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December 2018 Volume 10  Issue 12 PHARMACYNEWSIRELAND.COM

THE INDEPENDENT VOICE OF PHARMACY

Dynamic 100 Issue In this issue: NEWS: Antibiotic overuse a major threat Page 5

REVIEW: Assuring trust and facing challenges Page 8

CONFERENCE: IPHA: Irish medicine waits under par Page 18

AWARDS: Launch of the Irish Pharmacy Awards 2019 Page 37

FEATURE: Eyes at the front of care Page 42

CPD: Alcohol & Mental Health Page 47

DYNAMIC 100: Ireland’s Pharmacy Dynamic 100 Page 52


Winter smells good without a cold!

S ell the world ! m

Marimer hypertonic seawater spray helps clear your blocked nose to once again breathe easily and enjoy all the fragrances of winter. Naturally rich in mineral salts and marine trace elements, Marimer hypertonic is recommended for adults and children for nasal decongestion in case of colds, rhino-sinusitis or for post-operative care.


Foreword

Contents

“For last year’s words belong to last year’s language. And next year’s words await another voice. And to make an end is to make a beginning” So said T.S Eliot.

Page 5: Pharmacists come to aid of main suffering suspected cardiac arrest

All too quickly we have found ourselves at the end of another year. 2018 marked many milestones, presented many challenges and bore fruit on many opportunities. Many of these are identified in our series of Year Reviews on the opening pages, in which pharmacy associations including the Irish Pharmaceutical Healthcare Authority and Pharmaceutical Society of Ireland reflect on achievements and goals.

Page 6: Dáil debates community pharmacy

To mark an end is to make a beginning and there are some exciting developments also noted to get underway in the next twelve months. Indeed Brexit is cause for concern amongst many, but work is being carried out diligently to prepare for any negative impacts.

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Page 20: IPHA says ‘We must get right medicines to patients’

In other news this issue, eHealth received a welcome boost with the announcement of a major ¤225m investment which will go towards the rollout of this transformational programme. Turn to page 8 for the full story.

Page 37: Irish Pharmacy Awards launched Page 52: Dynamic 100 revealed Page 92: CarePlus annual conference

The benefits of self care for both individuals and health systems are well documented. On page 18 our Report goes in-depth as to the role of community pharmacists in the development of the self-care market following on from IPHA and the Irish Pharmacy Union’s joint awareness campaign, ‘Be Well this Winter – Think Pharmacy’.

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Our last issue of 2018 carries the annual Dynamic 100 - now in its fourth year, Irish Pharmacy News are once again saluting the most dynamic leaders, innovators and thinkers, offering role models for a vibrant and ever-changing Pharmacy future.

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562 MANAGING DIRECTOR Natalie Maginnis natalie@pharmacyawards.co.uk EDITOR Kelly Jo Eastwood kelly-jo@ipn.ie ADVERTISING DIRECTOR Debbie Graham debbie@ipn.ie ADVERTISING SALES Louie French 00353 (1) 6690562

From page 52 onwards, we feature 100 of the trailblazers across Ireland’s Pharmacy landscape; 100 unique stories of hard-work, determination, leadership and success. The Dynamic 100 features those who stand out for their contribution to changing the face of the industry.

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Irish Pharmacy IRISH News is circulated PHARMACY NEWS to all independent, multiple and group pharmacies and academics in Ireland.

All rights reserved by Irish Pharmacy News. CONTRIBUTORS All material published in Irish Pharmacy News Ola El-Garawany | Eamonn Brady is copyright and no part of this magazine may Jonny McCambridge be reproduced, stored in a retrieval system or transmitted in any form without written PHARMACYNEWSIRELAND.COM permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going @Irish_PharmNews to press, however the publishers assume no responsibility for any effects from omissions IrishPharmacyNews or errors.

Regulars

Over the last four years we have heard stories of stunning lifetime achievement and monumental milestones. But the Dynamic Top 100 features the individuals of the moment, those at the forefront of services making marked and noticeable investments in services. Lastly, next year’s word do belong to another voice, and I look forward to bringing you the latest news, reports, features and updates in 2019. A very Merry Christmas and a Happy New Year from all the team at Irish Pharmacy News.

FEATURE – SMOKING CESSATION 25

FEATURE – DIET AND SLIMMING

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FEATURE – BLADDER ISSUES

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FEATURE – EYE CARE

CPD

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CLINICAL PROFILES

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Have you considered using data analytics in 2019? Join the 375 Irish pharmacies who have!

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“The payback in the first year is well in excess of 10 times its cost” Tony McEntee, Former CEO of Allcare Pharmacy

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News news brief

CPD asthma management programme launched A new online CPD asthma management programme has been launched at University College Cork.

HICKEY’S LAUNCHES NEW PHARMACY APP

importance of having collaborated with the Asthma Society will further enhance the adaption of this material across all healthcare professionals.”

Hickey’s Pharmacy has launched its new app giving people in Ireland access to express prescription delivery and a Click & Collect service. The app enables customers to order in advance, with the prescription medication ready to collect in one hour from any of the 37 Hickey’s Pharmacy stores across the country. To save even more time, the ‘Click & Collect’ service allows customers to pay for medication in advance.

The launch of the new online CPD asthma management course

“This free online CPD accredited module will enable community pharmacists all over the country to remotely access up to date information on the diagnosis, treatment and management of asthma. Optimal asthma management is essential to prevent attacks and GSK is committed to helping those with the condition do more, feel better and live longer,” said a GSK spokesperson. CEO of the Asthma Society of Ireland, Sarah O’Connor said, “There are 470,000 people with asthma in Ireland, we have the fourth highest prevalence of asthma in the world, where one in five children and one in ten adults have asthma. We aim to help people with asthma to live a full life, symptom free and this course will assist pharmacists and other healthcare professionals in their work to support people with asthma. We want to eliminate asthma deaths and we believe that pharmacists can play a key role in achieving that."

The Hickey’s Pharmacy App offers repeat prescription customers an express twohour delivery service from 20 of its stores. Prescriptions can go directly from the pharmacy counter to a work place or home at the touch of a button.

The course was developed by the School of Pharmacy and the Department of Physiotherapy at UCC in collaboration with the Physiotherapy Department of University Hospital Kerry, the Asthma Society of Ireland and Health Innovation Hub Ireland and supported by GlaxoSmithkline.

With over 20 years’ experience providing healthcare services to communities in Ireland, the Hickey’s Pharmacy App is designed to ensure that their service offering, adapts to suit the needs of those with increasingly busy lives. Hickey’s Pharmacy has spoken to their customers to find out more about their needs.

The course incorporates novel flexible learning software to provide physiotherapists, pharmacists and all healthcare professionals with up-to-date knowledge on the causes and treatment

For example, the app includes a reminder facility around when to take medication and will also alert patients as to when they need to order a repeat prescription. The app also offers a call back from a pharmacist feature so that customers can speak to an expert directly.

The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) has launched a national public awareness campaign in partnership with the Irish Pharmacy Union (IPU).

Stephen Butterly, from Hickey’s Pharmacy commented: “We are delighted to announce the launch of our new app and are excited to offer people in Ireland a new way to access the quality healthcare offered by the Hickey’s Pharmacy Group. Health is a priority for everyone. Our new app ensures that no matter how hectic your lifestyle, the service you need is always only a few clicks away.”

strategies of asthma. It will enable physiotherapists and pharmacists to optimise patient welfare. They will also be provided with tools to empower patients to manage their own conditions. Professor Stephen Byrne, Chair in Clinical Pharmacy Practice, and Head of the School of Pharmacy in UCC said, “The asthma programme will be successful due to the combined inter-professional efforts taken in the design and development of materials which are patient-centric in nature. The

HSE advises that emergency contraception is available without prescription up to five days after sex The aim of the campaign is to increase public awareness that the emergency hormonal contraception (EHC) pill is available to women directly from a pharmacist up to five days (120 hours) following unprotected sex. The EHC pill can be used as an effective secondary method to prevent a crisis pregnancy when contraception has failed or has not been used. Minister for Health Simon Harris said, “It is vital for women to be aware that they can access the EHC pill directly from their community pharmacist without a prescription. Women with medical cards can also get the EHC pill free-of-charge directly from a pharmacist without the need for a prescription from their GP. This is an important public health measure and will remove any barrier to women getting timely treatment from their local pharmacy.”

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In addition, Minister Harris has outlined his belief that contraception should be free. Work is underway in the Department of Health in this regard, which includes exploring all of the issues associated with enhancing access to contraception and removing the barrier of cost. Helen Deely, Programme Lead of the HSE SHCPP, said, “There is a misconception that the EHC pill, commonly known as the ‘morning after pill’, can only be taken the morning after unprotected sex. We would encourage women to consult a pharmacist as soon as possible after an occasion of unprotected sex.” Darragh O’Loughlin, IPU Secretary General, said, “Emergency contraception is time-sensitive. Its effectiveness diminishes between the time of unprotected sex and the time of taking it, making it crucial that all women are able to access it readily when necessary. The convenience and

accessibility offered by community pharmacies is therefore hugely valuable in helping to prevent a crisis pregnancy. Pharmacists are fully qualified to offer advice to medical card holders on emergency contraception, as they have been safely providing emergency contraception, without prescription, to private patients since 2011.” Ms Deely continues, “It is important to remember that the EHC pill is not a primary method of contraception and that it is available as a secondary method if needed. We encourage women to talk to their GPs about the best methods of contraception for them.” While the EHC pill can prevent an unplanned pregnancy, it does not provide protection against sexually transmitted infections (STIs). Using condoms correctly and every time sexual intercourse happens will significantly reduce the risk of getting an STI.


News Antibiotic overuse becoming major threat to public health according to pharmacists

news brief

Overuse of antibiotics in Ireland, and around the world, represents one of the most significant threats to long term public health. This warning was issued by the Irish Pharmacy Union (IPU) which has called on patients to help fight the growing problem of antibiotic resistance. infections, but will also undermine the treatment of more complicated infections, especially in patients with chronic diseases and could make many surgeries impossible.

Darragh Connolly, President, IPU According to the IPU, health services are experiencing an increase in the levels of antibiotic resistant infections, and this is largely being attributed to the overuse and misuse of antibiotics. Increased levels of resistance, coupled with the lack of new antibiotics coming on stream, means there is a risk that we could return to the ‘pre-antibiotic era’ if this overuse is not addressed. This will not only cripple the ability to fight routine

President of the IPU, Daragh Connolly, said, “As the theme of this year’s Antibiotic Awareness Week is ‘keep antibiotics working,’ it is essential that everyone takes responsibility for ensuring that antibiotics are only used when absolutely necessary. The key message is that antibiotics should only ever be taken when a patient actually requires them to treat a specific bacterial infection. For anyone suffering from coughs, colds, sore throat, sinusitis, flu, vomiting and diarrhoea, antibiotics will not work and should not be taken. “It is concerning that, at a time when we should be reducing our use of antibiotics, in the first half of this year the rate of antibiotic consumption in Ireland has actually increased, with Irish people taking 7% more antibiotics than they were 15 years ago. We are taking too many antibiotics and this is causing the very concerning

rise in antibiotic resistance. If this problem isn’t tackled, the antibiotics used to treat infections today will become ineffective or may stop working altogether in the future.” Mr Connolly reminded patients that the flu is not a bacterial infection, meaning antibiotics will have no impact, however, proactive prevention is possible. In conclusion, Mr Connolly outlined a series of advices that pharmacists all over the country will be continuing to emphasise to patients: 1. Don’t take antibiotics for colds and flu; sore throat, coughs, vomiting and diarrhoea; 2. If you do need to take an antibiotic, take it exactly as prescribed and finish the full course, even if you are feeling better; 3. Do not save antibiotics for later use or share them with others; and 4. Don’t expect to be prescribed antibiotics for viral conditions.

Carlow incident highlights the importance of pharmacy training and investment in heart health The team at LIoydsPharmacy Tullow Street including Supervising Pharmacist Ann-Marie Walsh and Pharmacy Manager Jackeline Kennedy used a defibrillator in conjunction with CPR on a local Carlow man who was in suspected cardiac arrest. The incident brings to the light the important role that local pharmacies play in delivering an accessible, high standard of heart healthcare services. LloydsPharmacy provides specialised heart health training for all colleagues nationwide, focusing on cardiovascular risk assessments, lifestyle advice, blood pressure, BMI and pulse checks, to ensure effective delivery of heart health services, advice and guidance. As part of the partnership, pharmacies nationwide have become ‘heart health hubs’. Defibrillators are situated inside 88 LloydsPharmacy pharmacies nationwide, and at least one colleague from each pharmacy has been trained on CPR. Tips and advice from the Irish Heart Foundation to reduce the risk of

heart disease are available for patients in all LloydsPharmacy pharmacies. On 15 November, LloydsPharmacy will hold a National Heart Health Day in stores nationwide, highlighting the importance of regular blood pressure and BMI check-ups. Together, LloydsPharmacy and the Irish Heart Foundation work to increase heart health awareness and encourage positive, preventative steps to a healthy and active lifestyle. Commenting, Supervising Pharmacist, LloydsPharmacy Tullow Street, Ann-Marie Walsh, said: “Our team drew on specialised training and experience to work quickly, and we’re pleased that the patient is recovering well. We have done a lot in the area of heart health, but must continue to

do more.” continue extensive training. Denis O’Driscoll, Superintendent Pharmacist, LloydsPharmacy, said: “Crucially for us, this incident has highlighted the need for ongoing extensive training in the area of heart health. This requires additional government investment both nationally and locally, as well as a commitment from pharmacies nationwide. “LloydsPharmacy and the Irish Heart Foundation work together with our colleagues to help our customers and patients across the country understand and monitor their heart health and how to look after it.

ACCESS TO BUPRENORPHINE IN OPIOID SUBSTITUTION BEING PHASED IN The Misuse of Drugs Regulations 2017 (SI 522 of 2017) allow for the use of buprenorphine containing products as part of Opioid Substitution Therapy. The Opioid Substitution Treatment Prescription Form has been amended to reflect this change. Access to buprenorphine as part of the Opioid Substitution Treatment programme is being introduced by the HSE on a phased basis. It should be noted that methadone remains the drug of choice in opioid substitution. Pharmacists should be aware that the principles of clinical governance and safe patient care, as set out in the Pharmaceutical Society Ireland Guidance for Pharmacists on the Safe Supply of Methadone, apply equally to the supply of buprenorphine products in Opioid Substitution Therapy. If you are providing this service, it may be useful to review the following sections of the guidance: Section 4: Code of Conduct Section 5: Guidance (including Initiation, Patient Registration, Storage, Counselling and Vaccination) Section 7: Policies and Procedures Pharmacists providing such services should also consult the HSE Clinical Guidelines for Opioid Substitution Treatment, which provide clinical advice in this area. It is also essential that pharmacists be aware of, and engage as needed, with their local addiction services supports, including the relevant addiction services support pharmacist where available.

“This year, LloydsPharmacy has organised four National Blood Pressure Days inviting customers and patients to get their blood pressure checked, a free service available all year round.”

PHARMACYNEWSIRELAND.COM | 5


News news brief UNIQUE SNAPSHOT OF EU HEALTHCARE SYSTEMS FutureProofing Healthcare: The Sustainability Index was launched in Dublin last month, with the aim of starting an EU-wide conversation on the need to act now to futureproof healthcare systems, in order to ensure patients will get the care they need in the coming decades. The Index - which was led by an independent panel of healthcare experts from across the EU, in partnership with Roche – gives a unique snapshot of the current status of the 28 EU healthcare systems, based on the largest data set of its kind. It also includes a separate in-depth analysis of the state of care for breast cancer. Ireland ranked eighth out of 28th in the Sustainability Index with the indicators focused on ‘Resilience’ and ‘Quality’ driving the country’s highest score, while its lowest ranked vital sign was in ‘Health Status’. Ireland is especially strong in training the next generation of healthcare professionals, while Irish people are the most likely to think they are in good health, compared to other EU countries. FutureProofing Healthcare: The Sustainability Index brought together a group of Irish experts to review the data, test the dashboard and discuss solutions. The panel included Former Tánaiste and Minister for Health, Mary Harney; Dr Nina Byrnes, GP; Vincent Barton, Director of Prospectus; Liam Doran, Former General Secretary, Irish Nurses and Midwives Organisation (INMO); Dr Miriam O’Connor, Consultant Oncologist; Dr Stephen Finn, Consultant Pathologist; Donal Buggy, Head of Services and Advocacy, Irish Cancer Society; Pierre-Alain Delley, General Manager, Roche Products (Ireland) Limited.

Dáil debates on pharmacy Community pharmacy in Ireland has been given the spotlight within the Dáil recently under the direct questioning of Fianna Fáil’s spokesperson on Primary Care and Community Health, John Brassil TD. In a question to the Minister for Health, Deputy Brassil asked; when community pharmacists will be provided with a pathway out of FEMPI and when negotiations will commence with the contractors involved. In a Dáil Éireann Debate, he also questioned if, following the successful roll-out of flu vaccines in pharmacies, consideration is being given to the expansion of pharmacy-based vaccination services. ‘The reason the essential pneumococcal vaccine is not yet reimbursed in pharmacies for public patients as the flu vaccine is; the timeframe for a decision in this regard,’ he added. On the issue of FEMPI, the Minister Simon Harris TD has stated that he acknowledges ‘the contribution made by pharmacists and other health professionals who provide services under contract on behalf of the HSE in addressing the unprecedented economic crisis which the State faced over recent

years,’ but added that contractors representative negotiation is to take place.

approach to engagement with contractor representative bodies in this matter.”

“The Public Service Pay and Pensions Act 2017 has put the setting and varying of payments for contractors on a non-emergency statutory basis, which will enable the determination of payments to contractors based on a range of considerations, including affordability and value for money, said Minister Harris.

With regards to expansion of pharmacy-based vaccination services, he revealed that there are a number of areas under consideration.

“My Department intends to consult with contractor representative bodies on putting in place a new multi-annual approach to payments, in return for service improvement and contractual reform and in line with Government priorities for the health service. This approach is also intended to deliver a phased exit pathway from FEMPI for contractors and this will form part of the proposed consultation. “My Department has commenced work to determine the preferred

“The Programme for a Partnership Government has a commitment to expand the role of community pharmacies in managing the health of public patients. Any service expansion should address unmet public health needs, improve access to existing public health services or provide better value for money or patient outcomes if delivered through pharmacies, and such decisions should be evidence based. “Among the areas under consideration is the expansion of pharmacy-provided vaccination for public patients, in order to make such treatment as accessible as possible,” said the Minister.

Boots Ireland Night Walks raises ¤50,000 for the Irish Cancer Society Night Nursing service Boots Ireland and the Irish Cancer Society want to extend a very warm and grateful “thank you!” to everyone who took part in the 2018 Boots Ireland Night Walks. Due to the incredible fundraising efforts of everyone involved, €50,000 was raised. Since the partnership began between Boots and the Irish Cancer Society in 2012, ¤1.4 million has now been raised for the Irish Cancer Society Night Nursing Service, the equivalent of over 4,064 nights of nursing care for families around the country. Now in its sixth year, the Boots Night Walks for Night Nurses is designed to raise both funds and awareness of the critical care provided by the Irish Cancer Society Night Nurses. Over 500 people came together to take part in the two public walks in Dublin and Cork and a further 38 regional walks were organised by Boots colleagues from stores across the country – making 2018 the biggest year yet for participation. The Irish Cancer Society Night Nurses provide in-home care through the night, for cancer patients requiring end of life care, whilst also providing rest and respite for the patient’s families. The service is provided free of charge and is an invaluable support to families and their loved ones during what can be a

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Boots staff taking part in the 2018 Boots Ireland Night Walk particularly difficult and anxious time. The service ensures patients and their loved ones receive nursing care, practical support and reassurance, keeping the patient comfortable and free of pain. Bernadette Lavery, Managing Director, Boots Ireland says: “Boots would like to extend a heartfelt thank you to everyone involved in making the 2018 Night Walks so special, your support really matters.

The Night Nursing service is funded almost entirely by donations, so fundraising initiatives like the Night Walks are vital and make it possible for the Irish Cancer Society to reach people affected by cancer. If you didn’t get the chance to be involved this year, there are lots of other ways you can help the Irish Cancer Society, visit www.cancer. ie to find out more.”


Protect her

IE/ELLA/0053 Date of preparation: October 2018

morning after

NEW ellaOne, the most effective Emergency Hormonal Contraceptive (EHC)1, is changing to a new shield-shaped golden pill and packaging.

shield-shaped pill

Golden shield as a universal symbol of protection and standard of efficacy in EHC Easy to swallow film-coated tablet.2 Visit www.ellaonepharmacists.ie REFERENCES: 1. Glasier A et al. Lancet 2010; 375 (9714): 555-62. 2. HRA data on file: consumer swallowability research 2017

PRODUCT INFORMATION: ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. DOSAGE: one 30mg tablet taken orally as soon as possible, but no later than 120 hours (5 days) after unprotected intercourse or contraceptive failure. Another tablet should be taken if vomiting occurs within 3 hours of intake. Can be taken at any time during the menstrual cycle. Not recommended for women with severe hepatic impairment. CONTRAINDICATIONS: Hypersensitivity to the active substance or excipients. SPECIAL WARNINGS AND PRECAUTIONS: Occasional use only. Use reliable barrier method after use until next menstrual period. If next menstrual period is delayed >7 days or is abnormal or suggestive symptoms occur then perform pregnancy test. Consider ectopic pregnancy. If pregnancy confirmed, woman should contact their doctor. Concomitant use with EC containing levonorgestrel not recommended. Does not contraindicate the continued use of regular hormonal contraception but reliable barrier method should be used until next menstrual period. Not recommended in severe asthma treated by oral corticosteroids. Concomitant use of CYP3A4 inducers [e.g. barbiturates (including primidone and phenobarbital), phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, herbal medicines containing Hypericum perforatum (St. John’s wort), rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine] not recommended (may decrease efficacy of ellaOne). Long term use of ritonavir not recommended. Not recommended for women who have used enzyme-inducing drugs in the past 4 weeks. Non-hormonal emergency contraception (i.e. a copper intrauterine device (Cu-IUD)) should be considered. Contains lactose. FERTILITY, PREGNANCY AND LACTATION: Not intended for use during existing or suspected pregnancy. Limited human data does not suggest safety concern. Does not interrupt existing pregnancy. No teratogenic potential was observed; animal data insufficient with regard to reproduction toxicity. Marketing Authorisation Holder maintains a pregnancy registry (www.hra-pregnancy-registry.com) to monitor outcomes of pregnancy in women exposed to ellaOne®. Patients and health care providers are encouraged to report any exposure. Ulipristal acetate is excreted in human breast milk; breastfeeding is not recommended for one week after intake. Breast milk should be expressed and discarded. A rapid return of fertility is likely following ellaOne use; regular contraception should be continued or initiated as soon as possible; subsequent acts of intercourse should be protected by reliable barrier method until next menstrual period. UNDESIRABLE EFFECTS: Always consult the SmPC before prescribing. Only the most common side effects and those which are rare but may be serious are listed below. Most commonly reported adverse reactions: headache, nausea, abdominal pain and dysmenorrhea. Common (≥1/100 to <1/10): mood disorders, dizziness, vomiting, abdominal discomfort, myalgia, back pain, pelvic pain, breast tenderness and fatigue. Rare (≥1/10,000 to <1/1,000): ruptured ovarian cyst. RETAIL PRICE: ellaOne 30 mg single film-coated tablet blister pack; € 35. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 15, rue Béranger, F-75003 Paris, France. Marketed in Ireland by: HRA Pharma UK & Ireland Limited, Haines House, 21 John Street, Bloomsbury, London, WC1N 2BF MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription. Date of last revision of text: October 2018 Adverse events should be reported. Reporting forms can be found at www.hpra.ie or email: medsafety@hpra.ie. Adverse events should also be reported to HRA Pharma UK & Ireland limited on Freephone: 1800 812 984 or email med.info.ie@hra-pharma.com


PSI Review

Assuring trust in pharmacy through effective regulation Niall Byrne, Chief Officer and Registrar at the Pharmaceutical Society of Ireland (PSI) talks about the PSI's strategic programme and reflections on 2018 registration to confirm that the Pharmacy Assessment System has been completed. A further proposal to reduce the frequency of completion of the Pharmacy Assessment System to once annually will be implemented from January 2019.

Niall Byrne, Chief Officer and Registrar, Pharmaceutical Society of Ireland

“2018 was a busy year for the PSI, as we began to implement our new three-year Corporate Strategy.

our forthcoming work on developing Governance and Accountability Standards for Retail Pharmacy Businesses.

“Building on the work undertaken in recent years to apply the provisions of the Pharmacy Act 2007, our Strategy sets a clear direction for change and further development over the coming three years and is centred on the core objective of assuring public trust in pharmacy through effective regulation.

“The development of these Standards will be progressed in 2019, and will involve a new approach from that underpinning the guidelines we have issued to date. These Standards will assist Superintendent Pharmacists in their role, particularly as regards the safe and effective management of pharmacies. They will also help inform the public as to the standard of safe care and professionalism which they can expect to receive from a registered pharmacy.

“Last spring we hosted a series of seminars across the country to explore with Superintendent Pharmacists how collaboration around the public interest objectives in the Strategy could be advanced in association with pharmacists. These seminars gave us the opportunity to share our intentions and strategic direction for the three years from 2018, and to discuss the key regulatory role of Superintendent Pharmacists. “Many other areas of mutual interest were also discussed and the views and feedback that we gathered will inform

“The PSI committed to reviewing the Pharmacy Assessment System in 2018. Our very positive engagement with pharmacists to date demonstrates a clear, and very welcome commitment to using this system to help ensure patient safety and ongoing quality of care. The recommendations from this review included a policy proposal that all pharmacies would provide the PSI with an annual declaration at continued

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“The PSI continues to carry out public consultations to ensure that our work is informed by, and takes account of, stakeholder views. Research and feedback received through public consultation, for example, were important components in our revision of the current Code of Conduct for Pharmacists during 2018. The review will ensure the Code continues to reflect the changing healthcare environment and the evolving role of pharmacists within the wider health service. The Code is a public declaration of the principles and ethical standards which govern pharmacists in the practice of their profession and which the public, patients, other healthcare professionals and society require and expect from pharmacists as frontline health professionals. The updated Code of Conduct will take effect from early in 2019. We are planning a range of events across the year where we will engage with the profession about updates to the Code. “As the pharmacy regulator, our governance arrangements must be effective. During the year, we reviewed our advisory committee structures to ensure they support the work of the Council in an efficient way. As a result, from December 2018, we will have a smaller number of new committees to support and oversee our progress on key strategic and policy areas. “In 2018, in common with many pharmacies and industry settings, the PSI became an accredited training establishment for Ireland’s Schools of Pharmacy. As part of our commitment to supporting pharmacy students in their journey to practice, we welcomed two students in September 2018 for their 4-month placement, as part of their experiential learning on the MPharm programme. “As we head into the new year the precise implications of Brexit

for Ireland are still uncertain. Nonetheless, we are very aware of the many challenges and uncertainties involved for pharmacy. During 2018, we engaged with our counterpart regulators in the UK and Northern Ireland on the matters of registration and recognition of qualifications for pharmacists. All three bodies are agreed on a commitment to patient and public protection, through the assurance of access to appropriately trained and competent health professionals who hold qualifications recognised for that purpose, and are registered in accordance with the applicable regulatory controls. Brexit will continue to be a significant issue for the PSI Council in 2019. “During 2019, we also plan to work with our educational partners and other healthcare regulators to promote the concept of inter-professional learning and to ensure that the PSI’s Core Competency Framework remains relevant to the expanding role of pharmacy. “We will also be examining how we can develop useful themed reviews of key services provided by pharmacies and we will publish overview reports on the results of these reviews. This will help to demonstrate and provide assurance to the public of the standard in pharmacy services. We hope that this will further underpin public trust in pharmacy services. We will also develop an integrated approach to how we gather, collate, assess and use all forms of risk information to help ensure that we focus our compliance resources on those pharmacy services which may represent risk to the public. “As Registrar, I look forward to further positive engagement and discussions with individual pharmacists and with the representatives of the pharmacy sector during 2019. I believe the PSI and the pharmacy sector share a common commitment to public safety and quality within pharmacy services, and I am very happy to work with all concerned to advance this important agenda in 2019.”


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IPHA Review

Closing the innovation and success gap Oliver O’Connor, Chief Executive of the Irish Pharmaceutical Healthcare Association (IPHA) says Ireland is ‘punching above its weight’ in the manufacture of medicines and discusses solutions in their Manifesto. manufacture of medicines. It is in many ways quite astonishing that a country of only 4.5 million people on the periphery of Europe is the fifth largest exporter of medicines in the world. All the top 10 global players have operations here, with almost 30,000 people employed and accounting for over ¤50 billion in exports. Some of the biggest selling and ground-breaking medicines are made in Ireland. IPHA Chief Executive, Oliver O'Connor

Brexit “As we write, great uncertainty still surrounds the outcome of Brexit and in particular, the exact nature of the UK’s exit from the EU. The possible impact of a so-called ‘hard Brexit’ is being debated across multiple sectors and there appears to be a consensus that the impact could be very negative. “These concerns are very real for the pharmaceutical industry, especially regarding possible risks to the supply of medicines. “The pharmaceutical industry has a major stake in the lives, livelihoods and lifestyles of people across the country. The medicines we make, jobs we provide and standards of living we enhance help improve Ireland’s society and economy. Our industry, just like many others, wants to help ensure that, after Brexit, Ireland functions as normal, with any risks to the supply of medicines mitigated by proper planning. “The industry has been working in the background with relevant public health stakeholders on appropriate Brexit preparedness. The main challenge for the industry is a regulatory one, rather than a trade one. Companies have been contingency-planning for well over a year, with the main consideration around supply

chains. Companies have been examining how supply chains might be reorganised when the UK is treated as a non-EU country. The ideal outcome for us would be a UK that stays hand in hand with the EU on medicines regulation. “In the IPHA’s case, we have engaged with key State authorities - the HSE, HPRA, the Revenue Commissioners (in respect of Customs) and the Department of Health - on planning for the management of medicines availability. Our shared goal is continuity of medicines supply for patients in Ireland, whatever the outcome of the Brexit talks. “Preparedness is critical. Every month, 45 million patient packs of medicine are supplied from the UK to the EU27, and 37 million patient packs are supplied from the EU27 to the UK. That’s one billion medicines packs per year. It’s one measure of the importance of medicines for human health, facilitated by regulatory alignment and free trade. Whatever the outcome of Brexit, it is critical that Irish patients, as well as patients across Europe, can continue to access their medicines without disruption.” Doing innovation better “Ireland punches well above its weight when it comes to the

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“Despite this positive manufacturing environment, there are areas in which we experience the worst delays for accessing medicines in Europe. This is not a pricing issue, despite what is often publicly articulated. We recognise the challenges of medicines affordability. We have tried to do our part on responsible medicines pricing. Our prices are limited to an average of the prices in 14 EU countries. Since July 2016, there have been three rounds of price cuts for thousands of medicines. By the end of 2020, when our formal supply agreement with the Government expires, ¤785 million in overall savings are expected to have been delivered to the State. “We are anxious to come forward with solutions which we have through our ‘Manifesto for Better Health’, published in October. This sets out how we can make real inroads into closing the gap between innovation and access. Our proposals include: 1. Boost funding. Create a predictable, multi-annual budgetary framework, with sustained, reasonable annual increases in funding for innovative medicines. This needs to be explored with payers based on ‘horizon scanning’ for new medicines on the way, as well as projected demand for existing treatments.

2. Speed access. Place Ireland in the top quartile of European countries for access to innovative medicines. This would rank Ireland in the top seven of the EU-28 and in the top half of the ‘basket of 14’ used for pricing in our deal with the Government. 3. Fuel innovation. The Government, with the support of the Taoiseach, should publicly recognise the value of the pharmaceutical industry to Ireland, with concrete actions that can be pursued jointly by a formal partnership between policymakers and industry leaders. This happens in other European countries and regions. “We are anxious to work with Government and play our part in delivering standards of care to patients that are among the best in Europe. We have identified some solutions and hope that in the year ahead, the longpromised industry-Government dialogue on innovative medicines commences. “We will also continue to diligently prepare for any negative impact Brexit might have on the supply of medicines to patients in Ireland. Our companies, in cooperation with stakeholders, are working to ensure that any possible threat to supply is minimised.”

