Community Pharmacy Practice

Presenters: Judy Riffee Art Wharton

Introduction
Filling a prescription: This is the most common and important duty of a technician Transcribing doctors orders: can be a very frustrating experience Clarification is needed at times-for patient safety Pharmacist makes the call to the prescriber for any clarification

Learning Objectives
Explain the retail pharmacy practice setting. Describe the two main types of retail pharmacies. List the various staff positions in retail pharmacies. Describe the typical work environment of a retail pharmacy. Discuss the two agencies that regulate retail pharmacy practice. List the legal requirements of a prescription medication order. Describe the different ways prescriptions arrive at a retail pharmacy.

Learning Objectives
List the steps required for a prescription to be filled. Discuss the various job duties of technicians in retail pharmacies. Discuss the importance of confidentiality for personal health information. Differentiate between inpatient and outpatient information requirements. List the types of automated machines used in filling prescriptions.

Learning Objectives
Describe why over-the-counter (OTC) medications are popular. List considerations concerning the use of OTC drugs. List the three categories used by the Food and Drug Administration for OTC drugs. Describe Food and Drug Administration regulations concerning the manufacturing of OTC drugs. Explain how legend drugs become OTC drugs. Describe the various types of conditions that OTC medicines treat.

Retail or Community Settings

Commonly referred to as community-based pharmacies Privately owned, chain, or franchise pharmacies Known as community pharmacies because they serve the local community in which they are located Face-to-face interactions between the pharmacist, technicians, and patients Community pharmacy staff is usually more accessible to the general public

Community Settings-Independents

An independent pharmacy
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Community Pharmacy-Independents

Independent Ethnic Pharmacy

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Community Pharmacy-Independents
Most are privately owned and small in size Also thought of as neighborhood pharmacy Has the flexibility to provide more personalized services to its customers Allows pharmacy staff to become better acquainted with their patients

Community Pharmacy-Independents
Some independents can provide: Compounded medications Home healthcare products Surgical supplies Delivery service Patient charge accounts

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Community PharmacyCorporations/Chains/Franchises

Corporate community pharmacy

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Community PharmacyCorporations/Chains/Franchises
Consist of branches, or chains, of more than one store Generally have a higher volume of prescriptions Often larger and faster-paced

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Community PharmacyCorporations/Chains/Franchises
Can be further categorized: Mass-merchandise stores (Wal-Mart) Chain drugstores (CVS, Walgreens,Rite-Aid) Grocery store pharmacies (Krogers,Albertsons, Publix) May offer other career opportunities to their staff, including retail management and training opportunities

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Retail Pharmacy-Chains/Franchises

Mass-merchandise stores
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Retail Pharmacy-Staff Positions

Certified Pharmacy Technician certified to assist pharmacists in providing pharmaceutical care; however, is not permitted to dispense medication or counsel Pharmacy clerk/cashier noncertified/nonlicensed individual authorized only to assist with nonpharmacy-related tasks, such as working the cash register

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Retail Pharmacy-Staff Positions

Pharmacy manager almost always a pharmacist; individual appointed to supervise all aspects of the daily pharmacy operations. May be at the B.S. or Pharm.D. degree level.

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Retail Pharmacy-Staff Positions

Pharmacist in charge (PIC) individual designated on the State Board of Pharmacy Record as the primary, onsite pharmacist; responsible for ensuring that the pharmacy operates in accordance with state laws and regulations Registered pharmacist (RPh) individual who is licensed to practice pharmacy in a specific state-may be at the B.S. or Pharm.D. degree level Store manager an individual appointed to supervise all aspects of the daily store operations, including the pharmacy department

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Eight Areas of a Retail Pharmacy

Over-the-counter/front end provides customers with various medications, devices, and aids that can be purchased without a prescription

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Eight Areas of a Retail Pharmacy

Behind-the-counter OTCmedications and devices that, although available without a prescription, are kept behind the pharmacy counter

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Eight Areas of a Retail Pharmacy

