1. Over the Counter Medication :

2. Overview of OTC Medications (Harris Survey) > 100,000 OTC Products Few unique active ingredients > 700 are former Rx meds

3. Some Interesting OTC Facts: 3/5 people have used an OTC medication in the last 6 months This is slightly more than who used an Rx medication in the last 6 months

5. Basic Points: Medication v. Drug MOST medications can cause Nausea Vomiting Diarrhea Dizziness Drowsiness

6. Interesting Facts and OTC Problems: People don’t consider OTC’s real medicine. People just don’t know what is in these medications, and many contain the same active ingredients. Only 34% of consumers could identify the active ingredient in the medicine they were taking.

8. OTC Medication Use by Category: Most common uses include: Pain (78%) Cough, cold, flu (52%) Allergy and sinus (45%) Heartburn, stomach (37%) Constipation, diarrhea (21%) Skin problems (10%)

10. For Example: Pain Most common ingredients: Acetaminophen (Tylenol aka, APAP) Aspirin (Many) Ibuprofen (Motrin IB, Advil) Naproxen (Aleve) and ketoprofen (Orudis) Caffeine Buffers, coatings, long acting, strongest pain reliever you can buy without a prescription….

12. OTC Medication Use: Some specific recommendations and considerations

13. OTC Medication

14. Pain Acetaminophen (apap) first line treatment in those < 18 Generally causes few problems Is very safe to use Aspirin should be avoided in the under 18 age group Reye’s syndrome Other problems usually associated with stomach distress (NVD)

15. Pain Ibuprofen Fine to use in the <18 age group Works about as well as apap Caution if kids are dehydrated Sometimes used in combo with APAP Dizziness, plus stomach problems CAUTION Aspirin / ibuprofen allergies a concern, in some cases you are seeing students after their first dose of a medication! Hives, shortness of breath, facial swelling, difficulty breathing or swallowing, itching, feeling funny Seek medical assistance immediately

17. Ibuprofen

18. Cough, Cold and Flu, Allergy and Sinus Decongestants (stuffy) Pseudoephedrine (Sudafed) PPA removed from the market, others include phenylepherine, and some nasal sprays (Afrin) Have been associated with hallucinations, hypertension, irritability and hyperactivity Can also cause drowsiness, especially as as the dose wears off Products are available for very young children, but dosing is critical, so use pediatric dosage forms and measure carefully

19. Cough, Cold and Flu, Allergy and Sinus Antihistamines (runny) Claritin, Alavert (loratidine) Diphenhydramine (Benadryl), chlor and brompheniramine (Chlortrimeton, Dimetapp) Alone, usually cause drowsiness In combination, variable effects NLD – 1:05 AM Kids need plenty of fluids when taking these, helps with drowsiness and dry mouth, PLUS MORE

20. Antihistamines - OTC

24. Cough Cough suppressants DM = dextromethorophan Drowsiness, dizziness, NV Codeine Have to sign for OTC use Not recommended for infants Small or young children, can be used with caution Expectorants Guiafenesin (basic ingredient in most) Usually no problem, need to use with water, works about as well as water in OTC doses. No, water probably works better…

26. Anti cough agents

27. Combination Products are very popular because they have many choices Plain, DM, CF, PE, Orange, Grape These products may contain Antihistamines Decongestants Cough suppressants Expectorants

28. Combination Products

29. Heartburn, Stomach, Gas Antacids – many, many Maalox, Riopan, Gaviscon, and plenty more Tagament, Zantac, Pepcid, etc. Gas Simethicone Breaks up the gas bubbles so they can be expelled and not cause pain. These products do not reduce the amount of gas! Gas X Mylicon Many generics available

30. Ask Your Pharmacist!

31. 10 Tips on OTC use 1. Read the label 2. Treat only the symptoms you have 3. Know what to avoid while taking OTCs – beware of interactions 4. ASK before you buy 5. Use as directed on the label 6. Be careful if you take > 1 OTC 7. Don’t mix Rx and OTCs including herbals 8. Give your doctor a list of ALL meds 9. For kids, use pediatric formulas 10. Throw meds away if they are expired

32. Keep in mind: If patient takes OTC meds, more than 1 medication, Rx and OTC meds, and something seems out of character, it could be the cause of adverse reaction. These kinds of problems need to be brought to the attention of a health professional.