associated with diabetes contribute to the development and/
or complicated management of hypertension, often requiring treatment with multiple antihypertensive medications.
Cognitive decline Alzheimer’s disease, dementia, stroke, and other conditions associated with a decline in cognition can impede identifying or altering a patient’s tolerance of a medication’s adverse effects. Sedative and anticholinergic medications often have pronounced effects in older adults, which could compound the manifestations Nonprescription medications Over the counter (OTC) medications are available without a prescription pursuant to a determination by the U.S. Food and Drug Administration (FDA). Such medications have been deemed to be safe for use by a consumer within the limits of product-label-specific indications, dosing, and warnings and without supervision by a licensed healthcare professional (U.S. Food and Drug Administration, 2022). Most OTC medications were previously approved as prescription-only but later petitioned for nonprescription status. Despite the relative safety of these products compared to prescription drugs, OTC medications produce a pharmacologic effect and have the potential for a variety of untoward effects, including drug–drug interactions, predictable and idiosyncratic side effects, and comorbidity complications. Examples of generally safe yet still concerning OTC medications are nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen, and naproxen. Originally marketed as Confusion with product branding A potentially dangerous trend in recent decades involves mar - keting OTC products with prominent labeling of a brand name across as a “family” of products. This is not a new phenomenon. For example, a variety of cough and cold medications have been marketed for decades under the Robitussin brand. Different for - mulations were labeled as Robitussin, each one with additional designations to identify its different content or intended uses: ● Robitussin contained only the expectorant guaifenesin. ● Robitussin DM contained guaifenesin and the cough suppressant dextromethorphan. ● Robitussin CF contained guaifenesin, dextromethorphan, and a decongestant. More recently, applying a brand name previously associated with one specific medication to the naming of multiple medications for a similar indication has blossomed. While good for a manufacturer to reinforce brand identity and
of dementia and other conditions affecting central nervous system function. These factors warrant a delicate balance when using a medication that may be helpful for one condition while being negatively impacted by another underlying condition.
prescription (Rx) only Motrin and Naprosyn, respectively, these two NSAIDs were later petitioned and approved for OTC sale at lower individual and daily doses than their Rx-only predecessors for various uses, including short-term pain relief. However, even at OTC-labeled doses, these NSAIDs can pose safety risks related to inducing or worsening renal impairment due to their vasoconstrictive effect on renal vasculature. Additionally, OTC NSAIDs may increase the risk of gastrointestinal bleeding, especially in those with a history of gastric mucosal damage and/or altered coagulation status attributable to disease or medications. The perceived safety of OTC drugs leading patients to a false sense of security may also result in patients not spontaneously including them when a medication history is conducted, which may ultimately lead to polypharmacy and/or therapeutic duplications. customer loyalty, a consumer’s potential confusion between products could be dangerous. A product listing on the Tylenol. com website displayed 30 unique products, some with more than just acetaminophen in their formulation. Similarly, most healthcare professionals associate the brand name Dulcolax with the stimulant laxative bisacodyl. However, the current Dulcolax-labeled family of products consists of nine differently branded products containing one of three different active ingredients, several of which still include bisacodyl. It is easy to appreciate that an older adult with a loss of visual acuity, decreased cognitive function, or a historical bias that a single brand is associated with a unique ingredient can incorrectly self-administer and/or self-report using an OTC medication. Thus, healthcare professionals must be attentive to detail when conducting a medication history that includes nonprescription medications. Furthermore, if they do not represent a naturally occurring substance in the body, the term xenobiotic would appropriately apply. Xenobiotics are substances that are foreign to the body. While this term would certainly apply to prescription and OTC medications, it is also relevant to many products that fit into the broad category of terms described above. Relevant to product safety concerns, these foreign substances ultimately undergo processes to facilitate their elimination from the body. This may include biotransformation by the same drug-metabolizing enzymes of the CYP450 system discussed in the Metabolism section of this paper. Therefore, any deviation from normal metabolism or excretion functions could adversely affect the body or other drugs. However, most, if not all, of these products still elicit a pharmacologic effect as part of their perceived beneficial impact. Several examples reinforce this concept. St. John’s wort is a supplement sourced from the plant Hypericum perforatum that has been used for centuries to treat depression and other conditions (Saper, 2022). Available evidence suggests that St. John’s wort has some impact on serotonin, which may explain its utility in depressive conditions that make it akin to selective serotonin reuptake inhibitors. While a full discussion of the clinical effectiveness of St. John’s wort is beyond this courses scope, studies of different quality, duration, and rigor
Nutritional supplements, vitamins, and complementary therapies The marketing and use of products that claim to be other than medications have also exploded in recent decades. Conventional wisdom established that vitamins—whose name evolved from the Latin vita, meaning life, and amine associated with amino acids— were often necessary and beneficial supplements for those with certain essential or secondary deficiencies (Council for Respon - sible Nutrition, 2017). Iron, vitamin C, and the B vitamins have effectively been associated with and remain effective treatments for anemias of various etiologies. Today, though, far more prod - ucts are available and regularly consumed by individuals without adequate scientific evidence and/or guidance from healthcare professionals. The products are characterized using various terms: ● Nutritional. ● Complementary. ● Alternative. ● Nontraditional.
● Natural. ● Herbal. ● Dietary. ● Medication-free. ● Supplements.
● Products. ● Therapies.
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