dietary supplement health and education act
provided definition for dietary supplements
established food manufacturing practices
allowed FDA to regulate supplements as food products
dietary supplement and non-prescription drug consumer protection act
requires manufacturers, packers, and distributors to submit reports of serious adverse events
dietary supplements are regulated as
food
no studies on safety or efficacy required
purity and potency not monitored
no review of adverse events required
FDA little regulatory oversight unless harm is established
antihistamines MOA and side effects
block binding of histamine to its receptors
drowsiness, dizz, fatigue, nausea, HA, urinary retention
antihistamines second gen > first gen
less anticholinergic effects = lower chance of sedation and less urinary retention
antacid MOA and SE
neutralize stomach pH by binding to HCl in the stomach
diarrhea (magnesium containing), constipation (aluminum containing)
antacids considerations
may cause “acid rebound” w prolonged use - paradoxical acid hypersecretion
may reduce absorption of other medications
H2RAs MOA
treatment of infrequent heartburn associated w acid indigestion
block histamine from binding to H2 receptors on gastric parietal cells which reduce gastric acid secretion
H2RAs SE and considerations
nausea, HA, agitation, dizziness
avoid >14 days
take before food/beverages known to cause heartburn
PPIs MOA
treat frequent heartburn >2days/week
block H/K ATPase enzyme (proton pump) in gastric parietal cells which reduce acid secretion
PPIs SE and considerations
HA, abd pain, N/D
not for immediate relief
increased risk of C. diff w diarrhea when used for long duration
bismuth subsalicylate (pepto bismol) MOA
diarrhea symptoms <2days
bismuth: kills some bacteria and prevent toxin binding
salicylate: reduce inflammation and binds toxins and bacteria for elimination
Loperamide (Imodium) MOA
diarrhea <2days
bind to opioid receptors in the intestinal wall to slow GI motility
bismuth subsalicylate SE & considerations
dark stool, black tongue, constipation, metallic taste
not intended for prolonges use
avoid if infectious cause suspected
do not use in children - Reye syndrome
Loperamide SE and considerations
constipation, nausea, dry mouth, gas, stomach cramping
may be abused for opioid-like effects
excessive doses increase risk of Torsades de Pointes
pseudoephedrine (Sudafed) MOA & considerations
stimulate alpha adrenergic receptors in the smooth muscle of the nasal passages thereby reducing swelling and congestion
avoid in pt w HTN
dextromethorphan (Delsym/Robitussin) MOA and considerations
relief of cough w common cold
block N-methyl-D-aspartate (NMDA) receptor leading to cough suppression
high doses produce dissociative effects; risk of abuse (>18 years old)
Guaifenesin (Mucinex) MOA and considerations
loosen mucus and bronchial secretions to make cough more productive
stimulates production of watery respiratory secretions to thin and loose mucus
take w large amount of water to improve efficacy
smoking cessation MOA
deliver steady controlled dose of nicotine to prevent withdrawal symptoms and cravins
smoking cessation SE and warnings
patch - vivid dreams and skin irritation; avoid in patients w adhesive allergy
gum - mouth/throat irritation; avoid in dentures
lozenge - mouth/throat irritation; avoid in soybean allergies
smoking cessation considerations
avoid in pregnant/lactating and <18yo
gum and lozenges can be used if patient is still smoking but patch CANNOT be used (increased risk of nicotine toxicity)
CoQ10
heart disease
glucosamine
osteoarthritis
echinacea
common cold
