OTCs Exam 2

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Ocular Emollients
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Terms in this set (47)
Ocular Emollients
Occlusive film on eye surface
Ingredients: white pet, mineral oil, lanolin
ADRs: blurred vision, sensitivity to preservatives
Artificial Tears
First line treatment of dry eyes, minor eye irritation, viral conjunctivitis
Prevent tear evaporation, increase eye fluid volume, coat surface of membranes/protect cells

Polyvinyl alcohol solutions: (PVA)
-Glycerin
-Propylene glycol
-Polyethylene glycol
-Polysorbate 80
Cellulose Ethers:
-"end in cellulose"
Others:
-Povidone
-Dextran 70
-Gelatin

ADRs:
-PVAs may cause thickening of solution
-PVAs have lower viscosity than cellulose ethers
-Rippled surface of cornea
-Cellulose ethers cause dry crusts on eye lids

Dosing:
-Initial: BID
-Maintenance: TID to every hour
Povidone
Artificial tears
Forms hydrophilic layer on cornea (like mucin)
Dextran 70
Artificial tears
ADRs: temporary stinging and blurred vision
Phenylephrine 0.12%
Ocular Decongestant
Alpha receptar agonist
1-2 drops every 6 hours (QID)
Treats Viral Conjunctivitis

ADRs:
allergic conjunctivitis/blepharitis
pupil dilation
epithelial xerosis (night blindness)

CI:
HTN, CHD, DM, narrow-angle glaucoma, <6yo
Atropine, TCAs, Methyldopa
72 hour warning*
Naphazoline 0.12%, 0.01%, 0.03%
Ocular Decongestant
Alpha receptar agonist
1-2 drops every 6 hours (QID)
Treats Viral Conjunctivitis

ADRs:
allergic conjunctivitis/blepharitis
pupil dilation
epithelial xerosis (night blindness)

CI:
HTN, CHD, DM, narrow-angle glaucoma, <6yo
Atropine, TCAs, Methyldopa
72 hour warning*
Oxymetazoline 0.025%
Ocular Decongestant
Alpha receptar agonist
1-2 drops every 6 hours (QID)
Treats Viral Conjunctivitis

ADRs:
allergic conjunctivitis/blepharitis
pupil dilation
epithelial xerosis (night blindness)

CI:
HTN, CHD, DM, narrow-angle glaucoma, <6yo
Atropine, TCAs, Methyldopa
72 hour warning*
Tetrahydrozoline 0.05%
Ocular Decongestant
Alpha receptar agonist
1-2 drops every 4 hours
Treats Viral Conjunctivitis

ADRs:
allergic conjunctivitis/blepharitis
pupil dilation
epithelial xerosis (night blindness)
*temporary stinging

CI:
HTN, CHD, DM, narrow-angle glaucoma, <6yo
Atropine, TCAs, Methyldopa
72 hour warning*
Pheniramine 0.3%
Ocular Antihistamine
H1-receptor antagonist
1-2 drops, 3-4 times/day

ADRs:
Burning/stinging

CI:
Pupil dilation, narrow-angle glaucoma
Antazoline 0.5%
Ocular Antihistamine
H1-receptor antagonist
1-2 drops, 3-4 times/day

