1.

Diarrhea

Diarrhea is the frequent passing of loose or watery stools.

CPR Definition: Diarrhea is defined as an increase in the frequency and looseness of stools compared to one's normal bowel pattern. The overall weight and volume of the stool is increased (> 200 g or mL/day) , and the water content is increased to 60%-90%. In general , diarrhea results when some factor impairs the ability of the intestine to absorb water from the stool , which causes excess water in the stool . Types: Diarrhoea can be categorized as: Acute: less than 5 - 10 days Acute diarrhea, which is a common cause of death in developing countries, appears rapidly and may last from five to ten days. Chronic: More than 14 - 21 days

 Chronic diarrhea lasts much longer and is the second cause of childhood death in the developing world. MOTHERS AND OTHER CAREGIVERS SHOULD Prevent dehydration through the early administration of increased amounts of appropriate fluids available in the home, and ORS solution, if on hand Continue feeding (or increase breastfeeding) during, and increase all feeding after the episode Recognize the signs of dehydration and take the child to a health-care provider for ORS or intravenous electrolyte solution, as well as familiarize themselves with other symptoms requiring medical treatment (e.g., bloody diarrhoea) Provide children with 20 mg per day of zinc supplementation for 1014 days (10 mg per day for infants under six months old). Role of Community Pharmacist

 Counsel mothers to begin administering suitable available home fluids immediately upon onset of diarrhoea in child Treat dehydration with ORS solution (or with an intravenous electrolyte solution in cases of severe dehydration) Emphasize continued feeding or increased breast- feeding during, and increased feeding after the diarrhoeal episode Use antibiotics only when appropriate, i.e. in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrhoeal drugs Issues to be Addressed to the Government Develop a 35 year plan to reduce mortality rates from diarrhoeal diseases Assess progress in controlling diarrhoeal diseases by monitoring usage rates of ORS, home-based treatment and zinc supplementation Using the media and face-to-face communication, promote and refine messages

on diarrhoea prevention, home management of diarrhoea and appropriate care-seeking Craft suitable strategies to educate health-care workers at all levels about using the new ORS and zinc supplements in treating diarrhea Promote the availability of ORS and zinc formulation that is cost-effective and easily administered to both infants and children Identify obstacles to the use of ORS, zinc supplements and home-based treatments in managing acute diarrhoea.

2. Over The Counter Drugs Over-the-counter (OTC) drugs are medicines that may be sold directly to a consumer without a prescription from a health care professional, as compared to prescription drugs, which may only be sold to consumers possessing a valid prescription. The Pharmacist-Patient Encounter: First, the pharmacist should evaluate, through the interview and observation, the patient's

physical complaint and/or symptoms alongside medical condition. Second, the pharmacist must differentiate between self-treatable conditions from those requiring the attention of the patient's health care provider (i.e. a doctor). Third, the pharmacists obligation is to provide adequate advice and counsel the patient on the proper course of action to be taken (i.e. either no treatment with drug therapy, selftreatment with an OTC product, or referral to a health care provider.) For example, the pharmacist can assist in product selection, taking into account the prescription medicines the patient is already taking, evaluate potential risk factors (i.e. contraindications, warnings, precautions, age, organ function) and counsel the patient about proper drug use (i.e. dosage, administration technique, monitoring parameters, storage) Nevertheless, a proper OTC pharmacist-patient encounter should be carried out in two steps .

Step 1 - Every pharmacist should begin the OTC counseling session by introducing himself/herself by name which identifies

him/her as the pharmacist. He/she should try to relax the patient by beginning the session with good oculesics (or eye contact), a friendly smile and a handshake that is employ basic non-verbal communication equally as important as verbal. The pharmacist should also explain that he/she can provide assistance with OTC product selection and explain how to use such medication. Step 2 - In order to elicit key information the pharmacist should first and foremost try to obtain relevant information about patients demographic (e.g. sex, age, pregnant, nursing, weight, allergies, social history etc), disease (e.g. history of present illness, current symptoms, course of illness, past history, other underlying medical conditions) and drug (e.g. current medication, medication taking history, OTC history etc.)

