DISPENSING I LAB - Exercise 3: Common Conditions and Minor Ailments

Minor Ailments

• Defined as medical conditions that will resolve on their own and can be reasonably self-diagnosed and self-managed with over-the-counter medications

• Patients often perceive that these symptoms can be self-managed with OTC medications

Common Cold

Common Cold or Allergic Rhinitis (Hay Fever)?

Etiology

• Due to viral infection obtained through direct contact or transmission

Allergic Rhinitis

Common Cold or Allergic Rhinitis (Hay Fever)?

Etiology

• Triggered by pollen, molds, dust, and other allergens that may lead to a hypersensitivity reaction

Common Cold

Common Cold or Allergic Rhinitis (Hay Fever)?

Pathophysiology

• Virus invades the mucosal membrane lining the nose, then binds to human ICAM-1.

• The immune system responds to this by releasing inflammatory mediators

Allergic Rhinitis

Common Cold or Allergic Rhinitis (Hay Fever)?

Pathophysiology

• Inflammation of mucosal membrane due to complex interaction of inflammatory mediators triggered by IgE

Common Cold

Common Cold or Allergic Rhinitis (Hay Fever)?

Clinical Presentation

• Nasal stuffiness or drainage

• Sore or scratchy throat

Allergic Rhinitis (Hay Fever)

Common Cold or Allergic Rhinitis (Hay Fever)?

Clinical Presentation

• Nasal congestion

• Clear runny nose

• Nose and eye itching

Common Cold

Common Cold or Allergic Rhinitis (Hay Fever)?

Pharmacotherapy

• No cure (self-limiting)

Non-Drug Treatment

• Get rest

• Drinking plenty of fluids

• Gargling with warm saltwater

Allergic Rhinitis (Hay Fever)

Common Cold or Allergic Rhinitis (Hay Fever)?

Pharmacotherapy

• Antihistamines

• Decongestants

Non-Drug Treatment

• Controlling dust and dust mites, animal dander and other pet allergens, and indoor molds

• Avoiding outdoor pollens

Vasoconstrictors

Oral Decongestants = _____

Oral Decongestants

• Narrow the blood vessels

  • Constricted blood vessels result in higher blood pressure

Rhinitis Medicamentosa

• Also known as Rebound Congestion

• A condition characterized by nasal congestion without rhinorrhea or sneezing that is triggered by the use of topical decongestants for more than 6 days

  • Lalo nang hindi makakahinga if more than 6 days

Red Flags for Allergies

• When to refer to a Physician?

  • Condition seriously impairs daily activities and do not improve with medication for 7 days

  • Chest tightness

  • Painful sinuses and ear

  • Painful and redder eyes with colored and sticky discharge

  • Wheezing and shortness of breath

Chronic Cough

Cough that lasts for over 4 weeks

Acute Cough

• Any cough lasting less than a month

• Often caused by a viral infection of the upper or lower respiratory tract

Non-Productive Cough

• No presence of phlegm

• Antitussives/Cough Suppressants

  • Butamirate citrate

  • Codein

  • Dextromethorphan

• Demulcents

  • Strepsils

  • Bactidol

Productive Cough

• Presence of phlegm

• Mucolytics

  • Ambroxol

  • Bromhexine

  • Carbocisteine

• Expectorants

  • Guaifenesin

Antitussives/Cough Suppressants

Direct suppression of cough reflex at the cough center of the medulla

• Butamirate citrate

• Codeine

• Dextromethorphan

Mucolytics

Reduce thickness or viscosity of bronchial secretions → mucus becomes thinner and can be removed by coughing

• Ambroxol

• Bromhexine

• Carbocisteine

Demulcents

Relieve pain and inflammation of the mucus membranes

• Strepsils

• Bactidol

Expectorant

Lubricate the airway which help loosen up the mucus → makes it easier to cough up mucus and clear the throat (expel phlegm)

• Guaifenesin

Counseling Tips for Cough

• Advise the patient to:

  • Avoid alcohol consumption when taking these medications

  • Neither drive ore operate machinery

  • Not to be used for more than 5 days as rebound congestion may occur

ACE (Angiotensin Converting Enzyme)

A class of antihypertensives that can cause cough

• drugs that end in “-pril”;

  • Captopril

  • Enalapril

Prevents the degradation of Bradykinin (causes vasodilation and increased risk of coughing)

Bradykinin

• Nonapeptide messenger which causes vasodilation and increased risk of coughing

• Causes coughing and vaasodilation

Red Flags for Cough

• When to refer to a Physician?

