47 minute read
FEATURE: OSTEOPOROSIS
Osteoporosis: The Silent Disease
Interview with Theresa Lowry Lehnen (GPN, RNP, PhD) Clinical Nurse Specialist and Associate Lecturer South East Technological University (SETU)
It is estimated that up to 300,000 people in Ireland have osteoporosis. Although more common in females who have gone through the menopause, it can also affect men and even children. It is commonly known as the “Silent Disease”, and is characterised by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures. Osteoporosis is the most common metabolic bone disease in Ireland and increases the risk of ‘fragility fractures’. These fractures occur mainly at the hip, vertebrae, and distal forearm and are associated with significant morbidity, mortality, and reduced quality of life, attributed not only to the fracture itself but also to the high prevalence of comorbidities in this patient population. According to the Irish Osteoporosis Society (IOS), 20% of people aged 60 and above who sustain a hip fracture will die within 6 to 12 months, due to secondary complications and 50% of people over the age of 60 who sustain a fractured hip will lose their independence. Only 15% of people in Ireland are diagnosed with bone loss, leaving an estimated 280,000 people undiagnosed.
Causes of Osteoporosis
According to Theresa Lowry Lehnen, Clinical Nurse Specialist and Associate Lecturer South East Technological University, osteoporosis is multifactorial in origin. “It occurs when there is an imbalance between new bone formation and old bone resorption,” she explains.
Modifiable and Non-modifiable Risk Factors for Osteoporosis Modifiable and Non-modifiable Risk Factors for Osteoporosis
Modifiable Risk Factors
Sex hormones: The reduction of oestrogen levels in women at menopause is a strong risk factors for developing osteoporosis. Men have a gradual reduction in testosterone levels as they age. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce oestrogen levels in women accelerate bone loss. Endocrine: Too much thyroid hormone can cause bone loss. This can occur in hyperthyroidism or if too much thyroid hormone medication is used to treat an underactive thyroid. Osteoporosis has also been associated with overactive parathyroid and adrenal glands and hypogonadism. Medication use: Long-term use of certain medications, such as glucocorticoids and some anticonvulsants can lead to loss of bone density and fractures. Depo-Provera contraceptive has been proven to cause bone loss, particularly high risk if given during adolescence when bone is being laid down.
Lifestyle factors: An inactive lifestyle can lead to weakened bones and increased risk of osteoporosis.
Cigarette smoking and excessive consumption of alcohol
increases the risk of bone loss and fractures. Poor diet increases the risk for osteoporosis. Low calcium and Vitamin D intake contributes to diminished bone density, early bone loss and an increased risk of fractures.
Eating disorders, severely restricting food intake, low BMI and being underweight weakens bone in both men and women.
Non-modifiable Risk Factors
Sex: Women are much more likely to develop osteoporosis than men. Women have less bone tissue and lose bone faster than men because of the changes that occur with menopause Age: The risk of developing osteoporosis as bones become thinner and weaker increases with age.
Body size: People who have small body frames tend to have a higher risk of developing osteoporosis because they have less bone mass to draw from as they age Ethnicity: White and Asian women are at highest risk. African American and Hispanic women have a lower but significant risk. Genetic: A family history of osteoporosis is a very strong risk factor. People whose parents have a history of fractures also seem to have reduced bone mass and may be at greater risk for fractures.
“Bone turnover is regulated by the interaction between osteoblasts and osteoclasts. Osteoblasts form new bone and osteoclasts are responsible for bone resorption. Both types of cell are under hormonal regulation. Up to 90 percent of peak bone mass is acquired by age 18 in females and age 20 in males. The amount of bone mass in the skeleton can keep increasing until a person reaches their late 20’s, at which point, bones have reached their maximum strength and density, known as peak bone mass. As people age the rate of bone resorption by osteoclast cells exceeds the rate of bone formation, so bone weakens.”
Theresa adds that the greatest cause of osteoporosis is oestrogen deficiency which results in increased bone turnover in which resorption exceeds formation. “Corticosteroids can also induce osteoporosis in which trabecular bone is particularly affected from suppression of osteoblastic activity,” she says.
Diagnosis
Osteoporosis can be diagnosed by: 1. The presence of a fragility fracture 2. Measurement of bone mineral density (BMD) 3. Bone biopsy: Bone biopsy is a diagnostic procedure restricted to untypical, unclear and complicated cases in evidence-based guidelines on diagnosis and treatment of osteoporosis. Bone Biopsy is not routinely used and should never be undertaken without consultation with a specialist in osteoporosis and metabolic bone disease.
Theresa continues, “Most fractures occurring after 50 years of age are osteoporotic. All persons presenting with a fragility fracture after 50 years of age or menopause should be considered as possibly osteoporotic. A detailed history of the fracture occurrence, physical examination and evaluation for other fractures is carried out while noting any presence of back pain, kyphosis, and height loss. Baseline laboratory tests include: Full blood count: Serum chemistry levels: Liver function tests: Thyroid-stimulating hormone level: 25-Hydroxyvitamin D level: Serum protein electrophoresis: 24-hour urine calcium/creatinine: Testosterone (total and/or free) and luteinizing hormone/ follicle-stimulating hormone. “Additional testing should include measurement of bone mineral density (BMD) and if there is height loss and/ or back pain, imaging of the spine. On average BMD is lower in women than in men, because women have smaller bones and smaller trabeculae. Women, as they also go through the menopause lose more bone in their lifetime than men; 50% in females Vs 35-40% in males.” Osteopenia is the early stage of osteoporosis and places a person at risk of developing osteoporosis. The Irish Osteoporosis Society divides osteopenia into three categories:
1. Mild Osteopenia is a T-score of -1 to -1.49 and usually requires lifestyle changes; however, causes should be investigated and addressed.
2. Moderate Osteopenia is a T-score of -1.5 to -1.9 which usually requires lifestyle changes. Causes should be found and addressed and the person may require medication, depending on the cause, or if they have had a fragility fracture.
