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July 2018 Volume 10  Issue 7

THE INDEPENDENT VOICE OF PHARMACY MGK6160 GSK Panadol Night trade ad IPN full page Amends 29-05-2018.pdf

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In this issue: NEWS: Rise in pharmacists seeking help for substance abuse Page 4 Dual Action

NEWS:

FORMULA

DUAL ACTION FORMULATION PROVIDING FAST & EFFECTIVE RELIEF FROM PAIN AT NIGHT

Push to expand the role of pharmacies in depression screening Page 18

NEWS: First ever Panadol Night marketing campaign worth €200,000 will encourage customers to visit your pharmacy!

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How to deal with negative social media commentary Page 21

FEATURE: Leading the way in monitoring hypertension Page 24

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FEATURE: INCLUDES TV & DIGITAL Paracetamol Diphenhydramine Hydrochloride

Product Information: Please consult the summary of product characteristics for full product information. Panadol Night Film-coated Tablets, paracetamol 500mg, diphenhydramine hydrochloride 25mg. Indications: Short-term treatment of bedtime symptoms of cold and flu pain, rheumatic and muscle pain, backache, toothache, headache, menstrual pain. Dosage: Adults and children 12 years and over: 2 tablets 20 minutes before bed. Max 2 tablets in 24 hours. Minimum dosing interval between this and any other paracetamol containing product: 4 hours. Other products containing paracetamol may be taken during the day but the total daily dose of paracetamol must not exceed 4000mg. Do not give to children under 12 years except on medical advice. Not to be taken by the elderly with confusion. Max duration of continued use without medical advice: 10 days. Contraindications: Hypersensitivity to paracetamol or any of the other ingredients, closed angle glaucoma, porphyria. Precautions: Liver or kidney impairment, epilepsy or seizure

Panadol is a registered trade mark of the GSK group of companies.

Acne Page 34

CPD: disorders, myasthenia gravis, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, pyloroduodenal obstruction, asthma, bronchitis, COPD, hereditary sugar intolerances, the elderly, pregnancy and lactation, concomitant use of sedatives, other antihistamine-containing preparations (including topicals and cough and cold medicines) or tricyclic antidepressants and other drugs with anticholinergic action, alcohol, use of MAOIs within 2 weeks. Side effects: Fatigue, attention disturbance, dizziness, dry mouth, confusion, paradoxical excitation, GI disturbances, hypersensitivity reactions including anaphylaxis and skin rash, thrombocytopoenia, angiodema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction, tachycardia, palpitations, unsteadiness. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Legal Category: Pharmacy only. MA Number: PA 678/39/8. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, CityWest Business Campus, Dublin 24. Text prepared: July 2016. Further information available on request.

Contains Paracetamol. Always read the label/leaflet. Speak with your Pharmacist for Further Advice. CHGBI/CHPAN/0037/18

Schizophrenia Page 39

AWARDS: Irish Pharmacy Awards Winners’ Profiles Page 48


Contents Page 5: Pharmacists seek right of ‘conscientious objection’ over abortion pills Page 9: One in five living with hayfever

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Page 28: Almost half would get their sons vaccinated against HPV Page 32: How the pharmacist can plan for income in retirement Page 46: Study shows benefits for infants when mothers eat healthy fats

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Page 48: Irish Pharmacy Award winners’ profiles

Foreword This edition of Irish Pharmacy News features several issues which are increasingly becoming prevalent in the everyday life of community pharmacists across Ireland. Lorcan Gormley, managing pharmacist at McMeel’s Pharmacy in Skerries talks openly about his battles with depression and the stigma which still surrounds the condition. Gormley would like to see the Irish Pharmacy Union lead a campaign that aims to break down the taboos associated with mental illnesses and promote pharmacists as front-line healthcare professionals who are capable of providing help and referring patients to specialists. Another issue which is increasingly in the news is social media ‘trolling’ and pharmacists are not exempt from it. In this edition pharmacist Janet Dillon explains why she believes it is vital that businesses engage with negative comments posted on their online accounts, but she draws the line at responding to trolls. Also IPN has spoken to Alice Gallagher, supervising pharmacist at Sion Hill Pharmacy in Dublin about how to lead the way in monitoring hypertension. Her pharmacy offers a walk-in blood pressure check and it is proving popular with customers.

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) 6690562

Financial advisor Robert McOwan continues his compelling series exploring the financial lifecycle of a pharmacist, this month concentrating on how you can plan for making sure you have enough income to cover your retirement.

MANAGING DIRECTOR Natalie Maginnis n-maginnis@btconnect.com

Dr Naomi Mackle is Medical Director of The Adare Clinic and gives expert advice on what the pharmacist can to do help with acne, a very common skin condition which can have a devastating effect on self-esteem and confidence.

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COMMERCIAL MANAGER Natalie Millar natalie.millar@ipnirishpharmacynews.ie COMMERCIAL MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie EDITOR Jonny McCambridge editorial@ipnirishpharmacynews.ie JOURNALIST Beau Donelly Editorial@ipn.ie Andrew Jennings andy.editorial@ipn.ie PHOTOGRAPHY Aidan Oliver and Stuart Pearson CONTRIBUTORS Robert McOwan | Dr Naomi Mackle Eamonn Brady | Aine Carroll july.pdf

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Irish Pharmacy IRISH News is circulated PHARMACY to all independent, NEWS multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufacturers and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists. Subscription rate for Irish Pharmacy News is ¤60 plus vat per year. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission. IPN Communications Ltd. has taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

Also this month, following the recent success of the Irish Pharmacy Awards, we begin our series of exclusive profiles looking in more depth at our award winners, discovering their stories and the secrets of their success. Finally, sleep disorders and travel health will be right at the forefront of pharmacists’ minds in the summer months and this edition contains features on both, packed with useful information and advice. Do you have a news tip? Is there a community pharmacy topic you would like to see covered in Irish Pharmacy News? Do you know of someone in your business going that extra mile to promote best practice in Irish pharmacy? Email: editorial@ipn.irishpharmacynews.ie

Profile

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Feature – Sleep disorders

Feature – Hypertension

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Feature – Travel

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CPD

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Clinical Profiles

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Ignite Potential.

̏ Our margin has jumped to 30% profit in our front of counter, with less stock. ̋ - Peter Rice, McKenzie’s Pharmacy

+353 1 6931433 realworldanalytics.com

Ignite Potential.


News Rise in Irish pharmacists seeking help for news brief substance abuse GLOBAL GATHERING OF PHARMA REGULATORS TO DESCEND ON DUBLIN One of the largest global gatherings for the regulation of medical products will take place in Dublin this year, representing a networking opportunity for Irish pharmacists. The Health Products Regulatory Authority was selected by the World Health Organisation to host delegates from 70 member countries. The first two days of the International Conference of Drug Regulatory Authorities are open to the industry. Companies specialising in health product research, development and manufacturing, as well as safety monitoring will be exhibiting. The event will be held at the Clayton Hotel in Dublin in September.

PHARMACISTS CAN HELP FURTHER CHRONIC PAIN RESEARCH Pharmacists are being encouraged to refer people suffering from chronic pain to take part in a new online treatment program. The trial is based on emerging science that shows the benefit in managing health conditions through mindfulness and psychological well being. In Ireland, over half a million people suffer from chronic pain on a daily basis. NUI Galway is looking for people with multiple chronic health conditions to test online treatment for multimorbidity in the comfort of their own homes. The ACTION programme, set up by psychologists and physiotherapists, provides free online sessions that encourage more day-to-day activity, and use mindfulness techniques and cognitive behavioural therapy to assist patients. Dr Brian Slattery, coordinator of the study, said the programme is open to people across Ireland who suffer from chronic pain. “We know that psychological therapies provided to people with chronic conditions are beneficial, but can be hard to access,” Dr Slattery said.

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All pharmacists who sought help from a confidential mental health support service last year reported substance abuse problems, raising serious questions about the misuse of prescription drugs. people were in the 25 to 34 age group (the number of referrals decreased among older people). Of those with substance abuse problems, misuse of prescription drugs was identified in 59% of cases, while alcohol was a problem for 29% of patients. In the misuse of prescription drugs category, almost half of the cohort were pharmacists.

Dr Ide Delargy, clinical lead of the Practitioner Health Matters Programme The Practitioner Health Matters Programme, a free service for pharmacists, doctors and dentists in Ireland, reported a rise in the number of health professionals seeking assistance for depression, anxiety, stress and burnout.

One pharmacist who was suffering from a family bereavement resorted to taking prescription medications to aid with depression and anxiety. The pharmacist was referred to the programme after a colleague noticed the missing medications and reported it to the Pharmaceutical Society of Ireland.

Doctor consultants and GPs made up 75% of the 48 referrals to the programme in 2017, but the number of pharmacists seeking professional help rose to nine representing the second largest group.

The report said the patient was stepped down from work to detox and had engaged well with the service, including taking up ongoing addiction counselling. “Now back working safely and confirmation of progress is communicated to the PSI with patient consent,” it said.

More than half of the health professionals who contacted the service were women, and most

In another case, a pharmacist referred a surgeon to the programme who was

self-medicating with tramadol by presenting scripts at a range of chemists. The report said the surgeon progressed well and was able to return to work. The programme’s clinical lead, Dr Íde Delargy, has said health professionals were “very slow” to come forward when they have a mental health or substance abuse problem, sighting the potential barrier of having to report the issue to their peers. “The key to overcoming this reluctance is to ensure that they will receive a high standard of care in a non-judgmental atmosphere and with complete confidentiality assured.” Those who present to the programme are given a mental health screening assessment, after which a care plan is agree, with a range of interventions on offer including advice, therapy, drug and alcohol testing, and referral to specialists. The not-for-profit charity aims to break down the barriers that delay health practitioners from seeking help, which can often fuel the problem.

Food intolerance tests not to be sold in pharmacies: warning Community pharmacists are being reminded not to offer food intolerance testing to patients, following an earlier warning about their lack of clinical evidence. The Pharmaceutical Society of Ireland said it had been monitoring compliance and had carried out more than 160 inspections so far this year. The regulator would not say whether it had identified any pharmacies still offering food intolerance tests. Earlier this year, the PSI told pharmacy owners and superintendent pharmacists that offering food intolerance testing services to patients was not appropriate. It followed a review by the Health Products Regulatory Authority, which found the cause of food intolerance was unknown, and as such, any test claiming to indicate an intolerance was of little clinical value. “In other words, a positive or negative test result is unlikely to be

specifically related to any particular symptom or clinical condition,” the notice said. The HPRA advised healthcare practitioners that the tests - which use blood, hair or saliva samples - cannot diagnose allergies, and advised patients not to act on the results without expert advice from a doctor or registered dietician. The health products' watchdog has previously raised concerns about an increase in food intolerance tests and associated services being sold to customers in pharmacies. Asked if any community pharmacies had been identified still stocking the tests, the pharmacy regulator said it had been “monitoring compliance through our inspection and enforcement function.”

“The PSI expects that all information and services provided by pharmacists is accurate, clinically valid and in line with current evidence and best practice,” PSI spokeswoman Louise Canavan said. “We would not expect food intolerance testing to feature in any pharmacy service listings. Appropriate follow-up actions are taken by the PSI where non-compliance is identified.” Food allergies and intolerances - including to gluten, nuts, dairy, eggs, fish and crustaceans - are estimated to affect up to 3% of adults and 6% of children. The Food Safety Authority of Ireland says dietary changes should only be undertaken in consultation with suitably qualified experts.


News Pharmacists seek right of ‘conscientious objection’ over abortion pills The organisation which represents community pharmacists in Ireland has confirmed that it has written to the Health Minister in the wake of the Irish referendum result. medical practitioners in order to ensure that individual practitioners would not be compelled to participate in a procedure to which they have fundamental religious or ethical objections.” A code of conduct states that a “pharmacist who, for religious or ethical reasons, cannot provide a specific service to a patient must direct that patient to someone who will.” This can involve delegating dispensing to another colleague in the pharmacy or referring the woman to another premises. Darragh O'Loughlin, secretary general of the Irish Pharmacy Union Darragh O'Loughlin, secretary general of the Irish Pharmacy Union, confirmed he has written to Health Minister Simon Harris to extend the right of conscientious objection to pharmacists who may not want to dispense abortion pills. “It is essential that such provisions be extended to all healthcare professionals, including pharmacists, and not only to

“We are talking about conscientious objection, not conscientious obstruction," he added. The likelihood is that women who have a medical abortion will be able to avail of the two medicines at the GP surgery and will not need to get a prescription filled by a pharmacist. Mr O’Loughlin said: “We are still waiting for detailed proposals. “We contacted our colleagues in Germany, Spain and Portugal

for insight because those three countries were referenced by the minister recently. “Broadly speaking, each of the three responses has indicated that the pills and the service are provided in hospitals or specialist clinics, rather than in a community setting.” The step taken by the IPU was revealed after it emerged that a public list of GPs who are registered to provide medical abortions may be necessary to ensure women looking for a termination are not left confused about where to get the service. Taoiseach Leo Varadkar reiterated that while GPs can have a conscientious objection to providing medical abortions, they will be ethically obliged to refer a woman to a doctor who is participating in the scheme. The referendum, which paved the way for liberalising the State’s strict abortion laws, was passed by a near two-to-one majority last month, but there have been a number of court challenges to the result.

Three separate applications were launched in the High Court in June. The government is planning to bring legislation before the Dáil, providing for abortion on request up to the 12th week of pregnancy, with a three-day “cooling off” period before abortion medication is administered. Health minister, Simon Harris, said he would ask for cabinet approval to turn the draft law into a formal legislative text and Leo Varadkar said he planned to have the new law enacted by the end of the year. Between 12 and 24 weeks, abortion will be available only in cases of fatal foetal abnormality, a risk to a woman’s life or a risk of serious harm to the health of the mother. After 24 weeks, termination will be possible in cases of fatal foetal abnormality. There will be provision for conscientious objection among medical practitioners, although doctors will be obliged to transfer care of the pregnant woman to another doctor.

Men should utilise convenience and accessibility of local pharmacies to tackle niggling health worries Men should take one small step to improve their health by asking their local community pharmacist about any outstanding issues that they have put on the long-finger. During last month’s Men’s Health Week, men were being asked to do at least one practical thing to improve their own health. The Irish Pharmacy Union (IPU) is encouraging men to utilise the convenience and accessibility of their local pharmacy, and ask about any niggling health issues. Community pharmacist and IPU Member Tomas Conefrey says, “A quick private conversation with a pharmacist could mean the difference between a problem being addressed while it’s still curable, or it being allowed to fester with the consequential impact on health and wellbeing”. “Your local community pharmacist is a qualified health professional

who can offer advice at a time that suits you. We know from our own experience that men are reluctant to talk about their health. “By opening up more about how they feel and any symptoms they are experiencing, men are more likely to identify health issues early, maximising the chance of a problem being resolved before it becomes untreatable”, continued Mr Conefrey. Research in Ireland has shown that Irish men have higher death rates than women for all of the leading causes of death, and that late presentation of symptoms leads to many problems becoming untreatable*.

Tomas Conefrey, community pharmacist and IPU member Men’s Health Week is coordinated in Ireland by the Men’s Health Forum in Ireland. Find out more about Men’s Health Week at

www.mhfi.org/mhw/mhw2018.html, on Facebook at MensHealthWeek, and on Twitter @MensHealthIRL.

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News news brief HIV PATIENTS IN EUROPE TO BE TREATED WITH SMALLEST SINGLE PILL REGIMEN Patients with HIV will soon have access to the first single-pill regimen to treat the chronic disease. The European Commission has granted ViiV Healthcare marketing authorisation for Juluca to treat HIV-1 infection in suitable adult patients who are virologically suppressed. Juluca is a two-drug regimen of dolutegravir (50mg) and rilpivirine (25mg), given in a single pill. Research shows the dolutegravir and rilpivirine regimen is non-inferior to traditional three and four drug regimens in maintaining virologic suppression through 48 weeks in adults who are infected with HIV-1. Deborah Waterhouse, ViiV Healthcare chief executive, said the decision was positive news.

‘COMPETENCY' IS A BARRIER TO WIDENING PHARMACISTS’ PUBLIC HEALTH ROLES The public view of community pharmacists’ competency has been identified as a hurdle to expanding the public health roles of the profession, a review of more than 70 studies has found. The UK study, published in Clinical Pharmacist, analysed the evidence for the public health roles that community pharmacists play. It found pharmacy-based interventions were effective in quitting smoking, health promotion, disease screening, providing emergency contraception, and vaccination services. There was mixed evidence for alcohol dependence intervention and weight management. But the research team, lead by Chijioke Agomo at Middlesex University in London, concluded there were many barriers to expanding the services that could be delivered by community pharmacists.

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200 Lloyds staff take part in strike action On 14 June up to 200 workers at 30 LloydsPharmacy stores in the Republic took part in strike action for one hour in a dispute over pay and trade union recognition. Of the 30 stores picketed, a small minority – four stores, were closed during the action, with the remaining majority continuing to trade as normal. to go on strike after the retailer rejected a recommendation from the Labour Court that it negotiate with trade union Mandate over pay conditions.

30 Lloyds Pharmacy stores have been affected by strike action Trade union Mandate members at the chain (13% of the total LloydsPharmacy workforce) voted for industrial action in a recent ballot. Following the first round of industrial action representatives from the union said that they would hold a further strike. ”We had over 200 people [from 30 stores] on the picket today but unfortunately, it is looking likely at this point that a strike will take place next Friday,” David Gibney, communications officer for Mandate Trade Union said. Mandate plans to escalate its protest by increasing the picketing time to two hours and involving more stores. More than 200 workers at 50 Lloyds Pharmacy outlets voted

It said Mandate had decided to strike following a ballot of just 13% of its staff.

Lloyds Pharmacy and Mandate attended a Labour Court hearing at which the union sought various changes to pay, contracts and annual leave entitlements.

The chain said it has agreed to a pay rise backdated to last April for all colleagues; to eliminate payment of the minimum wage; and, to roll out a new sick pay scheme with a Colleague Representative Committee.

Among its demands were the introduction of pay scales and improved annual leave entitlements and public holiday pay.

It said the committee represents most of its workers and with a majority of colleagues voting in favour of the deal.

The retailer said: “We wish to thank our patients and full team for their understanding and support during this morning’s one-hour industrial action.”

“Contrary to deliberately misleading information, we do not have and never had zero-hour contracts,” said the statement.

LloydsPharmacy denies Mandates claim that it is not negotiating with staff on pay conditions. It said that on 23 May, phase one of its discussions with its employee negotiating body – the Colleague Representative Committee (CRC) – took place, resulting in an agreement to increase pay for the full team, the introduction of a new sick pay scheme and the elimination of the minimum wage across its business. In a statement, the pharmaceutical chain said measures were put in place to minimise the impact of the industrial action.

It said further talks with the worker committee on further pay increments, including the introduction of pay scales are already underway. LloydsPharmacy Director, Pat Watt, said it was extremely regrettable that Mandate has pushed ahead with industrial action, two weeks after the “positive breakthrough”of increased pay and benefits for the workforce. The company is owned by the McKesson Corporation and is the largest pharmaceutical company in the world with revenues of ¤168.85bn last year.

Blood glucose test strips recalled over faulty readings The Health Products Regulatory Authority has issued a safety notice for a range of blood glucose test strips amid concerns the kits give diabetics faulty insulin readings. Roche recently announced an urgent recall for selected lots of Accu-Chek Inform II and AccuChek Aviva test strips due to a risk that strip errors might occur or incorrect results may be generated. The HPRA said Accu-Chek Inform II test strips were only supplied for professional use in Ireland, but Accu-Chek Aviva test strips have been sold for both self-testing and professional use. The recall comes after Roche identified some lots that showed an increase in strip errors prior to dosing, which could pose serious health consequences for people with diabetes. “In a limited number of cases the test strip can produce a biased result i.e. a falsely high or

a falsely low value, which might not be detected easily and which could lead to erroneous therapy adaptations,” the safety notice said.

In a letter to healthcare professionals, Roche Diabetes Care said it had identified the problem as part of its ongoing quality monitoring processes.

All pharmacy staff should be informed of the recall and any adverse events linked to the devices need to be reported to the manufacturer and the HPRA.

“We have thoroughly investigated this issue to identify the root cause of this potential error and have already started to implement the appropriate corrective measures,” it said.

The authority has advised people who have the device to stop using it, contact their pharmacy for a replacement, and report any concerns to Roche. The affected batches sold in Ireland include: Accu-Chek Aviva test strips (50s) 496915, 496809, 496802, 496807, 497391 and Accu-Chek Aviva test strips (10s) 497344.

“Please call your local sales representative if you need any additional advice on the operation of AccuChek blood glucose meters and test strips or have any further questions or concerns. For more information, visit https://www.accu-chek.co.uk.


Grasping every opportunity, not gasping for air THE DIFFERENCE IS

Symbicort is licensed for use in patients with asthma and COPD (FEV1 <70% predicted normal (post bronchodilator) and an exacerbation history despite regular bronchodilator therapy. Symbicort is not intended for the initial management of asthma. ABRIDGED PRESCRIBING INFORMATION SYMBICORT® TURBOHALER® 100 micrograms/6 micrograms/ inhalation, inhalation powder. SYMBICORT® TURBOHALER® 200 micrograms/6 micrograms/inhalation, inhalation powder. SYMBICORT® TURBOHALER® 400 micrograms/12 micrograms/inhalation, inhalation powder. (budesonide/formoterol fumarate dihydrate). Consult Summary of Product Characteristics (SmPC) before prescribing. Indication: Indicated in adults, adolescents aged 12 years and older and children aged 6 years and older (100/6 only), for the regular treatment of asthma where use of a combination (inhaled corticosteroid and long-acting ß2 adrenoceptor agonist) is appropriate: 1) patients not adequately controlled with inhaled corticosteroids and ‘as needed’ inhaled short-acting ß2 adrenoceptor agonists or 2) patients already adequately controlled on both inhaled corticosteroids and long-acting ß2 adrenoceptor agonists. Symbicort 100/6 is not appropriate for patients with severe asthma. Symbicort 200/6 and 400/12 only: Indicated in adults aged 18 years and older for the symptomatic treatment of patients with COPD with FEV1 <70% predicted normal (post-bronchodilator) and an exacerbation history despite regular bronchodilator therapy. Presentation: Inhalation powder. Symbicort 100/6: Each metered dose contains budesonide 100mcg/inhalation and formoterol fumarate dihydrate 6mcg/inhalation. Symbicort 200/6: Each metered dose contains budesonide 200mcg/inhalation and formoterol fumarate dihydrate 6mcg/inhalation. Symbicort 400/12: Each metered dose contains budesonide 400mcg/inhalation and formoterol fumarate dihydrate 12mcg/inhalation Dosage and administration: Asthma: The dose should be titrated to the lowest dose at which effective control of symptoms is maintained. Symbicort maintenance therapy: Patients should be advised to have their separate rapid-acting bronchodilator available for rescue use at all times. Adults (18 years and older): 100/6 and 200/6: The recommended dose is 1-2 inhalations twice daily. Some patients may require a maximum of 4 inhalations twice daily. 400/12: 1 inhalation twice daily. Adolescents (12-17 years): 100/6 and 200/6: The recommended dose is 1-2 inhalations twice daily. 400/12: 1 inhalation twice daily. Children 6-11 years (100/6 only): The recommended dose is 2 inhalations twice daily. Children under 6 years: Not recommended. Symbicort 400/12 is not recommended for children under 12 years. Symbicort maintenance and reliever therapy: 100/6 and 200/6 only (not indicated with 400/12 strength) Adults and adolescents (12 years and older): The recommended maintenance dose is 2 inhalations per day, given either as one inhalation in the morning and evening or as 2 inhalations in either the morning or evening. Patients should take 1 additional inhalation as needed in response to symptoms. If symptoms persist after a few minutes, an additional inhalation should be taken. No more than 6 inhalations should be taken on any single occasion. A total daily dose of more than 8 inhalations is not normally needed, a total daily dose of up to 12 inhalations could be used for a limited period. Patients using more than 8 inhalations daily should be strongly recommended to seek medical advice. Children under 12 years: Not recommended. COPD (200/6): The recommended dose in adults is 2 inhalations twice daily. COPD (400/12): The recommended dose in adults is 1 inhalation twice daily. Elderly: No special dosing requirements required. Patients with hepatic or renal impairment: Increased exposure is expected in patients with severe liver cirrhosis. Contraindications: Hypersensitivity to active substance(s) or excipients. Warnings and precautions: Recommended that the dose is tapered when the treatment is discontinued and should not be stopped abruptly. If treatment is ineffective, or exceeds the highest recommended dose, medical attention must be sought. Sudden and progressive deterioration in control of asthma or COPD is potentially life threatening and patient should undergo urgent medical assessment. Consideration should be given for increased therapy with corticosteroids, e.g. orally, or antibiotic treatment if infection present. Patients should have their rescue inhaler available at all times. Patients should be reminded to take their maintenance dose as prescribed, even when asymptomatic. The reliever inhalations should be taken in response to asthma symptoms but are not intended for regular prophylactic use e.g. before exercise, separate rapid-acting bronchodilator should be considered. Once asthma symptoms are controlled, consideration may be given to gradually reducing the dose. Patients should not be initiated on Symbicort during an exacerbation or if they have significantly worsening or acutely deteriorating asthma. Paradoxical bronchospasm may occur with an immediate increase in wheezing and shortness of breath after dosing. Symbicort should be discontinued immediately and an alternative therapy instituted if necessary. Systemic effects may occur, particularly at high doses prescribed for long periods e.g. Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma, and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). Recommended that height of children receiving prolonged treatment is regularly monitored and if growth is slowed, therapy should be re-evaluated and consideration given to referring the patient to a paediatric respiratory specialist. If adrenal function is impaired from previous systemic steroid therapy, care should be taken when transferring patients to Symbicort therapy. Patients transferring from oral steroids may remain at risk of impaired adrenal reserve for a considerable time. HPA axis function should be monitored regularly. Prolonged treatment with high doses of inhaled corticosteroids may result in clinically significant adrenal suppression. Additional systemic corticosteroid cover should be considered during periods of stress such as severe infections or elective surgery. Rapid reduction in dose of steroids can induce acute adrenal crisis, symptoms may include anorexia, abdominal pain, weight loss, tiredness, headache, nausea, vomiting, decreased level of consciousness, seizures, hypotension and

hypoglycaemia. Treatment with systemic steroids should not be stopped abruptly. Transfer from oral steroid therapy to Symbicort may result in the appearance of allergic or arthritic symptoms such as rhinitis, eczema, muscle and joint pain. Specific treatment should be initiated for these conditions. In rare cases, tiredness, headache, nausea and vomiting can occur due to insufficient glucocorticosteroid effect and temporary increase in the dose of oral glucocorticosteroids may be necessary. To minimise risk of oropharyngeal candida infection, patients should rinse mouth with water after inhaling doses. Concomitant treatment with itraconazole, ritonavir or other potent CYP3A4 inhibitors should be avoided. Observe caution in patients with thyrotoxicosis, phaeochromocytoma, diabetes mellitus, untreated hypokalaemia, hypertrophic obstructive cardiomyopathy, idiopathic subvalvular aortic stenosis, severe hypertension, aneurysm or other severe cardiovascular disorders such as ischaemic heart disease, tachyarrhythmias or severe heart failure. Observe caution when treating patients with prolongation of the QTc-interval. Re-evaluate need for Symbicort in patients with active or quiescent pulmonary tuberculosis, fungal and viral infections in the airways. Hypokalaemia may occur at high doses of ß2 adrenoceptor agonists. Particular caution recommended in unstable or acute severe asthma. Monitor serum potassium levels. As for all ß2 adrenoceptor agonists, consider additional blood glucose monitoring in diabetic patients. Visual disturbances may be reported with systemic and topical corticosteroid use. If a patient presents with these symptoms, consideration to ophthalmologist referral should be given to evaluate possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy. The excipient lactose contains small amounts of milk proteins, which may cause allergic reactions. 200/6 & 400/12: An increase in the incidence of pneumonia, including pneumonia requiring hospitalisation, has been observed in patients with COPD receiving inhaled corticosteroids. Physicians should remain vigilant as clinical features of such infections overlap with symptoms of COPD exacerbations. Risk factors include current smoking, older age, low BMI and severe COPD. Potential effects on bone density should be considered especially in patients on high doses for prolonged periods that have co-existing risk factors for osteoporosis. Drug interactions: Potent CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin, nefazodone and HIV protease inhibitors) are likely to increase plasma levels of budesonide and concomitant use should be avoided. If this is not possible the time interval between administration should be as long as possible. Symbicort maintenance and reliever therapy is not recommended in patients using potent CYP3A4 inhibitors. Not to be given together with beta-adrenergic blockers (including eye drops) as can weaken or inhibit the effect of formoterol, unless compelling reasons. Concomitant treatment with quinidine, disopyramide, procainamide, phenothiazines, antihistamines (terfenadine) and TCAs can prolong the QTc-interval and increase the risk of ventricular arrhythmias. L-Dopa, L-thyroxine, oxytocin and alcohol can impair cardiac tolerance towards ß2-sympathomimetics. Concomitant treatment with MAOIs, including agents with similar properties such as furazolidone and procarbazine, may precipitate hypertension reactions. Elevated risk of arrhythmias in patients receiving anaesthesia with halogenated hydrocarbons. Concomitant use of other beta-adrenergic drugs or anticholinergic drugs can have a potentially additive bronchodilating effect. Hypokalaemia may increase the disposition towards arrhythmias in patients taking digitalis glycosides. Hypokalaemia resulting from beta2-agonist therapy may be potentiated by concomitant treatment with xanthine derivatives, corticosteroids and diuretics. Pregnancy and lactation: Use only when benefits outweigh potential risks during pregnancy and breastfeeding. Budesonide is excreted in breast milk; at therapeutic doses, no effects on child are anticipated. Not known whether formoterol passes into human breast milk. Undesirable events: Consult SmPC for full list of side effects. Common: Headache, palpitations, tremor, candida infections in the oropharynx, coughing, mild irritation in the throat, hoarseness and pneumonia (in COPD patients using Symbicort 200/6) Uncommon: Tachycardia, muscle cramps, aggression, psychomotor hyperactivity, anxiety, sleep disorders, nausea, dizziness, blurred vision and bruises. Rare: Hypokalaemia, cardiac arrhythmias including atrial fibrillation, supraventricular tachycardia and extrasystoles, bronchospasm and immediate and delayed hypersensitivity reactions including exanthema, urticaria, pruritus, dermatitis, angioedema and anaphylactic reaction. Very rare: Depression and behavioural changes (predominantly in children), angina pectoris, prolongation of QTc-interval, hyperglycaemia, taste disturbances, Cushing’s Syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract, glaucoma and variations in blood pressure. Paradoxical bronchospasm may occur in very rare cases. Package Quantities Each Symbicort Turbohaler 100/6 or 200/6 contains 120 inhalations. Each Symbicort Turbohaler 400/12 contains 60 inhalations. Legal category: POM. Marketing authorisation numbers: PA 970/28/1-3 Marketing Authorisation Holder: AstraZeneca UK Limited, 600 Capability Green, Luton, LU1 3LU, UK. Further information available on request from The MAH (address above), Freephone – 1800 800 899. SYMBICORT and TURBOHALER are trademarks of the AstraZeneca group of companies. Date of API preparation: 12/2017 API REF: IE-0607 Adverse events should be reported directly to: HPRA Pharmacovigilance, Earlsfort Terrace, Dublin 2. Tel: +353 1 6764971 Fax: +353 1 6762517 Website: www.hpra.ie e-mail: medsafety@hpra.ie. Adverse events should also be reported to AstraZeneca Medical Information on 1800 800 899.

