MINOR AILMENTS: Menstrual pain- Pharmacology and non-pharmacological methods Food allergy Drug allergy

1. RESPONDING TO SYMPTOMS OF MINOR
AILMENTS: Menstrual pain, food and drug allergy
PRESENTED BY:
ZAINABATH MAHNOORA
NU20PHPP13
1ST MPHARM
PHARMACY PRACTICE

2. HAVE YOU EVER SUFFERED FROM ANY OF THE
FOLLOWING ?
 COLD FEVER
 COUGH AND SORE THROAT
 HEADACHE
 MINOR ACHE/PAIN
 DIARHORREA/CONSTPATION
 FOOD ALLERGY
 DRUG ALLERGY

3. MINOR AILMENTS :
Are generally defined as medical conditions that will
resolve on their own and can be reasonably self –
managed with over the counter medications.
Example: Headache, Back pain, Pyrexia, Menstrual
pain , Drug and food allergy.

4. Where to get advice on
how to treat it ?
Is there any medicine which
you can buy without
prescription to relieve these
symptoms ?
If you should see your
doctor, when ?

5. • OTC drugs-treatment is
done for temporary relief
• Take advice from
friends and family
• Health columns in
magazines and
newspaper
• Pharmacist are
trained to recognize
and treat these
minor ailment and
give healthcare
advice
• When your
pharmacist advice
or when your
symptoms prolong
to be serious

6. THINGS TO TELL YOUR PHARMACIST BEFORE TREATMENT
 WHAT ARE YOUR SYMPTOMS ?
 WHEN DID THE SYMPTOMS BEGIN ?
 DID YOU TRY ANY TREATMENTS FOR CURE ?
 YOU ARE ALLERGIC TO ANY MEDICINE
 YOU ARE UNDER ANY TREAMENT FOR ANY OTHER CONDITION
 DO YOU HAVE ANY FOOD ALLERGIES ?
 DO THE SAME DISEASE SUFFERED BY ANYONE ELSE IN YOUR FAMILY
OR LOCALITY ?

7. SOME TERMS:
 MENARCHE
 AMENORRHEA
 MENNORHAGIA
 DYSMENORRHEA
 MENOPAUSE

8. RESPONDING TO SYMPTOMS OF MENSTRUAL PAIN

9. DYSMENORRHEA
• Also known as painful periods or menstrual cramps, is a pain during menstruation
• Begins at the onset of periods
• Last less than 3 days
• Pain occurs in pelvic region or lower abdomen and thighs
Two types:
Primary dysmenorrhea Secondary dysmenorrhea
Common menstrual cramps, is recurrent Painful periods due to a disorder or an infection
Pain begins one or two days before periods Begins earlier in the menstrual cycle and last
longer, affect women of age 30 and above
Nausea and vomiting (may present) Dyspareunia, intermenstrual bleeding,
Reason ; contraction of uterus Problems with reproductive organs
• Endometriosis
• Adenomycosis
• Pelvic inflammatory disease
• fibroids

10. SYMPTOMS:
 Aching pain the abdomen
 Feeling of pressure in the abdomen
 Pain in the hips, lower back and inner thighs
 Loose stools
 Nausea
 Dizziness
 Hip pain
 Headache

11. CAUSES:
PRIMARY
 Being under 20
 Family history of painful
periods
 Smoking heavy bleeding
 Irregular periods
 Puberty reach
 Not having a baby
SECONDARY
 Endometriosis
 Leiomyoma
 Ovarian cyst or tumor
 Adenomycosis
 Pelvic congestion
 Fibroids
 Pelvic inflammatory disease
 Sexually transmitted infections

12. PHARMACOLOGICAL THERAPY:
 Pain relievers
 NSAIDs –naproxen, ibuprofen, celecoxib, COX-2
INHIBITOR,
 OC
 MPA- secondary
 Levonorgestrel-releasing IUD
 Mefenemic acid tabs

13. NON-PHARMACOLOGICAL
THERAPY:
A. HOME REMEDIES:
 Exercise
 Heat
 Dietary supplements
 Avoiding alcohol and tobacco
 Reducing stress
 Massage
 Warm bath

14. B. ALTERNATIVE MEDICINE:
 Acupuncture
 TENS
 Herbal medicine
 Acupressure

15. A. HOME REMEDIES
 EXERCISE
Ease the pain of menstrual cramps
 HEAT
• Using a heating pad or hot water bottle or heat patch on lower abdomen
• Taking it along with analgesic are more effective
• Taking a hot water bath
• Hot massage
 DIETARY SUPPLEMENTS
• Drinking plenty of fluids to ease abdominal bloating
• Vitamin E, Omega-3 fatty acids, vitamin B(thiamine), vitamin-B6 and management
• Papaya, olive oil, chicken, fishes and leafy vegetables, avocado, chickpeas, banana, peanut
butter, prunes

