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Otc Cource Out Line:

*Common Cold & Influenza *Cough *Allergic rhinitis ‫الجٌوب األنفٌة‬ *Conjunctivitis ‫احمرار العٌن‬ *Headache *Musculoskeletal conditions *Diarrhea *Constipation

medicaTIONS


patient ‫ٌثق فى الصٌدلى وال ٌفضل‬ ‫الذهــــــاب إلى الطبٌب‬

‫له عالج محدد‬ "‫"مزمن‬ ‫ٌطلب الدواء باالسم‬

‫محتاج‬ Medical advice

principles of OTC medications: 1Select product that is simplest in formulation 2Select product that contains a therapeutically effective dose 3Recommend a generic product if one is available ... ... ‫الحالة المادٌة البد أن تراعى‬

4Patient counseling


Notes about <Patient counceling> : .. << open ended Question >> ..

Eg. (wrong)

‫الصداع بٌجٌلك بالٌــــــــــــــل وال بالنهار؟‬

(right)

!!!!!‫أوصف لى الصدااااااااااااااع ؟‬

.. trying to know the LIFE STYLE of the patient .

5Children have aspecial prime consideration . ‫يعنى أبعد بعيــــــــــــد عن ال‬    ‫ والزم يكون طعمه حلو‬syrup ‫و نختار لهم‬

injections & suspensions >>>>

‫ الزم نستخدم‬.. ‫ عند االطفال فى أول مرة‬vomiting

‫و فى حالة ال‬


Injection as << CORTIGENE……… amp.>>

Structuring Consultation ‫طريقة التشاور مع المريض‬ <

W.H.A.M>

W Who is the patient ?

What are the signs ?

What are the symptoms ?

Who<< male or female .. child or adult >>

Signs

‫المرٌض بٌكون حاسس بٌها‬

Symptoms ‫الصٌدلى بٌكتشفها بنفسه‬


‫‪HOW Long the symptoms have been present‬‬ ‫‪<<acute : OTC‬‬ ‫‪<<Chronic : refer to the physician.‬‬

‫! ‪Action taken‬‬ ‫علشان المرٌض ممكن ٌكون بٌاخد الدوا بطرٌقة غلط ‪ .‬فأفهمه الطرٌقه الصح‬ ‫و نسأله ‪ ..‬اٌه االدوٌه اللى اخدها قبل كده للمرض اللى عنده ده عشان منقعش ف‬ ‫غلط اننا نوصفله دوا للبرد مثال ‪..‬و ٌجى ٌقولى أل انا اخدته قبل كده و مجابش‬ ‫نتٌجه ! ‪( ..‬السؤال ده نسأله ف األول عشان نتفادى اننا نتحط ف موقف بايخ ‪) ‬‬ ‫فاختار له ‪ combination‬تانٌه للبرد تنفع مع ‪ his response‬و مختلفه عن‬ ‫اللى اخدها قبل كده م مجابتش نتٌجه ‪.‬‬

‫! ‪Medications being taken‬‬ ‫ٌعنى اسأله‪ ..‬حضرتك بتاخد ادوٌه لعالج مرض مزمن زى الضغط او السكر مثال أو‬ ‫أل؟ ‪ ..‬عشان اتفادى ال ‪ Drug interaction‬و اختار بناء علٌه الدوا المناسب‬ ‫‪Ex.‬‬ ‫مرٌض عنده ضغط عالى ال ٌتعاطى أدوٌه للبرد ‪ ..‬بس ممكن أدٌله ‪vit. C‬‬ ‫فوار زي ‪cevamol eff. Tab.‬‬


! ‫ العـــــالج واحد‬.. ‫ بس‬.. ‫فرق بٌن االتنٌن‬

Influenza: A, B, C (winter & autumn) Virus infection Sudden onset Dry cough

Fever

: In BOTH children & adults

Common Cold : (

Summer

)

Bacterial infection Gradual onset

Fever :2ry Bacterial infection .. In case of children nOt in Adults !

