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OTC Drugs . Libby Bledsoe Arron Herring Anchalem Alemayehu. Vitamins. Vitamins: Two Categories. Fat Soluble Vitamins .

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otc drugs

OTC Drugs

Libby Bledsoe

Arron Herring


fat soluble vitamins

Fat Soluble Vitamins

Fat soluble vitamins are A, D, E and K . They are metabolized slowly; can be stored in fatty tissue, and liver, and muscle in significant amounts and excreted in the urine, at a slow rate.

vitamin a
Vitamin A
  • Contraindications: Hypervitaminosis A, pregnancy (Massive dose)
  • S/Es: HA, fatigue, drowsiness, irritability, anorexia, vomiting, diarrhea, dry skin, visual change
  • ADE: Evident only with toxicity: leukopenia, aplastic anemia, papilledema, increased intracranial pressure, hypervitaminosis A, bulging fontanelles in infants, jaundice
vitamin d calciferol
Vitamin D ( Calciferol)
  • Vitamin D has a major role in regulating calcium and phosphorous metabolism and is needed for calcium absorption from intestines.
  • Excess vitamin D ingestion (> 40, 000 international units) results in hypervitaminosis D and may cause hypercalcemia( an elevated serum calcium level).
  • Anorexia, nausea and vomiting are early symptoms of vitamin D toxicity.
vitamin e
Vitamin E
  • Has antioxidant properties that protect cellular components from being oxidized and red blood cells from hemolysis.
  • It has been reported that taking 400-800 international units of vitamin E per day reduces the number of nonfatal myocardial infarctions(MIs) and taking 200 unites for several years can reduces the risk of coronary artery disease(CAD)
  • S/Es: large doses of vitamin E may include fatigue, weakness, nausea, GI upset, headache, and breast tenderness.
  • Vitamin E prolongs the prothrombin time (PT) and patient taking Warfarin should have their PT monitored closely. Iron and Vitamin E shouldn't be taken together because iron interferes with the body's absorption and use of vitamin E.
  • Use Vitamin E: Cautiously in: Anemia due to iron deficiency, vitamin K deficiency (May increase risk of bleeding)
vitamin k
Vitamin K
  • Is used as antidote for oral anticoagulant overdose and to prevent and treat the hypoprothrombinemia of vitamin K deficiencies.
water soluble vitamins
Water Soluble Vitamins
  • Water soluble Vitamins are the B-complex vitamins and vitamin C. Theses group of vitamins are not very toxic unless taken in excessive amount.
vitamin b complex
Vitamin B complex
  • Four of the vitamin B-complex members are vitamin B1 ( thiamine), vitamin B2( riboflavin), vitamin B3( Nicotinic acid, or niacin) and vitamin B6 ( Pyridoxine)
vitamin b 12 cobalamin
Vitamin B12 (Cobalamin)
  • Functions as a building block of nucleic acids and to form red blood cells. And also it facilitates functioning of nervous system.
  • Vitamin B12 is stored in the liver and it can take 2 to 3 years for stored vitamin B12 to be depleted and a deficient noticed.
  • Contraindicated in: hypersensitivity
  • S/Es: Headache, dizziness, memory impairment, restlessness, chest pain. Tachycardia, diarrhea, abdominal discomfort, dusphagia, pain at injection (IM site)
  • Use cautiously in: Hereditary optic nerve atrophy (accelerates nerve damage); uremia, folic acid deficiency
vitamin c
Vitamin C
  • Is used to prevent and treat vitamin C deficiency (Scurvy); to increase wound healing, for burns. Preserves integrity of blood vessels. It is a water soluble vitamin, thus essential for collagen formation and tissue repair (bones, skin, blood vessels). Synthesis of lipids, protein, and carnithine
  • Contraindications(caution): Renal calculi, gout, anemia, sickle cell, sideroblastic and thalassemia
  • S/Es: Oral: Nausea, vomiting, diarrhea, heartburn, headache

