Over-the-counter Research Articles

Clinical Toxicology of OTC Cough and Cold Pediatric Medications: A Narrative Review.

Cough and cold symptoms (CCS) are common pediatric conditions often treated with over-the-counter (OTC) medications. However, the available knowledge regarding the safety and toxicity of these medications in children is inadequate. Therefore, understanding their clinical toxicology is crucial for safeguarding children's well-being. This narrative review highlights the importance of clinical toxicology in evaluating the safety and toxicity profile of OTC medications for treating CCS in pediatric patients. The pharmacology, clinical features, and adverse effects of various drug classes commonly found in cough and cold medications are briefly discussed. Pharmacokinetic and pharmacodynamic parameters are also examined to understand the interactions between these drugs and the body. OTC cough and cold medications often contain active ingredients such as antihistamines, decongestants, antitussives, expectorants, and analgesics-antipyretics. The combination of multiple ingredients in these products significantly increases the risk of adverse effects and unintentional overdoses. Several case studies have reported significant toxicity and even fatalities associated with the use of these medications in children. This review underscores the critical importance of clinical toxicology in evaluating the safety and toxicity profile of OTC medications employed for treating CCS in pediatric patients. The findings highlight the significance of informed clinical practice and public health policies to ensure the well-being of children using OTC cough and cold medications.

Assessment of Reader Technologies for Over-the-Counter Diagnostic Testing.

Background: Over-the-counter (OTC) diagnostic testing is on the rise with many in vitro diagnostic tests being lateral flow assays (LFAs). A growing number of these are adopting reader technologies, which provides an alternative to visual readouts for results interpretation, allowing for improved accessibility of OTC diagnostics. As the reader technology market develops, there are many technologies entering the market, but no clear, single solution has yet been identified. The purpose of this research is to identify and discuss important parameters for the assessment of LFA reader technologies for consideration by manufacturers or researchers. Methods: As part of The National Institute of Biomedical Imaging and Bioengineering's Rapid Acceleration of Diagnostics (RADx) Tech program, reader manufacturers were interviewed to investigate the current state of reader technology development through several parameters identified as important industry standards. Readers were categorized by technology type and parameters including cost, detection method, multiplex capabilities, assay type, maturity, and use case were all assessed. Results: Fifteen reader manufacturers were identified and interviewed, and information on a total of 19 technologies was assessed. Reader technology type was found to be predictive of other attributes, whether the reader is smart technology only, a standalone reader, a reader with smart technology required, or a reader with smart technology optional. Conclusions: Pairing reader technology with OTC diagnostic tests is important for improving existing COVID-19 tests and can be utilized in other diagnostics as the OTC use case grows in popularity. Reader technology type, which is predictive of core reader attributes, should be considered when selecting a reader technology for a specific LFA test within the context of regulatory guidance. As diagnostics increase in complexity, readers provide solutions to accessibility challenges, facilitate public health reporting, and ease the transition to multiplex testing, therefore increasing market availability.

Effectiveness of Homeopathic Medicine in Canine Urinary Incontinence: Outcomes of Owner Response Survey

