Pharmacology Chapter 7, Over-the-Counter Drugs and Dietary Supplements

A patient has been abusing cough syrup containing dextromethorphan. What is the term for this? 1 Robotripping 2 Reye syndrome 3 Herbal impairment 4 Cough suppression abuse

1 Dextromethorphan is a sedative used in cough syrups. It can be abused by patients because it is easily available as an over-the-counter medication known by the brand name Robitussin; the abuse of this medication is known as robotripping. Reye syndrome is an acute and potentially life-threatening condition involving progressive neurologic deficits. It is believed to be triggered by viral illnesses such as influenza as well as by salicylate therapy itself, in the presence of a viral illness. It is not related to abusing cough syrup. Herbal impairment and cough suppression abuse are not terms used specifically for abusing cough syrup containing dextromethorphan.

Which OTC medication produces the side effect of constipation related to long-term use? 1 Antacids 2 Antitussives 3 Expectorants 4 Decongestants

1 Long-term use of antacids can result in constipation or fecal impaction. Prolonged use of antacids causes stool to harden, leading to constipation. Antitussives, expectorants, and decongestants do not cause constipation. These drugs cause oversedation, seizures, tachycardia, and even death in toddlers.

A patient reports using an over-the-counter (OTC) nasal spray for nasal congestion; however, the symptoms appear again as soon as the spray is discontinued. What is the most probable reason for this? 1 Rebound effect 2 Ineffective action 3 Superimposed infection 4 Worsening of congestion

1 OTC nasal sprays may cause dependency, and the patient may continue using them because of the rebound effect (symptoms return without use). The rebound effect does not mean that the drug has no therapeutic actions or that there is worsening of the congestion. Superimposed infection would not cause a rebound effect.

A patient with a cold and fever is taking acetaminophen. What is important for the nurse to teach the patient about over-the-counter cold medications? 1 Read the labels carefully. 2 Over-the-counter medications often do not work. 3 Do not take over-the-counter medications with acetaminophen. 4 Call your health care provider before taking over-the-counter medications.

1 The safest intervention is to teach the patient to read labels carefully. Many cold medications include acetaminophen; therefore the patient may overdose on acetaminophen if taking both medications. Most cold medications are safe and effective in normal doses and may not cause drowsiness. Over-the-counter medications can be taken with acetaminophen. The health care provider does not have to be called.

A patient who has depression is taking prescription drugs and St. John's wort. What is essential for the nurse to assess? Select all that apply. 1 Pupils 2 Heart rate 3 Temperature 4 Electrocardiogram 5 Arterial blood gases

1, 2, 3 St. John's wort is an herb used as a medication to treat depression. It leads to serotonin syndrome when administered with other selective serotonin reuptake inhibitors commonly used to treat depression. The nurse should assess for symptoms of serotonin syndrome, including dilated pupils, increased heart rate, and fever. It is not necessary to assess electrocardiogram or arterial blood gases when serotonin syndrome is suspected.

Which patients are at high risk of developing adverse effects from over-the-counter drugs? Select all that apply. 1 A 1-year-old child 2 A young woman with anorexia 3 A woman with diabetes mellitus 4 A 75-year-old man in good health 5 A young man with cold symptoms

1, 2, 3, 4 Over-the-counter drugs may have side effects. Young children have impaired metabolism and may develop toxic effects. Anorexia may lead to malnourishment and cause adverse effects. Diabetes mellitus compromises the immune system and increases the risk of adverse effects. Elderly people may have impaired renal function, leading to accumulation of the drug in the bloodstream and resulting in adverse effects. A young man without any chronic illness may not be at risk of adverse effects because he has optimal levels of metabolism.

A patient has been prescribed digoxin and propranolol. The nurse advises the patient to avoid using herbal medications. What is the reason for the nurse's advice to this patient? Select all that apply. 1 Herbal medications can cause dysrhythmias. 2 Herbal medications potentiate digoxin toxicity. 3 Herbal medications reduce the action of digoxin. 4 Herbal medications reduce the action of propranolol. 5 Herbal medications increase the action of propranolol.

1, 2, 5 Patients with cardiovascular disorders must be advised to avoid using herbal medications because they cause dysrhythmias or heart block. Herbal medications potentiate digoxin toxicity, so they should not be used by patients who are prescribed digoxin. Herbal medications increase the action of antihypertensive medications such as propranolol and cause hypotension in patients, so their use must be avoided. Herbal medications do not reduce the action of digoxin. Herbal medications do not reduce the action of propranolol; they enhance it.

