Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP

 LS calls the pharmacy with questions regarding the rhinovirus, or the common cold, which her 2 boys contracted at school. Her children are aged 5 and 7 years and have had low-grade fevers, malaise, and nasal congestion for the past few days. What should the pharmacist recommend?

 In children, the common cold is a mild viral illness, usually precipitated by rhinoviruses. Because the common cold is self-limiting and the data with OTC antihistamine, antitussives, and decongestants are lacking for children, the risks of starting OTC medications for children with rhinovirus outweigh the benefits. Nonpharmacologic treatment, including nasal saline irrigation, has been shown to relieve upper respiratory–tract infection symptoms and decrease school absences.

 When choosing pharmacologic treatment for colds in children, data are limited to analgesics or antipyretics. If the symptoms of fever are bothersome, LS can give her children antipyretics acetaminophen or ibuprofen. Advise her to avoid combination products for the common cold in children.

 VK is a 29-year-old pregnant woman who asks about self-care for her cold symptoms, which started with a sore throat and then a runny nose. Her husband had the same symptoms a few days earlier, and Alka Seltzer Plus PowerMax helped him. VK had a low-grade fever earlier in the day and the previous night. She asks if she can use the same medication as her husband. What advice should the pharmacist give VK about Alka Seltzer Plus PowerMax?

Pharmacologic management of the common cold in pregnant patients is dependent on the availability of human data. Overall recommendations for pregnant patients are to target specific symptoms using nonpharmacologic and/or single-ingredient pharmacologic treatment. Advise to avoid combination, extra-strength, and long-acting OTC products. Alka Seltzer Plus PowerMax is a combination of dextromethorphan and phenylephrine for day and dextromethorphan, doxylamine, and phenylephrine for night. Given that VK has not reported a cough, she should avoid the cough suppressant dextromethorphan. VK should also avoid systemic decongestants, such as phenylephrine and pseudoephedrine, as they have been linked with malformations, such as abdominal wall defects, hip dislocation, and inguinal hernia.

 Advise her to use acetaminophen to address the fever. Intranasal cromolyn is considered a first-line treatment for a runny nose during pregnancy. Cromolyn is a mast cell stabilizer that treats rhinitis. Of note, antihistamines chlorpheniramine and diphenhydramine are also considered compatible with pregnancy.

 In addition to pharmacologic recommendations, VK should increase fluid intake and strive for adequate rest and a nutritious diet. Also advise her to increase humidity via humidifiers, steamy showers, or vaporizers. Hot tea with honey and lemon and salt water gargles may help ease her sore throat.

JP is a 24-year-old man who has a common cold and has been suffering from a headache, nasal congestion, and a sore throat for a few days. His physician recommended that he try Flonase Allergy Relief OTC nasal spray. JP brings Flonase to the pharmacy counter and asks how he should use it. How should the pharmacist counsel him?

 Advise JP to first clear his nasal passages and always wash hands before and after use. If this is a new Flonase device or has not been in used in a week or more, he will need to prime the nozzle. To prime, aim the bottle away from the face, and hold the bottle with the nozzle placed between the first 2 fingers and the thumb placed on the bottom of the bottle. JP should pump until a fine mist is visible. If pumped 6 times and a mist is not visible, the Flonase spray nozzle may be clogged and would need to be cleaned. After priming, JP should prepare for use. To begin, he should gently press the opposite side of the nose with a finger to block off the passage. Next, JP should tilt his head forward and aim the tip of the Flonase delivery device away from nasal septum (center) to avoid damage. He should sniff deeply while pressing down on the pump once and repeat in the other nostril. JP should then breathe through his mouth and wait a few minutes after using the medication before blowing his nose. Remind him to avoid sharing nasal sprays and to discard the medication if discolored or expired or if contamination is suspected. Advise JP to remove caps before use and replace tightly after each use.

