Transcript Slide 1

From Prescription to
OTC
Sapna N. Patel
UCSF Pharm. D. Candidate 2008
Preceptor Dr. Craig S. Stern
Febuary 29, 2008
Significance
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Unable to track usage
Difficult to obtain patient’s entire medication profile
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Many potential DDIs unidentified
May be more cost-effective for employers/patients to
switch to OTC usage
Many insurances do not cover OTC products
Pts more likely to postpone seeking medical
treatment
PUD/GERD represent 2 of the Top 5 most
expensive conditions to treat
Prescription Drug Categories now OTC
Loratadine (Claritin®, Claritin D®)
Non-Sedating
Antihistamines
Histamine Receptor
Blockers
Proton Pump
Inhibitors
Loratadine (Alavert®, Alavert D®)
Cetirizine (Zyrtec®, Zyrtec D®)
Cimetidine (Tagamet®)
Famotidine (Pepcid®)
Nizatidine (Axid®)
Ranitidine (Zantac®)
Omeprazole (Prilosec®)
Peptic Ulcer Disease
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Definition: Open sores on the inside lining of the
stomach, small intestine, or esophagus
Causes:
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Helicobacter pylori infection (90%)
Long-term use of NSAIDs
Common Symptoms:
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Epigastric pain
Weight loss
Bloating
N/V
Feels “better” after eating
Peptic Ulcer Disease
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(cont.)
Treatment:
 NEVER self treat
 See MD to be tested for H.
pylori
Role of OTC Proton Pump
Inhibitors (PPI)
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MOA: Inhibits acid formation by inhibiting H+/K+
ATPase pump
Available: Prilosec
Administration: 20mg daily before breakfast
Place in Therapy:
 H. pylori (-): 4-8 week regimen under
supervision of MD
ADRs: Acid rebound, abdominal pain, diarrhea,
headache, pneumonia
Patient Counseling
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Minimize fatty foods, spicy foods and
caffeine
Smoking cessation
Minimize alcohol consumption
Use NSAIDs only if absolutely necessary
Eat smaller meals more often vs. large
meals
Weight loss
GERD (Gastroesophageal Reflux
Disease)
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Definition: Movement of stomach contents into the
esophagus
Causes:
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Big meals
Fatty foods
Alcohol/Smoking
Lying down after a meal
Obesity
Common Symptoms:
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Difficulty Swallowing
Acidic taste in mouth
Coughing
Roughness of voice
H2 Receptor Blockers
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MOA: Stops histamine from stimulating the gastric
parietal cell, therefore inhibiting acid secretion
Available: Cimetidine (Tagamet®), Famotidine
(Pepcid®), Nizatidine (Axid®), Ranitidine (Zantac®)
Administration: Before meals
Place in Therapy:
 Mild Severity: Infrequent symptoms and short
duration (< 2x/week)
ADRs: N/V/D, constipation, dry mouth, drowsiness,
dizziness
Patient Counseling
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Weight loss
Decrease fatty food intake
Smoking cessation
Decreasing alcohol intake
Avoid laying down for 3 hours after
meals
Allergic Rhinitis
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Definition: Immune reaction due to exposure to
allergens
Risk Factors:
 Family history
 Male
 Firstborn status
 Early use of antibiotics
 Exposure to indoor allergens
 High IgE levels
Common Symptoms: (perennial or seasonal)
 Conjuctival, nasal, pharyngeal itching
 Rhinorrhea
 Sneezing
Role of OTC Anti-histamines
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MOA: Blocks peripheral histamine H(1)-receptor
activity
Available: Claritin®, Alavert®, Zyrtec®
Administration: Variable
Place in Therapy:
 Mild or intermittent allergic rhinitis symptoms
 Combined with the decongestant,
pseudoephedrine, provide better symptom relief
ADRs: Dry mouth, headache, drowsiness, fatigue
ADRs for pseudoephedrine sulfate: hypertension,
insomnia, irritability, and headache
Patient Counseling
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Allergen Identification:
 Skin testing (by
MD)
Avoid Allergens
 Pollens
 Insects
 Animal allergens
 Molds
Summary
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Globally, PUD/GERD represent expensive
conditions to treat
Many prescription medications are now found OTC
Benefits may include a more cost-effective choice
for employers/patients
Downfalls include information lost regarding
patient’s medication profile leading to suboptimal
medication management
Non-coverage of OTC products by insurances may
lead to patient not purchasing medication
Possible worsening of outcomes due to lack of
treatment
References
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http://www.acg.gi.org/ patients/ pdfs/ UnderstandGIBleednew.pdf
281k 27/Jan/2008
Antossian T, Madera X, Stern C. Peptic Ulcer Disease, California
Pharmacist 9/2005 pp 25-30.
Stern C, Antossian T, Choo C. Gastroesophageal Reflux Disease,
California Pharmacist 6/2005 pp25-30.
Micromedex Drugdex Evaluations-Pepcid, copyright 2006 by
Thomson MICROMEDEX.
Micromedex Drugdex Evaluations-Loratadine, copyright 2006 by
Thomson MICROMEDEX.
Micromedex Drugdex Evaluations-Cetirizine, copyright 2006 by
Thomson MICROMEDEX.
UpToDate-Allergic Rhinitis, copyright 2007 by deShazo R, Kemp S.
Kasper D, Braunwald E, Fauci A Harrison’s Principles of Internal
Medicine 16th edition, copyright 2005.