16.  REDUCING STRESS
May increase your risk of menstrual cramp and severity
 ADDING HERBS TO YOUR DIET
These herbal remedies contain anti-inflammatory and antispasmodic compounds
Example: chamomile tea, Cinnamon capsules, Ginger tea, Polygenol, Fennel extract
 AVOIDING ALCOHOL AND TOBACCO
Alcohol, carbonated beverages, Caffeine, salty foods, fatty foods
These can make menstrual cramp worse
 MASSAGE
Abdominal area massage or a full body massage may reduce overall stress
 HOT WATER BATH

17. B. ALTERNATIVE MEDICINE
1. ACUPENTURE
• Involves inserting extremely thin needles through skin at strategic points on body.
• Helps relieve menstrual cramps
2. TENS (transcutaneous electrical nerve stimulation)
• Connects to the skin using adhesive patches with electrodes in them, these electrodes deliver a varying
level of EC to stimulate nerves
• Works by increasing threshold of pain signals and release endorphins, body’s natural pain killer
• More effective than a placebo

18. 3. HERBAL MEDICINES
• pycnogenol, fennel or its combination products
4. ACUPRESSURE
• Stimulate certain points of body
• Done with gentle pressure on skin
• More effective

19. FOOD ALLERGY MANAGEMENT

20. FOOD ALLERGY:
 Food allergies are the body's abnormal responses to harmless foods;
the reactions are caused by the immune system's of body to some proteins
present in food.
 Out 4% of adults have food allergies according to the National Institute of
Allergy and Infectious Diseases (NIAID). The condition affects approxim
ately 6 to 8% of children age 4 and younger.
 They are of 3 types IgE mediated, non IgE mediated and both mediated

21. FOUR WAYS IT CAN HAPPEN:

22. CAUSES:
 In adults, the majority of food allergies are triggered by certain proteins in:
• Shellfish, such as shrimp, lobster, crab and fishes
• Peanuts, Tree nuts, such as walnuts and pecans
 In children: Peanuts, Tree nuts, Eggs, Cow's milk, Wheat, Soy
 Pollen-food allergy syndrome (oral allergy syndrome)
• Birch pollen, ragweed pollen, grass pollen
 Fruits such as bananas, cucumber, melons, zucchini, kiwi, orange, tomatoes, apple, peach, cherry,
pear, plum
 spices (anise, caraway, coriander, fennel, parsley)
 Vegetables such as onion, broccoli, garlic, celery, carrots, bell pepper, soybean and raw potatoes,
 Exercise-induced food eating

24. o Hives, swollen, itchy areas on skin
o Eczema
o Redness around eyes
o Nasal congestion
o Sneezing
o Odd taste in mouth
o Uterine contractions
o Abdominal pain, diarrhea, nausea or
vomiting
o Dizziness, lightheadedness or
fainting
o Metallic taste
SYMPTOMS:
MILD SYMPTOMS: SEVERE SYMPTOMS:
o Obstructive swelling of lips, tongue and throat
o Trouble swallowing
o Turning blue
o Chest pain
o Loss of consciousness
o Chest pain
o Drop in BP
o Impending doom sensor
o Thread pulse
o Anaphylaxis
o Constricting and tightening of the airways

25.  Family history: increased risk of food allergies if asthma, eczema, hives, hay fever are common in your family.
 Other allergies: If you're already allergic to one food, you may be at increased risk of becoming allergic to another
 Age: more common in children
 Asthma.
SERIOUS RISK FACTORS:
 Seek emergency treatment if you develop any signs/symptoms of anaphylaxis, such as
 Constriction of airways that makes it difficult to breathe
 Shock with a severe drop in blood pressure
 Rapid pulse
COMPLICATIONS:
 Anaphylaxis.
 Atopic dermatitis (eczema)
RISK FACTORS:

26.  Eosinophiliac esophagitis
 Dysphagia
 Urticarial
 Atopic dermatitis
 Hives
 Wheezing
 Eczema
 Anaphylaxis
 Rhinorrhea
 Angioedema

27. PREVENTIONS:
 Avoid foods that cause signs and symptoms
 Carry an epinephrine auto injector (Adrenaclick0
 Notify key people that your child has a food allergy
 wear a medical alert bracelet or necklace
DIAGNOSIS:
No perfect test used to confirm or rule out a food allergy
 Find your symptoms
 Family history of allergies
 Physical examination
 Skin test (IgE MEDIATED)
 Blood test (IgE MEDIATED)
 Elimination diet (NON IgE MEDIATED)
 Oral food challenge (NON IgE MEDIATED)

28.  For minor allergic reactions- anti histamines or albuterol are used
 For severe allergic reactions- epinephrine inj
 Epinephrine auto-injector (epinephen, adrenalick)
 Oral immunotherapy (treatment being studied)
TREATMENTS (PHARMACOLOGICAL METHODS):