  • Cough persisting, accompanied by blood or purulent phlegm

  • Cough for more than 3 weeks without relief from medicines

  • Cough with difficulty of breathing

  • Distressing cough in the elderly

  • Persistent nocturnal cough

  • Shortness of breath/wheezing

  • Whooping cough (sumisipol)

Constipation

• Occurs when bowel movements become less frequent and stools become difficult to pass

• Medical Causes

  • Crohn’s disease, stress, hyperthyroidism

• Drug Causes

  • Overuse of laxatives (your body becomes dependent on the laxative), painkillers, narcotics, vitamins, antidepressant drugs

Irritant and Stimulants

Type of Laxatives that:

• MOA

  • Irritate gastrointestinal lining causing an increase in muscle contractions in the intestinal wall

• Time of Onset

  • 6 to 12 hours

Bulk Laxatives

Type of Laxatives that:

• MOA

  • Absorb water and cause softening of stool mass

• Time of Onset

  • 12 to 24 hours up to 3 days

Saline and Osmotic Laxatives

Type of Laxatives that:

• MOA

  • Draw large amounts of water into the intestines, increasing intestinal pressure, then stimulates bowel movement

• Time of Onset

  • 1/2 to 3 hours

Stool Softeners

Type of Laxatives that:

• MOA

  • Mixes fatty and water-soluble substances in the stool, allowing the fecal mass to soften

• Time of Onset

  • 12 to 72 hours

Lubricant Laxatives

Type of Laxatives that:

• MOA

  • Coats stool then prevent absorption of fecal water in the colon

• Time of Onset

  • 6 to 8 hours

Chloride Channel Activators

Type of Laxatives that:

• MOA

  • Increases secretion of intestinal fluids that help in passing of stool

• Time of Onset

  • 3 hours

Aluminum

Drug that contains _____ causes constipation

Magnesium

Drug that contains _____ causes diarrhea

Laxative-Induced Constipation

• Condition resulting from abuse of laxatives

  • The intestines lose muscle and nerve response

• This is often reversible, but recovery may be a slow process

Counseling Tips for Constipation

• Advice the patient to:

  • Avoid foods such as tea, coffee, chocolate, unripe bananas, cheese, and white rice

  • Drink plenty of fluids

  • High Fiber intake (25-30g per day)

  • Stay active (3-4 times a week)

  • Do not ignore the urge to defacate

Red Flags for Constipation

• When to refer to a Physician?

  • Symptoms do not improve after a week with medications or lifestyle modification

  • Blood in stools

  • Unexplained weight loss

  • Regularly constipated for a long time

  • Persistent change in bowel habits (ex. laging umaga, naging gabi)

  • Tired feeling

  • Fecal impaction/obstruction

Diarrhea

Occurs when bowel movements (stool) become loose and watery

Acute Diarrhea

• Most common type of Diarrhea

• Lasts one to two days / less than 2 weeks

Chronic Diarrhea

Diarrhea that lasts for more than four weeks or comes and goes regularly over a long period of time.

Dehydration

Most dangerous complications of diarrhea alongside electrolyte imbalance which may lead to more fatal issues like kidney failure and organ damage

Counseling Tips for Diarrhea

• Advice the patient to:

  • Some drugs may cause drowsiness/sedation (do not drive or operate machinery)

  • Avoid dependence

  • Hand hygiene

  • Food and safety practices

  • Drink lots of fluids

  • Avoid greasy, fatty, high fiber foods

Oral Rehydration Therapy

Primary treatment for Diarrhea

Loperamide

• Most commonly used antidiarrheal

• Dosing

  • Initially, 4 mg, followed by 2 mg after each loose stool

  • Max dose: 8 (no prescription) to 16 (with prescription) mg/day

Nausea and Vomiting

• Causes:

  • For children: viral infection, food poisoning, milk allergy, and overeating

  • For adults: motion sickness and other medications

• Complications:

  • Aspiration of vomitus into the air passage and lungs, electrolyte and water loss, damage to the tooth enamel, and tearing of the esophageal mucosa.

1st Generation Antihistamines

• Meclizine

• Cyclizine (taken 1 hour before the travel tot)

• Dimenhydrinate

• Diphenhydramine

Reye’s Syndrome

• Causes swelling in the liver and brain

• Can lead to death

• A rare but serious condition

• Most often affects children and teenagers recovering from a viral infection

• Linked with Aspirin (DON’T USE TO CHILDREN WITH FLU)

Counseling Tips for Fever

• Advice the patient to:

  • Cold bath or cold compress (except children)

  • Wear light clothing and keep beddings light

  • Rehydration

  • Wash hands with soap and water

  • Avoid sharing cups, water bottles, cutleries

Red Flags for Fever

• When to refer to a Physician?

