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