The pharmaceutical industry has a major stake in the lives, livelihoods and lifestyles of people across the country


DIFFERENT FROM CLASSICAL OPIOIDS*

PALEXIA® SR Tablets are indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics1 PALEXIA® Film Coated Tablets are indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics2

*Palexia has a unique mode of action. Palexia MOR-NRI.3

PALEXIA® and PALEXIA SR® Prescribing Information Refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: Palexia: 50 mg (white), 75 mg (pale yellow) and 100 mg (pale pink) film-coated tablets contain 50 mg, 75 mg and 100 mg of tapentadol (as hydrochloride) respectively. Palexia SR: 50 mg (white), 100 mg (pale yellow), 150 mg (pale pink), 200 mg (pale orange) and 250 mg (brownish red) prolonged-release tablets contain 50 mg, 100 mg, 150 mg, 200 mg and 250 mg of tapentadol (as hydrochloride) respectively. Indication: Palexia is indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics. Palexia SR is indicated for the management of severe chronic pain in adults, which can be adequately managed only with opioid analgesics. Dosage and method of administration: Individualise according to severity of pain, the previous treatment experience and the ability to monitor the patient. Swallowed whole with sufficient liquid, with or without food. Palexia SR: should not be divided or chewed. The tablet shell may not be completely digested and eliminated / seen in the patient’s stool which has no clinical significance as the active substance will have already been absorbed. Palexia dosage: Initial dose 50 mg every 4 to 6 hours. On the first day of dosing, an additional dose may be taken 1 hour after the initial dose, if no pain control. The first day’s dose should not exceed 700 mg. Maximum maintenance daily dose of up to 600 mg. Palexia SR dosage: Initial dose 50 mg twice a day. Switching from other opioids may require higher initial doses. Titrate in increments of 50 mg twice a day every 3 days for adequate pain control. Total daily doses greater than 500 mg not recommended. Duration of treatment: Palexia: The possibility of switching to Palexia SR should be considered if longer term treatment is required, and pain relief is achieved with Palexia in the absence of intolerable adverse events. Discontinuation of treatment: Taper dose gradually to prevent withdrawal symptoms. Renal/hepatic impairment: Not recommended in patients with severe cases. Caution and dose adjustments with moderate hepatic impairment. Elderly: May need dose adjustments. Children below 18 years: Not recommended. Contraindications: Hypersensitivity to ingredients, suspected or having paralytic ileus, acute intoxication with alcohol, hypnotics, centrally acting analgesics or psychotropics. Not for use when mu-opioid receptor agonists are contraindicated (e.g. significant respiratory depression, acute or severe bronchial asthma or hypercapnia). Special warnings and precautions: Abuse and addiction potential of Palexia should be considered where there is increased risk of misuse, abuse, addiction or diversion. All patients should be carefully monitored for signs of abuse and addiction. At high doses or in mu-opioid receptor agonist sensitive patients, dose-related respiratory depression may occur. Caution and monitoring required with impaired respiratory function. Should not use in patients susceptible to intracranial effects of carbon dioxide retention (e.g. increased intracranial pressure, impaired consciousness or coma). Use with caution with head injury, brain tumors, moderate hepatic impairment, biliary tract disease including acute pancreatitis. Not recommended if history of or at risk of seizures or with severe renal or hepatic impairment. Care should be taken when combining with mixed mu-opioid agonists/antagonists (e.g. pentazocine, nalbuphine) or partial mu-opioid agonists (e.g. buprenorphine). Should not use with hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Use with benzodiazepines, barbiturates and opioid analgesics, antitussive drugs and substitutive treatments may enhance the risk of respiratory depression. Central nervous system (CNS) depressants (e.g. benzodiazepines, antipsychotics, H1-antihistamines, opioids, alcohol) can enhance the sedative effect and impair vigilance. Consider dose reduction with respiratory or CNS depressant agents. In isolated cases, there have been reports of serotonin syndrome in a temporal connection with the therapeutic use of tapentadol in combination with serotoninergic medicinal products (e.g. serotonin re-uptake inhibitors). Use with strong inhibitors of uridine diphosphate transferase isoenzymes (involved in glucuronidation) may increase systemic exposure of Palexia/Palexia SR. Caution if concomitant administration of strong enzyme inducing drugs (e.g. rifampicin, phenobarbital, St John’s Wort) starts or stops as this may lead to decreased efficacy or risk for adverse events, respectively. Avoid use in patients who have taken monoamine oxidase inhibitors (MAOIs) within the last 14 days, due to cardiovascular events. Pregnancy and lactation: Use in pregnancy only if the potential benefit justifies the potential risk to the foetus. Not recommended during and immediately before labour and delivery. Do not use during breast feeding. Driving and using machines: May have major effect on ability to drive and use machines, especially at the beginning or change in dosage, in connection with alcohol or tranquilisers. Undesirable effects: Very common (≥1/10): dizziness, somnolence, headache, nausea. Palexia only: vomiting. Palexia SR only: constipation. Common (≥1/100, <1/10): decreased appetite, anxiety, sleep disorder, tremor, flushing, diarrhoea, dyspepsia, pruritus, hyperhidrosis, rash, asthenia, fatigue, feeling of body temperature change. Palexia only: confusional state, hallucination, dry mouth, muscle spasms, constipation, abnormal dreams. Palexia SR only: depressed mood, nervousness, restlessness, disturbance in attention, involuntary muscle contractions, dyspnoea, vomiting, mucosal dryness, oedema. Other important undesirable effects observed in clinical trials and/or postmarketing: convulsion, impaired gastric emptying (rare ≥1/10,000, <1/1000). Palexia only: respiratory depression (uncommon ≥1/1000, <1/100), drug hypersensitivity including angioedema, anaphylaxis and anaphylactic shock, depressed level of consciousness, (rare ≥1/10,000, <1/1000). Palexia SR only: drug hypersensitivity, depressed level of consciousness, mental impairment (uncommon ≥1/1000, <1/100), respiratory depression, angioedema, anaphylaxis and anaphylactic shock (rare ≥1/10,000, <1/1000). No evidence of increased risk of suicidal ideation or suicide with Palexia/Palexia SR. Additional information is available on request. Overdose: Seek specialist treatment (see SmPC). Legal classification: POM, CD (Schedule II). Marketing Authorisation numbers and pack sizes: Palexia: 50 mg: PA 2242/12/1, 28 and 56 packs; 75 mg: PA 2242/12/2, 28 and 56 packs; 100 mg: PA 2242/12/3, 28 packs. Palexia SR: 50 mg: PA 2242/12/4, 28 and 56 packs; 100 mg: PA 2242/12/5, 56 pack; 150 mg: PA 2242/12/6, 56 pack; 200 mg: PA 2242/12/7, 56 pack and 250 mg: PA 2242/12/8, 56 pack. Marketing Authorisation Holder: Grünenthal Pharma Ltd, 4045 Kingswood Road, Citywest Business Park, Citywest, Co. Dublin, Ireland. IRE/P18 0017. Date of Preparation: May 2018. Reference: 1. Palexia SR Summary of Product Characteristics. 2. Palexia Film Coated Tablets Summary of Product Characteristics. 3. Kress, et al. European Journal of Pain, 2010. Date of Preparation: July 2018. IRE/P18 0027


HPRA Review Challenges and opportunities for the HPRA in 2019 Dr Lorraine Nolan, Chief Executive with the Healthcare Products Regulatory Authority reflects on a year of focus and flexibility with a nod to the uncertain forecast for 2019. ensued can help to reduce the use of these illegal medicines into the future.

Dr Lorraine Nolan, Chief Executive, HPRA “2018 has been another significant year for the HPRA. The key themes for the past year have been enhancing the flexibility and approach of the organisation to better respond to changes in our external environment, now and into the future. Through this we are ensuring an ability to better serve public and animal health. In line with these areas of focus, the organisation has prioritised the development of meaningful engagement with patients and patient advocates, supporting our stakeholders in preparation for Brexit, concentrating on medicines availability and harnessing and developing organisational talent and most importantly their wellbeing. “A key area of focus for the organisation in 2018 has been our Brexit preparedness planning. An internal working group, established in 2017, under the direction of Deputy Chief Executive Rita Purcell, has been working on HPRA scenarioplanning and the potential approach to post-Brexit medicines regulation. This has included the publication of an up-to-date Brexit guidance document and representation at relevant national, European and international fora. The HPRA remains committed to supporting all stakeholders in managing the regulatory and operational implications arising from Brexit, with the ultimate goal of ensuring continued access to medicines in Ireland so as to protect public and animal health. “Central to ensuring access to medicines, and an issue that has become even more pertinent in light of Brexit, the HPRA is responsible for co-ordinating the

management medicines shortages on the Irish market. A significant project has been undertaken this year with the HPRA working with a variety of stakeholders including manufacturers, wholesale distributors, marketing authorisation holders, healthcare professionals, the Health Service Executive, patients and representative groups. This collaboration with stakeholders has resulted in the publication of a framework for a multistakeholder approach to the handling shortages of human medicinal products. The aim of the framework is to help prevent shortages from occurring where possible but also to reduce the impact on patients by co-ordinating the management of potential or actual shortages as they arise. Work in this area will continue into 2019, with the project focusing on reviewing the measures to date and exploring further preventative measures to mitigate against product shortages. “In October, the launch of our public information campaign,” Zero Gains”, sparked nationwide conversation around the serious dangers of anabolic steroid misuse in Ireland and how this situation is changing. This was a new type of awareness campaign for the HPRA which targeted potential users through social, digital and outdoor advertising. The Minister for Health, Simon Harris, joined me for the launch of the campaign to highlight the serious consequences that can arise from anabolic steroid abuse. While it is too early to say, we hope both the campaign itself, which we will repeat in 2019, and the significant media focus on this topic that

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“Staying with the theme of sharing information with our stakeholders, this past year saw the first cohort of patients and patient advocates graduate from the IPPOSI Patient Education Programme. The programme has been designed to enable and empower patients to work effectively with Irish and EU-level health research and technology partners, health agencies and authorities. As an education partner, the HPRA hosted and delivered training to participants to support their knowledge and awareness of medicines regulation. We are delighted to support the programme again in 2019. “Within the organisation, we have seen some change, with the recruitment of a new Director of Human Products Authorisation and Registration, Gráinne Power and the appointment of Dr Niall MacAleenan as our Deputy Director of Medical Devices. With these new members of our senior management team, and indeed a number of appointments across all levels, the organisation continues to adapt and evolve while maintaining a clear focus on the delivery of our strategic goals. Personally, I have been appointed as a member of the Heads of Medicines Agencies management group, a role that I anticipate will further raise the profile of our agency and HPRA priorities in Europe. “Further evidence of our commitment to continuously develop and enhance our organisation, with a particular focus on our key resource, our employees, came in August with the award of the KeepWellMark. We were very proud to be the first public sector organisation to receive this external accreditation that recognises workplace wellbeing and we are committed to continuing our focus on health and wellness initiatives into coming year and beyond. “Responding to the external environment also includes monitoring how issues are evolving internationally. Key areas which the HPRA has focused on in this context include supporting the European Medicines Agency and the International Coalition of Medicines Regulatory Authorities, in leading projects

on regulatory preparedness for innovation. We are also very proud of our involvement in the 18th International Conference of Drug Regulatory Authorities conference. Colleagues from across the organisation came together in September to represent the HPRA as we co-ordinated and co-hosted the conference in Dublin, in collaboration with the WHO. The theme “Smart Safety Surveillance - a lifecycle approach to promoting safety of medicinal products” generated significant discussion and engagement, and challenged regulators, policy makers and other international stakeholders to consider ways to strengthen global collaboration in the area of medicines’ regulation. The conference also presented the WHO and regulators with an opportunity to enhance their efforts to harmonise processes to improve the quality, safety and efficacy of medicines. It is clear that timely access to safe and effective medicines is one of the key cornerstones of healthcare systems and ICDRA presented us with the opportunity to support the WHO in its efforts to enhance healthcare and medicines’ regulation globally, particularly in low and middle-income countries. “There is no doubt that 2019 brings an element of uncertainty, with Brexit negotiations ongoing and the relocation of the European Medicines Agency to the Netherlands. Nonetheless, the various health product regulatory networks in which we participate must continue to prioritise public health protection for all European patients. The HPRA has been steadfast in highlighting to all stakeholders that the Irish market is unique and that as a result there are vulnerabilities around the supply of medicines to Irish patients. However, through regular engagement with the Minister and Department of Health officials, we are promoting our position and working ceaselessly to ensure our message is penetrating the wider European system. “Personally, I feel that with challenges, come opportunities. The HPRA has been active for some time in seizing those opportunities and will continue to do so. This is an exciting time for the agency and we will continue to adapt and evolve as we always have to deliver on our public health remit.”


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DIORALYTE® NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION PRODUCT INFORMATION Presentation: Sachet containing the active ingredients sodium chloride 0.47g, potassium chloride 0.30g, glucose 3.56g and disodium hydrogen citrate 0.53g. Indications: Oral correction of fluid and electrolyte loss and the management of watery diarrhoea in infants, children and adults. Dosage and administration: Each sachet should be reconstituted in 200ml (approximately 7 fluid ounces) of fresh drinking water. For infants where fresh drinking water is unavailable the water should be freshly boiled and cooled. The solution should be made up immediately before use. If refrigerated, the solution may be stored for up to 24 hours, otherwise any solution remaining an hour after reconstitution should be discarded. The solution must not be boiled after reconstitution. Daily intake may be based on a volume of 150ml/kg body weight for infants up to the age of 24 months and 20-40 ml/kg body weight for adults and children. A reasonable approximation is: Infants under 24 months – Use only under medical advice. One to one and a half times the usual 24 hour feed volume. Children over 24 months – One sachet after every loose motion. Adults (including elderly) – One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Warnings and precautions: Dioralyte should not be used for treatment in infants below the age of 24 months without medical supervision. Dioralyte should not be used for self-treatment by patients with: chronic or persistent diarrhoea, liver or kidney disease, diabetes, on low potassium or sodium diets, intestinal obstruction. The use of Dioralyte in

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patients with these conditions should be supervised by a doctor. The solution must not be reconstituted except with water at the volume stated. A weaker solution than recommended will not contain the optimal glucose and electrolyte concentration and a stronger solution than recommended may give rise to electrolyte imbalance. If there is no improvement within 24-36 hours, consult the physician. If nausea and vomiting are present with the diarrhoea, small but frequent amounts of dioralyte should be drunk at first. No specific precautions are necessary in the elderly. However, caution is required in cases of severe renal or hepatic impairment or other conditions where the normal electrolyte balance may be disturbed. Pregnancy and lactation: Medical supervision is recommended for use during pregnancy and lactation. Interactions and side effects: None stated. Pack sizes: 6 and 20 sachets. Legal category: P. Product authorisation number: PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural). Product authorisation holder: Sanofi, Citywest Business Campus, Dublin 24, Ireland. Tel 01403 5600, email: IEmedinfo@sanofi.com. For further information please see Summary of Product Characteristics. Date of revision: August 2018. Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Sanofi on 01403 5600 or email IEPharmacovigilance@Sanofi.com Date of Preparation: September 2018 SAIE.DIO.17.01.0010c(1)


eHealth Ireland Review

‘Banking’ on eHealth for 2019 2018 has witnessed many changes and opportunities within eHealth Ireland’s agenda, commencing with the appointment of a successor to the role previously occupied by Richard Corbridge. work at the Innovation Value Institute to mention but a few. Generating Support

Professor Martin Curley, Chief Information Officer of the Health Service Executive

In March, Professor Martin Curley took over Corbridge’s position as Chief Information Officer of the Health Service Executive. “I am looking forward to the next phase of digital transformation within the HSE and working with all the staff in the Office of the CIO,” reflects Professor Curley, a proven thought leader in the application of data to provide innovative solutions. Professor Curley is an executive with a track record of building high-performance innovation teams and consistently delivering a strong pipeline of compelling innovations and transformations. He has strong experience in public affairs and communications with a deep history of working closely with the European Commission and National Governments. His achievements in his career to date are many, including transformation of Intel’s IT organisation into a world class IT capability; leading the startup of Mastercard Advisors Digital Capability; establishing and growing a global network of 15 Intel IT Innovation centres; Transforming Intel’s research reputation in Europe while creating trusted advisor relationships at Commissioner/ DG level in EU; Founded and created a consulting practice on IT/Digital capability and value management based on his PhD

Following on from his appointment, it was announced at the end of 2018 that the European Investment Bank have agreed to provide ¤225 million to support the roll-out of Ireland’s transformational eHealth programme. The new nationwide electronic health and information programme is expected to improve delivery of health services for the entire population of Ireland over the next decade. The 20 year European Investment Bank loan was signed in Dublin by Andrew McDowell, European Investment Bank Vice President and Conor O'Kelly, Chief Executive of the National Treasury Management Agency (NTMA). Minister for Health Simon Harris TD said of the deal, "The significant support from the European Investment Bank confirmed today marks a key step in delivering the benefits of eHealth for the people of this country and creating a modern patient-centred health service. I would also like to acknowledge the important role played by the NTMA in facilitating this loan. The roll-out of eHealth, which was a key recommendation of Sláintecare, will enable the reconfiguration of services across Acute, Community and Primary Care sectors and will provide the opportunity to deliver a more integrated service to patients, irrespective of where the patient may be.” Professor Curley notes, “We welcome the significant support announced by the EIB to support the roll-out of Ireland’s transformational eHealth programme. Ireland has embraced digital technology with confidence and we are starting to experience the benefits it can deliver for the health and well-being of each and every one of us.

14 | PHARMACYNEWSIRELAND.COM

Director General of the HSE John Connaghan, European Investment Bank Vice President Andrew McDowell and Minister of Health Simon Harris

‘‘The Sláintecare report calls for the continued strong support of the eHealth strategy – particularly ensuring the necessary funding for the timely rollout of the Electronic Health Record (EHR) system. EHR is a comprehensive solution that supports the creation and sharing of key patient information. It is a core capability required for the future delivery of healthcare. It will move us from a position where patient records and key information is locked in a paper format and within specific organisations, to an environment where digital patient records are shared securely across care settings with appropriate consent. “E-health is helping healthcare professionals save time and save lives. It’s also enabling patients, and the people who use our services, to experience better care. Our vision is to create a patient-centered, digitally integrated healthcare system and as we move towards this we are starting to see more and more benefits. The investment announced today will play a significant part in delivering this vision.” Empowering patients “Innovation and use of new technology empowers patients,

improves health and makes better use of limited resources. This is the first eHealth project ever supported by the European Investment Bank and we are pleased to provide EUR 225 million, a very significant contribution towards the overall cost, to support Ireland’s eHealth programme. This new engagement demonstrates the EIB’s firm commitment to supporting long-term health investment in Ireland. This follows recent support for health investment at the National Children’s Hospital, Primary Care Centres, the Royal College of Surgeons, Irish universities and medical research by world class Irish companies.” said Andrew McDowell, European Investment Bank Vice President. Digitalisation of the Irish health sector will include introduction of Individual Health Identifier numbers for every patient in the country, establishment of an Electronic Health Record system for acute and community care and development of a National Shared Record system accessible by all health care providers. The eHealth programme will be implemented by the Department of Health, the Health Service Executive (HSE) and eHealth Ireland. The NTMA is responsible for borrowing on behalf of the Irish Government and this is the ninth EIB loan to the NTMA since 2012.


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IPU Review A busy year with missed opportunities Calls for an expanded role for community pharmacy amidst a worsening healthcare crisis feature in Irish pharmacy Union’s 2018. Campaigning for what public needs have reflected, the IPU says the Government is missing vital opportunities to provide a better healthcare service, by ignoring potential services pharmacies could offer. Speaking in response to the publication of the Sláintecare Implementation Strategy, Mr Connolly said, “Sláintecare provides many useful proposals, particularly on treating patients locally. However, this Implementation Strategy makes only one passing reference to pharmacies and it does not provide any blueprint for future primary care services in Ireland. This is a missed opportunity. Darragh O'Loughlin, IPU Secretary During the last twelve months, the Irish Pharmacy Union (IPU) has been focused on promoting a concentrated effort to expand the role of community pharmacies to better patient outcomes.

here in Ireland in 2016 but for some unknown reason, it has not been implemented yet, even though 4 out of 5 members of the public have said they would welcome such an initiative.

The IPU also welcomed the ¤10 fall in the Drugs Payment Scheme (DPS) threshold to ¤124 from ¤134, but expressed disappointment that a more meaningful reduction was not announced.

Representing over 2,200 pharmacists across the country, the association recently reiterated calls for the introduction of a Minor Ailment Scheme in pharmacies. In January of this year the IPU stated that such a scheme was necessary immediately, which would allow Medical Card patients to access treatments for common illnesses directly from their pharmacist without having to attend their GP to obtain a prescription. This would alleviate pressure on overworked GPs, who could then see more seriously ill patients who may otherwise find themselves in hospital emergency departments, says the IPU.

The Scheme was not announced in the latest Budget 2019. “The failure to introduce a nationwide Minor Ailments Scheme is a missed opportunity for the tax payer, the health system and most of all the patient,” continues Mr O’Loughlin.

Daragh Connolly, President of the IPU, says, “While a prescription charge of ¤1.50 may seem insignificant, it is important to remember this is a charge on the healthcare of the vulnerable in our society. Today’s Budget, has clearly demonstrated our economy has recovered to a point where we don’t need such blunt and unfair taxes.”

IPU Secretary General Darragh O’Loughlin,says “Community Pharmacists can play a greater role in patient care, particularly at times such as now when the rest of the healthcare system is under extreme pressure. A Minor Ailment Scheme could divert patients away from busy GP surgeries when their ailment is one that can be treated by a pharmacist, allowing GPs more time for treating patients with more complex illnesses.” Similar schemes already operate very successfully in other jurisdictions including the UK. The IPU, together with the HSE, successfully piloted the service

“This would involve enabling medical card patients to receive treatment for common illnesses, free of charge, directly from their local community pharmacy in a timely manner and without the need to pay for a visit to the GP. The introduction of a pharmacybased Minor Ailment Scheme would save nearly 950,000 GP consultations every year, ensuring that this investment would serve patients with more complex cases. The IPU has already piloted this scheme with the HSE but has received no indication on when it will be rolled out.” In other developments, the IPU welcomed the decision to reduce the prescription levy to ¤1.50 per item for the over 70s, but continued their calls for it to be removed in its entirety especially for those in vulnerable patient groups, such as homeless people, those in residential care settings, patients with intellectual disabilities and palliative care patients.

16 | PHARMACYNEWSIRELAND.COM

The damaging health impact of this levy on many vulnerable patients was highlighted in the findings of a national Behaviour & Attitudes Survey carried out in April. According to Mr Connolly this found, “that one in six Medical Card holders would ‘think twice’ about taking their prescribed medicines because of the cost of this levy. The number one priority for any patient, particularly those with long term conditions, must be on getting better. However, the continuation of this levy will ensure that unfortunately many will have to focus on finance instead.” Mr Connolly also said that while “the ¤10 reduction in the DPS threshold is welcome, it is clearly not enough to have a significant impact on hard pressed families. The Government should set out a roadmap to significantly reduce this threshold to a more bearable level over the next number of Budgets.”

”50% of the Irish population live within 1km of their local pharmacy, and community pharmacists are in a unique position to expand their role as healthcare providers for the benefit of both patients and the State. Ireland is currently lagging far behind countries such as Canada and the UK, where community pharmacies are providing an increased range of services. These services include pharmacy-based Minor Ailment Schemes, New Medicine Services, management of chronic diseases, improved access to contraception and a wide range of vaccination services without the need for a doctor’s prescription. “The experience in these countries has shown that involving pharmacies in this kind of healthcare has delivered significant benefits to both patients and the State, taking pressure off other parts of the healthcare system, including GPs and hospitals, and leading to better health outcomes.” According to Mr. Connolly patients are strongly in favour of expanding the role of the pharmacist citing recent research conducted by Behaviour & Attitudes which has shown that 92% would like pharmacists to be able to prescribe some medications for minor ailments. Furthermore, nearly two-thirds of respondents (62%) said they “sometimes rely on a pharmacist’s advice rather than visiting the GP”, while 61% said they “think twice before going to the GP now due to the expense.


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3.6 Community reflects Health, Survey shows 2.5 3.23.2 3.33.3 3.0 3.0 4.8 4.8 5.7 5.7 6.4 3.6 2.5 6.4 THOSE WITH A THOSE WITH GPAVISIT CARD GP VISIT CARD

15-24 25-34 35-44 45-54 55-64 65-74 75+ THOSE WITH Survey, published last month, 15-24 35-44 55-64year olds65-74 What community live in,oldsreflects their Ireland year olds 25-34 year oldspeople year olds45-54 year year health, olds75+ year the olds annual Healthy THOSE WITH 2.4 NEITHER CARD year olds year olds year olds year olds year olds year olds year olds 2.4 NEITHER CARD has shown.

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74% have visited a GP in the past 12 months with an average of 3.8 visits per person among all aged 15 and older. This average includes * Due to changes in survey * Due to changes inmeasuremant, survey measuremant, this figure not directly comparable to those who have not visited a GP. thisisfigure is not directly comparable to previous waves previous waves Women (79%) are more likely to have visited a GP than men (68%) whilst older age groups are more ........................................................................................................................................................................................................................................................ consume at least one each week. The prevalence of smoking in smokers as a good motivation to ........................................................................................................................................................................................................................................................ likely to have visited a GP than (Admitted as has an in-patient in the last 12 months) This compares with 9% of people Ireland dropped from 23% quit. In the last 12 months 40% (Admitted as an in-patient in the last 12 months) those who are younger (94% of who never consume such foods, in 2015 to 20% in 2018 which of smokers have made an attempt those aged 75 and older; 64% of or consume them less than once means there are now an estimated By to quit.Type Hospital those aged 15 to 24) By Hospital Type a week 80,000 fewer smokers than there Further statistics show that of were three years ago. These Minister Byrne adds, “Successive all those who have smoked in Those aged 75 years and older are were just some of the results survey findings clearly show the the past 12 months, 9% have more likely (38%) than those aged highlighted in the Survey, funded problems we have with alcohol total and hospital successfully quitpublic duringhospital this time; under 25 (32%) private to consume at by the Department of Health public private hospitaland that we drink too much 40% of current smokers havehospital least one type of unhealthy conducted by Ipsos MRBI.total alcohol. It is absolutely critical made an attempt to quit in the food daily that we change the place that past 12 months; 12% of current Minister of State for Health alcohol has in our lives and in our 36% of people in more smokers who attempted to quit Promotion, Catherine Byrne TD society. I am therefore delighted disadvantaged areas consume at in the past 12 months stopped launched the Survey and says that the Public Health Alcohol Bill least one or more unhealthy foods smoking for at least 6 months. there are some positive and has now been enacted. This a day. This compares with 32% of 24% re-commenced smoking encouraging results, but added ground-breaking legislation should people in more affluent areas no room within one week of quitting, 17-052952 -there HI Report is 16 October.pdf 25 for complacency. 17/10/2018 12:01:12 serve to ultimately reduce the harm and 8% of current smokers are 17-052952 - HI Report 16 October.pdf 25 17/10/2018 12:01:12 causes.” alcohol When it comes to Self-Reported A new focus in the 2018 survey is currently trying to quit, and 57% Health, 85% perceive their health on the key health issues and the are at least thinking about quitting This is the fourth summary of to be very good or good. 3% differences between more affluent (See page 25 for our feature on the findings from the survey and perceive it to be very bad or bad. and more deprived areas; in Smoking Cessation.) adds to the data collected in the The gender gap in self-reported deprived areas 26% smoke, 43% good health is largest among those previous surveys published in Alcohol consumption figures for binge drink, and 33% have long 2015, 2016 and 2017. aged 55 to 64. 81% of women 2018 show that a worrying 37% standing illnesses compared those in this age group perceive their of the population binge drink, i.e., in more affluent areas where 16% The survey of over 7,500 health to be good or very good, consume six or more standard smoke, 33% binge drink, and 24% people aged 15 and over living compared with 73% of men. units in one drinking occasion. have long standing illnesses. in Ireland gives an up-to-date picture of the health of the nation Overall, 75% of people in Ireland Self-reported good health is higher Minister Byrne says, “It is very have consumed alcohol in the among those who are working than and reports on many lifestyle obvious that some groups in our behaviours such as smoking, past 12 months. Those aged among those who are unemployed society still have a greater risk of alcohol consumption, diet, oral between 25 and 44 are most likely (93% and 78% respectively). It poor health. We need to find better health and health services. to drink alcohol whilst 84% of 25 is also higher among those living ways of reaching out to these in more affluent areas than those to 34 olds and 82% of 35 to 44 people and helping them to live The data from Healthy Ireland living in more deprived areas (90% year olds are drinkers. healthier lives. I have confidence Surveys are being used to and 79% respectively). that the continued development underpin policy development Drinkers from more disadvantaged of Healthy Ireland’s work in and implementation to monitor, areas are more likely (43%) to Prevalence of certain health strengthening cross government measure and evaluate progress in binge drink on a typical drinking conditions support and cross community implementing various elements of occasion than those from more partnerships will translate into the Healthy Ireland Framework as affluent areas (33%). 29% of people reported that everyone feeling that they have they currently have a long-standing well as to meet many international the same supports and chances in reporting obligations, including to Of the 5 unhealthy food types illness or health condition that whatever communities they live.” the OECD, the EU and the WHO. measured in the survey (sweets, will last for 6 months or more. 56% of those reporting a Smoking & Alcohol Consumption cakes and biscuits, salted snacks, pastries and takeaways), 34% of long-standing illness or health people consume at least one of condition perceive their health to New plain packaging with health be good or very good. them daily and 91% of people warnings was cited by 23% of

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18 | PHARMACYNEWSIRELAND.COM

3% 3%


IPHA Conference

‘We must get right medicines to patients’ – conference hears Medicine waits were the main focus at the recent Irish Pharmaceutical Healthcare Association (IPHA) Annual Conference consistent with the Government’s objective to achieve cancer outcomes in the top quartile in Europe. The ‘Manifesto’ called for a multi-annual, reasonable rise in Exchequer funding for medicines, taking account of existing levels of service, demographic trends and new treatments on the horizon. Oliver O’Connor, IPHA CEO, said there is growing impetus for joint industry-Government cooperation to overcome the medicines access challenge. “There is no justifiable reason, particular to Ireland, that we should so often be among the last in western Europe to bring new medicines to patients. We want to solve that problem jointly with the Government. We believe there is a shared interest in ensuring that new medicines are continuously brought to patients in a timely way across all therapy areas. That will help raise standards of healthcare to levels competitive with our European peers,” said Mr O’Connor.

Aidan Lynch delivering his Presidential address at the Annual Dinner at the IPHA conference

The Radisson Blu Hotel in Dublin was the setting and the theme was ‘Patient Care Powered by Innovation.’ Over 300 attendees participated in a series of plenary sessions and workshops which explored how innovation can be fully utilised to provide better healthcare, hearing from some 20 speakers, panellists and workshop participants, drawn from patient advocacy, public health policy, industry and academia. Experts shared their thoughts about the future orientation of healthcare in Ireland, and the role of pharmaceutical innovation and partnerships in improving patient outcomes. Patients in Ireland are waiting more than twice as long as patients in other western European countries for access to many vital new medicines, figures revealed. As part of a four-year deal agreed with the Government, prices for innovative medicines in Ireland are calculated at the average of the price in 14 EU countries.*

IPHA analysed the reimbursement dates in these countries for 18 products which have been reimbursed or at least discussed by the HSE Drugs Group in 2018*.

works for patients. This should be our agreed pledge to patients: that we will, together, deliver the best medical innovation for their care,” said Mr Lynch.

The analysis found that, for the 18 medicines, it takes, on average, 322 days for them to be reimbursed for patients in the 14 countries. But, here in Ireland, it takes 792 days. That’s two-and-ahalf times slower.

Pharmaceutical innovators have urged the Government to begin a dialogue, promised a year ago, that can lead to faster access to the best treatments for patients. Ireland is among the slowest countries in western Europe for access to innovative medicines. Some of the medicines made here are available in other European countries before our own patients can get them.

IPHA called for a ‘pledge to patients’ that commits the industry and the Government to work together to deliver new treatments efficiently to the healthcare system. In delivering the keynote speech, IPHA’s President, Aidan Lynch, said the industry wants to work in partnership with the Government to deliver medical innovation to patients faster. “As an industry, we are focused on improved patient outcomes. That means getting the right treatments to patients when they need them. This can only be done by partnering with the Government to create a healthcare system that

20 | PHARMACYNEWSIRELAND.COM

Last month, IPHA published the ‘Manifesto for Better Health’ - a roadmap for improving Ireland’s healthcare system by making innovative medicines available earlier to patients, and positioning Ireland as a global leader in the discovery, development and delivery of life-changing treatments. It urged that Ireland should aim to be in the top seven of the EU-28 on speed of access to innovative medicines - a goal

Poor Access Also at the conference, it was revealed that nine in 10 people say patients should have access to the same range of medicines as other western European countries A recent survey, conducted by Ipsos MRBI on behalf of IPHA has shown strong public support for the timely availability of the latest medicines for Irish patients. Two-thirds of people feel it is ‘unacceptable’ that life-changing medicines are available to patients in other countries before our own can get them, according to a survey, the organisation that represents pharmaceutical innovators in Ireland. The results are part of a major new healthcare landscape survey by Ipsos MRBI for IPHA aimed at testing public attitudes to medical innovation and healthcare needs. In the survey, almost two-thirds of people said it was unacceptable that innovative medicines are available in Ireland later than in most other western European countries.


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IPHA Conference Mr Lynch added, “The public expects, too, that the researchbased pharmaceutical industry should work closely with the Government to create the best local conditions for the discovery, manufacture and delivery of innovative medicines. That is our focus: helping to provide the best care to patients through innovation and partnerships.” Mr Oliver O’Connor said the Ipsos MRBI survey was an important gauge of perceptions about our industry which is a major driver for improved healthcare outcomes, as well as high-quality jobs. “As an industry, we must remain focused on what we can and should deliver for patients, in partnership with the Government,” he said. “This should be our pledge to patients: that we will, together, deliver the best medical innovation for their care. The survey captures the expectations of the public that the best treatments be made available here as fast as other peer countries in Europe. If we are to invest in innovation, then it follows that we should make the medicines that emerge from that process available to patients quickly. That is the premise of the ‘Manifesto for Better Health’: the link between access and innovation.”

Aidan Lynch, IPHA President, Meir Pugatch and Paul Reid, IPHA Vice President

In the recently published ‘Manifesto for Better Health’, the industry urged that Ireland be in the top seven countries in the EU-28 for speed of access to innovative medicines. The Government’s National Cancer Strategy aims to place Ireland in the top quartile of European countries for cancer survival in the next decade. Ipsos MRBI interviewed 1,002 adults aged 15 and over by telephone in September 2018. The sample was nationally representative, controlled for gender, age, region and social class.

Dave Barrett, Chairman of the IPHA Consumer Healthcare Division moderates the Self-Care workshop at the IPHA conference Ireland is an outlier in western Europe when it comes to the availability of new treatments, often coming last among other countries, even for some medicines that are made here. In the most recent IPHA analysis of a batch of new treatments, we found that the average wait time is 792 days - two-and-a-half times slower than other western European countries.

other western European countries. More than four in five people believed savings delivered by the industry should be reinvested into making new medicines available to patients. Almost nine in

The Ipsos MRBI survey showed that nine out of 10 people believe Irish patients should have access to the same range of medicines as

The survey showed the public expects pharmaceutical innovators to continue discovering and manufacturing new treatments,

Ten people agreed that it is important for the Government to continue supporting pharmaceutical innovation, according to the survey.

22 | PHARMACYNEWSIRELAND.COM

with the Government backing their efforts with the right public policy environment. When asked to characterise their opinion of pharmaceutical companies, 44% of people said it was positive. More than half of that cohort cited innovation and human health impact as the reasons for their positive disposition towards the industry. Just 16% of people said their opinion about the industry was negative. Those who had a neutral opinion about the industry numbered 37%. The rest, 4%, said they didn’t know.