 MP is a 54-year-old woman with hypertension who is asking about supplements to treat a cold and is specifically interested in zinc. Her OTC medication options are limited because she has hypertension. What information should the pharmacist provide about the use of zinc for the common cold?

 Zinc has been studied in vitro for its antiviral properties, and it may provide modest antiviral efficacy. It is reported that high local concentrations of zinc block the adhesion of human rhinovirus to the nasal epithelium. It also thought that zinc inhibits viral replication by disrupting viral capsid formation. The results of a meta-analysis concluded that zinc lozenges or syrup at 75 mg or more per day are effective in decreasing cold duration or symptoms if started within 24 hours of the first symptom and administered every 2 hours. The study results applied regardless of the zinc salt. In terms of prevention, the study results showed that if zinc is used for 5 months or longer, there is a potential for decreased risk of cold. A variety of formulations of zinc are available, including capsules, chews, lozenges, oral sprays, syrups, and tablets. There was previously a nasal formulation of zinc, but it has been removed from the market due to reports of lost sense of smell with intranasal cold remedies containing zinc. Advise MP to take oral formulations of zinc with food because it may be associated with gastrointestinal adverse effects, such as bitter taste, nausea, or upset stomach if taken on an empty stomach.

OTC cough and cold products: not for infants and children under 2 years of age. FDA. Updated January 7, 2008. Accessed March 2, 2021. 

https://www.fda.gov/consumers/consumer-updates/otc-cough-and-cold-products-not-infants-and-children-under-2-years-age

King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. 

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Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 

Krinsky DL. Patient self-care and allergic rhinitis: new and emerging issues. 

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AMMIE J. PATEL, PHARMD, BCACP, is a clinical assistant professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

RUPAL PATEL MANSUKHANI, PHARMD, FAPHA, NCTTP, is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, and a transitions-ofcare clinical pharmacist at Morristown Medical Center in New Jersey.

Articles

OTC Cases around the Common Cold for March 2021. 

OTC Cases: March 2021 PT Retail

Q: RY is a 34-year-old woman looking for something to treat her daughter’s fever. Her daughter, HY, is 6 years old. She has a sore throat that started very quickly, a fever for the past 2 days, and pain when swallowing. Her oral temperature has been 101 °F to 103 °F. What recommendations does the pharmacist have for RY to treat HY’s fever?

A: In most cases, viruses are the cause of sore throats. In some cases, Group A 

can cause a throat infection. The only way to identify Group A 

 Therefore, RY should be referred to a health care practitioner who can test HY for the virus. In terms of her fever, no evidence suggest that fever worsens illness or causes other complications. Therefore, fever reducers should only be used to reduce HY’s discomfort. If she is uncomfortable, RY can give her acetaminophen or ibuprofen. Data show there is no difference between the efficacy and safety of acetaminophen or ibuprofen in otherwise healthy children. Acetaminophen typically works within 2 hours at the recommended dosage of 10 to 15 mg/kg every 4 to 5 hours. Advise RY not to give more than 5 doses in a 24-hour period. The recommended dosage for ibuprofen is 5 to 10 mg/kg every 6 to 8 hours, with a maximum of 4 doses per day.

 HY should stay hydrated as long as the fever persists.

Q: MR is a 58-year-old man who is looking for something to manage his blood sugar. He has hypertension and type 2 diabetes. MR started taking insulin approximately 6 months ago. He has been doing well on it, but he felt dizzy the previous evening, so he checked his blood sugar. It came back low, so MR ate dinner to raise his blood sugar level. He wants to buy OTC glucose tablets. What recommendations should the pharmacist give MR for managing his low blood sugar?

