KARPAGAM ACADEMY OF HIGHER EDUCATION,

COIMBATORE.

EVALUATION OF KNOWLEDGE AND DISPENSING PRACTICE IN THE

COMMUNITY PHARMACY ON NSAIDs- A CROSS SECTIONAL SURVEY

UNDER THE GUIDANCE:
V.A.SARANYA,M.PHARM.,
ASSISTANT PROFESSOR,
DEPARTMENT OF PHARMACY PRACTICE
FACULTY OF PHARMACY,KAHE
PRESENTED BY:
KEERTHANA.S(19PYU030)
CHINNARASA.K(19PYU014)
MOHAMMED IDRIS.Y(19PYU046)
PRASANTH.S(19PYU058)
SHOWMIYA.N(19PYU079)
 INTRODUCTION

Non steroidal anti inflammatory drugs(NSAIDs)(Pain killers) are among the most
frequently given medications in the world. NSAIDs are the drugs used for some
common conditions like Fever, Inflammation and pain as an antipyretic,an anti-
inflammatory, analgesic agents respectively.

NSAIDs are available as both the prescription and over the counter drugs . The
prolonged use of NSAIDs will leads to adverse gastrointestinal effects, ranging from
relatievly mild dyspepsia, Indigestion to potentially fatal Gastrointestinal bleeding and
Perforated ulcers,and also leads to serious Cardiovascular, Renal effects and hepatic
complications.
Many people are not aware that taking over the counter(OTC) NSAIDs along with
other popular medications like Anticoagulants, Corticosteroids, or Antihypertensive
drugs might results in potentially dangerous adverse events.
MECHANISM OF ACTION
 LITERATURE REVIEW

TITLE AUTHOR INFERENCE

Evaluation of Malebari AM, Khayyat This Study concluded that
community pharmacists AN et al community chemists in Saudi
performance in the Arabia must adequately
screening of non communicate the hazards of
steroidal anti NSAID use to their patients and
inflammatory dugs risks test them for adverse
in saudi arabia medication responses.The Saudi
Regulatory Authority should
support a number of methods to
put into practice a good strategy
for enhancing community
pharmacy Dispensing practices,
communication, and
understanding of risk concerns,
particularly in high-risk patients
taking NSAIDs.
TITLE AUTHOR INFERENCE

Assesment of quatar Yaw Boahene Owusu et al, This study showed that
community pharmacists Consumer misuse of NSAIDs
competence and has been linked to the
practices related to renal emergence of renal and
and gastro intestinal gastrointestinal(GI)problems.
adverse effects of non The knowledge,attitude, and
prescription NSAIDs practises of community
pharmacists in Qatar regarding
the renal and GI side effects of
NSAIDs. In order to lower the
risk of kidney and GI
problems, this study evaluated
the knowledge,attitudes,and
behaviours of community
pharmacists in Qatar on the
safe use of over the counter
NSAIDs.
TITLE
Deprescribing initiative of
NSAIDs (DIN):
Pharmacist-led
interventions for pain
management in a federal
correctional setting
AUTHOR INFERENCE
Keith G Dawson etal The study reveals that the
Clinical pharmacist-led
interventions in CSC have
been demonstrated to
improve patient pain levels
while also reducing oral
NSAID consumption.
TITLE AUTHOR INFERENCE
Used Drugs in Elderly Dhiren Chaudhari, Hiren This study narrated that
PatientsUsage of Non- Chaudhary Elderly patients frequently
Steroidal Anti- experienced mild to
Inflammatory Drugs moderate drug interactions,
(NSAIDS) And Their with just a few severe ones,
Interaction With Other which demands the
Concurrently attention of doctors and
chemists. The prevalence
of chronic illnesses among
older people rises with age,
which also causes a rise in
the number of prescribed
drugs and polypharmacies.
The danger of drug
interactions is increased by
polypharmacy.
TITLE AUTHOR INFERENCE
Use of analgesics in Alaa Burghle, Anton This study's findings
Denmark: A national Pottegård Etal.., pointed out the necessity of
survey ongoing monitoring of
analgesic(NSAIDs) usage
trends following the start of
treatment to guide advice
in neighbourhood
pharmacies.
 SCOPE

The purpose of the study was to collect and evaluate the data on the  knowledge
and dispensing practice of NSAIDs in the community pharmacies. The questions
related to NSAIDs were asked to the community pharmacies around the KAHE
region . NSAIDs were misused due to self medication practices and unaware of its
serious complications as they are readily available over the counter in commnity
pharmacies.     