Prescription drop-off where patients can turn in their prescriptions to be filled Pharmacy workstations the area in which new prescriptions and refill requests are entered into the computer system, insurance claims are billed, and prescription labels/monographs are produced

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Eight Areas of a Retail Pharmacy

Pharmacy counter where oral dosage forms are counted, liquids are measured, and compounds can be prepared Storage Common storage areas include: medication storage, including shelves, cabinets, and a refrigerator/freezer; filled prescriptions; dispensing supplies, such as vials, bottles, labels, and bags; and prescription records

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Eight Areas of a Retail Pharmacy

Pick-up area area designated for prescription pick-up May be a drive-thru area Counseling area mandatory area designated for patient counseling

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State Board of Pharmacy (SBOP)

Agency that registers and regulates retail pharmacy facilities, pharmacists, and pharmacy technicians Pharmacy practice is governed at the state level The pharmaceutical industry is governed at the national level Oversees compliance with the states pharmacy practice act, and may do the following: Administer unannounced site inspections-in FL under BOH Require operational changes Suspend or revoke the license of a pharmacy, pharmacist, or pharmacy technician

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10 basic elements of a Prescription

Prescription Information: Outpatient Ensure correct information is listed on prescription Allergy information for new patient needed

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10 basic elements of a Prescription

What does the abbreviation NKDA stand for? No known drug allergies Antibiotics in the penicillin family are the most common cause of drug allergies. Other common drug allergies are caused by sulfa drugs, barbiturates, insulins from animal sources, anticonvulsants, local anesthetics, and iodine.

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10 basic elements of a Prescription

Patient Information Name Phone number and address Insurance information, if applicable Age or date of birth

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10 basic elements of a Prescription

Important Information Required on the Prescription Prescribers Information Name Phone number and address Providers license number Providers DEA number, if applicable (Scheduled Drugs)

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10 basic elements of a Prescription

Important Information Required on the Prescription Prescription Information Name of & strength of medication- the name of the medication being prescribed and its strength, or the amount of active ingredient contained in manufactured prescription products Route- such as PO (by mouth) Dosage form- the specific dose, or measured amount, of medication being prescribed

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10 basic elements of a Prescription

Important Information Required on the Prescription Prescription Information-Continued Quantity-total quantity to be dispensed Sig- (Signa)-specific directions for the patient to follow, such as frequency of dosages, schedule of dosages, and additional instructions Refill information-the number of refills authorized by the prescriber, including zero

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10 basic elements of a Prescription

Important Information Required on the Prescription Prescription Information-Continued Providers signature-signaturethe prescription is not considered valid unless it is signed by the prescriber Date written- prescribedthe month, day, and year the prescription was written DAW-Brand necessary if brand name drug is desired Product selection permittedthe prescribers authorization for the patient to select a less expensive generic equivalent (if available) or the prescribers directive to dispense as written (no substitution permitted)

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Prescription Information: Outpatient

Medical record number or Plan number needed if patient is member of HMO DEA number is necessary for controlled substance Controlled drug written in ink or indelible pencil

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Prescription Information: Inpatient

Information required different from outpatient Doctors license and DEA number on file at hospital Dosing 24-hour period Doctor writes for daily dose Antibiotics normally have automatic stop date

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Prescription Information: Inpatient

Why do antibiotics have an automatic stop date? To be most effective, antibiotics are normally taken for the full duration necessary to control the infection being treated. After that, the medication should be stopped and not used again for some time, if possible. These practices together help to prevent the development of resistant bacteria.

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Processing a Prescription: Step-by-Step

Basic steps for filling a prescription: Taking in the prescription Translating the prescription Entering information in database Printing the label Filling the script Patient counseling

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Processing a Prescription: Step-by-Step

The first five steps are the usual responsibilities of a pharmacy technician. Patient counseling must be done by a registered pharmacist or pharmacist intern, not a pharmacy technician.