*As part of the deal, prices for innovative medicines in Ireland are calculated at the average of the price in 14 EU countries - Austria, Belgium, Denmark, Finland, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the UK. *The analysis was carried out for IPHA’s biannual oversight meeting with the Department of Health on October 25th, 2018.


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Septanazal® nasal spray with dexpanthenol not only unblocks the nose, but also heals and protects dry and irritated nasal mucosa. + Acts within 5–10 minutes + Long-lasting ease of breathing + Contains no preservatives Septanazal: The nasal spray solution contains xylometazoline hydrochloride and dexpanthenol. Indicated for adults and children over the age of 6 for reducing swelling of the nasal mucosa in rhinitis and as supportive treatment for healing the mucous membrane lesions, for the relief in vasomotor rhinitis and for the treatment of nasal respiratory obstruction after nasal surgery. Adults and children over 6 years of age: The usual dose of Septanazal for adults and children aged 6 years or over is one spray into each nostril up to 3 times a day. Regarding the duration of treatment in children, a doctor should always be consulted. Precautions: This medicinal product may be used only after a careful assessment of the risks and benefits in cases of: patients being treated with the monoamine oxidase inhibitors (MAOIS) and other drugs which potentially increase blood pressure, increased intraocular pressure, especially narrow-angle glaucoma, serious heart and circulatory diseases (e.g., coronary heart disease, hypertension), phaeochromocytoma, metabolic disorders (e.g., hyperthyroidism), porphyria and prostate hyperplasia. In chronic rhinitis it may be used only under medical supervision owing to the danger of the atrophy of the nasal mucosa. The prolonged use and overdose of decongestant sympathomimetics in particular may lead to reactive hyperaemia of the nasal mucosa. This rebound effect causes narrowing of the airways and, consequently, the patient uses the medicinal product repeatedly until its use becomes permanent. The consequences are chronic swelling (rhinitis medicamentosa) or even atrophy of the nasal mucosa. In less severe cases consideration can be given to discontinuing the use of the sympathomimetic in one nostril initially and, after the symptoms have abated, changing to the other side in order to maintain at least part of the nasal respiration. Direct contact of the medicinal product with the eyes should be avoided. In case of misuse or use of excessive amounts of the spray, the absorption of xylometazoline can cause systemic adverse effects, particularly in children (cardiovascular and neurological adverse effects) (see sections 4.8 and 4.9). Concomitant use of the product with medicinal products for local or systemic treatment of the flu and sympathomimetics contained in cough-and-cold medicines (e.g.: pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, xylometazoline, tramazoline, naphazoline, tuaminoheptane) is not recommended in order to avoid an increased risk of possible cardiovascular and neurological adverse effects (see section 4.5). Contraindications: Hypersensitivity to the active substances or to any of the excipients listed in section 6.1 of the SPC, dry inflammation of the nasal mucosa, history of transsphenoidal hypophysectomy or other surgical interventions which expose dura mater. Septanazal for adults is contraindicated in children under 6 years of age. Fertility, pregnancy and lactation: Septanazal should not be used during pregnancy, as there is not sufficient data available concerning the use of xylometazoline hydrochloride by pregnant women. Septanazal should not be used during the lactation period, since it is not known whether xylometazoline hydrochloride is excreted in the breast milk. There is no data on the influence of Septanazal on fertility. Adverse reactions: Uncommon: hypersensitivity. Rare: palpitations, tachycardia, hypertension. Very rare: restlessness, insomnia, fatigue, headache, hallucinations, rebound congestion, nosebleed, convulsions. Not known: burning and dryness of nasal mucosa, sneezing. Shelf life: 2 years. Legal category: Medicinal product not subject to medical prescription. Marketing authorisation number: PA1347/058/002. Marketing authorisation holder: Krka, d. d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia. http://www.hpra.ie/img/uploaded/swedocuments/LicenseSPC_PA1347-058-002_19012017142039.pdf Date of Preparation: October 2017. Additional information is available on request from Krka Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 KX88. Reference number: 02-02-2018. * Passàli D, Salerni L, Passàli GC et al. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opinion on Drug Safety 2006; 5(6): 783–90.

1/2018, Ireland, 63-2018, RB/MB.

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Feature Why stamina is required when quitting cigarettes Helping customers find cost-effective ways to successfully quit smoking means understanding the OTC products currently on the market.

Whether it’s a patient who has the idea in mind but doesn’t know if they’re ready to quit just yet, or if it’s another who is having intense cravings and feels as though they might succumb or relapse, the community pharmacist has the information to deal with any query In the words of Aristotle, “Quitting smoking is rather a marathon than a sprint. It is not a one-time attempt, but a longer effort.” Many who have attempted to kick the habit would probably agree that it is often easier said than done, and that it can be both overwhelming and challenging. Pharmacists are in a pivotal position to help patients find the most effective methods to successfully quit smoking and choose from the many OTC smoking cessation products currently on the market. According to the latest Healthy Ireland survey, 22% of people in Ireland are smokers; down from 23% last year. About one third of men and women aged 25-34 are smokers and, importantly, overall smoking rates are falling. The Tobacco Free Ireland action and its implementation are beginning to have the desired effect.

As frontline healthcare providers, community pharmacists are ideally placed to help this trend continue. They are centrally located with the opportunity to promote smoking cessation to a wide spectrum of the community. Many people who want to give up smoking will not necessarily feel ill and will therefore feel comfortable in the pharmacy environment. Knowing the health benefits associated with smoking cessation may help motivate many smokers to initiate a plan to successfully quit smoking. Denis O’Driscoll is a Superintendent Pharmacist with LloydsPharmacy, Castletroy. He believes the role of the community pharmacist is essential. “Personally, I consider support is the main role provided by a community pharmacist to those seeking to quit,” he told Irish Pharmacy News. “Pharmacists can provide the most appropriate and patient centred advice or guidance, depending on where they are at. Whether it’s a patient who has the idea in mind but doesn’t know if they’re ready to quit just yet, or if it’s another who is having intense cravings and feels as though they might succumb or relapse, the community pharmacist has the information to deal with any query. “We are also familiar with the range of OTC/POM medicines available, and as medicine experts can suggest the most suitable treatment for each individual quitter (while also including non-pharmacological treatment approaches too), and support their decision. “As community pharmacies are located in most urban and rural areas and have a wide range of opening hours which offers accessibility to the patient when they need support in their progression, relapse or precontemplative phase of their

journey in smoking cessation. Furthermore, it provides the patient with the opportunity to engage with the pharmacist to look at their overall health and wellbeing.” Identifying Support Whilst ideally placed, pharmacists can experience significant barriers to providing counselling and support, including limited time, reimbursement, and training. Mr O’Driscoll adds, “I believe the main barriers to offering smoking cessation advice/ support/treatments are: • If the patient isn’t actually as ready to quit as they initially anticipated • If there is a lack of funding/campaigns to support the initiative • Although NRT is cheaper and more beneficial in the long term, consideration should be given to having it reimbursed on all schemes, to improve patient accessibility to products. • Despite relapse being completely normal, some catchment areas may have a higher rate than others or some catchment areas may be less willing to quit compared to others. “Smoking cessation services/ campaigns across pharmacies can be strengthened with the philosophy of the right time, the right place and the right advice. When a patient requests advice or seeks help on quitting, this is the right time to engage in a professional and informed manner.This will engage the patient. It is important that we listen and reflect to the patient their requirements, what they see as their barrier and how they can be empowered to overcome them. “By demonstrating a genuine interest in their journey, they are more likely to return to the pharmacy for more information,

Denis O'Driscoll, Superintendent Pharmacist at LloydsPharmacy

support and advice. Most often than not, pharmacies have smoking cessation listed as one of their services offered, however as pharmacists we need to be aware at the right times in the patient journey to further promote the stopping smoking. “As mentioned previously, community pharmacies are in a unique position whereby they are at the forefront of primary care, with easily accessible locations and extended opening hours. It is reported that 70% of smokers want to quit, but not necessarily at a stage in the near future. Given this, I believe it’s imperative that smoking cessation is encouraged more throughout pharmacies. “Hosting designated events or a “smoking cessation week” throughout pharmacies could be a good incentive to even promote consideration of cessation amongst smokers. This would be done in partnership with the HSE and voluntary agencies speakers/ experienced quitters/smokingrelated cancer survivors to attend pharmacies to speak/ provide support. I believe the main reason for success with cessation is support and encouragement.”

PHARMACYNEWSIRELAND.COM | 25


Feature • Rewards: patients should be asked to identify any potential benefits they anticipate from cessation • Roadblocks: help the patient identify barriers to quitting and assist in overcoming these. E.g. stressful periods, trigger factors such as always having one with a cup of tea, boredom, negative side effects of quitting • Repetition: repeat the message when possible “Always acknowledge and congratulate a patient’s efforts, this can promote a positive mental attitude. Remind patients that slip-ups are normal and that they shouldn’t punish themselves. Promoting patients to take their cessation journey one day at a time, often allows for more reasonable goals.

The key elements of brief smoking cessation advice are:

or react badly to the adhesive or latex in the patches. If this happens, advise a switch to a different form of NRT.

1. Ask the patient if they smoke;

Nicotine gum

2. Advise them to quit;

Nicotine gum relieves withdrawal symptoms and gives ‘something to do with the mouth’ in place of smoking. This can help change a habit of smoking. The gum is available in various strengths depending on how the level of addiction to nicotine.

Available OTC Treatments

3. If they would like to quit smoking, provide assistance by referring them to the HSE and NHS stop-smoking service, or if they do not want to attend the service, provide an alternative. In addition, there are numerous over-the-counter aids. Nicotine patches This treatment reduces or removes withdrawals associated with giving up smoking. Patches suit the moderately addicted smoker. They can be used for 16 hour or 24 hour periods. There is no difference in the effectiveness of 16 hour and 24 hour patches. They work by giving a steady dose of nicotine into the blood through the skin. The 24 hour patch keeps the nicotine levels constant and is for people who smoke as soon as they wake up and people who smoke during the night. Customers should be advised to put the patch on a different part of the body each day so it won’t irritate the skin. Some people may have high skin sensitivity

Nicotine inhaler The inhaler (sometimes called an inhalator) is made up of a mouth piece and cartridges which contain nicotine. When it’s inhaled, the nicotine and menthol vapour is sucked into the body. This is absorbed into the blood through the lining of the mouth and throat. Nicotine lozenge The lozenge comes in various strengths depending on the level of addiction. Some people prefer the taste of lozenges over other oral forms of NRT. Lozenges may irritate the mouth and stomach and cause hiccups as the nicotine is swallowed. Because tobacco smoke interacts with various pharmacologic agents

26 | PHARMACYNEWSIRELAND.COM

through pharmacokinetic or pharmacodynamic mechanisms that may result in decreased therapeutic efficacy or, less commonly, increased toxicity, pharmacists are key in identifying possible drug interactions and contraindications associated with tobacco use. Examples of drug interactions with tobacco smoke include hormonal contraceptives, betablockers, theophylline, and benzodiazepines According to Mr O’Driscoll, there are a number of tips and techniques that can assist pharmacists in their quest to help smokers kick the habit. “Advise a quit date,” he says. “Deciding upon a specific date allows for adequate preparation including coming to terms with it mentally, which can have a huge impact on the outcome.

“In addition, for cravings, promoting “The 4 Ds” is a good way to overcome them: • Distract • Delay (until the urge passesusually within 3-5 minutes) • Deep breathe (about 20 times) • Drink (patients find water extremely beneficial) “Healthy snacks are often a good deterrent and encourage patients to reward themselves when they have achieved a milestone. Regarding NRT, patients often find the chewing gum a good distraction or the inhaler as it allows them to keep their hands busy and replicates the movements, whilst many patients find the patch option more convenient.” The Rise of the eCigarette

• Relevance: patients should be encouraged to think about the reasons why quitting is important

E-cigarettes are increasingly being used as a nicotine alternative as smokers seek ways to kick their habit. They work by heating a pure liquid called e-juice, composed of flavorings, propylene glycol, glycerin and often nicotine until it vaporizes. The resulting vapor is much less offensive to both smokers and non-smokers.

• Risks: patients should be asked to identify the negative health consequences of smoking

But their use has become controversial due to a lack of evidence on their efficacy as anti-smoking aids, warnings

“Secondly, follow ‘The 5 Rs’:


advises that pharmacists are required to ensure that products supplied to patients do not pose a hazard to a patient’s health or well-being.It may be the case if a person were to resort to a particular product in respect of which the safety and efficacy had not been established against other products and treatments that have met the required standards.

about possible long-term health effects and numerous studies showing that teen use is a direct gateway to traditional cigarette smoking.

Mr O’Driscoll states that more evidence is needed as to their efficacy, or indeed, harm.

become increasingly popular in recent times, the evidence surrounding them still remains very much conflicting. The longterm effect of e-cigarettes on individual and public health is unknown. Evidence from shortterm studies, although limited, shows that e-cigarette use is less harmful than smoking. However, the evidence does not support the use of e-cigarettes as a smoking cessation methodology.

“While it is no secret that e-cigarettes and “vaping” have

“Therefore, I strongly support the recommendations contained

It has been said that with the increasing use of e-cigarettes, pharmacists need to be ‘doubling their efforts’ in helping people quit.

in Tobacco Free Ireland, with increased controls being put in place with regards to the sale of tobacco products and Non-MedicinalNicotine Delivery Systems, including e-cigarettes. In addition, there is a requirement to regulate e-cigarettes and similar products more effectively as outlined by the EU Tobacco Products Directive. “Furthermore, the Pharmaceutical Society of Ireland has previously issued guidance for pharmacists. It

After 6 hours

your heart rate slows

After 12 hours

your body is free of nicotine

After 2 days

your sense of taste and smell improves and your breath, clothes and house will smell fresher

After 1 month

your blood pressure improves and your immune system begins to recover

After 2 months

your circulation improves, you will have some more energy and your fingers and toes will stay warmer

After 12 months your blood pressure returns to normal After 10 years

you have halved your risk of developing lung cancer compared to someone who continues to smoke

After 15 years

your chance of suffering a heart attack or stroke is the same as a non-smoker

“As pharmacists, yes, I do believe we still need to increase our efforts in the promotion of smoking cessation for the benefit of patients. However, in my opinion it would still be our priority to recommend/suggest the OTC NRT products/POM or non-pharmacological methods that we know have sufficient evidence base behind them.” Table 2: Opportunities for community pharmacists to give brief advice • Prescription service: the dispensing of many types of medication can be linked with smoking cessation advice, for example medication for respiratory disease and cardiovascular disease, and women using oral contraceptives. There is also an opportunity to ask clients with a prescription for smoking cessation medication if they are receiving additional support. • Minor ailment service: pharmacies are often the first port of call for minor ailments, for example a person presenting with a cough can be asked whether they smoke. • Purchase of over-the-counter medicines: it is appropriate to ask a customer purchasing, for example, a cold remedy whether they smoke. Smokers buying NRT over the counter can be informed about additional treatment options available locally. • Involvement in local or national campaigns: No Smoking Day and Quit campaigns, usually in January, are examples where pharmacists can be involved.

PHARMACYNEWSIRELAND.COM | 27


News Irish government urged to support EU proposals to deliver more affordable medicines and savings in health budgets Medicines for Ireland, has called on the Government to support EU proposals to deliver more affordable medicines, savings in national health budgets, and up to 25,000 new jobs. It made the call as an independent study found that proposed reforms to EU medicine regulations would result in savings for national health budgets of over ¤3 billion and create up to 25,000 additional direct high skilled jobs. Medicines for Ireland, the representative body for the generic, biosimilar and valueadded medicines industry here said that patients and the local economy risk losing-out on these potential gains unless the Government adopts a stronger stance in supporting the reforms. Under the current rules, when a pharmaceutical company creates a new medicine, its molecule is typically protected by both a twenty-year patent and a ‘supplementary protection certificate’, or ‘SPC’, which allows it to extend its market protection by a up to an additional five years. As a result, EU-based generic medicine manufacturers must delay the availability of more affordable, virtually identical versions of these drugs, until an SPC extension expires, even though the medicine is no longer patent protected. Now the European Commission, as part of its ongoing strategy to make the EU more economically competitive on the global market, has proposed a ‘SPC manufacturing waiver’, which would allow generic manufacturers to produce drugs for export to territories where the SPC does not apply during the five-year period. The move would see more affordable medicines entering the market sooner, stimulating increased pharmaceutical manufacturing within the EU, thereby creating job creation opportunities in the process. Irish and European generic manufacturers are calling on these reforms to the SPC to apply to all medicines, existing and future, particularly as protections on numerous significant medicines due to expire within the next two years. Medicines for Ireland is also calling on the Irish government to improve the reforms further

Owen McKeon, Chair of Medicines for Ireland

C

M

Y

CM

by supporting its ’day-1 launch’ proposal. This would allow EU MY patient use of more affordable CY generic medicines immediately upon SPC expiry, rather than CMY just the commencement of the K manufacturing process as is currently the case. Under current regulations, EU pharmaceutical companies can only begin manufacturing the medicine after SPC expiry, yet similar generic medicines manufactured outside of the EU are available for patients use upon SPC expiry. This places EU manufacturers at competitive disadvantage and restricts patient medicine access by extension. Commenting, Medicines for Ireland Chairperson and Mylan Country Manager, Owen McKeon said: “The SPC waiver is a very positive proposal for the EU and Ireland in particular. It will deliver more affordable medicines, resulting in savings for both patients and the national health budget.” He added: “The clock is ticking. Within the next two years alone, the SPC protection on many medicines will expire. We want to be able to capitalise to ensure that Irish patients have greater access to life saving medicines and that our health service can secure them at the most affordable rates. Patients, not vested interests with an agenda to maintain the status quo, must be our Government’s priority on this important issue”, Mr. McKeon concluded.

28 | PHARMACYNEWSIRELAND.COM


Self Care Report

Putting Pharmacy at the Front of Self-Care In the face of rising costs and ageing populations, many people are themselves seeking more control over every aspect of their lives, including their health. There is a growing awareness of the need for preventable health, and consumers are driving a move towards self-care. According to a 2012 economic Self-care and self-medication Association (IPHA), who at the end of this year launched analysis conducted by Booz & raise the issue of the a new self-care awareness Co for the Consumer Healthcare responsibility of consumers campaign, entitled ‘Be Well this Products Association, each and patients to ensure that the Winter – Think Pharmacy.’ dollar spent on OTC medicines care or medication they select saves $6 to $7 for the U.S. is appropriate to their needs, campaign will beofrolled SELFThe CARE Taking charge your health healthcare system. The safe and effective. Equally, out through the extensive availability of OTC medicines they pose several questions for deployment of social media, currently provides $102 billion pharmacists, including ‘how are as well as a series of posters in value to the U.S. healthcare patients and consumers advised to be displayed nationwide in system annually. regarding the technical and retail pharmacies. 92% ofissues respondents indicated ethical associated withthat they like to be Simple and strategic changes in involved in decisions about their own health and self-care and self-medication?’ This campaign builds on the the waywith self-care is A defined medicines that they take, which is consistent a third ofand those who participated the research previously highlyinsuccessful IPU/ organised in Ireland can make The benefits of self-care for both desire for increased self care. The research showed initiative launched earlier suffer from one ofIPHA a number of significant a difference individuals and health that younger adults aresystems much less likely to stronglyto the long-term this pervasive year, ‘Self-Care: conditions, the most of thesetaking being of the Irish people. are well documented. agree that they like to be very involvedwellbeing in decisions of (10%), your health’, which high or low bloodcharge pressure arthritis (9%), In botha health and fiscal terms, about their health and medication, whereas placed a major emphasis on diabetes (8%) and high cholesterol (7%). Although no economic studies prevention preference to do this grows substantially up to theis better than cure. the role of the pharmacist as haveofbeen age 65. carried out in Ireland, in assisting Two out of three a dokey notcomponent experience any one of The role of community studies have been carried out individuals manage their these more significant health to conditions. pharmacists is pivotal to the in other jurisdictions to measure own health. successful development of selfthe aggregate cost savings of From this we can assume that a third of the care and its more widespread using OTC medicines for the in Ireland going on population might‘Healthcare be comparatively moreisfocused adoption, according to the Irish most common self-treatable through a period of significant their personal health, whereas the other two-thirds Pharmacy Union (IPU) and the conditions, and their results are change – we have an increasing have less immediate reasons or needsevolving to do so. Irish Pharmaceuticalmay Healthcare relevant to Ireland. and ageing population,

PATIENT AILMENTS

NATIONAL SURVEY

Profile of Sample: Conditions and Ailments

Base: All Adults – 1,000 Firstly, which of the following conditions or ailments, if any, do you personally experience? Condition/Ailment suffer from High/Low Blood Pressure

(379,000)

Arthritis

(325,000)

Daibetes

(284,000)

High Cholesterol

(247,000)

Chronic pain (i.e. head/back)

(161,000)

Asthma

(132,000)

Depression and other anxiety conditions

(157,000)

Heart Disease

(97,000)

Cancer

(97,000)

Osteoporsis COPD Obesity Alzheimers Other serious health conditions

1% 1% 0%

9% 8% 7%

3% 3%

35%

Any Condition/ Ailment

(34)

379,000

3%

65% None

Among the main recommendations were: 1. Expand the role of the pharmacist including the free treatment of common illnesses to medical card patients through the establishment of a pharmacybased Minor Ailment Scheme.

3. The concept of selfcare should be actively promoted among healthcare professionals.

4% 4% 4%

(24)

IPHA and the IPU have for some years been working together and with other stakeholders to encourage the adoption of selfcare. Their earlier report made a number of recommendations on how the role of community pharmacists is pivotal to the successful development of self-care.

2. The range of medicines made available to patients should be expanded through switching.

10%

(95,000) 2%

health structures, greater private sector involvement in the health arena, a growing incidence of chronic diseases, ever-increasing public expectations of the service and the development of new treatments which offer hope to patients but which also pose a strong financial challenge to the State. This challenge is compounded further given the State’s requirement to control healthcare expenditure,’ stated the Report.

4. Patients should have access to good-quality, trustworthy information so that they can seek care at the appropriate level and, thus, enhance their independence within the healthcare system. 5. Patients should know that self-care means access to high-quality, safe and effective products. Patients are no longer passive recipients of healthcare

PHARMACYNEWSIRELAND.COM | 29


Your throat is your strength.

www.septabene.ie

L-ROUND L A

E AT M E N T

1/2018, Ireland, 67-2018, TBP/MB.

TR

NEW A new sore-throat medicine with a unique formula for all-round treatment: • Analgesic: quickly relieves pain • Anti-Inflammatory: reduces inflammation • Antiseptic: eliminates causes of infection • SUITABLE FOR DIABETICS • SUITABLE FOR COELIACS

Benzydamine hydrochloride/Cetylpyridinium chloride Septabene lozenges and spray: The spray solution and lozenges contain benzydamine hydrochloride and cetylpyridinium chloride. Septabene spray: Indicated for adults and children aged 6 years and over for anti-inflammatory, analgesic and antiseptic treatment of irritations in the throat, mouth and gums, in gingivitis, pharyngitis, laryngitis and before and after tooth extractions. Septabene lozenges: Indicated for anti-inflammatory, analgesic and antiseptic treatment of symptoms of sore throat associated with upper respiratory infections including pharyngitis, laryngitis and tonsilitis. Children from 6 to 12 years of age: The recommended dosage is 3 lozenges a day. The lozenge should be slowly dissolved in the mouth every 3-6 hours. For a single dose of the spray, press the spray head once. This may be repeated every 2 hours 3-5 times a day. Adults, elderly and children over 12 years of age: The recommended dosage is 3-4 lozenges a day. The lozenge should be slowly dissolved in the mouth every 3–6 hours. For a single dose of the spray, press the spray head once to twice. This may be repeated every 2 hours 3-5 times a day. Precautions: Septabene should not be used for more than 7 days. If there is no improvement after 3 days, the patient should consult a doctor. The use of topical preparations, especially over a long period of time, may lead to sensitization, in which case the treatment must be discontinued and doctor consulted to set up a suitable therapy. Septabene must not be used in combination with anionic compounds, such as those present in toothpastes, therefore it is not recommended to use the product immediately before or after cleaning teeth. Benzydamine use is not advisable in patients with hypersensitivity to salicylates (e.g. acetylsalicylic acid and salicylic acid) or other NSAIDs. Bronchospasm may be precipitated in patients suffering from or with a previous history of bronchial asthma. Caution should be exercised in these patients. Septabene should not be used in patients with open wounds or ulcerations in the mouth or throat. Septabene contains isomalt (E953). Patients with rare hereditary problems of fructose intolerance should not take this medicine. Direct contact of Septabene spray solution with eyes should be avoided. Septabene spray contains small amounts of ethanol. Contraindications: Septabene lozenges and spray: Hypersensitivity to the active substances or to any of the excipients listed in section 6.1 of the SPC. Children aged under 6 years: The pharmaceutical form is not appropriate for this age group. Fertility, pregnancy and lactation: There are no or limited amount of data from the use of benzydamine hydrochloride and cetylpyridinium chloride in pregnant women. Septabene is not recommended during pregnancy. It is unknown whether benzydamine hydrochloride (metabolites) are excreted in human milk. A risk to the newborns and infants cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue (abstain from) Septabene therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman. Adverse reactions: Septabene lozenges and spray: Rare: Hypersensitivity reaction, bronchospasm, urticaria, photosensitivity. Very rare: Oral mucosal irritation, burning oral sensation. Not known: Burning mucosa, anaesthesia of oral mucosa. Shelf life: 2 years. Legal category: Medicinal product not subject to medical prescription. Marketing authorisation number: Septabene spray PA1347/049/001, Septabene lozenges PA1347/063/001. Marketing authorisation holder: Krka, d. d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia. SPC: http://www.hpra.ie/homepage/medicines/medicines-information/ find-a-medicine/results?query=septabene&field= Date of preparation: June 2017. Additional information is available on request from Krka Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 KX88. Reference number: 01-02-2018.


Self Care Report and advice. Greater health literacy and greater access to information, combined with increased individual interest in personal health and personal choice, is leading to more and more patients actively looking after themselves. In addition, public awareness has increased the importance of certain lifestyle factors, such as avoidance of smoking and a balanced diet, in maintaining health and preventing illness.

and obesity are often caused by known and avoidable risk factors, such as poor diet, a lack of physical activity and smoking.

medical interventions and behaviour modification. We are at a crucial point as a society where we need to encourage small but significant changes in the behaviour of adults and children to avoid a potential health crisis, which could overwhelm the system in the years ahead.

The treatment and management of chronic illnesses account for a large share of health resources, including: • 80% of all GP visits;

The benefits of self-care for both individuals and health systems are well documented.

• 40% of hospital admissions; and

local communities, as well as all of society, is required. Although no economic studies have been carried out in Ireland, studies have been carried out in other jurisdictions to measure the aggregate cost savings of using over-the-counter (OTC) medicines for the most common self-treatable conditions, and their results are relevant to Ireland.

In the UK, it is estimated Healthy Ireland, the Government that up to 18% of general framework for action to improve practice workload relates to the health and wellbeing of minor ailments at a cost of £2 people living in Ireland over billion annually. Similarly, 8% the coming generation, has of Emergency Departments been developed in response (ED) consultations involve to rising levels of chronic consultations each year for illness and lifestyle trends that minor ailments costing the threaten health and persistent National Health Service (NHS) health inequalities. Healthy £136 million annually.3 Ireland is based on evidence Conversely, regular experience of a doctor or GP is The Australian Self Medication and experience from around Industry a (ASMI) estimates themuch world, lower, which shows withthat just 1% seeing doctor weekly, that 25 million minor ailment to create positive change in as many as 4% fortnightly consultations and 17% going to the are carried out by population health and wellbeing, GPs in Australia annually; the a whole-of-Government doctor at least once a month. approach and involvement of time investment required for

• 75% of hospital bed days1. In this context, self-care can be seen as the most widely There is considerable scope to available form ofTaking healthcare. number of avoidable SELF CARE charge ofreduce your the health As pressure grows on the Irish cancers through the promotion healthcare system, self-care will of healthy lifestyles in areas such come to be seen as a means as improved diet, more exercise of controlling and rationalising and reduced alcohol intake. healthcare and medication costs. Cancer and cardiovascular disease were each responsible If we are to successfully confront for about one third of all deaths the demands on our health in 2013.2 Three as inthe five (59%) of the adult population visits system population ages, we need to ensure that we all We live a world where a pharmacy at least once a month.inAs many as if a stay fit and healthy for as long as condition is diagnosed early, it 22% doIn so fortnightly of the full adult possible. Ireland, conditionsand 11% can often be quickly, effectively like cardiovascular and chronic and efficiently treated population, or 426,000 adults, do so weekly. using respiratory diseases, diabetes modern medicines, other

PHARMACY USAGE

Frequency of interacting with healthcare professionals

NATIONAL SURVEY

Base: All Adults – 1,000 About how often do you do the following these days? Weekly %

11

Visit a pharmacy

11

(426)

Look up healthcare related aspects online

Fortnightly %

5 3

37

(404)

7

Monthly %

Every 3 months %

Less often %

13

Never %

24

Ever Visit %

3

97%

(1,380)

29

9

57%

48

(163)(122)(242)

Go to the doctor/GP 13

13

23

56

4

96%

(51)(125) (491)

Visit other healthcare prefessionals 12 5

10

56

34

66%

(44) (64) (181)

NB: Figures in brackets are in thousands

Thus, it is apparent that although substantial

PHARMACYNEWSIRELAND.COM | 31 A substantial proportion of younger adults are


Self Care Report than the group visiting a doctor monthly: 2,210,000 visit a pharmacy versus 667,000 who go to the GP. A substantial proportion of younger adults are regular pharmacy visitors, although they may apparently have much lower medical ‘need’. That is to say, they don’t suffer from an enduring or significant medical condition, but nonetheless they still visit the pharmacy for other reasons. It is logical to assume therefore that they either go to the pharmacy to make nonmedical purchases, or potentially for other reasons such as selfcare or self-medication.

Dave Barrett, Chairman, Irish Pharmaceutical Healthcare Association, County Manager, Ireland, GSK

these consultations equates to the involvement of 1,000 full-time GPs who could instead be available to treat more serious conditions. ASMI concludes that it represents AUD 260 million in misallocated resources.4 According to a 2012 economic analysis conducted by Booz & Co for the Consumer Healthcare Products Association, each dollar spent on OTC medicines saves $6 to $7 for the US healthcare system. The availability of OTC medicines currently provides $102 billion in value to the US healthcare system annually.5 Simple and strategic changes in the way self-care is defined and organised in Ireland can make a difference to the long-term wellbeing of the Irish people. In both health and fiscal terms, prevention is better than cure.

Three in five (59%) of the adult population visits a pharmacy at least once a month. As many as 22% do so fortnightly and 11% of the full adult population, or 426,000 adults, do so weekly. Conversely, regular experience of a doctor or GP is much lower, with just 1% seeing a doctor weekly, as many as 4% fortnightly and 17% going to the doctor at least once a month. Thus, it is apparent that although substantial numbers may be living with a continuing or enduring medical condition, they are still much more likely to interact regularly with the pharmacist than they are with the GP. The number attending or visiting a pharmacy monthly is more than three times larger

Self-care is a healthcare philosophy, which emphasises the role of ordinary people in taking responsibility for their health and wellbeing. It includes taking actions to improve their health and wellbeing to prevent and decrease the likelihood of disease and to restore health after illness or injury. It is the first step and first choice for Irish people who are taking an increasingly active role in their healthcare. Research from Behaviour & Attitudes1 confirms that there is a clear desire from the majority of people (92%) to be involved in decisions about their own health and medication, with 80% expressing their view that they see their pharmacist as a key partner in maintaining their health.

Daragh Connolly, President of the Irish Pharmacy Union, says, “Promoting increased levels of self-care in Ireland would lead to a far more efficient and effective system of healthcare. Embracing a philosophy of self-care can lead to real, measurable savings in healthcare expenses and better outcomes for patients and pharmacists can play a critical role in this area. Allowing pharmacists to work to their full scope will help to deliver better patient outcomes, by utilising our accessibility and professional capabilities to benefit patients, in partnership with our healthcare colleagues and the pharmaceutical industry.” Dave Barrett, Chairman of the Irish Pharmaceutical Healthcare Association, adds, “As well as the obvious benefits for individuals in taking a greater role in maintaining healthy lives, adoption of self-care principles could also help the State manage the financial challenges of an ageing population and strained healthcare budgets. As people take care of their own health and self-treatable conditions, more healthcare resources can be used for patients with severe and chronic diseases. Our industry is committed to working with healthcare professionals, especially pharmacists who are often the first port of call for health information and advice, to support consumers to identify the most appropriate channel within the healthcare system.” References available on request

News Falsified Medicines Directive Registration now open Online registration for pharmacies and hospitals is now open, confirms the Irish Medicines Verification Organisation (IMVO). The Irish Medicines Verification Organisation is an organisation set up to protect Irish patients from the threat of falsified medicines being supplied through legitimate channels. This is an important milestone to assist pharmacies and hospitals in

complying with new EU Falsified Medicines Directive (‘FMD’) requirements that come into effect on 9th February 2019. IMVO has contacted all community pharmacies and hospitals registered with the Pharmaceutical Society of

32 | PHARMACYNEWSIRELAND.COM

Ireland with details of how to register. Registering with IMVO is a pre-requisite for connecting the system that community pharmacies and hospitals will use to scan barcodes, to the IMVO repository. For more information, including HSE updates, visit

the dedicated pharmacies & hospitals page at www.imvo.ie/ stakeholders1/pharmacists Wholesaler registration will commence shortly and wholesalers will receive a separate notification from IMVO.


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ARE NOW OPEN TO ENTER The OTC & Pharmacy Retail Product Awards offer top brands and products the opportunity to showcase the extensive support that they offer in self-care and beauty to the general public and to the pharmacy sector. By consistently establishing themselves as reliable, effective and innovative we would welcome any brand that offers this, the opportunity to be part of The OTC Awards. For further details on categories and how to apply please contact louie@ipn.ie


Feature

Diet and Drug interactions By Ola El-Garawany As a community pharmacist I learnt about the value of medicine and through the years I have personally seen the benefits of medicines that save lives. So I know when a doctor prescribes medication or when an OTC medicine is purchased the patient takes those medicines in the sincere hope that they will help and make them feel better but what happens when the patient still does not feel better? What I learnt after studying Nutrition and Functional Medicine is that some medicines can be in fact robbing some essential nutrients which means that although the medicine may be treating the specific health problem itâ&#x20AC;&#x2122;s indicated for, it may not still result in the patient feeling better as now something else is lacking preventing them from being at their best health.

