SELF CARE

AND
SELF MEDICATION
(PERAWATAN DAN PENGOBATAN
SENDIRI)

Suwaldi MartodiHARDJO
PSPA UNISSULA
SEMARANG

1
 GOOD PHARMACY PRACTICE
- WHO and FIP guideline 1996

I. Health promotion and illness prevention

II. Provision of prescription medicines

• Distribution
• Patient information
• Follow up on outcomes (Pharmaceutical Care)

III. Self Care

IV. Influencing prescribing and rational use of drugs

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• .

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Self-care may be defined as the care taken by
individuals towards their own health and well
being, including the care extended to their family
members and others.

In practice self-care includes:

1. the actions people take to stay fit and maintain
good physical and mental health;
2. meet social and psychological needs;
3. prevent illness or accidents;
4. avoid unnecessary risks;
5. care and self-medicate for minor ailments and
long-term conditions; and
6. maintain health and well being after an acute
illness or discharge from hospital.

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 Self-care
• Self-care is what people do for themselves to establish
and maintain health, prevent and deal with illness.

• It is a broad concept encompassing:

· hygiene (general and personal);
· nutrition (type and quality of food eaten);
· lifestyle (sporting activities, leisure etc.);
· environmental factors (living conditions, social
habits, etc.);
· socioeconomic factors (income level, cultural
beliefs, etc.);
· self-medication.

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6
 Pharmacists’ Evolving Role

From Dispensing
Services… …to a clinical service provider

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Pharmacists do not work in
silos….

they are integral members of the

health care team!

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Medicines are Dangerous

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“They just weigh and measure things”

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“Tell me how and when to use the Medicine”

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“Counter-prescribing”

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“Not really health care practitioners – they’re
businessmen”

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“Do you need a degree to be a pharmacist?”

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 Defining Pharmaceutical Care
Defined as a practice1 in 1997

Pharmaceutical care is a patient-

centered practice in which the
practitioner assumes responsibility
for a patient’s drug-related needs
and is held accountable for this
commitment.2
1Cipolle,R.J., Strand, L.M., Morley, P.C. (1998). Pharmaceutical Care Practice. New York: McGraw Hill.
2Cipolle, R.J., Strand, L.M., Morley, P.C. (2004). Pharmaceutical Care Practice: The Clinicians Guide New
York: McGraw Hill.
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 Pharmaceutical Care in Health Care
Primary Knowledge Responsibility
in the drug
Focus Base use process
Diagnosis
and
Medical Care Pathophysiology Prescribing
Treatment of the
patient’s disease

Giving care to the Biological,

Nursing whole patient psychological, Drug
Care during the cure or social, or spiritual administration
treatment human responses
Identification,
Pharmaceuti Identifying and
prevention,
meeting a Pharmacothera
cal and resolution
patient’s drug- py
Care of drug therapy
related needs
problems16
Effective drug Will the patient take
Safe drug
therapy the therapy? therapy

Aims of
What does the
Pharmaceutical
patient view as an Care
improved quality of
life?

Improve Economic drug

quality of life therapy
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18
 A case
44 year old lady with fever and green sputum
and cough – no known previous medical
history  Diagnosed with upper resp. tract
infection (URTI)
Pharmaceutical problems
• Prescribed: Common organisms for URTI?
– Co-Amoxiclav 1 tds Need for atypical organism ?
– Doxycycline 100mg D History of asthma – risk vs. benefit?
– Prednisolone 40mg D History asthma – risk vs. benefit
– Theophylline 200mg bd Need for acid suppression?
– Omeprazole 20mg D
Why is she nauseous ?
– Metoclopramide 10mg tds
Benefit of bronchodilation?
– Salbutamol 2 puff inhale Does she know what to take?
prn Will she take it?

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An Expert/Pharmacist Practitioner

• Assesses needs
• Finds problems
• Fixes problems
• Prevent problems
• Takes responsibility
• Follows-up to determine
outcomes
• Is held accountable

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To be a drug expert, society needs
practitioners who ……..…

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 Key knowledge, skills and attributes
Knowledge base
• Chemistry,
• Pharmaceutics,
• Pharmacology,
• Therapeutics,
• Law, Ethics, Professional conduct.

