THE 2001 OTC MEDICATION HANDBOOK (Book 2 of 2)
THE 2001 OTC MEDICATION HANDBOOK (Book 2 of 2) Tracy Shinjo, Pharm.D. Candidate Adam Kaye, Pharm.D., FASCP I would like to thank the University of the Pacific faculty, the San Joaquin Pharmacists Association, and all my close friends, especially Adam Kaye Pharm. D., for their supportand encouragement. This reference is intended to serve as an up-to-date reference for commonly available OTC products. It is filled with basic indications, directions for use, and precautions. The information contained in this publication is provided to medical professionals only – it is not intended to be used by lay readers. Every effort has been made to assure accuracy. Much of the information has been obtained from the manufacturers product label. It is my hope that future students can update this reference as OTC products are constantly being reformulated, removed form pharmacy shelves, and new OTC products are being introduced almost daily. - Tracy Shinjo, 2001 II Over the Counter Products Table of Contents The Common Cold and Respiratory Conditions Cold and Allergy - cold Sx’s - cold vs…. - antipyretics/analgesics - antihistamines - systemic decongestants - cough suppressant - expectorant - other products - child products 1-9 4 5 6 6 6 6 6 7 8-9 Cough syrups Topical Decongestants/Antitussives Asthma Sore throat 10-11 12-13 14 15-16 Pain/Fever Conditions Systemic Antipyretics/Analgesics - child products 17-20 20 Oral Conditions Oral sore products - cold vs. canker sores 21-22 22 Lip products Oral antiseptic products 23 24 III GI Conditions Acid Products Anti-emetics / Prevention of motion sickness Anti-nausea Emetics Laxatives Anti-diarrheals Flatulence Infant Colic Gas Prevention Lactose Intolerance Healthy Digestion Promotion Hemorrhoids Pinworms 25-27 28 28 28 29-32 33 34 34 34 35 35 36-37 38 Dermatologic Conditions First Aid Products Topical anti-itch Topical pain relief Scar management Drawing ointment Acne treatment Antifungals Warts Corns/Calluses Other foot products Psoriasis Eczema Dandruff Hair growth Head Lice treatment 39-40 41-42 43-45 46 46 47-48 49 50 50 50 51 51 52-53 54 55 CNS Conditions Sleep Aids Stimulants 56 56 Ophthalmic/Otic Conditions Ophthalmic products Otic products Baby Products 57-60 61 Diaper Rash 62 IV Electrolyte Replacement Teething Pain Formulas 62 63 63 Womens Health Products Menstrual discomfort UTI pain/Sx’s Feminine itching Yeast infection Sore nipples 64 64 65 65 66 Home Screening Tests UTI HIV Cholesterol Colorectal Cancer Illicit drugs Blood-glucose monitors Pregnancy Fertility Fertility monitor 67 67 67 68 68 68 69 69 69 Contraception/Sexual activity conditions Condoms Male genital desensitizers 70 70 Vitamins/Supplements Vitamins - multivitamins - multivitamins plus - eye vitamins - prenatal vitamins - B-complex combinations - antioxidants - vitamin packs Vitamins/Supplements (cont’d)…. 71-74 71 71 72 72 72 72 72 Supplements - calcium - iron - magnesium 75-78 75-76 77 78 V - niacin folic acid 78 78 Multivitamins for children, infants, and toddlers Supplements for children, infants, and toddlers 79 79 Natural product combinations - PMS - Other soy-containing products - Bone - Cholesterol - Prostate - Others 80-81 Dietary Supplements 82-83 VI Sodium chloride Chlorhexidine Iodine Triclosan Lidocaine Benzocaine Benzalkonium Benzethonium Cl Pramoxine Bacitracin Polymyxin B First Aid Products Available Over-the-Counter Neomycin First Aid Products COMMENTS Topical antibiotics (triple) – ointments: Neosporin original ointment Band Aid first aid antibiotic X X X X X X Topical antibiotics (triple plus pain) -- ointments: Lanabiotic Neosporin maximum strength plus pain ointment Gold Bond triple antibiotic Band Aid plus first aid antibiotic/pain relief ointment X X X X X X X X X X X X X X X X X X Other topical antibiotics: Neosporin maximum strength plus pain cream Betadine plus clear antibiotic Polysporin ointment Bacitraycin plus X X X X X X X Aquaphor Antiseptics/anesthetics: Lanacane antibacterial first aid spray Lanacane plus antibacterial antiitch cream Lanacane maximum strength anti-itch cream Bactine first aid – spray/liquid Solarcaine medicated first aid spray X X X X X X X X X X Topical anesthetics: Dermoplast pain relieving spray Solarcaine aloe extra burn relief X Menthol Aloe X Antiseptics: Betadine – ointment/solution Hibiclens Campho-phenique – liquid/gel Liquid bandages: Skin shield liquid bandage with pain reliever New Skin liquid bandage X X Camphor, phenol X Dyclonine Pyroxylin, alcohol Wound wash: Blairex wound wash saline X 44 OTC First Aid products consist of…. Antibiotics - includes: bacitracin, neomycin, polymyxin B - do not use >1 week - watch for allergic reactions! - Patient counseling: NOT to be used in already infected wounds 1. Bacitracin: active mostly against gram positive organisms 2. Neomycin: active against gram negatives, anaerobes, some gram positive organisms - high incidence of allergic contact dermatitis - produces cross-sensitivity to other aminoglycosides in some pts 3. Polymyxin: gram negative activity Antiseptics - helps prevent infection in minor cuts and scrapes - includes: alcohol, iodine, hydrogen peroxide, benzalkonium, chlorhexidine - apply small amount QD-TID - do not use >1 week - Patient counseling: NOT to be used in already infected wounds 1. Alcohol: have gram-positive, gram-negative, and antitubercular activity - includes: denatured ethyl alcohol 48-95% and isopropyl alcohol 50-91.3% 2. Hydrogen Peroxide: cleanses wound via effervescent action - should be used ONLY in initial care of a wound since it damages viable tissue and inhibits formation of granulation tissue - Patient counseling: NEVER use for deep wound or one with a cul-de-sac 3. Iodine: has bactericidal, sporicidal, tuberculocidal, fungicidal, and virucidal properties - watch for allergic reactions - Patient counseling: stains the skin a brownish color; colorless iodines are useless as antiseptics 4. Quaternary ammonium compounds: effective against gram-positive organisms - includes: benzalkonium chloride, benzethonium chloride, methylbenzethonium chloride 5. Chlorhexidine: effective against bacteria and fungi Anesthetics: provide temporary relief for pain of minor wounds - includes: benzocaine, butamben picrate, dibucaine, dyclonine, lidocaine, pramoxine, tetracaine, dimethisoquin 45 Hydrocortisone-containing: Cortaid – ointment/cream Cortizone 10 – cream/ointment/spray Cortizone 