ADRs:
Burning/stinging

CI:
Increased intraocular pressure
Pupil dilation, narrow-angle glaucoma
Ketotifen 0.035%Ocular Antihistamine H1-receptor antagonist 1-2 drops, 3-4 times/day ADRs: Conjunctival injection Burning/stinging CI: Not for contact associated irritation* Pupil dilation, narrow-angle glaucomaOcular AstringentsZinc sulfate 0.25% -treats minor eye irritation Benzalkonium chloride 0.01%, 0.05%Hypertonic sodium chlorideIncreases tonicity of tears First line treatment of corneal edema -2% solution 1-2 drops every 3-4 hours Second line treatment of corneal edema -2% solution 1-2 drops every 3-4 hours -5% ointment at bedtime Third line treatment of corneal edema -5% solution 1-2 drops every 3-4 hours -5% ointment at bedtime ADRs: Burning/stinging (more common with 5%) Use only when instructed by PCP -Don't use in traumatized corneas Can be used to flush foreign substances from eyeBlepharitis therapyTreatments: Hot compress 15-20 minutes 2-4 times/day Lid Scrubs: -baby shampoo, eye-scrub solution, lid wipes-spf pads, ocusoft solution and padsHordeolum (Stye)Refer to PCP if >1 week or chronic Prevention: Lid scrubs Treatment: Hot compress 3-4 times/day for 5-10min with gentle pressure -Internal: oral antibiotics if 1 week of compresses didnt work -External: topical antibiotic if 1 week of compress didnt work Surgery (extreme cases) Chalazion: similar to styes but not tender, treat/prevent same as styesExclusions for self-treatmentEye pain Blurred vision Light sensitivity Use contacts Blunt trauma to eye Chemical exposure Heat exposure (includes sun damage) 72 hour warningCranberry extractRich in Proanthocyanidins -decrease adhesion of filamented bacteria Prophylaxis for GI Infections Dose: 300-400mg BID (capsules) 1-32oz fruit cocktail NOT effective for TREATMENT of UTILactobacillusProbiotic therapy (usually non-pathogenic) MOA: -pathogen displacement -alteration of pH -impaired bioadhesion No benefit orally, some vaginally NOT effective for TREATMENT of UTIMigrainesTreatment: HT1 Serotonin receptor antagonists "triptans" Prevention: Avoid triggers Prophylaxis with beta blockers, TCAs, VPA, NSAIDs, or verapamil if => 2 attacks/month Supplements: Magnesium (po or IV) 600mg/day Riboflavin 400mg/day Feverfew 40-100mg dried leaf daily -inhibits prostaglandin synthesis, histamine release, platelet aggregation & serotonin secretion -smooth muscle spasmolytic Butterbur 50-100mg BID CoEnzyme Q10 150mg/day GinkgoGlucosamineOsteoarthritis - 1500mg po qday -May be combo with chondroitin (slower onset than diclofenac but lasts longer)Soy ProteinDecreases LDL with little/no effect on HDL/TG Foods must contain (per serving) 6.25g soy protein, less than 3g fat, less than 1g saturated fat, less than 20mg cholesterol, less than 480mg sodium to make claims. Presumed SERM (selective estrogen receptor modulator) actionGinsengPrevention of breast cancer Improves QOL (possibly)Saw PalmettoTreats BPH 160mg BID *equally effective as Proscar (finasteride) MOA: -Inhibits 5-alpha-reductase -Inhibits epithelial growth factor (EGF) -Alpha-1-receptor antagonist -Inhibits phospholipase A2 (anti-inflammatory) -Anti-oxidant Others for BPH: Nettle root Pygeum africanum (bark extract) Pumpkin seed Star grass Fermented rye Lycopene 15mg/dayAnti-depressantsPharmacologic agents: -TCAs -SSRIs St Johns Wort (SJW) 300mg po TID x 2months F/U in 2 months (or anytime symptoms worsen) CI: TCAs, SSRIs, SSNRIs use S-Adenosylmethionine (SAMe) 400mg/day up to 1600mg/day (expensive) Well tolerated (GI upset common) Adjunct to SSRIsSupplement Drug InteractionsSJW: CYP 3A4, 2E1, 2C19 inducer Warfarin Decreased effects when: -Increase Vitamin K intake -Increase enzyme activity (eg. SJW) Increased effects when: -Decrease Vitamin K intake -Decrease enzyme activity (eg. remove SJW) -Coumarin containing supplements (Dong Quai, Papaya, Red Clover) -Decreased platelet function from