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Ways Prescriptions Arrive at a Retail Pharmacy

Prescriptions arrive in various ways: Written order Hand carried Faxed Called in

Internet -Some pharmacies allow e-mail or online prescription refill orders

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Ways Prescriptions Arrive at a Retail Pharmacy

Computer-generated prescriptions becoming more common May be provided to patients on discharge from hospitals or physicians office

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Translation of an Order
Look at whole order if difficult to decipher If in doubt, ask the pharmacist

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Asking for Assistance

When handwriting is poor, assistance is needed Filling scripts under pressure can lead to guessing

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Enter the Information into the Database: Outpatient

After doctors order is read, enter into computer Check computerized label against prescription after it is filled Two labels generated: one for the vial; other for back of original prescription Pharmacist initial needed on both labels

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Enter the Information into the Database: Inpatient

Pharmacists may enter new prescriptions in computer, rather than technicians Multiple orders on patient sent during stay Computers alert to drug interactions Pharmacist calls physician to change order Why does the pharmacist (rather than the pharmacy technician) often enter the prescription in an inpatient setting? The pharmacist must review all prescriptions as they come in, so it saves a step if he or she also enters the order into the system.

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Fill the Prescription

After label preparation, match with original order and fill Do not rely on memory when going to the shelf to pull a prescription. Always take a hard copy of the prescription for side-by-side comparison.

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Check the Label Against the Script

Label checked many times before it reaches patient Hold original script next to label to check for errors or discrepancies Look at names of drug, strength, dosage form, sig (directions)

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Pull the Correct Medication

Take label to shelf when getting medication from the shelf Label helps you not to forget or to avoid distraction Can compare label with information on the bottle

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Pull the Correct Medication

Why does an opened bottle of medicine need to be marked with an X? Some prescriptions can be filled using a full bottle of medicine. This practice saves the pharmacy technician from having to check whether the bottle has ever been opened. It also helps to flag the open bottle for a technician who needs to fill a new order requiring less than a full bottle.

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Count and Fill the Medication

Check label and script against bottle for accuracy Counting trays still used Digital counters and automated machines Baker Cells used in larger pharmacies A Baker Cell is an electronic dosage form-counting device. Each cell contains a bulk quantity of a different medication.

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Prescription Lids
Appropriate lid applied after medication is filled Problem for elderly patient: safety lid Elderly lose dexterity and strength Older patients may not want safety lids Can replace with snap-on lid-waiver normally needs to be signed

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Prescription Lids
Why are a few medicines, such as nitroglycerin, always dispensed without a safety cap? Nitroglycerin is used as an emergency treatment for people who are having chest pain. It might be very difficult for a person in that situation to quickly open a standard container.

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Apply the Label

Professionalism is needed when applying label Do not place torn or crooked label on bottle Label not to cover lot and expiration date on full bottle prescriptions Auxiliary labels must be easily read

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Apply the Label

Why is it important not to apply a torn label to a bottle of medicine, even if all the information is present and legible? A patient who sees a torn label could wonder whether important information has been lost. In addition, a torn or crooked label conveys the impression that the prescription has been filled carelessly.

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Apply the Label

Computer systems print label and information on one sheet Law requires certain information to be on label

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Technicians Initials
Technicians should initial all orders they fill Pharmacist gives final check-off and knows who filled it by initials Pharmacist can notify or ask technician if errors or questions occur Pharmacist must always sign off after completion

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Technicians Initials
Do pharmacists always have to write their initials on prescriptions they have filled? No. Some computer programs insert the pharmacists initials on prescription labels when that pharmacist logs on to that terminal, and most state boards of pharmacy accept this practice.

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Auxiliary Labels
Auxiliary labels may be printed along with prescription label Drug classification, interactions, and side effects need to be known for auxiliary labels if not computerized

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Auxiliary Labels
The technician and pharmacist must decide which auxiliary labels should be affixed to each prescription, if the auxiliary labels do not print automatically or if there are too many labels to fit on a container.

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The Pharmacist Makes Final Inspection

The last step in filling scripts is passing the filled vial, along with medication container from shelf, and original prescription to the pharmacist Filling one prescription at a time is important to avoid errors Mark newly opened stock bottle with an X (do not cover NDC number or expiration date) The pharmacy technician should not pass a prescription to the pharmacist for inspection if there are any questions that have not been either already addressed or else flagged for review.