5 – cream Cortizone kids – cream Corizone 10 plus – cream Corticool gel Lanacort maximum strength cool crème Sarnol-HC maximum strength lotion COMMENTS X X X X X X X X Others: Benadryl original strength itch stopping cream -- also gel, spray, stick Benadryl extra strength itch stopping cream -also gel, spray, stick Dermarest plus cooling anti-itch gel Band Aid anti-itch spray Band Aid calamine spray Band Aid anti-itch gel Aveeno anti-itch – cream/lotion Caladryl lotion Caladryl clear lotion Gold Bond medicated anti-itch cream Itch-X Therapatch anti-itch patches for kids Respite anti-itch lotion Sarna anti-itch lotion Natural Harmony fast itch relief X X X X X X X X X X X X X X Zn acetate benzocaine X X X Zn acetate X X X X X X X X X Benzethonium Cl Astringents: Pedi-boro soak pads (AlSO4 + Ca acetate à Al acetate) (AlSO4 + Ca acetate à Al acetate) Domeboro astringent solution Poison Ivy Itch: Corticool gel Blistex ivarest medicated cream Aveeno anti-itch – cream/lotion Tecnu Ivy block lotion Menthol Camphor Benzyl alcohol Pramoxine Calamine Diphenhydramine Topical anti-itch Products Available Over-theCounter Hydrocortisone Topical anti-itch X X X X X X Deodorized mineral spirits Bentoquatum 46 OTC Topical Anti-itch products consist of…. Topical hydrocortisone: antipruritic and anti-inflammatory effects - for relief of itching associated with minor skin irritation, inflammation, rashes caused by eczema; poison ivy, oak, or sumac; detergents; cosmetics; and jewelry - doses available: 0.5%, 1% - use sparingly T-QID - do not use > 1 week - Pediatric: don’t use in children <2 y/o Topical antihistamines: depress cutaneous receptors for pain and itch - includes: diphenhydramine, tripelennamine Skin protectants: protect minor wounds from harmful or annoying stimuli - includes: allantoin, AlOH gel, cocoa butter, calamine, dimethicone, glycerin, kaolin, petrolatum, shark liver oil, sodium bicarbonate, Zn acetate, Zn carbonate, Zn oxide - dries the oozing and weeping of poison ivy, oak, and sumac (AlOH, calamine, kaolin, Zn acetate, Zn carbonate, Zn oxide) - Pediatric: don’t use AlOH gel in <6 months; Zn acetate in <2 y/o Topical anesthetics: temporarily relieves pain, burning, itching, irritation, soreness - includes: benzocaine, pramoxine, benzyl alcohol, dyclonine, lidocaine, tetracaine Counterirritants: external analgesics often used for insect bites - includes: camphor, menthol, allyl isothiocyanate, ammonia water, methyl salicylate, turpentine oil, histamine HCl, methyl nicotinate, capsaicin, capsicum products - camphor and menthol produce cooling sensation - Pediatric: don’t use in children <2 y/o Astringents: temporarily relieves rashes caused by soaps, detergents, cosmetics, and jewelry, as well as minor skin irritations d/t poison ivy - includes: Al acetate (Burow’s solution) - reduces weeping, aids in removal of crust, and soothes the skin - do not use >7 days 47 General pain relief – Flexalls: Flexall 454 maximum strength pain relieving gel Flexall 454 pain relieving gel vitamin E enriched Flexall quik gel Flexall plus pain reliving gel General pain relief – Bengays: Bengay vanishing scent Bengay original formula Bengay greaseless pain relieving cream Bengay ultra strength General pain relief – Tiger Balms: Tiger Balm pain relieving ointment extra strength Tiger Balm pain relieving ointment ultra strength General pain relief – Others: Mineral Ice pain relieving gel Absorbine Jr pain relieving liquid Theragesic Pain Bust R II Icy Hot Deep heating pain relieving rub Lini-mist spray Perform cool pain relieving gel Camphophenique pain relieving antiseptic liquid/gel Dibucaine Benzocaine Trolamine Benzocaine Phenol Capsaicin Camphor Methyl nicotinate Methyl salicylate Topical Pain Relief Products Available Over-the-Counter Menthol Topical pain relief COMMENTS X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X General pain relief – anesthetic-containing: Dermoplast pain relieving spray X Aspercreme Mobisyl Myoflex Sportscreme Boil Ease pain relieving ointment Americaine hemorrhoidal ointment Nupercainal hemorrhoidal and anesthetic ointment Tronolane anesthetic cream for hemorrhoids (camphorated phenol) X X X X X X X X Pramoxine 48 General pain relief (patch): Durapatch topical analgesic Salon Pas pain relieving patch J&J back plaster Mentholatum pain patch Skin shield liquid bandage with pain reliever Arthritis pain relief: Joint-ritis arthritis pain relief ointment Benejoint Stopain spray Banalg arthritic pain reliever Arthritis hot pain relief crème Bengay arthritis formula Arthritic hot deep penetrating pain relief crème Osteo bi-flex arthritis pain relieving cream Ziks arthritis pain relief Arthicare for women multi action Arthicare for women quick-drying Stop pain extra strength topical analgesic spray Arth-Rx topical analgesic lotion Jointflex pain relieving crème Blue star ointment Glucoflex herbal pain relief rub Capsagesic-HP arthritis pain relief crème Capzasin-P arthritis pain relief Capzasin-HP arthritis pain relief Zostrix arthritis pain relief Zostrix-HP arthritis pain relief Ease arthritis pain relief Natrol MSM with glucosamine lipoceutical creme Arthroflex max X X X X X X X X X X X X X X X X X X X X Dibucaine Benzocaine Trolamine Benzocaine Phenol Capsaicin Camphor Methyl nicotinate Methyl salicylate Topical Pain Relief Products Available Over-the-Counter Menthol Topical pain relief (cont’d)… COMMENTS (oleoresin of capsicum) Mentholatum Dyclonine, benzethonium X X X X X X MSM, glucosamine X X X X X X Glucosamine X X X X X MSM, glucosamine histamine dihydrochloride 49 OTC Topical Pain Relief products consist of…. Counterirritants: external analgesics often used for insect bites - includes: camphor, menthol, allyl isothiocyanate, ammonia water, methyl salicylate, turpentine oil, histamine HCl, methyl nicotinate, capsaicin, capsicum products - Pediatric: don’t use in children <2 y/o 1. Menthol: produces cooling sensation - NMT 3-4x/day in adults - May cause sensitization 2. Camphor: produces cooling sensation - can be toxic if ingested 3. Methyl salicylate: produces redness by activating nerve endings – distracts you from pain - other irritants that produce redness: allyl isothiocyanate, strong ammonia, turpentine oil - occurs naturally as wintergreen oil or sweet birch oil - Patient counseling: use caution in pts who are aspirin sensitive, have severe asthma, nasal polyps, or other conditions associated with ASA sensitivity - NMT 3-4x/day