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OTC Drugs, Herbal Remedies and Other Stuff

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 .

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OTC Drugs, Herbal Remedies and Other Stuff

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  1. OTC Drugs,Herbal RemediesandOther Stuff Chapter 14

  2. Lecture Outline • OTC Drugs • Antihistamines • Decongestants • Cough medicine • Analgesics • Herbal Remedies • St. John’s Wort • Ephedra • Ginkgo Biloba • Ginseng • Other Supplements and Prescription Drugs

  3. ADHD Treatments • Primarily treated with stimulants • Ritalin (Methylphenidate) • Concerta (a longer acting form of Ritalin) • Adderal (amphetamine salts) • Strattera (atomoxetine) - SNRI

  4. 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

  5. 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

  6. 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

  7. OTC Sleep Aids • For temporary relief of insomnia • Vast majority contain antihistamines • Benedryl • Tylenol PM • Unisom geltabs • Sominex • Doxylamine • Unisom sleep tabs

  8. 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

  9. 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

  10. 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

  11. 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”

  12. 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

  13. Kava • Plant native to South Pacific • Used much like alcohol • GABA agonist • Associated with liver failure

  14. The Moral • Look up the active ingredient • What is it? • What does it do? • Be aware of drug interactions • Antagonism • Synergism • Intolerance • Allergy

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