NUR750Z0-02-28-22 FNP Pediatrics OTC Project

OTC Medication Project

NUR750Z0-02/28/22 FNP Pediatrics 

04/10/2021

OTC Medication Project

When making the decision to use over-the-counter (OTC) medicines in managing their child's illness, most parents are often unaware of the description of the medicines they purchase. Most parents often use product information leaflets as a source of information. Factors like socioeconomic status, number and age of a child, parental age, and working families contribute to the complexities of how often and which types of over-the-counter medicines parents purchase for their children (Krajnović et al., 2019). Therefore, it is essential to educate parents on the possibility of OTC medicine use, their costs, and dosage for treatment of various conditions explored in this paper.

1. Skin - moisturizers, anti-itch medications

Cetaphil Moisturizing Cream (Cetaphil) and Hydrocortisone Cream (Cortef) 

Hydrocortisone Cream (Cortef) is an over-the-counter anti-itch cream used to treat various skin conditions like insect bites, eczema, dermatitis, rash, and anal itching. The active ingredient is Hydrocortisone 1%. Hydrocortisone works by activating natural substances in the skin to reduce swelling, redness, and itching. This medication should only be used on the skin. However, it should not be used on the face or underarms unless directed by the doctor. In children and infants, gently apply a thin layer of cream to the affected area two or three times daily. In infants, therapy must be limited to five to seven days. Adolescents and adults should use hydrocortisone cream once or twice a day. If used twice a day, it is essential to leave a gap of 8 to 12 hours before putting on any more. A fingertip unit is enough to treat the affected area.

On the other hand, Cetaphil Moisturizing Cream (Cetaphil) is an intensive moisturizing cream designed to provide moisture to the skin's driest areas without any greasy residue. The active ingredient includes Avobenzone 3% and Octocrylene 10%. This medication works by forming an oily layer on the top of the skin that traps water in the skin. This cream is also applied as a moisturizer to treat dry, dull, rough, itchy, and irritated skin. Cetaphil Moisturizing Cream can be applied liberally as often as needed, and the best results are obtained when used directly after bathing, wetting the skin, or washing hands.

Whereas Hydrocortisone cream is not appropriate for use on the face, Cetaphil moisturizing cream is appropriate for facial use and is fragrance-free. Again, Hydrocortisone cream only is more suitable for moist areas of the skin, whereas Cetaphil Moisturizing Cream is more suitable for dry or scaly areas of the skin. On shelves, the Cetaphil Moisturizing Cream 100 g goes for $14.99, while the Hydrocortisone cream 1% 28 g goes for $7.44. 

From the information, I would recommend Cetaphil Moisturizing Cream 100 g to help them treat children with skin conditions, even though it is twice as expensive as Hydrocortisone cream. As opposed to Hydrocortisone, Cetaphil Moisturizing Cream 100 g is clinically tested as hypoallergenic and non-comedogenic, so it won't irritate skin or clog pores (Kursewicz et al., 2022). It is also dermatologist tested and clinically proven to be gentle on sensitive skin. On the other hand, Hydrocortisone only offers temporary relief from the effects of poison ivy, oak, insect bites, itch, and rash (Kursewicz et al., 2022). 

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2. Allergy

Diphenhydramine (Benadryl) and Cetirizine (Zyrtec) 

Diphenhydramine (Benadryl) is an antihistamine used to relieve allergy symptoms, hay fever, and the common cold. The active ingredient is diphenhydramine HCl 25 mg and alcohol 14%. It works by blocking histamine's action in the body. It comes in capsules packed in a bottle with 1000 capsules and is indicated for allergy and fever. It is not desired for infants under 2 years. For children of ages 6 to 11 years, the recommended dose is 5 mL to 10 mL or 1 to 2 chewable tablets (12.5 mg to 25 mg) PO every 4 to 6 hours. The desired dose for adults and children 12 years and over is 10 mL PO or 25 to 50 mg every 4 to 6 hours. The average retail price is $37.30 per 1 1ML of 50MG/ML Solution.

On the other hand, Cetirizine (Zyrtec) is an antihistamine used to relieve allergy symptoms like watery eyes, runny nose, itching eyes/nose, sneezing, hives, and itching. The active ingredient is cetirizine hydrochloride. It works by blocking histamine produced during an allergic reaction. This medication comes as tablets, capsules, and as a liquid. Children aged 2 and over can take OTC cetirizine liquid. Children aged 12 and over can take OTC cetirizine capsules, tablets, and liquid. The normal dose for adults is 10 mg once a day. For children between 6 to 11 years of age, the usual dose is 5 mg twice a day. It is important to leave 10 to 12 hours between doses. So, one first thing in the morning and one before bedtime. For children between 2 to 5 years of age, the dose is 2.5 mg twice daily. The retail price of Cetirizine hydrochloride 10 mg is $33.02.

