Over the Counter Medications for Common Ailments and Possible Overdoses

1. Over the Counter Medications for common ailments and possible overdoses Rhynn Malloy, Cynthia Herrera, Katrina Karpowitch PGY-1 Pharmacy Residents Northwestern Memorial Hospital The speaker has no potential or actual conflicts of interest with this presentation

2. What can be treated? Pain The common Flu/Cold Heartburn/Upset stomach 2

3. Pain

4. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Ibuprofen (Advil, Motrin) Naproxen (Naprosyn, Aleve) Aspirin Uses: Fevers Rheumatoid arthritis/Gout/Osteoarthritis pain/inflammation Musculoskeletal pain/Bone pain Dysmenorrhea pain Migraines 4

5. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Contraindications : Peptic Ulcer Disease Renal/Kidney Disease Hypertension/Heart Failure Coronary Artery Disease (CAD) Cardiovascular Disease (CVD) Alternative if you have Peptic Ulcer Disease or increased bleeding risk: Celebrex 5

6. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Doses: Ibuprofen: 200mg every 4-6 hours as needed Max dose: 1,200mg in 24 hours Treatment >10 days not recommended Aspirin: 325mg every 4-6 hours as needed Max dose: 4,000mg in 24 hours Naproxen (sodium): 220 mg every 8-12 hours Max dose: 660mg in 24 hours 6

7. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Side Effects: Dyspepsia (indigestion) Ulcers Nausea Gastrointestinal bleeding Rash/Itching Kidney damage 7

8. Acetaminophen (Tylenol) Uses: Fevers Injury/Trauma pain Cramping, aches Contraindications: liver disease Doses: 325mg every 4-6 hours Max dose: 4,000mg in 24 hours Overdose = #1 cause of acute liver failure in the US 8

9. Insomnia

10. Melatonin Uses: Insomnia Limited evidence that it is effective Dose: 0.3mg to 5mg at bedtime Side effects: largely unknown 10

11. Valerian Root Uses: Insomnia Limited evidence that it is effective May take weeks of nightly use to be effective Dose: 400 -900mg at night Side effects: if withdrawn abruptly, may cause heart complications and withdrawal sympmtoms 11

12. Antihistamines Diphenhydramine Uses Insomnia Allergic reactions (skin rashes, hives) Congestion 12

13. Antihistamines Contraindications: Urinary retention Prostate enlargement Angle closure glaucoma Cardiovascular disease Patients of advanced age- may interact with medications and will increase fall risk 13

14. Antihistamines Doses: Diphenhydramine: 25-50mg before bed Max use : do not exceed 14 days of nightly use May develop tolerance in 2-3 nights 14

15. Antihistamines Side effects: Sedation extending into morning after Dry mucous membranes Elevated body temperature Constipation Blurred vision Urinary retention 15

16. Cold/Flu Management

17. Antihistamines Diphenhydramine Doxylamine Uses: Sinus and nasal congestion, allergy relief Insomnia 17

18. Decongestants Contraindications: Hypertension/Heart Failure Coronary Artery Disease (CAD) Cardiovascular Disease (CVD) Asthma Chronic Obstructive Pulmonary Disease (COPD) Alternative agents to use in hypertension: Antihistamines: desloratadine (Clarinex), fexofenadine (Allegra), cetirizine (Zyrtec) 18

19. Decongestants Doses: Phenylephrine HCl: 10mg every 4 hours as needed Max dose : 60mg in 24 hours Pseudoephedrine: 60mg every 4-6 hours as needed Max dose : 240mg in 24 hours Nasal sprays: Ephedrine 0.5%: 2-3 drops not more often than every 4 hours 19

20. Decongestants Side effects: Elevated blood pressure Palpitations, arrhythmias, fast heart beat Restlessness, insomnia Anxiety Rebound congestion Occurs within 3-5 days of continuous use 20

21. Antitussives and Protussives (Expectorants) Dextromethorphan (antitussive) Guaifenasin (expectorant) Uses: Cough related to post-nasal drip Chest congestion 21

22. Contraindications: Hypertension/Heart Failure Coronary Artery Disease (CAD) Cardiovascular Disease (CVD) Asthma, chronic bronchitis Chronic Obstructive Pulmonary Disease (COPD) 22 Antitussives and Protussives (Expectorants)

23. Antitussives and Protussives (Expectorants) Doses: Dextromethorphan: 10-20mg every 4 hours or 30mg every 6-8 hours Max dose : 120mg in 24 hours Guaifenasin (expectorant): 200-400mg every 4 hours Max dose : 2,400mg (2.4g) in 24 hours CAUTION : beware of combination products! 23

24. Antitussives and Protussives (Expectorants) Side effects: Drowsiness OR excitation, nervousness Dizziness Headache Stomach discomfort, nausea, constipation Respiratory depression in high doses 24

25. Heartburn

26. Heartburn-antacids Symptomatic treatment of heartburn and indigestion Tums, Milk of Magnesia, Maalox, Mylanta, Rolaids

27. Heartburn-antacids Things to watch out for: Drug interactions Constipation or diarrhea Nausea and/or vomiting Muscle twitching Confusion Irregular heartbeat

28. Heartburn-H2RAs Symptomatic Prevention or Treatment of acid reflux/peptic ulcer disease: Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine), Axid (nizatidine)

29. Heartburn-H2RAs Things to look out for: Drug interactions [Cimetidine] Diarrhea Abnormal heartbeat Flushing and/or sweating Nausea and/or vomiting Slurred speech Dosing: Famotidine: 10-20mg once to twice daily Ranitidine: 75-150mg once to twice daily Cimetidine: 200-400mg once to twice daily Nizatidine: 75mg once to twice daily **CAUTION in patients with kidney dysfunction**

30. Heartburn-PPIs Treatment for chronic acid reflux, GERD, and PUD Prilosec (omeprazole), Prevacid (lansoprazole)

31. Heartburn-PPIs Things to look out for: Nausea and/or vomiting Bone pain Sedation Muscle twitching Abnormal heart beats Diarrhea Dosing: Omeprazole: 20mg once daily Lansoprazole: 15mg once daily **CAUTION in patients with osteoporosis**

32. Nausea

33. Nausea Pepto-Bismol (bismuth subsalicylate) Symptomatic relief of upset stomach, nausea, indigestion, diarrhea Dramamine (meclizine) Symptomatic and preventive treatment of motion sickness

34. Nausea Things to watch out for with Pepto-Bismol Breathing problems Stomach bleed Hearing loss Aspirin allergy Dosing 30 mL every 30-60 minutes for maximum of 8 doses/day **DO NOT USE WITH STOMACH ULCERS**

35. Nausea Things to watch out for with meclizine: Urinary retention Closed angle glaucoma Dry mouth Drowsiness Flushing Dosing: 25-50mg one hour prior to traveling. Maximum dose of 50mg in 24 hours.

36. QUESTIONS?