Skills base
• Problem solvers,
• Make decisions,
• Good communication + Effective consultation process,
• Gather information,
• Calculate doses,
• Offer advice that’s timely and accurate (Pts, Dr’s and Nurses),
• Dispense medicines,
• Monitor and follow up

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 Key knowledge, skills and attributes

Attributes
• Takes responsibility for actions;
• Punctual;
• Caring nature;
• Professional behaviour;
• Open minded;
• Positive attitude;
• Treats patients equally;
• Treats information confidentially;

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 Lima kunci kebutuhan pasien tentang obat:

1. Pasien mempunyai indikasi yang sesuai dengan tiap obat yang

diberikan,

2. Terapi obat yang efektif,

3. Terapi obat yang aman,

4. Pasien patuh/bersesuaian dengan terapi obat dan segala

aspek terapi yang diperolehnya,

5. Pasien telah memperoleh terapi yang diperlukan untuk indikasi

penyakit yang belum ditangani.

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 To be Healthy, Don’t Forget
• To eat food with sufficient nutrition contents
• To get plenty of exercise
• Rest
• Manage stress
• Spend time with family and friends
• Your relationship with your higher self & the
divine
• To do earthing
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Optimum Health & Wellness

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 What is Self-Medication ??
• .

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Self-medication is the treatment of common
health problems with medicines especially
designed and labeled for use without medical
supervision and approved as safe and effective
for such use.
Medicines for self-medication are often called
‘non-prescription’ or ‘over the counter’ (OTC) and
are available without a doctor’s prescription
through pharmacies.
In some countries OTC products are also
available in supermarkets and other outlets.

Medicines that require a doctor’s prescription are

called prescription products (Rx products).
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 Self-medication

• Self-medication is the selection

and use of medicines by
individuals to treat self-
recognised illnesses or
symptoms.

• Self-medication is one element

of self-care.

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 The Case for Self Care Support
• People want more information, choice and
control over their health.
• Chronic illness is the biggest problem
facing health care systems world-wide.
• NHS(UK) focus managing acute episodes of
care
– poor management of chronic illness leads to wasteful
use of high intensity services
– 3/4 patients suitable to be cared for in alternative
setting have a chronic condition

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The Case for Self Care Support
• Impact on patients
– Better symptom management
– Improved feeling of well-being
– Increased life expectancy
– Improvement in quality of life with greater
independence

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 The Case for Self Care Support
• Impact on care services
– Visits to GPs can reduce by over 40% for high risk
groups
– Outpatients visits decrease by 17% generally
– Medication intake more appropriate
– Accute&Emergency visits can be reduced
– Days off work can reduce by as much as 50% for
people with arthritis.

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The Case for Self Care Support

• Economic Case
– For every £100 spent on encouraging self-care
£150 benefits can be delivered in return.

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 Types of Self Care Support
 Appropriate and accessible advice and information
 Patient and carer education about self management of their
illness, helping them to understand what to do, how to
adjust their medication dose and how and when to use
health care.
 Prompts and reminders for when they should be doing
something and attending for care.
 Support from a knowledgeable patient (often, but not
always an expert in their disease) and broader networks,
including attending practices as part of a group of patients
with the same condition.

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 Factors contributing to people
choosing to self-medicate
1. Economics
2. Greater access to drugs
3. Greater access to information
4. The time it takes to see a doctor
5. Tradition or cultural practices
6. Distrust of conventional drugs
7. Desire to self reliant
8. Advertising

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Role of the pharmacist in self-care and
self-medication
The pharmacist has several functions:
As a communicator
• the pharmacist should initiate dialogue with the patient (and the
patient's physician, when necessary) to obtain a sufficiently
detailed medication history;
• in order to address the condition of the patient appropriately the
pharmacist must ask the patient key questions and pass on
relevant information to him or her (e.g. how to take the medicines
and how to deal with safety issues);
• the pharmacist must be prepared and adequately equipped to
perform a proper screening for specific conditions and diseases,
without interfering with the prescriber's authority;

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 As a communicator (cont’d) .

• the pharmacist must provide objective information

• .
about medicines;
• the pharmacist must be able to use and interpret
additional sources of information to satisfy the
needs of the patient;
• the pharmacist should be able to help the patient
undertake appropriate and responsible self-
medication or, when necessary, refer the patient for
medical advice;
• the pharmacist must ensure confidentiality
concerning details of the patient’s condition.

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As a quality drug supplier .

· the pharmacist must ensure that the products he/she

purchases are from reputable sources and of good
quality;
• .

· the pharmacist must ensure the proper storage of these

products.

As a trainer and supervisor

• To ensure up-to-date quality service, the pharmacist
must be encouraged to participate in continuing
professional development activities such as continuing
education.
• The pharmacist is often assisted by non-pharmacist
staff and must ensure that the services rendered by
these auxiliaries correspond to established standards
of practice.
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 .