Date of Preparation: January 2018. VEEVA ID: IE-0649


News One in five Irish people have hayfever, 376,000 of these also live with asthma The garden is at the heart of the Irish summer. But for the 376,000 Irish people living with both asthma and hayfever, the garden can feel like the ultimate health hazard. In hayfever (or allergic rhinitis), an immune response starts in the eyes and lining of the nose whenever a particular allergen or allergens are inhaled. This immune response causes the swollen nasal passages and itchy eyes which are familiar to anyone with the condition. Hayfever can be seasonal or occur all year round. Seasonal hayfever usually happens because of an allergy to pollen or spores that only appear at certain times of year. Common hayfever symptoms: Asthma Society CEO Sarah O'Connor

Hayfever affects one in five people in Ireland, bringing with it irritating symptoms like itchy eyes, runny nose and headaches. For the 80% of people with asthma who also live with hayfever, it can be more serious, potentially leading to a flare-up of their asthma symptoms and, in some cases, causing an asthma attack. To help people with asthma and hayfever regain their green fingers, the Asthma Society, in partnership with Dyson Ireland has launched a ‘Practical Tips for Gardening with Asthma and Allergies leaflet’. Sarah O’Connor, CEO of the Asthma Society of Ireland, said: “People with asthma and hayfever often have to make significant lifestyle changes to stay well. When it comes to outdoor activities like gardening, hiking or family days out, these changes can often seem overwhelming and many people may feel their quality of life suffers as a result. “Luckily, small measures add up. Our list of practical tips is designed to help people with asthma and hayfever enjoy the garden and being outdoors without having to make major sacrifices, all while keeping well and avoiding any asthma flare-ups. Help and support on managing your asthma and hayfever is available by calling our free nurse Adviceline on 1800 44 54 64.” What is Hayfever? An allergy is an immune reaction in the body which is caused by contact with an allergen. Allergens are substances which are ordinarily harmless and cause no problems for people without allergies.

• Runny nose and nasal congestion • Watery, itchy, red eyes • Frequent sneezing • Itchy nose, roof of mouth or throat • Headache • Fatigue • Swollen blue coloured skin under the eyes • A loss of concentration and generally feeling unwell Practical Tips for Gardening with Asthma and Allergies: • Check the pollen forecast at asthma.ie before venturing outside. Try to stay indoors if the pollen count in your area is high. • Shut all your windows before gardening to keep dislodged pollen and dust out of your home. • Wear wraparound sunglasses to stop pollen getting into your eyes. • Put Vaseline around your nostrils to trap pollen. • Make sure your asthma is well controlled and take your regular preventer medication, as prescribed. • Wear a hat to stop pollen getting caught in your hair and brush your hair after gardening. • Shower, wash your hair and change your clothes if you have been outside for an extended period. • If you have a skin allergy, keep your hands, arms and legs covered when gardening. • Pollen can cling to animal fur. Keep furry pets out of the house during hayfever season and wash or bathe them after being outdoors to remove any pollen from their fur.

• Using an air purifier indoors can help reduce the airborne allergens present inside the home, even when the pollen count is high outdoors. For people with asthma, hayfever can be a serious condition. Hayfever can trigger asthma symptoms and this in turn increases the risk of an asthma attack. An asthma attack is a medical emergency and can be fatal. One person dies a week in Ireland as a result of their asthma. Know the symptoms of an attack and know the 5 Step Rule to save a life. Go to asthma.ie for more information on how to prevent and manage asthma attacks. The Asthma Society strongly recommends that people with asthma visit a health care professional if they have an asthma attack, as this indicates that their asthma is not controlled and they may be at risk. Symptoms of Asthma Attack • Cough • Wheeze • Shortness of breath • Chest tightness • Too breathless to finish a sentence • Too breathless to walk, sleep or eat • Lips turning blue 5 Step Rule 1. Stay calm. Sit up straight, do not lie down 2. Take slow steady breaths 3. Take one puff of your reliever inhaler (usually blue) every minute. Use a spacer if available. People over 6 years can take up to 10 puffs in 10 minutes. Children under 6 can take up to 6 puffs in 10 minutes 4. Call 112 or 999 if your symptoms do not improve after 10 minutes 5. Repeat step 3 if an ambulance has not arrived in 10 minutes Remember, if someone is having an asthma attack: • Do not leave them on their own

news brief FSAI APPOINTS NEW CHAIRMAN The Food Safety Authority of Ireland (FSAI) has welcomed the appointment of Martin Higgins as its new Chairman. Mr Higgins became the first Chief Executive of Safefood, the all-island Food Safety Promotion Board and led the organisation from its inception in 1998 until his retirement in 2014. Prior to that, he was the first Director of Corporate Services in the FSAI, having previously held the post of Principal Officer at the Department of Health, specialising in finance and health agency regulation. He has professional qualifications in accountancy, international regulation and governance; and is a Fellow of the Chartered Management Institute. In 2015, he was appointed to the Nursing and Midwifery Board of Ireland. Mr Higgins currently chairs the Audit and Risk Committee (ARC) of both An Bord Pleanála and COMREG and is also a member of the ARCs of the Central Statistics Offices and the Pharmaceutical Society of Ireland. He is a qualified mediator, and executive and leadership coach. Commenting on his appointment the Minister for Health, Simon Harris TD, said, “I was pleased to appoint Mr Higgins as Chairperson of the Board of the Food Safety Authority of Ireland. I am confident that his experience and expertise will continue to make a substantial and valuable contribution to the work of the Authority.” According to Dr Pamela Byrne, CEO, FSAI Mr Higgins is highly regarded in Irish health, food, and nutrition sectors; and his experience in policy formulation and implementation will be a great asset to the FSAI Board. His experience and acumen will prove to be a significant positive influence in striving to continuously protect and promote food safety in Ireland.

• Extra puffs of reliever inhaler (usually blue) are safe

9


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Research tells us that 75% of people would prefer to use a hayfever solution that’s natural.1 With STÉRIMAR™ being the GP’s choice2 AND inspired by nature, there’s no longer a need to compromise with symptoms or side effects. The STÉRIMAR™ hayfever range is drug, steroid and preservative free, making it the ideal solution to help manage allergies for all, including pregnant women and breastfeeding mothers. HELP PREVENT ALLERGY SYMPTOMS THE NATURAL WAY This 100% natural sea water based nasal spray helps prevent allergy symptoms by clearing and cleansing the nose of allergens and impurities. It not only washes away the allergens but helps rebalance the nose and reduce the risk of further nasal conditions developing. • Suitable for daily use to help prevent the onset of allergy symptoms • Free from drugs, steroids and preservatives • No known side effects • Suitable for pregnant women and the whole family, from 3 years and up

RELIEVE ALLERGY SYMPTOMS FAST & HELP PROTECT AGAINST ALLERGENS Scientifically proven to provide rapid relief from symptoms of allergic rhinitis and provides reinforced protection against further allergen attacks. With a base of 100% natural sea water and a patented complex based on sodium hyaluronate, this innovative formula unblocks nasal surrounds and neutralises the allergens responsible for allergic reactions – putting a stop to symptoms fast. It forms a protective and invisible film, preventing allergens from coming into contact with the nasal cavity to provide NEW reinforced effective protection against PACK allergic reactions. further DESIGN (Previously

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water, whereas others are saline, some with other added ingredients such as steroids. Some newer types of spray have a useful dual action, particularly beneficial in cases of allergic rhinitis, which use hypertonicity to clean the nasal mucosa with the addition of a film- forming complex of hyaluronic acids which can encapsulate, inactivate and neutralise allergens responsible for the allergic reactions, providing a protective lining on the mucosa, keeping the person symptom free for longer. Nasal sprays are much easier to administer than drops, especially to babies and young children. When looking at different products, it’s important to make sure that the nozzle has a feature that prevents it being inserted too far into the nostril, especially essential for noses in young children. It’s also important to look at how the spray is delivered. The finer the mist produced, the more likely that it will be delivered to a greater area of the nasal mucosa and stay in contact with it for longer.2 References: 1 Barberi S J Biol Regul Homeost Agents. 2016 AprJun;30(2):605-8 2 Bounty Health Journal, Professional Update, Volume 18, March 2017

When it comes to relieving allergy symptoms, it can be difficult for sufferers to find a trusted treatment that’s drug and preservative free. As a first step treatment to help your patients better manage their allergy symptoms I would recommend STÉRIMAR™ – a range of safe nasal solutions that are suitable for the whole family. Dr Michael Rudenko, Consultant in Allergy and Immunology at The London Allergy and Immunology Centre.

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Latest research tells us that 77% of people use medication to treat their allergy symptoms, but 56% would prefer to use a natural remedy**. Made from 100% natural sea water, the STÉRIMAR™ range is drug and preservative free and the ideal solution when treating allergy symptoms this season. Help your patients prevent allergic reactions*** with STÉRIMAR™ HAYFEVER & ALLERGIES and help stop symptoms in their tracks with STÉRIMAR™ STOP & PROTECT ALLERGY RESPONSE. ALLERGIC RHINITIS IN PRIMARY CARE www.sterimaracademy.com | Dr Michael Rudenko Consultant in Allergy and Clinical Immunology For more information please visit *GPrX data dataon onnasal nasalsaline salinepreparation preparation– –data datafrom fromJan Jan to July UK coverage. **Hayfever survey – May washing out nasal cavities. *GPrX 1515 to July 16. 16. UK coverage. **Hayfever survey – May 2016.2016. ***By***By washing out nasal cavities.


Future of Pharmacy seminar

Pharmacy owners told that the future is bright – but to remain vigilant The Irish pharmacy sector is experiencing a welcome bounce having endured a long period of uncertainty. At a recent business briefing ‘Pharmacy – what does the future hold?’ organised by the IPU (Irish Pharmacy Union) the message was clear: stay positive – but proceed with a certain degree of caution. Even though the pharmacy industry is still considered to be very much a growing, active and dynamic enterprise, it is susceptible to unique sectoral pitfalls and challenges and it is important for pharmacy owners to bear these in mind in order to protect their business interests going into the future. Conall MacCoille of Davy stockbrokers initiated proceedings by providing the packed room with a detailed overview of where we are in terms of the economy. Despite clear economic growth at present, a considerable amount of damage was wrought during the recession and not all of that damage has been repaired. “We are still only just back to where the level of employment was ten years ago and our overall recovery has very much lagged behind that of the United States and Europe”. There is still a fair amount of catching up to do before Irish business owners can truly consider themselves to be out of danger. While greater spending on big ticket “discretionary” items like cars and furniture indicate increased willingness on behalf of the Irish consumer to spend, this should be read by pharmacy owners with a degree of caution as the trend is not replicated in “defensive” spending sectors like healthcare. Consumption in this area of the economy still lags behind as people continue to put their financial houses back together. Conall MacCoille made it clear that growth in spending in terms of pharmacy items is proving to be stubbornly less responsive to the upswing of the current boom cycle. A lack of available staff is leading to wage demands that small businesses often can’t keep

12

Conall MacCoille, Davy stockbrokers

up with. Pharmacists need to continue to monitor their environments and be responsive to these trends in order to protect their businesses from short-term shocks and longer term disruptions. One such example of this would be Brexit.

the message out that Ireland can and should become a Reference Member State (RMS) for many of the drugs that could be affected. The HPRA is also putting new

Lorraine Nolan, CEO of the HPRA, outlined in very comprehensive and technical terms the potential impact of a hard Brexit on the supply and cost of medications here. Because Ireland is generally categorised as being in the same market as the UK - thanks to our close geographical, linguistic and cultural links - the end of the joint labelling system could lead to very serious problems with supply. In other words, when it comes to pharmaceuticals in Ireland and the UK, the “market is very much joined”. But Lorraine Nolan emphasised the HPRA’s engagement programme and their role in mitigating some of the worst envisioned effects of Brexit. She appealed to delegates to help get

Lorraine Nolan, CEO of the HPRA

systems in place to monitor stock levels, such as allowing stock to go to shelf life - as opposed the six-month flush out - as they plan for a hard Brexit.


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Future of Pharmacy seminar the coming years, which will come as good news to those who are operating in areas with a high density of older people or in areas with a lot of nursing homes. There will also be an extra million people in the country by 2046, which will bring its own set of challenges, not least of all in terms of housing. Profits and margins in pharmacy are steady but not ideal. The cost of renting is set to increase and this will continue to heap pressure on those who do not own their properties. Greenfield openings continue to be vulnerable and won’t turn over as much profit as established businesses and may continue to be unviable for some time. Overheads are naturally rising in line with inflation and costs are also increasing. While eighty percent is a good figure, Jason Bradshaw finds it ‘startling’ that twenty percent of pharmacies still do not operate a website.

Larry Ryan Director of Behaviours and Attitudes

Lorraine Nolan stressed the need for all stakeholders to embrace a flexible and creative approach so that the unique hurdles posed by Brexit can eventually be overcome in a way that does not risk patient safety: “A central tenet of the approach that we are taking is that we have to maintain the existing products and not lose any marketing authorisations, while probably accepting the fact that we will lose some, but we are trying to really minimise that.”

towards and around alcohol, he now spends a greater proportion of his time researching health.

Larry Ryan is the director of the independent market research group Behaviours and Attitudes and every year the Irish Pharmacy Union commissions a pharmacy-specific piece of research which is helpful in revealing the “gradual shifts in consumer behaviour that have implications for business.”

Interestingly, while millennials may be nurturing healthier life practices in the areas of diet and exercise, Larry Ryan outlined how they are spending more and more on grooming indulgences and as a symptom of the selfie generation, are “fundamentally more concerned with how they look as opposed to how they feel.”

Mr Ryan outlined his own experience with changing demographics and the impact this has had on his own professional life. Where once he spent a lot of time surveying behaviours and attitudes

14

One way to ensure a steady stream of revenue while things continue to settle down is to engage with the state by providing specific GP-led services like vaccinations, weight management services, blood pressure monitoring, cardiovascular risk assessment,

cholesterol testing and blood glucose monitoring. Educational events around weight and cholesterol management seem to work particularly well. “These can drive footfall, can drive turnover and can really make a difference to the bottom line. Offering these services has had a big impact on turnover over the years so if we can roll these out more it will help to cover our costs.” Despite the warnings, Jason Bradshaw’s message to pharmacy owners was essentially a positive one. “While some of this commentary is coming across as maybe negative, we certainly aren’t negative about the sector. Pharmacies are still very cashgenerative; debt is usually quite low so overall we are bullish about the sector so the message is: mind your balance sheet going forward and start thinking about maybe building up some cash reserves.” Pharmacy owners can take comfort from the fact that while they are still in recovery, some of the worse effects of the recession are thankfully now behind us. Be positive but by all means remain vigilant.

Irish people are thinking healthier and are gradually becoming healthier as the impact of a more educated population takes effect. The most recent study also found that Irish people continue to enjoy shopping in large shopping centres, bucking an international trend where other nations appear to be returning to the main streets.

Jason Bradshaw of chartered accountancy firm JPA BrensonLawlor also delved deeper into the detail on demogrpahic trends: the number of over 85’s is set to quadruple over

Jason Bradshaw, Partner at JPA Brenson-Lawlor


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News Three in five people support removing barriers news brief to accessing nicotine replacement therapy COUNTDOWN TO 'PHARMA MONTH' 2018 Guaranteed Irish will shine a spotlight on the pharmaceutical sector as part of a campaign calling on the government to ensure patients have early access to new medicines. The non-profit organisation, which has more than 300 members including some of the biggest pharmaceutical companies, will launch Pharmaceutical and Healthcare Month in October.

Donal Buggy, Head of Services and Advocacy at the Irish Cancer Society said: “At the moment, people with medical cards need a prescription from their GP to get quit supports like NRT. This puts up an extra barrier for people who want to quit, and can place additional pressure on GP services.” Currently, people without medical cards can purchase NRT without prescription from their pharmacist.

Guaranteed Irish is working on a submission paper for the government that outlines the supports needed to ensure the strength of the sector, with a focus on early access to new medicines.

“This means that medical card holders, who are often from the most deprived areas and are twice as likely to smoke as those living in the most affluent ones, can find it difficult to get the support they need.

Chief executive Brid O’Connell said Ireland was the seventh largest exporter of medicinal and pharmaceutical products in the world.

“We’re calling for the Minister for Health to introduce legislation to make sure they no longer need to get a prescription for NRT.”

“The sector continues to go from strength to strength – providing high tech, exciting career opportunities and contributing significantly to local communities across Ireland,” she said.

A recent survey carried out by the Irish Cancer Society showed that three in five people are in favour of removing the need for a prescription for NRT for medical card holders, while almost three in five felt that the state should do more to support smokers to quit.

Ger Brennan, managing director of MSD Ireland, said October will showcase the important work carried out in the pharmaceutical industry.

HOW DO PHARMACISTS RATE THEIR RELATIONSHIP WITH DOCTORS? Almost three quarters of pharmacists believe their relationship with doctors is positive, according to an industry poll. Two surveys, run by PharmaBuddy and GpBuddy, asked pharmacists and doctors across the country to rate their relationship with the other profession. More than 450 people cast their vote, with 74% of pharmacists saying their relationship with doctors was “good” or “great”. By comparison, 69% of doctors believe their relationship with pharmacists was positive. Twenty-three per cent of pharmacists rated their relationship as “poor”.

16

The Irish Cancer Society is calling on the Government to make sure medical card holders don’t face unnecessary barriers to accessing Nicotine Replacement Therapy (NRT).

“People need support on their mission to quit smoking for good and we need to encourage greater use of NRT to help smokers to quit and stay quit. Pharmacies need to be equipped, not only to dispense NRT, but also to provide the psychological supports most likely to ensure that a quit attempt is successful.” At any given time, the majority of smokers are thinking about quitting, and most have made a number of unsuccessful attempts to quit. In Ireland, half of those attempting to quit do so without assistance but those who access NRT along with psychological supports are significantly more likely to quit and stay quit. “We know that all forms of NRT make it more likely that attempts to quit succeed. The chances of stopping smoking are increased by 50 to 70%.” Currently, of the 3.76 million people aged over 15 living in Ireland, 22%, or just under 864,000, are smokers. The Government has set a smoking rate of less than 5% by 2025 in its Tobacco-Free Ireland Strategy.

Donal Buggy, head of Services and Advocacy at the Irish Cancer Society

Mr Buggy said: “To achieve this ambitious target, we need to make sure that 676,000 fewer people smoke in Ireland by then. While there is no one action that will make this a reality, allowing equal access to NRT for medical card holders will go some way to enabling current smokers to become ex-smokers.” The call from the Irish Cancer Society echoes a similar one from the IPU last year. Speaking last year IPU President Daragh Connolly said: “The evidence suggests that medical-card holders are likely to need support to successfully quit smoking. “This is a scheme that can be easily and quickly implemented as, from a professional perspective, no further training for pharmacists is required. Pharmacists have been safely providing a smoking cessation service to private patients since 2014. “The IPU believes that there should not be barriers on GMS patients accessing smoking cessation services or any other service from their pharmacist. Therefore, we particularly advocate for the rollout of this service as an after-hours service, as these are times of particular vulnerability for smokers.”

The IPU said the Department of Health’s 2015 Healthy Ireland Survey found that more than one in five (22.7%) people smoke. A range of NRT products are available in pharmacies. NRT treatment can significantly increase the chance of success if used correctly. Options include: • Patches - These work by continuous release of nicotine which is suitable for regular smokers. Patches available include a 16-hour patch and a 24-hour patch. • Gum - Helps to control the cravings when they occur. There are various flavours to choose from and various strengths which allow a step–down reduction programme. • Nasal Spray- Is fast acting which is helpful for highly dependent smokers. • Sublingual tablets - These are discrete. Place under the tongue and dissolve over 20 minutes. • Inhalers - These act as a cigarette substitute and are useful for smokers who miss the hand-to-mouth action • Lozenges - Various strengths are available which allow a step down reduction programme.


ICY WHITE GUM ACTIVELY FIGHTS CRAVINGS AND ALSO WHITENS TEETH

Abbreviated Prescribing Information. Please consult the summary of product characteristics for full prescribing information. Nicorette Icy White 2mg Medicated Chewing Gum. Composition: Each medicated given above. If the attempt to stop smoking completely has not been started within chewing gum contains 2 mg nicotine as a resin complex. Pharmaceutical Form: 6 months after the beginning of treatment, it is recommended to consult a Medicated Chewing Gum. A square, coated, white coloured chewing gum. healthcare professional. Combination Therapy: It may sometimes be beneficial to Indications: For the treatment of tobacco dependence by relieving nicotine craving utilize more than one form of NRT concurrently. For example, combination therapy and withdrawal symptoms: thereby facilitating smoking cessation in smokers could be used by smokers who have relapsed with NRT monotherapy in the past, motivated to quit. - helping smokers temporarily abstain from smoking In certain who experience breakthrough acute cravings or have difficulty controlling cravings circumstances, Nicorette 2mg Gum may be used in combination with Nicorette for cigarettes using monotherapy. Hence, if required, the Nicorette Invisi Patch and Invisi 10mg and 15mg Transdermal Patch for the treatment of tobacco dependence Nicorette 2mg medicated chewing gum may be combined. Step 1: The Nicorette as part of a stop smoking programme. In smokers currently unable or not ready Invisi 15mg Patch would be applied daily on waking for 16 hours and removed just to stop smoking abruptly, Nicorette gum may also be used as part of a programme before bedtime for a total of 8 weeks. The Nicorette 2mg medicated chewing gum to reduce smoking prior to stopping completely. Dosage: Nicorette Gum should be would be used ad libitum when the smoker felt an urge to smoke or in situations chewed slowly. Smoking cessation: Adults. The strength of gum to be used will where he/she feels that breakthrough cravings may occur, up to a maximum of 15 depend on the smoking habit of the individual. In general, if the patient smokes pieces per day. Step 2: After the initial 8 weeks the lower dose Nicorette Invisi fewer than 20 cigarettes a day, Nicorette 2mg Gum is indicated. If more than 20 10mg Patch should be used. The Nicorette Invisi 10mg Patch would be applied cigarettes per day are smoked Nicorette 4mg Gum will be needed to meet the daily on waking for 16 hours and removed just before bedtime for a total of 4 withdrawal of the high serum nicotine levels from heavy smoking. The patient weeks. The Nicorette 2mg medicated chewing gum would be used ad libitum should be urged to stop smoking completely when initiating therapy with Nicorette when the smoker felt an urge to smoke or in situations where he/she feels that Gum. The chewing gum should be used whenever there is an urge to smoke breakthrough cravings may occur, up to a maximum of 15 pieces per day. Step 3: according to the “chew and rest” technique described on the pack. After about 30 Use of the Nicorette Invisi Patch should be stopped after the 12 week treatment minutes of such use, the gum will be exhausted. Not more than 15 pieces of the program. The Nicorette 2 mg medicated chewing gum can continue to be used for chewing gum may be used each day. Absorption of nicotine is through the buccal a further 3 months during which time the habits associated with smoking will be mucosa, any nicotine which is swallowed being destroyed by the liver. lost. Contraindications: Hypersensitivity to the active substance or to any of the Administration of nicotine should be stopped temporarily if any symptoms of excipients Use in non-smokers Special Warnings and Precautions for use: The nicotine excess occur. Nicotine intake should be decreased by lowering dosing benefits of quitting smoking outweigh any risks associated with correctly frequency if nicotine excess symptoms persist (see Section 4.9). Nicorette Gum administered nicotine replacement therapy (NRT). A risk-benefit assessment may be used for up to 3 months during which time the habits associated with should be made by an appropriate healthcare professional for patients with the smoking will be lost. For those using the 4mg Gum, the 2mg will be helpful during following conditions: - Cardiovascular disease: Dependent smokers with a recent withdrawal. If not successful after 12 weeks the patient should be encouraged to myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, make a fresh attempt to stop smoking. This may necessitate full or partial re- severe cardiac arrhythmias, recent cerebrovascular accident, and/or who suffer treatment with an NRT programme. Temporary Abstinence: During periods of with uncontrolled hypertension should be encouraged to stop smoking with temporary abstinence, the patient should use Nicorette Gum when required to non-pharmacological interventions (such as counselling). If this fails, Nicorette relieve nicotine cravings and withdrawal symptoms. The strength of gum to be Gum may be considered but as data on safety in this patient group are limited, used will depend on the smoking habits of the individual. In general, if the patient initiation should only be under close medical supervision. Renal and hepatic smokes fewer than 20 cigarettes a day, Nicorette 2mg Gum is indicated. If more impairment: Use with caution in patients with moderate to severe hepatic than 20 per day are smoked Nicorette 4mg Gum is indicated. Not more than 15 impairment and/or severe renal impairment as the clearance of nicotine or its pieces of the gum should be used per day. A minor reduction in total clearance of metabolites may be decreased with the potential for increased adverse effects nicotine has been demonstrated in healthy elderly patients, however, not justifying Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering adjustment of dosage. Smoking reduction: For smokers who are unwilling or from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with unable to quit abruptly. Use the gum whenever there is a strong urge to smoke in caution in these conditions Phaeochromocytoma and uncontrolled hyperthyroidism. order to reduce the number of cigarettes smoked as far as possible and to refrain Nicotine, both from NRT and smoking, causes the release of catecholamines from the from smoking as long as possible. The number of pieces of gum is variable and adrenal medulla. Therefore, Nicorette should be used with caution in patients with depends on the patients needs. Not more than 15 pieces of the gum should be uncontrolled hyperthyroidism or pheochromocytoma. - Diabetes Mellitus. Patients used per day. If a reduction in number of cigarettes per day has not been achieved with diabetes mellitus should be advised to monitor their blood sugar levels more after 6 weeks, professional advice should be sought. Reduced tobacco consumption closely than usual when smoking is stopped and NRT is initiated, as reductions in should lead to complete cessation of smoking. A quit attempt should be made as nicotine-induced catecholamine release can affect carbohydrate metabolism. soon as the number of cigarettes has been reduced to a level whereby the smoker Patients with diabetes mellitus may require lower doses of insulin as a result of feels ready to quit completely, then start as outlined for “smoking cessation” as smoking cessation. - Smokers who wear dentures may experience difficulties in

chewing Nicorette Gum. The chewing gum may stick to, and may in rare cases damage dentures. Transferred dependence: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Undesirable Effects: Effects of Smoking Cessation Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or aphthous ulceration, or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. Adverse Drug Reactions (ADRs) Nicorette Gum may cause adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Most of the undesirable effects reported by the patient occur during the early phase of treatment and are mainly dose dependent. Irritation in the mouth and throat may be experienced, however most patients adapt to this with ongoing use. Adverse reactions observed in patients treated with oral nicotine formulations during clinical trials and post-marketing experience are listed below by system organ class (SOC). Frequencies are defined in accordance with current guidance, as: Very common (>1/10); common (>1/100, <1/10); uncommon (>1/1 000, <1/100); rare (>1/10 000, <1/1 000); very rare (<1/10 000), Not known - cannot be estimated from the available data. Immune System Disorders Hypersensitivity Common Anaphylactic reaction Not known. Psychiatric disorders Abnormal dreams Uncommon. Nervous System Disorders Headache Very Common Burning sensation Dysgeusia Paraesthesia Common Eye Disorders Blurred Vision Lacrimation increased Common Cardiac Disorders Palpitations Tachycardia Not known Vascular Disorders Flushing Hypertension Uncommon Respiratory, Thoracic and Mediastinal Disorders Cough Throat irritation Very common Bronchospasm Dysphonia Dyspnoea Nasal Congestion Sneezing Throat tightness Uncommon Gastrointestinal Disorders Hiccups Nausea Very common Abdominal pain Diarrhoea Dry mouth Dyspepsia Flatulence Salivary hypersecretion Stomatitis Vomiting Common Eructation Glossitis Oral mucosal blistering and exfoliation Paraesthesia oral Uncommon Dysphagia Hypoaesthesia oral Retching Rare Dry throat Gastrointestinal discomfort Lip pain Not known Skin and Subcutaneous Tissue Hyperhidrosis Pruritus Rash Urticaria Disorders Uncommon Erythema Not known Musculoskeletal and Connective Tissue Disorders Pain in jaw Uncommon Muscle tightness Not known General Disorders and Administration Site Conditions Fatigue Common Asthenia Chest discomfort and pain Malaise Uncommon Allergic reactions including angioedema Rare. Marketing Authorisation Holder: Johnson & Johnson (Ireland) Ltd. Airton Road Tallaght Dublin 24 PA numbers: 330/37/8. Product not subject to prescription. Full prescribing information available upon request. Date of revision of text: April 2018 IRE/NI/18-3180


News Push to expand the role of pharmacies in depression screening Lorcan Gormley’s struggle with mental illness peaked when he was studying pharmacy at Trinity College Dublin. to young men in particular - to let them know that I’m not broken, that this is something you can overcome. I tell them I have a mental illness, I tell them I was on antidepressants, that I nearly checked out six years ago. I tell them it can happen to anybody. I tell them that I’ve been there, and that it’s OK. I feel like I have to be open about it so it’s not something that’s just happening behind closed doors.” Pharmacists already monitor and review patients taking antidepressant medications, but there is a growing push around the world for pharmacies to take on a more formal role in mental health screenings. Advocates say every visit to a community pharmacy is an opportunity to educate patients about the mental health resources available to patients. Lorcan Gormley, managing pharmacist at McMeel’s Pharmacy in Skerries, Co. Dublin

He had suffered from depression, extreme mood swings and self-destructive behaviour since he was a young boy living in Donegal, but growing up in rural Ireland in the 1990s, his condition went undiagnosed. It culminated in two suicide attempts when he was in his early 20s. In 2012, at the age of 23, he was given a name for his condition: borderline personality disorder. Gormley, now 30, is the managing pharmacist at McMeel’s Pharmacy in Skerries, Co. Dublin. He believes Ireland’s mental health services are lagging, and wants community pharmacists to play a greater role in depression and mental health screening. “A pharmacist is much more accessible than a doctor,” Gormley said. “We can’t diagnose, but we can identify people with symptoms who might need a referral and help those who are suffering unnecessarily.

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“There shouldn’t be any shame or stigma associated with mental illnesses. These are illnesses that have a certain set of outcomes and they can be treated. We’ve made a lot of strides in Ireland and we’re much better than we used to be, but there’s still a long way to go.” Gormley would like to see the Irish Pharmacy Union lead a campaign that aims to break down the taboos associated with mental illnesses such as depression, and promote pharmacists as front-line healthcare professionals who are capable of providing help and referring patients to specialists. “It’s an area that the IPU could be very useful in,” he said. “People should be encouraged to talk about mental health and to talk to their pharmacist. Depression is the one thing that people can be most hesitant to seek help for, so making that initial step is really important. The public need to realise that the help and knowledge and resources are there for them in the pharmacy.”

