It is also the nurses responsibility to educate a patients about possible drug interactions that can occur between prescribed and over the counter medications.

 Just a cute/funny old advertisement:

When athletes and overdose are in the same sentence you would think its some crazy pills or an accident with steroids right? WRONG! I saw this story where an athlete accidentally died from an overdose using an ointment like Ben-Gay or Icy Hot for sore muscles.

When applying over the counter ointments, for the most part if used correctly they are topical and treat local problems. Most aren’t absorbed too much into your blood, but when used excessively you can overdose. The active ingredient in muscle ache creams such as Icy Hot and Ben-Gay is Methyl Salicylate, which when used in excess was stored in this particular athletes body. The extra build up of this stored ingredient triggered a reaction when the athlete took aspirin (another OTC) which sent her into cardiac arrest.

Who would have thought an ointment could be fatal?

okay I know it’s not funny, but seriously check out the story… it’s pretty shocking

CNN.COM-ointment overdose story

http://www.drugs.com/search.php?searchterm=doxylamine&is_main_search=1&type=0

http://www.drugs.com/search.php?searchterm=pseudoephedrine&is_main_search=1&type=0

http://www.drugs.com/search.php?searchterm=acetaminophen&is_main_search=1&type=0

http://www.drugs.com/search.php?searchterm=dextromethorphan&is_main_search=1&type=0

Over-the-counter medications are relatively safe to use as long as we as consumers use them as directed. Here are some tips that I found:

Make sure you have the right diagnosis

Don’t treat yourself unless you are familiar with your symptoms (like a headache or a runny nose). If the symptoms persist for longer than a week, then it is important to go see a doctor. The wrong diagnosis can be really dangerous when it hides a more serious problem like chronic headaches signifying hypertension (high blood pressure).

Pay attention to drug labels

ALWAYS read the drug labels!! Don’t take drugs longer than recommended on the label and the package insert. Also, don’t take more than the recommended dose on the drug label because too much of any drug can cause severe complications like liver toxicity. Be aware of drug interactions with prescription drugs and over the counter drugs.

Avoid overdose

Be aware of the active ingredients in the OTC drugs, especially if you are taking more than one. Be sure that you aren’t taking more than one medication with the same active ingredient like Tylenol for muscle aches and NyQuil for cold medicine, both of which have acetaminophen. Taking both of those medications at the same time means that you are getting 2x the amount you should. Pick an OTC medication based on the active ingredient and try to stick drugs that have one ingredient instead of multiple ones.

Be aware of the side effects

Some common side effects of OTC drugs can become severe if the medication is taken for prolonged periods of time. Aspirin and Ibuprofen found in Advil and Motrin are known to cause upset stomach and sometimes stomach bleeding or ulcers.

 http://www.medscape.com/viewarticle/556487

Adolescents

Many teenagers or young adults frequently experience headaches. The level of maturity is reason enough that the OTC medication is being misused. One of the common side effect of taking too much OTC medication for a headache is chronic headache, thus misusing the medication even more.

“I’ve been astounded by the large numbers of kids using over-the-counter medications 5 or 6 times a week—sometimes 15 to 20 times a week,” said Rothner, director emeritus of child neurology and director of the Pediatric/Adolescent Headache Clinic at the Children’s Hospital at the Cleveland Clinic, in Ohio. “A few of them even went into kidney failure or developed gastrointestinal bleeding because of all the medicine they were taking.”

Some ways to prevent adolescent misuse of OTC medication is educating the parents to be aware of what and how much there child is taking and also educating the adolescents the severe side effects that can happen if a OTC drug is misused (e.g. GI bleeding).

Elderly

Managing OTC drug misuse in the elderly is quite difficult because more than likely they are taking up to 11 different kinds of medication. Because of this deadly mixture of OTC meds and prescription meds the elderly are ending up in the hospital and costing the nation billions.

