community pharmacy mag

1. Community pharmacy
COMMUNITY MAG

2. Community pharmacy
“IT IS EASY TO GET A THOUSAND
PRESCRIPTIONS BUT HARD TO GET
ONE SINGLE REMEDY”

3. Community pharmacy
CONTRIBUTORS ( Fall 2017)
Ghaniya Saeed
Hifza Saleem
Summan
Gulzaib Zafar
Tayyaba mishal
Rafia
Umme kalsoom
Nida Sadaqat
Maryah Ashraf
Iqra Amir
EDITOR IN-CHIEF:
Sana ijaz (Lecturer)
Basma qasim
Umme Habiba khan
Arafah Zubeirah
Ayesha Abdul Haleem
Meerab Tanveer
Amina Tariq
Ruqia
Riphah international Islamic university, Lahore

4. Community pharmacy
COMMUNITY PHARMACY
Community pharmacy is the science
and art of preventing disease, prolonging life
and promoting mental and physical health
and efficiency under the supervision of
qualified pharmacist through organized
community efforts for the sanitation of the
environment, the control of communicable
infections, education about personal hygiene,
organization of medical and nursing services
for the early diagnosis and preventive
treatment of the disease, and development of
social machinery to ensure to every
individual a standard of living adequate for
the maintenance of health, so organizing
these benefits as to enable every citizen to
realize his birthright of health and longevity.
Goal The primary goal of community
pharmacy is to identify the health problems
and needs of people (community diagnosis)
and to plan, implement and evaluate the
effectiveness of health care system includes
 Drug information about their action
 Drug utilization
 Drug distribution
 Drug selection
 Patient counseling and evaluation
 Processing of prescriptions
 Care of patients or clinical
pharmacy
 Monitoring of drug utilization
 Extemporaneous preparation and
small-scale manufacture of
medicines
 Traditional and alternative
medicines
 Responding to symptoms of
minor ailments
 Informing health care
professionals and the public
 Health promotion

5. Community pharmacy
COMMUNITY PHARMACIST
“Community pharmacists are the health
professionals most accessible to the
public. They supply medicines in
accordance with a prescription or, when
legally permitted, sell them without a
prescription. They maintain links with
other health professionals in primary
health care.” Community pharmacists
where formerly known as chemists, but
they are not chemists. Chemists only
know about the salt in a medicine,
whereas community pharmacist has all

6. Community pharmacy
the knowledge about drug, the salt
present in the drug, the side effects, the
food interactions and much more which
is far away from the knowledge of a
mere chemist. A community pharmacist
is often the first health professional the
patient seeks advice from and, as such,
provides a filtering mechanism whereby
minor self-limiting conditions can be
appropriately treated with the correct
medication and patients with more
sinister pathology referred on to the GP
for further investigation.
Roles and responsibilities of pharmacist
 A community pharmacist may
involve in all drug related
problems like counseling on
prescribed medicines, proper use
of over the counter (OTC),
records, immunization schedule
etc.
 Into the area of
“Pharmacoepidimiology” (Post
marketing phase of a clinical trial
of drug, concern with safety or
risk of a new drug after coming in
market).
 He may involve the control of
serious communicable diseases
by making community aware
through counseling. By this
method a lot of diseases like TB,
Syphilis, and AIDS can be
control.
 He also beware about
environmental health. He may
also involve in patient health
education through pamphlets and
bulletins.
 A community pharmacist guide
patients about nutrition intake
according to requirement and
disease.
 He provides counseling to
pregnant ladies about material
and child health, diet and
hygiene.
 He can also help in guiding the
parents for the protection of child
against diseases by proper
immunization schedule.
 He provides counseling to
alcohol addicted people and also
encourages patient to prevent
themselves from chronic
diseases.
 Have a sound background of
pharmaceutical care,
pharmacotherapy, and health
promotion.
 Have good communication skills
with patients and other healthcare
providers.
 Maintain a high degree of
standard in products, services,
and communication.
 Record and maintain his
documents in order.

7. Community pharmacy
HEALTH

8. Community pharmacy
Health means a person having a
sound mind, in a sound body in a
sound family and in a sound
environment. According to WHO
the term health is defines as “health
is a state of complete, physical,
mental and social well-being and
not merely absence of disease or
infirmity”.
Public health is the planning
carrying out an evolution of health
measures and system services that
both maintain and improve the
health of a population group,
prevent and control diseases within
the population group. Public health
is the science and arts of
 Preventive disease
 Prolonging lifespan
 Promoting health and
efficiency through organized
community efforts for
 Sanitation of the environment.
 Control of communicable
diseases
 Education of the individual in
personal hygiene
 Development of the social
machinery to ensure everyone a
standard of living for
maintenance of health.
Hygiene is derived from the
Greek word Hygeia-the Goddess of
health who looks after the health of
people. Hygiene is the science and
art of preserving and improving
health. It is the science of health
and embraces all factors which
contribute to healthful living by

9. Community pharmacy
preventing disease either in the
individual or in the community.
Self-care the ability of individuals, families and communities to promote health,
prevent disease, and maintain health and to cope with illness and disability with or
without the support of a health-care provider’. It is a continuum starting with
individual choices on health (e.g., taking exercise), moving through to managing
their own ill health (e.g., self-medicating) either on their own or with help.

10. Community pharmacy

11. Community pharmacy

12. Community pharmacy
HEALTH EDUCATION:-
Health education is any combination of
learning experiences designed to help
individuals and communities improve their
health, by increasing their knowledge or
influencing their attitudes. It is a profession
of educating people about health. Areas
within this profession encompass
environmental health, physical health, social
health, emotional health, intellectual health,
and spiritual health.
AIM AND OBJECTIVES:-
 To provide information about health
and hygiene
 To maintain norms of good health
 To take precautionary and preventive
measures
 To take curative measures
 To develop and promote mental and
emotional health
 To develop a sense of civic
responsibility among pupils
AREAS OF HEALTH EDUCATION:-
It is concerned with communicating on those
areas that are related to:
 Water supply
 Sanitation
 Community health
 Mental health
 Disease control
 Personal hygiene
 Disaster management cycle
These are involved in reducing the risk of
communicable disease and its transmission,
proper nutrition, alcohol and drugs, accident
and first aid etc.
Priority Areas of the Health Education
Department are:
 Disease Prevention
 Nutrition/Obesity Education
 Diabetes Education
 Fitness & Weight Management Classes &
Education
 Community Fitness Center
 Massage Therapy/Aesthetics
 Other Continuing Health Education
 General Administrative Duties

13. Community pharmacy
CLASSIFICATION OF
COMMUNICATION METHODS:
Methods have been classified into three
main groups according to the number of
people who are willing to get health
education. Such as
 Individual method
 Group method
 Mass media method
1. INDIVIDUAL METHOD:-
 This method involves person to person or
faces to face communication which
provides maximum opportunity for two
way flow of idea, knowledge and
information.
 Adequate interaction between the health
educator and his client help provide health
education successfully resulting in
attitude and expected behavior change.
 Way of successful individual health
education method are counselling and
interview.
2. GROUP METHOD:-
 An ideal group may consist of six or
twelve members depending upon
situation.
 This small group also can get some
opportunity to ask questions and share
ideas, information and experiences.
 In spite of the advantage of individual
methods for health education cannot be
use due to the time limitation and
shortage of manpower.
 So it will be more practicable for him to
provide education in group as well.

 Group method include:-
 Group discussion
 Demonstration
 Mini-lecture
 Problem solving
 Brain storming
 Panel discussion
 Role play
 Field trip/ educational tour/ campaign
 Workshop/seminar
 Symposium
3. MASS MEDIA METHOD:
This method is especially meant
for a large number of heterogeneous people.
Mass method includes-
 Lecture,
 Exhibition,
 Audio aid – radio cassette player,
 Video aid- posters, pamphlets, flip chart,
flannel graph, butte tin board etc.
 Audio- visual aids such as television,
film& sound, videotape movies.
IMPORTANCE:-
Health education has a very wide area of
imparting knowledge to people which are
described below:
 It gives knowledge regarding structure and
functions of the body and tells how to keep
physically and mentally fit, about exercise,
rest and sleep; harmful effects of alcohol,
tobacco and drugs on the body.
 It gives knowledge regarding various
nutrients present in different food materials
and making a balanced diet from available
foods. It also gives knowledge regarding
storage, preparation, cooking, serving and
eating of food.
 It gives information about the causes of
various common diseases, how they spread
and protection from these diseases. People
should be encouraged to participate in the
national programs of disease control and
eradication.
 It imparts knowledge about personal and
environmental hygiene. Personal hygiene
includes bathing, washing, and clothing,
toilets, care of feet, nails, teeth, and hair
and skin; spitting, coughing, sneezing and
developing clean habits in young children.
Environmental hygiene includes cleaning,
proper lighting and ventilation of houses;
supply of clean water, control of rats and

14. Community pharmacy
mice; proper sewage and disposal of refuge
etc.
 It imparts knowledge about causes and
protection from environ-mental pollution.

15. Community pharmacy

16. Community pharmacy
Epidemiology is derived from the
word epidemic
 Study of the distribution and
determinants (causes) of
diseases and injuries in human
population
 Detailed scientific study of the
distribution and determinants of
disease or disability in society
 These studies cover sources and
modes of transmission of an
infection occurring endemically
or erupting as an epidemic in the
community
 It also covers the social,
economic and environmental
factors.

17. Community pharmacy
Scope of epidemiology
 To study the history of disease
in relation to its rise and fall in a
community
 To study the respective role of
agent, host and environmental
factors in the spread of disease
 Study of types of disease
prevalent in a community
 Helps to diagnose the health
problems of the community by
studying occurrence,
distribution by age, sex,
occupation and locality
 Helps to find out the morbidity
and mortality rates and to
identify those individuals or
groups at risk or those in need of
health care
 Helps to collect variety of data
from different sources which
will establish logical chains to
explain multiple factors in the
spread of a disease
 Helps to establish
epidemiological diagnosis of a
disease with better
understanding of its different
aspects after observing its
behavior in a group of person
 Helps in research and
experimental studies in the field
of medical sciences
 Helps to forecast the future
trends of the disease which will
help to take preventive measures
e.g. increased incidence of
cholera in summer season and
malaria during rainy season.

