May 2019 Volume 11 Issue 5 PHARMACYNEWSIRELAND.COM
THE INDEPENDENT VOICE OF PHARMACY
In this issue: FOR HEALTHCARE PROFESSIONAL USE ONLY
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NEWS: Pharmacists react to FEMPI reversal Page 5
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FEATURE: Skin Cancer in Pharmacy Page 35
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Supporting you to support parents IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding should continue for as long as possible. Infant milks are suitable from birth when babies are not breastfed and should only be used on the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist, or other professionals responsible for maternal and child care. SMA® Wysoy® milk-free formula is intended to meet the nutritional needs of babies and children who are intolerant to cows’ milk protein, lactose or sucrose. Soya infant formulae are not recommended for preterm babies or those with kidney problems, where medical guidance should always be sought. The following products must be used under medical supervision. SMA® Anti-Reflux is a special formula intended for the dietary management of bottle-fed babies when significant reflux (regurgitation) is a problem. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 12 months of age. If the baby’s reflux does not improve within 2 weeks of starting SMA® Anti-Reflux, or if the baby fails to thrive, the family doctor should be consulted. SMA LF® is a lactose-free milk-based formula for the dietary management of babies and young children who are intolerant to lactose or sucrose, or who are experiencing symptoms such as diarrhoea, tummy ache or wind caused by temporary lactose intolerance. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. SMA LF® is not suitable for those who are allergic to cows’ milk protein, or who suffer from galactosaemia or require a galactose free diet. SMA High Energy® is a milk-based formula for the dietary management of babies and young children with medically determined high energy requirements as identified by a healthcare professional. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. SMA High Energy® is not intended for use with preterm babies, for whom fortified breast milk or a low birth weight formula such as SMA Gold Prem® 1 is more appropriate. Learn more:
Reg. Trademark of Société des Produits Nestlé S.A.
Management of Parkinson’s Disease Page 49
AWARDS: Irish Pharmacy Awards 2019 – The Finalists Page 53
TRADE: United Drug Pharmacy Show Page 83
UK 0800 081 81 80 www.smahcp.co.uk ROI 1800 931 832 www.smahcp.ie ®
Rose McGrath: An Appreciation Page 9
SMA® Nutrition Ireland
...and thatâ€™s a wrap United Drug would like to take this opportunity to thank the Pharmacy Profession of Ireland who helped
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make The 2019 United Drug Pharmacy Show a huge success. We really hope that you all enjoyed it as much as we did. It really does go to prove that united, we do better!
Page 5: Pharmacists insist on FEMPI cut reversals
Following the news that the Government is committed to reversing cuts to GP fees during the recession, the Irish Pharmacy Union has demanded same for community pharmacists.
Page 6: James Joyce famous Chemist to fundraise
There are currently over 1800 community pharmacies delivering services to patients throughout the country each of which bear the scars of FEMPI, which removed ¤1.4 billion in revenue from pharmacy between 2009 and 2017.
Page 9: Industry pays tribute to Rose McGrath
Page 12: Funding allocated for antimicrobial resistance
In other news, the team at IPN were saddened to learn of the death of Rosemary McGrath, a well known and hugely respected face across the pharmacy industry both within United Drug and, latterly, McCartans Pharmacy Group.
Page 22: Pharmacy customers connect with retail Page 83: Record numbers for UD Pharmacy Show
This issue also carries all the eagerly awaited details for the 2019 Irish Pharmacy Awards Finalists. The quantity and quality of submissions this year surpassed all previous years. Our esteemed judging panel had a very difficult task in short listing over 120 final submissions.
MANAGING DIRECTOR Natalie Maginnis email@example.com EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 firstname.lastname@example.org
CONTRIBUTORS Eamonn Brady, MPSI DESIGN DIRECTOR Ian Stoddart Design
Paul Reilly, CEO of United Drug said of Rose, “She had the vision, the commitment, the energy and the respect of the Industry to ensure that her idea become a reality and a huge success. She knew customers wanted an opportunity to engage directly with manufacturers to talk business and to learn about new products and services. We made the Pharmacy Show happen under her stewardship.” Turn to page 9 for an Appreciation of Rose featuring comments from those she worked with and made an impact on.
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Commenting on the news, Darragh O’Loughlin, Secretary General of the IPU said, “We note the reports regarding the reversal of FEMPI cuts for GPs. This is a positive step towards restoring funding into primary care. This restoration must be delivered in an equitable fashion to other professions that experienced cuts including community pharmacists.” The full story is available on page 5.
83 Irish Pharmacy IRISH News is PHARMACY circulated to all NEWS independent, multiple Pharmacists and academics in Ireland. 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 or 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.
From page 53 we feature those who have successfully been shortlisted, representing a broad spectrum of fields; from innovation and business development, to the rising stars of the profession and the teams and individuals making a difference. We look forward to seeing you all on Saturday, May 18th for what will be a tremendous night of recognising and rewarding excellence and innovation in Ireland’s community pharmacy arena.
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HIV drug ‘safe, effective and cost saving’ The Health Information and Quality Authority (HIQA) has concluded a drug which helps prevent HIV would be “safe, effective and cost-saving” if provided by the public health service in Ireland. The State watchdog was asked to assess the cost of introducing a national scheme to provide the drug, PrEP, which is currently available but at a high cost. In a draft report, HIQA said PrEP had been found to be “highly effective” in preventing HIV acquisition among gay and bisexual men, with a risk reduction of 75% across all medical trials. Taoiseach Leo Varadkar TD and Minister for Health, Simon Harris TD welcomed the publication of a draft report by HIQA, which will now commence a public consultation for five weeks before presenting its final report for the Minister. Welcoming the announcement, the Taoiseach said, “This report not only confirms that PrEP can help to prevent HIV amongst those who are high risk, it also shows how a PrEP programme could save money. A PrEP programme involves the pre-emptive use of antiretroviral medication to prevent HIV
infection, within a holistic service which includes regular monitoring and testing, as well as advice and counselling on safer sex practices. Similar programmes have recently been introduced in a number of other countries. Health Minister Harris added, “Considerable work is already underway in the HSE to prepare for the introduction of a PrEP programme that meets appropriate standards. I encourage interested parties and members of the public to give their feedback on the draft report during the consultation process which runs to 28th of May, and I thank HIQA and the various experts and stakeholders for their work so far. I look forward to receiving HIQA’s formal advice when the report is finalised after the consultation process.” In a statement, Teva Pharmaceuticals Ireland welcomed the report stating, “In December 2018, Teva was the first company to make generic PrEP (Emtricitabine / Tenofovir disoproxil
Teva) available to Irish patients through community pharmacies across Ireland. “Today’s recommendation that PrEP should now be publicly funded and available to all eligible patients, and not just private patients as is currently the case, is particularly positive in ensuring that financial means is not a barrier to access. “The rate of new cases of HIV infection in Ireland, almost 500 in 2017, offers the most compelling reason why such a publicly funded programme, which provides not just the medication but supporting healthcare services, is critical at this time. “As a company with an extensive generic medicines’ portfolio, we are committed to ensuring that patients get timely access to the medicines they need, when they need them. We look forward to working with Government and healthcare providers to ensure that such access is available.”
Boots take first steps in Travel Health Boots Ireland has announced that it will be the first pharmacy in Ireland to offer a Travel Vaccination Service for customers travelling to certain long-haul destinations. Caoimhe McAuley, Pharmacy Director Boots Ireland
The Boots Travel Vaccination Service offers protection against a broad range of diseases or infections, which can be found in many exotic or remote travel destinations. It will be available across 10 Boots stores in Ireland, providing customers with convenient access at a time that suits them, with many Boots pharmacies also offering late night and weekend opening hours. The vaccinations will be administered by specially trained pharmacists.
The launch comes as a recent CSO study shows people are travelling more than ever before from Ireland, with 556,000 people making trips overseas in February 2019, up 13% on the previous year. Coupled with the increase in international travel, changes in travel patterns include a continuing trend for visiting remote destinations for longer stays. Visiting exotic holiday destinations like Bali, India and Vietnam can bring travellers into contact with diseases that are rare, or don’t occur in Ireland, meaning vaccinations are recommended ahead of visiting these destinations to ensure protection while travelling. The new service was launched at the beginning of World
Immunisation Week, which started globally on 24 April, and aims to promote the use of vaccinations to protect people of all ages against diseases. Commenting on the new service Caoimhe McAuley, Pharmacy Director Boots Ireland said, “We are very excited to be the first pharmacy in Ireland to offer a travel vaccination service as the interest in visiting exotic and remote destinations is becoming increasingly popular amongst Irish travellers. Protecting the health and wellbeing of our communities is always at the heart of what we do. “Travelling and exploring new destinations is exciting but can also bring risks when coming into contact with diseases that don’t occur or which are not typically seen in Ireland. Thankfully many of these diseases can be prevented by vaccination. We are delighted to be leading the way in encouraging safer travel with our travel vaccination service.”
Pharmacy workforce programme A new programme designed to advance pharmaceutical workforces in Ireland and other countries around the world has been launched. The development of an adaptable, flexible and competent pharmaceutical workforce is key to achieving access to quality essential health services, and safe and effective medicines and vaccines, which, in turn, are fundamental requirements of universal health coverage. It was launched by the International Pharmaceutical Federation (FIP). FIP’s new Workforce Transformation Programme (WTP) is a practical and flexible model, which will: assist countries in assessing their individual pharmacy workforce needs and priorities; support them to develop needs-based national workforce strategies and infrastructure; and provide co-created solutions, tools, mechanisms and resources for implementation. FIP’s member organisation the Jordan Pharmacists Association (JPA) is the first national pharmacy leadership body to join the programme, signing up today in Amman, Jordan. “Investing in the pharmaceutical workforce contributes towards strengthening health systems and achieving universal health coverage by 2030, as outlined in the United Nations Sustainable Development Goals. Our vision is for every country to have a national strategy and action plan for pharmaceutical workforce development,” said Professor Ian Bates, director of FIP’s Workforce Development Hub. “As the capacity of the Jordanian pharmacy workforce continues to increase and demand for quality health care rises to meet complex medicines and diseases, advancing the role of the pharmacists to ensure relevance and capability becomes more important than ever,” said Mr Zeid Al Kilani, President, Jordan Pharmacists Association. FIP CEO Dr Catherine Duggan added, “FIP believes that the pharmaceutical workforce around the world requires a global vision with clear and consensusbased objectives consistent with global health strategies. FIP’s Workforce Transformation Programme offers a realistic and achievable framework for real transformation.”
News PSI Election Results The Returning Officer Niall Byrne has declared the following four pharmacists as elected for appointment to the Pharmaceutical Society of Ireland (PSI) Council:
Pharmacy demands FEMPI fee reversal The Irish Pharmacy Union (IPU) while welcoming the reports of a new deal which sees the Government commit to reversing cuts to GP fees during the recession, has demanded a similar immediate reversal of cuts in fees to pharmacists. Darragh O’Loughlin, Secretary General, IPU
• Roy Hogan • Muireann Ní Shuilleabháin • Mark Jordan • Johanna Kissane The Returning Officer shall give notice in writing to the Minister for Health of those pharmacists that have been selected. The Minister is responsible for approving all appointments to the PSI Council. The counting of votes in the 2019 election of pharmacists for appointment to the PSI Council took place on Thursday, 18 April 2019 at PSI House.
Heart Failure Study Almost half of Irish adults surveyed for a new campaign mistakenly believe that heart failure means that the heart stops beating, confusing the condition with a cardiac arrest. According to the results of a new survey carried out on behalf of the Irish Heart Foundation by Ipsos MRBI between 28th February and 14th March 2019, 49% of those surveyed believed that heart failure meant that the heart stops beating or shuts down. Overall the survey, which was launched to mark the Irish Heart Foundation’s new campaign entitled ‘Don’t Ignore the Signs of Heart Failure’, revealed that the majority of adults in Ireland do not fully understand heart failure; a condition that affects 90,000 people here. The results also revealed that just 23% were aware that heart failure means that the heart does not pump blood as well as it should. More than half or 61% of those surveyed were unaware that swollen ankles were one of the key warning signs for heart failure, 90% were aware that shortness of breath can be a warning sign of the condition and 34% did not identify fatigue as a symptom associated with heart failure.
Commenting on the news, Darragh O’Loughlin, Secretary General of the IPU said, “We note the reports regarding the reversal of FEMPI cuts for GPs. This is a positive step towards restoring funding into primary care. This restoration must be delivered in an equitable fashion to other professions that experienced cuts including community pharmacists. “There are currently over 1800 community pharmacies delivering services to patients throughout the country each of which bear the scars of FEMPI, which removed ¤1.4 billion in revenue from pharmacy between 2009 and 2017. “With FEMPI now being reversed and pay restored for public servants and GPs it is essential pharmacists are not treated differently. We expect urgent engagement with the Department of Health on this matter and look forward to working constructively
with them to deliver real reform for patients and communities in Ireland.”
recommended fees to pharmacists be re-examined,” he said at the time.
At the IPU conference last year, the FEMPI cuts came under strong criticism from President Daragh Connolly as he highlighted the risk to the sustainability of community pharmacies, particularly rural pharmacies and ones based in disadvantaged areas, reliant on State payments for as much as two-thirds of turnover.
“That review recommended that payments to pharmacists be linked to Government health priorities and the expansion of services. We have enthusiastically embraced this opportunity and delivered on every commitment asked of us.
“It is almost 2 years since the Government’s own FEMPI review
“In spite of this we have been left out in the cold with no sign as to when these disproportionate cuts will be alleviated.”
Myths about Vaccinations must be Dispelled On World Immunisation Week, pharmaceutical innovators have come out to say it’s vital to take steps to reduce vaccine hesitancy and to dispel ‘damaging’ myths about vaccination. The organisation representing pharmaceutical innovators has called on the Government to include industry on a new alliance aimed at improving vaccination rates. The Irish Pharmaceutical Healthcare Association (IPHA), which represents the research-based pharmaceutical industry, said it was vital to take steps to reduce vaccine hesitancy and to dispel “damaging” myths about vaccination. As World Immunisation Week starts today [Wednesday], IPHA welcomed the initiative by the Minister for Health, Simon Harris TD, to form an alliance to promote the take-up of vaccinations. But industry should be represented on the group, according to IPHA, along with medical professionals, educators, parents, patient advocates and policymakers.
IPHA has launched a social media campaign, #VaccinesWork, aimed at raising public awareness about the importance of vaccination. The WHO estimates that vaccines save up to three million lives each year. With the exception of clean, safe drinking water, vaccination is one of the most successful and cost-effective public health interventions ever. However, its success is increasingly under threat as vaccination rates continue to fall below the required 95% uptake rate to ensure ‘herd protection’. A direct result of this is an increase in the number of global outbreaks of serious diseases such as measles. The best way to protect populations against these diseases is to vaccinate directly. IPHA Chief Executive, Oliver O’Connor, said all stakeholders, including industry, must work
together to ensure people make decisions about vaccinations based on facts. “Vaccines work. They save lives and protect the wider community. We welcome the announcement by Minister Harris that he intends to establish an alliance of likeminded stakeholders to tackle misinformation and lay out the facts about the benefits of vaccination. Our industry, which develops vaccines, is strongly placed to support that initiative. We look forward to being part of it.” “We hope World Immunisation Week and our social media campaign help to drive awareness of the benefits of vaccination and encourage people to play their part in stopping the spread of vaccine preventable diseases,” said Mr O’Connor.
Ulysses Dublin Chemist begins fundraising A 172 year-old Dublin chemist which featured in James Joyce’s novel Ulysses has begun fundraising to help pay for its rent after it was significantly increased. Sweny’s Pharmacy Volunteer P.J. Murphy
visitors about the history of the shop and of Dublin, and sell the same lemon soap which Leopold Bloom buys in Ulysses. Up until last year, the chemist was able to pay the rent out of soap sales and visitors’ donations. However, Sweny’s has said the rent was doubled last July, meaning that it increased by approximately ¤1,500 per month. In order to be able to keep up with the increased rent, the pharmacy has set up a Patreon account to raise money. For creators, Patreon is a way to get paid for creating the things they’re already creating. For patrons (people who sign up to donate), Patreon is a way to support and pay the creators for making their products.
Every day, the volunteers host open readings from James Joyce’s work in the building
Sweny’s Pharmacy, located at 1 Lincoln Place in Dublin 2, first opened in 1847. Its interior has been unchanged since. Since 2009, Sweny’s has been entirely maintained by volunteers who
give their time for free, dedicated to preserving the soul of the shop as it was in Joyce’s time. Every day, the volunteers host open readings from Joyce’s work in the building. They also inform
Speaking of what it would mean if the shop was to shut down, volunteer PJ said: “It would have a huge impact because it’s a great, fun place to be in and to be working in because you get people from all over the world. We made many friendships in the past 10 years.”
Pharmacy Call for Abstracts The All Ireland Pharmacy Conference 2019 will be held at Ballymascanlon House Hotel, Dundalk on 14th-15th October this year. This conference is jointly coordinated by the Northern Ireland Centre for Pharmacy Learning and Development and the Irish Institute of Pharmacy. Its focus is to share good practice in pharmaceutical care and practice development across the primary and secondary care sectors. Pharmacists, technicians and qualified assistants will be encouraged to exchange ideas for pharmaceutical service development in the Republic of Ireland and Northern Ireland. On the evening of Monday 14th October 2019 the conference dinner will take place at 8.00pm and provides an opportunity to network with colleagues. The main conference proceedings will start at 9.30am on Tuesday 15th October 2019 with a keynote address by Dr Catherine Duggan (CEO International Pharmaceutical Federation (FIP)) focused on policy formation for clear and manageable strategies to implement comprehensive needs-based development of the pharmaceutical workforce. The remainder of the conference will involve parallel oral sessions and poster presentations. The conference is themed around the FIP Pharmaceutical Workforce Development Goals. Abstracts are invited that deal with a broad range of pharmacy practice, including (but not limited to) the following areas:
Stemming the tide of rising drug prices
• Competency development (FIP Goal 5)
The third Annual Access to Medicines conference took place as Irish Pharmacy News was going to print.
• Advanced practice & specialisation (FIP Goal 4)
The conference brought together patient advocates, business leaders, NGOs, representatives from pharmaceutical companies, as well as a diverse range of medical and global health experts to address the problem of spiralling drug costs which threatens to bankrupt health care systems and deny patients access to essential medicines. The conference explores alternative research and development models that will ensure that medicines are made accessible at a fair price and that resources are directed at areas of greatest global health need.
In recent years, Irish patients have become entangled in difficult and protracted battles for drugs such as Orkambi, Spinraza and Pembro. The economic challenge is set to increase greatly once new and very effective cancer treatments come on stream. The conference keynote speaker was Professor Michael Barry, Clinical Director of the National Centre for Pharmacoeconomics (NCPE). Ahead of the conference he sounded the alarm that the available budget for new drugs was virtually exhausted less than two months into 2019. In his address he outlined the dilemmas
likely to face the Irish health system in the coming years. “It is clear, that unless addressed, the current system of medicines development will continue to heap financial pressure on strained health systems and put pressure on governments to reimburse medicines at any price. It will unfortunately also continue to deny patients access to essential medicines,” says Dr Kieran Harkin of Access to Medicines Ireland, a Comhlámh membership group of medical professionals, patients and concerned members of the public.
• Workforce impact (FIP Goal 11) • Working with others (FIP Goal 8) Abstracts can be submitted at www.iiop.ie/aipc2019abstracts Applicants should clearly indicate the corresponding and presenting author(s) and whether they wish their abstract to be considered for poster or oral presentation (10 minutes plus 5 minutes for questions). The closing date for receipt of abstracts is Friday 10th May 2019 and authors will be notified regarding acceptance by Friday 21st June 2019.
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Rosemary McGrath An Appreciation T
he wider pharmacy industry throughout Ireland was saddened to learn of the death of Rosemary McGrath at the end of last month. Rosemary McGrath
Described as a visionary and shining light, an individual with huge commitment, energy and dedication, Rose – as she was affectionately known – passed away after a short illness at the Mater Hospital. This year at the United Drug 13th Pharmacy Show, Managing Director Paul Reilly made a dinner speech at the Ballsbridge Hotel to approx. 500 guests. His speech was dedicated to Rose and the impact she had made to United Drug and indeed the wider Pharmacy Sector. He highlighted that the Pharmacy Show had been Roses idea thirteen years ago and is now established as Ireland's premier retail pharmacy event. For this month’s profile piece, we pay tribute to the work of Rose and reflect on how the tremendous difference she made not only to the pharmacy sector, but to those within in it. Rose’s contribution to United Drug Rose started in United Drug on the 11th September 1972 – on a temporary basis as was typical of that time. During her tenure, Rose played a significant role in evolving the Business over the subsequent 44 years. Rose came from Cahills and her role was that of order taking unfortunately the United Drug
archives struggled to furnish the correct title – based in Distillery Road, Dromcondra. Paul Reilly, CEO of United Drug reflects fondly, “Rose also came decked out in her stylish wooden Scholl sandles and was the envy of all. “Nights in Meaghers Log Cabin and the night her handbag fell into the Tolka will be remembered by all with great humour and affection.” The business moved to Glasnevin in 1976 and there Rose was appointed supervisor of TeleSales and subsequently Sales Manager. “She decided that it was time to purchase a small green Fiat 127 and she was most generous in letting everyone pile into the back of the car,” Paul adds. It was also here that Rose embraced the introduction of the ‘computer’ and got to use one for the first time – since then she proved to be an early adopter of all things technology related. It wouldn’t have been unheard of for Rose to upgrade her phone numerous times in a short period. By 1992, the United Drug business had grown to such an extent that a bigger facility was required and the business moved to Belgard Road. It was also here that Rose was appointed General Manager of UD Wholesale for the Leinster Region.
Profile “Rose’s ability to mentor and motivate was well known within the Customer Service Teams in Dublin, Limerick and Ballina. She would gather people around and say ‘we are going to row the boat together and get through the rough sea.’ 10 years on I have a caption that our departed colleague Regina gave Rose and I...Sometimes in the winds of change we find our true direction” Leonora Kinsella, Strategy, Planning & Development United Drug
Rose was the first ever female appointed General Manager in the pharmaceutical sector. Subsequently the business, and Rose moved to its current building in Magna Park. From this point Rose continued to drive the business onwards with many leading initiatives, including but not limited to, the PLC, Ostomy service, Unlicensed medicines and The Pharmacy Show. “There are two strong themes that shine through when I reflect on why Rose had such success,” continues Paul. “Firstly, she always placed the customer at the centre of what she and the business was about. Secondly, she placed a huge value on people and building relationships with those people. “On a personal note, Rose was a huge support to me as I began my learning curve within United Drug and indeed within this industry.
“When we began the ¤15m automation upgrade in Magna Park, every Tuesday morning Rose was there at the 8am meeting supporting the team and the business as we transformed the operation. To me when I think of Rose – I think of a Diamond. “She shone brightest in the light and was toughest of all under pressure.” Having a ‘Rose’ Vision This year at the United Drug 13th Pharmacy Show Paul Reilly made a dinner speech honouring Rose. He said, “She had the vision, the commitment, the energy and the respect of the Industry to ensure that her idea become a reality and a huge success. She knew customers wanted an opportunity to engage directly with manufacturers to talk business and to learn about new products and services. We made the Pharmacy Show happen under her stewardship.
“To me when I think of Rose – I think of a Diamond. She shone brightest in the light and was toughest of all under pressure” Paul Reilly, CEO, United Drug
“As a colleague Rose was fiercely competitive, tenacious, a brilliant networker and wonderful talent spotter. She often reminded me she only backed winners! Customers of United Drug were also her great friends and her social and business life almost merged into a single entity. “The fact remains that people do business with people and it is my responsibility, our responsibility to ensure we maintain strong legacy and relationships that Rose has created.”
person who continually sought to understand before being understood, what I learned from her has helped me so much as a business owner, a leader of a team and as a professional. She imprinted the idea on me, to always listen and attempt to see the other persons point of view before shaping an opinion on any situation. Rosemary was the very definition of a practical, strong, unshakeable woman. She gave so much and asked for so little in return.
“I will always be eternally grateful for the fact that Rosemary McGrath came into my life at the beginning of my career as a pharmacy owner. While we were originally brought together for business purposes I soon began to think of her much more as an exceptional friend than a business associate.
“She was a problem solver, a steady hand who was rational, cool under pressure and always out for people first. Rosemary was often my first call when things got rough, she could be counted on for guidance and to put any situation into perspective. I am so grateful to have had the gift of her mentorship, her support and her friendship over the many years I knew her. She probably won’t remember half the learnings she gave me, that I will never forget.
“Rosemary was the eternal connector of people; she had a skill for it. She was a people
“I have never met someone as equally impressive, grounded, intuitive and smart as Rosemary.
Oonagh O’Hagan, Managing Director, Meaghers Pharmacy Group
11 The Pharmacy industry has lost a truly special woman, she was a blessing for so many of us. “I have tremendous gratitude for the time I was able to spend in Rosemary’s company, sharing ideas, plans and lots and lots of laughter. I, like so many others will miss her terribly, she made a real impact on me as a business leader but also as a person. I can only hope to be half the woman she was in business. “Thank You Rose, your beautiful soul will always be loved, never forgotten and forever missed xx Oonagh.” Eoin McCartan, Superintendent Pharmacist, McCartan’s Pharmacy Group
Rose and Oonagh, Croke Park Tyrone versus Dublin down to earth attitude was what everyone warmed to. During shop refits Rose would be seen among work men covered in dust giving a vital supply of coffee to ensure the job was done and then shake the dust off and be in a meeting a few minutes later. “She was able to look at problems from a different perspective and work to find the best solution for everyone and if the solution included tea, coffee or a night out then all the better for it. I have two stories that sum Rose up;
“How do you put Rose on paper? Do you talk about Rose the colleague or Rose the friend? It’s only when you think like this you realise how much these qualities overlap. Respect, Trust, Caring, Loyal, and always there when you need her.
“I met her for lunch one day to introduce her to my daughter Clara Rose and quickly she took a photo and sent it to Brian with the caption, ‘When the cats away the mice will play’ and rubbed her hands in glee when his name came up her on phone.
“As Northy GAA people in Dublin, Rose can only be described as the Mícheál ó Muircheartaigh of the pharmacy industry; she knew everything about everyone, who they worked, how long for, where they completed their pre-reg, did they (or any of their family) play county minor.
“She rang me one morning saying she had something important to tell me and needed to speak to me in person before I went into any shop. So I met her in a coffee shop at 8.30am in Northside worrying the whole way there. When I arrived she was sitting in the middle of the coffee shop with a cake, birthday balloon and a badge and simply said, ‘Happy birthday’ and gave me a big hug.