With advances in data collection via electronic surveys, they have become a popular tool for researchers especially with the changes in normalcy caused by the Coronavirus pandemic. During this pandemic period, previously collected traditional format paper data on Homeopet ™ ‘Leaks No More’ was collated, analysed, written up, reviewed, and published Farrington TJ and Smith . The current study was again an owner response survey like the previous studies but done electronically. In the case of this Homeopet™ 'Leaks No More' survey, the selection criteria used to identify eligible participants who had purchased the product directly from the manufacturer's website helped to ensure that the responses collected were from genuine product users including first time and repeat users. This helped to eliminate potential bias in the responses and ensured that the data collected was of high quality. It ensured elimination of spurious responses and replies from unverified users. The use of gratuities only to those who agreed to provide fully completed surveys containing a true assessment of their pets' responses with an email and other contact details including agreement to be contacted helped to improve the response rate and quality of data collected. In fact the normal verifying of email addresses and names of respondents was turned off for data protection requirements after collection before sending data to analyst and authors removing only from them ability to cross-reference to an original mail shot offering the survey to people who had joined the mailing list on Homeopets own sales site, the researchers were after completion of the paper able to ensure that the data collected was authentic and reliable without exposing any personal data for the participants from the survey collection while still ensuring it was verifiable. Despite striving to write the survey questionnaire in a balanced inclusive way so that it would resonate with a wide range of perspectives and viewpoints across a broad range of views, one can assume that those who filled it out were more likely to have been open to complementary medicine or to have a pet who had failed to respond or responded poorly to conventional therapy. It also meant that emails and names could be verified and if necessary, through the email DNS, and thus could be contacted to complete any missing data needed, which thanks to response numbers was not necessary so the data remained completely confidential. As Homeopet ™ ‘Leaks No More’ is an OTC (Over the Counter) retail product which during the pandemic sold primarily online through various online retailers due to the restricted access to bricks and mortar retailers, shops, and stores there was little or no direct access to or contact with the end users and thus the electronic survey proved highly effective in that environment. Overall, electronic surveys have proven to be a more successful and time-efficient way of collecting data compared to traditional methods as shown in this research paper. The high-quality data collected in this study will be valuable for future research and product development in the field of complementary medicine for pets. Methods and Outcomes: An online questionnaire template was developed using questionnaires from the previous studies and he decision was to use SurveyMonkey® as the mode of delivery to participants. Homeopet™ LLC employed an independent consultant to design and develop the front end for owner response input and the back end for data collection. Ms Jenny Doran Halcyon Days Ltd. worked with Dr Farrington and his team, some external individuals unfamiliar with the project (to ensure the public would understand the questionnaire fully), including staff at Homeopet familiar with the process, to test prototype versions of the SurveyMonkey® and tailor them to the projects requirements till the entire team came to a consensus acceptable to Homeopet™ in the time constraints available. The survey was then made available online with an invitation to participate added to the purchase process on the manufacturer’s website. Other online outlets were considered but were not open to the authors having access to their customer information even for verification purposes. This outlet area is being worked on for future surveys.

Quality Evaluation of Locally Manufactured Paracetamol Tablets in East Africa.

Background: Paracetamol, also known as acetaminophen, is categorized as an analgesic and antipyretic medication and is available as over the counter (OTC) medication. It is commonly used in conditions associated with pain and fever. There is a tendency for community to prefer using imported paracetamol tablets from Europe and United States than from Asia and Africa worrying of the quality of the products. Safety, effectiveness, and efficacy of a medicine can be guaranteed when its quality is reliable; however, there is limited data on the quality of locally manufactured paracetamol tablets, thus necessitating this study. Aim: This study is aimed at assessing the quality of paracetamol tablets 500 mg manufactured by local companies by evaluating their physical parameters, assay results, and dissolution profiles. The compliance of these tablets with the specifications outlined in the British Pharmacopoeia (BP) was analyzed. Additionally, a comparative dissolution test was conducted to assess dissolution profile for innovator product and generics. Method: Five different brands from East African countries with 76 tablets from each brand were compared with the innovator product regarding weight variation, hardness, friability, assay, and dissolution test based on the BP specifications. Results and discussion: All samples of paracetamol tablets 500 mg from the local manufacturers in this study met the specifications set by the BP for physical parameters, including weight variation, friability, hardness, and disintegration tests. The weight variation test, directly related to drug content variation, demonstrated compliance within the acceptable deviation of 5%. Similarly, the assay test, which determines the concentration of the active pharmaceutical ingredient (API), confirmed that all samples complied with the acceptable concentration range of 90%-110% for paracetamol. The dissolution test, assessing the percentage release of the API within a specified time, demonstrated that at 15 min, two samples (diodol and enamol) exhibited lower concentration releases than the required 80%, indicating potential delays in their bioavailability and onset of action. Conclusion: To conclude, all samples had good quality and they can be used for their therapeutic purposes.