  • Infants less than 3 months

  • Fever lasts longer than 3 days

  • Signs of dehydration

  • Fever is accompanied by: severe headache, skin rash, sensitivity to light, stiff neck, chest pain, confusion, persistent vomiting, and convulsions/seizures

Counseling Tips for Pain

• Advice the patient to:

  • Protect muscle from injury

  • Restrict activity for up to 72 hours

  • Ice/cool the area to reduce swelling

  • Compress with an elastic bandage

  • Elevate the affected limb to reduce swelling

Red Flags for Pain

• When to refer to a Physician?

  • Pain is severe or unexplained

  • Pain persists for more than 3 days, despite treatment

  • Redness and swelling around the affected area

  • Presence of rashes

Dry Eyes (Xerophthalmia)

• Lubrication in eyes decreases

• Clinical Presentation:

  • Stinging sensation, stringy mucus in the eyes, sensitivity to light, eye redness, watery eyes, and blurred vision or eye fatigue

• Possible Causes:

  • Aging, certain medical conditions or medications, tear gland or eyelid problems, eye strain, or tear evaporation

• Treatment:

  • OTC Eyedrops (for occasional/mild dry eyes)

  • Corticosteroids/Antibiotics (for inflammation)

  • Cholinergic Drugs (to increase tear production)

Glaucoma

• A group of eye conditions linked to a buildup of intraocular pressure, which can damage the optic nerve (can cause blindness), the health of which is vital for good vision

• Progressive

Allergic Conjunctivitis

• Often called “pink eye“

• An inflammation of the conjunctiva caused by exposure to allergy-causing substances, such as mold, pollen, and dust.

• May be relieved by antihistamines

Corneal Edema

• Also called “corneal swelling”

• A buildup of fluid in the cornea manifested by blurred vision or halos around light, blistering, or eye pain

• Can be temporarily reduced with the use of hypertonic saline drops or ointment

Counseling Tips for Dry Eyes

• Advice the patient to:

  • Stay away from dry, warm rooms

  • Use humidifier to add moisture to air

  • Take breaks from long task that requires visual concentration

  • Avoid using contact lenses for long time

  • Use artificial tears or eye lubricants

  • Apply warm compress on eyes

Red Flags for Dry Eyes

• When to refer to a Physician?

  • Condition worsens despite self-care

  • Physical injury to the eyes

  • Ophthalmic disorders (Glaucoma, Allergic conjunctivitis, Corneal edema, etc.)

  • Red eyes while wearing contact lenses

  • Presence of sticky pus in the eyes

  • Severe headache and changes in vision

Sleep Aid

• Any medications that help a person sleep

  • Valerian Root

  • Melatonin

  • Benadryl

Stimulants

• Substances that affect the central nervous system and body, leading to increased alertness and difficulty in getting to sleep

  • Caffeine

  • Moderate intake is 8 oz cups of coffee (250 mg) per day

Restless Leg Syndrome

Unpleasant “creeping” sensation associated with aches and pains throughout the legs that makes it difficult to sleep.

Narcolepsy

A sleeping disorder that involves excessive, uncontrollable, daytime sleepiness, which is caused by dysfunction of the brain mechanism that causes sleep and wake.

Cardiac Rhythm Disorder

Sleeping disorder often caused by jet lag, shift work sleeping problems, or delayed sleep phase disorder.

Counseling Tips for Sleeping Aids

• Advice the patient to:

  • Observe adequate sleep, following the sleep-wake cycle (standard schedule)

  • Do not use gadgets at least 1 hour before going to bed

  • Avoid excessive eating prior to sleeping

  • Avoid taking stimulants (caffeine, alcohol)

  • Simulate sleeping conditions (dark and cold)

Counseling Tips for Stimulants

• Advice the patient to:

  • Avoid taking it at bedtime

  • Some stimulants may increase blood pressure, blood sugar, etc. (may cause headache)

  • Follow the suggested daily dietary guidance set by regulatory agencies

Vaccines

A suspension of attenuated live or killed microorganisms or fractions administered to induce immunity and prevent infectious diseases.

Herd Immunity

Happens when enough of the community is immune to a particular disease, either because of vaccination or natural infection, that it makes it less likely to spread from one person to another.

Between +2C to +8C

Vaccine Conditions for vaccines requiring Refrigeration

Between -50C to -15C

Vaccine Conditions for vaccines requiring Freezing