Chronic use of NSAIDs without physicians consent in patient having comorbid

condition like heart disease, chronic kidney disease, hypertension, particulary in
elderly may worsen the condition even more. Hence while dispensing OTC NSAID
community pharmacist must be aware of the patients need of medicine and required
dosage and frequency of use and also the importance of dispensing NSAIDs along
with PPI and H2 blockers must be properly followed to minimize unwanted serious
complications.
 AIM AND OBJECTIVES

AIM:
The main aim of the study is to evaluate knowledge and dispensing practices in
the community pharmacist on NSAIDs.

OBJECTIVES:
The Main objectives of the study are:
1. To develop a self questionarries.
2. To acquire a knowledge about NSAIDs and its current usage in the community
pharmacy.
3. To assess the dispensing practices of NSAIDs in the community pharmacy.
4. To create an awareness for the misuse of OTC NSAIDs as self medication practice
by implementing NSAIDs information brochure in community pharmacies using
pamphlet and QR code Scanner.
 METHODOLOGY

STUDY SITE:
All the community pharmacy surroundings to KAHE, coimbatore
STUDY DESIGN:
A Cross sectional prospective study.
STUDY DURATION:
5 Months.
STUDY PERIOD:
December to Apirl.
STUDY SIZE:
Among 60 Pharmacies around KAHE we were able to do our survey
study in around 55 Pharmacies.
INCLUSION CRITERIA :
 Those who are interested to participate in the survey.
 Expected to answer genuinely.
EXCLUSION CRITERIA:
 Those who are not interested to participate in the survey.
 Not allowed to search in net .
 PLAN OF WORK

PHASE 1:
 Literature review
 Desigining of protocols
 Developing of Questionnare followed by validation.
PHASE 2:
 Data collection
 Documentation of collected data using the data entry format
PHASE 3:
 Analysis of collected data
 Interpretation of the data
PHASE 4:
 Preparation of the project report and submission to the study department.
 RESULT AND DISCUSSION

Table 1: Number of pharmacist and non pharmacist

n=55

ROLE NUMBER PERCENTAGE

Pharmacist 10 20%
Non pharmacist 45 82%

DISCUSSION:
Pharmacist Among 50 community pharmacies we surveyed
Non only 20% of the pharmacy had pharmacist working
Pharma- while the other 82% of the community pharmacy
cist has non pharmacist which affects the role of
community pharmacist who are often the health
care professional that patients see most .
TABLE 2: Knowledge of NSAIDs known by community pharmacist
staffs
n=55

OPTIONS FREQUENCY PERCENTAGE

NSAIDS Known 41 74%
NSAIDS unknown 14 26%

DISCUSSION:
NSAIDs In this survey we came to know that 26% of
Known the community pharmacy staffs known about
NSAIDs NSAIDs while the other 74% of community
UnKnown pharmacy staffs lack the knowledge about
NSAIDs
TABLE 3: Full form of NSAIDs known
n=55
OPTIONS FREQUENCY PERCENTAGE
Answered 15 27%
Not answered 40 72%

DISCUSSION:
Only 27% of the community staff
Answered members are familiar with the whole
Not Answered term of NSAIDs as Non Steroidal Anti
Inflammatory drugs
TABLE 5: Reason for patients taking NSAIDs
n=55
OPTIONS FREQUENCY PERCENTAGE
Body pain 23 41%
Inflammation & 18 32%
swelling

