -tocopherols - antioxidant activity of tocopherols help prevent oxidation of unsaturated FA to avoid cellular damage and neurologic problems 4. Vitamin K: oil-soluble - essential for production of prothrombin and other proteins necessary for blood clotting General Information on Water-soluble vitamins - includes: B-complex, C - rapidly absorbed by the intestine and carried by the circulatory system to specific tissues to be put to use 1. B-complex: water-soluble - B1: thiamin – cofactor in carbohydrate metabolism, therefore plays a key role in the generation of cellular energy • severe deficiency à beriberi (manifests as peripheral neuritis and cardiac abnormalities) – esp. prone to occur in alcoholics - B2: riboflavin – key to functions that keep energy flowing - B3: niacin – active form nicotinamide serves a vital role in tissue respiration • deficiency à pellegra (Sx’s occur in skin, GIT, CNS) • toxicity à flushing and itching (max dose: 35 mg/d) - B5: pantothenic acid – required for synthesis of coenzyme A, therefore essential for carbohydrate, fat, protein metabolism - B6: pyridoxine – required for synthesis and catabolism of a.a.’s • toxicity à sensory neuropathy (max dose: 100 mg/d) - B7: biotin – essential in gluconeogenesis, FA synthesis, propionate metabolism, BCAA catabolism - B9: folic acid – catalyzes the conversion of homocysteine à methionine (w/ B12), therefore potentially protecting against CVD and stroke • deficiency à megaloblastic anemia (reversible) • toxicity à sensory neuropathy (max dose: 1 mg/d) • Pregnancy: very important in first trimester to prevent neural tube defects • Patient counseling: levels are significantly reduced with even 1 or 2 alcoholic beverages per day - B12: cyanocobalamin – necessary for cell growth and replication; as a cofactor, is used during the catabolism of some FA and a.a.’s and catalyzes the conversion of homocysteine à methionine (w/ B9) • deficiency à pernicious anemia (irreversible) • Patient counseling: levels are significantly reduced with even 1 or 2 alcoholic beverages per day 2. Vitamin C: water-soluble; antioxidant - used for wound healing, normal immune response, formation of collagen - as an antioxidant, acts by scavenging radicals, reduce some food carcinogens to inactive products, and protect the lung lining against damage from air pollutants such as the ozone, nitric oxide, and cigarette smoke - deficiency à scurvy Calcium citrate products: Citracal Citracal + D Citracal plus Mg Calsure Magnesium Zinc Manganese Copper X X X X X X X X X Vitamin K Soy isoflavones Calcium phosphate Vitamin D Calcium carbonate products: Tums calcium for life bone health Caltrate 600 Caltrate 600 + D Caltrate 600 + soy Caltrate 600 plus Oscal 5000 Oscal 500 + D Your life calcium Your life calcium with Vit D Your life calcium + soy isoflavones and Vitamin D Nature made Calcium supplement– tablets/chews Nature made Calburst calcium supplement softchews Nature made calcium plus soy advanced bone care Nature’s bounty absorbable calcium with Vitamin D Sundown calcium 900 plus D Sundown calcium 1200 plus D Natrol calcium chewable with Vitamin D Soy care + 600 Calcium Osteo-P Viactiv chews Calcium citrate Calcium Supplements Available Over-the-Counter Calcium carbonate Calcium supplements COMMENTS X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Calcium phosphate products: Posture-D Posture-D high potency Calcium products from other/unknown sources: One A Day Calcium plus X Calcet triple calcium plus Vit D X Sundown calcium plus Vit D X X X X X X X X X X X X X X X X X X X X X Vit B6, Boron X X X X X X Ca lactate and gluconate Ca from oyster shell General Information - most abundant element in body - benefits include: reduction of HTN associated with pregnancy; prevention of osteomalacia and