18. Community pharmacy
Epidemiological triads
Chain of infection

19. Community pharmacy
Communicable diseases An illness
due to a specific infectious agent or its toxic
products capable of being directly or
indirectly transmitted from man to man,
animal to animal from the environment to
man or animal. Vaccination and proper
precautionary campaigns should be planned
and implemented in accordance with WHO
recommendations of following
communicable disease
 Acute lower respiratory tract infections
 Diarrheal diseases (cholera, bacillary
dysentery (Shigella, Salmonella))
 Hepatitis E
 Measles
 Meningitis
 Malaria / Dengue
 Poliomyelitis
 HIV/AIDS
 Tuberculosis.
Non-communicable disease
(NCD) is a medical condition or disease that
is not caused by infectious agents (non-
infectious or non-transmissible.
 Cardiovascular disease (CVD)
 Chronic obstructive pulmonary
disease (COPD)
 Diabetes mellitus
 Lower back pain caused by too little
exercise
 Malnutrition caused by too little food, or
eating the wrong kinds of food
(e.g. scurvy from lack of Vitamin C)
 Skin cancer caused by radiation from the
sun
 Obesity

20. Community pharmacy
4

21. Community pharmacy
HYPERTENSION

22. Community pharmacy
Introduction
Hypertension, also known as high blood pressure (HBP), is a chronic medical condition in which
the blood pressure in the arteries is persistently elevated. It is also defined as a systolic blood
pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg or more,
or taking antihypertensive medication.
Classification
Based on recommendations of the Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of BP for
adults aged 18 years or older has been as follows
 Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg
 Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg
 Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg
 Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater
Causes
Primary hypertension (90–95%)
• Essential hypertension
Secondary hypertension (5–10%)
• Renal diseases
• Endocrine diseases
 Steroid excess hyperaldosteronism
(Conn's syndrome);
hyperglucocorticoidism (Cushing's
syndrome)
 Growth hormone excess: acromegaly
 Catecholamine excess:
phaeochromocytoma
 Others: pre-eclampsia
• Vascular causes
 Renal artery stenosis: fibromuscular
hyperplasia; renal artery atheroma;
coarctation of the aorta
• Drugs
 Sympathomimetic amines
 Oestrogens (e.g. combined oral
contraceptive pills)
 Ciclosporin
 Erythropoietin
 NSAIDs
 Steroids
Regulation of blood pressure The
mean blood pressure is the product of cardiac
output and total peripheral resistance. In most
hypertensive individuals, cardiac output is
not increased and high blood pressure arises
as a result of increased total peripheral
resistance caused by constriction of small
arterioles. Control of blood pressure is
important in evolutionary terms and a
number of homeostatic reflexes have evolved
to provide blood pressure homeostasis.
Minute-to-minute changes in blood pressure
are regulated by the baroreceptor reflex,
while the renin–angiotensin–aldosterone
system is important for longer term salt,
water and blood pressure control.
Clinical presentation Hypertension is
often an incidental finding when subjects
present for screening or with unrelated
conditions. Severe cases may present with
headache, visual disturbances or evidence of
target organ damage (stroke, ischemic heart
disease or renal failure).
Malignant hypertension Malignant or
accelerated hypertension is an uncommon
condition characterised by greatly elevated

23. Community pharmacy
blood pressure (usually >220/120 mmHg)
associated with evidence of ongoing small
vessel damage. Fundoscopy may reveal
papilloedema, haemorrhages and/or
exudates, while renal damage can manifest as
haematuria, proteinuria and impaired renal
function. The condition may be associated
with hypertensive encephalopathy, which is
caused by small vessel changes in the
cerebral circulation associated with cerebral
oedema. The clinical features are confusion,
headache, visual loss, seizures and coma.
Brain imaging (particularly MRI) usually
demonstrates extensive white matter
changes. Malignant hypertension is a medical
emergency that requires hospital admission
and rapid control of blood pressure over 12–
24 h towards normal levels.
Diagnosis of hypertension
Blood pressure should be measured using a
well-maintained sphygmomanometer of
validated accuracy. Blood pressure should
initially be measured in both arms and the
arm with the highest value used for
subsequent readings. The subject should be
relaxed and, at least at the first presentation,
blood pressure should be measured in both
the sitting and the standing positions. An
appropriate sized cuff should be used since
one that is too small will result in an
overestimation of the patient's blood
pressure. The arm should be supported level
with the heart and it is important that the
patient does not hold their arm out since
isometric exercise increases blood pressure.
Blood pressure is measured using the
Korotkov sounds which appear (the first
phase) and disappear (the fifth phase) over
the brachial artery as pressure in the cuff is
released. Cuff deflation should occur at
approximately 2 mmHg/s to allow accurate
measurement of the systolic and diastolic
blood pressures. The fourth Korotkov phase
(muffling of sound) has previously been used
for diastolic blood pressure measurement but
is not currently recommended unless
Korotkov V cannot be defined. Having
established that the blood pressure is
increased, the measurement should be
repeated several times over several weeks,
unless the initial measurement is at
dangerously high levels, in which case
several measurements should be made during
the same clinic attendance.
White-coat hypertension Some people
develop excessive and unrepresentative
blood pressure rises when attending the
doctor's surgery, so-called ‘white coat’
hypertension. These patients can be
diagnosed if they use a blood pressure
machine themselves at home or by 24-h
ambulatory blood pressure monitoring

24. Community pharmacy
Non-pharmacological treatment
Non-pharmacological management of
hypertension is important. Patients with mild
hypertension in the range 140–159/90–100
mmHg can be assessed for levels of risk
while offered lifestyle advice. General health
education is important to allow patients to
make informed choices about management.
In patients who are overweight, weight loss
results in reduction in blood pressure of about
2.5/1.5 mmHg/kg. The DASH diet (Dietary
Approaches to Stop Hypertension) was
evaluated in a clinical trial and found to lower
blood pressure significantly (4.5/2.7 mmHg)
compared with a typical US diet. This diet
emphasizes fruit, vegetables, and low-fat
dairy produce in addition to fish, low-fat
poultry and whole grains while minimising
red meat, confectionary and sweetened
drinks. Subjects should reduce their salt
intake, for example, by not adding salt to food
on the plate. A daily sodium intake of <100
mmol (i.e. 6 g sodium chloride or 2.4 g
elemental sodium) should be the aim. There
is a significant amount of hidden salt in
processed meat, ready meals, cheese and
even bread. A dietary assessment may be
required to accurately quantify a patient's salt
intake and advice on how reductions might be
made. Most subjects will need to control their
intake of calories and saturated fat. Regular
aerobic exercise, at a level appropriate to the
individual subject, at least 3 times a week for
at least 30 min derives maximum benefit.
This results in improved physical fitness as
well as a reduction in blood pressure. Alcohol
intake should be restricted to two (females)
or three (males) units per day. Although
smoking does not affect blood pressure, it
increases cardiovascular risk and patients
should quit or, if this is not possible, reduce
their cigarette consumption.

25. Community pharmacy
Diabetes is a defect in the body’s ability to convert glucose (sugar) to energy. Glucose is the main
source of fuel for our body. When food is digested it is changed into fats, protein, or carbohydrates.
Foods that affect blood sugars are called carbohydrates. Carbohydrates, when digested, change to
glucose. Examples of some carbohydrates are: bread, rice, pasta, potatoes, corn, fruit, and milk
products.
Glucose is transferred to the blood and is used by the cells for energy. In order for glucose to be
transferred from the blood into the cells, the hormone - insulin is needed. Insulin is produced by
the beta cells in the pancreas (the organ that produces insulin). In individuals with diabetes, this
process is impaired.

26. Community pharmacy
TYPES
Diabetes develops when the pancreas fails to
produce sufficient quantities of insulin –
Type 1 diabetes or the insulin produced is
defective and cannot move glucose into the
cells – Type 2 diabetes. Either insulin is not
produced in sufficient quantities or the
insulin produced is defective and cannot
move the glucose into the cells
Type 1 diabetes occurs most frequently in
children and young adults, although it can
occur at any age. Type 1 diabetes accounts
for 5-10% of all diabetes in the United States.
There does appear to be a genetic component
to Type 1 diabetes, but the cause has yet to be
identified. Type 2 diabetes is much more
common and accounts for 90-95% of all
diabetes. Type 2 diabetes primarily affects
adults, however recently Type 2 has begun
developing in children. There is a strong
correlation between Type 2 diabetes,
physical inactivity and obesity.
CAUSE
 Deficiency in the production of insulin
 Genetic susceptibility
 Autoimmune devastation of beta cells
 Environmental factor
 Insulin resistance
 Metabolic syndrome
RISK FACTORS
 Family background
 Overweight or obese
 Physical inactive
 Age
 Ethnic background
 High blood pressure
DIAGNOSIS
The diagnosis of diabetes is made by a
simple blood test measuring your blood
glucose level. Usually these tests are
repeated on a subsequent day to confirm
the diagnosis. Both forms and all stages
of diabetes are serious, with many
possible complications, including eye,
heart, kidney, and nerve damage.
TREATMENT
 Request a referral to a certified diabetes
educator and/or a dietitian.
 Obtain a prescription for a glucometer and
testing supplies.
 Begin to make life style changes.
 Begin an exercise
program
 Make healthy food choices
 Increase your fiber intake
 Limit your intake of concentrated sweets
 Test your blood sugar at varying times of
the day.
Get informed. If you have diabetes, there are
many things you can do to help yourself.
Medication is only one aspect of your care;
maintaining a healthy weight, increasing
your physical activity, eating healthy foods,
testing your blood sugars, taking your
medications as prescribed, attending diabetes
education programs, and consulting with
your health professional to keep your blood
sugar in control will help you.
The test provides you and your doctor with
an assessment of the overall control of your
diabetes. In simple terms, this test measures
the sugar coating on red blood cells. The life
of a red blood cell is three months, so this test
should be done every three to six months to
assess your blood sugar control. Your daily
blood sugar results will also provide you with
helpful information on the impact of foods,

27. Community pharmacy
physical activity, and medications. Together
these tests should help you manage your
diabetes.
Although you may not feel sick, high blood
sugar levels are damaging blood vessels and
your organs. Complications of diabetes are
preventable if you keep your blood sugar as
close to normal as possible. The goal is an
A1C level between 6.5% -7%. It is important
to take care of yourself. Be sure you work
with your doctor.
YEARLY
 Complete physical exam, foot exam,
creatinine, cholesterol, triglycerides,
and urine micro albumin tests.
 You may have an electrocardiogram
and/or a stress test
 Dilated eye exam by an
ophthalmologist.
 Referral to a diabetes educator or
nutritionist
 Referral to a smoking cessation
program.

