1.8 Medication Types

Prescription Medications, OTCs, Herbals, and Supplements

There are a variety of drug types and substances patients may utilize for symptom management or to enhance wellness. Having an accurate record and knowledge of the different types of substances a patient is taking is important to the patient’s medical and nursing plan of care.  It is also important to note any substances that are prescribed, over-the-counter, or herbal that have been taken in the past month, as some medications have a long half-life and still be in the body with the potential to  interact with new medications.

A variety of substances available to the public include (but are not limited to) prescription medications (including brand name and generic drugs), over-the-counter medications, and herbals and supplements.

Prescription Medications

Drugs are prescribed by a licensed prescriber for a specific person’s use and regulated through the United States Food and Drug Administration (FDA).  More information about FDA approval of medications is described in the “Legal/Ethical” chapter.  Prescription medications include brand-name medications and generic medications. ^[1]

Generic Medications

Generic medications can be safe and effective alternatives to their brand-name counterparts and often at a reduced cost.  By FDA law, generic medications must have the same chemically active ingredient in the same dose (i.e., they must be “bio-equivalent”).  However, the excipients (the base substance that holds the active chemical ingredient into a pill form (such as talc) or the flavoring can be different. Some patients do not tolerate these differences in excipients very well.  When prescribing a medication, the provider must indicate that a generic substitution is acceptable.  Nurses are often pivotal in completing insurance paperwork on the patient’s behalf if the brand-name medication is more effective or better tolerated by that particular patient.  When studying medications in nursing school, it is important to know  medications by their generic name, since the NCLEX exam does not currently include brand-name medications in their question format.  ^[2] 

Over-the-Counter Medications

Over-the-counter (OTC) medications do not require a prescription.  They can be bought at a store and may be used by multiple individuals.  OTC medications are also regulated through the FDA. Some prescription medications are available for purchase as OTC in smaller doses.  For example, diphenhydramine (Benadryl) is commonly prescribed as 50 mg every 6 hours, and the prescription strength is 50 mg.  However, it can also be purchased OTC in 25 mg doses (or less for children.) ^[3]

Herbals & Supplements

Herbs and supplements may include a wide variety of substances including vitamins, minerals, enzymes, and botanicals.  Supplements such as “protein powders” are marketed to build muscle mass and can contain a variety of substances that may not be appropriate for all individuals. These herbal and supplement substances are not regulated by the FDA and most have not undergone rigorous scientific testing for safety for the public. While patients may be tempted to try these herbals and supplements, there is no guarantee that they contain the ingredients listed on the label. It is also important to remember that there is a potential for adverse effects or even overdose if the herbal or supplement contains some of the same drug that was also prescribed to a patient. ^[4]