Syringes must be stored behind the counter, and the pharmacy must provide verbal counseling or written information regarding how to access drug treatment, how to access HIV and hepatitis screening and treatment, and how to safely dispose of used syringes.
The concept of a third class of drugs had languished for years chiefly due to opposition from the FDA and those who did not want the pharmacist to be granted additional medical responsibilities. However, the rise of methamphetamine meth labs created an environment favorable to the third class. Pseudoephedrine PSE was the most widespread starter chemical for meth production.
Individual states e. Congress and federal authorities saw the wisdom of the state laws and realized that a national law would also be extremely beneficial. Eventually, President George W. With passage of this law, pharmacists became the gatekeepers for PSE sales.
While nonpharmacy personnel can handle some aspects of the transaction, the law requires hands-on approval and completion of the sale by a pharmacist. The legal limit for purchase is 3. In the ideal situation, pharmacists would ask the same types of questions of PSE patients that should be asked of patients requesting any other group of nonprescription products prior to sale.
It would be prudent to first ask patients whether they are experiencing additional symptoms. They should mention additional symptoms that help confirm presence of the common cold e. If a patient cannot do so, it is best to refer him or her to a physician for diagnosis of the problem causing the nasal congestion.
Patients should be asked if they have such medical conditions as fever, heart disease, thyroid disease, hypertension, diabetes, or prostate insufficiency, or whether they are pregnant or breastfeeding.
PSE products carry a warning against self-use if the symptoms do not improve in 7 days. Have you been using it recently? Thus, legitimizing PSE sales goes far beyond the relatively simple step of detecting overuse via electronic logbooks.
Of course, those seeking PSE for illegal purposes will eventually learn the questions and formulate acceptable responses in advance, but the questions should be asked nonetheless. State legal authorities have acted against pharmacists and pharmacies that refuse to obey the law.
This agent was originally approved by the FDA in as a nonprescription product for women aged 18 years and above, but is now nonprescription for those aged 17 years and above. Emergency contraceptives most often function by preventing or delaying release of the ovum from the ovaries, but may also hamper implantation of a fertilized egg. The latter point is the focus of controversy, and has caused pharmacists to refuse to stock or sell it because of their personal beliefs.
For pharmacists who do stock the product, there are many questions. Should sales be documented in a logbook? If a young man claims that his girlfriend is 17 years old, should the pharmacist demand that the woman come in herself to present her ID? Is any government agency responsible for monitoring these sales? Should the FDA or state authorities plan sting operations in the same manner as they control underage sales of tobacco or alcohol?
What are the penalties for selling the product to a year-old? FDA and state Web sites are generally silent on these issues, although educational materials and guidelines can be obtained from the manufacturer.
While a third class of drugs is no longer a novel concept, it is apparent that pharmacists are in a unique position to counsel patients and improve or restrict accessibility to nonprescription drugs with BTC status. This third group is known as behind-the-counter or BTC medications. BTC drugs do not require a prescription, but they are not available in just any location either.
Instead, you can only buy them in locations where a pharmacist is present. The reason you must visit a pharmacist before purchasing these BTC products varies with the specific item. For example, insulin is too dangerous to allow its sale by those without a pharmacy degree, as even a small overdose can lead to deadly insulin shock.
In some states, codeine-containing cough syrups are available in the BTC category. You may be aware that certain cold products are not available except from a pharmacy. However, illegal drug lab operators found that PSE could be used as a starting element to make methamphetamine meth.
They began to buy PSE in large quantities, many times from nonpharmacy outlets such as convenience stores. To help control the growing problem of meth, state and federal authorities decided to pass laws that would restrict sales to pharmacies.
Purchasers must show photo identification, have their transaction logged, and are subject to daily and monthly limits. Pharmacists were chosen as the critical gatekeepers for PSE sales because they have the knowledge to determine whether sales are legitimate.
They may ask you about such issues as other symptoms of a common cold to ensure that you have a medical need for a proposed purchase of PSE. If the pharmacist is not convinced that you have a legitimate need for PSE, he or she may ask you to visit a physician to determine whether a prescription product is more appropriate.
It is available on a BTC basis for those aged 17 years and above. For younger patients, a prescription is required. In this case, pharmacists were again chosen to be the point of control to make sure that those too young to obtain an emergency contraceptive would see a physician instead of using it on their own.
If you have any questions regarding nonprescription drugs or products that are only available BTC, your pharmacist will be there to address any concerns. Some pharmacies even provide pharmacy request cards in the aisle that you can bring up to the counter to help facilitate the sale. Pray WS. Nonprescription Product Therapeutics. Lober CW. The pharmacist physician. J Am Acad Dermatol. Nonprescription drugs: considerations regarding a behind-the-counter drug class.
Government Accountability Office. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:. All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:.
These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1- Use this drug as ordered by your doctor.
Read all information given to you. Follow all instructions closely. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications.
This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. For more resources, visit www. Opioid drugs can put you at risk for addiction, abuse, and misuse. Misuse or abuse of this drug can lead to overdose and death. If you have questions, talk with your doctor. This drug has an opioid drug in it. Severe side effects have happened when opioid drugs were used with benzodiazepines, alcohol, marijuana or other forms of cannabis, or prescription or OTC drugs that may cause drowsiness or slowed actions.
This includes slow or troubled breathing and death. Benzodiazepines include drugs like alprazolam, diazepam, and lorazepam. Benzodiazepines may be used to treat many health problems like anxiety, trouble sleeping, or seizures.
If you have questions, talk with the doctor. Many drugs interact with this drug and can raise the chance of side effects like deadly breathing problems. Talk with your doctor and pharmacist to make sure it is safe to use this drug with all of your drugs. Do not take with alcohol or products that have alcohol. Unsafe and sometimes deadly effects may happen.
Get medical help right away if you feel very sleepy, very dizzy, or if you pass out. Caregivers or others need to get medical help right away if the patient does not respond, does not answer or react like normal, or will not wake up.
This drug may cause very bad and sometimes deadly breathing problems. Call your doctor right away if you have slow, shallow, or trouble breathing. Children: This drug is not for use in children younger than 18 years of age. The benefits of taking this drug for a cough due to allergies, a cold, or other infection do not outweigh the risks in children. What is this drug used for? It is used to thin mucus so it can be taken from the body by coughing.
It is used to relieve coughing. If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had. If you have any of these health problems: Lung or breathing problems like asthma, trouble breathing, or sleep apnea; high levels of carbon dioxide in the blood; or stomach or bowel block or narrowing. If you have a cough with a lot of mucus, a long-term cough caused by smoking or being around smoke, or lung problems like asthma or emphysema.
This includes isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. Very high blood pressure may happen. If you are taking any of these drugs: Buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine.
If you have been told by your doctor that you are a rapid metabolizer of some drugs. If you are breast-feeding. Do not breast-feed while you take this drug. This is not a list of all drugs or health problems that interact with this drug. What are some things I need to know or do while I take this drug? Tell all of your health care providers that you take this drug.
This includes your doctors, nurses, pharmacists, and dentists. Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects. Do not use longer than you have been told by the doctor. Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you. To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down.
Be careful going up and down stairs. This drug may be habit-forming with long-term use. Do not take this drug with other strong pain drugs or if you are using a pain patch without talking to your doctor first. This drug may affect certain lab tests.
Tell all of your health care providers and lab workers that you take this drug. If you are 65 or older, use this drug with care. You could have more side effects.
Different brands of this drug may have different doses for children. Talk with the doctor before giving this drug to a child.
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