Community Pharmacy · Short notes

OTC and Self Medication: Short Notes & Cheat Sheet

Responsible self-medication, questioning with WWHAM and ASMETHOD, red flags for referral, and OTC treatment of common minor ailments.

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Short notes

Read these before you attempt the topic's MCQs.

Questioning with WWHAM

Five questions decide whether to treat, advise or refer. Any red flag means referral.

The pharmacist's role

Responsible self-medication means treating minor illness with safe, effective OTC medicines, with advice from a pharmacist.
Question the patient systematically. WWHAM: Who is the patient, What are the symptoms, How long, Action already taken, Medication already being taken.
ASMETHOD adds age and appearance, extra medicines, history, other symptoms and danger symptoms.
In Pakistan many prescription-only medicines, especially antibiotics, are sold without prescription, which drives resistance. The pharmacist should refuse and advise.

Refer to a doctor when

Symptoms last longer than expected (e.g. cough over 3 weeks), or OTC treatment has failed.
There is blood in sputum, stool, urine or vomit, unexplained weight loss, difficulty swallowing, or severe or chest pain.
A baby under 3 months has a fever, or a child shows signs of dehydration.
The patient is pregnant or breastfeeding, very young or very old, or has serious other illness, for many conditions.
Heartburn with alarm features (new symptoms over 55, weight loss, vomiting, bleeding or difficulty swallowing).

Common ailments

Dry cough: dextromethorphan. Chesty cough: guaifenesin. Avoid OTC cough and cold medicines in young children (under 6 in UK guidance).
Nasal decongestant sprays (oxymetazoline) are limited to a few days because of rebound congestion. Oral pseudoephedrine is avoided in hypertension and with MAOIs.
Allergic rhinitis: a non-sedating antihistamine or an intranasal steroid.
Pain and fever: paracetamol or ibuprofen; no aspirin under 16 years.
Diarrhoea: ORS first (plus zinc for children); loperamide for adults if there is no blood or fever.
Fungal skin infection: clotrimazole or terbinafine. Scabies: permethrin 5% for all household contacts. Vaginal thrush: clotrimazole or single-dose fluconazole 150 mg (refer if pregnant, recurrent or unusual).
Emergency contraception: levonorgestrel 1.5 mg as soon as possible, within 72 hours.

Cheat sheet

High-yield facts in one place. Cover the right-hand column and test yourself.

Ailment → OTC choice

Ailment	OTC option
Dry cough	Dextromethorphan
Productive cough	Guaifenesin
Blocked nose	Oxymetazoline ≤ 3–5 days
Hay fever	Cetirizine, loratadine; nasal steroid
Heartburn	Antacid, alginate, short-course H2RA/PPI
Diarrhoea	ORS (+ zinc for children), loperamide (adults)
Constipation	Fibre, ispaghula, lactulose
Scabies	Permethrin 5%
Athlete's foot	Clotrimazole, terbinafine
Emergency contraception	Levonorgestrel 1.5 mg ≤ 72 h

Red flags

Sign	Action
Blood in stool, urine or sputum	Refer
Cough > 3 weeks	Refer (TB?)
Fever in baby < 3 months	Refer urgently
Chest pain	Emergency referral
Difficulty swallowing, weight loss	Refer
Failed OTC treatment	Refer

Memory aids

WWHAM: Who, What symptoms, How long, Action taken, Medication.

Exam traps

Nasal decongestant sprays used for more than a few days cause rebound congestion.
Aspirin must not be sold for children under 16 because of Reye's syndrome.
A cough lasting over 3 weeks needs referral; in Pakistan, TB must be considered.
Loperamide should not be used when diarrhoea is bloody or accompanied by fever.

Revised? Now test yourself.

Attempt the OTC and Self Medication MCQs while the notes are fresh. Anything you get wrong is saved to your incorrect list for the next revision round.