over the counter drugs and herbals

  1. How many cases of tylenol overdoses are there each year
  2. What is the maximum dose for tyelnolper day
    4 grams with a healthy liver
  3. extra strength tylenol is how many mg per tablet?
  4. Regular tylenol is how many mg per tablet
  5. Its easy for the elderly to overdose on tylenol which causes
    liver failure
  6. Tylenol is the number one over the counter drug used for
    arthritis, fever, chills, and body aches
  7. _____ of Americans use and OTC every 2 days
  8. ____ of all medications administered are OTC
  9. most common OTC drug is
    ASA (Aspirin) keep platelets from clotting, relief of inflammation and pain.
  10. 2nd most common drug is
    tylenol for fever, aches, but can cause hepatotoxicity with large doses; over 4g a day
  11. common errors with OTC drugs include:
    • self dosing or overdosing. Client may not be aware of their own metabolism, body chemistry, kidney function or liver function.
    • mixing herbals with OTC drugs can cause an increase or decrease in absorption
    • taking meds with or without food such as grapefruit juice can increase absorption in the stomach causing higher or toxic levels of drugs released into the blood stream.
    • interactions with other meds the client is on
    • using OTC drugs in the wrong route. ex glycerin suppositories
    • trade name confusion- using the wrong drug for the wrong complaint.
  12. education for clients taking OTC drugs include
    • time and correct dosage
    • correct route and usage
    • Don't take oral OTC drugs with grapefruit juice and other Rx meds.
    • Take all NSAIDs with food (ibuprofen (motrin), naprosyn (Aleve)) to prevent GI bleeds
    • Stop any herbals and ASA (aspirin) one week prior to surgery
    • supplements such as creatinine and protein can be hard on the kidneys, if you have trouble urinating see a doctor and stop all herbals immediatly
    • tylenol should not be taken if they have liver disease.
  13. doasge forms include
    • OTC are usually oral, nasally, or topical
    • forms include: creams, liquids, syrups, pills and capsules
    • The strength of an OTC is half the strength of a perscription to prevent overdosing.
  14. FDA classifies herbs as
    "dietary supplements"
  15. Other then Phytomedicines herbs include:
    botanicals, neutraceuticals, vitamins, and dietary supplements.
  16. Problems with herbs are
    • herbs are not standardized except in Germany. The strength, method of delivery, and half lives vary depending on the dosage, delivery, and amount of binders
    • most herbs except ginger are contraindicated in pregnancy
    • there are not very many randomized trials so they may not be safe
  17. common myth about herbs is
    herbs are not medicines
  18. more then ______ americans use herbal supplements
    28 million
  19. Billberry (huckleberry)
    route, dosage, frequency
    side effects:
    • route, dosage, frequency: oral, 60mg-240mg of extract, bid or tid
    • indications: relaxes smooth muscle, used for simple diarrhea.
    • side effects: inhibits platelet congregation, increases coagulation time, interferes with iron absorption.
    • education: should not be used with aspirin, anticoagulants, fish oil, garlic, ginger, ginko biloba.
    • contraindication: pregnancy
  20. Black Cohosh (black snake root, squaw root)
    route, dosage, frequency
    side effects:
    • route, dosage, frequency: oral form, 40mg per day
    • indications: used for PMS, post and perimenopausal symptoms
    • side effects: causes hypotension, bradycardia, and can promote abortion
    • education: should not be used in pregnancy
    • contraindication: antihypertensives
    • native americans use a topical treatment for snake-bites
    • stimulates estrogen production
  21. Echinacea (American purple coneflower)
    route, dosage, frequency
    side effects:
    • route, dosage, frequency: capsule, tablet, lollipops, lozenges, tea, tinctures, extracts. 3.5% echinoside, 380 mg capsules tid
    • action: stimulates tumor necrosis factor, interferon, and activates T lymphocytes and macrophages to fight disease and infection, anti-oxidant
    • indications: boost immune system. fight influenza
    • side effects: heptatoxicity, jaundice
    • contraindication: pregnancy, HIV or immunosuppressed clients, MS, TB, allergies to sunflowers
  22. Garlic (stinking root, most widely researched herb)
    route, dosage, frequency
    side effects:
    • route, dosage, frequency: dried powder, capsules, fresh bulbs, antiseptic oil, fresh extract, 5000mcg of total allicin, or 10mg aliin daily
    • indications: reduces triglycerides and cholesterol, treatment of mile hypertension, anti-bacterial salve, reduces risk of stroke.
    • side effects: gastric distress, bad breath, inhibits platelet aggregation
    • education: should not be used in high doses with aspirin, coumadin, ginko biloba, billberry, or ginger as it prolongs bleeding
    • contraindication: pregnancy, GI bleeds, peptic ulcers, and other bleeding disorders
  23. Ginger (the root of the ginger plant)
    route, dosage, frequency
    side effects:
    • route, dosage, frequency: tea, powdered, 500mg capsules, fresh ginger root, canddied root, 500mg - 1000mg a day
    • indications: anti-emetic, digestion aid, anti-inflammatory for osteoarthritis, muscle pain. Used for motion sickness and vertigo. 500mg-1g every 4 hours during travel.
    • side effects:headache, anxiety, insomnia, tachycardia, hypertension, asthma attack, thinning of the blood, GI ulcers
    • contraindication: pregnancy, GI bleeds, patients on anticoagulants
  24. Ginkgo Biloba (EGB 761, GBE)
    route, dosage, frequency
    side effects:
    • route, dosage, frequency: capsules, tablets, nutrition bars, sublingual sprays, 120-160mg per day
    • indications: relief of organic short term memory loss, peripheral vascular disease, depression, tinnitus, vertigo, early dimentia
    • actions: mild anticoagulant, antioxidant, protects the brain from effects of hypoxia, increases cerebral circulation used alot by students for studying/concentration.
    • side effects: allergy to urushiol (related to poison ivy) = itching, restlessness, headahe, GI upset, diarrhea
    • contraindication:Patients on anticoagulants, ASA, in pregnancy, children, prior to surgery, clients with bleeding disorders.
  25. assessment includes:
    • a history of what OTC drugs the client is using and a list of their current medications. Do they see multiple doctors.
    • Do they understand the side effects of their drugs and the different drug interactions.
  26. nursing diagnoses include
    • knowledge deficit
    • potential for drug interactions
    • potential life threatening side effects
  27. elderly risks are
    • the baby boomers with 5,000 people per day turning 65
    • rate of absorption may be slower for PO drugs due to slow GI motility and lower concentration of gastric acids
    • distribution: a deacrease in muscle mass and an increase in body fat causes a depot for lipid soluble drugs
    • meabolism: liver function is diminished causing slower metabolism which can increase the half life of drugs
    • excretion: renal function starts to decline in early adulthood. toxicity due to renal function the number one cause of adverse events in the elderly.
    • 40% of all elderly paitients fail to take their meds as perscribed.
    • multi-dosing encourage your patient to get a pill box with times and days on it and set up their meds on sunday for the whole week.
    • vision problems? Can they read the labels on their meds? make a sheet with large enough writing to put on the cabinet or refrigerator so they have instructions and schedules for their drugs.
    • 75% of all noncompliance in elderly is intentional. many elderly take 20 pills a day.
Card Set
over the counter drugs and herbals
over the counter drugs and herbals