supplements (Ginkgo, feverfew, grape extracts, ginger (?))Cancer and SupplementsAnti-oxidants may decrease the benefit of treatment Some studies show a BENEFIT of antioxidants (high dose Vitamin C, E, K3) Breast Cancer Mega-Dose Vitamins: (3-6 of) Beta-Carotene, Vitamin C, Niacin, Selenium, Coenzyme Q10, ZincGERDLifestyle Modifications: Don't eat before bed Don't overeat Avoid foods that trigger "heartburn" Elevate the head of the bed Lose weight Moderate alcohol intake Avoid smokingAntacidsRapidly emptied (20-40min) on empty stomach Long lasting (3hrs) if taken 1 hour post meal May take 4-5 times/day NO overnight relief* Limit duration to 2 weeks ADRs: Magnesium -CrCl < 30ml/min not recommended -diarrhea Aluminum -constipation -avoid in renal failure -phosphate deficiency CaCO3 -constipation -hypercalcemia (esp. in CKD) -not to exceed 2.5g -acid rebound* NaHCO3 -alter pH -Na overload -SHORT-TERM relief only* -CI: HTN, CHF, CKD, Cirrhosis Drug Interxns Pregnancy Category B (generally safe and widely used) -AVOID NaHCO3* in pregnancy (Ca/Mg best choices) -Al/Mg safe in breastfeedingH2-receptor antagonistsFamotidine (Pepcid) 10-40mg/day Cimetidine (Tagamet) 200-400mg/day Ranitidine (Zantac) 75-150mg/day Nizatidine (Axid) 75-150mg/day (no generic) -All equally effective (Cimetidine shorter duration) Relief in 1-2 hours AFTER administration -take when symptoms occur or 1 hour before meal Much lower doses than for ulcer healing Limited to 14 days of use, then see PCP ADRs: Mild - HA, drowsy, NVD, constipation Serious - confusion/dizziness Cimetidine - impotence/gynecomastia (uncommon) CYP interaction Cimetidine - 3A4, 1A2, 2C9, 2D6 Ranitidine - not usually with OTC dose Nizatidine/Famotidine - NONE Pregnancy Category B Not for children <12 yoOmeprazole (Prilosec OTC)20mg tabs Take before eating generic available Not for immediate relief -takes 2-3hrs, max relief in 1-3 days Metabolized by CYP450 Treatment for heartburn occuring => 2days/week Limit therapy to 14 days May repeat in 4 MONTHS if needed -If recurs within 4 months contact PCP ADRs: Mild - HA, diarrhea, constipation, NV, cough, backpain Possible increased fracture risk -Carcinoid tumors in rats (not yet in humans) Pregnancy Category C Secreted in breastmilk Not recommended in children <18 yoLansoprazole (Prevacid 24hr)15mg tabs Take before breakfast Not for immediate relief -takes 2-3hrs, max relief in 1-3 days Metabolized by CYP450 Treatment for heartburn occuring => 2days/week Limit therapy to 14 days May repeat in 4 MONTHS if needed -If recurs within 4 months contact PCP ADRs: Mild - HA, diarrhea, constipation, NV, cough, backpain Possible increased fracture risk -Carcinoid tumors in rats (not yet in humans) Pregnancy Category C Secreted in breastmilk Not recommended in children <18 yoOmeprazole and sodium bicarb (Zegerid OTC)Omeprazole 20mg/Sodium Bicarb 1100mg capsules Take on empty stomach* => 1 hour before a meal Not for immediate relief -takes 2-3hrs, max relief in 1-3 days Metabolized by CYP450 Treatment for heartburn occuring => 2days/week Limit therapy to 14 days May repeat in 4 MONTHS if needed -If recurs within 4 months contact PCP ADRs: Mild - HA, diarrhea, constipation, NV, cough, backpain Possible increased fracture risk -Carcinoid tumors in rats (not yet in humans) Pregnancy Category C Secreted in breastmilk Not recommended in children <18 yoSimethicone (Gas-x, Mylanta, etc)Act as defoaming agents, breaks up gas bubbles Does Not prevent gas formation No strong evidence it works, but FDA considers safe/effective Minimal pregnancy risk No evidence it works in children, but is safe ADRs: NV (uncommon) D-Ds: Levothyroxine (separate by 4 hours)LactaseEnzyme breaks down lactose May help with lactose intolerance (results vary) Taken same time as dairy products (3000-9000units before a meal with dairy products; max 9000units)Alpha-Galactosidase (Beano; Gaz Away)Prevents