Identification of Factors Necessary for Gatekeeper of Overdose.

Overdose has become a global social problem. The Japanese government requires gatekeeper training to detect and prevent indicators of overdose and suicide. However, knowledge of necessary factors for the gatekeeper of overdose (patient intervention) is limited. This study aimed to investigate the characteristics of individuals who experienced intervening persons expected to overdose, and to identify the factors required of gatekeepers. A Google form was used to survey 298 pharmacists and registered sellers in Japan. We searched for factors by logistic analysis. Knowledge of prescription drugs used for overdose was higher among pharmacists than among registered sellers. Conversely, pharmacists and registered sellers had similar knowledge about OTC drugs. Overall multivariate logistic regression analysis revealed countermeasures against overdose at their workplace (odds ratio (OR): 4.01, 95% confidence interval (CI): 2.25-7.15, p < 0.01) and knowledge that overdose is on the rise (OR: 1.93, 95% CI: 1.04-3.69, p < 0.05) to be significantly associated with intervention experience as a gatekeeper. Countermeasures against overdose at their workplace (OR: 2.40, 95% CI: 1.10-5.25, p < 0.05) in pharmacists and years of work experience (OR: 1.13, 95% CI: 1.04-1.24, p < 0.05), countermeasure against overdose at their workplace (OR: 3.43, 95% CI: 1.18-10.0, p < 0.05), and willingness to participate in study sessions and workshops on overdose (OR: 3.50, 95% CI: 1.51-8.10, p < 0.05) in registered seller were significantly associated with intervention experience as a gatekeeper. These results are useful evidences for countermeasures and gatekeeper training for overdose at pharmacies and drugstores in the community.

Risk factors for the need for advanced care among prescription and over-the-counter drug overdose patients.

Prescription drug and over-the-counter (OTC) drug overdose is a major problem in emergency departments in Japan, and some need advanced care which is more than observation. We aimed to identify the prehospital risk factors for the need of advanced care among overdose patients. This was a single-center retrospective cohort study. We included overdoses patients of prescription drugs or OTC drugs, who admitted to our hospital between 2016 and 2021. We grouped them into advanced care and non-advanced care. The main outcome was the need for advanced care. We performed a multiple logistic regression analysis, calculated the PAV score (Paracetamol use, Alcohol use, abnormal Vital signs on scene) and performed a receiver operating characteristic (ROC) analysis. There were 229 subjects. The logistic regression analysis revealed that alcohol, paracetamol, and the abnormal vital signs on scene were associated with advanced care (alcohol-odds ratio [OR]: 2.95; 95% confidence interval [CI]: 1.29-6.75; paracetamol-OR: 5.47; 95% CI: 2.18-13.71; abnormal vital signs-OR: 4.61, 95% CI: 2.07-10.27). The rate of advanced care in the high PAV score (2 and 3) group was statistically higher than that in the low PAV score (0-1) group (p = 0.04). Area under the ROC curve of the PAV score was 0.72 (95% CI, 0.65-0.80). Alcohol, paracetamol use and abnormal vital signs on scene might be risk factors for advanced care among prescription drugs or OTC drugs overdose patients, and the PAV score may predict the need for advanced care.

Assessment of knowledge, attitude, and practice on over-the-counter drugs among medical and nursing students: A cross-sectional study

