Okay OTC time. The two I'm to counsel on tomorrow are either heartburn or cold/allergy and I'm praying to the high heavens it's heartburn because heartburn is easy and straightforward and doesn't include fifty thousand meds like cold/allergy does.

HEARTBURN
So, someone comes in: "Hey, do you have anything for heartburn?"
First things first is get more information, cause yeah, I've got stuff for heartburn. But is it the right stuff? We'll see after you answer these few questions for me.

Q) Is this medication for you?
--> Sometimes people come in to pick up something for a friend/family. In both OTC cases I hope that's not the case, because most of these guiding questions I need answered by the people experiencing them D:

Q) Are you on any other medications? Do you have any current medical conditions? (If a woman) Are you pregnant or plan on becoming pregnant?
--> pray with all my heart that their history is clean and i don't have to worry about contraindications. Basically Tums is good w/ everything, let's just... pray. Doctor's referral in case they have any of these. It'll be a short counseling session with auto referral and they can't really grade me past that if I cut them off after 30 sec, so chances are it's not.

Q) How long have you been experiencing heartburn?
--> greater than 3 months = HOORAY, AUTOMATIC REFERRAL TO THE DOCTORS! Seriously, don't wait out three months of pain before getting help D: Heartburn this long may be due to an underlying condition that's not actually heartburn but another medical problem, so get that checked out.

Q) How often do you experience heartburn? Is there anything, like food, that triggers it?
--> If it's frequent heartburn (constantly 2+ days out of the week) no matter what, then you've got a constant trigger; going to make some recommendations on lifestyle (REDUCE STRESS!! somehow. tell me how you do it and help me too.) and diet changes (reduce commonly triggering foods that are spicy, acidic, alcohol, caffeine, etc). Because it's frequent and you can't predict when it'll occur, I'd start a PPI
--> If it's episodic with specific food, then don't... eat... that food. idk why, but some foods are too good to give up and are worth putting up with the pain I guess, so in this case, do lifestyle/diet (esp diet... just stop eating that, come on) rec and start either antacid or H2RA or a combo depending on how severe the heartburn is.

Q) What have you tried so far?
--> Basically to rule things out and maybe step up (if an antacid didn't work, try an H2RA, etc.) or determine they weren't using the correct drug (antacid for frequent heartburn) or the drug correctly (e.g. PPI at night)

Once we determine what class of medication will work best, take them over to the shelves and let's pick one out together!! because I sure as heck don't know the nuances between these thousands of brands that have basically the same stuff in them. Yo, patient, you get to choose what makes you happy.

bold is just the brands I remember best, but they're all pretty much the same.

PPI: Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole) --> for chronic heartburn; takes a couple days to get working but after that it's 24 hr coverage so you're all set. TAKE IN MORNING ON EMPTY STOMACH!!!!

H2RA: Pepcid (famotidine), Tagamet (cimetidine), Zantac (rinitidine) --> take these for when you KNOW what triggers heartburn, bc you can take it 30 min before you eat and it'll take care of your symptoms

H2RA + antacid: Pepcid Complete (famotidine, calcium carbonate, magnesium hydroxide) --> the additional antacid in this makes it so you get some immediate relief with the antacid combined with the longer duration of the H2RA

Antacid: Tums (calcium carbonate; my friend's bf uses this as a calcium supplement... I mean, you could do this and it works, but when you get older the amount of acid in your stomach decreases and then you'll start seeing problems. just drink your milk, eat some kale D:),
Rolaids (calcium carbonate, magnesium hydroxide; magnesium may cause diarrhea so ask if they have problems with diarrhea, maybe this isn't for them),
Alka-Seltzer (aspirin, sodium bicarbonate; I guess if it hurts a lot),
Children's Pepto (calcium carbonate; this is different from regular Pepto Bismol, which contains bismuth subsalicylate and freaked me out the first time I used it because bismuth subsalicylate turns your stool black and I legit thought I was bleeding and going to die and this is a major concern for people and why I crossed Pepto off my counseling list, I don't want to freak out my patients) --> take at onset bc immediate relief! calcium antacids are safe for pregnant women and children, but make sure to watch daily calcium levels so you're not getting too much.

