Non-RX 31-50

Cryotherapy

Dr. Scholls freeze away

Class of cryotherapy

wart remover

Indications for freeze away

wart remover

MOA of cryotherapy

Cryotherapy selectively necroses wart tissue by reducing the temperature of cells infected with viruses that cause warts.

A/E of cryotheapy:

-burning or stinging sensation at site of administration

Counseling points for cryotherapy:

-Follow manufacturer instructions very carefully to avoid damage to healthy tissue surrounding wart.

-May take 10-14 d for wart to fall off after treatment.

-Do not use on skin conditions that are not warts (eg, moles or birthmarks); may cause serious burns and permanent scarring of skin.

-Some products suggest soaking affected area for several minutes before application.

-May cause pain at the site of administration for several hours after treatment.

-Do not use on thin, sensitive, or irritated skin. -Do not use more frequently or for more total doses than recommended by the manufacturer; if not effective after those administrations, see an HCP.

-Coolant is highly flammable, so avoid flames; store at room temperature and do not expose to temperature >120°F.

-Only use in well-ventilated area and do not inhale vapor/spray.

-Avoid contact with eyes.

Delsym

Dextromethorphan

Robitussin

Dextromethorphan

Triaminic

dextromethorphan

Class for dextromethorphan

cough suppressant

Indications for delsym

cough

MOA of delsym:

Dextromethorphan is the D-isomer of levorphanol (a codeine analogue). It has no analgesic or addictive properties but suppresses cough by depressing the cough center in the medulla oblongata.

Drug interactions of deslysm:

-MAOI

-SSRI

-SNRI

-antipsychotics

-avoid concurrent use

Counseling with delsym:

-Shake extended-release suspension well before use.

-Advise patients to get adequate rest and hydration.

-Take with plenty of noncaffeinated liquids.

-Only use the measuring cup provided with individual product.

Voltaren

diclofenac

Aleve arthritis pain gel

diclofenac

Boxed warnings for voltaren:

-cardiovascular

-GI risk

-CABG

A/E of diclofenac:

-application site pain

-itching

-rash

-xeroderma

Counseling points with diclofenac gel:

-Avoid concurrent oral NSAIDs.

-Wash hands after applying.

-Do not use heat or bandages in area gel or patch is applied.

-Wait 1 h after gel application before bathing.

-Gel formulation available from multiple manufacturers under multiple brand names.

-Other NSAIDs also available in topical formulation.

-Ensure appropriate route (topical versus oral) and active ingredient contained in product.

Dimenhydrinate

Dramamine

Dramamine class

antihistamine and antiemetic

Indication for Dramamine:

-motion sickness

MOA of Dramamine:

The efficacy of dimenhydrinate in motion sickness is related to effects on labyrinthine function, and it has been shown to inhibit the vestibular system. It competes with histamine for H1-receptor sites on effector cells in the GI tract and blocks chemoreceptor trigger zone.

Drug interactions with dramamine:

-CNS depressants

-anticholinergics

A/E of Dramamine:

-dizziness

-drowsiness

-nervousness

-restlessness

Counseling points for Dramamine:

-patient should avoid alcohol or activities requring mental alertness or coordination until drug effects are known

-avoid CNS depressants

-avoid use in elderly patient from anticholinergic effects

Diphenhydramine

Benadryl

ZZZquil

diphenhydramine

Indications for benadryl:

-allergic reactions

-cough

-sleep

-motion sickness

MOA of benadryl:

Diphenhydramine competes with histamine for H1-receptor sites on effector cells in the GI tract, CNS, and blocks chemoreceptor trigger zone.

Drug interactions with benadryl:

-CNs depressants

-anticholinergic

-avoid use with both

A/E of benadryl:

-dizziness

-drownsiness

-nervousness

-restlessness

Counseling points for benadryl:

-May cause drowsiness and impair physical or mental abilities; avoid driving and operating machinery.

-Avoid alcohol, other CNS depressants, and other diphenhydramine-containing products (including topical).

-Avoid use in elderly patients due to risk of anticholinergic effects.

-Avoid use in children for sleep; may cause paradoxical excitability in children.

-If used for sleep, good sleep hygiene (including avoidance of caffeine, alcohol, nicotine) should be recommended.

-ZzzQuil packing resembles Nyquil, but active ingredients differ.

-Do not use for >2 wk without discussing with an HCP.