in adults 4. Methyl nicotinate: vasodilator - other vasodilators: histamine - may induce drop in BP and pulse rate with possible syncope d/t vascular dilation - NMT 3-4x/day in adults 5. Capsicum preparations: depletes substance P - gives burning sensation therefore not recommended in kids - NMT 3-4x/day in adults Phenol: external analgesic that depresses cutaneous receptors - caution: can cause sloughing of the tissue in certain conditions Topical anesthetics: temporarily relieves pain, burning, itching, irritation, soreness - includes: benzocaine, pramoxine, benzyl alcohol, dyclonine, lidocaine, tetracaine 50 Scar management OTC scar management products include…. - Speco 2nd skin scar management pad (silicone with breathable polyurethane membrane) Mederma (water, PEG-4, onion extract, xanthan gum, methyl paraben, sorbic acid) Curad scar therapy cosmetic pad (polyurethane) Cica-Care gel sheet Drawing ointment (salve) - Ichthammol ointment 51 Diaper rash Product Balmex diaper rash ointment Desitin – ointment/creamy ointment DRC diaper rash crème Johnson’s diaper rash ointment A+D ointment with zinc oxide Aveeno diaper rash cream Blistex ultra dyprotex Vaseline nursery jelly A+D original ointment Diaper guard therapeutic skin rash ointment Gerber diaper rash lotion Zinc oxide X X X X X X X Petrolatum X X X X Dimethicone X X X lanolin X X OTC Diaper Rash products consist of…. Protectants: helps protect skin from moisture (exclude wetness, prevent dryness) - includes: Zn oxide, petrolatum, dimethicone, allantoin, calamine, cod liver oil, kaolin, lanolin, mineral oil, talc, corn starch Lifestyle modifications - frequent diaper changes – clean with water - keep as dry and clean as possible - cornstarch dusting powder Electrolyte Replacements OTC products include…. - ReVital oral electrolyte freezer pops ReVital oral electrolyte liquid squeezes ReVital oral electrolyte jell cups Kaolectrolyte electrolyte replenisher Pedialyte oral electrolyte maintenance solution Pedialyte freezer pops oral electrolyte maintenance solution Oralyte oral electrolytesolution Gerber pediatric electrolyte oral electrolyte maintenance solution 52 Comments Teething OTC products include…. - Zilactin baby (benzocaine 10%) Baby Orajel teething pain medicine (benzocaine 7.5%) Orabase baby (benzocaine) - Hyland’s homeopathic teething tabs Humphrey’s “3” (homeopathic) General information - teething pain is d/t pressure of teeth erupting through gum surfaces - first teeth come in at 6-10 months (central incisors); last teeth in adulthood (wisdom teeth) - approved agents: benzocaine, phenol - should not be applied >QID - Pediatric: don’t use in <4 months of age Other remedies - crushed ice or bottle of cool water applied to child’s gums - chewing on clean, damp, or frozen washcloth Formulas OTC products include…. - Similac with iron infant formula Similac low iron infant formula Similac NeoSure infant formula with iron Similac lactose-free infant formula with iron Similac 2 infant and toddler formula with iron Isomil DF soy formula for diarrhea Isomil soy formula with iron Isomil 2 infant and toddler soy formula with iron Enfamil with iron infant formula Enfamil low iron infant formula Enfamil ProSobee soy formula Enfamil A.R. thickened formula with Added Rice Starch Enfamil lacto-free Enfamil nutramigen hypoallergenic formula Enfamil next step toddler formula Enfamil pregestimil hypoallergenic formula with MCT oil Carnation good start infant formula Carnation follow up infant formula Carnation Al soy infant formula 53 Multi-vitamins - Centrum – lquid/tabs Centrum Silver – tabs One a day womens formula One a day mens formula One a day 50+ formula One a day maximum Theragram M advanced Theragram M with minerals Geritol extend Geritol complete Geritol tonic SSS Tonic Myadec Unicap M Unicap SR Nature made essential daily complete Nature made essential 50+ complete (with high levels Ca, Se) Nature made essential mega Theragran heart right Dr. Art Ulene’s optimal vitamin formula for men Dr. Art Ulene’s optimal vitamin formula for women Dr. Art Ulene’s nutrition boost formula for men and women Radiance Natrol my favorite multiple Multi-vitamins plus - Nature made essential multi plus energy (with korean ginseng) Nature made essential multi plus heart health (with garlic, soy, Vit E) Nature made essential multi plus stress relief (with kava, Vit B) Nature made essential multi plus memory (with gingko) One a day bedtime and rest (valerian, kava) One a day cholesterol health (garlic, soy extracts) One a day energy formula (ginseng, B vitamins) One a day joint health (glucosamine, Vit C, Vit E) One a day memory and concentration (ginkgo, B vitamins) One a day menopause health (black cohosh, natural soy extracts) One a day prostate health (saw palmetto, Zn) One a day tension and mood (St. John’s wort, kava) Centrum focused formulas bone health (Vit D, Ca citrate, Mg, Zn, Cu, Mn, boron) Centrum focused formulas energy (B complex, ginseng) Centrum focused formulas heart (garlic, coQ10, Vit E, Se, Mn, B6, B12, folic acid) Centrum focused formulas mental clarity (ginkgo, B-complex, Vit E, Zn, folic acid) Centrum focused formulas prostate (saw palmetto, Vit A) Centrum focused formulas stress (ginseng, Vit C, E, B-complex, Zn, Cu) 54 Eye vitamins - I Caps plus formula I Caps lutein and zeaxanthin fomrula Ocuvite Ocuvite lutein Prenatal vitamins - Stuart prenatal Enfamil Natalins Natrol for women prenatal care B-complex combination vitamins - Stresstabs high potency B-complex (B complex with Vit C, Vit E, folic acid) - Stresstabs high potency B-complex + iron (B complex with Vit C, Vit E, folic acid, iron) - Stresstabs high potency B-complex + zinc (B complex with Vit C, Vit E, folic acid, zinc) - All BEE plus Vitamin C (B complex, Vit C) - All BEE plus Vitamin C, iron, Vitamin E (B complex, Vit C, Vit E, iron) - Z-BEC plus Zn, Vitamin E, Vitamin C (B complex, Zn, Vit E, Vit C) - Surbex-T (B complex, Vit C) - Nature made super B complex Antioxidants - Nature made antioxidant formula with minerals One a day antioxidant (Vit A, Vit C, Vit E, Zn, Se, Cu, Mn) Protegra antioxidant (Vit A, Vit C, Vit E, Zn, Se, Cu, Mn) Vitamin Packs - Nature made antioxidant pack (multi plus vitamins and minerals, Vit C, Vit E, Zn, βcarotene) Nature made men’s pack (multi plus vitamins and minerals, Vit C, Vit E, B-complex) Nature made stress pack (multi plus vitamins and minerals, Vit C, Ca, super B-complex) Nature made maximin pack (multi plus vitamins and minerals, Vit C, E, B-100, A, D, Ca) Your life memory body benefits pak (ginkgo, gotu kola, phosphatidylserine, lecithin) Your life circulatory and heart body benefits pak (coQ10, garlic, Vit E, folic acid, B vitamins) Your life energy body benefits pak (siberian ginseng, B-100 complex, ginseng, gotu kola, guarana) Your life daily pak maximum (multivitamin, Vit C, Vit E, siberian ginseng, chromium) 55 General Information on Oil-soluble Vitamins - includes: A, D, E, K - held in body much longer than water-soluble vitamins – elevated potential for toxicity - involved for the most part in maintaining the structure of cell membranes and possibly responsible for synthesis of certain enzymes 1. Vitamin A: oil-soluble - essential for proper vision, growth, cellular differentiation and proliferation, reproduction, and immune system integrity - naturally-occurring compounds: retinol, retinaldehyde, retinoic acid - pre-vitamin A carotenoids: -carotene, -carotene, cryptoxanthin 2. Vitamin D: oil-soluble - essential for calcium metabolism in animals therefore important for normal mineralization of bone and cartilage - skin forms Vitamin D3 from a precursor when exposed to sunlight • 7-dehydrocholecalciferol à cholecalciferol (D3) - vitamin D3 is extensively metabolized, forming metabolites such as: • 25-hydroxyvitamin D (calcidiol), formed in the liver and further metabolized to... • 1,25-dihydroxyvitamin D (calcitriol) and 24,25-dihydroxyvitamin D in the kidneys - calcitriol is the active form of Calcium Pediatric: large doses of Vitamin D is potentially toxic 3. Vitamin E: oil-soluble; antioxidant - deficiency results in reproductive failure, muscular atrophy, wasting, neurologic deficits - compounds exhibiting Vit E activity: , , , -tocopherols - antioxidant activity of tocopherols help prevent oxidation of unsaturated FA to avoid cellular damage and neurologic problems 4. Vitamin K: oil-soluble - essential for production of prothrombin and other proteins necessary for blood clotting 56 General Information on Water-soluble vitamins - includes: B-complex, C - rapidly absorbed by the intestine and carried by the circulatory system to specific tissues to be put to use 1. B-complex: water-soluble - B1: thiamin – cofactor in carbohydrate metabolism, therefore plays a key role in the generation of cellular energy • severe deficiency à beriberi (manifests as peripheral neuritis and cardiac abnormalities) – esp. prone to occur in alcoholics - B2: riboflavin – key to functions that keep energy flowing - B3: niacin – active form nicotinamide serves a vital role in tissue respiration • deficiency à pellegra (Sx’s occur in skin, GIT, CNS) • toxicity à flushing and itching (max dose: 35 mg/d) - B5: pantothenic acid – required for synthesis of coenzyme A, therefore essential for carbohydrate, fat, protein metabolism - B6: pyridoxine – required for synthesis and catabolism of a.a.’s • toxicity à sensory neuropathy (max dose: 100 mg/d) - B7: biotin – essential in gluconeogenesis, FA synthesis, propionate metabolism, BCAA catabolism - B9: folic acid – catalyzes the conversion of homocysteine à methionine (w/ B12), therefore potentially protecting against CVD and stroke • deficiency à megaloblastic anemia (reversible) • toxicity à sensory neuropathy (max dose: 1 mg/d) • Pregnancy: very important in first trimester to prevent neural tube defects • Patient counseling: levels are significantly reduced with even 1 or 2 alcoholic beverages per day - B12: cyanocobalamin – necessary for cell growth and replication; as a cofactor, is used during the catabolism of some FA and a.a.’s and catalyzes the conversion of homocysteine à methionine (w/ B9) • deficiency à pernicious anemia (irreversible) • Patient counseling: levels are significantly reduced with even 1 or 2 alcoholic beverages per day 2. Vitamin C: water-soluble; antioxidant - used for wound healing, normal immune response, formation of collagen - as an antioxidant, acts by scavenging radicals, reduce some food carcinogens to inactive products, and protect the lung lining against damage from air pollutants such as the ozone, nitric oxide, and cigarette smoke - deficiency à scurvy 57 Calcium citrate products: Citracal Citracal + D Citracal plus Mg Calsure Magnesium Zinc Manganese Copper X X X X X X X X X Vitamin K Soy isoflavones Calcium phosphate Vitamin D Calcium carbonate products: Tums calcium for life bone health Caltrate 600 Caltrate 600 + D Caltrate 600 + soy Caltrate 600 plus Oscal 5000 Oscal 500 + D Your life calcium Your life calcium with Vit D Your life calcium + soy isoflavones and Vitamin D Nature made Calcium supplement– tablets/chews Nature made Calburst calcium supplement softchews Nature made calcium plus soy advanced bone care Nature’s bounty absorbable calcium with Vitamin D Sundown calcium 900 plus D Sundown calcium 1200 plus D Natrol calcium chewable with Vitamin D Soy care + 600 Calcium Osteo-P Viactiv chews Calcium citrate Calcium Supplements Available Over-the-Counter Calcium carbonate Calcium supplements COMMENTS X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Calcium phosphate products: Posture-D Posture-D high potency Calcium products from other/unknown sources: One A Day Calcium plus X Calcet triple calcium plus Vit D X Sundown calcium plus Vit D X X X X X X X X X X X X X X X X X X X X X Vit B6, Boron X X X X X X Ca lactate and gluconate Ca from oyster shell 58 General Information - most abundant element in body - benefits include: reduction of HTN associated with pregnancy; prevention of osteomalacia and osteoporosis - supplements contain…. • Ca carbonate • Ca phosphate • Ca citrate • Ca gluconate • Ca lactate - absorption comparison…. • Ca phosphate = Ca citrate > Ca carbonate - RDA’s: • 1-10 y/o • 11-24 y/o • > 25 y/o • pregnant or lactating 800 mg/d 1200 mg/d 800 mg/d 1200 mg/d NIH recommendations: • 25-65 y/o • postmenopausal women on estrogen • postmenopausal women w/o estrogen • >65 y/o 1200 mg/d 1000 mg/d 1500 mg/d 1500 mg/d - - 40% Ca++ 40% Ca++ 21% Ca++ 9.3% Ca++ -- not commonly used 13% Ca++ -- not commonly used SE’s: constipation, GI upset, gas, gastric ulceration (gas esp. prevalent in CaCO3) 59 Iron supplements Product Feosol Fer-in-Sol Slow Fe Slow Fe plus folic acid Fergon Ferralet Ferrosequels FeoSol Sundown perfect iron Fe sulfate X X X X Fe gluconate absorption comparison…. • all absorbed equally - RDA’s: • < 4y/o • males 4-19 y/o • males > 19 y/o • females 