“Rose started with the McCartan’s Pharmacy Group three yearsago and quickly became an irreplaceable cog in the wheels. During that that time she made a connection with every member of staff, always seeing the best in everyone. She loved bringing people together both inside and outside of work. No matter how much else was going on, Rose always had time to talk, normally over tea and a biscuit (that she wasn’t supposed to have). “No job was too big or too small for Rose and this hardworking
“Rose McGrath - what can I say? A rose without a thorn a heart as big as a house. Rose brought me into United Drug 26 years ago and since my mam passed away 6 years ago she took over the role of being my second mother. Always there to advise and help me in every way, she was my rock. I am so lucky to have had her in my life. She has left a void that no one can fill. I cannot imagine life without her, but I know she’ll be my guardian angel now. Rest in peace” Bridget Doyle, Customer Service Liaison Officer, United Drug
“What I will miss most about Rose is her bobbin hats, her colourful trainers, her big smile, her mischief and how she rubbed her hands together when the craic was good. “Rose we all miss you every day. From everyone at McCartan’s.”
Eoin McCartan with Rose McGrath and family
“I have known Rose over 25 years and in that time reported directly to her for seven of those years. In my time working with Rose we became true friends and I don’t believe we ever had a falling out, just some colourful conversations. It is very difficult to capture Rose as a person in a few lines but I think one word that goes some way is loyal. Rose was loyal to her family, friends, customers, company and colleagues. She was always considerate, supporting, professional and fun. Rose had a great gift of making lasting friendships with everybody she encountered and will be dearly missed. Rest In Peace”
“My memories of Rose. Rose helped so many people out in so many ways and was always willing to give to others. She treated everyone equally and made everyone feel important. Without Rose I might possibly not be working in UD and for that I will always be grateful. The two things she said most to me were; the glass is always half full, and I was like, a dog with a bone. Thanks for everything Rose you will he missed but not forgotten”
Leonard Manley, Business Development Manager, United Drug Wholesale
Veronica Carragher Business Development Manager United Drug Wholesale
¤7 million for antimicrobial resistance An allocation of €7 million for antimicrobial resistance (AMR) measures in the health service has been announced, as it was revealed the funding will be used for infection prevention and control teams in both the community care and acute hospital settings in 2019. This includes €2 million allocated in 2018 and a further €5 million for 2019. Newly appointed Director of the National Patient Safety Office, former Chief Pharmaceutical Officer Marita Kinsella
Newly appointed Director of the National Patient Safety Office, former Chief Pharmaceutical Officer Marita Kinsella, says, “AMR is a significant challenge to medicine and society as a whole. Prevention of infection and appropriate management when it does occur is a cornerstone of patient safety.” Minister for Health Simon Harris TD said, “I am delighted to announce this significant targeted investment to increase our public health system’s capacity to tackle AMR and healthcare associated infections, including the superbug CPE. “This represents a significant step forward in funding our infection control teams in hospitals and community care settings.” He continued, “Ireland is standing up and playing its part in tackling the global threat of AMR in our health services and in health
services around the world. As the World Health Organisation has emphasised, managing the AMR crisis is of the utmost urgency and the Government is doing exactly that. We are building infection prevention and control teams both in hospitals and in the community to reduce the spread of infection and disease, enhance surveillance and optimise the use of antimicrobials such as antibiotics.” The National Public Health Emergency Team (NPHET) was convened as a result of the activation of the Public Health Emergency Plan, on 25 October 2017, by the Minister Harris as a public health response to CPE in Ireland. The purpose of the NPHET has been to provide advice, guidance, support and direction on the surveillance and management of CPE at national level. Over the last eighteen months, a number of measures have been put in place and the Department of Health and the HSE will continue to work closely together on this. The Chief Medical Officer, Dr Tony Holohan, who chaired the NPHET,
added that, “The NPHET sought to develop and implement a strategy to contain CPE. I am pleased to say that we have come a long way in overseeing the health system’s response to CPE. “This funding is key to ensuring a sustainable response in Ireland to healthcare associated infections and antibiotic resistant organisms, including CPE.” Throughout its work on this issue, the NPHET has implemented strong governance arrangements for healthcare associated infections (HCAIs) and AMR within the HSE. The NPHET has also driven enhanced surveillance of HCAIs and built capacity within the system for the challenges associated with these threats. Many guidance documents have been developed by the Expert Group convened by the NPHET which provide expert advice to hospitals and the community health care services regarding actions that should be taken regarding CPE screening and control of spread of CPE. The next phase of work focuses on the HSE implementation and operationalising of measures to address CPE and other HCAIs. While the number newly diagnosed CPE patients has slightly increased, this is in the context of substantially increased screening activity.
World Pharmacists Day 2019 “Safe and effective medicines for all” is the theme of this year’s World Pharmacists Day, which falls on 25 September, the International Pharmaceutical Federation (FIP) announced. The theme for 2019 aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors. “Studies show that a significant number of patients are harmed during health care, resulting in permanent injury, increased length of stay in healthcare facilities, or even death. Medication errors are a contributing factor to this and pharmacists have a vital role in curtailing this global health challenge,” said FIP President Dominique Jordan.
“Pharmacists use their broad knowledge and unique expertise to ensure that people get the best from their medicines. We ensure access to medicines and their appropriate use, improve adherence, coordinate care transitions and so much more. Today, more than ever, pharmacists are charged with the responsibility to ensure that when a patient uses a medicine, it will not cause harm,” Mr Jordan added. FIP’s member organisations and others around the globe use World Pharmacists Day to highlight
the value of the pharmacy profession to stakeholders, and to celebrate pharmacy. The official logo is freely available now, in the six official United Nations languages (Arabic, Chinese, English, French, Russian and Spanish) at www.fip.org/worldpharmacistsday. FIP is working on an app that pharmacists can use to amplify World Pharmacists Day messages.
Access to Medicines for NCDs At the invitation of Chair of the Joint Committee on Health, Michael Harty, experts from the Trinity Centre for Global Health hosted a seminar recently to present international evidence for access to medicines for noncommunicable diseases (NCDs). The chief aim of the seminar was to support the capacity of the Houses of the Oireachtas to engage in knowledge-based decision making in the context of Sláintecare’s prioritisation of non-communicable disease prevention and treatment. Assistant Professor in Global Health at Trinity, Dr Ann Nolan said, “There is no relationship between the cost of research and development and the market cost of drugs. The pharmaceutical industry is largely free to demand the most they can from the market and this has enormous implications for health systems in highincome countries, like Ireland, but particularly in low and middle income countries. “Having played a leading role in the 2030 Agenda for Sustainable Development Ireland must ensure to meet its own targets for sustainable development in health while also supporting our partner countries in sub-Saharan Africa to strengthen systems, staff and skills to respond to the challenges of accessing essential medicines for noncommunicable diseases.” Non-communicable diseases are caused by a combination of genetic, physiological, environmental and behavioural factors. Estimates suggest 40.5 million (71%) of 56.9 million deaths reported globally in 2016 were from NCDs including cancers, cardiovascular diseases, chronic respiratory diseases and diabetes. In Ireland, up to 91% of deaths reported annually are due to NCDs with 29% from cardiovascular diseases; 30% from cancers; 9% from chronic respiratory diseases and 2% from diabetes. Researchers at Imperial College London estimate that Ireland will meet the target of reducing premature deaths by one third in men by 2030, but will not achieve the same target in women until after 2040.
Do you want to increase your team’s knowledge and confidence on vitamins, minerals and supplements? If so, we invite you to join us for the next instalment of Uniphar’s FREE expert-driven product training. Training Dates: Date
Tuesday, 28th May
9.30 – 16.00*
Clayton Hotel Liffey Valley, Dublin
Wednesday, 29th May
9.30 – 16.00*
The River Lee Hotel, Cork
*registration begins 9.30, first speaker at 10.00
Our speakers and what they will cover: Eimear Nee (Pharmacy Trainer, MPSI) Covering AYA, Uniphar’s new Irish vitamins & supplements range Jenny Logan (Product Development & Training Manager) Covering the new probiotic range, CBD oil and an overview of all products from Nature’s Aid Dr Daniel Jones (Director of Research & Development) Covering Zest Active, Revive Junior, Revive Teen and Mastermind Roseanna Gorman (Training Manager) in Dublin & Lorna O’Regan (Product Specialist) in Cork Covering Active Iron’s new ranges for men and women To book your free place at one of these events, contact our Training Coordinator: Jacqui Leonard on email@example.com or (01) 428 7860
Boost for Community Engagement Funding of €1 million has been announced to boost community engagement on health and wellbeing in every county within Ireland. The news came as Taoiseach Leo Varadkar TD, Minister for Health Simon Harris TD and Minister for Health Promotion Catherine Byrne TD launched the 2019 Healthy Ireland campaign. Analysis by the Healthy Ireland Unit in the Department of Health shows that 60% of Irish adults are overweight or obese, with only one in three adults meeting physical activity guidelines or eating enough fruit and vegetables. This year's Healthy Ireland campaign aims to address this by encouraging people to make positive choices to improve their health and wellbeing across three main themes – Healthy Eating, Physical Activity and Mental Wellbeing. The 2019 campaign seeks to raise public awareness of gov.ie/ HealthyIreland as the place to go that brings trusted sources o f information and supports together in one place to help people get started on making healthy changes. Unveiling the new campaign, An Taoiseach Leo Varadkar said,
“When you are trying to switch to a healthier lifestyle, it can be hard to know what to do and even where to start. The Healthy Ireland 2019 campaign aims to help you get the information you need to make positive changes to improve your physical and mental health. Through Healthy Ireland, we are growing awareness in every county to make it easier for you to know where you can make that healthy start in your own community so you can eat better, exercise more and feel better. If you want to get started, check out gov.ie/HealthyIreland for more information.” Speaking at the event, Minister Simon Harris added, “Promoting the health of our population to prevent illness is an essential part of our Sláintecare strategy. Under the Sláintecare Action Plan we will progress a programme to engage and empower citizens in their own health and wellbeing. The new phase of the campaign being launched today will help us get the messages of Healthy Ireland to an even wider audience. The work already underway through Healthy Ireland at national and local level,
including through the growing Healthy Cities and Counties initiative, will be expanded as we seek to engage every family and community in improving the health of the nation.” Dr Tony Holohan, Chief Medical Officer in the Department of Health says, “Improving the health of our population is the ongoing priority for all of us who work in the health system, but it's important to acknowledge that health and wellbeing is also a priority for us as a society. We have made some good progress in implementing Healthy Ireland with significant support from the growing alliance of partners and champions for health and wellbeing across many different sectors, at both national and local level, including local authorities, schools and colleges, workplaces and community groups. A key role for the health system as we move forward is to continue to build capacity in these other sectors so that they can play an even stronger role in leading and sustaining a national movement for health and wellbeing and increasing our collective focus on prevention.”
Allcare Pharmacy hit the airwaves Allcare Pharmacy is set to reach hundreds of thousands of radio listeners across Ireland as the new sponsor of The Ray D’Arcy Show on RTÉ Radio 1. Emma Vaughan Allcare Pharmacist and RTÉ's Ray D'Arcy
“Allcare is a well-loved Irish pharmacy brand supporting families in communities across Ireland,” said Siobhán Flynn, Marketing Director at Allcare Pharmacy. “Our partnership with The Ray D’Arcy Show, which is listened to in communities across the country, is a perfect fit for us. “Investing in the brand through this media partnership is one of the many exciting and innovative developments we are rolling-out in 2019.” The show, which will air on weekdays from 3 p.m. to 4.30 p.m., will feature 25 10-second stings each week. Each sting will highlight all the great things customers and patients experience in Allcare community pharmacies across the country.
As part of the deal, Allcare will also have credited promotions on RTÉ’s other highest-rated shows including Morning Ireland, Today with Sean O’Rourke, Liveline, The Ryan Tubridy Show, Saturday with Cormac Ó hEadhra and Sunday with Miriam.
Allcare Pharmacy is now the largest Irish-owned pharmacy group. It recently expanded the Allcare network through the acquisition of the Bradley group of pharmacies and is planning continued growth through new franchises and acquisitions.
Increase in Sexually Transmitted Infections The HSE Sexual Health & Crisis Pregnancy Programme (SHCPP) is advising people on the importance of using condoms to protect against sexually transmitted infections (STIs) following the publication of the Health Protection Surveillance Centre (HPSC) 2018 report on STIs. Provisional 2018 data from the HPSC indicate a 7% increase in STIs in 2018 compared to 2017, the predominant STIs being chlamydia, gonorrhoea, genital herpes and syphilis. In recent years, the greatest burden of STIs is among young people (aged 15-24 years) and men who have sex with men (MSM). The HSE has implemented a multi-faceted approach in response to the rise in STI and HIV notifications. National responsive safer sex and prevention campaign aligned to #Respectprotect messages for young audiences (18-30years) and Man2man.ie campaign messaging for MSM, have been running across social and digital media. Sexual health campaigns are supported by the HSE National Condom Distribution Service (NCDS), which distributes free condoms and lubricant to third level colleges, festival and nightlife venues, NGOs and community organisations. Condoms are also distributed to MSM specific social venues such as saunas, bars, clubs and pubs. Helen Deely, Programme Lead of the SHCPP advises, “Many STIs do not have any symptoms. Those who think they have an STI or who may have been at risk, it is important to get tested and if necessary, be treated. Treating STIs promptly reduces the likelihood of them being passed onto someone else. This is particularly important for HIV. Starting HIV treatment as early as possible keeps people healthy and stops HIV transmission to others.” STI and HIV testing is available through many GP’s, student health services and NGO’s at a fee. STI and HIV tests can also be purchased in pharmacies.
DONâ€™T LET PAIN HOLD YOU BACK
ESSENTIAL INFORMATION Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Date of preparation: April 2017.
Talking EHC – The Integral Role of Pharmacy Recent research has found that young women are becoming more empowered to make decisions that affect their body by themselves, however, many still believe that there is still a stigma associated with taking the morning after pill. As accessible health care professionals, pharmacists are uniquely positioned to provide educational information, advice and support to consumers seeking information about emergency contraceptives and their appropriate use. In this article, we take a look at what some of the more common barriers to knowledge are, and how community pharmacists and their teams can provide the best in support and advice to this group of consumers. Pharmacists can address consumers’ questions, provide counselling on emergency contraceptive products, and inform women about product availability. Pharmacists should understand the available options of emergency contraceptive products that are available over the counter (OTC), as they are the only direct health care professionals who can advise consumers at the time of purchase. Pharmacists’ knowledge and awareness of emergency contraceptive products that are
readily available in the store is crucial in assisting you, and your pharmacy staff, to help women and address potential barriers to emergency contraceptive use. It is important for pharmacists to not only understand the barriers consumers navigate when purchasing an OTC emergency contraceptive, but also to understand specific needs to appropriately advise emergency contraceptive use. Pharmacists should feel comfortable discussing the events leading to the pharmacy visit, particularly to identify when the event of unprotected intercourse or failed birth control occurred. You should be knowledgeable on what constitutes an incident of unprotected sex, including failed first method of contraception (ie, condom breaking), lack of contraceptive use, and contraceptive misuse. The availability of emergency contraceptive pills from pharmacy without a prescription is critical to increase access and minimise delay of intake. This is especially significant given that emergency
contraceptive pills are more effective the sooner they are taken after unprotected intercourse. Women may also like the anonymity of the pharmacy as they can feel embarrassed about needing emergency contraception. • Pharmacists promote dialogue on contraceptive alternatives and influence the beliefs and the outcomes through effective counselling on EHCs. The supply of emergency contraception from pharmacies can be accompanied by patient education from pharmacists, who have expertise on this topic • Pharmacists provide information to patients at the time of EHC supply, which allows women to understand proper use of this medicine. Pharmacists ensure consistency of information about EHCs, in particular for women less than 17 years of age When EHC is available through pharmacies without a prescription, the use of the medication increases compared to when it is available from doctors, clinics or
hospitals. Increased access to EC through pharmacies does not have a negative impact on the use of other forms of contraception. Studies have shown that women and adolescents with greater access to EC are more likely to adopt an ongoing contraceptive method after EC use.9 Notably, it has been shown that greater level of use through nonprescription availability. Barriers to Access Just last month, ellaOne undertook research to investigate ‘morning after’ behaviour and young peoples’ conversations on emergency contraception. When asked how they felt the morning after unprotected sex, where the contraception failed or no contraception was used, 6 in 10 (61%) young women said they were worried that they could be pregnant, while just one third said they felt confident, knowing what steps to take. In May of 2017 the UK Faculty of Reproductive & Sexual Health
IE/ELLA/0053 Date of preparation: October 2018
NEW ellaOne, the most effective Emergency Hormonal Contraceptive (EHC)1, is changing to a new shield-shaped golden pill and packaging.
Golden shield as a universal symbol of protection and standard of efficacy in EHC Easy to swallow film-coated tablet.2 Visit www.ellaonepharmacists.ie REFERENCES: 1. Glasier A et al. Lancet 2010; 375 (9714): 555-62. 2. HRA data on file: consumer swallowability research 2017
PRODUCT INFORMATION: ellaOne® 30 mg film-coated tablet (ulipristal acetate). Refer to the SmPC for further information. INDICATION: Emergency contraception (EC) within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. DOSAGE: one 30mg tablet taken orally as soon as possible, but no later than 120 hours (5 days) after unprotected intercourse or contraceptive failure. Another tablet should be taken if vomiting occurs within 3 hours of intake. Can be taken at any time during the menstrual cycle. Not recommended for women with severe hepatic impairment. CONTRAINDICATIONS: Hypersensitivity to the active substance or excipients. SPECIAL WARNINGS AND PRECAUTIONS: Occasional use only. Use reliable barrier method after use until next menstrual period. If next menstrual period is delayed >7 days or is abnormal or suggestive symptoms occur then perform pregnancy test. Consider ectopic pregnancy. If pregnancy confirmed, woman should contact their doctor. Concomitant use with EC containing levonorgestrel not recommended. Does not contraindicate the continued use of regular hormonal contraception but reliable barrier method should be used until next menstrual period. Not recommended in severe asthma treated by oral corticosteroids. Concomitant use of CYP3A4 inducers [e.g. barbiturates (including primidone and phenobarbital), phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, herbal medicines containing Hypericum perforatum (St. John’s wort), rifampicin, rifabutin, griseofulvin, efavirenz, nevirapine] not recommended (may decrease efficacy of ellaOne). Long term use of ritonavir not recommended. Not recommended for women who have used enzyme-inducing drugs in the past 4 weeks. Non-hormonal emergency contraception (i.e. a copper intrauterine device (Cu-IUD)) should be considered. Contains lactose. FERTILITY, PREGNANCY AND LACTATION: Not intended for use during existing or suspected pregnancy. Limited human data does not suggest safety concern. Does not interrupt existing pregnancy. No teratogenic potential was observed; animal data insufficient with regard to reproduction toxicity. Marketing Authorisation Holder maintains a pregnancy registry (www.hra-pregnancy-registry.com) to monitor outcomes of pregnancy in women exposed to ellaOne®. Patients and health care providers are encouraged to report any exposure. Ulipristal acetate is excreted in human breast milk; breastfeeding is not recommended for one week after intake. Breast milk should be expressed and discarded. A rapid return of fertility is likely following ellaOne use; regular contraception should be continued or initiated as soon as possible; subsequent acts of intercourse should be protected by reliable barrier method until next menstrual period. UNDESIRABLE EFFECTS: Always consult the SmPC before prescribing. Only the most common side effects and those which are rare but may be serious are listed below. Most commonly reported adverse reactions: headache, nausea, abdominal pain and dysmenorrhea. Common (≥1/100 to <1/10): mood disorders, dizziness, vomiting, abdominal discomfort, myalgia, back pain, pelvic pain, breast tenderness and fatigue. Rare (≥1/10,000 to <1/1,000): ruptured ovarian cyst. RETAIL PRICE: ellaOne 30 mg single film-coated tablet blister pack; € 35. MARKETING AUTHORISATION HOLDER: Laboratoire HRA Pharma, 15, rue Béranger, F-75003 Paris, France. Marketed in Ireland by: HRA Pharma UK & Ireland Limited, Haines House, 21 John Street, Bloomsbury, London, WC1N 2BF MARKETING AUTHORISATION NUMBER(S): EU/1/09/522/003. LEGAL CATEGORY: Medicinal product not subject to medical prescription. Date of last revision of text: October 2018 Adverse events should be reported. Reporting forms can be found at www.hpra.ie or email: firstname.lastname@example.org. Adverse events should also be reported to HRA Pharma UK & Ireland limited on Freephone: 1800 812 984 or email email@example.com
issued an update on Emergency Contraception (www.fsrh-guideline-emergencycontraception-2017). This raised important points about the timing of use for emergency contraception (EC) and what methods are likely to be most effective at which stages of the menstrual cycle. Quite a complex set of recommendations had already been in place concerning the relative efficacies of the three main EC options available in Ireland namely; Copper IUDs, ulipristal acetate (EC-UPA) and levonorgestrel 1500microg (EC-LNG). The following year, in April 2018, the Irish Pharmacy Union (IPU) made its submission to Minister for Health, Simon Harris on improving access to contraception for women. Crisis pregnancy has long been acknowledged as a significant global health, social, and economic problem. It is an area of grave concern with the potential to cause great distress to those affected. A 2003 analysis of CPA and CSO figures revealed that an estimated 136,000 women living in Ireland have experienced a crisis pregnancy in their lifetime. Given the passing of time, that figure is likely to be significantly higher now. The HSE commissioned a study, ‘Irish Contraception and Crisis Pregnancy Study 2010’, which found that: • Nearly half of the women surveyed (47%) reported that they would prefer to get their contraception from a pharmacy, with 37% citing a preference for the GP; • Approximately 1 in 5 men and 1 in 3 women with experience of pregnancy has experienced a crisis pregnancy, a higher proportion than in 2003; • For women, 1 in every 7 pregnancies was a crisis pregnancy, with 1 in 5 crisis pregnancies (21%) resulting in abortion; • The majority of people who experience a crisis pregnancy are in their early twenties. The ICCP-2010 study also found that 15% of women and 9% of men experienced difficulty in accessing contraception, reporting barriers to access such as locality, cost and embarrassment. Although the consultation process can be uncomfortable for both the woman and the pharmacist, it is important to ensure women feel supported and not judged when coming in for help and/or advice on EHC. The best way of doing
“It is important for pharmacists to not only understand the barriers consumers navigate when purchasing an OTC emergency contraceptive, but also to understand specific needs to appropriately advise emergency contraceptive use”
this is by remaining objective, yet understanding and offering the opportunity to speak privately in the consultation room. Pharmacists should ensure the entire team is trained to treat patients with respect and sensitivity to ensure women understand all the choices available to them. Finally it is worth remembering that the woman’s experience starts as soon as she realises she may need help and through until she is assured she is not pregnant. Treatment Considerations In addition to assessing the suitability of the different product for an individual patient, there are other factors which may require addressing when dealing with requests for oral emergency contraception. There are two forms of EHC available to women, those containing levonorgestrel (LNG) and those containing ulipristal acetate (UPA). There are a number of considerations for the supply of EHC: The woman’s perspective It is important to consider any preference or view that the woman may have about her treatment. She is likely to be very anxious, might have had previous experience using EC and may have made an assessment about the amount of risk she wishes to take. As healthcare professionals, pharmacists must do all that they can to understand what’s important to her and avoid making assumptions about her understanding. Is UPA or LNG contraindicated? Neither UPA nor LNG should be offered to women with severe liver dysfunction. UPA is not suitable for women who have severe asthma
treated by oral glucocorticoids or those who have been using ritonavir long term. For those women currently taking or have taken enzyme-inducing medicines in the last 4 weeks, a Cu-IUD should be fitted or a double dose of LNG should be given as the efficacy of UPA and LNG is affected. Severe malabsorption syndromes, such as Crohn’s disease, might impair the efficacy of LNG. Women who are breastfeeding and given UPA should be advised not to breastfeed and to discard their milk for seven days. For LNG, it is recommended that women should avoid nursing for 8 hours but there is no evidence for adverse effects on the infant or lactation. If a woman presenting for EHC has allergies to any ingredients in either type of EHC, or is taking any of the above medications, it is advised that a Cu-IUD is fitted. UPA is suitable for any woman of child bearing age, including adolescents, whereas LNG is licensed for sale for over 16s only. Weight The latest FSRH guidelines note that the efficacy of EHC may be affected by a woman’s weight or BMI. LNG has been found to be less effective in women weighing over 70kg or with a BMI over 26kg/m2 For those women with a higher weight or BMI, UPA can be offered as an alternative if a Cu-IUD is not appropriate or acceptable for women, as it may be less affected by weight. Do you have any safeguarding concerns? Pharmacy professionals and the pharmacy team are well placed to identify people who may be vulnerable, including children. It is important that all pharmacy staff
are aware of, and understand, possible signs of abuse, neglect or exploitation and how to manage these. Any common side effects of taking EHC and what can be done to ease these Both UPA and LNG are generally well tolerated, although some women may experience mild symptoms such as: abdominal pain, headache, irregular menstrual bleeding or nausea. Paracetamol 1000mg can be taken if the woman experiences headache or abdominal pain. EHC can be taken with or without food. Training your Team When women visit their local pharmacy seeking emergency contraception it is essential that the pharmacy team know how to respond, so that women get the help they need to avoid unintended pregnancy. Your team should know: • Your pharmacy offers EHC • Your aim is to offer women EHC in a reassuring way In training sessions you could develop more examples or roleplay the scenarios to build the team’s confidence so they can deal with requests for emergency contraception smoothly. You can encourage your team to make the process of obtaining EHC as least embarrassing as possible. They should recognise that this may be an emotional time for the woman. Other women may ask for EC in a way that may make you or your team members feel uncomfortable, maybe by providing too many intimate details or having a loud or brazen manner. Exploring ways to deal with this can also form part of a training role-play.
6:0 6: 00 0am am
7:00am am Coffee on the run
Relvar Ellipta – superior asthma control vs. other ICS/LABAs in everyday clinical practice*1,2 Long-lasting molecules4,5 Once daily dosing3 Easy to use device6** Asthma control that takes the lead in a 24-hour world Relvar Ellipta is indicated for the regular treatment of asthma in adults and adolescents aged 12 years and older where use of a combination medicinal product (long-acting beta2-agonist and inhaled corticosteroid) is appropriate: patients not adequately controlled with inhaled corticosteroids and ‘as needed’ inhaled short acting beta2-agonists or patients already adequately controlled on both inhaled corticosteroid and long-acting beta2-agonist3
For Healthcare Professionals only. Images used are for illustrative purposes only. Relvar is well tolerated. Most common adverse events are nasopharyngitis and headache3 IE/FFT/0057/18(1) January 2019 Relvar Ellipta was developed in collaboration with References: 1. Woodcock A, Vestbo J, Bakerly ND, New J, Gibson JM, McCorkindale S, et al. Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open label, parallel-group, randomised controlled trial. Lancet 2017; 390:2247–2255. 2. Svedsater H, Jones R, Bosanquet N, Jacques L, Lay-Flurrie J, Leather DA, et al. Patient-reported outcomes with initiation of fluticasone furoate/vilanterol versus continuing usual care in the asthma Salford Lung Study. Respiratory Medicine 2018; 141:198–206. 3. Relvar 92/22 Ellipta, Summary of Product Characteristics, 2018. available on www.medicines.ie. 4. Bardsley G, Daley-Yates P, Baines A, Kempsford R, Williams M, Mallon T, et al. Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: a cross-over randomised controlled trial. Respir Res 2018; 19:133. 5. Braithwaite I, Williams M, Power S, Pilcher J, Weatherall M, Baines A, et al. Randomised, double blind,placebocontrolled, cross-over single dose study of the bronchodilator duration of action of combination fluticasone furoate/vilanterol inhaler in adult asthma. Respir Med 2016; 119:115–121. 6. Svedsater H, Jacques L, Goldfrad C, Bleecker ER. Ease of use of the ELLIPTA dry powder inhaler: data from three randomised controlled trials in patients with asthma. Prim Care Respir Med 2014; 24:14019.
