General provisions of General provisions of pharmaceutical carepharmaceutical care

DRUGSDRUGSConsumers have two routes of access totherapeutic drugs. One route is by prescription or order

from a licensed health care provider. The other route is by over-the-counter(OTC) purchase of drugs that do not

require a prescription.Both of these routes are regulated by

various drug laws.

Drug Laws and StandardsTheir main goal is to protect the

public by ensuring that drugs marketed for therapeutic purposes, whether prescription or OTC, are safe and effective.

With prescription drugs, a health care professional diagnoses the condition, often with the help of laboratory and other diagnostic tests, and determines a need for the drug.

With OTC drugs, the client must make these decisions, with or without consultation with a health care provider.

Questions to be answered

1. Can patients accurately self-diagnose the condition for which a drug is indicated?

2. Can patients read and understand the label well enough to determine the dosage, interpret warnings and contraindications and determine whether they apply, and recognize drugs already being taken that might interact adversely with the drug being considered?

Questions to be answered

3. Is the drug effective when used as recommended?

4. Is the drug safe when used as instructed?

Available OTC, advantages for patients

Greater autonomy; faster and more

convenient access to effective treatment;

possibly earlier resumption of usual activities of daily living;

fewer visits to a health care provider;

possibly increased efforts by patients to learn about their symptoms/conditions and recommended treatments.

Available OTC, disadvantages for patients

Inaccurate self-diagnoses and potential risks of choosing a wrong or contraindicated drug,

Delaying treatment by a health care professional,

developing adverse drug reactions and interactions

OTC productsOTC products To use OTC products safely, it is To use OTC products safely, it is important to understand important to understand

(1)(1) their side effects, their side effects,

(2)(2) their effects on other underlying their effects on other underlying medical conditions such as medical conditions such as diabetes mellitus, , high blood pressure, , asthma, and other conditions, asthma, and other conditions,

(3)(3) their interactions with other their interactions with other prescribed medications such as prescribed medications such as antidepressants, , anticoagulantsanticoagulants, and , and high blood pressure medicines, high blood pressure medicines,

(4)(4) the product's limitations.the product's limitations.

COMPLIANCECOMPLIANCE ComplianceCompliance (sometimes called (sometimes called adherenceadherence) ) is is

the extent to which patients follow treatment the extent to which patients follow treatment instructionsinstructions. There are four types of . There are four types of noncompliancenoncompliance leading to medication errors. leading to medication errors.

(1) The patient fails to obtain the (1) The patient fails to obtain the medication. Some studies suggest that medication. Some studies suggest that one third of patients never have their one third of patients never have their prescriptions filledprescriptions filled. Some patients leave . Some patients leave the hospital without obtaining their the hospital without obtaining their discharge medications, whereas others discharge medications, whereas others leave the hospital without having their leave the hospital without having their prehospitalization medications resumed. prehospitalization medications resumed. Some patients cannot afford the Some patients cannot afford the medications prescribed.medications prescribed.

COMPLIANCECOMPLIANCE (cont’d) (cont’d) (2) The patient fails to take the (2) The patient fails to take the

medication as prescribed. Examples medication as prescribed. Examples include include wrong dosage, wrong wrong dosage, wrong frequency of administration, improper frequency of administration, improper timing or sequencing of timing or sequencing of administration, wrong route or administration, wrong route or technique of administration, or taking technique of administration, or taking medication for the wrong purposemedication for the wrong purpose. . This usually results from inadequate This usually results from inadequate communication between the patient communication between the patient and the prescriber and the pharmacist.and the prescriber and the pharmacist.

COMPLIANCECOMPLIANCE (cont’d) (cont’d)

(3) The patient prematurely discontinues (3) The patient prematurely discontinues the medication. This can occur, for the medication. This can occur, for instance, if the patient incorrectly assumes instance, if the patient incorrectly assumes that the medication is no longer needed that the medication is no longer needed because the bottle is empty or because the bottle is empty or symptomatic improvement has occurredsymptomatic improvement has occurred..

(4) The patient (or another person) takes (4) The patient (or another person) takes medication inappropriately. For example, medication inappropriately. For example, the patient may share a medication with the patient may share a medication with others for any of several reasons.others for any of several reasons.

COMPLIANCECOMPLIANCE (cont’d) (cont’d) Several factors encourage Several factors encourage

noncompliance. Some diseases noncompliance. Some diseases cause no symptoms (eg, cause no symptoms (eg, hypertension); patients with these hypertension); patients with these diseases therefore have no diseases therefore have no symptoms to remind them to take symptoms to remind them to take their medications. Patients with their medications. Patients with painful conditions, such as arthritis, painful conditions, such as arthritis, may continually change medications may continually change medications in the hope of finding a better one. in the hope of finding a better one.

