HOW TO PRACTICE

O.T.C
Lecture three

foot
Redness, bad odour, itching, yes maceration inbetween toes (4-5) No yes Big toe or ankle are suddenly red , swollen, and painful

Tinea pedis gout Planter warts corns or callus

No

Lesion in foot sole with black dot in center, painful on walking No it on yes Hard lesion on bone surface on compression sites of foot

yes

yes Excessive walking or standing Only pain on foot Require rest

No

Treatment of Tinea pedis
topical antifungal for about 2-4 weeks Systemic antifungal may be added (weekly capsule of ketoconazole)

topical antifungal
1-Imidazole group: *Miconazole (Daktarin, miconaze)® *Clotrimazole(Candistan,colosol,Dermatin) *Tioconazol (Trosyde)® 2- Tolnaftate (Tinea cure) ®

3- Terbinafine (lamisil)

Topical antifungal

Topical antifungal

ketoconazole

corns

Plantar warts

Treatment of corns and warts
Salicylic acid (keratolytic action)
cover surrounded healthy tissue with Vaseline´. Salicylic acid is contraindicated with DM. due to reduced sensation in the foot delay awareness of skin breakdown & sepsis. Patients should never attempt to lower calluse with bladdes or files as can cause infection & hemorrhage.

Example of OTC prescription
Callomack paint
21

Oral problems
yes

Vesicle around the lip with history of Herpes common cold or low immunity simplex No yes White patches on tongue Mouth thrush or lip or tongue disfiguring

No
Painful ulcer in mouth with white covering membrane

yes yes yes

oral sore gingivitis

No
red painful edamatous gingiva No Only pain cracked & dry lips are on foot

chapped lips

treament for Gingivitis :: treament for Gingivitis
Antiseptic mouth wash Chlorohexidine, povidone, citrimide, benzdiamine Antibiotic or antibacterial : Amoxicillin, metronidazole, tetracycline Analgesic Ibuprofen, ketoprofen

treament for Gingivitis : treament for herpes simplex:
Antiviral drug ( acyclovir) Analgesic

treament for Gingivitis : treament for mouth thrush
Oral antifungal Miconazole, nystatin

treament for Gingivitis : treament for mouth sore:
Antiseptic mouth wash Analgesic or anesthetic
.: (Jogel) ® -----> ³Lidocaine + Jojob as antibacterial´ (Oracure)® -----> ³Lidocaine + cetylpyridinium as Antiseptic´ (Salvix ± L)® -----> lignocaine + anthraqinone +SA

dental pain
Loose tooth No

yes

Dental pain disappear in seconds cold, hot, sweaty things

physicia n yes

Dental decay
Dental hypersensiti vity

No
Continous pain even on touch, bite, cold, or hot, dental fracture

yes

No

Dental pain with facial swelling at jaw line, pus, fever No

yes dental abcess

Give local anesthetic or analgesic

Ear problems
Pus discharge

Drum rupture

exclud e

fever

sudden hear loss

Ear problems yes
ain accompany common cold symptoms

otitis media

No
Gradual decrease in hearing Feeling of ear fullness

yes yes

No

Wax impaction otomycosis Antifungal solution

pruritus, white scaling, and swelling No Pain on moving auricle, pain increase on chewing

yes otitis externa

No
Give local ear analgesic

Wax impaction

Ear analgesic

Eye problems yes
redness

Eye redness yes Dry eye stye

No
Occular discomfort ,itching desire, eye awareness

Inflammation or infectionof the yes sebaceous gland of the eye lash

No

No

yes

Inflammation of eye lid

belpharitis

No
Tearing, mild swelling below eyes & itching, allergic history

yes

allergic conjunctivitis

Red eye treatment
Ophthalamic vasoconstrictor ³ sympathomimetic
Naphazoline (Prisoline) ® Tetrahydrozoline (Visine) ® ‡ ‡

‡

Dry eye

Allergic conjunctivitis
1-Ophthalamic vasoconstrictor ³ sympathomimetic 2-antihistaminic loratidine Fexofenadine citrizine