Relvar Ellipta (fluticasone furoate/ vilanterol [as trifenatate]) Prescribing information (Please consult the full Summary of Product Characteristics (SmPC) before prescribing) abnormalities, thyrotoxicosis, uncorrected hypokalaemia or patients predisposed Interactions with other medicinal products: Interaction studies have only been Relvar Ellipta (fluticasone furoate/vilanterol [as trifenatate]) inhalation to low levels of serum potassium. chronic or untreated infections, diabetes mellitus. performed in adults. Avoid β-blockers. Caution is advised when co-administering powder. Each single inhalation of fluticasone furoate (FF) 100 micrograms Paradoxical bronchospasm – substitute alternative therapy if necessary. In patients with strong CYP 3A4 inhibitors (e.g. ketoconazole, ritonavir, cobicistat-containing (mcg) and vilanterol (VI) 25mcg provides a delivered dose of 92mcg FF and with hepatic with moderate to severe impairment 92/22mcg dose should be used. products). Concomitant administration of other sympathomimetic medicinal products 22mcg VI. Each single inhalation of FF 200mcg and VI 25mcg provides a Acute symptoms: Not for acute symptoms, use short-acting inhaled bronchodilator. may potentiate the adverse reactions of FF/VI. Relvar should not be used in conjunction delivered dose of 184mcg of FF and 22mcg of VI. Indications: Asthma: Regular Warn patients to seek medical advice if short-acting inhaled bronchodilator use with other long-acting β2-adrenergic agonists or medicinal products containing longtreatment of asthma in patients ≥12 years and older where a long-acting increases. Therapy should not be abruptly stopped without physician supervision due β2-agonist and inhaled corticosteroid combination is appropriate and where acting β2-adrenergic agonists. Pregnancy and breast-feeding: Experience limited. to risk of symptom recurrence. Asthma-related adverse events and exacerbations patients are not adequately controlled on inhaled corticosteroids and ‘’as needed” Balance risks against benefits. Side effects: Very Common (≥1/10): Headache, may occur during treatment. Patients should continue treatment but seek medical short-acting inhaled β2-agonists, or where patients are already controlled on both nasopharyngitis. Common (≥1/100 to <1/10): Candidiasis of the mouth and throat, advice if asthma symptoms remain uncontrolled or worsen after initiation of Relvar. inhaled corticosteroid and long-acting β2-agonist. COPD (Relvar 92/22mcg only): pneumonia, bronchitis, upper respiratory tract infection, influenza, oropharyngeal pain, Systemic effects: Systemic effects of inhaled corticosteroids may occur, particularly Symptomatic treatment of adults with COPD with a FEV1<70% predicted normal sinusitis, pharyngitis, rhinitis, cough, dysphonia, abdominal pain, arthralgia, back pain, at high doses for long periods, but much less likely than with oral corticosteroids. (post-bronchodilator) and an exacerbation history despite regular bronchodilator muscle spasms, fractures, pyrexia. Uncommon (≥1/1,000 to <1/100): Hyperglycaemia, Possible Systemic effects include: Cushing’s syndrome, Cushingoid features, adrenal therapy). Dosage and administration: Inhalation only. Asthma: Patients with asthma vision blurred, extrasystoles. Rare (≥1/10,000 to <1/1,000): Hypersensitivity reactions suppression, decrease in bone mineral density, growth retardation in children and should be given the strength of Relvar Ellipta containing the appropriate fluticasone including anaphylaxis, angioedema, rash and urticaria; palpitations, tachycardia, adolescents, cataract, glaucoma. More rarely, a range of psychological or behavioural furoate (FF) dosage for the severity of their disease. Prescribers should be aware tremor, anxiety, paradoxical bronchospasm. Marketing authorisation (MA) Holder: effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or that in patients with asthma, FF 100 mcg once daily is approximately equivalent to GlaxoSmithKline (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin aggression (particularly in children). Increased incidence of pneumonia, including fluticasone propionate (FP) 250 mcg twice daily, while FF 200 mcg once daily 24, Ireland. MA Nrs: 92/22mcg 1x30 doses [EU/1/13/886/002]; 184/22mcg pneumonia requiring hospitalisation, has been observed in patients with COPD is approximately equivalent to FP 500 mcg twice daily. Adults and adolescents 1x30 doses [EU/1/13/886/005]. Legal category: POM B. Last date of revision: receiving inhaled corticosteroids. If a patient presents with visual disturbance they ≥12 years: one inhalation once daily of: Relvar 92/22mcg for patients who require December 2018. Job Ref: IE/FFT/0046/15(11). Further information available on should be considered for referral to an ophthalmologist for evaluation of possible a low to mid dose of inhaled corticosteroid in combination with a long-acting request from GlaxoSmithKline, 12 Riverwalk, Citywest Business Campus, Dublin 24. causes which may include cataract, glaucoma, or rare diseases such as central serous beta2-agonist. If patients are inadequately controlled then the dose can be increased Tel: 01-4955000. to one inhalation once daily Relvar 184/22mcg. Relvar 184/22mcg can also be chorioretinopathy. Physicians should remain vigilant for the possible development of considered for patients who require a higher dose of inhaled corticosteroid in pneumonia in patients with COPD as the clinical features of such infections overlap Adverse events should be reported to the Health Products Regulatory combination with a long-acting beta2-agonist. Regularly review patients and reduce with the symptoms of COPD exacerbations. Risk factors for pneumonia include: Authority (HPRA) using an Adverse Reaction Report Form obtained either from dose to lowest that maintains effective symptom control. COPD: one inhalation current smoking, older age, low body mass index and severe COPD. The incidence the HPRA or electronically via the website at www.hpra.ie. Adverse reactions once daily of Relvar 92/22mcg. Contraindications: Hypersensitivity to the active of pneumonia in patients with asthma was common at the higher dose of Relvar can also be reported to the HPRA by calling: (01) 6764971. Adverse events substances or to any of the excipients (lactose monohydrate & magnesium stearate). (184/22mcg). Patients with rare hereditary problems of galactose intolerance, the should also be reported to GlaxoSmithKline on 1800 244 255. Precautions: Pulmonary tuberculosis, severe cardiovascular disorders, heart rhythm total lactase deficiency or glucose-galactose malabsorption should not use Relvar.
*The primary endpoint was the proportion of ACT responders (improvement from baseline of ≥3 or achieving a total ACT of ≥20) in patients initiating Relvar vs. continuing usual care (as prescribed by GP) at months 6 in the PEA (primary effectiveness analysis) population. The primary endpoint was met (p<0.001). Data presented are from a subset of patients in the PEA population prescribed ICS/LABA at baseline: 70% of patients initiating with Relvar (n=637/908) improved asthma control vs. 56% of patients continuing on their ICS/LABA (n=511/916). OR 1.95, 95% CI: 1.60, 2.38.1 **95% of patients use Ellipta correctly after one demonstration.6
Pharmacists warned on Measles outbreak The Health Service Executive has confirmed an outbreak of measles in Dublin and is advising that people should make sure they have had the MMR vaccine to protect themselves from measles. This is particularly important for children and young adults (under forty). There have been eighteen cases in Dublin since the start of February 2019. Recent cases have involved young adults working in the city centre. Travel to Europe has been identified as a risk with some cases developing measles after trips to France, Poland, the Netherlands and Lithuania. There are on-going outbreaks of measles in multiple countries in the European region including France, Italy, Greece, Romania and the Ukraine and worldwide.
Dr Ruth McDermott, Public Health Specialist says, “Measles is a serious illness and is highly infectious. The best protection is to be vaccinated with MMR (Measles, Mumps, and Rubella) vaccine.” People planning to travel abroad should make sure they are protected from measles. Those who have not been vaccinated with MMR vaccine or have not had measles in the past are at risk of measles. If unsure whether they
had the vaccine they should speak to their GP about getting the MMR vaccine before travelling. Children age 6 to 11 months should have an early MMR prior to travel. Measles symptoms include fever, red rash, red eyes, cough and runny nose. The rash usually starts a few days after onset of illness. It typically starts on the head and spreads down the body. There is a risk of developing measles for up to 21 days after contact with a case of measles.
Driving Innovation in Medicines The TOPRA Annual Symposium 2019 takes place in Dublin from 30 September to 2 October in co-operation with the HPRA. The theme for this year's event is: “Europe at the forefront of global healthcare regulation: Driving innovation through convergent approaches in medicines, devices and veterinary regulatory affairs.” • Network with innovators and opinion leaders in the healthcare regulatory affairs arena; • Share your peers' experiences and discuss solutions to current regulatory issues; • Navigate the practical implications of disruptive technologies and a changing regulatory landscape. Over the course of three days it brings together the latest developments in the human, veterinary, medical device and diagnostic regulatory sectors, giving participants access to insights directly from regulators, key opinion leaders and innovators.
Driving innovation through convergent approaches in medicines, devices and veterinary regulatory affairs, the TOPRA symposium brings together the pharmaceutical, medical device and veterinary communities for the first-choice key event in the European regulatory affairs calendar for anyone working in, or alongside, regulatory professionals. The programme will cover topics such as the impact of technology on the regulatory profession,
the new veterinary medicines legislation and the implementation of the medical device and in-vitro diagnostic Regulations. Why attend? • Access the latest information and insights from the most comprehensive EU regulatory affairs programme; • This is the only regulatory affairs conference in Europe where you can meet regulators from around the world;
The 2018 Symposium in Stockholm, Sweden, attracted almost 600 attendees, with representation from a total of 22 regulatory agencies (including EMA and the European Commission) along with industry colleagues in the human medicines, veterinary medicines and medical device sectors, plus support services. Delegates were also present from notified bodies, patient groups, charities, healthcare professions, legal firms, universities, and the media.
Importance of Sleep on Health Recently, World Sleep Day took place, an annual global call to action about the importance of sleep. As an adult getting between 7 and 8 hours of sleep every night is one of the best things that can be done for both mental and physical health and well being. Children will need more sleep depending on their age. Lack of sleep or poor-quality sleep is known to have a significant negative impact on individual’s health in the long and short term. Obstructive Sleep Apnoea is a common sleep disorder which has been associated with an increased risk of cardiovascular disease, high blood pressure and atrial fibrillation. Left untreated, OSA may lead to heart disease, stroke and vascular dementia. According to the Irish Thoracic Society, “Apnoea” means temporary cessation or stopping of breathing. In obstructive sleep apnoea syndrome (OSAS), frequent pauses of breathing occur during sleep due to closure of the air passage in the pharynx. OSAS is diagnosed by sleep monitoring. Heavy snoring and excessive daytime sleepiness are common symptoms of OSAS. Others include, morning headaches, impaired memory and concentration during the day and heavy snoring, restless sleep, waking up abruptly accompanied by choking or gasping at night. Commenting Dr Angie Brown, Medical Director of the Irish Heart Foundation said, “There is a lot of evidence that sleep apnoea is associated with an increased risk of Cardiovascular disease, hypertension and atrial fibrillation. Its therefore important that people with signs and symptoms of sleep apnoea get a check-up usually requiring overnight sleep studies. If diagnosed, this can be treated and the associated risk reduced.” Created and hosted by World Sleep Society, World Sleep Day is an internationally recognised awareness event bringing researchers, health professionals and patients together to recognise sleep and its important impact on our health.
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Connecting with customers Real World Analytics (RWA) held their annual gathering of owners and senior executives of the leading pharmacy groups in Ireland in the Kingswood Hotel on Wednesday 27th March. These meetings give RWA customers a great opportunity to connect with each other and to have open discussions about the RWA Pharmacy Solution and the wider industry.Helen Taylor and Niamh Doyle from McLernons joined the meeting as RWA’s exclusive PMR partner in Ireland to facilitate discussions related to data access. RWA introduced their new developments to aid more accurate reconciliation of patient payments and claim optimisation. The group worked through a margin growth checklist and identified new benchmarking opportunities among the customer network.
RWA strive to make accessing and
understanding the right information increasingly attainable and so have developed a new solution interface for easier navigation. They have also designed an Executive Dashboard which offers all of your important business metrics on one page like item growth, sales and margin growth, stock and risk management. There was a great response to this on the day. Customer input is so valuable as their industry knowledge helps to shape the solution and ensures that it is always meeting the needs of the Irish Pharmacy sector. The RWA community encompasses thought leaders who are empowered to operate to their most efficient potential. Call us directly if you’d like to benefit from this support, 016931433.
1: Ade Stack, Managing Director Stack’s Pharmacy and Eoin McCartan, Superintendent Pharmacist, McCartan’s Pharmacy 2: Gareth Clancy, Director, C&D Medical Group and Eugene Renehan, Superintendent Pharmacist Meagher’s Pharmacy 3: Kilian McGreal, Managing Director, McGreal’s Pharmacy and Rory Keating, Managing Director, R.Keating Pharmacy 4: Ronan Mulligan, Director, Mulligan’s Pharmacy and Ger Lyons 5: John Bolger and Canice Nicholas, Cara Pharmacy, Simon Eames, RWA, Mike Curran, Stephen Duggan and Paul Dunphy, Hickey’s Pharmacy
IPN Teams up with 4FrontPharmacy.ie Irish Pharmacy News are pleased to announce a new educational partnership with Ireland’s leading online pharmacy training website, 4Front Pharmacy Online. David McLean, Director 4Front Pharmacy Online, Rachel Dungan MPSI, Director 4Front Pharmacy Online and Natalie Maginnis, Managing Director, IPN Communications
The new partnership means that pharmacists and their teams are able to ‘Train, Assess & Validate’ along with keeping track of completion records for IPN CPD articles online each month in an aim to make continuous professional development more
accessible and structured within pharmacies across Ireland. Registration to complete the MCQs is free and registration is only required once. Natalie Maginnis, Managing Director of IPN Communications
said, “We are delighted to be partnering with 4Front Pharmacy to create an outlet for free online testing and certification for Community Pharmacists within their Continuing Professional Development Portfolios. CPD has always been an important core
to the IPN publication so we are really pleased to be able to offer the CPD through an interactive online platform.” David McLean, Director, 4Front Pharmacy Online added, “This is a really exciting opportunity for both 4Front Pharmacy Online and Irish Pharmacy News. As companies we are both really aligned; being dedicated to excellence within pharmacy. Linking up will allow all Irish Pharmacy News readers to engage in Continuous Professional Development each month, providing certification of CPD articles. 4Front Pharmacy are delighted to partner with IPN in this and look forward to welcoming all their readers to complete these programmes free of charge each month.” The IPN MCQs are officially online at the 4Front Pharmacy website at: www.4FrontPharmacy.ie.
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1,000 IU Name of product: Caltrate 500 mg / 1000 IU, chewable tablets Active ingredient(s): 500 mg calcium (as calcium carbonate) and 25 µg cholecalciferol (vitamin D3, equivalent to 1000 IU) as cholecalciferol concentrate powder form. PA number: PA822/187/1. Name and address of the marketing authorisation holder: Pfizer Healthcare Ireland, 9 Riverwalk, Citywest, Dublin 24. Supply classification: Pharmacies only, pack size 30. Indications: For the prevention and treatment of vitamin D and calcium deficiency in the elderly or as an adjunct to specific osteoporosis treatment for patients who are at risk of vitamin D and calcium deficiency. Dosage and Method of use: Adults/Elderly: 1 chewable tablet daily. Not to be used during pregnancy or by patients with renal impairment. Method of administration: Oral use. The chewable tablets can be taken at any time, with or without food and should be chewed and swallowed. Side Effects: Hypercalcaemia, nausea, diarrhoea, abdominal pain, constipation, flatulence, abdominal distension, eructation, vomiting, rash, pruritus, urticarial, hypercalciuria, nephrolithiasis, milk-alkali syndrome, hypersensitivity reactions such as angioedema or laryngeal oedema. Reporting of suspected adverse reactions: 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: firstname.lastname@example.org. Contra-indications: Hypersensitivity to any of the ingredients. Hypercalciuria and hypercalcaemia and diseases and/or conditions, which lead to hypercalcaemia and/or hypercalciuria. nephrolithiasis, nephrocalcinosis, hypervitaminosis D, severe renal impairment. Due to its high content of vitamin D the use in children or adolescents is contra-indicated. Warnings and Precautions: In the event of long-term treatment, serum calcium levels and renal function should be monitored. Monitoring is especially important in patients on concomitant treatment with cardiac glycosides or thiazide diuretics and in patients with a high tendency to calculus formation. In case of hypercalcaemia or signs of impaired renal function, the dose should be reduced or the treatment discontinued. Vitamin D should be used with caution in patients with impairment of renal function and the effect on calcium and phosphate levels should be monitored. The risk of soft tissue calcification should be taken into account. In patients with severe renal insufficiency, vitamin D in the form of cholecalciferol is not metabolised normally and other forms of vitamin D should be used. Caltrate 500 mg / 1000 IU, chewable tablets should be prescribed with caution to patients suffering from sarcoidosis, due to the risk of increased metabolism of vitamin D into its active form. These patients should be monitored with regard to the calcium content in serum and urine. Caltrate 500 mg /1000 IU, chewable tablets should be used cautiously in immobilised patients with osteoporosis due to increased risk of hypercalcaemia. The content of vitamin D (1000 IU) in Caltrate 500 mg / 1000 IU, chewable tablets should be considered when prescribing other medicinal products containing vitamin D or other dietary sources with a high vitamin D or calcium content (such as milk). Additional doses of calcium or vitamin D should be taken under close medical supervision. In such cases it is necessary to monitor serum calcium levels and urinary calcium excretion frequently. Co-administration with tetracyclines or quinolones is usually not recommended or must be done with precaution. This medicinal product contains aspartame (E951), a source of phenylalanine which may be harmful for people with phenylketonuria. It also contains sorbitol (E420), isomalt (E953) and sucrose. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. May be harmful to the teeth. Date: 22nd June 2018 PCRS Code: 28902
Pfizer Healthcare Ireland, Citywest, Dublin 24.
*Trade Mark. PP-CAL-IRL-0031. March 2019
DAILY DOSAGE: 1 TABLET
Based on Worldwide Sales.
Number of people with cancer to double by 2045 if rates continue into the future Professor Kerri Clough-Gorr, director of the National Cancer Registry
head and neck cancer are projected to increase in males from 518 in 2015 to 857 in 2045 (+65%) and in females from 182 in 2015 to 304 in 2045 (+67%) – an increase to 1,161 overall (+66%). Cancer of the oesophagus Between 1994 and 2005, age-standardised rates of oesophageal cancer declined, non-significantly, for males by, on average, 0.3% per year. For females the age-standardised rates decreased marginally, but significantly, from 1994 to 2015 by 0.9% on average per year.
A report published by the National Cancer Registry shows that the number of cases of cancer could double by 2045 if current rates continue into the future. However, the overall increase could be a more modest 50% increase in both sexes if recent trends, including declines, in some cancers continue. The increase in the incidence of cancer is the result of a growing population and the ageing of that population, and will place increased pressure on healthcare services. The report projects a 111 per cent increase in cancers among men to the year 2045, and an 80 per cent increase among women, based on demographic factors alone. This is equivalent to an estimated 43,000 additional cases. However, when a more complex projection model taking account of recent or long-term trends is used, the increase in cancer cases for men is just 18 per cent, while for women it is 84 per cent. This amounts to a 50 per cent increase overall. Professor Kerri CloughGorr, Director of the National Cancer Registry said: “There is no doubt that population growth and ageing will result in substantial increases in numbers of cancers diagnosed in Ireland over the coming
decades, with resultant increases in the demands on cancer healthcare services. Potentially, between 2015 and 2045, we could see a doubling of the number of cases diagnosed annually if current cancer rates continue to apply. “Nevertheless, there are some grounds for optimism. Recent trends in age-standardised cancer incidence rates, which reflect the risk of an individual being diagnosed with cancer, appear to show a levelling-off or even a decline for a range of cancers. If these recent trends continue, increases in numbers of cancers diagnosed may prove to be substantially smaller, but they are still likely to amount to at least a 50% increase by 2045. “But even that more limited increase in projected numbers of cancers will depend on sustained and where possible expanded public health and cancer prevention interventions aimed at reducing the risk of cancer diagnosis at the individual and population level.” All invasive cancers combined, excluding non-melanoma skin cancer Between 1994 and 2011, age-standardised rates for all cancers combined (excluding NMSC) increased significantly for males by, on average, 1.3% per year, followed by a
significant decline of 1.8% per year between 2011 and 2015. For females the pattern was similar, though less marked, with the rates increasing significantly from 1994 to 2010, by 1.2% on average per year, before flattening out, with no change in the age-standardised rates in from 2010 to 2015.
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of oesophageal cancer are projected to increase in males from 259 in 2015 to 558 in 2045 (+115%) and in females from 157 in 2015 to 328 in 2045 (+109%) – an increase to 886 overall (+113%).
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of all cancers combined (excluding NMSC) are projected to increase in males from 11,460 in 2015 to 24,160 in 2045 (+111%) and in females from 10,240 in 2015 to 18,840 in 2045 (+84%) – a doubling of numbers overall (+98%).
Cancer of the stomach
Cancer of the head and neck
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of stomach cancer are projected to increase in males from 387 in 2015 to 842 in 2045 (+118%) and in females from 204 in 2015 to 452 in 2045 (+122%) – an increase to 1,294 overall (+119%).
Between 1994 and 2001, agestandardised rates of head and neck cancer declined significantly for males by, on average, 2.8% per year, followed by a significant increase of 1.9% per year between 2001 and 2015. For females the age-standardised rates increased significantly from 1994 to 2015 by, on average, 1.6% per year. Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of
Between 1994 and 2003, agestandardised rates of stomach cancer declined significantly for males by, on average, 2.8% per year. Since 2003, rates have been almost unchanged, declining non-significantly by 0.2% on average per year. For females the age-standardised rates decreased steadily and significantly from 1994 to 2015, by 1.1% on average per year.
Cancer of the colon Between 1994 and 2015, agestandardised rates of colon cancer increased marginally, but significantly, for males by, on average, 0.4% per year.
For females average agestandardised rates showed no significant change between 1994 and 2015.
females the average agestandardised rates increased non-significantly, by 0.4% from 1994-2015.
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of colon cancer are projected to increase in males from 1,021 in 2015 to 2,196 in 2045 (+115%) and in females from 776 in 2015 to 1,617 in 2045 (+108%) – an increase to 3,813 overall (+112%).
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of pancreatic cancer are projected to increase in males from 312 in 2015 to 657 in 2045 (+111%) and in females from 252 in 2015 to 576 in 2045 (+129%) – an increase to 1,233 for males and females combined (+119%).
Cancer of the liver, gallbladder and biliary tract
Cancer of the lung
Between 1994 and 2015, agestandardised rates of cancer of the liver, gallbladder and biliary tract increased significantly for males by, on average, 4.0% per year. For females the age-standardised rates also increased significantly, by 2.2% on average from 1994 to 2015. Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of cancer of the liver, gallbladder and biliary tract are projected to increase in males from 266 in 2015 to 597 in 2045 (+124%) and in females from 174 in 2015 to 407 in 2045 (+134%) – an increase to 1,004 for males and females combined (+128%). Cancer of the pancreas Between 1994 and 2015, age-standardised rates of pancreatic cancer increased significantly for males by, on average, 0.7% per year. For
Between 1994 and 2015, age-standardised rates of lung cancer decreased significantly for males by, on average, 0.8% per year. In contrast, for females the average age-standardised rates increased significantly by 2.3% in the same period. Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of lung cancer are projected to increase in males from 1,356 in 2015 to 3,137 in 2045 (+131%) and in females from 1,130 in 2015 to 2,313 in 2045 (+105%) – an increase to 5,450 for males and females combined (+119%).
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of melanoma of the skin are projected to increase in males from 546 in 2015 to 960 in 2045 (+76%) and in females from 584 in 2015 to 925 in 2045 (+58%) – an increase to 1,885 for males and females combined (+67%).
Cancer of the prostate
Female breast cancer
Between 1994 and 2004, age-standardised rates of prostate cancer increased sharply and significantly, on average, by 7.5% per year. Between 2004 and 2011 the average rates continued to increase significantly, but at a slower rate, by 2.3% per year. Since 2011 rates have declined significantly by an average of 4.2% per year.
Between 1994 and 2008, age-standardised rates of female breast cancer increased significantly, on average, by 2.1% per year, before decreasing marginally (and nonsignificantly) by 0.3% per year between 2008 and 2015.
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of prostate cancer are projected to increase from 3,214 in 2015 to 6,869 in 2045 (+114%).
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of female breast cancer are projected to increase from 3,106 in 2015 to 5,050 in 2045 (+63%).
Cancer of the brain and central nervous system
Cancer of the ovary
Melanoma of the skin
Between 1994 and 2015, age-standardised rates of cancer of the ovary decreased significantly, on average, by 0.6% per year.
Between 1994 and 2015, agestandardised rates of melanoma of the skin increased significantly for males by, on average, 5.1% per year. For females, the average agestandardised rates also increased significantly, by 2.6% from 1994-2015.
Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of cancer of the ovary are projected to increase from 407 in 2015 to 731 in 2045 (+80%).
Between 1994 and 2015, age-standardised rates of cancer of the brain and central nervous system did not change significantly for males or females. Rates decreased by, on average, 0.2% per year for males, and rates increased by 0.4% per year, for females. Assuming that the average age-standardised rates during 2011-2015 continue to apply (‘demographic’ projection), annual numbers of cases of cancer of the brain and central nervous system are projected to increase in males from 220 in 2015 to 382 in 2045 (+74%) and in females from 152 in 2015 to 285 in 2045 (+88%) – an increase to 667 for males and females combined (+79%).
PMI Celebrate 30 Years of Business The Pharmaceutical Managers’ Institute had their 30th Annual Business Day on April 4th in the Radisson Blu, Golden Lane. Darragh O’Loughlin, Secretary General, IPU
The theme of the day was “Future Proofing the Healthcare Industry” with a glance back at the last 30 years in Ireland as well as looking forward to what the incoming decade would bring to the industry. Focus was very much on community healthcare, tracking pharmacy trends around the world and how we can further engage our pharmacists in providing primary care as well as the rise in rare diseases and how best to tackle the treatment and management of these.
