HOW TO PRACTICE

O.T.C
Lecture three
 foot
Redness, bad odour, itching, yes
maceration inbetween toes (4-5) Tinea pedis
No
Big toe or ankle are suddenly
yes
gout
red , swollen, and painful
No yes
Lesion in foot sole with black dot Planter warts
in center, painful on walking on it
No
Hard lesion on bone surface on
yes
corns or callus
compression sites of foot
No yes Excessive walking or standing
Only pain on foot
Require rest
 Treatment of Tinea pedis

topical antifungal for about 2-4 weeks

Systemic antifungal may be added

(weekly capsule of ketoconazole)
 topical antifungal
1-Imidazole group:

*Miconazole (Daktarin, miconaze)®

*Clotrimazole(Candistan,colosol,Dermatin)

*Tioconazol (Trosyde)®

2- Tolnaftate (Tinea cure) ®

3- Terbinafine (lamisil)
Topical antifungal
Topical antifungal
ketoconazole
corns Plantar warts
 Treatment of corns and warts
Salicylic acid (keratolytic action)

cover surrounded healthy tissue with Vaseline”.

Salicylic acid is contraindicated with DM. due to

reduced sensation in the foot delay awareness of
skin breakdown & sepsis.

Patients should never attempt to lower calluse with

bladdes or files as can cause infection &
hemorrhage.
 ‫‪Example of OTC prescription‬‬

‫‪Callomack paint‬‬
‫مس صباحًا ومساءً لمدة ‪ 21‬يوم مع حمايت الجسء المحيط بطبقت رقيقت من فازلين‬
 Oral problems
Vesicle around the lip with history of
yes
Herpes simplex
common cold or low immunity
No
White patches on tongue
yes
Mouth thrush
or lip or tongue disfiguring
No
Painful ulcer in mouth with white
yes
oral sore
covering membrane
No yes
red painful edamatous gingivitis
gingiva
No
yes
Only
lips pain on foot & dry
are cracked chapped lips
 treament
treamentfor
forGingivitis
Gingivitis::
Antiseptic mouth wash
Chlorohexidine, povidone, citrimide,
benzdiamine

Antibiotic or antibacterial :
Amoxicillin, metronidazole, tetracycline

Analgesic
Ibuprofen, ketoprofen
 treament
treament forfor Gingivitis
herpes :
simplex:
Antiviral drug ( acyclovir)
Analgesic
 treamentfor
treament formouth
Gingivitis :
thrush
Oral antifungal
Miconazole, nystatin
 treament for
treament for mouth
Gingivitis :
sore:
Antiseptic mouth wash
Analgesic or anesthetic

.: (Jogel) ® -----> “Lidocaine + Jojob as antibacterial”

(Oracure)® -----> “Lidocaine + cetylpyridinium as
Antiseptic”
(Salvix – L)® -----> lignocaine + anthraqinone +SA
 dental pain
yes
Loose tooth physician
No
Dental pain disappear in seconds
yes
Dental decay
cold, hot, sweaty things
No
Continous pain even on touch,
yes Dental
bite, cold, or hot, dental fracture hypersensitivit
No y
Dental pain with facial
yes
swelling at jaw line, pus,
dental abcess
fever
No
Give local anesthetic or analgesic
 Ear problems

Pus discharge

Drum rupture exclud fever

e

sudden hear loss

 Ear problems
yes
Pain accompany common cold symptoms otitis media
No
Gradual decrease in hearing yes
Feeling of ear fullness
Wax impaction
No
yes
pruritus, white scaling, and otomycosis
swelling
No Antifungal solution
Pain on moving auricle, pain
yes
increase on chewing
otitis externa
No
Give local ear analgesic
Wax impaction
Ear analgesic
 Eye problems
yes
redness Eye redness
No
Occular discomfort ,itching yes
desire, eye awareness
Dry eye
No
Inflammation or infectionof the yes
sebaceous gland of the eye lash
stye
No yes
Inflammation of eye lid belpharitis
No
Tearing, mild swelling below
yes
allergic conjunctivitis
eyes & itching, allergic
history
 Red eye treatment
Ophthalamic vasoconstrictor “ sympathomimetic •
Naphazoline (Prisoline) ® •

