Wrap Up: Key Points to This Blog

This blog is so full of information, that we have created a wrap up post to help our readers get the main points of it all:

1)Whether you are reading from a health care professionals prospective, or a student trying to avoid myths about over the counter medications, this blog discusses the processes of Sleeping Aids, Tagament, and Cough/Cold medications and how they work in the human body, allowing you to see just how a certain OTC medication might affect you. Make sure to note what take home points are best for you, whether you are a nurse or a patient.

2) Drugs such as creams/ointments, and herbals are considered OTC drugs, even though they are often overlooked. Safety with these forms of a drug also need to be considered.

3)Now more than ever, men and women of all ages are using sleeping aids to help them through hard times. One of the biggest mistakes a user of this over the counter drug can make is taking a second dose before the first kicks in. Note the "take home points" for both the general public, and nurse.

4)Tagamet in the elderly is so commonly used, many would not even realize it is for occasional use only. The process of how Tagamet works on the body may be lengthy and slightly difficult to understand; but as this blog states, the consequences, such as worsening existing conditions, is a big red flag that this over-the-counter medication should be taken seriously.

5)Cough and cold medications are popping up everywhere as the cold season hits this year, so learning that you can not mix a cough/cold medication with any other medication containing acetaminophen is a crucial point for readers to understand. Unfortunately though, cough and cold abuse is predominant in mainly high school aged kids no matter what time of year, as is seen in the video clip.

Photo source: http://images.google.com/imgres?imgurl=http://dangersofpolypharmacy.files.wordpress.com/2008/10/polypharm1.jpg&imgrefurl=http://dangersofpolypharmacy.wordpress.com/2008/10/14/what-is-polypharmacy/&usg=__0FR9b8_9Ghzi8JyBlOXoVAGrqzc=&h=500&w=500&sz=178&hl=en&start=35&um=1&tbnid=dOnrT8L-6i62dM:&tbnh=130&tbnw=130&prev=/images%3Fq%3Delderly%2Btagamet%26ndsp%3D21%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-SearchBox%26rlz%3D1I7DKUS_en%26sa%3DN%26start%3D21%26um%3D1

Wrap Up Continued: Responding to our readers questions

Many interested readers gave us their feedback, and now it is time for us to give them ours:

Katherine mentioned:

"interested in seeing further information about OTC misuse"

In response, I would like to go ahead and extend these links to you:
From the Center for Disease Control and Prevention: Poisoning in the United States Fact Sheet:

http://www.cdc.gov/ncipc/factsheets/poisoning.htm

From the World Health Organization: Inventions for Emergency Contraception and their misuse
http://apps.who.int/rhl/fertility/contraception/smcom1/en/

From the Environmental Protection Agency: Cough, Cold, Allergy, Bronchodailator for OTC Use
http://www.epa.gov/EPA-IMPACT/2005/July/Day-13/i13709.htm

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Joyr left a comment that mentioned:

"I have always been very careful with prescription meds but didn't think too
much about taking OTC meds, especially Tylenol and Ibuprofen."

Tylenol and Ibuprofen are very commonly misused OTC drugs, and you made a great point with mentioning them. Here is a link from the National Institute of Drug Abuse about the treatment of chronic pain and how those two OTC drugs are often misused in that instance:
http://www.drugabuse.gov/pdf/monographs/36.pdf

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Natalieunderoath commented:

"I didn't know a lot about that, that's good to know"

For our blog readers, especially those not in the medical field, this information can sometimes be overwhelming. Here is a link from the National Institute of Health website that allows you to explore tons of over the counter medicines and read simplified (not medical talk) versions of how they can cause harm if misused:
http://www.nlm.nih.gov/medlineplus/overthecountermedicines.html
______________________________

Pharmacology in Nursing 2009 wrote:

"I'm pretty sure I am currently misusing
Vicks vapor rub at night. I just huff it out of the jar for about 10 min. before
bed. I think we all forget that just b/c drugs are over the counter, they are
still drugs and can be harmful"

This is a great real life example of simple misuse that is normally overlooked. We encourage our blog readers to visit this FDA article covering Poisonous Plants to read on about the effects of Vick's Vapor Rub: http://www.accessdata.fda.gov/scripts/Plantox/Detail.CFM?ID=17952

______________________________

Patavia wrote:

"It does not change my perspective because I
am extremely cautious with all medication"

We always like to see people who are extremely cautious with drugs. You will make a great nurse!

__________________________________

highmedicinecost commented:

"I don't know if you were aware of the young high school girl who died because...[she] rubbed icy hot all over her body before and after practice. She died from massive vasodialation ...from an over the counter cream"

We appreciate your feedback on that story, and we have actually located the news video and placed it on our blog. You can find it by clicking here.

