Introduction to OTC Medicines PDF

OSPAP Programme Introduction to community pharmacy over the counter (OTC) medicines in the UK Deanne Marshall OSPAP MPHM14 Introduction to OTC  Objectives Overview of community pharmacy OTC The Law Responsible Pharmacist Referral points/war...

OSPAP Programme Introduction to community pharmacy over the counter (OTC) medicines in the UK Deanne Marshall OSPAP MPHM14 Introduction to OTC  Objectives Overview of community pharmacy OTC The Law Responsible Pharmacist Referral points/warning symptoms Conditions Products Licensing restrictions Pharmacy first OSPAP MPHM14 Introduction to OTC  The Law The sale and supply of medicines in the UK is restricted by law Medicines act 1968 part III Legal Classifications P medicines GSL medicines PO medicines (not a legal classification) Pack sizes (Section 8) can determine whether a product can be sold OTC e.g: Paracetamol can be POM, P or GSL OSPAP MPHM14 Introduction to OTC  P medicines A pharmacy (P) medicine is a medicinal product that can be sold from a registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist. Pharmacy medicines must not be accessible to the public by self-selection. MEP guide July 2024 See MPHM15 lectures for a more detailed definition of supervision 4  GSL medicines General sale medicines, also known as ‘General Sales List' (GSL) medicines, are those that can be made available as ‘self-selection’ items for sale in registered pharmacies. They can also be sold in other retail outlets that can ‘close so as to exclude the public’. MEP guide July 2024 5  Legal classifications 16 tablets/capsules GSL 32 tablets/capsules P 100 tablets/capsules POM Paracetamol capsules or tablets can be sold to the public provided packs contain no more than 32 capsules or tablets; pharmacists can sell multiple packs up to a total quantity of 100 capsules or tablets in justifiable circumstances. (BNF) 6  Responsible Pharmacist Regulations In order to run a pharmacy, there must be a responsible pharmacist (RP) signed in and present in the pharmacy – P medicines can only be sold under the supervision of a Responsible Pharmacist. – An RP must be present to be able to hand out dispensed prescriptions If the RP is absent but still signed in, then only GSL medicines may be sold If there is no RP signed in then no GSL or P medicines can be sold The Responsible Pharmacist must ensure that their staff are adequately trained to supply OTC medicines in their absence - This means having an NVQ Level 2 in Pharmacy Services minimum OSPAP MPHM14 Introduction to OTC  Evidence Base A lot more evidence available particularly for recent POM to P switches Older medicines may have little or no evidence Does not necessarily mean it is ineffective Evidence Sources you can use... Clinical evidence (BMJ) NICE SIGN Clinical Knowledge Summaries Cochrane library Database searches e.g. Medline, Embase OSPAP MPHM14 Introduction to OTC  Consultation acronyms E Explore W Who N No Medication W What C Care H How long A Action taken O Observe M Medication R Refer E Explain S Site I Intensity A Age/appearance T Type/nature S Self or not D Duration M Medication O Onset W With (other symptoms) E Extra medicines N Annoyed or aggravated T Time persisting S Spread H History I Incidence O Other symptoms R Relieved by ? D Danger symptoms OSPAP MPHM14 Introduction to OTC  Warning Symptoms Chest Gut Chest pain Difficulty swallowing Shortness of breath Blood in vomit Wheezing Bloody diarrhoea Swollen ankles Vomiting with constipation Blood in sputum Weight loss (unexplained) Palpitations Sustained alteration of Persistent cough bowel habit Whooping cough Croup Sputum mucoid, coloured OSPAP MPHM14 Introduction to OTC  Warning Symptoms Eye Ear Painful red eye Pain Loss of vision Discharge Double vision Deafness Irritation Tinnitus Vertigo OSPAP MPHM14 Introduction to OTC  Warning Symptoms Genitourinary Other Difficulty in passing urine Neck stiffness/ rigidity with Blood in urine temperature Abdominal/loin/back pain Vomiting (persistent) with cystitis Urethral discharge Vaginal discharge Vaginal bleeding in pregnancy OSPAP MPHM14 Introduction to OTC  Other things to consider... Interactions - with prescribed, non-prescribed and herbal medications Contraindications - with conditions already present Age of patient License restrictions