HOW TO PRACTICE

O.T.C
Presented by
Khaled 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

Pregnancy exclude cancer

< 3m

GIT surgery
 1-Abdominal pain

Other
diagnosis location
symptoms
 Abdominal pain
yes
Upper side Gastritis & gall bladder disorder
No yes Renal stone &
Back pain & urine problem
renal infection
No
Fever & vomiting
yes
Gastroenteritis & appendicitis
No
yes
Expect menses Menstrual pain
No
yes
Gas production & spasm Spastic colon
No
Only spasm antispasmodic
 Upper abdomen

Gall bladder Gastritis&

GERD
Right side Central pain
Fatty meal Milk & antacid
NSAID & Cs
 1-Back pain & urine problem

Renal stone U.T.I

No fever Fever
Dark pinkish colour Pain on urinatin
Flow interruption Frequency
 2-Vomiting & fever

appendicitis gastroenteritis

Tender palpitation diarrhoea

Right side left side
 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

antacids -1

H2 blockers -2

proton pump inhibitors -3

 Antacids
They neutralize acids which
They neutralize already
acids whichproduced
already produced
(symptomatic treatment) (symptomatic treatment)

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

TabletsTablets
should should
be chewed thoroughly
be chewed to obtain
thoroughly to-obtain-
.optimum effects .optimum effects

they
theyshould
shouldbe
betaken
takenafter
aftermeals
mealsto
toneutralize
neutralizegastric
gastric--
acid secretion acid secretion
antacids
antacids
 H2 Blockers

.Prevent about 70% of acid production

-:Examples
Ranitidine
mg twice daily at breakfast and bed time 150
mg at bed time 300

Famotidine
mg twice daily at breakfast and bed time 20
mg at bed time 40
ranitidine
famotidine
 Proton pump inhibitors
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:- Omeprazole
ex:- Pantoprazole
omeprazole
pantoprazole
 ‫‪Example of OTC prescription:‬‬

‫‪Alucal chewable tab‬‬

‫‪ 2 – 1‬قرص تمضغ بعد األكل ‪ 3‬مرات يوميا‬

‫‪Zantac 150mg‬‬
‫قرص صباحا ً قبل األكل وقبل النوم‬

‫‪Omepral‬‬ ‫‪20 mg‬‬

‫قرص صباحا ً على الريق يوميا‬
 antispasmodics

: Atropine like derivatives -1

.EX 1 :- Hyoscine ( Buscopan)
EX 2: Dicyclomine ( Spasmorest )
EX 3: Tiemonium ( Visceralgine )
EX4: Clidinium Br. ( Librax )

: Papaverine like derivatives-2

EX 1: Drotaverine ( Do-Spa)
®EX 2: Papaverine ( Vasorin )
Atropine like derivatives
papaverine like derivatives
:Example of OTC prescription

Buscupan Tab
‫ مرات قبل األكل‬3 ‫قرص‬
 vomiting

yes Gastroenteritis &

Fever, abdominal pain
appendicitis
No
yes
On starting drug use Drug induced vomiting
No
yes
on traveling long distance Motion sickness

No
Give anti emetic
 Motion sickness
It refers to nausea & vomiting on long *
.distance travel

Prevention:
.Avoid reading in cars & ships-
Shift the field of vision to objects out side-
.vehicles
 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 prescription
motion sickness

Draminex tab
‫ قرص عند اللزوم‬1-2
 Anti emetics

Metoclopramide-3

:Dompridone-2
.Not show CNS side effects of metoclopramide

: Antihistaminic-1
metoclopramide domperidone
Example of OTC prescription
for vomiting

primepran tab
‫ قرص عند اللزوم‬1-2
 diarrhea
yes
Fever & vomiting Gastroenteritis
No
yes
Tensmus & offensive odour, Pain on dysentery
defecation& small quantity stool
No yes
Gas production & spasm May constipation Spastic colon
No
On starting drug use
yes
Drug induced
No yes
On changing milk type Dietary induced
No
Give anti diarrheal drug
 Dysentery
Parasite infection is characterized by diarrhea,
abdominal cramps, anorexia, and offensive odour,
: pain on defecation. So treated by antiprotozoal as

Metronidazole
Diloxanide
Secindazole
Tibindazole
 Tibindazole

Secindazole Diloxanide
metronidazole
Example of OTC prescription

Furazole susp
‫ مرات يوميا ً بعد االكل‬3 ‫ مل‬10 - 5

Fladazole tab
‫ قرص بعد العشاء‬2 ‫ قرص بعد الفطار و‬2
 Antidiarrheal drugs
antibacterial agent-1

adsorbent-2

drugs inhibit GIT motility-3

Rehydrin solution-4
1-antibacterial agent

Nifuroxazid& Sulfa drugs

if fear of infection
 2-adsorbent
Acts by adsorption of bacteria, toxin & noxious
materials e.g.:
” EX 1 : Kaolin & pectin “kaopectate
 3- drugs inhibit motility
EX 1 : Loperamide (lmodium)®
EX 2 : Disphenoxylate (Lomotil)®

Avoid using alone in fear of infection

 4-rehydrin
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)
Example of OTC prescription

Kapect susp
‫ مرات يوميا ً قبل االكل‬3 ‫ مل‬10 - 5
Antinal susp ِ
‫ مرات يوميا ً قبل االكل‬3 ‫ مل‬10 - 5
 constipation
yes
Rectal pain, itching, prolapse hemorrhoid
No yes
On starting drug use Drug induced
No
Gas production ,spasm, may diarrhea
yes
Spastic colon
No
Give laxative
 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
Mineral oil (paraffin oil )-1
Impair absorption of fat soluble vitamins, Late onset

osmotic laxatives (lactulose)-2

Watery bowel movement, so risk of dehydration & diarrhea

stimulant laxatives (castor oil)-3

rapid onset specially suppositories
osmotic laxatives
stimulant laxatives
‫‪Example of OTC prescription‬‬

‫‪Lactulose syrup‬‬
‫ملعقة كبيرة قبل االكل ‪ 3‬مرات يوميا‬
‫‪Picolax‬‬ ‫‪drops‬‬
‫‪15‬نقطة على نصف كوب ماء عند اللز‪j‬وم‬