Nonprescription Products Research Articles

A Survey of Cannabis Use in a Large US-Based Cohort of People with Multiple Sclerosis.

As cannabis products become increasingly accessible across the United States, it is important to understand the contemporary use of cannabis for managing multiple sclerosis (MS) symptoms. We invited participants with MS from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry (aged 18 years or older) to complete a supplemental survey on cannabis use between March and April 2020. Participants reported cannabis use, treated symptoms, patterns, preferences, methods of use, and the factors limiting use. Findings are reported using descriptive statistics. Of the 6934 participants invited, 3249 responded. Of the respondents, 31% reported having ever used cannabis to treat MS symptoms, with 20% currently using cannabis. The remaining 69% had never used cannabis for MS symptoms, for reasons including not enough data about efficacy (40%) and safety (27%), and concerns about legality (25%) and cost (18%). The most common symptoms current users were attempting to treat were spasticity (80%), pain (69%), and sleep problems (61%). Ever users (vs never users) were more likely to be younger, be non-White, have lower education, reside in the Northeast and West, be unemployed, be younger at symptom onset, be currently smoking, and have higher levels of disability and MS-related symptoms (all P < .001). Despite concerns about insufficient safety and efficacy data, legality, and cost, almost one-third of NARCOMS Registry respondents report having tried nonprescription cannabis products in an attempt to alleviate their symptoms. Given the lack of efficacy and safety data on such products, future research in this area is warranted.

Omega-3 fatty acids for the prevention of atherosclerotic cardiovascular disease.

Marine-derived omega-3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are a type of polyunsaturated fatty acids with many purported beneficial health effects including the prevention of atherosclerotic cardiovascular disease (ASCVD) events. Omega-3 fatty acid intake may be supplemented via dietary sources, as well as prescription or non-prescription products. Omega-3 fatty acids have been shown to reduce serum triglycerides, but there remains ongoing debate regarding the effect of omega-3 fatty acids on major adverse cardiovascular events in patients with established, or at risk of, ASCVD. Recent evidence from randomized, placebo-controlled trials has demonstrated that low-dose (1g daily or less) omega-3 fatty acids (DHA and EPA) do not reduce cardiovascular events or death in patients with or without established ASCVD. Contrarily, the REDUCE-IT trial demonstrated that a purified form of EPA ethyl esters (icosapent ethyl) at 4g daily reduced cardiovascular events and death in patients with ASCVD (or diabetes and multiple cardiovascular risk factors) and elevated triglycerides on background statin therapy. However, 4g daily of omega-3 carboxylic acids (DHA and EPA) did not show a cardiovascular benefit in the STRENGTH trial, which enrolled a similar population. The explanation for this observed discrepancy remains a source of contention and discourse. For now, icosapent ethyl has the most compelling evidence to support a cardiovascular benefit and should be considered in select patients who meet the REDUCE-IT criteria. Furthermore, alternative versions of omega-3 fatty acids should not be considered equivalent to icosapent ethyl. Patients taking an omega-3 fatty acid supplement should be monitored for potential adverse effects, including gastrointestinal disorders or bleeding, in addition to a possible increased risk of atrial fibrillation.

A simulated patient experience in the self-care aisle utilizing Flipgrid as a platform for sharing nonprescription product information

Background and purposeStudents visiting local pharmacies can enhance their learning about nonprescription products while improving their understanding of the patient self-care experience. This study was designed to examine student perceptions of an activity utilizing Flipgrid to share a simulated patient experience in the nonprescription aisle. Educational activity and settingStudent groups traveled to local pharmacies to review available products pertaining to a self-care scenario. Students submitted brief video recordings with product recommendations and counseling points via the Flipgrid platform. Following the activity, students submitted brief reflections. At course conclusion, students completed a questionnaire regarding perceptions of Flipgrid. FindingsSixty-eight students completed the activity. Response rates were 91.2% for the project reflection and 79.4% for the Flipgrid questionnaire. In the reflections (n = 62), the majority of students (87.1%) found it easy or extremely easy to locate pertinent nonprescription products; no student found it extremely difficult. All except four students indicated the assignment helped develop empathy, and all except two indicated a greater likelihood to help a patient in the aisle. In the Flipgrid questionnaire (n = 54), most students found the platform enjoyable (74.1%) and easy to use (79.6%). SummaryStudents perceived that the project increased empathy for assisting patients with selection of nonprescription products. Students found the Flipgrid platform enjoyable and easy to use. This activity can be utilized to simulate a patient self-care experience, and the Flipgrid platform is a novel way to share information between student groups in pharmacy education.

