What it is
In a community pharmacy, most of what is dispensed comes from a handful of drug groups. Knowing them well is the basis of any useful intervention at the counter.
This map helps you get your bearings quickly when a patient arrives with a prescription or a health complaint.
The 8 groups you will see most
The ones that reach the counter every day:
- NSAIDs and analgesics (ibuprofen, paracetamol, metamizole) — pain, fever, inflammation
- Stomach protectors (omeprazole, pantoprazole) — gastric protection, reflux
- Antihypertensives (enalapril, amlodipine, losartan) — blood pressure control
- Statins (atorvastatin, simvastatin) — cholesterol
- Antibiotics (amoxicillin, co-amoxiclav, azithromycin) — bacterial infections
- Antihistamines (loratadine, cetirizine) — allergies, rhinitis, urticaria
- Antidiabetics (metformin, insulins) — blood glucose control
- Psychotropics (benzodiazepines, SSRIs) — anxiety, depression, insomnia
At the counter
When to recommend it
- Use this map to place any medicine you do not recognise
- To spot potentially dangerous combinations
- To anticipate which patients need more follow-up
When not to
- This map is a guide: every patient and every situation is different
- Do not assume that a common medicine is always safe for everyone
Warnings
- Caution People over 65 take 5–7 medicines a day on average. Every time you add one, interactions have to be checked.
- Caution Paracetamol is the safest analgesic overall, but overdose (even accidental) is a frequent cause of acute liver failure.
- Caution Benzodiazepines carry a risk of dependence from 4–6 weeks of use. If a patient has been taking them for years, the counter is not the place: it is a conversation for their doctor.
- Caution With iodinated contrast for imaging, metformin may have to be stopped temporarily if kidney function is reduced. Many patients do not know this.
Four keys that repeat across every group
- Onset of action: most oral medicines take 30–60 minutes to work. The patient who says 'it does nothing' often has not waited long enough.
- Frequent interactions: NSAIDs + anticoagulants, statins + fibrates, benzodiazepines + alcohol.
- The liver as the hub: a large share of medicines are metabolised in the liver. Patients with liver disease or who drink heavily need special attention.
- The kidney as the filter: many medicines are eliminated by the kidney. In older people and people with diabetes, kidney function may be impaired even when blood tests do not make it obvious.
Over-the-counter vs prescription medicines
| Aspect | Over the counter | Prescription only |
|---|---|---|
| Access | Without a prescription (OTC) | With a medical prescription |
| Baseline risk | Lower (selected for that reason) | Higher, or more specialised use |
| Pharmacist advice | Essential: there is no doctor involved | Complements the doctor |
| Common examples | Ibuprofen 400, paracetamol, loratadine | Ibuprofen 600, antibiotics, benzodiazepines |
| Refer if | Symptoms do not improve in 3–5 days | The treatment is not working or there are side effects |
An OTC medicine is not a risk-free medicine: it is a medicine whose risk is considered manageable with pharmacist advice. That advice is your responsibility.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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The drug group already tells you a good part of the basic precautions: an NSAID brings gastric and kidney risk, a benzodiazepine brings sedation and dependence. Once the group is identified, you complete the picture with the summary of product characteristics.
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Iodinated contrast can temporarily impair kidney function, and with reduced kidney function metformin can accumulate and cause lactic acidosis. Depending on kidney function, the radiology team may tell them to stop it at the time of the scan and not restart it until kidney function is confirmed, 48 hours later.
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A valid prescription is dispensed. But 3 years of benzodiazepine use is an opportunity for a brief intervention: telling them that gradual withdrawal strategies exist, with medical support, improves their quality of life in the long run.
Training content. It does not replace the summary of product characteristics or clinical judgement.