Parenteral: Flushing, headache, dizziness, soreness at injection site

  • ADE: Kidney stones, crystalluria, hyperuricemia, hemolytic anemia with clients with G6PD
  • Life threatening: Sickle cell crisis, seep vein thrombosis
nursing process assessment
Nursing Process: Assessment
  • Check client for vitamin deficiency before start or therapy and regularly there after. Explore such areas as inadequate nutrient intake, debilitating disease and GI disorders.
  • Obtain 24 and 48 hour diet history analysis
nursing process interventions
Nursing process: Interventions
  • Administer vitamins with food to promote absorption
  • Store drug in light - resistant container
  • Administer IM primarily for clients unable to take by PO route( eg., GI malabsorption syndrome)
  • Recognize need for vitamin E supplements for infants receiving vitamin A to avoid risk of hemolytic anemia.
  • Monitor for vitamin A therapeutic serum levels ( 80 to 300 international unites/ ML)
nursing process teaching
Nursing process: Teaching
  • Instruct client to take prescribed amount of drug
  • Inform clients to read vitamin labels to determine which vitamin is most appropriate for them.
  • Instruct client to consult with health care provider/ pharmacist regarding interactions with prescription and OTC medications
  • Discourage client from taking megavitamins over a long period unless these are prescribed for specific purpose by health care provider.
  • Inform client that missing vitamins for 1 or 2 days is not a cause of concern, because deficiencies do not occur for sometime.
  • Advice clients to check expiration dates on vitamins containers before purchasing them.
  • Instruct client to avoid taking mineral oil with vitamin A on a regular basis, because it interferes with vitamin E absorption. If needed take mineral oil at bed time.
  • Explain to client that there is no scientific evidence that megadoses of vitamin C ( ascorbic acid) will cure a cold.
  • Alert client not to take megadose of vitamin C with aspirin or sulfonamides because crystals may form in the kidneys and urine.
  • Instruct client to avoid excessive intake of alcoholic beverages. Alcohol can cause vitamin B – complex deficiencies.
nursing process diet
Nursing process: Diet
  • Advice client to eat well balanced diet, and inform client that vitamin supplements are not needed if the person is healthy and receives the proper nutrition on a regular basis.
  • Instruct client about foods rich in vitamin A, including whole milk, butter, eggs, leafy green and yellow vegetables, fruits and liver.
nursing process se ade s
Nursing process: SE/ADE’s
  • Instruct client that nausea, vomiting, headache, loss of hair, and cracked lips (symptoms of hypervitaminosis A) should be reported to the health care provider. Early symptoms of hypervitaminosis D are anorexia, nausea and vomiting.
  • Herbs are a plant or plant parts used for its medicinal qualities.
  • Herbs were the originals medicines used throughout the world and are still used today for therapeutic effects.
  • Herbs can help promote health, but when mixed with some certain medications they can be contraindicated or even cause toxicity.
client responsibility
Client Responsibility
  • Because of the risks of mixing herbal remedies and medications, It is the responsibility of the client
        • To consult with the health care provider before taking any herbal preparation
        • Report any herbal preparations taken to the health care provider
        • Inform health care providers of any allergy or sensitivity to any herbal products
dietary supplement health and education act of 1994
Dietary Supplement Health And Education Act of 1994
  • This act made regulations for herbal preparations
  • Made herbs marketed with dosages
  • Physiologic effects can be noted, but cant make claims about preventing or curing conditions
  • Herbs need a disclaimer that indicates it is NOT approve by the U.S. Food and Drug administration and not meant to be used as a drug.
types of herbal preparations
Types of Herbal Preparations
  • Dried: fresh herbs that have their moisture removed by the sun
  • Extracts: certain isolated components of the herb
  • Oils: soaking herb in olive or vegetable oil then heated
  • Salves: crushing herb and mixing it in a petroleum jelly base
  • Teas: steeping fresh or dried herbs in boiling water
  • Syrups: adding sweetener to herb then cooking it
aloe vera
Aloe Vera

The juice is used for minor sun burns and insect bites. If ingested, it can be used as a laxative. But can cause increased menstrual flow.