Treatment
Osteoporosis is treatable and fractures are preventable. “The primary goal of osteoporosis therapy is to reduce the risk of fracture,” she says. “A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, medication to slow or stop bone loss, increase bone density, and reduce fracture risk may be prescribed.
“The treatment selected for each individual is based on their risk of fracture or re-fracture, causes of osteoporosis, age, DXA scan results and medical history. Assessment of bone markers before and at three and six months after the commencement of treatment will give an earlier indication of the response to treatment.” Calcium and vitamin D are essential for the prevention and treatment of osteoporosis. “Bone is a major store of calcium and phosphate. Every cell in the body requires calcium. Vitamin D helps to regulate cell growth and the immune system and is essential for the absorption of calcium. It increases the body’s ability to absorb calcium by 30-80%. Vitamin D is the only vitamin required by the body that does not have to be consumed through food or supplements as it is manufactured through the skin, when exposed to sunlight,” adds Theresa. “Supplements are generally only recommended when the daily amounts of calcium and Vitamin D from dietary sources are not being met.
HRT – Hormone Replacement Therapy
Oestrogen replacement for women going through the menopause can help to maintain bone density and reduce fracture rates while they are on the treatment. “There is a direct relationship between the lack of oestrogen after menopause and the development of osteoporosis. Early menopause before age 45 and any long phases in which the woman has low hormone levels and no or infrequent menstrual periods can cause loss of bone mass. Oestrogen therapy and oestrogen with progesterone hormone therapy are approved for the prevention of osteoporosis in postmenopausal women provided there are no contraindications. HRT is not suitable for people who have a history of breast cancer in their family, particularly in early menopausal patients or patients who have had a history of deep vein thrombosis,” she says.
Babies
Age (years) Calcium (mg/day) Vitamin D (µg/day)
0-1 N/A 5 (as supplement)
1-3 800 10
4-6 800 0-10
7-10
Males & Females 11-14 800
1200 0-10
0-15
15-18
Males & Females 19-64 1200
800 0-15
0-10
65+ 800 10
Pregnancy 1200 10
Lactation 1200 10
Theresa continues, “SERMs, brand name Evista® work in a similar manner to oestrogen on bone, by preventing bone loss in postmenopausal women who do not have hot flushes and provided there are no other contraindications. It is used for the prevention and treatment of osteoporosis in postmenopausal women and to reduce risk of invasive breast cancer in postmenopausal women at high risk or with osteoporosis. Evista helps to maintain bone density and reduce fracture rates, specifically at the spine. It is administered as a 60mg tablet once daily. Evista can be taken with or without food or drink and at the same time as calcium and vitamin D supplements. Appropriate weight bearing exercise is also necessary.”
Monoclonal Antibody
Denosumab, brand name Prolia, is a monoclonal antibody which binds to RANK Ligand, inhibiting the maturation of osteoclasts, therefore protecting the bone from degradation. “Prolia is indicated for the treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures. In postmenopausal women Prolia reduces the risk of vertebral, non-vertebral and hip fractures. Prolia is also indicated for the treatment of bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures. It is the first choice of drug for those at high risk of hip fracture or who have had a hip fracture over the age of 75 with T scores < −2.5 at femoral neck or with a humeral fracture. The recommended dose of Prolia is 60 mg administered as a single subcutaneous injection once every 6 months into the thigh, abdomen or upper arm. Patients must be adequately supplemented with calcium and vitamin D.”
News
Bisphosphonates
“Parathyroid Hormone – (PTH) brand name preotac is a bone forming agent that stimulates the formation of new bone administered as a daily 100mcg dose, subcutaneous injection in the thigh or abdomen for 24 months. It can only be prescribed by a Consultant, as it is a ‘high tech’ drug for severe osteoporosis. It is contraindicated in patients with cancer. Patients need to have follow up tests done at 1, 3 and 6 months, for elevated serum or urinary calcium. The patient should then have a repeat DXA scan and a new treatment plan should be implemented at the end of the course of treatment. “Parathyroid hormone - (PTH) teriparatide, brand name Forsteo is a recombinant human parathyroid hormone 1-34 and a bone forming agent that stimulates the formation of new bone. Foresto is a ‘high tech’ medication that can only be prescribed by a Consultant. It is given as a daily 20mcg, subcutaneous injection in the thigh or abdomen for 24 months. The patient should then have a repeat DXA scan and a new treatment plan should be implemented at the end of the course of treatment. PTH is usually recommended for those with severe osteoporosis or fractures and those who cannot tolerate other medications. Forsteo can help with the pain of vertebral Theresa reflects that other treatments for osteoporosis can include Kyphoplasty and Vertebroplasty: “Kyphoplasty is a surgical treatment involving a balloon being placed into the fractured vertebrae, followed by “bone cement” being injected into the balloon. Vertebroplasty is a non-surgical treatment involving a needle with “bone cement” inserted into the fractured body of the vertebrae under imaging guidance. The decision to perform these techniques is made by a multi-disciplinary team to ensure that this is the correct approach to managing the collapse. “Many of the consequences of osteoporosis, particularly vertebral fractures, are associated with severe pain. Patients with established osteoporosis should be treated for pain relief and physiotherapy offered for the secondary effects of osteoporosis. Pharmaceutical and non- pharmaceutical measures can be used to alleviate pain. Patients should be advised of all the options, and encouraged to try different approaches until they find what works best for them.
“Prevention of osteoporosis should ideally start in utero. Childhood and teenage years, are critical periods for developing a strong healthy bone, especially before puberty, between the ages of 8 and 12 years. If good peak bone strength is achieved in early childhood, the risk of osteoporosis in later life is reduced.”
References available on request
¤3.2m for Degenerative Retinal Diseases
The project (EYE-D) will target diseases that can result in severe loss of vision and are estimated to affect 224,000 people in Ireland, and 40 million people worldwide.