Gormley said pharmacists were well placed to screen patients for depression, and while it does already happen informally across the country, a targeted campaign would help promote the service to the general public. “We know there’s a stigma around mental health,” he said. “People don’t want to be seen as having a mental illness. But as pharmacists we have to assess how serious the problem is when someone comes in feeling unwell. Are they just having a bad day, like we all do? Or are there persistent symptoms that warrant further referral?” Gormley said many people who come into his busy seaside pharmacy with a prescription for antidepressants were often reluctant to take the medication. “There’s a real perception that if you’re on them you’re not trying hard enough or that you’re weak,” he said. “I always go and talk to patients when I’m dispensing antidepressants. I tell my story -

The Irish Pharmacy Union said running a depression awareness campaign was “not on the list of our immediate campaigns” but could be considered in the future. The Pharmaceutical Society of Ireland said it was unable to provide information on the number of pharmacists who have undertaken further study in mental health, but the regulator said pharmacists’ unique skills and expertise equipped them to maximise the benefits of medicine, and minimise the potential for patient harm. “Provision of information by pharmacists to their patients about the appropriate and most effective use of medicines, and care as to interactions of certain medicines, is a vital part of the pharmacist-patient relationship, and a pharmacist’s professional role,” PSI spokeswoman Louise Canavan said. For help, or more information, visit aware.ie.


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CAREPLUS PHARMACY GOES FROM STRENGTH TO STRENGTH CarePlus Pharmacy, the leading brand for independently owned pharmacies, has seen a significant increase in new pharmacy openings during 2018. So far this year, the CarePlus footprint has expanded in counties Kerry, Mayo, Clare, Tipperary, Offaly and Meath, while the network presence has grown in counties Dublin and Cork. The group says it is already exceeding its own ambitious growth targets, which will see 150 pharmacies trading under the CarePlus brand by the end of 2020. As competition increases across the sector, more and more community pharmacists are seeing the benefits of being part of the CarePlus group. awards, run by Family Carers Ireland, are an annual celebration of carers working in their own community and culminate in an awards ceremony in the Westin Hotel in Dublin every November. Nomination forms have been available in every CarePlus Pharmacy, and the company has proudly supported the Family Carers Ireland’s campaign to highlight the important work of carers. At a local level, every pharmacy host special Carer’s events and fundraisers to help celebrate their local heros. The CarePlus brand has also appeared on television for the first time through sponsorship of “Paramedics” on TV3, and through appearances by brand ambassador Lucy Wolfe on “Today with Maura and Daithi” on RTE television.

The last twelve months have seen the introduction of some significant digital innovations, which is reflective of a ¤5 million capital spend on technology by both the CarePlus Support office and Pharmacists. The main focus has been on improved ordering and category management systems, along with world class stock and inventory systems such as the development of bespoke electronic shelf edge label technology, AcuTag®, and a state of the art business intelligence tool, AcuTag® BI. These specialised operational and reporting tools allow pharmacists to monitor sales, footfall and category information for each of their stores. The introduction of electronic shelf edge labels technology was a first for pharmacies in Ireland and the UK, and has been pivotal in saving CarePlus pharmacists money and driving efficiencies in-store. The technology ensures pharmacists have the exact digital tools they need to make informed decisions on how best to run their business. CarePlus pharmacists have also benefited from improved management practices in their day to day management of their pharmacies. There is an “always-

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on” support link for all CarePlus Pharmacy partners, particularly in areas such as marketing, commercial, merchandising and IT support. The goal is simple, to free pharmacists up to concentrate on delivering the best possible customer and patient interaction. A key support offered by the CarePlus Pharmacy team is in the critical area of training and development. The CarePlus Training Academy is developing category experts in each pharmacy, leading to the establishment of a superior knowledge bank available to customers on each pharmacy visit. For example, each pharmacy has a dedicated Baby Advisor, Skin Advisor and Health & Wellbeing Advisor to deliver a better customer experience in a more meaningful and helpful way. In March, CarePlus Pharmacy brand ambassador Lucy Wolfe travelled around Ireland for special community-led “Baby Roadshows”, where she met with CarePlus pharmacists, team members and their customers. The roadshow drove large numbers to each location and CarePlus will continue to work with experts in key areas to continue to drive a

number of engaging community events and experiences for CarePlus customers. In addition to the improved in-store offering, CarePlus is growing its brand awareness through key marketing and sponsorship strategies. Community engagement remains at the core of the business, which is why it made perfect sense for CarePlus to sponsor the Carer of the Year and Young Carer of the Year awards for the second year running. The

“CarePlus is growing quickly and we are thrilled with its progress,” said Niamh Lynch, Commercial Director of CarePlus Pharmacy. “Our recruitment pipeline has never been healthier and we are seeing interest in the brand from independent and, now for the first time, members of other groups. Our partner pharmacists are seeing the benefits of being part of such a dynamic brand. The key to success is teamwork, and from the support staff, to the pharmacist, to the front of pharmacy staff, everyone at CarePlus Pharmacy is moving forward together.”


Social Media

Social media and negative commentary in modern-day pharmacy When Janet Dillon saw a negative comment on the social media feed of a large pharmacy chain, posted by a customer who complained about rude staff, medication shortages and bad service, she didn’t hesitate. The owner of Janet Dillon Pharmacy seized the opportunity to make a connection with her former customer. Ms Dillon told the woman she’d love for her to come back into her pharmacy, and wished her well. The customer quickly replied, saying she would be more than happy to make the trip. “The personalised service and friendly staff have been sorely missed,” she wrote back to Ms Dillon. To date, the pharmacy chain at the centre of the complaint has not responded to the negative Facebook post. Ms Dillon, meanwhile, has won back a customer. Ms Dillon believes it is vital that businesses engage with negative comments posted on their online accounts, but she draws the line at responding to trolls. “If it is about poor customer service then absolutely you need to [respond] and make amends,” she said. “In some instances it is best to steer away from contentious issues. I don’t engage with rants on Facebook.” Dealing with negative feedback is often seen as one of the greatest hurdles to businesses that are considering a move into the world of social media. Research shows almost two thirds of all businesses already use social media, but that figure drops among small businesses, including community pharmacies. While social platforms are a cost-effective way to promote instore events and competitions, or announce new stock, they also pose a risk to the business by opening a forum - which is visible to the public - where customers can share negative experiences, or, in the case of Facebook, can give the company a public rating. Experts are urging community pharmacies to embrace social media, saying it has become part of the fabric of our society, and

Janet Dillon, the owner of Janet Dillon Pharmacy

that to shun it could have a more detrimental impact on the future of the brand. Greg Canty, managing partner at Dublin-based social media consultancy, Fuzion, said the best way to minimise risk to your pharmacy online is to have a clear strategy. The plan should outline the business’ objectives, key messages, content, target audience and, perhaps most importantly, procedures for responding to negative posts. “Make sure that everyone who is posting knows the strategy as well as the business,” Mr Canty said. “Giving the college intern ‘the keys’ to your social media accounts is where most mistakes occur.” Asked if Irish pharmacies were doing enough to promote themselves on social media, Mr Canty’s answer was blunt:

“No,” he said. “As a heavy social media user I can't think of one pharmacy that I notice posting on social media. I am sure there are exceptions and there must be some who are doing well online, but I haven't come across them in my circles.” According to Mr Canty, this vacuum in the sector presents a “huge opportunity” for pharmacists who decide to be proactive. Aside from promoting their own brand and the personality of the business, social media provides pharmacies with a free forum to raise the profile of the profession and publicise their healthcare expertise. Some Irish pharmacies already share blog posts, health tips and advice, and important news updates, such as information about the cervical cancer scandal.

Fuzion’s tips for pharmacies to optimise social media to grow their business: • choose platforms that are most appropriate for your audience • develop a content plan to ensure your audience gets to know everything about the pharmacy • have a clear follower strategy: who do you want to interact with? • get into a healthy habit of posting at least once per day • don't be robotic - allow your audience to get to know you and your team • follow other social media accounts and put as much energy into interacting with those accounts as you do posting about yourself

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Social Media “Time is given aside to social media usually first thing in the morning and after work as we found that it can be a distraction,” Ms Dillon said, adding that most product enquires are sent online in the evenings. The business also follows various social media accounts to monitor what is happening in the industry and has teamed up with local social media influencers, who promote the pharmacy and its product ranges, which Ms Dillon said has boosted sales. Marketing experts agree that some of the most important factors to a business’ social media success include its ability to differentiate itself from competitors, and implement a strict policy that covers online content, customer engagement and comment moderation.

Greg Canty, managing partner at Dublin-based social media consultancy, Fuzion

• Facebook requires a budget to boost post - the era of 'show me the money' is here • all social media accounts are part of your brand - ensure all accounts have strong graphics that showcase the business • have your alerts constantly monitored and be sure to respond in a reasonable time span (no more than 24 hours) • make sure that the people posting are trained to do so • never, NEVER respond to trolls

Ms Dillon believes it is important to be proactive online. She started social media accounts for her business five years ago. Initially, there were three separate business pages (one for each store), but they have since been condensed into one dedicated Facebook page. Two years ago, Ms Dillon began exploring other avenues, including Snapchat and Instagram. Her staff now post updates most days - sometimes multiple times a day - about new product ranges, promotions, in-store events and local causes that the pharmacy supports.

In the pharmacy sector, ethical considerations such as patient confidentiality are also important. The Irish Pharmacy Union’s Siobhán Kane said it runs training courses on social media for members and also provides general advice on request. The UK’s Royal Pharmaceutical Society publishes a comprehensive guide for social media use, covering professional development, pharmacy research and ethical challenges. “Conversations on Facebook and Twitter are often

blurred between personal and professional lives,” it cautions. One of the most important considerations for pharmacies using social media is to avoid dispensing specific advice. Pharmacists can draw on their bank of knowledge to discuss medicines and other general issues in healthcare, but when it comes to individual patients, be careful not to give advice. In its Guidance for Pharmacists on the use of Digital and Social Media, the Pharmaceutical Society of Ireland cautions that pharmacists should consider the potential consequences of providing information, services and products online. Preserving patient confidentiality is vital.“Standards of privacy and patient confidentiality must be maintained online, and pharmacists must not post identifiable patient information without the patient’s informed consent,” the report says. “Where anonymised patient data is posted, ensure that this data cannot be linked back to the patient. Remember that, although individual pieces of information may not alone identify a patient, a combination of online information could unwittingly compromise confidentiality and give rise to patient complaints.”

Which social media platform is best for my business? Facebook: Facebook is one of the easiest ways to connect with people from all walks of life. It is the largest social media platform in the world - and anyone can use it. Businesses can create a professional page, from which they can post news, reviews, comments, and multimedia. They can also pay for advertising to target audiences based on age, gender, employment, interests, and purchasing behaviours. Instagram: Geared towards a younger audience, this visual platform allows business owners to promote their offering online through imagery, connecting with other similar brands, and posting and receiving comments. With half a billion daily active users, Instagram (owned by Facebook) is a fantastic option for businesses. Twitter: A news and social networking platform where users can “Tweet” up to 280 characters at a time (as well as photos and videos). Twitter is a popular platform for current events, and has become a staple for news organisations around the world. Businesses can use the hashtag feature to tap into trending news events, engage with the public, and drive traffic to their website and social media pages. Snapchat: Also targeted to younger audiences, Snapchat users can post stories, stream live video from in-store events and upload photographs. LinkedIn: The social media platform for professionals and corporate audiences, LinkedIn allows users to upload a CV and relevant career information, as well as connect with other people in their industry. Think of it like a networking event. YouTube: Companies can upload and share videos with customers and the wider public. Owned by Google, businesses that adopt YouTube can have access to Google’s advertising platform, AdWords. The title and description of a video is vital to where it will appear in search rankings.

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NASACORT ALLERGY 55 MICROGRAMS/DOSE NASAL SPRAY SUSPENSION (TRIAMCINOLONE ACETONIDE) PRODUCT INFORMATION Presentation: 20 ml bottle, providing 30 actuations containing 55mcg triamcinolone acetonide per metered dose. Indications: Treatment of the symptoms of seasonal allergic rhinitis. Dosage and Administration: Patients aged 18 years and over: The recommended dose is 220 micrograms as 2 sprays in each nostril once daily. Once symptoms are controlled patients can be maintained on 110 micrograms (1 spray in each nostril once daily). If symptoms are not relieved within 14 days, a physician must be consulted. Not recommended in children and adolescents under 18 years of age. Contraindications: Hypersensitivity to the active substance or excipients. Precautions and Warnings: If adrenal function may be impaired, take care when transferring patients from systemic steroids. Localised infections of the nose and pharynx with Candida albicans has rarely occurred which may require local treatment and temporary discontinuation of Nasacort Allergy. Should be used with caution in recent nasal septal ulcers, nasal surgery or trauma, until healing has occurred. Systemic effects may occur, particularly at high doses prescribed for prolonged periods. Potential systemic effects may include Cushing’s syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression. Treatment with higher than recommended doses may result in clinically significant adrenal suppression which may require additional systemic corticosteroid cover during periods of stress or elective surgery. Close monitoring in patients with a change in vision or with a history of increased intraocular pressure, glaucoma and/or cataracts. Contains benzalkonium chloride, an irritant, which may cause skin reactions. Interactions: No interaction studies have

been performed. Pregnancy and Lactation: should not be administered during pregnancy or lactation unless therapeutic benefits outweigh the potential risk to the foetus/baby. Adverse Reactions: commonly reported adverse reactions: flu syndrome, pharyngitis, rhinitis, headache, bronchitis, epistaxis, cough, dyspepsia & tooth disorder. Rare reactions: nasal septum perforations. Frequency not known: hypersensitivity (including rash, urticaria, pruritus and facial oedema), insomnia, dizziness, alterations of taste and smell, cataract, glaucoma, increased ocular pressure, nasal irritation, dry mucous membrane, nasal congestion, sneezing, dyspnoea, nausea, fatigue, decreased blood cortisol. Legal Category: P. Marketing Authorisation Number: PA 540/11/2. Further information is available from the Marketing Authorisation Holder: Medical Information Department, Sanofi-aventis Ireland Limited T/A SANOFI, 18 Riverwalk, Dublin 24, IE-medinfo@sanofi.com. Tel. 0845 372 7101. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of preparation of PI: December 2016

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Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600.


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Irish pharmacies leading the way in monitoring hypertension Irish Pharmacy News spoke to Alice Gallagher, supervising pharmacist at Sion Hill Pharmacy in Dublin.

Dublin pharmacist Alice Gallagher and pharmacy assistant Mairead Oâ&#x20AC;&#x2122;Brien What is hypertension? Hypertension, or high blood pressure, rarely has noticeable symptoms, but if left untreated it can increase your risk of developing heart disease or stroke. Hypertension is responsible for significant premature mortality, reduced quality of life and significant costs to the health and social care system. Almost 64% of people over the age of 50 here have high blood pressure, with many unaware that they suffer from the condition. There are various risk factors which include age, family history and certain medical conditions. The only way to find out if your blood pressure is high is to have your blood pressure checked. How do you measure blood pressure? Blood pressure is the force exerted on artery walls as the heart

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pumps blood through the body. Hypertension occurs when blood pressure is consistently higher than the pressure needed to carry blood through the body. Two numbers are used to measure the level of blood pressure. One number records blood pressure when the pressure is at its highest i.e. as the heart muscle squeezes out the blood from your heart. This is called systolic. The other number is when your heart relaxes i.e. allows the blood to flow back into the heart. This is called diastolic. The normal level of blood pressure is usually about 120 (systolic) over 80 (diastolic). What services does your pharmacy offer? We offer a walk in blood pressure check. Following from this if a patient has higher readings we would refer them on to the GP. We can also offer the 24 hour monitor

to anyone who wishes to get their BP checked before they go to their doctor. By measuring the blood pressure over a 24 hour period, the doctor can get a clearer picture of how a patient's blood pressure changes over the course of the day and night. When, and how, did you identify a need for blood pressure monitoring services in your pharmacy? We started offering free blood pressure monitoring services in the pharmacy as soon as we opened three years ago. After referring several patients on to their GP's, we realised that 24 hour BP monitoring is a service we should also be providing. We introduced this new service in January 2017. Whilst it is an expensive initial outlay, we see the benefits in the number of people we are referring to their GPs.

Is this a growing area for the business? Since we opened, there has been a notable increase in the number of customers coming into the pharmacy to avail of our free blood pressure check service. We have one 24 hour monitor, which we hire out to patients for 50 euro. We average one or two patients per week. Health promotion and management is part of our role as pharmacists, so it is great to be able to assist with this. How do you use these services to build relationships with patients? In a community pharmacy setting we have the opportunity to start a conversation with patients on a less formal basis. Some people are reluctant to make an appointment with their GP, so we can talk to them about getting their BP checked. We are also available to


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PRESCRIBING INFORMATION DIORALYTE™ NATURAL, BLACKCURRANT AND CITRUS, POWDER FOR ORAL SOLUTION 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 and 20-40 mg/kg body weight for adults and children. A reasonable approximation is: Infants – One to one and a half times the usual feed volume. For infants under 12 months, use only under medical advice. Children – 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: None known. Warnings and Precautions: The solution must not be reconstituted except with water at the volume stated. Solutions of greater concentration may result in hypernatraemia. Those of greater dilution may result in inadequate replacement. 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: Dioralyte is not contra-

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indicated in pregnancy or lactation. Interactions and Adverse Effects: None stated. Overdose: In the event of significant overdose, serum electrolytes should be evaluated as soon as possible, correct any abnormalities and monitor levels until return to normal, especially in the very young and in cases of severe hepatic or renal failure. Precautions for Storage: Do not store above 25°C. The reconstituted solution should be used immediately but may be stored for up to 24 hours in a refrigerator at 2-8°C. Marketing Authorisation Holder: Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24. Marketing Authorisation No. PA 540/98/1 (Blackcurrant), PA 540/98/2 (Citrus), PA 540/99/1 (Natural) Legal Category: P Further information: Available from Sanofi Ireland Ltd., Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi. com. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Date of Preparation: January 2016 Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Suspected adverse events can also be reported to Sanofi Ireland Ltd. directly by emailing IEPharmacovigilance@Sanofi.com or calling 01 403 5600. Date of Preparation: June 2018 SAIE.DIO.17.01.0010c


Feature • Beta blockers. Beta blockers can reduce blood pressure by making your heart beat more slowly and with less force. Common exmaples are bisoprolol, nebivolol and atenolol • Calcium channel blockers. These work by widening your blood vessels. Common examples are amlodipine, nifedipine, felodipine, diltaizem and verapamil • Diuretics. Diuretics work by flushing excess water and salt from the body through urine. Common examples include bendrofluamethiazide and indapamide. What do you believe Irish pharmacies’ role in managing high blood pressure should be? Many Irish pharmacies are now offering blood pressure tests to patients

provide health and lifestyle advice which can positively impact a patients’ wellbeing. These include cutting your intake of salt to less than 6g per day, eating a low fat, balanced diet, increasing your level of physical activity, cutting down on alcohol, weight loss where appropriate, smoking cessation. We have resources on site which can guide patients in making simple changes in their daily lives, such as smoking cessation advice. If we can start

discussions with patients it may lead to improved outcomes. What products are available in pharmacies to treat high blood pressure? If you are diagnosed with high blood pressure you may be prescribed one or more medications to keep it under control. Common blood pressure medications include: • Angiotension-converting

enzyme (ACE inhibitors) reduce blood pressure by relaxing your blood vessels. Common examples include lisinopril, perindopril • Angiotensin-2 receptor blockers (ARBs). ARBs work in a similar way to ACE inhibitors by widening your blood vessels. Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan

According to the Irish Heart Foundation, more than half the adults in Ireland over the age of 45 have high blood pressure, but about four in every five men and two out of three women with high blood pressure are not being treated. Many pharmacies around the country are now offering blood pressure checks to patients. Some, like us, also do 24-hour blood pressure monitoring. We think it’s important that Irish pharmacies continue to lead the way in this area. Pharmacies are offer an accessible and low cost option where patients can check their blood pressure and receive expert advice about how to decrease their risk factors and manage the condition.

News Focus ‘must remain on biopharma innovation’ as European Commission proposes new IP laws The Irish Pharmaceutical Healthcare Association (IPHA) has warned that proposed new patent protection rules for new drugs would be a setback for the biopharma industry in Ireland. The patent protection rules that curb competition for medicines in markets outside the European Union should be changed, the European commission has proposed. The commission says it wants to introduce an “export manufacturing waiver” to offer protections for the pharmaceuticals sector known as supplementary protection certificates (SPC). An SPC is an EU-wide intellectual property right that extends the protection of a patented medicine

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by up to five years. SPCs effectively compensate patent holders for time lost in getting regulatory approval for medicines. Under the current regulation, European-based manufacturers are prevented from producing medicines even for regions outside the EU during the period of an SPC, despite the fact that those markets may not be subject to a supplementary protection certificate or where it might already have expired. Generics and biosimilar manufacturers, which produce

“me too” versions of drugs that have come off patent, have been pressing for a number of years for a waiver covering European manufacture for such markets outside the EU. The IPHA, which represents the research-based pharmaceutical industry in Ireland, has said a continued focus on innovation is key to unlocking the potential of new medicines to improve healthcare outcomes and attract investments in the future. The IPHA believes the proposed laws on intellectual property

would be a setback for an industry centred on innovation when the focus should remain on creating the best conditions required for the discovery and delivery of new medicines and the attraction of fresh investments to Ireland. IPHA Chief Executive Oliver O’Connor said: “It is critical that policy for the biopharma industry remains focused on innovation as the key to unlocking the potential of new medicines to improve healthcare outcomes and generate more high-quality jobs for Ireland.”


ZIRTEK ALLERGY RELIEF MEANS BUSINESS

More allergy sufferers use Zirtek Allergy Relief in Ireland than any other brand. That’s because it’s a trusted, non-drowsy way to ease the symptoms of hayfever and other allergy symptoms, 24-hours-a-day.1,2 With Zirtek Allergy Relief, you’ll also get: High-profile marketing support, including a new website, national television campaign, online advertising and social media Your own point-of-sale material A range of products suitable for all the family3 A heritage and reputation based on reliability and dependability, supported by extensive knowledge and research Round-the-clock, max strength treatment, available in extra-value packs of 30

www.zirtek.ie 1 2 3

ZirtekIE

Zirtek IE

Zirtek Usage and Attitude in the ROI report. Does not cause drowsiness in the majority of people. Zirtek is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards. Zirtek D is suitable for adults and adolescents from 12 years of age and upwards.

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 Ireland Ltd

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 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

May 2018 UK/18ZI0009(1)


News Almost half of Irish parents would get their sons vaccinated against human papillomavirus (HPV) Human papillomavirus (HPV) is now so common that the majority (80%) of Irish men and women will get the virus at some point in their lives, yet new research reveals that 95% of parents underestimate just how prevalent the virus is. vaccination in boys, alongside girls, is two-fold; not only does it help to prevent the spread of the virus to others, it also prevents HPV-related cancers in both males and females, by helping the immune system fight and clear the HPV infection.

Dr Phillip Kieran

This is part of research announced as part of Irish Life Health’s “Not Just for Girls” HPV awareness campaign. HPV is a family of common viruses that are passed on through sexual contact. In most cases, HPV goes away on its own and does not cause any health problems; however, there are numerous strains of HPV, some of which can cause cancer or precancerous lesions. The HSE currently offers the HPV vaccination only to girls, in their first year of secondary school. However, the benefits of

The “Not Just for Girls” campaign by Irish Life Health also highlights that 85 men in Ireland are diagnosed with HPV related cancers every year, which could potentially be prevented by a simple vaccination. Commenting on the Irish Life Health research, Dr Phillip Kieran said; “We are seeing more and more HPV related cancers recently in men as well as women, so I feel it is important to consider vaccinating boys as well as girls. Administering the HPV vaccine to both boys and girls is the most effective way of preventing a range of cancers caused by the virus, yet it’s currently only available free to girls in their first year of secondary school.” The research also highlighted that there is a low understanding among Irish parents about HPV related cancers in men. Only 8% of Irish parents believe the leading cause of oropharyngeal (throat) cancer in men is from a HPV-

infection. However, up to half of all oropharyngeal cancers in Ireland may be caused by HPV infection. People who are diagnosed with HPV are 16 times more at risk of developing oropharyngeal cancer and on average nearly one third (27%) of all HPV related cancer diagnoses in Ireland are in men. In addition to this, more than 99% of cases of cervical cancers in women are thought to be caused by HPV. Parents have shown to be receptive about vaccinating their

sons against HPV, with almost half (47%) of parents of boys under 18 years considering getting their sons vaccinated against the virus. The main reasons given were: protecting their son from HPV-related cancers and sexually transmitted diseases (59%); shared responsibility between boys and girls to prevent STDs (22%); and equal rights to HPV vaccination for boys and girls (10%). The research also showed that nearly 8 in 10 (77%) parents of dependent children understand that both genders can carry the HPV virus.

What is HPV? Human papilloma virus (HPV) is the name for a group of viruses that affect your skin and the moist membranes lining your body. Examples of this include your: • cervix • anus • mouth and throat There are more than 100 types of HPV. Around 30 types of HPV infection can affect the genital area. Genital HPV infections are common and highly contagious. They are spread during sexual intercourse and skin-to-skin contact of the genital areas. What can HPV infection do? Infection with some types of genital HPV can cause: • genital warts – which is the second most common sexually transmitted infection (STI) in England • abnormal tissue growth and other changes to cells within your cervix – which can sometimes lead to cervical cancer Other types of HPV infection can cause minor problems, such as common skin warts and verrucas.

Stable COPD patients may not need added inhaled corticosteroid to prevent exacerbations COPD patients who do not exacerbate frequently but who are using a complex regimen including inhaled corticosteroids (ICS) may not need the ICS component if they de-escalate to a simplified contemporary regimen that combines a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA) in a single inhaler. These were the findings of a randomised controlled trial presented at the ATS 2018 International Conference and published online in the American Journal of Respiratory and Critical Care Medicine. In “Long-term Triple Therapy De-escalation to Indacaterol/ Glycopyrronium in COPD Patients (SUNSET): a Randomized, Double-Blind, Triple-Dummy Clinical Trial,” lead study author Kenneth Chapman, MD, MSc, and coauthors described the first randomised controlled study

28

investigating ICS withdrawal in stable COPD patients on long-term triple therapy. Current COPD guidelines recommend that ICS be used only for the minority of COPD patients who exacerbate frequently but many stable, non-exacerbating patients end up on inhaled therapy that includes ICS. Often patients receive triple therapy with a LAMA/LABA/ ICS combination. The SUNSET study enrolled 1,053 such patients without frequent COPD

exacerbations (no more than 1 in the previous year) and randomly selected 527 of them to take the long-acting muscarinic antagonist and a long-acting beta-agonist, indacaterol/glycopyrronium (110/50 once daily), without an ICS. The remainder continued on the triple therapy. In the study, those taking only indacaterol/glycopyrronium were no more likely to have an exacerbation than those who remained on their triple therapy during the six-month period. Nor was there a difference in the time

to the first exacerbation or the use of rescue inhalers between the two groups of patients. There was a small, but statistically significant, decline in lung function, FEV1, or the amount of air that can be forcefully exhaled in one second, which was 26 milliliters less in those receiving indacaterol/ glycopyrronium than in those continuing triple therapy a day after the medications were taken. This decrease has been seen in other studies and is not likely to be clinically significant.


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News Pain management programme results in 21% reduction in moderate to severe pain The ‘mypainfeelslike…’ campaign has announced results from a nurse-led pain management programme run across Leinster in 2017, which aimed to improve quality of life for people with persistent pain. 44% required further intervention, 41% had poorly controlled or uncontrolled pain in the last seven days and 38% were not adhering to their pain medication. The nurse assessed the patient using an audit tool and determined if the patient required a follow up with their GP by assessing the following:

Dr Rukshan Goonewardena

• Stage 1: Pain levels/description of the pain • Stage 2: Review of current treatment medication plan

The results showed a 21% reduction in the proportion of patients experiencing moderate to severe pain, a 6% drop in the proportion of patients who missed work days in the previous week due to pain and a 60% decrease in the proportion of patients waking three to four times a night as a result of pain. The ‘mypainfeelslike…’ campaign has been created by Grünenthal Pharma Limited who also provided funding and support for the nurse-led pain management programme. The pain clinics, run over two stages of assessment and re-assessment were developed to support general practitioners (GPs) and practice nurses with the management of people diagnosed with persistent pain i.e., pain lasting three months or more. For the initial clinic, 629 patients were assessed and 52 patients attended the re-assessment clinics. In the initial assessment, 67% of patients attending the clinic did not have a pain management plan, whereas, 88% of those who attended the second clinic had a pain management plan in place showing the benefits of the programme. Patients identified during an audit process, conducted with the GP, were invited to attend a 30 minutes face-to-face pain management review clinic or assessment with a registered nurse. The nurse provided support and education to achieve better patient outcomes and more effective pain control. Results from the initial clinic showed that

30

• Stage 3: Quality of life • Stage 4: New treatment plan and advice A reassessment was conducted within six weeks of the initial assessment to measure if the patients’ pain control was being better managed following their review. Patients who were still experiencing uncontrolled pain were referred back to their GP. “A large number of patients in my practice have been diagnosed with persistent or chronic pain”, says Dr Rukshan Goonewardena,

GP Principal, Ballyjamesduff Family Practice, Cavan. “It can be difficult to assess and manage as there are many factors at play and it affects people in a variety of ways. This programme showed improvements in pain scores, the proportion of patients with poorly controlled pain and in the number of work days missed due to pain. “For me, it clearly demonstrates the impact advice and education can have on this patient group in a real-world setting. I highly recommend this programme to GPs and practice nurses to improve pain control and quality of life in our patients.” The inclusion criteria were as follows: • Patients who had been prescribed a World Health Organisation pain ladder step 2 or 3 pain medication for 12 weeks or more • Patients diagnosed as having persistent pain “These clinics show how effective pain management can be achieved through nurse-led

assessments with support from the GPs”, commented Joanne O’Brien, Registered Advanced Nurse Practitioner (RANP) in Pain Management. “Providing pain education and support, improving sleep and access to a pain management plan are crucial to helping patients move out of the persistent pain cycle. Practice nurses could take on this task and liaise with the GP as needed to better manage these patients and ensure they adhere to a pain management plan set out for them.” The ‘mypainfeelslike…’ campaign has developed an information leaflet which gives a brief overview of the nurse-led pain clinic and outlines the stages and the results of the programme. The leaflet and a video, where Dr Rukshan Goonewardena and Caitriona Pollard, registered nurse who ran the programme, discuss the clinics in more detail; the steps taken, the challenges and the benefits to patients, are available to download at mypainfeelslike.ie.