4-50 y/o • females > 50 y/o • pregnancy and lactation - Carbonyl iron Comments Folic acid X X X X X General Information - most abundant trace element in body - supplements contain…. • Fe sulfate • Fe gluconate • Fe fumarate - Fe fumarate 60 mg/325 mg tab 30 mg/325 mg tab 105 mg/325 mg tab 10 mg/d 12 mg/d 10 mg/d 15-18 mg/d 10 mg/d 30-60 mg/d from diet, only 10-15% is absorbed deficiency à anemia – takes 3-6 months to correct 60 Calcium Magnesium supplements - Slow-Mag (MgCl) General Information - helps with carbohydrate metabolism, protein synthesis, neuromuscular function; clinically used to treat eclampsia of pregnancy - deficiency à rarely occurs unless chronic alcoholic, protein malnourished, or experiencing chronic vomiting or diarrhea Niacin supplements (B3) - Slo niacin Endurance plain niacin Endur-acin niacin Folic acid supplements (B9) - Folgard supplements (folic acid) 61 Multivitamins for Children - Li’l Critters Gummy Vites Centrum Kids complete Centrum Kids extra C Centrum Kids with extra calcium One a day Kids complete Sesame Street complete Bugs Bunny complete (sugar free) Sundown Pokemon complete Sundown Pokemon with extra C Sundown Pokemon with extra iron Flintstones original Flintstones complete Flintstones with iron Flintstones with calcium Flintstones plus extra C Multivitamins for Infants and Toddlers - Enfamil Poly-Vi-Sol multivitamin supplement drops Enfamil Poly-Vi-Sol with iron multivitamin supplement – chews/drops Gerber vitamin drops Supplements for children - Li’l Critters Vitamin C with echinacea Supplements for Infants and Toddlers - Enfamil Tri-Vi-Sol with iron Vit A, D, C supplement drops Enfamil Fer-In-Sol iron supplement drops 62 Natural product combinations PMS - Nature made Soy 50 (soy) Healthy woman soy menopause supplement (soy) Soy care for menopause (soy isoflavones) Promensil (isoflavone phytoestrogens) Remifemin (black cohosh) New Phase (soy isoflavones, black cohosh, chastetree) Estroven (soy, Vit E, folic acid, Vit B6, Ca, kava, black cohosh, boron) Rejuvex (dong quai, Mg, boron, glandular powders) Lydia Pinkham herbal tabs (iron, Ca, Vit C, Vit E, herbs) Tums calcium for life PMS (CaCO3) Natrol for women hot flashex (black cohosh, Vit E, kava) Natrol for women soy isoflavones (soy isoflavones) Nature’s bounty soy isoflavones (soy isoflavones) Sundown concentrated soy isoflavones (Ca, soy isoflavones) Other soy-containing products - Genisoy vanilla protein shake Genisoy natural protein powder Health source soy protein shake CardioLink Soy 25 protein powder Bone - Dr. Art Ulene’s Soy Plus (soy isoflavones) Soy care + 600 Calcium (CaCO3, Vit D, soy isoflavones) Knox Nutra Joint gelatine dietary supplement (Vit C, Ca) – help maintain healthy bones, joints Knox Nutra Joint + glucosamine dietary supplement maximum strength formula (Vit C, D, E, K, Ca, Zn, Cu, Mn) Cholesterol - Cholestaid cholesterol blocker (esterin alfalfa saponin extract) – blocks new cholesterol in stomach before absorption HPF Cholestene dietary supplement (red yeast rice) – promote HMG CoA reductase inhibition 63 Prostate - Soy care prostate (Se, E, soy isoflavones, saw palmetto) Prostatonin (pygeum africanum, urtica dioica) Natrol advanced prostate formula PC care (saw palmetto, other herbs) Propalmex (saw palmetto) Prostate formula (saw palmetto, etc…) Others - Nature’s Bounty evening primrose Nature’s Bounty nutritional support for your skin, hair, nails Natrol for women skin, hair, nails (silica, a.a.’s, vitamins, MSM) Calcet triple calcium plus Vit D (Ca, Vit D3) – for low Ca leg cramps Venastat leg health dietary supplement (horse chestnut seed extract) – help maintain leg circulation; protect against leg swelling Your life health legs (horse chestnut seed extract) Sundown Cellasene (lipovascolen, etc…) – eliminate cellulite Movana mood support dietary supplement Sunsource Harmonex (St. John’s wort with siberian ginseng) – emotional and physical harmony Sunsource Melatonex (melatonin with Vit B6) – promote natural sleep cycle Protegra cardio (Vit C, A, E, B6, B12, foklica cid, Mg, Zn, Se, Cu, Mn) – helps break down homocysteine Nature’s Bounty shark cartilage – source of chondroitin Super juice daily with multi phyto-nutrient formula (Vit A, C, phytoactives…) ENADAlert stabilized NADH dietary supplement – alertness and energy Head Start protein for your hair Your life Accu-mind and memory (ginkgo, vinpocetine) Your life women’s cycle multivitamin (multivitamin, soy) Your life pycnogenol pine bark extract – maintains collagen Your life Syndrox – help support already healthy BP, cholesterol, pancreas fxn, circulation, metabolism 64 Dry Eyes (lubricant drops) – Refreshs: Refresh tears lubricant eye drops X Refresh plus lubricant eye drops X Refresh lubricant eye drops X X X Alcon tears naturale II X X Phenylephrine Tetrahydrozoline Naphazoline Pheniramine Mineral oil benzalkonium, NaCl, KCl benzalkonium, NaCl, KCl, polyquaternium X X Dry Eyes (lubricant drops) – Moisture eyes: Moisture eyes propylene glycol, glycerin Moisture eyes PM Dry Eyes (lubricant drops) – Others: Thera tears lubricant eye drops X Celluvisc lubricant eye drops X Gen Teal lubricant eye -- drops and gel Visine tears Bion tears lubricant eye drops OcuCoat PF lubricating eye drops Murine tears COMMENTS X Dry Eyes (lubricant drops) – Alcons: Alcon tears naturale Dry Eyes (lubricant drops/ointments) – Hypotears: Hypotears – drops and ointment X Hypotears PF – drops and X ointment White petrolautm Dextran Povidone Polyethylene glycol Polyvinyl alcohol Hydroxypropyl methylcellulose Ophthalmic Products Available Over-the-Counter Na carboxymethylcellulose Ophthalmic Products X X X X X X X glycerin X X X X Dry Eyes (lubricant ointments): Alcon tears naturale II PM lubricant eye ointment Lacrilube ophthalmic ointment Refresh PM lubricant eye ointment 65 X X X X X X Eye redness (decongestants): Naphcon Original Visine Visine AC Visine LR – long-lasting OcuClear Combination for dry eyes and redness: Prefrin liquifilm All Clear All Clear AR Clear Eyes Clear Eyes ACR Visine Advanced Relief Relief Murine tears plus Vasoclear COMMENTS Phenylephrine Tetrahydrozoline Naphazoline Pheniramine Mineral oil White petrolautm Dextran Povidone Polyethylene glycol Polyvinyl alcohol Hydroxypropyl methylcellulose Ophthalmic Products Available Over-the-Counter Na carboxymethylcellulose Ophthalmic Products (cont’d)… X X X X X X X X X X X X X X X ZnSO4 Oxymetazoline Oxymetazoline X X glycerin