Professors Matthew Campbell and Sarah Doyle, Trinity College Dublin
The funding for EYE-D was announced by Simon Harris, Minister for Further and Higher Education, Research, Innovation and Science. Science Foundation Ireland will provide ¤1.6 million funding to EYE-D, matched by project partners. The proposed partnership involves separate collaborations with three companies: Roche, Disarm/Eli Lilly, private ophthalmology clinic, Progressive Vision Research, and the charity Fighting Blindness Ireland.
Cumulatively, these groups will fund ¤1.6 million to advance various research programmes focused on identifying the underlying causes of degenerative eye diseases. Professor Matthew Campbell said, “We are excited about the potential developments that will emerge from this grant. Spearheading a project with a cumulative budget of ¤3.2 million will allow us to make a major impact on the international stage of vision research. In addition, our research endeavours put us in a perfect position to identify the cause of some of the most common forms of blindness.”
Co-PI, Professor Sarah Doyle, added, “This funding will allow us to build on the major successes our group has had in understanding degenerative eye diseases. Added to this, we can now recruit the most talented group of scientists internationally and place Ireland at the forefront of vision research.”
Professor Philip Nolan, Science Foundation Ireland, said, “We are looking forward to working with the researchers and collaborators of EYE-D research project as they work to find solutions to vision loss caused by retinal diseases. The project highlights the impact that the Strategic Partnership Programme can deliver. I welcome the broad partnership involved in supporting this research which includes industry, charities and higher education institutes.” TheEYE-D research project seeks to identify new therapeutic treatments for Age Related Macular Degeneration (AMD), glaucoma, and other inherited diseases that cause vision loss.
DON’T WAIT UNTIL OSTEOPOROSIS STRIKES AGAIN
Rebuild bone before it breaks again—with Movymia®1
MOVYMIA®: THE NEW TERIPARATIDE BIOSIMILAR FROM CLONMEL HEALTHCARE
RELIABLE: Movymia®’s quality, safety and efficacy is highly similar to its reference product1,2,* EFFECTIVE: Anabolic MoA effectively rebuilds bone through the stimulation of osteoblasts1,3 AFFORDABLE: Allows more eligible patients to benefit due to its cost advantage4,5 RE-USABLE: One high quality reuseable pen for the entire treatment period1
MOVYMIA 20 MICROGRAMS/80 MICROLITERS SOLUTION FOR INJECTION
Each dose of 80 microliters contains 20 micrograms of teriparatide. One cartridge of 2.4 ml of solution contains 600 micrograms of teriparatide (corresponding to 250 micrograms per ml). Presentation: Glass cartridge. Indications: Movymia is indicated in adults. Treatment of osteoporosis in postmenopausal women and men at increased risk of fracture. In postmenopausal women, a significant reduction in the incidence of vertebral and non-vertebral fractures but not hip fractures has been demonstrated. Treatment of osteoporosis associated with sustained systemic glucocorticoid therapy in women and men at increased risk for fracture. Dosage: The recommended dose is 20 micrograms administered once daily. Patients should receive calcium and vitamin D supplements if dietary intake is inadequate. The maximum total duration of treatment is 24 months. The 24 month course should not be repeated over a patient’s lifetime. Following cessation of teriparatide therapy, patients may be continued on other osteoporosis therapies. Teriparatide must not be used in severe renal impairment. Use with caution in moderate renal impairment and impaired hepatic function. Teriparatide should not be used in paediatric patients (less than 18 years), or young adults with open epiphyses. Method of administration: Movymia should be administered once daily by subcutaneous injection in the thigh or abdomen. It should be administered exclusively with the Movymia Pen reusable, multidose medicine delivery system and the injection needles which are listed as compatible in the instructions provided with the pen. The pen and injection needles are not included with Movymia. However, for treatment initiation a cartridge and pen pack should be used. Movymia must not be used with any other pen. Patients must be trained to use the proper injection techniques. Contraindications: Hypersensitivity to the active substance or excipients. Pregnancy and Breast-feeding. Pre-existing hypercalcaemia, severe renal impairment, metabolic bone diseases other than primary osteoporosis or glucocorticoid-induced osteoporosis, unexplained elevations of alkaline phosphatase, prior external beam or implant radiation therapy to the skeleton, patients with skeletal malignancies or bone metastases. Warnings and precautions: In normocalcaemic patients, slight and transient elevations of serum calcium concentrations have been observed following teriparatide injection. Serum calcium concentrations reach a maximum between 4 and 6 hours and return to baseline by 16 to 24 hours after each dose of teriparatide. Therefore, if blood samples for serum calcium measurements are taken, this should be done at least 16 hours after the most recent teriparatide injection. Routine calcium monitoring during therapy is not required. Teriparatide may cause small increases in urinary calcium excretion, but the incidence of hypercalciuria did not differ from that in the placebo-treated patients in clinical trials. Teriparatide should be used with caution in patients with active or recent urolithiasis because of the potential to exacerbate this condition. In short-term clinical studies with teriparatide, isolated episodes of transient orthostatic hypotension were observed. Typically, an event began within 4 hours of dosing and spontaneously resolved within a few minutes to a few hours. When transient orthostatic hypotension occurred, it happened within the first several doses, was relieved by placing subjects in a reclining position, and did not preclude continued treatment. Caution should be exercised in patients with moderate renal impairment. Experience in the younger adult population, including premenopausal women, is limited. Treatment should only be initiated if the benefit clearly outweighs risks in this population. Women of childbearing potential should use effective methods of contraception during use of teriparatide. If pregnancy occurs, teriparatide should be discontinued. The recommended treatment time of 24 months should not be exceeded. Contains sodium. Interactions: Digoxin, digitalis. Fertility, pregnancy and lactation: Women of childbearing potential should use effective methods of contraception during use of teriparatide. If pregnancy occurs, Movymia should be discontinued. Movymia is contraindicated for use during pregnancy and breast-feeding. The effect of teriparatide on human foetal development has not been studied. The potential risk for humans is unknown. Driving and operation of machinery: Teriparatide has no or negligible influence on the ability to drive and use machines. Transient, orthostatic hypotension or dizziness was observed in some patients. These patients should refrain from driving or the use of machines until symptoms have subsided. Undesirable effects: Nausea, pain in limb, headache, dizziness. Refer to Summary of Product Characteristics for other adverse effects. Pack size: 1. 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: medsafety@hpra.ie. Marketing authorisation holder: STADA Arzneimittel AG, Stadastrasse 2-18, 61118 Bad Vilbel, German. Marketing authorisation number: EU/1/16/1161/001-003. Medicinal product subject to medical prescription. Date last revised: July 2019.