________________

Ashley made the point that:

"Well, I can add that people just love to self medicate, especially with OTC meds, Why?"

Besides the points you made on this issue, another reason is perhaps patients trust their health in their own hands rather than a doctors. Another theory might be that they know their parents, friends, relatives etc who have taken these over the counter medications and have been fine, whereas you will hear horror stories about those prescription drugs because they are "always in trials" or whatever people may say about them. Thanks for your input! Here is a great link to a story I found on the FDA's web page about that Robitussin you love so much: http://www.fda.gov/ohrms/dockets/ac/07/transcripts/2007-4323t1-Part2.pdf

______________________________________

Sarah commented that:

"If people are not able to find a solution from their doctor, then they will try to solve the problem on their own, which of course, usually doesn't turn out too well"

It is so true, especially with the health care issues being spoken of within the government right now, that may people do not even have insurance to go to a doctor in the first place. To play devils advocate, sometimes self medication turns out to work very well, its when the medication is misused that problems arise. Unfortunately, more times than not, self medication does end up having issues, causing illness and death. If you are interested in reading more, here is a great abstract I found from the CDC on the statistics of emergency room visits related to self medicating through over-the-counter drugs: http://www.cdc.gov/nchs/data/ad/ad372.pdf

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Antibioticmisusesucks made the point that:

"This will no doubt become of greater concern in the near future as the baby boomer generation is now starting to enter the age where this drug is necessary"

That is a great point. It is also a really big advantage with the possible decline of support for medical assistance for retired people, and elderly patients, that in America, over-the-counter drugs such as Tagamet are offered so that a solution can be created without a prescription.

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LiveLoveLena025 wrote in with:

"This only addresses that it is unsafe if the two medications you're taking have the same active ingredient. Does that mean that if they have different ingredients that it's not as harmful or not harmful at all?

What kinds of effects can happen if two cold/cough medicines are taken that have two different active ingredients?"

When mixing any two over-the-counter medications, it is important to review on websites such as the FDA

if mixing the ingredients in each is okay. You can also call your local pharmacy. It is equally important not to mix drugs containing the same ingredients, as well as making sure there are no interactions between mixing drugs with different ingredients. This link to eHow goes more into depth on that subject: http://www.ehow.com/how_2310994_select-otc-medication-cold-flu.html#at.

Here are the cases of side effects that can occur if two cough/cold medications are taken that have different active ingredients (the list contains the main active ingreidents in cough/cold medications and the effects of taking too much of them)

• "Antihistamines such as Benadry in extreme overdoses can cause increased heart rate, coma and seizures
• Decongestants such as pseudoephedrine can cause excitability and an increased heart rate
  
• Cough suppressants containing dextromethorphan can cause nausea, vomiting, drunken-like behavior, decreased breathing and coma" (source: http://www.kumed.com/default.aspx?id=4232)

. Photo source: https://web1.cybersharks.net/curriculumcore-com/_borders/question_mark_Animatio

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Introduction to OTC misuse: A patient and nurses prospective

Introducing Over-The-Counter drugs...

How did drug misuse begin? Before standards were put into place, over the counter drugs were not regulated by the government. After tampering with medications occurred, the government dealt with the situation by regulating packaging (hence it takes the strength of steel to get that lid off the Pepto Bismol.) There is no real specific time and place when misuse began-humans are not perfect; there is never enough time in the day to learn about all the interactions between drugs that can occur, and there certainly is not enough time to read the entire box concerning dosaging with the busy lives we lead. As our over the counter drugs have become more readily available, and as ingredients of the drugs in them have increased, misuse statistics have also seen a positive rise.

According to a recent survey, Americans are investing about five billion in OTC drugs every year. That's quite a big number for the average nurse conducting an assessment and asking the staple question "what medications are you on, or have taken today"?

More and more medications are moving from prescription to over-the-counter everyday, and while this may save the average buyer money, it also poses the risk of misuse among drugs. The FDA has placed on their website, a very helpful guide to assist the public on how to use over the counter drugs. This includes strategies such as how to properly read the labels, tips for parents administering dosage amounts to their children, how to use pain relievers safely, ect. In one specific example, such as Tylenol, which many Americans see as an everyday drug, acetaminophen poisoning can damage the liver to the extent that liver disease may occur(http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm133426.htm) Liver disease is very serious, but how odd is it that it is caused by misuse of an over the counter drug, which the public does not take very seriously?

Misuse is simply defined as "to use incorrectly" by Merriam-Webster dictionary. Abuse and misuse are not the same thing; abuse of drugs by the user is for the effects of getting "high", while misuse can simply be the situation of a mom, dead tired from lack of sleep due to her child being sick, accidentally giving three tablespoons instead of four.