As a collaborator
It is imperative that pharmacists develop quality
• .

collaborative relationships with:

· other health care professionals;
· national professional associations;
· the pharmaceutical industry;
· governments (local/national); and,
· patients and the general public.

In so doing, opportunities to tap into resources and

expertise, and to share data and experiences, in order
to improve self-care and self-medication, will be
enhanced.

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 As a health promoter .

As a member of the health-care team, the pharmacist

• .
must:
· participate in health screening to identify health
problems and those at risk in the community;

· participate in health promotion campaigns to raise

awareness of health issues and disease
prevention; and

· provide advice to individuals to help them make

informed health choices.

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 Manage Symptoms Using Self-care
• Step 1. Prevent symptoms from occurring.
• Step 2. Read and use the self-care measures.
• Step 3. Use common non-medications/home
remedies.
• Step 4. Use available OTC medications.
• Step 5. See a health care provider.

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Over-The-Counter Drugs (OTC Rx)
• Non-prescription medications.
• Most OTCs relieve symptoms only.
• Some cure minor medical problems.
• Others prevent minor illness.
• Make sure you read and follow the directions.
• Learn to recognize generic names.

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 OTCs That Relieve Symptoms
• Analgesics: Motrin IB (Ibuprofen - generic name)
• Anti-Itch Creams: Cortaid (Hydrocortisone)
• Cough Suppressants: Sucrets Cough Suppressant
• Nasal Decongestants: Sudafed
(pseudoephedrine - generic name)
• Sore Throat Lozenges: Cepacol

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 OTCs That Cure Minor Illness
• Antifungals: Miconazole Cream

• Antibiotic Ointments: Bacitracin

• Acne Treatment: Benzoyl Peroxide

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 OTCs That Prevent Illness
• Body Powders: Talcum Powder

• Mole Skin: Mole Foam

• Stool Softeners: Colace (Ducosate)

• Skin Protection: Sunscreen

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 Patient Awareness and Self-Care for
HYPERTENSION
What is Blood Pressure and High Blood Pressure?
• .

Blood pressure is the force generated as your heart pumps blood

and moves it through the blood vessels in your body.
It is made up of two numbers called the systolic and diastolic blood
pressure.
Systolic blood pressure represents the pressure while the heart is
beating. A normal systolic blood pressure is 140 mmHg or below.
Diastolic blood pressure represents the pressure when the heart is
resting between beats. A normal diastolic blood pressure is 90 mm
Hg or below.

Blood pressure that stays persistently above this level is considered

high and the person is said to have high blood pressure or
hypertension.
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 What Causes Hypertension?
• In most patients, the cause for high blood pressure is not
clear.
• However, we know that we are at risk of getting high blood
pressure if we:
Are overweight
Eat too much salt
Regularly consume large quantities of alcohol
Do not have enough exercise
Are constantly under stress
Have a family history of high blood pressure
Are 40 years or older
Have certain medical problems such as kidney diseases

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 What are the Symptoms of Hypertension?

• People with high blood pressure usually do

not feel unwell.

• Many people are found to have high blood

pressure during routine medical examination.

• So if you haven't had it checked in a while,

make an appointment now.

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 What Can Hypertension Cause?

• High blood pressure can be dangerous and

can hurt your body in many ways.

• These include:
Heart attack
Heart failure
Stroke
Kidney failure, Etc

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 Self Care
• High blood pressure is a lifelong disease.
• It can be controlled but not cured.

• You can help your blood pressure control by:

Eating sensibly
Reducing your salt and fat intake
Reducing your calorie and sugar intake
Reducing your alcohol intake
Exercising regularly and losing weight
Stop smoking
Keeping stress under control
Taking your medicines regularly
Keeping up with your doctor’s/pharmacist’s appointment
Monitoring your blood pressure regularly.

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Why Is It Important to Keep Up with the Appointments?
 High blood pressure is a silent killer.
.

 It is important for you to follow the plan that your doctor has
come up for you.
• .
 Remember to keep up with your appointments so that your
doctor can assess and monitor your condition and recommend
any other actions when necessary.

Why Is It Important to Take the High Blood Pressure

Medications Regularly?
 High blood pressure medication only works when it is taken
regularly as directed.
 Therefore, you have to follow the instructions and take your
medication at the same time of the day.
 Never stop taking your medications without your doctor's consent.
 Stopping your medication can cause a sudden, life-threatening
increase in your blood pressure.

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 Blood Pressure Monitoring
• Blood pressure monitoring can be easily learnt and
done conveniently at home.

• There are several home blood pressure monitoring

devices available on the market. These devices are
battery-operated and are relatively easy to use.

