OTC drugs (O-Med)

  1. Components of Mouthwashes
    • ®antibacterial
    • ®anti-inflammatory
    • ®pain relief
    • ®cleansing & deodorizing
  2. MOUTHWASH Properties + Ingredients: Antibacterial-antiseptic

    - fxn?
    - ingredients
    Reduce number of bacteria & fungi

    ®Phenols, essential oils, halogens, biguinides, quaternary amonia

    ®Oxygenating agents against anaerobic bacteria
  3. MOUTHWASH Properties + Ingredients:
    Anti-inflammatory- astringent 

    - fxn?
    - ingredients
    Cause local vasoconstriction and reduce tissue edema

    ®Alcohol, zinc chloride, zinc acetate, alum, tannic acid, acetic acid, citric acid
  4. MOUTHWASH Properties + Ingredients: Pain relief- anodynes

    - fxn?
    - ingredients
    Alleviate pain and soreness

    ®Phenol derivatives, oil of wintergreen and eucalyptus oil
  5. MOUTHWASH Properties + Ingredients: Cleansing & deodorizing - detergents

    - fxn?
    - ingredients
    Degrade bacterial cell walls and also wash away microorganisms (Sodium laurel sulfate)   

    Neutralize odor from decomposing oral debris (Chlorophyll)
  6. MOUTHWASH Properties + Ingredients: Buffers

    - fxn?
    - ingredients
    Reduce the pH change resulting from bacterial metabolism

    ®Sodium perborate and sodium bicarbonate
  7. Components of OTC aka covering Agents
    • 1. anesthetic
    • 2. lubrication
    • 3. antiseptic
    • 4. atringent

    Topical oral agents aka "covering agents" for sores and irritations
  8. Anesthetic
    ®benzocaine, lidocaine, dyclonine
  9. Lubrication
    ®sodium carboxymethyl cellulose, propylene glycol, hydroxypropyl cellulose, glycerin
  10. Antiseptic
    ®ethyl alcohol, salicylic acid, benzyl alcohol, phenol, K iodine, povidone iodine, benzalkonium chloride, benzethonium chloride, stearyl alcohol, cetyl pyridium chloride (CPC), benzoin tincture
  11. Atringent
    ®sugar gum, tannic acid, zinc chloride
  12. Examples of topical anesthetic agents
    • Benzocaine alcohol Free
    • Benzocaine and Alcohol
    • Benzocaine & Eugenol
    • Benzocaine & Menthol
    • Benzocaine & Phenol
    • Dyclonine
    • Lidocaine
  13. Orabase
    - OTC topical covering agent

    ®an emollient paste of Na carboxymethyl cellulose in a plasticized hydrocarbon gel

    available with benzocaine to provide relief; they may be compounded with other agents for better mucosal drug delivery
  14. Zilactin
    - OTC  topical covering agent

    ®a film-forming liquid composed of a hydroxypropyl cellulose and benzyl alcohol

    available with benzocaine to provide relief; they may be compounded with other agents for better mucosal drug delivery
  15. Orabase Soothe-N-Seal
    OTC  Topical Covering Agents

    a mucoadherent compound with Na hyaluronate (healing), glycyrrhetinic acid (anti-inflammatory) and aloe vera (soothing)
  16. Debacterol
    OTC Topical Covering Agents

    ®sulfuric acid & phenol
  17. Mucoadhesives

    - what is it?
    - Rx examples
    - targeted to chemo or radiation-induced stomatitis as well as for other drug delivery

    • Examples:
    • - GelClair® oral gel
    • - Carafate® (sucralfate)
    • - Kepivance™ (keratinocyte growth factor, palifermin)
  18. GelClair® oral gel

    used for?
    - mucoadhesive (targeted for chemo or radiation-induced stomatitis)

    - contains PVP (polyvinylpyrrolidone) and sodium hyaluronate in a liquid gel – powder reconstituted w/ water to make oral suspension
  19. Carafate® (sucralfate)

    - used for?
    - Rx?
    - mucoadhesive (targeted for chemo or radiation-induced stomatitis)

