Over-the-Counter Drugs and Herbal and Dietary Supplements Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Over-the-Counter (OTC) Drugs Nonprescription drugs Use for short-term treatment of common minor illnesses More than 300,000 OTC drugs available OTC Drug Review (1972) Safety and efficacy Appropriate labeling standards Reclassification Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Over-the-Counter Drug Label Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Reclassified OTC Drugs ibuprofen (Advil) naproxen (Aleve) diphenhydramine (Benadryl) loratadine (Claritin) famotidine (Pepcid AC) omeprazole (Prilosec OTC) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question OTC medications now account for about what percent of all medications used in the United States? 5% 15% 30% 60% Correct answer: D Rationale: OTC medications now account for about 60% of all medications used in the United States. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Use of OTC Drugs: Potential Hazards May postpone effective treatment of more chronic disease states May delay treatment of serious and/or life-threatening disorders May relieve symptoms of a disorder but not the cause Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Use of OTC Drugs: Potential Hazards (cont’d) Toxicity Interactions with current prescription medications may occur Abuse Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A 56-year-old man is taking over-the-counter antacids for relief of indigestion. He tells the nurse that he consumes at least one bottle a week and has done so for over a month because “it works for me.” The nurse’s main concern is that this self-treatment is expensive. this self-treatment may be delaying treatment of a more serious problem. this self-treatment may be the best treatment of his indigestion. the long-term use of antacids may make the indigestion worse. Correct answer: B Rationale: Normally, over-the-counter medications should be used only for short-term treatment of common minor illnesses. Their use may postpone effective management of chronic disease states and may delay treatment. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Classroom Response Question The nurse associates use of which over-the-counter medication with the development of hepatotoxicity? acetylsalicylic acid (aspirin) ibuprofen (Motrin) pseudoephedrine (Sudafed) acetaminophen (Tylenol) Correct answer: D Rationale: Acetaminophen (Tylenol) is associated with the development of hepatotoxicity. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Herbal and Dietary Supplements Dietary supplement—orally administered alternative medicines including herbal supplements Herbs—plant components, including bark, berries, roots, leaves, gums, seeds, stems, and flowers, used for their medicinal qualities Herbal medicine—using herbs to heal Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Consumer Use of Herbs Therapeutic agents for treatment and cure of diseases Prophylactic agents for long-term prevention of disease Proactive agents to maintain health and wellness and “boost” one’s immune system Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Conditions Treated with Herbal Products Arthritis Constipation Fever Infection Stress Weakness Anxiety Colds and cough Depression Headache Insomnia Ulcers Premenstrual syndrome (PMS) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Commonly Used Herbal Products Echinacea Garlic Ginseng Hawthorn Saw palmetto Aloe Feverfew Gingko Goldenseal St. John’s wort Valerian Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Herbal and Dietary Supplements Dietary Supplement Health and Education Act (DSHEA) of 1994 Herbal products are considered “dietary supplements” No proof of efficacy or safety required No standards for quality control May claim effect but do not have to promise a specific cure Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Alternative/ Complementary Medicine Alternative medicine—use of herbal products and other nontraditional remedies Complementary medicine—simultaneous use of both traditional and alternative medicine Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A patient tells the nurse that he wants to stop taking his antilipemic drugs and start taking garlic to lower his cholesterol. The nurse’s best reply would be: “That decision is up to you.” “You have every right to switch to herbal remedies.” “You should not go against what the doctor has prescribed for you.” “Let’s explore the evidence that supports the use of garlic to lower your cholesterol.” Correct answer: D Rationale: The nurse can provide patient education regarding potential risks and adverse drug reactions that are possible with herbal products. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Nursing Implications Obtain thorough medication history, documenting all medications used (prescription, OTC, herbal products, vitamins, minerals, other dietary supplements) Assess level of education and understanding Assess for information specific to various products Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Assess system functions (especially renal, liver, and cardiac) Assess for conditions that are contraindications Assess for potential drug-drug and drug-herb interactions Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Provide thorough and individualized patient education Ensure that patients recognize that manufacturers of herbal products/dietary supplements are not required to prove safety and effectiveness Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Herbal products may not be safe for pregnant or breastfeeding women, infants, children “Natural” does not mean safe Teach patients to monitor themselves for unusual or adverse reactions as well as therapeutic responses Copyright © 2014 by Mosby, an imprint of Elsevier Inc.