Pharmaceutical Care for Self-Care Patients

Ghada A Bawazeer, MSc, PharmD, BCPS College of PharmacyKing Saud University

Fall Semester 2010

Objectives of the lecture

• Understand why people seek self medication • Appreciate the role of pharmacist in managing self care

patient • Comprehend why and how self care can be a problem • Formulate a patient-centered pharmaceutical care plan

with the patient using a systematic approach to self care.

• For selected illness, students should be able to – Recommend self care or refer to other healthcare specialist– Recommend an OTC product regimen, monitor and counsel

patient during a self care intervention.

Self Care

• part of daily living• includes the care extended to

children, family, friends and others in neighbourhoods and local communities

• Most care in life is self care

Reflection: Discuss an incidence of self care for you or a member of your family?

Self Care

• maintaining good physical and mental health• meeting both social and psychological needs• preventing illness or accidents • caring for minor ailments and long-term

conditions• maintaining health and wellbeing after an

acute illness or discharge from hospital

Definition

• Self Care….–The independent act of preventing,

diagnosing, and treating one's own illnesses without seeking professional advice

• Maintaining well being and appearance through exercise and a healthy lifestyle.

Preventive self- care

• Diagnosing their condition and obtaining products for the goal of mitigating illness and relieving symptoms

Sickness- self-care

Number of HBC products for selected departments in 2006Preventative Care Sickness Care

Options for Self Care1. Nonprescription medications

(OTC) (self medication)2. Nutritional dietary supplements3. Natural products and

homeopath remedies

Options for Self Care

• Home diagnostic tests and monitoring devices (e.g., weight balance, pregnancy tests, home blood glucose monitors)

• Devices for treatment (e.g., first aid bandages, ice packs, nasal strips, vaporizers)

• Use of dental, skin, and hair-care products

Options for Self Care

• Dietary interventions (e.g., chicken soup for a cold)

Self-Care in the New Millennium Survey

• Adults (n=1,505)• Health care decision made by themselves:

– 38% somewhat confident – 58% very confident

• 73% prefer treat by self care than go to MD• 62% will continue treat and diagnose their ailment at

home in the future• 77% choose OTC • Source of advice on treating minor illness

– Family/friends (27%), physician (20%), pharmacist (7%), internet (7%)

Self-Care in the New Millennium Survey

• > 80% were satisfied with the nonprescription

medications they used

• 87% believe nonprescription medications are

safe when used as directed.

• >90% read the package when they took an

OTC for the first time

The Attitudes and Beliefs About the Use of Over-the-Counter Medicines: A Dose of

Reality Survey• Participants:

– Adults, n=1011– Practitioners: 451 pharmacists, nurses, and

general practice physicians• 59% used OTC consumption in the past 6

months, 28% had >3 OTC products• Only 34% of read the label• 1:3 took more than the recommended dose• 1:3 took more than one OTC

National Council on Patient Information and Education (NCPIE

Why people do it….!

• To take an active role of their own life & health– Empowered by: health-related self-help books,

newspaper feature articles, television advertisements, magazine and radio programs, instructional audio- and videotapes, and Internet sites

– preventative – acute minor sicknesses– adjunctive therapy for chronic diseases managed with

prescription medications• Example: Arthritis, Glucosamine and chondritin, Dyslipidemia, fish oil

Why people do it….!

• Increased cost of health care• restricted access to prescribers • Rapidly increase in number of elderly

population– Patients>65 years purchase 40% of all nonprescription medications– Conditions to treat: arthritis pain, insomnia, and constipation,

amenable to OTC– OTC are low-cost alternatives – Accessibility to pharmacists in the community setting

• Gender differences

Why people do it….!