Nonprescription Products of Internet Retailers for the Prevention and Management of Herpes Zoster and Postherpetic Neuralgia: Analysis of Consumer Reviews on Amazon.

Herpes zoster affects approximately 1 million people annually in the United States, with postherpetic neuralgia as the most common complication. The frequent prescription of opioids as the first-line medication for herpes zoster or postherpetic neuralgia contributes to the increasing health care costs of their treatment. Despite the advent of internet retailers providing alternative products for the prevention and management these conditions, there are limited studies on the availability, ingredients, and consumer preference for the products. This study used the internet retailer Amazon to determine the availability of products for the management of herpes zoster and postherpetic neuralgia, and assessed consumer preference based on listed ingredients. The internet retailer Amazon was used to perform a search for products related to "shingles" in September 2020. Top products sorted by reviews and ratings were determined to be either shingles-specific (including "shingles" in either the product title or description) or shingles-nonspecific. Analysis of price, rating, type of vehicle, and ingredients was performed. The types of vehicles, ingredients, and percentages of positive and negative reviews related to "shingles" of the product groups were analyzed with a two-tailed two-sample proportions Z-test to assess the difference between shingles-specific and shingles-nonspecific products. Statistical significance was judged at P<.05. The top 131 products among over 3000 products retrieved were determined based on a rating of 4 or more stars after searching for the term "shingles" on Amazon. Forty-six of the 131 products (35.1%) were shingles-specific. Shingles-nonspecific products were more likely to have positive reviews mentioning "shingles" (P=.005). Vehicles, balms (P=.02), and salves (P=.04) were more likely to be shingles-specific, whereas tablets or capsules (P=.002) were more likely to be shingles-nonspecific. Among the ingredients analyzed, aloe vera was the top-ranked ingredient, included in 29 of the 131 total products (22.1%). Aloe vera (P=.01), lemon balm (P<.001), vitamin E (P=.03), and peppermint oil (P=.008) were more likely to be included in the shingles-specific products, whereas magnesium (P=.01) was more likely to be included in shingles-nonspecific products. There is an abundance of products and ingredients being used for the management and treatment of shingles with certain ingredients preferred by consumers. There is a discrepancy between approved ingredients and the ingredients preferred by consumers. Furthermore, there are insufficient studies on ingredients used by consumers on internet retailers such as Amazon, and future studies can focus on the effectiveness of popular ingredients to decrease misinformation on the internet.

16983 Quality of life in patients with vitiligo: Results from a global patient survey

Vitiligo, a common skin disease characterized by depigmentation, is associated with significant quality of life (QoL) impairment in routine activities, employment, and psychosocial health. The objective of this global population-based survey was to understand the disease burden in patients with vitiligo related to QoL. Participants were aged ≥18 years and were part of an online survey in Europe, the United States, and Japan. Participants with self-reported physician-diagnosed vitiligo were asked to respond to the validated Vitiligo-Specific Health-Related Quality of Life (VitiQoL) instrument. The VitiQoL domains were assessed independently and summarized by total score (higher scores indicate poor QoL). There were 219 participants who self-reported formal vitiligo diagnosis and participated in the full survey. The majority were aged <45 years (68.9% [n = 151]), female (54.1% [n = 118]), and Caucasian (77.7% [n = 146]), and self-reported light brown skin on the Fitzpatrick scale (type 3; 40.2% [n = 88]). Most patients described the extent of vitiligo as low (1-2 on Likert scale [1-6]; 63.9% [n = 140]). Analysis of VitiQol total scores indicated worse QoL among patients with high extent of disease (median 79 [n = 23]) and in patients who started with stable disease that quickly spread later in life (median, 74, [n = 62]). Patients who reported using ≥1 treatment (ie, prescription [off-label] and nonprescription products, surgery, phototherapy; 89.0% [n = 195]) reported higher QoL scores (median 51) than those with no treatment (median 11). This is the first known study to examine the correlation between vitiligo disease characteristics and QoL on a global scale and provides additional evidence of the burden of vitiligo.