Darragh O’Loughlin, Secretary General with the IPU kicked off the day and spoke of the trends in pharmacy both in Europe and in the US. They then shifted attention to rare diseases with both Prof Orla Hardiman, National Clinical Lead Neurology with the HSE and Vicky McGrath, CEO Rare Disease Ireland speaking. Joe Marshall and Ian Ray from Pegasus in the UK gave an insightful talk on using behavioural science in patient engagement programmes and gave examples of a project they worked on with the Samaritans & British Rail in the UK.
from the US to give some insights into the US systems and lessons to be learned with doctors and pharmacists working closely together to roll out community based schemes. Closing out the day was Frankie Sheahan, Founder of Pendulum Summit and former Irish footballer Packie Bonner. PMI members can view the speaker videos and their slides in the member section of their website – www.thepmi.com
After lunch, Prof Martin Curley Director Digital Academy with the HSE took to the floor giving an overview of the work the HSE are undertaking to digitise the healthcare sector and their “shift left, stay left” project, followed by Jack Cochran, MD who flew in
Orla Hardiman, National Clinical Lead Neurology, HSE
Minister for Health Simon Harris has said that he “instinctively” agrees with a suggestion that unvaccinated children should be barred from attending schools or creches.
Dr Rowley said, “It’s a really simple life saving concept. We should be protecting those kids who cannot receive #vaccines.” Responding to Dr Rowley, Mr Harris tweeted: “Instinctively agree. Think we may have constitutional issues here. Will research further.
Leading doctors have raised concerns about an decline in vaccination rates among Irish children in recent years, which has led to outbreaks of diseases like measles. Mr Harris said this is now “part of the debate” in the EU and he is to consult with European colleagues, adding that sending a child who is not vaccinated against measles to school is an “irresponsible and dangerous thing to do.” The take up rate for the MMR vaccine in Ireland is 92% and the target is 95%. The warning
Irish patients will be the first in the world to take part in a new trial to treat one of the most aggressive forms of breast cancer. The clinical study will see women with advanced triple negative breast cancer being treated with the drug ‘COTI-2’ in combination with chemotherapy at St. Vincent’s University Hospital (SVUH) in Dublin. The research was carried out by Dr Naoise Synnott in University College Dublin and SVUH. Her work was funded by the Irish Cancer Society’s ‘BREASTPREDICT’ research programme and the Clinical Cancer Research Trust. Chief Executive of the Irish Cancer Society Averil Power says, “News like this shows the positive difference cancer research is making for Irish people. Everyone who has donated to the Irish Cancer Society can feel a part of making this clinical trial a reality.
Minister ‘tweets’ support #banunhealthyunvaccinatedkids
Mr Harris was responding to a tweet from Dr Dominic Rowley, who is a consultant at Portlaoise Midlands Regional Hospital, who suggested that the Minister should “take a bold step and #banunhealthyunvaccinatedkids from creche/school.”
Study First for Ireland
comes in the wake of new figures showing the outbreak of measles in Dublin has worsened with eighteen cases at the time of going to press. Recent cases have involved young adults working in the city centre. Travel to Europe has been identified as a risk with some cases developing measles after trips to France, Poland, the Netherlands and Lithuania. Minister Harris has raised concerns on several previous occasions about inaccurate information about vaccines, such as the HPV vaccine, being spread on social media.
“But we want to do more. Every year we have to turn away researchers who come to us with potentially life-saving projects, simply because we don’t have enough funds to support them. “The Irish Cancer Society needs the public’s support so that we can fund more research and push for more trials like this one, which give patients the earliest possible access to medical breakthroughs they so desperately need and which we hope will save more lives.” More than 250 people are diagnosed with triple-negative breast cancer each year. Naoise was supervised by Professor Joe Duffy and Professor John Crown who said, “At the moment the only form of drug treatment available to patients with triple-negative breast cancer is chemotherapy. While this will work well for some patients, others may find that their cancer cells don’t respond as well as might be hoped to chemo, leading to patients suffering the side effects of this treatment without any of the desired outcomes.
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Stérimar™. 100% Natural sea-water based solutions for Hayfever. The No.1 GP recommended brand 1.
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As a pioneer brand, Stérimar has over 40 years of expertise in nasal conditions. It continues to develop effective solutions for noses of all ages, from babies through to adults. As the top natural hayfever range2,
• Younger adults (aged 25-34 educational leaflets, shelf Stérimar offers a range of years) are the most likely strips and a counter display REFERENCES products to suit consumer 1. GPrX data: Sodium Chloride subcategory - data from • Relieve itchy noses needs. The range includes: to suffer from allergies and unitApril – all2016 of which help – Aprilwill 2018 - UK coverage. • an isotonic solution, which Its exclusive patented 2. Nielsen data, full year ending 29.12.18. means the solution has the complex, based on natural 3. KirkStérimar A, The Telegraph; keep top of mind2015. 53 per cent of nasal spray same salt concentration as ingredients, provides 4. 1154 Sterimar Quant Debrief, June 2017. cells in the human body long-lasting hydration and 5. Analgesics report, May users 2016. are aged 25-34 years. andMintel driveOTC purchase. For any enquiries or to place your order please contact your local PembertonEnsuring Rep orpharmacy call Customer on 01-4632424 This is welcome news for shelves Service same salt concentration as
lasting hydration and forms a
• Significantly reduces nasal discharge and sneezing
listenership of 58,000 over the course of the show! The Pollen Count will also appear on the Classic Hits website and will be updated each morning. We will also see a post weekly across their Facebook, Twitter and Instagram pages.
PHARMACY MAGAZINE MARCH 2019 00
Managing Sneezing Season W
hilst the weather is turning (marginally) warmer, the arrival of spring and summer is not welcome for everyone, especially by those who suffer from hay fever.
As someone with a special interest in the treatment of allergies, Dr Paul Carson recommends that people who suffer from hay fever should take pre-emptive action by visiting their local pharmacy and working out a treatment plan in advance of the high pollen season. According to Dr Carson, hay fever is still unknown to many people, at least in so far as they might understand it to be a possible cause of their symptoms. "As many as 20% of the population have some form of allergy", he explained. "Half of these have serious conditions, such as asthma, eczema or severe food allergies. Many of the others put up with minor symptoms, or explain them away as summer colds. Many doctors even will not recognise hay fever when it is presented to them.” With temperatures due to increase and the pollen count predicted to be high, pharmacists have warned hay fever sufferers to take preventative steps to deal with their condition. This time of the year is particularly difficult for the 1 in 5 of the Irish
population who suffer from hay fever. However, the condition can often be effectively managed, and the Irish Pharmacy Union (IPU) is advising sufferers to consult with their local pharmacist about the best treatment methods for them. Hay fever, also known as seasonal allergic rhinitis, is caused by pollen and spores creating an allergic reaction affecting the nose and sinuses. While it can occur at any time of year, sufferers are particularly impacted from the early summer until autumn. This is due to the increased pollen levels in the air released by trees, plants and grass. Although hay fever is a relatively common condition, the symptoms can be extremely unpleasant and include itchy eyes, runny nose, sneezing, coughing and headaches. 87% of hay fever sufferers also report difficulty sleeping. Additionally, there are potentially more serious impacts – asthma sufferers have an 80% chance of also suffering from hay fever, which brings an increased risk of asthma attacks. Ann-Marie Horan, Executive Committee member of the Irish Pharmacy Union (IPU), issued the following advice to hay fever
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sufferers, “Hay fever can make life miserable, especially for people with severe symptoms. On a daily basis during the summer, I see in my pharmacy the negative impact hay fever can have on people’s overall wellbeing. It makes life very uncomfortable, sometimes for prolonged periods. That in turn can impact on sleep, productivity and overall levels of happiness. Thankfully, there is a range of treatments available which can dramatically reduce symptoms: these include antihistamines, decongestants, corticosteroid nasal sprays and anti-allergy eye-drops. Occasionally, for more severe cases, prescription medications may be required, so we refer people to their GP or allergy specialist. “The key to treating hay fever is finding the treatment that works for you – there is no one-sizefits-all cure because everyone experiences it differently. Pharmacists are highly trained health professionals and experts in medicines and can play a significant role in the management of allergies, including hay fever. Anyone suffering from hay fever should consult with their pharmacist first who will work with
them to choose the best treatment options for them.” Pharmacists should also warn that as hay fever is a significant trigger for asthma, asthma patients should ensure they carry their inhaler at all times and use it as prescribed. Hay fever is usually a seasonal (mid-summer) problem but can start earlier and even drag on until late autumn. Most sufferers are troubled with grass pollen only (10,000 pollen grains fit on the tip of a pin) but a significant number are troubled with a combination of tree and grass pollen allergy. Their season starts in early spring with mild nasal irritation. By the time the summer months arrive they are already compromised so that even small amounts of grass pollen can trigger quite aggressive hay fever. If the summer is especially warm and sunny with high surges of pollen, then those three to four months can be a write-off. For those with the extra burden of mould spore allergy hay fever misery can drag on through the autumn/fall months.
Hay fever is a name that covers a range of different allergic reactions, all of which peak around the same time of the year. Some people are allergic to the spores released by certain fungi, though this is not a major cause of hay fever. Fungi are more easily avoided than the plants, flowers and grasses, which are responsible for most cases of allergic rhinitis. When we think of pollen, we tend to envisage the fine yellow powder that gathers on the calyxes of flowers, but trees and grasses also spread pollen. The pollen of the birch tree is one of the most prolific pollen allergens in Britain and Ireland. “Grass pollen is the most common allergen in Ireland without a doubt”, says Dr Paul Dowding, a senior lecturer with the Trinity College Dublin botany department. "Herb pollen is less common and tree pollen is not a great factor in Ireland because it is not a heavily wooded country. The highest pollen count levels within Ireland are usually found in lowland country areas, especially agricultural areas where there is likely to be a lot of grassland. Levels in cities would be a half or quarter of that and in coastal areas pollen levels would be lower again.” Some research suggests that air pollution may make hay fever worse but the evidence is not clear. Studies in countries such as Sweden, Italy and Spain have shown that hay fever rates are greater in cities than in the surrounding rural areas where pollen counts are higher. Hay fever Symptom Summary • Sneezing • Blocked and runny nose • Sinus congestion with headaches, especially along the forehead • Itchy, red and watery eyes • Puffy eyes and lower eyelids • Cough and occasional wheeze • Ears popping with occasional hearing impairment • Diminished senses of taste and smell (severe hay-fever sufferers) • Itch along roof of mouth and back of throat when eating certain foods • Feeling of intense lethargy People’s experience of hay fever symptoms can vary from year to year, which can make it difficult for customers to know which products to use, even those who have experienced symptoms before. Pharmacies should offer a varied range of allergy remedies in multiple formats. First-time sufferers often have
to use trial and error to find a remedy that works well for them, so having multiple options available allows customers to continue returning to trial a variety of products. Advice relating to the different remedies from the pharmacist will also help the customer determine the best treatment for them. The hay fever season can be a frustrating time for sufferers, so quality advice from a trusted professional will be greatly appreciated. Community pharmacists have a key role to play in the management of hay fever. Their role is especially important because the majority of medications used to treat it are available for purchase over-thecounter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients’ self-selection often results in suboptimal treatment selection, undertreated hay fever and poor clinical outcomes. In order for pharmacists to optimise the care for these patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement. With an increasing number of OTC medications being available from community pharmacies, and online, the choice of medication becomes more complicated. It is important therefore that hay fever sufferers seek advice from pharmacists when in the community pharmacy, in a timely and regular manner. Vaccine on the Horizon A vaccine against hay fever could be ready within three years after human trials showed a major reduction in symptoms. Scientists from the Medical University of Vienna said results were so encouraging that they 'dared' to hope that sufferers would be cured of the condition after several years of booster jabs. The new phase-II trial showed the vaccine for grass pollen reduced symptoms by at least 25% over two years, and researchers said unpublished results also showed reductions of up to 60% in some people. Dr Rudolf Valenta, who led the vaccine development, says, "In the last study, still unpublished, we reach up to 60% for certain patients after one year of treatment. “It is likely that we can make them symptom-free after longer treatment. The planned schedule is five pre-seasonal injections before the pollen season of the first year and one daily refreshment every year.” The team is also confident that the
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vaccine could be tweaked to fight against dust mite allergy, birch pollen, ragweed, and even help people who are allergic to cats. Asked whether the vaccine could be considered a cure, Dr Valenta added, "I dare to say that. More important, our next step will be preventive vaccination.” The vaccine, which is the first in the world to target grass pollen, is made from peptides - strings of amino acids - from the pollen. They are modified so they no longer bind to antibodies which trigger a reaction. It allows the body to learn that pollen is safe and does not require a fierce immune response. The new trial involved 180 patients who suffered from grass pollen allergy, and who were regularly troubled by a runny nose, cough and breathing problems. Two-thirds were given different levels of the vaccine, while one third acted as a placebo group. The patients were given four injections in the first year and a booster jab in the second year. Can we Predict Hay Fever? Meanwhile, scientists in Australia have discovered a new way to predict outbreaks of hay fever and asthma in the population. The University of Queensland-led (UQ) study published on Tuesday, found that grass pollen exposure varied substantially across the allergy season because in areas further from the equator, seasonal variations were released later. “Using this method, we may be able to better predict when allergenic pollen is present and allow people affected by asthma, chronic obstructive pulmonary disease (COPD) and rhinitis to more effectively manage their condition," UQ School of Public Health Associate Professor Nicholas Osborne said. “(And) with the advent of personalized medicine, more and more people are becoming aware of which allergen is responsible for their allergy," Osborne said. While Professor Osborne admits much more research is needed in order to fully understand the matter, he believes within three to four years it could be possible to produce a better forecast of when and where exposure to pollen occurs. “We hope to use this data to examine if particular grass species are more allergenic than others," Professor Osborne said. "We are doing this by examining hospital and GP records in Britain and seeing if demand for these services involving asthma and rhinitis correlates with the presence of one grass species over another,” he added.
Advice on Reducing Exposure It is very difficult to completely avoid pollen or spores. However, reducing exposure to the substances that trigger hay fever should ease the severity of symptoms. Offer customers presenting in the pharmacy advice below to avoid being exposed to excessive amounts of pollen and spores. • Avoid cutting grass, playing or walking in grassy areas, and camping • Wear wraparound sunglasses to stop pollen getting in the eyes when they are outdoors • Change their clothes and take a shower after being outdoors to remove the pollen on their body • Try to stay indoors when the pollen count is high (over 50) • Keep windows and doors shut in the house. If it gets too warm, draw the curtains to keep out the sun and keep the temperature down • Do not keep fresh flowers in the house • Vacuum regularly, ideally using a machine with a HEPA (high-efficiency particulate air) filter • Damp dust regularly. Dusting with a wet cloth, rather than a dry one, will collect the dust and stop any pollen from being spread around • Keep pets out of the house during the hay fever season. If a pet does come indoors, wash it regularly to remove any pollen from its fur • Do not smoke or let other people smoke in the house. Smoking and breathing in other people's smoke will irritate the lining of the nose, eyes, throat and airways, and can make symptoms worse • Keep car windows closed
FAST RELIEF OF ALLERGIES
ONE TABLET PER DAY
Available in 7 & 30 packs. Ref 1: “Cetrine Allergy 10mg Film-coated Tablets” was awarded “Best Allergy product” by IPN (Irish Pharmacy News) on 07/03/2019 at the OTC 2019 and retail pharmacy product awards. Ref 2: IMS Data. Ref 3: Divided dose for 6-12 years (half a tablet twice daily).
Date of preparation: (03-19) CCF: 21907
ABBREVIATED PRESCRIBING INFORMATION
Product Name: Cetrine Allergy 10mg Film-coated Tablets. Composition: Each tablet contains 10mg Cetirizine Dihydrochloride. Description: White, oblong film-coated tablets, scored on one side. Can be divided into equal halves. Indication(s): Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis (hay fever), chronic idiopathic urticaria. Dosage: Adults, elderly and children aged 12 years and over: 10mg once daily. Children from 6 years to 12 years: 5mg (half a tablet) twice daily. Moderate renal insufficiency (creatinine clearance CrCl 30-49ml/min): 5mg once daily. Severe renal insufficiency (creatinine clearance ≤30ml/min): 5mg once every 2 days. Children under 6 years: Not recommended. Contraindications: History of hypersensitivity to any constituent in the tablet, piperazine derivatives or hydroxyzine. Severe renal impairment < 10ml/min creatinine clearance. Warnings and Precautions for Use: Reduce dosage in patients with significant renal impairment. Cetirizine may increase risk of urinary retention, therefore caution in patients with predisposition factors of urinary retention (e.g. spinal cord lesion, prostatic hyperplasia). Caution in epileptic patients and patients at risk of convulsions. Contains lactose. Discontinue use of cetirizine three days before allergy testing. Interactions: Caution is advised when taken concomitantly with alcohol or other CNS depressants. Pregnancy and Lactation: Caution during pregnancy and breast-feeding. Ability to Drive and Use Machinery: Usually non-sedative, patients should take their response to the product into account. Undesirable Effects: Cetirizine at the recommended dosage has minor adverse effects on the CNS, including somnolence, fatigue, dizziness and headache. In some cases, paradoxical CNS stimulation has been reported. Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevated bilirubin have been reported which resolves on discontinuation of the drug. Uncommon: Agitation, diarrhoea, pruritus, rash, asthenia, malaise, paraesthesia. Marketing Authorisation Holder: Rowex Ltd, Bantry, Co. Cork. Marketing Authorisation Number: PA 711/75/2. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417 E-mail: email@example.com Legal Category: Not subject to medical prescription. Date of Preparation: August 2014
If your customers feel good, your profit margin will too Playing in the park, enjoying a family picnic, or going on a bike ride – nothing feels as good as being in the great outdoors. Encourage your customers to make the most of it with Zirtek Allergy Relief, which can help ease the symptoms of hayfever and other allergies. 24-hour around the clock relief, max strength treatment Range of products suitable for the whole family1 Non-drowsy in the majority of cases Zirtek Oral Solution is Ireland’s No.1 best-selling allergy solution2 A reputation based on reliability, knowledge and research3,4
Feel free with all this marketing support: National TV advertising campaign Outdoor advertising Social media and digital advertising New POS material Pharmacy-focused section of our website zirtek.ie – coming soon Daily web-based pollen forecast
Feel free to place an order with your local rep or customer service team: Call: 01 463 2424 Email: firstname.lastname@example.org
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. Legal Category: OTC. Classification: Zirtek tablets & oral solution: Cetirizine dihydrochloride. Zirtek Plus Decongestant prolonged release tablets: Cetirizine dihydrochloride, Pseudoephedrine hydrochloride. Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or via email to email@example.com Adverse events should also be reported to UCB Pharma Ireland Ltd via email UCBCares.IE@ucb.com 1 2
Zirtek Allergy Relief is available in liquid formula for ages 2 and upwards, and in tablets suitable for ages 6 and upwards. IMS Data, December 2018 MAT units. 3 Zirtek Usage and Attitude in the ROI Report. 4 Antihistamines - Rossen Boev, MD.
March 2019 UK/IE-P-ZI-ALY-1900029
Spotlight on Skin Cancer Presenting in Pharmacy As the Irish population continues to age, the incidence of cancer is on the rise
o help alleviate the burden malignancy imposes on the health care system, a shift toward early cancer detection is necessary.
Pharmacists are well positioned and willing to assume a more active role in cancer surveillance. Research has demonstrated that patients are receptive to pharmacist involvement and seem to prefer a convenient community pharmacy-based location for screening programmes. The community pharmacist’s current and potential role in cancer screening and prevention is summarised in this article. A review of screening recommendations and a discussion of opportunities will hopefully inspire pharmacists to consider incorporating malignancy screening initiatives into their daily pharmacy practice. Skin Cancer in Ireland In 2015, there were 11,785 cases
of skin cancer here. 1,118 of these were melanoma, the most serious form of skin cancer. The number of skin cancer cases is due to rise to 18,989 by 2040, at a conservative estimate. A recent medical study outlined Ireland’s ranking of 14th in a global table of skin cancer susceptibility. New Zealand has the highest rate of skin cancer, according to the annual Skin Cancer Susceptibility Index. It is followed by Australia, Switzerland, Sweden and Norway. Ireland ranks behind Germany, and just ahead of Belgium. The study is produced by Derma plus, a German organisation that provides online dermatological advice from leading physicians. The United Kingdom was ranked 10th in the study, and the United
States had the ninth-highest skin cancer rate. Scale of the Problem Ireland records, on average, 859 melanoma-related diseases per year, the study said. The situation is so critical, the Irish cancer Society last year stated Ireland is facing a ‘skin cancer epidemic’ and need to take urgent steps in ensuring we bring down the skin cancer rates, as has been the case in Australia. They made the call ahead of a seminar with Craig Sinclair, Director of the World Health Organisation’s Collaborative Centre for UV Radiation and Head of Cancer Prevention at Cancer Council Victoria, Australia. “Skin cancer is one of the most preventable cancers,”
he explained. “In Australia, we started innovative public awareness campaigns 30 years ago, and we are now seeing the results of these with a downward trend in melanoma cases in younger age groups. It is vitally important that a comprehensive and well-resourced plan is put in place by the Irish government, to tackle skin cancer in Ireland, or unfortunately, the significant human and financial burden of skin cancer will continue to increase.” Importance of Screening The statistics are alarming. Fortunately, early screening and treatment have allowed for improved malignancy detection and improved patient outcomes. Screening for breast cancer, for instance, has decreased the mortality rate by up to 23%,
PHARMACYNEWSIRELAND.COM | 35
and between 21,000 and 40,000 deaths could be avoided with proper colorectal screening. The scope of the pharmacist has dramatically changed in recent years. With a shift toward patient care and away from dispensing activities, pharmacists are in a prime position to incorporate cancer-screening initiatives into their practice. Pharmacists have embraced the opportunity to participate in the prevention and screening of a variety of other chronic conditions such as osteoporosis, osteoarthritis, diabetes, hypercholesterolemia, hypertension, asthma, chronic obstructive pulmonary disease, sleep disorders and depression. Risk Factors and Symptoms The main risk factors for developing skin cancer include a history of severe sunburn and intense intermittent exposure to the sun at an early age. Those with cutaneous lesions that may possibly be pre-malignant, such as actinic keratoses are also at risk. Other risk factors include lighter skin colour, family or personal
history of skin cancer, skin that burns, freckles or reddens easily in the sun. Less established risk factors include having blue or green eyes, blond or red hair, certain types and a large number of moles. The main skin cancer preventive strategy is to reduce UV radiation exposure, especially in those at risk. All individuals should adopt effective sun protection habits, such as wearing sunscreen, hats, shirts, and sunglasses. Pharmacists should advise their customers on proper use of sunscreens and encourage patients to limit or abstain from using indoor tanning equipment, especially if risk factors are present. Both pharmacists and patients share responsibility for routine examination of the skin. The arms, face, back and upper chest are of particular concern. Patients may present with complaints of moles or skin lesions that have changed, relative to their original size, shape or colour. Some may also experience local discomfort, bleeding, or notice a lesion that does not heal. Basal cell carcinoma can appear to be waxy, translucent, or pearly, whereas SC cancer
often presents as an indurated nodular tumor with or without keratinization. Pharmacists should refer these patients to their GP, or a dermatologist for medical examination. It is helpful to assess pigmented lesions using the ABCDE approach (see below). Patients should be educated on this checklist: The ABCDE approach A Asymmetry B Border irregularity C Colour â€“ three or more colours or one colour that is different from the rest D Diameter greater than 7mm E Evolution â€“ persistent growth of a new or pigmented lesion Pharmacists are well placed to provide sun protection advice to all ages groups in the community and encourage those bonafide sun worshippers to alter their behaviours. Here are 10 sun smart tips to share with your patients: 1. Limit the amount of time you are out in the sun between 11-3pm. This is when the
suns rays are most intense so seek shade when out and about. 2. When going on holiday, remember the closer the holiday destination is to the equator, the greater the exposure of UVA and UVB to the skin and the greater the risk of sun damage and being burnt. 3. Clothes are the best form of sun protection. If possible, wear long sleeved shirts and trousers. Dark, tightly woven clothing provides greater protection than white loosely woven clothing. Look for the Ultraviolet Protection Factor (UPF) on the garment label. 4. Wear a wide brimmed hat and sun glasses with lenses that have 99%-100% UV absorption providing optimal protection to the eyes and surrounding skin. 5. Use sunscreen every day, even if it is cloudy. 6. Choose a broad spectrum sunscreen that protects against Ultraviolet A and Ultraviolet B (UVA and UVB) radiation â€“ Minimum SPF 30. 7. Use sufficient quantities of sunscreen and apply 30 minutes before going out in the sun. Apply every two hours and hourly if swimming or sweating during physical activity. 8. Use a lip balm with sun protection factor (SPF) 30. 9. Be careful around water and sand as these surfaces reflect sunlight causing extra sun damage to the skin. 10. Remember UV Exposure not only increases the risk of skin cancer but also causes photo-ageing. So if you still want to look young with good looking skin in later life, slip on a shirt, slip into the shade, slop on sunscreen, slap on a hat and wrap on sunglasses! Pharmacists and pharmacy staff are in a great position to educate patients on the importance of minimising solar exposure to decrease the risk of skin cancer. They can also promote regular skin self-exams, teaching patients to pay careful attention to moles, especially those with changing border shapes and sizes, or those that bleed or itch. Pharmacists should refer patients back to their GP in the event that suspicious lesions are detected.
36 | PHARMACYNEWSIRELAND.COM
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Challenge of integrating health outcomes Better integration of data on healthcare outcomes will improve decision-making in health policy and healthcare reimbursement, according to Professor Jan Sorensen, Director of the Healthcare Research Outcomes Centre at the Royal College of Surgeons Ireland (RCSI). Professor Jan Sorensen, Director of the Healthcare Research Outcomes Centre, RCSI
Speaking ahead of Ireland’s second National Healthcare Outcomes Conference, Professor Sorensen said that greater efficiency could be achieved if the health service consistently integrated robust outcomes data into its decision-making processes.
“Ireland’s health services continue to struggle to meet multiple and escalating resource demands and there is much debate relating to appropriate access to diagnostic and therapeutic interventions,” he says. “The only sustainable approach to the dilemma of increasing demands in a resource-constrained system is to base decision-making and resource allocation on clear
outcomes based criteria. If the system doesn’t get to grips with this now, it will face even greater challenges as Ireland’s population gets older.” The conference facilitated a discussion about the value as well as challenges of integrating healthcare outcomes data in health policy, healthcare decision-making and healthcare procurement. The conference also aimed to better connect patients’ experience of a healthcare outcome, with perceptions of the outcomes from the perspective of clinicians and policy-makers. Professor Sorensen adds, “It is never easy for a clinician or policy maker to make a decision which compares the needs of one group of patients with another. Yet that is a decision that is made every day in healthcare. Only by using robust information on outcomes can those decisions be made fairly and with the interests of all users of the health service in mind.”