While assessing a patient who has anxiety, the nurse learns that the patient has been taking kava for 2 years for stress relief. Which statements made by the nurse are appropriate? Select all that apply. 1 "Kava enhances the effects of alcohol. You need to abstain from alcohol." 2 "The Food and Drug Administration banned the sale of kava in April 2004." 3 "You need to stop taking kava immediately because it causes liver toxicity." 4 "The Food and Drug Administration has issued a warning as to the effects of kava." 5 "Kava reduces the effect of the barbiturates prescribed by your primary health care provider."

1, 3, 4 Certain herbal medications such as kava, which are used for stress relief, insomnia, and anxiety, have potential side effects. Kava enhances the effects of alcohol and causes increased sedation. Kava may cause liver toxicity. The FDA has issued a warning letter about the risk of kava and liver toxicity. The sale of ephedra was banned by FDA in April 2004. Kava enhances the effect of barbiturates because of synergism.

A patient who has rheumatoid arthritis has for many years been taking high doses of over-the-counter (OTC) acetaminophen for pain relief. Based on this information, what will the nurse review when assessing the patient? 1 Heart rate 2 Liver enzymes 3 Bowel movements 4 Creatinine and BUN

2 Acetaminophen is the most commonly used OTC drug. It is used as an analgesic. However, if it is used in excessive quantities it can cause hepatic toxicity and lead to liver failure. Therefore, the nurse should assess the patient's liver function tests to see whether liver enzymes are elevated. Acetaminophen doses that exceed a total of 3 to 4 g/day may lead to hepatic toxicity. This medication should not change heart rate or affect bowel movements or renal function tests.

The nurse is educating a patient who will begin taking a medication to treat erectile dysfunction. Which instruction provided by the nurse is most appropriate? 1 Consume a low-calorie diet. 2 Restrict the intake of grapefruit. 3 It is safe to use herbal medications. 4 Start with a low dose of the prescribed medicine.

2 Grapefruit can cause food-drug interactions and decrease the metabolism of drugs used for erectile dysfunction. Decreased metabolism of drugs causes an accumulation of the drug in the body and leads to toxic effects, so consumption of grapefruit should be avoided. The metabolism of drugs is not affected by high- or low-calorie foods. Herbal medications also have some side effects, so consumption of herbal drugs should be avoided. The prescribed medicine should be taken in the appropriate quantity because low doses do not give the desired therapeutic effect.

Which drug is a proton pump inhibitor, formerly prescription, and now over the counter? 1 Ibuprofen 2 Lansoprazole 3 Naproxen sodium 4 Chlorpheniramine maleate

2 Lansoprazole is a proton pump inhibitor. Proton pump inhibitors also are considered acid-controlling drugs. Ibuprofen and naproxen sodium are nonsteroidal antiinflammatory analgesics. Chlorpheniramine maleate is a histamine blocker and acts on H 1 receptors.

What should the nurse include in the teaching plan related to the use of herbal therapy for a patient prescribed an oral contraceptive? 1 It is safe to drink cranberry juice. 2 Avoid taking saw palmetto with oral contraceptives. 3 Echinacea does not typically interact with prescription drugs. 4 Herbal therapy is often as effective as prescription drugs and should be tried first.

2 Saw palmetto may change the effects of hormones in oral contraceptive drugs and increase the chances of contraception failure. Therefore, patients should avoid using saw palmetto. Cranberry and Echinacea interfere with the effectiveness of some prescription drugs. Herbal therapy is not tried first and often is ineffective.

A nurse is educating parents about the use of drugs in children. Which statement by the parents indicates the need for further teaching? 1 "I should abstain from giving any aspirin to my children." 2 "Over-the-counter medications are always safe for children." 3 "I should always double-check the dose before giving the medicine." 4 "I should not give over-the-counter cough and cold products to my kids.

2 Special precautions should be taken before administering drugs to children. The parent should never assume that just because the product does not require a prescription that it is safe. Children are at high risk of developing Reye syndrome if aspirin is administered during fever. The dose should be checked carefully before administering the drug to children because overdose may cause toxic effects. Administration of over-the-counter cough and cold products to children may cause side effects such as oversedation, seizures, tachycardia, and even death in toddlers.

What is the increasing use of herbal products and other nontraditional remedies for treating illness known as? 1 Integrative medicine 2 Alternative medicine 3 Conventional medicine 4 Complementary medicine

2 The increasing use of herbal products and other nontraditional remedies for treating illness is known as alternative medicine. Medications that are derived from chemical substances and are prescribed by most of the primary health care providers are called conventional medicines. The simultaneous use of both conventional and alternative medicine for treating an illness is called complementary treatment or medication. Complementary medicine is also known as integrative medicine.

