LESSON 6.6
Over-the-Counter and Prescription Drugs
PRESCRIPTION AND OTC DRUGS 15 page student lesson - 1 of 15
Prescription Drugs A medicine that is available only with a written prescription from a doctor is called a prescription drug. Prescription drugs are regulated by the Food and Drug Administration’s Center for Drug Evaluation and Research (CDER). Before any new prescription drug is approved for sale in the United States, its manufacturer must prove that the new drug is safe and effective for human use.
Quick Notes prescription drug any medicine that is available only with a written prescription from a doctor
Common information lab els used on prescription dru gs
brand-name drug
A drug with a registered name or trademark is called a brand-name drug. An example is Valium.® A generic drug contains the same active chemical ingredients as a brand-name drug but is usually less expensive. For example, the generic version of Valium® is diazepam.
a drug with a registered name or trademark
generic drug contains the same active
Prescription Drug Cost Comparison
chemical ingredients as a brand-name drug and
Generic
$25
is usually less expensive
over-the-counter (OTC) drug
Brand Name
a drug that can be purchased without a prescription
$82
Over-the-Counter Drugs Drugs that can be purchased without a prescription are called overthe-counter (OTC) drugs. Typical over-the-counter drugs include aspirins, cold remedies, laxatives, antacids and antihistamines. Although a doctor’s prescription is not required, this doesn’t mean that the drug can’t be abused or used incorrectly. When OTC drugs are abused, the consequences can be deadly.
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6.6-5
Over-the-counter drugs at a pharmacy
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
TAKING MEDICINES RESPONSIBLY 2 of 15
W
hen a doctor recommends a medication—whether it is a prescription drug or over-the-counter remedy—it’s important to follow the directions on the label precisely. Many medications need to be taken for a specific period, even if symptoms disappear before the entire course of drugs has been consumed. It’s important to be aware of the possible side effects of drugs as well as any possible interactions with other drugs. Never share medicines with others. Keep medications in the original bottle or package to avoid misidentification. Make sure that all medications are kept out of the reach of small children and pets.
DO l Do read the label carefully. l Do take your medicine exactly as your doctor tells you to. l Do make sure your doctor has a list of all the medicines you are currently taking.
DON’T l Don’t combine medications (prescription or OTC) unless your doctor or pharmacist approves. l Don’t stop taking a medicine, change how much you take or how often you take it unless your doctor instructs you.
l Do make sure that everyone you live with knows what medicine you are taking and when you’re supposed to take it.
l Don’t take someone else’s medication.
l Do complete the full course of treatment; even if you begin to feel better before you finish your medicine.
l Don’t crush or chew tablets or capsules unless the directions instruct you to do so. Some medicines will not work properly unless they are swallowed whole.
l Don’t use medicine after its expiration date.
Continued on the next page Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-6
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LESSON 6.6
Over-the-Counter and Prescription Drugs
TAKING MEDICINES RESPONSIBLY CONTINUED 3 of 15
Read the Label The U.S. Food and Drug Administration (FDA) requires that all over-the-counter medicines have a “Drug Facts” label that follows a standard format and contains specific guidelines for correct usage. Drug Fact labels include these details:
Active Ingredient Always the first line on the label. Identifies the chemical(s) in the medicine that relieve symptoms. There may be more than one active ingredient.
Uses Lists the symptoms that this medicine is meant to treat. FDA must approve these uses.
Warnings Safety information that lists other medicines, foods or situations that should be avoided while taking this medication. Possible side effects are also identified.
Directions Indicates how much medicine equals one dose, how often to take the medicine and special instructions on how to take it (such as with food or with water).
Other Information Includes instructions on how to store the medicine.
Inactive Ingredients Lists the chemical compounds that aren’t meant to treat a symptom. This section is especially important for people who have allergies to things like food coloring or preservatives.
