Non-RX drugs 16-30

Brimonidine

Lumify

What is lumify for?

ocular redness

MOA of brimonidine:

Brimonidine, a relatively selective alpha-adrenergic agonist, reduces aqueous humor production and increases uveoscleral outflow, which can reduce ocular redness. It is also used to lower IOP in open-angle glaucoma or ocular hypertension.

A/E of lumify:

-allergic onjuctivitis

-conjunctival discolaration

drug interactions for Lumify:

-MAOIs: avoid use because of increased risk of CNS depression

Counseling points for lumify:

-Ophthalmic use only.

-Do not use if solution is discolored or has particulates.

-Remove contacts prior to use; soft contact lens wearers should wait at least 10 min before putting their lenses in.

-Do not contaminate dropper tip or solution when placing drops in eyes; replace cap after each use. -Wash hands before use. To administer, tilt your head back, pull down the lower eyelid to make a pouch, and place 1-2 drops in corner of eye without touching the bottle tip to your eye; look downward and gently close your eyes and hold for 1-2 min. If using other ophthalmic products, wait at least 5 min before using other product.

Budesonide nasal:

Rhinocort

Indications for budesonide:

-upper respiratory allergies

MOA of budesonide:

Budesonide is an anti-inflammatory with potent glucocorticoid and weak mineralocorticoid activity. It exhibits a broad range of active inhibition against multiple cell types and mediators involving allergic and nonallergic/irritant-mediated inflammation.

A/E of budesonide:

-upper respiratory tract infections

Counseling for Budesonide:

-avoid triggers

-greater than 12 may reduce dose to 1 spray/nostril

-For administration, bottle must be primed and shaken well prior to first use or if it has not been used in >2 d; avoid spraying in face.

-Patients should clear nasal passages by blowing nose prior to use. Press against outside of 1 nostril to close off. Employ the "nose to the toes" technique of tilting the head slightly downward to avoid overspray into the esophagus while inhaling to avoid bad taste. Aiming the spray away from the nasal septum toward the ears slightly inserted into the nostril can help minimize irritation and nosebleeds.

-Medication may take 24-72 h to take full effect. If patient forgets a dose, do not double next dose. Sniff gently as you pump the bottle.

-Do not blow nose for at least 15 min after use. Brief stinging or sneezing may occur immediately after use. Wipe nozzle with tissue and replace cap. Nozzle only can be cleaned with tap water if pump does not spray properly; follow included instructions.

-Should not be shared between multiple people to reduce spread of infection.

Butterbur

Petasites hybridus

What is butterbur for?

prevention of migraines

Allergic rhinitis

Butterbur MOA:

Petasites is the active ingredient from the butterbur plant and has smooth muscle relaxant activity on vascular walls with a particular affinity for cerebral blood vessels. In allergic rhinitis, butterbur and purified petasin decrease blood concentrations of histamine and leukotrienes. They also appear to decrease priming of mast cells in response to contact with allergens.

Drug interactions with butterbur:

-anticholinergic: additive toxicity

a/e of butterbur:

-nausea

-flatulence

-burping

Counseling tips for butterbur:

Not effective in treating a migraine. If migraine develops, use migraine abortive therapy. Raw butterbur plant contains pyrrolizidine alkaloids that are hepatotoxic if not removed; only recommend products labeled "PA-free."

Caffeine

No dox

jet-alert

Indication for NoDoz:

-mental alertness

MOA of caffeine:

Caffeine increases levels of cyclic AMP by inhibiting phosphodiesterase; CNS stimulant that increases medullary respiratory center sensitivity to carbon dioxide.

Drug interactions for caffeine:

Sympathomimetics: increase hypertensive effects

A/E of caffeine:

-insomnia

-gi upset

Counseling points with caffeine:

-A typical cup of coffee contains 200 mg of caffeine, similar to a caffeine tablet; however, coffee is consumed over a period of minutes, resulting in slower onset and lower Cmax than caffeine tablets.

-Beverages (energy drinks, coffee, tea, soda, etc) and many OTC products contain caffeine; be aware of caffeine consumption from multiple sources that can worsen nervousness, irritability, and sleeplessness.

Calcium carbonate

Tums

A/E of calcium carbonate:

-diarrhea

-cramping

-abdominal pain

-constipation

Drug interactions with tums:

-quinolone: take 2 h before or 6 hrs after

-bisphos: separate by 1 to 2 hrs

-iron: calcium reduces iron absorption

Counseling points for tums:

-May take with or without food, although most foods can enhance absorption.

