HOW TO PRACTICE

O.T.C

Presented byKhaled Sobhy

Aim Of These LECTURES

“JUST PUT ME ON THE ROAD”

*How to deal with different symptoms

*When to give OTC drugs

*Practical example of OTC drugs in Egypt

*Examples of OTC prescriptions

GIT symptoms

blood

cancer

GIT surgery

Pregnancy

< 3mexclude

Other symptoms locationdiagnosis

1-Abdominal pain

Abdominal pain

Menstrual pain

Renal stone & renal infection

Gastroenteritis & appendicitis

Gastritis & gall bladder disorderUpper side

Fever & vomiting

Back pain & urine problem

Expect menses

Gas production & spasm Spastic colon

yes

No

yes

yes

yes

yes

No

No

No

NoantispasmodicOnly spasm

Gall bladder

Right sideFatty meal

Gastritis& GERD

Central painMilk & antacidNSAID & Cs

Upper abdomen

Renal stone

No feverDark pinkish colour

Flow interruption

U.T.I

FeverPain on urinatin

Frequency

1-Back pain & urine problem

appendicitis

Tender palpitationRight side

gastroenteritis

diarrhoea left side

2-Vomiting & fever

Gastritis

-Avoid Acidic food or hyperosmolar food “orange, bear, Milk, tomato”

-Avoid smoking, tea, coffee, and stress

-avoid NSIAD or Cs use without physician contact

treatment

1 -antacids

2 -H2 blockers

3 -proton pump inhibitors

They neutralize acids which already produced (symptomatic treatment)

It includes Na+, mg++, Al+3 salts, may be combined It includes Na+, mg++, Al+3 salts, may be combined with with Simethicone (Anti flatulence)

-Tablets should be chewed thoroughly to obtain optimum effects .

- they should be taken after meals to neutralize gastric

acid secretion

Antacids

They neutralize acids which already produced (symptomatic treatment)

It includes Na+, mg++, Al+3 salts, may be combined It includes Na+, mg++, Al+3 salts, may be combined with with Simethicone (Anti flatulence)

-Tablets should be chewed thoroughly to obtain optimum effects .

- they should be taken after meals to neutralize gastric

acid secretion

antacids

antacids

Prevent about 70% of acid production.

Examples-:

Ranitidine150 mg twice daily at breakfast and bed time

300 mg at bed time

Famotidine20 mg twice daily at breakfast and bed time

40 mg at bed time

H2 Blockers

ranitidine

famotidine

-They inhibit > 90% of gastric acid secretion

-PPI are taken once daily before breakfast

-PPI should not be use more than 2 months without separation

Examples-: ex:- Omeprazoleex:- Pantoprazole

Proton pump inhibitors

omeprazole

pantoprazole

Alucal chewable tabاألكل 2 – 1 بعد تمضغ يوميا 3قرص مرات

Zantac 150mgالنوم وقبل األكل قبل صباحا* قرص

Omepral 20 mgيوميا الريق على صباحا* قرص

Example of OTC prescription:

antispasmodics

1 -Atropine like derivatives: EX 1 :- Hyoscine ( Buscopan).

EX 2: Dicyclomine ( Spasmorest )

EX 3: Tiemonium ( Visceralgine )

EX4: Clidinium Br. ( Librax )

2-Papaverine like derivatives:

EX 1: Drotaverine ( Do-Spa) EX 2: Papaverine ( Vasorin )®

Atropine like derivatives

papaverine like derivatives

Example of OTC prescription:

Buscupan Tab

األكل 3قرص قبل مرات

vomiting

Motion sickness

Drug induced vomiting

Fever, abdominal pain

on traveling long distance

On starting drug use

Give anti emetic

yes

No

yes

yes

No

No

Gastroenteritis & appendicitis

*It refers to nausea & vomiting on long distance travel .

-Avoid reading in cars & ships .

-Shift the field of vision to objects out side vehicles .

Motion sickness

Prevention:

Treatment of motion sickness

Antihistaminic drugs as: Cyclizine (Emetrex) ®

Dimenhydrinate (Draminex)®

Meclozine (Navoproxine) ®

Side effects -:

Sedation & Drowsiness

Drugs should be taken 30 min before trip.

antihistaminic

Example of OTC prescriptionmotion sickness

Draminex tabاللزوم 1-2 عند قرص

Anti emetics

3-Metoclopramide

22--DompridoneDompridone::

Not show CNS side effects of metoclopramide.

11--AntihistaminicAntihistaminic: :

domperidonemetoclopramide

Example of OTC prescription for vomiting

primepran tabاللزوم 1-2 عند قرص

diarrhea

dysentery

GastroenteritisFever & vomiting

Tensmus & offensive odour, Pain on defecation& small quantity stool

Gas production & spasm May constipation Spastic colon

yes

Noyes

yesNo

NoDrug induced

Dietary induced

On starting drug use

On changing milk type

Give anti diarrheal drug

yesNo

yes

No

Parasite infection is characterized by diarrhea, abdominal cramps, anorexia, and offensive odour,

pain on defecation. So treated by antiprotozoal as:

Metronidazole

Diloxanide

Secindazole

Tibindazole

Dysentery

Secindazole Diloxanide

Tibindazole

metronidazole

Example of OTC prescription

Furazole suspاالكل 3مل 10 - 5 بعد يوميا* مرات

Fladazole tab

و 2 الفطار بعد العشاء 2قرص بعد قرص

Antidiarrheal drugs

1-antibacterial agent

2-adsorbent

3-drugs inhibit GIT motility

4-Rehydrin solution

Nifuroxazid& Sulfa drugs

if fear of infection

1-antibacterial agent

Acts by adsorption of bacteria, toxin & noxious materials e.g.:

EX 1 : Kaolin & pectin “kaopectate”

2-adsorbent

3- drugs inhibit motility

EX 1 : Loperamide (lmodium)® EX 2 : Disphenoxylate (Lomotil)®

Avoid using alone in fear of infection

-Not affect diarrhea frequency or duration but only replace electrolyte loss preventing possible dehydration.

-It contains Na, K, Ca, Mg, citrate, carbohydrate, Cl--,

HCO3 & Zn e.g. : (Rehydran N, Rehydran Zn)®

4-rehydrin

Example of OTC prescription

Kapect susp

االكل 3مل 10 - 5 قبل يوميا* مرات ِAntinal susp

االكل 3مل 10 - 5 قبل يوميا* مرات

constipation

Spastic colon

Drug induced

Rectal pain, itching, prolapse

Gas production ,spasm, may diarrhea

On starting drug use

Give laxative

yes

No

yes

yes

No

No

hemorrhoid

Prevention of constipation

-increase fluid intake .

-increase dietary fibers. food contains low fibers lead to constipation. e.g. (ice cream– cheese)

-increase exercise: exercise promotes bowel motion .

-returning defactory habits

-Avoid tea , coffee

Laxatives

1-Mineral oil (paraffin oil )

Impair absorption of fat soluble vitamins, Late onset

2-osmotic laxatives (lactulose)Watery bowel movement, so risk of dehydration & diarrhea

3-stimulant laxatives (castor oil)

rapid onset specially suppositories

osmotic laxatives

stimulant laxatives

Lactulose syrup

االكل قبل كبيرة يوميا 3ملعقة مراتPicolax drops

اللزوم 15 عند ماء كوب نصف على نقطة

Example of OTC prescription