Over the Counter,Prescription, &Herbal Drugs

Ch. 15

S/S

Confusing…Overwhelming

Health Literacy

• Obtain & understand basic health info and services to make appropriate health decisions.

• 12% of adults have proficient health literacy skills• Source: US Dept. of Health & Human Services, Office of Disease Prevention and Health Promotion. Quick Guide to Health Literacy.

Retrieved from https://health.gov/communication/literacy/quickguide/default.htm

Medication Mode of Delivery

Taking Medications

Pain Response

COX1

Trauma,Injury

Cell Damage

Redness, Swelling, Pain, Heat, Clotting

Prostaglandins

COX2

Pain Response

COX1

Trauma,Injury

Cell Damage

Redness, Swelling, Pain, Heat, Clotting

Prostaglandins

COX2

NSAID

Pain Response

COX1

Trauma,Injury

Cell Damage

Redness, Swelling, Pain, Heat, Clotting

Prostaglandins

COX2

Pain Response

COX1

Trauma,Injury

Cell Damage

Redness, Swelling, Pain, Heat, Clotting

Prostaglandins

COX2

https://www.tylenolprofessional.com/adult-dosage

Work Groups

• MAN Phoenix - OTC: Internal analgesicsBRN Bluegolds - OTC: Cold, Allergy, and Cough RemediesMNT Buccaneers - OTC: Sleep Aids & StimulantsFOX Titans - OTC: Diet AidsBRN Chargers - OTC: Herbals

MAN Phoenix

• -OTC: Internal analgesics

Brand strength monitoring

Each month survey 1000 respondents- 500 female- 500 male- 130 African Americans- 400 Millennials

BRN Bluegolds

• OTC: Cold, Allergy, and Cough Remedies

MNT Buccaneers

• OTC: Sleep Aids & Stimulants

FOX Titans

• OTC: Diet Aids http://www.buycheapdietpillsonline.com/

http://www.buycheapdietpillsonline.com/

BRN Chargers

• OTC: Herbals

Natural Health

Prescription Drugs

Rx Drugs

• https://www.drugabuse.gov/sites/default/files/rx_drugs_placemat_508c_10052011.pdf

https://www.drugabuse.gov/sites/default/files/rx_drugs_placemat_508c_10052011.pdf

Source: D. O. Sarnak, D. Squires, and G. Kuzmak, Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier? The Commonwealth Fund, October 2017.

Prescription Drugs

• 1.3 million ER visits due to adverse effects of Rx drugs

• 124,000 OD deaths

Source: Carr, T. (August 3, 2017). Too many meds? America’s love affair with prescription medication. Consumer Reports. Retrieved from https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/

https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/

Pain Management

Analgesic • Pain Relief• (Acetaminophen,

Oxycodone, morphine)

Opiate• Derived from opium• (heroin)

Narcotic• Mood or behavior

altering• Illegal • (cocaine, heroin)

Opioid• Synthetic• Opiate-like effect• (Fentanyl, oxycodone,

morphine)

Why are opiates so addictive?

Neurotransmitters - Dopamine

Why are opiates addictive?

• Human Emotion receptor sites in the brain• Dopamine & serotonin

Why are opiates addictive?

• Opioid receptor cites• Overlap with emotion, mood, pleasure, pain suppression

Source: https://www.challengemdd.com/opioid-system

Chemical Action – Side Effects

Opiates

• Codeine (only available in generic form)

• Fentanyl (Actiq, Duragesic, Fentora, Abstral, Onsolis)

• Hydrocodone (Hysingla, Zohydro ER)

• Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)

• Hydromorphone (Dilaudid, Exalgo)

• Meperidine (Demerol)

• Methadone (Dolophine, Methadose)

• Morphine (Kadian, MS Contin, Morphabond)

• Oxycodone (OxyContin, Oxaydo)

• Oxycodone and acetaminophen (Percocet, Roxicet)

• Oxycodone and naloxone

Side Effects

Why such an increase in Opioid Prescriptions?

Disease Mongering

1986

#13%

$

#26%

$1991

Disease Mongering

1986 1991

Disease Mongering

• 1987 ADHA APA

•

• USA consumes 85% of Ritalin production in the World.

Source: Frontline (2001). PBS. Retrieved from https://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html

1986 1991

1986 1991

1996

Physician Productivity

• 1992 – Health Care Financing Administration

• Relative Value System (RVU)

• Physician Expenses• Expertise – time, training, judgement, skill…(52%)

• Practice – Facilities, staff, overhead (44%)

• Malpractice – insurance, legal fees (4%)

• Specialization

• High volume

• Patient Satisfaction

19921986 1991

Direct to Consumer Advertising

• 1997 – FDA redefined “Adequate Provision”• Fair balance of drug effectiveness and risk/side effects

• Rx Drug advertising• 1993 = $166 million

• 2005 = $4.2 billion

1992 19971986

Terri Schiavo Case

• 1990 – 2005

• Patient Rights

1992 1997

1990 2005

1986

Vital Signs

1. Body Temp

2. Pulse

3. Respiration Rate

4. Blood Pressure

• 2001 Pain• VA & Joint Commission

1992 1997

1990 2005

20011986

https://www.jointcommission.org/assets/1/6/Pain_Std_History_Web_Version_05122017.pdf

1992 1997 20011986

1992 1997 2001

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

1996 2006

1990 2005

1986

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

Prescription Drug Monitoring System• Implemented 2013

1992 1997

1990 2005

2001 20131986

1992 1997 2001 20131986

1992 1997 2001 2013 20161986

Disease Mongering?

• You have a unhealthy condition…

• I have a cure…

1992 1997 2001 2013 20161986 2019?

Source: Marijuana Business Daily. (April 2014).

Health LiteracyConversation with health care providers

Before Leaving the Doctor’s Office

Ask questions

• Why do I need this prescription?

• What is the name of the medication?

• What does it do?

• What are the benefits?

• What are the risks and side effects?

• Are there alternatives to this medication?

• How do I take it?

• Does the medication interact with anything?

• How long do I need to take this medication? When can I stop?

• What if I miss a dose?

• How much does it cost?

Discussion Groups

• MAN Blue Devils - Rx: AntibioticsMNT Phoenix - Rx: AntidepressantsFOX Cyclones - Rx: Stimulants

MAN Blue Devils -

• Rx: Antibiotics

MNT Phoenix -

• Rx: Antidepressants

FOX Cyclones -

• Rx: Stimulants