gas before it starts Breaks down carbs before bacteria metabolize them 2-3 tablets with first bite/just before eating complex carbs (beans, onions brocc, grains)LoperamideTreatment for IBS/Diarrhea (acute/traveler's) Reduces stool frequency, improves stool consistency u Opiod receptor agonist -reduces GI motility/secretions Not recommended for pregnancy self treatment Dosing: Adult 4mg initially, then 2mg after each loose stool (max 8mg/day) Children (>6yo) 2mg initially, then 1mg after each loose stool (max 4mg/day) (20-30kg child) 2mg initially, then 1mg after each loose stool (max 6mg/day) (30+ kg child) Probiotics Lactobacillus - not effective Bifidobacteria/combo products - some efficacyOral Replacement Therapy (ORT)Pedialyte, Rehydralyte, others For mild/moderate dehydration due to diarrhea Not for children <6 months old See PCP if diarrhea >48 hoursBismuth Subsalicylate (Pepto)Acute diarrhea, traveler's diarrhea 2 tabs or 30ml (525mg) - max 8 doses/day Not for children <12 yo Not for use if sick with flu/chicken pox (Reye's syndrome) Drug Interactions*Laxatives (Bulk Forming)Metamucil, FiberCon, Citrucel, Benefiber Short-term relief of constipation Take with plenty of water CI: Avoid if taking opiates* Severe renal dysfunction Ulcers, stenosis, or disabling adhesions Safe in pregnancy but use lifestyle mods first Wise to take 1-2 hrs apart from other meds (interxns)DocusateEmollient laxative Best for PREVENTION, not very effective treatment Softens stool in 1-3 days ADRs: Diarrhea, ab cramps No significant drug interxns Safe in pregnancy but bulk agents are first lineMineral OilLubricant Used when required maintenance of soft stools to avoid straining (HTN, post-hernia, surgery, etc) ADRs: Lipid pneumonia -Dont give at night, to the very old/very young, or those with difficulties swallowing Reduces absorption of Vitamins ADEK (can affect warf) NOT safe in pregnancySaline (Osmotics)Magnesium Citrate, Magnesium Hydroxide, Magnesium Sulfate For bowel prep for surgery/diagnostics -Also OCCASIONAL diarrhea in adults who need rapid effect Starts working in 30min-3hours Not recommended in pregnancy or childrenSenna and BisacodylStimulants Works in 6-10hours For chronic constipation caused by opiates or occasional use only! -Not for use >1 week without PCP consult ADRs: Cramping, severe fluid imbalances Senna 15-17mg daily dose (max 34-50mg BID) Take at bedtime Bisacodyl 10-15mg daily dose Take at bedtime Also used pre-op for GI surgeryHyperosmoticsMiraLax (Polyethylene Glycol) Used for occasional constipation and when necessary for rapid effect Approved for adults 17+ yo One week, then PCP consult Produces poop in 1-3 days Not recommended in pregnancyDentrificesPrevention of Caries (soft spots on teeth) Disrupt plague/bacteria to aid in mechanical removal Powders/gels/pastes Abrasive ingredients: Low - 10-25% silica abrasives Mild - baking soda High - 40-50% dicalcium phosphate, calcium pyrophosphate, calcium carbonate, aliumina trihydrate Other ingredients: Whitening - baking soda, peroxide, fluoride Chemo agents - fluoride, potassium nitrate, triclosan, stanous flouride, metal salts, essential oils, hydrogen peroxide, sodium bicarbAntiplaque ProductsMouth rinses: Ingredients: Surfactants, humectants, flavor, color, water, therapeutics Therapeutic rinses: Ingredients: Aromatic oils - antibacterial, local anesthetic Antimicrobials - bactericidal activity Phenol - local anesthetic, antiseptic, bactericidal activity Cosmetic: Freshen breath, remove debris Ingredients: Alcohol, flavor, surfactants, astringents, demulcents, antimicrobials, fluoride 1-2 tablespoons swished for 30 seconds, then spit After brushing 1-2 times/daily Avoid eating for 30min after use ADRs: Occasional burning, irritation CI: Children (supervise) Alcohol content issuesPlague Control GumIncreased saliva flow Mechanical removal of debris Chew 2 pieces after eating