5111 Quiz 2 Study

what are the 3 ways non-Rx drugs can be brought to the market

OTC monograph process

New Drug Application

Drug Reclassification

T or F? OTCs and dietary supplements are required by the FDA to have drug facts labeling

False

drug facts labeling only applies to OTCs, not dietary supplements

what are the 4 factors that drive self-reliance (self-care therapeutics)

1. aging population

2. decreased availability of PCPs

3. increased health care costs

4. high proportion of under-/uninsured

the ____ Act of 1994 amended the 1993 Food, Drug, and Cosmetic Act to establish standards (including accurate labeling) for ____

Dietary Supplement Health and Education

dietary supplements

list some common forms of complementary and alternative medicine (CAM)

natural/herbal products

deep breathing

meditation

chiropractic and osteopathic care

massage

yoga

list some common natural/herbal products

cranberry

soy

saw palmetto

garlic

echinacea

what are the 3 big factors influencing self-care medication

1. cost

2. aging population

3. gender differences

list some benefits of nonprescription medicine

accessibility and convenience

number conditions can be treated by OTCs

variety of products and dosage forms

can be used to manage a condition while waiting for appointment with HCP

more affordable

how can product reformulation lead to safety concerns

Reformulated products may be labeled as "new and improved" but not indicate that active ingredient is changed → leading to confusion and misuse

what does QuEST for patient assessment stand for

Quickly and accurately assess patient

Establish that the patient is an appropriate self-care candidate

Suggest appropriate self-care strategies to the patient

Talk with the patient about these strategies

what does SCHOLAR-MAC stand for in assessing a patient to determine self-care candidate status and identify which treatments would be most appropriate

Symptoms

Characteristics of symptoms

History of symptoms

Onset

Location

Aggravating factors

Remitting factors (what makes the problem better?)

Medications (Rx, OTC, herbal, dietary supplements)

Allergies

Conditions

why is pseudoephedrine now behind-the-counter

can be used to illicitly manufacture methamphetamine

Emergency contraceptives have an efficacy of > ___% when used as indicated

95%

T or F? emergency contraceptives (ECs) inhibits implantation of a fertilized egg to prevent pregnancy

False

ECs inhibit or delay ovulation but do NOT inhibit implantation of a fertilized egg or terminate an established pregnancy

Emergency contraceptives are most effective if taken within _ of primary contraceptive failure or unprotected sex

72 hours

T or F? emergency contraceptives can be sold to patients of any age and gender without ID or counseling*

True*

allowing access to syringes with hypodermic needles without an Rx addresses what public health issue

the spread of blood-borne infections related to sharing of contaminated needles

T or F? syringes are usually stored in an area where the public can conveniently access

False

Syringes must be stored in an area not directly accessible to public

pharmacists may furnish syringes to patients age ___

18 or older

what are some pharmacist roles in nonprescription medicine

Be available to patients seeking preventative and self-care products

Interview, screen and perform physical assessment as needed

Assess patient risk factors (contraindications, precautions…)

Assist in product selection

Provide counseling (dosage, administration, duration…)

Maintain accurate drug profile including non-Rx meds

Assess the potential of non-Rx medicine to mask symptoms of more serious conditions

Educate on when to seek medical attention of no improvement or if symptoms worsen

T or F? the use of self-care are usually limited to mild illness or short-term management of illness

True

what are the 3 general categories of self-care products

1. nonprescription medicine

2. nutritional dietary supplements

3. natural products

what are the characteristics of nonprescription medicine

low potential for misuse/abuse

can be used for self-diagnosed conditions

adequately labeled

do not require access to HCP

what is an immunization neighborhood

collaboration, coordination and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases

which of the following age groups tend to have the lowest annual influenza vaccination rates

c) 18 yrs through 49 yrs

what was the most common place of vaccination for children? how about for adults?

children- doctor's office

adults- pharmacy/store

an infant receiving antibodies from breast milk is an example of what type of immunity

passive immunity

what are the live vaccines

MMR

chikungunya

live attenuated influenza

varicella

oral rotavirus

oral typhoid capsules

yellow fever

why can't pure polysaccharide vaccines (PPSVs) be given to those under 2 years old

PPSVs activate B cells without the help of T cells but the immune system of young children is too immature to effectively respond to this to produce long-term immunological memory

can a patient 1 years of age receive a conjugate polysaccharide vaccine?

yes, because conjugate polysaccharide vaccines involve the stimulation of T-cells in producing immunological memory (unlike pure polysaccharide vaccines)

what is the minimum interval between 2 non simultaneous live vaccines

28 days

live vaccines followed by blood products require a minimum interval of…

2 weeks

live vaccine followed by a PPD skin test requires a minimum interval of…

28 days

when giving more than 1 vaccine on the same arm, the injection sites must be separated by ___