• Economical reasons– eliminates the direct and indirect costs

• physicians’ fees, travel costs, and time away from work– OTC products for heartburn saved $757 M in 2009

Accessibility to Nonprescription Drug Products for Self-Medication

– Internet Pharmacies and Drug Information– Rx-to-OTC Switch– Behind-the-Counter (BTC) Medications

…Internet Pharmacies and Drug Information

• Women• younger than 65 years of age• college graduates• Have broadband access at home. • 17 health topics• 37% of those seeking health

information were looking for both prescription and nonprescription

2006 Pew Internet & American Life Project

Few points on RX OTC • Defined as over-the-counter marketing of a drug

product that was once a prescription (Rx) drug for the same indication, with the same strength, dose ,duration of use, dosage form, and route of administration

Rx R x

R x

Few points on RX OTC • FDA reclassification of Rx to OTC based on:

– Can the patient adequately self-diagnose the clinical abnormality?

– Can the clinically abnormal condition be successfully self-treated?

– Is the self-treatment product safe and effective for consumer use, under conditions of actual use?

Rx R x

R x

Year of Approval

Ingredient Brand Name Use

2000 Ibuprofen Motrin Migraine Pain Migraine2000 Ibuprofen Advil Migraine Liqui-Gels Migraine2000 Famotidine, calcium carbonate,

magnesium hydroxidePepcid Complete Heartburn, acid indigestion

2001 Butenafine hydrochloride Lotrimin Ultra Athlete's foot, jock itch, ringworm

2002 Ibuprofen, pseudoephedrine Children's Advil Cold Cold symptoms2002 Guaifenesin extended-release tablet Mucinex Loosens mucus2002 Nicotine polacrilex Commit Smoking cessation2002 Loratadine Claritin Allergy symptoms2002 Loratadine, pseudoephedrine Claritin-D Allergy symptoms2003 Omeprazole Prilosec OTC Acid reducer, heartburn2003 Loratadine Claritin Hives relief2005 Diphenhydramine, ibuprofen Advil PM Pain relief, sleep aid2006 Ecamsule (combined with avobenzone

and octocrylene)Anthelios SX Sunscreen

2006 Levonorgestrel Plan B Contraception2006 Polyethylene glycol 3350 MiraLAX Constipation2006 Ketotifen Zaditor Itchy eyes2007 Orlistat alli Weight loss aid2007 Cetirizine Zyrtec Allergy symptoms2007 Cetirizine, pseudoephedrine Zyrtec-D Allergy symptoms

Examples of Prescription-to-Nonprescription Switches, 2000–2007 

Few points of Behind-the-Counter (BTC) Medications

• third drug class, "pharmacist only“ or “Schedule 3”

• kept behind the pharmacy counter and require a pharmacist to dispense but without the need of a prescription

• Example: – Canada & UK: emergency contraception and

simvastatin, – USA: pseudoephedrine (PSE), emergency

contraceptive (Plan B)

Nonprescription pseudoephedrine

Nonprescription pseudoephedrine

• Combat Methamphetamine Epidemic Act, 2005. Act was effective in Sep 2006– Limit the monthly amount of PSD (9

grams/month and 3.6 grams in a single day) – Requires a photo ID for purchasing and sign

logbook.– Require pharmacies to keep a “logbook” of

personal information about customers for 2 years

commonly treated illnesses with nonprescription medications

• Pain (78%) • Cough/cold/flu/sore throat (52%) • Allergy/sinus problems (45%) • Heartburn, indigestion (37%) • Constipation/diarrhea/gas (21%) • Minor infections (12%) • Skin problems (10%)

The Attitudes and Beliefs about the Use of Over-the-Counter Medicines: A Dose of Reality: A National Survey of Consumers and Health Professionals. Harris Interactive, Inc; Bethesda, Md: National Council on Patient Information and Education; 2002. Available at: http://www.bemedwise.org/survey/summary_survey.pdf. Last accessed July 28, 2008.