A: MR likely had an episode of hypoglycemia. The signs and symptoms of hypoglycemia can vary and may include blurred or impaired vision, chills, confusion, dizziness, fainting, fast heartbeat, weakness, headaches, or sweating. The best way to determine if a patient is experiencing hypoglycemia is to check their blood sugar level. Encourage MR to use the 15-15 rule if he is experiencing hypoglycemia. The rule of 15 starts with checking his blood sugar level. If it is low, then MR should take 15 g of carbohydrates to raise it. After 15 minutes, he should recheck his blood sugar level. If it is still lower than 70 mg/dL, he should take another 15 g of carbohydrates, which can include glucose gels or tablets. MR can also have 4 oz (1/2 cup) of juice or regular soda (not diet), hard candy, or 1 tbsp of corn syrup, honey, or sugar. Once his glucose returns to normal, he should have a small snack if it is not near mealtime to prevent another episode.

Q: MB is a 55-year-old woman who wants to know if there are OTC options to prevent pneumococcal disease. MB has had breast cancer, diabetes, and high cholesterol. She is being treated with chemotherapy and other medications. What recommendations should the pharmacist make?

A: The best way for MB to prevent pneumococcal disease, which can cause meningitis, pneumonia, and sepsis, is to get the pneumococcal vaccination. The CDC recommends the pneumococcal vaccination for children younger than 2 years and adults 65 years or older. In certain situations, older children and other adults also can receive the pneumococcal vaccines. There are 2 pneumococcal vaccines on the market: PCV13 (Prevnar 13) and PPSV23 (Pneumovax 23). The recommendations for PCV13 include children younger than 2 years and patients 2 years of age and older with certain medical conditions. PPSV23 is recommend for patients 65 years and older, individuals 2 to 64 years with certain medical conditions, and adults who smoke cigarettes. MB is eligible for both PCV 13 and PPSV23, because she is immunocompromised due to chemotherapy. The CDC recommends that PCV13 should be followed by a dose of PPSV23 a year later in all immunocompetent persons aged 65 years or older who have not previously received the pneumococcal vaccine. Because MB is immunocompromised, the interval between doses would be shortened to 8 weeks.

Q: RD is a 58-year-old woman who is looking for an OTC option to prevent heart failure (HF). She has been taking prescription medications for the past year for HF. RD’s friend recommended she try coenzyme Q10 (CoQ10). What recommendations should the pharmacist give to RD?

A: Because RD has HF, she should discuss treatment with her health care providers before initiating therapy. If she can take CoQ10 safely without drug interactions, it is important to look at longterm efficacy and safety. A meta-analysis demonstrated that patients with HF who took CoQ10 at doses of 30 to 300 mg or 2 mg/kg daily for up to 2 years showed improvements. Improvements included ability to exercise, fewer deaths, and reduced hospitalizations compared with a placebo. Although benefits were seen, all patients were taking conventional therapies in addition to CoQ10. Other markers, such as cardiac output, ejection fraction, and New York Heart Association Functional Classification, did not improve.

 Advise RD to continue taking her prescription medications.

 is a clinical assistant professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

RUPAL PATEL MANSUKHANI, PHARMD, FAPHA, NCTTP

, is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, and a transitions-ofcare clinical pharmacist at Morristown Medical Center in New Jersey.

CDC. Strep throat: all you need to know. Updated January 12, 2021. Accessed January 20, 2021. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Section on Clinical Pharmacology and Therapeutics, Committee on Drugs, Sullivan JE, Farra HC.Fever and antipyretic use in children. 

. 2011;127(3):580-587.doi:10.1542/peds.2010-3852

American Diabetes Association. Hypoglycemia (low blood sugar). Accessed January 20, 2021. https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia

CDC. Pneumococcal ACIP vaccine recommendations. Updated November 21, 2014.Accessed January 20, 2021.https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html

Lei L., Liu Y. Efficacy of coenzyme Q10 in patients with cardiac failure: ameta-analysis of clinical trials. 

. 2017;17(1):196. doi:10.1186/s12872-017-0628-9

Four OTC cases studies are presenting, including a case of strep throat.

OTC Cases: Strep Throat

RD is a 66-year-old woman who is looking for echinacea to prevent influenza. She is relatively healthy and does not take any medications. What should the pharmacist recommend to RD?

Although RD has no medical conditions, she is considered high risk for influenza complications based on her age.