Bowel cancer rates set to double Looking after bowel health can save lives. That is the call being made as news figures show the number of people in Ireland diagnosed with bowel cancer is set to double by 2045. The Irish Cancer Society is encouraging people to check their bowel health by using their online bowel health checker. Bowel Cancer Awareness Month took place last month (April). This year it is estimated that up to 2,800 people will be diagnosed with this disease, and more than 1,000 people will die from it. However, with a growing, ageing population, the National Cancer Registry projects the number of diagnoses to reach over 5,700 by 2045. There are many opportunities for pharmacists to raise awareness of, and to identify, the early warning signs of bowel cancer. For example, during medicines use reviews, when giving advice on over-the-counter products and when counselling on prescription medicines. Pharmacists should also give consideration to the side effects of other medicines patients may be taking since these may be similar to the symptoms of bowel cancer.
The symptoms of bowel cancer include: • A change in normal bowel motion, such as diarrhoea or constipation. • Feeling they have not emptied their bowel fully after a motion. • Pain or discomfort in the abdomen or back passage. • Trapped wind or fullness in the stomach. • Weight loss. • Tired and breathless (due to anaemia from blood loss). • Rectal bleeding or blood in stools. These symptoms can also be due to complaints other than bowel cancer. But they should be checked, especially if they last for more than 4 to 6 weeks.
Joan Kelly, Cancer Support Manager with the Irish Cancer Society says, “Bowel cancer most commonly occurs in people over 60 years of age and is often diagnosed in the later stages. However, if bowel cancer is caught early, it is extremely treatable. Recent figures showed us that 95% of people diagnosed at Stage 1 were alive 5 years later. That is good news but this is not the case for people diagnosed with stage 3 and 4 bowel cancer. We need to work towards increasing the number of people diagnosed in the early stages. “To do this, the public need to be aware of the main signs and symptoms. We would encourage anyone who might be interested in checking their bowel health to take our easy to do online Bowel Health Checker which can be found at www.cancer.ie/bowelhealth. It’s a quick questionnaire and includes a letter which can be brought to their GP.”
Cosmetic Association Trade Fair Those attending the Irish Pharmacy Awards 2019 will be able to enjoy a double-event attendance, with the annual Cosmetic Association Christmas Trade Fair being held the following days. The Cosmetic Association was formed over 30 years ago to offer the Pharmacy sector a onestop-shop for their Christmas trade. As the years went by, exhibitors took the opportunity of introducing new brands at the Trade Fair and this was a welcome addition. For buyers to see a full stand of cosmetics, or a display of perfumes, or a range of jewelry or a display of wrapping / bags, in one day, and in one place, is a huge benefit. This year the Trade Fair is being held on Sunday, May 19thMonday, May 20th in the RDS. “As the years have gone by our event has grown in many ways. Exhibitors have increased in numbers and the variety of products available is beyond measure. This year is better than ever with exciting new companies and lovely new brands being exhibited,” says Jo Somerville, Managing Director, the Cosmetic Association. “The event will be the most colourful to date and we hope all visitors will enjoy their visit. Remember, we have free parking within the RDS grounds and everyone will receive a voucher for coffee and a pastry when they register,” she adds. The event is scheduled for May 19th 20th and 21st, in the Main Hall and Hall 3, in the RDS, Merrion Road, Ballsbridge, Dublin 4. Registration is available at the door.
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Supplements – Pathway to Care
utritional Supplements have been available in Ireland for over thirty years. Originally available in health food stores only, supplements now have several distribution channels including pharmacy and via online channels.
Recommendations for consumption can come from many sources including community pharmacy, GPs, alternative practitioners, dieticians and nutritionists. The demand for nutritional supplements has increased over the years, and the industry has expanded exponentially. Nutritional supplements provide an important opportunity to optimise illness prevention. As scientists and health professionals start to understand the value of supplements in terms of the prevention and treatment of disease, consumers follow suit. The Vitamins, Minerals and Supplement (VMS) market is growing at a steady rate thanks to increasing consumer awareness of preventative healthcare. The VMS market has benefited from the strong health and wellness trend in Ireland over the past 12 months. Data from Euromonitor also shows that
Vitamin D is set to drive sales growth over the forecast period as more consumers are being aware of the importance of supplementation due to limited sunshine. Busy, modern lifestyles seem to be having an adverse effect on consumers, with tiredness and stress being the most pressing of health concerns. Supporting their health is a key motivation for exercise among the most active consumers, which creates opportunities for multifunctional sports nutrition that incorporates additional health benefits. Meanwhile, many people who have busy lifestyles and feel they are not able to obtain a healthy and balanced diet through food consumption alone address this issue through vitamin and mineral supplementation. Over-Consumption The food supplement industry in Ireland has been growing dramatically over recent years and the number of different products on the market has risen
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from 700 in 2007 to over 2,500 in 2017 - an increase of over 300%. Just last year, new guidelines on how many vitamins and mineral supplements can be safely consumed were published by the Food Safety Authroty of Ireland’s (FSAI) Scientific Committee alongside warnings about the dangers of over consumption. The report outlines the process that the burgeoning food supplement industry can use to establish maximum safe levels for 21 of the 30 vitamins and minerals permitted in food supplements in Ireland. The guidelines set out the highest dietary intakes of micronutrients which are safe for people of different ages and gender and the FSAI expressed the hope that the information will help consumers understand the amounts of vitamins and minerals that are excessive. “We are concerned about the growing number of these products and, in particular, the
safety of vulnerable groups of the population in Ireland including children, pregnant women and older people,” the Chief Executive of the FSAI Dr Pamela Byrne said at the time. She expressed the view that the report would allow the FSAI “to provide robust advice and guidance to the industry on the levels of nutrients for their products by age and gender groupings.” She said the advice for the general public regarding taking food supplements remains “that it is not necessary to take food supplements to maintain a healthy lifestyle” and instead the FSAI recommends a “well-balanced diet with plenty of fruit and vegetables and, plenty of exercise”. She said the only food supplements the FSAI recommends for the general population are folic acid for women who are sexually active and vitamin D supplements for infants from birth to 12 months.
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Pregnant and breastfeeding women are also at risk of vitamin D deficiency and should take a daily supplement containing 10 micrograms – a point pharmacy teams could raise with expectant mothers. Fish oil supplements should be pregnancy-specific to avoid high doses of vitamin A and breastfeeding women should continue with vitamin D and fish oil supplementation. According to Euromonitor, multivitamins continue to drive the vitamins, minerals and supplements category, with many people believing that these are good value for money in terms of the health benefits they bring. The use of specific supplements and nutritional advice should be targeted towards vulnerable groups such as children and the elderly, pregnant women and anyone who is convalescing. Yet there’s no one-size-fits-all approach, as deficiencies and needs vary from person to person.
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Statistics have shown that a large number of the over-50s are falling short of the nutritional goals needed to maintain optimal health. The take-home message is clear - Supplements, such as a daily multivitamin, can provide an effective strategy for maintaining health, supporting nutrient intakes, plugging dietary gaps and helping to address the nutritional challenges associated with ageing. Due to weaker digestive systems in older age, it is difficult for the human body to absorb the required nutrients from food. Among the geriatric population, loss of appetite and the weakening of bones are common issues. In many cases, the diet does not contain sufficient calories or the essential nutrients that the body needs. With the growing interest in healthy ageing, B vitamins, fish oils and zinc have all been shown in randomised clinical trials to support cognitive function, while vitamin D is recommended across the board for the over-65s. While probiotics have yet to achieve authorised health claims
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for gut health in Europe, there is consistent evidence that they offer some benefit in terms of stool consistency and could certainly be of help to older adults alongside dietary advice to boost intakes of wholegrains, vegetables and fruit. The vitamins category is a complicated area for consumers with strange names and baffling ingredients. Most consumers don’t have the time to research. Unless they have a particular vitamin deficiency, it’s difficult to know what the correct combination is. So consumers are looking for easy, tailored solutions to meet their needs from a single product, from a brand they trust, instead of trying to find the right combination of ingredients for themselves. Offering Education Customers also have to make the choice between premium products and products presented more cheaply. Pharmacies shouldn’t shy away from offering premium brands, where they have strong knowledge of the area. Research also shows that family health and the ‘beauty from within’ trend are key contributors to the strong growth of vitamins and dietary supplements. The interpretation is that consumers are realising that internal health is as important as external health. It is important therefore that community pharmacists and their teams understand the products they sell. Customers need to have confidence that the pharmacy understands their needs and is able to recommend appropriate products to help treat whatever condition they require help with. Being able to offer customers qualified advice on the products they sell will result in greater immediate sales and long-term repeat sales. Choosing which products to stock and recommend in pharmacy can be difficult due to conflicting information about the benefits of certain supplements as well as a variation in the quality of products with the same ingredients. Highlight products that have some research behind them, are manufactured with high quality control and have accreditation. It may also be beneficial to purchase from companies that are investing in promotional campaigns that could draw more customers into pharmacy, as well as companies that offer in-store
Who says nutritious can’t be delicious? SMOOTHIE High Purity Fish Oil support material and training for pharmacy staff. While trends and sales are affected by media coverage, there will always be a need for the basic vitamin and mineral essentials such as calcium, vitamins B, C and D and magnesium. Strategies for Effectiveness Those who are going to make the effort to take vitamins, minerals, and other supplements daily to improve their health and nutrition, owe it to themselves to use simple strategies to make them as effective as possible. It’s no secret that vitamins should be taken at mealtimes. When we consume foods, it initiates a cascade of digestive processes that help absorb the nutrients from food, and this will also optimise the absorption of the vitamins and minerals. Taking vitamins and minerals with food also helps to prevent nausea which some people may experience from supplements. There are exceptions to every rule and in this case, it’s iron. It should be taken in the morning on an empty stomach for better absorption. It is also key for consumers to know how their vitamins work with their other medications. Vitamins and minerals can interact with prescription and OTC medications. In some cases, this will make one or the other less effective and in other cases, it could amplify their effects and put some at risk for an overdose. For example, calcium may interfere with the absorption of a commonly prescribed thyroid medication, and many women take both.
Knowing the difference between fat and water solubles will help get the most out of vitamins. Fat-soluble vitamins, namely A, D, E, and K are stored in the body, where they can accumulate and in some cases, cause harm. By contrast, water-soluble vitamins such as the B vitamins folate, thiamine, riboflavin, niacin, pantothenic acid, biotin, vitamin B6, and vitamin B12 and vitamin C, are excreted in the urine so they can’t build up in the body like their fat-soluble counterparts. Knowing when to pair is also important, as is knowing when to split. Some vitamins and minerals are better together. This includes vitamin D, Vitamin K, and calcium. Vitamins D and K help the body and bones absorb calcium, so taking them together is one of many simple ways to boost the bones. Other winning combos include iron and vitamin C, as Vitamin C helps the body release a higher percentage of iron. A lot of times vitamins that go better together are packaged together. Some vitamins and minerals are best when taken separately. Zinc and copper compete with one another, as do iron and zinc when they are out of ratio, but multivitamins keep it balanced. Calcium also inhibits iron, which means they should be separated, Splitting pills can also make sense with some water-soluble vitamins. If a vitamin is water soluble, then an individual will urinate much of it out on their next bathroom trip, so some will need to be taken more than one time per day.
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Pharmacy Category Training Initiative Uniphar will host free expert-driven product training for the growing vitamins, minerals and supplements category in Dublin and Cork at the end of May. The Dublin training will take place on Tuesday, May 28th at the Clayton Hotel Liffey Valley. The Cork event will be hosted on Wednesday, May 29th at The River Lee Hotel in Cork. Both events run from 9.30 – 16.00 and are free to attend. According to research from Uniphar, the wider wellness category is witnessing high growth in Irish pharmacy, with a 30% increase in retail sales observed
in pharmacies who focused on the area. A Euromonitor report forecasted 2018 sales of vitamins, minerals and supplements at ¤16 million. Four key front of shop vitamins and supplements products will be covered in detail at the training. These include AYA, Nature’s Aid, Revive Active and Active Iron. The training is designed to increase the knowledge and confidence of pharmacy staff.
Eimear Nee MPSI, pharmacy trainer for Uniphar, will cover the 19-line AYA range. AYA, which was launched on April 25th, is a new vitamins and supplements range from Uniphar. Training will include an overview of the AYA range and the benefits it offers to consumers. Nature’s Aid will cover its new probiotic range and CBD oil products, in addition to an overview of their full range of products. Revive Active will present on their new product Zest
Active, plus Revive Junior, Revive Teen and Mastermind. Participants will also receive an overview of the new men’s and women’s ranges from Active Iron. Both vitamins, minerals and supplements training events are free to attend for all pharmacy staff in Ireland. To book your place, contact Jacqui Leonard, Uniphar Training Coordinator by emailing firstname.lastname@example.org or by phone 01 428 7860.
Fresh Insights into Vitamin D Scientists have uncovered fresh insights into how vitamin D affects the immune system and might influence susceptibility to diseases such as multiple sclerosis. Vitamin D is produced by the body in response to sunlight and is often lauded for its health benefits. Researchers found it also affects key cells of the immune system. This discovery might explain how vitamin D regulates immune reactions that have been implicated in autoimmune diseases such as Multiple Sclerosis. Researchers say the findings shed light on how vitamin D deficiency may regulate the immune system and influence susceptibility to autoimmune diseases.
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Burns & Scalds: Management Don’t keep the management of burns and scalds at arm’s length. The category can offer the pharmacy team a host of opportunities, ranging from optimising the management of burns to providing first aid advice on treating minor injuries such as scalding in the home. There are 4 main types of burn, superficial epidermal burn; superficial dermal burn; deep dermal or partial thickness burn and full thickness burn
films. When managing burns in the pharmacy environment it is also important to exercise key precautions: • Never apply lotions, ointments or creams to a burn • Avoid adhesive dressings unless specifically indicated for burns • Do not attempt to remove jewellery or clothing if it has adhered to the skin • Burn blisters should be left intact and not burst.
Pharmacists are in a pivotal position to guide patients on the proper selection of the OTC products marketed for treatment of minor burns, as well as to ascertain the appropriateness of self-treatment and direct patients to seek medical attention when warranted. The overall goals of burn, scalds and minor wound care treatment are to promote healing, prevent infection or further complications, relieve pain, and minimize the incidence of scarring. Burns and scalds are damage to the skin caused by heat. Both are treated in the same way. A burn is caused by dry heat – by an iron or fire, for example. A scald is caused by something wet, such as hot water or steam. Burns affect children and elders disproportionately, often with more severe consequences. Young children are scalded more than older children, who suffer more flame burns. With their thin skin, children lose more fluids and have a greater systemic inflammatory response. Amongst the elderly, burns and fire-related injuries are the second leading cause in home accidents. Elder burn victims have longer hospitalisations, poorer prognosis, and are more apt to be transferred to rehabilitative or long-term care facilities. Burns are assessed by how
seriously the skin is damaged and which layers of skin are affected. Skin has 3 layers: • the epidermis - the outer layer of skin • the dermis - the layer of tissue just beneath, which contains blood capillaries, nerve endings, sweat glands and hair follicles • the subcutaneous fat, or subcutis - the deeper layer of fat and tissue There are 4 main types of burn, which tend to have a different appearance and different symptoms: • superficial epidermal burn - where the epidermis is damaged; skin will be red, slightly swollen and painful, but not blistered
• full thickness burn - where all 3 layers of skin (the epidermis, dermis and subcutis) are damaged; the skin is often burnt away and the tissue underneath may appear pale or blackened, while the remaining skin will be dry and white, brown or black with no blisters, and the texture of the skin may also be leathery or waxy. Minor burns can usually be self-treated safely but large first and second-degree burns (covering an area of more than 3-4cm) and all third-degree burns require medical attention. The first step with any burn or scald should be to hold the wound under cool running water for a minimum of 10 minutes or until the pain subsides.
• superficial dermal burn - where the epidermis and part of the dermis are damaged; skin will be pale pink and painful, and there may be small blisters
Burn spray products are also available which, applied to the burn or scald, can alleviate pain and aid with cooling. After removing jewellery, watches and clothing from the affected area, the cooled burn or scald should then be dressed.
• deep dermal or partial thickness burn - where the epidermis and the dermis are damaged; this type of burn makes skin turn red and blotchy; skin may be dry or moist and become swollen and blistered, and it may be very painful or painless
Advise customers to use a sterile gauze bandage or clean lint-free dressing to prevent infection; specialised burn plasters are also available OTC. Specific types of dressing available from the pharmacy for burns and scalds include gauze-impregnated dressings and vapour-permeable
When offering advice to patients about wound care and burn products, it is imperative for pharmacists to ensure that patients are thoroughly educated about the proper use of these products, including the recommended duration of use. For years, many individuals believed that minor wounds should be left uncovered to heal more quickly; however, recent studies have shown that uncovered wounds increase chances of scarring and possible infection and reinjury. Recent research has demonstrated that a moist healing environment will accelerate healing and may minimise scarring and reduce incidence of infection Those with burns should be advised not to rupture blisters, and if the skin is broken, they should apply topical antibiotics to prevent infections. It is also important for pharmacists to remind certain patient populations, such as patients with diabetes or those individuals currently taking medications that may impair the healing process, to adhere to minor wound care protocols and to seek the advice of their GP. Furthermore, individuals should always be advised to seek medical care for wounds or burns that do not exhibit any signs of healing after 5 days of self-treatment or if the wound or burn shows signs of infection, such as redness, swelling, or severe pain.
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Continuing Professional Development
CPD 102: PARKINSON’S DISEASE This module is suitable for use by community pharmacists as part of their Continuing Professional Development. After reading this module, in the magazine or online, complete the post-test on our website at www.pharmacynewsireland.com and include in your personal CPD ePorfolio. Biography - Since becoming owner of Whelehans, Eamonn Brady MPSI has striven to build and grow his business around his philosophy of placing his customer led, independent pharmacy firmly at the centre of his community and to extend its reach through engagement “outside the front door” with the public and local groups. At the core of Eamonn’s vision of his own role as a community pharmacist, is his belief that prevention is better than cure and to “help people to help themselves” through education and information initiatives delivered in a variety of ways.
Parkinson’s Disease: profile, causes, symptoms and treatments
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?
Parkinson's disease is a chronic (long-term) disorder of caused by the degeneration of dopamine generating cells in the mid-section of the brain. The reason for this degeneration in Parkinson’s patients remains largely unknown. It mainly affects the way the brain co-ordinates movements of the muscles in various parts of the body. Symptoms gradually worsen over time. The main symptoms of Parkinson's disease are stiffness, shaking (tremor) and slowing of movement. There is no cure, but treatment can slow down its progression and can provide good relief of symptoms for several years in most patients. Modern treatment options mean that people with Parkinson’s can have a normal or near normal life expectancy.
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.
60 Second Summary Parkinson's disease is a chronic disorder caused by degeneration of dopamine generating cells in the mid-section of the brain. The reason for this degeneration remains largely unknown. Parkinson’s usually develops in people over the age of 50 and is rare in people under 50. Parkinson’s does not seem to have a genetic link. Symptoms: The brain cells and nerves help produce smooth, co-ordinated movements of muscles. The gradual reduction of dopamine causes the three main symptoms of Parkinson’s: slowness of movement, stiffness and tremor. Treatment: While there is no cure for Parkinson’s, treatments ease symptoms and slow progression. Medication: General consensus recommends starting with a dopamine agonist (i.e. levodopa) with a dopa-decarboxylase inhibitor or a monoamine-oxidase inhibitor. Levodopa is considered most effective and is central to any pharmalogical treatment regime Dopamine agonists: Dopamine agonists mimic dopamine. Ropinirole (Requip®), pramipexole (Mirapexin®) and rotigotine (Neupro® patch) are used most commonly. Despite being slightly less effective than Levodopa, one potential advantage compared with levodopa is at least 50% lower risk of dyskinesia. Dopamine agonists may be prescribed first choice to delay starting levodopa as levodopa generally only works well for about five years. Mono-amine oxidase-B inhibitors: They include selegiline (Eldepryl®) and rasagiline (Azilect®). They work by inhibiting or blocking the effect of monoamine-oxidase-B (MAO-B) in the brain preventing the breakdown of levodopa and dopamine. Blocking MAO-B means the effect of dopamine lasts longer. Most Parkinson’s patients require levodopa eventually when the disease gets worse. Other medication used for Parkinson's disease Catechol-O-methyltransferase (COMT) inhibitors have become available in the last 20 years. (eg) Entacapone (Comtess®) and also an ingredient in Stalevo®. COMT inhibitors may be prescribed in combination to levodopa.
Profile of patients According to the Parkinson’s Association of Ireland, approximately 9000 people in Ireland are affected by Parkinson’s. Parkinson’s usually develops in people over the age of 50 and is rare in people under 50. It affects about 5 in 1,000 people in their 60s about 40 in 1,000 people over 80.1 Men are one and a half times more likely to get Parkinson’s than women2; the reason for this is unknown. Parkinson’s does not seem to have a genetic link, so it does not appear to run in families. There is some evidence that there is a small risk of a hereditary link in those who develop it under 50. There is some evidence that smoking increases risk of Parkinson’s.3 Causes The substantia nigra region of the brain is the area affected. The substantia nigra controls muscles in the body by sending messages via nerves in the spinal cord to the rest of the body. Messages are passed between brain cells, nerves and muscles
Planning - Will this article satisfy those knowledge gaps or will more reading be required? What resources are available?
Evaluation - How will you put your learning into practice? Have I identified further learning needs? Published by IPN, supported by Elastoplast. Copies can be downloaded from www.irishpharmacytraining.ie Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author.
via chemicals called neurotransmitters. Dopamine is the main neurotransmitter produced by the brain cells in the substantia nigra. With Parkinson’s, cells in the substantia nigra become damaged and die over time. As the cells die, the amount of dopamine produced is gradually reduced. Symptoms The brain cells and nerves normally help to produce smooth, co-ordinated movements of muscles. The gradual reduction of dopamine causes the three main symptoms of Parkinson’s, slowness of movement, stiffness and tremor. The symptoms of Parkinson’s often occur in one side initially (eg) tremor in one leg or one hand, loss of ability to swing your arm or leg on one side.3 It is worth noting that a reduced sense of smell may be one of the initial symptoms in early Parkinson’s.4
CPD 102: PARKINSON’S DISEASE Slowness of movement (bradykinesia). This causes difficulty performing simple everyday activities like walking, climbing stairs or getting out of a chair. Many people mistake this as a normal part of aging which means diagnosis is delayed in many cases. Diagnosis often does not occur until other symptoms like tremor of stiffness occur. With time, normal walking becomes difficult and Parkinson’s patients often develop a 'shuffling' type of walk with difficulty in starting, stopping, and turning. Stiffness of muscles (rigidity) is when the muscles become tense with the arms and legs tending not to swing as easily. Tremor is common symptom of Parkinson’s. For many people it is the symptom that leads them to seek treatment and thus allow diagnosis. However not all patients with Parkinson’s have tremor. About 30% of Parkinson’s patients do not suffer from tremor initially but it always develops as the condition progresses. It usually affects the fingers, thumbs, hands, and arms, but can affect any part of the body. It is most noticeable when resting. Tremors tend to worsen when anxious or emotional and tends to reduce when using your hands or picking up an object or moving the affected area. The speed in which symptoms become worse varies from person to person. It can take several years before symptoms become bad enough to affect routine tasks and quality of life. In many cases one side of the body may be more affected than the other initially but with time both sides are usually affected equally. As the condition develops and more dopamine receptors are destroyed, other symptoms develop. These include difficulty with balance and posture and an increased tendency to fall. Further symptoms include inability to perform facial expressions like smiling or frowning; reduced blinking; difficulty with fine movements such as using a scissors, tying shoelaces, opening and closing buttons, zipping up and difficulty with writing (handwriting tends to become smaller). There can be a slowdown in speech leading to a monotone voice and swallowing difficulties can develop leading to pooling of saliva in the mouth. Tiredness, aches and pains are other possible symptoms. Other symptoms which occur in some people as the condition develops include: • Bladder symptoms including incontinence • Constipation • Sweating • Sexual difficulties.