Top 15 therapeutic categories of nonprescription medications in 2003-2006

http://www.chpainfo.org/ChpaPortal/PressRoom/Statistics/OTCSalesbyCategory.htm

700 products contain ingredients that were Rx

1000 Active ingredients

100,000 OTC products

100,000 OTC productsThat is a BONUS

Everyone will find something that will satisfy their needs…. And is a great

revenue for pharmaceutical industry

Bowel preparation (diagnostic) Hair loss Chapped skin Abrasions

Cold sores Halitosis Burns (minor, thermal) Aches and pains

Colds Morning hangover relief Calluses Acidity

Congestion (chest, nasal) Head lice Candidal vaginitis Acne

Constipation Headache Canker sores Albumin testing

Contact lens care Heartburn Carbuncles Allergic reactions

Contraception Diaper rash Gastritis Allergic rhinitis

Corns Diarrhea Gingivitis Anemia

Cough Dry skin Hemorrhoids Arthralgia

Cuts (superficial) Dyslipidemia Herpes Asthma

Dandruff Dysmenorrhea Impetigo Athlete's foot

Decongestant, nasal Dyspepsia Indigestion Bacterial infection

Dental care Fever Ingrown toenails Blisters

Blood pressure monitoring Flatulence Insect bites and stings Dermatitis (contact)

Diabetes mellitus supplies Jet lag Insomnia Boils

Jock itch Nutrition (infant) Periodontal disease Prickly heat

Migraine Obesity Pharyngitis Psoriasis

Occult blood, fecal (detection) Motion sickness Pinworm infestation Ringworm

Myalgia Ostomy care Pregnancy (diagnostic) Seborrhea

Nausea Ovulation prediction Premenstrual syndrome Sinusitis

Warts (common and plantar) Toothache Sunburn Smoking cessation

Xerostomia Vomiting Teething Sprains

Wound care Stye (hordeolum) Thrush Strains

92 Medical Disorders are amenable to Nonprescription Drug Therapy

WHEN AND HOW TO ????????

treat oneself, consult a physician, visit

an ED or use a diagnostic test?

Patient knowledge and experience is limited

Great revenue for your pharmacy…BUT!!!

700 products contain ingredients that were Rx

100,000 OTC products

1000 Active ingredients

Big area for medication related morbidity and mortality….

• Multiple active ingredients• Line extension dilemma• different products that contain the same or

similar active ingredients (e.g. analgesics)• Drug-drug, drug-disease interaction

• St. John's wort has 59 herb–drug interactions, • Ginkgo biloba having 20 interactions

Safe use of OTC products depends on..

1. OTC Drug Labeling

2. Pharmacist role as a drug expert

OTC Drug Labeling

• The Omnibus Budget Reconciliation Act of 1990 (OBRA’90) applies to prescription drugs but not OTC products

• In 2002, FDA has mandated use of a standard label format for OTC medications “Drug Facts”

• In 2005, Drug Facts on ALL OTCs

Active ingredient

Use

Warnings

Directions

Other information

Inactive ingredients

when to use the product

“Drug Facts” Labeling: NCPIE Survey

- Reading the label: - 44% looked for the active ingredient, 20% about

possible side effects, and 8% read nothing• following the dosing recommendations:

– 48% would take more than the recommended dose to increase the effectiveness. • More frequent than recommended• More amount/dose

The Attitudes and Beliefs About the Use of Over-the-Counter Medicines: A Dose of Reality Survey

“Drug Facts” Labeling: NCPIE Survey

• 51% used Rx and OTC Concurrent • 44% are chronic users of OTC medication• 32% Using OTC medications for Rx indications • 27% had the >2 products with the same active

ingredient

The Attitudes and Beliefs About the Use of Over-the-Counter Medicines: A Dose of Reality Survey

“Drug Facts” are Great but not enough….

• People with limited reading skills or language barriers

• The size of type• Price or antitheft tags improperly placed over

critical information

Pharmacist Role

• Ensure that patients are able to read and understand product labeling.

• Help patients avoid drug interactions.• Warn about potential allergic reactions and

side effects.• Discuss appropriate drug storage and

handling.