Over-the-counter drug label for generic allergy medicine
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
WHAT IS POLYPHARMACY? 4 of 15
P Quick Notes polypharmacy taking more than one medication (prescription or OTC) at the same time; dangerous drug interactions can occur
olypharmacy is the term used when a person takes more than one prescription or OTC drug at the same time. When a person is taking medications concurrently, there is a risk of dangerous interactions. Certain drugs may amplify the effect of other drugs, leading to a stronger effect than either drug would have produced if taken alone. It’s important to tell your doctor what other prescription or OTC drugs you are taking so that harmful interactions can be avoided. Taking more than one drug at once can present unanticipated problems. For example, a person taking a prescription pain reliever should check before taking any OTC multi-symptom cold medicine. If both drugs contain acetaminophen, an acetaminophen overdose could result. This can cause kidney damage and liver damage, especially in people who use alcohol regularly. Always read the labels of OTC and prescription drugs, as they provide information about possible interactions. Try to avoid taking more than one medication at a time. Consult your doctor or pharmacist for information about drug interactions.
th e pu bli c’s ey es to ed en op er dg Le h at He r to ac of h Th e de at at h Le dg er die d on Ja nu ar y He y. ac rm ha lyp po of ue iss us rio th e se ta l ov er do se of pr es cri pt ion en cid ac an of lt su re a as 08 20 , 22 es , no ne of th e dr ug s he me dic at ion s. Ac co rd ing to au th or iti ti- an xie ty dr ug s an o tw s, ion at dic me ep sle o tw —— co ns um ed n in ex ce ss . Th e ac to r’s ke ta as —w rs— ille ink pa tic rco na o an d tw ea th ’s ac cid en ta l de at h se rv es “H t: en em at st is th d ue iss s nt re pa mb ini ng pr es cri pt ion co of s er ng da n de hid e th t ou ab as a ca ut ion me dic at ion s, ev en at low do sa ge s.” Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-8
Heath Ledger
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LESSON 6.6
Over-the-Counter and Prescription Drugs
THE DANGERS OF INTERNET PHARMACIES 5 of 15
O
btaining or using prescription drugs without a prescription is illegal. By law, prescription drugs must be prepared and sold by licensed pharmacists. Unfortunately, it is all too easy for teenagers to purchase prescription drugs via the Internet. Although many online pharmacies are legitimate, safe and legal, there are other sites—called “rogue” Internet pharmacy sites—that are illegal marketplaces. Rogue sites often sell unapproved drugs, drugs that contain the wrong active ingredients, drugs that may contain too much or too little of the active ingredient or drugs that contain dangerous ingredients. Some websites sell counterfeit drugs that may look exactly like FDA-approved medicines but in fact are not. Obtaining drugs from a rogue Internet pharmacy site is risky. Avoid Internet pharmacies if:
l the website fails to provide a telephone contact number.
l the website offers prices that are dramatically lower than the competition.
l the website sells medicine without requiring a proper prescription, which is illegal.
l the address of the pharmacy is not in the United States.
It is ill eg al to se ll m ed ic in e w it h o u t re qu ir in g a pr o pe r pr es cr ip ti o n . Essential Health
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
SPOTLIGHT ON DXM 6 of 15
N
early half of all OTC cough and cold medications contain the cough suppressant dextromethorphan (DXM). DXM has chemical properties similar to morphine and codeine and is found in products such as NyQuil,® Coricidin® and Robitussin,® among others. OTC medications containing DXM are available in liquid, lozenge, tablet, capsule or gel cap forms. DMX can be extracted from cough syrup and converted to a powder that is inhaled or swallowed. DXM is the most commonly abused OTC drug in the United States today. When taken in large doses, DXM can produce a powerful high. It can also cause seizures, brain damage, panic attacks, coma and, in rare instances, death. Slang names for DXM include candy, robo, Triple C, DM, Skittles, Rojo, Red Devils and Vitamin D. Using DXM is often referred to as “robo-tripping” or “skittling.”
D X M is th e m o st co m m o n ly ab u se d O T C dr u g in th e U n it ed S ta te s to da y .
