Handle with Care
Per manufacturer voluntary labeling updates from the Consumer Healthcare Products Association in 2008, OTC cough and cold products carry a "do not use" warning for children below this age.
What is 4 years old?
Taking fexofenadine concurrently with apple, grapefruit, or orange juice requires a separation window of at least this many hours to prevent impaired gastrointestinal absorption.
What is 2 hours?
Patients attempting to self-treat cough must be referred to a physician if the cough fails to subside after this duration, or if it progressively worsens after 3 to 5 days.
What is >7 days?
Extended-release guaifenesin bi-layer tablets (such as Mucinex ER) carry a strict age restriction and should not be administered to children younger than this age.
What is 12 years old?
Characterized by periorbital darkening beneath the lower eyelids, this classic facial hallmark of allergic rhinitis results directly from local venous stasis and congestion.
What are allergic shiners?
This nasal spray formulation is designated as the preferred initial agent during pregnancy and lactation.
What is cromolyn sodium (Nasalcrom)?
(This is because it stabilizes mast cells while having minimal systemic absorption.)
Dextromethorphan interacts adversely with MAO inhibitors and other serotonergic drugs, posing a life-threatening risk for this toxic syndrome.
What is serotonin syndrome?
An adult presenting with an acute cough accompanied by a fever at or exceeding this temperature must be excluded from OTC care and evaluated by a prescriber.
What is 103°F (39.4°C)?
In treating upper airway cough syndrome (UACS) secondary to a post-viral cold, CHEST guidelines favor a combination of a decongestant, naproxen, and an antihistamine strictly from this chemical generation.
What is a first-generation antihistamine?
This validated eight-question tool assesses habitual daytime sleepiness by measuring the likelihood of dozing in specific everyday situations.
What is the Epworth Sleepiness Scale?
This second-generation antihistamine is strictly contraindicated in patients with end-stage renal disease whose creatinine clearance is less than 10 mL/min or who are undergoing dialysis.
What is levocetirizine (Xyzal)?
Urinary alkalinizers like sodium bicarbonate or sodium citrate interact with this common oral decongestant by decreasing its renal elimination.
What is pseudoephedrine?
While short-term sleep disturbances may be managed with OTC sleep aids, insomnia meeting this duration threshold or presenting with frequent early-morning awakenings demands medical referral.
What is 3 months or longer (chronic insomnia)?
Unlike dextromethorphan, this prescription-only antitussive capsule suppresses cough by exerting a local anesthetic action on stretch receptors within the respiratory passages.
What is benzonatate (Tessalon Perles)?
The prominent horizontal skin fold forming directly across the lower bridge of the nose secondary to continuous upward wiping of the nasal tip.
What is the allergic crease?
This specific fluticasone ester carries a strict pediatric cut-off requiring patients to be at least 4 years old.
What is fluticasone propionate?
(The furoate ester can be initiated as young as 2 years old.)
Patients taking this mood stabilizer who suddenly fluctuate their daily caffeine intake risk therapeutic failure or toxicity, as caffeine decreases the serum levels of this cation.
What is lithium?
First-generation sedating antihistamines are flagged by the AGS Beers Criteria as potentially inappropriate for older adults and are clinically contraindicated in patients with this ocular disorder.
What is narrow-angle (or angle-closure) glaucoma?
When recommending OTC diphenhydramine as a nighttime sleep aid, the adult dose is 50 mg for the hydrochloride salt, but changes to this milligram strength if using diphenhydramine citrate.
What is 76 mg?
On the Stanford Sleepiness Scale, a patient who self-reports feeling "Somewhat foggy, let down" corresponds to this exact integer rating.
What is Scale Rating 4?
Codeine is strictly contraindicated for all indications in children under 12 years of age and in patients under 18 years of age undergoing these two specific surgical procedures due to risk of CYP2D6-related respiratory depression. (Must give both for points)
What are tonsillectomy and adenoidectomy?
This can trigger caffeine toxicity by inhibiting the specific hepatic CYP450 isoenzyme responsible for caffeine clearance (CYP1A2). (Only need to give one of the two for points)
What is Ciprofloxacin or combined oral contraceptives?
While acute viral rhinitis and allergic rhinitis share overlapping congestion, a patient seeking self-care must be immediately excluded and referred to a physician if this is accompanied by any of the following symptoms:
(Name 2 for points)
1. ear pain (ear infection?)
2. facial tenderness over the sinuses (sinus infection?)
3. wheezing (asthma?)
4. lower RTI (bronchitis?)
Under West Virginia Schedule V controlled substance laws for cough syrups, a preparation cannot exceed this maximum milligram quantity of codeine per 100 milliliters.
What is 200 mg per 100 mL?
In physical airway assessments, a persistent dry morning cough that transitions into a daytime productive cough in a chronic smoker suggests chronic bronchitis or COPD, but if accompanied by inspiratory stridor or severe coughing fits ending with a high-pitched inspiratory sound, it points instead to these two specific exclusionary pediatric infections. (Must name both for points).
What are croup and pertussis?