1. OTC Drugs, Herbal Remedies and Other Stuff Chapter 14

2. Lecture Outline OTC Drugs – Antihistamines – Decongestants – Cough medicine – Analgesics Herbal Remedies – St. John’s Wort – Ephedra – Ginkgo Biloba – Ginseng Other Supplements and Prescription Drugs

3. ADHD Treatments Primarily treated with stimulants – Ritalin (Methylphenidate) – Concerta (a longer acting form of Ritalin) – Adderal (amphetamine salts) – Strattera (atomoxetine) - SNRI

4. Antihistamines Used to treat allergies as well as dermatological conditions All block H1 (Histamine) receptor – Histamine is an excitatory NT and mediates part of the generalized immune response. Drowsy vs. Non-drowsy – Based on whether it crosses BBB Benadryl (Diphenhydramine) – Crosses Chlorpheniramine (Chlor-Trimeton) - Crosses Allegra (Fexofenadine) – Doesn’t Cross Claritin (Loratadine) – Doesn’t Cross Zyrtec (Citirizine) – Doesn’t cross Clemastine (Tavist) - Crosses H2 receptor antagonists are Pepcid, Tagamet, Axid … Anti-ulcer and Antacid drugs

5. Decongestants Dilate bronchial passages by constricting blood vessels in respiratory system – Mediated by NE (Agonist) Pseudoephedrine most common Ephedrine once common Activate SNS, but cross BBB weakly Names – Sudafed – Actifed – Dimetapp

6. Analgesics Non-Steroidal Anti-Inflammatory (NSAIDS) Inhibit Prostaglandins and Proinflammatory Cytokines through inhibition of COX enzymes Names – Acetylsalycillic Acid (Aspirin) – COX 1 & 2 – Acetaminophen (Tylenol) – COX3 – Motrin (Ibuprofen) – Cox 1 & 2 – Alleve 1 & 2 – Naprosin 1 & 2 – Vioxx (Rofecoxib) 2 – Celebrex (Relecoxib) 2 Not good to inhibit COX 1 = kidney and stomach problems

7. OTC Sleep Aids For temporary relief of insomnia Vast majority contain antihistamines – Benedryl Tylenol PM Unisom geltabs Sominex – Doxylamine Unisom sleep tabs

8. Herbal Remedies Derived from natural sources Not currently regulated by FDA Purity and potency are large issues – Extraction of active ingredient can be a problem Currently popular Have been around forever

9. St John’s Wort Grows as an invasive weed Hypericum For mood disorder (We think this is what it does) – Agonist of catecholamines SSRI Increases DA and GABA Effective if one gets enough (mounting evidence is good) Speeds up metabolism of birth control pills and antivirals Induces photosensitivity

10. Ginseng Extract from plant Thought to induce a number of actions – Anti-fatigue – Antioxidant – Lower cholesterol – Stimulant? Headaches, insomnia, anxiety, breast soreness or tenderness, skin rashes, asthma attacks, increased blood pressure, diarrhea, euphoria, nervousness, skin eruptions, heart palpitations, or post- menopausal uterine bleeding

11. Ginkgo Biloba Increases blood flow to brain Thought to increase memory and cognitive ability Inhibits Platelet Activating Factor and induces vasodilation Few side effects. GI distress. Possibly some problems with >2 years use Effective for people with problems; may not have much effect for “normals”

12. Ephedra Ephedra, Ephedrine, Ma Huang – Derived from plant source NE agonist. Stimulates NE release and acts on receptors Typical sympathomimetic response – Increase – HR, BP, Respiration, Glycogenesis and Lypolysis Does not cross BBB very well, so little CNS effect Used for bronchial dilation, as well as weight loss and narcolepsy in the past Stroke and arrhythmia

13. Kava Plant native to South Pacific Used much like alcohol GABA agonist Associated with liver failure

14. The Moral Look up the active ingredient – What is it? – What does it do? Be aware of drug interactions – Antagonism – Synergism – Intolerance – Allergy