• Alterations in sense of smell • Sleeping problems (can be disturbed sleep at night or excessive sleep during the day) • Hallucinations • Weight loss • Pain • Depression • Anxiety Diagnosis There is no specific test to diagnose Parkinson’s. Diagnosis is based the typical symptoms. It may be difficult for diagnosis initially with many people not being diagnosed for years after developing the condition as symptoms are mild and may be mistaken as a normal part of aging. Parkinson’s is sometimes confused with other conditions that have some “Parkinson” type symptoms. Parkinson symptoms may occur in people suffering from neurological disorders such as Alzheimer's disease, Huntington's disease, Wilson's disease, spinocerebellar ataxias and Creutzfeldt-Jakob disease (better known as “mad cow disease”). Other conditions that can occasionally display symptoms similar to Parkinson’s include brain injury, brain infections (such as encephalitis), hyperthyroidism, brain tumour, liver disease, stroke, carbon monoxide poisoning and heavy metal (such as manganese) poisoning. Some medication can cause side effects that resemble symptoms of Parkinson’s. A form of Parkinson’s which is reversible sometimes develops from some antipsychotic drugs, especially 1st generation antipsychotics such as chlorpromazine and haloperidol. Some antiemetic medication (metoclopramide) and epilepsy medication (valproate) may also cause Parkinson type symptoms. Reducing the dose of these medications generally eases or stops the Parkinson type symptoms. A neurologist or a consultant specialising in elderly care usually makes the diagnosis of Parkinson’s. While a scan of the brain cannot determine if Parkinson’s is present it is sometimes used to differentiate Parkinson’s from other conditions that cause Parkinsonism features. Link between Parkinson's disease and dementia The thinking part of the brain is not affected by Parkinson’s, so dementia is not a usual early feature. However, Parkinson’s increases the risk of developing dementia. Approximately 40% of patients
with Parkinson’s develop dementia but dementia typically does not develop until 10 years or more after the first Parkinson symptoms occur.3 If dementia occurs, it generally develops in Parkinson patients over 70. The cholinesterase inhibitors rivastigmine (Exelon®), donepezil (Aricept®) and galantamine (Reminyl®) have been shown in studies to have a modest benefit in cognitive function and in the reduction of hallucinations and psychosis in patients with Parkinson related dementia. Rivastigmine5 appears to be most effective for Parkinson’s related dementia with donepezil to a lesser extent.6 Treatment While there is no cure for Parkinson’s, treatments can ease symptoms and slow progression. If diagnosis is early, medication is often started before symptoms become troublesome to slow progression. Medication Scottish Intercollegiate Guidelines Network (SIGN) which is an influential health guidance authority in the UK recommend starting with a dopamine agonist (i.e. levodopa) with a dopa-decarboxylase inhibitor or a monoamine-oxidase inhibitor. There are other anti-Parkinson medicines available, but they are not used as often as the three types of medication described above but they can be used in addition to these to improve response. Levodopa is considered the most effective Parkinson treatment and is central to any pharma logical treatment regime.7 It can take 8 to 10 weeks from the start of treatment before the patient notices improvement in symptoms. Levodopa Levodopa tends to give a good improvement in symptoms. Levodopa is converted to dopamine in the brain. The dose is started low but tends to be increased to control symptoms. Levodopa is always used in combination with another medicine to prevent side effects (either benserazide or carbidopa). Benserazide and carbidopa prevent levodopa being converted to dopamine before it reaches the brain thus reducing side-effects. Levodopa combined with benserazide is called co-beneldopa (Madopar®) and levodopa combined with carbidopa is called co-careldopa (Sinemet®). Side effects from Levodopa tend to be rare at low doses. Nausea is the most common side effect. Other side effects which may occur include vomiting, dizziness and low blood pressure; however, these often ease after a few days of use and are minimised by starting with lower doses. Levodopa can occasionally cause compulsive behaviour in some people (eg) urge to gamble, spend
CPD 102: PARKINSON’S DISEASE money. The effect of Levodopa tends to wear off over time, usually over a period of 3 to 5 years. Problems that occur with time include 'on-off' effects; thus, alternating between being 'on' (being able to move freely), and being 'off' (not being able to move) in quick succession. Another side effect can be dyskinesia which is uncontrollable jerky movements which can be disabling, tiring and painful. Levodopa can cause other movement disorders such as head nodding, jerking and twitches. Movement disorders caused by Levodopa appear to come on quicker in younger patients (under 60) than older patients.3 Keeping the levodopa dose at the lowest that is effective to control Parkinson’s symptoms is the best way to reduce risk of movement disorders. Dopamine agonists Dopamine agonists mimic dopamine. There are several types. Ropinirole (Requip®), pramipexole (Mirapexin®) and rotigotine (Neupro® patch) are used most commonly. Bromocriptine (Parlodel®), cabergoline or pergolide are used less often because of the risk of side effects which include thickening of heart valves and thickening or scarring of lung tissue.8 Initial side-effects are similar to levodopa (nausea, vomiting and dizziness) however side-effects tend to ease within a few days or weeks. Drowsiness can also occur. Like Levodopa, compulsive behaviour can be a side-effect; compulsive behaviour is more of a problem with dopamine agonists than levodopa. Dopamine agonists should be avoided in the treatment of patients with dementia because dopamine agonists can produce hallucinations. Despite being slightly less effective than Levodopa, one potential advantage of them as compared with levodopa is that their use is associated with at least a 50% lower risk of dyskinesia (involuntary movements) and other movement type side effects in the first four to five years of treatment, particularly among patients receiving dopamine-agonists on their own.9, 10, 11 Many doctors prescribe dopamine agonists as the first choice to delay the starting of levodopa as levodopa generally only works well for about five years, thus the longer you can hold off using levodopa, the longer it takes to get to the stage when it wears off.12 A dopamine agonist may be tried in combination with levodopa as the condition gets worse. Apomorphine is an alternative dopamine agonist that is used in combination with levodopa; it is administered as a subcutaneous injection. It is only used when the condition is no longer controlled by the main drugs used for Parkinson’s such as levodopa and is reserved for patients with severe 'off'
episodes and immobility. As its effect wears off after about an hour, frequent injections are therefore needed, thus it is sometimes given as a continuous infusion. In trials comparing levodopa and dopamine agonists, symptoms of Parkinson’s improved with levodopa by about 40 to 50% as compared with approximately 30% with dopamine agonists.9,10,11 Mono-amine oxidase-B inhibitors Sometimes used as alternative to levodopa for early Parkinson’s. They include selegiline (Eldepryl®) and rasagiline (Azilect®). They work by inhibiting or blocking the effect of monoamine-oxidase-B (MAO-B) in the brain, a chemical that prevents the breakdown of levodopa and dopamine. Blocking the effect of MAO-B means the effect of dopamine lasts longer. Most Parkinson’s patients require levodopa eventually when the disease gets worse. MAO-B inhibitors are sometimes used as the first treatment after diagnosis as it can delay the requirement for levodopa for months or years. MAO-Bs are often used in combination with levodopa as the condition progresses. Other medication used for Parkinson's disease Catechol-O-methyltransferase (COMT) inhibitors have become available in the last 20 years. Entacapone (Comtess® and also an ingredient in Stalevo®) is a COMT. COMT inhibitors are often given in combination to levodopa as it slows the breakdown of levodopa by the body, so a higher percentage of levodopa can get to the brain to work. A COMT inhibitor is often added to levodopa when levodopa is not controlling symptoms sufficiently alone or where the effect of levodopa wears off. Hence Stalevo® has grown in popularity in recent years. Other medicines are sometimes used to help relieve symptoms. These medicines aim to correct the chemical imbalance in the brain. Examples include beta-blockers, amantadine and anticholinergic drugs. However, they are only a temporary or add on therapy as levodopa or dopamine agonists are the mainstay and the most effective therapies available for Parkinson’s. NON-DRUG TREATMENT OPTIONS Therapies A physiotherapist can advise and help with movement. They will concentrate on posture, walking and exercises, thus maximising the length the person can move and manage independently. An occupational therapist can advise on areas that will make the person’s day to day living easier to manage and will advise on
home adaptations and devices which can simplify tasks that become difficult due to the condition. A speech and language therapist can help if difficulties with speech, swallowing or saliva occur; these difficulties normally only occur later on in the condition. Surgery Surgery was not traditionally part of Parkinson’s treatment and is not still commonly used as a form of treatment and techniques are still in the early days of development. Surgery will not cure Parkinson’s but may help ease symptoms when medicines are not working well. An example of a surgical procedure for chronic Parkinson’s is a technique that involves putting a pulse generator (like a heart pacemaker) in the chest wall. Fine cables are placed under the skin; they connect to electrodes placed in the brain. The electrodes stimulate parts of the brain affected by Parkinson’s and can help to ease symptoms. Clinical trials are still underway for this therapy as long-term safety of this surgery is not certain. Deep brain stimulation is not yet available in Ireland and you must travel to the UK for treatment with this technique under the HSE. GENERAL ADVICE Stay as active as possible Exercise regularly as much as you are able. Exercise may not be possible as the condition progresses. Walking and movement may be slower than before but walking regularly can help loosen up stiff muscles and will help maintain and improve balance which will make falls less likely. Constipation Constipation is common with Parkinson’s as the nerves which allow the bowels to move freely are not functioning as well. Prevention includes staying well hydrated and eating plenty of fruit and veg and high fibre foods. Exercise can also improve constipation. Laxatives may be required as the disease progresses. Side effects of medication Familiarise yourself with any possible side effects of medication so you can recognise them early and deal with them promptly if they occur. Speak to your doctor and pharmacist about possible side effects and ‘Patient Information Leaflets’ that come with the medicines are an important source of information. You should inform your doctor or pharmacist of any side effects. For example, hallucinations, confusion and mental changes are possible side-effects of some medicines used to treat Parkinson’s. Bear in mind a lot of Parkinson medication
CPD 102: PARKINSON’S DISEASE is advised before food as they are absorbed better on an empty stomach; this can make compliance more challenging as in some case patients must take levodopa type medications up to 6 times daily and in later stages of Parkinson’s, polypharmacy can become a significant challenge. Driving Your doctor can advise if driving is still possible. Depending on the severity of symptoms and the medication prescribed, driving may still be possible following a medical assessment. Depression Depression is thought to occur in approximately 40% of patients with Parkinson’s Disease.3 The main reason for depression is the massive impact Parkinson’s can have on day to day living and life expectancy. Depression can cause symptoms similar to Parkinson’s and which may make it look like Parkinson’s is getting worse when actually it is not (such as lack of energy and becoming slower). Psychosis Psychosis may occur in up to 30% of patients with Parkinsons.13 It often presents as hallucinations which are usually visual together with delusions and agitation or occasionally aggressive behaviour. Paranoia may occur particularly towards partners and family members. Psychosis is thought to be due to the loss of dopamine receptors in the substantia nigra region of the brain. Older “typical” antipsychotics such as chlorpromazine (Clonactil®, Largactil®) and haloperidol (Serenace®) can worsen symptoms of Parkinson’s including movement and should be avoided. The newer “atypical” antipsychotic agents such as quetiapine (Seroquel®) and clozapine are better tolerated and often effective in controlling psychosis. Close monitoring of the white cell count is important with clozapine because of a 1% chance of a serious condition called agranulocytosis (a loss of the white blood cells which reduces the ability to fight infection). Acetylcholinesterase inhibitors such as the anti-Alzheimer’s drugs rivastigmine (Exelon®), donepezil (Aricept®) and galantamine (Reminyl®) may also be beneficial in reducing hallucinations and delusions in Parkinson patients. Practical tips Limit caffeine intake as caffeine can act as a diuretic and increase the frequency of urination. Decrease fluids to either two hours before bedtime, after dinner or earlier; this will reduce waking up at night to use the
bathroom. Sleep deprivation can exacerbate symptoms of Parkinson's. At night, a portable urinal and or bedpan can be an alternative to getting out of bed to make trips to the bathroom which can be difficult. Using a shower stall is much easier and much safer than a shower/tub combination. The shower area should be fitted with at least two handrails. It is easier to get up from a high chair than from a low couch. Consider using Velcro fasteners instead of buttons; carrying a walking stick when out can increase confidence if unsteadiness is a problem. Use an electric toothbrush and razor to make brushing your teeth and shaving easier. There are many utensils designed for people living with disability which can make everyday chores like eating, preparing food easier, grooming and cleaning easier. Examples include reaching devices, electric jar openers, modified cups and utensils for ease of holding and use, the list is limitless. Occupational therapist or pharmacist can advise on options. Longer term outlook Symptoms tend to get worse with time, but the speed of progression may vary significantly from person to person. Many do not need treatment initially as symptoms may be relatively mild. Most diagnosed with Parkinson’s Disease have a period of relatively mild symptoms. When symptoms become worse, medication can give several years of good or reasonable control of the symptoms. It is difficult to predict how quick the condition will progress. Some people may only have mild symptoms 20 years after diagnosis with others being disabled after only 10 years. Parkinson’s Association of Ireland The Parkinson’s Association of Ireland provides support for Parkinson’s patients, their families, carers and healthcare professionals. They operate a Freephone number (1800 359 359, Monday to Friday 9am to 9pm), they have a nurse on staff, provide free information leaflets and organise regular information evenings around Ireland. They also operate 14 branches around Ireland which operate on a local basis and are run by volunteer committees. They are a great source of information and support to both those living with the condition and loved ones of those affected. Their website www.parkinsons.ie is a great source of information and support. References 1. Mutch WJ, Dingwall-Fordyce I, Downie AW et al. Parkinson’s disease in a Scottish City. British Medical Journal. 1986; 292, 534–536
2. Wooten GF, Currie LJ, Bovbjerg VE, Lee JK, Patrie J. Are men at greater risk for Parkinson’s disease than women? Journal of Neurology, Neurosurgery & Psychiatry. 2004; 75:637-9 3. Davie, C.A. A review of Parkinson’s disease. British Medical Bulletin. April 2008; 86: 109–127 4. Hughes AJ, Daniel SE, Ben-Shlomo Y et al. The accuracy of diagnosis of Parkinsonian syndromes in a specialist movement disorder service. Brain. 2002; 125, 861–870 5. Emre M, Aarsland D, Albanese A et al. Rivastigmine for dementia associated with Parkinson’s disease. New England Journal of Medicine. 2004; 351, 2509– 2518 6. Ravina B, Putt M, Siderowf A et al. Donepezil for dementia in Parkinson’s disease: a randomised, double blind, placebo controlled, crossover study. Journal of Neurology, Neurosurgery & Psychiatry. 2005; 76, 934–939 7. Nutt JG, Wooten GF, Diagnosis and initial management of Parkinson’s disease. Clinical Practice. New England Journal of Medicine. 2005; 353;1021-7 8. Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE. Valvular heart disease in patients taking pergolide. Mayo Clinical Proceedings. 2002; 77:1280-6 9. Lees AJ, Katzenschlager R, Head J, Ben Shlomo Y. Ten-year follow-up of three different initial treatments in de-novo PD: a randomized trial. Neurology 2001;57: 1687-94 10. Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A fiveyear study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. New England Journal of Medicine. 2000;342: 1484-91 11. Holloway RG, Shoulson I, Fahn S, et al. Pramipexole versus levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial. Archives of Neurology. 2004; 61:1044-53 12. Braak H, Bohl JR, Muller CM et al. Stanley Fahn Lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson’s disease reconsidered. Movement Disorders. 2006; 21, 2042– 2051 13. Naimark D, Jackson E, Rockwell E et al. Psychotic symptoms in Parkinson’s disease patients with dementia. Journal of the American Geriatric Society. 1996; 44, 296–299.
Working together to celebrate success
“If everyone is moving forward together, then success takes care of itself” The Irish Pharmacy Awards represent a unique and highprofile opportunity to celebrate the excellence and amazing achievements of Ireland’s pharmacy professionals, and reaffirm Irish Pharmacy News’s commitment to the core pursuits of pharmacy: excellence in health and innovation. The Awards recognise outstanding examples of high standards, best practice, innovation and excellence. It has been, and continues to be, the goal of Irish Pharmacy News to recognise the exact added value of the contribution made by community pharmacists and their teams. Through entering your businesses, teams and colleagues and by nominating those who are making a difference and the examples of innovation that they demonstrate, IPN want to inspire you to think about your role, that of your team and of the community pharmacy profession in which you operate, as a whole.
The quantity and quality of submissions this year surpassed all previous years. Our esteemed judging panel had a very difficult task in short listing over 120 final submissions. Over the next pages we feature those who have successfully made it as finalists for the 2019 Irish Pharmacy Awards. They represent a broad spectrum of fields; from innovation and business development, to the rising stars of the profession and the teams and individuals making a difference. The aim of the Irish Pharmacy Awards is to celebrate, recognise and reward those displaying dedication and commitment. They also create a platform which fosters shared learning and education. The winners will be announced at a gala dinner in the Clayton Hotel, Burlington Road, Dublin on Saturday, May 18th, 2019. We would like to thank all those who took the time to enter, and to wish the very best of luck to our finalists on the night.
Have you Booked Your Table? The eighth Irish Pharmacy Awards are taking place on Saturday, May 18th 2019 in the Clayton Hotel, Burlington Road Dublin and we have a very limited number of tables and individual tickets remaining. The importance and popularity of the Irish Pharmacy Awards are reflected by the speed with which table bookings are made. Last year’s table booking sold out a month before the event, and for that reason, those wishing to attend are being urged to book fast, as this year’s event promises to be even bigger and better than its predecessors! Join over 650 of Ireland’s leading pharmacy professionals, academics, VIPs and pharmaceutical leaders for a unique opportunity to network, celebrate, share in innovation and education and celebrate with the pharmacy individuals and teams leading the way, judges, finalists and sponsors.
Individual ticket price ¤250 + VAT | Table of 10 price ¤2,000 + VAT | All Table Bookings include (per person seated): Champagne on arrival Unrivalled networking Awards Book of Excellence – programme and commentary on finalists and the night 5 course dinner Tea, coffee and petit four Top entertainment and keynote address Charity auction featuring incredible and unique prizes and experiences Discounted accommodation at the Clayton Hotel and other hotels near the ceremony To book your table today, please contact Anna Carr directly on 087 337 9258 or via email@example.com Alternatively you can make a booking through our website by visiting www.pharmacynewsireland.com
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Awards The Irish Pharmacy
Awards Charity Partner – Spinal Injuries Ireland This year, the Irish Pharmacy Awards are partnering up with Spinal Injuries Ireland. We will be raising much needed funds on the night of Saturday, May 18th for this extremely worthwhile cause. Emma Golding, Spinal Injuries Ireland
in 2019 to potentially 3600 in 2023. This increase will mean a real need for further SII funding in the coming four years in order to ensure that we can support every person who needs us, for as long as they need us. ‘You walk outside the door and you are walking into a maze. There’s no direction…’ Spinal Injuries Ireland (SII) is the only organisation of its kind offering on-going, specialised support services to people who have sustained a spinal cord injury (SCI) in Ireland and their families. SII was established over 25years ago by people who themselves were impacted by an SCI as they really felt the gap in support, information and services that existed within the complexities that arise when trying to build a new life post-injury. Since then SII has expanded from informational support widening the organisations resources to included activities, peer-to-peer mentoring, counselling and family services. The World Health Organisation recognises SCI as one of the most devastating injuries that a person can endure. An SCI can happen to anyone at any time. Depending on the location and severity of the injury an individual can suffer from paralysis, chronic pain and reduced organ functionality and mental health difficulties. With this can come the steep, uphill battle of learning how to live life as independently as possible with a plethora of new challenges and needs. Spinal Injuries Ireland
exists to encourage, empower and most importantly give hope to those people who find themselves in this life-changing situation. SII’s recent research on the epidemiology of SCI in Ireland showed that the number of people affected, and the type of person affected is changing as medical technology advances and we age as a population. Each week, an average of 3 new people sustain a spinal cord injury in Ireland. Traumatic instances account for approx. one injury per week with the highest instances occurring from falls. Non-traumatic injuries account for two further injuries per week with 128 instances of SCI reported in Ireland in 2017. Nontraumatic injuries occur through degenerative conditions or spinal tumours for example. These causes are estimated to increase leading to a projected rise in the number of people SII will need to support from 2100 service users
54 | PHARMACYNEWSIRELAND.COM
Ciaran Pollard, Spinal Injuries Ireland
Leaving post-injury rehabilitation and entering back in to the home or community can be a daunting time for people and their families. Our Community Outreach Team reach out to people from that point of crisis with vital information, support and a vision of what they can do to live a fuller life and overcome the daily challenges that must be faced. SII’s works to the principle of active support meaning our team of nationwide Community Outreach Officers engage with individuals on a one-to-one basis
encouraging and supporting people to set goals in the short, medium and long term that are specific to their lives, wants and needs. Goals can be anything from learning wheelchair skills or getting a grant for homeadaptation, to learning to drive or returning to employment. Each individual is different, and each injury can create different difficulties. At SII the focus is on what a person can do, not on what they can't. We work with people to realise their potential at each stage of their post-injury journey. We see people living fulfilling lives each day and through peer mentoring aim to incite inspiration for others. As an organisation and a community, we recognise the strength and resilience within each and every individual and work in practical ways to make sure that people and their families can find the resilience they need to create meaningful and fulfilling lives for themselves. ‘I would not have got through the last number of years without the support of my community outreach officer, I encourage people to link in with SII and access their services’
Awards - The Judges
Irish Pharmacy Awards Expert Judging Panel The Irish Pharmacy Awards, and all that they stand for within community pharmacy in Ireland, would not be possible without the highly valuable input of our esteemed judging panel. All of those who entered submissions and who were nominated have been reviewed by our panel of judges, hand-picked from the most experienced and knowledgeable names in the industry.
In order for any Awards process to be transparent and independent, having such a panel of independent judges is crucial. Irish pharmacy News recently hosted our judging day at Carton House Hotel, Kildare, at which our judges examined each submission against criteria searching for excellence, innovation, evidence and results.
The Irish pharmacy Awards are annual, so current or recent performance was of key relevance, alongside quality, value and services. Judges were looking for evidence of excellence, and a real feel for the individuals in the categories such as Community Pharmacist of the Year and Counter Assistant of the Year; range and innovation offered within the specialist categories such as Self-
Care and service offering in entries for OTC Retailer of the Year and Category Management. It was a tough task, and whilst there can only be one winner on the night, our judging panel felt all those shortlisted were worthy of high commendation for their submissions. Below we present the judging panel for 2019.
Professor Fabio Boylan, Associate Professor in Pharmacognosy, School of Pharmacy, Trinity College Dublin Professor Boylan is a pharmacist with particular interest in the areas of ethnopharmacology (encompassing natural product isolation and analysis of herbal medicinal preparations and the validation of their pharmacological activities) and chemotaxonomic analysis. Transdisciplinarity is applied to his approach to teaching and researching. Professor Boylan is closely engaged in Global initiatives in the area of pharmacognosy having current projects running in conjunction with institutions in Brazil, Serbia, Kazakhstan, among others. Several MSc. and Ph.D. students from those countries as well as Ireland were supervised to completion by Professor Boylan.
Patrick McCormack, Consultant A Trinity College Dublin graduate in Pharmacy and a graduate of the IMI with a Diploma in Applied Finance, Patrick worked in the USA, UK and the Middle East before establishing a successful career with the Sam McCauley pharmacy group. As Managing Director of Sam McCauley Chemists, he accomplished the transition and expansion of the chain, which became the largest 100% Irish owned pharmacy group in Ireland with an excess of 550 employees in 30 stores. Patrick was involved in the successful sale of the business to Carlyle Cardinal Ireland in 2017. Patrick is now involved in many projects including angel investment and consultancy in the health, beauty, retail and wholesale and hospitality sectors.
Billy Sweetman, Partner, Price Waterhouse Coopers A Partner in PwC's South East Practice and has over twenty-five yearsâ€™ experience advising clients in the area of accounting, corporate finance and restructuring. Billy has a wealth of experience in dealing with a variety of corporate transactions, including advising on both buy-side and sell-side M&A deals, company valuations, financial appraisal, restructuring and corporate recovery. He has worked with a range of private and public companies, from owner managed start-ups to large subsidiaries of US multinationals and Irish listed plcs, as well as entities in the not-for-profit and state sectors. A sample of his clients include Sheridan Insurances, Prim-ed, Prepaypower.ie and Brandshapers. Billy regularly supports companies through the corporate acquisition and disposal process, in particular within the pharmacy sector where he has advised on transactions including the disposal of Sam McCauley Chemists in 2017.
Dr Shane Cullinan, Lecturer, Pharmacy Practice, Royal College of Surgeons Ireland Dr Cullinan is a graduate of Pharmacy from University College Cork. Having worked for a number of years in both community and hospital pharmacy settings, he returned to UCC in 2012 to complete his PhD investigating inappropriate prescribing in older patients, and subsequently took up a post-doctoral position in UCC. In 2016 Dr Cullinan took up the role of Lecturer in Pharmacy Practice in the Royal College of Surgeons in Ireland. As well as his teaching duties, he has several research projects ongoing in the areas of electronic health record implementation and evaluation, prescribing optimisation in older patients and medical education.
Awards - The Judges David McLean, Managing Director, CPD Sessions Successful business owner, consultant and strategist with multi-sector experience across media production, healthcare, pharmaceuticals and financial services. Proven track record with over 25 years’ experience at disruptive project delivery, including digital engagement and business development, across a variety of industries. Particular strengths in finding solutions to problems and implementing change. I have been responsible for some of the biggest changes in both undergraduate and post graduate healthcare education over the past 15 years, with global uptake of developed solutions across 5 continents. Currently David is continuing to develop educational strategies in healthcare along with consulting with pharmaceutical companies in relation to digital marketing, market engagement strategies, access and online business transformation.
Patrick Grice, Pharmacy Consultant A pharmacist and was Editor of Chemist+Druggist, a leading UK title for community pharmacists, from 1995 to 2003. As well as day-to-day management of the title he was involved with the Chemex Exhibition and various C+D award programmes and conferences. He then moved ‘behind the scenes’ as Projects Director for the Pharmacy Group at UBM, where he worked on C+D Data and developed the C+D Training portfolio. He left UBM, publisher of C+D, in January 2014 and is currently working as a pharmacy consultant and writer for a number of clients. Rachel Dungan B.Sc. (Pharm), M.Sc. MPSI, Co-Founder, 4Front Pharmacy Pharmacist and Award Winning Executive and Leadership Coach, Rachel Dungan has been a practising pharmacist for almost 25 years. After years of delivering live, onsite team training, 4Front Pharmacy Online is proud to announce that it has launched its modular online Pharmacy Education Platform to train, assess and validate excellence within your pharmacy team. 4Front Pharmacy Online is proud to partner with IPN to assess and validate learning from IPN Continuous Education Articles. To register for free team training and IPN Continuous Education Article Multiple Choice Questionnaires, go to https://4FrontPharmacy.ie To register for free leadership training, 'Profile of a Pharmacy Leader' 6-Part Series at https://racheldungan. coachesconsole.com/profile-of-a-pharmacy-leader-optin.html Elaine Lorigan McSweeney, Founder, Pharmacy Wizard Elaine provides assistance to pharmacies throughout Ireland in: • Reclaims and reconciliation of all PCRS Schemes • Process improvement and training for all staff involved • Business Development and growth advice • In house or off site training, one to one or in teams/groups Born and raised in Cork, Elaine first entered the Pharmacy Sector at aged 19. Elaine became a qualified Pharmacy Technician in 2013, and with a passion and drive to support and enhance the scope for Technicians, Elaine joined the committee of the Irish Association of Community Pharmacy Technicians (IACPT). She was later nominated to take the role of President of the Association. In April 2017, with a desire for yet another new challenge she took the plunge and became her own boss which saw the birth of Pharmacy Wizard.
Sinead Ryan, Pharmacist Sinead Ryan has over a decade of practical experience working in community and hospital pharmacies in both the UK and Ireland. She is a part time lecturer in Therapeutics and Pharmacology in Technology University Dublin and Trinity College Dublin, and is about to complete an MBA in UCD Smurfit Business School. She serves on the committees of the Irish Pharmacy Union, Pharmaceutical Society of Ireland, CORU and the Irish Medical Council. Sinead has also published a number of articles in industry magazines and national media, consults to industry and is an IIOP Peer Support Pharmacist. Sarah O’Connor, CEO, Asthma Society of Ireland A native of Tipperary and a graduate of University College Cork, Boston College and the European Institute of Communications, Ms Sarah O’Connor has a background in public relations, having worked at a PR agency for three years. She worked with clients like Science Foundation Ireland, Enterprise Ireland, ESB and a number of private sector clients. Prior to that, Ms O’Connor worked in politics in various research, strategy and communications roles. In May 2018, she was appointed CEO of the Asthma Society of Ireland. She understands the challenges that people face in managing chronic conditions from her personal experience with asthma and IBS. She is dedicated to ensuring that the patient’s voice and needs are at the core of our health system and was appointed to the Sláintecare Advisory Council in 2018.
John McGrane, Director General, British Irish Chamber of Commerce John McGrane is Director General of The British Irish Chamber of Commerce, a private sector organisation which he co-founded in 2011 to represent businesses with interests in the two islands and their economies. He is a retired financial services professional having completed a 40 year career with the Royal Bank of Scotland / Ulster Bank Group in Ireland. His career has spanned substantial initiatives in the enterprise and corporate sectors, both indigenous and foreign direct investment. He is Founder of NSI Technology, a tech start-up which helps Not For Profits become Not For Losses. He is a Board Director at Dublin Chamber of Commerce and at The British Irish Chamber of Commerce and a number of charities.
