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From Prescription to OTC

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Presentation on theme: "From Prescription to OTC"— Presentation transcript:

1 From Prescription to OTC
Sapna N. Patel UCSF Pharm. D. Candidate 2008 Preceptor Dr. Craig S. Stern Febuary 29, 2008

2 Significance Unable to track usage
Difficult to obtain patient’s entire medication profile Many potential DDIs unidentified May be more cost-effective for employers/patients to switch to OTC usage Many insurances do not cover OTC products Pts more likely to postpone seeking medical treatment PUD/GERD represent 2 of the Top 5 most expensive conditions to treat

3 Prescription Drug Categories now OTC
Non-Sedating Antihistamines Loratadine (Claritin®, Claritin D®) Loratadine (Alavert®, Alavert D®) Cetirizine (Zyrtec®, Zyrtec D®) Histamine Receptor Blockers Cimetidine (Tagamet®) Famotidine (Pepcid®) Nizatidine (Axid®) Ranitidine (Zantac®) Proton Pump Inhibitors Omeprazole (Prilosec®)

4 Peptic Ulcer Disease Definition: Open sores on the inside lining of the stomach, small intestine, or esophagus Causes: Helicobacter pylori infection (90%) Long-term use of NSAIDs Common Symptoms: Epigastric pain Weight loss Bloating N/V Feels “better” after eating

5 Peptic Ulcer Disease (cont.)
Treatment: NEVER self treat See MD to be tested for H. pylori

6 Role of OTC Proton Pump Inhibitors (PPI)
MOA: Inhibits acid formation by inhibiting H+/K+ ATPase pump Available: Prilosec Administration: 20mg daily before breakfast Place in Therapy: H. pylori (-): 4-8 week regimen under supervision of MD ADRs: Acid rebound, abdominal pain, diarrhea, headache, pneumonia Must know why before breakfast. Rx Strength: 20mg twice daily

7 Patient Counseling Minimize fatty foods, spicy foods and caffeine
Smoking cessation Minimize alcohol consumption Use NSAIDs only if absolutely necessary Eat smaller meals more often vs. large meals Weight loss

8 GERD (Gastroesophageal Reflux Disease)
Definition: Movement of stomach contents into the esophagus Causes: Big meals Fatty foods Alcohol/Smoking Lying down after a meal Obesity Common Symptoms: Difficulty Swallowing Acidic taste in mouth Coughing Roughness of voice Chocolate, onions, spicy food

9 H2 Receptor Blockers MOA: Stops histamine from stimulating the gastric parietal cell, therefore inhibiting acid secretion Available: Cimetidine (Tagamet®), Famotidine (Pepcid®), Nizatidine (Axid®), Ranitidine (Zantac®) Administration: Before meals Place in Therapy: Mild Severity: Infrequent symptoms and short duration (< 2x/week) ADRs: N/V/D, constipation, dry mouth, drowsiness, dizziness Refer if symptoms more than 2x a week

10 Patient Counseling Weight loss Decrease fatty food intake
Smoking cessation Decreasing alcohol intake Avoid laying down for 3 hours after meals

11 Allergic Rhinitis Definition: Immune reaction due to exposure to allergens Risk Factors: Family history Male Firstborn status Early use of antibiotics Exposure to indoor allergens High IgE levels Common Symptoms: (perennial or seasonal) Conjuctival, nasal, pharyngeal itching Rhinorrhea Sneezing

12 Role of OTC Anti-histamines
MOA: Blocks peripheral histamine H(1)-receptor activity Available: Claritin®, Alavert®, Zyrtec® Administration: Variable Place in Therapy: Mild or intermittent allergic rhinitis symptoms Combined with the decongestant, pseudoephedrine, provide better symptom relief ADRs: Dry mouth, headache, drowsiness, fatigue ADRs for pseudoephedrine sulfate: hypertension, insomnia, irritability, and headache Histamine H1 receptor location, all come in “D” forms, Asthma: (allergic asthma) 10 to 20 mg ORALLY once daily has been used for up to 8 weeks Idiopathic urticaria, chronic: 10 mg ORALLY once daily , The second-generation agents appear to be similarly efficacious to each other

13 Patient Counseling Allergen Identification: Skin testing (by MD)
Avoid Allergens Pollens Insects Animal allergens Molds Molds: (which are difficult to differentiate from other perennial allergens by history alone)

14 Summary Globally, PUD/GERD represent expensive conditions to treat
Many prescription medications are now found OTC Benefits may include a more cost-effective choice for employers/patients Downfalls include information lost regarding patient’s medication profile leading to suboptimal medication management Non-coverage of OTC products by insurances may lead to patient not purchasing medication Possible worsening of outcomes due to lack of treatment

15 References patients/ pdfs/ UnderstandGIBleednew.pdf 281k 27/Jan/2008 Antossian T, Madera X, Stern C. Peptic Ulcer Disease, California Pharmacist 9/2005 pp Stern C, Antossian T, Choo C. Gastroesophageal Reflux Disease, California Pharmacist 6/2005 pp25-30. Micromedex Drugdex Evaluations-Pepcid, copyright 2006 by Thomson MICROMEDEX. Micromedex Drugdex Evaluations-Loratadine, copyright 2006 by Thomson MICROMEDEX. Micromedex Drugdex Evaluations-Cetirizine, copyright 2006 by Thomson MICROMEDEX. UpToDate-Allergic Rhinitis, copyright 2007 by deShazo R, Kemp S. Kasper D, Braunwald E, Fauci A Harrison’s Principles of Internal Medicine 16th edition, copyright 2005.

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