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For more information please contact: Free Phone 1800 440 440 I PharmaSource@uniphar.ie I www.uniphar.ie


Financial Feature

How the pharmacist can plan for income in retirement In the second instalment of a six-part series, Robert McOwan continues his exploration of the financial lifecycle of the community pharmacist. Using his experience in both the business and pharmacy sectors, Robert works as a financial advisor offering both business and personal financial planning. This month he discusses planning for retirement. 3. Discretionary income – holidays, shopping, social events 4. Discretionary wealth/gifts – education funds, first time buyer deposit 5. Discretionary wealth/luxury items – travel, hobbies, shopping Reasons to Plan

Robert McOwan

Retirement Planning Many people agree that having a pension is very important but delay in doing something about it because they believe it is not very urgent today. However at some time in the future, it will become both very important and very urgent. Depending on when that happens there is a risk it may be too late. A consequence of this is potentially retiring from work without having the necessary income available and ready to use. Hopefully the information below will help with understanding how to make decisions regarding planning for income in retirement. In our last edition of IPN News, we published ‘Float Like A Butterfly’ which explained the four step cycle of financial planning. A quick recap is that for both employees and business owners, there are four financial planning steps; one is the early financial years, step two, the financial growth years and step three, the financial

32

consolidation years. During these steps regular income is earned and saving regularly, building assets and creating wealth are financial goals. These steps lead to a final step four and financial security in retirement, hopefully, based on the excellent financial planning in all previous steps. In this article there is a more detailed look at how to plan for income in retirement. This includes using Revenue Approved tax efficient methods of creating wealth from current income, to help ensure the standard of living enjoyed while working, is maintained when work stops and retirement starts. Hierarchy of financial needs in retirement 1. Essential income – utilities, household shopping 2. Emergency income – urgent travel, car repairs, medical costs

An important factor to consider is an increase in life expectancy. People can now look forward to spending up to a third of their lives in retirement, which is typically a time when it is not possible to earn a regular income. In addition the age profile of the Irish population is getting older, which means less money available to the Government in the future to pay for state pensions. The real expectation is that more people will be living their lives in retirement than there are people working. This is one of the reasons why the Government actively encourages people to save for their income in retirement. On offer to investors is attractive and immediate tax relief on contributions, tax free returns on investments and an option to take a tax free cash lump sum at retirement. Investing in a Pension Plan is an opportunity to make a very wise investment as there is no simpler, easier or more tax-efficient way of saving money In Ireland. What Pension Plan? • The most suitable pension plan depends on your employment status, for example; Personal Pension plans are only available to self-employed, employees who are not members of a company pension scheme. • Executive Pension Plans and Defined Contribution Schemes are available to business owners for their own use. These are also used to provide pension

benefits for employees who become members of a company sponsored executive pension plan or a defined contribution scheme Pension Contributions The amount of money invested in a pension plan is called a contribution. Many people underestimate how much they will need to contribute in order to provide an adequate income when they retire. One way to overcome this challenge is to decide on potential income needs and then start saving as soon as possible. While it is never too late to start a pension plan, an early start usually equals smaller contributions to be put aside each month to reach an income in retirement. The points below show some key steps to help with thinking about achieving income in retirement targets • Decide on retirement income goals • Calculate time between now and target retirement date • Set up a plan with affordable contributions • Measure progress of retirement plan Government Income Support in Retirement A full state pension, called a State Contributory Old Age Pension is paid to people who have made the required number of PRSI contributions during their working lives. If a person does not have the required number of PRSI contributions they may be entitled to a reduced State Contributory Old Age Pension. Old Age NonContributory Pensions are also available. This is a means-tested payment for people aged 66 or over who do not qualify for an Old Age Contributory Pension based on their social insurance record.


Age limits apply to receiving state pensions, for example, a person who was born on or after 1 January 1955 qualifies for a state pension at age 67. A person born on or after 1 January 1961 qualifies for a state pension at age 68. Pensions are paid for life.

Flexible Pension Fund Options at Retirement

Contributions Tax Relief

In the 1999, 2000 and 2011 Finance Acts the Minister for Finance made significant changes to pension legislation. This allowed owners of personal pensions and members of defined contribution scheme or contributors to executive pension plans to retain ownership of their pension funds. In addition, there are now more flexible Revenue Approved options available to how accumulated pension funds are used when people reach their selected retirement age.

By contributing to a pension plan it is possible to reduce personal income tax. This is true for personal contributions to a personal pension or member’s contributions to an executive pension plan or a defined contribution scheme. Tax relief is allowed by Revenue on all personal pension contributions at a person’s marginal rate of income tax. The following table illustrates the effects of tax relief on monthly contributions.

Please Note: the flexible options listed below are choices that only have to be made at retirement. The first priority is to build the pension fund which makes these options available. At retirement day, any option selected depends on current personal and financial circumstances. It is accepted that financial and personal circumstances and therefore income in retirement priorities may have changed since a pension plan was originally set up.

Personal Pension Plans flexible options are as follows:

It is important to note that any private pension planning in a personal pension, executive pension plan or a company scheme allows a person to have a pension income paid sooner than a state pension.

Standard Marginal Tax Tax Rate Rate @ 20% @ 40%

Gross monthly contribution ¤200

¤200

Tax relief

¤40

¤80

Net Cost

¤160

¤120

Tax Relief Limits The tax relief limits shown in the table below apply to personal contributions to any Revenue Approved pension plan: Age Limit attained (% of Net during Relevant tax year Earnings) Under 30 15% 30 - 39 20% 40 - 49 25% 50 - 54 30% 55 - 59 35% 60 + 40% Net relevant earnings are subject to an earnings limit of ¤115,000 for the years of assessment.

1. Invest the pension fund in an annuity which delivers a pension for life based on annuity rates at the time of retirement. 2. Invest the fund in an Approved Retirement Fund, subject to Revenue terms and conditions. (see point 6 below) 3. Take 25% of the pension fund as a tax free lump sum. 4. Invest the remainder of the fund in an annuity to provide a pension for life - or 5. Invest the remainder of the fund in an Approved Retirement Fund - or 6. If a pension of ¤12,700 per annum is not available, ¤63,500 of the fund must be invested in an Approved Minimum Retirement Fund until age 75 or alternatively, invested in an annuity which would provide a pension for life. 7. Subject to terms and conditions, an ARF or AMRF can be used to provide taxable income in retirement at a person’s marginal rate of income tax.

Financial planning for retirement 1. Think about income needs in retirement 2. Decide on a retirement plan start date 3. Get trusted expert advice 4. Allocate available funds to the plan 5. Review funds versus income goals regularly Executive Pension Plans & Defined Contribution Schemes Pension Options These are the same as those for Personal Pension Plans listed above, with one additional option available. • Take a tax free lump sum based on final salary and years of service If this tax free cash option is taken, the remainder of the fund must be used to purchase an annuity. Important point to note is that the tax free lump sums are subject to a limit of one and half times final salary and a lifetime limit of ¤200,000 (Finance Act 2011). Reasons to Start a Pension Plan 1. Tax relief at marginal rate on contributions (subject to revenue terms and conditions) 2. Investment returns are tax free. 3. Tax free lump sum at retirement. 4. Excellent options and flexible choices at retirement. 5. Flexible retirement dates. 6. Financial security and independence. Hopefully this article will have removed some of the mystery on how to organise a pension plan to support your income in retirement. It might be a good time to think about how to get started on building a pension fund to ensure all essential, emergency and discretionary income needs are comfortably met during retirement. This can be achieved by taking advantage now of the excellent Revenue Approved tax relief available on contributions to any pension plan. As a starting point, consider the steps listed in the

diagram as a starting point for your decision. In the meantime, if you have any queries about any of the information in this article please contact Robert McOwan M: 086 896 1223 Robert McOwan is a Personal Financial Advisor with Acorn Life. Acorn Life DAC is regulated by the Central Bank of Ireland. Acorn Life is a 100% Irish owned Life Assurance Company offering protection, savings and investment products designed for the Irish public. Deductions for charges and expenses are not made uniformly throughout the life of the products mentioned above, but are loaded onto the early period. This means that if you withdraw from the product in the early period, the practice of front-end loading will impact on the amount of money which you receive and you may not get back the full amount invested. Warning: If you invest in this product you may lose some or all of the money you invest. Warning: The income you get from this investment may go down as well as up. Warning: The value of your investment may go down as well as up. About the Author Rob McOwan is a Personal Financial Adviser with Acorn Life. Rob also has a strong connection to the Pharma Industry having worked alongside numerous pharmaceutical organisations to assist with the design and launch of key brands. He has significant experiences creating, building and supporting pharma companies within the Irish and European markets and in his current role is now ideally positioned to present financial advice within the pharmacy industry to owners and employees.

IPN Readers Offer: Claim your FREE 1:1 Consultation with author Robert McOwan To avail yourself of this offer call 0868961223 and quote 4698

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Feature Acne â&#x20AC;&#x201C; what the pharmacist can do to help with a common skin condition Dr. Naomi Mackle is Medical Director of The Adare Clinic. Dr. Mackle is on the Specialist Register in Ireland and holds an H.Dip in Dermatology. Her wealth of experience as a GP, as well as practising in aesthetics, allows her to provide a unique and comprehensive service to her patients. Naomi undertook her medical training both in Ireland and in Perth, Australia. She worked alongside Dr. Jayson Oates (Consultant Plastic Surgeon) in the Australian Academy of Cosmetic Dermal Science. This opportunity provided her with the most up to date and innovative techniques available. Naomi returned to Ireland and continued her passion for dermatology and plastics by training in administration of Toxin, to relax wrinkles in the face and neck. During this period she also undertook a Diploma in Dermatology, which gave her an in-depth knowledge of skin condition as well as advanced techniques in the use of lasers, chemical peels, and microdermabrasion. Dr Mackle also has extensive experience in the advanced application of Dermal fillers. As well as completing a diploma in Dermatology, Naomi is in the process of completing a Masters in Dermoscopy from Graz University, Austria. Naomi now enjoys tutoring in her specialty at Cardiff University as well as training others in the injecting of Dermal Fillers for major manufacturers.

Dr. Naomi Mackle, Medical Director of The Adare Clinic ACNE VULGARIS This is a very common skin condition characterised by comedones (blackheads and white heads) and pus-filled spots (pustules). It usually starts at puberty when androgens increase the production of sebum from enlarged sebaceous glands and varies in severity from a few spots on the face, neck, back and chest to a more significant problem that may cause scarring and impact on self-confidence. For the majority it tends to resolve by the late teens or early twenties, but it can persist for longer in some people. Acne can develop for the first time in people in their late twenties or even the thirties. Adult acne can be a lot more difficult to treat and does not always seem to respond well to standard therapy. In women it is sometimes triggered by pregnancy and withdrawal from the oral contraceptive pill seems to be a definite contributing factor. Occasionally acne occurs in young children as blackheads and pustules on the cheeks or the nose. Causes of Acne The sebaceous (oil-producing) glands of people who get acne are particularly sensitive to normal blood levels of certain hormones, which are present on both men and women. These cause the glands to produce an excess of oil. At the same time, the dead skin cells lining the pores are not

shed properly and clog up the follicles. These two effects result in a build-up of oil, producing blackheads (where a darkened plug of oil and dead skin is visible) and whiteheads. Genetic factors play a part and a positive family history is often a factor to earlier and more severe acne. The acne bacterium (known as Propionobacterium acnes) lives on everyoneâ&#x20AC;&#x2122;s skin, usually causing no problems, but on those prone to acne, the build-up of oil creates an ideal environment on which these bacteria can multiply. This triggers inflammation and formation of red or pus-filled spots. Diagnosis of acne

are for everyday use for men and women; they are excellent for make-up removal. Salicylic cleansers are stronger and can really dry the skin so are for the more severe acne and should be built up slowly so use 3 days per week the first week, 4 days per week the 2nd week etc. Make-up: Mineral make-ups allow the skin to breathe and should be recommended to female patient who are acne-prone. Topical Products/Prescription The most commonly prescribed topical products in our clinic would be:

DUAC: Benzoyl peroxide 5%, Clindamycin 1%. This reduces sebum production and comedones and inhibits growth of Propionobacterium Acnes. It can stain bedclothes/tee-shirts, so warn the patient. Topical antibiotics: Topical solutions of erythromycin, clindamycin and tetracycline are all equally effective. They are well tolerated and effective but seem to stop working after a few months probably due to antibiotic resistance. Topical retinoids: Local treatment with isotretinoin, tretinoin or adapalene reduces comedones and has an anti-inflammatory

Acne is usually a clinical diagnosis. Seborrhoea or oiliness of the skin is usually visible. Open pores, blackheads, white heads, pustules and occasionally large inflammatory cysts can be visible on the face chest neck and back. Scarring may also be visible. Sometimes a blood test or ultrasound scan might be required for example to diagnose polycystic ovarian syndrome or other hormonal abnormality. Treatment of Acne: Topical products/Over the Counter: All acne patients should be recommended a proper skin care regime. Glycolic cleansers

Acne is a very common skin condition characterised by comedones and pus-filled spots

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Feature in adults. Rosacea commonly presents as a rash on the face. It affects the central third of the face especially the nose and cheeks and its intensity varies over time. Rosacea is characterised by flushing and redness, dilated blood vessels, small red bumps and pusfilled spots. What causes rosacea? The cause of acne rosacea is unknown. It tends to run in families and there is nearly always a positive family history. There are a variety of trigger factors that will make rosacea worse: alcohol, exercise, high and low temperatures, hot drinks, spicy foods and stress.

Acne is very treatable as long as therapies are used correctly effect. These drugs are effective but very drying and many patients are unable to tolerate them. This needs to be introduced very slowly and used with a daily oil free moisturiser and vitamin B5 gel. Oral drugs OCP (oral contraceptive pill): For female patients who require contraception the combined pill is a very good option combined with a proper daily skin care regime. The skin friendly pills are Dianette, Yasmin and Marviol. It takes 3-4 months for the benefits to show. Oral antibiotics: The commonly prescribed antibiotics are tetracycline antibiotics. However if these are contraindicated or for example the patient is pregnant or breast feeding, erythromycin can be prescribed. For young female patients; where menstruation is not established and tetracyclines are contra-indicated; erythromycin can be prescribed or trimethoprim. Isotretinoin: This is an extremely effective drug for the treatment of acne. It should be considered for patients with severe acne or acne scarring. It takes about 3 months to start working but will give very good results overall and the overall effect can last for many years although this isn’t guaranteed. However there are serious potential side effects associated with roaccutane like mood swings/depression, liver failure, renal failure. It causes very serious fetal abnormalities necessitating a termination so females must be in a pregnancy prevention programme if sexually active. Patients need to be closely monitored. Other treatments: Skin boost peels: These peels are a combination of lactic, mandelic

36

and salicylic acid and give excellent results for the treatment of mild to moderate acne. IPL (415nm wavelength). This blue light specifically targets the bacteria which multiplies in Propionobacterium acne. The target patient would have mild to moderate acne. Acne scarring: Medical microneedling. This is a form of needling treatment where needles are pushed through the epidermis into the dermis. The dermis will react by forming collagen which improved the appearance of scarring. Scarlet RF: This is for the more severe acne and is also a needling device. The difference is the needles have radiofrequency at the tips. The machine is programmed that when the needles hit the dermis they release the radiofrequency into the dermis which causes tightening and therefore contraction of the scar.

Recent research has highlighted the importance of skinenvironmental interactions. What does rosacea look like? The skin looks red and dry. There are visible telangiectasias and under Dermoscopy there is a characteristic appearance of dilated blood vessels arranged in a polygonal pattern which is diagnostic. Diagnosis is usually clinical and specific tests are not usually required. There are pus-filled spots and small red bumps sometimes visible but there would not usually be seborrhoea or comedones which would be characteristic of acne vulgaris. Scarring is rarely a problem. Occasionally there may be swelling of the facial skin (lymphoedema) especially under the eyes. Occasionally rhinophyma is visible especially in men where the nose becomes bulbous and enlarged

Topical antibiotics: Metronidazole gel works well but seems to lose efficacy after about 8 weeks in a lot of our patients. Skinoren gel ( azeleic acid) is effective but sometimes difficult to tolerate in very inflammatory rosacea. Soolantra: Ivermectin10mg/g. This is designed to treat the inflammatory lesions of rosacea by reducing the quantity of the Demodex mite on the skin. Mirvaso: Brimonidine gel. This is used for treatment of facial erythema of rosacea. This drug seems to be very effective initially after application but patients complain that they get rebound flushing after about 12 hours. Again this is a "wait and see" approach. Antibiotics: Oral tetracycline’s are widely prescribed for the long-term management of acne rosacea. Photosensitivity is a problem so patient should wear SPF and topical vitamin C daily. Erythromycin is an alternative in pregnant patients etc. Pulsed dye laser:

Polymyositis and dermatomyositis

IPL (Intense pulsed light)

Photosensitive eruptions

This is a light source and is effective for the milder rosacea. It is painful to perform but downtime should be minimal.

Acne Vulgaris Seborrhoeic Dermatitis

Phenol peeling:

Menopause

This is a deep chemical peel which is really only suitable for female patients with very severe acne scarring. This will give outstanding results but the face remains red for at least 6 months and the patient would require 2 weeks off work.

Management:

Acne rosacea is a common chronic incurable skin condition of fair-skinned people (Irish, English, Scottish, Welsh) and some West –Indians. It usually presents

Topical preparations:

Systemic Lupus erythematosus or discoid lupus erythematosus

Differential Diagnosis:

Peri-oral dermatitis

What is Acne Rosacea?

Drugs:

This is a vascular laser and very effective in rosacea. The main side effect is bruising but this is not always a problem. We do a patch test at the side of the face before starting the laser treatment which will give a very good indication if bruising will occur or not . Treatment course are 6 treatments done 2 weeks apart.

CO2 laser. This is an aggressive form of laser resurfacing for the more severe acne scarring. It can trigger acne so patients would be asked to use antibiotics for 3 months after treatment. Patients need to be off roaccutane for 6-12 months prior to treatment with CO2 laser.

ACNE ROSACEA

C 20 %( redness), vitamin B5 gel (anti-inflammatory), moisturiser and sunscreen. This process takes under one minute in the mornings and will protect the rosacea patient from environmental pollution and UV.

Sarcoidosis

The management of acne rosacea is multi-factorial and for optima results a combination of proper skincare, antibiotics, and treatment of the redness with either laser (pulsed dye laser) or IPL (intense pulsed light) is required. Skin care: We recommend daily washing with aqueous cream (apply it to face and then wash it off), cetpahil or simple. These products don’t irritate the skin. After that we recommend daily application of topical vitamin

Conclusion: Acne can have a huge psychological impact on sufferers, who are likely to be embarrassed when seeking help, which is something the pharmacist should always be aware of. But they should always reassure patients that acne is very treatable, and if therapies are used correctly then the symptoms can usually be eased.


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CPD 92: SCHIZOPHRENIA Biography - Eamonn Brady MPSI is the owner of Whelehans Pharmacy in Mullingar. He graduated from the Robert Gordon University in Aberdeen in 2000 with a Masters in Pharmacy. He worked for Boots in the UK before moving back to Ireland in 2002. He bought Whelehans Pharmacy in Mullingar in 2005. Since then, Eamonn and his team have extended the range of services offered by Whelehans.

Welcome to the Continuing Professional Development Module. CPD is a mandatory professional requirement for pharmacists. Journal based education programmes are an important way of keeping up to date with personal clinical and professional development. This module can be used in your personal learning log and can be completed in the magazine or online by completing the reflection questions at the end of the module. You can also track the progress of your development by going to www.pharmacynewsireland.com/cpdtraining where you can register to record your learning.

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? Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available? 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. Evaluation - How will you put your learning into practice? Have I identified further learning needs?

60 second summary Symptoms Symptoms include hallucinations, delusions, disordered thoughts, and problems with mood, behaviour and motivation.

Schizophrenia INTRODUCTION Schizophrenia is a serious mental illness associated with symptoms which include hallucinations, delusions, disordered thoughts, and problems with mood, behaviour and motivation. It can cause a person to lose touch with reality and thus become unable to tell what is real and what is not. The cause is not clear. In many people symptoms recur or persist long-term, but some people have just one episode of symptoms that lasts a few weeks. Like other mental illnesses, there is a general misunderstanding of schizophrenia amongst the general public. For example, there is a general misconception that schizophrenia sufferers have a split or “Jekyll and Hyde” type personality which is not true. There is also a misconception that schizophrenia sufferers have a tendency to be violent; the truth is that the vast majority of schizophrenia sufferers are not violent. When does it generally occur?

Occurs in about 1 in 100 people; this rate is the same for all ethnic groups and occurs equally in men and women. It most often first develops between the ages of 15 to 25 in men and 25 to 35 in women..

Schizophrenia occurs in about 1 in 100 people; this rate is the same for all ethnic groups.1 It occurs equally in men and women.1 It most often first develops between the ages of 15 to 25 in men and 25 to 35 in women. First diagnosis of schizophrenia is rare after the age of 45.2 It normally continues throughout life however symptoms can be kept to a minimum with proper treatment. 3 If a person develops schizophrenia in their teens, early diagnosis can be difficult. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability, all of which are behaviours that are common among teenagers. A combination of factors and behavioural changes can help doctors predict schizophrenia in up to 80% of youths who are at high risk of developing the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions and a family history of psychosis.4 Psychosis is a serious mental condition that is caused by a disturbance in brain functioning. A person with psychosis experiences a loss of contact with reality, characterised by changes in their thoughts, beliefs, perceptions and/or behaviour.

Treatment

Initial signs

Antipsychotic drugs are the mainstay of treatment and are broadly divided into two categories; older typical or newer atypical antipsychotics.

The onset of schizophrenia can be abrupt. However most people undergo a “prodromal phase” characterised by a slow and gradual development of symptoms, including social withdrawal, loss of interest in school or work, deterioration in hygiene, becoming

Positive and negative symptoms Symptoms are classed as either positive or negative. Positive symptoms are abnormal mental functions while negative symptoms are a loss of normal mental functions. Negative symptoms include loss of motivation, loss of a sense of pleasure, slow movements, lack of facial expression, low mood, neglecting appearance and looking unkempt. Positive symptoms are psychotic behaviours causing loss of touch with reality and include delusion, hallucinations, disordered thoughts and movement disorders Incidence and prevalence

uncharacteristically unkempt, unusual behaviour, or outbursts of anger. Family members may assume that the person is just “going through a phase”, especially in the case of adolescents who are notorious for going through difficult phases. Often it is only after the appearance of classic symptoms associated with schizophrenia (e.g., psychosis such as delusions and hallucinations) that diagnosis can be made.1 Symptoms The symptoms are classed as either positive or negative. Positive symptoms are abnormal mental functions while negative symptoms are best described as loss of normal mental functions. Positive and negative symptoms vary in intensity over time; people with schizophrenia display predominantly one type at any particular time. Negative symptoms Negative symptoms include loss of motivation (including loss of interest in social activities, mixing with people, loss of concentration and inability to complete activities you previously had no problem completing), loss of a sense of pleasure, slow movements, lack of facial expression and low or flat mood. The person may neglect their appearance and look unkempt. The negative symptoms of schizophrenia are very similar to the symptoms of depression and can be misdiagnosed as depression; the biochemical reactions in the brain that cause negative symptoms are similar to those that cause depression. Positive symptoms Positive symptoms are psychotic behaviours not seen in healthy people; they cause people to lose touch with reality. The symptoms come and go so at times they can be severe and at other times they can be hardly noticeable. Delusions These are false beliefs that are not part of the person’s culture and most people of the same culture would agree are not true. For example the person may believe that aliens are coming to get them, that television is directing special messages to them or that people are plotting to kill them; the delusions can be anything, there is no set trend for the types of delusions a person may experience. Hallucinations This can include hearing, seeing, feeling,


CPD 92: SCHIZOPHRENIA

smelling, or tasting things that are not real. Hearing voices tends to be the most common type of hallucination. Some people with schizophrenia appear to talk to themselves as they respond to the voices. People with schizophrenia believe that the hallucinations are real. Disordered thoughts Thoughts become jumbled or blocked. Thought and speech may not follow a normal logical pattern. The person may make up meaningless words or “neologisms”. Types of thought disorder with schizophrenia include thought echo (person hears their thoughts as if they were being spoken aloud), knight's-move thinking (person moves from one train of thought to another that has no apparent connection to the first) and disorders of thought possession. Disorders of thought possession include thought insertion (when someone believes that their thoughts are being put there by someone else), thought withdrawal (when someone believes that their thoughts are being removed from their mind by someone or something else), thought broadcasting (when someone believes that their thoughts are being read or heard by others) and thought blocking (when there is a sudden interruption of their train of thought meaning the person stops talking mid-sentence, the person often cannot recall what he or she has been saying). Movement disorders Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today due to the availability of modern antipsychotic medication to prevent it.5 Causes While the exact cause of schizophrenia is not known there is evidence that the balance of some brain chemicals (neurotransmitters) is altered which means that the messages from the brain do not pass correctly. The neurotransmitter dopamine appears to play an important role. Most antipsychotics decrease the neurotransmission of dopamine.6 There is a genetic influence meaning that it does tend to run in families; 70% of the risk of schizophrenia is thought to be hereditary.7 For example, a close family member (child, brother, sister, parent) of someone with schizophrenia has a 10% chance of also developing the condition. This is 10 times the normal chance. A child born to a mother and father who both have schizophrenia has a 1 in 2 chance of developing it too. However certain triggers appear to be needed to trigger the condition in people who are genetically prone to it. There are various theories as to what these might be and they are thought to account for 30% of the risk of developing schizophrenia8,9 (the other 70% of risk is hereditary). These include: • Stress such as relationship problems, financial problems, separation from family when a child, social isolation, bereavement • A viral infection during the mother's pregnancy, or in early childhood.

• Childhood brain injury (eg) a lack of oxygen at birth may damage part of the brain • Illegal or street drugs may trigger the condition in some people. Those who use cannabis heavily are six times more likely to develop schizophrenia than nonusers.10,11 Many other drugs of abuse such as amphetamines, cocaine, ketamine, and lysergic acid diethylamide (LSD) can trigger a schizophrenia-like illness. Other conditions that can be confused with schizophrenia Substance abuse can cause symptoms that are similar to schizophrenia. Substance abuse including the abuse of multiple substances (e.g., hallucinogens, narcotics, alcohol) and the withdrawal from these substances can cause delusions and hallucinations. Therefore diagnosis of schizophrenia should not be made while a person is still taking drugs. Bipolar disorder and depression can also cause psychotic type symptoms which can lead to misdiagnosis of schizophrenia. On the flip side, schizophrenia can be misdiagnosed as bipolar disorder or depression (especially when negative symptoms predominate). Delirium can have features that are similar to the positive symptoms of schizophrenia (e.g., hallucinations, delusions). Delirium is a confused state that is brought on by medical illness. The main feature that distinguishes schizophrenia from delirium is the timing. Symptoms of schizophrenia generally develop over weeks or months, whereas delirium usually develops quite rapidly and is mostly associated with medical illnesses. Delirium tends to be a lot shorter lasting than schizophrenia. The diagnosis of new-onset schizophrenia should be made cautiously while a patient has an existing serious medical illness. Some illnesses can cause symptoms similar to schizophrenia. These include hypoglycaemia, hepatic encephalopathy, electrolyte abnormalities (e.g., hyponatraemia, hypercalcaemia, hypocalcaemia, hypomagnesaemia), and sepsis. The symptoms resolve once the condition is controlled. Delirium explains the psychotic symptoms in some of these conditions. Some prescription medication can cause schizophrenia like symptoms. These medications generally only cause these symptoms when the levels in their blood go too high. Examples of drugs that can cause schizophrenia like symptoms include anticholinergics, benzodiazepines, digoxin, phenytoin, steroids and opioid analgesics. These drugs are safe in the majority of patients when prescribed appropriately and psychotic type symptoms only occur in exceptional situations; for example, when they interact with other drugs or if the patient has a medical illness which causes the effect of the medication to be exaggerated. Treatment In many cases, people living schizophrenia do not realise they have a mental illness. They may not think they need help because they believe their delusions or hallucinations are real. Therefore it is often up to family and friends to seek treatment. Occasionally people with schizophrenia pose an immediate

risk to themselves or others during an acute episode and may need rapid tranquillisation. Tranquillisation with benzodiazepines should only be a temporary measure. The causes of schizophrenia are still unknown; therefore treatment focuses on eliminating the symptoms of the disease. Antipsychotics are mainly used to treat schizophrenia. They work by altering the balance of some neurotransmitters in the brain thus controlling symptoms. Positive symptoms respond well to antipsychotic drugs however they do not work as well on negative symptoms. Therefore, antipsychotic medication is usually taken on a long-term basis thus preventing relapses. Antipsychotic drugs are broadly divided into two categories; typical or atypical antipsychotics. Older typical antipsychotics These are sometimes called first generation antipsychotics and were the first type of antipsychotics developed in the 1950s for psychosis, especially schizophrenia. Examples include chlorpromazine (Largactil®), trifluoperazine (Stelazine®), haloperidol (Serenace®), flupentixol (Depixol® Injection, Fluanxol® tablets), zuclopenthixol (Clopixol® Injection), and sulpiride (Dolmatil®). 30% of patients have a relapse during treatment with first-generation antipsychotic drugs compared with 80% without treatment.12,13,14 Newer atypical antipsychotics These were first introduced in the 1990’s and are also known as second generation antipsychotics. Examples are amisulpride (Solian®), aripiprazole (Abilify®), clozapine (Clozaril®), olanzapine (Zyprexa®), quetiapine (Seroquel®) and risperidone (Risperdal®). Atypical antipsychotics are often used first-line for newly diagnosed schizophrenia. This is because they demonstrate good balance between chance of success and the risk of side-effects. However, for people already stabilised on typical antipsychotic there is no need to change to a newer one. Depot injections of an antipsychotic drug In some cases, an injection of a long-acting antipsychotic drug is used once symptoms have eased. The drug from a depot injection is slowly released into the body and is given every 2 to 4 weeks. This aims to prevent relapses. The main advantage is that it prevents the problem of non-compliance. Non-compliance can be a problem with schizophrenia as the patient often does not realise they have a problem. An American study showed that 74% of patients with schizophrenia discontinued medication within 18 months without consulting with their doctor leading to relapses.15 Non-compliance is similar for atypical and typical antipsychotics; therefore, depot injections can be a solution where compliance is a problem.16,17 There are five FGA depot injections and two SGAs (risperidone (Risperdal Consta®) and paliperidone (Xeplion®) available in Ireland as a long-acting injection (LAI). Second-generation long-acting antipsychotic injections Risperidone injection Risperidone was the first second generation LAI to be licensed in the UK and Ireland.


CPD 92: SCHIZOPHRENIA

The risperidone LAI antipsychotic works in a separate way to the first-generation depot injections. The drug will not reach a therapeutic level for a few weeks after injection; therefore, it is essential that the patient receive alternative antipsychotic medication during the initial period of treatment following the first injection. Paliperidone injection Xeplion® injections contain the active ingredient paliperidone. Paliperidone blocks serotonin 5-HT2 and dopamine D2 receptors. Dopamine and serotonin are neurotransmitters known to be involved in regulating mood and behaviour, amongst other things. Paliperidone is effective in relieving both positive and negative symptoms of schizophrenia, whereas older antipsychotics are usually less effective against the negative symptoms. Paliperidone also relieves 'affective symptoms' that are associated with schizophrenia, such as depression, guilt feelings or anxiety. Xeplion® injection is administered into the muscle of the upper arm or buttock, where it forms a reservoir of medicine that is slowly released into the bloodstream. The injection is given once every four weeks. Patient suitability Paliperidone LAI has not been shown to be any more efficacious than risperidone long acting injection but does have some practical advantages including the fact it does not have to be stored in the fridge, it is only administered once monthly and comes as a pre-filled syringe meaning administration is easier and quicker. There are no data on efficacy in prevention of relapse relative to other long acting injections. Choice of Drug There are some differences between the various antipsychotic drugs. No one drug can be considered significantly better than the others, however one may be better for one individual than another. For example, some are more sedating than others so may be suitable for patients who are agitated or cannot sleep. If one does not work so well, a different one is tried until a good response occurs. A good response to antipsychotic medication occurs in about 70% of cases. Symptoms such as agitation and hallucinations generally ease within a few days of starting medication. Symptoms like delusions usually subside within a few weeks and it can take several weeks for full improvement. Antipsychotic medication is normally continued long-term once symptoms improve. Long term treatment aims to prevent relapses, or at least limit the number and severity of relapses. There is some evidence that the newer atypical antipsychotics have lower relapse rates than older typical antipsychotics.18,19 Newer atypical antipsychotics have been shown in studies to be more effective at improving cognitive function (including attention, memory and speech) than older typical antipsychotics.20 Newer atypical antipsychotics also appear to be more effective than older typical antipsychotics for negative symptoms of schizophrenia. Clozapine should be tried for patients who have not responded adequately to treatment despite the use of adequate doses of at least two different antipsychotic drugs.21 At least one of the drugs should be an atypical antipsychotic before trying clozapine.21 Clozapine (Clozaril®) is very effective for psychotic symptoms

including hallucinations and breaks from reality. Clozapine can sometimes cause a serious condition called agranulocytosis, a loss of the white blood cells which reduces the ability to fight infection. People who take clozapine must get their white blood cell counts checked weekly for the first 18 weeks and every two weeks after that for the first year and every four weeks thereafter, including the first four weeks after the drug is discontinued. Other atypical antipsychotics do not cause agranulocytosis. While all antipsychotics lower the threshold for seizures (making an epileptic fit more possible), this effect is more pronounced with clozapine.22 The risk of agranulocytosis and the cost of blood tests is the main reason that clozapine is generally reserved for when other medication fails which is estimated to be 30% of cases.23 For patients who have only one episode of schizophrenia and who remain symptom free for two years with treatment, the medication may then be discontinued slowly; the patient should be closely monitored for relapse when medication is being discontinued. Side-effects of antipsychotic drugs Side effects can occur and there is a trade off between easing symptoms and side effects from treatment. Different antipsychotic drugs cause different types of side effects. Sometimes one drug causes side effects in some people and not in others. Quite often, two or more different drugs have to be tried before one is found that is best suited. Anticholinergic side effects are more common with the older typical anti-psychotics and include dry mouth, blurred vision, flushing and constipation. These tend to be worse at the start of treatment and may ease off as the patient gets used to the drug. Chlorpromazine has a tendency to cause skin photosensitivity when exposed to sunlight. Sunscreen must be used if going out in strong sun while taking chlorpromazine. Drowsiness is also common but may be reduced by reducing the dose. Extrapyramidal side effects (movement disorders) can occur with typical antipsychotics. These include: • Parkinson type symptoms, for example, tremor and muscle stiffness. • Akathisia, which is like a restlessness of the legs (a major cause of non-compliance) • Dystonia, which is abnormal movements of the face and body. • Tardive dyskinesia, which is a movement disorder that can occur with longer term treatment with antipsychotics. It causes rhythm like, involuntary movements. Tardive dyskinesia most commonly affects the mouth and can include lip-smacking, grimacing and tongue-rotating movements, although it can affect the arms and legs too. About 30% of people treated with typical antipsychotics long term eventually develop tardive dyskinesia.24 Nowadays people are closely monitored for symptoms of tardive dyskinesia and the drug is changed once the symptoms start to develop. If movement disorders are a problem, then other drugs may be used to try to counteract them. These include anti-cholinergic drugs such as biperiden (Akineton®). Tardive dyskinesia will

not respond to treatment with anti-cholinergic drugs but usually resolves slowly after discontinuation of the typical antipsychotic. However it is irreversible in some cases. Propranolol (20 to 80 mg daily) can be used to control akathisia.25 Atypical antipsychotic drugs are less likely to cause movement disorder side-effects than typical antipsychotic drugs. This reduced incidence of movement disorders is the main reason why an atypical antipsychotic drug frequently is the first choice for treatment. Atypical antipsychotics do have their own risks, particularly the risk of weight gain. Weight gain can occur and this may increase the risk of developing diabetes26 and heart problems (due to raised cholesterol)27 in the longer term thus blood sugars and cholesterol levels should be monitored regularly. Weight gain appears to be a particular problem with clozapine and olanzapine. For example, trials show that olanzapine can cause weight gain of 5.4kg within 5 weeks of treatment and weight gain of 20kg or more after longer term treatment.28 Ziprasidone (Geodon®) and amisulpride (Solian®) tend to cause less weight gain than other atypical antipsychotics.29 Atypical antipsychotic drugs can sometimes cause the tendency to cause obsessive compulsive symptoms.30 Antidepressants Antidepressants may be used in some cases, especially for patients primarily showing negative symptoms. Research suggest that taking an antidepressant drug in addition to an antipsychotic drug may be better than an antipsychotic drug alone in treating negative symptoms of schizophrenia. An antidepressant drug may also be useful to treat depression which is common in people with schizophrenia. Patients who display manic episodes including excitement and agitation may benefit from mood stabilisers such as lithium carbonate or sodium valproate.31 Family education People with schizophrenia are often discharged from the hospital into the care of their families. It is important that family members know as much as possible about the disease. With the help of a therapist, family members can learn coping strategies and problem solving skills. In this way the family can help make sure their family member continues with treatment and continues to take prescribed medication. Psychological treatments Cognitive behavioural therapy (CBT) Psychological treatments include a variety of talking treatments, in particular a treatment called cognitive behavioural therapy (CBT). CBT is used as a treatment for various mental health and physical problems and is being increasingly used as a treatment for schizophrenia. CBT aims to help the person change the way that they think, feel and behave. CBT is actually a wide term which includes various types of therapy. The patient may be asked to keep a diary of important events in their life and the way they feel about them. The therapist may challenge beliefs and ask the patient to explain them. The patient may be asked to try out new ways of behaving and reacting.


CPD 92: SCHIZOPHRENIA

CBT and other talking treatments are not alternatives to drug treatment. They are often used in conjunction with medication. The National Institute of Clinical Excellence (NICE) in the UK recommends up to 16 CBT sessions. This is because studies have found that, on average, CBT reduces the chance of being admitted or readmitted to hospital, can reduce symptom severity and can improve social functioning. In summary, CBT has two phases or goals. The first is to raise your awareness of the condition and what behaviours, thoughts and emotions are leading to your mental health difficulties. The second is to use this knowledge to tackle the problem and to behave in a different way so as to relieve the underlying problems such as schizophrenia, anxiety or depression. Schizophrenia and heart disease and smoking Nicotine addiction is more common in people with schizophrenia. They are addicted to nicotine at three times the rate of the general population (75 to 90% versus 25 to 30%).32 The full reason for higher smoking rates among people with schizophrenia is not fully understood; it is thought to be partly due to the positive effects of nicotine on the cognitive function of people with schizophrenia including attention, memory and speech.33,34,35 The rate of smoking in people with schizophrenia is

Medication

also higher than for those living with other mental health illnesses including depression and bi-polar disorder.33,34 The risk of death from heart disease is two to three times higher than the general population.36 The reason for this is mainly attributed to the higher rate of smoking among people with schizophrenia. What is the outlook (prognosis)? • In most cases there are recurring episodes of symptoms (relapses). Most people live relatively independently with varying amounts of support. The frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never quite fully recover. Treatment often prevents relapses, or limits their number and severity. • In some case (approximately 2 in 10 cases), there is only one episode of symptoms that only lasts a few weeks. This is followed by a complete recovery without any further relapses. • In up about 20% of people with schizophrenia, medication is not very effective at controlling symptoms and they need long-term dependent care. For some, this is in secure accommodation. • Depression is a common complication of schizophrenia.

First-generation antipsychotic agents Chlorpromazine (Clonactil) Trifluoperazine (Stelazine) Haloperidol (Serenace) Second-generation antipsychotic agents Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Amisulpride (Solian)

Intramuscular Dose

• It is thought that up to a third of people with schizophrenia abuse alcohol and/or illegal drugs. This can make treatment more challenging. • About 1 in 10 people with schizophrenia commit suicide.37,38 The outlook is thought to be better if: • Treatment is started soon after symptoms begin. • Symptoms develop quickly over several weeks rather than slowly over several months • The main symptoms are positive symptoms rather than negative symptoms. • The condition develops in a relatively older person (aged over 25). • Medication is taken as advised. • There is good family and social support which reduces anxiety and stress. • Abuse of illegal drugs or alcohol does not occur. Newer drugs and better psychological treatments mean that prognosis is now better than it was in the past. Written and researched by Eamonn Brady (MPSI), Whelehans Pharmacies, Pearse St and Clonmore, Mullingar. 04493 34591. REFERENCES AVAILABLE ON REQUEST

Dose for Schizophrenia Daily Oral Dose mg 150–1000 5–60 2–25 100–900 2–10 5–20 75–750 40–160 15–30 400–1200

Dose for Schizophrenia

Depot preparations Fluphenazine decanoate (Modecate decanoate injection) Haloperidol decanoate (Haldol decanoate injection) Flupentixol decanoate (Depixol depot injection) Risperidone microspheres (Risperdal Consta) Paliperidone palmitate (Xeplion PR Injection)

Every 2 to 4 weeks mg 12.5–50 50–200 20–100 25–50 25–150 (monthly)


Nurofen for Children Strawberry 100mg/5ml Oral Suspension. Contains ibuprofen. Suitable from 3 months and weighing over 5kgs. Always read the label. Date of preparation: Jan 2018. IRL/NfC/0117/0002a(1)

Abbreviated Prescribing Information for Nurofen for Children Orange 100mg/5ml Oral Suspension Nurofen for Children Strawberry 100mg/5ml Oral Suspension Please refer to Summary of Product Characteristics for full information. Active ingredient: Ibuprofen 100 mg/5 ml (equivalent to 2.0% w/v). Pharmaceutical Form: An off-white orange flavoured syrupy oral suspension or an off white strawberry flavoured syrupy oral suspension. Indications: Reduction of fever and relief of mild to moderate pain, such as cold and flu symptoms, teething pain, headache, sprains and strains and to ease the pain of sore throats and earache. Dosage and Administration: For short term use only. The maximum daily dosage is 30mg of ibuprofen/kg bodyweight administered in divided doses, achieved as follows: 3-6 months (weighing 5kg-7.6kg) is 2.5ml, 3 times a day. 6-12 months (weighing 7-7.9kg) is 2.5ml, 3 times a day. 1 to 3 years (10-16kg) is 5ml, 3 times a day. 4 to 6 years (17-20kg) is 7.5ml, 3 times a day. 7 to 9 years (21-30kg) is 10ml (two 5ml spoonfuls) 3 times a day. 10 to 12 years (31-40 kg) is 15ml (three 5ml spoonfuls) 3 times a day. This product should only be given to infants aged 3-6 months who weigh more than 5kg. For infants aged 3-5 months medical advice should be sought if symptoms worsen, or not later than 24 hours if symptoms persist. If in children aged from 6 months and in adolescents this medicinal product is required for more than 3 days, or if symptoms worsen, a doctor should be consulted. Do not dose more frequently than at 6 hourly intervals. The recommended dose should not be exceeded. Not suitable for children under 3 months of age unless advised by a doctor. For oral administration. For patients with sensitive stomachs, the product can be taken during a meal. Contraindications: severe hepatic failure, severe renal failure or severe heart failure. History of GI bleeding or perforation related to previous NSAID therapy. History of, or existing peptic ulceration, or other gastrointestinal disorders. Known hypersensitivity to ibuprofen or any of the ingredients. History of bronchospasm, asthma, rhinitis, angioedema or urticaria associated with aspirin or other non-steroidal anti-inflammatory drugs. During the last trimester of pregnancy. Warnings and Precautions: Undesirable effects may be minimised by using the minimum effective dose for the shortest duration necessary to control symptoms. Concomitant use of NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided. The elderly have increased frequency of adverse reactions to NSAIDs especially GI bleeding and perforation which may be fatal. GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at any time during treatment, with or without any warning symptoms or a previous history of serious GI events. The risk is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation and in the elderly. Combination therapy with protective agents should be considered for these patients and also for patients requiring low dose aspirin or other drugs likely to increase GI risk. Caution should be advised in patients receiving concomitant medications such as oral corticosteroids, anticoagulants, selective serotonin reuptake inhibitors or anti-platelet agents. Treatment should be withdrawn if GI bleeding or ulceration occurs. Caution is required in patients with a history of GI diseases, cardiac impairment or a history of hypertension and/or heart failure (see SPC). Use of ibuprofen may be associated with a small increased risk of arterial thrombotic events. Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. < 1200mg daily) is associated with an increased risk of myocardial infarction. Caution is required in patients with renal or hepatic impairment. Caution is required in patients with idiopathic thrombocytopenic purpura (ITP), intracranial haemorrhage and bleeding diathesis. Patients with rare hereditary problems of fructose intolerance should not take this medicine. Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs. Treatment should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. It is advisable to avoid use in the case of varicella as NSAIDs can worsen serious cutaneous and soft tissue infectious complications. May impair female fertility by an effect on ovulation, however this is reversible on withdrawal of treatment. Bronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergic disease. Caution is advised in patients with systemic lupus erythematosus and connective tissue disease. This medicinal product contains 1.2mmol of sodium per dose. To be taken into consideration by patients on s controlled sodium diet. There is a risk of renal impairment in dehydrated children and adolescents. Interactions with other medicinal products: Please see SPC for full details. Ibuprofen should be avoided in combination with Aspirin and other NSAIDs. Considered unsafe to take NSAIDs in combination with warfarin or heparin unless under direct medical supervision. Care should be taken in combination with anti-hypertensives, Corticosteroids, Anti-coagulants, Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs), Cardiac glycosides, Lithium Methotrexate, Cyclosporin, Tacrolimus, Aminoglycosides, Probenecid, Oral hypoglycaemic agents, Mifepristone, Zidovudine and Quinolone antibiotics. Fertility, pregnancy and lactation: Not recommended in the first 6 months of pregnancy. Do not use in the last trimester of pregnancy. It is not necessary to interrupt breast-feeding for short-term treatment with the recommended dose for mild to moderate pain and fever. May impair female fertility by an effect on ovulation, however this is reversible on withdrawal of treatment. Ability to Drive and Operate Machinery: No adverse effects known. Side Effects: The list of the following adverse effects relates to those experienced with the product at OTC doses (max 1200mg per day), for short-term use. In the treatment of chronic conditions, under long-term treatment, additional adverse effects may occur. Gastrointestinal Disorders: Uncommon: Abdominal pain, dyspepsia and nausea. Rare: diarrhoea, flatulence, constipation and vomiting. Very rare: Peptic ulcer, GI perforation or haemorrhage, melaena, haematemesis, exacerbation of colitis and Crohnâ&#x20AC;&#x2122;s disease. Mouth ulcers and gastritis. Nervous System Disorders: Uncommon: Headache. Very rare: Aseptic meningitis. Renal and Urinary Disorders: Very rare: Acute kidney failure. Liver Disorders: Very rare: Liver disorders, especially in long-term treatment, cholestatic jaundice, hepatitis, elevation of serum enzymes. Blood and Lymphatic System Disorders: Very rare: Haematopoietic disorders. Skin and Subcutaneous Disorders: Uncommon: Skin rash. Very rare: Severe forms of skin reactions such as erythema multiforme, epidermal necrolysis and Stevens-Johnson syndrome. Immune system Disorders: Uncommon: Hypersensitivity reactions with urticarial and pruritus. Very rare: Severe hypersensitivity reactions including facial, tongue and throat swelling, dyspnoea, tachycardia and hypotension. Cardiac Disorders: Very rare: cardiac failure and oedema. Vascular Disorders: Very rare: Hypertension. Respiratory, Thoracic and Mediastinal disorders: Very rare: Asthma, aggravated asthma, bronchospasm or dyspnoea. Investigations: Very rare: Haemoglobin decrease, urea renal clearance decrease. Infections and infestations: Very rare: Exacerbation of infections related inflammation, severe skin infections. Soft tissue complications may occur during a varicella infection. See SPC for more detail. Name and address of Marketing Authorisation Holder: Reckitt Benckiser Ireland Ltd., 7 Riverwalk, Citywest Business Campus, Dublin 24. PA numbers: PA 979/32/1, 979/32/9. For full prescribing information, please consult the SPC which is available on www.medicines.ie. For product queries, please call (01) 630 5429 or contact the MAH above. Legal Category: Supply through Pharmacy only. Date of preparation: December 2016.


News Innovative pharmacy mole scanning service news brief raises awareness of skin cancer threat DITCHLEY BUYS RIVAL HEALTHCARE BUSINESS

To raise awareness of melanoma in Ireland and to encourage a life-long habit among Irish people of regularly checking their moles, Boots Ireland are now offering, in conjunction with ScreenCancer UK, an innovative mole scanning service in 10 Boots Ireland pharmacies nationally. Dermatology Specialists analyse the moles or lesions to help identify any suspicious characteristics that might need further investigation.

Healthcare business the Ditchley Group has bought rival company Talacare for almost ¤10m. Talacare is the developer and operator of a primary care centre in Tallaght in Dublin that also provides academic facilities for trainee medical professionals. The 75,000 sq ft centre houses local GP practices, HSE local services, out-of-hours services and a community pharmacy. An academic centre has also been established to accommodate Trinity College Dublin's Institute of Population Health. It also delivers undergraduate and postgraduate teaching, including GP training. It's the sixth investment by Ditchley, which owns five nursing homes in counties Kerry, Galway, Cork and Kilkenny. The deal brings the value of Ditchley's portfolio to more than ¤40m. "The state-of-the-art centre greatly enhances health and patient care for the people of Tallaght and the surrounding area with its wide range of healthcare services," said Ditchley CEO John Minihan. "This centre successfully demonstrates how privatelyfunded investment can significantly expand and enhance health and patient care in Ireland. "We look forward to working with the HSE, local GPs and Trinity College to deliver worldclass healthcare and academic research services." Ditchley employs 325 staff and is looking to expand further. Formerly know as iNua Health, its executive chairman is Noel Creedon, who runs the iNua hospitality arm. The private healthcare sector has been a hotbed of investment activity in recent times.

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Boots pharmacist Susan O'Dwyer Developed in conjunction with ScreenCancer, the Boots Mole Scanning Service allows people aged 18 and over to have their moles or pigmented lesions scanned using a specialist device called a SIAscope. The scan is then assessed by a dermatology specialist, and each person will receive a report based on the specialist assessment. Should a suspicious lesion be identified, the individual will be referred to their doctor or specialist for follow-on treatment. While the service doesn’t provide a diagnosis of skin cancer, ScreenCancer

Incidences of melanoma in Ireland are at a record high, with over 10,000 cases of skin cancer diagnosed annually. However, if spotted early, up to 90% of cases are curable. Information from the National Cancer Registry Ireland shows that diagnoses of melanoma have more than trebled in Ireland in the last twenty years. Boots Pharmacist, Susan O’Dwyer, says: “Providing a mole scanning service through pharmacies helps people to quickly check any moles that might be causing concern. I would encourage anyone who is worried about a mole to pop into a participating Boots pharmacy, especially if the mole has changed size, shape or colour recently. Our teams can advise you on the best way to stay safe in the sun, provide you with information on how to self-check your moles and scan suspicious lesions if required” As part of the service, people will also be provided with guidance on assessing their own moles

using the ABCDE guide, and given further advice on staying safe in the sun. The ABCDE guide advises people to monitor moles for: A – Asymmetry: Irregular shape, the two halves should be symmetrical B – Borders: Unclear, irregular or ragged boundaries against normal skin C – Colour: Changes in colour, especially black, blue or uneven colours D – Diameter: More than 5-6mm in diameter and changes in size E – Evolving: Changes in shape, size and colour, itching or bleeding of existing moles, or a new mole The Mole Scanning service has been available via Boots pharmacies internationally since 2010, with 99% of respondents scoring their overall satisfaction as “good or higher” and 95% saying they would recommend the service to others.

HPRA listed by FDA as part of EU/US mutual agreement The US FDA has concluded its capability assessment of the HPRA and confirms that it has the capability, capacity and procedures to carry out GMP inspections at an equivalent level. Consequently, Ireland has been included on the list of recognised member states as of 1 June 2018. This follows the EU and US authorities signing a mutual recognition agreement (MRA) that entered into force on 1 November 2017 with a transition phase for recognition of EU Member States until July 2019. The MRA contains a sectoral annex on the mutual recognition of pharmaceutical good manufacturing practice (GMP). The MRA comes as a result of assessments of both the EU national competent authorities’ (NCAs) and US FDA’s inspection systems. In June 2017, the European Commission confirmed that the US FDA has the capability, capacity and procedures in place to carry out GMP inspections at a level equivalent to the EU.

An audit of the HPRA’s GMP inspection system, under the joint audit programme (JAP), took place from 15 to 19 May 2017 and was observed by FDA investigators.

As a direct result of Ireland being included on the list, the US FDA can now rely on HPRA inspections to replace their own inspections. This should result in the following:

The initial scope of the MRA includes:

• Reduced number of FDA inspections of manufacturers located in Ireland;

• Human medicines, which incorporates intermediates and in-process materials, biologicals, including immunologicals and biotherapeutic products, and active pharmaceutical ingredients (APIs). • Biological medicines, including vaccines, advanced therapy medicinal products and plasma derived medicines, are excluded at this time but may be added in the future. What does this mean for pharmaceutical manufacturers located in Ireland and the US?

• Reduced number of HPRA inspections of US manufacturers; • Improved efficiency of assessments involving contract manufacturing sites based in the US; • Increased inspection resources available to inspect in other parts of the world where active pharmaceutical ingredients and medicines for the EU or US markets are manufactured.


News Groundbreaking study shows benefits for news brief infants when mothers eat healthy fats NEW COUNCIL MEMBERS TO JOIN PHARMACY REGULATOR

A new study from the Science Foundation Ireland Research Centre APC Microbiome Ireland at Teagasc and University College Cork, together with collaborators at Massachusetts General Hospital/Harvard University, has found that mothers who eat healthy fats from oily fish may help their children form healthy guts and maintain healthy weights throughout their lives.

The government has announced four appointments to the Pharmaceutical Society of Ireland’s 21-member council. Health Minister Simon Harris re-appointed two members, solicitor Shane McCarthy and Dr Paul Gorecki, for a four year term. Two new council members were also appointed until May 2022. They are Dorothy Donovan, a barrister with experience in regulatory law and professional negligence cases, and Fiona Walsh, an investment advisor and non-executive director on the boards of four organisations. The PSI Council is the pharmacy regulator’s governing body.

HEALTH INNOVATION HUB IRELAND OFFERS QUID PRO QUO TO START UPS AND THE HSE Government initiative, Health Innovation Hub Ireland has launched a national focused call for products and services that enable positive ageing. This annual focused call centres on meeting a strategic need in Irish healthcare, as recommended by HIHI partner, the HSE. Areas for consideration under the focused theme include but are not limited to: • Dementia Care • Integrated Care • Limiting acute hospital admissions • Promoting healthy living for longer • Minimising polypharmacy • Promoting increased independence at home • Providing care closer to home The HIHI call is open until August 31, during which time companies must submit an application form online. Successful applicants are then invited to pitch to a board with representatives from Enterprise Ireland, Science Foundation Ireland, Health Research Board, HSE and others.

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Dr Ruari Robertson, lead author of the study

The new research, published in Microbiome, shows that, in laboratory mice, babies gained less weight on a high fat diet if they were born to a mother who had more healthy fats called omega-3s in her body. The mice also gained less weight if they breastfed from a mother with more omega-3 fats. Interestingly, this only occurred in male babies; the mother’s fats had no effect on weight in female babies. The modern Western diet is deficient in healthy omega-3 fats, which are found in oily fish, nuts and seeds. Humans can't produce these fats in their body and need to get them from their diet. Instead, the Western diet is overloaded with less healthy omega-6 fats, which are found in vegetable oils and fried foods such as chips and crisps. This imbalance in dietary fats may contribute to obesity, heart disease and other chronic diseases. But prior to this study, little was known about how mothers’ omega-3/ omega-6 ratios affect their children’s health. In this study, the balance of omega-3 and omega-6 fats in the mother’s body was also found to affect the health of her pups’ guts. If a mother had more omega-6 fats in her body during pregnancy or breastfeeding, her pups’ guts were more ‘leaky’, which led to inflammation in their blood. These

babies also had more unhealthy bacteria in their intestines, which may have contributed to their weight gain. However, if these pups were breastfed by a mother with a more healthy ratio of omega-3: omega-6 fats, their guts were healthier and had more healthy bacteria. Interestingly, the effect of mother’s fat on her babies gut health continued throughout their life until they were adults. Commenting on the study, Dr Ruairi Robertson, the lead author, said: “we have shown that a mother’s diet during pregnancy and breastfeeding may affect her babies’ weight and gut health in the long term. Furthermore, we know that your gut bacteria are extremely important for your overall health, particularly to maintain a healthy weight and gut. These results suggest that if a mother eats more healthy fats and less unhealthy fats during pregnancy and breastfeeding, she may be able to help the right types of microbes grow in her baby’s intestines and form a healthy gut for later life”. Prof Jing Kang at Massachusetts General Hospital and Harvard University added "our study, using unique transgenic mouse models, has produced reliable data suggesting two important things: 1) a balanced ratio of omega-6/omega-3 fats in a mother's body during pregnancy and breastfeeding is critical for reducing risk of obesity in her

children over lifetime, and 2) microbes in her baby’s gut is a key player in mediating this effect." Previously there have been concerns over pregnant women eating too much fish due to the potential dangers of mercury. However, this is only a concern for certain types of fish, particularly predatory fish such as shark, swordfish and certain types of tuna. Current recommendations suggest that everyone, including pregnant women, eat 2 portions of oily fish (mackerel, salmon, sardines, trout, herring) per week. “The benefits of omega-3s from oily fish far outweigh the risks of mercury, if kept to 2-3 portions per week” says Prof. Catherine Stanton, Principal Investigator at Teagasc and APC Microbiome Ireland. “However, most important is the balance of fats. Aim to get enough omega-3s from oily fish, nuts and seeds whilst at the same time reducing omega-6 intake from vegetable oils and fried foods”. This research is published in the journal Microbiome and was funded through a Teagasc Walsh Fellowship, and Fulbright Scholarship from the Fulbright Commission of Ireland to Ruairi Robertson and by Science Foundation Ireland through a Centre grant to APC Microbiome Ireland. Prof Kang is supported in part by Fortune Education Foundation and Sansun Life Sciences.


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Awards The Irish Pharmacy

2018

Winners’ Profiles

The Life Pharmacy Student of the Year Award 2018

Future is bright for student award winner Life Pharmacy 'Student Pharmacist of the Year': Meabh Ryan “I have no doubt at all that Meabh will be one of the future leaders of pharmacy in Ireland,” John Walsh, Associate Professor of Pharmacy at Trinity College Dublin, tells Irish Pharmacy News about his star student picking up the Life Pharmacy Student of the Year at the recent Irish Pharmacy Awards 2018. “She is known to be exceptionally hard-working and has achieved outstanding academic results during her time at Trinity College Dublin (TCD), and her passion for pharmacy is matched only by her empathy towards those around her, and with her patients.“It is lavish praise indeed for the inaugural recipient of the Irish Pharmacy Awards' newest gong, however it is also richly deserved, given that in talking to Meabh Ryan it is hard to disagree that she, and several of her graduating class from TCD’s School of Pharmacy and Pharmaceutical Sciences, will represent the future of pharmacy in this country. It has been said that success comes from hard work, being brave and following an ambition. These particular virtues look set to propel the former student of Dublin’s Colaiste Iosagain to great things in the industry. However, as she explains, it could have been a lot different had she not eventually decided to follow her instinct and passion. “To be honest, pharmacy wasn’t even on my CAO, despite always having it in my head that I would like to

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eventually study it. I never really had eyes on doing medicine, I was more interested in science subjects in school. When it got to sixth year my guidance councillor kept on telling me that I would be perfect for a business degree course following my graduation. So instead of listening to my own gut instinct, I decided to take up a place on the Business, Economics and Social Sciences programme at TCD.” However, within a matter of weeks, Meabh knew TCD was the place for her, but studying business and economics certainly was not. “I asked myself, 'what am I doing? this is not for you', and thankfully I was fortunate enough that I had enough CAO points that I was able to transfer over to pharmacy, where I immediately felt more at home, because it was much more structured and the curriculum was something I was far more interested in.” Meabh, who graduated with a first class honours degree in June, and her classmates are in fact the last to graduate from outgoing four-year pharmacy programme at TCD. In 2015, the model of pharmacist education and training changed in Ireland, when the three schools of pharmacy - TCD, University College Cork and the Royal College of Surgeons worked to develop a new five year Integrated Pharmacy Programme (M.Pharm) for delivery in each of the institutions. Now, those students who carry on to successfully complete year four of the programme will be

Meabh Ryan, TCD Pharmacy student and Gerard Coffey, Chairman of Life Pharmacy


jobs hospital pharmacists have on their hands compared to ones in the community. She says this experience showed her how hospital pharmacists are limited in their opportunity to provide individual counselling to each patient on their discharge medicines and medication use.“Beaumont was a brilliant experience. It is something I did by my own initiative rather than it being a defined placement. It was an unpaid placement, so while it was optional, not every student decided to do it over their summer break in second and third year. I really wanted to do it and I'm so glad that I did it. Loughlinstown was obviously a smaller hospital with a small pharmacy.