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-10
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LESSON 6.6
Over-the-Counter and Prescription Drugs
ABUSING PRESCRIPTION AND OTC DRUGS 7 of 15
A
pproximately 33% of the teens who abuse prescription drugs say that getting high from a prescription drug is safer and will cause fewer side effects than using street drugs. Nothing could be further from the truth. Taking any drug for a non-medical reason or in order to get high is drug abuse, plain and simple.
Consider these startling facts: FACT: From 1997 to 2007, treatment admissions for FACT: O verdosing on prescription pain abuse of prescription pain relievers grew more medications accounted for 95% than 400%—from 16,274 admissions in 1997 to of all accidental poisoning deaths 90,516 admissions in 2007. in 2007. FACT: From 1999 to 2005, accidental poisoning deaths from prescription drug overdoses increased by 86%.
FACT: T he majority of prescription or OTC drug abusers obtain their drugs from family or friends’ prescriptions.
Warning Signs of Abuse Here are some warning signs that might indicate a person is abusing a prescription or over-the-counter drug:
l Carrying cough, cold or other medications among personal possessions, especially when the person is not sick.
l If you notice a prescription or other medicine is emptying faster than it should, it could be a sign that someone with access is abusing it.
l Changing behavior such as declining grades, loss of interest in previously enjoyed activities, disrupted eating or sleeping patterns or a change in hygiene or appearance.
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6.6-11
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
PRESCRIPTION DEPRESSANTS 8 of 15
D
epressants are prescription drugs that depress the central nervous system, relax muscles, decrease anxiety, impair coordination and slow reflexes. They are prescribed to relieve anxiety, tension, panic attacks and help individuals with sleep disorders. Large doses of depressants can be fatal, especially if combined with alcohol—which is also a depressant— or other drugs. Depressants can lead to physical or mental dependence if abused. Some people abuse prescription depressants to achieve a state of intoxication similar to alcohol intoxication. Depressants are also abused by those who are trying to “come down” from the stimulant effects of cocaine or heroin. There are two major classes of prescription depressants:
Barbiturates
Also referred to as sedatives, these drugs induce sleepiness and mood changes. A brand-name example is Nembutal.®
Barbiturates Nembutal®
Benzodiazepines
These are commonly known as tranquilizers. Examples include Valium® and Xanax.®
Benzodiazepines
Xanax® Valium®
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-12
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LESSON 6.6
Over-the-Counter and Prescription Drugs
PRESCRIPTION PAIN RELIEVERS 9 of 15
Pain Relievers Pain relievers block transmission of pain messages to the brain. They are prescribed to ease moderate to severe pain from injury, surgery, toothache, cancer, arthritis and more. Commonly abused prescription painkillers include morphine, codeine, propoxyphene (Darvon,® Darvocet®), oxycodone (OxyContin,® Percocet®) and hydrocodone (Vicodin®). Prescription pain relievers are often abused to gain a euphoric high or to avoid withdrawal symptoms associated with other drugs such as heroin. When abused, pain relievers can result in slow heartbeat, low blood pressure, severe respiratory depression, coma and death. These effects are intensified when prescription pain relievers are combined with other drugs such as alcohol, antihistamines or barbiturates.
Vicodin®
Generic oxycodone
Spotlight on Oxycodone Although oxycodone is the generic name, many people refer to this dangerous and powerful prescription painkiller by its brand name, OxyContin.® When used as prescribed, it is an effective pain reliever. However, OxyContin® has been responsible for many deaths, especially when combined with alcohol. Symptoms of OxyContin® abuse are slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, tiredness, cold and clammy skin, small pupils, reduced vision, nausea, vomiting and clouding of mental functions. Overdosing on OxyContin® can cause a person to stop breathing, so if you see any of these symptoms, call 911 immediately.
OxyContin®
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
PRESCRIPTION STIMULANTS 10 of 15
Stimulants Stimulants are drugs that stimulate the central nervous system, increasing alertness, attention and energy. They are prescribed to treat narcolepsy, attention-deficit hyperactivity disorder (ADHD), depression, asthma and obesity (as an appetite suppressant). Commonly abused prescription stimulants include amphetamines (Dexedrine,® Adderall®), methylphenidate (Ritalin,® Concerta®) and prescription appetite suppressants such as phentermine (Obenix,® Fastin®).