Ola El-Garawany MPSI,Community Pharmacist,Diet counsellor and functional medicine Practitioner

And whether or not the patient is eating all food groups in general or following a specific diet they will still feel miserable from lacking the depleted nutrients. Personally, I always prefer the natural approach if I can, rather than recommending supplements to my patients. This is also to decrease the amount of pills and capsules any patient has to take daily especially if they are already on a few prescriptions medicines. But in some cases I do recommend supplementation if itâ&#x20AC;&#x2122;s needed. Here are some examples and what to do to reverse the depletion with simple nutrition tips and without compromising taking the medications prescribed; Coenzyme Q10 Cholesterol reducing medicines deplete the body from a very important co enzyme called Coenzyme Q10 also known as CoQ10. What is it and what does it do in the body? An enzyme is a substance that help a specific chemical reaction to happen in the body and the coenzyme is

a substance that helps the enzyme to do its job. Coenzyme Q10 is a powerful antioxidant that helps the body to generate energy for every single cell in the body in order to function. Also lots of studies show its importance for heart health. Unfortunately also as we age the amount of Co Q10 production slows down. What to put on your plate to get more of it? Beef, chicken, fish (especially oily fish), spinach, broccoli , cauliflower, organ meats, whole grains, nuts, peanuts, lentils, sesame seed oil. It is equally well absorbed from foods as it is absorbed from supplements. Supplementation dose for general health is 10-30 mgs once daily For patients on cholesterol reducing medicines 100 mgs once or twice daily.

Probiotics Also known as good bacteria or friendly bacteria. Good friendly bacteria live in our digestive tract and we need to have them for good health. They are the security system of our body. Research and science in this area is evolving massively and scientists have discovered the link between many chronic conditions and the imbalance of good bacteria. What is it and what does it do in the body? Good bacteria protects us from bad bacteria, it is amazing how this happens! A healthy gut should have about three pounds of normal intestinal flora. In fact people with enough healthy bacteria in their guts will be less likely to suffer from heartburn, flatulence and gas accumulation, diarrhoea and constipation.

Examples of some medicines that rob our good bacteria are; Antibiotics, acid blockers, antacids and many more. In my opinion each time the doctors prescribes an antibiotic they should advise patients to take a good probiotic or eat foods that would help to fix the damage of depleting the good bacteria. What to put on your plate to get more of it? Yogurt that is home-made or with live bacteria written on the label, try to avoid yogurt with Fruits as most likely they have a hidden high sugar content and little live bacteria. I always advise my patients to buy live yogurt and add fruits to it. Kombucha drinks and kefir. They are fermented drinks that can be bought from good health stores and some pharmacies nationwide.

PHARMACYNEWSIRELAND.COM | 35


Feature Kombucha is almost like drinking sparkling apple cider vinegar with different flavours. People get used to the taste and some brands taste really good. These drinks also contain lots of vitamins, minerals and enzymes. It contains all the B vitamins which give a lot of energy, and it’s a good source of vitamin C. Kefir is fermented milk, think of it as a liquid yogurt. Kefir, also like kombucha , contains lots of friendly bacteria and enzymes to repair the damaged ecosystem of the gut after the medicines mentioned above. Kefir should be taken on an empty stomach anytime of the day. Supplementation with good probiotics is also an easy option for most people and they are widely available in good health stores and pharmacies . The B Vitamin family The health benefits of the B Vitamins are endless they need their own write up! But I will list today in general how important they are for good health and general well- being.

Because it is a big family of vitamins, you need to get the different B vitamins from different foods in order to get the full spectrum as they vary between foods. Supplementation with a good B complex is also an option especially for patients who do not consume lots of green vegetables. A good tip I always give to my patients is to mildly steam their vegetables or bake them. If they boil their vegetables they lose all their benefits unless they consume the water in which they boiled their vegetables. Iron What is it and what does it do in the body? The body needs iron to make haemoglobin which is the main carrier of oxygen to every cell in our body. Fatigue is one of many symptoms that can be caused by lack of Iron and the doctor will always confirm the iron deficiency and if it is the cause of the fatigue leading to anaemia by a simple blood test. Some people seem to run out of iron or become very low most easily they include: - Vegetarians and vegans.

What is it and what does it do in the body?

- Women who experience heavy periods.

The B vitamins are water soluble vitamins and their deficiency can cause many health problems. Lack of the B vitamins can cause chronic fatigue, mental exhaustion and insomnia. Weak hair and nails are also reported when the B vitamins are depleted or levels are compromised.

- People who have a minor perforation in the GI tract such as an ulcer that can cause a slow and steady leak of blood.

Examples of some Medicines or agents that deplete B vitamins are; Alcohol, acid blockers, antacids, some antibiotics, some oral contraceptives and Hormone replacement therapy and some anti-depressants and many more. What to put on your plate to get more of it? All green vegetables without any exception will be a great source of the B vitamins. Dairy products, lean meats, mushrooms, eggs, fruits, nuts, oats, seeds and many more.

- Pregnant women. - People who suffer from inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. - Frequent blood donation. - Chronic Kidney disease. Examples of medicines and Miscellaneous food and supplements that can rob Iron are; Antacids, Acid blockers, Various Antibiotics, Alcohol, Coffee & tea (even decaffeinated), certain dairy products, Zinc supplements among others. What to put on your plate to get more of it? Meat, Poultry and Fish all contain Iron in a form that is

36 | PHARMACYNEWSIRELAND.COM

easy to absorb. Also all the dark green vegetables such as spinach, broccoli and kale, all contain Iron in abundant amounts. Chickpeas, leaks, lentils and mushrooms all also contain Iron. Tea may reduce the absorption of Iron from fruit and vegetables, so it’s recommended to drink it 1-2 hours away from eating food. For general health, I always recommend that people try and obtain their Iron through their diet rather than supplementation as excess Iron in the body can lead to detrimental effects. It’s quite common to self-diagnose fatigue as lack of Iron in the general public, however again I would strongly encourage against self-prescribing without confirming it with a blood test from their doctor. Calcium and Magnesium When we hear calcium, we instantly think of bone health, and although it is vital for bone health, it is also vital for so much more than that. What is it and what does it do in the body? Deficiency of calcium can put the body at risk of osteoporosis, tooth decay, high blood pressure, heart disease, insomnia, acid reflux and obesity. However, calcium and magnesium have an interesting relationship in relation to bone health. Magnesium is in fact essential for calcium absorption. The magnesium pushes the calcium out of the soft tissues into the bones where it’s needed, otherwise calcium will just build up in the soft tissue and actually result in joint pain. Medicines that may deplete calcium levels include; Antacids, Acid blockers, Various antibiotics, certain blood pressure medications, steroids, laxatives. Medicines and certain foods/ drinks that may deplete magnesium levels include; Antacids, acid blockers, various antibiotics, various oral contraceptives, alcohol, coffee, excessive calcium supplementation and more.

What to put on your plate to get more of it? Calcium-rich foods for your plate include turnip, spinach, collard green, basil, thyme, cinnamon, yoghurt, kale, mozzarella cheese, sardines, garlic and quinoa. For magnesium load up on spinach, swiss chard, legume, dark chocolate, baked potato with skin, whole grains, oatmeal, quinoa, pumpkin seeds, flaxseeds, broccoli, tomatoes, brown rice, tuna and scallops. My advice is always to supplement both Calcium and Magnesium in cases of low calcium levels diagnosed by a doctor or through dietary analysis. In order to achieve of optimal nutrient levels in the body especially in cases of patients on medications, who may have compromised levels due to those medications, it’s vitally important to look at their diet as a whole. Not only can they be lacking vital nutrients, they may also have drug-food interactions which they may be unaware of which can be detrimental. I always look at my patient’s diet first, and pinpoint where there may be a lack by looking at their medications in conjunction with their diet. I will always start by providing them with dietary advise to increase the relevant nutrients before I rely on supplementation. In cases where there’s an extra need for the nutrient in question or dietary limits, only then will I turn to supplementation. My motto has always been let food be thy medicine and I truly believe it is the ultimate first step in the healing process. Ola El-Garawany MPSI,Community Pharmacist,Diet counsellor and functional medicine Practitioner. She has published few articles in the local and the National news papers and Health magazines in Ireland on different Health and Nutrition topics. To contact Ola: email fmpractice1@gmail.com


Awards The Irish Pharmacy

2019

Launching the 2019 Irish Pharmacy Awards – showcasing innovation, dedication and dynamic approaches

Irish Pharmacy News are delighted to this month launch the 2019 Irish Pharmacy Awards. Now in their 8th year, the Irish Pharmacy Awards challenge community pharmacists, their teams and wider staff across Ireland to come forward with entries detailing innovation, dedication and business successes that address unmet needs and improve patient services within their communities.

The 2019 Awards culminate with a first class awards evening of celebration and recognition in the Clayton Hotel, Burlington Road Dublin on Saturday, May 18th, 2019. To be in with a chance of winning in 2019, enter now. We are looking for leading examples of dedication, expertise and dynamic approaches.

 McLernon Computers Innovation & Service Development of the Year (Chain)  Innovation & Service Development of the Year (Independent)  Sanofi People's Pharmacist of the Year

The Categories are:

 Superintendent Pharmacist of the Year

All members of the community pharmacy team play an important role on the success of the sector and we are keen to hear your nominations across a wide spectrum of categories including the KRKA Counter Assistant of the Year, Superintendent Pharmacist of the Year and of course, the ever popular, Community Pharmacist of the Year.

 Community Pharmacist of the Year

 Life Pharmacy: Pharmacy Student of the Year

 KRKA Counter Assistant of the Year

 Young Pharmacist of the Year

The Awards also showcase the latest in business development and OTC pharmacy retailing, and have been designed from inception to promote the shared learning.

 Business Development of the Year (Independent)

 Children’s Baby Health Pharmacy of the Year

 Uniphar FIXXA Category Development of the Year

 Pharmacy Representative of the Year

 Community Pharmacy Technician of the Year  Clonmel Business Development of the Year (Chain)

 Self-Care Award  Community Pharmacy Team of the Year  OTC Retailer of the Year

Anyone wishing to enter or nominate a colleague can do so by downloading an entry form at www.irishpharmacyawards.ie or by contacting Anna Carr directly on: Telephone - 00353 (01) 6690562 Email – anna@ipn.ie

PHARMACYNEWSIRELAND.COM | 37


Haven Awards

Haven Pharmacy recognises excellence at Awards Night 2018 Haven Pharmacy hosted their 5th Annual Awards night on Saturday 24th November in the Rochestown Park Hotel in Cork. The night welcomed over 230 guests from Haven Pharmacies across Ireland as well as many of Haven’s Commercial Partners. This very special and much anticipated night celebrated the hard work, dedication, superior customer service, professional excellence and care demonstrated by independent Haven pharmacies throughout the Group. A total of nine awards were presented on the night: Haven Rising Star, Haven Professional Services, Haven Digital Media Leader, Haven Pharmacy Technician, Haven in the Community, Haven Community Pharmacist, Haven Ambassador of the Year, Haven Customer Service the Year and Haven Pharmacy of the Year.

Indepharm Co-Op and Haven Pharmacy Chairman Keith Brennan thanked the Haven family on another successful year for the Group. He referred to increased margins and turnover but focused on the dedication of the Haven teams in the pharmacies delivering exceptional care on a daily basis as well as their steadfast community spirit. Keith emphasised that it was this community spirit that underpinned Haven’s partnership with the Irish Men’s Sheds Association and sparked the various fundraising activities throughout the year. He praised

the teams on raising more than €54,000 for charities including Temple Street Children’s Hospital, Irish Cancer Society, Jigsaw and the Beaumont Hospital Foundation in 2018. Mr. Brennan concluded by extending thanks to all the sponsors for the event: Clonmel Healthcare, Accord Healthcare, Fitzgerald Power, HCS Business Solutions, Graphite HRM, GSK Ireland, Reckitt Benckiser Ireland Ltd., Teva Pharmaceuticals, Uniphar Retail Services, United Drug, Fleming Medical, HMR Ireland, Mylan, Parle & Hickey, Perrigo,

Sam McLernons, Touchstore and Visualise. Mary Byrne, of X Factor fame, wowed the audience with a lively and engaging performance and Niall Rynne was the MC for the night. Over €2,000 was raised on the night for the Palliative Care Unit at Kerry General Hospital.

Haven Pharmacy Award Winners 2018:

Haven Pharmacy Award Winners 2018:

Haven Pharmacy of Haven the Year – Haven Raffertys, Stillorgan Shopping Centre, Co. Main Image: Pharmacy of Pharmacy the Year – Haven Pharmacy Raffertys, Haven Community Pharmacist of the Year – Niamh O’Dwyer, Haven ofCo. theOffaly Year –sponsored Niamh O’Dwyer, Pharmacy Butlers, Birr, PharmacyPharmacist Butlers, Birr, by ReckittHaven Benckiser Ireland Ltd Dublin sponsored ClonmelCentre, Healthcare Ltd and presented by BarryHealthcare Fitzpatrick. Stillorgan by Shopping Co. Dublin sponsored by Clonmel Ltd Haven Community presented CiaranBenckiser Woods. Ireland Ltd and presented by Ciaran Woods. and presented by Barry Fitzpatrick. Co. Offaly and sponsored byby Reckitt

38 | PHARMACYNEWSIRELAND.COM


Customer Service Team of the Year (joint winner) – Haven Pharmacy McAleers, Finglas East, Dublin 11 sponsored by United Drug and presented by Customer Service Team of the Year (joint winner) – Haven Pharmacy McAleers, Finglas East, Veronica Carragher Dublin 11 sponsored by United Drug and presented by Veronica Carragher

Customer Service Team the(joint Yearwinner) (joint winner) Haven Pharmacy Brennans, Customer Service Team of theofYear – Haven –Pharmacy Brennans, Ballyboden, Ballyboden, Dublin by GSK and presented by Stuart Keegan Dublin 16 sponsored by16 GSKsponsored and presented by Stuart Keegan

Haven in the Community – Haven Pharmacy Gildeas, Kinnegad, Co. Westmeath sponsored by Graphite HRM and presented Moira Grassicksponsored by Haven in the Community – Haven Pharmacy Gildeas, Kinnegad,byCo. Westmeath Graphite HRM and presented by Moira Grassick

Haven Ambassador of the Year - Ann Doyle, Haven Pharmacy Brennans, Ballyboden, Dublin 16Year sponsored by Uniphar Retail Services and Ballyboden, presented by Haven Ambassador of the - Ann Doyle, Haven Pharmacy Brennans, Dublin 16 Billy Reidyby Uniphar Retail Services and presented by Billy Reidy sponsored

Haven Pharmacy Technician – Marie Nevin, Haven Pharmacy Butlers, Birr, Co. Offaly sponsored by–Teva Pharmaceuticals and presented Sinead Finucane Haven Pharmacy Technician Marie Nevin, Haven Pharmacy Butlers,by Birr, Co. Offaly sponsored by Teva Pharmaceuticals and presented by Sinead Finucane

Haven Digital Media Leader – Andre Barbosa, Haven Pharmacy Brennans, Mullingar, Westmeath sponsored byHaven HCS Business presented Haven DigitalCo. Media Leader – Andre Barbosa, Pharmacy Solutions Brennans, and Mullingar, Co. by Neil Phelan Westmeath sponsored by HCS Business Solutions and presented by Neil Phelan

Haven Professional Services – Haven Pharmacy Frawleys, Roscrea, Co. Haven Professional Services – Haven Pharmacy Frawleys, Roscrea, Co. Tipperary sponsored by Tipperary sponsored by Fitzgerald Power and presented by Noel Winters Fitzgerald Power and presented by Noel Winters

Haven Rising Star - Aine Madden, Haven Pharmacy Brennans, Cavan sponsored by Accord presented byPharmacy Gregg Farrell Haven RisingHealthcare Star - Aineand Madden, Haven Brennans, Cavan sponsored by Accord Healthcare and presented by Gregg Farrell

PHARMACYNEWSIRELAND.COM | 39


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Feature

Eyecare in Pharmacy Eye conditions, and eye discomfort or irritation are quite common for patients to present to the pharmacy with. Most of the time, a pharmacist will not have to refer a patient to a doctor, and can safely and effectively treat whatever symptoms a patient has using OTC products. Irish Pharmacy News looks at some common eye conditions that patients suffer from and some of the treatments which are available. STYES (hordeolum) Many people with eye or eyelid infections tend to self-diagnose before presenting in pharmacy, so it is important for them to be directed to the pharmacist if there is some element of infection suspected. Similarly, the pharmacist needs to ask the right questions and recognise symptoms to ensure the customer is given the right advice and treatment if required. Knowing what to recommend, how to treat, and when to refer is therefore essential. A stye is an infection of either an eyelash follicle or the accessory glands of the eyelashes. Styes develop when a gland at the edge of the eyelid becomes infected. Resembling a ‘pimple’ on the eyelid, often with a yellow spot of pus in the middle, styes can grow on the inside or outside of the lid. These can be quite painful and sometimes result in the swelling of the complete eyelid so that the eye presents as almost closed. Cause: Staphylococcal bacteria. Symptoms: Pain, redness, tenderness and swelling, as well as frequent watering of the eye. Treatment: Most styes are self-limiting and usually resolve within one to two weeks, but in community pharmacy OTC products can be recommended to alleviate the symptoms by inhibiting bacterial replication. Recommend an eye ointment which contains dibrompropamidine isetionate (such as Golden Eye etc) for use at night, which can be used in conjunction with propamidine isetionate drops during the day if required. Both of these agents act as an anti-infective for use in local infections of the superficial structures of the eye. These infections can include styes, conjunctivitis and blepharitis. Patients must be advised not to

To meet the sterility condition, multidose eyedrops traditionally contained a preservative

wear contact lenses during use of the ointment or drops.

 The eye looks cloudy face

Stopping use of eye make-up during treatment is recommended.

 Suspected injury to the eye

The key to successful management of a stye is to get the infection site to form a ‘point’. A clean warm compress held against the eye should help the stye to release the pus contents, thus relieving the discomfort. Patients must be advised never to attempt to burst the stye themselves.

 During pregnancy or breastfeeding

When to refer: Patients should be referred to a doctor if any of the following apply:  Disturbed vision  Severe pain within the eye  Photophobia (sensitivity to light)  Eye inflammation associated with a rash on the scalp or

42 | PHARMACYNEWSIRELAND.COM

Eyelid hygiene is essential to stop the spread of bacterial eye infections. Advice can be given such as: • Clean hands - avoid touching your eyes with dirty hands. This will reduce the risk of spreading or getting an eye infection. • Don’t rub your eyes - try to avoid rubbing or scratching your eyes as this can lead to an infection. • Don’t share personal items avoid sharing items like towels, flannels or make-up as this could pass on an infection.

• Cleaning your eyes - Any eye discharge should be gently cleaned from the eye area. Use a separate cotton wool pad soaked in water for each eye. Always wipe from the corner of the eye nearest the nose outwards to prevent cross-contamination of any infection into the other eye. • Contact lenses - always follow your optician’s instructions for cleaning your lenses and avoid wearing them for long periods of time. Always wash your hands before touching them. Supplied by Cambridge Healthcare PRESERVATIVES AND EYEDROPS Pharmaceutical regulations require an ophthalmic solution to meet criteria of stability, tolerance, activity and sterility. To meet the sterility condition, multidose eyedrops traditionally contained a preservative.


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Medicinal product not subject to medical prescription. Please consult the summary of product characteristics for information about dosage, method of use,side-effects, precautions, and contraindications, which can be found at: www.goldeneye.ie Cambridge Healthcare Supplies Ltd, Wymondham, NR18 9SB, United Kingdom

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Feature seeing more and more patients concerned about these symptoms,” explains Dr Pinney. “For some, dry eyes can be a chronic and persistent condition, which causes irritation on a daily basis, for others it means occasional periods of discomfort. Identifying the issue is a key step to healthier and more comfortable eyes.” Dry eye is often a natural part of getting older, but may be exacerbated by certain medications and other medical conditions. While these causes often can’t be changed, managing the condition is the key to healthy, comfortable eyes. Our increasing use of technology however, can trigger dry eye and adopting healthy habits around these can help ease some symptoms.

Preservatives; such as BAK, in eyedrops are toxic to the ocular surface

Although eyedrops are mostly well tolerated, especially when they are used in short-term treatments, in certain circumstances patients may frequently complain of stinging, burning, discomfort, irritation or eye dryness. In some cases, less frequently, conjunctivitis or corneal damage may occur, in particular in long-term treatment or during repeated concurrent use of several eyedrops. Quaternary ammonium salts, in particular benzalkonium chloride (BAK), are the most frequently used preservatives. They are also the most toxic for the ocular surface, even at low concentrations. They are responsible for modification of the tear film causing eye dryness and patient discomfort. In the past few years many observations and clinical studies have been published suggesting that preservatives (primarily BAK) are strongly implicated in the topical toxicity of eye drops, especially when these are used in long term treatment. The prolonged used of eyedrops containing preservatives can cause allergic or inflammatory reactions, either immediate or delayed, most often benign. The use of preserved eyedrops has been linked to more serious conditions, in some cases leading to intraocular lesions: chronic conjunctival fibrosis

(pseudopemphigoid), trabecular modifications, cataract, cystoid macular oedema, and failed glaucoma filtering surgery. Preservatives reduce the stability of the tear film by their detergent effect on the lipid layer. The changes in the tear film induce an increased evaporation and ocular dryness. The effects of preservatives on the tear film are closely linked to the development of inflammation and conjunctival metaplasia. Preservatives induce an infiltration of the conjunctiva by inflammatory cells (lymphocytes and macrophages). The intensity of this inflammatory response is related to the duration or the number of preserved eyedrops used. Patients receiving preservative-free eyedrops exhibit no inflammation. The preservative causes changes in the conjunctival epithelium. The loss of goblet cells is the first sign of squamous metaplasia. These histological modifications appear rapidly, two weeks after the start of a treatment with a preserved ophthalmic solution. The use of preserved eyedrops may in certain conditions (contact lens wear, ocular dryness, antiglaucoma treatment, during general anaesthesia or after surgery) be the cause of severe cell toxicity resulting in prolonged superficial keratitis and corneal

44 | PHARMACYNEWSIRELAND.COM

ulcers. Switching to an equivalent preservative-free solution can improve these conditions. Hence considering the occurrence of adverse effects (stinging, burning and dryness sensations, itching, hyperaemia) of ranging severity, it is advisable to restrict the use of preserved eyedrops and to replace them with preservative-free alternatives devoid of preservative related adverse effects. Supplied by TheaPamex DRY EYES Sitting close to the TV making your eyes square may be a myth, but staring at your computer screen for too long has been shown to increase symptoms of Dry Eye disease (DED). More people are suffering with symptoms of dry eye, sore and excessively watery eyes often triggered by too much time staring at computers and tablets. “Modern lifestyles are partly to blame for the increase in people experiencing problems such as dry eye. Symptoms can range from mild to severe but it’s important to know that people can and should do something about it,” says Dr Huw Pinney, Optometrist and Director at Brownbills in Ashford. “Dry eye is an increasingly common condition and we’re

When we’re concentrating the rate at which we blink decreases. We usually blink between 6 and 8 times a minute, but this can slow to once or twice a minute when we’re concentrating. This means that the tears that keep our eyes hydrated have more time to evaporate between blinks, contributing to dryness. 3 tips for keeping eyes healthy and hydrated: 1. See a specialist - Have an assessment with an optometrist or a pharmacist with a special interest in dry eye disease. They will be able to advise on the best way to manage the condition and keep your eyes healthy. 2. Have a digital detox - Bad habits when using computers are some of the most common reasons for irritable, dry eyes. It’s caused by concentration and not blinking as often as we should so it’s important to take regular screen breaks to give your eyes a much-needed rest. Try the 20:20:20 rule; every 20 minutes, look at something 20 feet away, for 20 seconds. 3. Heat Cleanse Hydrate - A comprehensive care routine is essential for managing both the day-to-day symptoms of dry eyes, but also the underlying causes. Supplied by Scope


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CPD 97: ALCOHOL AND MENTAL HEALTH PROBLEMS Biography - Since becoming owner of Whelehans, Eamonn Brady MPSI has striven to build and grow his business around his philosophy of placing his customer led, independent pharmacy firmly at the centre of his community and to extend its reach through engagement “outside the front door” with the public and local groups. At the core of Eamonn’s vision of his own role as a community pharmacist, is his belief that prevention is better than cure and to “help people to help themselves” through education and information initiatives delivered in a variety of ways.

Reflection - Is this area relevant to my practice? What is your existing knowledge of the subject area? Can you identify any knowledge gaps in the topic area?

Alcohol and Mental Health Problems

Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available?

Units of alcohol

Action - After reading the article complete the summary questions at www. pharmacynewsireland.com/cpdtraining and record your learning for future use and assessment in your personal log.

Alcohol is measured in units. A unit of alcohol is 10g of pure alcohol. This is about half a pint of lager or a single measure (25ml) of spirits. A small glass (125ml) of wine contains one and a half units of alcohol.

Evaluation - How will you put your learning into practice?

Increased-risk drinking

Have I identified further learning needs?

60 second summary Alcohol can be described as both a tonic and a poison. The difference between “tonic and poison” lies in the dose. A common Alcoholics Anonymous (AA) saying is “There is no problem that alcohol cannot make worse.” Of all the problems that alcohol can exacerbate, mental illness is one of the most common, serious, and frequently missed. Patients with mental illness, irrespective of the diagnosis, can face profound consequences when they misuse alcohol. Alcohol causes some depressive and anxiety syndromes, worsens others, always impairs sleep, and has harmful interactions with psychiatric medications. Thus, a person who drinks any amount of alcohol while receiving psychiatric treatment, especially pharmacologic treatment, should be advised to stop all use of alcohol. Of course, the addicted individual may not be able to stop his or her alcohol use and may need education about the interaction between addiction and mental illness, treatment of the addictive substance use, or even inpatient treatment of the addiction. Cessation of alcohol use is an important clinical goal but will most likely not be achieved overnight. The cessation of alcohol use does not guarantee the remission of psychiatric symptoms. Nonetheless, discontinuing alcohol use for the psychiatric patient is often necessary, partly to remove an impediment to effective treatment. Recent scientific studies have suggested that nearly one-third of people with mental illness experience alcohol abuse. Conversely, more than one-third of all alcohol abusers are also battling mental illness.

Increased-risk drinking is classified as regularly drinking 22 to 50 units of alcohol per week (men), or 15 to 35 units per week (women). However, binge drinking can be dangerous even if within the weekly limit. Binge drinking is drinking a lot of alcohol in a short time period, considered eight units in a day for men and six units in a day for women. Harmful drinking

drinking is stopped abruptly. Symptoms of alcohol withdrawal can be both physical and psychological in nature. Physical withdrawal symptoms include hand tremors (known as “the shakes'), nausea, sweating, visual hallucinations and seizures. Psychological withdrawal symptoms include depression, anxiety, irritability, restlessness and insomnia. Severely dependent drinkers can experience severe withdrawal symptoms leading to vicious circle of the person drinking to avoid withdrawal symptoms. Severely dependent drinkers can tolerate very high levels of alcohol, amounts that would comatose or even kill moderate drinkers. How do you know if you’re drinking too much alcohol?

Regularly drinking more 50 units of alcohol a week (men) or over 35 units a week (women) is classified as harmful drinking. This type of drinking can cause health problems like depression, alcoholrelated accidents and acute pancreatitis. Many health problems caused by harmful drinking do not cause symptoms for a number of years but can eventually lead to high blood pressure, heart disease, cirrhosis (scarring of the liver) and cancers such as mouth cancer and bowel cancer. Other problems include social problems such as relationship difficulties, unemployment, domestic violence, committing crimes and homelessness.

You could be drinking excessively if:

Dependent drinking

• Regularly go binge drinking

Alcohol is both physically and psychologically addictive and it is easy to become dependent on it. Alcohol dependence is an inability to function without it with drinking becoming an important or sometimes the most important aspect the person’s life. Depending on the level of dependence, withdrawal symptoms can occur if alcohol

• You feel you need to cut down on drinking • You feel guilty or ashamed about your drinking • Other people are critical of how much you drink • Sometimes have memory loss of drinking sessions • You need a drink first thing in the morning to settle nerves or ease a hangover • Drink at least a few drinks every day • Not doing as expected due to drinking (eg) missing an appointment or work due to being drunk or hungover. Alcohol problems and psychiatric problems It can be difficult to assess psychiatric complaints for patients who abuse or are dependent on alcohol because heavy


CPD 97: ALCOHOL AND MENTAL HEALTH PROBLEMS drinking associated with alcoholism can coexist with, contribute to, or result from several different psychiatric syndromes. In order to improve diagnostic accuracy, doctors can follow an algorithm that distinguishes among alcohol-related psychiatric symptoms and signs, alcohol-induced psychiatric syndromes, and independent psychiatric disorders that are commonly associated with alcoholism. The patient's gender, family history, and course of illness over time also should be considered to attain an accurate diagnosis. Alcoholism can complicate or mimic practically any psychiatric condition, thus making it difficult sometimes to accurately diagnose the nature of the psychiatric complaints. When alcoholism and psychiatric disorders co-occur, patients are more likely to become a dependent alcoholic, to attempt or commit suicide, and to require mental health services. DIAGNOSTIC DIFFICULTIES IN ASSESSING PSYCHIATRIC COMPLAINTS IN ALCOHOLIC PATIENTS In general, it is helpful to consider psychiatric complaints observed in the context of heavy drinking as falling into one of three categories: 1. Alcohol related symptoms and signs 2. Alcohol-induced psychiatric syndromes 3. Independent psychiatric disorders that co-occur with alcoholism. These three categories are discussed in the following sections. Alcohol-Related Psychiatric Symptoms and Signs Heavy alcohol use directly affects brain function and alters various brain chemicals (i.e., neurotransmitter) and hormonal systems known to be involved in the development of many common mental disorders (e.g., mood and anxiety disorders). For example, regular drinking reduces serotonin levels in the brain that can lead to lower mood and sometimes depression. Thus alcoholism can manifest itself in a broad range of psychiatric symptoms and signs. In fact, such psychiatric complaints often are the first problems for which an alcoholic patient seeks help. The patient's symptoms and signs may vary in severity depending upon the amounts of alcohol used, how long it was used, and how recently it was used, as well as on the patient's individual vulnerability to experiencing psychiatric symptoms in the setting of excessive alcohol consumption. For example, during acute intoxication, smaller amounts of alcohol may produce euphoria, whereas larger amounts may be associated with more dramatic changes in mood, such as sadness, irritability, and nervousness. Alcohol's disinhibiting properties may also impair judgment and unleash aggressive,

antisocial behaviors that may mimic certain externalizing disorders, such as antisocial personality disorder (ASPD). In addition to the direct pharmacological effects of alcohol on brain function, psychosocial stressors that commonly occur in heavy-drinking alcoholic patients (e.g., legal, financial, or interpersonal problems) may indirectly contribute to ongoing alcohol-related symptoms, such as sadness, despair, and anxiety. Alcohol-Induced Psychiatric Syndromes Given the broad range of effects heavy drinking may have on psychological function, these alcohol-induced disorders span several categories of mental disorders, including mood, anxiety, psychotic, sleep, sexual, delirious, amnestic, and dementia disorders. The essential feature of all these alcohol-induced disorders is the presence of prominent and persistent symptoms, which are judged based on their onset and course as well as on the patient's history, physical exam, and laboratory findings to be the result of the direct physiological effects of alcohol. Alcohol-induced psychiatric disorders may initially be indistinguishable from the independent psychiatric disorders they mimic. However, what differentiates these two groups of disorders is that alcohol–induced disorders typically improve on their own within several weeks of abstinence without requiring therapies beyond supportive care. Thus, the course and prognosis of alcohol-induced psychiatric disorders are different from those of the independent major psychiatric disorders.

PSYCHIATRIC DISORDERS COMMONLY ASSOCIATED WITH ALCOHOLISM Independent Major Depression According to drinkaware.co.uk, people in Britain who experience anxiety or depression are twice as likely to be heavy or problem drinkers. Warning signs that alcohol is affecting mood include: • disturbed sleep • feeling lethargic and tired all the time • low mood • experiencing anxiety in situations where you would normally feel comfortable Mood disturbances (which frequently are not severe enough to qualify as "disorders") are arguably the most common psychiatric complaint among treatment–seeking alcoholic patients, affecting upwards of 80 percent of alcoholics at some point in their drinking careers (Brown and Schuckit 1988; Anthenelli and Schuckit 1993). In keeping with the three broad categories described above into which such complaints may fall, mood problems may be characterized as one of the following: • An expected, time-limited consequence of alcohol's depressant effects on the brain • A more organized constellation of symptoms and signs (i.e., a syndrome) reflecting an alcohol-induced mood disorder with depressive features

Alcoholism with Comorbid, Independent Psychiatric Disorders

• An independent major depressive disorder coexisting with or even predating alcoholism.

Alcoholism is also associated with several psychiatric disorders that develop independently of the alcoholism and may precede alcohol use and abuse. These independent disorders may make certain vulnerable patients more prone to developing alcohol-related problems. One of the most common of these comorbid conditions is personality disorder often marked by a longstanding pattern of irresponsibility and violating the rights of others that generally predates the problems with alcohol. Other psychiatric disorders associated with alcoholism include obsessive-compulsive disorder, anxiety, anxiety disorders (e.g., social phobia, panic disorder, and post-traumatic stress disorder) eating, mood, psychotic, sleep, and drug-related disorders., schizophrenia, and major depression. It is important for clinicians to know which disorders are most likely to coexist with alcoholism so that they may specifically probe for these conditions when evaluating the patient's complaints.

