Self-Care
Over-the-Counter Products, Herbal Therapies, and Drugs for Health Promotion
Objectives
Key Terms
alternative medicine (ăl-TĔR-nă-tĭv, p. 60)
complementary medicine (kŏm-plě-MĔN-tă-rē, p. 60)
health promotion (HĔLTH pră-MŌ-shun, p. 67)
herbal (ĔR-băl, p. 61)
integrative practices (ĬN-tě-grā-tĭv, p. 60)
http://evolve.elsevier.com/Edmunds/LPN/
Overview
When we think of patient drugs, we often forget that many of the drugs patients use are those they buy in drugstores because they learned about them from their friends, read about them in magazines or saw a television ad. More than ever before, people are learning about how to care for themselves and are more likely to purchase over-the-counter (OTC) products. Health care remedies not prescribed by health care providers also did a booming business in the United States in 2007; Americans spent $18 billion on nonprescription remedies. The majority of drugs that patients buy and use are OTC. What is safe for patients to take? What do they need to know about OTC products? What products should they take to keep them well? Can they believe the articles and stories about “wonder” drugs they can get without a prescription that promise such good results for chronic problems? How can you answer their questions?
Documenting Patient Health Care Practices
It is important for you to be familiar with the many nonprescription products now available to patients. Many of these products contain chemicals that are useful in treating common health problems. Nurses should be familiar with these products, so that they can help patients choose the safest product for their current health concerns, problem, or illness. Some of the active chemicals in these products may make existing medical problems worse or interact with a patient’s prescribed medications.
Always ask about OTC medications that patients may be taking when you ask about their drug history. Patients often neglect to tell their providers about these products because they may regard them as harmless and not a “real drug.” Many Americans consider herbal or OTC products to be safe because they are so easily available. But they may not be safe for all patients. Ask patients to bring questionable products to the attention of the patient’s physician or health care provider.
It is also important to have patients bring in all herbs or drug remedies they are using so that what they are taking may be accurately recorded as patients often do not know the active ingredients or effects of natural medications they are taking. Seeing products in their original bottles or boxes gives more information that might be needed to tell if the products are safe. This action may be very helpful in preventing drug interactions or complications.
Patients who rely on complementary and alternative medicine (CAM) may be taking alternative products (herbs, supplements, or other drugs) instead of prescription drugs because of the cost, or they may use such products in addition to prescription drugs in a complementary way. When asking a patient about the use of CAM, do not make judgments about these treatments. This approach is important if you wish to have patients trust you enough to tell you the truth about what health regimens they are following or what herbal and OTC products they are taking. Understand that patients who use these different treatments do so for many reasons:
• They have tried regular treatments without success.
• The regular treatments had undesirable side effects.
• There is no known therapy that will cure their problem, but they keep searching for one.
• Other people they trust in their family or community have told them about the product.
• Regular treatment violates the patient’s religious or spiritual beliefs.
Over-the-Counter Medications
The role of OTC agents in health care today is growing, because there are now more people who are better educated and believe they should take an active role in their own health care. The Nonprescription Drug Manufacturers Association estimates that more than 100,000 products are now available over the counter. These products contain one or more of approximately 700 active chemicals and come in a variety of dosage forms, sizes, and strengths. The sales of OTC products total more than $20 billion a year.
Nonprescription medications, or OTC products, are defined as drugs that are thought to be safe and effective for people to use without instructions from a health care provider about how to use them. OTC products differ from prescription medications in five ways:
The most common categories of OTCs are similar to those available by prescription. These include laxatives, peptic acid disorder products (antacids, H2 receptor antagonists), analgesics, cough and cold products (antihistamines, decongestants, expectorants, antitussives), vaginal antifungals, stop-smoking products, and topical steroids. Also, many drugs that were once available only by prescription have now been given OTC status although frequently in lower dosages.
OTCs are sold in pharmacies, grocery stores, gas stations, and many other places. Less than one half of all OTC products are sold in pharmacies. Because there are so many different names and versions of these products, it is important to learn the generic drug name instead of just the product (trade) name. Many of these products have multiple ingredients. The cost of these combination products can be more than buying all of the ingredients singly, so it is important to check out commonly used products for price comparisons.
Product Labeling
The U.S. Food and Drug Administration (FDA) requires that OTC product labels contain important information in a manner that a typical person can read and understand. Drug companies are required to use a standard labeling format for all OTCs sold in the United States. Key information, beginning with active ingredients, followed by purposes, uses, warnings, and directions, is placed in the same order on all OTC packages in an easy-to-read format. Surveys show that women are the family members most likely to buy OTC products, and they are also more likely than men to read labels before taking medications.
One of the most important things to look for on the OTC label is the presence of other chemicals in a product that might pose a risk. These “hidden” chemicals are used for different purposes: to help make the drug taste better, to help preserve the drug, to give color, and to help deliver the product or make it more stable. Consumers who have an allergy or intolerance to even small doses of any of these products may not be aware of the risk unless they read the label. Table 6-1 lists a number of common hidden chemicals in OTC products.