 Let her know that studies show that obtaining the annual vaccine is the most effective way to prevent influenza.

 There are conflicting data related to the use of echinacea for the prevention of influenza. The results of 1 study show that echinacea can help with influenza vaccine response in patients with respiratory conditions

 and may be beneficial to take with the vaccine. Results from another study showed that echinacea with elderberry reduced the rate of influenzarelated respiratory complications like oseltamivir, the gold standard of influenza treatment. However, the sample size included 473 patients and did not have a placebo group.

 Based on the literature, RD should probably try other methods of prevention, such as avoiding individuals who are sick, cleaning and disinfecting surfaces, washing her hands regularly with soap and water, and wearing a mask.

RA is a 56-year-old woman who asks about her OTC aspirin 81 mg daily, which she started taking a few years ago, because she heard it has heart benefits, though she never discussed the matter with a health care provider. She has diabetes but no history of a heart attack, stomach bleeding, or strokes. RD does not drink alcohol and has never smoked. She exercises regularly and has a healthy diet. What recommendation should the pharmacist give?

RA has no secondary prevention indication for aspirin use. The guidance on the use of aspirin for the primary prevention of cardiovascular disease in patients with diabetes is controversial. The results of 1 meta-analysis with 13 studies showed that aspirin reduces the incidence of cardiovascular events.

 However, the results of another meta-analysis with 11 studies showed no reduction in all-cause mortality.

 The results of both meta-analyses showed a higher rate of gastrointestinal (GI) bleeding. Although the data are conflicting, the American Diabetes Association recommends that patients with diabetes use aspirin if they are older than 50 years of age and have any of the following risk factors: albuminuria/chronic kidney disease, dyslipidemia, family history of premature atherosclerotic cardiovascular disease, hypertension, or smoking. It is important to assess that patients taking aspirin are not at risk for GI bleeding before initiating aspirin therapy. Although RA is older than 50 years, she has no additional risk factors and therefore, based on the guidelines, should not take aspirin for primary prevention.

MG, is a 33-year-old woman who is looking for a lice treatment. Her 5-year-old daughter, SG, came home from school and was complaining of an itchy scalp. Upon examination, MG noticed live lice and nit casings on SG’s head. MG is looking for a recommendation for an OTC product. In the past, when SG has had lice, MG has used permethrin and pyrethrin. What recommendation should the pharmacist provide?

In October 2020, the FDA approved ivermectin (Sklice) lotion, 0.5% for the treatment of head lice infestation in patients 6 months of age and older to be converted from prescription to OTC status.

 The results of 1 study showed that patients using ivermectin were louse-free on day 2 (94.9%), day 8 (85.2%), and day 15 (73.8%).

 When treating head lice, it is important to use nondrug strategies with OTC medications.

 For example, any clothing that was worn within the time frame of infestation should be machine-washed in hot water or sealed in a plastic bag and stored for 2 weeks. Soak brushes and combs in hot water and vacuum floors. Use a fine-tooth comb to remove dead lice or nits. Sklice lotion can be applied directly to dry hair and the scalp.

 It is important to rub the lotion throughout the entire head so that all lice and eggs are exposed to it. Use the entire tube. An adult must apply Sklice for children. Let the lotion stay on the head for 10 minutes, and then completely rinse using only water. SG should wait 24 hours before using shampoo. Avoid exposure of Sklice to eyes, but if it does get accidentally get in the eyes, gently flush with water. Adverse effects include burning sensation on the skin, dandruff, and eye redness or soreness. Do not use Sklice lotion again without talking to SG’s health care provider first.

AS is a 49-year-old man who is looking for zinc as he wants to lower his chance of getting the coronavirus disease 2019 (COVID-19). He has a history of diabetes and hypertension. AS heard from his co-workers that zinc supplements boost the immune system, so they will provide protection against the virus. What recommendations should the pharmacist make?

