Prescriptions
Pharmacist interventions in the healthcare system
السلامة والامن الدوائيMedicine safety
تعلم ايضا حول تعزيز الصحة Health promotion
Prescriptions
Definition :-
It is a written order from a doctor , dentist or veterinary practitioner to the pharmacist for the supply of medicines or drugs to a patient .
The prescription may be hand written or printed but certain drugs e.g. control drugs such as morphine derivatives , amphetamine or barbiturates . the prescription should be hand written by the doctor .
In certain emergency cases the prescription may not be written immediately but verbally instructed by the doctor to the pharmacist through phoning or any other means of communication .
Types of prescription :
1- Community prescription
2- Hospital prescription
Community prescription can be classified into :-
- National health service prescription (NHSP)
- Private prescription
1- NHSP :-
These prescriptions are issued by family practitioner (general practitioner ) to the sick family members in a community . the price of the prescription is usually paid by the NHS authority.
2- Private prescription
These are issued by doctors or dentist or veterinary practitioner in private clinics . all the cost of such prescriptions are paid by the patient .
Hospital prescription can be classified into :-
1- Inpatient prescription
2- Outpatient prescription
Non-prescription drugs or over-the-counter drugs
(OTC drugs)
drugs are generally classified into :-
1- Prescription drugs which are dispensing only upon the presentation of a medical prescription .
2- Non-prescription (OTC) drugs which are dispensing by pharmacist without prescription Non –prescription drugs
- It is including drugs dispensed by a pharmacist without the need of a medical prescription .
They include mainly the drugs of the following diseases:-
1-pain
2-cough
3-diarrhea
4-constipation
5-common cold
6-hemorrhoids
7-gastritis , indigestion and gastroesophageal reflux distress
8-insomnia
9-allergy
10-infestations of ear, nose and throat
11-genitourinary tract infections
12-skin disorders
13-wounds
14-burns
15-irritable bowel syndrome
16-girdiasis , amebiasis , ascariasis and pine worm infestation .
17-hair loss
18-oral contraceptives
1-Constipation
Constipation: a change from the normal body habits ,where normal body habits vary from one individual to another, ranging from several stools a day to the passage of one stool every 2–3 days.
Aetiology of constipation
• Inadequate intake of dietary fibre.
• Dehydration.
• Lack of exercise and poor mobility
• Failure to recognize or answer normal call to Stool.
• Medical causes
• Drugs.
Drugs causing constipation
• Antacids
• Antidiarrhoeal agents
• Anticholinergic drugs
• Antihistamines
• Anti-parkinsonian drugs
• Phenothiazines
• Tricyclic antidepressants
• Diuretics
• Iron.
Medical causes of constipation
• Gastrointestinal disease e.g. haemorrhoids
• Neurological disorders e.g. Parkinson’s disease
• Psychiatric disorders e.g. stress, depression.
• Metabolic disorders e.g. diabetes, hypothyroidism.
Symptoms of constipation
• Inability to pass stools at regular intervals
• Production of abnormally hard stools
• Straining at stool, abdominal pain and discomfort.
• Sensation of incomplete evacuation
• Mild abdominal distension, headache, slight anorexia.
Treatment :-
1- general measures
• High-fiber diet
• High fluid intake
• Regular exercise.
2- Drugs (Laxatives)
There are four main types of laxatives :-
1- bulk-forming laxatives:-
These are polysaccharide and cellulose derivatives that are not digested. They exert an effect within 12–72 hours of administration and are useful in hard stools. e.g. ispaghula husk (powder)
2- osmotic laxatives:-
it Increases amount of water in the intestines by osmosis. This increased volume results in distension of the lumen which promotes peristalsis e.g. lactulose (liquid)
3- stimulant laxatives:-
These stimulate intestinal motility , They have a rapid onset of action e.g. senna (tablets), bisacodyl (tablets, suppositories), sodium picosulphate (liquid), glycerol (suppositories)
4- saline laxatives:-
it increase amount of water in the intestine Cause a very rapid action e.g. magnesium salts (powder).
2-Diarrhea
Definition :-
an increased frequency of bowel movements and the production of soft or watery stools resulting in fluid and electrolyte loss.
Diarrhoea may be acute or chronic.
There are three main types :-
1- Osmotic diarrhoea: non-absorbable solute retains water in the intestine lumen.
Examples include osmotic substances such as sorbitol (found in sugar-free sweets) and drugs such as magnesium containing antacids.
2- Secretory diarrhoea: damage to intestinal wall leading to increased secretion in contrast to absorption of electrolytes e.g. infectious diarrhoea.
3- Motility diarrhoea: decreased contact time of faeces in intestine resulting in fluidy faeces e.g. inflammatory gastrointestinal disease, drugs.
Common causes of diarrhoea
• Gastroenteritis due to bacteria and virus.
• Irritable bowel syndrome
• Crohn’s disease
• Ulcerative colitis
• Neoplasms
• Metabolic disorders e.g. hyperthyroidism, diabetes.
Drugs that may cause diarrhoea
• Antibacterial drugs
• Antacids
• NSAIDs
• Iron preparations
Symptoms of diarrhoea
• Sudden onset
• Mild abdominal cramping pain
• Flatulence
• General weakness
• Nausea and vomiting may also be present, particularly in infective diarrhoea.
treatment :-
1- General measures
• To use oral rehydration salts to rehydrate and replace lost electrolytes .
• To avoid dairy products.
2- Oral rehydration salts
- Oral rehydration salts (ORSs) provide fluid and electrolyte replacement.
- They are presented in the form of powder for reconstitution, consisting of sodium, potassium and glucose.
- The intestinal absorption of sodium and water is enhanced by glucose.
- Patients should be advised to reconstitute ORSs with potable water and any unused reconstituted solution should be discarded within 1 hour after preparation unless stored in a refrigerator where it can be kept for up to 24 hours.
- Factors that affect patient acceptance are palatability and flavouring.
3- Drugs
- Antimotility drugs
These relieve symptoms by reducing peristalsis through stimulation of the mu opioid receptors on the intestinal wall. They are not recommended for use in children.
• Examples: codeine, loperamide(immodium)
• Side-effects: abdominal cramps, constipation
• Chronic use may cause paralytic ileus and toxic megacolon
• Dose for loperamide: adults 4 mg followed by 2 mg after each unformed stool.
- Anti-infectious drugs
It is used according to the causative agents e.g. antibacterial , Antiprotozoal ……etc
3- gastro-esophageal reflux disease(GERD)
• Reflux into the oesophagus of the gastric or intestinal contents occurs which causes oesophagitis due to acidic contents coming into contact with the oesophagus.
• Patient complains of heartburn .
• Risk factors:-
- pregnancy
- obesity
- foods with high fat content, spices, citrus fruit, coffee.
• Occurrence increases at night when patient is in supine بطني position.
Extra-oesophageal complications of gastro-oesophageal reflux disease
• Laryngo-pharyngeal disorders
• Dental erosion
• Sinus problems
• Reflux-induce asthma.
Treatment :-
general measures
Achieve ideal body weight.
Decrease cigarette smoking.
Avoid foods that irritate gastric mucosa (spicy foods, citrus, tomato extracts)
Avoid foods that lower oesophageal sphincter pressure (chocolate, alcohol, peppermint, fatty food) or stimulate secretion (cola, beer).
Elevate head of bed.
Drug
- Antacids
- H2 – blockers
- Proton pump inhibitors
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