‫وال‬sec. bacterial infection ‫التطعٌم ٌمنع فقط ال‬ ‫ٌمنع الرشح و الزكام‬

‫فى‬


Symptoms for referral : 1- Earache 2- Productive cough <sputum colour is green or yellow> Due to respire. Infec.

3- Patient with Heart or Lung disease <lung disease = asthmatic patient > ‫ من ضهره وقت التنفس‬ ‫بٌزٌق‬

4- Night cough & wheezing Paracetamol ,ibuprofen Aspirin fever & malaise (Antipyretic and analgesic)

Nasal conjection & Rhinorrhea

Sedating & non sedating Hestamine Local & systemic Decongestant

Note: Antibacterial are NOT effective Here


Analgesics Contraindications: <<peptic ulcer <<asthmatic patient (Broncho constriction) Except: ParacetamOl

Aspirin...

Cause viral infection << Rey's Syndrome >> Cause patient Death!  Aspirin is the STRONGEST, but, the most DANGER! 325-400 mg 6 hours ‫ و هو عباره عن اسبرٌن و‬Aspirin C ‫و ممكن نستبدل االسبرٌن ب‬ ‫ و بنعالج‬kidney ‫ ف ال‬salicylate ‫و لكنه بٌرسب ال‬Vit C . ‫المشكلة دى بشرب ماء كتٌــــــــــــر‬


Acetaminophen (paracetamol)...

Child dose << 5mg 4-6 hours >> Adult dose << 650-1000 mg 4-6 hours >>

Ibuprofen...

D.C <<10 mg 6 hours >> D.A << 200-400 mg 6 hours >>

SOME NOTES: << Motillium (Anti vomiting) 3 times daily before eating.

<< ZantaC (Ranitidine)

‫لعالج الحموضة بعد االكل‬ <<

Conaz or Streptoquine For treatment of Diarrhea.

<< Migraine< mostly in females not males << Headache < mostly in adults not children ‫ ٌبقا‬child ‫حصل مع ال‬headache ‫ أو ال‬male ‫حصل مع‬migrane ‫لو ال‬ refer to the physician ‫ لو حد جاه قالى‬ Hyper Tension ‫ انا حاسس ان دماغى بتفوررر ! ٌبقا‬ Hypo Tension ‫و لو قالى أنا حاسس ب وجع او ضغط ف الدماغ من خلف ! ٌبقا‬


Decongestants =============== Inflamtation

vasodilatation

Local Topical:Pseudoephedrine Otririn Vasoconstriction Afrin

5 ‫عند االستخدام االدوٌة دٌما تسبب تكرار االحتقان اذا استخدمت لمدة‬ ‫ لذا ٌتم اٌقافه بعدها‬. ‫اٌام‬ Physiomer ‫ماء بحر‬

purified

‫ سنٌن‬6 ‫ال تستخدم فى الحاالت االقل من‬ ‫ال تستخدم فى حاالت الحمل‬ Rhinitis medi camentosa Systemic decongestant:-

Vit. C -:‫فى الحمل‬ Rx cevamal ParacetamOl


‫اذا لم تاتى بنتٌجه ٌتم اعطاء ادوٌة البرد بجرعات اقل‬ *In case of hypertensive patient:‫ٌتم إعطاؤه ادوٌه فى حاله ال‬ Controlled hypertension Only twice a day. hyperthyroidism –“ tachycardia” ‫للمرضى اللى عندهم فى الغده الدرقٌة مشكله‬ ‫إلتروكسٌن‬

Sedating anti- histamine:====================== Anti_muscarinic

Dryness of secretion

Side effect:Drowsiness, Blurred Constipation, Rear eases motility Dry mouth

Percautions:Glaucoma. Epilepsy, Liver disease, prostatic hypertrophy

Interactions:Alcohol, sedatives & hypnotic. Anti cholinergic Rx Congestal Comtrex Noflu Contaflu Ezamol-c