    - oral suspension (1 g/10 mL)
  20. Kepivance™ (keratinocyte growth factor, palifermin)

    - used for?
    - rx?
    - mucoadhesive (targeted for chemo or radiation-induced stomatitis)

    - powder reconstituted for IV injection
  21. Lip balms

    - uses?
    - ingredients?
    ®Used for dry/cracked lips

    ®Have many ingredients: beeswax, petroleum jelly, menthol, camphor, scented oils, etc; may contain sunscreens (oxybenzone, dimethicone)
  22. frequent uses of lip balms and lip licking may cause what?
  23. Dry Mouth Products (general categories)
    • saliva substitutes
    • saliva stimulants
    • sialogogue agents
    • salivary gland protective agents
  24. Saliva Substitute

    - ingredients
    • 1. Carboxy methyl cellulose & Hydroxymethyl cellulose
    • 2. Mucopolysaccharide
    • 3. Glycerate polymer
    • 4. mucin
    • 5. xylitol
  25. saliva substitutes:Carboxy methyl cellulose & Hydroxymethyl cellulose

    • Examples:
    • ®Moi-stir spray & liquid
    • ®Salese liquid
    • ®Saliment aerosol
    • ®Saliv-aid liquid
    • ®Salivart aerosol
    • ®Oralube liquid
    • ®Xerolube spary
    • ®Optimoist spary and drops which also contains fluoride, calcium and phosphate
    • ®Oasis spray and mouthwash
  26. saliva substitutes:Glycerate polymer
    ®Oral Balance gel also contains lactoperoxidase enzyme system

    ®Other Biotène products
  27. saliva substitutes: Mucin

    - examples
    - Orthana spary and lozenges
  28. saliva substitutes: Xylitol Products

    - examples
    • - Xylomelt
    • - Xerostom
    • - Mighteaflow (also has catechins from tea plant)
  29. saliva stimulants
    - Chewing gums (Xylitol, Biotene)

    - Oramoist discs

    - Parasympathomimetic (cholinergic) herbal remedies (Pilocarpus jaborandi leaves, Narcissus pseudonarcissus (daffodil) bulbs)
  30. sialogogue agents

    - used for?
    - Rx?
    - For patients w/ severe xerostomia require medical tx

    • Examples:
    • - Pilocarpine (Salagen) 5 mg
    • - Cevimeline HCL (Evoxac) 30 mg
    • [There are contraindications to the use of these agents]

    • Bile secretion-stimulating drug (cholagogue)
    • - Anethole trithione (Sialor) --> Serious side effects
  31. salivary gland protective agents

    - example
    - fxn
    Amifostine (Ethyol)

    drug that protects against the damage of radiation and is the first drug to be approved by the FDA for the treatment of patients with head and neck cancers receiving radiation therapy
  32. hypogeusia
    diminished taste seen in pts w/ dry mouth
  33. dysgeusia
    diminished taste seen in pts w/ dry mouth

    phantom tastes (metallic, sour, bitter, foul)
  34. Burning Mouth Syndrome

    - what is it?
    - duration?
    - clinical and lab findings?
    - clinical presentation
    - population?
    - associated w/ what dz?
    - Burning sensation in the tongue or other oral sites (like after biting into hot pepper)

    • - Burning may be intermittent or continuous
    • - absence of clinical and laboratory findings

    - Pt presents w/ multiple oral complaints (Burning, dryness and taste alterations)

    - More in women, especially after menopause

    - Sometimes associated w/ type 2 DM, anxiety & depression, deficiencies in vitamins and nutrients
  35. BMS association w/ supertasters

    - % Population born as "supertasters"
    - what is it?
    - population?

