HOW TO PRACTICE

O.T.C

Lecture two

Fever

Respiratory infection

renal infection

Gastroenteritis & appendicitis

Teething fever

Vomiting & diarrhea

Sneezing, fatigue, rhinorrhea

Cough& dyspnea

Pain on urination

Teething period< 2 y

Common cold

yes

No

yes

yes

yes

yes

No

No

No

Noantipyrtic

Body temperature measurements:

�ْOral “sublingual: ” Good reflex of body temperature but usually lower than body temp due to breathing from mouth while taking temp.

Tympanic:

Due to high blood flow in tympanic membrane, so reflects body temp.

Axillaries

But its validity is questionable .

Treatment

Supportive Cool bath, ice packs, fans reduce fever

Antipyretic: acetaminophen, Ibuprofen, ketoprofen or aspirin, declofenac

Antipyrtic should be taken after meal

NB: Aspirin should be avoided in children lower than 12 years due to risk Ray’s syndrome

paracetamol

Ibuprofen

ketoprofen

declofenac

Example of OTC prescription

Pyral syrp

االكل 3مل 10 بعد مرات

headache

sinusitis

migraine

Eye problemEye pain, blurred vision

Sinus congestion, pain in sinus areas

Throbbing pain in one side of headworsen with normal movements,

Give analgesicLike fever

yes

No yes

yesNo

No

Prevention of headache

1 -avoid high amount of caffee, tea, ice cream, chocolate

2-avoid stress and avoid change normal routine as “dieting, traveling, sleeping”

Treatment of migraine

Mild cases:

Acetaminophen plus metoclopramide

Sever cases:

Ergotamine combinationAvoid use in hypertensive patients or pregnant

Paracetamol + metoclopramide

ergotamine

Example of OTC prescription for migrain

Migracid tab

اللزوم 1-2 عند قرص

insomnia

Drug induced

Physician contactPsychological causes or sever pain

On starting drug use

Give first generation antihistaminicor natural sedating product

yes

No

yes

No

Prevention of insomnia “sleep hygiene”

1-avoid CNS stimulant drugs

2-Hunger can inhibit sleep, so not go to bed hungry.

3-Avoid coffee, smoking completely after noon.

4-Bed room should be comfortable

5-avoid napping

Treatment

Antihistaminic:

as diphenhydramine & doxylamine at bedtime

Plant extracts:

Valerians (Dormival)®

Kava kava extract (kava)®

Plant extracts

First gen. antihistaminic

Example of OTC prescription:

Kava cap

النوم 2 – 1 قبل يوميًا� كبسوالتAvil retard tab

النو قبل يوميًا� م قرص

Fatigue & weakness

anemia

hyperthyroidism

Common coldFever & rhinorhea, sneezing

Recurrent Hypotension, palpitation, pale skin

Unintended potent weight loss, good appetite, sweeting, tachycardia, nervousness

Overworking or under eating is the cause

yes

Noyes

yesNo

No

Drug inducedOn starting drug useyes

Treatment: “for fatigue & weakness

1-Caffeine stimulant:

NB: too much caffeine may cause nervousness, irritability & no sleep.

2-multivitamins

-Supply vitamins and minerals and energizers

-Avoid those concentrate on iron or calcium

-Multivitamins are taken once daily after meal

multivitamins1 -royal jelly

2 -vitamins and minerals

2 -ginseng

4 -wheat germ oil

5 -antioxidant

6 -Bee pollen

multivitamins

Example of OTC prescription:

Royal jelly 600 mg tab

الغداء بعد يوميًا� كبسولة

Back pain

Renal stone or infection

Sciatica (disc)

physicianAccident, fall, injury

Urine problem

Numbness or pain in one leg

Give analgesic, muscle relaxant

yes

Noyes

yesNo

NoOsteoarthritis or

rheumatic arthritisChronic pain, inflammation,

stiffness In both sides of joints

yes

Treatment of back pain

1 -analgesic:acetaminophen, Ibuprofen, ketoprofen or aspirin, declofenac, piroxicam,celecoxib, nimasulide, indomethacin

2-muscle relaxntEX 1 :- Baclofen(Baclofen).® EX 2 :- Chlozoxazone (Myolgine) .®

EX 3:- Orphenadrine (Norflex).®

3-counter irritantMask the painNot applied to wound or damaged skin

AntiCox 2

indomethacin

Muscle relaxant and analgesic

Example of OTC prescription:

myolgin cap

االكل 3كبسولة بعد مراتOlfen amp

يوميًا عضل حقنة

cough

Physician contact

Interfere with sleep or activity or painful

Respiratory infectionFever

Asthmatic patient

dry cough

Give antitussive

yes

Noyes

yesNo

No

Give mucolytic or expectorant

Productive

yes

cough suppressant + expectorant

yes

No

Cough

Cough removes foreign bodies, so not recommend selling a cough suppressant to

smokers.

Productive cough brings up accumulated mucus preventing pneumonia, so must be allowed to be continued for its cleansing effect

Treatment productive cough

Bromohexyine (Bisolvon)®

Ambroxol (Ambroxol)®

Active metabolite of bromohexine

Acetyl cystiene: (Acetyl cystiene) ® Powder

Carboxy methyl cystiene ( solvex):

mucolytic

mucolytic

Treatment of dry cough

Cough suppressant ( antitussive) Central:

codeine Diphenhydramine; Dextromethorphane; Noscapine”, Pipozethate, Butamirate

Peripheral: camphor & Menthol

Codeine&Dextromethorphane have the risk of abuse ( addiction)& constipation.

antitussive

antitussive

Expectorant & cough suppressant

Guaifensin

Ammonium cl

Tr. Ipeca

Tr. Squill

KI

Diphenhydramine

Dextromethorphane ;

Camphor

Menthol”

Antitussive+ expectorant

Natural preparations for cough

They act as cough suppressant and expectorant

Examples:

Guava leaves, fennel, thyme, honey, tilia, comphor, mentol.

Suitable for pregnant, patients with kideny, liver disorder.

Natural cough product

Example of OTC prescription for productive cough:

muco syrup

االكل بعد كبيرة مرات 3معلقة

Example of OTC prescription for Dry cough:

sinecode syrup

االكل بعد كبيرة مرات 3معلقة

Example of OTC prescription for Combination Drug for cough:

Toplexil syrup

االكل بعد كبيرة مرات 3معلقة