glycerin, ZnSO4 X X X X X X Eye allergies (antihistamines): Naphcon-A Vasocon-A Visine-A Opcon-A X X X Other eye products: Muro 128 5% NaCl hypertonicity ophthalmic solution Stye ophthalmic ointment X X X X Antazoline 5% NaCl X 66 X Cannot cure or prevent stye - refer to MD! OTC Ophthalmic Products consist of…. Artificial tears: demulecents to help treat dry eye - prevent and alleviate irritation and dry eye - consists of lubricants with or without preservatives • includes: carboxymethylcellulose, hydroxypropyl methylcellulose, methylcellulose, polyvinyl alcohol, polyethylene glycol, glycerin, polyethylene glycol, polysorbate 80, povidone, dextran 70 - preservatives: benzalkonium, chlorhexidine, methylparaben, thimerosal do not use >72 hours Ocular emollients: ophthalmic ointments used to relieve burning and irritation of dry eye - soften tissue by forming an occlusive film on the surface of the eye - includes: lanolin, mineral oil, parraffin, petrolatum, white petrolatum, white ointment, white wax, yellow wax - Patient information: may cause blurred vision, therefore optimal time of use in HS Decongestants: vasoconstrictors for redness associated w/ minor irritation and conjunctivitis - includes: oxymetazoline, naphazoline, tetrahydrozoline, phenylephrine - do not use for >72 hours – rebound congestion may occur (more so with phenylephrine) Antihistamines: to relieve ophthalmic redness and itching d/t allergic conjunctivitis - includes: pheniramine, antazoline - dosage: 1-2 drops in affected eye up to QID - SE’s: burning, stinging - CI: do NOT use in pts with glaucoma, CVD, HTN, difficulty urinating - Pediatric: do not use in <6 y/o Hypertonic NaCl: osmotic gradient that draws fluid from the cornea (for corneal edema) - NOT to be used unless advised by MD - SE’s: temporary burning and irritation of eye 67 Other ophthalmic products available consist of isotonic solution and include…. Rewetting drops - Visine for contacts Clear Eyes CLR -- contact lens relief Clerz plus lens drops Refresh contacts Allergan lens plus Renu rewetting drops Opti-free rewetting drops Etc….. Eye washes - Flent’s eye wash Collyrium for fresh eyes Bausch and Lomb eye wash 68 Cerumen softening agents OTC products all consist of carbamide peroxide and include…. - Auro ear drops Otix drops Debrox drops Murine ear drops Murine ear wax removal system B&L ear wax removal system Flent's ear drops General information - softens ear wax - pt may use for few days then go to MD to have it removed (if necessary) - dosage: place 5-10 drops in each ear QD for up to 4 days - do not use >4 days - do not recommend removal of hard wax - Pediatric: consult MD for children < 12 y/o Swimmer's ear OTC products include…. - Star-otic (Burow's solution) -- protective, drying Swim-ear (isopropyl alcohol, anhydrous glycerin) Auro-dri (isopropyl alcohol, anhydrous glycerin) General information - external otitis that follows prolonged exposure of the ear to water - OTC products indicated ONLY to dry water-clogged ears, NOT for other Sx’s that accompany swimmer’s ear such as acute pain, itching, inflammation, and drainage of a foulsmelling watery discharge Other ear product - sweet oil (olive oil emollient) General Information - used to kill insects in ear - apply small amt olive oil to kill it – then irrigate ear so it will come out - other uses: to soften and smooth tissues (elbows, knees, heels, hands) 69 Home screening tests UTI screening test…. - UTI home screening test kit (urine) General Information - nitrate generally excreted as nitrate in the urine – in pts with gram-negative UTI, bacteria converts it to nitrite - contains arsanilic acid which reacts with urinary nitrite to form a pink color - should test first morning urine or urine retained in bladder for >4 hours HIV screening test…. - Home access HIV-1 test (blood) Home access express HIV-1 test (blood) General Information - pt must apply blood to specimen collection card and send to lab - card must be received within 10 days of specimen collection - test initially uses ELISA test – if positive, more specific immunofluorescence assay is used - can call for results after 3-7 days (3 for express kit) Cholesterol screening test…. - Choles Trak home cholesterol test (blood) General Information - uses progressive enzymatic action to measure total cholesterol - measures cholesterol from blood sample in a range from 125-400 mg/dL – will produce color change within 12-15 minutes 70 Colorectal cancer screening test…. - EZ detect (BM’s in toilet) ColoCare General Information - tests for fecal occult blood - directions: place test pad in toilet following BM - positive test indicated by blue/green color on test pad - results appear in 30 seconds to 2 minutes - 3 consecutive BM’s should be tested Drug screening test…. - Personal drug testing service (PDT-90) (hair) General Information - urine tests only detect usage within last 2-3 days and do not provide index of degree of drug abuse over time - hair however traps within it substances that were in the blood at the time the hair was formed in its follicle - hair grows ~0.5 inches per month – will provide good index of degree of drug abuse - this test requires a sample of hair be sent to the manufacturer where they test for marijuana, cocaine, crack cocaine, opiates (heroin), methamphetamine, PCP - can call after 5 business days for results Blood-glucose monitors…. - One Touch Basic One Touch Fast Take One Touch Sure Step One Touch Ultra Accu Chek Simplicity Accu Chek Advantage Accu Chek Instant Accu Chek Easy Glucometer Dex Glucometer Elite Medisense ExacTech RSG Medisense Precision Xtra Medisense Precision QID Therasense Freestyle Amira At Last 71 Pregnancy tests (urine – 2 lines = yes; 1 line = no/control)…. - Clear blue easy First response early result pregnancy test Answer one-step pregnancy test E.P.T. pregnancy test Early pregnancy test Fact plus select Fact plus pro pregnancy test General information - detects human chorionic gonadotropin (HCG) in urine via monoclonal antibody reaction - HCG appears in urine 1-2 weeks after implantation – can be detected during the subsequent 2-3 weeks - 99% accurate - recommended reading time for results: 1-3 minutes (depending on test) Fertility tests (urine – 2 lines = yes; 1 line = no/control)…. - Clear plan easy ovulation test First response 1-step ovulation predictor kit Answer one-step ovulation test General information - detects preovulation surge of luteinizing hormone (LH) in urine via monoclonal antibody reaction, which occurs 24-36 hours prior to ovulation - in response to the LH surge, an ovarian follicle will rupture releasing a mature ovum - “yes” answer indicates that ovulation will occur within 20-44 hours - kits contain sufficient materials to test urine for 5, 6, or 9 days - should use first test kit 2-3 days prior to expected ovulation date - clomiphene and other medications may induce false positive results – should not test till 1 or more days after d/c drug - recommended reading time for results: 3-5 minutes (depending on test) Fertility monitor…. - Clear plan easy fertility monitor 72 Condoms OTC latex-containing products include…. - Trojan Trojan-enz Trojan plus 2 Durex Lifestyles OTC polyurethane-containing products include…. - Trojan supra Durex avanti OTC natural skin-containing products include…. - Kling-tite OTC female products include…. - Reality female condom Male genital desensitizers OTC products all consist of benzocaine and include…. - Maximum strength Mandelay Durex Maintain Detane 73 Psoriasis Product Tegrin coal tar solution Oxipor psoriasis lotion Exorex psoriasis medication Psoriasin -- gel/liquid MG217 medicated tar ointment MG217 sal-acid ointment with Vitamin E Dermarest psoriasis medicated scalp treatment Dermarest psoriasis medicated shampoo plus conditioner Lomalux psoriasis medication Coal tar solution X X X X X Salicylic acid Comments X X X homeopathic General information - hyperproliferative skin condition of ~10-20 times the normal rate - most often occurs in individuals 16-22 y/o and 57-60 y/o - probably d/t exposure of skin to trauma , Strep infections, certain meds - improves in hot weather, increases its severity in cold weather (like dandruff) - manifests as scales that are silvery on top and pink to dull red underneath, most commonly on scalp, sacral area, and extensor surfaces of knees and elbows • can occur at any location on body • less common on face – opposite of seborrheic dermatitis - also affects fingernails – hyperproliferates producing a disordered nail plate chronic condition that does not yield to treatment treatments: coal tar, salicylic acid Non-pharmacologic treatments - soaking affected area in warm water • hydrates skin, especially when hypoallergenic emollient if used directly following bath Eczema OTC products iclude…. - Exorex eczema regular formula (emulsified coal tar) Lomalux eczema (homeopathic) General information - also known as dermatitis - appearance ranges from transient redness to severe swelling with bulla formation - types: contact, atopic, seborrheic, nummular, chronic, generalized exfoliative, stasis - treatment is generally by Rx and involves either an oral or topical corticosteroid - tar products may help reduce itchiness, redness, and inflammation of the scalp and skin 74 Head lice treatment Product Pyrethrum RID maximum strength X Piperonyl butoxide X Pronto MS A-200 Clear total lice elimination system Nix lice treatment Clear lice egg remover Not nice to lice Acu-med lice cure X X X X X X Permethrin Comments shampoo/gel/mousse/spray shampoo/spray shampoo/spray shampoo X cream rinse/spray natural enzymes – gel natural enzymes – shampoo tea tree oil – gel OTC lice treatment products consist of…. Synergized pyrethrins: natural chemicals derived from plants used to treat head or pubic lice - to be effective, pyrethrins are synergized with piperonyl butoxide - since no treatment is completely ovicidal, another treatment in 7-10 days is mandatory to kill newly hatched nits - Pediatric: not recommended in <2 y/o Permethrin: synthetic chemical derived from pyrethrins used to treat head lice only - following application and removal, a residual is left on the hair which enhances its activity - Pediatric: not recommended in <2 months old Nonpharmacologic therapies - vacuum area (instead of using environmental spray) to get rid of live lice - after treatment, a lice/nit comb should be used to remove dead lice/nits as well as viable eggs - wash all clothes, towels, and bed linens on hot cycle, then dry in heated air cycle for at least 20 minutes - any clothing that cannot be washed should be sealed in a plastic bag for at least 2 weeks - combs and brushes should be cleaned in hot water of at least 130oF for 5-10 minutes 75 Denorexs: Denorex medicated shampoo and conditioner Denorex medicated shampoo extra strength Denorex medicated shampoo and conditioner extra strength Neutrogenas: Neutrogena therapeutic T/Gel shampoo intensive antiflake treatment Neutrogena maximum strength T/salicylic acid Neutrogena healthy scalp anti-dandruff shampoo Ketoconazole Sulfur Salicylic acid COMMENTS X X X X X X Head and shoulders: Head and shoulders dandruff shampoo Head and shoulders dandruff shampoo plus conditioner Head and shoulders dandruff shampoo dry scalp Head and shoulders dandruff shampoo plus conditioner dry scalp Head and shoulders intensive treatment X X X X X Selsun blues: Selsun blue dandruff shampoo moisturizing treatment Selsun blue dandruff shampoo with menthol medicated treatment Others: Ionil.T plus conditioning shampoo Pentrax maximum strength anti-dandruff tar shampoo MG217 extra strength medicated tar shampoo Zincon medicated dandruff shampoo Scalpicin lotion dandruff Medicated Sebulex dandruff shampoo Nizoral A-D – shampoo/conditioner Selenium sulfide Zinc pyrithione Dandruff Products Available Over-the-Counter Coal tar Dandruff X X Aloe X X X X X X X X 76 OTC dandruff products consist of…. Coal tar: reduces the number and size of epidermal cells produced by the body - effective against hyperproliferative conditions such as dandruff, seborrheic dermatitis, and psoriasis - Patient information: coal tar has an unpleasant odor and may stain skin and hair; may also cause photosensitivity Zinc pyrithione: treats dandruff d/t its antifungal effect and/or by reducing cell turnover Selenium sulfide: exerts cytostatic effect (reduces rate of cell turnover) - may also inhibit the growth of Pityrosporum ovale Salicylic acid: lowers pH of tissues thus effective in hyperproliferative conditions - can be combined with sulfur Sulfur: possible fungicidal effect - can be combined with salicylic acid Ketoconazole: antifungal which controls the flaking, itching, and scaling of dandruff - approved for Rx to OTC switch - do not use longer than 2-4 weeks - Pediatric: not recommended in <12 y/o General information - d/t skin cell turnover rate of approximately