    - An unusually high number of taste buds = ability to taste phenylthiocarbamide “PTC” = bitter

    - Women > men
  36. Trends of supertasters

    - super-perceivers of?
    - more sensitive to?
    - prone to what?
    ®Supertasters are also super-perceivers of oral pain (alcohol & capsaicin)

    ®Supertasters are more sensitive in touch responses (fatty foods)

    ®Supertasters are more prone to dveloping BMS
  37. BMS: Taste Receptors
    Receptors found in taste buds throughout tongue, soft palate, pharynx, larynx, uvula, epiglottis       and the beginning of esophagus ®Tongue is innervated by V, chorda tympani of VII (ant 2/3), IX and XII (post 1/3) ®Soft palate, pharynx, larynx, uvula are innervated by the superficial petrosal of VII®Epiglottis & 1st third of esophagus is innervated by XTaste buds are surrounded by a         basket-like collection of pain neuronsCranial nerves transmit taste information from these sites to brain stem
  38. BMS – Role of peripheral
    ®Many BMS patients have phantom tastes or loss of certain tastes  

    ®Because taste inhibits oral pain, taste dysfunction may contribute to altered sensations
  39. BMS – Role of Central Systems
    ®Loss of pain inhibition? Chorda tympani, trigeminal (V) & glossopharyngeal (IX) nerves all implicated

    ®Dysfunction in central dopaminergic system – protective effect of estrogen…
  40. BMS Causes
    • ®Aging
    • ®Menopause (Loss of estrogen effect)
    • ®Dry mouth (Sjögren's syndrome, Chemotherapy or radiation therapy)
    • ®Cranial nerve injury (Trauma, neoplasms, Bell’s palsy)
    • ®Psychiatric conditions (Depression, anxiety,   eating disorders)
    • ®Nutritional deficiencies (B1, zinc, copper)
    • ®Medications (ACEI (timing?)
    • ®Oral diseases (LP, Candida, viral infxns, periodontitis)
    • ®Systemic conditions (Liver & renal disease)
  41. BMS Management (general)
    • 1. benzodiazepines
    • 2. SSRI antidepressants
    • 3. Anticonvulsants
    • 4. Alpha lipoic acid
    • 5. Topical tx
  42. BMS Management- Benzodiazepines

    ®Clonazepam (Klonopin)- 0.25 to 2 mg/day

    ®Chlordiazepoxide (Librium)- 10 to 30 mg/day
  43. BMS Management- SSRI antidepressants

    ®Paroxetine (Paxil)- 20 mg/day x 8 wks

    ®Sertraline (Zoloft)- 50 mg/day x 8 wks
  44. BMS Management-Anticonvulsants

    - Rx
    ®Gabapentin (Neurontin)- 300 to 1,600 mg/day
  45. BMS Management- alpha lipoic acid

    - 600 mg/ d x 2 mo
  46. BMS Management-Topical tx

    Clonazepam- Wafers 1 mg, 3 min tid

    • Capsaicin
    • - Hot pepper & water 1:2 dilution
    • - Rinse w/ 1 teaspoon; increase strength to 1:1 dilution
  47. what % of adults take dietary supplements?

    what % believe that supplements help live longer?
    ®48% of US adults take a dietary supplement

    ®36% believe that supplements can help them live longer
  48. ®Dietary Supplements Health & Educational Act (DSHEA) passed in 1994
    ®Dietary Supplements are regulated similarly to foods

    ®Exemption from premarket safety & efficacy research
  49. Most commonly used supplements

    - 2 categories
    - Name 5 that have scientific evidence of efficacy
    • 10 Multivitamins & minerals 
    • - Multivitamins, Vit E, C, B12, A, D
    • - Ca, Mg, Zn, folic acid

    • 10 Herbal supplements
    • - Echinacea, ginseng, gingko biloba, garlic, St. John’s wort, peppermint, ginger, soy, chamomile, kavav kava

    - 5 of these (ginkgo, garlic, St. John's wort, soy, and kava) have scientific evidence suggesting efficacy

    - Concerns over safety and a consideration of other medical therapies
  50. Gingko biloba (Gingko biloba)
    - Evidence suggests effectiveness against dementia

    - Although has mild effect on PVD, no good evidence for claims of: Erectile dysfunction + Cerebrovascular ischemia

    - Reports of anti-platelet activity causing spontaneous bleeding; also GI complaints, headaches, allergic rxns