Indication for topical benadryl:

-pruritus

A/E for topical Benadryl:

-photosensitivity

counseling points for topical Benadryl:

- Unlikely to cause systemic adverse effects unless applied to large area of skin; advise patients to apply sparingly.

-Avoid other diphenhydramine-containing products (including oral).

-Avoid contact with eyes and do not ingest by mouth.

-Do not wrap or occlude treated area. Do not use for >7 d.

Abreva

Docosanol

Indications for abreva:

herpes simplex

MOA of abreva:

Docosanol inhibits viruses that enter cells by fusion with the plasma membrane of the cell. It inhibits entry of the virus into the cell and fusion between the plasma membrane and the viral envelope. As the virion is not able to migrate into the nucleus of the cell, viral replication is blocked. Docosanol has no direct viricidal activity

counseling for abreva:

-Counsel patient to keep infected area clean, and wash hands before and after use.

-Initiate therapy at the first sign of cold sore/fever blister (tingle, redness, burning, or itch) and continue until lesion is completely healed; early treatment is more effective.

-Do not use inside mouth or on lesions anywhere on the body except for lips and around mouth (not for use in genital areas); avoid eyes.

-Use 5 times daily for maximum effectiveness.

-Monitor lesion for signs of secondary bacterial infection.

-Avoid sharing product to reduce risk and spread of infection.

Docusate

Colace

Class for docusate

stool softner

MOA of docusate:

Docusate is an anionic surfactant that acts as a stool softener; it is believed to stimulate intestinal secretion and increase the penetration of fluid into the stool by emulsifying feces, water, and fat.

A/E of docusate:

-abdominal cramps

-bitter taste

Counseling points for docusate:

-Lifestyle interventions (increasing exercise, intake of water and dietary fiber) generally first-line management of constipation.

-May require several days of treatment before stool softening is noticeable.

-Patients can take as a single daily dose or in divided dose if desired.

-Discontinue and contact an HCP if rectal bleeding occurs or bowel movement fails to occur after appropriate use.

-Do not use with products containing mineral oil without consulting HCP.

doxylamine

Unisom

class of unisom

H1 antagonist

Unisom indication

sleep

MOa of unisom:

Doxylamine competes with histamine for H1-receptor sites. One of its adverse effects, sedation, is the basis for its use as a hypnotic.

Drug interactions with unisom:

-CNS depressants

-anticholinergics

A/E of unisom:

-dizziness

-drowsiness

-nervousness

-restlessness

Counseling points for unisom:

-Administer 30 min before going to bed.

-Avoid alcohol, other CNS depressants, and other diphenhydramine-containing products.

-May cause drowsiness and impair physical or mental abilities; avoid driving and operating machinery.

-Avoid use in elderly patients due to risk of anticholinergic effects.

-Good sleep hygiene (including avoidance of caffeine, alcohol, and nicotine) should be recommended in addition to self-management of insomnia.

-Do not use for >2 wk without discussing with an HCP.

Coneflower

Echinacea

Class for coneflower

immune stimulant

indications for coneflower

upper respiratory tract infections

MOA of coneflower:

While the active ingredient has not been identified, Echinacea extracts may stimulate multiple cytokines and increase macrophage proliferation and phagocytosis.

Drug interactions with echinacea:

-immunosuppressants: avoid

A/E of echinacea:

-Gi distress

-dizziness

counseling for echinacea:

-Advise rest and plenty of fluids.

- Initiate treatment at the first sign of illness.

-Not recommended for use >10 d in otherwise healthy individuals.

A/E of Nexium:

headache

Class for evening primrose oil:

-hormonal modulator

Indications for evening primrose oil:

-eczema

-hot flashes

MOA of primrose oil

Evening primrose oil's active ingredient is thought to be GLA, an omega-6 essential fatty acid. Essential fatty acids must be obtained from the diet and cannot be synthesized. A deficit of GLA may be present in patients with atopic eczema.

A/E of evening primrose oil:

-GI distress

Counseling points for primrose oil:

-Advise patient to avoid triggers by avoiding heat, perspiration, dry skin, stress, and anxiety.

-Low-water-content creams (Eucerin) and ointments (Vaseline and Aquaphor) are recommended for all patients.

-First-generation antihistamines may be used to control itching and sleep disturbances secondary to itching.

-Topical corticosteroids are the mainstay of therapy for mild disease.

-If taking evening primrose oil, avoid alcohol or NSAIDs as the combination may increase the risk of bleeding.