Background: As future health-care practitioners’, self-medication assumes special importance among MBBS, nursing, and paramedical students. They are the ones who differ from the general population due to their exposure to the disease and drugs. The idea of conducting the present study was due to the scarcity of data regarding knowledge, attitude, and practice (KAP) of over-the-counter (OTC) drugs among them. Aims and Objectives: The aim of this study was to check KAP regarding OTC drug use among medical and nursing students and also to know the different reasons for self-medication and influences regarding their choice for the same. Materials and Methods: A cross-sectional study was done including medical and nursing students for time duration of 6 months from January to May 2023. A well-designed, pre-validated questionnaire with various items on a Likert scale was distributed to medical and nursing students all over Maharashtra via Google Forms, sharing links through the contacts of the medical and nursing students' association of Maharashtra. Descriptive statistical analysis was used. Results: A total of 161 students (102 medical, 59 nursing) took part in the present study. Most of the students (84.4%) practiced self-medication. Fever and headache (56.4%), followed by cough and common cold (27.5%), are the most common illness for which students self-medicate. One of the most common reasons students have been found to self-medicate was found to be refusal to spend time seeing a doctor for minor illness (64.5%). Conclusion: There is an extensive habit of self-medication among MBBS and nursing students. Lack of understanding regarding the proper use of medications, their storage, expiry, action to be taken in case of side effects, and increasing the dose of medication when symptoms are not subsiding were some of the significant problems found.

Drugs Avoided during Pregnancy

Some medicines can harm a developing baby or beget a confinement or birth. Occasionally, not taking a certain drug can beget further problems for you or your baby than if you do take them. Generally, you shouldn’t take any OTC drug while pregnant unless it’s necessary. Gestation is a special physiological condition where medicine treatment presents a special concern because the physiology of gestation affects the pharmacokinetics of specifics used and certain specifics can reach the fetus and beget detriment. Total avoidance of pharmacological treatment in gestation isn’t possible and may be dangerous because some women enter gestation with medical conditions that bear ongoing and episodic treatment (e.g. asthma, epilepsy, and hypertension). Also during gestation new medical problems can develop and old bones can be aggravated (e.g. migraine, headache) taking pharmacological remedy. The fact that certain medicines given during gestation may prove dangerous to the future child is one of the classical problems in medical treatment.

Teaching Homeopathy in U.S. Pharmacy Schools.

Objectives: Pharmacists often advise patients on the use of over-the counter (OTC) medications. A class of medications that is growing in popularity is homeopathic products. Little is known about student pharmacist education about homeopathy. The objectives of this study were to: 1) describe homeopathic topics being taught in pharmacy schools and 2) evaluate faculty views about pharmacists' roles in counseling patients about homeopathic products. Method: An explanatory sequential mixed methods approach was used. Online surveys were distributed to 3,300 pharmacy practice faculty members representing all schools accredited in the US. Frequencies were calculated to describe faculty characteristics and their responses. Moreover, 18 interviews of faculty involved with teaching homeopathy were conducted to learn about homeopathy teaching and expectations about roles of pharmacists in counseling patients. Results: Survey data were collected from 365 respondents. Over half (84 of 137) of the responding pharmacy schools reported teaching homeopathy to pharmacy students. In addition, the responses from most of the interviewed faculty were summarized into two themes which emphasized that pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from taking homeopathic products. Conclusion: Over half of US pharmacy schools are teaching students about homeopathy topics. Further, there was support for pharmacists being able to counsel effectively about homeopathic products.

Investigating the understanding, beliefs, and behaviors regarding over-the-counter (OTC) medications among rural communities: An analysis using cross-sectional research

Investigating the understanding, beliefs, and behaviors regarding over-the-counter (OTC) medications among rural communities: An analysis using cross-sectional research

The Role of Pharmacists in Fighting Substance Abuse: A Systematic Review

Pharmacists are crucial to caring for patients who use and abuse psychoactive substances, especially those with substance use disorders, in all care settings. The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has created key skills for pharmacists to address substance use in the 21st century to maximize, maintain, and increase these independent and collaborative responsibilities. Thus, this study aims to explore the role of pharmacists in fighting substance abuse. This is an updated systematic review of studies on the role of pharmacists in fighting substance abuse between 2019 and 2022. The PubMed and Google scholar databases were used to explore studies regarding our subject. The keywords included &amp;quot;Role, Pharmacists, Fighting, Substance, and Abuse&amp;quot; and were used in various combinations. Original research reporting medical therapies used in the role of pharmacists in fighting substance abuse and full-text publications served as the inclusion criterion.Though 150 articles were obtained, only eight met the inclusion criteria. The review involved community pharmacists; all the studies were cross-sectional. The most abused prescription and non-prescription drugs were anti-malarials and simple analgesics, over-the-counter (OTC), opioids, prescription medicines, and Pregabalin. Nearly half of the studied pharmacists received substance use disorder (SUD) education concerning pharmacists\&amp;apos; knowledge and perceptions in pharmacy school. The number of years worked significantly predicted knowledge and screening. Relationships between knowledge, attitudes, and practices indicate a need for experiential education that includes psychosocial aspects of care. This clarifies that the pharmacists\&amp;apos; role in preventing drug abuse is significant. Training programs influenced pharmacists\&amp;apos; attitudes and perceptions about targeted behaviors and associated them with the value of screening for opioid misuse or overdose risk and counseling patients about the benefits and risks of opioids.