osteoporosis - supplements contain…. • Ca carbonate • Ca phosphate • Ca citrate • Ca gluconate • Ca lactate - absorption comparison…. • Ca phosphate = Ca citrate > Ca carbonate - RDA’s: • 1-10 y/o • 11-24 y/o • > 25 y/o • pregnant or lactating 800 mg/d 1200 mg/d 800 mg/d 1200 mg/d NIH recommendations: • 25-65 y/o • postmenopausal women on estrogen • postmenopausal women w/o estrogen • >65 y/o 1200 mg/d 1000 mg/d 1500 mg/d 1500 mg/d - - 40% Ca++ 40% Ca++ 21% Ca++ 9.3% Ca++ -- not commonly used 13% Ca++ -- not commonly used SE’s: constipation, GI upset, gas, gastric ulceration (gas esp. prevalent in CaCO3) Iron supplements Product Feosol Fer-in-Sol Slow Fe Slow Fe plus folic acid Fergon Ferralet Ferrosequels FeoSol Sundown perfect iron Fe sulfate X X X X Fe gluconate General Information - most abundant trace element in body - supplements contain…. • Fe sulfate • Fe gluconate • Fe fumarate - absorption comparison…. • all absorbed equally - RDA’s: • < 4y/o • males 4-19 y/o • males > 19 y/o • females 4-50 y/o • females > 50 y/o • pregnancy and lactation - Fe fumarate Carbonyl iron Comments Folic acid X X X X X 60 mg/325 mg tab 30 mg/325 mg tab 105 mg/325 mg tab 10 mg/d 12 mg/d 10 mg/d 15-18 mg/d 10 mg/d 30-60 mg/d from diet, only 10-15% is absorbed deficiency à anemia – takes 3-6 months to correct Calcium Magnesium supplements - Slow-Mag (MgCl) General Information - helps with carbohydrate metabolism, protein synthesis, neuromuscular function; clinically used to treat eclampsia of pregnancy - deficiency à rarely occurs unless chronic alcoholic, protein malnourished, or experiencing chronic vomiting or diarrhea Niacin supplements (B3) - Slo niacin Endurance plain niacin Endur-acin niacin Folic acid supplements (B9) - Folgard supplements (folic acid) Multivitamins for Children - Li’l Critters Gummy Vites Centrum Kids complete Centrum Kids extra C Centrum Kids with extra calcium One a day Kids complete Sesame Street complete Bugs Bunny complete (sugar free) Sundown Pokemon complete Sundown Pokemon with extra C Sundown Pokemon with extra iron Flintstones original Flintstones complete Flintstones with iron Flintstones with calcium Flintstones plus extra C Multivitamins for Infants and Toddlers - Enfamil Poly-Vi-Sol multivitamin supplement drops Enfamil Poly-Vi-Sol with iron multivitamin supplement – chews/drops Gerber vitamin drops Supplements for children - Li’l Critters Vitamin C with echinacea Supplements for Infants and Toddlers - Enfamil Tri-Vi-Sol with iron Vit A, D, C supplement drops Enfamil Fer-In-Sol iron supplement drops Natural product combinations PMS - Nature made Soy 50 (soy) Healthy woman soy menopause supplement (soy) Soy care for menopause (soy isoflavones) Promensil (isoflavone phytoestrogens) Remifemin (black cohosh) New Phase (soy isoflavones, black cohosh, chastetree) Estroven (soy, Vit E, folic acid, Vit B6, Ca, kava, black cohosh, boron) Rejuvex (dong quai, Mg, boron, glandular powders) Lydia Pinkham herbal tabs (iron, Ca, Vit C, Vit E, herbs) Tums calcium for life PMS (CaCO3) Natrol for women hot flashex (black cohosh, Vit E, kava) Natrol for women soy isoflavones (soy isoflavones) Nature’s bounty soy isoflavones (soy isoflavones) Sundown concentrated soy isoflavones (Ca, soy isoflavones) Other soy-containing products - Genisoy vanilla protein shake Genisoy natural protein powder Health source soy protein shake CardioLink Soy 25 protein powder Bone - Dr. Art Ulene’s Soy Plus (soy isoflavones) Soy care + 600 Calcium (CaCO3, Vit D, soy isoflavones) Knox Nutra Joint gelatine dietary supplement (Vit C, Ca) – help maintain healthy bones, joints Knox Nutra Joint + glucosamine dietary supplement maximum strength formula (Vit C, D, E, K, Ca, Zn, Cu, Mn) Cholesterol - Cholestaid cholesterol blocker (esterin alfalfa saponin extract) – blocks