Community pharmacists' lack of knowledge and confidence in non-prescription cannabidiol products.

Non-prescription cannabidiol (CBD) products have recently been available in community pharmacies. However, there is only limited data to support its use, placing community pharmacists in a challenging position to provide evidence-based information to patients. The objective of this study was to assess knowledge, experience, and confidence of non-prescription CBD products among community pharmacists. A 38-question pen-and-paper survey pertaining to knowledge, experience, and confidence of non-prescription CBD products was administered to community pharmacists in the California Bay Area. Inclusion criteria consisted of registered pharmacists at community pharmacies during regular business hours. Participants were excluded if they were under 18 years old or unwilling to participate. Of 128 pharmacists, 103 took part and completed the survey (response rate 80.4%). The majority (78.5%) were unable to answer at least 80% of the non-prescription CBD knowledge-based questions. Over 50% have received patient questions and 20.4% recommended non-prescription CBD products in the last 12 months. More than half were "not confident" answering questions about non-prescription CBD products, and 14.5% received formal training on the topic. Despite patients commonly asking about non-prescription CBD products, the majority of pharmacists lack clinical knowledge and confidence on the topic. There is a need to provide formal training and educational resources on non-prescription CBD products.

Access to cannabidiol without a prescription: A cross-country comparison and analysis

BackgroundRecent legislative change has allowed increased access to cannabis products in many jurisdictions. In some locations, this includes over-the-counter (OTC) and/or online access to products containing cannabidiol (CBD), a non-intoxicating cannabinoid with therapeutic properties. Here we compared the availability of CBD products and the associated legislative and regulatory background in nine selected countries. MethodsAccessibility of CBD products was examined in the USA, Canada, Germany, Ireland, United Kingdom, Switzerland, Japan, Australia, and New Zealand as of May 2020. Regulatory and other relevant documents were obtained from government agency websites and related sources. Relevant commercial websites and some physical retailers were visited to verify access to CBD-containing products and the nature of the products available. ResultsA range of CBD products appeared to be accessible without prescription in seven out of nine countries reviewed. Australia and New Zealand were the exceptions where clinician prescription was required to access any CBD-containing product. CBD products commonly available without prescription included oils, gel capsules, purified crystal and topical products. The daily recommended doses with orally administered non-prescription products were typically well below 150 mg and substantially lower than the doses reported to have therapeutic effects in published clinical trials (e.g., 300-1500 mg). The legal foundations enabling access in several countries were often unclear, with marketed products sometimes failing to meet legal requirements for sale. There was an obvious disparity between federal directives and available products in both the USA and European countries examined. ConclusionsThere are a variety of approaches in how countries manage access to CBD products. Many countries appear to permit OTC and online availability of CBD products but often without legislative clarity. As consumer demand for CBD escalates, improved legislation, guidelines and quality control of CBD products would seem prudent together with clinical trials exploring the therapeutic benefits of lower-dose CBD formulations.

Nonprescription acne vulgaris treatments: Their role in our treatment armamentarium-An international panel discussion.

BackgroundAcne vulgaris (acne), a common inflammatory skin disorder, has its peak incidence between 14 and 19 years of age, with girls frequently developing acne earlier than boys. Over recent years, persistent acne is becoming more prevalent in adult women.ObjectivesThis review and panel discussion addresses challenges in acne management, particularly in adult women. The role which nonprescription acne treatment can play is explored when used as monotherapy or as an adjunctive treatment for acne of all severity.MethodsThe best available evidence on nonprescription acne treatment was coupled with the opinion of an international expert panel of dermatologists to adopt statements and recommendations discussed in this review.ResultsAll severity of acne has a significant burden on patients. Addressing environmental factors that are important for the individual with acne may help to educate, prevent, effectively manage, and maintain acne, as per the panel. They agreed that the adult female acne population has unique needs because of their aging skin and social environment. Nonprescription acne treatment products may help to balance the efficacy and tolerability of prescription acne treatment. Currently, there are no specific guidelines for how to use nonprescription acne treatment products in these patients.ConclusionThe panel agreed that guidelines including nonprescription acne treatment either as monotherapy for mild acne or in combination with prescription treatments for more severe acne would address a significant unmet need.