Antihistaminic drugs

rhinorrhea No
Sneezing, family infection yellowish discharge, onset less 1 week, fever

yes

Common clod

No
Chronic, itching, no fever, clear watery discharge, allergic history N

yes

allergic rhinitis

Headache, o face pain yes around sinus area, yellowish discharge, sinus congestion

sinusitis

No

unknown

Treatment of cold
Oral nasal decongestants :
EX: phenylephrine. Phenyl propanolamine (No flu, contaflu) ® Pseudoephedrine (Actified) ®

Antihistaminic :

Analgesics :
paracetamol

antihistaminic
Relieve sneezing, runny nose, nose itching First generations : Side effects of sleepiness & drowsiness

Second generations : ³No Sedation´

First gen. antihistaminic

Sec. Antihistaminic drugs

Tinea pedis

Ex1: Clioquinol (Vioderm) Ex2: Imidazole group: Miconazole (Daktarin)® Clotrimazole (Canesten, Dermatin)® Tioconazol (Trosyde, Topozole) Ex3: Tolnaftate (Tinea cure) Ex4: Povidone I2 (Betadine) ®

-Topical antifungal & may accompanied ‡ with oral antifungal if sever. Ex: Diflucan

Body temperature measurements :
Oral ³sublingual´ :
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 (tempogel)
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 3 10

headache
yes
Eye pain, blurred vision

Eye problem sinusitis

No yes Sinus congestion, pain in sinus areas

No

yes migraine

Throbbing pain in one side of head worsen with normal movements,

No
Give analgesic Like fever

Prevention of headache
1- avoid high amount of caffee, tea, ice cream, chocolate 2-avoid stress and avoid change normal routine as ³dieting, traveling, sleeping´

Treatment of migraine
Mild cases : Acetaminophen plus metoclopramide Sever cases: Ergotamine combination
Avoid use in hypertensive patients or pregnant

Paracetamol + metoclopramide

ergotamine

Example of OTC prescription for migraine

Migracid tab 2-1

insomnia
yes
No On starting drug use

Psychological causes or sever pain

Physician contact

yes

Drug induced

No
Give first generation antihistaminic or natural sedating product

Prevention of insomnia ³sleep 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 2±1 Avil retard tab

Fatigue & weakness
yes
Fever & rhinorhea, sneezing

Common No cold yes anemia ecurrent Hypotension, palpitation, pale skin No Unintended potent weight loss, good yes hyperthyroidism No
On starting drug use

appetite, sweating, tachycardia, nervousness

yes

Drug induced

Overworking or under eating is the cause

Treatment: ³for 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

multivitamins
1- 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

Back pain
yes
Accident, fall, injury No Urine problem

physician

yes

Renal stone or infection yes Sciatica (disc) yes Osteoarthritis or rheumatic arthritis

No
Numbness or pain in one leg

No
Chronic pain, inflammation, stiffness In both sides of joints

Give analgesic, muscle relaxant

Treatment of back pain
1- analgesic: acetaminophen, Ibuprofen, ketoprofen or aspirin, declofenac, piroxicam,celecoxib, nimasulide, indomethacin 2-muscle relaxnt
EX 1 :- Baclofen(Baclofen)®. EX 2 :- Chlozoxazone (Myolgine) ®. EX 3:- Orphenadrine (Norflex) ®.

3-counter irritant Mask the pain Not applied to wound or damaged skin

indomethacin

AntiCox 2

Muscle relaxant and analgesic

Example of OTC prescription:
myolgin cap 3 Olfen amp

cough
yes
Fever No Asthmatic patient

yes yes

Respiratory infection Physician contact yes
cough suppressan t+ expectorant

No
Productive

No
dry cough

Interfere with sleep or activity or painful

No Give mucolytic or expectora nt

yes Give antitussive

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
Guaifensin Ammonium cl Tr. Ipeca Tr. Squill KI

& cough suppressant
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 3

Example of OTC prescription for dry cough:

sinecode syrup 3

Example of OTC prescription for productive interfere with sleep

Toplexil syrup 3

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