Table 6-1
Common “Hidden” Ingredients in Over-the-Counter Products
| HIDDEN DRUG | OVER-THE-COUNTER CLASS THAT MAY CONTAIN THE DRUG |
| Alcohol (ethanol) | Cough syrups and cold preparations, mouthwashes |
| Antihistamines | Analgesics, antiemetics, asthma products, cold and allergy products, dermatologic preparations, menstrual products, motion sickness products, sleep aids, topical decongestants |
| Antimuscarinic agents | Antidiarrheals; cold, cough, allergy preparations; hemorrhoidal products |
| Aspirin and other salicylates | Analgesics, antidiarrheals, cold and allergy preparations, menstrual products, sleep aids |
| Caffeine | Analgesics, cold and allergy products, diuretic and menstrual products, stimulants, weight control products |
| Estrogens | Hair creams |
| Local anesthetics (usually benzocaine) | Antitussives, cold sore products, dermatologic preparations, hemorrhoidal products, lozenges, teething and toothache products, weight-loss products |
| Sodium | Analgesics, antacids, cough syrups, laxatives |
| Sympathomimetics | Analgesics, asthma products, cold and allergy preparations, cough syrups, hemorrhoidal products, lozenges, menstrual products, topical decongestants, weight control products |
Modified from Katzung BG: Basic and clinical pharmacology, ed 10, New York, 2006, McGraw Medical.
Patient Teaching
There are some basic facts health care providers should tell patients about OTC products. Sometimes this information is printed and given out to the patient, because it is so important for patients to know about it. Whether they are given verbally or in writing, these are some of the key facts patients should learn:
• Always read the instructions on the label.
• Do not take OTC medicines in higher dosages or for a longer time than the label states.
• If you do not get well, stop treating yourself and talk with a health care professional.
• If you do not understand the label, check with the pharmacist.
• Do not take medicine if the package doesn’t have a label on it.
• Throw away medicines that have expired (are older than the date on the package).
• Do not use medicine that belongs to a friend.
• Buy products that treat only the symptoms you have.
• If cost is an issue, generic OTC products may be cheaper than brand name items.
Parents should know the following special information about using OTCs for children:
Complementary and Alternative Medicine, Including Herbal Therapies
Patients often believe they know more than their health care providers do about their health problems, and that their providers do not listen to them or respect their choices. These individuals often turn away from traditional Western medicine and seek other forms of alternative health care.
The practices that are known as alternative medicine have often been somewhat of a mystery, and the scientific basis for the action of alternative therapies has been uncertain. Because of the lack of research to explain therapeutic action, most medical and nursing schools do not teach their students about alternative medicine. Alternative therapies include herbal therapies, aromatherapy, chiropractic care, acupuncture, massage, and homeotherapy. A similar type of treatment known as complementary medicine includes these same basic alternative therapies and is preferred by many because it uses these therapies together with standard medical care and not as an alternative. Another term to describe this type of treatment is integrative practices.
Recent studies have found that 40% to 50% of Americans are using some type of alternative therapy, and even more are taking herbs and supplements. A survey estimated that in 2008 more than 48 million adults in the United States used herbal products and dietary supplements. Another survey estimated that approximately 18% of the U.S. population uses herbal therapy on a regular basis. More than half of those users said the products were important to their health and well being, and 70% may not tell their regular health care provider about what products they are taking.
The estimated number of visits to providers of alternative medicine (425 million) exceeded those to all primary care physicians (325 million). There is increasing patient interest in herbs, supplements, and homeopathic remedies, but there is little scientific information in texts and reference books about these products. Most of the books and articles about herbal therapies are written to sell products. You will want reliable information about the medicines patients are taking. Because of the widespread use of herbal products, it is crucial that you have up-to-date, balanced, and scientific material to help you understand herbal therapies and learn about strengths, weaknesses, clinical indications, proper dosages, toxicities, and interactions of different alternative drug therapies so you are able to answer patient questions accurately.
Herbal Therapies and Supplements
Use of herbal medicine (drugs made from plant sources) has long been an accepted part of health care in many cultures. China and other Asian cultures have used herbal products for centuries as an important part of medical practice. People in the United States are now using these same herbal remedies in growing numbers, because they wish to prevent disease, treat illness, and improve health. Because herbal therapies have such a long history in different cultures, this may have created the impression in the minds of some consumers that they are safe, natural, and effective. The fact that something is “natural” does not mean it is safe or effective. With the growing scientific research into use of many herbal products, there is growing belief in the health care community that if herbs are effective, then they should be used under the direction of a health care professional.
Product Labeling
Herbal preparations are not regulated anywhere in the world. Germany has done the most in terms of scientific research into the safety and efficacy of some of these herbs, but these studies have been small and do not begin to meet the scientific standard demanded by the FDA for prescription drugs. Unlike prescription and OTC drugs, the FDA does not require manufacturers to determine purity or potency of herbal products. In fact, some products have been found to contain contaminants, including prescription drugs or heavy metals, and their potency depends on many factors, such as what part of the plant is used and the climate and soil conditions where they are grown, harvested, and stored. Some herbal preparations have even resulted in toxicities.
The FDA has taken action as a result the Dietary Supplement Health and Education Act passed by Congress in 1994, which said health and disease claims are different than structure and function claims. The act says that labels cannot make claims that a product cures a disease or has a special benefit or health effect without special FDA approval. The act allows general statements about the product’s function in the body. The new rules bar makers of supplements and herbal remedies from claiming to cure, prevent, or alleviate cancer, acquired immune deficiency syndrome, and other specific diseases. Companies are limited to making general claims about the product’s ability to make the immune system stronger. Critics claim that most disease treatments can be described in terms of their effects on a structure or function of the body, so it will be difficult to tell the difference between structure and function claims, which are allowed, and disease claims, which are not. The herbal drug manufacturer must now use the following statement in their labeling: “This product is not intended to diagnose, treat, cure, or prevent any disease.”
It might be noted that the labels on herbal products are designed to promote sales and product use and not necessarily to educate the consumer, so health professionals with a general understanding of popular herbs and supplements can talk to patients about efficacy, common side effects, risks, and interactions. When talking to the patient on admission, the nurse may ask about his or her patients’ use of unconventional medicines. This might alert the physician or nurse practitioner that they need to explore these products more to avoid drug interactions with medications ordered in the hospital or clinic.