  • Side Effects: arrhythmias, edemas, neuropathies, and hematuria.
  • Contraindicated in: pregnant or lactating women and children under the age of 12.
  • Drug Interactions in cardiac glycosides, antiarrthymics, corticosteroids, and thiazide diuretics.
ginko ginkgo biloba
Ginko (Ginkgo Biloba)
  • Antioxidant, peripheal vasodilation, and increased blood flow to CNS. Reduces platelet aggregation.
  • Uses: Allergic rhinitis, Alzheimer’s disease, anxiety/stress, dementia, tinnitus, impotence, and poor cirulation.
ginko continued
Ginko Continued…
  • Avoid use in pregnancy, lactation, children, and with MAOI’s.
  • Drug Interactions: Caution with prescription anticoagulants. May increase Blood pressure with thiazide diuretics. Must discontinue two weeks before surgery.
  • Other Herbal Contraindications: Ginger, Garlic, or feverfew.
  • Side Effects/ ADE’s: mild headache, mild gastric distress
  • Toxicity: vomiting, diarrhea, dermatitis, irritability.
st john s wort1
St. John’s Wort
  • AKA: “Herbal Prozac” because of its use as a “tonic” for the nervous system.
  • Uses: Mood swings, mild to moderate depression, anxiety, and sleep disorders.
st john s wort continued
St. John’s Wort Continued…
  • When taken with prescription antidepressants, adverse effect of suicidal ideations.
  • Side effects/ Adverse effects: skin photosensitivity, headache, GI upset, dry mouth, dizziness, confusion.
  • Interactions: avoid with pregnancy, lactation, prescription antidepressants, MAOI’s, indinavir, children <2 years.
  • Drug interactions: decreased effect of digoxin, use with amphetamines, trazodone may cause serotonin syndrome.
  • Interferes with absorption of other minerals.
echinacea purple coneflower
Echinacea (Purple coneflower)
  • Is used to enhance the immune system, and for an antipyretic, antifungal (topical) and antibacterial.
  • Increases leukocytes, spleen cells, and activating granulocytes.
  • Leaf preparation: used for respiratory and urinary tract infections.
  • Root extract: for flu-like symptoms
echinacea side effects adverse effects and contraindications
Echinacea Side Effects/ Adverse Effects and Contraindications
  • Temporary tingling of tongue.
  • cross-sensitivity in clients allergic to daisy (flower) family
  • GI upset
  • Diarrhea
  • Contraindicated in: immunosuppressants (corticosteroids). Persons with systemic disease of immune system (HIV, AIDS, TB)
nursing process
Nursing Process


  • Obtain patient’s baseline info about herbal use and OTC drug use
  • Include dosage, frequency, side effects
nursing process1
Nursing Process


  • Knowledge, deficient about therapeutic regimen related to use of herbal products


  • Herbal Therapy
  • Prescription and OTC drugs
  • Interaction between herbal therapy, prescription, and OTC drugs
nursing process2
Nursing Process


  • Check client’s response to herbal therapy
  • Monitor response to prescrip. And OTC drug therapy
  • Consult dietician and other specialists necessary
  • Continue same brand of herbal therapy; notify health care provider if considering change brands/ preparations
nursing process3
Nursing Process

Client Teaching

  • Explain rationale
  • Encourage client to read labels and heed recommended info
  • Inform client of storage conditions


  • Teach about food that diminish/enhance the action of herb
  • Foods to avoid
nursing process4
Nursing Process