Assessment of over-the-counter medication use among pregnant women visiting public and private tertiary hospitals in Lahore, Pakistan

Over-the-counter (OTC) medications are considered safe when used as directed agents and are widely used for self-medication due to their accessibility and affordability. However, self-medication during pregnancy can lead to irrational drug use and potential complications. This study aimed to assess the use of OTC medicines among pregnant women visiting public and private tertiary care hospitals in Lahore, Pakistan. A cross-sectional study was conducted over three months in 2023 involving 170 pregnant women at public hospitals and 155 at private hospitals. The data were collected using a structured questionnaire and analyzed using descriptive statistics and chi-square tests. Familiarity with OTC medications was greater among pregnant women visiting public hospitals (56.50%, p = 0.036) than among those visiting private hospitals (54.40%). Most women from public hospitals perceived all OTC drugs as safe during pregnancy (64.20%, p = 0.009). The perceived critical period for drug use varied, with more pregnant women in private hospitals identifying the first trimester as critical (58.82%, p = 0.002), while the third trimester was more commonly perceived as critical by public hospital visitors (62.50%). The use of OTC medication before and during pregnancy was similar between groups (p &gt; 0.05). A significant difference was observed in reading OTC medicine leaflets, with more private hospital visitors reading them (60.98%, p &lt; 0.001). This study concluded that the proportion of OTC medicine use among pregnant women visiting public and private healthcare facilities in Lahore is moderately high. There were notable differences in the sociodemographic characteristics and perceptions of OTC medication safety. Public hospital visitors were more familiar with OTC medications and believed in their safety during pregnancy, while private hospital visitors were more concerned about the first trimester and more likely to read OTC medicine leaflets. These findings highlight the need for targeted education and counseling to promote safe OTC medication practices among pregnant women.

Effect of Retinoic Acid on HaCaT and NIH-3T3 cells in an in vitro 3D Collagen Cell Culture Skin Model

Human skin aging is characterized by epidermal and dermal thinning, loss of elasticity, and wrinkles. Keratinocytes, the most common type of skin cell and fibroblasts, present in the cellular stroma beneath the skin’s surface, each play a role in aging. Using these cell types in in vitro research can reveal a deeper understanding of the dermatological function and cellular changes in aged skin. 3D cell culture techniques provide an opportunity to use these cell types in a model that can more accurately mimic human skin. Treatment of aging skin is of interest to both medical and consumer communities. Retinoic acid (RA) is a metabolite of vitamin A and retinol that assists in cell proliferation, differentiation, and immune functions. Over the counter (OTC) and prescription retinoids are common topical products used for anti-aging and acne treatments. This study seeks to determine the impact of topical retinoid creams on keratinocyte proliferation and morphology in 3D cell culture models of aged and unaged human skin. NIH-3T3 fibroblasts were embedded in a 3D collagen matrix of varying thickness, and HaCaT keratinocytes were seeded on top of the matrix at varying seeding densities to mimic aging and youthful skin. 0.1 µM 0.025% tretinoin and 0.1 µM 0.1% adapalene topical creams were prepared in culture medium and used to treat cells daily, on alternate days, or just once during a week-long period. Alamar Blue assays and microscopy showed that tretinoin treatment was cytotoxic at this concentration, with a single treatment reducing cell viability by ~43% compared to the untreated control. Adapalene treatment, while showing significantly greater cell proliferation than tretinoin, did not exceed the proliferation of the untreated control. It is understood that retinol increases cell turnover by killing cells rapidly, so it is proposed that in our model, the rate of proliferation does not overcome the rate of cell death. Cell viability trends remain similar between young and old skin model treatments. Future studies should focus on creating a 3D model more accurately representing the aging in vivo skin environment where keratinocytes can be readily differentiated from epidermal stem cells. KEYWORDS: HaCaTs; NIH-3T3; Retinoids; Retinoic Acid; Tretinoin; Adapalene; 3D Collagen Gel; Proliferation