Legal issues Confidentiality OSPAP MPHM14 Introduction to OTC  Common GI Illnesses Oral thrush Apthous ulcers Indigestion IBS Constipation Haemhorroids Nausea and vomiting Diarrhoea OSPAP MPHM14 Introduction to OTC  Common Respiratory Issues Common cold and influenza Symptoms Decongestants Cough productive /unproductive Sore throat Hay fever OSPAP MPHM14 Introduction to OTC  Common Women’s and Men’s Health Issues Cystitis Thrush Menstrual problems Pregnancy EHC Hair problems Erectile dysfunction Sleeping problems BPH OSPAP MPHM14 Introduction to OTC  Common lifestyle Issues Smoking Alcohol intake Diet Exercise Stress and emotional health Holiday and travel health Sexual health (safe sex) STDs: Chlamydia infection; Genital warts; Genital herpes OSPAP MPHM14 Introduction to OTC  Common Skin Complaints Rash Contact eczema Minor wounds Atopic eczema Dandruff Psoriasis Sebborhoeic dermatitis Scabies Cradle cap Pubic lice Hair loss Body lice Head lice Warts/ verrucas Acne Nail problems Rosacea and SLE Fungal infections Impetigo Corn/ callous/ bunion Cold sores Chilblains Shingles Skin cancer Vitiligo OSPAP MPHM14 Introduction to OTC  Common Eye Issues Conjunctivitis Allergic conjunctivitis Subconjunctival Haemorrhage Blepharitis Serious causes of a red eye symptoms Acute glaucoma Keratitis (corneal ulcer) Iritis (uveitis) – If any of the above are suspected they should warrant referral to a doctor OSPAP MPHM14 Introduction to OTC  Common Ear Issues Earwax Acute otitis media Otitis media with effusion (glue ear) OSPAP MPHM14 Introduction to OTC  Common CNS Complaints Insomnia Vertigo Pain Muscoskeletal pain Headache Migraine Sumatriptan OSPAP MPHM14 Introduction to OTC  Common Paediatric Illnesses Pyrexia Teething Colic Threadworm Infectious Diseases Measles/German Measles (Rubella) Chicken Pox Mumps Whooping cough Meningitis Vaccinations OSPAP MPHM14 Introduction to OTC  Vitamins and Minerals Commonly Used and Supplied OTC Water soluble Minerals Vitamin B group Calcium B1 Thiamine Iron B2 Riboflavin Selenium B3 Niacin Zinc Folic Acid B5 Pantothenic acid You should have a good B6 Pyridoxine working knowledge of each of B12 Cobalamin their: Vitamin C Function Fat soluble Food sources A Symptoms of deficiency and of marginal deficiency D E K OSPAP MPHM14 Introduction to OTC  Common Herbal Products Sold OTC Garlic - Lower cholesterol/ anticoagulant Glucosamine and chondroitin - Osteoarthritis St John’s Wort - Antidepressant Echinacea - Immune system Ginseng - vitality, immune function, help in cancer, cardiovascular disease, sexual problems Gingko biloba - cognitive function Evening Primrose oil - pre-menstrual syndrome which includes mastalgia (sore tender breasts) and pre-menstrual symptoms Feverfew - migraine/ headache/ toothache Ginger - Nausea Valerian - Anxiety/ sleep Saw Palmetto - Prostate OSPAP MPHM14 Introduction to OTC  Homeopathy “Like cures Like” Use minute amounts of medicine which in much greater concentration actually causes the symptoms being treated. Produced from a Mother Tincture Plant material; Animal and insect material; Biological material; Chemical material Dilution process The mother tincture is diluted serially (The more dilute the more potent the remedy is) Do not interact with conventional medicines Not commonly supplied from pharmacies OSPAP MPHM14 Introduction to OTC  Pharmacy first Commenced 31st January 2024 NHS funded treatment for 7 common conditions (where clinically appropriate) Allows pharmacist to be funded for the healthcare advice they give to patients Establishes the community pharmacy as the first port of call for advice Advanced community pharmacy service www.cpe.org.uk 26 Pharmacy first 27  Pharmacy first Patients can self refer, or be referred by NHS 111 or their GP Pharmacist goes through a consultation with the patient using the clinical pathway for each condition They will be provided with advice and supplied, where clinically necessary, with a medicine prescription-only (POM) treatment under a Patient Group Direction (PGD) or in one pathway, an over-the-counter medicine (supplied under a clinical protocol), all at NHS expense. 28  Summary Selling OTC medications in the UK The law Evidence base How to question a patient Warning signs/red flags Common conditions Vitamins and minerals, herbal and homeopathy Pharmacy first 29