Synthetic Access to Cannabidiol and Analogs as Active Pharmaceutical Ingredients.

Cannabinoids have surely been one of the most widely self-administered drugs other than caffeine. The U.S. FDA recently approved one cannabinoid-based drug whose active pharmaceutical ingredient (API) is cannabidiol (CBD). The long history of individual use of cannabis for a wide range of conditions has sparked great interest in other uses of CBD, in ethical drugs and botanical supplements as well as in foods and nonprescription wellness products. CBD may be sourced from cannabis plants but can also be prepared synthetically, the topic of this review.

Community Pharmacists' Knowledge, Attitude, and Practice in Providing Self-Care Recommendations for the Management of Premenstrual Syndrome.

Background and objectives: Premenstrual syndrome (PMS) comprises a variety of physical and emotional symptoms that affect women of reproductive age. The distress caused by PMS often leads to self-medication, and many over-the-counter or non-prescription products are available for relieving PMS symptoms. The choice of a suitable product should be based on advice from a health professional, such as a community pharmacist. Hence, we assessed the knowledge, attitude, and practice of Malaysian community pharmacists in providing self-care recommendations for the management of PMS. Materials and Methods: A cross-sectional survey was carried out in Kuala Lumpur, Malaysia from September to November 2018 using a self-administered questionnaire. The respondents were community pharmacists working in Kuala Lumpur and were chosen from a list of Type A license holders in the city. Results: We achieved a response rate of 79% and included 181 questionnaires in the final analysis. Of the 181 respondents, most of them (76.8%; n = 139) had medium to good levels of knowledge of PMS. Likewise, most of the respondents (78.5%; n = 142) had positive attitudes toward their role in PMS management. Having taken courses on managing minor illnesses in women substantially enhanced their levels of knowledge of (p = 0.002), but not their attitude towards, PMS management. Among the PMS-relieving products, the most commonly recommended products were ibuprofen (79%; n = 143), mefenamic acid (74.5%; n = 135), and naproxen (66.9%; n = 121), which are well known for their anti-inflammatory effect. This suggests that the respondents based their product choice on sound evidence. Conclusions: Community pharmacists can play an important role in the management of PMS. In future work, a larger sample can be assembled to obtain more insight into the readiness of community pharmacists to help women in self-managing PMS and establish a specialized service to this end.

The long-term supply of tobacco and nicotine: some goals, principles and policy implications

There is a growing literature on regulating the supply of tobacco products to achieve tobacco-free goals. This article suggests three goals and eight principles that could underpin regulatory approaches to...

Atopic dermatitis

A topic dermatitis (AD) is a common, pervasive inflammatory condition of the epidermis and dermis that results in lesions that are typically erythematous, edematous, papular, and crusty. It usually occurs in episodic flares along with periods of remission. In the United States, 15% to 20% of children up to age 17 years and 1% to 3% of adults are estimated to have AD. Eighty percent of AD is classified as mild and can be safely treated with nonprescription products in patients older than 2 years.

2421 A Case of Acute Liver Injury Caused by an Herbal Supplement Containing Saw Palmetto: “Good for the Prostate but Not for the Liver”