Coadministration of Vaccines – Guidance for Pharmacy
The International Pharmaceutical Federation (FIP) has released the new guidance “Optimising vaccination through coadministration of influenza and COVID-19 vaccines: Guidance for pharmacists”.
Vaccination is a key strategy in the prevention of COVID-19 and influenza, improving quality of life. Administering vaccines against COVID-19 and influenza at the same time is safe and increases uptake of each vaccine and increases protection against both diseases, according to new guidance “Optimising vaccination through coadministration of influenza and COVID-19 vaccines: Guidance for pharmacists” published by FIP. The guidance includes focus on opportunities for coadministration of the two vaccines and how pharmacists can contribute to global health by supporting this. It explains that while there is a need for more data on safety and effectiveness of different combinations of vaccines, the currently available evidence supports coadministration, as highlighted by guidelines issued by the World Health Organization. Gonçalo Sousa Pinto, FIP lead for practice development and transformation, and coauthor of the guidance, said: “Many countries still do not have pharmacy-based vaccine administration services. FIP encourages pharmacists around the world to advocate pharmacy vaccines administration programmes and to seek legislative approaches to facilitate their implementation. Where such regulations are already in place, advocating pharmacybased coadministration of flu and COVID-19 vaccines will contribute to improving vaccination coverage against both diseases”. Says the report, “Vaccination is key to preventing disease and improving quality of life for people of all ages. In the past couple of years, vaccination has become an important topic on the agendas of policy makers, healthcare professionals and society overall. The recent pandemic highlighted the central role that immunisation plays as a pillar of primary health care and universal health coverage. “While vaccination against seasonal influenza has been well established for decades and is recommended in many countries on a yearly basis, particularly for older adults and other vulnerable population groups, flu vaccination coverage rates remain below the World Health Organization (WHO) recommended target of 75% of adults above 65 years of age except in a handful of nations. As COVID-19 evolves into a post-pandemic phase, with multiple variants of the virus that, albeit less lethal, are highly transmissible, it will continue to affect millions around the world and to be a significant threat — just as flu is — to the health and lives of the most vulnerable members of our communities. Having access to the vaccine is therefore an important step to prevent disease and alleviate pressure on health systems. “Coadministration of COVID-19 and influenza vaccines can provide a critical opportunity to increase protection of patients and the community against the dual impacts of the respiratory illness caused by these viruses, as highlighted by this publication. This publication explores how vaccination strategies for two important respiratory conditions — COVID-19 and influenza — can and should be considered together, combined in an effective way to improve uptake rates for both vaccines.
“Pharmacists can highlight the importance of vaccination to highrisk groups, as those are frequently visiting community pharmacies to access medicines and services. Pharmacies were used in several countries as places to deliver COVID-19 vaccines and to provide another extensive access point to these vaccines. Many countries also provide influenza vaccination in pharmacies. However, as many countries still do not have pharmacy-based vaccine administration, it is important to reflect on the main aspects that can facilitate its implementation in the future. Coadministration of vaccines can have a big impact on the increase in vaccination coverage rates, as it can be convenient, save patients’ time and increase the probability that people will be fully vaccinated, as they might not return for a second vaccine in situations where they are given separately.”
Key messages
• Scientific evidence and WHO guidelines support that coadministration of influenza and COVID-19 vaccines with inactivated vaccines is acceptable in terms of safety and reactogenicity, as well as efficacy and immunogenicity. • The WHO considers that “coadministration of an inactivated seasonal influenza vaccine and any dose of a COVID-19 vaccine is acceptable, given that the known risk of serious illness for adults infected with influenza virus or SARS-CoV-2 is substantial”.
• Coadministration is convenient, saves time, avoids missed opportunities and provides a safe and effective win-win for people and healthcare professionals. • Each time a person walks into a pharmacy is an opportunity to engage in conversations about vaccination. • Leveraging the accessibility, convenience and professionalism of community pharmacies to build confidence in vaccines, raise awareness of the importance of vaccination — especially among vulnerable groups — and ultimately to administer vaccines is an effective and powerful way of increasing vaccine uptake. • Actively promoting the coadministration of the influenza and COVID-19 vaccines in the same visit further enhances convenience, which is a central pillar of any person-centred approach to vaccination. • Pharmacists can highlight the importance of vaccination to high-risk groups, as these frequently visit community pharmacies to access medicines and services.
• High-risk groups for flu and COVID-19 vaccination include older adults and people with comorbidities, among other groups that pharmacists may target — in addition to getting vaccinated themselves.
68 Corporate Profile
Keeping Their Eyes on the Future
This year has marked milestones for many businesses, not just across Ireland but across Europe. As the waves of the Covid-19 pandemic continue to ebb away, new opportunities and those which had previously been put on the backburner are arising.
Diarmuid Gavin, Country Manager Théa Pharma Ireland
This is especially true for Théa Pharma, who are embracing the potential of the future. Théa Pharma is renowned as being the Number 1 ophthalmology brand in Ireland; an innovative company solely dedicated to developing high-quality products that support ophthalmic care and eye health across Ireland. We spoke with Country Manager Diarmuid Gavin to learn more about the exciting developments in the pipeline for this industry leader.