Line extensions

1989 2000

65% of drugs approved by FDA were modified versions of existing drugs

The National Institute for Health Care Management

To continue the success of patent expiring brand-name drugs >>>> new extensions >>>> shift demand from original brands to their new extensionsLine extension: as new formulationCombinationsingle enantiomer vs. stereoisomercombination product

Line extension Original product Esomeprazole (Nexium ®), marketed since 2000 as

Omeprazole (marketed since 1988 as Prilosec )

scitalopram (Lexapro), marketed since 2002

Citalopram (marketed since 1989 as Celexa)

Paliperidone (marketed since 2007 as Invega )

risperidone (marketed since 1993 as Risperidal )

Desloratadine (marketed since 2001 as Clarinex

loratadine (marketed since 1988 as Claritin

Birth control pillsAcetaminophenAuto inhalerInjectors Second generation productsExtra Strength Tylenol PM TylenolCombination products with other drugs

VICKS DAY QUIL ALCOHOL FREE SYRUPPARACETA. 650 MG+ PSEUDOEPHED. 60 MG+ DEXTROMETHORPHAN 20 MG SYRUP

ADOL ALLERGY SINUS 325MG/2MG/30MG CAPLET

PARACETA325MG+CHLORPHENIRAMINE2MG+PSEUDOEPHED30MG CAPLET

ADOL COLD 325MG/30MG/15MG CAPLETPARACETA325MG+PSEUDOEPHED30MG+ DEXTROMETHOR15MG CAPLET

FLUTAB TABLETPARACETA500MG+PSEUDOEPHED30MG+DIPHENHYDRA 25MG TABLET

PERFALGAN 10 MG / ML INJECTION VIAL PARACETAMOL 10 MG / ML VIALCETAMOL 100 MG SUPP PARACETAMOL 100MG SUPPFEVADOL 100MG SUPPOSITORY PARACETAMOL 100MG SUPPTYLENOL, SUPP. 100 MG PARACETAMOL 100MG SUPPADOL DROPS 100MG/ML PARACETAMOL 100MG/ML DROPSAMOL 100MG/1ML ORAL DROPS PARACETAMOL 100MG/ML DROPSDOLOMOL DROPS 100 MG/ML PARACETAMOL 100MG/ML DROPSPEDIAMOL 100MG/ML ORAL DROPS PARACETAMOL 100MG/ML DROPSRIAGESIC 100 MG / ML ORAL DROPS PARACETAMOL 100MG/ML DROPSVONAL 100MG/ML ORAL DROP PARACETAMOL 100MG/ML DROPSADOL SYRUP 120MG/5ML PARACETAMOL 120 MG/ 5 MLAMOL 120MG/5ML SYRUP PARACETAMOL 120 MG/ 5 MLAMOL 120MG/5ML SYRUP PARACETAMOL 120 MG/ 5 MLCALPOL 120MG\5ML SUSP PARACETAMOL 120 MG/ 5 MLDOLOMOL SYRUP 120 MG / 5 ML PARACETAMOL 120 MG/ 5 MLEMIDOL 120MG\5ML SYRUP PARACETAMOL 120 MG/ 5 MLFEVADOL SYRUP 120MG/5ML PARACETAMOL 120 MG/ 5 ML