A way to prevent the elderly from misusing OTC drugs is having the physician and nurses aware of any and all medications their patient is taking and educating the elder in keeping track of all the medications taken daily. This prevention could eliminate this costly behavior and could save lives.

http://jama.ama-assn.org/cgi/content/full/292/4/424

http://seniorjournal.com/NEWS/Health/5-07-13DrugMisuse.htm

Check out these informative links below to get a little more in depth about what I was talking about in this post.

http://www.oas.samhsa.gov/2k8/cough/cough.htm

http://www.priorityhealth.com/healthwellness/subabuse/drugabuse/otcabuse/

http://www.emedicine.com/ped/TOPIC7.HTM

All of these have the potential to be overused or misused.

As consumers, we sometimes seem to have the misconception that by increasing the intake of oral medications is the only way to cause harmful effects. However, ointments, creams, and sprays that were meant only to be applied to a certain part of the body have the potential to cause adverse side effects. 

For example: If a consumer were to apply a topical medication to their entire body, their skin could possibly absorb too much of the active ingredient and cause overdose effects. In addition, we should make sure to wash our hands after applying any topicals because exposure to either the eyes or mouth could cause irritation.

Be sure to also pay close attention to any wounds on the skin, such as scraps or cuts when applying because harmful effects might arise, such as: burning, redness, or swelling.

Overall, be careful and read labels thoroughly; it would definitely be in your best interest to do so!

http://www.fda.gov/consumer/updates/otc_creams040108.pdf

“The Food and Drug Administration warns consumers that all over-the-counter pain relievers should be taken with care to avoid serious problems that can occur with misuse.”

Well what do they mean “misuse”? Here’s my understanding of what I found:

1. Taking more than one OTC medication

Consumers (that’s you and I) need to be aware of OTC’s and how to read their labels. Just from my experience yesterday I almost took triple the dosage of Tylenol PLUS Naproxen. Guess what? The active ingredient in both of those drugs is acetamenophin. I really would have taken 4+ TIMES the normal amount! Throw in some cough syrup that’s got acetomenophen too, and I could have had an overdose. Now imagine if all that was given to a child… UH! OH! is right, it could easily cause serious liver damage or be a deadly combination.

Now I research and double check the labels for active ingredients, dosages, warnings, uses, etc. to make sure I know what I am taking. Here’s an example (and a nice note at the bottom) taken from an interactive website  to help with visuals and learning if you aren’t familiar:

Random Drug Label

2. Taking OTC’s in combination with prescription medications

If you are taking any prescribed anti biotic or prescription medication you should always check with a pharmacist, doctor, or if your busy like me (google a drug interaction website and type in all of your medicines to check for a reaction) before you take an over-the-counter remedy. Some OTC’s can interfere with (either increase or even stop) the effects of your prescribed meds. Either interaction (depending on the drug and severity of the case, etc) can cause serious problems and side effects or even death.33.

3. Intentional Misuse

For most this is not an issue, BUT for those of you with unruley teens or teens with what I like to call “shady” friends, just be aware that some kids are using these over the counter drugs to get high. So again education about OTC’s and their ingredients and side effects, etc. can come in handy here too.

4. Taking as Directed

Obviously we know to only take a certain amount of medication within a given time frame, duh! But you know the extended release Tylenol PM you take when you’re really stressed out and have a headace and can’t sleep? Well the extended release drugs are tricky. If it says to swallow the pill that’s what you need to do! If you can’t take pills or you’re sick and can’t swallow DO NOT CRUSH THESE PILLS (talk to your doctor). The “extended release side of the pill or the granules in the capsule dissolve and are absorbed into the body differently to help them last longer (or “get you through the night” per say). So if you squish them or grind them up, they get absorbed like the rest of the pill, which in turn increases the amount of the drug in your system at one time= possible overdose

Just be sure you know what you are taking and educate yourself about what you are putting into your body. Especially if you are a parent because children are more succeptible to drugs and they don’t know any better. Just a quick fact I found:

“Acetaminophen is an active ingredient found in more than 600 over-the-counter and prescription medicines.” Below is a link where you can find a whole list of over the counter meds often mixed-and-matched that contain acetaminophen.

http://www.keepkidshealthy.com/Medicine_Cabinet/acetaminophen.html

And this active ingredient isn’t the only one of concern, just the one that made me think twice. I really feel education about anything we sometimes robotically put in our bodies is important not only for peace of mind, but to help us stay healthy.  So if you know more about other common active ingredients or interactions or even have a story feel free to share as well.