double the normal rate - not common until onset of puberty - major manifestations: scaling, occasional pruritus - more severe from October till December; milder in summer - shampoo should be used at least twice weekly; creams/ointments/lotions are applied Q-QID or UTD and left on skin - Patient information: to maximize epidermal absorption of shampoos, pts should wait several minutes before rinsing their hair 77 Hair growth OTC products all consist of minoxidil and include…. - Rogaine extra strength for men (5%) Rogaine regular strength for men (2%) Rogaine for men (2%) Rogaine for women (2%) General Information - approved for androgenetic alopecia – not approved for frontal or patchy hair loss - causes an increase in cutaneous blood flow to the scalp which may be responsible for MOA - regrowth may not be apparent for ~4 months since hair grows at a rate of 0.5 inches/month - best growth seen after using product BID for 12 months - must continue using product forever to retain hair that has grown d/t minoxidil – otherwise will fall out in ~3-4 months - Pregnancy/Lactation: not recommended - Pediatric: not recommended in <18y/o - Patient information: absorbed over 4 hour period, therefore best not to wet the scalp in anyway for 4 hours after application 78 Daily cleansers: Neutrogena oil-absorbing acne mask Clean & Clear continuous control daily cleanser Oxy balance oil-free maximum strength acne wash Fostex acne medication bar Panoxyl bar Clearasil stay clear Clearasil stay clear deep clean pads Neutrogena maximum strength oil-controlling pads Neutrogena clear pore treatment Neutrogena multi-vitamin acne treatment Neutrogena skin clearing moisturizer Neutrogena oil-free acne wash Neutrogena body clear body wash/scrub/lotion Aveeno acne treatment bar Clean & Clear oil-free deep action cream cleanser Clean & Clear oil-free dual action moisturizer Clean & Clear oil-free continuous control acne wash Clean & Clear clear skin body wash Oxy on-the-go cleansing pads Oxy balance daily cleansing pads Stridex face wipes to go Stridex triple action acne pads PHisoderm 4-way daily acne cleanser Noxzema extra strength 2 in 1 pads Biore blemish fighting cleanser Biore blemish double agent Biore blemish bomb Ponds overnight blemish reducers Clearasil daily face wash Clearasil antibacterial soap Clean & Clear oil-free foaming facial cleanser Stridex anti-bacterial foaming wash Salicylic acid Triclosan Spot treatments: Clearasil treatment cream – vanishing/tinted Neutrogena on-the-spot acne treatment Clean & Clear maximum strength persa gel 10 Oxy balance maximum acne treatment – vanishing/tinted Clearasil adult care tinted cream Acnomel adult acne medication Clearasil stay clear zone control clearstick Neutrogena on-the-spot acne patch Clean & Clear maximum strength invisible blemish treatment Clean & Clear maximum strength overnight acne patches PHisoderm blemish patch Sulfur/ resorcinol OTC Acne Products Available Over-the-Counter Benzoyl peroxide Acne Treatment X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 79 COMMENTS OTC Acne Products consist of…. Benzoyl peroxide: releases oxygen to destroy anaerobic P. acnes - also acts as exfoliant, peeling the outermost layer of the skin - most frequently used acne medication - SE’s: redness, burning, swelling, itching, peeling Sulfur/resorcinol combination: lessen severity of acne by its keratolytic and antibacterial action - resorcinol enhances the activity of sulfur - sulfur can cause ophthalmic and dermatologic irritation so must avoid contact with eye Salicylic acid: presumably works as a keratolytic Triclosan: unapproved ingredient in acne treatment General Information - cannot be cured with OTC products; however, judicious use can reduce the severity and extent of the condition - acne exacerbators: stress, menses, mechanical trauma, tight athletic equipment, humidity, air pollution, harsh scrubbing, oil-based products – diet has little effect 80 X X X X Potassium X X Caffeine Pyrilamine X X Pamabrom Menstrual discomfort: Multi Sx Pamprin maximum strength Pamprin maximum cramp relief Midol Cramp maximum strength Midol PMS maximum strength Midol Teen maximum strength Midol menstrual maximum strength Presym PMS maximum strength Women's Tylenol multi Sx menstrual relief Diurex PMS Diurex long-acting water capsules Diurex aqua gels Diurex 2 with calcium Diurex water pills Aqua Ban maximum strength Chromaslim water pill Ibuprofen Women’s Health Products Available Overthe-Counter APAP Women’s Health Products COMMENTS Mg salicylate X X X X X X X X X X X X X X X X X X X Mg salicylate tetrahydrate Salicylamide X Vit B6, herbal complex X X X X X Cranberry Na salicylate Urinary tract pain/Sx’s: Uristat Prodium AZO standard urinary pain relief AZO cranberry Cystex Methenamine Women’s Health Products Available Overthe-Counter Phenazopyridine Menstrual discomfort products: helps relieve mild to moderate Sx’s - APAP/NSAIDs help relieve pain from cramps, HA, backache - Diuretics help with bloating and water retention - Caffeine helps to relieve fatigue d/t PMS; also helpful as diuretic - Antihistamine (pyrilamine) helps with emotional/mood changes COMMENTS X X X X Urinary tract analgesics - includes: phenazopyridine, methenamine, benzoic acid 81 (natural powder concentrate) X X X X X X Benzalkonium Resorcinol Feminine itching: Vaginex Gynecort Vagisil Vagisil maximum strength Vagigard advanced sensitive formula Vagigard maximum strength Benzocaine Women’s Health Products Available Overthe-Counter Hydrocortisone Women’s Health Products (cont’d)…. COMMENTS X X X X Yeast infection: Mycelex 3 Femstat 3 Gyne-lotrimin 3 Mycelex 7 Monistat 3 Monistat 7 Monistat 1 Vagistat 1 Yeast Gard homeopathic vaginal suppositories Tioconazole Miconazole Clotrimazole Women’s Health Products Available Overthe-Counter Butoconozaole Feminine itching products - include: hydrocortisone, benzocaine, resorcinol, tripelennamine, diphenhydramine, benzethonium chloride - vaginal irritation/pruritus should not be self-treated for >1 week COMMENTS X X X X X X X X Homeopathic Vaginal antifungals - may damage condoms and diaphragms - be aware that Candida organisms may persist in vagina as long as 5 days after onset of tx, therefore 1 or 3 day therapy may not be long enough 82 Women’s Health Products (cont’d)…. Other Women’s Health concerns…. Sore nipples - Lansinoh for breast feeding mothers (lansinoh à lanolin) 83
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