Which patient should be cautioned as to the use of over-the-counter drugs due to the potential for increased adverse reactions or side effects? 1 A patient who has cold symptoms 2 A patient who has a chronic illness 3 A patient who has a fungal infection 4 A patient who has gastric acidity problems

2 Use of over-the-counter (OTC) medications is hazardous for patients with various chronic illnesses because OTC drugs may cause toxic effects. Because of chronic illnesses, metabolism may be impaired, leading to toxic effects. OTC drugs may be safely used by patients who have cold symptoms, fungal infections, and gastric acidity problems (although herbal therapy may stimulate the release of gastric acid or alter metabolism).

Which side effects are associated with the use of nonsteroidal antiinflammatory drugs (NSAIDs)? Select all that apply. 1 Grand mal seizure 2 Myocardial infarction 3 Cerebrovascular accident 4 Gastrointestinal ulceration 5 Development of hepatic toxicity

2, 3, 4

Which dietary supplements increase the risk of bleeding due to the interaction with anticoagulants? Select all that apply. 1 Basil 2 Gingko 3 Digitalis 4 Green tea 5 Chamomile

2, 5 Because of drug interactions, some herbal medications reduce the number of platelets and increase bleeding when administered with anticoagulants. Gingko and chamomile are examples of herbal medications that increase the risk of bleeding due to interaction with anticoagulants. Increased risk of bleeding is not caused by the consumption of basil or green tea. Basil has wound-healing properties. Digitalis is a cardiac glycoside and does not affect the platelet count, so there is no increased risk of bleeding.

The nurse observes that a patient is taking aspirin to get relief from a headache. Which is the best response from the nurse in this situation? 1 "Aspirin is safer than other medications used to treat headache." 2 "Aspirin is an over-the-counter drug and is generally not very effective." 3 "Aspirin can lead to liver toxicity and should be used in recommended doses." 4 "Aspirin should be taken only after consulting the primary health care provider."

3 Aspirin is an antiinflammatory drug used to relieve pain and fever. The maximum dose is 4 g/day. An overdose can lead to liver toxicity. Therefore, the nurse will tell the patient to keep track of the intake of aspirin to prevent liver toxicity. Even though aspirin helps to relieve headache, an overdose can cause serious adverse effects like hepatotoxicity. Aspirin is an over-the-counter product that is effective in treating fever and pain and can be used without a prescription. If the patient has liver disease, the patient should consult with the health care provider before taking aspirin.

What herbal supplement may suppress the immune response? 1 Valerian 2 Hawthorn 3 Echinacea 4 Chamomile

3 Echinacea counteracts the immunosuppressant medications and therefore causes severe adverse effects. The nurse should check whether the patient is taking any herbal medications containing Echinacea to avoid drug interactions. Valerian causes sedation and depression by interacting with antidepressants and anxiolytic medications. Hawthorn interacts with cardiac glycosides, leading to toxic effects. Chamomile interacts with anticoagulant drugs.

A nurse is admitting a patient who has chronic obstructive pulmonary disease (COPD). The patient wants to use herbal medications for a cold rather than conventional medications. Which statement made by the nurse is appropriate? 1 "Herbal supplements have more side effects than conventional medications." 2 "Many herbal medications are very expensive compared to conventional medications." 3 "Herbal medications may work, but you still should discuss this with your health care provider." 4 "You will need a prescription from your primary health care provider for herbal medications."

3 Herbal therapy should always be discussed with the health care provider when the patient has a preexisting chronic disease. Herbal supplements are made from natural substances, so they have fewer side effects compared to conventional medications. Herbal medications are often less expensive than conventional medications because production costs are lower. Herbal medications are supplied without a prescription.

What should the nurse teach about the consequences of using over-the-counter (OTC) drugs for long periods without medical consultation? 1 Prevention of worsening diseases 2 Prompt diagnosis and treatment of diseases 3 Ineffective management of chronic diseases 4 Timely treatment of life-threatening diseases

3 Long-term use of OTC drugs may make people postpone visits to their primary health care provider, resulting in ineffective management of chronic diseases, which may worsen. OTC drugs are not used to prevent disease progression or to treat life-threatening diseases. OTC drugs may suppress symptoms for a short period of time and prevent prompt diagnosis and treatment of diseases.

What should the nurse teach patients about the risk of over-the-counter medications for cough and cold? 1 These medications rarely work. 2 These medications are expensive. 3 These medications interact with many prescription drugs. 4 These medications work just as well as prescription drugs.