Student Pharmacist of the Year winner Meabh Ryan

awarded a B.Sc. (Pharm.) and may progress into a postgraduate fifth year which leads to the award of a M.Pharm. The five-year integrated Pharmacy programme comprises of a variety of approaches to teaching pharmacy, including: lectures, seminars, tutorials, workshops, small-group teaching, problem-based learning, sitevisits, computer-assisted learning, web discussion boards, wikis, online group assignments, communication skills, career planning, clinical case studies, inter-professional learning, laboratory and dispensing practicals and a research project. “How we teach pharmacy in Ireland is always changing,” explains John Walsh, “as the profession changes, we change with it, which is an important thing to understand. We are now into the new five-year integrated pharmacy programme, which is in its third year.” So how's the change worked so far? “It's worked out well. Students are getting structured work experience in years two, four and five. Previously, such as for Meabh and her class, students generally went on what we'd describe as their own 'voluntary work experience',

but the placements are now structured. Like anything new it has its challenges, but we're facing those challenges and it's worked so far.” GAINING EXPERIENCE The work experience Meabh undertook during her four years of study proved an enormously beneficial experience, as it has forged an idea in her head about the career path she would most like to take. She looked to use and develop her clinical skills by working in community pharmacies during term-time and completing hospital placements in Beaumont and Loughlinstown over the summer periods. Meabh has worked in a wide variety of pharmaceutical care settings over the past three years, seeking to develop her clinical knowledge and learn more about the relationship between pharmacists and patients. Work experience in three community pharmacies in Dublin, St Stephen’s Green, Dundrum Town Centre and Dun Laoghaire proved eye opening for her, while the five week stint working in Beaumont Hospital pharmacy department really opened her awareness about the different

“I guess every community pharmacy and hospital pharmacy is very different. The difference between Loughlinstown and Beaumont was phenomenal, just in terms of the size of the pharmacy department. Both were equally great and I learnt a lot from both of them. Also, every community pharmacy I've worked in operates differently to each other. I'm happy that I've worked in so many community pharmacies, which I kind of did on purpose because I think it's good to get different views. If you stick with the one type of pharmacy the whole way through the year you only get one view of everything, while if you have experience through a few different types you see things are completely different."Meabh, who plays both basketball and GAA to a high level both inside and outside of college, added that she felt from her experience in hospital pharmacy that they are under resourced, while reiterating that all patients should have the opportunity to speak to their pharmacists, particularly at discharge. "This is to ensure that patients have a continued understanding of their conditions and related treatments.” CLASS REP In her senior sophister year, Meabh was voted as the SS class representative, reflecting the degree of trust her fellow classmates had in her skills. In addition to attending faculty assemblies and her involvement in the student union, she took on

the responsibility of setting up a system where each week she sent an email to the class highlighting the main changes/additions to the weekly timetable. She also included a 'drug of the week' in each weekly email, highlighting the major counselling points of some drugs which she believed to be relevant for future practice. Her aim was to ensure all classmates were constantly involved and informed of various lectures, tutorials and events so as to maximise participation and enjoyment of final year. Meabh has also looked to expand her knowledge of the pharmaceutical world, becoming involved with the Irish Academy of Continuing Medical Education (iaCME). Most recently, she took part in the IIOP’s 'Quality improvement in supply of high risk medicines' workshop, which was run by iaCME. Her thirst for new experiences and challenges has led her to accept a placement in the Health Products Regularity Authority (HPRA) in her preregistration year. “Next year will be full on for me as I will be working full-time in Lloyds Pharmacy in Churchtown, Dublin, and the HPRA (six months at each). While I’m doing this I’m also doing a Masters at the same time. I think it will be pretty full on but I'm looking forward to it. It's pretty much all online based with a lot of group work. Regarding Lloyds, I'll have a tutor who will guide me through the process, making sure I'm keeping up with my Masters work, explaining to me what's involved, I think it will be pretty intense because I will be doing in six months what others will probably be doing in 12 months. I think there will be a bit of time pressure, but I do have plenty of experience in community pharmacy so I think that should stand to me. So, with so much knowledge and experience already under her belt at a tender age, where does Meabh see herself in five years time? “I'm hoping to work in the pharma industry, which is what I'm kind of gunning for at the moment. Working at the HPRA next year, I'm excited, because I think that will give me a good overview of everything, because you will be dealing with various different (pharma) companies.”

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Awards The Irish Pharmacy

2018

Winners’ Profiles

The JPA Brenson Lawlor Young Community Pharmacist of the Year Award 2018

Young community pharmacist award winner has excelled in every way JPA Brenson Lawlor Young Community Pharmacist of the Year: Grace Grimes from the Meaghers Pharmacy Group In late February, when Ireland was hit by severe weather that brought unusually low temperatures and heavy snow, the advice from the government’s national emergency centre was unequivocal: stay indoors. There was a red weather warning for Leinster and Munster as the storm, dubbed the Beast from the East, swept across the country, shutting down busy routes and causing flash-flooding. Meaghers Pharmacy Glenview, in Dublin’s south, was one of the many businesses that had to close its doors as the storm struck. When it reopened, most of the roads around the city were still blanketed deep in snow. Pharmacist Grace Grimes was forced to make her way across town on foot. When she arrived at work, it was chaos. One of Meaghers other pharmacies had been devastated by the storm: the roof of the Castletymon store had collapsed and it would take another week before it could safely reopen to the public. Grimes and her colleagues, aware that they had many vulnerable patients needing scripts urgently filled, spent

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the day ferrying essential medications from Castletymon to Glenview, where they served customers of both pharmacies until the repair works were finished. Staff even used walkie-talkies to communicate with each other between stores, a kind of instant messaging to triage customers and prioritise orders. “I knew it was going to be crazy,” says Grimes, who came into work on her days off. “But I knew a lot of our patients needed their medication and I couldn’t leave my co-workers to deal with everything alone.” This is one of the many examples given by Grimes’ boss, Meaghers retail director Joanne O’Hagan, when nominating the 26-year-old for the 2018 Young Community Pharmacist of the Year award, which she won in May. Grimes has been a pharmacist for less than two years, but already she has made a strong impression on her customers and colleagues alike. The letters from patients and comments from colleagues speak for themself. They describe Grimes as dedicated, compassionate, and always willing to go above and beyond.

Grace Grimes, Meaghers Pharmacy and Jason Bradshaw, partner at JPA Brenson Lawlor


Since joining the team last year, Grimes’ employer says she has “excelled in every way.” Grimes, on the other hand, isn’t one to self-promote. “By nature I am a bit of a pushover,” she says. “I would be quite timid.” Grimes, who says she was very shy in school, got a job in a pub during college in an effort to train herself to be more outgoing. So how does she manage the stress and occasional confrontation that comes with working in a busy dispensary?

Grace Grimes at Meagher's Pharmacy Glenview

After completing her internship at Meaghers’ flagship store on Baggot Street, Grimes was immediately hired as a floating pharmacist for the company. It was short-lived. Two months later, having only just been put on the pharmacist register, she was brought on to work full-time as the support pharmacist at Glenview, the second busiest dispensary in the company’s stable of eight stores. “This was a role that could possibly have been given to someone with more experience but Grace stood out as the right choice,” says O’Hagan, describing her recruit as having an always-positive attitude and a deep commitment to patient care. “Being exceptionally patient focused comes easy to Grace,” says O’Hagan. “She is so natural with customers, easily adapting her communicating style to approach any situation. She approaches her job with an air of calmness and there is no doubt

you can see she completely enjoys what she is doing, always going out of her way to help or support patients.” Glenview is a small pharmacy, nestled in a tight-knit residential community in an expansive housing estate in Tallaght. Grimes, who grew up the youngest of six children in a rural village in Co. Offaly, moved to Dublin to pursue her career. She works every second weekend, but makes sure she goes home to visit her family at least once a month. In her spare time, Grimes volunteers to take part in charity initiatives. In 2016, she raised money for Diabetes Ireland by helping to organize a number of in-store activities, and in 2017, she played a key part in fundraising ¤68,000 for The Peter McVerry Trust, which funded housing for four families. At the end of last year, Grimes took part in a sleep-out outside the Baggot Street pharmacy.

“I’m learning to stand my ground,” she says. “It’s only in the last few months that I’ve made a real conscious effort to improve in this area. Pharmacy can be confrontational and I had to learn to trust myself, my judgement, so that people don’t take advantage of the fact that I’m quite soft and easy going. I’ve also learnt not to take things to heart as much because you never know what’s going on in other people’s lives. Some days this can be hard but I’m learning to get better at that all the time.” Among close friends - and occasionally strangers - Grimes is known for being a listener. The type of person people bring their problems to. But that’s not to understate her inner confidence, a certain steely resolve. On a recent busy Saturday afternoon, a customer came into the pharmacy complaining of a persistent itch. After noticing the woman also had yellowing in her eyes and a visible skin rash, Grimes realised she might be suffering from an adverse reaction to a new medication (Rifanah). She suspected that the woman had increased levels of Bilirubin, which was causing the symptoms, and that her liver could be severely compromised. Grace explained her belief to the woman that she was presenting with symptoms of jaundice and urged her to go to a doctor immediately. But the patient, having seen her GP only the day before and being told to treat the symptoms with a steroid cream,

was reluctant to seek further medical help. Grace knew all the markers pointed towards a liver issue and insisted the woman go to the hospital. The woman finally agreed to go to A+E, where she was admitted and treated for a number of weeks. When the woman was released from hospital she came into the pharmacy to thank Grimes for her advice and life-saving clinical intervention. Luckily, the liver damage was reversible. “The [hospital] consultant told the patient that she was very impressed that the pharmacist caught the issue and that the intervention had undoubtedly saved her life,” O’Hagan says. “Grace’s unwavering persistence in telling the patient to go to the hospital, even when the patient showed resistance, showed how confident she was in her decision making and ultimately how much the patient respected and trusted in her judgment as a health care professional. “At such a young age this really is an outstanding achievement.” With just a couple of years in pharmacy under her belt, Grimes’ has already been placed on Meaghers’ management training and development plan, a step towards becoming a supervisory pharmacist and manager. She isn’t exactly sure what the future holds, but Grimes does know she wants to stay in community pharmacy. She’s also eager to expand her knowledge by building on her education, perhaps with a masters degree in pharmacy or business. “I don’t know where I’ll end up,” she says. “It’s funny because I didn’t initially want to be a pharmacist. When I was younger I went from wanting to be a nurse to a doctor to vet and then, finally, a pharmacist. “Pharmacy’s the one that sat with me in the end.”

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Awards The Irish Pharmacy

2018

Winners’ Profiles

FLEXISEQ Innovation & Service Development (Chain) of the Year Award 2018

Hickey’s – taking simple steps to make a huge difference to patient care FLEXISEQ Innovation and Service Development (Chain) Award 2018: Hickey’s Pharmacy of medications with the patient and talked through the problems he’d experienced. The man now takes all his medication - and he comes into the pharmacy like clockwork every four weeks to fill his prescription. “Counselling patients on problems they have experienced is much more effective than counselling them on a theoretical problem they may have,” says Concannon. “This intervention definitely prevented a hospital readmission and the patient is doing really well.”

Rebecca Maxwell, support pharmacist, Amy Flynn, supervising pharmacist Tom Concannon, superintendent pharmacist, Hickey’s Pharmacy with Deirdre Holden, Sales and Marketing Manager, Pro Bono Bio Tom Concannon, superintendent pharmacist at Hickey’s Pharmacy speaking about the company’s StartRight Service said: “It was a Thursday night. The 63-year-old man had just been discharged from hospital after suffering a heart attack. He walked into his suburban pharmacy with a new script. It contained 12 medicines.” The pharmacist explained each of the items carefully, and the

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man seemed to understand the new regimen. A week later when the pharmacist called him to check how he was getting on, he said he was “grand.” But after some gentle probing, it became clear he had become frustrated and stopped taking 10 of the 12 medicines. “He’d taken some of his older tablets but none of the new medications,” says Tom Concannon, superintendent

pharmacist at Hickey’s Pharmacy. “He was very confused and that’s not actually that uncommon. There are a lot of similar examples, cases where it’s too daunting for the patients so they just stop taking their medicine altogether.” In this case, the pharmacist put a plan in action. She urged the patient to go back to his GP and then call in to see her. Again, she went through the long list

Hickey’s new patient follow-up service, StartRight, earned the company this year’s Innovation and Service Development (Multiple) Award. The seed for the initiative was planted three years ago, when Concannon started investigating a new customer service initiative centred on follow-up calls to patients. Based on the same principles that inspired the New Medicine Service in the UK, Hickey’s pharmacists target patients on new or adjusted medicines by building on their initial consultation with a phone call one week later. After carrying out a small pilot in Navan, Co. Meath, with Hickey’s pharmacist Alan Reilly, the programme was last year


“These are really simple things,” says Concannon, who started his career as a support pharmacist at Hickey’s busy Northside store in 2000. “They’re really simple, but they make a huge difference to patients.”

Tom Concannon, superintendent pharmacist at Hickey’s Pharmacy

expanded to six stores. It has now been being rolled out across the group, with Hickey’s pharmacists making contact with more than 800 patients every month. The company believes the simple, cost-effective initiative will result in more than 10,000 additional patientpharmacist interactions over the next year alone. Importantly, it has already started to produce results, with pharmacists regularly uncovering irregularities in medication adherence and working with their patients to get it right. Concannon says the StartRight program is based on data which shows a lack of patient understanding about new medicines. Research shows that about one third of patients don’t take their new medicine as prescribed, and almost half do so deliberately." “All the research indicates that patients don’t fully understand all the information during their interactions in pharmacies,” he says. “It’s only when they get home and go to take the medication - they might lay their tablets out in front of them and become overwhelmed - that suddenly they actually aren't sure what to take and when. That’s when we have problems. And unfortunately an awful lot of people at that point just give up, they don’t take their medication, or they only take some of their tablets. “A lot of the reason for that is

people are a bit fearful or they might start taking the medication and have a side effect. The side effect could be expected, but telling them about it when they’re buying the medicine doesn't seem to resonate with people. But if you ring them a week later and they’ve already had that side effect, or they haven't taken the tablet because of a perceived problem that they might have, they’re much more engaged and willing to talk about it. We don’t want to wait a month, at that stage it’s too late. It’s about intervening at the right point.” Hickey’s pharmacists underwent training to help them identify those at risk during the followup calls and employ a series of informal questions to encourage patients to discuss their progress and any concerns. Stores were then given targets to meet to ensure the service was implemented and pharmacists who embraced the initiative from the outset were asked to share their experiences at group meetings in a bid to motivate their colleagues. StartRight is not the only innovative service launched by Hickey’s. The company was the first in Ireland to use a prescription ordering app, allowing patients to take a picture of their medicine and send it to their pharmacist. It also led the way in cutting down medicine waiting times, as one of the first pharmacists to adopt a text message service informing patients when their prescriptions were ready.

The company has almost tripled in size since Concannon came on board two decades ago. In his role at head office, he now oversees 37 pharmacies across Dublin, Meath, Louth, Kildare, Cork and Wexford, including three new stores that are opening this month. Concannon says he is always looking for new ways to improve and adapt the business. He says service innovation programs, such as StarRight, are effective because they show the community how pharmacies can help people to get more out of their medicines, which, in turn, builds trusting relationships between pharmacists and their patients. The payoff it twofold: higher job satisfaction for pharmacists, and more engaged, loyal and healthy customers. “Pharmacies are in danger of becoming really transactional, where people will just come and grab a prescription and go,” Concannon says. “And unless we change that dynamic, basically we’re just competing with Amazon. If we don’t make it less transactional and more about relationships I think pharmacy is at real risk. Ringing someone back, showing them you care, is a very effective way of changing the relationship between pharmacies and patients. "Heavy users of pharmacy will often be aware of the role of their pharmacist, but this service is getting to another cohort of patients and showing them the role their pharmacist can have in managing their medication. We’re never going to be able to compete with the Amazons of the world so we need to work really hard on our relationships before technology takes over.”

Concannon says the response to the service from patients and staff has been overwhelmingly positive, with pharmacists reporting higher levels of engagement with their patients and more job satisfaction because they are making clinical interventions. The customer-centric service has laid the foundations for a new type of patient-pharmacist conversation. “The transactionional relationship of pharmacy can breed a fair bit of disillusionment, particularly among younger pharmacists. You hear a lot about pharmacists leaving the profession,” he says. “At Hickey’s we want pharmacists who are passionate about their profession and we are committed to establishing services that advance the role of the pharmacist, and enable them to use their unique skills for the benefit of our patients.” “What gives pharmacists the most rewards is when a patient comes back into them and thanks them, or comes in because they’ve been referred by a friend or family member. That’s the sort of reward system that makes people turn up for work in the morning. If you don't have that, if it just remains handing out closed bags, there’s no rewards in it for pharmacists as health professionals.” Concannon believes there is no reason why similar programs to StartRight can’t be rolled out across all pharmacies in Ireland. “We, as pharmacists, need to realise that no matter how good our initial consultation with a patient was, some will have problems after they leave the pharmacy,” he says. “Changing the relationship between pharmacists and their patients will open up lots of opportunities for further clinical services, and as a sector pharmacy needs to get these initiatives moving. “Even in its simplest form this service has the potential to do a lot of good.”

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Awards The Irish Pharmacy

2018

Winners’ Profiles

The IPN Community Pharmacy Technician of the Year Award 2018

THE INDEPENDENT VOICE OF PHARMACY

Pharmacy Technician award winner is an inspiration to all who work with her The Community Pharmacy Technician of the Year Award 2018 winner, Lynsey Rigney, from The Village Pharmacy in Coolock, Co. Dublin. Lynsey Rigney is that inspirational member of staff who pushes everyone around her to live a healthier life. Whether it’s signing up for a new exercise challenge, giving nutrition advice, or competing in a charity run, she’s always encouraging co-workers to get involved. “I like to pick different challenges,” Rigney says. “I always try to get my colleagues involved. I think the girls think I'm a bit mad.”

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have cemented her as an integral part of the team. Rigney started working in pharmacy part-time on the OTC counter when she was 16. After graduating from DIT in 2014 with an honours degree in marketing, she continued working in the store, assisting the pharmacist, before qualifying as a pharmacy technician in 2016.

“She definitely has a positive influence on all the girls in the shop and always boosts team morale,” says pharmacist Jennifer Rigney, her sister and the owner of The Village Pharmacy in Dublin. “Lynsey is very health conscious and she’s particularly good at helping patients, especially those who struggle with their weight or are wanting to make lifestyle changes.”

Since then, she has taken every opportunity to expand her education, completing numerous courses to complement her skill set, including training in social media, women’s health, mental health, leadership and management. Lynsey is dedicated not only to her own professional development, but to her colleagues’, too. On a quiet afternoon she’ll often be found summarising her notes for co-workers so the team can stay up to date on new products.

The judges in the community pharmacy technician category were looking for an inspirational leader, someone with a record of outstanding achievement, and a champion for the pharmacy business. They found these attributes in Rigney. At just 27, her commitment to patients, combined with business nouss,

On top of her role purchasing medicines and preparing scripts under the supervision of the pharmacist, Rigney takes care of the business’ marketing and social media platforms, which she uses to educate customers. She has also coordinated several media campaigns spanning radio and print.

Lynsey Rigney with her award


Lynsey and the team at The Village Pharmacy in Coolock. To celebrate the 10 year anniversary Rigney organised a customer appreciation week, with special offers, raffles, goodie bags and refreshments. She incorporated fundraising for St Francis Hospice and The Marie Keating Foundation. “Lynsey is aware that some areas of our neighbourhood are less healthy than the national average and she works tirelessly to combat this,” says Jennifer Rigney. “She encourages patients to quit smoking, eat healthily and enjoy more exercise.” The Village Pharmacy is a small independent, tucked away in the northside suburb of Coolock. Located on the doorstep of Beaumont Hospital, it mostly serves patients over the age of 65.

To get Active Living off the ground, Rigney carried out extensive research on which services would be best suited to the pharmacy’s customer base. Then she targeted healthcare workers in the area, such as Beaumont’s prostate cancer specialist nurses, to educate them about the pharmacy’s large range of incontinence wear. On top of all this, she built the website that compliments the in-store offering. “Active Living is taking up a lot of my time, but it’s worth it,” Rigney says. “We used to have people coming in asking about

incontinence products and we just felt like we were always turning them away. We don’t have to do that anymore. What started off as a really small range has expanded. The nurses know all about us now, and they send a lot of people down.”

with the Travelling community, carrying out blood pressure tests and educating patients about the increased risk of stroke and heart attack when hypertension is left untreated. This month she’s travelling to Germany for World Fitness Day.

Rigney is always one to get involved in events to raise money for charity. In recent years, she has coordinated the pharmacy’s fundraising events for the Irish Motor Neuron Disease Association and Pieta House. Last year she participated in the Womens Mini Marathon to raise funds for IMNDA after a beloved customer died from the degenerative condition.

Rigney, who credits her sister as being her role model, says she never expected to spend a decade working in pharmacy when she started her high school job. “I didn’t think I would stay on,” she says.

Outside of work, Rigney hosts three Kangoo Jumps classes each week (Kangoo Jumps is the leading brand in safe rebound fitness) and is involved with the local Friends of the Elderly group. She has also ran events

“But by the time I finished my courses it started getting busier and I was helping in the dispensary and I just absolutely loved it. I plan on staying here forever now. I just want to continue what I’m doing, get better at it and keep learning. I wouldn’t change a thing. I love coming to work and I love the people I work with.”

Drawing on her marketing expertise, Rigney has been the driving force behind the pharmacy’s latest venture. Active Living is an extended section, located in a separate store opposite the dispensary, which stocks incontinence wear, compression hosiery, walking aids, wheelchairs, urinary aids, advanced foot care products, and specialised orthotic fittings. “Lynsey’s marketing experience has been invaluable to the business,” says Jennifer Rigney. “She identifies services and products that other pharmacies don't offer. Active Living was Lynsey’s project and from something small it has grown into a flourishing part of the business.”

Lynsey Rigney at The Village Pharmacy

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Awards The Irish Pharmacy

2018

Winners’ Profiles The Uniphar Fixxa Category Development of the Year Award 2018

Pharmacy group demonstrating the ability to excel in a competitive industry Winner: CarePlus Pharmacy Group The CarePlus Pharmacy Group is what you might describe as a tightly run ship. It's network of independent pharmacies around the country, which are ably supported by its experienced support office in Dublin, has positioned the group as one of the fastest growing and most respected in Ireland. This was recognised at the recent Irish Pharmacy Awards 2018 when CarePlus Pharmacy took home one of the most sought after accolades of the night: the Fixxa Category Development of the Year Award 2018. In beating off stiff competition from the other finalists in this category, CarePlus Pharmacy was able to clearly demonstrate the measurable benefits from one of its successful recent retail projects, which is already adding value, profits, increased productivity and customer satisfaction. At the Irish Pharmacy Awards, CarePlus also picked up the Clonmel Business Development (Multiple) of the Year Award, making it the only group to win two on the night. Irish Pharmacy News sat down with three women working diligently behind the scenes to help propel CarePlus Pharmacy's rapid growth, as it continues on its expansion plans and looks to consolidate its position as one of the major players in the Irish pharmacy market.

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Lee-Ann McCarthy, head of marketing at CarePlus, explains what it means to win the two awards and why the group is pressing ahead with its expansion, where it hopes to hit the 70 stores mark by the end of the year. “We are thrilled to win the awards, we see it as a recognition of so much hard work across the whole group, both in our network of pharmacies and in our support team. We currently have a lot of new pharmacies under construction. I'd probably describe it as a 'movable feast' right now. We have set a target of 70 pharmacies nationwide this year and we are on track for it.

as it attempts to highlight how the CarePlus brand stands out from the rest of the pack. One area it is trying to do this is in its digital strategy, while another is about building expertise within its pharmacy network.

“What we want is whereby somebody goes into one of our pharmacies and they immediately know that there's a knowledge there, and that it's a knowledge that goes deep into the philosophy that 'we are here to help'. So what we are

“In terms of business growth, we are in triple figure growth. We have so many projects going on right now it's insane! As a business, it's been an exceptional year. We are at a point now where it's more about people coming to us rather than being out there looking to make business. This is because people can see what we are doing. This was first year we did a national marketing campaign, which is really all about building brand awareness nationwide, and that doesn't even take into account what we do at a local level. We are in key locations all across Ireland with local marketing plans in place as well.” STAYING AHEAD McCarthy adds that the group is highly focused on a differentiation strategy from its competitors,

Sarah Jane Bruton and Martina Urngrknova of Careplus, Sarah Sambrookes of Uniphar Group


implement its Remedies Planogram change and scoop the award. CarePlus support team provide training guides for the pharmacy teams and host workshops in-store nationwide, with point of sale packs to support the category, which are all sent directly to the pharmacy. In the case of the remedies section, Vengrinova highlights that it includes a new back wall with new OTC Hotspot.

Jennifer Zamparelli, Jane Bruton, Martina Urngrkhora and Sarah Sambrooks

about is building this kind of knowledge bank, which is all about execution and making sure standards are super high. It is to do with our merchandising and product ranges, really looking at how everything looks and what the experience is like for the customer coming in. I think the reason we won the award is because we look at everything from so many different points of view, such as, 'are our experts trained? How does it look? How is it executed in our pharmacies?' We've got all that. We're investing in digital and working on a new website project. We have an app and we also use influencers so we can generate content quite quickly.”

Breege McTigue, head of customer engagement at CarePlus, reveals that the group is continually updating its categories and staying in tune with the market thanks to its experienced team of buyers and category specialists, who ensure that CarePlus pharmacies have all the tools and information required to execute in store. She highlights that all of its category plans are specific to each of its pharmacies and are

“ready and available to download from its customer intranet as required.”

CATEGORY DEVELOPMENT AWARD Running a successful pharmacy means much more than just knowledge of top-selling products, it is also the ability to optimise retail performance through a specific group of products managed as a distinct business unit and showing an understanding and appreciation of the market. The reason CarePlus Pharmacy took home the Fixxa Category Development of the Year 2018 award was chiefly down to the successful range change in its remedies section, which started back in December on a 12-week category change programme. The category was implemented by the group and rolled out to all the CarePlus Pharmacies in March. The buyer for the OTC category at CarePlus is Martina Vengrinova and its category expert for designing the planograms is Tina Lehkec. McTigue believes that having a specialist team allowed CarePlus to successfully

"It is a new solution to offset PSI restrictions on current Hotspots, which allows more product focus for new products, product of the month etc. All of our CarePlus pharmacies have category champions whose responsibility it is to implement the new range change. The process of execution is monitored by our team of merchandisers who visit our pharmacies monthly. Directional point of sale for PSI products that have moved from the pharmacy floor to the OTC wall or Dispensary. This was audited as part of the implementation process to ensure compliance." Vengrinova adds that OTC back wall unit has made it easier for customers and has increased sales by 10% in some pharmacies, where remedies generally accounting for 40% of over the counter transactions, while compliance is 100% on execution of category and this is evidenced by the reports from its internal store visits. Merchandising is very important and CarePlus has a specific approach to the way in which this should be executed. “We have pusher systems in all our pharmacies so that the staff don’t have to facing off product after a customer purchases from the shelf," says McTigue.

CarePlus believes that customers need to be aware of the changes regarding self-service and it has created clever point of sale which directs the customer to where the product has moved to.

In the remedies section, where the customer would traditionally use self-service, it can often be confusing and they could potentially leave the pharmacy because they cannot find a particular product, therefore it was very important for the pharmacies to reflect this. As mentioned, with remedies generally accounting for 40% of OTC sales, the business felt it was important to ensure it got this category right and have the products the customers were looking for. “We have a process between the pharmacy team and CarePlus support office which allows OTC teams to feedback products customers have requested and we look at this at our weekly range meetings to see if, one, the product would work within the range, and two, when this next category change is likely to happen,” says McTigue, adding that pharmacy teams are trained to help customers and explain the changes.

She adds that the implementation of a new category or range change such as remedies involves the support and delivery by not only the CarePlus commercial team, but it's graphic design and marketing team, it's operation team being briefed weekly so that they are involved in the overall process, and finally it's customer service team who support the operations team with the execution. “We regularly carry out research through exit shoppers and mystery shoppers and research has shown that shoppers form an opinion of a store in the first ten feet of entering so once customers enter our CarePlus pharmacy the initial appearance must make a positive impression and what they see in the first few feet will have a big impact on their decision to return to your store the pharmacy. Having the right product and easy to read point of sale to an overall positive shopping experience for our customers.”

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Awards The Irish Pharmacy

2018

Winners’ Profiles

Teva Superintendent Pharmacist of the Year Award 2018

Award winning pharmacist who turns challenges into opportunities Winner: Jack McPolin, Smith’s Pharmacy Group “Would you like a wee bottle of water?” asks Jack McPolin, on one of the hottest days of the year, as he reaches into a fridge at the back of his store on Quarry Road in Cabra. Jack recently won Teva Superintendent Pharmacist of the Year at the Irish Pharmacy Awards and it quickly becomes apparent that the key to his success, and that of his business, lies in a deep empathy that Jack himself is barely aware of. Neither is he the type of person who allows adversity to stand in the way of success. In fact many times during his career he has demonstrated a natural, almost effortless, talent for turning a challenge into an opportunity. Having started with just one store in Leixlip, Smith’s Pharmacy chain is now a shining example of what can be achieved when ambition, community spirit and empathy are combined. Expanding from five to ten stores in 2016 alone, Jack has built a bright and knowledgeable team around him: Smith’s Pharmacy is quickly establishing itself as a brand with longevity. From a small place called Hilltown in County Down, Jack was inspired to pursue a career in healthcare by both the local pharmacist Leo Lowry and the local GP Dr Edmund Miller, men who would “call round to your house at midnight if they had to and they’d never see anyone stuck.”

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He worked in a pharmacy while a student at Brighton University and spent his pre-registration year working in Great Ormond Street hospital where he was exposed to some of the world’s most cutting edge medicine. During that time he also worked in research and development at Glaxo-Smith Klein, one of the biggest pharmaceutical manufacturers in the world. “While it was all very exciting, I knew I wanted to be of service to the community and almost as soon as I came home from England a lady that I knew very well, her husband passed away suddenly and left her with two young children and a pharmacy shop to run. She had no experience and so immediately after qualifying I went in to manage this shop, and I held the fort for her until it was sold, with absolutely no management experience at all. I absolutely relished it and loved it.” From the beginning Jack displayed a talent for community service. “It was a very interesting pharmacy because it served an older population in quite a deprived area of Newry and I found that there were a lot of things that I was able to pick up by employing screening. Some of the things that are commonplace now weren’t so commonplace back then and I was able to guide a lot of people and make interventions in people’s

Teva Superintendent Pharmacist of the Year 2018 winner Jack McPolin, Smith's Pharmacy Group with sponsor Paul Neill, Teva Pharmaceuticals Ireland


more private entrance. He thinks nothing of sticking snow chains on the four by four to help get medication out to patients in bad weather and he has also inspired the Smith’s Pharmacy team to embrace social media. The group’s Facebook page went from having zero to five hundred likes in the space of one weekend thanks to his enthusiastic leadership. The team also recently managed to raise 2,260 euros in aid of Cystic Fibrosis Ireland, using Facebook as a key medium for engaging the local community, and further plans are afoot to continue to raise funds for this important charity. Jack is also a very flexible employer who often goes above and beyond the call of duty in order to facilitate last minute rostering changes so that staff members can attend to important personal matters.

