Over the Counter Medications for common ailments and possible overdosesRhynn Malloy, Cynthia Herrera, Katrina KarpowitchPGY-1 Pharmacy ResidentsNorthwestern Memorial Hospital

The speaker has no potential or actual conflicts of interest with this presentation

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What can be treated?

• Pain

• The common Flu/Cold

• Heartburn/Upset stomach

Pain

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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Ibuprofen (Advil, Motrin)•Naproxen (Naprosyn, Aleve)•Aspirin

•Uses:- Fevers- Rheumatoid arthritis/Gout/Osteoarthritis

pain/inflammation - Musculoskeletal pain/Bone pain - Dysmenorrhea pain- Migraines

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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

•Contraindications:- Peptic Ulcer Disease- Renal/Kidney Disease- Hypertension/Heart Failure- Coronary Artery Disease (CAD)- Cardiovascular Disease (CVD)

•Alternative if you have Peptic Ulcer Disease or increased bleeding risk: Celebrex

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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

•Doses:- Ibuprofen: 200mg every 4-6 hours as needed•Max dose: 1,200mg in 24 hours• Treatment >10 days not recommended

- Aspirin: 325mg every 4-6 hours as needed•Max dose: 4,000mg in 24 hours

- Naproxen (sodium): 220 mg every 8-12 hours•Max dose: 660mg in 24 hours

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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Side Effects:- Dyspepsia (indigestion)- Ulcers- Nausea- Gastrointestinal bleeding- Rash/Itching- Kidney damage

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Acetaminophen (Tylenol)

•Uses: - Fevers- Injury/Trauma pain- Cramping, aches

•Contraindications: liver disease

•Doses: 325mg every 4-6 hours - Max dose: 4,000mg in 24 hours- Overdose = #1 cause of acute liver failure in the US

Insomnia

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Melatonin

•Uses: - Insomnia- Limited evidence that it is effective

•Dose: 0.3mg to 5mg at bedtime

• Side effects: largely unknown

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Valerian Root

•Uses: - Insomnia- Limited evidence that it is effective- May take weeks of nightly use to be effective

•Dose: 400 -900mg at night

• Side effects: if withdrawn abruptly, may cause heart complications and withdrawal sympmtoms

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Antihistamines

•Diphenhydramine

•Uses- Insomnia- Allergic reactions (skin rashes, hives)- Congestion

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Antihistamines

•Contraindications:- Urinary retention- Prostate enlargement- Angle closure glaucoma- Cardiovascular disease- Patients of advanced age- may interact with

medications and will increase fall risk

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Antihistamines

•Doses:- Diphenhydramine: 25-50mg before bed•Max use: do not exceed 14 days of nightly use

•May develop tolerance in 2-3 nights

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Antihistamines

• Side effects:- Sedation – extending into morning after- Dry mucous membranes- Elevated body temperature- Constipation- Blurred vision- Urinary retention

Cold/Flu Management

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Antihistamines

•Diphenhydramine•Doxylamine

•Uses: - Sinus and nasal congestion, allergy relief - Insomnia

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Decongestants

•Contraindications:- Hypertension/Heart Failure- Coronary Artery Disease (CAD)- Cardiovascular Disease (CVD)- Asthma - Chronic Obstructive Pulmonary Disease (COPD)

•Alternative agents to use in hypertension:- Antihistamines: desloratadine (Clarinex),

fexofenadine (Allegra), cetirizine (Zyrtec)

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Decongestants

•Doses:- Phenylephrine HCl: 10mg every 4 hours as needed•Max dose: 60mg in 24 hours

- Pseudoephedrine: 60mg every 4-6 hours as needed•Max dose: 240mg in 24 hours

•Nasal sprays:- Ephedrine 0.5%: 2-3 drops not more often than

every 4 hours

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Decongestants

• Side effects:- Elevated blood pressure- Palpitations, arrhythmias, fast heart beat- Restlessness, insomnia- Anxiety- “Rebound congestion”•Occurs within 3-5 days of continuous use

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Antitussives and Protussives (Expectorants)

•Dextromethorphan (antitussive)•Guaifenasin (expectorant)

•Uses: - Cough related to post-nasal drip- Chest congestion

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•Contraindications:- Hypertension/Heart Failure- Coronary Artery Disease (CAD)- Cardiovascular Disease (CVD)- Asthma, chronic bronchitis - Chronic Obstructive Pulmonary Disease (COPD)

Antitussives and Protussives (Expectorants)

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Antitussives and Protussives (Expectorants)

•Doses:- Dextromethorphan: 10-20mg every 4 hours or

30mg every 6-8 hours•Max dose: 120mg in 24 hours

- Guaifenasin (expectorant): 200-400mg every 4 hours•Max dose: 2,400mg (2.4g) in 24 hours

•CAUTION: beware of combination products!

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Antitussives and Protussives (Expectorants)

• Side effects:- Drowsiness OR excitation, nervousness- Dizziness- Headache- Stomach discomfort, nausea, constipation- Respiratory depression in high doses

Heartburn

Heartburn-antacids• Symptomatic treatment of heartburn and indigestion- Tums©, Milk of Magnesia©, Maalox©, Mylanta©,

Rolaids©

Heartburn-antacids

• Things to watch out for:- Drug interactions- Constipation or diarrhea- Nausea and/or vomiting- Muscle twitching- Confusion- Irregular heartbeat

Heartburn-H2RAs• Symptomatic Prevention or Treatment of acid

reflux/peptic ulcer disease:- Pepcid© (famotidine), Zantac© (ranitidine), Tagamet©

(cimetidine), Axid© (nizatidine)

Heartburn-H2RAs

• Things to look out for:- Drug interactions [Cimetidine]- Diarrhea- Abnormal heartbeat- Flushing and/or sweating- Nausea and/or vomiting- Slurred speech• Dosing:- Famotidine: 10-20mg once to twice daily- Ranitidine: 75-150mg once to twice daily- Cimetidine: 200-400mg once to twice daily- Nizatidine: 75mg once to twice daily

**CAUTION in patients with kidney dysfunction**

Heartburn-PPIs

• Treatment for chronic acid reflux, GERD, and PUD- Prilosec© (omeprazole), Prevacid© (lansoprazole)

Heartburn-PPIs

• Things to look out for:- Nausea and/or vomiting- Bone pain- Sedation- Muscle twitching- Abnormal heart beats- Diarrhea• Dosing:- Omeprazole: 20mg once daily- Lansoprazole: 15mg once daily

**CAUTION in patients with osteoporosis**

Nausea

Nausea

• Pepto-Bismol© (bismuth subsalicylate)- Symptomatic relief of upset stomach, nausea,

indigestion, diarrhea• Dramamine© (meclizine)- Symptomatic and preventive treatment of motion

sickness

Nausea

• Things to watch out for with Pepto-Bismol©- Breathing problems- Stomach bleed- Hearing loss- Aspirin allergy• Dosing- 30 mL every 30-60 minutes for maximum of 8

doses/day

**DO NOT USE WITH STOMACH ULCERS**

Nausea

• Things to watch out for with meclizine:- Urinary retention- Closed angle glaucoma- Dry mouth- Drowsiness- Flushing• Dosing:- 25-50mg one hour prior to traveling. Maximum dose of

50mg in 24 hours.

QUESTIONS?