Download 2001 OTC Volume 1 of 2

THE 2001 OTC MEDICATION
HANDBOOK
(Book 1 of 2)
Tracy Shinjo, Pharm.D. Candidate
Adam Kaye, Pharm.D., FASCP
I would like to thank the University of the Pacific faculty,
the San Joaquin Pharmacists Association, and all my
close friends, especially Adam Kaye Pharm. D., for their
supportand encouragement.
This reference is intended to serve as an up-to-date
reference for commonly available OTC products. It is
filled with basic indications, directions for use, and
precautions. The information contained in this publication
is provided to medical professionals only – it is not
intended to be used by lay readers.
Every effort has been made to assure accuracy. Much of
the information has been obtained from the manufacturers
product label.
It is my hope that future students can update this reference
as OTC products are constantly being reformulated,
removed form pharmacy shelves, and new OTC products
are being introduced almost daily.
- Tracy Shinjo, 2001
II
Over the Counter Products
Table of Contents
The Common Cold and Respiratory Conditions
Cold and Allergy
- cold Sx’s
- cold vs….
- antipyretics/analgesics
- antihistamines
- systemic decongestants
- cough suppressant
- expectorant
- other products
- child products
1-9
4
5
6
6
6
6
6
7
8-9
Cough syrups
Topical Decongestants/Antitussives
Asthma
Sore throat
10-11
12-13
14
15-16
Pain/Fever Conditions
Systemic Antipyretics/Analgesics
- child products
17-20
20
Oral Conditions
Oral sore products
- cold vs. canker sores
21-22
22
Lip products
Oral antiseptic products
23
24
III
GI Conditions
Acid Products
Anti-emetics / Prevention of motion sickness
Anti-nausea
Emetics
Laxatives
Anti-diarrheals
Flatulence
Infant Colic
Gas Prevention
Lactose Intolerance
Healthy Digestion Promotion
Hemorrhoids
Pinworms
25-27
28
28
28
29-32
33
34
34
34
35
35
36-37
38
Dermatologic Conditions
First Aid Products
Topical anti-itch
Topical pain relief
Scar management
Drawing ointment
Acne treatment
Antifungals
Warts
Corns/Calluses
Other foot products
Psoriasis
Eczema
Dandruff
Hair growth
Head Lice treatment
39-40
41-42
43-45
46
46
47-48
49
50
50
50
51
51
52-53
54
55
CNS Conditions
Sleep Aids
Stimulants
56
56
Ophthalmic/Otic Conditions
Ophthalmic products
Otic products
Baby Products
57-60
61
Diaper Rash
62
IV
Electrolyte Replacement
Teething Pain
Formulas
62
63
63
Womens Health Products
Menstrual discomfort
UTI pain/Sx’s
Feminine itching
Yeast infection
Sore nipples
64
64
65
65
66
Home Screening Tests
UTI
HIV
Cholesterol
Colorectal Cancer
Illicit drugs
Blood-glucose monitors
Pregnancy
Fertility
Fertility monitor
67
67
67
68
68
68
69
69
69
Contraception/Sexual activity conditions
Condoms
Male genital desensitizers
70
70
Vitamins/Supplements
Vitamins
- multivitamins
- multivitamins plus
- eye vitamins
- prenatal vitamins
- B-complex combinations
- antioxidants
- vitamin packs
Vitamins/Supplements (cont’d)….
71-74
71
71
72
72
72
72
72
Supplements
- calcium
- iron
- magnesium
75-78
75-76
77
78
V
-
niacin
folic acid
78
78
Multivitamins for children, infants, and toddlers
Supplements for children, infants, and toddlers
79
79
Natural product combinations
- PMS
- Other soy-containing products
- Bone
- Cholesterol
- Prostate
- Others
80-81
Dietary Supplements
82-83
VI
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
1
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
2
X
Same as above
Dextromethorphan
Guaifenesin
X
X
X
X
X
X
X
X
X
X
X
X
Diphenhydramine
APAP
Doxylamine
X
Brompheniramine
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
3
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
4
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
5
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
6
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!
7
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
8
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
9
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
buffered with CaCO3
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,
MgO2, MgCO3
buffered with CaCO3,
MgO2, MgCO3
buffered with Maalox,
CaCO3
buffered with Maalox,
CaCO3
buffered with Maalox,
CaCO3
10
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
11
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
12
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
13
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
14
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
15
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
16
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
17
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
18
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
19
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
20
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
X
X
X
X
X
X
X
X
Benzalkonium
Benzoin tincture
compound
Benzyl alcohol
Zilactin
21
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
22
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
23
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
24
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
25
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
(2-12 y/o)
alcohol-free
(2-15 y/o)
Sodium phosphate
(>2 y/o)
X
26
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
27
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
28
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
29
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
30
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)
31
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
32
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
33
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)
34
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
Mg trisilicate; alginic acid
X
X
35
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
36
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)
37
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
38
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
39
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
40
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
41
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
X
Acutrim natural PM
Heart bar
X
X
* all products listed above have additional ingredients not shown
42
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
43