-Bran, foods high in oxalates, or whole grain cereals may decrease calcium absorption.

-Consider lifestyle modifications, including avoidance of late and large meals, staying upright for at least 3 h after a meal, weight loss, smoking cessation, avoiding alcohol, and elevating the head of their bed to resolve heartburn symptoms.

-Consult product-specific guidance for maximum dose, including in pregnancy (max 5 g calcium carbonate per 24 h).

Calcium polycarbophil

fibercon

FiberCon is what class?

bulk laxative

Fibercon used for what?

laxative and antidiarrheal

MOA of fibercon:

Polycarbophil (calcium polycarbophil) is a hydrophilic resin capable of absorbing 60 times its original weight in water. It is not absorbed and is metabolically inert. In the treatment of diarrhea, polycarbophil absorbs free fecal water, forming a gel and producing formed stools. As a bulk laxative, it retains free water, increasing luminal pressure and peristalsis and decreasing transit time.

Fibercon a/e;

-diarrhea

-cramping

-abdominal pain

-constipation

Counseling for fibercon:

-The addition of dietary fiber (eating foods high in fiber), as well as other lifestyle interventions (increasing exercise, intake of water), should accompany the use of this product for constipation.

-Oral rehydration therapy for mild, uncomplicated diarrhea should accompany treatment with polycarbophil, and each dose must be taken with 240 mL of water or other fluid.

-Patients who are unable to take with adequate fluids should not take this medication—medication may swell in the throat and causing choking.

-As a laxative, symptom relief generally occurs within 12-24 h but may require as long as 72 h.

-May interfere with absorption of some medications; patients should separate administration with other medications by 2 h.

Cannabidol

Cannabis sativa

indication for cannabidiol:

nausea and vomiting

pain

MOA of cannabis:

Promotes analgesia, anxiolytic, antipsychotic, antidepressant, and antiemetic effects by activating serotonin 5-HT1a.

A/E of cannabidiol:

-drowsiness

-lethargy

-sedation

-fatigue

-rash

-malaise

-weight loss

-diarrhea

Counseling points for cannabidiol:

Available in combination or as ingredient in many OTC preparations including approved medications (eg, lidocaine, methyl salicylate); FDA-approved labeling is specific to active ingredient as the CBD ingredient is not regulated by FDA.

-Read labels carefully prior to use.

-Avoid driving and other activities requiring mental alertness.

-Avoid alcohol and other CNS depressants. May interfere with cannabis drug tests or produce positive results despite delta-9-tetrahydrocannabinol (THC)-free labeling. Due to lack of FDA regulation, previous studies have identified significant variation in concentration of CBD products sold online.

-Clinically significant drug interactions have been reported; discuss medications with an HCP before starting.

Capsaicin

capsaicin

Indications for capsaicin:

-minor pain

MOA of capsaicin:

Capsaicin is an agonist of the transient receptor potential vanilloid 1 (TRPV1) receptor, found in nociceptive nerve fibers. Activation of TRPV1 by capsaicin results in depolarization, initiation of action potential, and pain signal transmission to the spinal cord, and subsequent desensitization and inhibition of pain transmission initiation.

A/E of capsaicin:

-local erythema

-pain

Counseling for capsaicin:

-For skin application, wash and dry area.

-Apply thin layer or patch to affected area.

-You may wear gloves when putting on. Do not apply to open wounds or damaged skin, and treated area should not be exposed to heat or direct sunlight.

-Avoid contact with eyes or other mucous membranes. Do not bandage.

-Do not bathe, shower, or swim within 1 h of applying topical product. Remove patch 1 h before bathing, showering, or swimming; patches should not be used >5 d consecutively.

-Local skin irritation declines with continuous use, while treatment effect continues; intermittent use may delay decline in local irritation.

-If medication comes in contact with hands, wash hands well after application and carefully avoid touching eyes, mouth, nose, or groin area.

Carbamide peroxide

debrox

indication for debrox.

earwax

MOA of debrox:

Carbamide peroxide breaks down into hydrogen peroxide and urea. Hydrogen peroxide subsequently releases oxygen, causing foaming on contact with wax and loosening and softening impacted cerumen.

Counseling points for debrox:

-Wash hands before and after use.

-Lie on side with problem ear facing up and administer drops to that ear.

-Do not touch dropper to ear.