Jack McPolin, Smith's Pharmacy Group

healthcare that maybe otherwise wouldn’t have happened.” In Jack’s world, success is meaningless unless it’s shared; knowledge is pointless if it’s not put to the service of others and ambition is futile if its fruits are not enjoyed by the whole community. Whether it’s a bad situation, bad weather, or other people’s bad advice or financial decision-making, Jack has built up a successful business by maintaining his sense of ambition, regardless of the setbacks. “When I wanted to open my first shop in 2000, I went to every bank in Ireland to get finance and I had the door closed in my face every time. Not one of them looked at the most important factor as far as I’m concerned: and that was the drive and ambition and enthusiasm I had for the business. In fact they all rejected my application before they had even met me.” After being turned down nine times Jack kept going and eventually got finance through

an investor who came out to the shop to meet him. This is what he believes made the difference. “If more of the banks were like this guy maybe we wouldn’t have had the crash we had in the last ten years. This guy came out and met me in the shop that I was hoping to buy. He listened to me and he got to know the person who he was lending to instead of just looking at the balance sheet. And this is how I treat my customers: I’m dealing with people and you have to get to know and understand the person you are treating instead of simply seeing it as some kind of financial transaction. I use the philosophy that I treat everyone in the same way as I’d like to see other people looking after my own elderly family members at home and that’s exactly how I look after my own customers.” As a student Jack was told that he should take a job with one of the big multiples as he “was ten years too late” into the business. Looking back, Jack takes pride in the fact that he has proven

them wrong. He knows the meaning of the long haul and has an infectious sense of hope and community spirit. “Within twelve months of buying my first store, I’d knocked the back wall out, I doubled the size of the business, I increased the opening hours and very soon we were flying. The business today is thriving and what worked for me in the first store has worked for me in all the subsequent stores and I do have ambitions to grow further, probably through acquisitions. We’ve done our fair share of new openings and now I think it’s time to acquire existing stores and rebrand them and offer the same service levels and the same value through bulk buying and our retail offering.” He combines his own ambition with the needs of the community and has built a business that has the needs of the community at its core. The new stores were designed to give methadone patients more dignity and privacy by giving them the option of collecting their medication at a

Jack hired Samantha Bakir to manage his stores and she nominated him for the award without his knowledge. “In my twelve years working in the community pharmacy sector, I have never come across a Superintendent who has such integrity, who is not afraid to take risks and who shares learning like Jack. He listens to the team, provides sound advice and cares so much about his patients that instead of having a ‘snow day’ like everyone else during the bad weather, Jack risked his own life in order to deliver vital medications. He goes out of his way for patients and in doing so sets an example for the team to do the same.” For a man with such drive, ambition and ability, it is Jack McPolin’s humble and caring nature that is proving to perhaps be his greatest asset. By combining this with a respect for the core values of community pharmacy, it is no surprise that Jack is quickly establishing himself as one of the most talented and popular Superintendent pharmacists in the country. Despite his bigbusiness ideals, Jack knows that fundamentally, it is the little things that keep people coming back.

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News New research from AVEENO reveals more than half of children in Ireland suffer from a skin condition New research from the AVEENO Baby brand has revealed that more than half (52%) of parents in Ireland say their child suffers from a skin condition such as dry or irritated skin. and cleansers is a good way to incorporate it into your skincare routine, but for the little ones around the house, AVEENO Baby offers something gentler and doctor approved. The survey, which was conducted with a nationally representative sample of parents in Ireland, also revealed:

Lucy Kennedy, Aveeno ambassador

The survey furthermore reveals the wide-ranging impacts of this, with 51% of parents reporting that their child experiences distress or upset because of their skin condition. On average, parents are being woken twice a month due to their child’s skin condition, and more than a third (37%) of parents say the family has experienced tiredness due to dealing with their child’s skin condition through the night. The research findings were revealed as part of the official

Dr Sinead Beirne, Aveeno ambassador

launch of AVEENO Baby in Ireland, a range of paediatrician-tested skincare products specially formulated to soothe, nourish and protect babies' skin. The AVEENOBaby range uses natural ingredients such as colloidal oatmeal and oat essence. Oatmeal has long been used by those who want something natural for their skin. Containing lipids and saponins, oatmeal has been shown to help with locking in moisture and as an anti-inflammatory for dry and sensitive skin. Using it in homemade face masks, scrubs

• Bedtime is the most prevalent time for skin conditions to flare up (36%), followed by morning (28%), warm weather (26%) and bathtime (10%). • 13% of parents say they have cancelled activities due to their child’s skin condition, 11% have had to keep their children off school, 8% of parents have taken time off work and 4% have even had to cancel holidays Brand ambassador Lucy Kennedy says: “As a busy mum of three, having a child with a skin condition can cause havoc when there’s sleepless nights and upset. Fun times such as bath time and warm sunny days can become a nightmare when skin conditions flare up. “My daughter Jess has at times

had dry skin and I've found the AVEENO Baby range made a huge difference from the very first application. Knowing that it contains natural ingredients and is paediatrician-tested gives me peace of mind that I’m choosing something designed for my children’s sensitive skin.” AVEENO Ambassador Dr Sinead Beirne, GP says: “I have seen children with a huge variety of skin conditions, and it certainly can impact everyday life. Small children and babies can often scratch and this can lead to further irritation. “Every baby has different needs for their unique skin, so it is good to know that AVEENO has two ranges of baby products; a daily range for caring for everyday dry and sensitive skin, and Soothing Relief for dry skin prone to irritation. The AVEENO Baby range includes a number of skincare products that are specially formulated for babies' skin, with natural colloidal oatmeal. The AVEENO Baby range is paediatrician tested and helps soothe, nourish and protect baby’s sensitive skin. There are eight products in the range, including barrier cream, cleansing milk, moisturising lotion, body and hair washes and wipes.

Ireland well positioned to secure thousands of additional jobs in pharma sector A leading Irish pharma body, Medicines for Ireland, which represents the generics industry here, has met with MEPs to discuss the current Commission proposal to amend the Supplementary Protection Certificate regulations (SPC) which forces the European generic and biosimilar medicines industry to transfer production outside of Europe. Currently, pharmaceutical companies with patent protected medicines enjoy protection from competition through an SPC. An SPC can afford the holder additional patent protection for up to 5 years. Under the Commission’s proposal published on 28 May last, the Commission wants to introduce an ‘export manufacturing waiver’ across the EU to allow

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pharmaceutical companies to manufacture and export medicines to countries outside the EU, where the patent has already fallen. Commenting on the event and the proposal itself, David Delaney, Vice-Chairman Medicines for Ireland and European Director Policy & Market Access Mylan, commented: “I met with MEPs and other relevant stakeholders because Medicines for Ireland

recognises the value of this proposal for the pharma sector here. If this waiver is introduced properly there is a massive opportunity to grow our sector further. “There will be tens of thousands of jobs up for grabs. Ireland can and must be in pole position for these jobs. As a country we have already proven our ability to be a global leader in pharma and Medicines

for Ireland want to see our existing footprint expand.” He added: “For patients this reform will result in a more competitive medicines market, drive greater and earlier access to medicines in Europe not just outside Europe, with locally produced medicines, and spur on the development of more affordable generic and biosimilar medicines across Europe.”


Nourish, soothe & protect sensitive baby skin from st the 1 use

IRE/AV/18-3233


Feature

Spotlight on Contraception In the run-up to the referendum, the Government committed to consider the introduction of free contraception in the event of a repeal of the Eighth Amendment. Now, in the context of the yes vote on May 25, the health minister is examining the funding of free contraception as part of its package of measures to reduce crisis pregnancies. of its contraceptive services were related to LARCs, up from 19% three years earlier.

in Norway and Finland, has been “shown to reduce the abortion rate in Scandinavian countries”.

“I would see more demand for LARC prescriptions in my practice than I would have for the pill this has changed immensely in the last 15 years or so,” says Dr Short.

It’s very much about educating earlier and having well thought out programmes. If it’s done in a holistic way, and parents are brought on board, children will inform parents and vice versa, so it’s about education, personal integrity about sexually transmitted infections and contraceptive options.

While the Irish Pharmacy Union does not have statistics on the uptake of LARCs, secretary general Darragh O’Loughlin says that, anecdotally, there has been a definite increase in the demand for LARCs across its 1,740 pharmacies around the country.

During the repeal campaign, the Government promised to consider introducing free contraception. Dr Mary Short, president of the European Society of Contraception and Reproductive Health, says the availability of free contraception has the potential to make a significant difference to the number of crisis pregnancies which occur in this country, but realistically only if two issues are effectively tackled: • Ensuring long-acting reversible contraception devices (LARCs), such as intrauterine devices and implants are included in the State’s proposed free contraceptives scheme. • Provision of a truly effective sex education to young people. The Irish Family Planning Association and Well Woman Centre emphasise the need for the Government to prioritise inclusion of in any free contraceptives programme. In real terms, say the experts, LARCs are more dependable than certain other popular forms of contraception such as the pill or condom, whose effectiveness depends on rigorously compliant

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use. Implants and injections are, for example, more than 99% effective. LARCs have an extremely high rate of success, and thus are our best chance of reducing the incidence of unintended pregnancy, says Dr Shirley McQuade, medical director of the Well Woman Centre in Dublin. Free condoms might reduce the STI rate, but the failure rate for contraception with condoms is quite high, she warns when used correctly, the effectiveness of condoms is 98%, but in reality, and when human error is taken into account, they have found to be only about 85% effective. According to Dr Short and other experts in the birth control area, LARCs are increasingly in demand in Ireland. Things have changed significantly since the most recent Irish Contraception and Crisis Pregnancy Study, conducted in 2010 and published in 2012. It found that while 43% of women used the oral contraceptive pill and 62% of respondents used condoms as contraception, just 19% of women used LARCs. But this low take-up is changing, a 2015 study by the IFPA showed 39%

The IPU is now strongly advocating that access to free contraception should also be through pharmacists without prescription. O’Loughlin points to the US, where, in many states, women can now access hormonal birth control without the need for a prescription. Similarly, in New Zealand and Canada, contraceptives can be bought from a chemist without prescription. “If we don’t tackle the education part of it, we don’t tackle it,” says Dr Henchion, warning that people must be aware of, and fully understand, the different birth control options in order to avoid unplanned pregnancy. Any difference that the availability of free contraception could make to crisis pregnancy levels will be restricted if Ireland doesn’t improve its education around sex, she says. Education is the key and we have to make sure people are getting good quality information. Good quality sex education must take in not just the biological facts around sex but the whole gamut of issues around relationships and self-esteem, explains Dr Short. “A lot of younger people are currently getting sex education from porn,” she says, adding that a holistic programme of education, such as that being implemented

The latest HSE figures on STI rates among teens show that in 2016, there was an 8% yearon-year rise of more than 8% from 2015 in the incidence of STIs in 15-19 year olds. "There needs to be more awareness that condoms provide protection against STIs, the message of double indemnity needs to be brought home," says Dr Short. In recent decades, the area of contraception has increasingly been the responsibility of women, primarily because there are still no good reversible methods of contraception for men (there is no guarantee that a vasectomy can be reversed) and because condoms are not particularly effective, says Dr McQuade. Yet, says Dr Henchion, even today some women can be reluctant to carry condoms, despite their proven protectiveness against STIs because they fear that carrying them may result in their being perceived as ‘permissive’. If there is one thing all the experts agree on, it’s the importance of recognising the need for LARCs to be a major part of any free contraception programme. “Long-acting reversible contraception has the best chance of reducing unintended pregnancy,” says Dr McQuad. “Once in place, they last three to 10 years depending on the device so unplanned sex would then simply not be an issue.”


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0.29

5-years Pearl Index1*

S M A LL T-BOD Y WITH A NARRO W, F L E X IBLE INSER T IO N TUBE 1,3 *Year 1 Pearl Index: 0.16 (95% CIs 0.02–0.58). 5-years Pearl Index: 0.29 (95% CIs 0.16–0.51).

L.IE.MKT.02.2017.0996

1. Bayer. Kyleena® Summary of Product Characteristics. 2. Bayer. Mirena® Summary of Product Characteristics. 3. Nelson A et al. Obstet Gynecol 2013;122:1205–1213. Kyleena 19.5 mg intrauterine delivery system. See full Summary of Product Characteristics (SmPC) before prescribing. Presentation: The product consists of a whitish or pale yellow drug core (19.5mg levonorgestrel) covered with a semi-opaque membrane, which is mounted on the vertical stem of a T-body. In addition, the vertical stem contains a silver ring located close to the horizontal arms. Indication: Contraception for up to 5 years. Dosage and administration: Insertion into the uterine cavity using aseptic technique by physicians/healthcare providers who are experienced in IUS (intrauterine delivery system) insertions and/or have undergone training on the Kyleena insertion procedure. Follow full instructions for preparation for insertion, insertion and removal/replacement, particularly with regard to timing and positioning. Kyleena can be distinguished from other IUSs by the combination of the visibility of the silver ring on ultrasound and the blue colour of the removal threads. The T-frame of Kyleena contains barium sulphate which makes it visible in X-ray examination. The system should be removed no later than by the end of the fifth year. If the woman wishes to continue using the same method, a new system can be inserted immediately following removal of the original system. If pregnancy is not desired, the removal should be carried out within 7 days of the onset of menstruation, provided the woman is still experiencing regular menses. After removal of Kyleena, the system should be examined to ensure that it is intact. Elderly patients: Kyleena has not been studied in women over the age of 65 years. There is no indication for the use of Kyleena in postmenopausal women. Paediatric population: Use of this product before menarche is not indicated. Contraindications: Pregnancy; acute or recurrent pelvic inflammatory disease (PID) or conditions associated with increased risk for pelvic infections; acute cervicitis or vaginitis; postpartum endometritis or infected abortion during the past three months; cervical intraepithelial neoplasia until resolved; uterine or cervical malignancy; progestogen-sensitive tumours, e.g. breast cancer; abnormal vaginal bleeding of unknown etiology; congenital or acquired uterine anomaly including fibroids which would interfere with insertion and/or retention of the IUS (i.e. if they distort the uterine cavity); acute liver disease or liver tumour; hypersensitivity to the active substance or to any of the excipients. Warnings and Precautions: Use with caution after specialist consultation, or consider removal of the system if any of the following conditions exist or arise for the first time: migraine, focal migraine with asymmetrical visual loss or other symptoms indicating transient cerebral ischemia; exceptionally severe headache; jaundice; marked increase in blood pressure; severe arterial disease such as stroke or myocardial infarction. May affect glucose tolerance, monitor the blood glucose concentration in diabetic users. However, there is generally no need to alter the therapeutic regimen in diabetics using levonorgestrel - IUS. Medical examination/consultation: Before insertion, a woman must be informed of the benefits and risks of Kyleena, including the signs and symptoms of perforation and the risk of ectopic pregnancy, see below. A physical examination including pelvic examination, examination of the breasts, and a cervical smear should be performed. Pregnancy and sexually transmitted diseases should be excluded. Genital infections should be successfully treated prior to insertion. The position of the uterus and the size of the uterine cavity should be determined. Fundal positioning of Kyleena is important in order to maximize the efficacy and reduce the risk of expulsion. Insertion and removal may be associated with some pain and bleeding. The procedure may precipitate a vasovagal reaction (e.g. syncope, or a seizure in an epileptic patient). A woman should be re examined 4 to 6 weeks after insertion to check the threads and ensure that the system is in the correct position. Follow-up visits are recommended once a year thereafter, or more frequently if clinically indicated. Kyleena is not for use as a post-coital contraceptive. The use of Kyleena for the treatment of heavy menstrual bleeding or protection from endometrial hyperplasia during estrogen replacement therapy has not been established. Ectopic pregnancy: In clinical trials, the overall incidence of ectopic pregnancy with Kyleena was approximately 0.20 per 100 woman-years. Approximately half of the pregnancies that occur during Kyleena use are likely to be ectopic. For women who become pregnant while using Kyleena, the possibility of an ectopic pregnancy must be considered and evaluated. Women with a previous history of ectopic pregnancy, tubal surgery or pelvic infection carry an increased risk of ectopic pregnancy. Because an ectopic pregnancy may impact future fertility the benefits and risks of using Kyleena should be carefully evaluated on an individual basis Effects on the menstrual bleeding pattern: Effects on the menstrual bleeding pattern are expected in most users of Kyleena. Those alterations are a result of the direct action of levonorgestrel on the endometrium and may not correlate with the ovarian activity. Irregular bleeding and spotting are common in the first months of use. Thereafter, the strong suppression of the endometrium results in the reduction of the duration and volume of menstrual bleeding. Scanty flow frequently develops into oligomenorrhea or amenorrhea. Pregnancy should be considered if menstruation does not occur within six weeks of the onset of previous menstruation. A repeated pregnancy test is not necessary in subjects who remain amenorrheic unless indicated by other signs of pregnancy. Pelvic infection: Pelvic infection has been reported during use of any IUS or IUD. In clinical trials, PID was observed more frequently at the beginning of Kyleena use. Before electing use of Kyleena, patients should be fully evaluated for risk factors associated with pelvic infection (e.g. multiple sexual partners, sexually transmitted infections, prior history of PID). As with other gynaecological or surgical procedures, severe infection or sepsis (including group A streptococcal sepsis) can occur following IUD insertion, although this is extremely rare. If a woman experiences recurrent endometritis or PID or if an acute infection is severe or does not respond to treatment, Kyleena must be removed. Expulsion: In clinical trials with Kyleena, the incidence of expulsion was low and in the same range as that reported for other IUDs and IUSs. Symptoms of the partial or complete expulsion of Kyleena may include bleeding or pain. However, partial or complete expulsion can occur without the woman noticing it, leading to decrease or loss of contraceptive protection. As Kyleena typically decreases menstrual bleeding over time, an increase of menstrual bleeding may be indicative of an expulsion. A partially expelled Kyleena should be removed. A new system can be inserted at that time provided pregnancy has been excluded. A woman should be advised how to check the threads of Kyleena and to contact her healthcare provider if the threads cannot be felt. Perforation: Perforation or penetration of the uterine corpus or cervix by an intrauterine contraceptive may occur, most often during insertion, although it may not be detected until sometime later, and may decrease the effectiveness of Kyleena. In case of a difficult insertion and/or exceptional pain or bleeding during or after insertion, appropriate steps should be taken immediately to exclude perforation, such as physical examination and ultrasound. Such a system must be removed; surgery may be required. Physical examination may not be sufficient to exclude partial perforation. A large prospective comparative noninterventional cohort study in users of other IUDs (N=61,448 women) showed that both breastfeeding at the time of insertion and insertion up to 36 weeks after giving birth were associated with an increased risk of perforation. These risk factors were independent of the type of IUD inserted. The risk of perforations may be increased in women with fixed retroverted uterus. Re-examination after insertion should follow the guidance given under the heading “Medical examination/consultation” which may be adapted as clinically indicated in women with risk factors for perforation. Lost threads: If the removal threads are not visible at the cervix on follow-up examinations, unnoticed expulsion and pregnancy must be excluded. Ultrasound or, if appropriate, x-ray may be used to ascertain the correct position of Kyleena. Ovarian cysts/enlarged ovarian follicles: Sometimes atresia of the follicle is delayed and folliculogenesis may continue. These enlarged follicles cannot be distinguished clinically from ovarian cysts and have been reported in clinical trials as adverse drug events in approximately 22.2 % of women using Kyleena including ovarian cyst, hemorrhagic ovarian cyst and ruptured ovarian cyst. Should an enlarged follicle fail to resolve spontaneously, continued ultrasound monitoring and other diagnostic/therapeutic measures may be appropriate. Interactions: Interactions can occur with drugs that induce microsomal enzymes, which can result in increased clearance of sex hormones. Substances known to increase the clearance of levonorgestrel are Phenytoin, barbiturates, primidone, carbamazepine, rifampicin, and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin, and products containing St. John’s wort. The influence of these drugs on the efficacy of Kyleena is not known. Many HIV/HCV protease inhibitors and non-nucleoside reverse transcriptase inhibitors when co-administered with sex hormones can have variable effects on the clearance of levonorgestrel (i.e. increase or decrease plasma concentrations of the progestin). Magnetic resonance imaging (MRI): Non-clinical testing has demonstrated that a patient can be scanned safely after placement of Kyleena under the following conditions: Static magnetic field of 3-Tesla or less, maximum spatial gradient magnetic field of 36000-Gauss/cm or less and maximum whole body averaged specific absorption rate (SAR) of 4 W/kg in the First Level Controlled mode for 15 minutes of continuous scanning. Fertility, pregnancy and lactation: Fertility: The use of a levonorgestrel-releasing intrauterine system does not alter the course of future fertility. Upon removal of the intrauterine system, women return to their normal fertility. Pregnancy: The insertion of Kyleena in pregnant women is contraindicated. If a woman becomes pregnant while using Kyleena ectopic pregnancy should be excluded and timely removal of the system is recommended since any intrauterine contraceptive left in situ may increase the risk of abortion and preterm labour. Removal of Kyleena or probing of the uterus may also result in spontaneous abortion. Clinical experience of the outcomes of pregnancies under Kyleena treatment is limited due to the high contraceptive efficacy. Breast-feeding: A levonorgestrel-releasing IUS does not affect the quantity or quality of breast milk. Small amounts of progestogen (about 0.1 % of the levonorgestrel dose) pass into the breast milk in nursing mothers. Effects on ability to drive and use machines: Kyleena has no known 19,5 MG INTRAUTERINE DELIVERY SYSTEM influence on the ability to drive or use machines. Undesirable Effects: Very common: headache, abdominal/pelvic pain, acne/seborrhoea, bleeding changes including increased and decreased menstrual bleeding, spotting, infrequent bleeding and amenorrhoea, ovarian cyst, vulvovaginitis; Common: depressed LEVONORGESTREL mood/depression, migraine, nausea, alopecia, upper genital tract infection, dysmenorrhea, breast pain/discomfort, device expulsion (complete and partial), genital discharge; Uncommon: hirsutism; Rare: uterine perforation Marketing Authorisation Number: PA 1410/081/001. Marketing Authorisation Holder/ Further information available from: Bayer Limited, The Atrium, Blackthorn Road, Dublin 18. Tel.: (01) 2999313. Classification for sale or supply: prescription only. Date of preparation: January 2017.

5 years. Low dose.


Feature How community pharmacy can help patients with sleep disorders A sleep disorder is the name given to a group of common conditions which are categorised by regular disturbance to a person’s sleep patterns. They range from grinding teeth and night terrors, to debilitating sleep patterns that interfere with a sufferer’s mental, physical, and emotional wellbeing. At their most severe, sleep disorders can be life-threatening. • pain that is mild to moderate, not severe • pain that lasts from 30 minutes to several days Many people who have tension headaches experience one or two every month. The pain symptoms can be easily managed with OTC painkillers. Some prevention advice may also be useful: Toothache Toothache occurs when the pulp inside the tooth gets inflamed (known as pulpitis). This is often caused by dental decay that results from poor oral hygiene, or it is sometimes caused by infection.

Many people experience sleep disturbances

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Types of sleep disorders

Causes

Many people experience occasional sleep disturbances but regular sleep problems are not normal. Common sleep disorders include sleep apnea (where the person stops breathing while asleep), narcolepsy (excessive and uncontrollable daytime sleepiness), cataplexy (sudden and temporary loss of muscle tone while the person is awake), sleeping sickness (sleep interruption caused by an infection), insomnia (the inability to sleep well or get to sleep), restless leg syndrome (where a person experiences a “creepy-crawly” type feeling in their legs), and sleep paralysis (the feeling of being awake but unable to move). According to the Mater Private in Dublin, there are also a range of abnormal behaviours during sleep, such as sleepwalking, night terrors, and sleep-related violence.

Lifestyle factors, such as substance misuse or shift work, mental health problems, and medications can cause sleeping problems. Researchers have drawn links between traumatic childhood experiences and an increased risk of a person suffering sleep apnea, narcolepsy, and insomnia in adulthood. People who have suffered a traumatic brain injury are also more susceptible to developing narcolepsy, obstructive sleep apnea, excessive daytime sleepiness, and insomnia. The effects Sleep disorders affect tens of millions of people worldwide and take a huge toll on a person’s health. They can leave people suffering from memory problems, decreased energy, mood swings and weight gain. Left untreated, the condition can

lead to severe health outcomes including depression, obesity, hypertension, occupational injuries, car accidents, diabetes, heart disease, and stroke. Sleep Disruption Disruption to sleep can be caused by many different things, for example fever, the aches and pains associated with colds and flu, headaches, backache, rheumatic pains and muscle pains, period pains and toothache. Headaches A tension headache will affect most of us at some time in our lives. In fact, even children get tension headaches. Although these headaches are more common in women than men, the symptoms are much the same in everybody: • pain that feels like a tight, squeezing band all over the head

Toothache often starts suddenly, and the pain can vary from mild discomfort to severe. People with toothache may have a throbbing pain in the head, jaw and ear that is constant or that comes and goes. The pain can be worse when eating or drinking, particularly if the food or drink is hot or cold. Menstrual Pain During the time that the lining of the womb is being shed, women experience cramping pain in the lower stomach, lower back and at the top of the legs – this is menstrual pain. The pain is caused by the womb contracting to remove the lining that it no longer needs. It’s thought that pain-causing chemicals, called prostaglandins, are involved in helping the womb contract. For some women and girls their menstrual pain can be mild, but in others the pain can be more severe. No one really knows why, but it could be that some women who have more severe pain may have too many prostaglandins or be more sensitive to them. This can make the womb squeeze especially hard, briefly cutting off


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Feature Getting better sleep Unfortunately, as beneficial as sleep is for keeping colds and sickness at bay, many of us struggle to get enough of it. In addition to leaving us vulnerable to colds and flu, lack of sleep also affects work performance, leisure activities, relationships, the ability to think clearly, and mental and emotional well-being. Small changes can help ensure sufficient, quality sleep: • Keeping a consistent sleep schedule. That means going to bed and waking up at the same time every day, including weekends!

Lifestyle factors can cause sleep problems blood supply to your womb and causing even more pain. Around 10% can suffer from severe pain that stops them from going to school or work. Treatment There are four categories under which treatment for sleep disorders broadly fall under: behavioural and psychotherapeutic treatment; rehabilitation and management; medication; and somatic treatment, such as music therapy and hypnosis. The choice of treatment depends on the patient's diagnosis, medical history, preferences, and the expertise of the treating clinician. Behavioural and pharmacological approaches can be used together to maximize therapeutic benefits. Medications and somatic treatments can provide quick symptomatic relief from some sleep disturbances. Narcolepsy is best treated with prescription drugs such as modafinil, while Insomnia sufferers may benefit more from behavioural interventions. Allergy treatment has been shown to help people suffering from sleep apnea. Some people who suffer from sleep apnea are required to wear a mask that generates a low pressure air flow which keeps the person’s collapsing airway open. For short-term insomnia, a physician may prescribe a course of sleeping tablets. In severe cases, Benzodiazepines with short-lasting effects, such as Temazepam, Loprazolam, Lormetazepam, can help promote relaxation and sleep. Z medicines (Zopiclone, Zolpidem,

66

Zaleplon) work in a similar way to benzodiazepines.

• feel very tired or fall asleep while driving

The HSE says medicines containing melatonin (in Ireland, Circadin) have been shown to be effective in providing short-term relief for insomnia. Circadin is for people who are aged over 55 and is only available on prescription.

• have difficulty concentrating

OTC medications

• need to take a nap almost every day

Pharmacies stock a wide range of OTC products, including herbal remedies and supplements, aimed at helping people who suffer from sleep disorders. They include Sona Relax For Restful Sleep, which contains a natural mild sedative and vitamin B6, and A.Vogel Dormeasan Sleep oral drops. OTC sleep aids include magnesium oils and Rescue Remedies, and a range of nasal strips, oral devices, throat sprays, lozenges, bath salts, candles and pillow sprays. Some herbal remedies, such as chamomile and passionflower, are reported to have had positive effects on sleep but this has not been supported by clinical investigations. How can the community pharmacist help? To help patients determine whether they need to seek specialised help for a sleep disorder, pharmacists can ask if they: • feel irritable or sleepy during the day • struggle to stay awake when sitting still, watching television or reading

• are often told that they look tired • react slowly • have trouble controlling their emotions

• require caffeinated beverages to get through the day An opportunity to engage Pharmacists can play an important role in helping to identify, manage and champion optimal sleep health. Pharmacists are perfectly placed in the community to help identify the aggravating factors that can cause sleep disorders, such as substance misuse and some medications. There is an abundance of medications that can negatively impact sleep. Pharmacists can identify medications that can have a negative impact on the body’s natural sleep cycle and recommend non-pharmacologic treatment options to help their patients get a good night rest. Pharmacists can also advise patients to keep a sleep diary so they are better informed about their condition, and, if required, refer them to a physician. When managing sleep disorders that are secondary to mood disorders, depression, anxiety, psychosis or substance abuse, medical professionals should always treat the underlying condition.

• Limiting food and beverage consumption at least two hours before bedtime to prevent heartburn and to keep from getting up for trips to the bathroom. • Avoiding caffeine, nicotine and alcohol before bed. These substances are known to interfere with sleep. • Creating a pro-sleep bedroom environment. That means low lighting, a comfortable temperature and a noise level. It’s also important to have a comfortable mattress and pillow to prevent tossing and turning. • Taking time to wind down before bed. Ease the transition from the hectic day to restful sleep by engaging in relaxing activities before bed. Take a warm bath, listen to soft music, or read a book. • Exercise regularly. In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. Finish exercise at least 3 hours before bedtime. • Keep prescription sleeping pills to a minimum. Sleeping pills are effective but can have side-effects, so they should be used sparingly and for the shortest amount of time possible. • If someone’s sleep is disrupted on a regular basis, they could have a sleep disorder. Their doctor can help to identify and treat the cause of the sleeping problems if they cannot be managed through self-care.


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Feature

Essential health advice for a globe-trotting nation With the summer holiday season in full swing and thousands of Irish people jetting off to various corners of the globe, it is a busy time of year for Irish pharmacists who are working on the frontline for advice on travel health matters. in some instances, disease can be prevented by vaccination, but there are some infectious diseases, including some of the most important and most dangerous, for which no vaccines exist. According to the WHO, general precautions can greatly reduce the risk of exposure to infectious agents and should always be taken for visits to any destination where there is a significant risk of exposure, regardless of whether any vaccinations or medication have been administered. It's list of the main infectious diseases that people need to be aware of when travelling abroad include: • Anthrax It is clear that more Irish people are travelling overseas than ever before. In fact, Ireland can lay claim to the honour of being the most 'globe-trotting nation' on the planet, according to data released last year based on holiday bookings to 170 countries, which analysed overseas and domestic holiday bookings since 2014. The research cited that per head of population Ireland is the most travelled nation, boasting more than 7.6 million trips abroad made by Irish residents in 2016, up 7.8% on the previous year. Most of these visits were to Europe and the US, however an increasing number of Irish travellers are venturing to more tropical destinations, bringing with it a vast array of new travel health concerns to contend with. For example, there were 81 malaria cases notified in Ireland in 2015, all of which were associated with overseas travel and people returning home from malaria-risk areas. In 2017, the Department of Foreign Affairs & Trade provided support to over 2,500 Irish citizens in distress

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abroad, with some 343 of these cases associated with healthrelated issues. The HSE has advised that all individuals planning travel should seek advice on the potential hazards in their chosen destinations and understand how best to protect their health and minimise the risk of acquiring disease, whether that is with a GP or a community pharmacist. It added that forward planning, appropriate preventive measures and careful precautions can protect people's health and minimise the risks of accident and of acquiring disease, such as malaria, while also stating that it is often easy to forget that many countries do not provide the same access to medical facilities and treatments as in Ireland. Malaria is a life-threatening disease that is caused by a parasite and is spread by mosquitoes. It is more common in tropical countries, such as parts of Africa, Asia and South America, although there have been cases reported in Europe.

Symptoms of malaria usually appear 10 to 15 days after you are bitten by an infected mosquito, with the initial symptoms similar to those of influenza.

• Brucellosis

Although access to travel medicine services, immunisations and antimalarials varies throughout Ireland, GPs and pharmacists can provide help and sound advice about understanding the risks involved and give advice about people taking the necessary precautions to protect their health while travelling.