3 The medications available for cough are made up of one or more categories of drugs such as antitussives (relief from cough), antihistamines (treat runny nose), and expectorants (loosen chest congestion). Many of these medications are sympathomimetic and interfere with medications used for high blood pressure and cardiac disorders. It is essential that the nurse teach safety and tell patients that these medications interact with many prescriptions. None of the other answers address the risks of over-the-counter medications.

From which plant does codeine originate? 1 Digitalis lanata 2 Taxus brevifolia 3 Datura fastuosa 4 Papaver somniferum

4 About 30% of all modern drugs are derived from plants. P. somniferum is a source of codeine. D. lanata is a source of digoxin. T. brevifolia is a source of paclitaxel. D. fastuosa is a source of scopolamine.

A patient has a fungal infection of the skin. Which over-the-counter medicine will be helpful for this patient? 1 Minoxidil 2 Loratadine 3 Famotidine 4 Clotrimazole

4 Clotrimazole (Lotrimin) is a common over-the-counter medication used for fungal infections. Minoxidil is used for hair growth. Loratadine is an antihistaminic drug. Famotidine is an acid-controlling drug.

Which statement is accurate when discussing the use of herbal and over-the-counter medications with patients? 1 "Over-the-counter medications are not as potent as prescription drugs." 2 "Herbal remedies have not demonstrated any adverse effects with their use." 3 "The use of over-the-counter medications is gradually decreasing with the increased availability of more effective prescription medications." 4 "Over-the-counter medications can, at times, be used in place of prescription drugs. It is important to discuss the use of these with your health care provider."

4 Over-the-counter medications can be appropriately used, but it is always best to use them in consultation with a health care provider. The other statements are not accurate.

The nurse is providing education to a group of patients interested in complementary medicine. What is the most important information to include? 1 "Stop taking prescription drugs when starting herbs." 2 "Read the directions and labels of all herbs before taking." 3 "Try the herb for a week before deciding to use it long term." 4 "Confirm with your health care provider that any herbs you take will not interact with prescribed medications."

4 The highest-priority teaching point is that the patient should seek education and confirm with a health care provider that any herbs taken will not have an adverse effect if taken with prescribed medications. It is not good practice to stop prescription drugs when trialing herbs.

A nurse is teaching a group of nursing students about the use of over-the-counter (OTC) medications. Which statement by the student indicates a need for further teaching? 1 "Be wary of overdosing when using OTC products." 2 "Read specific warning labels before taking OTC products." 3 "Do not use OTC products if you have cardiovascular disease." 4 "OTC cold products are safe in children younger than 2 years of age."

4 Use of OTC cold products should be avoided in children younger than 2 years of age because these medications can lead to side effects such as seizures, tachycardia, oversedation, and even death. OTC products also have side effects, so patients should be instructed to take only the recommended dosage to prevent overdose. Patients should read specific warnings before using OTC products because some have severe side effects. Patients with preexisting cardiovascular disease should not use OTC medications without checking with their primary health care provider first because the medications could worsen their condition.

A patient provides a list of current medications to the nurse. The patient tells the nurse that she takes medications prescribed by her health care provider as well as herbs from the local health food store. Based on this information, the patient uses which type of medicine? 1 Eastern medicine 2 Western medicine 3 Traditional medicine 4 Complementary medicine

4 When a patient uses traditional and alternative medications, the patient is considered to be using complementary medicine. Western medicine is conventional medicine.

How does a manufacturer obtain information about drugs and their side effects? Select all that apply. 1 Patients and their families 2 Nurses and nurse managers 3 Primary health care providers 4 Researchers and clinical trials 5 Postmarketing safety surveillance data

4, 5 Manufacturers obtain information about drugs and their side effects from clinical trials and postmarketing safety surveillance data. The manufacturer submits this information to the Food and Drug Administration (FDA). Patients, nurses, and primary health care providers do not submit information related to the drug directly to the manufacturer. Instead the information is passed to the manufacturer through a formal process.

Which statement is found in the Dietary Supplement and Health Education Act (DSHEA) of 1994? 1 No proof of efficacy is required for legend drugs. 2 No proof of efficacy is required for dietary supplements. 3 No proof of efficacy is required for over-the-counter drugs. 4 Dietary supplements have to be supplied upon prescription.

According to the Dietary Supplement Health and Education Act (DSHEA) of 1994, no proof of efficacy is required for dietary supplements because they are considered to be safe. In contrast to this, proof of efficacy is required for legend drugs and over-the-counter drugs. These drugs have a narrow therapeutic index when compared to dietary supplements. Prescription is not required for selling and supplying dietary supplements to patients because they have a greater margin of safety.