Tetrahydrozoline (Visine) ® •
Dry eye
 Allergic conjunctivitis
1-Ophthalamic vasoconstrictor “ sympathomimetic

2-antihistaminic
loratidine
Fexofenadine
citrizine
Antihistaminic drugs
 rhinorrhea
No
yes
Sneezing, family infection Common clod
yellowish discharge, onset less 1
week, fever
No
Chronic, itching, no fever, clear
yes
allergic rhinitis
watery discharge, allergic history
N
Headache, faceopain around yes
sinus area, yellowish sinusitis
discharge, sinus congestion
No
unknown
 Treatment of cold
Oral nasal decongestants :
EX: phenylephrine.
Phenyl propanolamine (No flu, contaflu) ®
Pseudoephedrine (Actified) ®

Antihistaminic :
Analgesics :
paracetamol
 antihistaminic
Relieve sneezing, runny nose, nose
itching

First generations :
Side effects of sleepiness & drowsiness

Second generations : “No Sedation”

First gen. antihistaminic
Sec. Antihistaminic drugs
Tinea pedis
Ex1: Clioquinol (Vioderm)

Ex2: Imidazole group:

Miconazole (Daktarin)®
Clotrimazole (Canesten, Dermatin)®
Tioconazol (Trosyde, Topozole)

Ex3: Tolnaftate (Tinea cure)

Ex4: Povidone I2 (Betadine) ®

 -Topical antifungal & may accompanied •
with oral antifungal if sever. Ex: Diflucan
 Body temperature
measurements :
Oral “sublingual” : ْ
Good reflex of body temperature but usually lower than
body temp due to breathing from mouth while taking
temp.

Tympanic:
Due to high blood flow in tympanic membrane,
so reflects body temp.

Axillaries
But its validity is questionable.
 Treatment
Supportive (tempogel)
Cool bath, ice packs, fans reduce fever

Antipyretic :
acetaminophen, Ibuprofen, ketoprofen or
aspirin, declofenac

Antipyrtic should be taken after meal

NB: Aspirin should be avoided in children lower than

12 years due to risk Ray’s syndrome
paracetamol
 Ibuprofen

ketoprofen
declofenac
 Example of OTC prescription

Pyral syrp
‫ مرات بعد االكل‬3 ‫ مل‬10
 headache
yes
Eye pain, blurred vision Eye problem
No yes
Sinus congestion, pain in sinus areas sinusitis
No
yes
Throbbing pain in one side of head migraine
worsen with normal movements,

No
Give analgesic
Like fever
 Prevention of headache

1- avoid high amount of caffee, tea, ice

cream, chocolate

2-avoid stress and avoid change normal

routine as “dieting, traveling, sleeping”
 Treatment of migraine

Mild cases :
Acetaminophen plus metoclopramide

Sever cases:
Ergotamine combination
Avoid use in hypertensive patients or pregnant
 Paracetamol +
metoclopramide
ergotamine
Example of OTC prescription for migraine

Migracid tab
‫ قرص عند اللزوم‬2-1
 insomnia
yes
Psychological causes or sever pain Physician contact
No
yes
On starting drug use Drug induced
No
Give first generation antihistaminic
or natural sedating product
Prevention of insomnia “sleep hygiene”

1-avoid CNS stimulant drugs

2-Hunger can inhibit sleep, so not go to

bed hungry.

3-Avoid coffee, smoking completely after

noon.