1 inch

ACIP counts ____days within of the minimum interval as grace period

4

which of the following are false contraindications? (select all that apply)

b) premature birth

d) mild fever

e) breastfeeding

what vaccines are recommended during pregnancy

Tdap (3rd trimester)

inactivated influenza

bivalent RSVPreF (3rd trimester)

if possible, live vaccines should be given how long prior to immunosuppression

4 weeks

what is the daily and monthly limit for purchase of pseudoephedrine

daily: 3.6 g

monthly: 9 g

what are the 7 risk factors for cold from lecture

increased population density

respiratory allergies

decreased diversity of social networks

smoking

sedentary lifestyle

chronic psychological stress

sleep deprivation

which of the following are NOT true risk factors for the cold (select all that apply)

a) enlarged tonsils

b) sudden chilling

which of the following is an appropriate candidate for self-treatment:

b) 49 y/o patient who's had a fever of 99.8 F for 1 day

what is the recommended therapy for infants experiencing a cold

non-pharmacological therapy-

keep upright

nasal aspirators

saline sprays/drops

humidifier/vaporizer

hydration

what is the dosing for pseudoephedrine for adults and children 12 yrs or older? for children 6-<12 yrs?

=12 y/o: 60 mg q4-6 hrs (240 mg per day)

6-<12 y/o: 30 mg q4-6 hrs (120 mg per day)

what is the dosing for phenylephrine for adults and children 12 yrs or older? for children 6-<12 yrs?

=12 y/o: 10 mg q4 hrs (60 mg per day)

6-<12 y/o: 5 mg q4 hrs (30 mg per day)

the use of topical decongestants is limited to ___ days. otherwise long-term use could lead to ___

3-7 days

rhinitis medicamentosa

what can someone with HTN use for nasal congestion instead of pseudoephedrine

Coricidin (contains 1st gen antihistamine instead of systemic decongestant)

what are the 4 first generation antihistamines that can be used for cold symptoms

diphenhydramine

dimenhydrinate

doxylamine

chlorpheniramine

first generation antihistamines exhibit what type of side effects

anticholinergic and sedative effects

__ can cause paradoxical excitation in young children who have an extra CYP2D6 gene

antihistamines

besides non-drug therapy, which of the following is PREFERRED for treating pregnant or lactating patients with cough/cold symptoms

c) topical oxymetazoline

Should try to avoid systemic decongestants, first gen antihistamines, combination products, extra-strength products

children recovering from viral illness should avoid taking Aspirin due to risk of having

Reye's Syndrome

a patient has been experiencing a cough without mucus for the last 4 weeks. what would the patient's cough be classified as?

d) subacute, non-productive

which of the following is on the Beer's list and should be avoided in elderly

d) diphenhydramine and all first generation antihistamines

what OTC medicine has a caution against phencyclidine-like euphoric effect

dextromethorphan

as a general guide, self-treatment should not exceed _ days

3-5

what part of SOAP notes does discussing the pros and cons of treatment options belong to

Assessment

what should be avoided in children younger than 2 y/o due to risk of methemoglobinemia

benzocaine

what is the dosing for dextromethorphan for adults >=12 y/o and children 6-<12 y/o

=12 y/o: 10-20 mg q4h or 30 mg q6-8h prn (120 mg)

6-<12 y/o: 5-10 mg q4h or 15 mg q6-8h prn (60 mg)

what is the dosing for diphenhydramine for adults >=12 y/o and children 6-<12 y/o

=12 y/o: 25 mg q4h prn (150 mg)

6-<12 y/o: 12.5 mg q4h prn (75 mg)

what is the dosing for guaifenesin for adults >=12 y/o and children 6-<12 y/o

=12 y/o: (IR) 200-400 mg q4h prn or

(ER) 600 mg to 1.2 g q12h prn (max 2.4 g/day)

6-<12 y/o: (IR) 100-200 mg q4h prn (max 1.2 g/day)

Cold Myths

Cold or wet environments

Sudden chilling or exposure to central heating

Walking barefoot outside

Teething

Enlarged tonsils or adenoids

Cold - When to Refer

Fever

Chest pain

Shortness of breath

Worsening of symptoms or development of additional symptoms during self-treatment

Concurrent underlying chronic cardiopulmonary diseases

AIDS or chronic immunosuppressant therapy

Elderly, frail patients

Infants < 3 months of age

Hypersensitivity to recommend OTC medications