As a nurse, misuse of over-the-counter drugs can be a point of education you can use with your patients in the crucial few minutes before they are discharged. Misuse can easily occur just by mixing a prescription drug with an OTC, which many patients will not consider before taking a Tylenol with Warfarin for example.

Take home points for the public:

• Use websites offered by FDA, EPA, and the NIDA to review how to properly use over the counter medications
• Make sure that "misuse" and "abuse" are noted as different-watch for abuse especially in the teenage population

Take home points for nurses:

• Patient education, patient education, patient education!
• Make sure to ask patients about any OTC drugs they may have taken. Keep them charted and in mind when you send the patient home with a prescription and instructions

This blog will hopefully be educational for both the public, and the nurse or nurse-in-training, by helping give everyday over-the-counter drug classes and how easily they can be misused and the effects of that misuse in the body.

Please take a moment to view the following video that depicts pharmacists "Top Picks for Over the Counter Drugs". Do you think its smart to run this news story without further detailing the terrible side effects that can occur from misuse?

Watch CBS News Videos Online

Sources: http://www.bio-medicine.org/medicine-news/Campaign-aims-to-simplify-OTC-drug-labels-1120-1/, http://www.merriam-webster.com/dictionary/misuse, http://www.medicinenet.com/acetaminophen/article.htmPhoto source:

http://images.google.com/imgres?imgurl=http://www.cartoonstock.com/lowres/for0528l.jpg&imgrefurl=http://www.cartoonstock.com/directory/d/drug_user.asp&usg=__CMhHF9CRQBTP50ZiUrmK_NGnoGI=&h=297&w=400&sz=31&hl=en&start=2&um=1&tbnid=Q3KyQXZnOV6_CM:&tbnh=92&tbnw=124&prev=/images%3Fq%3Dcartoon%2Bover%2Bthe%2Bcounter%2Bdrug%2Bmisuse%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-SearchBox%26rlz%3D1I7DKUS_en%26sa%3DN%26um%3D1

Movie source: http://www.cbsnews.com/video/watch/?id=4894144n&tag=contentMain;contentBody

An Over-the- Counter drug is still a drug

So what's the big deal if you misuse an over-the-counter drug? Yeah, so what if there are lots of hospitalizations every year? I'm sure many people have misused an OTC without suffering much of a consequence.

If misuse was not such a large issue, then why are large, well known groups such as "United Health Foundation", and "U.S. Food and Drug Administration" making such a big importance about this common act many Americans are guilty of?

The United Health Foundation wrote an article on a great way to remember the safest way to take an over-the-counter drug, by remembering: "Obey The Checklist". The UH Foundation makes the point that there "are over one hundred thousand hospitalizations each year due to the misuse of over the counter drugs" (UH Foundation).

The US Food and Drug Administration, although filled with endless amount of information about OTC and prescription drugs, warns about a usually overlooked non-prescription drug: ointments and creams. The FDA makes the point that after these medications cross the skin barrier, they will eventually enter your bloodstream.

Entering the bloodstream is a pretty big deal, so would this information make you want to double check that box with directions next time you apply an acne treatment, or a cream for those sore muscles after track practice?

Another category of seemingly forgotten OTC drugs, nutritional supplements, are mentioned in the American journal of Pharmaceutical Education article "Nonprescription Drug Therapy: Issues and Opportunities". The author, Covington, makes the point that the issues of self-medicating are endless, and include "polypharmacy involving prescription drugs, nonprescription drugs, and/or nutritional supplements". As a nurse, many patients will not include the "mood booster" nutritional supplement they took with their orange juice that morning, even though it still has just as big of a potential of causing a drug interaction as the Tylenol they mentioned they took at lunch.

The fact that these cremes, rubs, herbal supplements are over the counter means one thing: cheaper. Patients are always looking for ways to get their medications at a cheaper cost to them. If an over the counter steroid cream can provide the same therapeutic effects as the $100 prescription, tell your patient. Though the dangers are mainly stressed in this entry, it is also good to stress that over the counter drugs can be just as therapeutic as prescription, when used correctly.

Take home points for the public:

• Understand that herbals are not regulated by the FDA and therefore do not list as much information on the bottle as does a regulated over the counter drug.
• Remember that all herbal medications, as well as ointments, creams, eye drops, shampoo (if medicated), rubs etc are all drugs, even when bought over the counter.
• Tell your doctor about every over the counter medication you have taken-they could potentially cause drug interactions.

