Nahdi OTC cases

OTC cases

Pharmacy Training Department

Nahdi Training Academy
SOON IN SHAA Allah
Course objectives
By the end of this course you will Know
1) Differences between prescription medication and
over the counter
2) WWHAM technique
3) When to refer
4) Differential diagnosis of OTC cases
 Derma Cases
 GIT cases
 Pain Cases
4) Tools help you in dealing with cases and Drugs
Prescription and Over-The Counter (OTC)
Medications

Prescription Medications Over-the-Counter Medications

Require a written order or Can be bought without a

prescription from a physician, prescription
dentist, or nurse practitioner. This
prescription authorizes a pharmacist
to dispense a particular medication.

Are prescribed for the treatment of a Are intended for relief of minor
specific medical problem. ailments.

Are usually more powerful and have Are considered safe if warnings and
more side effects than OTC directions are followed.
medications.
 Stick Figures with Blocks
WWHAM technique

W H A M

Replace your OWN

Letters in any of the given layouts
WWHAM technique

• W Who is the patient

• W what are the symptoms?
• H How long have the symptoms been present?
• A Action taken?
• M Medication being taken?
Decision-making: risk
assessment
 long duration of symptoms
 recurrent or worsening problems
 Cases need to long protocol treatment
severe pain
failed medication (one or more appropriate
medicines used already, without improvement)
suspected adverse drug reactions (to
prescription or OTC medicine)
danger symptoms
.
Danger symptoms

Dangerous symptoms as blood in the sputum,

vomit, urine or faces
 unexplained weight loss
High fever or fever with un clear cause
unexplained weight loss
Also each case has special referral symptoms
Heart burn Refer

 Potentially serious cases such as patients with

peptic ulcer disease (associated with pain) and
gastric malignancy (associated with anorexia)
 Someone suspected to be suffering from a heart
condition should be referred immediately.
 Patients over
unexplained weight
the age of loss
40 are at increased risk of
both peptic ulcer disease and malignancy.
 OTC cases map
SKIN

GIT.
Respiratory .

Musculoskeletal
.

Women health.
Skin
Ring worm

Ringworm is a common fungal skin infection

otherwise known as tinea. Ringworm most
commonly affects the skin on the body (tinea
corporis), the scalp (tinea capitis), the feet (tinea
pedis, or athlete's foot), or the groin (tinea cruris,
or jock itch)
Ring worm
• Does Ringworm Mean I Have Worms?
• No. Ringworm is not caused by a worm. It's a
fungal infection that often forms a ring-shaped rash.
It can have a red center (seen here) or normal skin
tone inside the ring
Ring worm
• What Causes Ringworm?
Certain fungi can help the body, but the dermatophyte type
that cause ringworm irritate the skin instead. These fungi live
off the dead tissues of your skin, hair, and nails.
Dermatophytes thrive in warm, moist areas, such as the skin
folds of the groin area or between the toes. You’re at greater
risk of getting ringworm if you sweat excessively or have
minor injuries to your skin, scalp, or nails
Ringworm of the Body (Tinea
Versicolor)
Symptoms
Scaly round or oval macules (patches) the color of lesions varies from whitish to
light brown according to skin color, its sites: trunk, part of upper arm & neck
(fanela area), itching is absent
Lines of Treatment
 Cleaning with antifungal shampoo.
 Local antifungal.
 Systemic antifungal
Patient Education
Personal hygiene.
Exposure to the sunlight during the treatment period to accelerate restoring the
natural skin color.
Ultra violet rays later on for hypo pigmented area.
Ringworm of the Scalp (Tinea
Capitis)
Symptoms
Rounded or oval patch covered with small grayish white scales on the scalp. It
may be one or more batches
Lines of Treatment
 Cleaning with antifungal shampoo..
 Local antifungal for one month.
 Systemic antifungal as diflucan once or twice weekly

Patient Education
Hair must be cut short.
Head covering for infected child.
Personal hygiene.
Ringworm of the Groin (Tinea
Cruris)
Symptoms
Erythematous patches with active raised edge covered with minute papules,
vesicles, & crusts. Itching is present.
Site: upper medial side of the thigh, buttocks and the pubic area.
Lines of Treatment
 Local antiseptic wash.
 Local antifungal with topical corticosteroids for few days and then stop the
corticosteroids and continue with the antifungal.
 Systemic antifungal
Patient Education
‫تغسل كل المناشف و المالبس بالصابون و المطهر في الماء الساخن‬
‫استعمال المالبس الداخلية القطنية‬
‫كي المناشف و المالبس‬
‫عدم تبادل األغراض الشخصية‬
Ringworm of the Foot (Tinea Pedis)

