OTC Course

34
Otc medicaTIONS Cource Out Line: Common Cold & Influenza * Cough * ةنفوب ا الجAllergic rhinitis * احمرارن العConjunctivitis * Headache * Musculoskeletal conditions * Diarrhea * Constipation *

description

OTC COUSE FOR ALL

Transcript of OTC Course

Page 1: OTC Course

Otc medicaTIONS

Cource Out Line:

Common Cold & Influenza *

Cough*

*Allergic rhinitis الجوب األنفة

*Conjunctivitis العناحمرار

Headache*

Musculoskeletal conditions *

Diarrhea*

Constipation*

Page 2: OTC Course

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:

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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

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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 ?

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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

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! 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

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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

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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

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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

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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

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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

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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

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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

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-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

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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

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In case of wet cough use Mucolytic

-Herbal drugs:

All vent, Penta mix, Bronchium, Opticoughpan, Bronch

-Hay Fever :

Allergic rhinitis

Allergic conjunctivitis

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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.

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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

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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

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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.

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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

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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

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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:

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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?

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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.

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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 .

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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

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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.

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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:

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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.

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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.

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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.

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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:

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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.