MEDAMOL 120MG\5ML PAEDIATRIC SYRUP PARACETAMOL 120 MG/ 5 MLOMOL 120MG\5ML SYRUP PARACETAMOL 120 MG/ 5 ML

PANADOL BABY & INFANT SUSP 120MG/5ML PARACETAMOL 120 MG/ 5 MLPANADREX 24 MG/ML SYRUP PARACETAMOL 120 MG/ 5 MLPANADREX 24 MG/ML SYRUP PARACETAMOL 120 MG/ 5 MLPARAMOL SYRUP 120MG/5ML PARACETAMOL 120 MG/ 5 MLPMOL 120MG/5ML SYRUP PARACETAMOL 120 MG/ 5 MLRIAGESIC 120 MG / 5 ML SYRUP PARACETAMOL 120 MG/ 5 MLVONAL 120MG/5ML SYRUP PARACETAMOL 120 MG/ 5 MLDOLOMOL 120MG SUPP PARACETAMOL 120MG SUPPVONAL 120MG SUPP PARACETAMOL 120MG SUPPEMIDOL 120MG/5ML SUSPENSION PARACETAMOL 120MG/5ML SUSPENSIONNEOMOL 120MG/5ML SUSPENSION PARACETAMOL 120MG/5ML SUSPENSION

EMIDOL COLD SYRUPPARACETAMOL 120MG+CHLORPHENIRAMINE MALEATE 2MG +PSEUDOEPHEDRINE HCL 15MG/5ML SYRUP

REVANIN SUSP 125MG/5ML PARACETAMOL 125MG/5ML SUSPADOL 160 MG CHEWABLE TAB PARACETAMOL 160 MG CHEWABLE TAB

DEFADOL 160MG/5ML SUGAR FREE SYRUP PARACETAMOL 160MG/5ML

DEFADOL 160MG/5ML SUGAR FREE SYRUP PARACETAMOL 160MG/5ML

DEFADOL 160MG/5ML SUGAR FREE SYRUP PARACETAMOL 160MG/5ML

FEVADOL SYRUP 160MG/5ML SUGAR FREE PARACETAMOL 160MG/5ML

FEVADOL SYRUP 160MG/5ML SUGAR FREE PARACETAMOL 160MG/5MLTEMPRA 160MG/5ML SYRUP PARACETAMOL 160MG/5ML SYRUPTEMPRA 160MG/5ML SYRUP PARACETAMOL 160MG/5ML SYRUPCETAMOL 200MG SUPP PARACETAMOL 200MG SUPPFEVADOL 200MG SUPPOSITORY PARACETAMOL 200MG SUPPGRIPPO SUPP 200MG. PARACETAMOL 200MG SUPPTYLENOL, SUPP. 200 MG PARACETAMOL 200MG SUPPVONAL 200MG/SUPP. PARACETAMOL 200MG SUPPPANADOL JUNIOR SACHET 240MG PARACETAMOL 240MG SACHETS

ADOL PM 325MG/25MG CAPLETPARACETAMOL 325 MG+ DIPHENHYDRAMINE 25MG CAPLET

ADOL SINUS 325MG/30MG CAPLETPARACETAMOL 325MG + PSEUDOEPHEDRINE HCL 30MG CAPLET

DOLOMOL 325MG SUPP PARACETAMOL 325MG SUPPEFFERALGAN EFFERVESCENT TAB PARACETAMOL 330MG+ VITAMIN-C 200MG TABCETAMOL 350MG SUPP PARACETAMOL 350MG SUPPFEVADOL 350MG SUPPOSITORY PARACETAMOL 350MG SUPPTYLENOL, SUPP 350 MG PARACETAMOL 350MG SUPP

