Pharmacy Over-the-Counter (OTC) Medications and Counseling 1 — Questions and Answers
Question 1: A patient with chronic kidney disease asks for a pain reliever. Which OTC medication should be recommended with CAUTION or avoided?
- Acetaminophen (Tylenol)
- Ibuprofen (Advil) (Correct answer)
- Aspirin (low dose)
- Caffeine
Correct answer: Ibuprofen (Advil)
NSAIDs like ibuprofen reduce renal blood flow by inhibiting prostaglandins and can worsen kidney function in patients with CKD. Acetaminophen (with dose adjustments) is generally preferred.
Question 2: Which OTC decongestant is restricted under the Combat Methamphetamine Epidemic Act (CMEA)?
- Phenylephrine
- Guaifenesin
- Pseudoephedrine (Correct answer)
- Dextromethorphan
Correct answer: Pseudoephedrine
Pseudoephedrine can be used to manufacture methamphetamine. CMEA requires it to be kept behind the pharmacy counter with purchase quantity limits and ID verification.
Question 3: Maximum daily dose of acetaminophen for a healthy adult is:
- 1,000 mg/day
- 2,000 mg/day
- 3,000–4,000 mg/day (Correct answer)
- 6,000 mg/day
Correct answer: 3,000–4,000 mg/day
The standard maximum is 3,000–4,000 mg/day for healthy adults (4 g/day per manufacturer, though many clinicians recommend ≤3 g/day for regular use); doses above this risk hepatotoxicity.
Question 4: An OTC first-generation antihistamine like diphenhydramine (Benadryl) is not recommended in older adults primarily because of:
- Its high cost relative to alternatives
- Anticholinergic side effects including sedation, urinary retention, and confusion (Correct answer)
- Risk of serotonin syndrome
- Severe drug interactions with all antibiotics
Correct answer: Anticholinergic side effects including sedation, urinary retention, and confusion
First-generation antihistamines are on the Beers Criteria due to anticholinergic effects (sedation, confusion, urinary retention, dry mouth) — particularly risky in older adults.
Question 5: A parent asks which OTC cough-and-cold products are safe for their 3-year-old. You should tell them:
- Use half the adult dose
- OTC cough/cold products are not recommended for children under 4 years old (Correct answer)
- Dextromethorphan is safe at any age
- Codeine-containing syrups are fine for toddlers
Correct answer: OTC cough/cold products are not recommended for children under 4 years old
The FDA warns against using OTC cough/cold products in children under 4 years due to risk of serious side effects; many experts recommend against them in children under 12.
Question 6: Which OTC product class requires patients to be counseled about rebound congestion (rhinitis medicamentosa) with prolonged use?
- Oral antihistamines
- Topical nasal decongestants (oxymetazoline) (Correct answer)
- Saline nasal sprays
- Intranasal corticosteroids
Correct answer: Topical nasal decongestants (oxymetazoline)
Oxymetazoline (Afrin) and other topical nasal decongestants should not be used for more than 3 consecutive days; prolonged use causes rebound congestion worse than the original symptom.
Pharmacy Over-the-Counter (OTC) Medications and Counseling 1
A patient with chronic kidney disease asks for a pain reliever.
Which OTC medication should be recommended with CAUTION or avoided?