Bleeding 5 9%
Cold & cough 9 16%

DISCUSSION:
According to the current survey more
Body Pain people frequently take NSAIDs for
Inflammation & body pain than for inflammation &
Swelling swelling. Some staffs who are not
Bleeding pharmacist stated that NSAIDs can be
Cold & Cough administered for bleeding, cold &
cough demonstrating their lack of
knowledge about NSAIDs
TABLE 6: Side effects of NSAIDs
n=55
OPTIONS FREQUENCY PERCENTAGE
Indigestion 18 32%
Stomach ulcer 28 50%
Constipation 6 10%
Hair loss 3 5%

DISCUSSION:
Indigestion This statement implies that the most common
NSAIDs side effect is stomach ulcer which
Stomach Ulcer
can lead to internal bleeding ,dyspepsia,
Constipation gastroduodenal ulcer, GI perforation followed
Hair Loss by indigestion
TABLE 7: knowledge of drug interaction with NSAIDs
n=55

OPTIONS FREQUENCY PERCENTAGE

Anticoagulant 20 69%
Antiasthmatic 8 14%
Diuretics 5 9%
Antihypertension 22 40%

Anticoagulant DISCUSSION:
69% of the staff members in
Antiasthmatic
community pharmacies are aware
Diuretics that NSAIDs can interact with
Antihypertension anticoagulant to cause bleeding
and with antihypertensives to
elevate blood pressure
TABLE 8: ADRs of NSAIDs .
n=55

OPTIONS FREQUECY PERCENTAGE

Blood in urine 5 9%
GI bleeding 10 18%
Blurred vision 22 38%
Drug toxicity 18 32%

DISCUSSION:
Blood in urine Alcohol and NSAIDs interaction
GI Bleeding can have harmful effects like GI
haemorrhage. heavy drinking may
Blurred Vision
exacerbate gut irritation and raise
Drug Toxicity this risk of renal toxicity such as
renal papillary necrosis of
intestitial nephritis
TABLE 9: Antidode for NSAIDs poisoning
n=55

OPTIONS FREQUENCY PERCENTAGE

Answered 2 2%
Not answered 53 98%

DISCUSSION:
Despite the fact that there is no specific
antidode for nsaids poisoning. 2% of
Answered community pharmacy staffs who are
pharmacist responded that acetyl cystine is
Not used to treat NSAIDs overdose. Patients who
An- experience severe acidosis and considerable
swered toxicity may need to get supportive care with
intravenous sodium bicarbonate.
TABLE 10:Conditions in which NSAIDs are not prescribed
n=55
OPTIONS FREQUENCY PERCENTAGE
Kidney failure 21 38%
Heart failure 19 34%
Rheumatoid 10 18%
arthritis
Menstruation 5 9%

DISCUSSION:
34% of the community pharmacy staffs
Kidney Failure mentioned that NSAIDs can be taken by
Heart Failure heart failure patients, demonstrating
Rheumatoid their lack of knowledge and 38% of the
Arthritis staffs stated that NSAIDs can be given
Menstruation to kidney disease patients which may
increase the risk factor if taken without
prescription.
TABLE 11: Commonly dispensed drug along with NSAIDs
n=55

OPTIONS FREQUENCY PERCENTAGE

PPIs 33 60%
H2 Blockers 12 22%
Only NSAIDs 10 18%

DISCUSSION:
Proton pump inhibitors are the
PPIs
most common (70%) dispensed
H2 Blockers drug along with NSAIDs to
only NSAIDs reduce NSAIDs induced
gastrointestinal adverse events.
TABLE 12: Adverse effects of taking NSAIDs in pregnancy womens
n=55

OPTIONS FREQUENCY PERCENTAGE

Miscarriage 30 50%
Kidney damage in 8 13%
unborn
Affects mother 17 30%

DISCUSSION:
Miscarriage
Contrary to some studies, using NSAIDs
kidney Damage (ibuprofen,naproxen,aspirin & celecoxib)
in unborn in the first trimester of pregnancy may
raise the risk of miscarriage and taking
Affects mother them after 20 weeks of pregnancy may
result in a rare but serious kidney disease
in the unborn
TABLE 13: community pharmacies sold NSAIDs as OTC
n=55

