community pharmacy case
Post on 18-Nov-2015
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DESCRIPTIONCase presentation in community pharmacy
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
1. Ventolin evohaler (Salbutamol 100 mcg), 2
puffs four times a day
2. Serrin (serratiopeptidase), 2 tablets three
times a day, after meal.
provide short-acting bronchodilation
relaxing muscles in the airways
fast onset of action
commonly used for asthma, chronic
a proteolytic enzyme of Serratia
eliminates inflammatory edema and
Ventolin evohaler was dispensed here to
relieve the symptom of chest tightness. The
pharmacist has also demonstrated
instruction of use and handling the Ventolin
The pharmacist did not dispense any cough
medicine for the patient as she suspected
the cough was due to her dry and irritated
Thus, serrin tablet was given to relieve such
Meanwhile, the pharmacist also advised
the patient to drink more warm water or to
take honey to soothe the throat.
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
a phlebotonic drug and a vascular
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
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
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
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
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
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.
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
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
indicated for treatment of water & electrolyte
depletion associated with diarrhea, vomiting &
the girl was having diarrhea as well as vomiting,
she must have significant water and electrolyte
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
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
Thus it is useful as prophylaxis of
diarrhea and vomiting.
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
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
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