new cholesterol in stomach before absorption HPF Cholestene dietary supplement (red yeast rice) – promote HMG CoA reductase inhibition Prostate - Soy care prostate (Se, E, soy isoflavones, saw palmetto) Prostatonin (pygeum africanum, urtica dioica) Natrol advanced prostate formula PC care (saw palmetto, other herbs) Propalmex (saw palmetto) Prostate formula (saw palmetto, etc…) Others - Nature’s Bounty evening primrose Nature’s Bounty nutritional support for your skin, hair, nails Natrol for women skin, hair, nails (silica, a.a.’s, vitamins, MSM) Calcet triple calcium plus Vit D (Ca, Vit D3) – for low Ca leg cramps Venastat leg health dietary supplement (horse chestnut seed extract) – help maintain leg circulation; protect against leg swelling Your life health legs (horse chestnut seed extract) Sundown Cellasene (lipovascolen, etc…) – eliminate cellulite Movana mood support dietary supplement Sunsource Harmonex (St. John’s wort with siberian ginseng) – emotional and physical harmony Sunsource Melatonex (melatonin with Vit B6) – promote natural sleep cycle Protegra cardio (Vit C, A, E, B6, B12, foklica cid, Mg, Zn, Se, Cu, Mn) – helps break down homocysteine Nature’s Bounty shark cartilage – source of chondroitin Super juice daily with multi phyto-nutrient formula (Vit A, C, phytoactives…) ENADAlert stabilized NADH dietary supplement – alertness and energy Head Start protein for your hair Your life Accu-mind and memory (ginkgo, vinpocetine) Your life women’s cycle multivitamin (multivitamin, soy) Your life pycnogenol pine bark extract – maintains collagen Your life Syndrox – help support already healthy BP, cholesterol, pancreas fxn, circulation, metabolism Dry Eyes (lubricant drops) – Refreshs: Refresh tears lubricant eye drops X Refresh plus lubricant eye drops X Refresh lubricant eye drops X X X Alcon tears naturale II X X Phenylephrine Tetrahydrozoline Naphazoline X X propylene glycol, glycerin Moisture eyes PM Dry Eyes (lubricant ointments): Alcon tears naturale II PM lubricant eye ointment Lacrilube ophthalmic ointment Refresh PM lubricant eye ointment Pheniramine Mineral oil benzalkonium, NaCl, KCl benzalkonium, NaCl, KCl, polyquaternium Dry Eyes (lubricant drops) – Moisture eyes: Moisture eyes Dry Eyes (lubricant drops) – Others: Thera tears lubricant eye drops X Celluvisc lubricant eye drops X Gen Teal lubricant eye -- drops and gel Visine tears Bion tears lubricant eye drops OcuCoat PF lubricating eye drops Murine tears COMMENTS X Dry Eyes (lubricant drops) – Alcons: Alcon tears naturale Dry Eyes (lubricant drops/ointments) – Hypotears: Hypotears – drops and ointment X Hypotears PF – drops and X ointment White petrolautm Dextran Povidone Polyethylene glycol Polyvinyl alcohol Hydroxypropyl methylcellulose Ophthalmic Products Available Over-the-Counter Na carboxymethylcellulose Ophthalmic Products X X X X X X X glycerin X X X X X X X X X X Eye redness (decongestants): Naphcon Original Visine Visine AC Visine LR – long-lasting OcuClear Combination for dry eyes and redness: Prefrin liquifilm All Clear All Clear AR Clear Eyes Clear Eyes ACR Visine Advanced Relief Relief Murine tears plus Vasoclear Phenylephrine Tetrahydrozoline COMMENTS X X X X X X X X X X X X X ZnSO4 Oxymetazoline Oxymetazoline X X X X glycerin glycerin, ZnSO4 X X X X X X Eye allergies (antihistamines): Naphcon-A Vasocon-A Visine-A Opcon-A Other eye products: Muro 128 5% NaCl hypertonicity ophthalmic solution Stye ophthalmic ointment Naphazoline Pheniramine Mineral oil White petrolautm Dextran Povidone Polyethylene glycol Polyvinyl alcohol Hydroxypropyl methylcellulose Ophthalmic Products Available Over-the-Counter Na carboxymethylcellulose Ophthalmic Products (cont’d)… X X X X X X X Antazoline 5% NaCl X X Cannot cure or prevent stye - refer to MD! OTC Ophthalmic