INTRODUCTION: Saw palmetto (Serenoa repens), an herbal product used for benign prostatic hyperplasia, is a part of many herbal and dietary supplements (HDS) used for bodybuilding. It is associated with a hepatocellular pattern of acute liver injury. We present a case of liver injury secondary to supplement containing saw palmetto, which improved upon discontinuation. CASE DESCRIPTION/METHODS: A 36-year-old man with history of gastric bypass surgery was admitted with vomiting and diarrhea for the last 2 days. Abdominal examination was unremarkable. Labs revealed ALT of 2200 U/L, AST of 800 U/L with normal bilirubin, alkaline phosphatase and INR. Abdominal ultrasound revealed gallstones with a normal bile duct. Work up for infectious diarrhea was unremarkable. The symptoms were attributed to acute viral gastroenteritis. A diagnosis of acute liver injury was made, and further tests were performed to establish the etiology. Viral markers for Hepatitis A, B, C, E, Epstein Barr, Herpes simplex and Cytomegalovirus were all negative. The ANA, ASMA, ceruloplasmin and acetaminophen levels were unremarkable. He denied any alcohol use. Further history revealed that he had been using an over the counter herbal product to boost the testosterone levels to increase the muscle mass for the last one month. The ingredients of the product included saw palmetto and other herbal constituents. Review of the literature showed an association between saw palmetto and hepatocellular type of liver injury. The liver injury was attributed to the supplement and the cessation was advised. Follow up 4 weeks later showed normalization of the liver profile. DISCUSSION: HDS induced liver injury accounts for 20% cases of hepatotoxicity and 13% cases of acute liver failure in America. Many such cases are due to MINS (multi ingredient nutritional supplements), and the component responsible for the toxicity is usually unknown or can only be suspected. One of such ingredients used in these products is sawPalmetto which may cause supplement-induced liver injury. The latency to onset is within 1 to 2 weeks, and the clinical features resemble acute viral hepatitis with a hepatocellular pattern of liver enzyme elevations. Liver injury is probably an idiosyncratic phenomenon and usually resolves in 1 to 3 months. HDS-induced liver injury presents many challenges in diagnosis, identification of the responsible constituents, treatment and prevention. The regulation of non-prescription products to guarantee public safety is very important.

Non-prescription cannabis use for symptom management amongst women with gynecologic malignancies

ObjectivesTo evaluate interest in and patterns of use of non-prescription cannabis products for symptom management amongst gynecologic cancer patients living in states with legal access to medical and recreational marijuana. MethodsCross-sectional study using a novel 35-question survey distributed to women diagnosed with gynecologic cancer within two academic centers in California and Colorado. The survey queries demographic and disease traits, and both objective and subjective issues surrounding use of cannabis products for symptom management. Surveys were distributed to patients actively receiving treatment or under surveillance. ResultsEnrollment began July 16, 2018 and was completed December 1, 2018. Survey return rate was 52.7%. A total of 225 participants met inclusion criteria.Sixty-two percent reported that they have used or would be interested in using cannabis products for symptom management; 60 (26.7%) are using non-prescription cannabis for treatment of cancer related symptoms, and 80 (35.6%) are interested in using cannabis derivatives under direction of their oncologist. Reasons cited for use of cannabis included: pain control (n = 41, 68.3), insomnia (n = 33, 55.0%), anxiety (n = 29, 48.3%), nausea (n = 26, 43.3%), and appetite stimulation (n = 21, 35.0%). Of the women using cannabis products, almost half report decreased prescription narcotic use after initiation of cannabis products (n = 27, 45.0%). ConclusionsWomen with gynecologic cancer report a strong interest in the use of non-prescription cannabis products for management of cancer-related symptoms. Practitioners in the field of gynecologic oncology should be aware of the frequency of use of non-prescription cannabis amongst their patients as well as the growing desire for guidance about the use of cannabis derivatives. A substantial number of patients report decreased reliance on opioids when using cannabis derivatives for pain control.

Methodology of the formation of National standards of Good Pharmacy Practice and standard operating procedures system