Experience of Avascular Necrosis of Hip Joint due to Unjustified Use of Steroid: A Case Series Study

The use of steroids, whether in herbal or synthetic form, for purposes such as weight gain, appetite enhancement, and pain relief is a prevalent practice in Bangladesh. Lacking adherence to pharmacological guidelines, such as those outlined by the American College of Rheumatology (ACR) poses a significant health risk. Steroid-induced osteonecrosis is one in many adverse effects that consuming OTC steroid causes. AVN is characterized by the death of bone tissue due to the prolonged use or high-dose administration of corticosteroids. Commonly affected areas include the hip joints, knees, and shoulders. However, this seemingly innocuous trend has prompted concern, particularly at the Dhaka Specialized Pain Management and Research Centre, where a notable pattern has emerged. From July 2022 to June 2023, a total of six reported cases highlighted a worrisome trend of individuals encountering health issues due to the misuse or prolonged use of over-the-counter (OTC) steroids. The majority of the reported cases were male, predominantly in their 2nd to 3rd decade of life. The common thread among these cases was the history of oral steroid ingestion, either in the form of herbal or synthetic compounds. The patients presented with complaints of pain in the hip and groin area, particularly during walking. Diagnostic imaging, including X-ray and MRI of the hip joints, consistently revealed a classical picture of Avascular Necrosis (AVN), underlining the potential association between steroid use and this debilitating condition. The cases reported at the Dhaka Specialized Pain Management and Research Centre serve as a stark reminder of the potential consequences, such as AVN, that can arise from the uninformed or unsupervised use of steroids.

Impact of Self-medications and Medications Misuse on Health Outcomes

Introduction: The availability of prescription drugs as OTC medications is also becoming more common. However, self-medication carries risks such as misdiagnosis, use of excessive drug doses, prolonged use, and drug interactions. This review aimed to collect evidence about the impact of self-medications on health outcomes. Methods: The systematic review in this study involved several steps to identify and assess relevant research. The search phase involved finding potentially relevant studies in various databases such as PubMed, PsychInfo, EBSCO Medline, BioMed central, and Science Direct. The screening phase involved applying predetermined inclusion and exclusion criteria to determine which studies were appropriate for the review. To conclude the selection process, the full text of the articles was reviewed to determine whether they met the inclusion criteria. Additionally, the full text of review articles was reviewed to identify any additional articles that might be relevant and included in the review. Results: A total of 17 studies were found that met the inclusion criteria. The majority (11/17) of these studies were cross-sectional and relied on self-report. The combined sample size of the 17 studies was 28,628 (ranging from 5 to 5,426), and the average response rate was 66%. In 76% of the studies, reported self-treatment was 50% (ranging from 12% to 99%). Overall, only one or two respondents were registered with a general practitioner (GP) or primary care physician (mean of 56%, ranging from 21% to 96%). In the 13 studies that provided information on self-prescription, the mean percentage of physicians reporting self-prescription was 61% with a standard deviation of 25% and a range of 9% to 99%. Conclusions: Although many patients view over-the-counter (OTC) medications as completely safe, their use always carries some degree of risk for the consumer. This is especially true for patients who do not follow the instructions on the label or package insert.

Quality Care Program: Raise awareness, motivate and coach community-pharmacists to provide high-quality pharmaceutical care.