Zinc is important in maintaining cellular homeostasis and can potentially prevent viral replication in the nasal mucosa.

 The National Institutes of Health’s (NIH) recommended dietary allowance is 11 mg daily for men and 8 mg for nonpregnant women.

 With the surge of COVID-19 cases in 2020, some have considered using zinc as prophylaxis for the disease. However, a retrospective study of azithromycin and hydroxychloroquine with or without zinc showed no differences in outcomes.

 Because there are limited studies with COVID-19 and the use of zinc, the NIH guidelines recommend against the use of zinc.

 Additionally, excess zinc consumption is associated with long-term adverse effects, such as anemia, ataxia, copper deficiency, leukopenia, myelopathy, and spasticity.

, is a clinical assistant professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

CDC. People at high risk for flu complications. December 1, 2020. Accessed December 4, 2020. https://protect-us.mimecast.com/s/hW5hCZ6RoRi5g5ryUzUjjn?domain=cdc.gov

CDC. Preventivesteps. September 25, 2020. Accessed December 3, 2020. https://protect-us.mimecast.com/s/r89-C1wDnDuMGM2KiGB9Ye?domain=cdc.gov

Di Pierro F, Rapacioli G, Ferrara T, et al. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. 

Raus K, Pleschka S, Klein P, et al. Effect of an echinacea-based hot drink versus oseltamivir in influenza treatment: a randomized, double-blind, double-dummy, multicenter, noninferiority clinical trial. 

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Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. 

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Mahmoud AN, Gad MM, ElgendyAY, et al. Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials. 

The ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. 

American Diabetes Association. Standards of Medical Care in Diabetes-2020 abridged for primary care providers. 

. 2020;38(1):10-38.doi: 10.2337/cd20-as01

FDA approves lotion for nonprescription use to treat head lice. News release. FDA.October 27, 2020: Accessed December 4, 2020.https://www.fda.gov/news-events/press-announcements/fda-approves-lotion-nonprescription-use-treat-head-lice

Pariser DM, Meinking TL, Bell M, et al. Topical 0.5% Ivermectin lotion for treatment of head lice. 

. 2012;367:1687-1693. doi:10.1056/NEJMoa1200107

CDC. Parasites. October 15, 2019. Accessed December 4, 2020.https://www.cdc.gov/parasites/lice/head/treatment.html

Sklice. Package insert.Sanofi Pasteur;2012.Accessed January 8, 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/202736Orig1s000lbl.pdf

Read SA, Obeid S, Ahlenstiel C, Ahlenstiel G. The role of zinc antiviral immunity. 

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Carlucci P, Ahuja T, Petrilli CM, Rajagopalan H, Jones S, Rahimian J. Zinc sulfate in combination with a zinc ionophore may improve outcomes in hospitalized COVID-19 patients. 

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Kumar N. Copper deficiency myelopathy (human swayback). 

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Four patient cases involving OTC treatments are presented.

OTC Cases: Influenza

 RP is a 34-year-old man who is picking up OTC antitussive Robitussin 12 Hour Cough Relief. He describes his nonproductive cough and asks if he should be aware of any interactions with his prescription medications. Upon pulling up RP’s prescription profile, the pharmacist notes that he takes ergocalciferol for vitamin D replacement and fluoxetine for depression. Do RP’s prescriptions interact with the Robitussin? If so, what are the mechanisms

 The active ingredient in Robitussin is dextromethorphan. When patients use this antitussive at recommended dosages, there is little risk of addiction and low toxicity. However, dextromethorphan is a sensitive CYP 2D6 substrate and is metabolized via CYP 2D6 to its metabolite, dextrorphan. Selective serotonin reuptake inhibitors fluoxetine and paroxetine are both strong CYP 2D6 inhibitors that can increase the serum concentration of dextromethorphan. Several pharmacokinetic studies have investigated the impact of CYP 2D6 inhibitors with dextromethorphan and found significant increases in the serum dextromethorphan to dextrorphan ratio. This mechanism of interaction leads to increased dextromethorphan-related central nervous system depression and toxicity. Concomitant use of fluoxetine may lead to adverse effects such as confusion, drowsiness, excitation, irritability, nervousness, restlessness, and potential respiratory depression.

