9/9 5111 N&V OTCs

List the prevention methods for N&V

1. Smaller, more frequent meals

2. Avoid fatty, greasy, & spicy foods

3. Avoid excess alcohol

For medication-related N/V: take medications with food & water

For motion sickness-related N/V

1. Focus straight ahead

2. Avoid reading

3. Sit in the front seat, or near wings of airplane

For N/V in pregnancy

1. Fresh air

2. Dry crackers upon waking & before meals

3. Avoid sudden movements; get out of bed slowly

List the exclusions to self-care for N&V

1. Drug or alcohol-related

2. Due to chemo or radiation therapy

3. Due to CNS, endocrine, or GI disorders

4. Severe N/V during pregnancy

5. Signs of severe dehydration

6. Symptoms of suspected food poisoning over 24 hrs.

7. Vomiting following head or abdominal injury

8. Stiff neck or severe headache

9. Severe diarrhea, fever, abdominal pain

10. Vomit that contains red, black, or green fluids

11. Very high blood glucose in DM patients

12. Yellow skin/eyes, urine discoloration

13. Comorbid glaucoma, BPH, chronic bronchitis, asthma, or emphysema

14. Bulimia, anorexia nervosa

List non-pharmacological treatments of N&V

1. Carbonated beverages (take small sips)

2. Ginger (useful in NVP)

3. Relaxation techniques

4. Acupressure wristband (Sea-Band®)

   • Prevents motion sickness, treats Sx of NVP

   • Stimulates pericardium 6 (P6), or Nei-Guan point

Classes of OTC products for N&V

1. Antihistamine

2. Bismuth Subsalicylate

3. Antacids

4. Phosphorated Carbohydrate Solution

5. Vitamin B6

6. Ginger

7. Pressure bands

Antihistamine mechanism of action

Antihistamines inhibit binding of histamine to the H1 receptor, which decreases neuronal signaling involved in several N/V pathways

Examples of antihistamines

1. diphenhydramine (Benadryl)

2. dimenhydrinate (Dramamine Original Formula)

3. meclizine (Antivert, Bonine, Dramamine Less Drowsy Formula)

4. cyclizine (Marezine)

5. doxylamine (Unisom)

Antihistamine indications

1. N/V associated with motion sickness (take 30 minutes to 1 hour before travel)

2. N/V associated with pregnancy

First line antihistamine treatments for motion sickness

1. Diphenhydramine

2. Dimenhydrinate

3. Meclizine

4. Cyclizine

First line treatment for N/V associated with pregnancy (NVP)

Doxylamine + pyridoxine (V B6)

Antihistamine common side effects

1. Sedation

2. CNS depression

3. Anticholinergic SEs (dry mouth, dry eyes, blurry vision, constipation, urinary retention, confusion)

4. Paradoxical stimulatory effects (e.g., excitation/hyperactivity)

When should caution be taken with antihistamines?

Elderly patients, due to increased risk of sedation/confusion

Contraindications (CIs) with antihistamines

Narrow-angle glaucoma, BPH

Patient counseling for antihistamines

Do not drive or operate machinery until you know how this medication affects you

Use caution if combining with other medications that may cause sedation (e.g. alcohol, narcotics)

Bismuth subsalicylate MOA

Local anti-inflammatory activity at GI mucosa

Bismuth subsalicylate examples

Bismuth Subsalicylate (Kaopectate, Pepto Bismol, Maalox Total Relief)

Bismuth subsalicylate comes in _

regular strength and extra strength

Bismuth subsalicylate indications

Nausea, indigestion, upset stomach, heartburn, diarrhea

Common side effects with Bismuth subsalicylate

Discoloration of stool/tongue, neurotoxicity (rare)

Contraindications with bismuth subsalicylate

Do not use with pediatric patients with or recovering from influenza or varicella infection due to risk of Reye’s syndrome

Pediatric - birth to 21 years

Patient counseling for bismuth subsalicylate

May cause tongue and stool to be black - this is harmless

Caution when using with products that contain aspirin (ASA) or NSAIDs (e.g. ibuprofen, naproxen)

Antacid MOA

Neutralize gastric acidity by increasing the pH of the stomach and duodenum

Examples of Antacids

1. Aluminum hydroxide, magnesium hydroxide, and simethicone (Maalox Advance Regular Strength, Mylanta)

2. Calcium carbonate (Tums)

Indications of Antacids

N/V associated with indigestion

Infrequent heart burn

Common side effects of Antacids

Diarrhea (magnesium), constipation (aluminum/calcium), abdominal cramps, bloating

Patient counseling for antacids

Antacids may decrease absorption of certain medications.

Be mindful of which meds have interactions with antacids, and separate time of intake by certain amount of hours (depending on the medication)

Phosphorated Carbohydrate Solution MOA

Direct action on GI tract wall to decrease stomach smooth muscle contraction

Example of Phosphorated Carbohydrate Solution

Phosphric acid, dextrose, and fructose (Emetrol)

Phosphorated Carbohydrate Solution Indications

Relief of nausea associated with upset stomach with intestinal or stomach flu, and food indiscretions

Contraindications with Phosphorated Carbohydrate Solution

Use in pediatrics with or recovering from influenza or varicella infection due to risk of Reye’s syndrome