Approximately 30 to 40 percent of alcoholics experience a major depressive disorder (Anthenelli and Schuckit 1993; Schuckit et al. 1997a). Some controversy exists as to the precise cause-and-effect relationship between depression and alcoholism, with some authors pointing out that depressive episodes frequently predate the onset of alcoholism, especially in women (Kessler et al. 1997; Helzer and Przybeck 1988; Hesselbrock et al. 1985). Several studies found that approximately 60 percent of alcoholics who experience a major depressive episode, especially men, found that the depressive episode was induced by alcohol. (Schuckit et al. 1997a; Davidson 1995). The remaining approximately 40 percent of alcoholic women and men who suffer a depressive episode likely have an independent major depressive disorder that is, they experienced a major depressive episode before the onset of alcoholism or continue to exhibit depressive symptoms and signs even during lengthy periods of abstinence.


CPD 97: ALCOHOL AND MENTAL HEALTH PROBLEMS Among manic patients, 50-60 percent abuse or become dependent on alcohol or other drugs (AODs) at some point in their illness (Brady and Sonne 1995). Diagnosing bipolar disorder in alcoholic patients can be particularly challenging. Several factors, such as the underreporting of symptoms (particularly symptoms of mania), the complex effects of alcohol on mood states, and common features shared by both illnesses (e.g., excessive involvement in pleasurable activities with high potential for painful consequences) reduce diagnostic accuracy. Bipolar patients are also likely to abuse drugs other than alcohol (e.g., stimulant drugs such as cocaine or methamphetamine), further complicating the diagnosis. It can be helpful for an accurate diagnosis to obtain a careful history of the chronological order of both illnesses because approximately 60 percent of patients with both alcoholism and bipolar disorder started using AODs before the onset of affective episodes (Strakowski et al. 2000). Although it is important to distinguish major depression from depression due to alcohol consumption, clinicians rarely have the opportunity to wait 3 weeks to delineate the two disorders. Allowing a patient to suffer depressive symptoms any longer than necessary while waiting for a firm diagnosis is unnecessary. Rather than waiting for depressive symptoms to resolve, clinicians should treat both alcoholism and depression simultaneously and in an integrated manner. For example, the cessation of drinking should be treated as an essential component of recovery from depression. The clinician should provide clear instruction on how to avoid drinking. This instructive style often involves a paradigm shift for the therapist more attuned to the mental illness alone. Rather than remain neutral or give interpersonal or instructional interpretations, the person offering the treatment should involve a coaching role, where direct suggestions are made and behavioral change is strongly supported and encouraged. This psychotherapeutic stance is well-described in the motivational interviewing literature. Bi-polar disorder Bipolar disorder co-occurs with alcohol dependence more than any other mental illness. In a study of patients with bipolar disorder and alcoholism, patients who had primary alcoholism (unrelated to their bipolar disorder) were less likely to experience remission from their alcoholism. Bipolar patients with alcoholism have been shown to suffer more cognitive dysfunction and attempt suicide more often. The high prevalence and serious consequences of bipolar disorder combined with alcoholism necessitate

aggressive treatment for this combination of illnesses. Since impaired judgment, grandiosity, and irritability all promote excessive alcohol use, the clinician must address the mania and alcohol use together. Psychoeducation often serves as a useful warning about the dangers of further alcohol use. Psychotherapeutic methods can include group therapies with others who suffer from bipolar disorder, and relapse-prevention teaching. Medications such as sodium valproate (Epilim) and carbamazepine (Tegretol) are often used as mood stabilizers and can also serve as detoxification agents from alcohol.

benzodiazepine, must be used to treat an anxiety syndrome in an addicted person. In this circumstance, the treating clinician must carefully weigh the riskbenefit profile of the particular medication for a particular patient, and closely monitor the patient for side effects and addictive behaviors. Opinions on whether benzodiazepines should ever be used in the addicted patient vary widely in the field, and few studies examine this question. There is scant data-based evidence to support any clear perspective, so each clinician is obliged to make an individual decision based on the patient’s best interests.

Anxiety Disorders

Schizophrenia

Overall, anxiety disorders do not seem to occur at much higher rates among alcoholics than among the general population (Schuckit and Hesselbrock 1994). Specific anxiety disorders, such as panic disorder, social phobia, and PTSD, however, appear to have an increased co-occurrence with alcoholism (Schuckit et al. 1997b; Kranzler 1996; Brady et al. 1995). For example, even though panic disorder with agoraphobia occurs in the general population at approximately 6.1%, alcoholics suffer from panic disorder at a rate of up to 21%.

Patients with schizophrenia frequently use and misuse alcohol. For patients with schizophrenia, the lifetime prevalence of alcohol use disorder is in the 50% range according to studies. First psychotic breaks are difficult to diagnose and treat, and the addition of alcohol or any other mood-altering substance confuses the issue even further. Avoiding premature diagnostic closure in this scenario is even more important than with other psychiatric illnesses: the person misdiagnosed with schizophrenia because of intervening intoxicant use will face a lifetime of attempting to shed the diagnosis and receive the proper treatment.

The problem for the anxious alcoholic remains that alcohol initially treats anxiety, which worsens it later on. The immediate-term relief of medicating alcohol withdrawal with a drink in the morning or the reduction of painful anxiety with a few drinks overwhelms the intellectual understanding that alcohol will only make matters worse down the line. At a deeper level, the use of alcohol may function as a medication, as well as a way for the sufferer to assert control over her emotions. As with alcohol-induced depression, it is important to differentiate alcohol-induced anxiety from an independent anxiety disorder. This can be achieved by examining the onset and course of the anxiety disorder. Thus, symptoms and signs of alcohol-induced anxiety disorders typically last for days to several weeks, tend to occur secondary to alcohol withdrawal, and typically resolve relatively quickly with abstinence and supportive treatments (Kranzler 1996; Brown et al. 1991). In contrast, independent anxiety disorders are characterized by symptoms that predate the onset of heavy drinking and which persist during extended sobriety. As always, less potentially harmful treatments are preferred initially, including supportive psychotherapy, cognitive-behavioral psychotherapy, hypnosis, and acupuncture. However, there are some cases where a potentially addictive substance such as

Patients with schizophrenia use alcohol for a number of reasons. First, alcohol is an easily available, fast-acting agent that quells the fears and pain of becoming psychotic. Second, alcohol use can be one of the few easy social experiences available to long-term schizophrenics with few friends and impaired social skills. The rituals of drinking, whether in a bar or on a street corner, fosters an easy acceptance among “drinking buddies.” Finally, alcohol is legal, easily obtainable, and relatively inexpensive, making it an attractive intoxicant for the schizophrenic, who may not be able to muster the skills or cash to obtain other substances. Since all antipsychotics are metabolized by the liver, patients with schizophrenia may need vigilant monitoring of their liver functioning and a dosage adjustment if they are in liver failure. A period of abstinence from alcohol is important in making definite diagnoses in forming a treatment plan. Psychosis Extreme levels of drinking (such as more than 30 units per day for several weeks) can occasionally cause ‘psychosis’. It’s a severe mental illness where hallucinations and delusions of persecution develop. Psychotic symptoms can also occur when very heavy drinkers suddenly stop drinking and develop a condition known as ‘delirium tremens’ symptoms include body tremors and confusion.


CPD 97: ALCOHOL AND MENTAL HEALTH PROBLEMS

Alcohol-related psychosis spontaneously clears with discontinuation of alcohol use and may resume during repeated alcohol exposure. Distinguishing alcohol-related psychosis from schizophrenia or other primary psychotic disorders through clinical presentation often is difficult. It is generally accepted that alcohol-related psychosis remits with abstinence, unlike schizophrenia. Some characteristics that may help differentiate alcohol-induced psychosis from schizophrenia are that alcoholinduced psychosis shows later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment. Alcohol withdrawal psychosis is a symptom of alcohol withdrawal and should be treated in the context of alcohol withdrawal. Treatment is initiated with cautious use of oral or intramuscular benzodiazepines. Lorazepam (Ativan) at 1-2 mg or chlordiazepoxide (Librium) at 25-50 mg PO or IM is used commonly and should be under the guidance of an expert in this area. The dose of benzodiazepine is tapered over the next 5-7 days. In the event patients are in danger of harming themselves or others, rapid sedation should be initiated with a high-potency antipsychotic drug such as haloperidol at 5-10 mg PO or IM, frequently given with anticholinergics (e.g. akineton) which can be given PO or IM to prevent extrapyramidal adverse effects. Antipsychotics may lower the seizure threshold and should not be used to treat withdrawal symptoms unless absolutely necessary and used in combination with a benzodiazepine or antiseizure medications (eg, Sodium Valproate (Epilim) or carbamazepine (Tegretol). Treatment may include thiamine at 100 mg parentally followed by supplemental thiamine at 100 mg 3 times a day, folic acid at 1 mg, and a daily multivitamin. Antisocial personality disorder (ASPD) Antisocial personality disorder (ASPD) has long been recognized to be closely associated with alcoholism (Lewis et al. 1983). Epidemiologic analyses found that compared with non-alcoholics, alcohol-dependent men are 4-8 times more likely, and alcoholic women are 12-17 times more likely, to have comorbid ASPD (Helzer and Przybeck 1988; Kessler et al. 1997). Thus, approximately 15 to 20 percent of alcoholic men and 10 percent of alcoholic women have comorbid ASPD, compared with 4 percent of men and approximately 0.8 percent of women in the general population. Patients with ASPD are likely to develop alcohol dependence

at an earlier age than their non-antisocial counterparts and are also more prone to having other drug use disorders (Cadoret et al. 1984; Anthenelli et al. 1994). Inquiring About Alcohol Use When Evaluating Psychiatric Complaints Patients seldom volunteer information about their alcohol use patterns and problems when they present their psychiatric complaints (Helzer and Przybeck 1988; Anthenelli and Schuckit 1993; Anthenelli 1997). Unless they are asked directly about their alcohol use, the patients' denial and minimization of their alcohol–related problems lead them to withhold this important information, which makes assessment and diagnosis difficult. In addition, heavy alcohol use can impair memory, which may make the patient's information during history-taking less reliable. Therefore, clinicians should gather information from several resources when assessing patients with possible alcohol-related problems, including collateral informants (e.g., a spouse, relative, or close friend), the patient's medical history, laboratory tests, and a thorough physical examination. A review of the patient's medical records is another potentially rich source of information. This review should look for evidence of previous psychiatric complaints or of laboratory results that might further implicate alcohol in the patient's psychiatric problems (Allen et al. 2000). Pertinent laboratory results could include positive breath or blood alcohol tests; an elevation in biochemical markers of heavy drinking, such as the liver enzyme gamma-glutamyl transferase (GGT); and changes in the mean volume of the red blood cells (i.e., mean corpuscular volume), which also is an indicator of heavy drinking. Alcohol’s effect in memory Soon after drinking alcohol, your brain processes slow down and memory can be impaired. After large quantities of alcohol, the brain can stop recording into the ‘memory store’. That’s why people can wake up the next day with a ‘blank’ about what they said or did and even where they were. This short-term memory failure or ‘black out’ doesn’t mean that brain cells have been damaged, but frequent heavy sessions can damage the brain because of alcohol’s effect on brain chemistry and processes. Drinking heavily over a long period of time can also have long-term effects on memory. As a person ages, the brains shrinks at an average of approximately 2% per decade. However heavy drinking accelerates the shrinkage of key areas in the brain leading to memory loss and other symptoms of dementia. Heavy

drinking can also lead to mild but potentially debilitating problems including a person’s ability to plan, make judgments, solve problems and perform complex tasks which most people can perform to allow normal function. As well as causing damage to the brain, heavy drinking can cause nutritional deficiencies such a vitamin b deficiency which when severe can cause dementia. Treatment Medications tailored for the treatment of alcoholism can be of significant use in the mentally ill population. Psychiatric medications rarely have interactions with anti-alcoholism medications. Medications such as benzodiazepines and barbiturates may be used in the acute phase of detoxification. A mood stabilizer can simultaneously effectively treat withdrawal and bipolar mania. Naltrexone may be used with the mentally ill patient, as with other patients, with the hope that it will act as an anti-craving agent which also increases time to first drink and amount that the relapsing patient drinks. Disulfiram, while arguably more effective than naltrexone, does present some problems for the mentally ill alcoholic. Patients prescribed disulfiram must understand that alcohol combined with disulfiram will cause an uncomfortable reaction. The patient must be motivated to avoid that reaction. If the depressed patient is so cognitively impaired that he/ she cannot understand the risk/benefit profile of disulfiram, the medication should not be prescribed. A special consideration for the schizophrenic patient is that disulfiram inhibits aldehyde dehydrogenase activity, which might cause an increase in synaptic dopamine and a worsened psychosis. Similarly, if the treating physician believes that the patient exhibits self-destructive traits and might provoke a disulfiram reaction intentionally, the medication should not be prescribed. These problematic scenarios are extremely rare: most mentally ill alcoholics are candidates for a discussion about disulfiram. One study that appeared in the American Journal of Addiction found that of 33 severely mentally ill patients administered disulfiram, 64% experienced remission for at least 1 year. The medication was also associated with a decrease in days hospitalised. However, 28% of schizophrenic subjects experienced disulfiram reactions, and there was no change in work status. The benefits shown in the study demonstrated that although disulfiram must be carefully considered for the mentally ill individual, it has a place in the treatment programme. (Mueser KT, Noordsy DL, Fox L, Wolfe R). • References available on request


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DYNAMIC 100 - 2018 Coaching Pharmacists to business success Karen Ahern is a pharmacy leader, pioneering Self Care and Wellness Programmes in smoking cessation and winter wellness consultation days. As 4Front Pharmacy Solutions Wellness Programme Co-ordinator, and Client Relationship Manager, she supports pharmacy owners with ethical, legal and financial due diligence to enhance the value of their pharmacy business through coaching and training. Committed to CPD, Karen is currently upgrading her knowledge and skill by participating in the Irish Institute of Training & Development's (IITD) Professional Practice Certificate in Training & Development, to further develop 4Front Pharmacy Solutions services to support pharmacy owners and their businesses, for example through Onsite Pharmacy Assessment System and Action Plan Review and Solution Development.  In November 2017, Karen was delighted to be named the ICF Health & Wellness Coach of the Year sponsored by Irish Life Health for "demonstrating significant commitment to health and wellness of their clients." This year, she has pioneered 4Front's Self-Care and Wellness Programmes in Smoking Cessation and Winter Wellness Consultation Days. Karen Ahern, Pharmacist, Health & Wellness Coach

Continued growth for totalhealth John Arnold is Managing Director of the totalhealth Pharmacy Group, which has enjoyed continued growth during 2018, with membership increasing to 73 pharmacies in 2018. Services offered to members have continued to be developed, with a keen focus on business intelligence and technology solutions for claims management, performance insight, and ordering efficiency, along with support for staff development, front-of-shop maximisation and pharmacy marketing. Proud to work for a committed group of independent pharmacists who support each other on an equal basis within totalhealth, he believes that independent pharmacists are one of the most important health resources in Ireland, who have patients at the heart of everything they do. The role of totalhealth is to free up pharmacists’ time so they can focus more on their patients. Highlights of 2018 include the multiple industry award nominations for the Group and its members and the Group’s sponsorship of the Connacht Rugby Junior Summer camps. John Arnold, Managing Director, totalhealth Pharmacy Group

Passion leads to promotion Within only two years of working in a dispensary setting, Michelle Ashe has earned her place in a supervisory capacity over the entire shop at Chemo Pharmacy. In 2016 before commencing work with Chemco Pharmacy, Michelle worked solely in the front of shop. She had never stepped foot into a dispensary but was incredibly eager and expressed an interest to learn so she was given the opportunity to undertake the IPU Technician’s Course. She balanced her coursework, working full time and being a mother. Michelle runs the Methadone section of her pharmacy. Early this year she was promoted to Shop Senior and is finishing up her final submission for her IPU Technician’s course. Michelle Ashe, Pharmacy Technician, Chemco Pharmacy

PHARMACYNEWSIRELAND.COM | 53


DYNAMIC 100 - 2018 Putting Self-Care on the healthcare agenda Dave Barrett, Country Manager at GSK Consumer Healthcare Ireland, has this year implemented the collaboration between IPU and IPHA to raise public awareness of self-care launching the initiative ‘Self Care: Taking Charge of your Health.’ The initiative aims to educate people on what self-care actually is and why it is so important within a changing Ireland, where the population is both increasing and ageing, where there is significant private sector involvement within the healthcare industry and when the public expectations are growing for hope of new treatments which are financially challenging to the State.

Dave Barrett, Country Manager, GSK Consumer Healthcare Ireland

This collaboration highlights that the way in which self-care is defined and implemented in Ireland can make a long-term difference to overall health as prevention is better than cure. It expands the role of the pharmacist within the community, as they can play a crucial role in providing information for the public to make informed choices regarding their self-care.

Leader in Corporate Finance for pharmacy During the last 12 months Jason Bradshaw has continued to lend his expertise to community pharmacists on financial planning. A partner with JPA Brenson Lawlor Chartered Accountants, Jason has more than 15 years’ experience specialising in Corporate Finance for the community pharmacy sector, including providing services in buying and selling of pharmacies, setting up green-field pharmacies, pharmacy valuations and advice on business strategy. He regularly writes articles in pharmacy sector magazines and provides business lectures to the pharmacy students in the Royal College of Surgeons in Ireland (RCSI) and to University College Cork (UCC). JPA Brenson Lawlor also provides awards/Bursary’s for each of the pharmacy colleges; UCC - “The JPA Brenson Lawlor Exceptional Citizen and Future Leader” and the RCSI "Leadership" Award. In addition, he provides one-to-one meeting with interested pharmacists in order to assist them with acquiring their first pharmacy. Jason is a Fellow Chartered Accountant, having qualified in 2002 and completed a Management Study Programme with Harvard Business School in 2008.

Jason Bradshaw, Partner, JPA Brenson Lawler

Placing the customer first Eamonn Brady, Owner of Whelehan’s Pharmacy, has this year continued to build and grow his business around his philosophy of placing the customer-led, independent pharmacy firmly at the centre of his community. He has worked at extending its reach through engagement “outside the front door” with the public and local groups. At the core of his vision is his belief that prevention is better than cure and to “help people to help themselves” through education and information initiatives delivered in a variety of ways.

Eamon Brady MPSI, Superintendent Pharmacist, Whelehan's Pharmacy

These range from his “Ask the Pharmacist” columns and “condition specific” articles in local and national press, to the wide variety of subjects covered in public health talks hosted by Whelehan's, which now attract leading experts and speakers as well as sizable audiences. In addition, Eamonn has taken his education-led initiatives into local schools, both primary and secondary level to help educate and inform the communities of the future.

Technology at the heart of pharmacy Dan Burns, Allcare Pharmacy, is passionate about advancing the role of community pharmacists and pharmacy within the health system and is a firm believer that technology has potential to deliver more efficient, safer care. Burns looks after the regulatory requirements of more than 40 Uniphar-owned Allcare Pharmacies in the Group. A finalist in the Irish Pharmacy Awards 2018 for the Teva Superintendent Pharmacist of the Year, he has been instrumental in reminding, reassuring and promoting pharmacists as a vital resource in caring for their local communities and is adept at linking Allcare health promotional activities in tandem with national health campaigns.

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Dan Burns, Superintendent Pharmacist, Allcare Pharmacy


Growing sales at KRKA In Daniel Byers’ first year as General Manager with KRKA Pharmaceuticals Ireland, the company grew in sales by 24%. KRKA are working towards similar levels of growth again in 2018. Appointed in 2017, Daniel has progressed to his current position since first joining the company in early 2011, when KRKA entered the Irish market. Mid 2017, Daniel and his team launched into the hospital sector and have enjoyed triple digit sales growth to date. New OTC launches have also been a big part of KRKA’s focus with two new OTC products launched in 2017 and more on the horizon. In the short time since January 2017 KRKA have grown from the 8th largest supplier of prescription medicines in the state to 5th, a jump of just under 2% market share. Daniel and the whole team in KRKA remain focused on growing their presence in the Irish market.

Daniel Byers, General Manager, KRKA Pharmaceuticals Ireland

Leading pharmacy school to new heights During 2018, Professor Stephen Byrne has led the School of Pharmacy in University College Cork (UCC) from strength to strength. The School has increased its Postgraduate student numbers on its distance learning degree programmes while also starting a new postgraduate certificate focused on the Biopharmaceutical Sector. The School, in association with APPEL, has successfully placed its 4th year students on their MPharm - 4 month placements. This is the first time the pharmacy students have been placed on such placements in Ireland. Professor Stephen Byrne, Senior Lecturer Clinical Pharmacy, UCC

Professor Byrne’s research group has continued to publish a number of papers in the last year exploring where pharmacy can play a role in prescribing medicines in an older population and also reviewing the impact of computerized decision support systems, and how electronic prompts may impact on patient care.

KRKA Counter Assistant of the Year 2018 Phil Cahill, who works with Adrian Dunne Pharmacy in Trim, won the KRKA Counter Assistant of the Year Award 2018 due to all of her knowledge and experience spanning over three decades. Adrian Dunne customers have great respect for Phil with many attending the store to ask for her expertise and OTC advice. She takes the time to bridge the divide between pharmacist and customer, by introducing them and explaining in more detail the services that are on offer. Phil excels at her position with her colleagues saying, "she completely embodies what a great counter assistant should be."

Phil Cahill, Counter Assistant, Adrian Dunne Pharmacy

Delivering savings to community pharmacists Axium Buying Group are continuously improving their systems with value-added features implemented each year, many of which were suggested by its members. Pharmacist John Carroll founded and established Axium Buying Group in 2009 and the Group is now the largest independent community pharmacy buying group in Ireland, servicing over 400 independent pharmacies, delivering savings on products for members through daily supplier negotiations, ordering and advisory services. John Carroll, Pharmacist and Founder of Axium buying group

In 2015, Carroll established CarePlus Pharmacy, Ireland’s fastest growing pharmacy franchise group for independent community pharmacy owners, located in over 60 towns and cities across the country

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IBRANCE® + AI and IBRANCE® + fulvestrant1

JOINING FORCES, CHANGING THE OUTLOOK1 As a 1st line breakthrough therapy for mBC, IBRANCE® + letrozole has demonstrated >2 years mPFS.*2 And, when combined with fulvestrant, it offers enhanced efficacy to a wide patient population.*3

IBRANCE® is indicated for the treatment of HR+/HER2- locally advanced or mBC:1 • in combination with an AI • in combination with fulvestrant in patients who have received prior ET In pre- or peri-menopausal women, the ET should be combined with a LHRH agonist1

IBRANCE® (PALBOCICLIB) PRESCRIBING INFORMATION: Please refer to the Summary of Product Characteristics (SmPC) before prescribing IBRANCE 75 mg, 100  mg or 125  mg hard capsules. Presentation: Hard capsules containing 75  mg, 100  mg or 125  mg palbociclib. Indications: Treatment of hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER2) negative locally advanced or metastatic breast cancer: in combination with an aromatase inhibitor; in combination with fulvestrant in women who have received prior endocrine therapy. In pre- or perimenopausal women, the endocrine therapy should be combined with a luteinizing hormone releasing hormone (LHRH) agonist. Dosage: Therapy should be initiated and supervised by a  physician experienced in the administration of anti-cancer medicinal products. The recommended dose is 125 mg of palbociclib once daily for 21  consecutive days followed by 7  days off treatment (Schedule  3/1) to comprise a  complete cycle of 28  days. Treatment of pre/perimenopausal women with the combination of palbociclib plus letrozole should always be combined with an LHRH agonist (see SmPC section 4.4). Capsules should be swallowed (should not be chewed, crushed, or opened prior to swallowing). It should be taken with food, preferably a  meal to ensure consistent palbociclib exposure (see SmPC section 5.2). Palbociclib should not be taken with grapefruit or grapefruit juice (see SmPC section 4.5). Dose modification of IBRANCE is recommended based on individual safety and tolerability. Management of some adverse reactions may require temporary dose interruptions/delays, and/or dose reductions, or permanent discontinuation. For dose reduction guidelines for management of adverse reactions, haematologic and non-haematologic toxicities, refer to SmPC section 4.2. For patients who experience a maximum of Grade 1 or 2 neutropenia in the first 6  cycles, complete blood counts for subsequent cycles should be monitored every 3 months, prior to the beginning of a cycle and as clinically indicated. No dose adjustments of IBRANCE are required for patients with mild or moderate hepatic impairment (Child-Pugh classes A  and B) For patients with severe hepatic impairment (Child-Pugh class C), the recommended dose of IBRANCE is 75 mg once daily on Schedule 3/1 (see SmPC section  5.2). No dose adjustments of IBRANCE are required for patients with mild, moderate or severe renal impairment (creatinine clearance [CrCl] ≥15 mL/min) (see SmPC section 5.2). No dose adjustment of IBRANCE is necessary in patients ≥65  years of age (see section 5.2).

Contraindications: Hypersensitivity to the active substance or to any of the excipients (see SmPC section 6.1) use of preparations containing St. John’s Wort (see SmPC section 4.5). Warnings and Precautions: Ovarian ablation or suppression with an LHRH agonist is mandatory when pre/ perimenopausal women are administered IBRANCE in combination with an aromatase inhibitor, due to the mechanism of action of aromatase inhibitors. Palbociclib in combination with fulvestrant in pre/perimenopausal women has only been studied in combination with an LHRH agonist. Dose interruption, dose reduction, or delay in starting treatment cycles is recommended for patients who develop Grade 3  or 4  neutropenia. Appropriate monitoring should be performed (see SmPC sections 4.2 and 4.8). Since IBRANCE has myelosuppressive properties, it may predispose patients to infections. Infections have been reported at a  higher rate in patients treated with IBRANCE in randomised clinical studies compared to patients treated in the respective comparator arm. Grade 3  and Grade 4 infections occurred respectively in 4.5% and 0.7% of patients treated with IBRANCE in any combination (see SmPC section 4.8).Patients should be monitored for signs and symptoms of infection and treated as medically appropriate (see SmPC section 4.2). Physicians should inform patients to promptly report any episodes of fever. Strong inhibitors of CYP3A4 may lead to increased toxicity (see SmPC section 4.5). Avoid concomitant use of strong CYP3A inhibitors during treatment with palbociclib. Coadministration should only be considered after careful evaluation of the potential benefits and risks. If coadministration with a strong CYP3A inhibitor is unavoidable, reduce the IBRANCE dose to 75 mg once daily. When the strong inhibitor is discontinued, increase the IBRANCE dose (after 3–5  half-lives of the inhibitor) to the dose used prior to the initiation of the strong CYP3A inhibitor (see SmPC section 4.5). Coadministration of CYP3A inducers may lead to decreased palbociclib exposure and consequently a risk for lack of efficacy. Therefore, concomitant use of palbociclib with strong CYP3A4 inducers should be avoided. No dose adjustments are required for coadministration of palbociclib with moderate CYP3A inducers (see SmPC section 4.5). Women of childbearing potential or their male partners must use a highly effective method of contraception while taking IBRANCE (see SmPC section 4.6). IBRANCE contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-

galactose malabsorption should not take this medicine. Drug Interactions: The concomitant use of strong CYP3A inhibitors including, but not limited to: clarithromycin, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, nefazodone, nelfinavir, posaconazole, saquinavir, telaprevir, telithromycin, voriconazole, and grapefruit or grapefruit juice, should be avoided (see sections 4.2 and 4.4). No dose adjustments are needed for mild and moderate CYP3A inhibitors. The concomitant use of strong CYP3A inducers including, but not limited to: carbamazepine, enzalutamide, phenytoin, rifampin, and St. John’s Wort should be avoided (see SmPC sections 4.3  and 4.4). No dose adjustments are required for moderate CYP3A inducers. The dose of sensitive CYP3A substrates with a  narrow therapeutic index (e.g., alfentanil, cyclosporine, dihydroergotamine, ergotamine, everolimus, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus) may need to be reduced when coadministered with IBRANCE as IBRANCE may increase their exposure. Based on in vitro data, palbociclib is predicted to inhibit intestinal P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) mediated transport. Therefore, administration of palbociclib with medicinal products that are substrates of P-gp (e.g., digoxin, dabigatran, colchicine, pravastatin) or BCRP (e.g., rosuvastatin, sulfasalazine) may increase their therapeutic effect and adverse reactions. Based on in vitro data, palbociclib may inhibit the uptake transporter organic cationic transporter OCT1 and then may increase the exposure of medical product substrates of this transporter (e.g., metformin). Pregnancy & Lactation: Females of childbearing potential who are receiving this medicinal product, or their male partners should use adequate contraceptive methods (e.g., double-barrier contraception) during therapy and for at least 3 weeks or 14 weeks after completing therapy for females and males, respectively (see SmPC section 4.5). There are no or limited amount of data from the use of palbociclib in pregnant women. Studies in animals have shown reproductive toxicity (see SmPC section 5.3). IBRANCE is not recommended during pregnancy and in women of childbearing potential not using contraception. Based on male reproductive organ findings (seminiferous tubule degeneration in testis, epididymal hypospermia, lower sperm motility and density, and decreased prostate secretion) in nonclinical safety studies, male fertility may be compromised by treatment with palbociclib (see SmPC section 5.3). Thus, men may

*Based on results from a Phase III RCT. AI = aromatase inhibitor; ET = endocrine therapy; HR+/HER2– = hormone receptor positive, human epidermal growth factor receptor 2 negative; LHRH = luteinising hormone–releasing hormone; mBC = metastatic breast cancer; mPFS = median progression–free survival; RCT = randomised controlled trial. 1. IBRANCE® Summary of Product Characteristics. 2. Finn RS, et al. N Engl J Med 2016;375:1925-36. 3. Cristofanilli M, et al. Lancet Oncol. 2016;17(4):425-439. Date of Preparation: August 2018 PP-IBR-IRL-0187

consider sperm preservation prior to beginning therapy with IBRANCE. Driving and operating machinery: IBRANCE may cause fatigue and patients should exercise caution when driving or using machines. Side Effects: The most common (≥20%) adverse reactions of any grade reported in patients receiving palbociclib in randomised clinical studies were neutropenia, infections, leukopenia, fatigue, nausea, stomatitis, anaemia, alopecia, and diarrhoea. The most common (≥2%) Grade ≥3 adverse reactions of palbociclib were neutropenia, leukopenia, anaemia, fatigue, and infections. Dose reductions or dose modifications due to any adverse reaction occurred in 34.4% of patients receiving IBRANCE in randomised clinical studies regardless of the combination.Very common adverse events (>1/10) are neutropenia, infections, leukopenia, fatigue, anaemia, asthenia, pyrexia, nausea, stomatitis, alopecia, diarrhoea, thrombocytopenia, vomiting, rash, decreased appetite. Commonly reported adverse events (>1/100 to <1/10), are dry skin, AST increased, dysgeusia, epistaxis, ALT increased, lacrimation increased, vision blurred, dry eye, febrile neutropenia. Refer to SmPC for further information on side effects. Refer to section 4.8 of the SmPC for further information on side effects, including description of selected adverse reactions. Legal  Category: S1A. Marketing Authorisation Numbers: EU/1/16/1147/001 – 75mg (21  capsules); EU/1/16/1147/003 – 100mg (21  capsules) EU/1/16/1147/005 – 125mg (21 capsules). Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at EUMEDINFO@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer  Building  9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500. This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 of the SmPC for how to report adverse reactions. Last revised: 07/2018 Ref: IB 4_0


DYNAMIC 100 - 2018 Sarah’s success in training programme delivery Since qualifying as a Pharmacist in 2013, Sarah Chambers to date has had an extremely successful career. This culminated in her winning of the IPN 'Young Pharmacist of the Year’ Award in 2017. In April 2018 Sarah joined the Irish Institute of Pharmacy (IIOP) as a CPD Quality Assurance Pharmacist. In her role she works with Peer Pharmacists to develop the content of the IIOP Practice Review events. Sarah was instrumental in the delivery of the first ever IIOP Practice Review event, which also took place in April of this year, as well as the second Practice Review event, which took place later in October. She also works on the development and accreditation of training programmes and the ePortfolio Review process along with providing support to pharmacists.

Sarah Chambers, CPD Quality Assurance Pharmacist, IIOP

Driving Life Pharmacy forward In October 2017 Gerard Coffey was elected Chairman by his fellow Life Pharmacy members. Since his election he has relished the opportunity to work with both his pharmacy colleagues and Uniphar to drive the development and growth of the Life brand. Mr Coffey is a community pharmacist based in Co. Mayo and joined Life Pharmacy in 2015 with his three pharmacies in Kilkelly, Knock and Balla. The Life Pharmacy symbol group is a partnership between the group’s pharmacy members and Uniphar. The group’s significant marketing fund is managed through Independent Life Pharmacy plc, with the execution managed by Uniphar. On a day-to-day basis, Uniphar provides a support team to the Life Pharmacy members focused on marketing, margin-enhancement, category management and buying. Gerard Coffey MPSI, Chairman, Independent Life Pharmacy plc

Mr Coffey’s aim is for Life Pharmacy to be viewed as a strong, well-recognised and constantly evolving brand, capable of competing with larger international competitors, leading with innovation in product and service development, and acting as a strong support mechanism for its own members.

Offering Quick thinking solutions in retail Derek Colman, Managing Director of Quick Pharm Solutions this year designed EasyFMD as a solution that would enable retail pharmacies, hospitals and wholesalers to efficiently decommission products from their National Medicines Verification Organisation. His team also developed a bespoke conveyor belt system to enable hospitals and wholesalers to decommission large quantities with minimum impact on staffing levels and budgets. Quick Pharm Solutions has successfully delivered solutions at retail pharmacy and wholesale level across Ireland and as far reaching as Bulgaria. Quick Pharm Solutions are providers of software and hardware solutions for the European Falsified Medicines Directive. Colman’s background is quite diverse ranging from his early career as a Pharmacy Technician, then moving to the work in the HSE and from there to General Manager in PCO Manufacturing for almost 20 years.

Derek Colman, Managing Director, Quick Pharm Solutions

FlexiSEQ Innovation & Service Development (Chain) Award 2018 Tom Concannon from Hickeys Pharmacy won the Innovation and Service Development Award at the 2018 Irish Pharmacy Awards. He said: “Our StartRight service put the needs of our patient’s front and centre. Since its launch it has grown from strength to strength and continues to highlight the importance of our pharmacist interventions. All of our new services and initiatives require a huge amount of buy-in and effort from our teams, so it was great to get the recognition for this at a national level.” This year the pharmacy has also launched a Vitamin B12 injection service and a Fertility pharmacist. In recent weeks Concannon also launched a new app. Tom Concannon, Superintendent Pharmacist, Hickey’s Pharmacies

He said: “It’s an exciting time to be a pharmacist and Hickey’s are delighted to be at the forefront of developing services that really matter to our patients.”