Brufen cold Night & Day: 1. para. + chloraphenramine 2. para. + Nova C Power caps ‫ *لالطفال‬Brufen flue ‫ *للكبار‬Brufen cold ‫فعال‬Rx clarinase ‫جدا جدا جدا‬

(loratadine+ pseudoephedrine)

Local decongestant:Otrivin, Afrin, Oxymet . ‫ وٌتم وضع النقط وانت جالس‬, ‫المده‬

Cough ======= protective reflex against foreign materials Non productive cough Wet cough Not a disease

productive cough dry cough a disease

Expectorant Decrease viscosity

Mucolytic lysis of mucous

Asthmatic patient can't Take it.

more advantage than Expectorant

Types:Acute:

less than 3 weeks


Sub acute: Chronic:

3 – 8 weeks longer than 8 weeks

Causes:Acute:- asthma , acute infection. Sub acute: - post – infections cough, asthma. Chronic: - COPD, GERD, ACEI, Carcinoma. ‫ كحه وشرقان‬Angiogenesis converting enzymes inhibitor Carcinoma Dark blood in cough Against bright blood in cough Vit. C Differential diagnosis Asthma

chest tightness & wheeze

Pertujis

paroxysmal cough bouts

Chronical bronchitis long term productive Cough with shortness of breath. GERD heart burn & a sensation of acid regurgitation . Carcinoma cough with blood Drugs

ACE inhibitors

Treatment:1- Systemic antitussive. 2- Expectorant 3- Mucolytic


Systemic antitussive:Affect directly on the medulla to increase the cough threshold Codeine, dextromthorphan & biphenyl dramine derivative ‫قد ٌسبب االدمان‬Codeine Large dose

morphine cause dependence

Pregnant & locative cause prevented from codeine.

Expectorant:Contra – indicated with asthmatic patient.

Guaifenesin:Rx

xentolin Xentolin expectorant

Rx

congestal Broncho phene

Expectorant

Palma care


Codiphan N Rx

ultrasolv – Expect , Mucolytic Muco S.R

Mucolytic

Acetyl Cystain ACC 200

eff

3 times/ day

‫نوع الحكه‬Wet or dry ‫نحدد ال‬Duration ‫بتاخد دواء الضغط وال أل‬ Anti

‫فى حاله عدم جدوى‬

Phendoxine

SYP ‫ مرات‬3 ‫ اٌام‬3 ‫ٌومٌا لمدة‬ ‫ اٌام‬3 ‫مرتٌن ٌومٌا لمدة‬ ‫ اٌام‬3 ‫مرة ٌومٌا لمدة‬ In case of wet cough in the first two days

tussive

Phenadone

corticorticoid

Rx phenadone ‫ ٌوم‬55 ‫فى حاله العالج لمدة تزٌد عن‬

cough increase


In case of wet cough

use Mucolytic

Herbal drugs:All vent, Penta mix, Bronchium, Opticoughpan, Bronch

Hay Fever :Allergic rhinitis Allergic conjunctivitis


Conjunctivitis Types: 1. Allergic conjunctivitis. 2. Bacterial conjunctivitis. 3. Viral conjunctivitis. ( differential diagnosis )

Pain or photophobia : YES

or

NO

If yes  refer to physician.

Discharge : YES

or

NO

If yes (watery)  allergic. (Purulent discharge)  bacterial.


If no (mucoid)  viral

(sandy feeling).).

Itching : YES

or

NO

If yes  allergic conj. If no  referral.