Driving Innovation
2022 has already been a special year for the company. “In many ways, it is the year we have all been waiting for,” Diarmuid tells us. “Driving Innovation, Education and Professionalism in improving Eye Health has been our motto from day one. This year Théa Pharma Ireland has become a reality moving from a joint venture to a full subsidiary of Théa global, allowing us to offer our customers and patients the full Théa experience. “Our brand-new, state of the art offices located in Castlebar, Co Mayo offer us the opportunity to invest further in Ireland while staying closer to the increasing wants and needs of customers and patients for improved eye care and a better quality of life.” By developing treatments, providing information and sharing knowledge with specialists around
Diarmuid Gavin, Country Manager Théa Pharma Ireland
the world, Théa Pharma enable everyone to keep their eyes wide open. Théa specialise in preservative-free treatment. What led the company to their leading ranking? Diarmuid explains, “Théa possesses 150 years of knowledge and expertise in ophthalmology. We are 100% dedicated to eye health and world leaders in 100% preservative free eye care solutions. “The key to Théa’s growth is a combination of scientific, technical, regulatory and commercial expertise, unique in the world of Ophthalmology. The Chibret family own and run Théa, they pride themselves on reinvesting in discovering future innovations.
Road Mapping for Pharmacists
“Over the last few years we have placed a strong emphasis on OTC. We provide Pharmacies with a full scope of trade and digital marketing offerings, merchandising and emerchandising, a clear roadmap for Pharmacists to increase profitability while enjoying high margins, as well as working together to provide expert Eye Care advise and raising awareness on the importance of Eye Health. “And I want to thank wholeheartedly all Pharmacists throughout Ireland for helping us raise awareness on the importance of eye care. The Eyes are the windows to our soul and body. Let’s take good care of them!” Much like the rest of the industry, the team behind Théa were not without their challenges when it comes to the pandemic, presenting the company with one of their largest hurdles to date. But as Diarmuid points out, ensuring their team and their customers are kept at the heart of everything has driven morale and resilience.
So what sets Théa apart from their competitors?
Diarmuid says the answer to this is four-fold. “Firstly, our products are 100% preservative free which means they wont damage or irritate the eyes. Secondly, our products are clinically tested and proven to treat various symptoms of eye care conditions. For example for Dry Eyes, which is a rapidly growing market, we offer Thealoz Duo eye drops which are Europe’s number one dry eye drop, 100% preservative free and clinically proven to treat symptoms of dry, stingy, tired eyes. In Blepharitis we have Ireland’s No 1 daily eyelid cleanser Blephaclean which is 100% preservative free and clinically proven to treat symptoms of eyelid inflammation. “Furthermore, each product offering allows the Pharmacist to enjoy high levels of margin and profitability, and lastly, because we are 100% dedicated to eye health, our product portfolio is extensive and covers all eye care needs including Dry Eyes, Glaucoma, Eyelid inflammation, Blepharitis, Eye nutrition, Infection and Allergy.”
Overcoming Challenges
“Dealing with the Covid-19 pandemic has been, above all, about people,” he reflects. “From all the people working in the healthcare sector, who have willingly put themselves in harm’s way, to the people who have kept essential services running, we owe them all a tremendous thanks – today more than ever. The Covid-19 pandemic has gone through phases, each of which is characterised by a different set of needs and requirements that have impacted all businesses. “What it did for us, was to force us to respond to, cope with, and look beyond the crisis. People are the first line of resilience for the workforce during a crisis. From the very first moment we stayed close to our people ensuring they have all they needed, strengthening the ‘work from home’ experience with much needed fun that kept morale at a high level. “We provided guidance on alternative ways of working while protecting productivity, performance, and safety for each work location. We adopted our work environment to be more agile, flexible, and clear open communication gave our team reassurance and short-term direction.”
It can be true to say that the pandemic also forced the hand of many businesses into the digital era. Diarmuid adds, “Furthermore, we accelerated the digitalisation of our internal, customer and supply chain interactions and their internal operations by three or four years. Once ‘nice to have,’ digital capabilities are now a ‘must have’ to build resilience for a sustainable future ahead.
“While we can put 2021 under the theme ‘new normal’ we are now in a transition phase toward
Diarmuid Gavin, Country Manager Théa Pharma Ireland
the “next normal.” We learn as we go and can build on this experience to be prepared for future disruptions. Perhaps most important is long-term adaptability and resilience. We will undoubtedly face new challenges caused by geopolitical events, climate change, health crises, energy crisis and the like. Companies must be able to actively manage continuous change and adapt to new circumstances.”
The Ophthalmology Market Value
The ophthalmology market and its value to pharmacy has been steadily increasing over the last number of years but more recently it has visibly accelerated. Diarmuid adds, “The pandemic accelerated rapidly the growth that was already occurring the previous years. In 2019, 1 out of 5 adults suffered from dry eyes. Within just 3 years we saw a dramatic increase and as of 2022 dry eye sufferers account for 1 out of 2 of the general population which means almost half of the population are suffering from dry, tired, itchy, stingy eyes. “Eight out of 10 dry eye sufferers experience symptoms of blepharitis. Google search for eye health keywords increased by a staggering +1,078% during the pandemic. The increase in screen time use, the Mask Associated Dry Eye symptoms (MADE), our environment, air conditioning, menopause, poor tear quality and ageing are some of the contributing factors for this new, harsh reality.” According to IQVIA’s Ireland General Manager, Gwynne Morley, the OTC market is recovering faster than expected following the impact of Covid-19. Is this sentiment true for eye care we asked Diarmuid. “It is. The eye care market is increasing significantly and will continue to do so in the years to come. Based on IQVIA data over the last 5 years the Dry eye market has increased by +37%. Between 2016-2021 the eyelid market increased by +62%. 1 out of 5 people is allergic and more than 60% of them have eye related allergy symptoms. Studies show that younger people are also affected more and more by dry eyes.”