Symptoms
Cracked flaking peeling between the toes. The affected area is usually reddish or
whitish and itchy with burning sensation.
Sites: On the feet or between the fingers.
Lines of Treatment
 Local antiseptic wash.
 Local antifungal.
 Systemic antifungal.
Patient Education
‫الحفاظ الدائم على جفاف القدمين و بين األصابع خاصة بعد الوضوء و الغسل المتكرر‬ 
‫تغسل كل المناشف والجوارب بالصابون و المطهر في الماء الساخن‬ 
‫استعمال الجوارب القطنية‬ 
‫كي المناشف و الجوارب‬ 
‫عدم تبادل األغراض الشخصية‬ 
ScabiesParasite
Scabies is classified by the WHO as a water-related
disease.[3] The disease may be transmitted from objects,
but is most often transmitted by direct skin-to-skin contact,
with a higher risk with prolonged contact. Initial infections
require four to six weeks to become symptomatic become
symptomatic
Scabies

Symptoms
Severe itching mainly at night, lesion consists of burrows, papules, vesicles,
scratch marks.
Lines of Treatment
 ‫حمام دافئ باستعمال لوفة خشنة و صابون كبريت‬
 Anti mite as Eurax , Benzanil , Ectometherin , Scabine , Benzyl benzoate
‫يدهن علي الجسم مرة يوميا ً ماعدا الوجه والرقبة‬
 Sedating anti histamine.
 Emollient lotion to decrease itching
 Local antibiotic. If there is secondary bacterial infection
 Systemic antibiotic if there is secondary infection
Patient Education
‫يعزل المريض عزال ً تاما عن اآلخرين‬. 
‫غلي المالبس و األلحفة و الماليات و غيرها من األغراض المنزلية التي يحتك بها المريض‬ 
‫يعطي العالج لجميع أفراد األسرة في نفس الوقت‬ 
Diagnose Psoriasis (as chronic
case)
Symptoms
Red papules and plaques covered with silvery scales on elbow, knees, sacral
region and scalp.
Nail infection occur (pitting, brittleness, thickening) also in other joints.
Psoriasis characterized by remissions & relapses.
Lines of Treatment
in case of limited cases, the following can prescribed:
 Potent corticosteroid as immunosuppressive (scalp, palms, soles).
 Regulate the cell growth using topical Calcipotriol (Daivonex).
 Decrease the growth of cells using tar.
 Keratolytic, using salicylic A. to reduce flakes.
 Emollient or moisturizing cream
Callus and Corns
‫‪Callus and Corns‬‬
‫‪Symptoms‬‬
‫‪A callus (Tayloms) is an area of skin that thickens after exposure to repetitive‬‬
‫‪forces in order to protect the skin, when a calluse develop a mass of dead cells‬‬
‫‪in its center; it becomes a corn (Heloma).‬‬
‫‪Lines of Treatment‬‬
‫‪ Keratolytic agent.‬‬
‫‪ Electrical cautery.‬‬
‫‪ Surgical.‬‬
‫‪Patient Education‬‬
‫طريقة االستعمال‪:‬‬
‫‪ ‬تغمس المنطقة المصابة فى ماء دافئ لمدة خمس دقائق و تجفف برفق‬
‫‪ ‬في حالة كون الدواء دهان أو سائل (ليس لصقة) يوضع الجلي الواقي على الجلد السليم المحيط بالمنطقة‬
‫المصابة لحمايته من أثر الدواء‬
‫‪ ‬تدهن المنطقة المصابة بالدواء أو تلصق اللصقة على المكان المصاب و يترك لمدة ال تقل عن يوم أو حسب‬
‫المدة المذكورة في النشرة‬
‫‪ ‬في المرات التالية يغمس الجلد فى ماء دافئ ثم يبرد بالمبرد قبل و ضع الكمية الجديدة من الدواء‬
‫‪ ‬يراعى عدم مالمسة الدواء للعينين خاصة في حاالت األطفال‬
‫‪Warts‬‬
‫‪Symptoms‬‬
‫‪Benign papillomatous of skin or mucous membrane caused by‬‬
‫‪virus (papilloma virus). Common in children 6 – 12 year‬‬