Draugs for allergic conjunctivitis: 1. Levocabastine  Levostine. 2. Olopatadine  Patanol. (The first line) 3. Epinastine  Relestat. (The second line)

1-2 drops / 4 times

4. Acular, Alomide, Emadine. Acular after operations

uses

as

analgesic

and

anti–inflammatory


‫عند فتح القطرات ال ٌتم استخدامها بعد‬ ‫اسبوعٌن او ‪4‬اسابٌع‬ ‫ٌستخدم ‪Isoptophenicol ‬‬ ‫عند الوالدة لالطفال حتً تمنع عمً االطفال‬ ‫حجم القطرة ‪ 51‬مل‬

‫‪Bacterial conjunctivitis:‬‬ ‫‪Rx:‬‬ ‫‪Levoxin‬‬ ‫‪Zymar‬‬ ‫‪Vigamox‬‬ ‫‪Tobramycin:‬‬ ‫‪tobrin‬‬

‫‪Tobrex‬‬

‫ال ٌفضل استخدامه مرهم للعٌن كـ ‪Isoptocetamide ‬‬

‫ٌستخدم مرة واحدة فً الٌوم قبل النوم‬ ‫طرٌقة االستخدام ‪ٌ :‬وضع علً الجفن السفلً للعٌن وٌتم اغماضها لمدة التقل عن ‪ 5‬دقائق‬


Viral conjunctivitis: ‫ الراحة‬.... ‫العالج‬ ‫بدائل الدموع‬ Refresh tears. Refresh liquid. Tear guard. Refresh plus.

Zovirax, acyclovir herbs

‫ٌستخدم فً عالج ال‬

‫ٌستخدم المدمنون البروزالٌن باكثر من طرٌقة‬

Smoking is considered as a disease. Cigar consists of chemical, gases. Dopamine  norepinephrine. Acetyl choline  glutamate.


‫‪Gerotonin  GABA.‬‬ ‫ٌمكن تغطٌة االنسحاب من شرب السجائر باعطاء الدوبامٌن على هٌئة‬ ‫‪Dosage form.‬‬

‫‪Health benefits of smoking cassation:‬‬ ‫‪ .5‬عودة الضغط المعتاد‪.‬‬ ‫‪ .2‬درجة حرارة الٌد تعود للمعدل الطبٌعً‪.‬‬ ‫‪ٌ .3‬قلل معدل ‪.heart attack‬‬ ‫المدة الالزمة لعودة الجسم لطبٌعته كأن شئ لم ٌكن تستغرق ‪ 55‬سنة ‪.‬‬

‫‪Drugs of smoking:‬‬ ‫‪First line drags:‬‬ ‫‪Bupropion  anti depressant‬‬ ‫‪Nicotine replacement therapy‬‬ ‫قرص واحد صباحا لمدة اسبوع ‪Wellbuterin  bupropion‬‬ ‫قرصٌن فً الٌوم من ‪ 52-6‬اسبوع‬

‫‪Champix ‬‬


By physician only

Side effect of champix  nausea & vomiting ‫تعطً بعد االكل وبكمٌة مٌاه كبٌرة‬ Abnormal disease  ‫عالجها ال تاخذ الجرعات قبل النوم‬ Champix  ‫علً وشك السحب من السوق‬

Nicotine replacement therapy Nicorette  15 mg / 16 h (patch) 15mg  8 weeks 10mg  2weeks 5mg  2weeks Patch  ‫ٌفضل لزقها علً الظهر من الخلف‬ Nicorette gum

(2mg – 4mg)

2mg  less than 25 4mg  more than 25


‫الموجوده فً ال‬Dose ‫كالنٌكوتٌن ٌسبب كمقٌاس النتهاء‬ ‫تنمٌل اللسان‬ Gum

Diarrhea Bowel movement Min  1times /3days times / days

Types: Acute  14 days duration Persistent  14 days – 4 weeks Chronic  4weeks

Causes:

max  3


Viral infection  rotavirus in children & adult. Bacterial infection  E-coli, salmonella, shigella in adult only. Protozoa infection  giardia, entaemeba in adult only.

General measures: .ً‫ نأخذ اجازه اذا كان طبٌب او صٌدل‬.1 Normal feeding ‫ نبدأ فً اقرب وقت ممكن‬.2 4. Oral rehydration therapy

1. Rx: Rehydran_n Rehydro zinc Hydrocef salts

Zinc element is the main rehydran therapy as it : decreases diarrhea duration & decreases stool output. How?