Products consist of…. Artificial tears: demulecents to help treat dry eye - prevent and alleviate irritation and dry eye - consists of lubricants with or without preservatives • includes: carboxymethylcellulose, hydroxypropyl methylcellulose, methylcellulose, polyvinyl alcohol, polyethylene glycol, glycerin, polyethylene glycol, polysorbate 80, povidone, dextran 70 - preservatives: benzalkonium, chlorhexidine, methylparaben, thimerosal do not use >72 hours Ocular emollients: ophthalmic ointments used to relieve burning and irritation of dry eye - soften tissue by forming an occlusive film on the surface of the eye - includes: lanolin, mineral oil, parraffin, petrolatum, white petrolatum, white ointment, white wax, yellow wax - Patient information: may cause blurred vision, therefore optimal time of use in HS Decongestants: vasoconstrictors for redness associated w/ minor irritation and conjunctivitis - includes: oxymetazoline, naphazoline, tetrahydrozoline, phenylephrine - do not use for >72 hours – rebound congestion may occur (more so with phenylephrine) Antihistamines: to relieve ophthalmic redness and itching d/t allergic conjunctivitis - includes: pheniramine, antazoline - dosage: 1-2 drops in affected eye up to QID - SE’s: burning, stinging - CI: do NOT use in pts with glaucoma, CVD, HTN, difficulty urinating - Pediatric: do not use in <6 y/o Hypertonic NaCl: osmotic gradient that draws fluid from the cornea (for corneal edema) - NOT to be used unless advised by MD - SE’s: temporary burning and irritation of eye Other ophthalmic products available consist of isotonic solution and include…. Rewetting drops - Visine for contacts Clear Eyes CLR -- contact lens relief Clerz plus lens drops Refresh contacts Allergan lens plus Renu rewetting drops Opti-free rewetting drops Etc….. Eye washes - Flent’s eye wash Collyrium for fresh eyes Bausch and Lomb eye wash Cerumen softening agents OTC products all consist of carbamide peroxide and include…. - Auro ear drops Otix drops Debrox drops Murine ear drops Murine ear wax removal system B&L ear wax removal system Flent's ear drops General information - softens ear wax - pt may use for few days then go to MD to have it removed (if necessary) - dosage: place 5-10 drops in each ear QD for up to 4 days - do not use >4 days - do not recommend removal of hard wax - Pediatric: consult MD for children < 12 y/o Swimmer's ear OTC products include…. - Star-otic (Burow's solution) -- protective, drying Swim-ear (isopropyl alcohol, anhydrous glycerin) Auro-dri (isopropyl alcohol, anhydrous glycerin) General information - external otitis that follows prolonged exposure of the ear to water - OTC products indicated ONLY to dry water-clogged ears, NOT for other Sx’s that accompany swimmer’s ear such as acute pain, itching, inflammation, and drainage of a foulsmelling watery discharge Other ear product - sweet oil (olive oil emollient) General Information - used to kill insects in ear - apply small amt olive oil to kill it – then irrigate ear so it will come out - other uses: to soften and smooth tissues (elbows, knees, heels, hands) Home screening tests UTI screening test…. - UTI home screening test kit (urine) General Information - nitrate generally excreted as nitrate in the urine – in pts with gram-negative UTI, bacteria converts it to nitrite - contains arsanilic acid which reacts with urinary nitrite to form a pink color - should test first morning urine or urine retained in bladder for >4 hours HIV screening test…. - Home access HIV-1 test (blood) Home access express HIV-1 test (blood) General Information - pt must apply blood to specimen collection card and send to lab - card must be received within 10 days of specimen collection - test initially uses ELISA test – if positive, more specific immunofluorescence