Apart from providing pharmaceutical care when dispensing prescribed medicines, responding to the demand for an OTC drug or advice, is another core task of the community pharmacist. By asking the correct questions, the pharmacist collects all the necessary information to accurately estimate a patient's specific health problem. Pharmacists have a social responsibility and guarantee the responsible delivery of health products and medicines at all times, especially when it concerns non-prescription medicines or in the context of self-care. By providing this person centered care, pharmacists can distinguish themselves from other dispensing channels and can justify why the dispensing of medicines, including OTC medicines, is reserved for the pharmacy. &#x0D; This brought the Association of Pharmacists Belgium (APB), together with the training institutes for pharmacists, the local pharmacists' associations, and the Belgian universities, to set up the Quality Care Program. The aim of this program is to raise awareness, to motivate and to coach community-pharmacists to provide high-quality care. The program consists of 4 main components:&#x0D; 1. Scientific education: knowledge is the foundation when it comes to quality of care. In addition to cooperation with the training institutes, the existing educational material is collected at a central location.&#x0D; 2. A knowledge test that assesses the knowledge, skills and attitude of pharmacists. The test is intended to be constructive, to confirm that people are doing well or to indicate which points deserve more attention in the pharmacist's approach.&#x0D; 3. Pharmacy Simulator, a serious game (educational video game), is a virtual learning program in which pharmacists learn in a playful way to ask their patients the right questions.&#x0D; 4. A patient perception study aims to provide feedback to pharmacists about how they approach patients with their demand for an over-the-counter medicine in their pharmacy.&#x0D; The Quality Care Program was launched in 2021. Each year, the emphasis is on two therapeutic drug groups. Meanwhile, 4 cycles have already been organized on analgesics, laxatives, emergency contraception and reflux for which the global results have been published after each cycle. In the coming months we will investigate how the pharmacy simulator can be better applied and how pharmacists can learn from each other.&#x0D;

Risk, Trust, and Emotion in Online Pharmacy Medication Purchases: Multimethod Approach Incorporating Customer Self-Reports, Facial Expressions, and Neural Activation.

Online pharmacies are used less than other e-commerce sites in Germany. Shopping behavior does not correspond to consumption behavior, as online purchases are predominantly made for over-the-counter (OTC) medications. The objective of this study was to understand the purchasing experiences of online pharmacy customers in terms of critical factors for online pharmacy adoption. This study examined the perceived risk, perceived trust, and emotions related to purchasing medications online and, consequently, the purchase intention toward online pharmacies. In a within-subjects design (N=37 participants), 2 German online pharmacies with different perceptions of risk and trust were investigated for their main business, namely OTC and prescription drugs. The results of a preliminary study led to 1 online pharmacy with high and 1 with significantly low self-reported risk by the prestudy sample. Emotions were measured with a multimethod approach during and after the purchase situation as follows: (1) neural evaluation processes using functional near-infrared spectroscopy, (2) the automated direct motor response during the use of the online pharmacy via facial expression analysis (FaceReader), and (3) subjective evaluations through self-reports. Following the shopping experiences at both pharmacies for both product types, risk, trust, and purchase intention toward the pharmacies were assessed using self-assessments. The 2 online pharmacies were rated differently in terms of risk, trust, emotions, and purchase intention. The high-risk pharmacy was also perceived as having lower trust and vice versa. Significantly stronger negative emotional expressions on customers' faces and different neural activations in the ventromedial prefrontal cortex and dorsomedial prefrontal cortex were measured when purchasing prescription drugs from the high-risk pharmacy than from the low-risk pharmacy, combined with OTC medications. In line with this, customers' self-ratings indicated higher negative emotions for the high-risk pharmacy and lower negative emotions for the low-risk pharmacy. Moreover, the ratings showed lower purchase intention for the high-risk pharmacy. Using multimethod measurements, we showed that the preceding neural activation and subsequent verbal evaluation of online pharmacies are reflected in the customers' immediate emotional facial expressions. High-risk online pharmacies and prescription drugs lead to stronger negative emotional facial expressions and trigger neural evaluation processes that imply perceived loss. Low-risk online pharmacies and OTC medications lead to weaker negative emotional facial expressions and trigger neural evaluation processes that signify certainty and perceived reward. The results may provide an explanation for why OTC medications are purchased online more frequently than prescription medications.