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Computer Dispensing Systems

Major versions of dispensing systems: Outpatient dispensing systems Inpatient dispensing systems Nursing care facilities Large mail-order companies McKesson and Pyxis are two companies that produce this type of equipment. Many models operate much like vending machines: pharmacy personnel can enter their passwords and prescriptions into a connected computer, and then the medication drops or slides into a drawer.

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Outpatient Dispensing Systems

Three primary reasons for using dispensing systems: Cut down on errors Increase productivity Inventory control

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Inpatient Dispensing Systems

Hospitals need medications around the clock Computerized dispensing systems cut down on staffing needs; gives doctors and nurses access Control narcotics and track their movement Both inpatient and outpatient dispensing systems can usually be security-programmed to protect and monitor narcotics inventories.

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Inpatient Dispensing Systems

Automated dispensing systems: Pyxis MedStation 3000 Robot dispensing machine incorporated into hospital pharmacies Dispenses unit-dose medications Fills with 99% accuracy The dispensing cabinets dont necessarily have to be in the pharmacy itself: a pharmacist could enter a prescription into a computer on one floor, and a connected dispensary on another floor would allow a waiting doctor or nurse to retrieve that item only.

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Patient Rights
Right dose Right medication Right route Right time Right price Right dosage form Right patient

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When and Who Needs Pharmacist Consultations

First-time prescriptions flagged and pharmacist is alerted Patient needs consultation with new script Federal law: all new or changed prescriptions need consultation OBRA 1990

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When and Who Needs Pharmacist Consultations

What information might the pharmacist and patient discuss during a consultation? They might discuss when and how to take the medication, possible side effects, and possible drug interactions. If the medicine needs to be measured, the pharmacist can demonstrate this.

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Miscellaneous Orders: Outpatient

Technicians, clerks, and pharmacy interns fill refills and transfer prescriptions over the phone Technicians may phone and receive authorization for a prescription refill Does this apply to new scripts? No. Technicians cannot receive new prescriptions over the phone, nor can they independently transfer prescriptions that have not yet been filled.

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Zero Refill Reorders

Additional phone lines set up in pharmacies for refill Patient should allow at least 2 days to get proper authorization from prescriber

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Transfers
Previously filled prescriptions transferred by pharmacist from one pharmacy to another Most Boards of Pharmacy prefer to allow only one transfer Federal law states that narcotics prescriptions can be transferred one time only

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How to File Prescriptions

Hard copy prescriptions manually filed Hard copy filed for future reference Prescription kept on file for 3 years Prescription numbers used HIPAA guidelines state that prescription numbers or patient numbers should be used as the primary means of patient identification instead of Social Security numbers.

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How to File Prescriptions

All controlled substances stamped with a red C 1 inch down on right-hand side of prescription label for easy location All Schedule II medications must be filed separately

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Medication Pick-Up
Patients can wait for prescriptions Have it delivered Pick up another day or at a later time All third-party prescriptions must have a signature of the person receiving medication Check all ID before releasing medication for controlled substances

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Medication Pick-Up
Is it a HIPAA privacy violation if a pharmacist counsels a patients relative about a new prescription? No. HIPAA regulations allow the pharmacist the practical discretion to discuss personal health information (PHI) with a person who has the patients implicit permission to act on his or her behalf. Explicit (written) consent might be required by state law or institution protocol, however, and any stricter rule must be followed.

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Patient Billing
No third-party coveragepatient charged full price Each type of insurance has limitations, rules, and individual copays. Tiered co-pays are now very common among third party payers.the higher the tier of drug coverage, the higher the copay for that prescription.