FLUDREX SINUS CAPLETSPARACETAMOL 416.6MG +CHLORPHENIRAMINE 3MG +PSEUDOEPHEDRINE 30MG TABLET

MYOGESIC TAB.PARACETAMOL 450 MG + ORPHENANDRINE CITRATE 35 MG TAB

PANADOL ACTIFAST FILM COATED TABLETEPARACETAMOL 500 MG + SODIUM BICARBONATE 630 MG

PANADOL 500MG COATED TAB PARACETAMOL 500MG F.C.TABPANADOL COLD AND FLU DAY F.C. TABLETS

PARACETAMOL 500MG + PHENYLEPHERINE HCL 5MG + CAFFEINE 25MG FILM COATED TABLET

PANADOL SINUS CAPLETPARACETAMOL 500MG + PSEUDOEPHEDRINE HCL 30MG TAB

SINOFREE 500MG/30MG TABPARACETAMOL 500MG + PSEUDOEPHEDRINE HCL 30MG TAB

SOLPADEINE SOLUBLE TABPARACETAMOL 500Mg CAFFEINE 30Mg CODEINE PHOS. 8Mg EFF.TAB

SOLPADEINE CAPSULEPARACETAMOL 500Mg CAFFEINE 30Mg CODEINE PHOSPHATE 8Mg CAP

PANADOL SOLUBLE 500MG TAB PARACETAMOL 500MG DISPERSABLE TABADOL 500 MG RECTAL SUPPOSITORIES PARACETAMOL 500MG RECTAL SUPPOSITORIESADOL 500MG CAPLET PARACETAMOL 500MG TABSAMOL 500MG TABLET PARACETAMOL 500MG TABSDOLOMOL 500MG TAB PARACETAMOL 500MG TABSEMIDOL 500MG TABLET PARACETAMOL 500MG TABSFEVADOL 500MG TAB PARACETAMOL 500MG TABSFEVADOL 500MG TAB PARACETAMOL 500MG TABSMEDAMOL 500MG TABLET PARACETAMOL 500MG TABSOMOL 500MG TABLET PARACETAMOL 500MG TABSPANADOL 500MG TAB PARACETAMOL 500MG TABSPANADREX 500 MG TAB PARACETAMOL 500MG TABSPANADREX 500 MG TAB PARACETAMOL 500MG TABSPARAMOL 500MG TAB. PARACETAMOL 500MG TABSPMOL 500MG CAPLET PARACETAMOL 500MG TABSREVANIN 500MG TAB PARACETAMOL 500MG TABSRIAGESIC 500MG TAB PARACETAMOL 500MG TABSTYLENOL FORTE TAB 500MG PARACETAMOL 500MG TABSVONAL 500MG TAB. PARACETAMOL 500MG TABS

PANADOL COLD & FLU CAPLET

PARACETAMOL 500MG+ CHLORPHENIRAMINE2MG+PSEUDOEPHEDRINE30MG TAB

REVACOD 500MG TABS PARACETAMOL 500MG+ CODEINE 10MG TAB

FEVADOL PLUS TABPARACETAMOL 500MG+CAFFEINE 30MG+CODEINE 8MG TAB

ADOL COMPOUND CAPLETSPARACETAMOL 500MG+CAFFEINE 50MG+CODEINE PHOSPHATE 8MG TABLET

ADOL EXTRA CAPLETS PARACETAMOL 500MG+CAFFEINE 60MG TABFEVADOL EXTRA TAB. PARACETAMOL 500MG+CAFFEINE 60MG TABPANADOL EXTRA TAB PARACETAMOL 500MG+CAFFEINE 60MG TAB

PANADOL NIGHT CAPLET PARACETAMOL 500MG+DIPHENHYDRAMINE25MG TABDOLOMOL 650MG SUPP PARACETAMOL 650MG SUPP

PANADOL EXTEND 665MG F.C. TABLETS PARACETAMOL 665MG FILM COATED TABLETFEVADOL SF 120MG\5ML SYRUP PARACETAMOL SUGAR FREEFEVADOL SF 120MG\5ML SYRUP PARACETAMOL SUGAR FREEADOL 125 MG RECTAL SUPPOSITORIES PARACETAMOL SUPP FOR INFANTS 125MGREVANIN 125MG SUPP FOR INFANTS PARACETAMOL SUPP FOR INFANTS 125MG

ADOL 250 MG RECTAL SUUPPOSITORIES PARACETAMOL SUPP.FOR CHILDREN 250MGREVANIN 250MG SUPP FOR CHILDREN PARACETAMOL SUPP.FOR CHILDREN 250MG

