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Case presentation in community pharmacy

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  • COMMUNITY PHARMACY

    CASE PRESENTATION

  • CASE 1

    A woman, presented to the pharmacy asking for

    something for cough and her throat is dry and

    irritating. She also had chest tightness, she

    wanted something which can help to dilate

    bronchial airway. At this point the patient is

    referred to the pharmacist and the pharmacist

    dispensed following:

    1. Ventolin evohaler (Salbutamol 100 mcg), 2

    puffs four times a day

    2. Serrin (serratiopeptidase), 2 tablets three

    times a day, after meal.

  • Salbutamol

    provide short-acting bronchodilation

    relaxing muscles in the airways

    fast onset of action

    commonly used for asthma, chronic

    bronchitis

    Serratiopeptase

    a proteolytic enzyme of Serratia

    species source.

    eliminates inflammatory edema and

    swelling

  • Comment:

    Ventolin evohaler was dispensed here to

    relieve the symptom of chest tightness. The

    pharmacist has also demonstrated

    instruction of use and handling the Ventolin

    evohaler.

    The pharmacist did not dispense any cough

    medicine for the patient as she suspected

    the cough was due to her dry and irritated

    throat.

    Thus, serrin tablet was given to relieve such

    irritation

    Meanwhile, the pharmacist also advised

    the patient to drink more warm water or to

    take honey to soothe the throat.

  • CASE 2

    A man complained of having hemorrhoid. He

    claimed that he was unable to clean the area

    around anus appropriately and causes itchiness.

    The pharmacist dispensed as below:

    1. Daflon.500mg (diosmin 450 mg, hesperidin 50

    mg), 2 tablets daily in the divided dose.

    2. Xyloproct (Lidocaine base 50 mg,

    hydrocortisone acetate 2.5 mg, Aluminium

    subacetate 35 mg, Zinc oxide 180 mg), Apply thin

    layer several times a day. Max: 6 g/day

  • Daflon

    a phlebotonic drug and a vascular

    protecting agent

    It reinforces venous tone by prolonging the

    vasoconstrictor effect of noradrenaline on

    the vein wall. Thus, decreases venous

    capacitance, venous distensibility and

    venous emptying time

    It significantly improves signs and

    symptoms of hemorrhoid

    eg, anal irritation, pain or discomfort,

    bleeding, a lump or swelling in the anus

  • Xyloproct

    Indication: relieve pain and discomfort of

    haemorrhoids (piles), itching, cracking or tearing of

    the anus, inflammation of the rectum and anus

    (back passage), and post-operation pain

    Lidocaine has analgesic effects, reduces pain and

    itching.

    Hydrocortisone has anti-inflammatory properties,

    reduces the redness and swelling

    also contains aluminium subacetate and zinc oxide,

    which have astringent and disinfectant properties.

    They help in skin protection and healing

  • Comment:

    Besides treating the signs and symptoms of the haemorrhoids it is important that the patient ensure good toilet hygiene.

    Eg: gently clean the area around the anus with warm water at least once a day and after passing a motion.

    Use moist towels such as wet tissues or baby wipes to gently pat, rather than rub dry to avoid irritation to the swollen tissues.

    Sit in warm bath esp after going to the toilet

    Also keep stools soft and easy to pass by eating plenty of food containing fibre and drinking enough water every day

  • CASE 3An old man presented to the pharmacy asking for

    something to treat dizziness and he has postural

    imbalance as he always bang into people while

    walking. Before dispensing the following medication,

    the pharmacist checked his blood pressure:

    1. Tanakan tablet (Gingko biloba extract 40 mg), 3

    tablets per day, to be taken with food or just before

    the meal

    2. Methycobal (Mecobalamin 500 mcg), 1 tablet

    three times a day

    3. Merislon (Betahistine mesylate 6mg), 1-2 tablets

    three times a day, to be taken with food.

  • Tanakan active ingredient: gingko biloba

    helps in blood circulation

    also indicated for cerebral circulatory insufficiency.

    Methycobal Vitamin B12 is an essential nutrient for normal body

    functioning,

    helps in maintenance of proper function of nerve cells and brain chemistry

    Merislon active ingredient: betahistine mesylate.

    relieve vertigo and dizziness associated with Menieres disease

    also improves cerebral circulation, increasing blood flow in the internal carotid artery.

  • CASE 4

    A young girl complained of vomiting and having

    indigestion. She also suffered from diarrhea. The

    pharmacist dispensed following:

    1. Motilium (Domperidone 10 mg), 1 tablet three

    times a day before meal

    2. Uphalyte Oral Rehydration Salts (NaCl 525 mg,

    Na bicarbonate 425 mg, KCl 375 mg, glucose

    anhydrous 6.25 g), 1 sachet after diarrhea

    3. Lacto GG (Lactobacillus rhamnosus strain GG),

    1 capsule a day

  • Motilium

    To relieve nausea by blocking dopamine receptors

    at the chemoreceptor trigger zone (CTZ)

    indicated for vomiting

    a Group B poison, which need to be sold with the

    prescription

  • Uphalyte

    indicated for treatment of water & electrolyte

    depletion associated with diarrhea, vomiting &

    excessive sweating

    the girl was having diarrhea as well as vomiting,

    she must have significant water and electrolyte

    depletion

    rehydration and replenishment of electrolytes are

    important as they are the essential molecules to

    maintain normal body functions.

  • Lacto GG probiotic

    Contains 20 billion live bacteria per

    capsule

    it was dispensed to the girl as she has

    frequent diarrhea problems.

    able to colonise the human intestine

    and form a protective barrier of

    good bacteria in the intestines and

    to support the natural immune

    defences.

    Thus it is useful as prophylaxis of

    diarrhea and vomiting.

  • CASE 5

    A man has been smoking for a couple of year, he

    smoked about 10 cigarettes a day. He came to the

    pharmacy as he wishes to quit smoking. The

    pharmacist dispensed following:

    Champix (Varenicline tartrate 0.5mg), Day 1-3: 0.5

    mg once daily. Day 4-7: 0.5 mg twice daily. Day 8-

    end of treatment: 1 mg twice daily.

    The duration of this smoking cessation treatment is 12

    weeks

  • It partly stimulates the nicotine receptors to mimic

    the effect of nicotine on the body. Thus, it both

    reduces the urge to smoke and relieves

    withdrawal symptoms

    also partially blocks the receptors and prevents

    nicotine from attaching to the receptors. This

    blocks the effect of nicotine in people who give in

    to temptation and have a cigarette.

    If successfully stopped at 12 week, an additional

    course of 12 week treatment may be considered.

    Champix dosing should start 1-2 week before the

    quit date.

    Champix

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