Adderall®
Ritalin®
Dexedrine®
Prescription stimulants are often abused by people seeking to lose weight or experience the euphoric effects of the drugs. These drugs may also be used to counteract the sedative feelings caused by alcohol or tranquilizers.
Abuse of prescription stimulants produces many effects similar to those of cocaine, including euphoria, nervousness, insomnia, loss of appetite, nausea, vomiting, dizziness, headaches, elevated heart rate, increased blood pressure, abdominal pain and digestive problems. Higher doses may result in muscle twitching, elevated body temperature, irregular heartbeat, psychotic episodes, paranoia, hallucinations, delusions and death due to cardiovascular failure or seizures.
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-14
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LESSON 6.6
Over-the-Counter and Prescription Drugs
WHAT YOU NEED TO KNOW ABOUT OTC DRUG ABUSE 11 of 15
W
hile many OTC drugs are safe and effective when used as directed, they can be hazardous when misused.
OTC Pain Relievers Over-the-counter pain relievers are used to relieve minor pain from headaches, muscle aches and fever. They usually contain either non-steroidal anti-inflammatory drugs (NSAIDs)—such as aspirin, ibuprofen, naproxen and ketoprofen—or acetaminophen, the active ingredient in Tylenol.® Unlike prescription pain relievers, which are often intentionally abused to get high, abuse of OTC pain relievers is often unintentional such as when a person exceeds the recommended dose or takes the medicine for longer periods than recommended. Overuse is a particular concern if a person is taking more than one medicine, since many prescription and OTC drugs sold for different uses have the same active ingredients. For example, both a prescription pain reliever and an OTC multi-symptom cold medicine may contain acetaminophen. An acetaminophen overdose can cause kidney damage and serious liver damage, especially in people who use alcohol regularly. The symptoms of alcohol-acetaminophen toxicity include abdominal pain, nausea and vomiting. With the use of aspirin and other NSAIDs such as ibuprofen, there is a risk of gastrointestinal problems. This risk increases when these drugs are taken on a regular basis. NSAIDs can also cause kidney and liver damage.
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
WHAT YOU NEED TO KNOW ABOUT OTC DRUG ABUSE CONTINUED 12 of 15
OTC Depressants Over-the-counter depressants relieve a variety of conditions, including itching and sneezing associated with colds, allergies, insomnia and anxiety. Commonly abused OTC depressants are diphenhydramine and doxylamine. Diphenhydramine is an antihistamine found in cold and allergy medicines and OTC sleep aids. Doxylamine is another antihistamine used in OTC sleep aids. While abuse of non-prescription depressants most often results from an unintentional overuse or misuse of the drugs, some people may intentionally abuse these drugs, particularly diphenhydramine, to get high. The most common effects of diphenhydramine and doxylamine abuse are drowsiness, lethargy, dizziness, dryness of the mouth, inability to sweat, flushed skin, high body temperature, nausea and nervousness. Larger doses may result in disorientation, agitation, impairment of shortterm memory, incoherent speech, hallucinations, seizures and coma. Taking any depressant product—whether prescription, OTC or a dietary supplement—with other substances that depress the central nervous system (including alcohol) can result in serious respiratory depression, coma and death.
OTC Stimulants Over-the-counter stimulants are sold in a variety of products, including decongestants (to relieve a stuffy nose), weight loss products and energy boosters. One common OTC stimulant is pseudoephedrine, which is found in decongestants like Sudafed.® Another stimulant, caffeine, is often listed as an ingredient in OTC energy products and some pain relievers. The most common way of abusing non-prescription stimulants is using more than the recommended dose. A person taking an OTC decongestant containing pseudoephedrine should avoid products that contain other stimulant ingredients, such as caffeine. Side effects of pseudoephedrine use include dizziness, drowsiness, headache, sweating, vomiting, high blood pressure, anxiety and tremors. Allergic reactions, seizures, hallucinations and irregular or rapid heart rate have also been reported. The use of stimulant laxatives may result in dizziness, stomach cramps, nausea, vomiting and diarrhea. More severe effects, especially in persons with eating disorders or extreme dieters, have been reported. Taking any stimulant product—whether prescription, OTC or a dietary supplement—with other substances that stimulate the central nervous system (including caffeine) can result in an intensification of the products’ harmful side effects.