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Job Duties of Technicians in Retail Pharmacies

Help patients locate OTC medications and prices Take care of inventory orders, rotations, returns, and billings Perform counting, measuring, filling, and labeling Do insurance billing

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Importance of Confidentiality
Pharmacy technicians have access to sensitive, personal information about: Patients health Prescription drug information Payment records Patients trust that this information will not be distributed or abused HIPAA protects the privacy of patients health information

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Over The Counter Products (OTC)

OTC medications: no prescriptions necessary Drugs: common staples in home medicine cabinet Acetaminophen (Tylenol), cough syrup, ibuprofen (Motrin) OTC drugs: Comprises 50% medication purchased There are more than 100,000 OTC products on the market. In any given month, 70% of adults and 50% of children use a nonprescription medication

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Over The Counter Products (OTC)

Consumers must learn about appropriate dosages and proper use of these medications Pharmacists need to know what OTC medications are being taken by their patientspart of the patient profile Patients need to know what OTCs to avoid Self-treatment using drugs OTC may result in substantial savings

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Over The Counter Products (OTC)

Can you think of examples of how misuse of OTC drugs could contribute to hospital stays? A person who does not carefully read and comply with a drugs labeling can be at risk for drug interactions and other complications. Using an OTC drug to treat an erroneously selfdiagnosed condition can mask the true conditions requirement for medical attention. In 1982 seven people in the Chicago area died after using Tylenol capsules that had been laced with cyanide. The manufacturer quickly issued a recall. The cases were never solved, but an investigation revealed that the drug had been stolen from stores, tampered with at another location, and then returned to store shelves.

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Over The Counter Products (OTC)

Consumers use OTC products: To save money To be involved in their own treatment Because they are more readily available Generic drugs (whether prescription or OTC) are required to have the same quality, purity, and strength as the corresponding brand name drug. Manufacturing facilities for generic drugs must meet the same standards as those for brand name drugs. In fact, approximately half of all generic drugs are produced by brand name drug producers.

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Over-the-Counter Drug Considerations

Wide variety of drugs Misuse of drugs contributes to hospital stays Expiration dates need to be checked Tamper-proof packaging needs to be checked

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Over-the-Counter Drug Considerations

Dosages for children under 2 years not recommended Many OTC medications have identical ingredients Manufacturers swap like ingredients without notifying the customer. The label will show the change Package labeling for OTC medications follows a standard format, titled Drug Facts, which is designed to make the information clear and easy for the consumer to understand. Patients using more than one OTC at the same time need to be aware that different products might contain the same active ingredients.

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Over-the-Counter Drug Considerations

No adverse reaction reports required Patients with special diets, allergies, diabetes, and other medications need to exercise caution Extra care for babies and young children when purchasing OTC drugs.doses often not defined on the label

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Three FDA Categories of OTC Drugs

FDA classifications: I. Safe and effective for claimed therapeutic indication II. Not recognized as safe and effective III. Additional data must determine whether safe and effective

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Three FDA Categories of OTC Drugs

According to the FDA, Category I drugs can safely be sold OTC because they generally have the following characteristics: Their benefits outweigh their risks Their potential for misuse and abuse is low The consumer can use them for self-diagnosed conditions They can be adequately labeled A health practitioner is not needed for their safe and effective use

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FDA Regulations
Five major safety areas: Purity Potency Bioavailability Efficacy Safety and toxicity

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Purity
Purity of a product represents the lack of contamination from environmental factors of the chemical (drug) contained in the product Additives include fillers, dyes, solvents, buffers, and waxes Various ingredients increase the size of the medication, decrease absorption, improve taste

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Potency
Refers to the strength of the drug Measurement in: grams (g) milligrams (mg) micrograms (mcg or g) Drug tested on research animals Strength measured in units

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Bioavailability
Level at which a drug is both absorbed and transported to the site of action Measured by the concentration of the drug in the blood or tissue at the peak time of administration

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Bioavailability
How are bioavailability and potency interrelated? Potency is the strength of the drug in its original form. Bioavailability is how much of the drug makes it to the site of action in an active form.

