Otc medicaTIONS
Cource Out Line:
Common Cold & Influenza *
Cough*
*Allergic rhinitis الجوب األنفة
*Conjunctivitis العناحمرار
Headache*
Musculoskeletal conditions *
Diarrhea*
Constipation*
1- Select product that is simplest in formulation
2- Select product that contains a therapeutically effective dose
3- Recommend a generic product if one is
available ... ... المادة البد أن تراعى الحالة
4- Patient counseling
patient
ثق فى الصدلى وال فضل
الذهــــــاب إلى الطبب
له عالج محدد "مزمن"
طلب الدواء باالسم
محتاج
Medical advice
principles of OTC medications:
Notes about <Patient counceling> :
.. << open ended Question >> ..
Eg. (wrong)لــــــــــــــل وال بالنهار؟االصداع بجلك ب
(right) !!!!! أوصف لى الصدااااااااااااااع ؟
.. trying to know the LIFE STYLE of the patient
.
5- Children have aspecial prime
consideration .
<<<< injections & suspensionsيعنى أبعد بعيــــــــــــد عن ال
والزم يكون طعمه حلو syrupو نختار لهم
الزم نستخدم .. فى أول مرة عند االطفال vomiting و فى حالة ال
Injection as << CORTIGENE……… amp.>>
Structuring Consultationطريقة التشاور مع المريض
< W.H.A.M>
Who<< male or female .. child or adult >>
Signsا المرض بكون حاسس به Symptomsالصدلى بكتشفها بنفسه
W Who is the patient ?
What are the signs ?
What are the symptoms ?
HOW Long the symptoms have been present
<<acute : OTC <<Chronic : refer to the physician.
Action taken !
فأفهمه الطرقه الصح. شان المرض ممكن كون باخد الدوا بطرقة غلطلع
عشان منقعش ف دها قبل كده للمرض اللى عنده دهاه االدوه اللى اخ.. و نسأله قبل كده و مجابش و جى قولى أل انا اخدته..غلط اننا نوصفله دوا للبرد مثال ( ف األول عشان نتفادى اننا نتحط ف موقف بايخ السؤال ده نسأله)! .. نتجه
ختلفه عن و م his responseتانه للبرد تنفع مع combinationفاختار له .اللى اخدها قبل كده م مجابتش نتجه
Medications being taken !
حضرتك بتاخد ادوه لعالج مرض مزمن زى الضغط او السكر مثال أو .. عنى اسأله
و اختار بناء عله الدوا المناسب Drug interactionعشان اتفادى ال .. أل؟
Ex.
vit. Cبس ممكن أدله .. ه للبرد مرض عنده ضغط عالى ال تعاطى أدو
.cevamol eff. Tabزي فوار
! العـــــالج واحد .. بس .. فرق بن االتنن فى
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 !
وال sec. bacterial infectionال فقط التطعم منع منع الرشح و الزكام
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 > وقت التنفس من ضهره بزق
4- Night cough & wheezing
Paracetamol ,ibuprofen
Aspirin (Antipyretic and analgesic)
fever & malaise
Sedating & non sedating
Hestamine
Local & systemic Decongestant
Nasal conjection &
Rhinorrhea
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 اسبرن و Aspirin Cو ممكن نستبدل االسبرن ب
Vit C و لكنه برسب الsalicylate ف الkidney و بنعالج . المشكلة دى بشرب ماء كتــــــــــــر
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
بقا childحصل مع ال headacheأو ال maleحصل مع migraneلو ال
refer to the physician
لو حد جاه قالى
بقا ! س ان دماغى بتفوررر انا حاسHyper Tension
Hypo Tensionبقا ! و لو قالى أنا حاسس ب وجع او ضغط ف الدماغ من خلف
Decongestants
=============== Inflamtation vasodilatation
Local Topical:- Pseudoephedrine
Otririn
Vasoconstriction
Afrin
5عند االستخدام االدوة دما تسبب تكرار االحتقان اذا استخدمت لمدة لذا تم اقافه بعدها. اام
Physiomer purified
ماء بحر
سنن 6حاالت االقل من ال تستخدم فى ال ال تستخدم فى حاالت الحمل
Rhinitis medi camentosa
Systemic decongestant:-
Vit. C - :الحملفى
Rx cevamal
ParacetamOl
اذا لم تاتى بنتجه تم اعطاء ادوة البرد بجرعات اقل
*In case of hypertensive patient:- Controlled hypertension تم إعطاؤه ادوه فى حاله ال
Only twice a day.
hyperthyroidism –“ tachycardia” إلتروكسن للمرضى اللى عندهم فى الغده الدرقة مشكله
Sedating anti- histamine:-
====================== Anti_muscarinic Dryness of secretion
-Side effect: Drowsiness, Blurred
Constipation, Rear eases motility
Dry mouth
-cautions:Per
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
* Brufen flue لالطفال
* Brufen cold للكبار
Rx clarinase (loratadine+ pseudoephedrine) فعال جدا جدا جدا
-Local decongestant:
Otrivin, Afrin, Oxymet
.وتم وضع النقط وانت جالس , المده
Cough
======= protective reflex against foreign materials
Non productive cough productive cough Wet cough dry cough
Not a disease a disease
Mucolytic antExpector
Decrease viscosity lysis of mucous
Asthmatic patient can't more advantage than
Expectorant Take it.