COMPLIANCECOMPLIANCE (cont’d) (cont’d) Characteristics of the therapy itself Characteristics of the therapy itself

can limit the degree of compliance; can limit the degree of compliance; patients taking a drug patients taking a drug once a day are once a day are much more likely to be compliant much more likely to be compliant than those taking a drug four times a than those taking a drug four times a dayday. .

COMPLIANCECOMPLIANCE (cont’d) (cont’d)

Various patient factors also play a role in Various patient factors also play a role in compliance. Patients living alone are much compliance. Patients living alone are much less likely to be compliant than married less likely to be compliant than married patients of the same age. Packaging may patients of the same age. Packaging may also be a deterrent to compliance¾elderly also be a deterrent to compliance¾elderly arthritic patients often have difficulty arthritic patients often have difficulty opening their medication containers. Lack opening their medication containers. Lack of transportation as well as various social or of transportation as well as various social or personal beliefs about medications are personal beliefs about medications are likewise barriers to compliance.likewise barriers to compliance.

Strategies for improving Strategies for improving compliancecompliance

include enhanced communication include enhanced communication between the patient and health care between the patient and health care team members; team members;

assessment of personal, social, and assessment of personal, social, and economic conditions (often reflected economic conditions (often reflected in the patient's lifestyle); in the patient's lifestyle);

development of a routine for taking development of a routine for taking medications (eg, at mealtimes if the medications (eg, at mealtimes if the patient has regular meals); patient has regular meals);

Strategies for improving Strategies for improving compliancecompliance

provision of systems to assist taking medications provision of systems to assist taking medications (ie, containers that separate drug doses by day of (ie, containers that separate drug doses by day of the week, or medication alarm clocks that remind the week, or medication alarm clocks that remind patients to take their medications); patients to take their medications);

mailing of refill reminders by the pharmacist to mailing of refill reminders by the pharmacist to patients taking drugs chronically. The patient who patients taking drugs chronically. The patient who is likely to discontinue a medication because of a is likely to discontinue a medication because of a perceived drug-related problem should receive perceived drug-related problem should receive instruction about how to monitor and understand instruction about how to monitor and understand the effects of the medication. the effects of the medication.

Compliance can often be improved by enlisting Compliance can often be improved by enlisting the patient's active participation in the treatment. the patient's active participation in the treatment.

Algorithm of pharmacist’s actions at Algorithm of pharmacist’s actions at pharmaceutical guidelines of patients pharmaceutical guidelines of patients

with OTC drugs usingwith OTC drugs using To set, for treatment of which To set, for treatment of which

symptom agent is acquiredsymptom agent is acquired To define, on the basis of questioning To define, on the basis of questioning

of patient, whether there is not this of patient, whether there is not this symptom the display of disease, symptom the display of disease, requiring obligatory intervention from requiring obligatory intervention from a doctora doctor

To define the pharmacological group To define the pharmacological group of drugs for treatment of this symptomof drugs for treatment of this symptom

Algorithm of pharmacist’s actions at Algorithm of pharmacist’s actions at pharmaceutical guidelines of patients pharmaceutical guidelines of patients

with OTC drugs using (cont’d)with OTC drugs using (cont’d)

To choose among medicinal agents To choose among medicinal agents of certain group optimum drug for of certain group optimum drug for this patientthis patient

To give a patient the proper To give a patient the proper information about the chosen drug information about the chosen drug and terms of his rational applicationand terms of his rational application

Information about drugInformation about drug1. Action of agent: 1. Action of agent:

Why is the agent required? What Why is the agent required? What symptoms of disease will disappear, and symptoms of disease will disappear, and what - no? When will the action of the drug what - no? When will the action of the drug show up? What will happen at the wrong show up? What will happen at the wrong taking of the drug or refuse of him?taking of the drug or refuse of him?

2. Side effects: What side effects can arise 2. Side effects: What side effects can arise up? How to recognize them? How long will up? How to recognize them? How long will they be saved? As far as are they serious? they be saved? As far as are they serious? What is it necessary to undertake?What is it necessary to undertake?

Information about drug Information about drug (cont’d)(cont’d)

3. Terms of rational reception of the drug: How to 3. Terms of rational reception of the drug: How to accept the agent? When to accept him? how long accept the agent? When to accept him? how long to continue treatment? How to keep the agent?to continue treatment? How to keep the agent?

4. Warnings: When is it impossible to accept the 4. Warnings: When is it impossible to accept the drug? which is a maximal dose? why is it drug? which is a maximal dose? why is it necessary to pass the complete course of necessary to pass the complete course of treatment? or Why is not it necessary to treat treatment? or Why is not it necessary to treat oneself longer than 2 days and it is necessary to oneself longer than 2 days and it is necessary to be consulted with a doctor?be consulted with a doctor?