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Efficacy
The ability of the drug to produce the desired chemical change in the body Clinical trials judge effectiveness Variances affect end results Variance: unknown health conditions, age, weight, lifestyle, gender, and genetic influences

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Safety and Toxicity

Represent significant negative of a drug being studied. How narrow is the margin of safety? Lab animals used as test subjects in beginning stages of trials Published results may or may not include effects of drugs on pregnancy

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Safety and Toxicity

Can you think of an example of a drug which was originally known for its toxicity, but which is now used as a therapeutic agent? The toxin from Clostridium botulinum causes botulism, a type of severe food poisoning. In low doses, it is used to treat patients with certain types of facial spasms. In even lower doses, it is used as a treatment for wrinkles (marketed as Botox Cosmetic).

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Safety and Toxicity

Any drug can be toxic if not taken correctly Difference between toxic and desirable effects documented Difference is known as the margin of safety

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How a Prescription Drug Becomes an OTC Drug

Amount of research extensive FDA approves all new drugs entering the marketplace FDA uses three phases of testing Monograph gives information about a drug

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How a Prescription Drug Becomes an OTC Drug

Three FDA phases of OTC drug approval: Phase 1: Advisers evaluate agent for safety and efficacy Phase 2: Final review done on ingredients Phase 3: After evidence presented and all aspects of the agent are exhausted, the final monograph is published

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How a Prescription Drug Becomes an OTC Drug

Status Changeif all criteria met,approved as an OTC drug Some legend drugs become OTCsometimes at the lowest strength Legend Ibuprofen (400, 600, or 800 mg) OTC Ibuprofen (200 mg) According to the FDA, more than 700 products are now sold OTC that contain either ingredients or drug strengths available only by prescription 30 years ago.

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How a Prescription Drug Becomes an OTC Drug

FDA in charge of recalls Manufacturers must show consistency between batches of drugs on a day-to-day basis OTC drugs can be taken off the market if not consistent

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Conditions Treated with OTC Drugs

As new medications enter the market as OTC drugs, consumers can choose new routes of administration

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OTC Agents: Patient Information

Analgesics and antipyretics: help reduce or relieve pain and fever Aspirin: antiinflammatory agent; decreases platelets; prophylaxis to decrease risk of blood clotting in heart disease and stroke Aspirin associated with Reyes syndrome in childrenformerly known as baby aspirin, the 81 mg low dose aspirin is now primarily used for its anticoagulant effect

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OTC Agents: Patient Information

That same dosage and form is useful for adults taking aspirin therapy for heart health, so the marketing was revised to target that new group of consumers. Although low-dose aspirin therapy has been shown to reduce the risk of a first heart attack or stroke in older adults, it is not appropriate for all patients. Long-term use of aspirin is associated with an increased risk of gastrointestinal bleeding.

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Allergy and Cold Agents

Relief of common cold: decongestants and antihistamines Decongestants open nasal passages and promote drainage of the sinuses, cause vasoconstriction, reduce congestion Antihistamines: used with allergic symptoms; action blocks histamine (H-1) that causes allergic reaction OTC antihistamines such as chlorpheniramine and diphenhydramine can cause drowsiness, and decongestants often have a stimulant effect, so combination products that balance the effects can be useful. Combination products should only be used when a patient has symptoms that need to be relieved by multiple agents

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Antihistamines
First-generation: common side effect is sleepiness

Second-generation: some still require a prescription cause less drowsiness Several second-generation antihistamines (SGAs), such as loratadine and cetirizine, are now available OTC. SGAs have fewer side effects than older first generation antihistamines, which can cause sedation, dizziness, and dry mouth.

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Decongestants
Indicated for stuffiness and congestion of nasal passages and sinuses Act to open passages and allow release of mucus Available in both OTC and prescription preparations Decongestants containing pseudoephedrine are under intense scrutiny because of their use in the illegal manufacture of methamphetamines.

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Sleep Aids
Diphenhydramine (antihistamine) used to treat insomnia Diphenhydramine: most commonly prescribed agent ordered in hospitals for sleep May cause drowsiness Avoid alcoholic beverages Do not use if suffering with asthma, glaucoma, emphysema, or an enlarged prostate For chronic insomnia consult a physician

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Sleep Aids
What other symptoms is diphenhydramine approved to treat? The active ingredient in many sleep aids, diphenhydramine, is the same active ingredient found in the antihistamine Benadryl.