-Keep head tilted for 2 min or place cotton in ear after instilling drops to keep drops in ear. Note, solution may foam or may produce a crackling sound on contact with wax. May repeat on the other side.

-Remaining earwax may be removed by gently flushing with warm water and syringe bulb.

-Store at room temperature. Keep out of reach of children and pets, avoid contact with eyes.

-Avoid oral consumption.

Cetirizine

Zyrtec

MOA of ceterizine:

Cetirizine is a low-sedating, long-acting H1-receptor antagonist that is a metabolite of hydroxyzine. Cetirizine competitively inhibits the interaction of histamine with H1-receptors, thereby preventing the allergic response.

Drug interactions for Zyrtec:

-CNS depressants: possible increase in sedation

A/E of zyrtec:

-drowsiness

-headache

Counseling for cetirizine:

-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.

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

Chlorpheniramine

Chlor-trimeton

Chlorpheniramine indication

allergic rhinitis

MOA of chlorpheniramine:

Chlorpheniramine specifically blocks the H1-receptor, which inhibits the action of histamine.

Drug interactions with chlorpheniramine:

-CNS depressants

-anticholinergic additive effects

A/E of chlorpheniramine:

somnolence

Counseling points for chlorpheniramine:

Avoid allergic triggers. Use nasal wetting solutions. Avoid alcohol and activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects. Take with full glass of water; may take with food if stomach upset occurs. Tablets are scored if needed for pediatric dose. Avoid use in elderly patients as risk of anticholinergic adverse effects may be higher.

Chloecalciferol:

vitamin D3

Clotrimazole

Lotrim AF

Counseling for clotrimazole:

-Wash and dry area before applying.

-For athlete's foot, allow shoes to dry between wearing (leather shoes may take up to 3 d to dry); most effective if applied in morning and at night.

-Change of socks several times daily to keep the foot dry.

-Avoid use of public facilities or use shower shoes in public showers.

-Avoid sharing towels, clothing, or shoes (as relevant for the site of infection).

-For jock itch, change to looser fitting boxer shorts instead of briefs to allow better air circulation.

-All topical skin infections are contagious; avoid skin-to-skin contact with infected area to prevent spread.

-Vaginal azole products may weaken latex condoms and diaphragms, suggest alternate birth control, or avoid sex and the use of tampons during treatment.

Colloidal oatmeal:

Aveeno

What is colloidal oatmeal used for?

eczema

A/E of colloidal oatmeal:

-local skin irritation

-inflammation

-dryness

Counseling on Aveeno:

-Do not use on broken skin (lacerated or burned) or on skin infections.

-Avoid contact with eyes; if contact occurs, flush with copious amounts of clean water until irritation subsides.

-Avoid falls after the use of the bath product by using a bathmat.

-To create bath, turn warm water faucet on full force and add product directly under the faucet to suspend the colloid in the water, agitating water to prevent lumping. Resuspend any product that settles to the bottom of the tub by stirring bath. Soak in bath approximately 15-30 min, more warm water can be added as necessary; in some conditions, soaking too long may overdry.

-Remove any lumps before draining bath to avoid clogging drain.

-After bathing, pat skin dry (do not rub) to retain a thin film of oatmeal colloid on skin.

Cromolyn

NasalCrom

Cromolyn indications:

allergic rhinitis

MOA of cromolyn:

Cromolyn reduces symptoms associated with rhinitis by producing mast-cell protective effects against antigen-antibody reactions (IgE-type) and blocking liberation of mediators of anaphylaxis, such as histamine.

A/E of cromolyn:

-sneezing

-burning

-stinging or irritation inside of nose

Counseling for cromolyn:

-Avoid allergic triggers.

-Use multiple scheduled doses daily instead of prn use; symptoms often require 3-7 d for initial effect and 2 wk for full benefit. Start 1-2 wk before allergen exposure if possible.

-For administration, bottle must be primed prior to first use or if it has not been used in >14 d.

-Patients should clear nasal passages by blowing nose prior to use. Press against outside of 1 nostril to close off. Employ the "nose to the toes" technique of tilting the head slightly downward to avoid overspray into the esophagus while inhaling to avoid bad taste.

-Aiming the spray slightly away from the nasal septum toward the ears can help minimize irritation and nosebleeds. Sniff gently as you pump the bottle.

-Do not blow nose for at least 15 min after use. Brief stinging or sneezing may occur immediately after use.