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-16
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LESSON 6.6
Over-the-Counter and Prescription Drugs
SIGNS OF OVERDOSE 13 of 15
A
drug overdose is the accidental or intentional use of a drug in an amount that is higher than is normally used. A drug overdose does not necessarily have to occur with only one drug. It can also occur when one drug interacts with another. For example, a person may take a prescribed dose of a sedative and then overdose if the drug is combined with alcohol (a depressant drug). If someone is experiencing any of the symptoms below, seek medical treatment immediately. Respiratory depression from depressant and pain reliever overdose can cause brain damage or death if not treated promptly by a medical professional. Call 911 immediately. While waiting for help to arrive, check the victim’s airways and perform CPR if necessary.
Signs of Prescription/OTC Drug Overdose Stimulants
Depressants and Pain Relievers
l agitation
l confusion
l confusion
l dilated pupils
l increase in body temperature
l cold and clammy skin
l excessive sweating
l shallow, slowed breathing
l high blood pressure
l low blood pressure and heart rate
l increased heart rate
l passing out
l hallucinations l seizures
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
STUDY POINTS 14 of 15
N o t e t o s e lf .. . S T U D Y t h is ! 1. Prescription drugs are medicines that can be obtained only with a written prescription from a doctor. Prescription drugs are regulated by the U.S. Food and Drug Administration. 2. Prescription drugs should be used only by the patient for whom they are prescribed; patients should follow the directions for use and finish the prescription, even if they are feeling better. Never share prescription drugs. 3. Over-the-counter (OTC) drugs are available without a prescription. They still can be misused or intentionally abused to get high. 4. Read the Drug Facts label! Know what you’re taking. Know the possible side effects and dangerous interactions of prescription or OTC drugs with other drugs. 5. Polypharmacy refers to taking several different OTC or prescription drugs simultaneously. Be aware of potentially dangerous drug interactions or unintentional overdoses. Check with your doctor or pharmacist before you take more than one drug at a time. 6. Rogue Internet pharmacies are websites that sell counterfeit or unsafe prescription drugs. They may also sell drugs without a prescription. If you are buying prescription drugs online, be certain you are dealing with a reputable pharmacy. 7. DMX or dextromethorphan is the active ingredient in many OTC cough medicines. It is hazardous if misused or abused. 8. A brand-name drug is one that is sold under a registered trademark. A generic drug has the same active ingredients but is not protected by a registered trademark.
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-18
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LESSON 6.6
Over-the-Counter and Prescription Drugs
STUDY POINTS CONTINUED 15 of 15
N o t e t o s e lf .. . S T U D Y t h is ! 9. Depressants slow down the heart rate, lower blood pressure, relax muscles and reduce stress and anxiety. Barbiturates and benzodiazepines are two classes of depressants. Alcohol is also a depressant. 10. The most commonly abused prescription drugs are depressants (tranquilizers and sedatives) and pain relievers such as OxyContin® and Percocet.® 11. The most often abused OTC drugs include pain remedies (acetaminophen and ibuprofen), depressants (antihistamines and other cold remedies) and stimulants (Sudafed,® caffeine energy products and weight control products). 12. Overdose is the accidental or intentional ingestion of a drug (or drugs) in an amount that is beyond the recommended dose. Overdose can be caused by an interaction of two or more drugs or by mixing drugs with alcohol. Call 911 immediately if an overdose is suspected.
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Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
Over-the-Counter and Prescription Drugs
LESSON 6.6
NOTES
Module 6—Alcohol, Tobacco and Other Drugs
LESSON 6.6—Over-the-Counter and Prescription Drugs
6.6-20
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