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Cough Medicines
Largest OTC section: cold and flu For congested coughs: expectorants For dry nonphlegm-producing coughs: cough suppressants Do not use if suffering with asthma, glaucoma, emphysema, heart problems, or an enlarged prostate Dextromethorphan (DM) is a common OTC cough suppressant available in liquid and tablet forms. In 2005, the FDA issued a warning about DM abuse after five teenagers deaths were linked to ingestion of pure, powdered DM in capsule form.

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Sore Throat Products

Cold or flu: causes of sore, scratchy, and dry throats Sore throat: can be symptom of Strep throat (treat with antibiotics) Syrups and sprays: relieve throat pain Phenol, menthol,and benzocaine-local anesthetics to numb the throat

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Headache Products
Analgesics Some contain additives: caffeine Migraines: prescription drug required Some headache medicines cause a rebound effect if overused. When the patient stops taking the medicine, the headache returns. Many people have experienced this with caffeine, which is a component of certain headache medicines.

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Stomach Remedies/Antacids
Common upset stomach remedies Histamine-2 (H2) antagonistsdecrease acid secretions (heartburn) Proton pump inhibitors-several now are OTC-relieve acid secretions Antacids used to balance pH level in stomach; for short-term heartburn relief

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Stomach Remedies/Antacids
What is an antiemetic? Antiemetics (such as Emetrol) are used for treatment of nausea.

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Anti-inflammatories
Nonsteroidal antiinflammatory drugs (NSAIDs) treat inflammation Reduce pain Used as antipyretic and analgesic May cause drowsiness, upset stomach; take with food or milk

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Anti-inflammatories
Most OTC NSAIDs treat inflammation by inhibiting cyclooxygenase (both COX-1 and COX-2) enzymes. COX-1 enzymes protect the lining of the stomach and intestine, which is why using an NSAID can cause an upset stomach, or, with long-term use, even ulcers. NSAIDs inhibit prostaglandins, which are responsible for protecting the mucous lining of the stomach and intestines.

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Intestinal Remedies
Intestinal discomfort: constipation, diarrhea, gas (flatulence) Intestinal products contain oil or saline solution For diarrhea: anticholinergic agent, bulk-forming fiber

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Intestinal Remedies
In general, a laxative is any treatment that promotes bowel movements. What are the four main classes of laxatives, and how does each class work?: Bulk-forming laxatives (psyllium, fiber) increase stool volume and reduce intestinal transit time. Osmotic laxatives (magnesia citrate or lactulose) draw water into the intestine, thereby increasing stool volume. Stimulant laxatives (Senokot, Correctol, Bisacodyl, castor oil) act on the nerves of the intestines. Surfactants (Colace, Surfak) soften stool.

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Intestinal Remedies
Loperamide-antidiarrheal-may cause drowsiness or dizziness Most commonly used gas treatment: simethicone (Gas-X) Laxatives: do not use if abdominal pain, nausea, and vomiting are present Laxatives should not be used for longer than 1 week to avoid laxative dependence or tolerance. Prolonged use of stimulant laxatives is thought to damage the nerves of the colon.

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Topical Antibiotics
Used to treat abrasions, small cuts, and scrapes Clean wound properly first Help the body to fend off infection Examples: Neosporin, Polysporin

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Topical Antibiotics
Pharmacy technicians should refer patients to a pharmacist for wound assessment. In general, though, what wounds shouldnt be self-treated? Cuts or scrapes that continue to bleed after pressure has been applied continuously for 20 to 30 minutes Wounds that have jagged edges or that cannot easily be closed with medical tape Cuts deep enough to expose fat or muscle Wounds that are or could become infected (e.g., animal bites, deep puncture wounds) Extensive first-degree burns, second-degree burns larger than 23 inches, and all third-degree burns.

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