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DYNAMIC 100 - 2018 Tomas champions Twitter trends Tomas Conefrey has been at the forefront of using social media as a tool to assist in his pharmacy business. During 2018 his Twitter profile reached over 10,000 followers. He said: “I take a positive, proactive approach to the platform which is hopefully a reflection of my own personality. I am always surprised that more Pharmacists do no use twitter as I find it a great way to advertise and promote the profession and what we can do, rather than focusing on what we can't.

Tomas Conefrey, Superintendent Pharmacist, Conefrey's CarePlus Pharmacy

“I have come across several accounts such as The Medic's Mic which is associated with a podcast that is full of excellent CPD material. Even though it is aimed at Irish GPs I still get a lot out of it. Twitter is also a great place to network with other people has broadened my mind to how similar the challenges all healthcare professionals face. For 2019, I would recommend everyone to get tweeting.”

President leads the profession through change This year has been a busy one for the President of the Irish Pharmacy Union (IPU), Daragh Connolly. The association has been at the forefront of various initiatives ranging from publishing ‘Self Care – taking care of your health’ in a collaboration with IPHA at the start of the year, to voicing the unrealised potential of pharmacy services in April and then to lobbying Government for a phasing-out of the medical card prescription levy, especially for those patients who are vulnerable or cannot afford to pay the levy. Daragh was elected to the position of President by the Executive Committee and took up the position at the IPU National Pharmacy Conference on 24 April 2016. He has been involved with the IPU for a number of years and was previously Vice-President. Daragh is a third generation pharmacist. He graduated from the University of Portsmouth in 1996, where he was President of the Pharmacy Students’ Association. He is a native of Waterford and proprietor of Haven Pharmacy Connolly’s in Dungarvan.

IPU President, Daragh Connolly

Promoting female equality in pharmacy Dr Abina Crean is a Senior Lecturer in Pharmaceutics at University College Cork where she is actively involved in the School’s teaching, research and administration. Her highlight for 2018 was leading the School’s successful application for an Athena Swan Bronze Award. The Bronze Athena Swan Award recognises the School of Pharmacy’s demonstrated commitment to promote the advancement of gender equality in higher education. Actions to promote gender equally in higher education are pertinent for Schools, such as Pharmacy, with high female student and staff representation. Obtaining an Athena Swan Bronze Award is an important achievement for the School of Pharmacy, and recognises its' commitment to promoting equality and the value of diversity within UCC and the wider pharmacy community. Dr. Abina Crean, Senior Lecturer in Pharmaceutics, UCC

New post at eHealthIreland Martin Curley joined the eHealthIreland team in May of 2018 as the new Chief Information Officer for the Health Service Executive and Chief Officer of eHealthIreland. Curley is an executive with a track record of building high-performance innovation teams and consistently delivering a strong pipeline of compelling innovations and transformations. He has strong experience in public affairs and communications with a deep history of working closely with the European Commission and National Governments. He also has strong knowledge and skill in advanced Technology and Digital/IT innovation across multiple domains, most recently Digital Payments and Finance. Recognised as a leader in Open Innovation and founder of the Innovation Value Institute driving scaled research and consulting engagements across multiple industries, his achievements in his career to date are many, including transformation of Intel’s IT organisation into a IT capability; leading the start-up of MasterCard Advisors Digital Capability and establishing and growing a global network of 15 Intel IT Innovation centres.

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Martin Curley, Chief Information Officer, Health Service Executive and Chief Officer


Impacting the long-term health of patients Adele Curran was this year appointed Chief Customer Officer with Real World Analytics (RWA) and it is within this remit that she has outlined her objective to work alongside their community pharmacy customers to identify areas where they can impact the long-term health of patients. This in turn, directly affects the huge impact that undiagnosed, untreated and mismanaged health conditions have on a healthcare system. RWA analyse the dispensary and retail data for group pharmacies. Adele was also a finalist in the DatSci Awards which recognised her work in helping pharmacies identifies patients at risk of diabetes and asthma.

Adele Curran, Chief Customer Officer, Real World Analytics (RWA)

Advocate of best standards in healthcare Mike Curran is Head of Change and Improvement at Hickey’s Pharmacy Group and an advocate of the best standards in healthcare environment and ensuring the highest standards of customer engagement. To reduce the roadblocks of engagement, he has completed extensive works to improve technology experiences through standardisation of network, hardware, software & updating, increasing availability, reliability and security.  ike Curran, Head of Change and M Improvement, Hickeys Pharmacy

Having recently completed an MBS in Retail, graduating with a First Class with Award, he has also completed Project Management with the University of Limerick and Lean Six Sigma Green Belt. The focus of his dissertation has become a model of interest and an ongoing reference tool, to add value in patient understanding and how design can influence, Consumer Perception of Brand Experience, through Design & Service Experience Evaluations, within the context of retail pharmacy.

Serving as a Haven Ambassador Dorothy Deasy is a finalist in the upcoming Haven Ambassador of the Year 2018 Awards. She is the Haven Brand Ambassador and Manager of Haven Riverview & Scannell’s Bandon, leading a team of 17 people. With over 20 years’ experience in the pharmacy sector, she continues to bring a wealth of knowledge and experience to the job. Joining Haven in 2015, she started working on improving the store beginning with a retail audit and each year has seen significant changes and improvements. This year she co-ordinated the Daffodil Day Coffee Morning fundraiser. Its resounding success this year with ¤3,394.47 rose for the Irish Cancer Society. Another fundraiser held this year was a Spinathon in aid of a local Playground Group and a local centre for the elderly. She organised this event, with the local radio station broadcasting it live.

Dorothy Deasy, Pharmacy Manager, Haven Pharmacy

Laura makes best use of social media Laura Dowling is Supervising Pharmacist Manager with LloydsPharmacy and has brought instrumental success in using social media to inform the public about healthcare, skincare and medicines, with relatable, every-day scenarios. Laura has over 13 years of experience in community pharmacy. A preceptor for undergraduate pharmacy students, she has a keen interest in pharmacy education within this diverse and rapidly changing sector. Dowling writes healthcare articles for various print media and makes television and radio appearances advising on health and wellbeing. She also gives corporate and school talks on nutrition and children’s health. Laura Dowling, Supervising Pharmacist Manager, LloydsPharmacy

In 2018 she presented to pharmacy students in both Trinity College Dublin and University College Dublin on the role of the Community Pharmacist within the Primary Care setting.

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ALL THE POWER

OF ZIRTEK

ALLERGY RELIEF

WITH ADDED

DECONGESTANT Zirtek Plus Decongestant delivers all the allergy relief of Zirtek with added decongestant for up to 12 hours of control Helping to relieve symptoms including blocked or runny noses, sneezing and itchy eyes associated with indoor allergies and hayfever Awareness and sales driven by high-profile marketing activity, including a new website and online activity

To place your order please contact your local Pemberton rep or customer services on: Tel: 01-463 2424 Email: cs.pemberton@united-drug.com

www.zirtek.ie

ZirtekIE

Zirtek IE

Please consult the Summary of Product Characteristics before prescribing, information about this product can be found at www.medicines.ie Further information is available on request from UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Citywest Road, Dublin 24 MA Numbers:

Zirtek 1 mg/ml oral solution: PA 891/8/3, Zirtek Plus Decongestant 5/120mg Prolonged Release Tablets PA 891/8/1, Zirtek Tablets PA0891/008/005

Product licence holder:

UCB Pharma Limited

Classification:

Zirtek tablets & oral solution: Cetirizine dihydrochloride Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride

Legal Category: OTC

Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or via email to medsafety@hpra.ie Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com

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July 2018 UK/16ZI0052


DYNAMIC 100 - 2018 Sanofi People’s Pharmacist of the Year 2018 Sligo Pharmacist Joel Duffy of Markievicz Pharmacy was named the 2018 Sanofi People’s Pharmacist of the Year at the Irish Pharmacy Awards. This is a huge accolade given that it is the only Award solely nominated for by members of the general public. Joel says: “The Award has been a huge positive for both me and the pharmacy. There was a great buzz around the pharmacy before the event, with all the regular customers waiting to hear if we had won. “There is a lot of pride within the local community that we had been nominated for a National Award and I lost count at the amount of all the cards and gifts I received after winning. It was a really humbling experience and an honour to hear the genuine appreciation from the customers for the job we do. Winning the Sanofi People’s Pharmacist accolade has been tremendous in boosting the profile of our pharmacy locally.”

Joel Duffy, Pharmacist, Markievicz Pharmacy, Sligo

At the Forefront of online learning Rachel Dungan is passionate about the educational development within the pharmaceutical industry, making active steps to create new learning resources for pharmacy-led teams to improve success. This year she has founded 4Front Pharmacy Solutions, an online platform which is accredited by the IIOP. Its' purpose is to develop consultation skills and practices for pharmacies to an excellent standard. 4Fronts’ online learning material provides over the counter training programmes for pharmacists and teams alike. Rachel has designed the online learning programmes to facilitate both growth and learning within a pharmacist-led team and the pharmacists themselves. This creates an improved delivery of pharmaceutical services from the teams within their communities and for pharmacists themselves it provides personalised support in their professional development and leadership skills. Rachel Dungan MPSI ACC PMC, Founder, 4Front.ie

Rachel is a pharmacist, Trinity scholar and serves as a Peer Support Pharmacist with the Irish Institute of Pharmacy (IIOP). She is committed to the advancement of professionalism and competency of pharmacy teams.

Adrian’s pursuit of excellence in service The Adrian Dunne Pharmacy Group prides itself on its family focus and commitment to the local communities in which it operates. With over 180 staff in the group now, their priority this year was to communicate updated HR policies emphasising their Core Values and Capabilities and the organisational skills needed to obtain these. An important aspect of this, is investing in the training and development of all employees. Through the pharmacies’ pursuit of excellence in service, the group has been awarded with several national awards, including Top 30 Store and Rising Star at the Retail Excellence Awards 2018 and winner of Counter Assistant of the Year at the Irish Pharmacy Awards 2018. Adrian Dunne bought his first pharmacy in Whitehall, Dublin 9 in 1999. Over the following years he acquired a further 11 pharmacies, the most recent of which is in Kilbarrack, Dublin 5. Adrian Dunne, Managing Director, Adrian Dunne Pharmacy Group

Empowering customers in efficiency Empowering pharmacy customers to operate as efficiently as possible using data to make informed decisions that drive profitability has been at the forefront of Simon Eames’ year. Simon is the Customer Success Manager for the Irish pharmacy customer base with Real World Analytics which accounts for 27 customers with a total of 375 branches. He ensures that all levels of the business have the right information, at the right time to do their job. Simon Eames, Success Manager, Real World Analytics

Simon has 30 years of experience in planning roles covering both manufacturing and retail businesses, including Heatons and Harvey Norman Ireland.

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DYNAMIC 100 - 2018 Passionate in charity work Rose Finlay, Pharmacist at totalhealth Pharmacy in Tullamore has had a very busy year to date. Whilst working in her very busy pharmacy she has been extremely active in the local community, constantly sponsoring local fundraisers and has made several donations to local sports clubs. At the National Ploughing Championships held in Tullamore Rose spoke in the Bayer Pharmaceuticals tent about "Self-Care" along with Karl Henry. She highlighted the major role the pharmacist and pharmacy team play in self-care and encouraged people to call to their local pharmacy as the first port of call to get help and advice for minor ailments. She was also involved in the Tullamore Show where she highlighted the role of the local pharmacy and sponsored the Best Dressed Lady competition. Helping local charities is something Rose Finlay's totalhealth Pharmacy is passionate about.

Rose Finlay, Pharmacist, totalhealth Pharmacy, Tullamore

Cell Nutrition Community Pharmacy Team of the Year 2018 Kerrie Finnan, Supervising Pharmacist Manager with McCartans Allcare Pharmacy Donaghmede has demonstrated her team are the cream of the crop, after scooping the Cell Nutrition Community Pharmacy Team of the Year Award for 2018. She says: “Obtaining my Masters in Clinical and Translational Research from UCD was a personal highlight but taking home the highly sought after Cell Nutrition Community Pharmacy Team of the Year Award at the Irish Pharmacy Awards was the real icing on the cake.

Kerrie Finnan, Supervising Pharmacist Manager, McCartan’s Allcare Pharmacy

“Recognition for hard work can be often hard to come by, especially in community pharmacy, so to win this Award has been a fantastic achievement for a truly deserving team. The community’s involvement and support for the pharmacy after we received the Award was overwhelming and really reflects the loyal customer base that has been built here. This has only been possible through the hard work and dedication of our team members and I couldn’t be more proud to be part of a dynamic and caring team.”

Stuart authors report on pharmacy Stuart Fitzgerald authored “Review of the Community Pharmacy Sector 2016 / 2017 – The Economic Forces Shaping the Sector” in June of this year. This report discussed critical pharmacy sector issues with a particular focus on economic factors and was commissioned by the Irish Pharmacy Union. This was Fitzgerald Power’s fourth annual review of the sector and work has already commenced on next year’s study. In October 2018 he co-hosted The Real Deal, a corporate finance event which was staged in Goffs and included panel discussion contributions from some of Ireland’s leading business people. Fitzgerald Power partnered with Renatus Capital Partners, Byrne Wallace and The Sunday Times to deliver the event. Fitzgerald continued to provide advice on some of the largest pharmacy sector transactions in 2018. By the end of the year Fitzgerald Power’s corporate finance team will have completed more than ¤38m worth of pharmacy acquisitions and disposals.

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Stuart Fitzgerald, Director, Fitzgerald Power Chartered Accountants


Educating the community on healthcare Suzanne Goggin’s interest and enthusiasm in the community allows her to offer great patient care, which led to her being nominated for the JPA Brenson Lawlor Young Community Pharmacist of the Year Award, 2018. Suzanne was also the Haven Community Pharmacist of the Year in 2017. Over the last year, Suzanne has recorded short educational videos for the Haven Group on various healthcare topics. These featured on social media to educate and offer advice to the community. She visited primary schools to talk to young children about safety with medicines and promote pharmacy and carried out mock interviews with secondary school students interested in following healthcare paths. She is actively involved in many charity fundraising events such as Daffodil Day, educational coffee mornings and spinathons.

Suzanne Goggin, Haven Pharmacy Scannell’s and Riverview, Co Cork

Advocate for mental health Lorcan Gormley has over seven years of pharmacy experience, joining the McCartan’s Group as Supervising Pharmacist in 2015. Since completing an MBA from UCD Michael Smurfit Graduate School of Business, he is working to improve operations and the strategic direction of the 12 stores within the McCartan’s Group, using a technological and data-driven approach to business intelligence. Lorcan was also shortlisted for the JPA Benson Lawlor Young Community Pharmacist of the Year Award earlier this year, in recognition of his efforts to improve pharmacy in a rapidly changing landscape, by using new innovations to improve service levels in community pharmacy. As an advocate for mental health, Lorcan has delivered a number of talks on this topic to mental health professionals. He has also been vocal about the potential role of pharmacists in suicide prevention and depression screening. Lorcan’s combination of pharmacy, business administration and data analytics skills represent the direction of modern pharmacy. Lorcan Gormley, Senior Strategy & Operations Lead, McCartan’s Pharmacy Group

Improving patient care through innovation Dr Michelle Flood strives to improve patient care through innovation and embracing disruptive technology. Earlier this year, Dr Flood, a Lecturer at the RCSI School of Pharmacy, won a prestigious Fulbright HRB-HealthImpact Award. She travelled to the Design Institute for Health – a radical collaboration between Dell Medical School and the College of Fine Arts at The University of Texas. In Austin, she worked with world-leaders researching how applying human-centred design principles helps improve healthcare systems. Through ongoing collaboration with the Design Institute and colleagues at the NCAD, she is using these principles in pharmacy education and practice. Michelle focuses on developing pharmacy graduates prepared to meet increasingly complex needs of society.

Dr Michelle Flood, Lecturer, RCSI School of Pharmacy

She aims to provide high quality, innovative learning experiences, and was awarded the RCSI President’s Teaching Award in 2014 and 2018, and a National Teaching Hero Award in 2014.

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DYNAMIC 100 - 2018 JPA Benson Lawlor Young Community Pharmacist of the Year 2018 Grace Grimes will finish off 2018 with the title of being the JPA Benson Lawlor Young Community Pharmacist of the Year. Grace has worked as a Support Pharmacist with Meagher’s Pharmacy in their Glenview store in Tallaght since February 2017. She says: “Since commencing my role as a community pharmacist, I have gained experience in all areas of pharmacy which demands knowledge of many different disciplines; however patient care has always been my main focus as a pharmacist. My biggest achievement of the year is without a doubt being nominated and winning Young Pharmacist of the Year 2018 at the Irish Pharmacy Awards. It was an honour to be nominated by mentors and even higher honour to win. “Winning this Award has given me confidence to continue to support my patients with whatever issues they may have. It has also encouraged me to branch into other areas such mentoring pharmacy students and progressing my career to gain more knowledge and experience in the hope of becoming a supervising pharmacist one day.”

Grace Grimes, Support Pharmacist, Meagher’s Pharmacy

Taking Pharma Buddy ethos to new heights With significant experience in the community pharmacy arena, Justine Heneghan has played a pivotal role this year within the Pharmabuddy Forum. Able to resolve various enquiries and issues from Irish pharmacist counterparts, colleagues, pharmacy interns and pharmacists find her ability to resolve queries invaluable. Justine is a community pharmacist based in Ryder’s Pharmacy, Headford where she works as the Support Pharmacist. Now with 3,000 members, Pharmabuddy is an exclusive platform developed for pharmacists by pharmacists whereby members can share and discuss learning and best practice, as well as useful pharmacy resources. Justine Heneghan, Community Support Pharmacist, Ryders Pharmacy Headford

Victoria adds value to dispensing team Victoria Hinds was a recent finalist for the Haven Pharmacy Technician 2018 Award. Having recently completed two years of the IPU technician course, she is already seeking new learning opportunities and began a business course in September. As well as the demands faced by every pharmacy technician, she deals with the extra set of demands make by the pharmacy dispensing robot. Never having been a “computer person” before joining the team, she rose to the challenge and is now the undisputed robot expert. She ensures that the robot adds efficiency and value to the dispensary team by keeping it running smoothly and constantly looking for ways to utilize it more efficiently to suit ever-changing needs. Victoria also initiates, and takes part, in health promotion events in the pharmacy, especially regular asthma days and “know your numbers” health checks. She recently ran such a successful May Measurement Month event that she was name-checked on the International Society of Hypertension’s website.

Victoria Hinds, Pharmacy Technician, Haven Pharmacy, Riverview Bandon, Co Cork

Hogan heads up operations and brands Norabeth Hogan has been Head of Operations & Brand for Natur House Ireland since April 2018 and has significantly grown the brand since her appointment over the last few months. She is embarking on many projects to ensure this new service works well in community pharmacy. Norabeth’s work includes liaising with pharmacies on best practice for the programme as well as marketing and promotional material development. She is also about to launch a large scale digital marketing campaign to heighten awareness of this programme in pharmacy in Ireland.

Norabeth Hogan, Head of Operations & Brand, Natur House Ireland

Natur House is a weight management company which has operated across Europe for the last 25 years. They were awarded the ‘Master Franchise’ in 2017 and were the first in the country to work with community pharmacies to offer this service. They now have a total of 10 Pharmacy locations offering the service and many more in the pipeline.

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DYNAMIC 100 - 2018 Fulfilling the healthcare needs of her local community A finalist for the 2018 JPA Benson Lawlor Young Community Pharmacist of the Year Award, Fathimah Kara is Supervising Pharmacist in Reidy’s Pharmacy, Rathcoole. Since her nomination she has been actively thinking of new and innovative ways to fulfil the healthcare needs of the local community through consultations with customers and other healthcare professionals. She says: “Being a finalist for the second time has had a significant impact for me both professionally and personally. The buzz in the local community since the Awards has been incredible among my patients and has motivated me to continue to provide services of the highest standard to all.

Fathimah Kara, Supervising Pharmacist, Reidys Pharmacy, Rathcoole, Co Dublin

“Personally, being a finalist has given me more confidence in my abilities as a community pharmacist and in my contribution to the progression of the pharmacy profession in Ireland that I am so proud to be a member of.”

Katie climbs pharmacy career ladder Katie Kavanagh began working at the Chemco Pharmacy store in Bunclody in 2016 as a Pharmacy Technician and has worked her way up to become the only Shop Manager across the whole group who is not a pharmacist. Her skills and productivity saw her promoted to Supervisor a mere two months after starting with the group. This promotion was as a direct result of her perseverance to enable an organised workflow; creating an advance dispensing system thus ensuring patients have continuity of supply happy in the knowledge that their prescription is always ready. Recently she has worked tirelessly to organise an event celebrating 10 years in business which the group celebrated in November 2018 Katie Kavanagh, Shop Manager, Chemco Pharmacy

Friary continues focus on primary care Seamus Kennedy MPSI has been owner-operator of the independently trading ‘Friary Pharmacy Cashel’ since 2005. Throughout the years his team have worked diligently, providing a 24/7 service to grow and develop the business whilst always remaining faithful to its core ethos, that being ‘Focused on Patient Care’. A previous finalist for the Patient Nominated ‘Pharmacist of the year Award’, Kennedy believes that by developing a strong clinical rapport with patients and their respective multidisciplinary team members, Patient care and medical intervention can be truly optimised.

Seamus Kennedy, Owner, Friary Pharmacy, Cashel

Following a recent store refit and investment in new diagnostic devices, he has improved his professional service offering in areas such as Atrial Fibrillation detection and the provision of an ABPM service. This has fostered a strong working relationship with local medical practitioners and the cardiology team in neighbouring hospitals thus enhancing the role the pharmacy plays in the primary care of its patients.

Ensuring effective medicines acces David Keyes has been involved in the Irish pharmaceutical sector for over 25 years and is a member of the Country Board of McKesson Ireland. In his current role he is responsible for the activities of United Drug Distributors a business which provides supply chain solutions to over 80 pharmaceutical companies. He is passionate about ensuring that pharmacists can access medicinal products in a safe, secure and timely manner. Ensuring alignment to this objective involves strong engagement with the manufacturing community and other stakeholders as a strong supply chain is necessary to advance the role of community pharmacists and pharmacy within the health system.

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David Keyes, Director Pre-Wholesale, United Drug Plc


United Drug Business Development (Independent) Award 2018 Amy Kieran is Director at Kieran's Avenue Pharmacy which this year won the United Drug Business Development Award at the Irish Pharmacy Awards. She says: “We were thrilled with the recognition of our thriving independent pharmacy. We work very hard to maintain our excellent customer service, fabulous product displays in store and procuring something special for our customers. “Our clients were delighted that we won yet another Award to add to our collection. It is their support that keeps us developing for the future. Winning such an Award definitely enthuses staff and boosts morale. “We are reaching all corners of Ireland and the UK through our website and our social media channels. It is wonderful to be recognised as one to watch in the pharmaceutical industry.”

Amy Kieran, Pharmacist, Kierans Pharmacy

Growing collaboration in RCSI research Professor Brian Kirby is Acting Head of the School of Pharmacy, RCSI. Professor Kirby has led the roll-out of Year 4 of the integrated MPharm programme in RCSI, in which the students undertake their first 4 month placements. He joined RCSI in 2003 following his degree and PhD in TCD and post-doctoral research in the University of Oxford. Professor Kirby has taught pharmacy, medicine and nursing students in RCSI and was also the Lead in Clinical Pharmacy at PU-RCSI School of Medicine during a secondment to Malaysia. Professor Kirby has successfully grown his international research with collaborators in University Putra Malaysia (UPM), where he holds an adjunct Professorship. He was also an invited speaker at an international conference on Translational Medicine in Malaysia where he spoke on the complexities of modelling neurodegenerative diseases for testing novel therapeutics Professor Brian Kirby, Interim Head, School of Pharmacy, RCSI

Celebrating 30 years with Boots Bernadette Lavery has just celebrated 30 years with Boots. She began her career as a pharmacist and has held a wide range of positions across Pharmacy, Retail, HR and Stores leadership. In her current role as Managing Director of Boots Ireland, Lavery is focused on supporting the delivery of exceptional care for colleagues and customers across retail and pharmacy. Lavery sits on the board of Business in the Community and Retail Ireland. She is passionate about the role of pharmacy in the provision of care in Ireland. Bernadette Lavery MPSNI, Managing Director, Boots Republic of Ireland

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DYNAMIC 100 - 2018 Led pharmacist development programme Cormac Loughane, Superintendent Pharmacist, McCabes Pharmacy led Irelandâ&#x20AC;&#x2122;s first CIPD Pharmacist and Development Programme which was completed by over 12 high potential manager pharmacists at McCabes Pharmacy over the past year. This unique and ground-breaking certificate for pharmacists was led by Loughane who worked with CIPD adapting a programme that had originally been held by The Royal Pharmaceutical Society in The UK. He has been a true innovator in driving best in class professional development for the McCabes pharmacy team, whilst upholding the strongest professional processes and standards across McCabes Pharmacy and his team of 55 pharmacists. Cormac Loughane MPSI, Superintendent Pharmacist McCabes Pharmacy

Clonmel Business Development (Chain) Award 2018

Niamh Lynch, Commercial Director, Careplus Pharmacy

Niamh Lynch is the Commercial Director for CarePlus Pharmacy, who were the 2018 recipients of the Clonmel Business Development (Chain) Award. Niamh is responsible for developing the groupâ&#x20AC;&#x2122;s commercial retail strategy, managing long-term relationships with customers and suppliers. With her extensive background in senior positions within the grocery sector, she has overseen a successful year for CarePlus Pharmacy, particularly around growth which has seen the CarePlus footprint extend into nine new counties in Ireland, adding over 500 new team members to their network. Niamh has also spearheaded a successful collaboration with the charity Family Carers Ireland, positioning CarePlus as title sponsor of their annual Family Carer of the Year Awards for the second year.

Setting strategy for pharmacy chain Caoimhe McAuley is Director of Pharmacy & Superintendent Pharmacist for Boots in Ireland. She has been instrumental in setting and realising the strategy for the Boots Ireland pharmacy business. This includes the provision and delivery of quality pharmacy services such as emergency contraception, winter flu vaccination service and asthma control programme in addition to prescription dispensary. Within this remit, she is also responsible for clinical governance, regulatory compliance, resourcing and training of the pharmacy team in Ireland. She was appointed to the role of Director of Pharmacy for Boots Ireland in 2017 and also holds accountability as Superintendent pharmacist. McAuley originally joined Boots as a relief pharmacist 11 years ago and has worked in a number of areas across the retailer, including store leadership, field pharmacy roles and part of the regional leadership team. Caoimhe McAuley MPSI, Director of Pharmacy & Superintendent Pharmacist, Boots Republic of Ireland

Maintaining focus on pharmacy balance sheets Jim McAuliffe is Finance Director of McKesson Ireland and is uniquely placed to view the Irish pharmaceutical sector from a number of different viewpoints. At a time when margins have been eroded by price intervention he is passionate in ensuring community pharmacists are focused on their balance sheet, cash generation and working capital management. Jim is always willing to share his views and expertise on an informal basis and regularly engages with community pharmacies in this regard. Jim McAuliffe, Finance Director, McKesson Ireland

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Fingerprick Vitamin D Test

HOW TO TEST: 1. PREPARE SAMPLE 2. ADD TO TEST 3. WAIT 15 4. READ VIT D VALUE

Vitamin D levels plunge in winter. This affects bone resilience, but mood, immune function and pain sensitivity too. Rapi-D is the first reliable Vitamin D test suitable for pharmacy use. Itâ&#x20AC;&#x2122;s DEQAS benchmarked. And it gives 25-hydroxyvitamin D results in 15 minutes from a fingerprick blood sample. Then, following international best practice, you calculate the appropriate dose of Vitamin D3. At 12 weeks, you test again and, if necessary, adapt the dose.

AFib is scary. But so is recuperation after a heart operation. D-Heart is a compact ECG that is run by a mobile phone App. The scans can be uploaded to the 24/7 team of cardiologists for assessment. In 15 minutes, theyâ&#x20AC;&#x2122;ll give a Green, Yellow or Red flag verdict. At reasonable cost. You can screen the public or teams. Or rent D-Heart to surgical heart patients during their vulnerable post-op period. NB D-Heart requires a smartphone

Nutricentric Healthcare provides Point of Care tests to pharmacies, nutrition professionals and (some) GPs. Ask us about other popular pharmacy fingerprick screening services, such as: ImmunoCAP rapid the 30-minute respiratory IgE allergy test. Or our inexpensive single-use safety lancets.

Find out more. E-mail info@nutricentric.com or call +353 86 348 3592 NUTRICENTRIC HEALTHCARE LTD. BRAY ROAD, ENNISKERRY, CO. WICKLOW A98 C1Y6


DYNAMIC 100 - 2018 Providing an engaging and supporting role Trevor McBrearty is Senior Operations Coordinator at APPEL (Affiliation for Pharmacy Practice Experiential Learning), where he is the first point of contact for pharmacists in relation to APPEL placements provided to students of the three Schools of Pharmacy in Ireland. As an experienced tax professional, the world of pharmacy was new to McBrearty when he joined APPEL. However, he now supports pharmacists all over the country in community, hospital, industry and other practice settings to prepare for and deliver placements to APPEL students. He is renowned for developing great relationships with all APPEL placement providers thanks to the engaging and supportive service he provides. This has resulted in hundreds of placements being provided to students in new APPEL training establishments all over Ireland.

Trevor A. McBrearty, APPEL Senior Operations Co-ordinator

Using IT to improve efficiencies Finn McCann is the Technology & Systems Director for the Axium Buying Group and CarePlus Pharmacy. He oversees the development and implementation of technology across 400+ member pharmacies in Axium and CarePlus, including the Axium trading portal, TouchPlus ordering system, CarePlus mobile app and FMD software integration.

Finn McCann, Director for Axium buying group and Careplus Pharmacy

McCann is passionate about finding IT solutions to difficult business problems and making life easier and work less frustrating for the busy pharmacist. He is building on his IT experience in the telecoms, insurance, cloud computing and gaming industries to build innovative and easy-to-use software that improves efficiencies and margins for the growing number of CarePlus members and Axium members.

Increasing PR reach of pharmacy Lee-Ann McCarthy oversees the implementation of the CarePlus Pharmacy marketing strategy, working closely with CarePlus pharmacists to leverage local marketing plans as well as positioning the CarePlus brand to consumers nationally. She is particularly focused on digital and content marketing and led the recent launch of the new CarePlus website. PR is also a key area of focus and this year saw CarePlus Pharmacy generate a PR reach of over 8.1 million people through various initiatives including headline sponsorship of Paramedics TV Series. Lee-Ann McCarthy joined CarePlus Pharmacy in early 2018 bringing extensive retail marketing and brand experience.

Lee-Ann McCarthy, Head of Marketing for CarePlus Pharmacy

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DYNAMIC 100 - 2018 Leadership in the retail industry Having spent 26 years at The Sam McCauley Group with a 10 year term as CEO Patrick McCormack decided to leave the group in the capable hands of Tony McEntee in late 2017 following its acquisition by Carlyle Cardinal Ireland Private Equity. McCormack has shown a major leadership role not just within the Sam McCauley Group but also within the wider retail industry through his involvement as a board member with Retail Excellence Ireland since 2012 and prior to that as a council member.

Patrick McCormack, former CEO, Sam McCauleys Group

Since leaving the Sam McCauley group McCormack has taken on several nonexecutive directorships in the health, beauty and retail sectors. He currently works for Manara Aesthetics, Tan Organic, Wallace Retail Group and has a significant involvement in Mobility Genie which will shortly deliver the ideal solution to retail pharmacies who wish to sell the full range of medical mobility aids without having the cost of holding any stock.

Tony takes McCauleys to pastures new Under the direction of Chief Executive Officer Tony McEntee, during 2018 Sam McCauley Chemists embarked on acquisition process which is the start of process of doubling the size of the business by the end of 2021. The company has already purchased five pharmacies in 2018, Dublin (1), Cork (1), Meath (2) & Kildare (1) with another due to be announced before the year end. Additionally, a new and unique concept store will open on Charlemont St., D2 in early Dec. Tony was appointed CEO of the Sam McCauley Chemist Group in 2017. He joined McCauleys following the completion of a majority investment in the group by the private equity fund established by The Carlyle Group and Cardinal Capital Group, Carlyle Cardinal Ireland (CCI). He has previously said his priority is to â&#x20AC;&#x2DC;expand Sam McCauley customer touchpoints while maintaining a strong retail presence in communities throughout Ireland.â&#x20AC;&#x2122; He was formerly Chief Executive of Allcare Pharmacy Group and Finance Director of Lifestyle Sports

Tony McEntee, CEO, Sam McCauley Group

Raising awareness of heart health Dervila McGarry is Head of Marketing at LloydsPharmacy. She played a key role in appointing the Irish Heart Foundation as the charity partner and set out to raise awareness of the proactive ways patients can manage their heart health. Every quarter LloydsPharmacy operates a Free Blood Pressure event activation day across their network of 91 stores. In total 3,268 customers have had their blood pressure checked over the past four quarters and 379 referred to a GP for a follow- up consultation during national events.

Dervilla McGarry, Head of Marketing, LloydsPharmacy

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Many customers also avail of the BMI and Blood Pressure checks all year around. All LloydsPharmacy stores are now equipped with defibrillators and most of the pharmacies have also received extra training from Irish Heart Foundation to provide advice and support to patients and customers at risk of developing cardiovascular related disease.


Innovation in healthcare training David McLean has been a successful entrepreneur in the Specialist Medical Education sector for over 18 years. Recognised with multiple awards for projects since the millennium, publishing numerous papers and presenting nationally and internationally, his work continues to innovate in healthcare training. His company, CPD Sessions Limited, has developed some of Irelands leading elearning websites including Clinics in Motion, ICGP Education, IPNA Education, Medical Meetings and PCT Education. His products are now used in almost every continent to assist both undergraduate and postgraduate medical education. McLean has pioneered the development of ‘Adult Based Learning’ principles applied to all forms of Medical education and overcoming the challenges of time, cost and capacity boundaries that traditional training is limited by.