-Types:
Acute: less than 3 weeks
Sub acute: 3 – 8 weeks
Chronic: longer than 8 weeks
-Causes:
Acute:- asthma , acute infection.
Sub acute: - post – infections cough, asthma.
Chronic: - COPD, GERD, ACEI, Carcinoma. Angiogenesis converting enzymes inhibitor قان كحه وشر
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
Codeine morphine قد سبب االدمان
Large dose cause dependence
Pregnant & locative cause prevented from codeine.
-Expectorant:
.patientindicated with asthmatic –Contra
-Guaifenesin:
Rx xentolin
Xentolin expectorant
Rx congestal
Broncho phene
Expectorant Palma care
Codiphan N
Rx ultrasolv – Expect , Mucolytic Muco S.R
Mucolytic Acetyl Cystain eff
ACC 200 3 times/ day
Wet or dry الحكه نوع
Duration نحدد ال بتاخد دواء الضغط وال أل
Phenadone Anti tussive فى حاله عدم جدوى
Phendoxine corticorticoid
Rx phenadone SYP
مرات 3 وم 55فى حاله العالج لمدة تزد عن اام 3وما لمدة
اام 3مرتن وما لمدة اام 3مرة وما لمدة
In case of wet cough cough increase
in the first two days
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. 1-2 drops / 4 times
(The second line)
4. Acular, Alomide, Emadine.
Acular uses as analgesic and anti–inflammatory
after operations
عند فتح القطرات ال تم استخدامها بعد اسابع4اسبوعن او
Isoptophenicol ستخدم عند الوالدة لالطفال حت تمنع عم االطفال
مل 51حجم القطرة
Bacterial conjunctivitis: Rx:
Levoxin
Zymar
Vigamox
Tobramycin:
Tobrex tobrin
Isoptocetamide كـ ال فضل استخدامه مرهم للعن م مرة واحدة ف الوم قبل النوم ستخد
دقائق 5وضع عل الجفن السفل للعن وتم اغماضها لمدة التقل عن : طرقة االستخدام
Viral conjunctivitis:
الراحة.... العالج
بدائل الدموعRefresh tears.
Refresh liquid.
Tear guard.
Refresh plus.
Zovirax, acyclovir herbs ستخدم ف عالج ال
ستخدم المدمنون البروزالن باكثر من طرقة
Smoking is considered as a disease.
Cigar consists of chemical, gases.
Dopamine norepinephrine.
Acetyl choline glutamate.
Gerotonin GABA.
مكن تغطة االنسحاب من شرب السجائر باعطاء الدوبامن على هئة
Dosage form.
Health benefits of smoking cassation:
.عودة الضغط المعتاد. 5
.درجة حرارة الد تعود للمعدل الطبع. 2
.heart attack قلل معدل . 3
.سنة 55كأن شئ لم كن تستغرق المدة الالزمة لعودة الجسم لطبعته
Drugs of smoking:
First line drags:
Bupropion anti depressant
Nicotine replacement therapy
Wellbuterin bupropion قرص واحد صباحا لمدة اسبوع
Champix 52-6الوم من قرصن ف اسبوع
By physician only
Side effect of champix nausea & vomiting
تعط بعد االكل وبكمة ماه كبرة
Abnormal disease عالجها ال تاخذ الجرعات قبل النوم
Champix عل وشك السحب من السوق
Nicotine replacement therapy
Nicorette 15 mg / 16 h (patch)
15mg 8 weeks
10mg 2weeks
5mg 2weeks
Patch فضل لزقها عل الظهر من الخلف
Nicorette gum (2mg – 4mg)
2mg less than 25
4mg more than 25
النتهاءكمقاس Dose الموجوده ف ال النكوتن سبب ك تنمل اللسان
Gum
Diarrhea
Bowel movement
Min 1times /3days max 3
times / days
Types:
Acute 14 days duration
Persistent 14 days – 4 weeks
Chronic 4weeks
Causes:
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 طبب او صدل. 1
Normal feeding نبدأ ف 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 epithelial cell growth &
regeneration.
2. Increases water & electrolytes.
3. Increases & activates intestinal brush
border enzymes.
4. Enhance GI immune response.
5. Decrease endotoxin transfer to the
circulation.
Dose:
01 mg / day /10-14 days for infants less than 6
years.
20 mg / day / 10-14 days for infants less than 6
years.
2. Anti-motility drugs:
MU receptors when activated decrease the motility of
GIT.
Imodium cap.
Lomotil Tab.
Imodium:
Dose:
2 tablets 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 Syp.
Syp.-sachets Smecta
Compound Syp. Kapect
Kapect is preferable as OTC than kapect compound
due to the presence of kaolin .
Probiotics:.4
lactéol fort Cap. Rx:
5.Anti-microbials:
Nifuroxazide
Local antibiotics are safe for pregnant & lactating
women & infants .
Rx:
Antinal Cap.
Flagyl Tab.
Entocid Tab.
Streptomycin 200 mg Tab.
Streptoquine Tab.
Cap. Intitrix
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.