OLDER ADULT MISUSE OF OVER-THE-COUNTER MEDICATIONS: BENEFITS OF A NOVEL PHARMACY-BASED INTERVENTION

Abstract Older adults’ inappropriate use of over-the-counter medications (OTCs) is prevalent and comprises: (1) Drug-Age misuse – medication risks due to advanced age, (2) Drug-Drug misuse – medication interactions, (3) Drug-Disease misuse – contraindications with health conditions, and (4) Drug-Label misuse – deviations from label instructions. Since pharmacies are ubiquitous sources of OTC accessibility and medication safety expertise, a structural redesign of pharmacy aisles (Senior SafeTM) was conceived to mitigate older adult OTC misuse. A central feature of Senior Safe is the use of Stop Signs for high-risk OTCs and Behind-the-Counter Signs (BTC) for particularly high-risk OTCs. Given the signage’s practical importance, this study’ principal aim was to determine whether Senior Safe reduced misuse of Stop Sign/BTC OTCs. Twenty pharmacies from a mid-Western healthcare system were matched and randomly allocated to either control or intervention groups, from which 288 older adults were recruited (ages 65-91). Participants’ reported OTC use for a symptom scenario (pain, sleep, cough/cold/allergy) was evaluated to determine whether it fulfilled the four misuse types. Misuse occurrences between intervention/control sites were compared using multivariate modeling. Drug-Age and Drug-Drug misuse frequencies were significantly lower in intervention sites (Coef.=-1.012, p=.004; Coef.=-1.702, p=.004, respectively), while Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. Also, adults aged 85+ had the greatest likelihood of all misuse types. Senior Safe shows substantial benefit reducing high-risk OTC misuse, which is important particularly for vulnerable adults ages 85-91. Future research should document intervention mechanisms contributing to lower older adult OTC misuse.

THE HIGH PREVALENCE OF OVER-THE-COUNTER MEDICATION MISUSE IN OLDER ADULTS: RESPONSE TO THE CHPA-GSA NATIONAL SUMMIT

Abstract Older adults (65+) are the largest consumer of over-the-counter (OTC) medications and disproportionately prone to adverse drug events (ADEs). Despite perceptions that OTCs are generally safe, OTC misuse can lead to ADEs. However, as identified through the Consumer Health Products Association (CHPA) and Gerontological Society of America (GSA) National Summit, little is known about OTC misuse in older adults. This is the first muti-site study to prospectively quantify how older adults select OTCs in community pharmacies where products are typically purchased. Older adults (n=144) were recruited from 10 community pharmacies. Participants were given hypothetical symptoms and asked to select one or more OTCs. After selection, they were asked to report how they would use the product, their home medications, and their health conditions. OTC selections were evaluated for the following misuse categories: 1) drug-age (Beers Criteria), 2) drug-drug (interactions with home medications), 3) drug-disease (health conditions), and 4) drug-label (product’s indications and directions). At least one type of misuse was identified in 114 (79%) older adults, with 57 (40%) demonstrating misuse in &amp;gt;1 category. Overall, 363 total instances of misuse were identified (x̄=3.18 per participant). There was high prevalence of drug-drug and drug-label misuse, as 107 (74%) demonstrated misuse in one or both categories. The results highlight OTC misuse frequency and complexity in older adults. Knowing older adults’ OTC misuse prevalence is critical for understanding medication-associated risks and developing effective interventions. Importantly, these results are a first step toward addressing the research gaps identified by CHPA and GSA.

Pharmacists' perspectives on recommending herbal medicines for acute infections: a qualitative study.

Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. A qualitative study using semi-structured interviews with community pharmacists in England. Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine.