Over-the-Counter Drugs

Chapter 102 Over-the-Counter Drugs




Clinical Case Problem 1: A 6-Month-Old Infant with an Upper Respiratory Tract Infection


A 6-month-old infant is brought to your office by his mother. He has had a runny nose, cough, and mild fever for the past 4   days. The infant was playful but occasionally fussy, and his temperature reached 39° C (102° F). He is otherwise healthy, and his immunizations are up to date.


On physical examination, the child looks well and is afebrile. He has nasal congestion and a hyperemic pharynx. Tympanic membranes look normal. His lungs are clear and heart sounds are regular.



Select the best answer to the following questions




1. The infant’s mother is concerned about the fever. Your recommendation to her would be


a. treat the fever with baby aspirin if it reaches 39° C again

b. treat the fever with elixir of acetaminophen if it reaches 39° C again

c. treat the fever by alternating doses of acetaminophen and ibuprofen every 4 hours

d. use only symptomatic treatment (lukewarm bath, cool clothes, and fan in the room)

e. tell the mother that everyone has a different opinion; as far as you are concerned, she can do whatever she wants

2. What is the analgesic agent of choice in the treatment of childhood fever and mild childhood pain?


a. elixir of naproxen

b. elixir of hydromorphone

c. elixir of acetaminophen

d. children’s aspirin, 75   mg

e. elixir of acetaminophen and codeine

3. Which of the following statements most accurately reflects current practice recommendations regarding antipyretics and analgesics for fever and mild pain in children?


a. aspirin is still the analgesic of choice in the treatment of infant and childhood pain

b. aspirin is not contraindicated in the treatment of infant and childhood pain associated with upper respiratory infections (URIs)

c. aspirin is a more potent analgesic than acetaminophen or ibuprofen

d. acetaminophen is the most widely used antipyretic and mild analgesic for children

e. ibuprofen is the preferred agent

4. Regarding the use of antihistamines in children, which of the following statements is true?


a. cold-related nasal congestion and rhinorrhea are primarily due to histamine release

b. antihistamines shorten the duration of upper respiratory tract illness in children

c. antihistamine use reduces the incidence of common complications such as otitis media

d. antihistamines have been shown to be of benefit in reducing rhinorrhea and cough in children with cold

e. young children may develop seizures when given antihistamine doses (tablets or suppositories) that are meant for older children (on a milligram per kilogram basis)

5. Regarding the relief of nasal congestion in infants and children, which of the following statements is true?


a. antihistamines produce excellent relief of pediatric nasal congestion

b. intranasal and oral decongestants have been shown to relieve nasal symptoms in young children

c. supportive treatment, such as humidified air, bulb suctioning, and saline nasal drops, is of no significant benefit

d. nasal bulb suctioning done too frequently can cause nasal trauma, swelling of nasal mucosa, and greater congestion

e. combined antihistamine and decongestant treatment has been shown to benefit young children

The child returns 3   days later with his mother. She states that despite your treatment, the child has not improved. He now has significantly greater nasal congestion and is having difficulty breathing at night. She has been using an over-the-counter (OTC) cold medication and asks if she should use something stronger.


Physical examination is completely normal. You do not notice any change in the state of the nasal congestion.



6. With respect to treatment of this infant at this time, what would you tell the mother?


a. decongestants have not been shown to reduce the duration of viral URI symptoms

b. use nasal saline with bulb suctioning of nasal passages and humidified air instead of a decongestant

c. reassure the mother and educate her about common cold and antihistamine-decongestant use

d. overstimulation is a common side effect when decongestant preparations are given to children

e. all of the above statements are true


Clinical Case Problem 2: An 18-Month-Old Infant with a Persistent Cough


The parent of an 18-month-old girl calls your office with a complaint that the toddler has had a persistent cough for the past 10   days. You saw the child for a routine checkup a few months ago. The cough is nonproductive, and the mother believes it is significantly interfering with the child’s sleep. The child is otherwise well. She makes an appointment to see you in a couple of days and asks if you could recommend an OTC cough medication for her child.



7. Regarding the use of antitussives or expectorants in infants and children, which of the following statements is true?


a. there is a lack of evidence that any OTC medicine is effective in treating pediatric cough

b. centrally acting cough suppressants, such as codeine and dextromethorphan, are effective in treating pediatric cough

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Over-the-Counter Drugs

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