and then take the product off the shelves and read the directions, side effects, etc with them bc I'm not memorizing those when they're right there. Important part is that they're getting the right med and that they know where to find the instructions on the box, it's regulated to be patient friendly
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COLD AND ALLERGY THE BANE OF MY EXISTENCE idk I get colds once a year or every two years; sore throat day one and then stuffy nose for a week and I'm fine, I don't ever do anything special and never realized it's a big problem for others. I don't have allergies either, so I don't know how much a pain that is. I'm blessed with being able to breath :x

FIRST OFF, EXEMPTIONS: fever above 101.5F, chest pain, shortness of breath --> the first suggests an infection and is a doctor's referral, and the other two lean towards underlying medical conditions that may have symptoms similar to a cold, so get that checked out
if they're a kid under 12 with 'allergies' then refer to doctor bc it may be undiagnosed asthma and they need the proper med for that, not just treating symptoms
PREGNANT WOMEN DEFER FOR ALLERGY bc nonallergic rhinitis may just bc you're pregnant

So the thing with colds is that it's self-limited with no cure so it basically goes away in around two weeks and there's more non-pharmacological therapy to recommend so I'm not pumping people full of drugs they might not need, just enough to manage their symptoms. Common symptoms are congestion (if you don't want to take meds, try a salt nasal spray to loosen things up), sore throat (take acetaminophen, salt gargle, honey in hot tea) cough (non-medicated lozenge), etc (lots of rest and fluids, the whole chicken soup thing if that so pleases you). Make sure to ask what symptoms they have and target each individually bc if you give a combination product and the cough disappears before congestion and you're treating for both, that's unnecessary drug therapy and we want to avoid that.

Allergies, on the other hand, you want to determine if it's chronic like you've always had allergies, or if there's something that's triggering it like a new pet (assuming you can't get rid of it, you can vacuum more often and with a filter, clean bed sheets, make sure the animal doesn't get on your bed or clothes and stuff).

OKAY let's start with the actual therapy now. Come at me with your symptoms!


DECONGESTION ONLY: Sudafed (pseudoephedrine; I love when brand name and generic sound similar and I can remember easier. This is an oral systemic med so it's fine to use this for a longer duration, unlike below)
Afrin (oxymetazoline; for COLDS only bc it's a nasal spray and you're only allowed to take it for 3 days max or you'll get rebound congestion which is even worse than original congestion and original congestion is already hell)


DECONGESTION + PAIN: Advil Cold & Sinus (ibuprofen, pseudoephedrine; helps with pain from fever if you have it, but if the fever's really high then I'm gonna refer; I don't want to mask symptoms while some infection's wreaking havoc under cover. If they have pain meds at home, it's fine to use those with Sudafed instead of buying the combo if they don't mind taking two meds; ask for preference)

ANTIHISTAMINE ONLY: Allegra (fexofenadine); Claritin loratadine; Zyrtec (cetirizine) --> great for itchy everything due to allergies, both seasonal and perennial
Benadryl (diphenhydramine; this one's strongly sedating, but it's stronger than the above, so if they've tried the above and it didn't work, rec Benadryl and counsel that it's sedating so use it at night and don't operate machinery or drive or anything dangerous like that)
NasalCrom (cromolyn sodium; good for seasonal allergies when you know you're going to get allergies e.g. during the spring when all the flowers pollinate the air, take this a week before spring start so it can build up effect; otherwise this is v effective and safe for children, the elderly, pregnant and lactating women
Zaditor (ketotifen fumarate; this one's an eyedrop!! so use this for itchy eyes)

ANTIHISTAMINE + DECONGESTION: Allegra-D (fexofenadine, psudoephedrine); Claritin-D (loratadine, psudoephedrine); Zyrtec-D (cetirizine, pseudoephedrine) --> yeah, that -D stands for decongestion, thank you easy naming. This is where you'd do combo instead of reg Allegra + Sudafed, for example
Naphcon A (naphazoline, pheniramine; EYEDROP!! for itchy eyes and congestion)

i guess
the only good thing about otcs is that the names are all familiar
like yeah i remember claritin commercials, i've used tums before

hopefully i'll get someone nice tomorrow
last semester i got evaluated by somebody nice; he's a hospital lawyer protecting doctors from lawsuits and he acted the part of a nice old man who came in, saw how stiff and nervous i was, and chatted with me about yard work for a couple of minutes to ease me into conversation
please be like nice lawyer guy