Opportunities for Pharmacy
Diarmuid is keen to highlight the upcoming opportunities and potential within ophthalmology for community pharmacists here, and explains more about how he and his team will be supporting the profession in embracing these. “Eyecare is the second most valuable and important product category based on total value within the Irish Pharmacy, just behind skincare,” he notes. “The market is growing rapidly and Pharmacists need to be aware of the increasing needs for eye health that more and more people and families around Ireland have. Education is the key. Preservative free products are the present and future in ophthalmology. As the number 1 Group in Eye Care in Europe and world leader in 100% preservative free products, Théa Pharma continues to stay ahead and complete its range of eye care solutions to satisfy the full needs of all Ophthalmologists, Optometrists, Pharmacists and Patients.
“Already in 2022 we have launched 4 new pioneering and innovative eye health products that cover a wide range of eye care needs from eyelid warming and cleansing to evaporative dry eye solutions and leading products for dry eyes caused by allergies.” The eye care market continues to show significant growth, how can community pharmacists make the most of this segment in reaching customers? Diarmuid concludes by stating, “I would urge all pharmacy teams to consider this. How much space and time have you dedicated to eyecare?” “Community pharmacists play a crucial and significant role in promoting the right eye care solutions for their patients. We brush our teeth morning and evening and yet we rarely take care of our eyes unless we have a problem; You can replace a tooth but not an eye. “Quality plays a huge role when proposing an eye care product. Is the solution 100% preservative free? Is it clinically proven and tested?
“Our products are indicated to battle and treat various serious eye symptoms such as dry eyes and blepharitis. Most importantly, we ensure high margins and profitability as well as full online and offline marketing support including merchandising to ensure the right shelf space for the eye care category. We have a full Pharmacy team that regularly visit Pharmacies around Ireland as well as dedicated Medical, Surgical and GP teams for dedicated visits to Ophthalmologists, GPs and Hospitals. Education is the key and we offer numerous webinars and training. We are fully dedicated to eye care therefore we guarantee high quality products with high margins and an expert team to help and train Pharmacy teams around Ireland to deliver the best advice and care for patients.”
Management and Treatment of – Cough
Following on from the September issue Continuing Professional Development on the Management of Cough, this 5-Minute Learning Module is designed to enhance the community pharmacy team understanding and ask further questions as to how you can support and advise patients.
Learning Objectives
After studying this module, pharmacy teams will:
Understand that cough is a common symptom and complaint, and is associated with a wide variety of aetiologies and clinical conditions.
Be aware of the different types of presenting cough (acute, subacute or chronic) and identify the correct pharmacy treatments
Identify red flags and/ or danger symptoms, and know when a patient needs to be referred to the GP or seek urgent medical attention.
Be aware of any potential drug-drug interactions or contraindications, considerations and questions to ask the patient before supplying OTC or prescribed cough medication
After completing this module, you should recognise the varying types of cough that may present to the pharmacy and the OTC treatments available for each. Where pharmacy management is appropriate you will be able to explain to patients the nature of their type of cough and suggest possible solutions. You will be able to give advice on current recommendations symptom management and know how to signpost to relevant resources. Where a patient wishes to purchase OTC treatments, you should be able to support that person to make appropriate choices. Cough is a common symptom and complaint, particularly during the winter months, and is associated with a wide variety of aetiologies and clinical conditions. A cough is one of the most common medical complaints, and is the most common symptom for which people seek advice at their community pharmacy. Coughs are classified as acute, subacute or chronic. A cough is considered ‘acute’ if it is present for less than 3 weeks. A ‘subacute’ cough, is one lasting 3 to 8 weeks, most often due to a recent respiratory infection. A cough of greater than 8-week duration is considered a ‘chronic’ cough. Most coughs are self-limiting and will usually self-resolve within 3 weeks, however, it is important for the person to see or be referred to the GP, if the cough lasts more than 3 weeks, or if the person is coughing up blood (haemoptysis). Smoking is a leading risk factor for coughs, and additional common causes of an acute cough include acute rhinosinusitis, pertussis, acute exacerbations of COPD, allergic rhinitis, asthma, congestive heart failure, pneumonia, aspiration syndromes, and pulmonary embolism. An acute cough is also a main symptom of SARS-CoV-2 (Covid-19) infection, and this must always be considered when a patient presents with a cough, and investigated and treated appropriately. Those presenting to the pharmacy with a cough should be referred to their GP if they: • Are finding it difficult to breathe • Are short of breath or have a wheeze • Are coughing up blood (Haemoptysis) • Have a hacking cough or cannot stop coughing and it is getting worse
• Have a recurrent nocturnal cough Coughs and colds in children are frequent and usually self-limiting, and there is no clear evidence to support the use of these products in children under six. Children under six years should not be given OTC cough and cold medicine containing; • brompheniramine, chlorphenamine maleate, diphenhydramine, doxylamine, promethazine or triprolidine (antihistamines) • dextromethorphan or pholcodeine (cough suppressants) • guaifenesin or ipecacuanha (expectorants) • phenylephrine hydrochloride, pseudoephedrine hydrochloride, ephedrine hydrochloride, oxymetazoline, or xylometazoline hydrochloride (decongestants) Certain cough remedies however, made with mainly natural ingredients including traditional herbal medicinal products (THRs) are licenced for sale in Ireland, available in pharmacies nationwide, and suitable to use for children over 12 months old. A range of products are specifically formulated for children from 1 year of age, and can be used to treat dry or chesty coughs. Opioid derivatives are commonly sold as cough suppressants / antitussives to suppress the cough reflux from the medulla in the brain stem to provide relief from frequent coughing. Common drugs include dextromethorphan, pholcodine, dihydrocodeine, and codeine. Preparations may be sold as syrups, medicated lozenges, tablets or capsules. Medication licensed for the management of productive coughs fall into two categories: expectorants (protussives) and mucolytics. Like antitussives, these drugs come as syrups, medicated lozengers, tablets or capsules. Herbal medicines are popular in the treatment of minor medical conditions, including coughs. Herbal medicines are those with active ingredients made from plant extracts such as leaves, roots and flowers. Like conventional medicines, herbal medicines have an effect on the body, and can be potentially harmful if not used correctly. While traditional herbal remedies are safe to use for most people, some herbal medicines may not be suitable for certain individuals including; those taking other medicines; people with serious health conditions, such as kidney or liver disease; people who are undergoing surgery; pregnant or breastfeeding women; some older people and children. There are a wide variety of herbal remedies available for coughs in pharmacies. Consumers should check for a traditional herbal registration (THR) marking on the product packaging, which means the medicine complies with quality standards relating to safety and manufacturing, and provides information about how and when to use it.
Now I should:
Update my knowledge of the signs, symptoms, causes and treatment of cough Reassess my and my staffs’ ability to do a risk assessment Train my pharmacy counter assistants to ensure they can meet the points in the training checklist
Funding for New Health Projects
The Health Research Board has announced its support for three University College Cork-led projects that will tackle health inequality, prevent childhood obesity, and explore how our gut can affect our memory, concentration, and social interactions.
The Health Research Board (HRB) announced that it was funding nine new projects under Emerging Investigator Awards for Health (EIA) 2022, three of which are led by researchers at University College Cork (UCC). Based in UCC’s Institute for Social Science in the 21st Century (ISS21), Dr Monica O’Mullane has been funded to develop a Health Impact Assessment Implementation Model (HIA-IM) - a tool aimed at tackling health inequalities. “Public health research has shown that our health and wellbeing are affected by the circumstances into which we are born, grow, live, work and age,” Dr Mullane explained. “HIA-IM is now needed more than ever to ‘health-proof’ public policies as we cope with challenges such as the global climate emergency. HIA-IM will help reduce the risk of policies that impact adversely on health and wellbeing, with particular reference to Ireland’s marginalised groups,” she said.
A lecturer in UCC’s School of Public Health, Dr Karen Matvienko-Sikar has been awarded funding to develop a standardised approach to measuring infant feeding outcomes to prevent childhood obesity. “Approximately one in five children experience obesity worldwide, making it a major public health challenge. What, how and when children are fed in the first year of life contributes to childhood obesity risk,” Dr Matvienko-Sikar said.
“This research aims to provide researchers, practitioners, and policymakers with a toolkit of measurement instruments, such as questionnaires and clinical assessments, to better evaluate infant-feeding interventions and prevent childhood obesity. “This will enhance the evaluation of interventions to prevent childhood obesity, with potential for significant impact on, and meaningful improvements for, population health,” she said. Dr Linda Katona is a neuroscientist based at UCC’s Department of Anatomy and Neuroscience and the APC Microbiome Ireland SFI Research Centre has also been awarded by the HRB’s Emerging Investigator Awards for Health. Her research seeks to identify the gut microbiome-responsive brain biomarkers of cognitive impairments relevant to schizophrenia. “Ireland has among the highest rates of mental illness in Europe, and schizophrenia is one of the leading psychiatric diagnoses nationally and the one carrying the biggest economic cost. Schizophrenia patients have problems remembering their past, are unable for social interactions and cannot retain information long enough to use it. Gut microbes affect our mood and motivation and interfere with our mental abilities,” Dr Katona said.
“Recent research shows that information from our gut gets transferred to our brain through the vagus nerve, and that disruptions in the communication between gut microbes, vagus and brain often accompany the core symptoms of schizophrenia. This project will examine this and attempt to answer questions such as how our gut microbiome, through the vagus nerve, interferes with our memory, how it influences our social interactions, and how it can affect our concentration.
“By exploiting these gut-brainbehaviour relationships for novel, better-targeted therapeutic interventions, this study could revolutionise how schizophrenia and similar brain disorders are treated, significantly improving the lives of millions of people globally,” she said.
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76 Pharmacy Retail
Peak Trading 2022: A Pharmacy Guide to Success
The holiday and therefore peak trading period is just around the corner. Following several years of lockdowns, reduced social contact and uncertainty consumers are ready to return to their pre pandemic festive traditions and for many that includes shopping.
This year however consumers are facing unfamiliar pressures to their disposable income resulting from increases to cost of living and spiralling energy costs and retailers continue to face relentless supply chain issues. It is clear that in a highly competitive market online pharmacists will need to work harder than ever to ensure a successful peak trading period.
Where to begin? With Planning
September & October is all about planning. Consider your stock, resourcing, promotions, and digital marketing strategies, by October you want to ensure that you have all the plans in place to maximise the peak trading opportunity. Do you know what product ranges you want to push, have you sufficient stock, what discounts to offer, what campaigns to run, what channels to use and do you have the assets and resources in place to make the magic happen. Also consider the customers user experience when they visit your website. Optimise your online store ahead of the shopping rush to keep your customers converting. • Advanced site search will offer your customers search as you type functionality and ensure that the most relevant products appear first, increasing your conversion chances.
• Personalisation services will customise their online shopping experience and make recommendations based on individual browsing histories. • Take every opportunity to upsell and feature complimentary products, this is a fantastic way to encourage your customers to increase their basket value.
Examples of these products include offering a tanning mitt with a tanning cream or make up brushes with makeup • Employ Out of Stock email alerts so you never miss an opportunity to convert a sale when you restock • For high ticket items like hair dryers, styling tools etc, why not offer the option for the customer to pay in instalments.
Great way to entice and convert the organised early shopper particularly when customers are more considered about spending this year • For multi outlet retailers allow customers to view instore stock availability across your store network from the product detail page. Offer them the control to select home delivery or the option to collect from their local store.
• Optimising your checkout to provide a painless checkout process boosts your conversion rate and gives customers more reason to return to your online store.
At the heart of your planning should be your omnichannel strategy, successful Retailers don’t think of online retail and physical retail as separate functions, it is all Retail. Your customer could see a product on your Instagram page, order it online via your website but return it in-store OR see a product in-store and go home and buy it later online so make sure that your various marketing channels are synced and do not function independently November is the time to capitalise on the organised shopper, those who know what they want and are price sensitive. Marketing should be focussed on showcasing your best offers and ensuring you stand out from the competition. Email & SMS marketing are excellent means of staying connected with customers during this time, promote your offers in advance, create a buzz with pre-sale exclusive offers and reward loyalty with access to this years “must haves” before stock runs out. Providing excellent customer service can also help you stand out from the competition during peak trading periods. Superior customer service will also bring customers back to your online store long after the peak trading period. Everything from their first interaction with you, to transparent and fair delivery and returns policies are crucial in developing long lasting relationships with your customers. Surprise your customers, add free samples with orders, allow your customers to add gift messages, go above and beyond with customer service, or offer a discount on next purchase. Customers are also more green conscious then ever and are using their buying power with a renewed desire to buy from brands that demonstrate a genuine commitment to sustainable business practices. Sourcing ecofriendly materials, the consolidation of shipments, reducing the distance packages travel and minimising paper and packaging used for shipments and returns are ways that Retailers can contribute to a more sustainable future.
December is the time to target the last minute shopper. Time is of the essence with Christmas approaching so take the stress out of your customers shopping experience and focus on your delivery and customer service terms. Reassure your customers that their purchases will arrive on time and that you will deal with any issues that might arise without delay. Building this trust will not only convert Christmas shoppers but will have those shoppers returning post-festivities. For the reluctant shopper make it easy with gift guides like Gifts for Mum and Gifts for Teenagers etc, Gift Hampers and Gift Cards will also help those shoppers who have run out of ideas.
In the peak shopping frenzy, customers are likely to browse numerous online stores and place multiple items in their shopping carts. Often the customer gets distracted by another product or promotion and these carts become abandoned. Use email to entice these customers back, remind them of their potential purchases and consider offering a promotional incentive to encourage conversion. Post-Christmas will see the return of the deal hunter, it is important that you have your promotions in place, and you are ready to again stand out from the competition. Depending on what stock you have left over you also need to be prepared to pivot your plans and react to the opportunities that may present themselves. To succeed this peak trading period you need to consider the organised shopper, the deal hunter and the last minute frenzied shopper and create a shopping experience that exceeds all your customers’ expectations. Orla Cooney, Chief Operating Officer, Magico with over 20 years’ experience. Orla’s strength is in her ability to focus on the practical application of ecommerce strategies for her clients, she works with clients to identify the best strategy for them and how to deliver it.
Written by Orla Cooney, Chief Operating Officer, Magico
Magico (www.magico.com) is a client-first, innovative eCommerce Agency based in Ennis, Co. Clare, that has been delivering websites for Irish retailers since 1999 and specialises in getting pharmacies online & helping them to grow fast.
Children’s Health and Wellness in Ireland
Paediatric healthcare in Ireland is currently undergoing a revolution
Children’s Health Foundation is working to support sick children and their families in Children’s Health Ireland (CHI) hospitals, Crumlin and Temple Street, and urgent care centres Tallaght and Connolly. We raise vital funds to support sick children and their families in CHI hospitals and urgent care centres.
Children’s Health Ireland was formed January 1st, 2019, following the enactment of the Children’s Health Act 2018 in November 2018. This provided for a dedicated board, appointed by the Minister for Health, to take over responsibility for services currently provided by Dublin’s three children’s hospitals, Our Lady’s Children’s Hospital, Crumlin, Temple Street Children’s University Hospital, and the National Children’s Hospital, Tallaght. Latterly an urgent care centre in Connolly Hospital, Blanchardstown joined under Children’s Health Ireland’s governance, this is in operation today and will serve as one of two urgent care centres supporting the new children’s hospital, along with Tallaght hospital. Children’s Health Ireland (CHI) governs and operates acute paediatric services for the greater Dublin area and all national paediatric services, some of which are on an all-island basis.
In addition to this, a new state-of the art paediatric hospital is being built in Dublin city at the St James site. This hospital will form the centre of a hub-and-spoke model which will provide care for every single child all over Ireland. The new children’s hospital is the central cog of the National Model of Care for child healthcare in Ireland.
Childhood illness in all its forms is persistent, indiscriminate, and often devastating. As many of the children who pass through the doors of CHI sites every day have rare and complex conditions that are life-limiting or life-threatening, Children’s Health Foundation know all too well that the burden of disease can have a significant impact on a child and their family. Children’s Health Foundation is the largest fundraising charity in Ireland supporting sick children. From the funding of cutting-edge equipment and technologies to the refurbishment of critical hospital facilities, Children’s Health Foundation is committed to supporting the provision of world class care for children in need. Ensuring that patients continue to have access to the very highest standards of care, world-class facilities, and benefit from the most up-to date research that will change young lives for the better. This can only be achieved through supporters’ funding, bringing real long-term impact for sick children and their families. From understanding disease progression in children with cystic fibrosis, to providing tailored treatment options for children who have been diagnosed with cancer, these funds will allow Children’s Health Foundation to invest in the innovative research programmes that will make each day easier for those children battling chronic illness, enable us to provide state-of- the-art equipment and treatment programmes, and allow us to offer supports to children and their families.
Sona has partnered with the Children’s Health Foundation since 2019 as one of their charity partners. This October, Sona will launch a Golden Ticket campaign in aid of Children’s Health Foundation to support the life-saving work of CHI hospitals and urgent care centres. A golden ticket will be hidden inside a product from the Sona Children’s range. During this October and November, Sona will launch a Golden Ticket campaign in aid of Children’s Health Foundation to support the life-saving work of CHI hospitals and urgent care centres. A golden ticket will be hidden in the packaging of one Sona’s products. Whoever finds the golden ticket will win ¤1,000 in cash, and will also trigger a ¤30,000 donation from Sona to Children’s Health Foundation. For more information, visit www.childrenshealth.ie/sonagolden-ticket and or visit www. Sona.ie