Considering the two drugs, I would recommend Cetirizine to my patients. Cetirizine possesses similar efficacy and onset of action compared with diphenhydramine in treating acute food allergic reactions. Again, Cetirizine has added benefits of similar efficacy but a longer duration of action compared with diphenhydramine, making it a good treatment option for acute food allergic reactions (He & O'Shea, 2020).

3. Constipation, diarrhea

Milk of Magnesia (magnesium hydroxide) and Loperamide (Imodium) 

Milk of Magnesia (magnesium hydroxide) is a type of saline laxative recommended for occasional constipation. The active ingredient of Milk of Magnesia is magnesium hydroxide. This medication functions by drawing water to the bowel from nearby tissues, thus softening and moistening the stool and helping increase bowel activity. Adults can take 30–60 ml. Children ages 6–11 can take 15–30 ml. The cost for Milk of Magnesia oral suspension 8% is around $11 for a supply of 355 milliliters.

On the other hand, Loperamide (Imodium) is used to control and relieve the symptoms of acute diarrhea. Loperamide works by several different mechanisms of action that decrease peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes from the gastrointestinal tract. The active ingredient in is loperamide hydrochloride. For an adult, the dose is 4 mg initially, then 2 mg after each loose stool, not to exceed 16 mg/day. The dose should be discontinued if no improvement is seen within 48 hours. Children of ages 2-6 years should take 1 mg q8hr PO, 6-8 years should take 2 mg q12hr PO, and 8-12 years should take 2 mg q8hr PO. The cost for a loperamide oral capsule of 2 mg is around $12 for a supply of 6 capsules.

From the information about the two medications, I can recommend both for my patients because episodes of diarrhea are best managed with Loperamide. At the same time, constipation often responds well to Milk of Magnesia (Hay et al., 2019).

4. Fever, Pain

Tylenol (Acetaminophen) and Ibuprofen (Advil) 

Tylenol (Acetaminophen) relieves mild to moderate pain from headaches, muscle aches, menstrual periods, colds and sore throats, toothaches, backaches, and reactions to vaccinations (shots) and reduces fever. Each tablet contains Ibuprofen 200 mg, which is the active ingredient. It reduces fever through its action on the heat-regulating center of the brain. Acetaminophen is not recommended for infants under 12 weeks unless the pediatrician says so. Acetaminophen should be given every 4 to 6 hours as needed. Adults should take 2 tablets every 4-6 hours while symptoms last. For infants of ages 0-3 months, the recommended dose is 40 mg/dose or oral suspension of 1.25 mL. For ages 4-11 months, the recommended dose is 80 mg/dose. For ages 9-10 years, the recommended dose is 400 mg/dose. The cost for Tylenol oral tablet 325 mg is around $14 for a supply of 50 tablets.

On the other hand, Ibuprofen (Advil) is used in adults and children at least 6 months old to reduce fever and treat pain. The active ingredient is Ibuprofen 200 mg. It works by decreasing hormones causing inflammation and pain in the body. For children of ages 3 to 5 months, the recommended dose is 2.5 mL and Max 3 times in 24 hours. For children of ages 4 to 6 years, the recommended is 7.5 mL. The recommended dose is 200 mg to 400 mg, Max 3 times in 24 hours for adults. The average retail price for 30 tablets of 800 mg generic ibuprofen is $13.39.

From the information on the two medications, I would recommend Advil to my patients because Acetaminophen is only effective at relieving pain and fever. In contrast, ibuprofen relieves inflammation in addition to pain and fever. Further, research suggests that NSAIDs such as ibuprofen are more effective than Acetaminophen at relieving pain (Barbagallo & Sacerdote, 2019).

References

Barbagallo, M., & Sacerdote, P. (2019). Ibuprofen in the treatment of children's inflammatory pain: a clinical and pharmacological overview. Minerva Pediatric, 71(1), 82-99.

Hay, T., Bellomo, R., Rechnitzer, T., See, E., Abdelhamid, Y. A., & Deane, A. M. (2019). Constipation, diarrhea, and prophylactic laxative bowel regimens in the critically ill: a systematic review and meta-analysis. Journal of critical care, 52, 242-250.

He, X., & O’Shea, K. E. (2020). Rapid transformation of H1-antihistamines cetirizine (CET) and diphenhydramine (DPH) by direct peroxymonosulfate (PMS) oxidation. Journal of Hazardous Materials, 398, 123219.

Krajnović, D., Ubavić, S., & Bogavac-Stanojević, N. (2019). Pharmacotherapy literacy and parental practice in use of over-the-counter pediatric medicines. Medicine, 55(3), 80.

Kursewicz, C., Fourzali, K., & Yosipovitch, G. (2022). Itch and Pain Treatments. Atopic Dermatitis: Inside Out or Outside in-E-Book, 264.