-If taking for vasomotor symptoms, advise patient that weight loss, smoking cessation, stress management, and avoiding alcohol can reduce frequency of symptoms.

-Dress in layers.

-Lower the thermostat if possible and avoid spicy or hot (temperature) foods.

Fer-in-sol

ferrous sulfate

Feosol

ferrous sulfate

Class for ferrous sulfate

mineral supplement

indications for ferrous sulfate

-anemia

MOA of iron:

Iron is a component of hemoglobin and required for synthesis of red blood cells. Absence of iron results in smaller hemoglobin molecules and microcytic anemia.

A/E of iron:

-GI irritation

-constipation

drug interactions with iron:

-aluminum agents: separate by administration by 1-2 hours

-H2 antagonists and PPIs: decreased absorption

Counseling points for iron:

-May require several weeks for maximum effect.

-Stools will turn black.

-Take on empty stomach, if possible, to maximize absorption.

-May take with food if significant nausea occurs.

-Avoid calcium-containing food and antacids as this decreases iron absorption.

-Should be separated by 2-12 h from many medications to avoid interfering with absorption, including tetracycline antibiotics.

-Keep out of reach of children; accidental ingestion may be fatal.

-Do not crush or chew any formulations.

Fexofenadine

allegra

indications for allegra:

Upper respiratory allergies

seasonal allergies

Drug interactions for allegra:

-CNS depressants

-antacids

a/e for allegra:

-headache

-vomiting in children

Counseling for allegra:

-Avoid allergic triggers.

-Use scheduled doses instead of prn.

-Symptoms should improve after 3-4 d but may require 2-4 wk for full benefit.

-Use provided measuring device with oral suspension.

-Patients should avoid activities requiring mental alertness or coordination until drug effects are known as drug may cause dizziness or sedative effects.

-Avoid alcohol.

-Patients should not take at the same time as aluminum or magnesium antacids. Orange, grapefruit, and apple juice can decrease effectiveness; separate at least 4 h.

Linum usitatissimum

omega 3

Indications for flaxseed oil

lipid lowering

MoA of flaxseed oil:

Potential mechanisms of action include inhibition of acyl-CoA:1,2-diacylglycerol acyltransferase, increased mitochondrial and peroxisomal b-oxidation in the liver, decreased lipogenesis in the liver, and increased plasma lipoprotein lipase activity.

Drug interactions with flaxseed oil:

increased risk of bleeding with anticoagulants

Counseling with flaxseed oil:

-swallow whole capsule

-take with food and full glass of water

-do not eat raw flaxseed

Allium

garlic

Alho

garlic

Class for alho

antihyperlipidemic

Indications for allium

hyperlipidemia

-colon cancer prevention

MOA of allium:

Allicin is thought to be the active ingredient of garlic and has antioxidant and antilipid properties, although the precise mechanism is unknown.

A/E of garlic

-offensive odar

-nausea

Counseling points with garlic:

-May take with food or milk to reduce GI upset.

-Odorless formulations are available, although this may influence the efficacy of the garlic.

-Garlic may increase your risk of bleeding; discontinue 10 d prior to elective surgery.

Tebonin

ginkgo biloba

EGb 761

ginkgo biloba

Indications for ginkgo

-Peripheral vascular disease

-dementia

-memory improvement

-tinnitus and vertigo

MOA of ginkgo:

Ginkgo has antioxidant effects that scavenge-free radicals and reduces lipid peroxidation, which is thought to be beneficial in dementia and memory, and is a smooth muscle relaxant that may be beneficial in claudication.

A/E of ginkgo biloba:

-hypotension

-headache

-dizziness

Counseling for gingko:

-Normal age-related changes usually cause minor difficulties in short-term memory and a slowed ability to learn and process information.

-These changes are usually mild and do not worsen greatly overtime in normal aging, nor should they interfere with a person's day-to-day functioning.

-Discontinue prior to elective surgery and dental procedures to reduce the risk of bleeding.

-Consuming raw ginkgo seeds may be poisonous.

Berberine

Goldenseal

Indications for berberine:

--traveler's diarrhea

-hyperlipidemia

MOA of berberine:

The active ingredient of goldenseal is berberine that has antimicrobial activity and prevents adherence of bacterial to host cells. It also reduces cholesterol by reducing absorption, increasing fecal excretion, and upregulation of LDL receptors.

Goldenseal in pregnancy:

contraindicated