    - Interacts w/ MAOI, ASA, anti-PLT drugs & thiazide diuretics
  51. Garlic (Allium Sativum)

    - main use?
    - evidence of reduction of?
    - no support for what other claims?
    - side effects
    - caution w/ what other drug?
    ®Mainly used for hyperlipidemia

    ®Evidence shows 4-6% reduction in cholesterol levels (17-32% w/ statins)

    • ®No support for other claims:
    • - Hypertension
    • - Protective against gastric CA (antibacterial compound allicin)

    ®Reports of increased risk for bleeding; also GI symptoms, allergy (contact dermatitis, asthma, rhinitis, urticaria)

    ®Caution with anti-platelet drugs
  52. St John’s Wort (Hypericum perforatum)

    - uses?
    - efficacy studies?
    - adverse effects?
    - drug interactions?
    - for mild to moderate depression

    • No good support for:
    • - Wound healing
    • - Anti-inflammatory & analgesic effects

    ®Causes GI symptoms, dizziness, confusion, tiredness, sedation, photosensitivity, inhibition of sperm motility

    ®Many drug interactions due to interference w/ liver drug metabolism
  53. Soy (Glycine)

    - uses?
    - evidence?
    - no good evidence for?
    - adverse side effects?
    -  for tx of menopausal symptoms and for lowering cholesterol

    - Evidence shows a 4-5% reduction in LDL

    - No good evidence for tx of hot flashes

    - Concern for long-term estrogen effects
  54. Kava-kava (piper methysticum)

    - uses?
    - no good evidence for?
    - long term concerns?
    ®Used as a sedative, relaxant or for its euphoric effects in the islands of South Pacific

    ®A small benefit for tx of anxiety

    ®Case reports of severe hepatotoxicity

    ®Combination w/ benzodiazepine may cause semicomatose state
  55. Echinacea (Echinacea pallida, E. Purpurea, E. angustifolia)

    - uses?
    - efficacy studies?
    - adverse effects on what population?
    - contraindications?
    - drug interactions?
    - herbs

    ®Immune stimulant®Used for common cold, URI, lower UTI®Studies inconclusive®Rxn in people allergic to         sunflower seeds®Contraindicated in multiple sclerosis, HIV infection and tuberculosis®No known drug interaction
  56. Ginseng (Panax ginseng)

    - uses?
    - interactions?
    - drug interactions?
    ®Used for physical & cognitive performance

    ®Claims of anti-cancer and immunomodulatory effects

    ®Has androgenic effects

    ®Interacts w/ warfarin and other anti-coagulants, MAO inhibitors (Phenelzine)

    ®Not to be used w/ stimulants, antipsychotic drugs or hormones

    ®Reports of excessive arousal & hyperactivity
  57. Peppermint (Mentha piperita)

    - uses?
    - efficacy studies?
    - side effects?
    • ®Used for tx of IBS
    • ®Trials suggest some benefit but no definitive conclusion
    • ®Infrequent and mild side effects
  58. Ginger (Zingiber Offcinale)

    - uses?
    - efficacy studies?
    - side effects?
    - drug interactions?
    ®Used for nausea

    • ®Questionnable effect on post-operative nausea
    • ®May have some efficacy in motion sickness and chemotherapy-induced nausea

    ®No good evidence for:Thrombosis, Rheumatic & musculoskeletal diseases

    ®Reports of contact dermatitis but no other side effects®Caution w/ anti-platelet drugs
  59. Chamomile (Matricari recutita)

    - uses?
    - efficacy studies?
    - safety?
    - side effects?
    • ®Used for sleep disorders, (mild sedative), anxiety and GI problems
    • ®No good evidence for any
    • ®Believed to be generally safe
    • ®Some reports of serious allergic rxns
  60. Adverse reactions to herbs are due to...
    inherent toxicity, overdose, drug-herb interactions & allergic responses
  61. General herb efficacy
    there are over 20,000 herbal products in this country. There is limited evidence to support the efficacy of even the top 10 herbs, and there is far less evidence for the rest
Card Set
OTC drugs (O-Med)
D3 O-Med