Dr Paul Ryan, Co-Founder & Director, Pharmabuddy Dr Ryan works as both a community pharmacist and as a GP. He is also the co-founder and director of Pharmabuddy.ie which now has over 2,800 registered Irish Pharmacists. PharmaBuddy.ie is an online resource full of useful information exclusively for pharmacists. The core of PharmaBuddy.ie is a private discussion forum where pharmacists can share problems or concerns and an education section which helps pharmacists keep up to date on a number of topics and with their CPD requirements. Martina Doyle, Strategic Procurement Professional Strategic Procurement Professional, Speaker, Consultant, LecturerMartina is a strategic procurement professional with experience spanning over 25 years’ in both B2B and B2C sectors. In 2018, Martina joined West Pharmaceutical Services, Inc., as Business Development Director for Contract Manufacturing Europe. Prior to this, Martina spent 13 years in pharmaceutical wholesale, distribution and retailing sectors. Martina worked for McKesson Ireland which owns the market brands of United Drug and LloydsPharmacy, employing 1,600. Martina worked as Operations Director with LloydsPharmacy where she was responsible for overall Commercial Strategy including Strategic Procurement, Category Management, Supply Chain and IT Strategies. Prior to working in the Pharmaceutical Sector, Martina has also held a number of management roles across software development, management consulting and international banking. Martina holds a Master’s in Business Studies from the Michael Smurfit Business School as well as a primary degree in commerce. Martina has trained in professional coaching, provides expertise to Enterprise.
Alan Makin, AIB Bank Sector Specialist, Head of Retail and Franchise, Allied Irish Bank Alan Makim has 13 years experience as Sector Specialist. Emerging Sectors / Enterprise Ireland Relations Development and provision of banking propositions to support innovative companies operating in emerging, smart economy sectors. Managing relationships with national and supranational agencies. Relationship Manager Relationship and risk management of invoice discounting facilities for a portfolio of large corporate and commercial customers.
Cormac Tobin, Chairman of Boards Cormac Tobin is the previous Managing Director, and Member, of Celesio’s European Leadership Team. Prior to his resignation in November 2017, Cormac’s vision for Celesio UK included creating a healthcare eco-system which operates at the intersection point of the digital and physical worlds so customers and patients can live life to the fullest. During his tenure as MD he led the way with his commitment and his approach is evidenced by years of success for the family of brands, including Lloyds Pharmacy being named the UK’s most customercentric brand in a study by independent agency CSpace, AAH’s recognition by Consumer Insights Group as the UK’s most trusted pharmaceutical wholesaler and industry recognition for winning Store of the Year, for John Bell and Croydon royal warranted pharmacy and Betterlife assisted living concept store. Cormac is currently Chairman of Cara Pharmacy.
Feargal O’Shea, Pharmacy Key Accounts Manager, IQVIA With 7 years previous experience in the primary care pharmacy sector across the UK and Ireland Fergal has developed a strong clinical and commercial acumen, data analytic skills and adaptability. His resume includes; University of York Graduate Diploma/MSc in Health Economics; University of York Graduate Certificate in Health Economics; Royal College of Surgeons Ireland Tutor Training and Accreditation Programme (TTAP); Registration with the Pharmaceutical Society of Ireland (PSI); Registration with the General Pharmaceutical Council of Great Britain.
David McNally - McNally’s Pharmacy, Kingscourt, Cavan
Awards The Irish Pharmacy
Brenda Moran - Tony Walsh Allcare Pharmacy, Merrion
Áine Costello - Boots Pharmacy, The Park Retail Park, Carrickmines
Shane Ryan Ryan’s Pharmacy, Kildare
Awards The Irish Pharmacy
Jonathon Morrissey Marron’s Pharmacy, Clane
Emma Storrie Fairgreen Pharmacy, Naas
MediMarshal Community Pharmacist of the Year Award FINALISTS
Awards The Irish Pharmacy
Meaghers Pharmacy Group Oonagh O’Hagan, Managing Director
McCartan’s Pharmacy, Maynooth Ben Hibbitts, Rosaleen Harrington, Aisling O'Sullivan, Niamh Ford, Aine Shine, Bernie Walshe, Elaine Dunne and Zoe Palmer
Remedi IFSC Pharmacy, Dublin
GSK Self-Care Award FINALISTS
Aneta Walczyns, Juan Jose Del Alamo, Stephen Conan and Sophie McGuinness Ivers
Awards The Irish Pharmacy
McCauley Health & Beauty Pharmacy, Douglas
Keane’s CarePlus Pharmacy, Mullingar Helen Hassett, Lorraine Kelly, Robert Keane and Audrey Jackson
(Front row) Annmarie Cremin, Michael Ahern, Freya Kearney, Robyn O Leary, Laura O Donoghue, Meghan Kearney, Elaine Walsh (Back row) Gill O Connor, Sharon Madden, Michelle Hourihan, Mairead O’Donovan
Sudocrem Children Baby Health Pharmacy of the Year FINALISTS
Health Express Pharmacy, Mullingar Natasha Lawlor and Jessica Corrigan
Awards The Irish Pharmacy
O’Brien’s Pharmacy, Cahir
Leahys Pharmacy, Oakpark, Tralee
Dermot OBrien - O'Briens Pharmacy
Claire Kelly, Leahys Pharmacy Oakpark
Hiltons Pharmacy, Cornelscourt, Dublin
Stacks Pharmacy Group From Left to Right: Amy McMahon, Jennifer McCabe, Colette Greenhalgh, Sue O’Neil, Shaun Sugden, Thao Phan, Monica Macken, Carol Moran, Claire Crehan, Antoinette Snell, Marian Ryan, Mark Keegan and Sharon Kelly
David Gilisenan, Hilton Pharmacy, Dublin
McLernon Computers eHealth & Innovation Award FINALISTS
Cormac Black McCabes Pharmacy, Swords
Awards The Irish Pharmacy
Meabh Downey Adrian Dunne Pharmacy, Trim
Diana Truta - Hickey’s Pharmacy, Baker’s Road, Cork
JPA Brenson Lawlor Young Community Pharmacist of the Year Award FINALISTS
Shane Ryan, Ryan's Pharmacy Ryan’s Pharmacy, Kildare – Moving with the Times
The Irish Pharmacy
Dervila McGarry, Head of Marketing
LloydsPharmacy Ireland, Dublin – Heart Health Hub
Life Pharmacy, Dublin Loyalty for Life
Clonmel Healthcare Business Development (Chain) Award FINALISTS
Helen from Osborne’s Life Pharmacy, Limerick
Awards The Irish Pharmacy
McCauley Health & Beauty Pharmacy, Dublin - McCauley’s Mobile App Operations Team at McCauley Health and Beauty Pharmacy, John Keavney, Sara Jane Allen and Lynn Gaynor
Boots Ireland - Boots Mole Scanning Service Muhammad Shahid Ayub, Hazel O’Rourke, Nicole Geraghty, Aidene Browne, Audrey Donegan and Anna Jurak, Boots Pharmacy, St Stephen’s Green
Allcare Pharmacy, Dublin Allcare Online OTC Training Angela in Kiniron’s Allcare Pharmacy, Lucan with Eimear Nee MPSI, Allcare Pharmacy Trainer
KBC Bank Innovation & Service Development (Chain) Award FINALISTS
Awards The Irish Pharmacy
Commons Road Pharmacy, Navan Laura Gilmartin Lillyâ€™s Pharmacy & Health Store, Ratoath Ola Alaa El Garawany and Sally El-Banna
United Drug Business Development (Independent) Award FINALISTS
Remedi IFSC Pharmacy, Dublin Aneta Walczyns, Juan Jose Del Alamo, Stephen Conan and Sophie McGuinness Ivers
Good luck! United Drug would like to wish the finalists for The Business Development of the Year (Independent) Award the very best of luck. United, we do better.
A McKesson Company
Samantha Jones - Keane’s CarePlus Pharmacy, Enfield
Awards The Irish Pharmacy
Emma O’Brien - Donnelly’s Pharmacy, Portmarnock
Breda Brennan - Barry’s Pharmacy, Tubbercurry
David Collins - Marronâ€™s Pharmacy, Clane
Awards The Irish Pharmacy
Lauren Kelly - Haven Pharmacy, Brennans, Barna
Marie Louise Philips - Cottage Pharmacy, Drogheda
Pure Pharmacy Recruitment Community Pharmacy Technician of the Year Award FINALISTS
Margaret Faherty McCabes Pharmacy, Swords
Awards The Irish Pharmacy
Pat Keating Adrian Dunne Pharmacy, Lucan
Ashley Gough McMeelâ€™s Pharmacy, Skerries
Barbara Gilhooley - Keane’s CarePlus Pharmacy, Green Road, Mullingar
Awards The Irish Pharmacy
Nicola Purdy - McCartan’s Pharmacy, Portmarnock
Rose Cummins Meaghers Pharmacy, Castletymon
Avène Counter Assistant of the Year Award FINALISTS
Teva in Ireland Teva is one of the largest pharmaceutical companies in Ireland, with over 600 employees.
Teva’s commercial activities span the sales and support services for Teva’s large portfolio of medicines, both generics and branded innovative medicines, along with over-the-counter consumer health products.
We are the largest supplier of prescription medicines to Irish pharmacies. That’s around 13% of total packs of medicine in Ireland.2
We estimate that every day almost 1 million Teva medicines are taken by patients in Ireland.1
1 in 7
prescription packs supplied to Irish pharmacies is a Teva medicine.3
In Ireland, we supply the equivalent of one Teva pack every 3 seconds.4
Respiratory manufacturing plus R&D
Baldoyle, Dublin Manufacturing (Sudocrem®)
Baldoyle is a manufacturing site for the over-the-counter medication Sudocrem® Antiseptic Healing Cream.
invested over the last 10 years
It was first developed in 1931 and is now a multi-award winning, globally recognised product sold in over 50 countries. Sudocrem® is loved for its ability to heal nappy rash as well as cuts, grazes, bed sores, sunburn and eczema.
It is the top selling nappy rash product in 15 countries, and 34 million pots are sold worldwide every year.
in export sales over the last 5 years
of research and development and FDA approved pharmaceutical manufacturing
References: 1-4 Teva Ireland - Data on file
The respiratory medicines manufactured in Waterford are distributed to over
Date of preparation: February 2019
Ola El-Garawany - Lilly’s Pharmacy & Health Store, Ratoath
Awards The Irish Pharmacy
Enda Lannon - Lannon Late Night Pharmacy, Sligo
Ade Stack - Stack’s Pharmacy Group
Teva Superintendent Pharmacist of the Year Award FINALISTS
Awards The Irish Pharmacy
Meagher’s Pharmacy Group Life Pharmacy Group
Catherine, Orlagh, Niamh and Marion, Colm’s Life Pharmacy, Salthill, Galway
AYA Vitamins Category Development Award FINALISTS
CarePlus Pharmacy Group
VITAMINS & SUPPLEMENTS
AYA IS A BRAND NEW, HIGH QUALITY VITAMIN & SUPPLEMENT RANGE FROM UNIPHAR 19 premium products at an affordable price Free product training events for your staff (Regional locations) Free Counter Display Unit and Point of Sale material available All gluten-free, many vegan friendly AYA is Guaranteed Irish For more information, contact your Uniphar representative or visit www.uniphar.ie
Lannon Late Night Pharmacy, Sligo Treacy Bambury, Sinead Mc Gettigan and Sandra Barber McCabes Pharmacy, G24 Pavilions, Swords Aishling Flanagan, Chloe Preston, Sinead Mullins, Niamh Maguire, Frances Joyce, Patricia McTiernan, Jaroslaw Ciurylo, Kelly Masterson, Christina Rooney and Dita Paula
Adrian Dunne Pharmacy, Ashbourne Back row: Pamela, Brid, Natalie, Berni, Lauren, Gemma, Eileen Front row: Maureen, Susan and Marin
Smythâ€™s Life Pharmacy, Dundalk Back row: Darina McArdle Pharmacist, Aoife McCaughey OTC Sales, Danielle O'Shaughnessy OTC Sales, Michelle Campbell Pharmacist, Anna Luchessi Beautician - Front Row: Eugene McEntegart Management, Anne McEntegart Supervising Pharmacist, Gerard Smyth Dispensary
Awards The Irish Pharmacy
Treacy’s Pharmacy, Ballinrobe
Tullyallen Pharmacy, Tullyallen
Back row: Grainne Kennedy, Eileen Duffy, Dara McLaughlin, Kay Ryan, Tom Treacy, Leah Treacy, Ciara McGreal, Ashya Femina, Ann Treacy - Front row: Eamon Hennelly, Tegan Mahon and Caithriona Keane
Dermot Allen and Caitriona Lane. Not pictured: Jeanette Matthews, Ciara Burns, Eleanor Murphy, Laura Corrigan, Orla Cournane, Breda Coyle and Megan Martin
McCauley Health & Beauty Pharmacy, Tralee Paula O’Sullivan, Roisin Donnellan, Luke O’Shea, Christine Foley, Alison O’Brien, Chloe Goulding and Brian Kearney
Lilly’s Pharmacy & Health Store, Ratoath Sally El-Banna, Aine Noctor, Ola El-Garawany and Adrienne Fleming
Community Pharmacy Team of the Year Award FINALISTS
Glenn Ryan - School of Pharmacy, Trinity College, Dublin/McCabes Pharmacy
Awards The Irish Pharmacy
Emer Lynch - School of Pharmacy, University College Cork
Ciaran Fitzgerald - School of Pharmacy, Royal College of Surgeons
Life Pharmacy: Pharmacy Student of the Year Award FINALISTS
Lauren Oâ€™Donovan - School of Pharmacy, Trinity College, Dublin
Awards The Irish Pharmacy
Boots Ireland Boots ROI Healthcare Trading Team Pamela White, Category Assistant, Nathalie Kalo, Assistant Buying Manager, Conor O’Farrell, Buying Manager Positive Health, Avril Farrell, Buying Manager OTC Medicines, Teresa Heffernan, Assistant Buying Manager and Danielle Murray, Category Assistant Adrian Dunne Pharmacy, Newtownmountkennedy, Wicklow Lisa Synnott, Charley Byrne and Aoife Meade
Allcare Pharmacy Angela in Kiniron’s Allcare Pharmacy, Lucan with Eimear Nee MPSI, Allcare Pharmacy Trainer
RB Nurofen Rapid Relief OTC Retailer of the Year FINALISTS
Spo Proud n Irish sors of the Pha Awa rmacy rds
Award Winning Beauty Gummies!
For more information contact your Nature’s Bounty® Territory Account Manager or call +44 1442 821 419 naturesbounty.co.uk firstname.lastname@example.org Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Nature’s Bounty® is a registered trademark.
Employees of United Drug at The Pharmacy Show at The Aviva Stadium
United Drug’s Pharmacy Show returns with record numbers Now in its 13th year, The Pharmacy Show, organised by United Drug, Ireland’s largest pharmaceutical distributor, returned to the Aviva Stadium with record registrations of over 600 guests for the two-day event, the biggest of its kind in Ireland. This year also saw United Drug partner with the Irish Heart Foundation to provide CPR training for pharmacists and pharmacy staff to offer lifesaving skills across Ireland.
pharmacy owners from shopping trends, social media advice to skincare including:
Kicking off on Sunday 14th April, this year’s Show saw United Drug bring insights, knowledge and expertise to the pharmacy sector through Ted Talk style sessions, called UD Talks, as well as offering attendees the opportunity to meet suppliers and broaden their knowledge to grow their business. UD Talks, which is free of charge to attend, includes an influential group of speakers covering a range of topics to empower
• CEO & founder of The Skin Nerd® Jennifer Rock
• Paediatric Sleep Consultant, Lucy Wolfe
• CEO of Visualise Eoghan Phelan, talking shopper trends and insights • CEO of Pharmacy Wizard Elaine Lorigan McSweeney, talking rebates and claims • FMD Lead at United Drug Grace Murphy talking Falsified Medicines Directive
Pat Watt, Director of Sales & Marketing for United Drug and Paul Reilly, Managing Director, United Drug in Ireland pictured at The Pharmacy Show
PHARMACYNEWSIRELAND.COM | 83
• CEO of Connector, Conor Lynch offering top tips to grow customer engagement and brand awareness through Social Media
times more likely to act in one of these emergency situations. 70% of these situations happen outside of a hospital setting, in places like the home or in the workplace.
• Caroline McEnery from HR Suite covering HR topics
The Pharmacy Show brings over 1,400 forward-thinking pharmacies and other pharmaceutical businesses together, empowering them with information, skills and networking opportunities in an increasingly competitive market. The number of exhibitors has continued to grow with this year seeing over 80 exhibitors from all over Ireland attending the two-day event.
United Drug also partnered with the Irish Heart Foundation (IHF) to give specialist CPR training classes along with using an automated external defibrillator, the aim of which is to provide life-saving skills at a local level by training pharmacy owners, pharmacists and staff. Attending this class even once in your life means you are ten
Speaking at The Pharmacy Show, Managing Director of United Drug in Ireland, Paul Reilly said, “The theme of this year’s show is United we do Better meaning it’s crucial that we work together with all our stakeholders to protect and grow the pharmacy sector. “As the supplier of over 50% of all medicines in Ireland we are recognise the importance of supporting our customers which is why we continue to invest in areas which make a real difference to their business needs. This year, we’ve made enhancements to our website to make ordering processes more convenient and
offered more choice and value to the sector through buying groups including Pharmax. United Drug will continue to provide a sustainable healthcare platform for our customers through technologically advanced supply chains, getting medicines to people more efficiently and swiftly.” The Pharmacy Show is Ireland's premier retail pharmacy event, provides attendees a unique opportunity to network with pharmacies, manufacturers and suppliers, and get insight into exclusive products and promotions.
Robin Hanna, Sales Director and Anne Marie McWilliams, Communications Manager, McLernon Computers, Tony McEntee, CEO, McCauley Health & Beauty Pharmacy, Padraic Ferguson, Partner, JPA Brenson Lawlor and Keith McLernon, Managing Director, McLernons Computer
Tina Buckley, Tracey Carey and Charlotte Clonliffe, GA Distribution
Nicola Shields, Health Express, Grace Kelly, Johnson & Johnson and Laura Henry, Johnson & Johnson
Fergus McCauley, IQVIA and Sean Hyde, GSK
Noreen Kindregan and Shane Gallagher, KDL Retail Interiors
Angela Fitzgerald, Peter O Keefe, Paul Kiely and Alan Finn, BR Healthcare
Sonia Boyle, United Drug
Elaine Lorigan McSweeney, Pharmacy Wizard
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Graeme McInerney, RB, Don Croin, RB, Mervyn Kneafsey, RB & Ciaran Woods, RB
Jennifer Byron, Eucerin Consultant Allegro
Jessica Melia, Sheridans Pharmacy and Rachel Mulhall, RB
John O'Sullivan, Product Manager, Mark Lamb Lloyds and Jonny Murphy, A Menarini
Paul Finnegan, Allegro and Maeve Healy, Allegro at the Niva Travel stand
Paula McLaughlin, Haven Pharmacy McLaughlins, Barry Fitzpatrick, Clonmel Health Sales Director and Rachel Ennis, Haven Pharmacy McLaughlins
Sinead Finucane, Teva Pharmaceuticals and Jane Clements, Teva Phamaceuticals
Daniel Bolton, Market Pharmacy Smithfield, Patricia Laurence, Bayer Consumer Health, Micheal Clarke, Bayer Consumer Health, Fiona Taylor, Bayer Consumer Health and Darren Hoare, Hickeys pharmacy
PHARMACYNEWSIRELAND.COM | 85
Michael Graham, Head of Sales, RB, David Keyes, Distribution and Hospitals Director, United Drug, Will Oâ€™Brien, Country Manager, RB and Ciaran Woods, Pharmacy and Medical Field Sales Team Lead, RB
Sharen McCabe, Managing Director and Aine McCabe, both McCabes Pharamcy Group with Claire Manning, RB
Adrian Dunne, Adrian Dunne Pharmacy and Ciara Toolen, Adrian Dunne Pharmacy
David McLean, 4 Health and Eve Anna Tunney, Aston Village Pharmacy
Cait Brown, Lynchs Pharmacy, Tom Farrell, Clonmel Healthcare and Aileen Lynch, Lynchs Pharmacy
Peter Ronagan, Ronaghans Pharmacy Ltd Oonagh OHaggan, Meaghers Pharmacies
John Ryan, United Drug Annette O'Sullivan, United Drug, Maura Cronin, United Drug and Aine Devlin, United Drug at the Nuk range
Stephen Byrne and Anne Clarke, PillPacPlus with Ade Stack, Managing Director, Stacks Pharmacy Group
Sanofi Consumer Healthcare Team - Padhraic Speight, Business Developer, Munster, Cormac Leonard, Ireland National Account Manager Sanofi Consumer Healthcare, Brian Quill, Sales Manager, Laurence Oâ€™ Carroll, Business Developer, East Coast, Colm Moran, Business Developer, Midlands, North West
Peter Ahearn and Jason Clarke, Virgina Medical Supplies
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Through the Lens of Photography in Pharmacy DLK Photo, established in 1973 has over 45 years experience supplying the pharmacy sector with a full portfolio of Photo Kiosks and labs, Passport and ID Systems, large format printers, DSLRs, batteries, photo media, frames and albums. The company specialises in brands such as DNP, Mitsubishi, ID Station, Fuji, Kodak, Canon, Nikon, Sony and Epson. Recently DLK and its manufacturer, have been working with the Irish Passport Service on the online renewals process. Their biometric passport system is now licensed by the Irish Passport Service to hand over digital photos for adults, children and babies renewals. The passport photos will have a code to retrieve the photo while completing the online application process. DLK is now setting up pharmacies throughout Ireland to provide the photo code for the online service. Once trained and registered these pharmacies will become part of the network listed on the DFA website store locator, as enabled and trained to provide photos for the online renewal service.
DLK are also working with DNP, the manufacturer of a photo printing kiosk, the SL620. The DNP photo kiosk is a perfect match for a busy pharmacy. It offers a wide range of services to their customers from photo printing in many sizes, including panoramic prints and photo calendars. Included in the kiosk is the option to offer biometric passport photos and driving licences photos. The DNP SL620 is a very affordable photo kiosk and offers great value along with a comprehensive photo service for pharmacy customers. For further information or advice come and see them at The Cosmetic Show, being held on Sunday, May 19th-Monday, May 20th in the RDS, or contact them on the number below. DLK Photo - T: 048 9077 4455 E: email@example.com www.dlkphoto.co.uk
‘Good’ progress on medicinal cannabis programme It is believed the Department of Health have finally sourced a supplier for the provision of medicinal cannabis and that Minister of Health Simon Harris will submit proposals for the cannabis access programme to his office next month. The department also confirmed that officials are actively working to finalise the legislation needed to support it. It is believed that the bill could be ready by this month (April). Current Progress In a statement, the Ministry of Health said it ‘is currently looking for solutions to provide appropriate products to Irish patients. Officials have been in regular contact with our counterparts in Denmark, the United Kingdom, Canada and elsewhere.’ It has been more than two years since the Minister announced the establishment of an access programme to medicinal cannabis, but no programme has been put in place. The delay was attributed to the fact that the government had a hard time finding a supplier of quality
cannabis and a supplier capable of exporting its products to Ireland. It is understood that the medicinal product of cannabis for Irish import has been imported into Denmark. Last year, a team of officials visited the country to assess the operation of foreign access programmes.
Pharmacy staff OTC product training
The Access Programme aims to provide access to cannabis-based therapies for the treatment of multiple sclerosis patients, nausea and vomiting associated with chemotherapy, and persons with severe, refractory epilepsy and resistant to treatment. The implementation of the plan
follows the recommendations of the Health Products Regulatory Authority (HPRA). As a result of this report, Ministry of Health officials said they had worked intensively on the issue to ensure a supply of appropriate medical cannabis products from other EU Member States and from other countries to meet the needs of Irish patients. Until the importation of medicinal cannabis is authorised in Ireland and until the access programme is in place, Irish doctors operate under the current procedure of ministerial licensing, which allows them to prescribe medical cannabis to their patients. Since the end of last year, licenses have been granted for 16 patients, the majority of whom obtain their medical cannabis from a Dutch medical prescription pharmacy.
New Appointment for Cormac
Allcare Pharmacy and Life Pharmacy staff recently took part in training for over-the-counterproducts.
Cormac Leonard MSc. appointed Ireland National Account Manager with Sanofi Consumer Healthcare.
The well-attended event covered skin care, digestive care, allergies and pain relief. Participants also received training on AYA, the recently launched vitamins and supplements range from Uniphar.
Cormac has over 30 years’ experience in commercial leadership and account management roles within consumer health covering pharmacy and grocery channels. Most recently he held position of Commercial Controller with Valeo Healthcare where he developed successful VMS brands such as Vitabiotics & MorEPA. Prior to this Cormac worked with major FMCG companies L’Oréal and Nestle.
In skin care, pharmacy staff received the latest information on La RochePosay and Ovelle. For digestive care, participants were informed about Buscopan and Dulcosoft. Covering allergies, training was provided on Opticrom Eye Drops and Nasacort. In pain relief, staff were updated on Nurofen Durance and Nurofen Rapid Relief.
Cormac is responsible for leading the strategic and operational development of Sanofi CHC business in ROI.
Uniphar’s Pharmacy Trainer, Eimear Nee MPSI, offered an overview of AYA, going into detail on the recently launched range of products and their benefits.
Pharmacy staff receive training at the OTC training event
Cormac Leonard MSc, Ireland National Account Manager, Sanofi Consumer Healthcare
Feeling better already
Pain and fever relief for babies* & children
Easofen for Children Strawberry 100 mg/5 ml Oral Suspension and Easofen for Children Six Plus Strawberry 200 mg/5 ml Oral Suspension. Always read the label. Do not exceed the stated dose. Consult your doctor if there is no improvement. Available in Pharmacy only. Contains maltitol liquid & sodium. Sugar free and colour free. *This product should only be given to infants aged 3â€“6 months who weigh more than 5kg. Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. Date prepared: December 2017. 2017/ADV/EAS/055 Easofen for Children Strawberry 100 mg/5 ml Oral Suspension and Easofen for Children Six Plus Strawberry 200 mg/5 ml Oral Suspension. Contains maltitol liquid & sodium. Sugar free and colour free. *This product should only be given to infants aged 3â€“6 months who weigh more than 5kg. Retail sale through pharmacies only. A copy of the summary of product characteristics is available upon request. PA 126/60/3-4 PA Holder: Clonmel Healthcare Ltd., Clonmel, Co. Tipperary Date prepared: May 2018. 2018/ADV/EAS/059
Pain and fever relief for & children Children babies* Strawberry
100 mg/5 ml Oral Suspension Six Plus 200 mg/5 ml Oral Suspension
for Children Strawberry
100 mg/5 ml Oral Suspension Six Plus 200 mg/5 ml Oral Suspension
Topic Team Training –
Targeting Pain in Children
A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date. movement could signal a problem with constipation or, less often, inflammatory bowel disease. Daily abdominal pain without nausea, vomiting, or diarrhea could be a special form of migraine, or could fall under the category of chronic recurrent abdominal pain, a common but frustrating complaint in children. Communicating with and involving children in taking their medications will have a significant impact on their adherence. Children take responsibility for their medications at different ages. Children are often not present when their parents collect their medications from the pharmacy and, therefore, this prevents them from receiving support and advice from community pharmacists so ensure parents are well educated on the symptoms, medications and side effects. Communication: The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Pain in Children. It can be a challenge to recognize the symptoms of pain in children. Are they really hurting, or are the parents overreacting? Pain is a highly individual and complex experience. Here we take a look at reading the symptoms of pain in children. Symptoms of Pain in Babies Unlike with older children, crying isn't always a reliable pain indicator in babies. That's because crying is a baby's way of expressing a whole host of needs. Here are signs that a baby may be in pain. Changes in crying patterns. A baby's distressed cry sometimes, but not always, sounds different from ordinary crying. Changes in a baby's behavior can also be a tip-off. For example, crying that can't be soothed with a bottle, diaper change, or cuddling could signal pain. Also, a calm baby who becomes unusually fussy could be in pain. Crying while nursing. The baby who cries while nursing could very well have a painful ear infection. Prolonged, intense crying, often at the same time each day. This behavior is common with colic. It often starts at the age of 2 weeks, peaks at 6 weeks, and then gradually declines.