FLUDREX SYRUPPARACETAMOL120MG+CHLORPHENIRAMINE0.75MG+PSEUDOEPHEDRINE15MG

FLUDREX SYRUPPARACETAMOL120MG+CHLORPHENIRAMINE0.75MG+PSEUDOEPHEDRINE15MG

FLUDREX TABPARACETAMOL400MG+CHLORPHENIRAMINE3MG+PSEUDOEPHEDRINE30MG+CAFFEINE32MG TAB

CAFAMOL TABPARACETAMOL450MG+DOXYLAMINE 3MG+CAFFEINE 30MG TAB

AMOL EXTRA TABLETSPARACETAMOL500MG+CAFFEINE ANHYDROUS 65MG CAPLETS

OMOL EXTRA TABLETSPARACETAMOL500MG+CAFFEINE ANHYDROUS 65MG CAPLETS

Registered Paracetamol containing products in KSA market = 107

http://www.sfda.gov.sa/Ar/Drug

Nonprescription Drug Product Reformulation

• Kaopectate ® antidiarrheal • Contain Kaolin and pectin

– Reformulated in 1992 to Attapulgite• Because pectin was banned

– In 2003 attapulgite was discontinued and reformulated and contained bismuth subsalicylate

Nonprescription Drug Product Reformulation

• Old Percogesic : – Pain reliever– contain phenyltoloxamine + acetaminophen

• New Percogesic– Diphenhydramine + acetaminophen

• Maalox– Antacid: Aluminum and magnesium hydroxides

• Maalox Total Relief– Upset stomach reliever and Antidiarrheal:

Bismuth Subsalicylate

Drug Interaction

• Big area of concern when it comes to OTC self care

• OTC drugs, dietary supplements, herbal products, food and beverages

Allergies to Active or Inactive/Inert Ingredients

• any medicine can cause an allergic reaction. • Allergic reactions and side effects are caused

by:– Active ingredient– Inactive ingredients: binders, disintegrants, fillers,

and preservatives, coloring agents

Phenylalanine

Handling and Storage of Nonprescription Medications

• Many recalls of OTC medications because of impurity, contamination, or incorrect potency can occur.

• Expiration dates– the product is no longer under the manufacturer's

"warranty" and that the product "may" no longer work.

• Storage conditions– Cool, dry, dark place, in a child-proof container

Where do you keep your Medicines??

Role of Pharmacist in Counseling on nonprescription medications Survey

• Participants: 41.4% chain store and 34.4% independent retail– > 90% stated they take an active role in

counseling patients on OTCs– >40% recommend 6 to 10 products per day.

Role of Pharmacist in Counseling on nonprescription medications Survey

• Pharmacists ranking of counseling topics:

1. Selecting the right product2. Rx to OTC drug interaction3. Side effects/ADRs4. Directions/instructions5. Cost

Most important

Least important

Pharmacist Role

• Assess patient's physical complaint/symptoms• Differentiate self-treatable conditions from

those requiring referral.• Advise and counsel on the proper course of

action and the outcome expected• Assure patient that outcomes can be achieved

if OTC medications are taken as directed.• follow-up assessment of the treatment.

If self care is indicated Then Pharmacist Should:

• Assist in product selection• Assess patient risk• Counsel about proper drug• Maintain an accurate patient drug• Assess the potential of nonprescription

medications to mask symptoms of a more serious conditions

• Prevent delays in seeking appropriate medical attention.

Approach to Self Care Patient

• You will apply your skills in interview and medication history

• Apply your skills in communications: – With patient and their caregivers– Other healthcare provider

• You will apply your skills in identifying patient needs and DRP.

Systematic Process

• Assess, or systematically review, the patient's drug-related needs, presence of DRPs

• Create a care plan to resolve any drug therapy problems and achieve treatment goals, and to prevent any potential drug therapy problems.

• Evaluate the patient's outcome and current status at planned follow-up intervals.

Exclusions to self treatment

• Hoarseness, wheezing, coughing• Unexplained weight loss• Continuous N/V/D• Chest pain• Pregnancy• Nursing mothers• Children <12 years (for antacids or H2RA) or

<18 (for PPI)