David McLean, CPD Sessions

Within the Pharmacy Sector, he has developed many accredited programmes for the IIOP (Irish Institute of Pharmacy) and most recently founded 4Front Pharmacy.

Celebrating success of new patient app In 2018 Keith McLernon, Managing Director of McLernon Computers, celebrated the success of the McLernons’ patient app, Medi Marshal. This app, which can be embedded into a customised app for each customer’s pharmacy, allows patients to re-order their medicines, schedule appointments and contact the pharmacy. He says: “We have been inundated with requests from our customers to use the app – it increases loyalty of patients, raises the profile of the pharmacy and improves workflow in the dispensary. Everyone from our large groups to sole practitioners has signed up, and most of them have availed of our in-house expertise to embed the Medi Marshal functionality in a branded app.

Keith McLernon, Managing Director, McLernon Computers Ltd.

“Using MediMarshal improves compliance and provides better, safer outcomes for patients. We are constantly innovating and improving the app, and predict it will become invaluable to our McLernons’ customers in 2019.”

Offering business improvement services Elaine Lorigan McSweeney set up her own consultancy business Pharmacy Wizard, in 2017 after many requests for her expertise in Claims, Analysis and experience of over 25 years in many areas of pharmacy and healthcare. She has since developed her skills to also offer Business Improvement services, offering advice on all aspects of community pharmacy, from finance, business analytics advice, work flow, footfall increase and retention, category management and HR to name a few. She has been involved in some investigations as an expert in claims on behalf of pharmacies. This year she was honoured to be an invited Advisor and Contributor to the 4Front online pharmacy training website which promises to be an exceptional training tool for all pharmacy staff. She remains the President of the Irish Association of Community Pharmacy Technicians (IACPT), using Facebook as the main point of information transfer to nearly 2000 Technicians.

Elaine Lorigan McSweeney, Head of Pharmacy Wizard

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DYNAMIC 100 - 2018 Demonstrating Retail Excellence Orla Mellerick is Owner of Mellerick’s Pharmacy, Cork, which has won Best Pharmacy in Ireland at the Retail Excellence Awards for the last two years. She says: “We are hoping for the hat-trick this year and would love to win the overall best shop in Ireland. We have worked hard to develop our front of shop and our in- house health store. This has been very successful and financially rewarding. “We have incorporated the history of Fermoy into Mellerick heritage features which has anchored the shop in Fermoy even though we are only in situ for four years in our new location. Our wonderful staff are engaged and delighted to be part of our great team. We all work hard but working together we have a bit of fun and banter with our customers , and each other, so it’s not only about being a beautiful premises but also a wonderful atmosphere.” Orla Mellerick, Owner of Mellericks Pharmacy

RB Nurofen for Children Baby Health Pharmacy of the Year 2018 Sheena Mitchell scored a hat-trick in 2018 by winning the RB Nurofen for Children Baby Health Pharmacy of the Year for the third year running. Sheena is a regular contributor to IPN magazine, mummypages.ie and her own creation WonderBaba. ie and has led the team in totalhealth Pharmacy Milltown since 2008; many of her colleagues have worked there for almost 20 years. Joining the totalhealth brand in 2014 has freed her up to work on her passion for child and baby health, a passion that runs through her whole team. She has also been awarded Pharmacist of the Year at the Maternity and Infant Awards in the past, and the team regularly receives recognition at internal totalhealth Awards. She understands the importance of digital activity in reaching new patients and customers. WonderBaba.ie offers free and impartial advice about baby and child health, giving parents access to advice from a working mum who is also a medical professional.

Sheena Mitchell, Pharmacist, Milltown Totalhealth Pharmacy

Pharma Evolving community pharmacy business Ultan Molloy’s community pharmacy business, Healthwest Pharmacy, continues to thrive, having recently undergone a complete refit to facilitate further patient care, his team intend to serve their communities through their core values of community focus, trusted advice, exceptional service and warm friendship. In his coaching consultancy business, he works with pharmacist owner managers through the PharmEvolve brand.

Ultan Molloy, Owner, Pharmacist, Healthwest Community Pharmacy

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An accredited business coach with a business, HR and management masters degree, Ultan supports owner pharmacists through these one-to-one impactful relationships. This arrangement allows them to develop their business, develop their own learning, and ensure their personal work-life balance. We tackle HR, patient and systems opportunities head on, ensuring that their business works for them and their families, and they can leave it behind them on evenings and weekends!


Tracking pharmaceutical markets globally Gwynne Morley is the Commercial Manager at IQVIA Ireland, where she leads the Pharmaceutical and Pharmacy Solutions teams. As a pharmacist and pharmacy owner who has also worked for many years in distribution in Ireland she has a comprehensive understanding of the Irish market. She has advanced this market knowledge further since having joined IQVIA where they track the pharmaceutical markets both locally and internationally. With Gwynne’s leadership, IQVIA Ireland has grown their panel of pharmacies to now capture and process anonymised data shared by well over half the retail stores nationally. Supported by the wider team, IQVIA gives insightful analyses to those stores on panel as to how they are performing commercially and how they can optimise their business and patient care. Gwynne is also an active member of PIER, having been its Chairperson from 2014-17, bridging across the dispensary and industry sides of the business. Gwynne Morley, Commercial Manager, IQVIA Ireland

Driving commercial strategy at Uniphar David O’Brien has been with Uniphar since 2016 in his position as Commercial Director. He is tasked with driving Uniphar’s commercial and sales strategy, particularly focused on unlocking category growth opportunity and retail pharmacy margin expansion. David achieved marketing and sales operational objectives by contributing marketing and sales information along with recommendations for strategic plans and reviews. These include identifying trends, resolving problems, determining system improvements, implementing change, meeting marketing and sales financial objectives by forecasting requirements, implementing and evaluating action plans. David O'Brien, Commercial Director, Uniphar

He sustains and develops rapport with key accounts by making periodic visits and exploring specific needs and has accomplished marketing and sales objectives by planning, developing, implementing, and evaluating action plans.

Going the extra mile for your team Hannah O’Brien is Supervising Pharmacist at Chemco Pharmacy Sligo and prides herself in ensuring exemplary care to all who attend her store as well as the staff that surround her. Upon starting the position, she spent several evenings going door to door introducing herself, which cemented this Mayo woman into the hearts of the community in Sligo. After an unfortunate incident of an armed robbery last year, she orchestrated as well as facilitated any external follow up the staff needed at the time, making their wellbeing her priority. This highlights her willingness and compassionate ability to go the extra mile for the good of her team and their welfare. All her patients speak highly of her and the advice and time she gives so freely, whether they are only calling into the store to buy an OTC item or with a regular prescription. Hannah O'Brien, Chemco Pharmacy Sligo

Delivering solutions to consumers Will O’Brien has been working with RB for the past 13 years which has seen his career move from the Irish business into several different markets including Denmark, Iceland and India. He returned to Ireland in 2018 as Country Manager - RB Health following the global reorganisation of the business into distinct Health and Hygiene-Home Business units. His ambition for 2018 was to build a new organisation with the specific capabilities to lead and collaborate with retail partners and hold a mind-set purely focussed on how we can deliver solutions to consumers to enable them to lead healthier lives.

Will O'Brien, Country Manager RB Health

He said: “We are constantly looking towards the future development of the pharmacy channel within Ireland and take key learning’s from other markets. We take pride in leveraging our global scale to share insights with our partners and help them to develop the vital service they offer within local communities.”

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DYNAMIC 100 - 2018 Dynamic young pharmacy graduate Amy O’Connor graduated with a BPharm from School of Pharmacy, University College Cork in 2018 and this dynamic individual combines academic success with outstanding sporting achievements. Amy is a four-time senior All-Ireland camogie medallist with Cork, Irish women’s U19 international footballer, and UCC Quercus Sports Scholar. She is currently completing her MPharm at the Royal College of Surgeons while undertaking an internship at BioMarin International Limited, Cork. Amy O'Connor, RCSI

President of the PSI council Rory O’Donnell is the Pharmacist/Owner of O’Donnell’s totalhealth Pharmacy Derrybeg, Donegal. He also finds time to act as Chairman of HMR (Health Market Research) Ireland, and President of the PSI Council of Ireland. In the past, he has also held the position of President of the IPU and President of the Pharmacy Benevolent Fund. All this extensive sector experience, along with his valuable work as a community pharmacist, led Rory to be chosen as Chairman of the totalhealth Pharmacy Board. Being a member of totalhealth also offers him access to over 70 independent pharmacy teams, benefiting the other organisations he works with, with real awareness into the workings of various types of pharmacies across Ireland. He sees the clear benefits to an independent pharmacist in joining totalhealth as being part of the group has improved his business, allowed him freedom to pursue his outside professional interests. Rory O’Donnell, Owner of O’Donnell’s totalhealth Pharmacy, Derrybeg, Co. Donegal.

Leading IIOP in Practice Reviews Upon a return to Ireland from Australia, Alicia O’Dwyer took a maternity leave position in the IIOP. Here she led the organisation and delivery of the first ever IIOP Practice Review event, which took place in April 2018, as well as the second Practice Review event, which took place in October 2018. She has also worked on a range of other IIOP projects, including accreditation, GDPR implementation, and providing support to pharmacists. In Australia, Alicia had worked in the Department of Cardiology in the Prince of Wales Hospital in Sydney. As Practice Manager there, in a busy cardiology clinic, she worked as part of multi-disciplinary team alongside consultant cardiologists, sonographers, and nurses. She developed her clinical skills through the provision and delivery of services such as performing ECGs, Holter monitoring, 24-hour blood pressure monitoring, medication reviews, and answering medicine information queries. Alicia O’Dwyer, CPD Quality Assurance Pharmacist, IIOP

Showcasing the Boots pharmacy strategy Susan O’Dwyer has the led the development and implementation of a number of innovative clinical services at Boots Ireland over the past decade.

Susan O'Dwyer MPSI PhD., Pharmacy Strategy Manager, Boots Ireland

In her current role she is responsible for the pharmacy strategy that will deliver against Boots Ireland’s ambition to be the community pharmacy of choice for the people of Ireland. By identifying key patient care needs and gaps in healthcare provision Susan and her colleagues support pharmacists to expand their professional role by making clinical services such as ambulatory blood pressure monitoring, mole scanning and vaccinations more accessible to communities throughout Ireland. She is also keen to share the learning’s from such service provision and has presented at a number of national and international conferences, highlighting the role of pharmacists in primary healthcare.

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DYNAMIC 100 - 2018 Keeping consistent and innovative Group growth Joanne O’Hagan is the Retail Director with Meagher’s Pharmacy Group and has led the consistent innovation and growth of their retail offering. The Meagher’s brand has become synonymous with expertise and Joanne has engaged the entire team to continue to surprise and delight the Meagher’s customer. She leads the way in improving access to quality pharmacy information online, reaching the different demographics through a range of social media platforms. As Meagher’s resident skincare expert she has developed new and informative content across these platforms and Meagher’s are now the most followed pharmacy on both Instagram and Snapchat, engaging thousands of customers on a daily basis.

Joanne O’Hagan, Retail Director, Meagher’s Pharmacy Group

Meagher’s MD – A Gold Standard Oonagh O’Hagan is Managing Director of the Meagher’s Pharmacy Group, a Gold Standard Deloitte Best Managed Company for 2018. She is a dynamic leader and inspires a loyal and committed team of experts. Working closely with her Retail Director and Superintendent Pharmacist, she has managed to diversify the pharmacy model, embracing technology and social media to enhance the customer experience both in store and online. She also sits on the finance committee for RSCI and is a current board member and former Chairperson of Retail Excellence Ireland. She founded Women in Retail with REI and continues to champion women in business. She is a Lead Entrepreneur with Going for Growth, a nationwide Enterprise Ireland initiative for women in business. Oonagh consistently facilitates professional development within a rapidly expanding company and her pharmacists and staff are given regular opportunities to expand their skillset

Oonagh O’Hagan, Managing Director, Meagher’s Pharmacy Group

Bringing new ideas to community pharmacy Paul O’Neill, Sales Director of Cosmetic Alliance believes in innovation. Community pharmacy is something close to his heart and to that end he is constantly working on ideas he can bring to the pharmacy industry. Paul’s end goal is to create and work with brands that the end consumer are excited about and he believes in reinvesting profits made by supporting current brands and working with current trends. Paul believes that the pharmacy industry has changed in recent years and has said there is ‘no loyalty in brands’ with the shelf life for any brand getting shorter and shorter. This has to change, he says, and by reinvesting in what you have and innovation will bring back the loyalty of the end consumer.

Paul O'Neill, Sales Director, Cosmetic Alliance

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His main belief is that there is nothing wrong with making mistakes once you learn from them and whilst he has made a few himself, it gives him the knowledge to provide the products that can have a high turnover in Irish retail pharmacy.


Lobbying the Irish pharmacy agenda Darragh O’Loughlin has been Secretary General of the Irish Pharmacy Union (IPU) for five years. During the last twelve months, he along with the IPU team have spearheaded numerous initiatives and calls for action on a wide range of issues pertinent to community pharmacy, including savings on medicines, the biosimilars agenda, impact of Brexit and have been instrumental in lobbying the Government on the minor ailment scheme. He has experience in both hospital and community pharmacy and has operated his own pharmacy for the last 17 years. Darragh advocates consistently for a greater recognition of the contribution that community pharmacists make to patient health and for an expansion of the role of pharmacists in delivering convenient, accessible and cost-effective healthcare for the benefit of patients, the public and the health system.

Darragh O’Loughlin, Secretary General, IPU

Passionate about customer service Olivia O’Regan is the Managing Director of Foodys Pharmacy, Market Square, Ballina and Harcourt Street, Dublin 2. This year saw huge uptake in services provided to patients in both stores. This improved patient accessibility to services was previously only provided by GPs. The flu vaccination services were very well received and this served to show that pharmacy can finally serve as the place to come for more than just your prescription. Olivia and her team are passionate about customer service, patient care and expansion of services in both stores. Expansion of services and information is on the agenda for the coming year and everyone in Foodys Pharmacy is excited for the year ahead.

Oliva O'Regan, Managing Director, Foody's Pharmacy

Making self care more accessible Tanya O’Toole is passionate about maximising self care in Ireland, especially through increasing pharmacy treatment options for consumers. She has in the past year has focused on optimising the Irish business approach and establishing a new dedicated Sanofi Ireland Consumer Healthcare team, including a partnership with Star Medical. Heading up Sanofi Consumer Healthcare Ireland, Tanya continuously encourages innovation by always seeking for opportunities to bring new non-prescription products to pharmacies. In the past two years Sanofi has launched three new OTC products including Buscopan, Nasacort Allergy and Dulcosoft. These include two Rx to OTC switches, providing pharmacy customers with new ways to manage their health issues. Tanya led the recent integration of the Boehringer Ingelheim and Sanofi Consumer business for UK and Ireland. Ms O’Toole believes in having a strong local team which ensures a comprehensive understanding of the needs of Irish Pharmacies and their customers which results in the ability to identify the best products for launch to improve Irish consumers’ ability to manage their health.

Tanya O'Toole, Head of Sanofi Consumer Healthcare Ireland

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Email: info@pamex.ie Phone: 094â&#x20AC;&#x201C; 902 4000 Website: www.pamex.com


DYNAMIC 100 - 2018 Providing excellence in front of shop Bethan Pearmain joined Haven Pharmacy Riverview in October 2017. Her role has transitioned from a mere Christmas-temp to now running the front of shop full time. Quick to realise that the demographic in the pharmacy is often of an older clientele, she worked hard to remember names and details about their lives, thus reassuring them that though she is a new face, they can expect continued professionalism and exceptional service. She is actively undertaking her course in over-the-counter medicines which she has attacked with the same zealousness as she does all tasks bestowed on her. This has greatly helped with the day to day running of the pharmacy and has also equipped her with the skills requisite to ‘fill the gap’ in dispensary when the need arise. With a keen flair for social media, she has taken to this platform to advertise these new products and in doing so, has reached out to a younger clientele in the process.

Bethan Pearmain, Haven Pharmacy Scannells Bandon, Co. Cork

Developing new therapy approaches Dr Roger Preston is Lecturer in Vascular Biology in the Department of Molecular and Cellular Therapeutics at Royal College of Surgeons in Ireland (RCSI). His research group is dedicated to developing new therapeutic and diagnostic approaches for treatment of haematological and inflammatory disorders. He was recently awarded a prestigious Special Project Award from Bayer Healthcare to develop novel haemostatic drugs to treat bleeding disorders such as haemophilia.

Dr Roger Preston, Lecturer in Vascular Biology, RCSI

Dr Preston is Co-Founder and Scientific Director of the recently launched Irish Centre for Vascular Biology (ICVB), based at RCSI, which comprises an integrated network of research groups across Irish hospitals and universities that are actively engaged in vascular biology research. The ICVB network already includes more than 50 research groups, affiliated to 10 different Irish universities and more than 20 different academic teaching hospitals.

Launched new locum training academy Aishling Quinlan has been working with PharmaConex for the past six years, starting as a Locum CoOrdinator. She very quickly showed an in-depth understanding of the locum business and expanded the locum team to include four locum co-ordinators. Quinlan has a Masters in HR and now works as a Recruitment Manager recruiting both Irish and UK candidates for the Irish market. She has provided CV and Interview skills workshops to our locums in addition to launching the PharmaConex training academy to offer more services to the locums working in Ireland. She has proved an invaluable asset to PharmaConex and has been instrumental in expanding the business in both Ireland and the UK over the past five years. Ashling Quinlan, Recruitment Consultant, PharmaConex

MRII Pharmacy Representative of the Year 2018 Amanda Quinn was awarded the MRII Pharmacy Representative of the Year Award for 2018 at the Irish Pharmacy Awards. She says: “This was a huge achievement, not only for myself but also for my company Perrigo, from a professional and business perspective. Being recognised by my customers for this Award, has increased my profile across the territory and has led to beneficial growth across my product portfolio.

Amanda Quinn, Pharmacy Representative, Perrigo

“The impact of winning the Award has also benefited my career hugely, as I have been given honorary membership of the Medical Representatives Institute of Ireland in recognition of my success, which has led to networking opportunities among leading pharmaceutical professionals in the Industry, something I could have only dreamed of a couple of short years ago. I would like to acknowledge my Perrigo team for their knowledge, guidance and support which has significantly contributed to receiving the Award.”

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DYNAMIC 100 - 2018 Delivering placements for pharmacy students Aisling Reast is Director & National Co-ordinator of APPEL (Affiliation for Pharmacy Practice Experiential Learning). There she manages the 2nd, 4th and 5th year experiential learning placements for the three Schools of Pharmacy in Ireland. Aisling and her team have had a busy but exciting year delivering the first 4th year placements in the new integrated pharmacy programme. Thanks to the support of pharmacists all over the country, these four-month placements have been provided to students in community, hospital, industry and role emerging practice. Her team have visited many of these placements and were delighted to see the quality and range of learning experiences being provided to their students. New additions to the APPEL programme this year are placements in role emerging practice; these placements take place outside the traditional fields of community, hospital and industry. Aisling Reast, Director & National Co-ordinator, APPEL

Leading a team of innovative pharmacists Eugene Renehan, as the Superintendent Pharmacist at Meagher’s Pharmacy Group leads a team of award winning, engaged and innovative pharmacists to deliver the very best of patient care to the patients. As a key member of the Meagher’s management team he helps drive the business strategy mentoring and leading the pharmacists, Interns and technicians. Through the Meagher’s ‘Your Health Matters’ programme he delivers training in practical skills such as personal financial management for the team. He is a regular contributor and dispenses expert advice to customers via the Meagher’s social channels. He sits on the strategic advisory board in Trinity College and is passionate about inspiring the future pharmacists of Ireland in his position of adjunct assistant professor in Trinity. He also represents community pharmacy in the drugs and therapeutics committee in the Mater hospital and is committed to giving back to the profession through his role on the Professional Conduct Committee in the PSI.

Eugene Renehan Superintendent Pharmacist, Meagher's Pharmacy Group

Community Pharmacy Technician of the Year 2018 Lynsey Rigney, from The Village Pharmacy in Coolock, Co. Dublin won the Community Pharmacy Technician of the Year Award at the Irish Pharmacy Awards this year. She said: “The Award has had a huge impact on our small independently run pharmacy in Coolock Village. Our customers have told us they feel the Award was well deserved and how wonderful all of the staff is.

Lynsey Rigney, The Village Pharmacy, Coolock

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“The Award was won in perfect timing of our pharmacy's 10 year anniversary in June 2018. We featured in the Northside People Newspaper and we were delighted to be able to mention the IPN Award our pharmacy received. It has personally boosted my confidence as a Pharmacy Technician and increased staff morale, and we're looking forward to entering the Awards next year already. I have since been promoted to Dispensary Manager.”


Improving communication in pharmacy Colin Ryan MPSI from McCabe’s Pharmacy, Bray, took part in the McCabe’s Pharmacy Leadership Programme in 2018 He said: “I analysed the resources available to me in my pharmacy, aiming to identify team members with characteristics which would best suit specific roles in the pharmacy. I reviewed my communication style and the styles within my team in order to identify the most functional style that would suit team members. “I initiated hosting a daily huddle each morning. This involves a five minute, informal meeting allowing the team and I to set the goals for the day and discuss any issues from the previous days. This simple but effective action assisted my team to improve communication, increase efficiency and create clarity around goals.

Colin Ryan MPSI, Pharmacist, McCabe’s Pharmacy

Life Pharmacy Student of the Year 2018 Meabh Ryan was this year the first recipient of the Life Student Pharmacist of the Year Award at the Irish Pharmacy Awards. She said: “This is an award which I hope many students will continue to receive in future years. I believe this award is an important one, as it empowers students as well as encouraging and celebrating their hard work and determination. “I also believe that this award was a tremendous achievement for Trinity Pharmacy, with my good friend Faiza Sefron having also been shortlisted. These nominations are a reflection on the high standards of Trinity’s School of Pharmacy.

Meabh Ryan, Life Pharmacy, Student Pharmacist of the Year Award 2018

“The award was also an opportunity to increase awareness of the dynamic change that pharmacy in Ireland is currently undergoing with the new five-year integrated programme. Pharmacy is such a versatile degree to have, one which can lead you down more paths than I or many of my peers could have expected starting out.”

Success in launch of online portal Nicola Ryan began working with PharmaConex as a locum Co-ordinator. She grew the PharmaConex office in Shannon and quickly became the Operations Manager of the business overseeing the expansion of our offices in Shannon and Dublin. This year she oversaw the launch of the HealthConex Academy, collaboration between PharmaConex and Olive Media. The HealthConex Academy is an online portal made available to Pharmacists, Locums and Pharmacy owners. This is an interactive portal that gives access to training courses, such as GDPR, first aid, upselling skills and time management, among others. It allows people to up skill without leaving the Pharmacy. This tool was also introduced by PharmaConex to support Pharmacists with their CPD. Nicola Ryan, Operations Manager, PharmaConex

Founder and Pharma Buddy Advocate Dr Paul Ryan is the co-founder of PharmaBuddy.ie which is a free online resource for pharmacists. There are over 3,200 Irish pharmacists registered on PharmaBuddy.ie helping each other with everyday problems encountered in the pharmacy setting. He has also founded Prescription Revision which gives up to date therapeutics tutorials to GPs, pharmacy and medical students.

Dr. Paul Ryan, Co-Founder, PharmaBuddy.ie

Dr Ryan is a clinical pharmacist, a GP, a peer support pharmacist with the IIOP and an IPU academy tutor.

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DYNAMIC 100 - 2018 Instrumental in the success of the IIOP Sonya Saenz Saralegui was one of the first team members to join the Irish Institute of Pharmacy (IIOP) in 2014 following a successful career working in both community pharmacy and pharmacy wholesale. She is instrumental in the operational success of all of the 2018 IIOPs activities including the first series of Practice Review events which took place in April and October of 2018. She has had a busy year working closely with Peer Pharmacists who contribute to the IIOP Quality Assurance processes (ePortfolio Review and Practice Review) along with Accreditation and Review of Training Programmes. She is also a keen baker and has treated the IIOP team to a variety of delicious bakes throughout 2018.

Sonya Saenz Saralegui Operations Co-ordinator, IIOP

Supporting consumer offers in retail pharmacy Sarah Sambrooks is Head of Consumer at Uniphar. With close on 20 yearsâ&#x20AC;&#x2122; experience in retail pharmacy, she has a wealth of knowledge that she employs to best support the consumer offers Uniphar brings to its extensive customer base. She heads up the team that looks after procurement of consumer goods to the independent pharmacy market. Sarah Sambrooks, Head Of Consumer, Uniphar

Influencing pharmacy in retail Una Sheil joined the CarePlus Pharmacy Commercial Team as Front of Shop Buyer in 2017. Her role is to influence pharmacies to become more retail focused and maximise selling opportunities in their front of store. Sheil has spearheaded a new Parent and Baby campaign in 2018 which included two Baby promotional events in stores in March and October, partnering with key suppliers to launch CarePlus Baby Club and a dedicated training course for front of store staff to become certified Baby Advisors. This will position CarePlus Pharmacy as a lead player in the parent and baby category in pharmacy, with plans for further growth and investment in 2019. Una Shiel, Front of Shop Buyer, CarePlus Pharmacy

GSK Self-Care Award 2018 Ronan Sheridan has been a hugely positive influence since he joined LloydsPharmacy Ireland as a Regional Manager in February 2018, and the group enjoyed success at the 2018 Irish Pharmacy Awards taking the GSK Self-Care Award. Ronan is responsible for the operations of 24 stores across South Dublin, Wicklow and Wexford. In his role he supports Managers in achieving their KPIs, ensures best practice across his region and provides various training. As well as his full time role, Sheridan is an assessor for the IPU Pharmacy Technician course, tutor for IPU Academy, Peer Support Pharmacist with the IIOP and Director of the Pharmacy Benevolent Fund.

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Ronan Sheridan MPSI, Regional Manager, LloydsPharmacy Ireland


Established pharmacy as hub of the community Martin Slattery is passionate about advancing the role of the pharmacist in the community setting by promoting health and wellness through a wide range of health services he offers and events organised in the pharmacy. Martin is the Supervising Pharmacist at Headford CarePlus Pharmacy and this year they were named “Health & Wellness” Pharmacy of the Year at the recent CarePlus Awards. They have also have been nominated as a top three finalist at the recent Irish Pharmacy Awards for the 'RB Nurofen for Children Baby Health Pharmacy of the Year' title. As a pharmacy that is only open just over two years, Headford CarePlus has already established itself as a hub for the community to get excellent advice on a wide range of health topics.

Martin Slattery, Supervising Pharmacist, Headford Pharmacy, CarePlus

Dedication to medicine management Ade Stacks, Founder of Stacks Pharmacy, was inspired to create accommodation for the families of seriously ill children. The project works with the families who are separated from their severely ill children when they are needed most, by providing a safe homely environment named ‘Hugh’s House.’ After working in pharmacies in Ireland and having travelled around the world, Ade Stack prepared to undertake a giant leap. Using friendliness and a sense of community as her model, she opened her first Stacks Pharmacy in Skerries in 2000. Her second pharmacy, in Darndale North Dublin, followed less than a year later. Stacks has now grown to more than 17 pharmacies, each of which is unique but which share common values. Ade Stack, MPSI, Owner, Stacks Pharmacy

A particular interest of Ade’s is a dedication to medication management and Stacks Pharmacy now leads the field in Ireland with regard to practical ways to manage medication. Today, as much as in 2000, Stacks Pharmacy stays close to their roots through being involved in the community.

Partnership to aid cancer survival Marina Timotijevic, Marketing Manager at McCabes Pharmacy has worked with Cancer Trials Ireland, a charity that aims to prolong the quality and length of life of patients with rare forms of cancer. The charity receives little to no fundraising income. In a new initiative, McCabes Pharmacy will run a variety of unique and innovative fundraising projects for the charity that will raise public awareness of the highly innovative work that the charity conducts. It will involve pharmacists and oncologists in the search for new cures for the rarest forms of cancer. Marina’s ground-breaking work with a little known but high impactful charity will make lasting impact. Marina Timotijevic, Marketing Manager McCabes Pharmacy

Chairman of Boards Cormac Tobin is the previous Managing Director, and Member, of Celesio’s European Leadership Team. Prior to his resignation in November 2017, Cormac’s vision for Celesio UK included creating a healthcare eco-system which operates at the intersection point of the digital and physical worlds so customers and patients can live life to the fullest. During his tenure as MD he led the way with his commitment and his approach is evidenced by years of success for the family of brands, including LloydsPharmacy being named the UK’s most customer-centric brand in a study by independent agency CSpace, AAH’s recognition by Consumer Insights Group as the UK’s most trusted pharmaceutical wholesaler and industry recognition for winning Store of the Year, for John Bell and Croydon royal warranted pharmacy and Betterlife assisted living concept store.

Cormac Tobin, Chairman of Boards

Cormac is currently Chairman of Cara Pharmacy, Fallon & Byrne, From Me to You Gift Card company and My Clinic On-Line Doctor.

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DYNAMIC 100 - 2018 Community appreciation for a dynamic approach Tom Treacy and his team at Treacy’s Pharmacy Westport were this year nominated for the Sanofi People’s Pharmacist Award. This comes on the back of his mission statement, which is "always giving more" and has set the precedent for their high quality care and ensuring they offer the latest pharmacy services at competitive independent prices. Tom’s customer service approach is renowned within his community for its uniqueness and effectiveness. The Award is voted for and nominated by the general public alone therefore showcasing their appreciation for the way the pharmacy promotes health and wellbeing. The future of the pharmacy profession for Tom and his team is a bright one as they continue to make the needs of their patients’ health and wellbeing their priority. Tom Treacy, Pharmacist, Treacy's Pharmacy, Westport

Driving efforts to improve community health Amanda Tringle, Pharmacist at Haven Pharmacy Scannell's Bandon, has recently completed a post-graduate diploma in general pharmacy practice. Earlier this year she also organised for a talk on medication safety to be given to a local breastfeeding group, using the expert knowledge she developed while working on women’s wards in the UK to come up with practical, relevant information to deliver to these mothers. Furthermore, this summer she championed the IPU BPAF pilot in her pharmacy, recruiting regular patients and passers-by alike to have a heart health screening check. She had incredible enthusiasm for this project, firmly believing that the development of pharmacy practice in Ireland is essential to population health and, as always, eager to take on research and learning opportunities. She has recently rolled-out her plan for the pharmacy to become the smoking cessation experts in their local community, named the Haven “Stop Smoking” Campaign. Amanda Tringle, Pharmacist, Haven Pharmacy Scannell's Bandon, Co. Cork

Uniphar FIXXA Category Development of the Year 2018 Martina Vengrinola has been with CarePlus Pharmacy for the last four years, overseeing the buying division for OTC, Vitamins and First Aid categories. She is very focused on working closely with suppliers to deliver the most competitive offers for CarePlus customers. Martina Vengrinola, OTC Buyer, CarePlus Pharmacy

Martina has also led key initiatives that saw CarePlus Pharmacy take home the Uniphar FIXXA Category Development of the Year Award for 2018 at the Irish Pharmacy Awards.

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Championing the cause for Independents Aiden Walsh has produced a number of reports on the future of independent pharmacy in Ireland and has strongly argued that the sector will continue to lose market share to the large chains unless they play to their strengths. He says: “We should also seek to satisfy the documented demand that we provide new health services to our customers. As the Midlands representative on the Community Pharmacy Committee of the IPU for the last decade or so, I have been involved again this year in forming the future strategy of the Union and have influenced the greater emphasis on pharmacists helping patients care for their own health by providing advice and testing for such conditions as hypertension, raised cholesterol, diabetes, and more. “Having prompted the creation of the Allcare Pharmacy Franchisee Committee, I am working to ensure that the group adapts and does likewise. Finally, I was nominated by the IPU this year to serve on the Midlands Regional Hospital Pharmacy & Therapeutics Committee: I intend to use this opportunity to promote the role of community pharmacy in maintaining the health of the general community, to the benefit of the taxpayer and the people.”

Aidan Walsh, Pharmacist at Allcare

Reward for life-saving act Ann-Marie Walsh, Supervising Pharmacist at LIoydsPharmacy Tullow Street, Carlow displayed tremendous bravery and expertise when she used a defibrillator in conjunction with CPR on a local Carlow man who was in suspected cardiac arrest. The incident brings to the light the important role that local pharmacies play in delivering an accessible, high standard of heart healthcare services and both are worthy of praise for this life saving act. Ann-MarieWalsh, Supervising Pharmacist, LloydsPharmacy

Increasing engagement with the community Lisa Walsh has leveraged her education and extensive consulting experience to introduce a professional coaching element to the LloydsPharmacy CYHD (Change your Health Direction) Campaign, training programme. The purpose of the CYHD campaign is to increase engagement within the community, educate and support our customers to help them live a healthier life and deliver an exceptional free service to our customers. Customers who sign up for the programme are supported by the CYHD coach in store to make improvements such as weight loss, smoking cessation, improve their diet and generally lead a healthier life. Free BMI checks, Blood Pressure Measurement, Food Diaries and smoking cessation advice and weekly health check ins, are included for customers who sign up to the programme. To prepare the Coaches to deliver this service Lisa trained the CYHD colleagues to use professional coaching techniques.

Lisa Walsh, Pharmacist, LloydsPharmacy

Clinigen Group Community Pharmacist of the Year 2018 Mike Walsh, Walsh's Pharmacy, Fermoy, Co Cork, has gone above and beyond the call of duty this year, often taking measures to extend his work outside of the confines of the pharmacy. He is known throughout his community for his contributions to charity supporting 40 local causes, hosting public health talks and he is regularly featured in his local newspaper lending his knowledge on the industry.

Mike Walsh, Walsh's Pharmacy, Fermoy, Co Cork

Living above the pharmacy, he has also been known to answer calls at unsociable hours to help the most vulnerable customers that require urgent assistance. As well as this he has established various local initiatives such as mother-and-baby first aid sessions and defibrillator training for GAA. He is always finding ways to build solid grounds of communication with his customers, even reaching the individuals that live in rural areas by creating a convenient prescription delivery service. All of his dedication and hard work paid off this year when he was awarded the Clinigen Group Community Pharmacist of the Year 2018.