• Pharmacist can help you choose a device that best

suit your needs and advise you on the appropriate
techniques for taking your blood pressure at home.

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 How to Measure My Blood Pressure?
1. Be seated comfortably in a chair with your elbow and forearm
resting on a flat surface.
2. Attach the blood pressure monitor cuff to your upper arm. Be
careful that there is no difference in height between the cuff and
your heart. Place a cushion or pillow to adjust to the correct height
should there be a difference.
3. Switch on the power to the blood pressure monitor.
4. Inflate the monitor cuff manually or by pressing the "ON" button on
the blood pressure monitor.
5. Read the blood pressure reading from the monitor screen and
record the readings in your blood pressure monitoring diary.
Make sure you enter the dates when the readings are taken.
6. Show your doctor your blood pressure readings at your next
appointment.

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Points to Note While Taking Blood Pressure:
.

The blood pressure readings may be higher than normal

under
• . the following conditions:
- After an exercise or after performing a physically
strenuous activity
-After a heavy meal, after drinking coffee or cigarette
smoking
- When you are anxious, nervous or upset about something
- When you are in a hurry

Therefore, always try to take your blood pressure when you

are relaxed or when you have rested for approximately 15
minutes after any strenuous physical activities.

Be sure to note down any reason which you think may

affect your blood pressure reading.

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  Tryto take your blood pressure at around the
.

same time everyday as blood pressure

• readings may be slightly different at different
.

times of the day.

 Blood pressure readings are lower when

taken in an upright position compared to when
you are lying down. So, be sure that your blood
pressure readings are measured in the correct
posture.

 Different blood pressure monitors may give

slightly different readings. They may not be
the same as those taken by your doctor.

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 .

• Discard all medication that

is outdated or no longer
required

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 Example of Chronic Disease Management:
Management of hypertension Medical
devices

Blood Pressure Measuring Equipment

traditional mercury sphygmomanometer

semi-automatic apparatus
automatic apparatus

Accuracy - Quality - CE marking

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Example of Chronic Disease Management:
Management of hypertension- Pharmacist review
To monitor blood pressure

To provide patient support with drug therapy and

lifestyle modifications
To discuss symptoms and medication (identify

unwanted drug effects, any other drugs taken by

patient for other disease states)
To evaluate need for patient referral to physician

To consider use of other drugs that reduce

cardiovascular risk (aspirin and statin therapy)

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 Diet and Hypertension
 Non-pharmacologic way of treating hypertension
 DASH diet
 Dietary Approaches to Stop Hypertension
 High in whole grains, fruits, vegetables, and low-fat dairy
 Adequate Calcium, Potassium, Magnesium
 Low in red meat, sweets and sugar beverages
 Low in saturated and trans fat, cholesterol

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 DASH In Summary
 Make a “Dash” for more –
 fruits and vegetables
 whole grains and breads
 non-fat and low fat dairy foods
 nuts, seeds and beans

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 The long–term effects of diabetes mellitus
include progressive development of the specific
complications of retinopathy with potential
blindness, nephropathy that may lead to renal
failure, and/or neuropathy with risk of foot
ulcers, amputation, Charcot joints, and features
of autonomic dysfunction, including sexual
dysfunction.

 People with diabetes are at increased risk of

cardiovascular, peripheral vascular and
cerebrovascular disease.

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Secondary causes of Diabetes mellitus include:

 Acromegaly,
 Cushing syndrome,
 Thyrotoxicosis,
 Pheochromocytoma
 Chronic pancreatitis,
 Cancer
 Drug induced hyperglycemia:
◦ Atypical Antipsychotics - Alter receptor binding characteristics, leading to increased
insulin resistance.
◦ Beta-blockers - Inhibit insulin secretion.
◦ Calcium Channel Blockers - Inhibits secretion of insulin by interfering with cytosolic
calcium release.
◦ Corticosteroids - Cause peripheral insulin resistance and gluconeogensis.
◦ Fluoroquinolones - Inhibits insulin secretion by blocking ATP sensitive potassium
channels.
◦ Naicin - They cause increased insulin resistance due to increased free fatty acid
mobilization.
◦ Phenothiazines - Inhibit insulin secretion.
◦ Protease Inhibitors - Inhibit the conversion of proinsulin to insulin.
◦ Thiazide Diuretics - Inhibit insulin secretion due to hypokalemia. They also cause
increased insulin resistance due to increased free fatty acid mobilization.

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 Prediabetes is a term used to distinguish people who
are at increased risk of developing diabetes. People
with prediabetes have impaired fasting glucose (IFG)
or impaired glucose tolerance (IGT). Some people may
have both IFG and IGT.