  • Evaluate effectiveness of herbal remedies for alleviating symptoms.
  • Evaluate client’s use of resources
  • Vital for hemoglobin regeneration
  • 60% of the iron in the body is found in hemoglobin
  • Normal diet = 5 to 20 mg per day
  • Found in liver, lean meats, egg yolks, dried beans, green vegetables, and fruit
  • Foods and antacids slow absorption of iron and Vitamin C increases iron absorption
  • More iron is needed when pregnant, but during the first trimester megadoses are contraindicated because of its possible teratogenic effects
  • Dose for infants and children 6 months to 2 years is 1.5 mg/kg
  • Adults is 50 mg/day
  • Iron toxicity is a serious cause of poisoning in children
  • Needed for the formation of RBC’s and connective tissues
  • Cofactor of many enzymes and its function in the production of the neurotransmitters norepinephrine and dopamine
  • Excess levels may be associated with Wilson’s disease
  • Prolonged deficiency may result in anemia
  • Abnormal blood and skin changes caused by deficiency include a decrease in WBC count, glucose intolerance, and a decrease in skin and hair pigmentation. Mental retardation may also occur in the young
  • RDA for copper is 1.5 to 3 mg/day
  • Most adults only consume about 1mg/day
  • Foods rich in copper: shellfish, liver, nuts, seeds, legumes, and cocoa
  • Important to many enzymatic reactions and is essential for normal growth and tissue repair, wound healing, and taste and smell
  • Some believe it can alleviate symptoms of the common cold and shorten its duration
  • Intranasal zinc preparations may cause permanent loss of smell
  • Up to 200 mg/day can be taken
  • RDA for an adult is 12 to 19 mg/day
  • Foods rich in zinc: beef, lamb, eggs, and leafy and root vegetables
  • More than 150 mg may cause a copper deficiency
  • Said to be helpful in control of Type 2 Diabetes
  • Thought to help normalize blood glucose by increasing effects of insulin on the cells
  • No RDA
  • 50 to 200 mcg/day is considered within the normal range
  • Foods rich in chromium: meats, whole-grain cereals, and brewer’s yeast
  • Cofactor for an antioxidant enzyme that protects protein and nucleic acids from oxidative damage
  • Works with Vitamin E
  • Thought to have an anticarcinogenic effect, and doses lower than 200 mcg may reduce the risk of lung, prostate, and colorectal cancer
  • Excess doses greater than 200 mcg may cause weakness, a loss of hair, dermatitis, nausea, diarrhea, and abdominal pain, and may also be a garlic-like odor from the skin and breath
  • RDA is 40 to 75 mcg (lower dose for women and higher for men)
  • Foods rich in selenium: meats, seafood, eggs, and dairy products
iron assessment
Iron Assessment
  • Obtain a drug history of current drugs and herbs client is taking.
  • Obtain a history of anemia or health problems that may lead to anemia.
  • Assess client for signs and symptoms of iron deficiency anemia such as fatigue, malaise, pallor, shortness of breath, tachycardia, and cardiac dysrhytmias.
  • Assess client’s RBC count, hemoglobin, hematocrit, iron level, and reticulocyte count before start of and throughout therapy.
iron nursing diagnoses
Iron Nursing Diagnoses
  • Nutrition, less than/more than body requirements, imbalanced inadequate intake of food sources of iron
  • Knowledge, deficient of food sources of iron
  • Decision-making, readiness for enhanced related to food choices and vitamin/mineral supplementation
iron planning
Iron Planning
  • Client will name six foods high in iron content
  • Client will consume foods rich in iron
  • Client with iron deficiency anemia or with low hemoglobin will take replacement as recommended by health care provider, resulting in laboratory results within desired range
  • Nursing interventions
  • Encourage client to eat a nutritious diet to obtain sufficient iron.
  • Store drug in light-resistant container
  • Administer IM injections of iron by Z-track method
iron client teaching
Iron Client Teaching
  • Instruct client to take the tablet or capsule between meals with at least 8 ounces of juice or water to promote absorption. If gastric irritation occurs, instruct the client to take with food.
  • Advise client to swallow the tablet or capsule whole.
  • Instruct the client to maintain upright position for 30 minutes after taking oral iron preparation to prevent esophageal corrosion from reflux.
  • Do not administer the iron tablet within 1 hour of ingesting antacid, milk, ice cream, or other milk products such as pudding.
iron client teaching continued
Iron Client Teaching Continued
  • Inform client that certain herbal drugs can decrease absorption of iron and other minerals.
  • Advise client to increase fluids, activity, and dietary bulk to avoid or relieve constipation.
  • Instruct adults not to leave iron tablets within reach of children.
  • Encourage client to take on the prescribed amount.
  • Be alert that iron content varies among iron salts; therefore do not substitute one for another.
  • Advise client that drug treatment for anemia is generally less than 6 months.
iron diet
Iron Diet
  • Counsel client to include iron-rich foods in diet: liver, lean meats, egg yolk, dried beans, green vegetables, and fruit.
iron side effects
Iron Side Effects
  • Advise client taking the liquid iron preparation to use a straw to prevent discoloration of tooth enamel.
  • Alert client that the drugs turns stools a harmless black or dark green.
  • Instruct client about signs and symptoms of toxicity, including nausea, vomiting, diarrhea, pallor, hematemesis, shock, and coma, and report occurrences to health care provider.
  • Kee, J. L., Hayes, E. R., McCuistion, L. E., & et al, L. E. (2012). Pharmacology: a nursing process approach. (7th ed.). St. Louise, MO: Elsevier.
  • 1. ---------- is an antidote for Warfarin( Coumadin) overdose?
  • A. Vitamin B
  • B. Vitamin E
  • C. Vitamin K
  • D. Zinc
  • 2. Vitamin E shouldn't be taken with ------------
  • A. Zinc
  • B. Iron
  • C. Chromium
  • D. None of the above  

3. Which type of herbal preparation uses petroleum jelly?

  • Tea
  • Syrup
  • Salve
  • Exctract
  • 4. Which Herb is known as “herbal Prozac?”
  • Echinacea
  • Ginko
  • Aloe Vera
  • St. John’s Wort

Name 3 foods rich in Iron???

  • What do you instruct a client to do if he has gastric irritation when taking the tablet/capsule?