The aim of the work is the development of system of National standards of Good Pharmacy Practice (GPP) and standard operating procedures (SOPs). Materials and methods. The research materials were legal acts of Ukraine, Guidelines on GPP, materials of professional public organizations of different countries on the issues of quality assurance of pharmacy services. Methods of logical and system-structural analysis, modeling processes were used. Results. A comparative analysis of the definitions of the term “standard operating procedure” in the domestic legislation has been conducted. A number of advantages of SOPs in practice have been highlighted. The normative regulation of pharmaceutical activity in developed countries and post-Soviet countries has been analyzed, which allows to assert the use of SOPs to meet the requirements of the quality standards of pharmacy services. Different approaches to the definition of GPP standards and the establishment of the list of SOPs have been identified. Taking into account international experience and national peculiarities of the implementation of good practices, the following structure of the Guidance with GPP in Ukraine was proposed. It consists of: Introduction, Glossary, 8 process guides (Quality management; Receiving, storing and disposing of medicines and medical products; Preparation of medicines in the pharmacy; Prescription and non-prescription medicines delivery and medical products; Providing effective pharmacotherapy; Professional development of pharmacy staff; Improving the effectiveness of the public health system; Self-Inspection); Sources of information. This structure of the proposed Guidance with GPP is focused on the content and functional-role approach to the development of national standards of pharmacy practices. They establish rules and give recommendations for the development of the list of SOPs for a particular pharmacy. Conclusions. There is no definition of the term SOP in normative legal acts which directly regulate the activity of pharmacy establishments in Ukraine. Different approaches to the formation of the list of SOPs in the countries of Europe and the post-Soviet area were found. The structure of the GPP Guidance was proposed based on a functional-role approach to the development of national standards, which includes eight separate process guides that are specific to pharmacies activity.

The Chemical Forms of Iron in Commercial Prenatal Supplements Are Not Always the Same as Those Tested in Clinical Trials

In the US, 70% of pregnant women use an iron-containing prenatal supplement product; however, only 2.6% of pregnant women have iron-deficiency anemia and 16.3% are iron deficient. Yet, published data on the amounts and chemical forms of iron used in formulating these products are not available, although they are known to affect bioavailability. This information is especially important in comparing commercially available products with those that were tested in clinical trials. Our examination of nonprescription and prescription iron-containing prenatal supplement products in NIH's Dietary Supplement Label Database (DSLD) and DailyMed found the labeled amount of elemental iron ranged between 9 and 60 mg/serving in 148 nonprescription supplements and between 4.5 and 106 mg/serving in 101 prescription supplements. Ferrous fumarate was the preferred chemical form used in these products. In contrast, ferrous sulfate was the preferred chemical form of iron reported in the clinical trials summarized in a 2015 Cochrane Systematic review assessing the effects of daily oral iron supplements for pregnant women. Ferrous sulfate was not found on any prenatal supplement product label in the DSLD or DailyMed. The chemical forms of products on the market and those tested in clinical trials are dissimilar, and we believe this may have clinical implications. The findings raise several questions. Do outcomes in clinical trials correlate with the benefits and risks that might adhere to iron supplements with different iron formulations? Should the differences in chemical forms, their bioavailability, and safety profiles, be considered in greater depth when evaluating the effect of the various formulations on maternal iron nutriture? Should new clinical trials for pregnant and lactating women in the US use a form of iron not found in prenatal supplements sold in the US or should a more common form be used?

PDG52 A COMPARATIVE ANALYSIS ON THE RISKS OF USING OTC PRODUCTS COMPARED TO PRESCRIPTION DRUGS

Access to medicines in modern health systems, both on prescription and OTC, involves risks associated with side effects, drug interactions and excessive use of medicines. OTC products can potentially cause serious implications for the health of the patients. The free access to them can misleads the consumers in terms of their safety and efficacy, which can end up as unfavorable consequences.The aim of this study is to identify the potential health risks to society related to easy access to OTC products in Bulgaria. Comparative analysis of the cases of poisoning with OTC medicines belonging to the following groups: non-opioid analgesics, antipyretics and non-steroidal anti-inflammatory drugs (NSAIDs) - (ICD-T39) and cases of poisoning with different groups of systemic antibiotics on prescription - (ICD-T36). The study is based on data from a hospital registry of a major emergency center in Sofia, collected for a period of 5 years. The frequency distribution of cases of poisoning is analyzed in both groups by sex, age, length of hospitalization and seasonal exposure. 89,75% of 488 incidents were caused by NSAIDs and painkillers and only 10,25% by antibiotics. In both groups, women predominate – 71,46% of the cases with analgesics and 78% of those with antibiotics. Highest poisoning risk out of all OTC available are 4-aminophenol derivatives and NSAIDs. For the incidents with antibiotics leading to both sexes are the cases of ICD-T36.8. 45% of the incidents in both groups are children. 43,15% are with NSAIDs and 62% with antibiotics. OTC products taken in combination with antibiotic therapy help to increase the frequency of poisoning in both categories. Accidents caused by non-prescription products can be far more serious due to mass access and lack of control over their release as compared to prescription products.