assay is used - can call for results after 3-7 days (3 for express kit) Cholesterol screening test…. - Choles Trak home cholesterol test (blood) General Information - uses progressive enzymatic action to measure total cholesterol - measures cholesterol from blood sample in a range from 125-400 mg/dL – will produce color change within 12-15 minutes Colorectal cancer screening test…. - EZ detect (BM’s in toilet) ColoCare General Information - tests for fecal occult blood - directions: place test pad in toilet following BM - positive test indicated by blue/green color on test pad - results appear in 30 seconds to 2 minutes - 3 consecutive BM’s should be tested Drug screening test…. - Personal drug testing service (PDT-90) (hair) General Information - urine tests only detect usage within last 2-3 days and do not provide index of degree of drug abuse over time - hair however traps within it substances that were in the blood at the time the hair was formed in its follicle - hair grows ~0.5 inches per month – will provide good index of degree of drug abuse - this test requires a sample of hair be sent to the manufacturer where they test for marijuana, cocaine, crack cocaine, opiates (heroin), methamphetamine, PCP - can call after 5 business days for results Blood-glucose monitors…. - One Touch Basic One Touch Fast Take One Touch Sure Step One Touch Ultra Accu Chek Simplicity Accu Chek Advantage Accu Chek Instant Accu Chek Easy Glucometer Dex Glucometer Elite Medisense ExacTech RSG Medisense Precision Xtra Medisense Precision QID Therasense Freestyle Amira At Last Pregnancy tests (urine – 2 lines = yes; 1 line = no/control)…. - Clear blue easy First response early result pregnancy test Answer one-step pregnancy test E.P.T. pregnancy test Early pregnancy test Fact plus select Fact plus pro pregnancy test General information - detects human chorionic gonadotropin (HCG) in urine via monoclonal antibody reaction - HCG appears in urine 1-2 weeks after implantation – can be detected during the subsequent 2-3 weeks - 99% accurate - recommended reading time for results: 1-3 minutes (depending on test) Fertility tests (urine – 2 lines = yes; 1 line = no/control)…. - Clear plan easy ovulation test First response 1-step ovulation predictor kit Answer one-step ovulation test General information - detects preovulation surge of luteinizing hormone (LH) in urine via monoclonal antibody reaction, which occurs 24-36 hours prior to ovulation - in response to the LH surge, an ovarian follicle will rupture releasing a mature ovum - “yes” answer indicates that ovulation will occur within 20-44 hours - kits contain sufficient materials to test urine for 5, 6, or 9 days - should use first test kit 2-3 days prior to expected ovulation date - clomiphene and other medications may induce false positive results – should not test till 1 or more days after d/c drug - recommended reading time for results: 3-5 minutes (depending on test) Fertility monitor…. - Clear plan easy fertility monitor Condoms OTC latex-containing products include…. - Trojan Trojan-enz Trojan plus 2 Durex Lifestyles OTC polyurethane-containing products include…. - Trojan supra Durex avanti OTC natural skin-containing products include…. - Kling-tite OTC female products include…. - Reality female condom Male genital desensitizers OTC products all consist of benzocaine and include…. - Maximum strength Mandelay Durex Maintain Detane Psoriasis Product Tegrin coal tar solution Oxipor psoriasis lotion Exorex psoriasis medication Psoriasin -- gel/liquid MG217 medicated tar ointment MG217 sal-acid ointment with Vitamin E Dermarest psoriasis medicated scalp treatment Dermarest psoriasis medicated shampoo plus conditioner Lomalux psoriasis medication Coal tar solution X X X X X Salicylic acid Comments X X X homeopathic