The practice of over-the-counter drugs and self-medication are important components of any healthcare system. The use of over-the-counter drugs is part of the self-medication process. The popularity of over-the-counter drugs among patients can increase the likelihood of abuse of such drugs. Pharmacists are often the first point of contact with patients as they are the most accessible. Now you have the opportunity to educate and advise your patients on the correct use of over-the-counter drugs. The presence of a pharmacist ensures the safe and effective use of over-the-counter drugs. Pharmacists can collaborate with other health care providers in managing patient self-care practices.
However, pharmacists have traditionally been underutilized in this role. This article discusses the barriers pharmacists face in misusing over-the-counter drugs, given the increased likelihood of switching from prescription to nonprescription drugs in recent years. In addition, we discuss the potential of the OTC category to improve the interaction between patient and pharmacist. The current review confirms the active role of pharmacists in the fight against the abuse of over-the-counter drugs.
Currently, there is a trend in the world, which is expressed in the desire of citizens to take responsibility for preserving their health by making decisions regarding the prevention, identification and treatment of diseases, including – the use of over-the-counter medications on their own initiative. The development of the concept of responsible self-medication is intended to play a positive role in providing the population with more accessible, high quality and cheaper medical services (Anderson, 2021).
The world practice shows that comprehensive informing of the medical community and population about modern approaches to responsible self-medication and the introduction of appropriate standards for over-the-counter medications can lead to a reduction in health care costs and improve the overall health of the population (Kebodeaux, 2019). It is quite natural that with the formation of the pharmaceutical market and the self-help and self-prophylaxis sector, the role of the pharmaceutical professional is increasing.
A pharmacist with a pharmaceutical education increasingly has to act as a consultant (for he or she is the most accessible specialist to the patient) on the competent use of medications, medical devices, parapharmaceutical products, and the promotion of healthy lifestyles. A number of publications, both in our country and abroad, evidences the fact that the pharmacist plays an increasing role in the system of self-care and self-prevention (Tesfamariam et al., 2019).
Speaking about the role of pharmacy and pharmaceutical workers in the system of self-help and self-prevention, including over-the-counter dispensing of medicines, we should know how prepared today’s pharmacy professional is for the new requirements. Currently, pharmaceutical professionals are not always able (ready) to responsibly address the issues of over-the-counter dispensing of medicines in order to minimize the risk of their use: they do not always have the necessary amount of knowledge to provide highly qualified information and advisory services.
In this regard, a completely new requirement for the pharmacist must be the knowledge and ability to provide highly professional information and counseling services. WHO experts involved in program assurance of drug safety believe that the main mechanism for regulating the dispensing of drugs around the world is the economic factor (compensation for patient expenditures), but by no means the interests of rational pharmacotherapy. In many parts of the world, there is a shortage of medical personnel, and legislation governing the dispensing of medicines is flawed or non-existent. In addition, the cost and time required to see a physician is prohibitive for many patients. Self-treatment can increase access to medications and reduce health care costs.
Thus, the positive components of the self-help and self-medication sector should be noted. Over-the-counter dispensing of medications is of objective and necessary importance (Anderson, 2021). In other words, strict regulation of the dispensing of medicines is practically impossible at the present stage of health care development. The main argument is that free medical provision for citizens at the current time is only partially possible. This can be confirmed by the capacity of the drug market, which in Russia amounts to 4 billion dollars (in Japan – 10 billion, in Germany – 20 billion dollars).
The patient considers only acute infectious and traumatic injuries as a serious illness, while his attention to serious non-infectious and nontraumatic diseases is disastrously impaired. It is not surprising that the mortality rate from disease in developing countries is 7-8 times higher than in developed countries. Under the conditions of overloaded medicine, the quality of diagnostic and clinical-pharmacotherapeutic the quality of the diagnostic, clinical and pharmacotherapeutic process is called into question.
At one time, medicines were mostly sold without a prescription. Before the existence of the US Food and Drug Administration (FDA), almost anything could be bottled and sold as an over-the-counter drug. Some over-the-counter drugs contained alcohol, cocaine, marijuana, and opium without notifying customers. The U.S. Food, Drug, and Cosmetic Act (FD&C), passed in 1938, gave the FDA the power to make regulations, but clearly defined which drugs could be sold with a prescription and which could be sold without a prescription.
Amendments to the FD&C Act of 1951 were intended to clarify the differences between prescription and over-the-counter drugs, as well as address some drug safety issues. Prescription drugs have been identified as compounds that can be addictive, toxic, or less safe when used without medical supervision. All other drugs were allowed to be dispensed without a prescription.
As specified in the 1962 FD&C Amendment, over-the-counter drugs must be effective and safe. However, determining efficacy and safety can be difficult. What works for one person may not work for another. In addition, any drug can cause unwanted side effects (also called side effects, adverse events, or adverse drug reactions). The United States did not have an organized system for reporting side effects of over-the-counter drugs until 2007, when new legislation came into effect requiring companies to report serious side effects associated with the use of over-the-counter drugs.