28. Community pharmacy

29. Community pharmacy
Depression is a common and serious medical
illness that negatively affects how you feel
the way you think and how you act. It vary
from person to person but it have common
signs and symptoms.
Childhood depression: The symptoms of
depression in children vary. Most of the time
undiagnosed and untreated. Child depressed
mood is evidenced by acting out or angry
behavior, sadness, not interest in normal
activities e.g. playing games or school work.
Teen depression: Teen depression has
noticeable change in their behavior and
thinking. Hormonal changes and
environment (peer pressure or academic
expectations) responsible for it.
Symptoms
It includes
 Loss of pleasure
 Depressed mood
 Excessive weight loss or gain
 Difficulty in sleeping
 Feeling either restlessness
 Being tired all the time
 Feelings of guilt
 Poor concentration
 Thought of suicide or death
Causes
It include
 Genes
 Biochemical environment
 Personal experience ( divorce ,
death of someone)
 Psychological factors
 Use of alcohol
 Chronic disease
Some barriers to recognition diagnosis and
optimal treatment of depression
 Believing can handled by self
 Not ready to accept diagnosis
 Fear of treatment
 Physician interviewing skill
deficiency
 Physician fear of offending
patient
 Time constraints
 Clinical issues
Life style changes
 Exercise
 Proper nutrition
 Social support
 Sleep
 Stress reduction
Foods to fight depression
 Banana
 Dark chocolate
 Yogurt and milk
 Brown rice
 Sweet potatoes
 Barriers
 Chicken
 Nuts
 Tea
 Oatmeal
 Dates
How medicines work
 It takes few week for the patient
begins feeling any positive effect
from medication

30. Community pharmacy
 Patient may feel tempted to stop
taking medication because it is not
doing anything
 If patient has not received any benefit
from the medication ,he should talk to
the doctor
o Each person react different to
medication
o Discus your symptoms with
doctor how you are
responding to medication for
successful treatment

31. Community pharmacy
LUNGS CANCER
H
ere,

32. Community pharmacy
The lungs are the primary organs of
the respiratory system in humans .Their
function in the respiratory system is to
extract oxygen from the atmosphere and
transfer it into the bloodstream, and to
release carbon dioxide from the bloodstream
into the atmosphere, in a process of gas
exchange.
Causes Lung cancer is the uncontrolled
growth of abnormal cells in one or both
lungs. These abnormal cells do not carry out
the functions of normal lung cells and do not
develop into healthy lung tissue. As they
grow, the abnormal cells can form tumors
and interfere with the functioning of the lung,
which provides oxygen to the body via the
blood. The other causes are
 smoking tobacco
 second-hand smoke
 exposure to asbestos
 exposure to radon
 exposure to occupational substances
such as uranium, chromium,
nickel, diesel fumes and soot
 HIV infection
 family history
 history of come lung diseases such as
lung fibrosis or emphysema
 Some metals (aluminum
production, cadmium etc.).
 Some products of combustion
(incomplete combustion, diesel
engine exhaust)
 Ionizing radiation (X-
radiation, gamma
radiation, plutonium)
 Some toxic gases (methyl ether,
fumes from painting)
 Rubber production and
crystalline silica dust
According to the World Health Organization
(WHO), 7.6 million deaths globally each year
are caused by cancer; cancer represents 13%
of all global deaths. As seen below, lung
cancer is by far the number one cancer killer.
Symptoms of lung cancer may include:
A cough that won't go away
 Cough might:
 be more painful
 have a different sound
 bring up colored mucus or phlegm
 shortness of breath and wheezing
 hoarseness
 chest pain
 loss of appetite
 unexplained weight loss
 feeling tired most of the time
(fatigue)
 Ongoing chest infection

33. Community pharmacy
Hormone related symptoms:
Some types of lung cancer cells produce
hormones that go into the bloodstream.
These hormones can cause symptoms that
don’t seem related to the lung cancer.
Doctors call them paraneoplastic
syndrome. These hormone symptoms
might include:
 pins and needles or numbness in
the fingers or toes
 muscle weakness
 drowsiness, weakness, dizziness
and confusion
 breast swelling in men
 blood clots
Diagnosis for lung cancer
You may have a number of tests to
determine if you have lung cancer.
 Chest X-ray
 CT scan
 PET scan
 Biopsy
 Sputum cytology
Staging allows the physician to fully
understand the extent of the patient’s
cancer to help make treatment decisions
and determine expected outcomes
 Localized: the cancer is confined
to the lung.
 Regional: the cancer has spread
to lymph nodes (or glands) within
the chest. Lymph nodes act as a
filtering system outside the lung,
collecting cancer cells that are
beginning to migrate out of the
lung.
 Distant: the cancer has spread (or
metastasized) to other parts of the
body.

34. Community pharmacy
Stages
The stage of a cancer tells you how big it
is and whether it has spread. It helps
your doctor decide which treatment you
need.
Stage 1 means the cancer is between
3cm and 4cm.
Stage 2 means the cancer is between
4cm and 5cm.
Stage 3 Your cancer is between 5cm and
7cm
Stage 4 Tumor is more than 7 cm means
that the cancer has spread to several
areas in one or more organs.
Treatment
 Surgery
 Radiotherapy
 Thermal ablation
 Chemotherapy
 Immunotherapy
 Targeted therapy
 Targeted therapy or personalized
medicine targets specific cells. Use
for advanced non-small cell lung
cancer.
Palliative care
Palliative care seeks to improve quality
of life by reducing cancer symptoms
without aiming to cure the disease.
Palliative treatment can be used at any
stage of advanced lung cancer to assist
with managing symptoms such as pain
and nausea as well as slow the spread of
the cancer.
Screening for lung cancer
There is currently no routine screening
test for lung cancer.
There is some evidence to support
annual screening for people at high risk
of lung cancer using low-dose computed
tomography.
Prevention

35. Community pharmacy
Chronic Kidney Disease

36. Community pharmacy
INTRODUCTION
Chronic kidney disease, also called
chronic kidney failure. Chronic
kidney disease (CKD) is progressive loss
in kidney function over a period of
months or years. When chronic kidney
disease reaches an advanced stage,
dangerous levels of fluid,
electrolytes and wastes can build up
in the body. When kidney disease
progresses, it may eventually lead to
kidney failure, which requires
dialysis or a kidney transplant to
maintain life.
SYMPTOMS OF CKD
Signs and symptoms of chronic kidney
disease develop over time if kidney damage
progresses slowly. Signs and symptoms of
kidney disease may include:
 Nausea
 Anemia
 Vomiting
 Loss of appetite
 Fatigue and weakness
 Sleep problems
 Changes in how much you urinate
 Muscle twitches and cramps
 Swelling of feet and ankles
 Persistent itching
 Chest pain, if fluid builds up around
the lining of the heart
 Shortness of breath, if fluid builds up
in the lungs
 High blood pressure (hypertension)
that's difficult to control
ETIOLOGY OF CKD
CKD can be caused by:
 High blood pressure – over time,
this can put strain on the small blood
vessels in the kidneys and stop the
kidneys working properly.
 Diabetes – too much glucose in your
blood can damage the tiny filters in
the kidneys.
 High cholesterol – this can cause a
build-up of fatty deposits in the blood
vessels supplying your kidneys,
which can make it harder for them to
work properly.
 Kidney infections
 Glomerulonephritis – kidney
inflammation.
 Polycystic kidney disease – an
inherited condition where growths
called cysts develop in the kidneys.

37. Community pharmacy
 Blockages in the flow of urine – for
example, from recurrent kidney
stones or an enlarged prostate.
 Long-term, regular use of certain
medicines – such as lithium and non-
steroidal anti-inflammatory drugs
(NSAIDs).
STAGING
The different stages of CKD form a
continuum. The stages of CKD are classified
as follows:
 Stage 1: Kidney damage with normal
or increased GFR (>90 mL/min/1.73
m 2
)
 Stage 2: Mild reduction in GFR (60-
89 mL/min/1.73 m 2
)
 Stage 3a: Moderate reduction in GFR
(45-59 mL/min/1.73 m 2
)
 Stage 3b: Moderate reduction in GFR
(30-44 mL/min/1.73 m 2
)
 Stage 4: Severe reduction in GFR
(15-29 mL/min/1.73 m 2
)
 Stage 5: Kidney failure (GFR <15
mL/min/1.73 m 2
or dialysis)
TREATMENT OF CKD
 High blood pressure
medications. People with kidney
disease may experience worsening
high blood pressure. Your doctor may
recommend medications to lower your
blood pressure — commonly
angiotensin-converting enzyme
(ACE) inhibitors or angiotensin II
receptor blockers and to preserve
kidney function. High blood pressure
medications can initially decrease
kidney function and change
electrolyte levels.
 Medications to lower cholesterol
levels. Recommend medications
called statins to lower your
cholesterol. People with chronic
kidney disease often experience high
levels of bad cholesterol, which can
increase the risk of heart disease.
 Medications to treat anemia. In
certain situations, recommend
supplements of the hormone
erythropoietin sometimes with added
iron. Erythropoietin supplements aid
in production of more red blood cells,
which may relieve fatigue and
weakness associated with anemia.
 Medications to relieve
swelling. People with chronic kidney
disease may retain fluids. This can
lead to swelling in the legs, as well as
high blood pressure. Medications
called diuretics can help maintain the
balance of fluids in body.
TREATMENT FOR THE
END STAGE OF KIDNEY
DISEASE
 Dialysis. Dialysis artificially removes
waste products and extra fluid from
blood when kidneys can no longer do
this. In hemodialysis, a machine filters
waste and excess fluids from your
blood. In peritoneal dialysis, a thin
tube (catheter) inserted into your
abdomen fills your abdominal cavity

38. Community pharmacy
with a dialysis solution that absorbs
waste and excess fluids. After a period
of time, the dialysis solution drains
from your body, carrying the waste
with it.
 Kidney transplant. A kidney
transplant involves surgically placing
a healthy kidney from a donor into
your body. Transplanted kidneys can
come from deceased or living donors.
PREVENTION
 Reducing protein consumption to help
decrease the buildup of protein waste in
the blood
 Limiting whole grains, legumes, nuts
and certain fruits and vegetables if
potassium and phosphorus are above
normal levels
 Limiting foods that contain
phosphorus, especially processed foods
with phosphorus additives, to help PTH
levels remain normal, prevent bone
disease and even preserve existing
kidney function
 Restricting high potassium foods if
blood levels are above normal
 Balancing carbohydrates for those with
diabetes
 Decreasing saturated fats to help
manage cholesterol
 Lowering sodium for people with
hypertension or fluid retention by
cutting out processed and pre-packaged
foods
 Limiting calcium if blood levels are too
high
 Taking water soluble vitamins such as
vitamin C (60 to 100 mg per day) and
vitamin B complex
 Don't smoke cigarette smoking can
damage the kidneys and make existing
kidney damage worse.
 Lose weight if you're overweight or
obese.
 Avoid over-the-counter non-steroidal
anti-inflammatory drugs (NSAIDs),
such as ibuprofen, except when advised
to by a medical professional – these
medicines can harm your kidneys if
you have kidney disease.



39. Community pharmacy

40. Community pharmacy
Gout is a form of arthritis that causes sudden
attacks of pain in certain joints. It may affect
any joint in the body but first attack usually
affects the big toe or any other part of the foot.
The joint becomes painful and swollen and the
skin over the joint may become red and shiny.
A gout attack usually lasts 7-10 days if it is not
treated.
Facts and Figures
 The big toe is the first joint affected in
70% of cases.
 Gout is the most common cause of joint
inflammatory disease in men over 40
years of age.
 Improper diet could be a causative
agent for gout but genetic factors and
metabolic disorders such as blood
pressure, diabetes, obesity and kidney
problems also play a role
How to Diagnose?
 A blood test may be performed to
determine high levels of uric acid but
this is not a reliable method as uric acid
levels are quite normal during an acute
attack.
 A better option is aspiration of the
affected joint. Fluid id removed from
the joint and examined under the
microscope for presence of uric acid
crystals.
Is gout serious?
 Yes, if it is not treated, it can cause
permanent joint damage and tissue
destruction.
 Excessive damage and destruction of
joints and large tophi (crystals under
the skin) will eventually lead to
deformities, especially of hands and
feet, and loss of normal use.
What causes gout?
 It occurs due to accumulation of a
chemical called Uric Acid in the body.
 It is normally present in low levels in
the blood and tissues since the body is
continually breaking down old cells
and because some familiar foods
contain substances which are the
forerunners of uric acid.
The best range for uric acid is 2-5 mg/dl.
 Excessive accumulation of uric acid
results in formation of crystals in and
around the joints. If uric acid crystals
enter the joint space, they jab at the
surrounding tissue when the body
moves and cause inflammation - the
affected joint becomes red, swollen and
extremely tender.

41. Community pharmacy
Who is at risk?
 Five times more common in men than
women.
 Rarely in women before menopause.
 Can occur in men of any age.
 Rarely in children, except due to
some genetic factor.
 People who are obese, have high
blood pressure, eat diet rich in
proteins or consume large amount of
alcohol.
 People who take certain medications
such as diuretics or water pills.
 Surgery, radiation therapy.
 Prolonged stress.

How to prevent gout?
 Uric acid is basically a by-product of
purine; therefore diets rich in purine
should be avoided. Food that should
be avoided include
 Meat: especially red and organ meats
such as liver and kidney.
 Game.
 Seafood such as mussels, herrings,
sardines.
 Alcoholic beverages especially beer.
 Asparagus.
 In addition, yeast products, white
flour, oatmeal, sugar, mushrooms,
spinach, cauliflower and even some
pulses – especially lentils – can all
increase the level of uric acid in the
body and should be eaten in moderate
quantities.
How to prevent reoccurrence
 First and foremost, patients should
know what triggers gout for them and
what and how to take a medicine to
break a flare.
 Gout sufferers should also have a
“gout flare” plan and keep the
effective medicines on hand.
 Maintaining a healthy diet, exercising
regularly and maintaining healthy
body weight are all important to help
prevent and minimize gout attacks.
 A 2004 study published in the New
England Journal of Medicine found
that each additional serving of purine-
rich red meat was associated with a 21
percent increase in the risk of gout in
men over age 40. A weekly serving of
seafood was associated with a 7
percent increase in risk.

42. Community pharmacy
Hair loss
(alopecia
Hair loss or Alopecia is the loss of hair from any part of the body but particularly from
head.95% of males throughout the world are suffering from Alopecia and 85% of the females.

43. Community pharmacy
Types of Hair loss
 Male pattern hair loss (genetic or hormonal imbalance)
 Female pattern hair loss
 Alopecia areta (autoimmune)
 Thinning of hair (stress or malnutrition
Less common causes of hair loss
 Pulling out of hair
 Chemotherapy
 HIV/AIDS
 Lupous erythromatosus
 Radiation therapy
 scardiosis
 Hypothyroidism
 Malnutrition
 Iron defficiency
 Fungal Infection
Signs And Symptoms
 Hair loss in patches usuallyin circular patterns.
 Dandruff
 Skin lessions
 Scarrings
 In Alopecia Areta (mild) hair loss occurs in eye brows, backside of head or above the ears.
 In male pattern hair loss, loss occurs at the temples, crown and either thins or fall out.
 Female pattern hair loss occurs at frontal and parietal regions.
 Hair thinning can cause psychological stress in people due to effect in their appearance.
 Excessive styling can also cause hair thinning at the crown part of head.
TREATMENT
 Maintain a healthy lifestyle
 Take balanced diet
 Massage with oil in your hair atleast twice a week.
 Take protein treatments
 Take nutrional supplements (viviscal)
 Minoxidil (Rogain)

44. Community pharmacy
 Laser treatment
 Yoga to releive stress
 Get checked your hormonal balance
 Cortisone shots
 Herbal treatments ( use of aloe vera)
PREGNANCY
AND
LACTATION

45. Community pharmacy
PREGNANCY AND LACTATION
Pregnancy and lactation is a demanding
physiological state. The pregnant/lactating
woman should eat a wide variety of foods to
make sure that her own nutritional needs as
well as those of her growing fetus are met.
Important nutrition tips for pregnant and
lactating women:
 Eat more food during pregnancy.
 Eat more whole grains, sprouted
grams and fermented foods.
 Take milk/meat/eggs in adequate
amounts.
 Eat plenty of vegetables and fruits.
 Avoid superstitions and food taboos.
 Do not use alcohol and tobacco. Take
medicines only when prescribed.
 Take iron, folate and calcium
supplements regularly, after 14-16
weeks of pregnancy and continue the
same during lactation.
 Mineral and vitamin requirements are met
by consuming a variety of seasonal
vegetables particularly green leafy
vegetables, milk and fresh fruits.
 Water soluble vitamin supplements (e.g., B
vitamins, vitamin C) taken by the mother
usually increase breast milk levels.
Exercise during pregnancy:
 Avoid overheating, which may be
harmful for your baby, especially
during the first trimester.
 Don't work up a heavy sweat while
exercising.
 Exercise less or not at all on hot or
humid days, or exercise inside.
Drink plenty of fluids before,
during, and after workouts.
 The safest and most productive
activities are
swimming, brisk walking, indoo
r stationary cycling, step
or elliptical machines, and low-
impact aerobics.
Vaccines during pregnancy and lactation
 Flu (influenza) shot. The flu shot is
recommended for women who are
pregnant during flu season.

46. Community pharmacy
 Tetanus toxoid, reduced diphtheria toxoid
and a cellular pertussis (Tdap) vaccine.
Contraindicated drugs:
 ACE (angiotensin converting enzyme)
inhibitors
 Acne medication
 Alcohol ingested chronically or in
binges.
 Androgens (male hormones).
 Antibiotics tetracycline and doxycycline
and streptomycin.
 Anticoagulant (blood-
thinner) warfarin (Coumadin)
 Anticonvulsants (seizure medications)
such as:
 Anti-depressants
 Antimetabolite/anticancer drugs.
 Antirheumatic agent and metal-binder
 Antithyroid drugs
 Cocaine.
 DES (diethylstilbestrol), a hormone.
 Thalidomide

47. Community pharmacy
Polycystic ovary syndrome (say "pah-lee-
SIS-tik OH-vuh-ree SIN-drohm") is a
problem in which a woman's hormones are
out of balance. It can cause problems with
your periods and make it difficult to get
pregnant. PCOS also may cause unwanted
changes in the way you look. If it isn't treated,
over time it can lead to serious health
problems, such as diabetes and heart disease.
Under normal conditions, women ovary
produces estrogen and progesterone —
hormones that regulate the menstrual cycle,
along with small amount of male hormone
called androgens. The ovaries release eggs to

48. Community pharmacy
be fertilized by a man’s sperm. The release of
an egg each month is called ovulation.
Follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) helps in ovulation.
FSH stimulates the ovary to produce a follicle
— a sac that contains an egg — and then LH
triggers the ovary to release a mature egg.
Polycystic ovary syndrome (PCOS) is a
disorder that affects approximately 10% of
women and 50% of the affected women are
overweight or obese.
Its three main features are:
 cysts in the ovaries
 high levels of male hormones
 irregular or skipped periods
In PCOS, many small, fluid-filled sacs grow
inside the ovaries. The word “polycystic”
means “many cysts.” These sacs are actually
follicles, each one containing an immature
egg. The eggs never mature enough to trigger
ovulation. The lack of ovulation changes
levels of estrogen, progesterone, FSH, and
LH. Estrogen and progesterone levels are
lower than usual, while androgen levels are
higher than usual.
Causes:-
The exact cause of PCOS isn't known.
Factors that might play a role include:
Excess insulin: Insulin is the hormone
produced in the pancreas that allows cells to
use sugar, your body's primary energy
supply. In obese patients , adipose tissues
contributes to the release of insulin
(hyperinsulinemia) that eventually causes
your body cells to become resistant to the
action of insulin, then your blood sugar levels
can rise and your body might produce more
insulin. Excess insulin increases androgen
(hyperandrogenims) production, causing
difficulty with ovulation.
Low-grade inflammation: This term is used
to describe white blood cells' production of
substances to fight infection. It’s observed
that women with PCOS have a type of low-
grade inflammation that stimulates
polycystic ovaries to produce androgens,
which can lead to heart and blood vessel
problems.
Heredity: There are certain genes might be
linked to PCOS and it may pass to
generations.

49. Community pharmacy
Excess androgen. The ovaries produce
abnormally high levels of androgen, resulting
in hirsutism (excess body hair) and acne.
Symptoms:
 Irregular periods: A lack of ovulation
prevents the uterine lining from shedding
every month. Some women with PCOS get
fewer than eight periods a year.
 Heavy bleeding: The uterine lining builds
up for a longer period of time, so the
periods you do get can be heavier than
normal.
 Hair growth: More than 70 percent of
women with this condition grow hair on
their face and body — including on their
back, belly, and chest. Excess hair growth
is called hirsutism.
 Acne: Male hormones can make the skin
oilier than usual and cause breakouts on
areas like the face, chest, and upper back.
 Weight gain: Up to 80 percent of women
with PCOS are overweight or obese.
 Male-pattern baldness: Hair on the scalp
get thinner and fall out.
 Darkening of the skin: Dark patches of
skin can form in body creases like those on
the neck, in the groin, and under the
breasts.
 Headaches: Hormone changes can trigger
headaches in some women.
How PCOS affects your body:-
Having higher-than-normal androgen levels
can affect your fertility and other aspects of
your health.
 Infertility: To get pregnant, you have
to ovulate. Women who don’t ovulate
regularly don’t release as many eggs to
be fertilized.
 Metabolic syndrome: Up to 80
percent of women with PCOS are
overweight or obese. Both obesity and
PCOS increase your risk for high
blood sugar, high blood pressure, low
HDL (“good”) cholesterol, and high
LDL (“bad”) cholesterol. Together,
these factors are called metabolic
syndrome, and they increase the risk
for heart disease, diabetes, and stroke.
 Sleep apnea: This condition causes
repeated pauses in breathing during the
night, which interrupt sleep. The risk
for sleep apnea is 5 to 10 times higher
in obese women with PCOS than in
those without PCOS.
 Endometrial cancer: During
ovulation, the uterine lining sheds. If
you don’t ovulate every month, the
lining can build up. A thickened
uterine lining can increase your risk for
endometrial cancer.
 Depression: Both hormonal changes
and symptoms like unwanted hair
growth can negatively affect your
emotions. Many with PCOS end up
experiencing depression and anxiety.
Diet and lifestyle tips to treat PCOS:-
Treatment for PCOS usually starts with
lifestyle changes like
 Weight loss, diet, and exercise. Weight loss
can also improve cholesterol levels, lower
insulin, and reduce heart disease and
diabetes risks.
 A low-carbohydrate diets are effective for
both weight loss and lowering insulin
levels. A low glycemic index (low-GI) diet
that gets most carbohydrates from fruits,
vegetables, and whole grains helps regulate
the menstrual cycle better than a regular
weight loss diet.
 30 minutes of moderate-intensity exercise
at least three days a week can help women
with PCOS lose weight. Losing weight
with exercise also improves ovulation and
insulin levels.

50. Community pharmacy
How to diagnose if you have PCOS?
1. Do a physical exam to look for signs of
PCOS, such as extra body hair and high
blood pressure. The doctor will also
check your body mass index (BMI).
2. Do a number of lab tests to check your
blood sugar, insulin, and other hormone
levels.
3. You may also have a pelvic ultrasound to
look for cysts on your ovaries. Your
doctor may be able to tell you that you
have PCOS without an ultrasound, but
this test will help him or her rule out
other problems.

51. Community pharmacy

52. Community pharmacy
ENDOMETRIOSIS:-
Endometriosis is a common cause of period
pain, chronic pelvic pain, infertility and
adhesions. Despite increasing awareness,
research has shown that it still takes on
average eight to nine years from the onset of
first symptoms to the time a diagnosis is
confirmed. This often means years of
unnecessary suffering and delay in
appropriate and effective treatments. Early
diagnosis remains the key to successful
treatment for endometriosis and prevention
of its long term complications.
WHAT IS ENDOMETRIOSIS?
The tissue lining the inside of the uterus is
called endometrium. Menstruation comes
from the shedding of this layer of tissue each
month as a result of ovarian hormones. This
occurs from the time of puberty and
continues until a woman reaches menopause.
This is a normal event. Endometriosis is a
condition in which endometrium like tissue
grows in locations outside the uterus. These
are often called endometriotic implants or
lesions.
WHAT HAPPENS IN
ENDOMETRIOSIS?
Like endometrium inside the uterus, the
endometriotic implants swell and bleed in
response to the cyclical ovarian hormones
each month. This results in inflammation,
adhesions, cysts and scar tissue which may
damage or destroy the affected organs on or
in which endometriosis occurs. The most
common sites of endometriosis are the lining
of the pelvis, the ligaments supporting the
uterus, the ovaries, the top of the vagina (the
pouch of douglas), and the fallopian tubes.
Endometriosis may also implant onto the
surface or into the walls of the bowel,
bladder, and the ureters. Rarely, it may be
found in other distant parts of the body.
HOW COMMON IS
ENDOMETRIOSIS?
Endometriosis may affect women at any
time during the menstruating years (from
puberty to menopause). It is estimated that
10-15% of women may have this condition
.
WHAT CAUSES
ENDOMETRIOSIS?

53. Community pharmacy
Several theories have been put forward
(retrograde menstruation, genetic
predisposition, environmental factors, and
immunological factors) but the exact cause of
endometriosis is still not known.
WHAT ARE THE
CONSEQUENCES OF HAVING
ENDOMETRIOSIS?
It is impossible to tell exactly what will
happen in individual cases. However, in
general, if the disease is not treated,
endometriosis tends to cause progressive
damage to the tissues or organs on or into
which it occurs, with possible consequences
of chronic pain, infertility, and adhesions.
HOW IS ENDOMETRIOSIS
DIAGNOSED?
Endometriosis can be suspected on the basis
of symptoms.
Pelvic examination may allow doctors to
detect the scar tissues caused by the implants.
Ultrasound may show the presence of cysts
inside the ovaries (chocolate cysts) which
occur in 10% of women with endometriosis.
At the present time, the only way to confirm
the presence of and to check for the extent of
endometriosis is by laparoscopy. This is a
day-only examination in hospital, under
general anesthesia, in which a small telescope
introduced through a small incision at the
umbilicus allows doctors to directly see
endometriosis.
Laparoscopy is the gold standard for
assessment of endometriosis.

54. Community pharmacy
.
HOW CAN I PREVENT
ENDOMETRIOSIS
You can't prevent endometriosis. But you can
reduce your chances of developing it by
lowering the levels of the hormone estrogen
in your body. Estrogen helps to thicken the
lining of your uterus during your menstrual
cycle.
To keep lower estrogen levels in your body,
you can:
 Talk to your doctor about
hormonal birth control
methods, such as pills, patches or
rings with lower doses of estrogen.
 Exercise regularly (more than 4
hours a week). This will also help
you keep a low percentage of body
fat. Regular exercise and a lower
amount of body fat help decrease the
amount of estrogen circulating
through the body.
 Avoid large amounts of
alcohol. Alcohol raises estrogen
levels. No more than one drink per
day is recommended for women who
choose to drink alcohol.
 Avoid large amount of drinks with
caffeine. Studies show that drinking
more than one caffeinated drink a
day, especially sodas and green tea,
can raise estrogen levels.
NATURAL
ENDOMETRIOSIS
REMEDIES
 Fish Oil (1,000mg daily)
Fish oil helps reduce inflammation and
balance hormones.
 B-complex (50 mg daily)
B vitamins are crucial in estrogen levels and
hormone balance.
 Milk Thistle (150 mg 2x daily)
Milk thistle supports liver detoxification
which can naturally balance hormones.
PHARMACIST INTERVENTION:
Although the precise etiology of
endometriosis remains a mystery, treatment
options have improved considerably in recent
years. Pharmacists are well positioned to
identify women with unexplained pelvic pain
or infertility that may be indicative of

55. Community pharmacy
endometriosis and refer them to their
physicians for further evaluation.
Pharmacists also can play an important role
in counseling patients about the safe and
effective use of the various treatments for this
disease and strategies to recognize and
reduce adverse effects.

56. Community pharmacy

57. Community pharmacy
Lactose intolerance is a digestive
problem in which milk or milk products can’t
digested and causes disturbance.
Mechanism
Lactose (the sugar in the milk) is broken
down by the lactase enzyme located in the
small intestine into two simple
sugars: glucose and galactose. When there is
a decrease or loss of the lactase enzyme, we
cannot break down or absorb lactose. So, the
children becomes intolerant.
Temporary lactose intolerance
Lactose intolerance can occur temporarily in
children after a viral infection (so it avoided
during a stomach bug) or it may be seen with
conditions that lead to inflammation of the
intestines (celiac disease).
Cause of lactose intolerance
Some causes of lactose intolerance are
known. Certain digestive disease, such
as crohn’s disease, ulcerative colitis, other
inflammatory bowel diseases and injuries to
the small intestine (surgery or trauma) may
reduce the amount of lactase available to
process lactose properly.
Symptoms
Symptoms of lactose intolerance can occur
within minutes to hours after drinking milk or
eating dairy products
 Nausea
 Abdominal pain, cramping, and
bloating
 Loose stools and gas
 Watery diarrhea with gas
 Food which contain lactose
 Milk, milkshakes
 Whipping cream and coffee creamer
 Ice cream, ice milk, sherbet
 Cheese
 Butter
 Puddings, custards
 Cream soups, cream sauces
 Foods made with milk

58. Community pharmacy
Diagnosis of lactose intolerance in children
Take all the milk products out of your child's
diet for two weeks and then see if his or her
symptoms improve. After two weeks, slowly
reintroduce the products in small amounts if
symptoms return than your child is lactose
intolerance. Hydrogen breathe test is also
another method.
Treatment
 Take lactase enzyme in liquid or tablet
form.
 Limit the amount of milk and milk
products in your diet.
 Eat yoghurt with live and active cultures.
How to maintain a balance diet in lactose
intolerant?
Milk and dairy products are a major source of
calcium, an essential nutrient for the growth
and repair of bones and teeth throughout life.
People who are lactose-intolerant should take
calcium from other sources such almond,
kale, orange juice, sesame seeds,
blackberries, leeks, figs, spinach, oatmeal,

59. Community pharmacy

60. Community pharmacy
Introduction Measles is a viral infection of the respiratory system. Measles is a very contagious
disease that can spread through contact with infected mucus and saliva. An infected person can
release the infection into the air when they cough or sneeze.
Symptoms of measles generally appear within 14 days of exposure to the virus. Symptoms
include:
 Cough
 Fever
 Red eyes
 Light sensitivity
 Muscle aches
 Runny nose
 Sore throat

61. Community pharmacy
 White spots inside the mouth
Non pharmacological treatment for Measles
 Drink orange or lemon juice at regular intervals during the day. The citrus flavor of these fruits
can offset the loss of appetite brought on by the infection. Lemon and orange juices also help
reduce dehydration and boost immunity with their vitamin C content.
 Turmeric powder mixed with honey or milk can aid recovery from measles and boost immunity.
 Children can be given powdered licorice mixed with honey to reduce coughs and sore throats.
 Barley water can offer relief against dry, heavy coughs during measles
 A barley bath can also soothe irritated skin and make the rash less itchy.
Mumps is a viral disease that passes from one person to another through saliva, nasal secretions,
and close personal contact followed by painful swelling of one or both parotid salivary glands.

62. Community pharmacy
Symptoms of mumps
usually appear within two
weeks of exposure to the
virus.
 Fatigue
 Body aches
 Headache
 Loss of appetite
 Low grade fever
Non pharmacological
treatment for Mumps
The home remedies for
mumps are:
 Fenugreek Seeds
 Baking Soda
 Mullein
 Banyan Leaves
 Indian Lilac
 Ginger

63. Community pharmacy
Psoriasis is a common skin condition that
speeds up the life cycle of skin cells. It causes
cells to build up rapidly on the surface of the
skin. The extra skin cells form scales and red
patches that are itchy and sometimes painful.
Psoriasis is a chronic disease that often comes
and goes. The main goal of treatment is to
stop the skin cells from growing so quickly.
There is no cure for psoriasis, but you can
manage symptoms. Lifestyle measures, such
as moisturizing, quitting smoking and
managing stress, may help.
SIGNS & SYMPTOMS:
Psoriasis signs and symptoms are different
for everyone.
 Red patches of skin covered with
thick, silvery scales
 Small scaling spots (commonly seen
in children)
 Dry, cracked skin that may bleed
 Itching, burning or soreness
 Thickened, pitted or ridged nails
 Swollen and stiff joints
Psoriasis patches can range from
spots of dandruff-like scaling to
major rashes that cover large areas of
body.
FACTORS THAT MAY TRIGGER
PSORIASIS INCLUDE:
 Infections, such as strep throat or
skin infections.

64. Community pharmacy
 Injury to the skin, such as a cut or
scrape, a bug bite, or a severe
sunburn.
 Stress.
 Smoking.
 Heavy alcohol consumption.
 Vitamin D deficiency.
COMPLICATIONS
If you have psoriasis, you are at greater risk
of developing certain diseases including:
 Psoriatic arthritis(causes joint damage and
loss of function)
 Eye conditions
 Weight gain
 Type 2 diabetes
 High blood pressure
 Heart diseases
 Metabolic syndrome
 Other diseases
HOME REMEDIES:
 Dietary Supplements
 Prevent Dry Skin
 Avoid Fragrances
 Eat Healthy
 Warm Baths For Itch Relief
 Light Therapy
 Reduce Stress
 Avoid Alcohol
 Try Turmeric
 Stop Smoking
TAKE AWAY:
There isn’t a single answer for keeping the
control on symptoms of psoriasis. What
works for one person may not work for
another. Some treatment options may have
negative side effects for pre-existing
conditions other than psoriasis. It is important
to remember that while these remedies may
help with mild cases, prescription therapy is
required for more severe cases. Talk to your
doctor before seeking treatment on your own.
When to see a doctor or a pharmacist:
If you suspect that you may have psoriasis,
see your doctor for an examination. Also,
Pharmacists have the potential to facilitate
effective self-care for patients with
dermatological problems. Furthermore the
chronic nature of many skin conditions
emphasizes the need for medicine
management support to improve outcomes
for those with conditions such as eczema and
psoriasis. Also, talk to your doctor if
psoriasis:
 Causes discomfort and pain
 Makes performing routine tasks
difficult
 Causes you concern about the
appearance of your skin
 Leads to joint problems, such as pain,
swelling or inability to perform daily
tasks.
Seek medical advice if your signs and
symptoms worsen or don't improve with
treatment. You may need a different
medication or a combination of treatments to
manage the psoriasis.

65. Community pharmacy

66. Community pharmacy

67. Community pharmacy
Fungal infections
Fungal Infections

68. Community pharmacy
Introduction:
Fungal infections are infections caused by a
fungus, a type of microorganism. They are
common and generally mild. However, in
very sick or otherwise immune suppressed
people, such as HIV/AIDS fungi can
sometimes cause serious disease.
Causes:
 Fungal infections are caused by the fungus
tinea. Tinea infections cause athlete's foot
infection, jock itch infection and ringworm
infection.
 Another common type of fungal infection
is a yeast infection, caused by the fungus
Candida albicans. This type of fungal
infection can infect different areas of the
body such as the vagina (vaginal thrush),
mouth (oral thrush) and the digestive tract
(fungal gastroenteritis).
 A fungal infection can also cause fungal
infections of the lungs. This is the result of
breathing in fungal spores. Fungal
infections can also be a symptom of a
serious disease, such as HIV/AIDS or
diabetes.
 People with diabetes are more likely to
develop fungal infections because the
elevated level of sugar in the body provides
food for some fungi and encourage its
overgrowth.
Symptoms
 Symptoms of athlete's foot include
scaling and flaking of the skin and itching
of the feet. Athlete's foot can spread to the
toenails causing thick, yellowish toenails.
 Symptoms of jock itch include itching of
the groin area and a red scaly rash. It
usually occurs in men. Symptoms of
ringworm include red itchy area on the
scalp, often in the shape of a ring.
 Symptoms of a vaginal yeast infection
include vaginal itching and irritation,
burning with urination, and a thick cheesy-
white vaginal discharge. Symptoms of a
fungal gastroenteritis include vomiting and
diarrhea.
 Symptoms of a fungal infection of the
lungs include fever, cough and symptoms
of pneumonia.
 Symptoms of a mouth yeast infection
(oral thrush) include the development of
yellow-white patchy lesions in the mouth
and on the tongue. The patches may
become sore and painful and difficulty in
swallowing.
Prevention & Treatment
 The first step in treatment is prevention.
Prevention measures include maintaining
good oral, groin and skin hygiene. It is also
important not to share towels, underwear
and other personal items with other people.
 To prevent transmission of fungal
infections to a newborn infant, pregnant
women should consult with their doctor if
they have symptoms of a vaginal yeast
infection, such as vaginal itching, burning
with urination, and a cheesy white
discharge.
 A treatment plan may also include
medications, including prescription topical
or oral antifungal medications, such as
fluconazole. For a severe fungal infection
of the lungs, hospitalization and
intravenous administration of antifungal
medications may be necessary.
 Treatment of fungal infections also
includes diagnosing any underlying
diseases such as HIV/AIDS and diabetes.
 Treating the high blood sugar levels of
diabetes may resolve a current infection
and is key to minimizing the risk of
developing fungal infections.
 Therapy may also include eating yogurt or
taking acidophilus supplements, which can
help to correct the abnormal balance of

69. Community pharmacy
microorganisms in the mouth and digestive
tract, which leads to fungal infections.
 Using of antiseptic mouth washes prevent
oral thrush.
Common example of fungal infection
Ringworm of the Body (Tinea Corporis)
Ringworm of the body is a skin infection
caused by a fungus.
“Ringworm” is a wrong term— the infection
has nothing to do with worms. Its name
comes from the small, ring- or circle-shaped
rash that appears on the body due to infection.
In ringworm of the body, the rashes appear
on skin regions except for the scalp, groin,
palms of the hand, and soles of the feet. The
condition is common and highly contagious,
but it’s not serious.
What causes ringworm of the body?
A group of fungi called dermatophytes
cause ringworm. Dermatophytes live off a
substance called keratin, a tissue found in
many parts of a person’s body, including the
nails, skin, and hair. In ringworm of the body,
the fungus infects the skin.
SYMPTOMS
Symptoms of ringworm of the body
 Symptoms of ringworm of the body usually
start about 4 to 10 days after contact with
the fungus.
 Ringworm of the body looks like ring- or
circular-shaped rashes with edges that are
slightly raised. The skin in the middle of
these ring-shaped rashes appears healthy.
Usually, the rashes are itchy.
 Symptoms of a more severe infection
include rings that multiply and merge
together. Patient may also develop blisters
and pus-filled sores near the rings.
Factors that may increase your risk
include:
 living in damp or humid areas
 excessive sweating
 participating in contact sports
 wearing tight clothing
 having a weak immune system
 sharing clothing, bedding, or towels with
others
How can ringworm infections be
prevented?
Ringworm of the body can be prevented by
avoiding contact with someone who has the
infection. This includes both indirect and
direct contact with that person.
Take the following precautions:
 Avoid sharing personal items like towels,
hats, hairbrushes, and clothing with
infected person.
 If you have ringworm of the body, be sure
to maintain good personal hygiene around
other people and avoid scratching the
affected areas of your skin.
 After a shower, dry your skin well —
especially between the toes and where skin
touches skin, such as in the groin and
armpits.

70. Community pharmacy
Home care
In addition to prescription and over-the-
counter medication, your doctor may
recommend that you care for your infection
at home by practicing some of the following
behaviors:
 Avoid clothing that irritates the infected
area
 Cover it with a bandage if you’re unable to
avoid clothing that irritates the area
 Wash bedding and clothes daily during an
infection to help disinfect your
surroundings
 Clean and dry your skin regularly
 A person can prevent ringworm by
practicing healthy and hygienic behaviors.
 Many infections come from contact with
animals and lack of proper hygiene.
 Wash your hands after interacting with an
animal.
 Disinfect and clean pet living areas.
 Avoid people or animals with ringworm if
you have a weakened immune system.
 Shower and shampoo your hair regularly.
 Wear shoes if showering in community
areas.
 Keep your feet clean and dry.

71. Community pharmacy

72. DENGUE FEVER:-
Dengue fever is a
mosquito-borne tropical disease
caused by the dengue virus. Dengue is
carried by the Aedes Aegypti
Mosquito, which can be found in the
home. Symptoms typically begin 3-
14 days after infection. This may
include a high fever, headache,
vomiting, muscle and joint pains,
and a characteristic skin rash.
Recovery generally takes 2-7 days.
LIFE CYCLE OF MOSQUITO:-
 This mosquito lays its eggs on the
walls of water holding containers
that are found around the home.
 Eggs hatch when submerged in
water.
 Within 8 days the mosquito can
complete its life cycle from egg, to
larvae, to pupae and to an adult
flying mosquito.
 To help reduce the mosquito
population in your community and
the risk of exposure to dengue,
eliminate larvae that grow in stored
water.
STEPS OF DENGUI VIRAL
REPLICATION CYCLE:-
Dengue viruses are members of the
family Flaviviridae genus Flavivirus.
They are small, enveloped viruses
containing a single-strand RNA
genome of positive polarity. Dengue
viruses infect a wide range of human
and nonhuman cell types in vitro.
Viral replication involves the
following steps:
 Attachment to the cell surface
 Entry into the cytoplasm
 Translation of viral proteins
TRANSMISSION:-
 The dengue virus is transmitted to
humans via the bite of an infected
mosquito.
 Only a few mosquito species are
vectors for the dengue virus.
 When a mosquito bites a person
who has dengue virus in his or her
blood, the mosquito becomes
infected with the dengue virus.

73. Community pharmacy
DENGUE SYMPTOMS
 Fever
 Headache
 Muscle and joint pains
 Nausea / vomiting
 Rash
 Hemorrhagic manifestations
ALARM SIGNS
 Intense abdominal pain
 Persistent vomiting
 Abrupt change from fever to
hypothermia, with sweating
 Restlessness or somnolence.
TREATMENT
 Rest
 Drink plenty of fluids and
consult a physician.
 Avoid pain relievers that
contain ASPIRIN and non-
steroidal anti-inflammatory
medications such as ibuprofen.
 Acetaminophen or Paracetamol
may be used.
DIET PLAN FOR DENGUE
PATIENTS
BREEDING SITES FOR
DENGUE:-
PREVENTION:-
 Stay in air-conditioned or well-
screened housing.
 Wear protective clothing.
 Use mosquito repellent.
 Reduce mosquito habitat.
 Avoid mosquito bites while you
have a fever.
 Rest in a screened room or under a
BED NET.
 Use INSECT REPELLENTS
 Eliminate any containers where the
mosquito can lay her eggs
 Look around every week for
possible mosquito breeding places.
 In order to prevent the Aedes
Aegypti mosquito from laying its
eggs in containers where you store
water, keep it covered.
 Immediately after the rain,
SEARCH for and ELIMINATE all
WATER accumulated in
containers and help your
community to PREVENT
DENGUE.
 If this is not possible they should
stay at home until they have no
fever and are therefore no longer
infectious (usually 3 to 5 days).
 There is no vaccine to prevent
human infection by this virus.

74. Community pharmacy
 Personal protection and the
environmental management of
mosquitoes are important in
preventing illness.
 Prevent access of mosquitoes to an
infected person with a fever.
PHARMACIST
INTERVENTION:-
 There are no medications that
specifically treat dengue fever,
PHARMACISTS have a role in
ensuring adequate fluid
resuscitation and appropriate
monitoring.
 Pharmacists should remind
patients affected by dengue fever
not to take aspirin and non-
steroidal anti-inflammatory drugs
because of bleeding concerns.

75. Community pharmacy
INTRODUCTION
Crimean-Congo hemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus
(Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks,
with a case fatality rate of 10–40%.
SYMPTOMS
The onset of CCHF is sudden, with initial signs and symptoms including
Headache, High fever, Back pain, Joint pain, Stomach pain, Vomiting, Redeyes
[[
TRANSMISSION
 Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as amplifying
hosts for the virus.
 Transmission to humans occurs through contact with infected ticks or animal blood. CCHF can
be transmitted from one infected human to another by contact with infectious blood or body
fluids
 Documented spread of CCHF has also occurred in hospitals due to improper sterilization of
medical equipment, reuse of injection needles, and contamination of medical supplies.