OPTIONS FREQUENCY PERCENTAGE

Yes 55 100%
No 0 0%

DISCUSSION:
NSAIDs are the most widely used OTC medications
world wide. Ibuprofen and paracetomol, which are
available over the counter from pharmacies can treat
acute pain. The use of over the counter pain killlers
Yes for the treatment of mild to moderate pain has been
No approved. The recommended maximum daily dose
should not be exceeded and they should not be used
for more than few days consequently. Pain killers
may lead to concern and in few cases have adverse
outcomes.
TABLE 14: Highly taking NSAIDs age group
n=55

OPTIONS FREQUENCY PERCENTAGE

5-15 years 0 0%
15-30 years 8 14%
30-50 years 43 76%
>50 years 5 9%

DISCUSSION:
According to this survey 30 to 50 age group of
people who can buy NSAIDs over the counter
5-15 Years is higher than that of other age groups. NSAIDs
15-30 Years should be used with extreme caution by older
30-50 Years persons. As people age , their side effects are
>50 Years more likely to be harmful. The risk of stomach,
small bowl ,or colon bleeding is one of the
serious and other fatal side effects of NSAIDs
 CONCLUSION

 The study was carried out by a Validated self-Questionnaire.

 We acquire knowledge about NSAIDs and its current usage in the community
pharmacies.
 Dispensing practices of NSAIDs in the community pharmacy were assessed.
 We created an awareness on misuse of OTC NSAIDs as self medication practice by
implementing NSAIDs information brochure in community pharmacies using
Pamphlet and QR code Scanner.
 This study shows that the need of pharmacists in the community pharmacy for
proper dispensing and counseling of NSAIDs play an important role to avoid
unwanted health complications among public as they are readily available as OTC.
 Misuse of NSAIDs in elderly people for joint and muscle pains should be
monitored cautiously due to their comorbid conditions and in addition NSAIDs
must be dispensed along with PPIs or H2 Blockers to reduce its side effects.
 Community pharmacists should mostly prefer precription NSAIDs than OTC
NSAIDs.
 FUTURE OUTLOOK

Using our expertise and efforts, we developed a QR code scanner to educate the
general public and community pharmacies about NSAIDs. We believe that the QR
code Scanner approach may able to reduce the adverse outcomes and improper use of
NSAIDs and also distributing them NSAIDs information pamphlets could decrease the
widespread use of NSAIDs self-medication practice.

We believe that patient counseling at all the community pharmacies may assist to
prevent the overuse of NSAIDs ,which according to our survey,0% of community
pharmacies deliver patients counseling.

We think that the government of India ought to implement patient counseling for a
minimum of thirty seconds in every community pharmacy. This will assist with
tackling the overuse of over the counter drugs NSAIDs and also other OTC drugs
among wider population , as well as possibly reducing chronic illness in public thus
improving the healthcare system.
QR Code Scanner for NSAIDs information
Implementing Pamphlets and QR code Scanner in
Community Pharmacies.
 REFERENCE

1. Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) [Updated

2022 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022 Jan.
2.Shah S, Mehta V. Controversies and advances in non-steroidal anti-inflammatory
drug (NSAIDs) analgesia in chronic pain management. Postgraduate medical journal.
2012 Feb 1;88(1036):73-8.
3. Fendrick AM, Pan DE, Johnson GE. OTC analgesics and drug interactions: clinical
implications. Osteopathic medicine and primary care. 2008 Dec;2(1):1-7.
4. Bidaut-Russell M, Gabriel SE. Adverse gastrointestinal effects of NSAIDs:
consequences and costs. Best Practice & Research Clinical Gastroenterology. 2001
Oct
1;15(5):739-53.
5. James DS. The multisystem adverse effects of NSAID therapy. The Journal of the
American Osteopathic Association. 1999 Nov 1;99(11):1-7.
THANK
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