1. Increases regeneration.

epithelial

cell

growth

2. Increases water & electrolytes. 3. Increases & activates intestinal brush border enzymes. 4. Enhance GI immune response. 5. Decrease endotoxin transfer to the circulation.

Dose: 01mg / day /10-14 days years.

for infants less than 6

20 mg / day / 10-14 days years.

for infants less than 6

2. Anti-motility drugs: MU receptors when activated decrease the motility of GIT.

&


Imodium

cap.

Lomotil

Tab.

Imodium: Dose: 2tablets in the first dose 2mg / 1-4 times / daily only for 2 days. If increased, causes constipation.

3. Adsorbent: Like kaolin which cannot be taken with other drugs. Rx: Kapect Smecta Kapect Compound

Syp. Syp.-sachets Syp.

Kapect is preferable as OTC than kapect compound due to the presence of kaolin .


4.Probiotics: Rx:

lactĂŠol fort Cap.

5.Anti-microbials: Nifuroxazide

Local antibiotics are safe for pregnant & lactating women & infants .

Rx: Antinal Flagyl

Cap. Tab.

Entocid

Tab.

Streptomycin 200 mg

Tab.

Streptoquine

Tab.

Intitrix

Cap.


Streptomycin injection is the only toxic administration form in streptomycin. Streptoquine: is the same as Entocid + haematropine. Dose: First dose equals 2 tablets then 1 tab. / 3times daily. Intitrix is anti-bacterial & anti-protozoal. Dose: 2 Cap. / Twice daily / 5 days.

Constipation May caused by a disease or a life style of the patient.

Common in case of elder people & pregnant women.


Causes: Poor diet: food doesn't contain fibers.

IBS: irritable bowel syndrome. Poor bowel habit. Pregnancy. Hemorrhoids. Medications: like anti-motility. Travel.

The person suffers from straining – hard stool – sensation of incomplete evacuation – sensation of anorectal obstruction – infrequent bowel movement per week (fewer than 3).

Advice for constipation patients:


Increase intake of fluids. Movement. Increase intake of fibers. Reduce intake of tea & coffee. Increase the level of exercises. Differential diagnosis: Bowel obstruction: nausea & vomiting. Carcinoma: associated with blood & weight loss. IBS: alternating diarrhea & constipation. Hypothyrodism: associated with weight loss. Drugs which cause constipation.

Drug treatment: Bulk forming laxatives:

Has fibers which absorb water & stimulates the peristalites.


Safe for long term use for pregnant women &breast feedings. Side effect: flatulence & distension. Takes 12-36 hrs to give an action.

Rx: Agiolax

Sachet

Regumucil

Sachet

Stool softners & lubricants: Mineral oils reduce the absorption of vitamins (k, A, E, D), so it is not used for long term. Rx: Glycerin

Supp.

Osmotic laxatives: Useful in hepatic encephalopathy. Must be used for long term.


Rx: Mg salts (Epsom salts) Mg hydroxide (milk of magnesia) Sorbitol Lactulose Laxolac Duphalac Enemax (phosphates / citrates enemas) Enemax is used in case of radiological, endoscopy, surgery.

Stimulant laxatives: Contra-indicated for pregnant & lactating women, not used for long term. Anthraquinone derivatives take 6-12 hrs to give an action. Diphenyl methamine derivative is found in bisacodyl. Dose must be taken before sleep only.


Rx: Sennalax

Tab.

Laxin

Tab.

Minalax

Tab.

Bisodyl

Supp.

Nasar

Tab.

Abilaxine

Tab.

Headache Tension type headache: Bilateral. No nausea or vomiting. Gradual in onset. Its duration is from minutes to days.

Migraine headache:


Unilateral. Throbbing, with an aura. Sudden onset. Its duration is from hours to days. Classified into 2 types: classic & common.

Sinus headache: Face, periorbital area. Caused by infection in sinus. Last for days.

Monday syndrome: drugs that contain nitrates cause headache.


OTC Course