Studies show that in all developed countries the pharmacist is the most accessible specialist in the health care system. It is their competence to decide when a pharmacy visitor should be sent to a doctor and when self-treatment is allowed. Pharmaceutical workers of Latvia, guided by the generally accepted standards of health care in the EU countries, have defined by the state regulation requirements to pharmaceutical provision, namely, the pharmacist must:
- Be a distributor of drugs and other medical products;
- Provide pharmacotherapeutic advice;
- Supervise the administration of medications;
- Provide observation of side effects that may occur with the use of medication medications;
- Inviting doctors with experience in doctors with experience in clinical pharmacology to consulting with patients in pharmacy.
The problem of medication safety is a topical issue all over the world. Given the basic provisions of the concept of responsible self-medication, the patient should receive detailed recommendations from the pharmacist when purchasing an OTC drug (Tesfamariam et al., 2019). In practice, the situation looks different. The difficulties stem from the fact that currently not only OTC drugs are dispensed without a prescription, but also prescription drugs. Today’s reality is that many patients besiege pharmacists with questions about dosages, procedures, and side effects of medications.
In the United States, most states have extremely strict restrictions on the sale of over-the-counter medications. Not only psychotropic drugs and antibiotics, but also most sulfonamides, cardiovascular drugs, and medications used in pediatric practice can be purchased only with a doctor’s prescription (Anderson, 2021). Pharmacists are prohibited from advising patients on this group of drugs – this prerogative is given to doctors. It is necessary to take into account the peculiarity of American society: the laws adopted there are enforced by the majority of citizens. In a typical American pharmacy, there are shelves of over-the-counter medications and related items such as toys, souvenirs, and greeting cards that are freely available in the customer area.
Prescription medications are placed on only a few shelves behind a partitioned counter at the pharmacist’s workstation. Rarely do people go to the pharmacy specifically for over-the-counter medications, since they can be purchased at any supermarket. The percentage of over-the-counter sales does not of over-the-counter sales is less than 10%. The main income of the pharmacy comes from the sales of prescription drugs. The average pharmacy receives 100 prescriptions a day.
Large pharmacies, often part of pharmacy chains, about 600 prescriptions come in daily. The heart of a pharmacy is its computer system. The computer contains information about each patient-purchaser, what medications he has purchased before and what he is currently taking, based on which an opinion is given about the expected interaction with newly prescribed medications. This way, the patient can also be warned about possible interactions between the prescription drugs they are taking and the over-the-counter drugs the patient is purchasing. The computer gives instructions about the prescribed medicine and prints a special label with the name of the medicine, the name of the patient, doctor, etc., glued to the individual container in which the pills intended for the patient are placed.
Information about medicines is publicly available today (primarily through advertising and the Internet), but is not always reliable. In this regard, one of the important tasks for the pharmacist is to provide patients with quality information and to promote among them the concept of rational use of medicines. The pharmacist remains a key figure in ensuring the competent choice of medications in self-care. When serving a patient, the pharmacist offers an over-the-counter medication, being assured that it has no teratogenic, mutagenic, carcinogenic effects, no adverse effects on blood, liver, kidneys, or cardiac function. There is an urgent need to develop criteria for classifying of drugs to the non-prescription issue and documents regulating this issue. The realization of these tasks will allow regulating more clearly the process of of self-help, will promoting the rational use of medicines and improving the system of medical medicines and improve the system realization.
Safety is the main characteristic that is considered when deciding whether a previously prescription-only drug should be placed in the OTC group. All drugs have both beneficial effects and side effects. Some degree of risk is considered acceptable if it outweighs the expected benefit of taking the drug. However, determining an acceptable degree of risk is difficult. The safety of BLP depends on its correct use. The use of the drug is based on a diagnosis (often a misdiagnosis) that the person has made for themselves. For example, most headaches are not a sign of severe illness, but sometimes they are an early signal of a brain hemorrhage or brain tumor. Similarly, the sensation of severe heartburn can be a symptom of a myocardial infarction. Ultimately, a person relies on common sense to determine when a symptom or illness is minor and when professional medical attention is required.
In establishing the dosages of OTC, manufacturers strive to balance safety and efficacy. People who buy a OTC should read the package insert and follow it carefully. Since the same name can be given to both fast-acting and slow-acting drugs, you should check the package label each time you purchase a drug. Do not assume that the dose of the drug is always the same. In recent years, there are many different drugs with similar brand names, so it is important to check the components of the product you are buying, rather than relying on familiar names. For example, not all products called “Maalox” contain the same components: some contain aluminum and magnesium compounds, while others contain calcium carbonate. When choosing an over-the-counter medication, a person should know which component is most important to treat his or her condition. Some people experience adverse reactions even when OTC is used correctly. For example, a severe rare allergic reaction (anaphylaxis) to analgesic drugs such as aspirin, ketoprofen, naproxen, and ibuprofen can manifest as hives, itching, difficulty breathing, and shock. These drugs can also irritate the gastrointestinal tract and lead to ulcers.
Often the prescription for a OTC does not include a complete list of side effects. As a result, many people begin to think that these drugs have few or no side effects. For example, one analgesic’s prescription only says that the drug should not be taken for more than 10 days. In addition, the information on the container, bottle or in the annotation contained in the package does not always describe the possible severe side effects of long-term use. Therefore, with chronic pain or inflammation, people may take the medication for a long time without realizing that this could lead to complications.
Aging changes the rate and pathways of drug breakdown in the body. Changes in liver and kidney function, which are natural with aging, can affect the transformation and excretion of medications. Older adults are more likely to have adverse reactions or drug interactions than younger adults (Shah et al., 2020). It is not uncommon for prescription drug formularies to indicate whether a dose change is necessary for the elderly, but prescription drug formularies usually do not contain such warnings. Many OTC drugs are potentially dangerous to the elderly. The risk increases if the medication is taken regularly or at the maximum dose. For example, in an elderly person with arthritis, the use of an analgesic or anti-inflammatory drug often leads to severe consequences. Bleeding ulcers, a life-threatening complication for an elderly person, can develop without warning symptoms.
Table 1. Sleep, pain, and cough/cold/allergy scenarios.
Table 2. Definitions and origins of the principal themes in the study
Antihistamines, especially at high doses or in combination with other medications, sometimes cause confusion or delirium in the elderly. In addition, older adults are more susceptible to possible side effects of medications that act on the digestive tract (Shah et al., 2020). For example, antacids containing aluminum salts are more likely to cause constipation, and similar magnesium-based medications cause diarrhea and dehydration (dehydration). Even taking vitamin C can lead to stomach upset or diarrhea. When seeing a doctor, seniors should report any OTC, they are taking, including vitamins and mineral supplements. This helps the doctor evaluate the drug therapy regimen as a whole and determine if the OTC may be causing the symptoms the patient reports.
Overprescribing of drugs to older people is driven by direct-to-consumer advertising and older people’s beliefs and expectations about drug-based decision making. Factors contributing to polypragmatism include a lack of professional training in geriatrics and pressure to achieve high patient satisfaction scores. The prescribing cascade, defined as the use of one drug to treat a condition unintentionally caused by another drug, is another important driver of overprescribing in the elderly. These factors create barriers to safe prescribing and polypragmatic reduction.
Clinicians recognize the complexity that polypharmacy presents for geriatric care, but its burden is not always recognized and it is important to consider it. Family members report that medication is stressful due to the fear of making a mistake and the complexity of the task (coordination with pharmacies) and drug use (remembering medication, organizing, planning and taking). The increase in medication exacerbates these problems and increases the burden on caregivers.
The aging process affects the safety and efficacy of drugs. Normal aging is associated with physiological changes, such as reduced liver size and blood flow, and reduced kidney function, which affect drug absorption, distribution, metabolism, and clearance. Other physiological changes, such as changes in the structure and function of the cardiovascular and central nervous systems, may affect drug resistance and increase the risk of side effects. With normal age-related changes in thinking and motor skills, the minimum recommended dose should be taken into account to reduce side effects and improve tolerability.
Side effects of the drug, potential long-term side effects, and efficacy are highly dependent on adherence. Treatment adherence is influenced not only by access to medicines and the ability to use them as prescribed, but also by the perceived benefits of medicines for older people and perceptions of health. and attitudes towards drugs (Shah et al., 2020). As more older people rely on the support of caregivers, caregivers should respect older people’s reluctance to take medication as prescribed and follow the advice of their doctors. lead to decline and conflict with caregivers.
References
Anderson, L. (2021). Over-the-Counter (OTC) Medications. Web.
Kebodeaux, C. D. (2019). Prescription and over-the-counter medication record integration: A holistic patient-centered approach. Journal of the American Pharmacists Association, 59(2), S13-S17.
Marathe, P. A., Kamat, S. K., Tripathi, R. K., Raut, S. B., & Khatri, N. P. (2020). Over-the-counter medicines: Global perspective and Indian scenario. Journal of postgraduate medicine, 66 (1), 28-34. Web.
Shah, S., Gilson, A. M., Jacobson, N., Reddy, A., Stone, J. A., & Chui, M. A. (2020). Understanding the factors influencing older adults’ decision-making about their use of over-the-counter medications – A scenario-based approach. Pharmacy, 8(3), 1-15. Web.
Tesfamariam, S., Anand, I. S., Kaleab, G., Berhane, S., Woldai, B., Habte, E., & Russom, M. (2019). Self-medication with over the counter drugs, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. BMC public health, 19(1), 1-9.