76. Community pharmacy
DIAGNOSTIC TEST
Laboratory tests that are used to diagnose
CCHF include
 antigen-capture enzyme-
linked immunosorbent assay
(ELISA),
 real time polymerase chain
reaction (RT-PCR), virus
isolation attempts, and
detection of antibody by
ELISA (IgG and IgM)
PREVENTION
 Agricultural workers and others
working with animals should use
insect repellent on exposed skin
and clothing.
 Insect repellants containing
DEET (N, N-diethyl-m-
toluamide) are the most effective
in warding off ticks.
 Wearing gloves and other
protective clothing is
recommended. Individuals should
also avoid contact with the blood
and body fluids of livestock or
humans who show symptoms of
infection.
 It is important for healthcare
workers to use proper infection
control precautions to prevent
occupational exposure.
PRECAUTIONS
 There is no vaccine available as
yet, so creating awareness is all
we can do.
 Stay fully covered, wear bright
clothes to detect ticks and wear
gloves when around animals.
Eliminate ticks, use a spray on
your animals and use a protective
spray on your clothes and
clothing. Avoid areas where there
are too many ticks.
 Isolate patients who have the
virus, maintain minimal or
protected contact, and wash your
body and hands afterwards.
 Wear gloves and masks. The
syringes and needles should be
carefully disposed.
 Health practitioners, hunters,
agriculturalists and those who
handle raw meat during
slaughtering, meat-supplying and
cooking are also at risk
 Minimize insect bites, pests and
rodents in the house or elsewhere.
 Cook meat thoroughly, avoid it if
possible. It is more common in
larger animals than in birds. So
chicken and fish might be safer.
 Try not to eat, drink around
animals and wear gloves
whenever possible. Sanitation is a
must here

77. Community pharmacy
 Infected animals show abnormal
behavior and other symptoms so
see a vet swiftly.
 Sanitation is important. The virus
is present in all fluids released by
the host animals and patients.
Don’t share utensils
PHARMACIST INTERVENTION
Pharmacist decided to reinforce the
surveillance system and to limit the risk of
virus transmission inside health facilities
and at the household level.
The prospects for control of the outbreak in
this urban setting seemed impossible if all
patients could not be drawn to one location,
where care could be provided under the best
available conditions in order to limit the risk
of transmission. The stigmatization of
patients and families and the collapse of the
hospital system were already leading to
possible cases being hidden in homes
without any precautions taken to prevent
infection of family members and frustrating
attempts to assess the progress of the
epidemic.

78. Community pharmacy

79. Community pharmacy
Pharmaceutical care and counselling
Providing pharmaceutical care entails
accepting responsibility for patients’
pharmacotherapeutic outcomes. Pharmacists
can contribute to positive outcomes by
educating and counseling patients to prepare
and motivate them to follow their
pharmacotherapeutic regimens and
monitoring plans. The purpose of this
document is to help pharmacists provide
effective patient education and counseling. In
pharmaceutical care, pharmacists should
encourage patients to seek education and
counseling and should eliminate barriers to
providing it. Pharmacists should also seek
opportunities to participate in health-system
patient-education programs and to support
the educational efforts of other health care
team members. Pharmacists should
collaborate with other health care team
members, as appropriate, to determine what
specific information and counseling are
required in each patient care situation.
Pharmacist knowledge and skills
 In addition to a current knowledge of
pharmacotherapy, pharmacists need
to have the knowledge and skills to
provide effective and accurate patient
education and counseling.
 They should know about their
patients’ cultures, especially health
and illness beliefs, attitudes, and
practices.
 They should be aware of patients’
feelings toward the health system and
views of their own roles and
responsibilities for decision-making
and for managing their care.
 Effective, open-ended questioning
and active listening are essential skills
for obtaining information from and
sharing information with patients.
 Pharmacists have to adapt messages
to fit patients’ language skills and
primary languages, through the use of
teaching aids, interpreters, or cultural
guides if necessary.
 Pharmacists also need to observe and
interpret the nonverbal messages
(e.g., eye contact, facial expressions,
body movements, and vocal
characteristics) patients give during
education and counseling sessions.
 Assessing a patient’s cognitive
abilities, learning style, and sensory
and physical status enables the
pharmacist to adapt information and
educational methods to meet the
patient’s needs.
 A patient may learn best by hearing
spoken instructions; by seeing a
diagram, picture, or model; or by
directly handling medications and
administration devices.
 A patient may lack the visual acuity
to read labels on prescription
containers, markings on syringes, or
written handout material. A patient
may be unable to hear oral
instructions or may lack sufficient
motor skills to open a child-resistant
container.

80. Community pharmacy
 In addition to assessing whether
patients know how to use their
medications, pharmacists should
attempt to understand patients’
attitudes and potential behaviors
concerning medication use.
 The pharmacist needs to determine
whether a patient is willing to use a
medication and whether he or she
intends to do so.
Environment
 Education and counseling should take
place in an environment conducive to
patient involvement, learning, and
acceptance—one that supports
pharmacists’ efforts to establish
caring relationships with patients.
 Individual patients, groups, families,
or caregivers should perceive the
counseling environment as
comfortable, confidential, and safe.
 Education and counseling are most
effective when conducted in a room
or space that ensures privacy and
opportunity to engage in confidential
communication. If such an isolated
space is not available, a common area
can be restructured to maximize
visual and auditory privacy from
other patients or staff.
 Patients, including those who are
disabled, should have easy access and
seating. Space and seating should be
adequate for family members or
caregivers.
 The design and placement of desks
and counters should minimize
barriers to communication.
Distractions and interruptions should
be few, so that patients and
pharmacists can have each other’s
undivided attention.
 The environment should be equipped
with appropriate learning aids, e.g.,
graphics, anatomical models,
medication administration devices,
memory aids, written material, and
audiovisual resources.
Process steps
Steps in the patient education and
counseling process will vary according to
the health system’s policies and
procedures, environment, and practice
setting.
Generally, the following steps are
appropriate for patients receiving new
medications or returning for refills:
1. Establish caring relationships with
patients as appropriate to the practice
setting and stage in the patient’s health
care management. Introduce yourself as a
pharmacist, explain the purpose and
expected length of the sessions, and
obtain the patient’s agreement to
participate. Determine the patient’s
primary spoken language.
2. Assess the patient’s knowledge about
his or her health problems and
medications, physical and mental
capability to use the medications
appropriately, and attitude toward the
health problems and medications. Ask
open-ended questions about each
medication’s purpose and what the
patient expects, and ask the patient to

81. Community pharmacy
describe or show how he or she will use the
medication. Patients returning for refill
medications should be asked to describe or
show how they have been using their
medications. They should also be asked to
describe any problems, concerns, or
uncertainties they are experiencing with their
medications.
3. Provide information orally and use
visual aids or demonstrations to fill
patients’ gaps in knowledge and
understanding.
Open the medication containers to show
patients the colors, sizes, shapes, and
markings on oral solids. For oral liquids
and injectable, show patients the dosage
marks on measuring devices.
Demonstrate the assembly and use of
administration devices such as nasal and
oral inhalers.
As a supplement to face-to-face oral
communication, provide written
handouts to help the patient recall the
information. If a patient is experiencing
problems with his or her medications,
gather appropriate data and assess the
problems. Then adjust the
pharmacotherapeutic regimens according
to protocols or notify the prescribers.
4. Verify patients’ knowledge and
understanding of medication use. Ask
patients to describe or show how they will
use their medications and identify their
effects. Observe patients’ medication-use
capability and accuracy and attitudes
toward following their
pharmacotherapeutic regimens and
monitoring plans.

82. Community pharmacy
Activity #1
PATIENT COUNSELING FOR THE USE OF ORAL POWDERS
 Ideally powders should be taken while standing or sitting upright.
 Open the powder carefully on the flat surface then either
a) Empty the contents of the sachet directly onto the back of tongue and swallow with
a glass of water or
b) Empty the contents of sachet into about a third of tumbler of water. Stir to disperse
and swallow resulting solution/suspension.
 Do not lie down flat for at least two minutes after taking the powder.

83. Community pharmacy
Activity #2
PATIENT COUNSELLING OF TABLETS AND CAPSULES.
 Ideally the tablets or capsules should be taken while standing or at least sitting upright.
 Place the tablet or capsule in the mouth.
 Swallow with the aid of glass of water (plenty of water ensures that the tablet or capsule reaches the
stomach and does not feel that it is stuck in the throat).
 Don't lie down flat for at least 2 minutes.
 For tablets that should be taken on an empty stomach, you should take the tablet an hour before food.
For tablets that should be taken with or after food, a small amount of food is usually sufficient.
 Many people are tempted to crush their tablets if they have problems swallowing them, however, this
can often be unsafe, and therefore you should never crush a tablet unless you have checked that it is
safe to do so with your pharmacist or doctors.
 Most tablets should be swallowed whole with a glass of water. This is especially important for modified
release and enteric coated tablets as these tablets have a special coating that would be destroyed by
chewing the tablet.
Activity #3

84. Community pharmacy
PATIENT COUNSELLING
OF INJECTION
ADMINISTRATION
Injections can be described as the act of
giving medication by use of a syringe and
needle. Medicines should only be
administered by injection when no other
route is suitable or available.
TYPES OF SYRINGES:
• Insulin syringe: This holds a
maximum of 1 ml of medicine. The
syringe has markings from 10 to 100.
The marking at 100 is the same as 1
ml. The marking at 50 is the same as
½ ml.
• Tuberculin syringe: This syringe
holds up to 1 ml of medicine. It has a
needle that is slightly longer than an
insulin syringe. The syringe is
marked every 0.1 ml.
INTRAMUSCULAR INJECTION
IM injections should be given into the densest
part of the muscle tissue under the
subcutaneous tissue. The extensive blood
supply of the muscle helps in rapid
absorption of the drug. The injection is made
at a 90˚ angle.
The thigh is a good place to give yourself an
injection because it is easy to see.
Divide the thigh into three equal parts and
the middle part is where the injection goes.

85. Community pharmacy
SUBCUTANEOUS INJECTION
A subcutaneous injection is a shot given into
the fat layer between the skin and muscle.
Subcutaneous injections are used to give
small amounts and certain kinds of medicine.
The injection is made at a 45˚ angle.
The injection is given below the shoulder and
above the elbow.
Any scars and moles should be avoided.