Common interactions of OTC drugs: The risk of drug interactions with concurrent use of multiple medications is a clinically

relevant issue. Many patients are unaware that over-the-counter (OTC) analgesics can cause potentially serious adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents. Of particular significance is the increased risk of upper abdominal gastrointestinal adverse events in patients who take traditional non steroidal antiinflammatory drugs (NSAIDs). Examples of interactions: Synergism:Aspirin if administered with diabetes medicines such as chlorpropamide then aspirin increases the blood sugar lowering effect of diabetes medicine. NSAIDS including aspirin when administered with anti cancer drugs like methotrexate aspirin reduces how the kidney clear the methotrexate from body. This may lead to too much drug in the blood.

3.

CONTRACEPTIVES:

1.Combined hormonal contraceptives 2.Progestogen-only contraceptives 3.Spermicidal contraceptives 4.Contraceptive devices 5.Emergency contraception 1.Combined hormonal contraceptives: Oestrogen used: ethinylestradiol(oral),mestranol,estradiol. Progestogens used: Desogestrel,drospirenone,gestodene,norelgestr omin,etonogestrel(vaginal ring). 1.Low-strength prep:20ug ethylest.for high risk pt. of circulatory diseases. 2.Stand.strength prepLphased pre.:30-40ug ethy est.for those having no withdrawl bleeding or breakthrough bleeding as with monophasic. Missed pill: Critical time is at the beginning & end of cycle If forgotten 1 time,take the pill as soon as reminded

 Missed pill is the one forgotten for 24hr.s than take an active pill & resume the plan again. If two pills are missed repeat above procedure. but additional contraception must be abide for next 7 days. In case of intercourse during these days without contraception take emergency pill. Interactions: Oral contraceptives efficacy is reduced with enzyme inducing drugs (Rifampicin,anitepileptic). Condom with injectable contraceptive are more suitable for HIV-pt.& at risk of HIV-Infection. For short course of E.I drugs: the dose of combined pill should have 50ug of ethyl est.during after stoppage of coarse till 4 weeks. For longterm E.I drugs: Alternate contraception method is used.In women unable to take alt. method above dose is recom. With only 4 days interval . Appropriate conta.even after 4-8 weeks of stopping drug use.

 Patch: additional cont.with & after stoppag e of drug use till 4 weeks.for long in-take of drug take ring application repeated without a gap period. Ampicillin& Doxycycline:efficacy is red. Due to impairment of bacterial flora resonsilble for recycling of ethylest,so additional contraceptive is recommended with or after stoppage till 7 days.& start next packet without gap.if coarse persists for more than 3 weeks resistance develops & no cont. is recomeneded till the change of anti-bacterial drug.Patch& ring.conmatinant cont.during & 7 days after stoppage..for 3weeks add.cont with aptch & ring for longer use no cont req. due to resist. Reasons to Stop Immediately: Sudden severe chest pain Sudden breathlessness Unexplained swelling or severe pain in calf of one leg Severe stomach pain Severe neurological effect. Hepatitis,jaundice,liver enlargement

 Blood pressue >160/95mmHg. Detection of Risk factor which contraindicates treatment Risk factor for venous thromboembolism: Family history of venous thromboembolism Obesitybody mass index >30kg/m2 Long-term immobilization History of superficial thrombophlebitis Age over 35 yr.s Smoking Risk for arterial thromboembolism: Family history of arterial throembolism Diabetes mellitus Hypertension Smoking Age over 35yr. Obesity Migraine without aura 2.Progestogen-only contraceptives:

 A)ORAL:recm. In venous thrombosis & in all risk factors mentioned in previous article. Interaction:E.I.drugs:an alt.contra.with & after stoppage till 4 weeks. Surgery:recm. in all combined oral contra.before all elective surgeries & where immobilisation is invovled. Starting routine:one tablet on day 1 of cycle ,repeat dose on same time a delay of 3 hr. is acceptable, after childbirth,3weeks of postpartum it is safe to take,lactation is not effected. Missed pill:if missed >3hr.s 2 days contra. Is req. Diarrohea&vomitting:if V. occurs 2hr.s after pill taken,repeat doseif not taken within 3 hrs 2days cont. is recm.

Exclusive Breast Feeding: What is meant by EBF. 1- Impact on neonatal and infant survival and health

 2- Impact on Child Nutrition 3- Impact on Child Development 4- Benefits for the mother. EBF importance regarding maternal health Infant Formula Milk Issues Role of Community Pharmacist Regarding EBF Shahwar whole presentation included. Naila whole presentation.