4-Bed room should be comfortable

5-avoid napping
 Treatment
Antihistaminic :
as diphenhydramine & doxylamine at
bedtime

Plant extracts :
Valerians (Dormival) ®
Kava kava extract (kava) ®
Plant extracts
First gen. antihistaminic
Example of OTC prescription:

Kava cap
‫ كبسوالث يومياً قبل النوم‬2 – 1
Avil retard tab
‫قرص يومياً قبل النو م‬
 Fatigue & weakness
yes
Fever & rhinorhea, sneezing Common cold
No
yes
Recurrent Hypotension, palpitation, pale skin anemia
No
Unintended potent weight loss, good yes hyperthyroidism
appetite, sweating, tachycardia, nervousness
No
yes
On starting drug use Drug induced

Overworking or under eating is the cause

 Treatment: “for fatigue & weakness

1-Caffeine stimulant:
NB: too much caffeine may cause nervousness,
irritability & no sleep.

2-multivitamins
-Supply vitamins and minerals and energizers
-Avoid those concentrate on iron or calcium
-Multivitamins are taken once daily after meal
 multivitamins
1- royal jelly

2- vitamins and minerals

2- ginseng

4- wheat germ oil

5- antioxidant

6- Bee pollen
multivitamins
Example of OTC prescription:

Royal jelly 600 mg tab

‫كبسولت يومياً بعد الغداء‬
 Back pain
yes
Accident, fall, injury physician
No
yes
Urine problem Renal stone or infection
No yes
Numbness or pain in one leg Sciatica (disc)
No
Chronic pain, inflammation,
yes Osteoarthritis or
stiffness In both sides of joints rheumatic arthritis

Give analgesic, muscle relaxant

 Treatment of back pain
1- analgesic:
acetaminophen, Ibuprofen, ketoprofen or aspirin,
declofenac, piroxicam,celecoxib, nimasulide,
indomethacin

2-muscle relaxnt
EX 1 :- Baclofen(Baclofen)®.
EX 2 :- Chlozoxazone (Myolgine) ®.
EX 3:- Orphenadrine (Norflex) ®.

3-counter irritant
Mask the pain
Not applied to wound or damaged skin
indomethacin

AntiCox 2
Muscle relaxant and analgesic
Example of OTC prescription:

myolgin cap
‫ مراث بعد االكل‬3 ‫كبسولت‬
Olfen amp
‫حقنت عضل يوميا‬
 cough
yes
Fever Respiratory infection
No
yes
Asthmatic patient Physician contact
No cough
yes Interfere with sleep or
yes
Productive suppressant
activity or painful + expectorant
No
dry cough
No

yes Give
mucolytic
Give antitussive or
expectorant
 Cough

Cough removes foreign bodies, so not

recommend selling a cough suppressant to
smokers.

Productive cough brings up accumulated

mucus preventing pneumonia, so must be
allowed to be continued for its cleansing
effect
 Treatment productive cough
Bromohexyine (Bisolvon)®

Ambroxol (Ambroxol)®
Active metabolite of bromohexine

Acetyl cystiene: (Acetyl cystiene) ® Powder

Carboxy methyl cystiene ( solvex):

mucolytic
mucolytic
 Treatment of dry cough
Cough suppressant ( antitussive)
Central :
codeine Diphenhydramine; Dextromethorphane;
Noscapine”, Pipozethate, Butamirate

Peripheral :
camphor & Menthol

Codeine&Dextromethorphane have the risk of abuse (

addiction)& constipation.
antitussive
antitussive
Expectorant & cough suppressant

Guaifensin Diphenhydramine

Ammonium cl Dextromethorphane;

Tr. Ipeca Camphor

Tr. Squill Menthol”

KI
Antitussive+ expectorant
 Natural preparations for cough

They act as cough suppressant and expectorant

Examples:
Guava leaves, fennel, thyme, honey, tilia,
comphor, mentol.

Suitable for pregnant, patients with kideny, liver

disorder.
Natural cough product
Example of OTC prescription for
productive cough:

muco syrup
‫ مراث‬3 ‫معلقت كبيرة بعد االكل‬
Example of OTC prescription for
dry cough:

sinecode syrup
‫ مراث‬3 ‫معلقت كبيرة بعد االكل‬
Example of OTC prescription for
productive interfere with sleep

Toplexil syrup
‫ مراث‬3 ‫معلقت كبيرة بعد االكل‬