 IFG is a condition in which the fasting blood sugar

level is elevated (100 to 125 milligrams per decilitre
or mg/dL) after an overnight fast but is not high
enough to be classified as diabetes.

 IGT is a condition in which the blood sugar level is

elevated (140 to 199 mg/dL after a 2-hour oral
glucose tolerance test), but is not high enough to be
classified as diabetes.

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 Research studies have found that lifestyle changes
can prevent or delay the onset of type 2 diabetes
among high-risk adults.

 These studies included people with IGT and other

high-risk characteristics for developing diabetes.

 Lifestyle interventions included diet and moderate-

intensity physical activity (such as walking for 2 1/2
hours each week).

 In the Diabetes Prevention Program, a large

prevention study of people at high risk for diabetes,
the development of diabetes was reduced 58% over 3
years.

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 Studies have shown that medications have been successful in
preventing diabetes in some population groups.
 In the Diabetes Prevention Program, people treated with the drug
metformin reduced their risk of developing diabetes by 31% over
3 years.
 Treatment with metformin was most effective among younger,
heavier people (those 25-40 years of age who were 50 to 80
pounds overweight) and less effective among older people and
people who were not as overweight.
 Similarly, in the STOP-NIDDM Trial, treatment of people with IGT
with the drug acarbose reduced the risk of developing diabetes
by 25% over 3 years.
 Other medication studies are ongoing. In addition to preventing
progression from IGT to diabetes, both lifestyle changes and
medication have also been shown to increase the probability of
reverting from IGT to normal glucose tolerance.

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 The major components of the treatment of
diabetes are:

A • Diet and Exercise

• Oral hypoglycaemic
B therapy

C • Insulin Therapy

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 Diabetes
Management
Algorithm

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 Diet is a basic part of management in every
case. Treatment cannot be effective unless
adequate attention is given to ensuring
appropriate nutrition.

 Dietary treatment should aim at:

◦ ensuring weight control
◦ providing nutritional requirements
◦ allowing good glycaemic control with blood glucose
levels as close to normal as possible
◦ correcting any associated blood lipid abnormalities

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The following principles are recommended as dietary guidelines for
people with diabetes:

 Dietary fat should provide 25-35% of total intake of calories but

saturated fat intake should not exceed 10% of total energy.
Cholesterol consumption should be restricted and limited to 300
mg or less daily.

 Protein intake can range between 10-15% total energy (0.8-1

g/kg of desirable body weight). Requirements increase for
children and during pregnancy. Protein should be derived from
both animal and vegetable sources.

 Carbohydrates provide 50-60% of total caloric content of the

diet. Carbohydrates should be complex and high in fibre.

 Excessive salt intake is to be avoided. It should be particularly

restricted in people with hypertension and those with
nephropathy.

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 Physical activity promotes weight reduction and
improves insulin sensitivity, thus lowering blood
glucose levels.

 Together with dietary treatment, a programme of

regular physical activity and exercise should be
considered for each person. Such a programme
must be tailored to the individual’s health status
and fitness.

 People should, however, be educated about the

potential risk of hypoglycaemia and how to avoid
it.

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 There are currently four classes of oral anti-
diabetic agents:

i. Biguanides
ii. Insulin Secretagogues – Sulphonylureas
iii. Insulin Secretagogues – Non-sulphonylureas
iv. α-glucosidase inhibitors
v. Thiazolidinediones (TZDs)

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 In elderly non-obese patients, short acting insulin secretagogues
can be started but long acting Sulphonylureas are to be avoided.
Renal function should be monitored.

 Oral anti-diabetic agent s are not recommended for diabetes in

pregnancy

 Oral anti-diabetic agents are usually not the first line therapy in
diabetes diagnosed during stress, such as infections. Insulin
therapy is recommended for both the above

 Targets for control are applicable for all age groups. However, in
patients with co-morbidities, targets are individualized

 When indicated, start with a minimal dose of oral anti-diabetic

agent, while reemphasizing diet and physical activity. An
appropriate duration of time (2-16 weeks depending on agents
used) between increments should be given to allow achievement
of steady state blood glucose control

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 Patients should be educated to practice self-
care. This allows the patient to assume
responsibility and control of his / her own
diabetes management. Self-care should
include:

◦ Blood glucose monitoring

◦ Body weight monitoring
◦ Foot-care
◦ Personal hygiene
◦ Healthy lifestyle/diet or physical activity
◦ Identify targets for control
◦ Stopping smoking

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• The End of the Lecture

• Thank you so much for paying

attention

• You can do it, you are on the right

track !

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