Professional Documents
Culture Documents
(6 Juli) Self Care - Prof. Suwaldi
(6 Juli) Self Care - Prof. Suwaldi
AND
SELF MEDICATION
(PERAWATAN DAN PENGOBATAN
SENDIRI)
Suwaldi MartodiHARDJO
PSPA UNISSULA
SEMARANG
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GOOD PHARMACY PRACTICE
- WHO and FIP guideline 1996
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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.
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Self-care
• Self-care is what people do for themselves to establish
and maintain health, prevent and deal with illness.
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Pharmacists’ Evolving Role
From Dispensing
Services… …to a clinical service provider
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Pharmacists do not work in
silos….
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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
Aims of
What does the
Pharmaceutical
patient view as an Care
improved quality of
life?
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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:
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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.
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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) .
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As a quality drug supplier .
As a collaborator
It is imperative that pharmacists develop quality
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As a health promoter .
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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
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OTCs That Prevent Illness
• Body Powders: Talcum Powder
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Patient Awareness and Self-Care for
HYPERTENSION
What is Blood Pressure and High Blood Pressure?
• .
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What are the Symptoms of Hypertension?
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What Can Hypertension Cause?
• 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.
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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.
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Blood Pressure Monitoring
• Blood pressure monitoring can be easily learnt and
done conveniently 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:
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Tryto take your blood pressure at around the
.
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.
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Example of Chronic Disease Management:
Management of hypertension Medical
devices
semi-automatic apparatus
automatic apparatus
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Example of Chronic Disease Management:
Management of hypertension- Pharmacist review
To monitor blood pressure
lifestyle modifications
To discuss symptoms and medication (identify
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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.
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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.
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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.
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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:
• 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.
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The following principles are recommended as dietary guidelines for
people with diabetes:
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Physical activity promotes weight reduction and
improves insulin sensitivity, thus lowering blood
glucose levels.
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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 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
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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:
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• The End of the Lecture
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