‫‪Lines of Treatment‬‬
‫‪ Keratolytic agent.‬‬
‫‪ Podophyllin resin25%.‬‬
‫‪ Increase the immunity , must be covered not cut to‬‬
‫‪prevent the spreading‬‬
‫‪ Then ----- Electrical cautery.‬‬
‫‪‬‬ ‫‪or ------ Surgical.‬‬
‫‪Patient Education‬‬
‫طريقة االستعمال‪:‬‬
‫‪ ‬تغمس المنطقة المصابة فى ماء دافئ لمدة خمس دقائق و تجفف برفق‬
‫‪ ‬في حالة كون الدواء دهان أو سائل (ليس لصقة) يوضع الجلي الواقي على الجلد السليم المحيط بالمنطقة‬
‫المصابة لحمايته من أثر الدواء‬
‫‪ ‬تدهن المنطقة المصابة بالدواء أو تلصق اللصقة على المكان المصاب و يترك لمدة ال تقل عن يوم أو حسب‬
‫المدة المذكورة في النشرة‬
‫‪ ‬في المرات التالية يغمس الجلد فى ماء دافئ ثم يبرد بالمبرد قبل و ضع الكمية الجديدة من الدواء‬
‫‪ ‬يراعى عدم مالمسة الدواء للعينين خاصة في حاالت األطفال‬
Warts
Herpes simplex

Symptoms
Small grouped vesicles on erythematous base, the regional
lymph node not enlarged unless secondary infection occurs,
herpes facials (around the mouth), herpes
keratoconjunctivitis; herpes genitalis.
Recurrent herpes simplex is stimulated by fever, common
cold, influenza, menstruation, exposure to sun, and
excessive coitus
Lines of Treatment
 Gentian violet.
 Topical antiviral.
 Topical antibiotic (in case of or to prevent secondary
infection).
 Systemic antibiotic to prevent secondary infection.
 Systemic Antiviral in severe cases. (by physician).
 Corticosteroids are contraindicated.
Herpes zoster ( referral case )
some information about the case
Symptoms
Unilateral grouped vesicles on an erythematous base along the course of
sensory nerve neuralgic pain, the regional lymph nodes are usually enlarged and
tender.
Sometimes, it is wrongly diagnosed as allergy.
Lines of Treatment
 Analgesic.
 Systemic antibiotic.
 Gentian violet topically.
 Vit.B12 depot amp.
 Systemic antiviral.
Musculoskeletal system
Low Back Pain
‫‪Low Back Pain‬‬
‫‪Symptoms‬‬
‫‪Pain comes on quickly, stiffness, acute sudden, also no sciatica pain,‬‬
‫& ‪neurological pain, electrical shock, the low back pain increases by cough‬‬
‫‪sneezing‬‬
‫‪Lines of Treatment‬‬
‫‪ Muscle relaxant.‬‬
‫‪ Systemic analgesic, anti inflammatory.‬‬
‫‪ Local analgesic anti inflammatory‬‬
‫‪Patient Education‬‬
‫تقليل الوزن‬ ‫‪‬‬
‫المشي اليومي المنتظم‬ ‫‪‬‬
‫تجنب االستمرار أو الوقوف لفترات طويلة و في وضع الجلوس يكون الظهر مفرودا‬ ‫‪‬‬
‫عدم حمل أشياء ثقيلة و عند رفع شيء من األرض حاول الجلوس بثني ركبتيك مع الحفاظ على الظهر‬ ‫‪‬‬
‫مستقيما ثم رفع الحمل عن طريق فرد الركبتين مع الحفاظ على الظهر مستقيما و ذلك بغرض التحميل على‬
‫عضالت الفخذين بدال من عضالت الظهر‬
‫النوم على مراتب قوية غير رخوة‬ ‫‪‬‬
Symptoms for referral
• numbness or tingling in legs or feet
• Problems with bowel or bladder function
• If backache is not related to movement
• Pain in the upper back not obviously due
to muscle or ligament strain
• If associated with other symptoms of
illness like Fever
• Severe pain at night that may wakes from
sleep
• No improvement with over-the-counter
medication after 1-2 weeks.
Low Back Pain
GIT
Oral ulceration
Symptoms
Red patches, necrotic patches. Pain , increase with citrus juice

