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Chapter 14: OTC and Other Drugs

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Chapter 14: OTC and Other Drugs Chapter 14: OTC and Other Drugs Presentation Transcript

  • OTC Drugs, Herbal Remedies and Other Stuff Chapter 14
  • Lecture Outline
    • OTC Drugs
      • Antihistamines
      • Decongestants
      • Cough medicine
      • Analgesics
    • Herbal Remedies
      • St. John’s Wort
      • Ephedra
      • Ginkgo Biloba
      • Ginseng
    • Other Supplements and Prescription Drugs
  • ADHD Treatments
    • Primarily treated with stimulants
      • Ritalin (Methylphenidate)
      • Concerta (a longer acting form of Ritalin)
      • Adderal (amphetamine salts)
      • Strattera (atomoxetine) - SNRI
    View slide
  • 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
    View slide
  • 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
  • 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
  • OTC Sleep Aids
    • For temporary relief of insomnia
    • Vast majority contain antihistamines
      • Benedryl
        • Tylenol PM
        • Unisom geltabs
        • Sominex
      • Doxylamine
        • Unisom sleep tabs
  • 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
  • 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
  • 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
  • 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”
  • 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
  • Kava
    • Plant native to South Pacific
    • Used much like alcohol
    • GABA agonist
    • Associated with liver failure
  • The Moral
    • Look up the active ingredient
      • What is it?
      • What does it do?
    • Be aware of drug interactions
      • Antagonism
      • Synergism
      • Intolerance
      • Allergy