86. Community pharmacy
INTRAVENOUS INJECTION
 Hydrate the patient.
 Palpate the vein.
 Wash your hands.
 Prepare the medication.
 Clean the injection site with rubbing
alcohol.
 Wrap tourniquet 2 to 4 inches above
the injection site.
 Identify the vein.
 Insert the needle at 45˚ angle.
 Pull back the plunger to check site
for blood. If blood does not appear in
the syringe, it implies the vein has
been missed. Pull out the needle and
try again.
 Remove tourniquet, push plunger to
inject medication and finally remove
the needle.
The term “intravenous” means “into the vein.
Some medications must be given by an
intravenous (IV) injection or infusion i.e.
they are sent directly into your vein using a
needle or tube. This route is beneficial for the
control it provides over dosage.
In some emergency situations e.g. stroke or
poisoning, people must receive medication
very quickly. In such cases, taking pills or
liquids orally is not fast enough to get the
drugs into the bloodstream. IV
administration, on the other hand, quickly
sends a medication directly into the
bloodstream.
Certain medications need to be given slowly
but constantly. IV administration is a
controlled way to give drugs over time.

87. Community pharmacy
INTRADERMAL INJECTION
It is the injection of a substance into the
dermis. This injection may be given for
diagnostic purposes such as allergy or
tuberculosis testing. The medication
administered as such is slowly absorbed due
to skin layer’s limited blood supply.
Recommended steps:
• Insert the needle at 5-15˚ angle.
• Inject slowly until a wheal or bubble
like area appears on skin’s surface.
• Discard the equipment properly.
Steps to be avoided:
• Don’t choose an inflamed, burned or
hairy site.
• Don’t massage the site after injection
to avoid false results.
• Don’t administer more than 0.1ml
intradermally without questioning
and confirming.

88. Community pharmacy
Activity #4
PATIENT COUNSELLING FOR THE USE OF SUPPOSITORIES
 If possible, go to the toilet and empty
the bowels.
 Remove foil or plastic pacing.
 Warm the suppository in hands to aid
insertion.
 Lie on one side with knees pulled up
towards the chest or alternatively
squat.
 Gently but firmly insert the
suppositories into the rectum with
the finger. Insert tapered end first
push the suppository in as far as
possible to prevent its slipping back
out.
 Lower legs and remain still for a few
minutes. Clenching buttocks together
if necessary to retain the suppository.
 Unless the suppository is a laxative.
Wash hands again.
Example
 ZnO suppository
 Hemamails suppository

89. Community pharmacy
Activity #5
PATIENT COUNSELLING OF CONTRACEPTIVE PILLS
Birth control pills (also called oral
contraceptive pills) are a type of female
hormonal birth control method, are very
effective at preventing pregnancy.
If you use oral contraceptive, take them at the
same time each day.
1. Use your chosen method of birth control
consistently. Just one incident of
forgetfulness can result in an unplanned
pregnancy.
2. Follow the directions for your birth control
method exactly as instructed.
3. Use an alternative method of
contraception, such as condom if you
forget two or more oral contraceptives in
one cycle.
4. If you are given antibiotics ask the
pharmacist they will reduce the
effectiveness of your oral contraceptives.
5. If you are given antibiotics ask the
pharmacist they will reduce the
effectiveness of your oral contraceptives
6. Using a condom and spermicide with a
diaphragm or cervical cap during fertile
period can result in almost 100%
contraceptive success.
7. If you use an IUD (an intrauterine device
(IUD or coil) is a small, often T-shaped
birth control device that is inserted into a
woman's uterus to prevent pregnancy.
IUDs are one form of long-acting
reversible birth control, check the string
extending from your cervix monthly, if you
can feel it use alternative contraception and
call your physician.
Call your physician immediately fix
emergency contraceptives after unprotected
sex. You have 72 hours after unprotected sex
to use emergency contraceptives to prevent
pregnancy.

90. Community pharmacy

91. Community pharmacy
Activity #6
Patient Counselling for the use of
Contraceptive Patches.
 Freshly wash and dry the area of skin
where the patch is to be applied.
Don’t use talc, oil, moisturizers or
creams as this may prevent the patch
sticking.
 Tear open the patch package, where
indicated (indicating the fingers
rather than scissors to prevent
accidental damage to the patch
 Remove the protective backing from
the patch. Try not to touch the
adhesive with fingers
 Press the adhesive side of the patch to
the prepared skin site firmly. Ensure
that there is a good skin contact,
particularly at the edges of the patch.
Precautions
 Hormone replacement patches should
be applied below the waist on the
buttocks or thighs; not on the breasts.
 Contraceptive patches should be
applied to the buttocks, abdomen,
upper outer arm or upper torso; not on
the breasts.
 Andropatch skin patches containing
testosterone should be applied on the
back, abdomen, upper arms or thighs.
 Glyceryl trinitrate patches for angina
should be applied to the chest or
upper arm. Nicotine replacement
patches should be applied to the chest,
upper arm or hip. The site of
application for fentanyl patches (an
analgesic) depends on the brand of
product used.

92. Community pharmacy
Activity #7
PATIENT COUNCELLING FOR
THE USE OF METER
DOSE INHALER
INHALERS
Inhalers are designed to help medication to be
delivered directly into the lungs, where it will
act mainly on the lung tissue and systemic
effects will be minimized. The doses
employed in inhalers are significantly lower
than those used in oral medication, so the
incidence of side effect will be reduced.
There are a number of different types of
inhaler available.
1. Metered dose inhalers (MDI) are also
called aerosol inhalers
2. Metered dose inhalers used with spacers
attachment
3. Dry powder inhalers:
 Burbohaler
 Accuhaler
4. Breath –actuated inhalers such as Easi-
breath
PROPER USE OF METER INHALER
1. Remove the cap covering the
mouthpiece and check that there is no
fluff or dirt in the mouth piece
2. Shake the inhalers
3. If the inhalers is new or has not been
used for some time it will need to be
tested. To test :hold the inhaler away
from body .press the top of the
aerosol container once .A fine mist
should be puffed into the air the
inhaler is now ready to use
4. Tilt head back slightly
5. Breath out gently
6. Place the mouthpiece in the mouth
between the teeth (do not bite). Close
lips around the mouth piece
7. Start to breath in through mouth, at
the same time press down on the
inhaler to release the medicine into
the lungs
8. Hold breath for between 5 and 10
seconds then breath out slowly
9. If a second dose is required, wait
approximately 30 seconds and repeat
the process.
10. Replace the cap and if the inhaler is a
corticosteroid inhaler, rinse the mouth
out with water
TIPS FOR USING METER DOSE
INHALER
 Practice using the inhaler in front of
a mirror to ensure inhalation
technique is correct (only when a
dose is required) if mist comes from
the top of the inhaler or the sides of
the mouth the technique is poor and
another dose will be required
 For patient with arthritis or stiff hand
,the inhaler can be held with both
hands rather than one hand
 Use of a spacer device will make the
inhaler easier to use successfully.
 To keep the inhaler clean, remove the
canister from the plastic mouth piece
and wash in warm water twice a

93. Community pharmacy
week. Allow to dry naturally
overnight and then re insert the metal
canister the following morning.
 It is important to try to keep track of
the amount of medicine. Deft in the
inhaler in order to ensure a constant
supply of the dose used is constant
(e.g. two puffs twice a day), work out
how long your inhaler will last by
dividing the number of puffs used
into the number of puffs in the
inhaler.in the (examination) example
here four puffs would be used each day,
if the inhaler contained 200 doses the
inhaler could be expected to last 50 days.
 Arrange to recorder the item about a week
before it will run out.
 If the inhaler is reliever and only used
infrequently it is advisable to have two
inhaler to begin with and when the first
inhaler is empty and the second brought
into use, a replacement spare inhaler
should be ordered, ensuring availability of
the reliever inhaler when it is needed most.
 If more than one type of inhaled medication
is taken it is important to take them in the
correct order.
 Broncho-dilating inhalers are used first to
help open the airways. These are followed
by corticosteroid inhalers .This ensures that
the airways are open, when the
corticosteroid is administered.

94. Community pharmacy
Activity #8
PATIENT COUNSELLING OF
PESSARIES AND VAGINAL
CREAMS
1. Wash hands with soapy water before
using the pessaries and creams.
2. Remove any external foil or plastic
packaging from the pessary and
applicator.
3. If an applicator is provided, load the
applicators as directed by the
manufacturer.
4. Stand with one leg on a chair or lie
down knees bent and legs apart.
5. Press the applicator plunger to insert
the pessary or cream into the vagina.
If no applicator is provided, insert the
pessary as high into the vagina as is
comfortable by pushing gently but
firmly in an upwards and backwards
direction using the middle finger.
6. If an applicator is used, wash it
readily for next use.
7. Wash hands once more.

95. Community pharmacy
Activity #9
PATIENT COUNSELLING ON
BLOOD GLUCOSE
MONITORING
Blood glucose levels are measured by
using an electronic device called
glucometer.
Directions
1. Prepare the lancet device by ingesting
new sterile lancet into the lancet
device firmly until it is on place and
removing the protective cap from the
lancet’s end.
2. Adjust the lancet devices puncture
depth setting for a shallower or
deeper puncture.
3. Setting is based on the sample size
required by the glucometer.
4. Hold the lancet device firmly across
the finger and press the release
button, ejecting the lancet from the
device and allowing it to puncture the
finger tip.
5. Gently squeeze the sides of the finger
to help oozing out the blood.
6. Insert the test strip into the
glucometer. Most glucometers will
turn on automatically by performing
this function.
7. Touch the drop of the blood on the
test strip and hold it until firmly
applied while the meter interprets the
blood glucose level.
8. Record the blood glucose level.
9. Remove the test strip from the
glucose monitoring device and turn it
off.
10. Discard the used test strip.

96. Community pharmacy
Activity #10
PATIENT COUNSELING FOR THE USE OF PREGNANCY
TEST STRIPS
Home pregnancy tests can find the presence of a pregnancy hormone (called Human chorionic
gonadotropin, or HCG) in a sample of urine. High levels of HCG is present in the urine during the
early weeks of pregnancy. The two basic types of home pregnancy tests:
 The most common types of home pregnancy tests use a test strip or dipstick that you hold
in the urine stream or dip into a sample of urine. An area on the end of the dipstick or test
strip changes color if HCG is present, indication of positive result.
 A second type uses a urine collection cup with a test device. To use this type of test, you
may place several drops of urine into a well in the test device or you put the test device
into urine collected in a cup. An area of the device changes color if HCG is present.
Indicates positive result.
Procedure:
 To begin testing, open the sealed pouch by tearing along the notch. Remove the test strip
from the pouch.
 Note the first urine of the morning (that has collected in the bladder overnight) is the best one to
check the results of the pregnancy test.
 Holding the strip vertically, carefully dip it into the urine sample. It should be in such a way that
the arrow head is pointed towards the urine.
 Take out the strip after 3-5 seconds and lay the strip on a flat on a clean, dry and nonabsorbent
surface.
 In rare instances when dyes does not enter the result area, dip the strips in the urine as instructed
above until the dye begins to travel across the white result area
 Wait for colored bands to appear.
 Depending upon the concentration of HCG in the urine sample, positive result in a short duration
but to confirm negative results the complete reaction time of 5 minutes is requested.

97. Community pharmacy
 It is important that the background is clear before the result is read.
 Do not read the result after the specified reaction time