OTC Drugs, Herbal Remedies and Other Stuff

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OTC Drugs,Herbal RemediesandOther Stuff

• Chapter 14

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Lecture Outline

• OTC Drugs
• Antihistamines
• Decongestants
• Cough medicine
• Analgesics
• Herbal Remedies
• St. Johns Wort
• Ephedra
• Ginkgo Biloba
• Ginseng
• Other Supplements and Prescription Drugs

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ADHD Treatments

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

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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) Doesnt Cross
• Claritin (Loratadine) Doesnt Cross
• Zyrtec (Citirizine) Doesnt cross
• Clemastine (Tavist) - Crosses
• H2 receptor antagonists are Pepcid, Tagamet, Axid
  Anti-ulcer and Antacid drugs

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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

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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

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OTC Sleep Aids

• For temporary relief of insomnia
• Vast majority contain antihistamines
• Benedryl
• Tylenol PM
• Unisom geltabs
• Sominex
• Doxylamine
• Unisom sleep tabs

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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

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St Johns 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

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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

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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 gt2 years use
• Effective for people with problems may not have
  much effect for normals

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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

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Kava

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

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The Moral

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