Lines of Treatment
 Anti septic washes.
 Astringent as Pyralvex.
 Local oral anesthetic as Lidocaine viscous.
 Local enhance the healing as mebo , hycum gel , gingi gel
• Systemic analgesic anti inflammatory
Patient Education
1-Oral care
2- Tooth paste with out Sod. Lauryl Suphate free

2-Soft brush
Dyspepsia atypical Heart Burn
(Hyperacidity)
Symptoms
A burning sensation in the chest, just behind the breastbone or in the
epigastrium
Lines of Treatment
 Treat the cause.
 Local neutralizing Antacid.as moxal
 Prokinetics if necessary
 H2 Blocker as zantac
 Proton pump. Inhibitors as losec

Patient Education
Avoid spicy, fatty meals, pepper, coffee, tea, coca, smoking, alcoholic drinks,
snacks between meals. Also avoid aspirin, & NSAIDs.
Never lay down after a meal, allow 2 to three hours between eating and bedtime
Diagnosed Peptic Ulcer ( referral
case )
Symptoms
Duodenal ulcer: epigastric pain 2hrs after meal commonly relieved by anti acid,
& food, patient is anxious; overweight due to food alleviates the case.
Gastric ulcer: epigastric pain 10- 30 min. after meal relieved by (vomiting & anti
acid) , there is loss of weight due to food lead to pain.
Lines of Treatment
 H2 blockers.
 Proton pump inhibitor is used in resistant cases.
 Ranitidine is the drug of choice because: no anti androgenic activity, no CNS
side effect, and no drug interaction.
 Anti acids (neutralization).
 Mucosal protective drug as Sucralfate.
 Prostaglandin analogues (Misoprostol), but contraindicated in pregnant
women.

Patient Education
AS hear burn
Irritable bowel syndrome (Spastic
Colon)
Symptoms
Tense anxious which may give dyspnea, palpitation, and tachycardia. In some
cases painless diarrhea with mucous (no blood), in majority cases flatulence,
distension, with diarrhea or constipation, tenderness in sigmoid colon, no
complete defection
Lines of Treatment
 Spasmolytic drugs.
 Digesting & anti acids if hyperacidity is in the symptoms.
 Ant flatulence & can use intestinal antiseptic.
 Regulate defecation by using fibers.
 Probiotic to activate the flora of intestine.
 Prokinetics.
• Anxiolytic
Patient Education
 Treat any depressive reaction, avoid any anxiety, regular physical activity, &
normal diet.
 Avoid much heavy eating, but several small meals with high fibers content
are recommended.
 Avoid rapid eating.
 Avoid high fatty meals & junk food.
 Decrease or eliminate fermentable food (gas forming diet).
 Avoid drinking much fluid with meal.
Constipation

• WWHAM
Overweight and Obesity
Symptoms
Overweight and obesity are defined as abnormal or excessive fat accumulation
that presents a risk of serious health problems.
Management
1. Modify the diet to be mainly dependent on low carbohydrate and high fibers
foods.
2. Increase exercise at least 3 times weekly
3. Use slimming drugs
Lines of TTT
 Decreasing fat absorption ( orlistat - chitosan - anthocyanidine ).
 Fats and carbohydrates burners (chromium).
 Decrease appetite by bulky forming fibers (Psyllium seed husk - bran –
Mucivital – Twinfast ).
 other lines:
o Metformin (increase the burning & utilization of glucose).
o Acarbose (decrease the absorption of glucose).
o Thyroxine (Increase basal metabolic rate).
Overweight and Obesity
Patient education
•Avoid junk food and soda drinks.
•Modify your life style: don’t eat one meal daily but divide it into 3 meals,
don’t sleep directly after meals.
•Walking, Running, Rowing, Swimming or any exercise must be done at least 3
times weekly.
•Always weigh yourself using the same scale to measure the weight change
perfectly.
The healthy weight loss is about 3-5 kg/month
References

• Symptoms in the pharmacy (sixth Edition)

• Community pharmacy and pharmacy
practices(20008) Cairo university
• http://www.medscape.com/
• SFDA
http://www.sfda.gov.sa/En/Drug/Pages/default.aspx

• http://www.webmd.com/