438 Exam 1 Challenging topics

How do you convert pounds to kg

1kg = 2.2 pounds

What is the best dosage form for children

\-Oral syringes with metric flow markings are preferred

\-Use mL ONLY

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Acetaminophen dosing for children under 12

10-15 mg/kg every 4-6 hours as needed. Max: 2400 mg in 24 hours

Ibuprofen dosing for children under 12

5-10 mg/kg every 6-8 hours as needed, max: 1200 mg in 24 hours

Acetaminophen suppository dosage form for kids

80 mg, 120 mg, 325 mg

Acetaminophen oral suspension dosage form for infants and children

160mg/5mL

Ibuprofen oral suspension dosage form infants

50mg/1.25mL,

Ibuprofen oral suspension dosage form in children

100mg/5mL

What OTCs don’t need tamper resist packaging

dermatological, dentifrice, insulin or lozenge product

Drug Definition

Prevents, mitigates, cures, treat a specific disease  

Are dietary supplements regulated as drugs

No

\-No criteria for safety data

What is a health claim

FDA approved

Ex: “Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life”

\-Specific how the product helps a **disease**

What is a Structure-function claim

Doesnt need to be FDA approved

Ex. “support healthy cholesterol levels”

Ex. “may reduce high”

\-How a nutrient or ingredient effects of the structure/body

What is required in the OTC drug label

\-Name

\-Address of manufacturer

\-Net contents

\-NDC

\-Cautions and warnings

What is required in the OTC directions label

\-Dosage for use and persons

\-Frequency of dosing

\-Duration of dosing

\-preparation (ie.shake)

\-Timing of dosing

What is included in the OTC Drug facts label

\-API

\-Purpose

\-uses/indication

\-specific warning & contraindications

\-Questions? And phone number

\-Directions 

\-Inactive ingredients 

What are general OTC Labeling requirements

\-Label on container and box

\-Package insert and everything else counts as labeling

\-The FDA must approve all text

What OTC medication are we concerned about for adults that have heart conditions

NSAIDs

What OTC medication are we concerned about for adults that have Delirium,dementia, cognitive impairment

1st generation antihistamines, H2 receptor antagonist

What OTC medication are we concerned about for adults that have falls, fractures

Proton pump inhibitor

What OTC medication are we concerned about for adults that have Gastric, duodenal

ASA (aspirin) > 325mg/day

NSAIDs

What OTC medication are we concerned about for adults that have Kidney dysfunction

NSAIDs

What OTC medication are we concerned about for adults that have Lower urinary tracy symptoms, BPH (large proastate gland)

1st generation antihistmatines

Anticolonergeics

What OTC medication are we concerned about for adults that have Osteoarthritis

NSAIDs: Renal failure, HPB, increase bleeding anticoagulant, cardiovascular disease 

\-\*95% older adults who take NSAID develop PUD

What are OTC treatment options for Rhinorrhea 

saline nasal spray

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decongestants (Topical: baphazoline, oxymetazoline, phenylephrine, propylhexedrine; Oral: Pseudoephedrine)

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1st generation antihistamine (Brompheniramine, chlorpheniramine, diphenhydramine)

When to follow up with PCP for Rhinorrhea 

\-sore throat>several days, fever/HA or nausea/vomitting

\-symptoms worsen during nonrx.

\-thick & colored nasal secretion persist, 

Temp higher than 101.5, SOB, chest congestion, wheezing, rash, ear pain

Zinc side effects

Nausea, upset stomach. Diarrhea, irritation of oral mucose, distortion of tase, copper deficiency