Another mechanism of interaction is the serotonergic effects of dextromethorphan with the serotonin reuptake inhibition of fluoxetine. This interaction increases the risk for serotonin syndrome, which is characterized by increased blood pressure, hyperpyrexia, arrhythmias, and myoclonus. A case report describes a patient who presented with serotonin syndrome and had confusion, hypertension, and rigidity after the concomitant use of paroxetine and OTC dextromethorphan.

Patients should typically avoid the combination of dextromethorphan and fluoxetine.

MA calls the pharmacy to ask about cough suppressants for her 2-year-old son. The child has had a cough since the weather started getting cooler and the family has been using their home heating system. MA says she has been reading about the adverse effects and risks associated with OTC antitussive therapy in children and wants to avoid medications if possible. What should the pharmacist recommend?

 One nonpharmacologic recommendation for MA is to purchase a cool-mist humidifier. It is likely that the increase in air and dry heat have irritated her child’s airways, therefore leading to a cough. Humidifiers increase the amount of moisture in the air, which may provide relief to the irritated airways and cough.

Concern about humid environments includes the increased risk of dust mites, microorganisms, and mold. Cool-mist humidifiers, however, are less likely to promote bacterial growth and less prone to accidental burning in the event of a spill. Care instructions for the humidifier include cleaning it daily to avoid bacterial and mold buildup and disinfecting it weekly. To avoid mineral buildup, consider using distilled or purified water.

MT is a 57-year-old man who calls to inquire about his new prescription medication. He has chronic obstructive pulmonary disorder that has been well controlled for a few months. Ever since MT began taking atorvastatin and carvedilol a few weeks ago, he has experienced a dry cough. MT asks if either of his new prescription medications could cause the cough. What information can the pharmacist provide?

 Antihypertensives are common inducers of cough, including angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and calcium channel blockers. Although ACE inhibitors are the most common inducers, both nonselective and selective β-blockers may induce bronchoconstriction and therefore a cough. Given that carvedilol is a nonselective β1 and β2 antagonist, it is possible that MT could be experiencing the cough as a result of carvedilol initiation.

 The results of a study, however, did show that even β1 selective β-blockers may have high affinity for β-2 receptors and may lead to bronchoconstriction and a cough.

 Patients such as MT who experience a cough while on β-blockers should be referred to a prescriber to assess whether the β-blocker is the true cause. If it is, consider switching to a cardio-selective β-blocker, such as metoprolol or atenolol at the lowest effective dose, if possible.

CASE 4: DISORDERS ASSOCIATED WITH CHRONIC COUGH 

AG is a 30-year-old woman who is asking about OTC medications to relieve her cough. She reported that she has experienced a cough at least 2 times per week for the past few months. When asked about the nature of the cough, AG said that it often occurs with heartburn and a sour taste in her mouth and is typically worse when she lies down after eating a large fatty or spicy meal. What recommendations should the pharmacist make to relieve AG’s cough?

 A common cause of chronic cough is gastroesophageal reflux disease (GERD). Given AG’s reports of heartburn, sour taste in the mouth, and worsening of symptoms in a supine position, consider working up the patient for GERD. Nonpharmacologic recommendations include avoiding foods that make symptoms worse, such as large, fatty, spicy meals. Additionally, AG should avoid lying down immediately after meals and consider raising the head of her bed 6 to 8 inches using blocks. Pharmacologic options for GERD include antacids and H2RAs or a combination of both for infrequent symptoms. If AG does not find relief with any of these options, she should consider stepping up to a proton pump inhibitor.

, is a clinical assistant professor of pharmacy practice and administration at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewbury and Eatontown, New Jersey.

, is a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.

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Four case studies demonstrate common OTC treatments for cough.