Impact of Novel Active-Learning Approaches Through iBooks and Gamification in a Reformatted Pharmacy Course

Objective. To compare pharmacy students' assessment and evaluation ratings of a newly formatted nonprescription products course that used innovative technology and gaming to that for a traditional nonprescription products course. Methods. Examination scores and course evaluations of students who completed the traditional course on nonprescription products were analyzed and compared with those of students who completed a revised course on nonprescription products that used teaching techniques in educational technology. Results. Students in the traditional course significantly outperformed those in the comparator group in eight nonprescription categories on examinations, while students in the new course significantly outperformed those in the comparator group in four categories. Students in the new course outperformed those in the traditional course in two additional examination categories, however these were not significant. Almost all students in both courses agreed or strongly agreed with each course evaluation item, including those items where use of gamification and iBooks were most likely considered. Conclusion. Improvements in student examination performance and course satisfaction may not be immediately seen in a course in which new teaching techniques using educational technology including gamification and iBooks are introduced.

Teaching non-FDA approved nonprescription products: Educating students about potential risks and liability

IntroductionUniversity professors who teach self-care and nonprescription products must decide which products and ingredients to recommend to students. The Food and Drug Administration (FDA) has approved many nonprescription ingredients as both safe and effective through the evidence-based FDA Over-the-Counter (OTC) Product Review or New Drug Application (NDA) processes. However, thousands of nonprescription products sold in community pharmacies are of unproven safety and/or efficacy. These include herbs, dietary supplements, homeopathic products, and essential oils. Selling products of unproven safety and/or efficacy can have serious consequences, exposing pharmacists to legal liability due to violations of the principles of implied and/or express warranties, as found in the Uniform Commercial Code. Further, the FDA defines products lacking proven safety and efficacy as health fraud, a crime aggressively pursued by both the FDA and the Federal Trade Commission. CommentaryFaculty members who limit their nonprescription ingredient recommendations to those with FDA approval can justify those recommendations by weight of evidence. If the faculty member recommends ingredients that the FDA has not approved (e.g., kava), students should be taught that those ingredients pose unknown risks and lack proven benefit, and also that their labels virtually always lack doses proven to be safe, precautions, contraindications, and drug interactions. ImplicationsSelling unproven products can lower trust in pharmacy, cause patient harm, and expose the pharmacist to legal action. These issues should be explained to students whenever unproven products are discussed or recommended.

Public Perception toward E-commerce of Medicines and Comparative Pharmaceutical Quality Assessment Study of Two Different Products of Furosemide Tablets from Community and Illicit Online Pharmacies.

Background:E-commerce of medicines has been extensively spread worldwide. Many reasons influence consumers to purchase their medical needs through the Internet, including low cost, availability, accessibility, and time saving. However, most of these medicines are substandard and counterfeit.Aim:To assess the perception of people in the UAE about purchasing medicines from online sources and to evaluate the quality of furosemide tablets from two different sources including illegal online source.Materials and Methods:A cross-sectional study was conducted on 528 participants in the UAE. The questionnaire included three parts to assess the public perception and experience toward purchasing medicines from online sources. Furosemide tablets, purchased from the UAE market and an illegal online source, were physically and chemically studied to assess their quality according to the British Pharmacopoeia (2018).Results:The survey results revealed that less than 10% of participants have purchased their medicines from online sources and mostly they were nonprescription products (78%). Most common motives for online purchasing were either unavailability in the local pharmacies (43%) or lower cost compared to that in local market (43%). The opinion of participants toward purchasing of online medicines was negative. On the other hand, the experimental analysis showed that online furosemide had failed to pass the chemical assay test (91.0% ± 0.8), which makes it a substandard product.Conclusion:This study showed that few consumers had considered purchasing pharmaceutical products from online sources as a feasible way to save money and time. However, most of them were in doubt about their quality, which encourages health-care providers to guide patients to government-supported websites if required. The study also showed that the quality of online medicines is questionable, indicating that these products are not equally effective as the medicines purchased from a local pharmacy.