Take home points for nurses:

• Chart every over the counter drug your patient mentions to you. If you suspect that they are simply forgetting an OTC drug they have taken, remind them by bringing up commonly overlooked ones, such as tylenol, or vicks vapor rub.
• Patient teaching: remind your patient that over the counter drugs can mix with their prescriptions. Remind your patient to call and ask the doctor before taking anything-herbal product, muscle rub, etc.
• Over the counter drugs are not always bad-if the same over the counter drug can offer the same therapeutic effects as a prescription, let your patient know, they will comply much more when the cost of a medication is cheaper.
  

Does this change how you see the potential hazards of over-the-counter medications, especially those ointments, creams, and nutritional supplements that many Americans do not consider drugs at all and rarely mention to health professionals?

Please watch the video below about a track runner, Ariel, who tragically passed away from innocently misusing Asprin and muscle rubs
Watch CBS News Videos Online

Sources: http://www.unitedhealthfoundation.org/otc.html,http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049367.htm,

Covington, Initials. (2006). Nonprescription Drug Therapy: Issues and Opportunities. The American Journal of Pharmaceutical Education, 15(70), 137.

Picture source:http://bigriverwholesale.com/zencart2/images/MusRublogo.gif

Video Source: http://www.cbsnews.com/video/watch/?id=2908984n&tag=related;photovideo

Sleeping Aids: Commonly misused OTC drug class

The first of many common OTC drug groups are the sleeping aids. Many college students are fans of Nyquil to get them to finally fall asleep after a three day study binge on energy drinks and coffee. As a nurse, it might be helpful to consider that your patients, such as the stressed businessman may also be using this non-prescription sleeping aid.


Due to hard economic times, familial problems, and other various issues, more and more people are turning to over-the-counter sleeping aids to help them get some shut eye.

The main ingredient in OTC sleeping aids is antihistamine. Histamine is usually released in situations that require one to be attentive and ready to act. Antihistamine therefore does just the opposite, it makes one sleepy and less alert. Antihistamines block histamine and the alertness and allergic inflammations that histamine causes. Some sleep aids that utilize antihistamine include diphenhydramine and doxylamine. Some commonly recognized brand names of diphenhydramines are Sominex, Nytol, Tylenol PM, Benadryl, and Compoz.

Brand names of some doxylamines include Unisom and Nighttime Sleep Aid.

Another ingredient that is sometimes used in sleeping aids is melatonin, which is said to regulate our Circadian rhythms which helps let our bodies know when to sleep and when to wake up.

As with many OTC drugs, it is not uncommon to see misuse with sleeping aids. The most common problem occurs in those who have insomnia. These people try to self-medicate rather than going to see a doctor about their problem. OTC sleeping aids target short-term sleeping problems, and don't focus on insomnia. People who buy over the counter sleeping aids often end up developing a tolerance for them. They end up taking more than the directions suggest and end up with problems such as extreme drowsiness, dizziness, decreased mental awareness, and lack of coordination. These side effects can pose major problems if the person has to drive, operate machinery, or perform another dangerous task the next day.

Other problems relating to misuse are drug dependence (person can not sleep without taking the drug) and rebound sleep problems (persons problems become more intense after stopping taking the drug).

Another problem with misuse is when people taking their sleeping medication and do not give it enough time to work. They often will consume another dose before the first has had time to take effect. This is dangerous and can pose many side effects, including depression of the medulla-center of the brain that controls many vital body functions such as control over respiratory rate.

Take home points for the public:

• Never take more than the recommended dose of an OTC sleeping medication
• Do not take a second dose if the effects of the first dose take too long to kick in
• Do not mix alcohol with sleeping aids
• Do not use a sleeping medication as a fix for insomnia

Take home points for nurses:

• Look for signs that your patient might be sleep deprived, then question if they have recently been using an over the counter sleep medicaiton
• Check for signs of otc sleeping aid use: dizziness, nausea, vomiting, blurred vision, constipation, feeling "groggy" or "hung over"
• Teach patients to never mix alcohol with sleeping aids, and warn them that it may cause respiratory depression
  

Are you guilty of using of second dosing on a sleeping aid because you are impatient about its effects?

Sources: http://drugs.about.com/od/overthecounterdrug/a/OTC_sleep_aids.htm, http://helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm, http://www.selfgrowth.com/articles/Do_OTC_Sleep_aids_work.html, http://www.nytol.com Picture source: http://images.google.com/imgres?imgurl=http://www.cartoonstock.com/lowres/hsc1405l.jpg&imgrefurl=http://www.cartoonstock.com/directory/h/hibernated.asp&usg=__HDxDXpxDzt2OJ_TSbDFv2gHbhxc=&h=320&w=400&sz=33&hl=en&start=2&um=1&tbnid=EiLbXQyNlm1SnM:&tbnh=99&tbnw=124&prev=/images%3Fq%3Dcartoon%2Bsleep%2Bmedication%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-SearchBox%26rlz%3D1I7DKUS_en%26um%3D1