Control of information about the agent.Control of information about the agent. To ask a To ask a patient, whether all to him clearly. To ask a patient, whether all to him clearly. To ask a patient to repeat the most important information. patient to repeat the most important information. To know, whether he have some questionsTo know, whether he have some questions

"Threatening" symptoms"Threatening" symptoms

A fever requires emergency treatment under the following circumstances:

• newborn (three months or younger) with a fever over 100.5°F (38°C)

• infant or child with a fever over 103°F (39.4°C)

• fever accompanied by severe headache, neck stiffness, mental confusion, convulsions, or severe swelling of the throat

"Threatening" symptoms"Threatening" symptoms A very high fever in a small

child can trigger seizures (febrile seizures) and therefore should be treated immediately.

A fever accompanied by the above symptoms can indicate the presence of a serious infection, such as meningitis, and should be brought to the immediate attention of a physician.

A fever over 100.5°F (38°C) 3 days and longer

A fever over 37,5°C 2 weeks and longer

ThreatningThreatning symptoms. symptoms. Cough Cough Cough with increasing Cough with increasing

intensity that lasting intensity that lasting above week above week

Cough accompanied by Cough accompanied by long steading (weeks) long steading (weeks) hyperthermia 38 hyperthermia 38 °C°C

Cough accompanied by Cough accompanied by hyperthermia above 38 hyperthermia above 38 °C during 3 days or °C during 3 days or moremore

Cough accompanied by Cough accompanied by dyspnea and thorasic dyspnea and thorasic pain on breathingpain on breathing

ThreatningThreatning symptoms. symptoms. CoughCough

Cough of pusCough of pus Blood spitting Blood spitting Cough with pronounced Cough with pronounced

dyspneadyspnea Cough and weakness and Cough and weakness and

weight lossweight loss Excessive sweating,Excessive sweating,

shiveringshivering Sudden attack of severe Sudden attack of severe

coughcough Severe cough during an Severe cough during an

hour without any intervalhour without any interval Abundant expectoration of Abundant expectoration of

sputumsputum

ANTICOUGH MEDICATIONS. GUIDELINES

The patient should take medications as prescribed or as directed on the labels of OTC preparations. Taking excessive amounts or taking recommended amounts too often can lead to serious adverse effects.

ANTICOUGH MEDICATIONS. GUIDELINES (cont’d)

The patient should take cough syrups undiluted and avoid eating and drinking for approximately 30 minutes. Part of the beneficial effect of cough syrups stems from soothing effects on pharyngeal mucosa. Food or fluid removes the medication from the throat.

Heartburn. Heartburn. Life-threatening Life-threatening symptomssymptoms

Accompanied by Accompanied by chest pain that chest pain that feels like a heart attack, feels like a heart attack, persistent dry cough, vocal persistent dry cough, vocal modification, hoarseness, a modification, hoarseness, a sensation of globus pharyngis (a sensation of globus pharyngis (a lump at the back of the throat) lump at the back of the throat) and otalgia (ear pain)and otalgia (ear pain)

Abdominal pain or difficulty Abdominal pain or difficulty swallowing, swallowing,

Heartburn. Heartburn. Life-threatening Life-threatening symptomssymptoms

weight loss, weight loss, fever or signs of bleeding, fever or signs of bleeding,

including vomiting and black including vomiting and black stools, which could indicate stools, which could indicate bleeding from the esophagus into bleeding from the esophagus into the stomachthe stomach

Heartburn Heartburn 3 days and more3 days and more Heartburn connected with certain Heartburn connected with certain

medicinesmedicines

Threatening symptoms of Threatening symptoms of constipationconstipation

blood in stoolblood in stool weight loss weight loss severe pain with bowel movementssevere pain with bowel movements constipation has lasted more than constipation has lasted more than

two weekstwo weeks feverfever sharp abdominal distentionsharp abdominal distention

Threatening symptoms of Threatening symptoms of diarrheadiarrhea

1. The presence of blood in the stool1. The presence of blood in the stool

2. Feces in the form of "rice broth"2. Feces in the form of "rice broth"

3. Increased body temperature3. Increased body temperature

4. Nausea and vomiting4. Nausea and vomiting

5. Diarrhea accompanied by severe 5. Diarrhea accompanied by severe abdominal painabdominal pain

Threatening symptoms of Threatening symptoms of diarrheadiarrhea6. Diarrhea occurs in several family 6. Diarrhea occurs in several family

membersmembers7. Diarrhea lasts for a few weeks7. Diarrhea lasts for a few weeks8. Diarrhea is accompanied by loss of 8. Diarrhea is accompanied by loss of

consciousnessconsciousness9. Diarrhea accompanied by severe 9. Diarrhea accompanied by severe

thirst, dry mouth, dry skinthirst, dry mouth, dry skin10. Diarrhea is accompanied by a 10. Diarrhea is accompanied by a

small amount of urinesmall amount of urine11. Diarrhea in pregnancy11. Diarrhea in pregnancy