OTC question

• 20 year old female came in asking for "Mucinex" which was recommended to her by her PCP
• Patient initially provided no other information
• Asked patient about what kinds of symptoms she was having
• patient stated she is having sinus/nasal/head congestion which is causing pressure build up within her ears
• it was recommended to her by myself and Chayla that she goes with a decongestant product such as Mucinex D (guiafenesin and pseudoephedrine) as her symptoms were mostly sinus congestion vs chest congestion (which is a behind the counter product)
• patient is college student and noted that she needs to buy generic due to cost issues and asked why we did not suggest one of the products OTC and what the difference between them is
• we explained to her that the products with decongestant were the behind the counter products
• since she was still hesitant to go with the product we were suggesting, we asked more questions and she revealed more information
• we found out that she has an undiagnosed "thyroid issue" currently that her doctor is trying to figure out and did not want her to take anything with pseudoephedrine in it due to cardiovascular side effects
• we then suggested that she goes with mucinex DM (guiafenesin and dextromethorphan) although this may not be the most efficacious product based on her symptoms, it is the safest option

Pseudoephedrine: 

Mechanism of action -- decongestant by alpha-adrenergic stimulation of receptors in vascular smooth muscle causing constriction of dilated arterioles in nasal mucosa leading to reduction in blood flow to inflamed nasal passages

Adverse effects: 

cardiovascular --  pseudoephedrine has been reported to cause atrial fibrillation, hypertension, tachycardia, myocardial infarction

should be used in caution in the follow disease states: hyperthyroidism, arrhythmia, diabetes, elderly, glaucoma, ischemic heart disease, renal failure

hyperthyroidism can cause tachycardia

if this was the condition our patient is being worked up for, it would be best for her to avoid a product with pseudoephedrine in it as it can cause further tachycardia and hypertension

patients should be counseled that this drug can cause insomnia, anxiety, nervousness, restlessness

all of which can make hyperthyroid symptoms worse as well