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Feature

The role of the pharmacist in treating urinary tract infections A urinary tract infection is an infection that begins in the urinary system. The urinary system is composed of the kidneys, ureters, bladder and urethra. Any part of the urinary system can become infected, but most infections involve the lower urinary tract, the bladder and the urethra. Women are at greater risk of developing a urinary tract infection than are men. A urinary tract infection limited to the bladder can be painful and annoying. However, serious consequences can occur if a urinary tract infection spreads to your kidneys. Patients with UTI symptoms should present to their GP. The role of the pharmacist Antibiotics are the typical treatment for a urinary tract infection and community pharmacists will be familiar with symptomatic UTI management. A pharmacist can also help with advice on how to reduce the chance of getting a urinary tract infection in the first place. Over-the-counter painkillers such as paracetamol can help with any pain. Pharmacists will also stock a range of capsules and oral solution granules for relief. If caught early UTIs can be treated with available over the counter medecines which can help to assist in managing symptoms. If further treatment is required a pharmacist can help to determine if referral to your doctor is required for a course of antibiotics. Symptoms such as discomfort and burning can be relieved before the antibiotics take effect (which can take up to 36 hours.) These include paracetamol and urinary alkalinisers. There are also natural agents that can help the antibiotics get rid of the infection such as cranberry. To help prevent UTIs in females a couple of very handy tips are: • After going to the toilet always wipe from front to back • After sexual intercourse always go to the toilet and urinate In post-menopausal women, local oestrogen gel to the vaginal area can prevent UTIs from occurring. Symptoms Urinary tract infections don't always cause signs and symptoms, but when they do they can include:

Most UTIs begin in the lower urinary tract

• A strong, persistent urge to urinate • A burning sensation when urinating • Passing frequent, small amounts of urine • Urine that appears cloudy • Urine that appears bright pink or cola coloured, a sign of blood in the urine • Strong-smelling urine • Pelvic pain, in women • Rectal pain, in men Causes The urinary system is composed of the kidneys, ureters, bladder and urethra. All play a role in removing waste from your body. Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to

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multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, the defences sometimes fail. When that happens, bacteria may take hold and grow into a fullblown infection in the urinary tract. The most common urinary tract infections occur mainly in women and affect the bladder and urethra. • Infection of the bladder (cystitis) is usually caused by Escherichia coli (E. coli), a species of bacteria commonly found in the gastrointestinal tract. Sexual intercourse may lead to cystitis, but you don't have to be sexually active to develop it. All women are susceptible to cystitis because of their anatomy, specifically, the close proximity of the urethra to the anus and the short distance from the urethral opening to the bladder.

• Infection of the urethra (urethritis) can occur when gastrointestinal bacteria spread from the anus to the urethra. In addition, because of the female urethra's proximity to the vagina, sexually transmitted diseases (STDs), such as herpes, gonorrhoea and chlamydia, also are possible causes of urethritis. Risk factors Some people appear to be more likely than are others to develop urinary tract infections. Risk factors include: • Being female. Urinary tract infections are very common in women, and many women will experience more than one. A key reason is their anatomy. Women have a shorter urethra, which cuts down on the distance bacteria must travel to reach the bladder.


Self testing Community pharmacists will stock urine infection tests as a simple reliable screening test to detect indirect signs of urinary tract infection such as protein, nitrite and leucocytes present in urine. What are the benefits of testing for Urine Infections? Urine infections can range from mild, bladder infections to severe kidney infections. All of these infections can be potentially serious and will require medical attention. In women Urine infections are 50 times more likely than in men. When should a urine infection test be used? If the patient is experiencing any of the following symptoms their urine should be tested • A need to urinate frequently

Serious consequences can occur if a UTI spreads to the kidneys • Being sexually active. Women who are sexually active tend to have more urinary tract infections than women who aren't sexually active. • Using certain types of birth control. Women who use diaphragms for birth control also may be at higher risk, as may women who use spermicidal agents. • Undergoing menopause. After menopause, urinary tract infections may become more common because the lack of estrogen causes changes in the urinary tract that make it more vulnerable to infection. • Having urinary tract abnormalities. Babies born with urinary tract abnormalities that don't allow urine to leave the body or cause urine to back up in the urethra have an increased risk of urinary tract infections. • Having blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of urinary tract infection. • Having a suppressed immune system. Diabetes and other diseases that impair the immune system, the body's defence against germs, can increase the risk of urinary tract infections. • Using a catheter to urinate. People who can't urinate on their own and use a tube (catheter) to urinate have an increased risk of urinary tract infections. This may include people who

• Experiencing any Pain while passing urine are hospitalised, people with neurological problems that make it difficult to control their ability to urinate and people who are paralysed. Complications When treated promptly and properly, urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can become something more serious than merely a set of uncomfortable symptoms. Untreated urinary tract infections can lead to acute or chronic kidney infections (pyelonephritis), which could permanently damage your kidneys. Urinary tract infections may be overlooked or mistaken for other conditions in older adults. Young children also have an increased risk of kidney infections. Pregnant women who have urinary tract infections may have an increased risk of delivering low birth weight or premature infants. Women who experience three or more urinary tract infections are likely to continue experiencing them. Diagnosis Tests and procedures used to diagnose urinary tract infections include: • Analysing a urine sample. A doctor may ask you to turn in a urine sample that will be analysed in a laboratory to determine if pus, red blood cells or bacteria are present. To avoid potential contamination of the

sample instruct patients to first wipe their genital area with an antiseptic pad and to collect the urine midstream. • Growing urinary tract bacteria in a lab. Laboratory analysis of the urine is sometimes followed by a urine culture, a test that uses as urine sample to grow bacteria in a lab. This test tells the doctor what bacteria are causing the infection and which medications will be most effective. • Creating images of the urinary tract. If a doctor suspects that an abnormality in the urinary tract is causing frequent infections, patients may undergo tests to create images of their urinary tract using ultrasound or computerised tomography (CT). Another test called an intravenous urinary pyelogram uses X-rays to create images. During this test, a dye is injected into a vein in the arm and X-rays are taken of the urinary tract. The dye highlights the bladder and urethra and allows the doctor to determine if there is any abnormalities that slow urine from leaving the body. • Using a scope to see inside the bladder. If someone suffers recurrent urinary tract infections, a doctor may use a long, thin tube with a lens (cystoscope) to see inside the urethra and bladder. The cystoscope is inserted in the urethra and passed through to the bladder. This procedure is called cystoscopy.

• Urine that has an offensive odour that may also be cloudy • Any fever or chills & Pain in the loins This test can be used by everyone, but it is strongly advised for women aged from 16 years and over. A greater role for pharmacists? Research has suggested that community pharmacists could take a greater role in the treatment of UTIs. Operating within patient group direction control antibiotic treatments for UTIs could be provided via community pharmacy to improve patient access to treatment which may also maintain antibiotic stewardship and reduce GP workload. Pharmacists in some Canadian jurisdictions have recently been granted the ability to prescribe for uncomplicated urinary tract infections (UTIs). The Scottish government has also rolled out a scheme across every health board in the country to enable pharmacists to treat patients with urinary tract infections (UTIs).


News Half of people in Ireland believe antibiotics kill viruses Almost half of Irish people mistakenly believe that antibiotics kill viruses, according to an EU-wide study. There have been repeated warnings that Irish people overuse antibiotics, with experts describing it as the greatest challenge to the health service. The new research, ordered by the European Commission, found that 46 per cent of Irish people knew that antibiotics should not be used to treat common viruses, down from 57 per cent in a similar poll conducted in 2016. It found that 48 per cent of Irish people believed that antibiotics killed viruses and 6 per cent did not know. Only in seven out of the 28 EU member states did a majority provide the right answer to the Eurobarometer poll. The study shows that there has been a positive evolution in the use of antibiotics: 32% of people said they had taken antibiotics in the last twelve months, compared to 40% in the 2009 survey. However, many of these antibiotics were taken unnecessarily: 20% of antibiotics were taken for flu or a

cold and 7% took them without a medical prescription. 66% of the respondents know that antibiotics are of no use against colds, and 43% are aware that antibiotics are ineffective against viruses. Over two thirds of people would like to have more information about antibiotics. In reaction to these figures, and on the occasion of the European Antibiotic Awareness Day Commissioner Vytenis Andriukaitis said: “This Eurobarometer shows that more effort is needed to raise awareness and knowledge on antimicrobials among fellow citizens. Moreover, the latest estimates of 33 000 deaths per year in Europe due to antimicrobial resistance must serve as a wake-up call to us all. “Most of these deaths are avoidable by stopping the unnecessary use of antibiotics and through better diagnosis and prevention of infections in hospitals and communities. I call on everyone who has influence

in the prevention and treatment of infection to redouble their efforts to combat the threat from antimicrobial resistance. On top of raising awareness and improving knowledge, we must join forces and tackle antimicrobial resistance from the animal health and environmental perspectives, as well as the human health angle. In a few days, the Council will give its green light for a new European legislation on veterinary medicines and medicated feed, a major breakthrough in this field.” The results of the Eurobarometer and the European Centre for Disease Prevention and Control (ECDC) report were in Brussels at the European Antibiotic Awareness Day 2018 conference: “One Health to Keep Antibiotics working”. Over the last 15 years, the EU has stood at the forefront of addressing antimicrobial resistance. Last year, a new and comprehensive EU action plan on antimicrobial resistance was adopted, setting the Commission's objectives to

There have been repeated warnings that Irish people overuse antibiotics tackle it in human health, animal health and environment policies. An important milestone will be the forthcoming European legislation on veterinary medicines and medicated feed, which lays down a wide range of concrete measures to fight antimicrobial resistance and to promote the prudent and responsible use of antimicrobials.

PERRIGO LAUNCHES INNOVATIVE NEW RANGE OF HEALTHCARE PRODUCTS

PERSPIREX OFFERS CLINICALLY PROVEN SWEAT PROTECTION FOR EXCESSIVE SWEATING

Leading global healthcare company Perrigo has launched an innovative new range of over-the-counter (OTC) products under the Perrigo name. The new Perrigo range is available exclusively in Pharmacy and will offer consumers relief from Pain and Cold & Flu symptoms, at an affordable price. Perrigo’s new range includes Perrigo Cold & Flu Multi Relief Max Powder for Oral Solution, which is the only max strength triple active sachet available in Ireland that can help relieve your cold and flu symptoms. Recent research conducted by Perrigo among Irish consumers, found that over 40% purchase OTC medicines multiple times a month and 70% would prefer to use OTC medicines to treat their illness and avoid taking prescription medication or antibiotics, where possible. In addition to Perrigo Cold & Flu Multi Relief Max Powder for Oral Solution, the range also includes Perrigo Cold & Flu Powder for Oral Solution, Perrigo Cold & Flu Multi Relief Capsules and Perrigo Cold & Flu Tablets to offer relief from flu symptoms, cold symptoms, sinus pain and other pains associated with the common cold. Perrigo’s pain range, which includes Perrigo Ibuprofen coated tablets and Perrigo Paracetamol film-coated tablets, offers short-term relief for mild to moderate pain such as headaches.

Sweating is a natural bodily function that helps us to regulate our body temperature but for millions of people around the world, excessive sweating or hyperhidrosis can be a cause of shame and embarrassment. While no figures exist on how many people are affected by hyperhidrosis in Ireland, it is estimated to affect around 5% of the population worldwide. The pharmacy is often the first port of call for people suffering from hyperhidrosis and Perspirex antiperspirants, available exclusively in pharmacy, are clinically proven to be one of the most effective lines of antiperspirants on the market. The Perspirex formula provides superior protection from sweat and odour for up to 5 days from a single application. Free from perfume and preservatives, and fortified with Perspirex special Skin Care Systems, the skin irritation often associated with high-performance antiperspirants is reduced to a minimum. Perspirex is so confident in their range of high performance products, that if consumers are not 100% happy with their purchase, they can avail of their money back until December 2019 (*while stocks last, applies to promotional packs only). Perspirex Roll-on Antiperspirant is available in three versions: Perspirex Original, Perspirex Comfort and Perspirex Strong.

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WaterWipes has launched a new

variant of its popular wipe made with 99.9% water plus a drop of fruit and Soapberry extract. With 57% of consumers purchasing natural products due to their lack of unnecessary ingredients or chemicals, the new wipes guarantee the purity parents rely on from WaterWipes, while harnessing the natural cleaning properties of Soapberry, for growing babies who are starting to explore food and the world around them. WaterWipes with Soapberry have been accredited by Allergy UK.


CarePlus Conference

CarePlus annual conference emphasises ‘The Power of One’ CarePlus Pharmacy, Ireland’s fastest growing pharmacy chain, held their much-anticipated annual conference in beautiful Lyrath Estate in Kilkenny on Sunday 21st October. The innovative theme of this year’s conference was the “Power of One.” The theme was centered around the importance of all the individual people within the CarePlus Pharmacy network, and each individual performing at their best within the company every day. The theme reinforced the idea that every person is equally important and great at what they do, from the person who opens the pharmacy in the morning, to the person who locks up at night, to the people running different events and supporting the pharmacies from Head Office. The Power of One symbolises the difference that one person can make on a daily basis. The success of CarePlus Pharmacy relies on each individual person within the network collectively working together to drive the success of the group.

Niamh Lynch addresses delegates at the CarePlus conference

Morning Session The speakers in the morning session articulating what this message meant to them included Niamh Lynch, Commercial Director at CarePlus; Michael Morgan, Sales Director at Supervalu and Mark Gallagher who works with Jordan, Formula 1. Niamh Lynch spoke about the thought process behind the Power of One theme and how everyone within the group has played a significant role in driving the many highlight moments of 2018 which has seen the CarePlus footprint grown significantly over the last year. Niamh also spoke about how CarePlus will soon be on the retail landscape in every county in Ireland, and again, that each individual person in the company plays a key role in making this a reality. She also explained to the audience about the strong plan CarePlus has as a company and how this differentiates them from other Pharmacy groups.

Michael Morgan at the CarePlus conference

Finally, Niamh highlighted the importance of knowing your strengths and weaknesses as a company, thus allowing your company to protect themselves from threats and capitalise on opportunities as they come. An essential part of this process for CarePlus is the Support Office and the Pharmacies working together. Michael Morgan from SuperValu, spoke about the importance of community and empowering people, highlighting that people are companies’ most valuable assets. He believes that people are behind everything that is successful about business. Michael also showed a video and spoke about the introduction of Autism Friendly Shopping in their Clonakilty store in West Cork. Created by SuperValu store owner, Eugene Scally, the store now runs an Autism-friendly shopping experience run every Tuesday evening between 6pm and 9pm.

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Mark Gallagher speaking at the CarePlus conference

“When there is a passion, enthusiasm and a ‘can do’ attitude, the results are phenomenal”, he added. Michael also highlighted the benefit of supporting vibrant local communities. As a brand, SuperValu sponsors Tidy Towns,

supports local food producers and sponsor many GAA initiatives. Mark Gallagher then took the stage and spoke about the importance of high performing teams, which are made great due to each person being at their best, and the difference this makes to


Clare Dillon addresses delegates at the CarePlus conference

the team unit is ground-breaking. Mark discussed how each person on the team has an idea that is worth listening to and that as a team they are constantly innovating to win. Formula 1 as a brand are constantly pushing success boundaries, breaking new ground and leading change. Mark further highlighted the importance of taking advantage of what appear to be business catastrophes and how a business make the best out of those situations by diversifying and remaining agile. Afternoon Session The afternoon session of the conference was hosted by Matt Cooper (TodayFM), who introduced Axium owner John Carroll to discuss more about his take on the Power of One, reminding attendees about the idea and meaning behind the message. Dr Dominic Hegarty spoke about pain management in Pharmacies from his experience as a doctor, mentioning important topics such as chronic pain. Matt Cooper rounded off this section with a quickfire Q&A round with Dr Hegarty with regard to pain management in pharmacies and gaining greater insight. Following Dr Hegarty, Paul Lavery, GDPR Specialist from McCann Fitzgerald shared his knowledge with the audience on all the essential aspects of GDPR, privacy, security and its importance, particularly in the Pharmacy industry. Next, economist Stephen Kinsella delivered an inspiring speech about Brexit and the changes we can expect in consumer behaviour

Dr Dominic Hegarty addressing the conference

as a result in the coming months and years. The final speaker of the afternoon session of the conference was Clare Dillon. Clare is a motivational speaker who gave a glimpse into the future about Artificial Intelligence (AI) and the role this plays in the life of the consumer as well as the company. Break-Out Session Attendees to the conference were also able to attend an important break-out session with Derek Colman, MD OF QuickPharm Solutions. The workshop provided information to Pharmacy owners regarding the impact of the EU Falsified Medicines Directive (FMD) when it comes into law in February 2019. Axium has partnered with QuickPharm Solutions to ensure their members can quickly and easily comply with this new legislation. Supplier Trade Show This yearâ&#x20AC;&#x2122;s conference also facilitated their biggest Supplier Trade Show to date, which took place throughout the day at the conference, beginning at 10am and concluding at 5:30pm after the last conference speaker session was finished. Before, after and in between talks, attendees had a chance to speak to suppliers showcasing their companies, both ones they were familiar with and new ones to their network, as well as having a chance to network with one another. The introduction of a Power of One APP for conference delegates this year was especially notable as being digitally proactive is core to CarePlus

Paul Lavery, GDPR specialist, delivers an address at the conference

Pharmacy ethos. The app was also developed in an effort to ensure ease of registration, encourage engagement from attendees and suppliers, Q&A sessions and overall to supply more information to pharmacists and suppliers alike. The APP also created an element of fun with

leaderboards and surprise and delight prize giveaways during the day. Delegates also got to enjoy competing with each other on a Formula 1 car simulator which was the perfect activity to bring the Power of One theme to life on the day.

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CarePlus Awards

Careplus 2018 Business Excellence Awards winners revealed As the afternoon session of the Careplus Pharmacy annual conference drew to a close, attendees got ready for an exciting evening ahead, starting with a cocktail reception with live music in the lobby of the Lyrath Estate. Lucy Kennedy (from the renowned TV series “Living with Lucy”) was the charming host for evening gala dinner and awards ceremony for the CarePlus 2018 Business Excellence Awards.

This year, CarePlus recognised winners across 11 categories including Social Media, Best Customer Range Offering, Operational Excellence, Excellence in Customer Service, Health & Wellness, Superior Knowledge,

Pillar Category, Team of the Year, Community Award and for the first time Supplier of the Year, both for CarePlus and Axium. The awards ceremony was opened with an amazing performance

from global performance group Sephira and closed with a special performance by renowned singer Simon Morgan and special guest Lisa Lambe.

Winners on the night were: McTiernan’s CarePlus Kinnegad & Rochfortbridge – Social Media Award

Keating’s CarePlus Pharmacy – Superior Knowledge Award

Murray’s CarePlus Pharmacy – Best Customer Range Offering

Kilcock CarePlus Pharmacy – Team of the Year

Madden’s CarePlus Pharmacy – Operational Excellence

Keane’s CarePlus Pharmacy – Community Award

Whelan’s CarePlus Pharmacy – Excellence in Customer Service

Perrigo – CarePlus Supplier of the Year

Headford CarePlus Pharmacy – Health & Wellness Award

GSK – Axium Supplier of the Year Award

Killian’s CarePlus Pharmacy – Pillar Category

A big congratulations to all the winners on the evening and to all in attendance for supporting their wins.

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1. McTiernan’s CarePlus Kinnegad & Rochfortbridge – Social Media Award 2. Murray’s CarePlus Pharmacy – Best Customer Range Offering 3. Madden’s CarePlus Pharmacy – Operational Excellence 4. Whelan’s CarePlus Pharmacy – Excellence in Customer Service 5. Headford CarePlus Pharmacy – Health & Wellness Award 6. Keating’s CarePlus Pharmacy – Superior Knowledge Award 7. Killian’s CarePlus Pharmacy – Pillar Category 8. Kilcock CarePlus Pharmacy – Team of the Year 9. Keane’s CarePlus Pharmacy – Community Award 10. Perrigo – CarePlus Supplier of the Year 11. GSK – Axium Supplier of the Year Award

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Clinical Profiles ACCORD HEALTHCARE LAUNCH PELGRAZ® (PEGFILGRASTIM) IN IRELAND Accord Healthcare Ireland is delighted to announce the launch of Pelgraz 6 mg solution for injection in pre-filled syringe. Pelgraz is indicated to reduce the duration of neutropenia and the incidence of febrile neutropenia in adult patients undergoing cytotoxic chemotherapy for malignancy with the exception of chronic myeloid leukaemia and myelodysplastic syndromes.[i] A study showed that daily G-CSFs are incorrectly administered in 42% of chemotherapy cycles, long acting pegfilgrastim has been shown to greatly reduce that figure to just 8%2. Evidence acquired over 10 years of clinical experience demonstrations that biosimilars approved through EMA can be used as safely and effectively in all their approved indications as other biological medicines3. Neutropenia is still one of the most common reasons for reductions or delays in the chemotherapy schedule which impairs survival outcomes and quality of life for patients4. Pelgraz, a pegylated G-CSF biosimilar, is the latest addition to Accord Healthcare’s established portfolio of over 30 oncology treatments across Europe. Accord Healthcare are the first to launch the biosimilar, pegfilgrastim, across Europe. Binish Chudgar, Vice Chairman and Managing Director of the Intas Group, parent company of Accord Healthcare stated “Accord launched its first European approved biosimilar product, Accofil (filgrastim), in 2015 and despite being the 6th entrant has become a leading supplier of this important medicine. Since then the product has been used over 2 million times and Accord has gained valuable experience in bringing biosimilar medicines to market. Our continued focus on bringing biopharmaceuticals to Europe has enabled us to be first to launch a biosimilar pegfilgrastim, and as a first mover we expect to gain an even bigger market share with Pelgraz.” Speaking from the Irish Headquarters in Cork, Tony Hynds, Accord Healthcare Ireland’s Managing Director said “At Accord, our mandate is to deliver affordable medicines that make a

real difference to patients’ lives. With the launch of Pelgraz we are continuing to demonstrate our commitment to reduce the cost of medicines to the state and Irish patients. Along with being a biosimilar, Pelgraz is also a Hi Tech medicine, which now expands our range of Hi Tech medicines in Ireland to 17, across 9 therapeutic indications; the widest of any generic supplier on the Irish market5. Accord is providing affordable alternatives in some of the most complex of therapy areas and this medicine reflects our increased focus in speciality pharmaceuticals and this latest launch further underlines our commitment to oncology patients”. Finally, Mr Hynds highlighted that “Accord will manufacture this medicine in its own state of the art production facility. The company has a wealth of experience with biosimilar medicines and as of 2017 were assessed using IQVIA data to have the second highest number of biosimilars in phase III to approval in the world6. This reflects the strategy of a long-standing commitment in biopharmaceutical development, research and manufacturing. [i] Pelgraz (pegfilgrastim) Summary of Product Characteristics (SmPC) 2 Lambertini M et al. (2015). Pegfilgrastim for the prevention of chemotherapy-induced febrile neutropenia in patients with solid tumours. Expert opinion on biological therapy. 15. 1-19. 3 Biosimilars in the EU. Information guide for healthcare professionals. European Medicines Agency. 2017. http://www.ema.europa.eu/ docs/en_GB/document_library/ Leaflet/2017/05WC500226648.pdf 4 Kourlaba G et al Support Care Cancer 2015;23:2045-2051 5 Accord Hi Tech Data on File 6 IQVIA MIDAS MAT Q3 2017; IQVIA Institute Jan 2018

ICOSABUTATE LATEST DATA SHOWS DIRECT AND POTENT ANTIFIBROTIC EFFECT IN BOTH DIFFERENTIATED RODENT NASH MODELS AND HUMAN STELLATE CELLS NorthSea Therapeutics B.V. (‘NST’), a newly established Dutch

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biotech company developing novel and innovative strategies for the treatment of NASH and other metabolic, inflammatory and fibrotic diseases, today announces the publication of two posters to be presented at the AASLD The Liver Meeting™ 2018 in San Francisco on 9-13 November. The posters will outline the Company’s latest research data of its lead product’s anti-fibrotic effect in both differentiated rodent NASH models and human stellate cells. NorthSea Therapeutics’ lead product, icosabutate, is a structurally designed fatty acid that regulates pivotal lipid signalling pathways involved in hepatic inflammation and fibrosis. Commenting on the newest data, Dr. David A. Fraser, NorthSea’s CSO, stated,“Icosabutate exhibits consistent anti-fibrotic effects in multiple NASH models, but it was unclear whether these effects were indirect. The new data in proliferating human stellate cells suggest these effects are not dependent on paracrine signals from other cell types. These findings are of considerable relevance given the association between degree of fibrosis and clinical outcomes and the complexity of indirect targeting of fibrosis in a highly heterogenous patient population.” All experiments were carried out in the laboratories of Professor Detlef Schuppan, Professor Scott Friedman and with Gubra (CRO), where pre- and post-treatment liver biopsies allowed longitudinal comparisons to be assessed in a well-established NASH ob/ob mouse model.

proliferative responses without reducing cell viability is a promising attribute of the compound and, while the mechanism is being explored, could translate into a potential benefit of reducing hepatic fibrosis in NASH.” Commenting on the combined preclinical and clinical results, Professor John J. Kastelein, Scientific and Advisory Board member, added: “We frequently see that the improved efficacy of a drug is offset by a worsening in the safety profile. On the contrary, icosabutate demonstrates superior efficacy versus other NASH drugs under development and, based on its clinical profile in hyperlipidemic subjects, should also prove superior on both safety and treatment of comorbidities.” Previous phase 1b and two phase 2 clinical studies on icosabutate in hyperlipidemic subjects have demonstrated significant improvements in atherogenic lipids/lipoproteins and glycemic control along with excellent safety. Icosabutate is on course to be phase 2b ready by Q2 2019 .

NEW ENGLAND JOURNAL OF MEDICINE PUBLISHES POSITIVE DETAILED RESULTS FROM PRALUENT® (ALIROCUMAB) CARDIOVASCULAR OUTCOMES TRIAL The New England Journal of Medicine (NEJM) has published positive detailed results of the 18,924-patient ODYSSEY OUTCOMES trial.

Both posters highlight the superior efficacy of icosabutate versus other late-stage NASH drugs on multiple fibrosis endpoints in rodent models. Data collected utilising an advanced optical imaging technique showing that the reduction in fibrosis after icosabutate treatment is associated with a >50% reduction in collagen fiber number, with no significant change after treatment with a GLP-1R agonist used as control.

The trial met its primary endpoint, showing that Praluent® (alirocumab) significantly reduced the risk of major adverse cardiovascular events (MACE) in patients who had suffered an acute coronary syndrome (ACS), which included a heart attack or unstable angina. MACE occurred in 903 patients (9.5%) in the Praluent group and in 1,052 patients (11.1%) in the placebo group (HR 0.85; 95% CI, 0.78 to 0.93; p<0.001).

Professor Scott Friedman, Scientific Advisory Board member and expert in stellate cell biology, liver fibrosis and NASH, added, “Proliferation of myofibroblasts is a key driver of fibrogenesis and thus represents an attractive target for novel anti-fibrotic therapies. Icosabutate’s ability to inhibit

Death from any cause was less frequent among Praluent-treated patients. Praluent was associated with a 15% lower risk of death; death occurred in 334 (3.5%) patients in the Praluent group and 392 (4.1%) patients in the placebo group (HR 0.85; 95% CI, 0.73 to 0.98).[1]


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Clinical Profiles The NEJM publication also includes results for MACE and other secondary endpoints including death, according to subgroups of baseline LDL-C (lowdensity lipoprotein cholesterol) levels, which are described in detail in the Supplementary Appendix. The data showed that patients with higher LDL-C at baseline (at least 100 mg/dL) were at greater risk of MACE, as well as other secondary endpoints including death. Moreover, the greater risk-reduction occurred in this category of patients: in the Praluent group MACE was reduced by 24% (HR 0.76; 95% CI, 0.65 to 0.87) and death from any cause was 29% lower (HR 0.71; 95% CI, 0.56 to 0.90) compared to placebo2. Adverse events were similar between groups except for injection site reactions (Praluent 3.8%, placebo 2.1%). Results of the ODYSSEY OUTCOMES trial were presented at the American College of Cardiology's 67th Annual Scientific Session & Expo in March 2018. Additional analyses, including mortality, will be presented later this week at the American Heart Association Scientific Sessions 2018. "Despite the use of statins, many patients with coronary heart disease go on to have recurrent cardiovascular events, underscoring the need for additional treatment options. This need is particularly urgent among patients with acute coronary syndrome and LDL-C levels that remain high despite best possible application of statin therapy," said Dr. Gregory G. Schwartz, M.D., Ph.D., University of Colorado School of Medicine, Aurora, CO, and co-chair of the trial. "These data in the New England Journal of Medicine show that adding alirocumab to intensive or maximum tolerated statin treatment significantly reduced the risk of future cardiovascular events. This benefit was heightened among study patients with higher LDL-C levels at baseline." The effect of Praluent on cardiovascular morbidity and mortality is currently being reviewed by regulatory authorities and has not yet been fully evaluated. Data from the ODYSSEY OUTCOMES trial has been submitted to regulatory authorities in the European Union and in the U.S., where the target

action date for the Food and Drug Administration (FDA) decision is April 28, 2019.

CROWN BIOSCIENCE EXPANDS CARDIOVASCULAR & METABOLIC DISEASE RESEARCH CAPABILITY Crown Bioscience, a global drug discovery and development services company providing translational platforms to advance oncology, inflammation, cardiovascular and metabolic disease research, announced the expansion of its New Iberia, Louisiana research facilities to support novel capabilities including non-GLP clinical chemistry, biomarker services and proprietary early stage preclinical models. With this enhancement CrownBio will focus on cardio-metabolic endpoints to cost effectively deliver robust, high-quality sample analysis data as a standalone service, or as a supplement to in vivo studies, which will provide valuable information about drug efficacy, candidate selection and enzymatic activity. The Company has also added an electrochemiluminescent technology platform to its on-site research capabilities, allowing clients to investigate the disease pathophysiology and the agents’ mechanism of action. This expansion follows CrownBio’s 2017 investment at the New Iberia Research Center (NIRC) to house its exclusive FATZO and ZDSD polygenic models for obesity, metabolic syndrome and diabetes translational research, in fully renovated, state-of-the art facilities that benefit from AAALAC, OLAW and USDA accreditations. “We are incredibly pleased with the outcome of our renovation and expansion,” stated Keefe Chng, General Manager and CSO of CrownBio Louisiana. “The addition of the FATZO and ZDSD preclinical models to our platform at CrownBio Louisiana is a significant step forward in our capabilities at this site.” “Our clients are thrilled to have access to an analytical lab onsite,” said Jim Wang, Senior Vice President of CrownBio’s Cardiovascular and Metabolic Disease division. “These platforms allow us to rapidly and costeffectively analyze samples thereby enabling our clients to get their compounds to the clinic sooner.”

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To learn more about CrownBio’s new clinical chemistry and biomarker services, visit https:// www.crownbio.com/reliableclinical-chemistry-biomarkerservices

SANOFI AND DENALI THERAPEUTICS TO DEVELOP TREATMENTS FOR NEUROLOGICAL AND INFLAMMATORY DISEASES • Candidate molecules have the potential to treat multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer's disease, and systemic inflammatory diseases • Denali to receive $125 million upfront payment and future milestone payments that could exceed $1 billion PARIS, France - November 1, 2018 - Sanofi plans to collaborate with Denali Therapeutics Inc. on the development of multiple molecules with the potential to treat a range of neurological and systemic inflammatory diseases. The two lead molecules (DNL747 and DNL758) target a critical signaling protein known as the receptor-interacting serine/ threonine-protein kinase 1 (RIPK1) in the TNF receptor pathway, which regulates inflammation and cell death in tissues throughout the body. The companies plan to study DNL747 in multiple sclerosis (MS), Alzheimer's disease, and amyotrophic lateral sclerosis (ALS), and DNL758 in systemic inflammatory diseases such as rheumatoid arthritis and psoriasis. Under the terms of the agreement, Sanofi will make an upfront cash payment to Denali of $125 million, with future development and commercial milestone payments that could exceed $1 billion. Sanofi and Denali will share commercial profits and losses from DNL747 in the U.S. and China equally, while Denali will receive a royalty from Sanofi for other territories for DNL747 and worldwide for DNL758. Phase 1b and 2 clinical development costs for DNL747 will be fully funded by Sanofi for MS, ALS, and other neurological indications, except in Alzheimer's disease, which will be funded by Denali. Phase 3 trials for all neurological indications will be jointly funded by Sanofi (70%) and

Denali (30%). Sanofi will fully fund the clinical development costs for DNL758 in systemic inflammatory diseases. "This collaboration with Denali is yet another example of Sanofi's commitment to accelerate the development of transformative and best-in-class treatments for patients living with serious illnesses," said Rita Balice-Gordon, Ph.D., Global Head of Rare and Neurologic Diseases Research at Sanofi. "We look forward to working with Denali on the RIPK1 program as we explore the potential of this mechanism in neurologic and inflammatory diseases." "RIPK1 is a promising target with the potential to bring disease modifying medicines to patients suffering from neurodegenerative diseases as well as systemic inflammatory diseases. We are very excited to partner with Sanofi and expand our RIPK1 program into new indications," said Ryan Watts, Ph.D., CEO of Denali. "With its considerable infrastructure and experience in both clinical development and commercial functions, Sanofi is an ideal partner for Denali to maximize the clinical and commercial success of our RIPK1 program." RIPK1 Molecules • DNL747, a brain-penetrant small molecule, is currently being evaluated in early clinical stage trials, known as Phase 1. Phase 1b studies in Alzheimer's disease and ALS patients are expected to commence in the near-term and will inform the subsequent clinical development. Denali will lead the Phase 2 clinical trials in Alzheimer's disease while Sanofi will lead the Phase 2 clinical trials in MS and ALS, as well as future Phase 3 trials in all neurological indications. • DNL758 is a small molecule that does not penetrate the brain. Sanofi will lead clinical development activities for all systemic inflammatory diseases. The clinical trials are expected to begin in 2019. The collaboration also includes additional pre-clinical RIPK1 inhibitor molecules. The transaction is expected to close in the coming months in accordance with customary regulatory approvals.


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IPN 2018 December  

IPN 2018 December