• Giardiasis

Echoing the HSE, the World Health Organization (WHO) has stated that depending on the destination, travellers may be exposed to a number of infectious diseases; exposure depends on the presence of infectious agents in the area to be visited. The risk of becoming infected will vary according to the purpose of the trip and the itinerary within the area, the standards of accommodation, hygiene and sanitation, as well as the behaviour of the traveller. The WHO found that

• Chikungunya • Coccidioidomycosis • Dengue

• Haemorrhagic fevers • Hantavirus diseases • Hepatitis C and E • HIV/AIDS and other sexually transmitted infections • Legionellosis • Leishmaniasis (cutaneous, mucosal and visceral forms) • Listeriosis • Lyme Borreliosis (Lyme disease) • Malaria • SARS (Severe Acute Respiratory Syndrome) • Schistosomiasis (Bilharziasis) • Trypanosomiasis • Typhus fever (Epidemic louseborne typhus)


Feature by holidaymakers. It is caused by the ultraviolet radiation (UV) in sunlight. Travelling to hot climates from countries such as Ireland, people may be at greater risk of getting sunburnt, which can be harmful whatever your age as it exposes your skin to UV rays that can damage skin and possibly lead to skin cancer.

Nadira Callachand, pharmacy services manager at Hibernian Healthcare

Nadira Callachand, a pharmacist and pharmacy services manager at Dublin-based Hibernian Healthcare, has developed an e-learning programme that she hopes will soon train Irish pharmacists in the area of travel health vaccination.

• How vaccines work

Speaking to Irish Pharmacy News, Callachand revealed that the course has been developed by a team of international experts in travel health, including specialist pharmacists and doctors, who have looked at every aspect of providing a safe and effective travel health service, drawn from national and international guidance and best practice.

• Hepatitis A and B

Callachand added that with 25 modules, "the programme will ensure pharmacists are competent at carrying out a travel health risk assessment on their patients, advise and vaccinate on travelrelated, vaccine-preventable diseases and offer appropriate travel advice".

• Tick borne encephalitis

"Our hope is that Irish pharmacists will soon be able to vaccinate in travel health. The course has been written for UK pharmacists but we have completed a separate programme with the relevant changes to make it suitable for pharmacists in Ireland. As soon as legislation changes in Ireland, we will be ready to go with training for pharmacists," she said. Some of the Hibernian Healthcare Travel Health Programme modules include:

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• Risk assessment • Vaccine-preventable diseases • Cholera • Diphtheria

• Japanese encephalitis • Malaria • Meningococcal disease • Polio • Rabies • Tetanus

• Typhoid fever • Yellow fever • Travel advice • Anaphylaxis • CPR • Adverse Events Following Immunisation SKIN DAMAGE Other than the threat of infectious disease, there are a host of other possible travel health emergencies that people will need to be mindful of when travelling overseas, particularly in hotter climes. Sunburn is one of the most widespread conditions suffered

That is not to say that the sun should be completely avoided as sun exposure is vital for obtaining vitamin D. Using a good sunscreen will give you some protection from UV rays but it is also important to use shade, clothes and sunglasses too. The Irish Cancer Society advises people to use a ‘broadspectrum’ sunscreen that protects against both UVA and UVB – SPF minimum 30, and it should be applied to dry skin 20 minutes before going out in the sun and reapplied every two hours. HEAT STROKE AND GI ISSUES Heatstroke is another medical emergency which can be serious and end up with a person being hospitalised. It occurs when the body becomes overheated very quickly. This can happen as a result of very hot temperatures, extreme physical exertion or sunburn. Meanwhile, travelers' diarrhoea is a common condition that can ruin a person's holiday very quickly. It is usually spread through poor hygiene and lasts for about three to five days and is mostly caused by bacteria that are passed from faeces to the mouth. This can happen when someone does not wash their hands after going to the toilet and then handles food that is eaten by travellers. When abroad, people should also be vigilant of stinging and biting animals and insects, such as scorpions, snakes, spiders and jellyfish. PRE-EXISTING CONDITIONS Thousands of Irish people travel overseas each year with various pre-existing medical conditions, for example, diabetes. Although travelling can be disruptive to the usual daily planning of meals and sleep, Type 1 diabetes should not restrict or discourage anyone's wish to travel.

In managing diabetes, it is important to take into consideration many factors, including blood glucose monitoring, carbohydrate intake, physical activities and insulin requirements to ensure good blood glucose control and to reduce the risk of complications. Diabetes Ireland believes that travelling with Type 1 diabetes is much the same as for people without diabetes. Like everyone, the person must plan efficiently before travelling by land, sea or air. According to Diabetes Ireland, some general precautions when travelling with diabetes include: • Prior to the trip, schedule an appointment with your diabetes team as you will need to bring a letter on medical stationary stating you have diabetes and you use pens/ pumps/meters. • Bring a written prescription with generic terms of medication you are taking in case you need to get extra supplies or need to visit a doctor when abroad. Photocopy all your relevant important documentation and give a copy to your travelling companion or keep a copy in separate luggage you are bringing. • Remember to always bring spare insulin (and spare pen devices), at least 2-3 times the normal amount you would use during the same timeframe. If using a pump, make sure you have adequate spare supplies you may need plus back up insulin. • More frequent testing may be necessary so you will need at least double your normal amount of glucose testing strips for the same timeframe plus a spare glucose meter. Don’t forget to bring ketone testing supplies also. Always split your supplies into two bags and if possible, give one set to a travelling companion in the event your luggage gets lost. • Look at your travel plans and check what vaccines are necessary. For information on what countries may need vaccines see Tropical Medical Bureau www.tmb.ie.


DAILY EYELID CLEANSING MORE IMPORTANT THAN YOU THINK

BLEPHACLEAN wipes for smooth cleansing and moisturising of eyelids. ®

BLEPHASOL lotion for daily maintenance and smooth cleansing of eyelids. ®

Cooling BLEPHAGEL for the daily hygiene of eyelids, ideal for night time use. ®

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Feature Focus on Blepharitis Blepharitis is not contagious but is a common condition which can develop at any age. Symptoms can include: • itchy, sore and red eyelids that may, but not always stick together. • crusty or greasy eyelashes. • a burning, gritty sensation in the eyes • increased sensitivity to light (photophobia) • swollen eyelid margins • abnormal eyelash growth or loss of eyelashes in severe cases In most cases both eyes are affected, but one eye can be more affected than the other. The symptoms tend to be worse in the morning. Types of Blepharitis Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods without symptoms. There are three main types of blepharitis: • anterior blepharitis – where the

Blepharitis is the medical term for inflamed eyelids. The inflammation is like eczema of the skin with red, scaly eyelids.

inflammation affects the skin around the base of the eyelashes • posterior blepharitis – where the inflammation affects the Meibomian glands, found along the eyelid margins behind the base of the eyelashes • mixed blepharitis – a combination of both anterior and posterior blepharitis • Anterior blepharitis can be caused by either: a reaction to Staphylococcus bacteria – these usually live harmlessly on the skin of many people, but for unknown reasons they can cause the eyelids to become inflamed. Seborrhoeic dermatitis - a skin condition that causes skin to become oily or flaky and sometimes can irritate the eyelids, causing the Meibomian glands to become blocked. Posterior blepharitis is caused by a problem with the Meibomian glands, where the glands do not function properly and can get blocked by either debris, skin flakes or inflammation.

Sometimes blockages in the Meibomian glands are associated with rosacea. If too much oily substance is being produced, this may be caused by seborrhoeic dermatitis. Mixed blepharitis, which is the most common, is caused by a combination of both anterior and posterior blepharitis. Blepharitis isn't usually serious, although it can lead to a number of further problems. For example, many people with blepharitis also develop dry eye syndrome. Serious, sightthreatening problems are rare, particularly if any complications that develop are identified and treated quickly. Treatment Options 1. Heat Compress 2. Massage 3. Eyelid Hygiene, twice daily for 3 weeks with a medical devise cleansing wipe indicated for the treatment of blepharitis and clinically proven to reduce the microbial load on the eyelids (such as Blephaclean). Followed

by once a day cleansing to maintain eyelid hygiene. 4. Lubricate the eyes with a preservative free sodium hyaluronate eye drop (such as Hyabak) or a preserative free 3rd generation eye drop (such as Thealoz Duo). 5. Recommend an eye ointment which contains the active ingredient dibrompropamidine isetionate, (such as Goldeneye) to kill bacteria that cause eye and eyelid infections like blepharitis. The ointment can be used at night, in conjunction with an eye drop solution containing propamidine isethionate during the day. Patients should not wear contact lenses while using the drops/ointment. There's some evidence to suggest a diet high in omega-3 fats can help improve blepharitis. The best sources of omega-3s are oily fish, such as mackerel, salmon etc. Nuts, seeds, vegetable oils, soya and soya products and green leafy vegetables are also sources of omega-3s. Omega 7 or sea buckthorn oil has also been found to be helpful.

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The Cosmetic Association Trade Fair

The Cosmetic Association (TCA) 2018 Trade Fair Another great trade show by The Cosmetic Association has taken place in the RDS, Dublin. The event was held from May 20th to May 22nd 2018. Jo Somerville, Managing Director said: “Visitors were very happy with the presentations and selection of products and the high standard of all the stands. “The exhibitors pulled out all the

stops with regards to dressing their stands and the compliments from the buyers were very encouraging. New members brought excitement to the show and they were very happy with their experience.

Packed stands at The Cosmetic Association Trade Fair

Displays at The Cosmetic Association Trade Fair

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“It is taking most buyers two days to get the full value out of the event. With in excess of 70 exhibitors taking part, you just have to give it your full attention. “We are preparing for next

year already. We organise the largest event, under one roof, for the pharmacy sector in both jurisdictions. We hope everyone will continue to support us in future years.”


Aisling Reidy and Aine O’Riordan, O’Riordan’s Pharmacy

Debbie McDonagh and Anne Hogan, Downey’s Pharmacy

Jennifer Alexander and Laura Elliott, REN Skincare

Hannah McFadden, Caroline Grieve, Colette McCormack, McFadden’s Pharmacy

Joanne Larby & Paul O’Neill, Easilocks

Jessica McMahon and Marilis McCabe, McGuires Pharmacy

More Simplicity. More Functionality. More Fun. Holos is luxurious plantbased aromatherapy skincare that maintains skin health and helps PREVENT the signs of premature ageing.

Holos works closely with Pharmacies to drive sales through training, promotions, incentives & in-store events. To learn more call 086 3183369 or email sales@holos.ie

Handmade / Irish / Ethical / Vegan

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Image Publications Most innovative Irish brand 2018


Ocean Healthcare has been appointed exclusive distributor for Bio-Oil in Ireland From 1st July 2018 Ocean Healthcare will manage all sales, marketing and distribution of Bio-Oil in Ireland. Graham Stafford, Managing Director, Ocean Healthcare “We believe we have a great opportunity to develop and grow Bio-Oil, Ireland’s No.1 selling scar and stretch mark product. It is an exciting time for the brand in terms of development and look forward to working closely with our retail partners to maximise the potential of Bio-Oil in Ireland.” Bio-Oil will be supported by a heavyweight marketing campaign including, TV throughout August and September with the highest ever ratings for a Bio-Oil TV campaign in Ireland. Consumer press advertising from September in Image Magazine, Irish Independent Sunday Life Magazine and Woman’s Way, and a comprehensive digital marketing campaign. New point of sale and training material will also be available from Ocean Healthcare. Bio-Oil will be available from Ocean Healthcare, United Drug & Uniphar. For more information contact Ocean Healthcare 01 2968080

NEW MyDoublebase.ie Dermal are pleased to announce the launch of a new website, MyDoublebase.ie, a promotional website to support Doublebase Emollient Gel in the Republic of Ireland. MyDoublebase.ie is a valuable resource for those purchasing Doublebase Emollient Gel in the Republic of Ireland; providing useful information about dry skin, the importance of emollients and how to use them. To assist prescribers and pharmacy staff in supporting their patients with dry skin conditions, the dedicated Healthcare Professional section of the website provides further information regarding Doublebase Emollient Gel and advice to share with patients on dry skin and using emollients. Doublebase Emollient Gel is a highly moisturising and protective hydrating gel available for self-selection, that is clinically proven to provide effective protection against dryness. Doublebase Emollient Gel offers an innovative solution for those who are dissatisfied with traditional ointments or creams or who are looking to try something different. Recommend Doublebase Emollient Gel to Soften, Moisturise and Protect dry skin

GlucoRX Allpresan Foot Foam Cream WINDZOR Pharmaceuticals are pleased to announce the launch of Allpresan Diabetic Foot Foam Cream. The range includes Allpresan Basic 5% Urea and Allpresan Intensive 10% Urea. Allpresan is clinically formulated to prevent dry cracked skin and calluses on diabetic feet, unlike conventional creams, Allpresan is clinically formulated for use on the entire foot including in between the toes. Allpresan foam cream forms a breathable protective coating with a specific formula that strengthens and repairs the skin barrier. Allpresan is quick to apply, non-greasy and dries immediately after application. Allpresan Foot Foam Cream 125ml Basic (5% Urea) and Allpresan Foot Foam Cream Intensive (10% Urea), is available now from United Drug and Uniphar. Trade Price Allpresan 125ml Foot Foam Cream ¤6.80 For more information contact us at info@windzorpharma.com or visit www.glucorx.ie

The perfect glow with Bronz’express Magic Radiance Drops Magic Radiance Drops are a unique tailor made self-tanner, just mix a few drops with your favourite skin care to get a natural sun-kissed glow! This ingenious self-tanner combines with any texture giving you a natural looking tan while enjoying the benefits of your daily face and/or body care. Facebook.com/BronzExpressIreland Twitter.com/ BronzExpressIRE Instagram.com/ bronzexpressireland

RRP ¤22.95

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KidsClin® Cradle Cap Treatment Kit

PoxClin® Shingles BodyMousse

Pharmed are delighted to introduce the new KidsClin® Cradle Cap Treatment Kit that offers everything needed for the effective treatment of Cradle Cap.

Pharmed are delighted to launch the new PoxClin® Shingles BodyMousse, formulated to relieve the symptoms of Shingles. A unique product designed to provide instant relief from skin irritation, helping to prevent scarring and infection whilst cooling and soothing the skin.

Formulated to remove, treat and prevent Cradle Cap. The kit includes a deep-acting serum, a brush with soft sponge and a comb for instant and safe removal of scales.

For further information contact info@pharmed.ie

For further information contact info@pharmed.ie

RRP ¤19.95

RRP ¤19.95


1 AUG

Product News – Nizoral STADA acquires EMEA rights to global anti-dandruff brand Nizoral from Janssen Pharmaceutica The company has acquired the rights to the medicated anti-dandruff shampoo Nizoral from Janssen Pharmaceutica NV. The shampoo generated sales of approximately ¤33 million in EMEA in 2017. “We are excited to add Nizoral into our portfolio and Pharmacy: Transforming outcomes! to further expand our presence in the consumer

New ways for pharmacy to provide better care healthcare market.patient In 2017 Ireland achieved sales

of EUR 750.000. In the next few months we will be closely withto theextend seller in your order Wherever you practise around the world, FIPworking wantstogether you tovery be inspired to ensure a smooth transition in distribution”, said Jim role so that you play a full part in ensuring patients get the Director best care possible. Hanlon, Managing of Clonmel Healthcare.

medical ingredient Ketoconazole, which was thth 78thThe FIP World Congress 7878 FIP FIPWorld World of Congress Congress ofof WELCOME TO GLASGOW developed by Janssen Pharmaceutica NV and its Glasgow, a former European Capital of Culture once voted the affiliates, is the most frequently prescribed active Pharmacy and Pharmacy Pharmaceutical Pharmacy and and Pharmaceutical Pharmaceutica Sciences world’s friendliest city, has expanded hugely from its origins as ingredient for the treatment of River dandruff. It distinguishes a small salmon-fi shing village on the Clyde, but it remains Glasgow, UK Glasgow, Glasgow, UK N museums, Nizoral from purely cosmetic anti-dandruff shampoos compact enough to explore with ease itsUK world-class ATIO for treating ATNIO R RATRIO T and makes substantially more effective IS galleries anditaward-winning visitor attractions. Away from the EGTIST E: E REG REGRIS : 2018 2-6symptoms September 2-6 2018 2-6 September September LINE2018 LAIN LIN D D D A A E E E D city, stunning scenery in theredness beautiful countryside. such as abounds dand ruff, 2018 itchiness of D D T 20T128 Tand

Today’s one-size-fits-all approach to pharmacological treatment is failing many patients around the globe. Come to the Glasgow congress, which will help you develop new ideas about how you can advance pharmaceutical care, use new technologies, work with others and empower yourselves to provide personalised medicines therapy – and thereby transform patient outcomes. CONGRESS STREAMS: A > From bench to bedside Advancing pharmaceutical care Focuses on new technologies and approaches to achieve individualised therapy, including emerging ethical th dimensions associated with their implementation. Advancements in drug discovery, formulation, compounding, delivery systems and mathematical modelling can be used to translate such innovations into better outcomes in populations and individual patients.

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1A the scalp and their causes. Nizoral’s long duration of effectiveness of up to seven days also makes it highly against persistentDdandruff. C >effective Empowered for health > Targeting special interests

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B > Partners in health Emphasises leadership developLooks at special interests in the Recognises that pharmacists and ment, including disseminating new different fields of pharmacy and pharmaceutical scientists cannot operate in a vacuum if the goal knowledge through the identifica- pharmaceutical sciences. is to transform patient outcomes tion of key competencies, along SPECIAL SATELLITE SYMPOSIA: and achieve the best possible care with outstanding approaches to for patients. New collaborative effective and ethical communicapractices, research and educatiotion, to enable life-long learning. BIOSIMILARS / 1 September nal models are needed among Transforming patient outcomes IMMUNIZATION TRAINING / traditional health care professio- can only be achieved with a 1 - 2 September PHARMACY TECHNICIANS / pharmacy workforce empowered nals like doctors and nurses, but these also must be expanded to to develop and implement 1 - 2 September ON the I T A R IST EGin R : include FIP pharmacist and phar-Wherever latest advances pharmacy and SCIENCE OFaround DIFFERENTIATED E IN you practise Wherever Wherever the THE world, you you practise FIP practise wants around you the tothe be world, inspired world, FIPFIP wants towants exten y ADL around DE 18 pharmaceutical care sciences. maceutical scientist members. role MEDICINES /a 7 September 20role T S U so that you role so so that that you you play a full part in ensuring play patients play full a full part get part the in in ensuring best ensuring carepatients possible. patients g 1 AUG

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A > From A >in From bench bench to bedside to bedside C > Empowered forinhealth D > Targeting C > Empowered C > Empower special in fo B > Partners health B > Partners B > Partners health in health WELCOME TO GLASGOW Emphasises leadership developEmphasises lead Advancing Advancing pharmaceutical pharmaceutical Looks at special intere Recognises that pharmacists andcarecare Recognises Recognises thatthat pharmacists pharmacists and and Emphasises Glasgow, a former European Capital of Culture ment, including disseminating new ment, including includi Focuses Focuses onscientists new on new technologies technologies andpharmaceutical different fiment, elds of phard pharmaceutical cannot and pharmaceutical scientists scientists cannot cannot operate inonce a vacuum iftothe goal knowledge operate operate through in a in vacuum the a vacuum identifi if the ifcathe goalgoal knowledge knowledge throu th approaches approaches to achieve achieve individuaindividuapharmaceutical scienc voted the world’s friendliest city, has is to transform patient outcomes toistransform to transform patient patient outcomes outcomes tiontion tion ofiskey competencies, along of key of key comp co lisedlised therapy, therapy, including including emerging emerging expanded hugely from its origins as a small SPECIAL SATELLITE SYM ethical ethical dimensions dimensions associated associated and achieve the best possible care with outstanding andand achieve achieve the best the best possible possible care carewith approaches to with outstanding outstan village on River Clyde, withsalmon-fishing with their their implementation. implementation. for patients. New collaborative forthe patients. for patients. New New collaborative collaborative effective effective and ethical communicaeffective andand eth practices, research and educatiopractices, practices, research andand educatioeducatioAdvancements Advancements in drug in drug discovery, discovery, tion, to enable life-long learning. tion,tion, to enable enabl lif BIOSIMILARS /to 1 Septe but it remains compact enough toresearch explore formulation, formulation, compounding, compounding, nal models are needed among nal models nal models are galleries needed are needed among among Transforming patient outcomes Transforming Transforming pat IMMUNIZATION TRAIN with ease its world-class museums, traditional delivery delivery health systems systems careand professioand mathemamathemacan only traditional be traditional achieved health health with care acare professioprofessiocan can onlyonly be achie be a 1 - 2 September and award-winning visitor attractions. PHARMACY TECHNICIA tical tical modelling modelling can be used be to pharmacy to nalsnals workforce empowered pharmacy workfo wo nals like doctors and can nurses, butused like like doctors doctors andAway and nurses, nurses, but but pharmacy the city, stunning scenery abounds in to1 -to these translate alsofrom translate mustsuch be expanded such innovations innovations to intointo to develop these these and alsoalso implement must must be expanded bethe expanded to develop to develop andan im 2 September include FIP pharmacist and pharlatest include advances include FIP in pharmacist FIP pharmacy pharmacist and and and pharpharlatest latest advances advanc i better better outcomes outcomes in populations in populations THE SCIENCE OF DIFFE the beautiful countryside. pharmaceutical care sciences. pharmaceutical pharmaceuti maceutical scientist members. maceutical maceutical scientist scientist members. members. andand individual individual patients. patients. MEDICINES / 7 Septem

Are you a community, hospital Today’sTransforming one-size-fits-all approach to Pharmacy: outcomes! pharmacological treatment is failing or industrial pharmacist, or a New waysmany forpatients pharmacy to provide better patient care around the globe. pharmaceutical scientist? Come to the Glasgow congress, which will practise around the world, FIP wants you to be inspired to extend your Wherever you practise, Wherever FIP wantsyou help you develop new ideas about how role so that you play a full part in ensuring patients get the best care possible. you to be inspired to extend your you can advance pharmaceutical care, Note Most congress sessions use new technologies, work with others accredited for continui Please fi nd more information: Please Please fi nd fi more nd more information: information: role so that you play a full part education. Check with y Today’s one-size-fits-all to pharmacological treatment GLASGOW andapproach empower yourselves to provide WELCOME TO www.fi country’s professional b p.org/glasgow2018 www.fi www.fi p.org/glasgow2018 p.org/glasgow2018 Glasgow, a former European Capital of Culture once voted the in ensuring patients getis the failingbest many patients around the globe. Come to the Glasgow personalised medicines therapy – and world’s friendliest city, has expanded hugely from its origins as congress, which will help you develop new ideas about how you www.fip.org/glasgow2018 thereby transform patient outcomes. a small salmon-fi care possible. shing village on the River Clyde, but it remains can advance pharmaceutical care, use new technologies, work with others and empower yourselves to provide personalised medicines therapy – and thereby transform patient outcomes.

compact enough to explore with ease its world-class museums, galleries and award-winning visitor attractions. Away from the city, stunning scenery abounds in the beautiful countryside.

77

CONGRESS STREAMS: A > From bench to bedside Advancing pharmaceutical care

B > Partners in health Recognises that pharmacists and

C > Empowered for health Emphasises leadership develop-

D > Targeting special interests Looks at special interests in the


Clinical Profiles RELETRANS 5, 10, 15, 20 MICROGRAMS/HOUR TRANSDERMAL PATCHES

right of first negotiation to broaden the field and territory related to MultiStem cells used in combination with iPSC-derived cells.

Rowex Ltd. announces launch of Reletrans 5, 10, 15, 20 micrograms/ hour Transdermal Patches, active ingredient: buprenorphine. Therapeutic Indications: Treatment of non-malignant pain of moderate intensity when an opioid is necessary for obtaining adequate analgesia. Reletrans is not suitable for the treatment of acute pain. Reletrans is indicated in adults. For further information or to order contact our Rowex® Telesales Team: Irene, Jeanne Marie or Rita on 1800 304 400 SPC is available from the Marketing Authorisation Holder: Rowex Ltd., Bantry, Co. Cork, P75 V009 Freephone: 1800 304 400 Fax: 027 50417 E-mail: rowex@rowa-pharma.ie

Also as part of the agreement, Healios has been granted a right of first negotiation regarding an exclusive option for a license to develop and commercialize MultiStem therapy for certain indications in China, and the potential inclusion of an additional indication to the Japan license.

ATHERSYS ANNOUNCES EXPANSION OF COLLABORATION WITH HEALIOS Athersys, Inc. (NASDAQ:ATHX) announced that it has entered into an agreement with HEALIOS K.K. ("Healios") to expand their collaboration into additional therapeutic areas. Under the terms of the agreements, Healios obtained exclusive licenses for the development and commercialization in Japan of MultiStem® therapy for the treatment of acute respiratory distress syndrome ("ARDS") and of MultiStem cells used in combination with iPSC-derived cells for the treatment of certain organs. Healios also received an exclusive global license to develop and commercialize MultiStem cells, either as a standalone therapy or in combination with retinal pigmented epithelial ("RPE") cells for certain ophthalmological indications, and an expansion of its license to use Athersys technology to support its organ bud programs to include other transplantation areas. In exchange, Athersys receives $20 million in license fees, comprising $10 million paid from an escrow account established with the letter of intent signed in March 2018 and four installments of $2.5 million each to be paid in this and the next three quarters. As part of the agreement, Athersys may also receive up to approximately $360 million in aggregate development and commercialization milestones for the licensed programs, as well as tiered double-digit royalties on MultiStem therapies developed for ARDS, and single-digit royalties for other licensed products. Under the terms of the agreement, Healios will also receive a credit of $10 million to be used against certain future development milestones and a

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NEW NOVARTIS PHASE III DATA FOR BROLUCIZUMAB DEMONSTRATE RELIABILITY OF 12-WEEK TREATMENT INTERVAL Novartis announced new positive brolucizumab (RTH258) data in neovascular age-related macular degeneration (nAMD) from a prespecified secondary analysis of the Phase III HAWK and HARRIER trials. The findings showed that patients assessed as appropriate for a 12-week treatment frequency during the first 12-week cycle after loading could reliably stay on that quarterly interval through week 48. This is the first time a high level of reliability has been prospectively demonstrated for a pre-specified secondary endpoint of a 12-week dosing interval with an anti-vascular endothelial growth factor (VEGF) therapy in Phase III trials. These additional data were presented at the Association for Research in Vision and Ophthalmology (ARVO) 2018 Annual Meeting, in a follow-up to data presented in November 2017 at the American Academy of Ophthalmology. The new findings showed that brolucizumab 6 mg patients who were suitable for 12-week treatment intervals during the first 12-week cycle after the loading phase had an 87% (HAWK) and 83% (HARRIER) probability of remaining on this quarterly treatment interval through week 48. The ability to reliably assess the likelihood of patients remaining on quarterly dosing could help physicians and patients better manage, personalize and optimize treatment plans.

CLINIGEN SIGNS EXCLUSIVE SUPPLY & DISTRIBUTION AGREEMENT WITH LUKARE FOR ELLIOTTS B® SOLUTION Clinigen Group plc (AIM: CLIN, ‘Clinigen’), the global pharmaceutical and services company, has signed an exclusive agreement with Lukare Medical (‘Lukare’) to manage the supply and distribution of Elliotts B® Solution. Under the terms of this supply and distribution agreement with Lukare, Clinigen will provide physicians and pharmacists with access to Elliotts

B® Solution on an unlicensed, on-demand basis for patients around the world, excluding the US and Canada. Marketing authorisation is granted in the United States, but Elliotts B® Solution is currently unavailable to meet patient needs elsewhere in the world. Elliotts B® Solution (buffered intrathecal electrolyte/ dextrose injection) is a diluent for methotrexate sodium, a chemotherapeutic drug and immune system suppressant, and cytarabine, a chemotherapeutic drug. These products require intrathecal administration (into the cerebrospinal fluid) for the prevention or treatment of meningeal leukaemia or lymphocytic lymphoma. Julie Gosper, Head of Global Access, Clinigen, said: “We look forward to working with Lukare Medical to make Elliotts B® Solution available on an unlicensed basis outside the US and Canada. This partnership demonstrates our ongoing commitment to supply the right medicine to the right patient at the right time, to improve the quality of people’s lives around the world.” Edwin Hernandez, CEO, Lukare Medical, said: “We are pleased to form this partnership with Clinigen. This relationship will greatly enhance our ability to make Elliotts B® Solution available to other regions of the world. We are confident many patients and researchers will benefit from the opportunity to use Elliotts B® Solution.” Healthcare professionals can obtain details about Elliotts B® Solution by emailing globalaccess@ clinigengroup.com or by visiting http://www.lukaremedical.com.

AMGEN WILL MAINTAIN ITS DOMINANCE IN THE PREVENTATIVE MIGRAINE SPACE WITH THE LAUNCH OF AIMOVIG, SAYS GLOBALDATA Amgen’s Aimovig (erenumab) is forecast to be the top-selling drug in the migraine market by 2026, generating nearly $1.4bn in sales in the seven major markets (7MM*), according to GlobalData, a leading data and analytics company. Aimovig was recently approved by the FDA for the prevention of migraine; which was scheduled to launch in the US in May 2018, securing the first-to-market position within a new class of drugs for migraine, the calcitonin generelated peptide (CGRP) receptor antagonists. Although Teva, Eli Lilly, and Alder are closely following Amgen with their respective anti-CGRPs, Amgen is expected to maintain its dominance in the preventative migraine space. According to GlobalData’s report ‘PharmaPoint: Migraine’, besides

being the first and only monoclonal antibody specifically designed to prevent migraines, Aimovig is also the only fully human monoclonal antibody in contrast, Teva’s, Eli Lilly’s, and Alder’s anti-CGRPs are humanized and as such, Aimovig may be viewed as a safer and the preferable option to physicians.

VIIV HEALTHCARE RECEIVES EU MARKETING AUTHORISATION FOR JULUCA (DOLUTEGRAVIR/ RILPIVIRINE), THE FIRST 2-DRUG REGIMEN, ONCE-DAILY, SINGLE-PILL FOR THE TREATMENT OF HIV

ViiV Healthcare, the global specialist HIV company, majority owned by GlaxoSmithKline, with Pfizer Inc. and Shionogi Limited as shareholders, has announced that the European Commission has granted marketing authorisation for Juluca (dolutegravir 50mg/ rilpivirine 25mg) for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen for at least six months with no history of virological failure and no known or suspected resistance to any nonnucleoside reverse transcriptase inhibitor or integrase inhibitor. Juluca is a 2-drug regimen of dolutegravir (ViiV Healthcare), the most widely prescribed integrase inhibitor worldwide, and rilpivirine (Janssen Sciences Ireland UC, part of the Janssen Pharmaceutical Companies of Johnson & Johnson). Deborah Waterhouse, CEO ViiV Healthcare said, “The European Commission Decision for Juluca is very positive news for people living with HIV (PLHIV) across Europe, who will now have the opportunity to maintain their viral suppression with a complete treatment regimen composed of only two drugs within a single-pill. Thanks to advances in treatment, many PLHIV who are on therapy are living longer, with near-normal life expectancies. We listened to their concerns about the potential long-term effects of being on treatment for decades, and have developed a solution aligned with a preference to streamline care by taking fewer antiretrovirals to manage their HIV.”

This approval brings another treatment option to the estimated 810,000 PLHIV in Europe. It follows the Positive Opinion from the European Medicines Agency’s (EMA) Committee for Human use of Medicinal Products (CHMP) on 22 March 2018. Juluca was approved by the US Food and Drug Administration (FDA) in November 2017 and Health Canada on 18 May 2018.


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