General information - hyperproliferative skin condition of ~10-20 times the normal rate - most often occurs in individuals 16-22 y/o and 57-60 y/o - probably d/t exposure of skin to trauma , Strep infections, certain meds - improves in hot weather, increases its severity in cold weather (like dandruff) - manifests as scales that are silvery on top and pink to dull red underneath, most commonly on scalp, sacral area, and extensor surfaces of knees and elbows • can occur at any location on body • less common on face – opposite of seborrheic dermatitis - also affects fingernails – hyperproliferates producing a disordered nail plate chronic condition that does not yield to treatment treatments: coal tar, salicylic acid Non-pharmacologic treatments - soaking affected area in warm water • hydrates skin, especially when hypoallergenic emollient if used directly following bath Eczema OTC products iclude…. - Exorex eczema regular formula (emulsified coal tar) Lomalux eczema (homeopathic) General information - also known as dermatitis - appearance ranges from transient redness to severe swelling with bulla formation - types: contact, atopic, seborrheic, nummular, chronic, generalized exfoliative, stasis - treatment is generally by Rx and involves either an oral or topical corticosteroid - tar products may help reduce itchiness, redness, and inflammation of the scalp and skin Head lice treatment Product Pyrethrum RID maximum strength X Piperonyl butoxide X Pronto MS A-200 Clear total lice elimination system Nix lice treatment Clear lice egg remover Not nice to lice Acu-med lice cure X X X X X X Permethrin Comments shampoo/gel/mousse/spray shampoo/spray shampoo/spray shampoo X cream rinse/spray natural enzymes – gel natural enzymes – shampoo tea tree oil – gel OTC lice treatment products consist of…. Synergized pyrethrins: natural chemicals derived from plants used to treat head or pubic lice - to be effective, pyrethrins are synergized with piperonyl butoxide - since no treatment is completely ovicidal, another treatment in 7-10 days is mandatory to kill newly hatched nits - Pediatric: not recommended in <2 y/o Permethrin: synthetic chemical derived from pyrethrins used to treat head lice only - following application and removal, a residual is left on the hair which enhances its activity - Pediatric: not recommended in <2 months old Nonpharmacologic therapies - vacuum area (instead of using environmental spray) to get rid of live lice - after treatment, a lice/nit comb should be used to remove dead lice/nits as well as viable eggs - wash all clothes, towels, and bed linens on hot cycle, then dry in heated air cycle for at least 20 minutes - any clothing that cannot be washed should be sealed in a plastic bag for at least 2 weeks - combs and brushes should be cleaned in hot water of at least 130oF for 5-10 minutes Denorexs: Denorex medicated shampoo and conditioner Denorex medicated shampoo extra strength Denorex medicated shampoo and conditioner extra strength Neutrogenas: Neutrogena therapeutic T/Gel shampoo intensive antiflake treatment Neutrogena maximum strength T/salicylic acid Neutrogena healthy scalp anti-dandruff shampoo Ketoconazole Sulfur Salicylic acid COMMENTS X X X X X X Head and shoulders: Head and shoulders dandruff shampoo Head and shoulders dandruff shampoo plus conditioner Head and shoulders dandruff shampoo dry scalp Head and shoulders dandruff shampoo plus conditioner dry scalp Head and shoulders intensive treatment X X X X X Selsun blues: Selsun blue dandruff shampoo moisturizing treatment Selsun blue dandruff shampoo with menthol medicated treatment Others: Ionil.T plus conditioning shampoo Pentrax maximum strength anti-dandruff tar shampoo MG217 extra strength medicated tar shampoo Zincon medicated dandruff shampoo Scalpicin