آقاي الف 70 ساله با علائم سرماخوردگي از شما درخواست دارو نموده است. ايشان بدليل ابتلا به گلوكوم زاويه باز از 6 ماه پيش تحت درمان با تيمولول مي باشد. ولي مدتي پس از مصرف تيمولول در دفع ادرار دچار مشكل شد. بررسي هاي ارولو‍ژيك شواهد بروز BPH را نشان داد و از سه ماه پيش تحت درمان با تامسولوسين قرار گرفت. ضمنا ايشان تحت درمان با آتنولول و انالاپريل براي كنترل HTN ميباشد. كدام آنتي هيستامين را براي اين بيمار توصيه ميكنيد؟ الف- كلرفنيرآمين ب- هيروكسي زين ج- ديمن هيدرينات د- پرومتازين آيا توصيه مي كنيد يك تركيب Decongestant مصرف كند؟

OTC Products Shahram E. Mehr, Associate Professor of Pharmacology, Dept. of Pharmacology, Tehran University of Medical Sciences

In the USA, drugs are divided by law into two classes: 1.Prescription ONLY 2.Non-prescription or over-the-counter (OTC) Q. What about Iran?

Q. What do we need OTC dugs? Scientific reasons Economic reason!

Q. Why is it important for us as a physician? Treatment of common aliments can be achieved by OTC drugs. Many of the active ingredients in OTC drugs may interact with medical conditions or other medications. Misuse or abuse of OTC drugs. physicians should help patients in the selection of OTC drugs Please express your idea!

Select product that: 1. Has simplest formulation 2. Has sufficient concentration of active ingredient 3. Has lists its ingredients and their amounts 4. Has dose, dosage form, and palatability suitable for children

Note! Certain ingredients in OTC products are hidden. Q. Do you know the ingredients of Adult cold, ACA, Children cold, …..?

Q. Does OTC products are ineffective and harmless? This idea cause: diagnostic confusion, unsuccessful therapy. 1. Caught and cold preparation, appetite control products should be avoided in IDDM, HTN, angina, hyperthyroidism

2. Aspirin and aspirin-likes in active PU, platelet disorders, oral anticoagulants. 3. Cimetidine can increase the toxicity of certain drugs.

Overuse or misuse of OTC products may induce significant medical problems: 1.Rebound congestion after use of decongestants. 2.Some antiacids may cause constipation. 3.Laxatives cause abdominal cramp, fluid disturbances. 4.Sympathomimetics, caffeine cause insomnia 5.Analgesics cause nephritis.

Prescription

Clinical problem Evaluation Diagnosis surgery medication others

Drug therapy is the most common approache. This approache requires the writing a prescription A prescription is the prescriber’s order to prerpare or dispense a specific treatment for a specific patient.

Rational prescribing 1. make a specific diagnosis. 2. consider the pathophysiology of the diagnosis. 3. Select a specific therapeutic object. 4. select a drug of choice. 5. Determine the appropriate dosing regimen. 6. Devise a plan for monitoring the drug action and determine an end point for therapy. 7. Plan a program of patient education.

The prescription Prescription (outpatient) Physician’s order sheet (POS) or chart order (hospitalized patient) Name, address, and medical council No. of physician Name and address of patient Name, strength, quantity, order, refill of drug Signature WARNING

Ampicillin 500 mg IV q6h × 5 days Aspirin 0.6 g per rectum q6h prn temp over 101 [signed] M. Shirazi, MD

What is the criteria for determination of quatity of drugs? Duration of therapy, cost, need for continued contact, potential for abuse, potential for toxicity or overdose.

1 grain (gr)= grams (g) 15 gr=1 g 1 ounce (oz) by volume= 30 milliliters (ml) 1 teaspoonful (tsp)= 5 ml 1 Tablespoonful (tbsp)= 15 ml 1 quart = 1000 ml 1 minim= 1 drop (gtt) 20 drop = 1 ml 2.2 pounds (lb) = 1 kilogram (kg) KCl 20%, 20 grams/dL

Tab: Tablet Cap: Capsule Syr: Syrup Elix: Elixir Susp.: Suspension Emul.: Emulsion Supp.: Suppository Vial.: Vial Amp.: Ampule