HOW TO PRACTICE O.T.C Lecture three
Nov 24, 2014
HOW TO PRACTICE
O.T.C
Lecture three
foot
gout
corns or callus
Tinea pedis
Excessive walking or standingRequire rest
Redness, bad odour, itching,maceration inbetween toes (4-5)
Lesion in foot sole with black dot in center, painful on walking on it
Big toe or ankle are suddenly red , swollen, and painful
Hard lesion on bone surface oncompression sites of foot
Only pain on foot
Planter warts
yes
No
yes
yes
yes
yes
No
No
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
Plantar wartscorns
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 paintلمدة ومساًء صباحا من 21مس رقيقة بطبقة المحيط الجزًء حماية مع يوم
فازلين
Oral problems
Mouth thrush
gingivitis
Herpes simplexVesicle around the lip with history of common cold or low immunity
Painful ulcer in mouth with white covering membrane
White patches on tongue or lip or tongue disfiguring
red painful edamatous gingiva
Only pain on foot
oral sore
yes
No
yes
yes
yes
No
No
No
lips are cracked & dry yes
chapped lips
treament for Gingivitis :
Antiseptic mouth washChlorohexidine, povidone, citrimide, benzdiamine
Antibiotic or antibacterial :
Amoxicillin, metronidazole, tetracycline
AnalgesicIbuprofen, ketoprofen
treament for Gingivitis :
treament for Gingivitis :
Antiviral drug ( acyclovir)
Analgesic
treament for herpes simplex :
treament for Gingivitis :
Oral antifungal
Miconazole, nystatin
treament for mouth thrush
treament for Gingivitis :
Antiseptic mouth wash
Analgesic or anesthetic
treament for mouth sore :
.: (Jogel) ® -----> “Lidocaine + Jojob as antibacterial” (Oracure)® -----> “Lidocaine + cetylpyridinium as
Antiseptic” (Salvix – L)® -----> lignocaine + anthraqinone +SA
dental pain
Dental decay
dental abcess
physicianLoose tooth
Continous pain even on touch, bite, cold, or hot, dental fracture
Dental pain disappear in seconds cold, hot, sweaty things
Dental pain with facial swelling at jaw line, pus, fever
Give local anesthetic or analgesic
Dental hypersensitivity
yes
No
yes
yes
yes
No
No
No
Ear problems
Pus discharge
fever
sudden hear loss
Drum rupture exclude
Ear problems
otitis media
otomycosisAntifungal solution
Gradual decrease in hearingFeeling of ear fullness
Pain accompany common cold symptoms
pruritus, white scaling, and swelling
Wax impactionyes
yes
yes
No
No
No
otitis externayes
Pain on moving auricle, pain increase on chewing
NoGive local ear analgesic
Wax impaction
Ear analgesic
Eye problems
Eye redness
stye
Occular discomfort ,itching desire, eye awareness
redness
Inflammation or infectionof the sebaceous gland of the eye lash
Dry eyeyes
yes
yes
No
No
No belpharitis
yesInflammation of eye lid
No
Tearing, mild swelling below eyes & itching, allergic history
allergic conjunctivitisyes
Red eye treatment
•Ophthalamic vasoconstrictor “ sympathomimetic •Naphazoline (Prisoline) ®
•Tetrahydrozoline (Visine)®
Dry eye
Allergic conjunctivitis
1-Ophthalamic vasoconstrictor “ sympathomimetic
2-antihistaminic
loratidine
Fexofenadine
citrizine
Antihistaminic drugs
rhinorrhea
allergic rhinitis
Sneezing, family infection yellowish discharge, onset less 1
week, fever
Chronic, itching, no fever, clear watery discharge, allergic history
Common clodyes
yes
No
No
No
sinusitisyesHeadache, face pain around
sinus area, yellowish discharge, sinus congestion
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 : “No 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 “sublingual: ” 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
االكل 3مل 10 بعد مرات
headache
sinusitis
migraine
Eye problemEye pain, blurred vision
Sinus congestion, pain in sinus areas
Throbbing pain in one side of headworsen with normal movements,
Give analgesicLike fever
yes
No yes
yesNo
No
Prevention of headache
1 -avoid high amount of caffee, tea, ice cream, chocolate
2-avoid stress and avoid change normal routine as “dieting, traveling, sleeping”
Treatment of migraine
Mild cases:
Acetaminophen plus metoclopramide
Sever cases:
Ergotamine combinationAvoid use in hypertensive patients or pregnant
Paracetamol + metoclopramide
ergotamine
Example of OTC prescription for migraine
Migracid tab
اللزوم 1-2 عند قرص
insomnia
Drug induced
Physician contactPsychological causes or sever pain
On starting drug use
Give first generation antihistaminicor natural sedating product
yes
No
yes
No
Prevention of insomnia “sleep 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
النوم 2 – 1 قبل يوميا كبسوالتAvil retard tab
النو قبل يوميا م قرص
Fatigue & weakness
anemia
hyperthyroidism
Common coldFever & rhinorhea, sneezing
Recurrent Hypotension, palpitation, pale skin
Unintended potent weight loss, good appetite, sweating, tachycardia, nervousness
Overworking or under eating is the cause
yes
Noyes
yesNo
No
Drug inducedOn starting drug useyes
Treatment: “for 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
multivitamins1 -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
الغداًء بعد يوميا كبسولة
Back pain
Renal stone or infection
Sciatica (disc)
physicianAccident, fall, injury
Urine problem
Numbness or pain in one leg
Give analgesic, muscle relaxant
yes
Noyes
yesNo
NoOsteoarthritis or
rheumatic arthritisChronic pain, inflammation,
stiffness In both sides of joints
yes
Treatment of back pain
1 -analgesic:acetaminophen, Ibuprofen, ketoprofen or aspirin, declofenac, piroxicam,celecoxib, nimasulide, indomethacin
2-muscle relaxntEX 1 :- Baclofen(Baclofen).® EX 2 :- Chlozoxazone (Myolgine) .®
EX 3:- Orphenadrine (Norflex).®
3-counter irritantMask the painNot applied to wound or damaged skin
AntiCox 2
indomethacin
Muscle relaxant and analgesic
Example of OTC prescription:
myolgin cap
االكل 3كبسولة بعد مراتOlfen amp
يوميا عضل حقنة
cough
Physician contact
Interfere with sleep or activity or painful
Respiratory infectionFever
Asthmatic patient
dry cough
Give antitussive
yes
Noyes
yesNo
No
Give mucolytic or expectorant
Productive
yes
cough suppressant + expectorant
yes
No
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 & cough suppressant
Guaifensin
Ammonium cl
Tr. Ipeca
Tr. Squill
KI
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
االكل بعد كبيرة مرات 3معلقة
Example of OTC prescription for dry cough:
sinecode syrup
االكل بعد كبيرة مرات 3معلقة
Example of OTC prescription forproductive interfere with sleep
Toplexil syrup
االكل بعد كبيرة مرات 3معلقة