CHAPTER 26 Nonprescription Products
A. Nonprescription or over-the-counter (OTC) products are medicines that can be bought without a prescription. They are relatively safe and effective when directions on the label are followed and when used as the prescriber or health care professional directs.
C. Reasons consumers self-diagnose and use OTC products
D. There are more than 80 therapeutic categories of OTC drugs, ranging from acne drug products to weight-control drug products.
E. Common OTC products
II. Cough and Cold
A. The common cold may involve the nose, throat, sinuses, eustachian tubes (connects the ears to the throat), trachea (windpipe), larynx (voice box), and bronchial tubes (airways).
B. The cause of developing a cold is due to a viral infection, including rhinoviruses (most common), coronaviruses, adenoviruses, echoviruses, respiratory syncytial viruses (RSV), and coxsackieviruses.
C. In response to infection, the immune system triggers a series of events, including release of inflammatory cytokines (a group of proteins that help regulate inflammation, blood cell production, and immunity), such as interleukin-6 (IL-6), interleukin-8 (IL-8), and granulocyte-macrophage colony-stimulating factor (GM-CSF), fluid leakage (runny nose), mucous membrane swelling (stuffy nose), increased mucous production, and stimulation of sneeze and cough reflexes.
1. Symptoms usually appear about 1 to 3 days after exposure to a cold virus. Nasal symptoms can begin as early as 2 hours after exposure; cough and sore throat symptoms usually begin 10–12 hours after exposure to the virus.
2. Signs and symptoms may include runny or stuffy nose, itchy or sore throat, dry cough, facial pressure due to sinuses (hollow bones in the front of the face), slight body aches or a mild headache, sneezing, itchy, watery eyes, low-grade fever (less than 102 °F), and mild fatigue (tiredness).
D. Risk factors
1. Social activity
3. Seasonal changes
4. Environmental toxins
F. Pharmacological therapy
1. Pain relievers and fever reducers
(1) Acetaminophen (Tylenol)
(c) Analgesic-antipyretic of choice for children with viral infections or chicken pox (no risk for Reye syndrome)
(2) NSAID (e.g., aspirin, ibuprofen)
2. Decongestants help open swollen mucous membranes of the nasal passages so the individual can breathe easier.
(1) Oral decongestant pseudoephedrine (e.g., Sudafed)
(a) Considerations: alpha-adrenergic activity; avoid use in patients with cardiac disease, hypertension, etc.
(2) Nasal spray oxymetazoline 0.05% (Afrin), phenylephrine 0.5% (Neo-Synephrine)
d) Side effects
(1) Stinging, burning, sneezing, increased nasal discharge, drying of the nostrils, and altered taste may occur.
g) Counseling points
(1) Over time, decongestant nose drops, inhalers, and sprays can actually cause rebound congestion, which means the nasal passages are not able to function normally without using these medications.
(3) Decongestant nasal drops and sprays are not to be used for more than 3 days, which helps to stop the potential of nasal rebound.
a) Indications: symptoms like runny or stuffy nose, itchy or sore throat, sneezing, and itchy, watery eyes
(1) First-generation, nonselective antihistamines that cause sedation
c) Side effects
4. Cough syrups
b) Examples (Figure 26-1)
(2) If the cough is productive (brings up mucus), the ingredient guaifenesin can help break up the chest congestion (water intake is also important).
e) Counseling points
(1) Coughs associated with a cold usually last less than 2–3 weeks. If a cough lasts longer than 3 weeks, the patient should see a doctor.
A. Otic preparations (ear drops) are commonly used in adults and children and may be used to relieve pain, itching, and inflammation in the ear caused by ear infections, for example. Otic preparations can also be used to remove cerumen (ear wax) and to clear water from the clogged ear (ear drying aid).
E. Ear wax removal
F. Ear drying aid
G. Side effects
H. Counseling points
1. It is best to warm the ear drops to body temperature (37 °C or 98.6 °F) by holding the bottle in the hand for a few minutes and gently rolling the bottle before using the medicine. This helps to lessen the pain in the ear.
3. The earlobe is gently pulled up and back for adults (down and back for children) to straighten the ear canal.
4. The medicine is then dropped into the ear canal as directed, keeping the ear facing up for approximately 5 minutes to allow the medicine to coat the ear canal.
a) For young children and other patients who cannot stay still for 5 minutes, keeping the ear facing up for at least 1 or 2 minutes may be best.
6. Keep the medicine as germ-free as possible, do not touch the dropper to any surface (including the ear), and keep the container tightly closed.
7. To help clear up the infection completely, the patient should keep using this medicine for the full time of treatment, even if the symptoms have disappeared, and do not miss doses.
8. Ask a doctor before use if a patient has:
A. Ophthalmic products include eye drops and lubricants. They are commonly used to relieve redness, dryness, itching, and inflammation in the eye caused by seasonal allergies or from working in front of a computer, to name a few examples. Some ophthalmic products can also be used to rinse the eye of debris.
B. Ocular decongestants