lotion dandruff Medicated Sebulex dandruff shampoo Nizoral A-D – shampoo/conditioner Selenium sulfide Zinc pyrithione Dandruff Products Available Over-the-Counter Coal tar Dandruff X X Aloe X X X X X X X X OTC dandruff products consist of…. Coal tar: reduces the number and size of epidermal cells produced by the body - effective against hyperproliferative conditions such as dandruff, seborrheic dermatitis, and psoriasis - Patient information: coal tar has an unpleasant odor and may stain skin and hair; may also cause photosensitivity Zinc pyrithione: treats dandruff d/t its antifungal effect and/or by reducing cell turnover Selenium sulfide: exerts cytostatic effect (reduces rate of cell turnover) - may also inhibit the growth of Pityrosporum ovale Salicylic acid: lowers pH of tissues thus effective in hyperproliferative conditions - can be combined with sulfur Sulfur: possible fungicidal effect - can be combined with salicylic acid Ketoconazole: antifungal which controls the flaking, itching, and scaling of dandruff - approved for Rx to OTC switch - do not use longer than 2-4 weeks - Pediatric: not recommended in <12 y/o General information - d/t skin cell turnover rate of approximately double the normal rate - not common until onset of puberty - major manifestations: scaling, occasional pruritus - more severe from October till December; milder in summer - shampoo should be used at least twice weekly; creams/ointments/lotions are applied Q-QID or UTD and left on skin - Patient information: to maximize epidermal absorption of shampoos, pts should wait several minutes before rinsing their hair Hair growth OTC products all consist of minoxidil and include…. - Rogaine extra strength for men (5%) Rogaine regular strength for men (2%) Rogaine for men (2%) Rogaine for women (2%) General Information - approved for androgenetic alopecia – not approved for frontal or patchy hair loss - causes an increase in cutaneous blood flow to the scalp which may be responsible for MOA - regrowth may not be apparent for ~4 months since hair grows at a rate of 0.5 inches/month - best growth seen after using product BID for 12 months - must continue using product forever to retain hair that has grown d/t minoxidil – otherwise will fall out in ~3-4 months - Pregnancy/Lactation: not recommended - Pediatric: not recommended in <18y/o - Patient information: absorbed over 4 hour period, therefore best not to wet the scalp in anyway for 4 hours after application Daily cleansers: Neutrogena oil-absorbing acne mask Clean & Clear continuous control daily cleanser Oxy balance oil-free maximum strength acne wash Fostex acne medication bar Panoxyl bar Clearasil stay clear Clearasil stay clear deep clean pads Neutrogena maximum strength oil-controlling pads Neutrogena clear pore treatment Neutrogena multi-vitamin acne treatment Neutrogena skin clearing moisturizer Neutrogena oil-free acne wash Neutrogena body clear body wash/scrub/lotion Aveeno acne treatment bar Clean & Clear oil-free deep action cream cleanser Clean & Clear oil-free dual action moisturizer Clean & Clear oil-free continuous control acne wash Clean & Clear clear skin body wash Oxy on-the-go cleansing pads Oxy balance daily cleansing pads Stridex face wipes to go Stridex triple action acne pads PHisoderm 4-way daily acne cleanser Noxzema extra strength 2 in 1 pads Biore blemish fighting cleanser Biore blemish double agent Biore blemish bomb Ponds overnight blemish reducers Clearasil daily face wash Clearasil antibacterial soap Clean & Clear oil-free foaming facial cleanser Stridex anti-bacterial foaming wash Salicylic acid Triclosan Spot treatments: Clearasil treatment cream – vanishing/tinted Neutrogena on-the-spot acne treatment Clean & Clear maximum strength persa gel 10 Oxy balance maximum acne treatment – vanishing/tinted Clearasil adult care tinted cream Acnomel adult acne medication Clearasil stay clear zone control clearstick Neutrogena on-the-spot acne patch Clean & Clear maximum strength invisible blemish treatment Clean & Clear maximum strength overnight acne patches PHisoderm blemish patch Sulfur/ resorcinol OTC Acne Products Available Over-the-Counter Benzoyl peroxide Acne Treatment X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X COMMENTS OTC Acne Products consist of…. Benzoyl peroxide: releases oxygen to destroy anaerobic P. acnes - also acts as exfoliant, peeling the outermost layer of the skin - most frequently used acne medication - SE’s: redness, burning, swelling, itching, peeling Sulfur/resorcinol combination: lessen severity of acne by its keratolytic and antibacterial action - resorcinol enhances the activity of sulfur - sulfur can cause ophthalmic and dermatologic irritation so must avoid contact with eye Salicylic acid: presumably works as a keratolytic Triclosan: unapproved ingredient in acne treatment General Information - cannot be cured with OTC products; however, judicious use can reduce the severity and extent of the condition - acne exacerbators: stress, menses, mechanical trauma, tight athletic equipment, humidity, air pollution, harsh scrubbing, oil-based products – diet has little effect X X X X Potassium X X Caffeine Pyrilamine X X Pamabrom Menstrual discomfort: Multi Sx Pamprin maximum strength Pamprin maximum cramp relief Midol Cramp maximum strength Midol PMS maximum strength Midol Teen maximum strength Midol menstrual maximum strength Presym PMS maximum strength Women's Tylenol multi Sx menstrual relief Diurex PMS Diurex long-acting water capsules Diurex aqua gels Diurex 2 with calcium Diurex water pills Aqua Ban maximum strength Chromaslim water pill Ibuprofen Women’s Health Products Available Overthe-Counter APAP Women’s Health Products COMMENTS Mg salicylate X X X X X X X X X X X X X X X X X X X Mg salicylate tetrahydrate Salicylamide X Vit B6, herbal complex X X X X X Cranberry Na salicylate Urinary tract pain/Sx’s: Uristat Prodium AZO standard urinary pain relief AZO cranberry Cystex Methenamine Women’s Health Products Available Overthe-Counter Phenazopyridine Menstrual discomfort products: helps relieve mild to moderate Sx’s - APAP/NSAIDs help relieve pain from cramps, HA, backache - Diuretics help with bloating and water retention - Caffeine helps to relieve fatigue d/t PMS; also helpful as diuretic - Antihistamine (pyrilamine) helps with emotional/mood changes COMMENTS X X X X Urinary tract analgesics - includes: phenazopyridine, methenamine, benzoic acid (natural powder concentrate) X X X X X X Benzalkonium Resorcinol Feminine itching: Vaginex Gynecort Vagisil Vagisil maximum strength Vagigard advanced sensitive formula Vagigard maximum strength Benzocaine Women’s Health Products Available Overthe-Counter Hydrocortisone Women’s Health Products (cont’d)…. COMMENTS X X X X Yeast infection: Mycelex 3 Femstat 3 Gyne-lotrimin 3 Mycelex 7 Monistat 3 Monistat 7 Monistat 1 Vagistat 1 Yeast Gard homeopathic vaginal suppositories Tioconazole Miconazole Clotrimazole Women’s Health Products Available Overthe-Counter Butoconozaole Feminine itching products - include: hydrocortisone, benzocaine, resorcinol, tripelennamine, diphenhydramine, benzethonium chloride - vaginal irritation/pruritus should not be self-treated for >1 week COMMENTS X X X X X X X X Homeopathic Vaginal antifungals - may damage condoms and diaphragms - be aware that Candida organisms may persist in vagina as long as 5 days after onset of tx, therefore 1 or 3 day therapy may not be long enough Women’s Health Products (cont’d)…. Other Women’s Health concerns…. Sore nipples - Lansinoh for breast feeding mothers (lansinoh à lanolin)
