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

2. 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.

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

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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.