When to start zinc use

within 24 hours of cold symptom onset

Zinc dosing

1 lozenge (13mg) every 2 hours while awake, initiate at first sign of cold

Zinc positive effects

 reduces duration and severity of cold

Honey effectiveness

\-Honey is better than placebo or no treatment 

\-Honey is about as effective as dextromethorphan

\-Honey>diphendyhramine 

What age groups can you use honey in and what dose

\-Do not use honey in children under 1 year because of risk of botulism

\-2.5-5mL in kids

\-No studies in adults: start with 5mL, then 10mL, then stop

Honey positive effects

decrease in cough frequency

OTC drugs for Nonproductive cough

*Oral antitussives*

\-Codeine

\-Dextromethorpan

\-Diphenhydramine

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*Topical antititussives*

\-Camphor

\-Menthol

OTC drugs for Productive cough

Expectorants: Guanifensin (limited efficacy, drink water instead)

Treatment course for acute cough

\-Little evidence that oral antitussives and expectorants are effective at treating acute cough

\-Start with nondrug measures first

What is a fever

elevation in core body temp above the daily range for an individual

Rectal fever temp

>100.4; preferred age older than 6mo.

Oral fever temp

>99.; avoid pt who are hyperventilating, not for children under 3 years

Axiliary fever temp

>99.3; variation due to inappropriate placement

Tympanic fever temp

>100; accuracy depends on proper placement

Nondrug measures for fever

Adequate fluid intake

\-children increase by at least 1-2oz per hour

\-adults: increase by at least 2-4oz per hour

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Sponging or bath

\-avoid isopropyl or ethyl alcohol due to alcohol toxicity

\-Avoid ice water bath (induces shivering with causes increase in body temp)

\-Lightweight clothing, remove blanket, maintain comfortable room temp

Fever exclusions for self care

\-patient older than 6mo. With rectal temp 104+

\-under 6 months with rectal temp 101

\-risk for hyperthermia

\-HIV, cancer

\-CNS damage

\-Children w/history of febrile seizures

\-Fever that persist beyond 3 days with or without treatment

In children: if rash, refuse to drink fluid, lethargy, vomiting

Fever OTC treatments

Ibuprofen

Acetminophen

Ibuprofen dosing for a child

5-10mg/kg every 6-8hours

Max 4 doses daily

Avoid if less than 6 month old

Use 3 days max

\-100mg/5mL

\-50mg/1.25mL

Acetaminophen dosing for a child

\-10-15mg/kg every 4-6 hours

\-use 3 days max

\-160mg/5mL liquid formulation

\-max 5 doses per day

Mild eye irritation Drug and Nondrug measures

__NonDrug:__

\-Cool, moist compress

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__Drug__

\-Artificial tears/ointments

\-Zinc sulfate solution

Corneal Edema First, second & third-line agents & regimens

__Sodium Chloride Solution:__

1st line: 2% solution 4x day

2nd line: 5% ointment @ night 

3rd line: switch to 5% saline solution 4x daily & continue ointment 

Allergic conjunctivitis First-line and other therapy

**Ocular Lubricants are first line**

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Other:

Ocular

* Decongestants:Phenylephrine, Naphazoline, tetrahydrozoline, oxymetazoline, bromonidine
* Antihistamines: Pheniramine , Ketotifen, Olopatadine
* decongestant/antihistamine combination
* Antihistamine-mast cell stabilizer

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Oral antihistamines

Combination eye+ oral

Eyedrop administration steps

\-You can **refrigerate the solution** before administering it (the cold drops on the eye surface are easily  detected) DO NOT refrigerate suspensions

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**-Wash hands thoroughly** and wash areas of the face around the eyes. Contact lenses should be removed unless the product is designed specifically for use with contact lenses

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**-Tilt head back.** When administering drops to children, have the patient lie down before placing drops in the eyes

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\-Gently grasp **lower outer eyelid below lashes and pull eyelid away to create a pouch**

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\-As soon as the drop is applied, release the eyelid slowly. **Close your eyes gently for 3 minute and position the head downward as though looking at the floor**. Minimize blinking or squeezing of the eyelid

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**-Use a finger to put gentle pressure over the opening of the tear duct**

\n -If multiple medications are indicated, **wait at least 4 minute before instilling the next eye drop** preparation.