Crying and drawing the legs up to the abdomen. The baby could have colic or a serious medical condition. Withdrawing. Chronic pain can sap a baby's energy, causing him or her to become still, quiet, and to avoid eye contact. Symptoms of Pain in Toddlers Fortunately, at this age, children in pain can talk. They will often also clutch the part that hurts. Pulling or rubbing the ear is common in toddlers and although it can sometimes indicate ear pain, it may be habit. Suspect an ear infection if the child has had cold symptoms or a fever and begins to tug at the ear suddenly. Symptoms of Pain in Children and Adolescents Chronic or recurrent pain is common in children and adolescents. Research has shown that as many as 30% to 40% complain of pain at least once a week. Acute abdominal pain. Pain that comes on suddenly can be caused by viral infections or by something more serious like appendicitis. If a child’s pain seems to be localised to the right of the belly button and is accompanied by nausea, vomiting, and desire to stay very still, they should be evaluated for appendicitis. Recurrent stomach aches and headaches. A stomach ache that goes away after a bowel
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• Check parents understand what the medication is for and supplement knowledge if needed; • Ensure parents are aware of the most common adverse effects and what to do if these occur; • Explain what to do if their child misses a dose; • Explain anything relevant to the particular medication (e.g. to take phenoxymethylpenicillin on an empty stomach); • Check parents understand how to administer the medication to their child; Consider: • Am I, and my team, aware of the different presenting symptoms of pain in children? • Are my pharmacy staff aware of suitable products they can offer to parents? • Is the pharmacy team aware of various aids designed to help administer medications to children, such as medicine soothers? • Conditions in children that cause pain and fever
• The importance of not using ibuprofen and paracetamol together in children • The symptoms of meningitis and the importance of looking out for these • Normal body temperature for children and the temperature at which a child is deemed to have a fever. Key Points: Check your pharmacy team are aware and understand the following key points: • Customers that should be referred to the pharmacist • Those suffering with chronic pain symptoms should be referred to their GP • A good range of products for various childhood ailments is vital. All need to be clearly signposted in store to make it quick and easy to identify suitable treatments • Ensure effective category management with allied condition treatments close to hand • Remind parents to take care with child doses. Recent research suggests that parents can often misinterpret dosage instructions for liquid medicines Actions: • Include POS that will allow children to feel comfortable and make shopping easier for parents by allowing room for manoeuvring pushchairs • Ensure that child and infant health products are merchandised together, along with related products such as thermometers, to help build sales • Ensure that this important category is fully stocked at all times and merchandising plans are amended based on school term times • Ensure that I know the recommendations for analgesic use following childhood vaccinations
• What types of pain in children can be managed in the pharmacy
• Train the team to meet all the above considerations
• Which painkillers and cough and cold ingredients are suitable for children at different ages
www.hse.ie/my-child - Guide to Pregnancy, Baby and Toddler Health
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Lets Kids be Kids MAH: Johnson & Johnson (Ireland) ltd. Airton Road, Tallaght, Dublin 24. Products not subject to medical prescription. Full prescribing information available upon request.
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Pharmacy Management of Preterm Births With advances in medicine the number of preterm births has increased and more premature babies are being seen in the community. It is estimated that approximately 10% of babies are born prematurely worldwide. This means that approximately 15 million babies are born prematurely every year. Here in Ireland, the figure stands at around 4,500 a year (about 1 in every 16 babies), meaning that there is a baby born prematurely every 116 minutes. Despite the high number of preterm births in the world, little is known about prevention of preterm delivery, the problems of delivery and risks to development. Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.
What is Considered Premature? A premature baby is defined as a baby born alive before they complete 37 weeks of pregnancy. There are three subcategories of premature birth based on gestational age: • Extremely preterm (less than 28 weeks’ gestation) • Very preterm (28 to 32 weeks’ gestation) • Moderate to late preterm (32 to 37 weeks’ gestation) Often, the birth weight of a baby is a predictor of their health; the lower the weight, the greater the association with poor outcomes. Each baby is different, and simply labeling all babies born before 37 weeks’ gestation as premature does not tell us what the baby may experience. For example: • A baby born at 36 weeks’ gestation may be slow at feeding initially.
• A baby born before 33 weeks’ gestation may have more serious problems such as immature lungs. This may result in the baby requiring assisted breathing until their lungs develop. Over 90 % of babies born before 33 weeks’ gestation survive. • Being born before 28 weeks’ gestation causes significant problems, but many babies go on to thrive. The natural development of major organs of the baby will have been disrupted and there is a potential for severe health risks. However, the survival rate for these babies is quite remarkable. Advances in understanding of how to care for these vulnerable babies means that more and more go on to live healthy and happy lives. Increases in Survival The survival rate of premature babies born at 23 weeks is expected to continue rising in
the coming years thanks to new medical practices and research, the Master of the Rotunda Hospital has previously stated. Of the estimated 4,500 premature babies born in Ireland each year, those born at less than 22 weeks are highly unlikely to survive. This rises to a 19% chance of survival at 23 weeks, 40% chance at 24 weeks, 66% chance at 25 weeks and 77% chance at 26 weeks. Despite the low chance of survival at 22-23 weeks, Master of the Rotunda, Professor Fergal Malone, has said advances in medicine means more premature babies are surviving at an earlier stage of gestation. Speaking on Newstalk’s Pat Kenny show about Prematurity Week, Professor Malone said technological advances have made a huge difference to premature births in the last four to five years and that survival rates after 26 weeks
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Retinopathy of prematurity (ROP) - This is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss. Jaundice - This is when a baby's eyes and skin look yellow. A baby has jaundice when his liver isn't fully developed or isn't working well. Anemia - This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body. Bronchopulmonary dysplasia (BPD) - This is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage. Infections - Premature babies often have trouble fighting off germs because their immune systems are not fully formed. Infections that may affect a premature baby include pneumonia, a lung infection; sepsis, a blood infection; and meningitis, an infection in the fluid around the brain and spinal cord. have risen by 95%. He added that survival between 24-26 weeks were also rising by 50 to 70% week by week. New practices such as delayed cord clamping, where the cutting of the umbilical cord is delayed, have made a big impact on survival rates. “Every last drop of blood is precious in a premature birth. Delaying cutting the umbilical cord can keep the blood flowing from the placenta and the extra flow can help,” he says. Other innovations such as steroid injections for mothers along with progesterone and magnesium infusions can greatly enhance survival rates for premature babies, he added. Complications of Premature Births Health problems that may affect premature babies include: Apnea - This is a pause in breathing for 20 seconds or more. Premature babies sometimes have apnea. It may happen together with a slow heart rate.
Respiratory distress syndrome (RDS) - This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing. Intraventricular hemorrhage (IVH) - This is bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricles is a space in the brain that’s filled with fluid. Patent ductus arteriosus (PDA) - This is a heart problem that happens in the connection (called the ductus ateriosus) between two major blood vessels near the heart. If the ductus doesn’t close properly after birth, a baby can have breathing problems or heart failure. Necrotizing enterocolitis (NEC) - This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth.
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What prescriptions might you expect for a premature baby in the community The Role of the Pharmacist Pharmacists can play a useful part advising pregnant women on making healthy choices. For example, meta-analysis of randomised controlled trials has shown that antenatal smoking cessation programmes can lower the incidence of preterm birth. Nutrition and lifestyle advice such as maintaining ideal weight by eating a healthy balanced diet and regular exercise is important. In particular, lack of micronutrients, such as magnesium, zinc, calcium and iron, are associated with intrauterine growth retardation. Preventing deaths and complications from preterm birth starts with a healthy pregnancy. Quality care before, between and during pregnancies will ensure all women have a positive pregnancy experience. The World Health Organisation’s antenatal care guidelines include key interventions to help
prevent preterm birth, such as counselling on healthy diet and optimal nutrition, and tobacco and substance use; fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies; and a minimum of 8 contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections. Better access to contraceptives and increased empowerment could also help reduce preterm births. Ensuring optimal nutrition is by far the most important intervention that can be made to ensure survival of a premature baby. Breast milk is the most complete form of nutrition in terms of providing appropriate calories and nutrients for growth and development. Breastfeeding has a protective effect on the gut and reduces the risk of necrotising enterocolitis. A mother’s antibodies are also passed on to her baby through breast milk. However, due to prematurity of the gut or other gastrointestinal complications, a neonate may not be able to tolerate milk and parenteral nutrition may be needed. Parenteral nutrition composition aims to mimic breast milk with macronutrients (glucose, lipid and nitrogen), micronutrients (sodium, potassium, calcium, phosphate and magnesium), vitamins and trace elements. In very premature neonates, breast milk, even at large volumes, may not be enough to sustain growth and preterm specific formula milks or breast milk fortifiers may be used. Most of the medicines used in neonates are not licensed in that population or are used off label. Pharmacists have an invaluable role in advising on appropriate use of such medicines. Often the low birth weights of preterm neonates make drug dosage calculation and administration more of a challenge. Pharmacists have an important role in procuring formulations that are suitable for use in the neonatal population. Liquid formulations often have excipients in them that may not be suitable and this is an area where pharmacists can have a huge impact.
BABY & MATERNITY For more than 60 years, Mustela has successfully developed products to nourish and protect both babies and their moms throughout the world. Mustela is Europe’s leading Mother and Baby Brand and is committed to safety first and foremost. Developed in collaboration with healthcare professionals, all of Mustela’s products are hypoallergenic*, high-tolerance and do not contain any parabens, phenoxyethanol, phtalates or alcohol.
The Graham Anthony Team offer high quality brands and products, Nationwide Training Programs, Excellent Customer Service, Efficient Delivery, Regular visits from Area Managers & Promotional Assistance. To find more about our products and services please contact us and we would be delighted to discuss our extensive range of beauty brands with you. REVOLUTIONARY NATURAL HAIR TREATMENTS PHYTO is an internationally renowned, natural haircare brand created by Patrick Ales, inventor of the “Blow Dry”. Amongst its vast product offering, PHYTO has ranges that include hair loss treatments, hair colouring and styling - all helping your customers reveal beautiful, healthy hair. INNOVATIVE ANTI-AGEING SKINCARE Founded in 1975, Lierac specialises in the correction of skin ageing and also of skin disorders that have been left untreated. Lierac is the #1 skincare brand in Italy, and #2 in France and has now brought its pioneering and innovative products to the Irish market.
DERMOCOSMETIC (UREA UP TO 50%) SVR Prescribed by dermatologists in some 45 countries and present at all major conferences, SVR has grown in size whilst remaining true to its values. An authentic, ethical and sincere approach combined with reliability and outstanding quality enabled the brand to bring leading skincare products to the market, for all skin types including the most sensitive. DERMOCOSMETIC (UREA UP TO 50%) Skeyndor is the number 1 skincare brand in Spain and is rated as one of the top 15 cosmetic brands in the world. “The Scientific Skincare” fundamental values reflect its progress, the ability to adapt constantly to new times and the confidence it has gained after working in the world of beauty for many years.
100% PURE SHEA BUTTER Developed with 100% shea butter, Institut Karité Paris has always tried to give every type of beauty, of any age, the benefits of shea. Because every type of skin has specific needs throughout a lifetime, IKP adapts its treatments to suit your needs at every stage. Made in France, IKPs products range from Hair Care, Face Care, Body Care to Men. NATURAL SOAP SINCE 1947 Nesti Dante formulates with quality, purity and integrity without compromise using traditional saponification The use of raw materials as whole neutral fats, both vegetable and animal, allows a qualitative selection of each individual material and, much more important, these Mustela is committed to healthy skin froma birth on*more andsoftening chooses qualitative material let us obtain richer and soapto thanks to ingredients, the presence of the glyceride fraction the fats.ingredients. Made with love and use safe, effective with a focus on innatural care in Florence, Italy since 1947.
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SELF TANNING MUSTELA USES SUSTAINABLY AND The world’s largest independent tanning brand with over 25 years’ experience in discovering and manufacturing revolutionary tanning ETHICALLY SOURCED INGREDIENTS products. Fake Bake uses luxurious formulations that contain the highest
ingredients, is free protecting from artificial preservatives Because takingquality careofofpremium infants also means their livingand parabens and has clinical trials to back up all specialist claims including environment, Mustela makes every effort to minimize the impact of anti-ageing. its products on Humans and their Environment.
NATURAL WHITENING TOOTHPASTE A natural whitening & refreshing toothpaste, through its formula enriched with natural ingredients, SENSIBLAN is a paraben-free toothpaste with unique properties. Building on the action of chlorhexidine, a powerful antibacterial agent, it helps fight the formation of plaque and bacterial growth while reducing gum sensitivity. Iris Florentina helps restore the natural whiteness of teeth, and essential mint oils purify the mouth and maintain a fresh breath, with long-lasting results.
MEDI COSMETIC For over 35 years, Filorga has been a leading provider of antiageing solutions for both the medical profession and general consumers. Filorga prides itself on providing cutting-edge, nonsurgical, anti-ageing solutions that include line fillers, polyrevitalising injections (NCTF®), peeling and photo-stimulation (LED).
NASAL TREATMENT A complete range based on sea water for the treatment of the nasal mucosae. Isotonic Solution (for daily use) helps to remove and fluidify the mucus in case of colds and mucosa dryness. HYPERTONIC > Paraben > Phenoxyethanol SOLUTION (for acute phase) decongests and fluidifies in case of colds, A demanding rhinitis allergies, sinusitis and rhinosinusitis. Lauryl Sulfate > Phtalate > Ammonium formulation charter > Sodium Lauryl Sulfate > BHA > Cyclotetrasiloxane > Benzophenone HOME DIAGNOSIS > p-Phenylenediamine > Ethylhexyl The SELFCheck tests are home diagnostic kits that detect a range of and analogousm methoxycinnamate different problemts from, bowel health, menopause, multi-drug to compounds cholesterol test > Triclosan > Phenoxyethanol
DERMOCOSMETIC Uriage meets the needs of sensitive skin thanks to an internationally recognised dermatological expertise. Uriage Thermal EXTREMELY Water is the best thermal water available on the Irish market, as it is DRY SKIN 52 times richer than any other thermal water brand. Uriage has 25 SELFCheck home screening tests years of skin expertise, and develop products in collaboration with dermatologists from all over the world. AROMATHERAPY 100% pure & natural essential oils. Delarom has made the theory of PSORIASIS/ECZEMA, the influence of plant scentsINFLAMMATORY on VERY DRY &“aromacology”, ATOPY-PRONE SKIN, AVOCADO PERSEOSE(*) and mood, the basis of its product range, using primarily DERMATOSISbehaviour Mediterranean ingredients and valuable essential oils that are known • Strengthens the cohesion and organization for their calming, regenerative, antioxidant and intensively Avocado of the barrier: A line of new generation emollient care for extreme and long-lasting moisturising properties. Each Delarom product contains balancing, (a) • In pharmacy training • Medical visits to GP’s close to +32% Ceramides scents such as sweet orange oil, orange mint or petit • Strongand opening offers cutaneousstress-relieving comfort. RESTORES the functions of three skin barriers +49% pharmacy Involucrin (b) grain oil to rapidly boost your energy. • Ongoing Monthly Specials • Event support • Maintains hydration of the epidermis: COSMECUTICAL/ ACTS directly on the SENSORIAL inflammatory process • Competitive margins • Stock management but high ® Doctor Nadia Payot created Payot when she combined her medical +175% Transglutaminase (c) Perseose • Shelf Talkers, wobblers and strong importance on profitability of shelf skills with beauty as well as the 42-Movement Facial Protocol. At the +47% Hyaluronique acid (d) merchandising space PEREFECT FOR SKIN heartBABY of Payot is advanced Research & Development Laboratories, a • Maintains complement epidermal • Shop Fit brand design • Slowthe selling sku’s canofbe swapped team of scientists and passionate experts (dermatologists, pharmacist, • Assets for Facebook, Instagram, stem cells: within 6 months of purchase chemists and pharmaceutical specialists) working together to (e) 80%•Integrin α6 conserved after UV exposure Websites create effective cosmetic formulations respecting safety, control Incentives for consultants in and dermatological ethical standards. • PR support pharmacy Sunflower COSMECUTICAL/ GLYCOLIC • Monthly support with Area Manager • Choose fromOIL 16 top selling brands SUNFLOWER DISTILLATE Alpha H spent 20 years researching the essential elements the skin visits, office support • Activates PPARα receptors needs for optimal health. The products work to take the skin out of its comfort zone in order to make a difference that is evident and genuine. • Restores the level of filaggrin expression The effective delivery systems infuse the skin with active ingredients by Oil distillate +77% filaggrin (f) adjusting the pH to stimulate action at a deeper layer of the epidermis, • Regulates the level of kallikrein expression where new and vibrant cells are replenished and repaired. • Training Plan, as knowledge is key • Provide a list of Doctors, Health
Range for atopic prone skin
Atopic Eczema is an increasingly common skin
problem that leads to extreme dryness, itchiness and skin discomfort that can be intense, affecting one out of five children. Caused by genetic and environmental SUPPORT FROM PHARMACY ROUGHNESS AND CALLUSES factors,SKIN it often appears at the age of three months -77% kallikrein Urea-based products different concentrations then improves after a fewwith years. The STELATOPIA to success Nurses and Antenatal classes SCIENTIFIC SKINCARE • Allow participation in incentives close to your area. which act according to the degree of roughness IDC is a high performance anti-ageing skincare brand that developed CONCENTRATION OF range helps to relieve the often uncomfortable • Be active on Social Media, post our • Follow merchandising guidelines Regen-16, a molecule complex combining the greatest diversity of UREA FOR KERATOLYTIC and flaking. PR, ACTION like shareON andROUGH comment. • Plan windows and hot spots cosmetic ingredients to their optimal dosages simultaneously targeting symptoms of this skin disorder and restore baby’s • Organise events which will be the 16 main mechanisms related to signs of skin ageing. With record SKIN AREAS. supported by GAD concentrations up to 43% CALMS of cosmetic ingredients selected among the SOOTHES, AND ELIMINATES healthy skin. best in the world, IDC goes beyond industry standards.
(*) except bath oil (a) Analysis by thin-layer chromatography of ceramides extracted from Stelaskin reconstructed epidermis. 72-hour treatment with Avocado Perseose. (b) ELISA measurement of Involucrin in normal human epidermal keratinocytes as a proportion of the number of live cells estimated by MTT assay. 48-hour treatment with Avocado Perseose. (c) Immunolabelling of Transglutaminase on skin explants following delipidation using an ether/acetone mixture. 3-hour treatment with Avocado Perseose. (d) ELISA analysis of hyaluronic acid in the culture medium of normal human epidermal keratinocytes as a proportion of the number of live cells estimated by neutral red assay. 24-hour treatment with Avocado Perseose. (e) Immunolabelling of Integrin alpha 6 on skin explants subjected to UV.Treatment with Avocado Perseose 24 hours before and after UV irradiation. (f) Culture of human skin explants treated with Stelatopia for 24 h, and stimulated with a cocktail of Th2 cytokines for 24 h.
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TEVA’S AJOVY® (FREMANEZUMAB) RECEIVES EU AUTHORISATION OFFERING PATIENTS THE FIRST AND ONLY ANTI-CGRP TREATMENT WITH BOTH QUARTERLY AND MONTHLY DOSING FOR THE PREVENTION OF MIGRAINE IN ADULTS
Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA) today announced that the European Commission (EC) has granted the Marketing Authorization for AJOVY (fremanezumab) 225 mg solution for injection in pre-filled syringe for the prophylaxis of migraine in adults who have at least four migraine days per month. AJOVY is a humanized monoclonal antibody (mAb) that binds to the calcitonin generelated peptide (CGRP) ligand and blocks its binding to the receptor. AJOVY is the first and only antiCGRP treatment authorised in the European Union (EU) and the United States (US) that is designed for the prevention of migraine and offers both quarterly and monthly dosing options. AJOVY was evaluated in two pivotal Phase III clinical trials
that enrolled patients with disabling migraine and studied fremanezumab as a prophylaxis for migraine in adults. In these trials, patients treated with fremanezumab had a significantly greater reduction in migraine days compared to placebo (change from baseline at week 12, Ajovy -3.4 to -5.0 days; placebo -2.2 to -3.2 days, p<0.001). Adverse drug reactions (ADRs) observed with fremanezumab were mostly mild to moderate, short-lasting skin reactions around the injection area: pain, hardening, redness, itching and rash at the injection site.1,2 Messoud Ashina, Professor of Neurology in the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, stated: “Migraine is a debilitating neurological disease which can have a substantial impact on quality of life. The disease is most common between the ages of 25 and 55 meaning that it strikes during the most productive years, disrupting patients’ personal and professional lives. The authorisation of fremanezumab in the EU will provide European physicians with an important new treatment option offering patients
The BioXtra range of mouth care products offers a complete solution to dry mouth that works throughout the day and night.
greater flexibility through monthly and quarterly dosing options and, most importantly, a significant reduction in the number of migraine days.” Dr Martin Ruttledge, Consultant Neurologist at Beaumont Hospital, Dublin said: "Migraine is a very common neurological disorder that may cause significant disability, especially in patients experiencing headaches and associated symptoms more than 10-15 days each month. Many patients experience migraine symptoms frequently for years or even decades. For the first time, we have specially designed molecular treatments for this condition in the form of monoclonal antibodies, such as fremanezumab. These medicines are likely to be more effective and better tolerated than previous migraine therapies. It is hoped that the licencing of this new treatment will help many of our patients in the medium and long term." PACK SIZE CHANGES FOR EPILIM AND EPILIM CHRONO TABLET PRESENTATIONS
presentations will be changing from 100 tablet packs to 30 tablet packs over the coming months as current 100 tablet packs are exhausted. This will ensure that as many patients as possible receive an original pack when Epilim is dispensed, including safety warnings and patient information leaflets. Sanofi would like to reinforce that all patients being dispensed Epilim should receive their medicine in the original package with an outer warning. Dispensing outside of original packaging should be avoided. In situations where this cannot be avoided, a copy of the package information leaflet should always be provided, as well as a warning label added to the outer packaging. Pharmacists are reminded that each time they dispense Epilim, they should ensure the patient has a Patient Card and Patient Guide; and should also remind the patient of the risks of pregnancy while taking Valproate and therefore the need for highly effective
Sanofi is happy to announce that pack sizes for all Epilim Tablet
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The Range Includes: Toothpaste and Mouthrinse for oral hygiene. Foam free toothpaste reduces dryness and doesn’t need rinsing from the mouth. The mouthrinse has NO alcohol and leaves the mouth fresh and clean. Spraygel and Moisturising Gel for instant and long term relief from the effects of dry mouth, perfect for all night comfort - prevents waking to drink water at night. Containing enzymes and proteins similar to those present in natural saliva. The BioXtra products reinforce the natural defences of saliva, which can be deficient in the case of dry mouth. Prescribed and recommended by doctors and dentists
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Totalhealth tackle with Connacht Rugby Totalhealth Pharmacy were delighted to sponsor the U18 Player of the Year at the Connacht Rugby Awards Gala Dinner held in Galway recently. Kenny Concannon from Reilly’s totalhealth Pharmacy from Belmullet, a very keen Connacht supporter, was delighted and privileged to be invited to make the presentation.
Sean Masterson accepts the Connacht Rugby U18 Player of the Year on behalf of Darragh Murray (Buccaneers / Coláiste Ciarán)) from Kenny Concannon, Reilly’s totalhealth Pharmacy, Belmullet
Darragh Murray (Buccaneers/ Coláiste Ciarán) was the overall winner of the U18 Player of the Year Award. The sponsorship of the Award was the culmination of a great year partnering with Connacht Rugby supporting their youth programme. In 2018, totalhealth were delighted to sponsor the Connacht Rugby Summer Camps that happened in 18 locations throughout Connacht. Following that totalhealth continued the sponsorship with supporting their Autumn Skill Camps.
The partnership is a win-win for totalhealth and Connacht Rugby. Totalhealth has 30 member pharmacies in the region so the opportunity to support the youth of Connacht was an opportunity they couldn’t let go. Totalhealth are delighted to announce that the partnership will continue and grow for 2019.
Are You Thinking of Selling Your Pharmacy?
Health and Genetics Study Genomics Medicine Ireland has opened a new clinic on Dublin's Pearse Street, which will run the popular GenoFit Research Study in conjunction with UCD that examines the relationship between health and genetics.
JPA Brenson Lawlor has over 30 years’ experience advising pharmacy owners and will help you to maximise your return.
Participation is free and volunteers receive almost ¤200 worth of health measurements including a detailed Dexa scan. Bookings are available via Genofit.ie. Pictured is broadcaster and personal trainer Karl Henry with Rebecca McGrath of Genofit. Picture Conor McCabe Photography.
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Date for your Diary
Telephone Jason Bradshaw or Padraic Ferguson on 01-6689760
World Hypertension Day will take place on Friday, 17th May. To mark this occasion, the National Institute for Preventative Cardiology (NIPC) are hosting an expert-led Hypertension Masterclass at the Croí Heart & Stroke Centre, Galway. This Masterclass will feature practical presentations designed to equip front-line healthcare professionals in the everyday management of hypertension. Registration is free but places are limited. Speakers will include Professor Bill McEvoy speaking about Hypertension Guidelines, Dr Conall Dennedy on Secondary Hypertension and Professor Eoin O’Brien who will look at Ambulatory Blood Pressure Monitoring. You can register at www.croi.ie/CIPCmasterclass
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CHRISTMAS Cosmetic & Gift Trade Fair
2019 The Main Hall, RDS, Ballsbridge, Dublin
Sunday 19th May 10am - 6pm Monday 20th May 9am - 6pm Tuesday 21st May 9am - 6pm www.cosmeticassociation.ie
Finalists edition of Irish Pharmacy News