29. LIFESTYLE MODIFICATIONS AND HOME REMEDIES (NON- PHARMACOLOGICAL)
 Avoid the food that cause allergies
 Differentiate allergies
 Read food labels carefully
 Use alternatives (eg: milk –Ca fortified orange juice and pulses)
 Consulting an allergist
 Medical alert bracelets
 Prepare a list of food person is allergic to
 Physical examination
 Consultation of nutritionist or dietitian
 Extensively heated products
 Dietary assessment
 Infant formulas
 Allergy education
 Assessing growth

30. TERMS:
 Eosinophiliac esophagitis
 Dysphagia
 Urticaria
 Atopic dermatitis
 Hives
 Wheezing
 Eczema
 Anaphylaxis
 Rhinorrhea
 Angioedema

31. DRUG ALLERGY MANAGEMENT:

32. Also called adverse drug reaction are defined as any harmful or unintended reaction to a drug that occurs at a dose
prescribed for prevention, diagnosis and cure of a disease.
They are classified into 2 types: Type A and Type B – Unpredictable
Also classified based on immune mechanism:
 IgE mediated -antibody type I
 IgG mediated-cytotoxic reaction type II
 IgM mediated –antibody type III or immune complex
 T-cells mediated- type IV
DRUG ALLERGY:
Type A - Predictable Type B - Unpredictable
• Drug overdose • Drug allergy; immunogically mediated
• Secondary drug effects • Lack of immunological specificity
• Side effects • Drug intolerance
• Drug interactions • Abnormal effect by abnormal metabolism/ excretion

33. RISK FACTORS:
 PATIENT RELATED FACTORS
 Age: young /middle aged > infant/elderly
 Gender: women > men
 Genetic polymorphism
 Viral infection: HIV
 DRUG RELATED FACTORS
 Frequency of exposure > single dose
 Route of administration: topical > iv/im > oral
 Molecular weight

34. CAUSES:
Antibiotics, such as penicillin
• Aspirin and non-steroidal anti-inflammatory medications, such as ibuprofen
• Anticonvulsants
• Monoclonal antibody therapy
• Chemotherapy
• Taking medication frequently

35. SYMPTOMS:
1. SKIN REACTIONS:-
• Measles like rashes, fever
• Hives
• Photoallergy
• Erythema
• Angioedema
• Steven – Johnson syndrome
• Toxic epidermal necrosis
2. LYMPH NODE SWELLING
3. INFLAMMATION OF KIDNEY
4. LIGHT HEADEDNESS, LOSS OF CONCIOSNESS, DIZZINESS

36. DIAGNOSIS:
 SKIN PRICK TESTING
Done for penicillin, local anesthetics, muscle relaxants, insulin and monoclonal anti bodies
 INTERDERMAL TESTS
Allergen injected into skin dermis for diagnosis of IgE mediated reactions to find out anti IgE
 PATCH TESTING
 DRUG DESENSITIZATION AND GRADED CHALLENGE

37. PHARMACOLOGICAL METHODS
 Antihistamines: To counter the allergic reaction.
Cetirizine . Diphenhydramine
 Corticosteroids: To reduce inflammation.
Cortisone
 Bronchodilators: Given to widen the airway, if symptoms
include lung congestion and coughing.
Ipratropium bromide . Albuterol
 Alpha- and beta-adrenergic agonists: For anaphylactic
reaction.
Epinephrine

38. NON PHARMACOLOGICAL THERAPY
 Additional therapy Avoidance of discontinuation of the drug
 Giving alternatives ( checked for cross reactivity)
 Written information of drug to be avoided
 Allergy bracelet
 Study patients history
 Rest And Drink Fluids

39. Prevention of future reactions
Prevention of future reactions is an essential part of patient management. The patient
should be provided with written information about which drugs to avoid (including over-
the-counter medications). The drugs should be highlighted in the hospital notes and within
electronic records (where available), and the patient’s family physician should be informed
of the drug allergy. Engraved allergy bracelets/necklaces, such as those provided by Medic
Alert, should also be considered, particularly if the patient has a history of severe drug
induced allergic reactions.

40.  Additional therapy Avoidance of discontinuation of the drug
 Giving alternatives ( checked for cross reactivity)
 (topical corticosteroids and oral antihistamines may improve cutaneous symptoms in anaphylaxis, but the drug of choice
should be epinephrine)
 Penicillin allergy – non penicillin agents (imipenem) or 2nd or 3rd generation cephalosporin's
identify the allergy by skin test response
 Sulphonamide antibiotics allergy- SJS and TEN ( tri methoprim sulphamethaxazole) used for HIV patients for infections
 Cephalosporin's – rashes and drug fever
 General anesthetics cause pseudo and allergic reaction – causing respiratory diseases, urticarial
 Written information of drug to be avoided
 Allergy bracelet
 Study patients history
MANAGEMENT OF COMMON DRUG ALLERGIES: