September 2022 Volume 14 Issue 9 THE INDEPENDENT VOICE OF PHARMACY In this issue: NEWS: studentoversight‘Inexplicable’forpharmacyplaces Page 5 REPORT: Pharmacy Workforce Survey Shortageshighlights Page 10 PROFILE: Haleon- Promoting Good Health Page 12 FEATURE: Updates in Chronic Pain Management Page 28 CPD: Pharmacy Role in Managing Cough Page 41 AWARDS: Profiling the 2022 Irish AwardPharmacyWinners Page 46 INTERVIEW: Overview of Asthma Care with Professor Stephen Lane Page PHARMACYNEWSIRELAND.COM78 This Publication is for Healthcare Professionals Only www.smahcp.ie/infant-health ZTC5679d/07/22 | JU001, ITNUL003, ITNUB019, ITNU004 IMPORTANT NOTICE: Breastfeeding is best. SMA® Xpert ProCol is not a substitute for breast milk and does not replace o balanced diet. Before using any dietary supplement, please discuss with your healthcare professional. Food supplements should not be used as a substitute for a balanced and varied diet or healthy lifestyle. Do not exceed the recommended doily dose. Keep out of reach of children. SMA® Xpert ProHydrate must be used under medical supervision. SMA® Xpert ProHydrate is intended for the dietary management of gastroenteritis. It is suitable for infants (0-12 months) and children (1-3 years). If the condition does not improve within 24-48 hours of starting SMA® Xpert ProHydrate, the family doctor should be consulted. SMA® Xpert ProHydrate is not suitable for use as the sole source of nourishment. For Enteral Use Only. Always follow medica l advice. For babies, always hold them while feeding and do not leave them unattended as they might choke.
Boost your immune system with Propolis! Propolis can be used as a safe non-toxic food supplement and may prove helpful in protection against colds, cough, flu and other viruses. Propolis is also a prime source of histamine and serotonin; two substances that help the body cope with allergies. Propolis has been recognised as a major breakthrough in the search for an all-natural aid that can help the body fight viral, bacterial and fungal infections, soothe skin, heal ulcers and improve general immune response. NEW For more information on promotions and POS, contact your Valeo Healthcare Account Manager or Sales Rep David Keane 087 279 2860 david.keane@valeofoods.ie Stephen Moloney 087 699 9344 stephen.moloney@valeofoods.ie Fintan Byrne 087 647 0764 fintan.byrne@valeofoods.ie Julie Webster 086 462 1723 julie.webster@valeofoods.ie Eamonn Connolly 087 238 5648 eamonn.connolly@valeofoods.ie Boosts the Immune System Natural Support for Immunity Season Improve Skin Condition
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You can read more about this on page 12.
Elsewhere in this issue, we have some excellent clinical content, including Dr Caitríona Henchion writing about the key points for pharmacists in an Emergency Contraception context; Michelle Greenwood who discusses eczema management in light of World Eczema Day and Professor Stephen Lane on new and current developments in asthma care.
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Turn to page 18 for the full article.
Irish multipleindependent,circulatedNewsPharmacyistoallPharmacists and academics in AllIreland.rightsreserved 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. IRISH PHARMACY NEWS 126PUBLISHER: IPN IrelandCommunicationsLtd. Clifton House, Fitzwilliam Street Lower, Dublin 2 00353 (01) MANAGING6690562DIRECTOR Natalie n-maginnis@btconnect.comMaginnis EDITOR Kelly Jo Eastwood: 00353 (87)737 6308 kelly-jo@ipn.ie ADVERTISING EXECUTIVE Amy Evans: amy@ipn.ie EDITORIAL/ EVENTS & MARKETING EXECUTIVE Aoife Jackson: aoife@ipn.ie CONTRIBUTORS Denis O’Driscoll | Dr Iseult Sheehan Professor David Finn | Mary Hopkins Stephanie Bourke | Hazel Breen Laura Stevenson | Dr Emma Doris Mariosa Kieran | June Shannon Professor Nicola Dalbeth Professor Geraldine McCarthy Professor Stephen Lane Professor Esther Pogatzki-Zahn Dr Caitríona Henchion Theresa Lowry Lehnen DESIGN DIRECTOR Ian Stoddart Design Page 4: Women should be given choice in accessing contraception Page 6: Safe Pharmacy initiative is rolled out Page 8: Rapid health checks launched in pharmacy Page 12: Dave Barrett tells us more about Haleon Page 18: Pharmacy at ‘threat’ without Government intervention Page 30: The People’s Pharmacist 2022 –Search Begins Page 46: Self-CarePharmacyMeagherschampion Page 68: newPharmacyMeaghersunveilservice Page 70: ofpharmacistImprovingknowledgeGout PHARMACYNEWSIRELAND.COM@Irish_PharmNewsIrishPharmacyNews Contents 68
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Lastly, we are delighted to announce that the search is now on for The People’s Pharmacist 2022. This hugely popular, public nominated and public voted-for Award saw a reach of over 500,000 across Ireland last year, further details will follow on our website, social media and in our October issue. I hope you enjoy the issue.
As Dave explains, “In establishing Haleon as an independent company on 18th July, we have created a new world-leader, purely focused on consumer health, with wonderful brands that our consumers and customers know and trust such as Voltarol, Centrum and Panadol, which is manufactured in Dungarvan where we employ over 900 people.”
Foreword
Our profile this month features Country Manager with Haleon, Dave Barrett. Haloen is the new company to result from the proposed demerger of Consumer Healthcare from GSK. As a standalone company, Haleon (pronounced Hay-Lee-On) will be a new world-leader in consumer healthcare, offering a compelling proposition – to bring deep human understanding together with trusted science – to deliver better everyday health with humanity.
3 PHARMACYNEWSIRELAND.COM
In other lead news this issue, LloydsPharmacy Superintendent Denis O’Driscoll outlines the serious and pressing threat which is currently facing community pharmacy across Ireland. He says that despite the status of pharmacists here ‘skyrocketing’ since the onset of the pandemic, pharmacists ‘continue to sit outside of the ‘inner circle’ within government structures.’
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Regulars
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“For all the services we’ve provided communities with right across Ireland over the last number of years, many pharmacists are still facing a real crisis, the biggest challenge being maintaining services for our patients,” he says. “A strong and vibrant community pharmacy presence is an essential element of the overall healthcare eco system. We urgently need policy makers and regulators to engage with our sector to start addressing these issues by looking to pharmacists for their counsel and expertise – just as the rest of society did with the pandemic hit these shores.”
One pharmacist we spoke to said, “In many cases we are nearly at the point of choosing between safe patient care, and FMD boxticking. It is a shame that we must stand together and initiate this petition ourselves, but we simply cannot stand back and wait for our representative body to act on our behalf,” they added.
The government plan to introduce free contraception for women aged 17-25 will be undermined if access to contraception is needlessly constrained. Funding was allocated in Budget 2022 for the creation of a scheme that would enable women aged 17 to 25 to access contraception free of charge. It is envisaged that the scheme will cover oral contraceptives (The Pill) as well as the administration of both long-acting reversible contraception (LARCs) and contraceptive injections. Despite being available over the counter in many other countries, women who opt for oral contraceptives will be required to obtain a prescription through their GP.
Ann Marie Horan pharmacist and Irish Pharmacy Union (IPU) Vice President, said the ease of access and choice for women should be at the centre of the new scheme. “The introduction of free contraception for young women is very welcome development in the provision of women’s health in Ireland. Ensuring convenient and easy access to contraception for should be central to the government’s plan.
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“The Pill is one of the most widely used forms of contraception in the world. It is a safe and well-studied medicine and has been used by women for almost half a century. It is now safely available over the counter in many other countries including the US, New Zealand and Canada.
Choice to Access Contraception
“Previous research in Ireland has shown that almost half of women would favour being able to access contraception direct from a pharmacy. Barriers to accessing contraception are not just financial,
A number of community pharmacists, over 1,400 thus far, have come together online to sign a petition to the Minister for Health. The petition relates to the Falsified Medicines Directive and its implementation, which for a huge number of pharmacists, is becoming un-tenable.
Ms. Horan explained that pharmacies already have experience in dispensing contraception without prescription. “Emergency hormonal contraception (the morning after pill) has been available over the counter since 2015. Pharmacists are trained and have the experience in reviewing patients to determine if it is safe to dispense contraception without referring to a GP. There is simply no clinical reason why this model could not be extended to other forms of oral contraception.
In March of this year, Kieran Dalton of the Pharmaceutical Care Research Group at the School of Pharmacy, University College Cork published research carried out with colleagues on pharmacists’ views on the impact of the Falsified Medicines Directive on community pharmacies. This research study showed that most respondents perceived that FMD requirements increased waiting times for patients (82%) and reduced time interacting with patients (65%). Only 28% agreed/strongly agreed that the introduction of the FMD legislation improves patient safety. The authors concluded that ‘Key stakeholder engagement is required to optimise the implementation and integration of the FMD procedures into community pharmacy practice with minimal impact on dispensing and without compromising patient care.’
A spokesperson from Uniphar, who have five of their stores nominated said, “This nomination reflects the continuous dedication, teamwork and fantastic customer service our colleagues deliver every day to our patients across all of our pharmacies. Congratulations to our colleagues and all finalists on their nominations and wishing everyone the very best of luck!”
Irish Pharmacy News has learned of frustration and concern amongst the profession, as the current pharmacy workload has meant adhering to the principles of the FMD is ‘near impossible.’
Pharmacy Unites to Petition Minister
“Just as women have the choice over what form of contraception, they wish to use they should also be given the choice of where they can access it. Where there is no medical reason for a woman to visit a doctor there should be no bureaucratic reason either. When it is clinically appropriate women should have the choice to access the pill direct from a pharmacy.”
Top Shortlisting100 for Pharmacy Retail Excellence have announced the finalists for their Top 100 Retail Stores in Ireland, with no less than 20 community pharmacies making the shortlist. The Top 100 stores are part of the AIB Merchant Services Retail Excellence Awards, which were established in 1997 to promote best practice and encourage high standards in the Irish retail industry and are now the largest and most prestigious of its kind in Ireland. The Awards will take place on November 12th in the Galmont Hotel in TheGalway.pharmacies listed include: Adrian Dunne Pharmacy – three stores have been shortlisted which are Ashbourne, Balbriggan and Portarlington. Allcare KCR Pharmacy, Kimmage C.H Chemists, Tralee Darwood Pharmacy, Newcastlewest Haven Pharmacy Butlers, Birr Hickey’s Pharmacy, Drogheda Jens Pharmacy t/a Morrison’s Pharmacy, Cahir Laura Armstrong Life Pharmacy, Arklow Loftus Allcare Pharmacy, Bunclody Two McCabes Pharmacy stores in City West and Dundrum Meaghers Pharmacy, Churchtown Reens Life Pharmacy, Millstreet
You can view and sign the online petition here: community-pharmacy-in-irelandorg/p/change-the-fmd-protocol-for-https://www.change.
Over
Havehavepharmacists1,400signed.you?
The EU Falsified Medicines Directive (Directive 2011/62/EU) introduced a number of measures to prevent falsified medicines infiltrating the legal supply chain and ultimately from reaching European patients.
“At a time when GPs across the country are raising concerns about their capacity, and patients are waiting increasingly longer and longer times for GP appointments, this is in no one’s best interests.
Anne Marie Horan concluded, “The essence of Sláintecare is about providing the right care at the right place and the right time. Providing women with the choice to access contraception from their pharmacy achieves all three aims. Failing to do so could undermine the value of the scheme and deprive women of contraceptive care.”
requiring the time and effort to get a doctor’s prescription, is entirely unnecessary and should be removed.
Boots Ireland is proud to announce the opening of a new store in Terminal 2 of Dublin Airport. The new location in T2 brings the total number of Boots stores in Ireland to 92 as the company continues its investment into the growth and expansion of stores across the country.
“The addition of pharmacists to the Government’s Critical Skills Occupation List just last week illustrates the Government’s awareness of the need for additional professionals in the community pharmacy sector,” said Mr Murray. “This illustrates the short sightedness of the recent decision by Minister Harris and points to a worrying lack of coherence within government.
+RowexCalcipotriol/Betamethasone50microgram/g0.5mg/gOintmentPA0711/254/001
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Mr Murray concluded by calling on both Minister Harris and Minister for Health, Stephen Donnelly TD to show some leadership in addressing the problem.
Employing over 2,200 people nationwide, Boots Ireland was recently named as the most reputable pharmacy in Ireland according to the 2022 Ireland RepTrak® study. Last year, the company invested ¤5m in revamping a number of its stores across the Commentingcountry.onthe store opening, T2, Dublin Airport Store Manager, Kim Weldon said, “We are delighted to open the doors of our new Boots Ireland store in Terminal 2 of Dublin Airport. It is a busy and bustling location, with thousands of people passing through daily. We will be on hand to welcome all customers with an extended range of health, wellness and beauty products as well as trusted advice.”
Following the announcement community pharmacist and IPU Honorary Treasurer, Tom Murray expressed his dismay and disappointment, “The extreme shortage of community pharmacists has been consistently raised in public and with the Minister for Further and Higher Education, Simon Harris TD. We wrote to him outlining the problem as early as last September and the extreme manpower shortage in community pharmacy was highlighted in Dáil Eireann within the last two weeks. It is deeply disappointing and concerning that the sector has been completely overlooked in today’s announcement.
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‘Inexplicable’ Oversight for Pharmacy Students
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The Irish Pharmacy Union (IPU) has described the failure to include a single space for pharmacy students in the list of new 1,000 college places announced today as an inexplicable oversight.
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Store Manager Kim Weldon and Boots Team Members Alexandra Pusca, Hiba Ahmed, Rini Ravichandran and Caoimhe Mullen at the opening of a new Boots store in Terminal 2 of Dublin Airport. The new location in T2 brings the total number of Boots stores in Ireland to 92 as the company continues its investment into the growth and expansion of stores across the country
• Typhim Vi Solution for Injection Typhoid Polysaccharide Vaccine - PA2131/011/001 The following shortages have been resolved and supply has resumed to the Irish market:
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The new Boots store, which recently opened its doors, employs 27 people and is open between 4am and 6pm, 7 days a week. Located in T2’s extensive shopping area, the new store will offer airside customers exciting and exclusive brands, health and wellness products and access to expert advice, all delivered with the great care that Boots Team Members are known for.
The IPU has said that Ireland can no longer rely on overseas training for pharmacists and that a failure to increase training places is beginning to impact on patient care.
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ShortagesMedicine
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• Palladone 1.3mg CapsulesPA1688/007/001
Out of a list of 1,000 new college places announced recently, not one space was left for pharmacy students, a move which has alarmed the profession.
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News
Turn to page 10 to read more about the current pharmacy workforce shortage.
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The Health Products Regulatory Authority has been notified of a shortage of the following products:
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• Cernevit, Powder for Solution for Injection or InfusionPA2299/019/001
• Januvia 25mg Film Coated Tablets - EU/1/07/383/002
• Orencia Solution for Injection in Pre Filled SyringeEU/1/07/389/008
• Piriton 4mg TabletsPA0678/080/001
“The fact of the matter is that Ireland is simply not training enough pharmacists. Half of those who work in the sector today were forced to train overseas. This is untenable in a modern healthcare system. In July 2021, the Minister publicly announced that an increase in pharmacy places was forthcoming. The failure to honour that commitment will further heap pressure on the system.”
Boots Ireland announces New Airport Opening
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Kate Mulvenna, MPSI, Head of the Pharmacy Function, HSE PCRS commented, “This is a really important initiative and I would encourage people at risk and those experiencing domestic abuse to avail of this service in pharmacies, particularly if access to phones is monitored and limited. Domestic abuse includes physical, emotional and sexual abuse and can happen to anyone. Safe Pharmacy provides the mechanism for a standardised, quality-assured, access point offering across the entire country and the HSE is committed to ensuring that people experiencing domestic abuse get the help that they need.”
A new initiative to enable people experiencing domestic abuse and coercive control to receive support in their local pharmacy has been launched nationwide. Safe Pharmacy, is being led by the Irish Pharmacy Union (IPU) in partnership with Safe Ireland, An Garda Síochána and the HSE.
Dr Lara McManus, Research Fellow, School of Medicine, Trinity Trinity’sCollegesuccessful
• Support talented individuals at a critical career transition stage to establish themselves as independent health investigators in an academic or research-basedotherinstitution.
Anyone who is experiencing a domestic abuse situation and wishes to seek the support provided is advised to look for the purple Safe Pharmacy sign on the window displays of participating pharmacies. In the pharmacy they should ask to speak to the pharmacist in the consultation room, this happens multiple times a day in every pharmacy so will not appear out of the ordinary to anyone who is in the pharmacy at the time. In the privacy and security of the consultation room the person can inform the pharmacist that they require support and this will be provided. Welcoming the launch of Safe Pharmacy, community pharmacist and Safe Pharmacy participant, Oonagh O’Hagan said, “Domestic abuse is an issue that affects people in every community. Safe Pharmacy will create access to safe points of contact in practically every town and village in the country. Pharmacies are a trusted part of our communities with highly trained and compassionate staff. By partnering with Safe Ireland, An Garda Síochána and the HSE we hope that this initiative will provide a pathway from abuse for those who are experiencing it.
Safe Pharmacy will see over 850 community pharmacies, in every county in Ireland, providing any person who is experiencing domestic abuse with a safe and secure location to seek support. Participating pharmacies will provide access to a phone in a private consultation room and contact details for local support services. This will allow victims to make that important call, for example, to a family member, local specialist domestic violence services or An Garda Síochána.
AwardsInvestigatorEmerging
Safe Pharmacy Launched Nationwide
• Develop researchknowledgeknowledgefacilitateresearcherscollaborativewhocanactionablebytranslatinggeneratedthroughintothehealthcare system, policies or practice, or generating research findings informed by policy and practice.
applicants were selected in a twostage application process, underpinned by rigorous review, including expert international peer review, an applicant response stage and interviews conducted by an independent and international panel. The main objectives of EIA 2022 are to:
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The Trinity awardees are: Dr Achilleas Floudas, Senior Research Fellow, Clinical Medicine, School of Medicine
New Initiative to Help Victims of Domestic abuse launched in pharmacies
The scheme benefits researchers who have a minimum of four years active post-doctoral research experience and who are progressing towards research independence.
Oonagh O’Hagan, MD, Meaghers Pharmacy, Louisa Power, HSE Live Pharmacist, Mary McDermott, CEO, Safe Ireland and Detective Superintendent Sinéad Greene
Dr Mary Canavan, Assistant Professor in Immunology, School of Medicine
“For anyone who is in need of help, I would say to them: ‘All that’s needed is that you ask for help. You will be prioritised. You will be believed. You will be supported.’
Trinity College Dublin has won three of nine new Emerging Investigator Awards for Health (EIA) 2022 from the Health Research Board (HRB) who have invested a total of ¤7 million to nurture a talented new generation of academic researchers. All three researchers are from the School of Medicine at TheTrinity.prestigious Emerging Investigator Awards aim to create a cohort of talented new independent academic investigators by facilitating and supporting their transition from postdoctoral researchers to independent and self-directed health research investigators in the Republic of Ireland.
Mary McDermott, CEO, Safe Ireland and Detective SuperintendentSinéadGreene
“Anyone who seeks the support of a Safe Pharmacy will be treated with compassion and respect can and be assured of full confidentiality. In the safety and privacy of our consultation rooms they will be provided with information, contact details and a means to access additional support from Specialist Domestic Violence Services and An Garda Síochána.”
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The free programme uses a combination of health checks, expert advice and digital technology to help people understand, maintain and improve their health. This phase will involve a total of 500 participants across 5 CarePlus Pharmacy outlets nationwide.
The Health Elevator marks the latest step in the HSE’s Digital Health Transformation Strategy, entitled ‘Stay Left, Shift Left’10X, which focuses on moving health and care closer to home, where patients are empowered to improve their self-care and be healthier. It aims to transition from reactive care pathways, by utilising remote monitoring and real time information, to a proactive approach with ongoing management and preventative health screening.
Digital Transformation at the HSE, Professor Martin Curley, At the launch of 'Health Elevator' rapid health check, which sees HSE and CarePlus join forces to empower the public on healthcare.
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function •
As part of the programme, each of the 500 pilot scheme participants is being provided with a Fitbit device and digital app to monitor their health and wellbeing in the long Directorrun.of
“Everyone can face the risk of developing atrial fibrillation, heart disease, stroke, type 2 diabetes, and anxiety or stress. The good news is that these concerns can often be prevented – and this is an aspect of care that CarePlus Pharmacy has always aimed forhelping people manage their own health better, with the support of their community pharmacy team.”
TD and Minister of State, Robert Troy, recently took part in the Health Elevator rapid health check, which is being rolled out on a pilot basis by the HSE and CarePlus Pharmacy.
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Partners in Health Elevator Living Lab include Careplus Pharmacy, HSE Digital Transformation, Full Health Medical, FitBit, Google, Patients Know Best, Amazon Web Services, Eurofins, Roche and Trimedika.
“Pharmacy united in action for a healthier world” is the theme of World Pharmacists Day on 25 September 2022
• BMI (Body Mass Index) Lung Waist circumference
The International Pharmaceutical Federation (FIP) invites colleagues from all sectors of the pharmacy profession to take part in the campaign and show the world how we are united for health, regardless of and overcoming conflict, different politics and cultures, and economic disparity.
pressure
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Each appointment will take ten to fifteen minutes. Immediate test readings are recorded in the Full Health Medical system, while blood samples are sent for testing to Eurofins laboratories. The results of these checks and the initial questionnaire are combined and reviewed by an algorithmic assisted system and medical professional who will issue a detailed report with recommended follow-up actions. The information is then released to the Personal Electronic Health Record, supplied by Patients Know Best, where each participant will be able to view their results the following day.
Participants in the Health Elevator programme will first be asked to fill out a questionnaire which examines their own health and wellbeing and some of their family’s medical history. Next, they schedule an appointment at their selected CarePlus Pharmacy, where a trained healthcare professional will run through checks relating to: Atrial fibrillation Blood tests, including cholesterol, Hb1Ac Blood
Rapid Health Checks Launched in Pharmacy
Pictured are Minister for Trade Promotion, Digital and Company Regulation Robert Troy, T.D. with Siobhan Kellett (left), Health and Wellness Manager, Navi Group and Samantha Jones, Dispensary Manager, Woods Care Plus Pharmacy, Mullingar. Picture by Shane O'Neill, Coalesce says today is an important step in the implementation of the National Digital Health Transformation Strategy: “A key principle of ‘Stay Left, Shift Left-10X’ is to help Ireland to be a digital health leader in Europe by 2025. As part of that, we’re driving the evolution of digital interventions which deliver 10 times the benefit - for example processes that are 10 times faster, 10 times cheaper, lead to a 10X reduction in inpatient admissions and so on. The Health Elevator - Rapid Health Check programme/Living Lab is a fantastic example of the kind of radical innovation we want to help us achieve those aims and I’m delighted we’re working with CarePlus Pharmacy and others to make that a reality”. Today is a brilliant example of architectural innovation and an accountable care ecosystem at work’ Pharmacist John O’Shaughnessy from Woods CarePlus Pharmacy in Mullingar says the system prioritises some of the most common health concerns among his customers.
“The United Nations Sustainable Development Goal number 3 sets out a number of health targets, including for non-communicable diseases (such as cardiovascular disease, cancer, diabetes, chronic respiratory disease and mental health) and communicable diseases (for example, HIV, tuberculosis and neglected tropical diseases). We have seen improvements in many of these areas and our profession should be proud of and make known its contributions. However, the COVID-19 pandemic has hindered progress and it is imperative that we rally to build back better,” said FIP president Mr Dominique Jordan. The World Pharmacists Day campaign is led by FIP every year and provides an opportunity to promote the pharmacy profession. The theme is chosen by the FIP Bureau.
This year’s theme aims to showcase pharmacy’s positive impact on health around the world and to further strengthen solidarity among the profession.
It is envisaged that an individual personal electronic health record could form the basis of a future national digital health platform and a key tool to allow individuals better manage their own health.
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Longford-Westmeath
Decision to Work a Locum Pharmacist
principal attractions of being a locum pharmacist from the options provided to respondents survey were the ability to have more flexible working hours, the potential to earn more, the appeal of having less managerial responsibility and indeed less administerial responsibility. These are very evenly pitched, although flexible hours and higher earnings are at the forefront. important facet visible from the survey results and a recommendation is that community pharmacist employers should try to build greater flexibility in their contracted hours are often longer than one’s current work hours.
Highlights Pharmacy Shortage Crisis
Recommendationssamplesurveyed concentrated in the 36-45 age range, with a substantial proportion 35 work as pharmacists. Interestingly, of those who pharmacist, a higher proportion of male They are most likely to have been on the PSI years and disproportionately more likely to work over 41 hours a that the PSI should explore the possibility of the supervising share facilitate those pharmacists who would be willing to do want to work in a full-time capacity. 3-5 years experience 60% Dublin 55% Female 50% Category % indicated - yes Category % indicated - no supervising pharmacist? regulation; as well as the attraction of additional salary. There is an evident need to address pharmacists working in earlier phases of research, there is a requirement for the provision of a broader array of benefits such as participation take on this governance role. These include, the unattractiveness of the administrative tasks | Pharmacy Workforce Survey FactorsRecommendations2022Influencingthe
in this position.
Key Recommendations:
The PSI and the Department of Health should conduct an annual survey to gain an accurate indication of pharmacist resources to allow for future workforce planning and to facilitate future expansion of the pharmacist role within the Sláintecare health service reform; The PSI should review the current third country qualification route with a view to streamline and expedite the process of registration for pharmacists who qualify outside of the EU; All stakeholders should review the current levels of administration activities to reduce or remove unnecessary activities. Stakeholders should be encouraged to invest in digital solutions and lean methodologies to reduce this administrative burden and make the role of the community pharmacist more rewarding;
to
Base: 855 all working in community pharmacy supervising pharmacist Q.21 Do you currently work as a Supervising Pharmacist? % Superintendent 81% Over 41 hours per week 79% Contractor 75% Never work as a locum 70% Male 65% 56 44 Yes No U25 hours per week 88% Ever work as a locum 72% Changed primary practise 69%
A recent survey conducted by the Irish Pharmacy Union (IPU) has shown that Irish pharmacies are suffering due to a chronic lack of qualified pharmacists available to work in community pharmacies. This, together with ongoing absences due to COVID-19 is resulting in some pharmacies being required to reduce hours, or in some cases close for certain days as they struggle to cope with staff shortages. Report
Pharmacy stakeholders should explore the delineation of a pharmacy business to understand how a better work/life balance and rest breaks can be introduced for pharmacists choosing a career in community pharmacy;
Figure 2: Work as supervising pharmacist
not
currently work as supervising pharmacists. In
The shortage of pharmacists comes at a time when the demands on pharmacies have increased significantly. Pharmacies are striving to maintain services to patients and the public, but reduced hours and temporary closures cannot be ruled out.
Minister Harris has implemented additional places for medical students and should now do likewise for pharmacists and other allied healthcare professionals. We are again calling on Minister Harris to make more spaces available in Ireland’s universities for pharmacy students.”
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Workforce
Survey10
IPU President, Dermot Twomey said, “Pharmacist shortages are placing the community pharmacy sector under severe pressure. We have a chronic lack of qualified pharmacists available to work in community pharmacies and it is having a detrimental impact on the level of service pharmacies can deliver. This is placing pharmacists under immense strain, often working without breaks and we are also spending too much time on administrative tasks due to endless red tape which is compounding this issue. If we can’t increase the supply of qualified pharmacists, the sector will be unable to keep up with demand and patient care will suffer.”
Of the pharmacists surveyed, 42% were first registered in the UK (GB &NI). This high percentage of pharmacists qualifying outside our jurisdiction is a significant concern and highlights the glaring lack of places for students to study pharmacy here in Ireland. Additionally, the report shows the severe lack of qualified pharmacists trained outside the EU choosing to work in Ireland and recommends that the registration process for non-EU pharmacists to facilitate them working in Ireland is expedited as a priority.
Pharmacist employers should try to build greater flexibility in their contracted positions’ working hours to increase retention of contracted pharmacists; Pharmacist employers should review current pharmacy operations to facilitate pharmacists’ lunch breaks and break periods;
Mr Twomey continued, “The fact of the matter is that Ireland is simply not training enough pharmacists. Half of those who work in the sector today were forced to train overseas. This is untenable in a modern healthcare system.
On average, vacancies tended to be open for recruitment for about five months, although 37% indicated that vacancies had remained open for more than six months and up to as
Work as supervising pharmacist
The PSI should explore the possibility of the supervising pharmacist role as a job share to facilitate those pharmacists who would be willing to take on the responsibility but do not want to work in a full time capacity; and The Department of Health and the Department of Further and Higher Education, Research, Innovation and Science should undertake a detailed review of current pharmacy undergraduate places to determine if adequate numbers of pharmacists are being trained. It should also be ensured that the student selection process for these courses includes steps to ensure retention of final qualified pharmacists in Ireland to meet future pharmacy workforce demands.
Explore other opportunities for pharmacist retention, such as paid maternity leave, health insurance and pension plans;
supervising
The survey, which was analysed by Behaviour and Attitudes and based on the responses of over 1,000 pharmacists, showed that more than half of the pharmacies surveyed had at least one open pharmacist vacancy in the past year, with more than one third indicating that these vacancies had remained for more than 6 months and up to one year. The report shows that at least 20% of pharmacies are relying on pharmacist locums to stay open.
The project was led, managed and designed by Clare Fitzell of the IPU
Ultimately, as highlighted previously, a majority (54%) acknowledge that there are not enough pharmacists qualifying in Ireland to meet existing patient-facing requirements. Not surprisingly, as many as 57% are concerned or very concerned in this regard.
in the role of supervising
The extent of the level of shortages of pharmacists can be garnered from the survey responses. Of the supervising pharmacists surveyed, 59% indicated that they had advertised a vacant position within the last 12 months. They also indicated that they had advertised on average 1.48 positions during that period. An extrapolation of this figure would indicate that 1,664 pharmacist positions were advertised last year, with over 616 pharmacist positions taking over six months to be filled.
It was announced in February of this year, that the new company to result from the proposed demerger of Consumer Healthcare from GSK, will be called Haleon. Haleon has now begun trading as a separate company, focusing on consumer health with brands trusted by millions not just across Ireland, but globally.
As a standalone company, Haleon (pronounced Hay-Lee-On) will be a new world-leader in consumer healthcare, offering a compelling proposition – to bring deep human understanding together with trusted science – to deliver better everyday health with humanity.
We recently spoke to Haleon Country Manager Dave Barrett to gain further insights into what this means for the pharmacy market within Ireland and for the team behind the brand.
PHARMACYNEWSIRELAND.COM 12 Profile Strength in Promoting Good Health
Highly Valuable Global Business
“Our purpose is to ‘Deliver Better Everyday Health with Humanity’. We now have the platform to drive everyday health for people and our planet and we are excited to finally get going”
“We couldn’t be more excited about our future – as a global leader, 100% focused on consumer health,” says Dave.
The creation of Haleon results from a series of successful investments and strategic changes to GSK’s consumer health business over the past eight years, including integrations of the consumer product portfolios from Novartis and Pfizer. It is now a highly valuable and focused global business generating annual sales of approximately £10 billion (For FY 2020).
Dave explains, “In establishing Haleon as an independent company on 18th July, we have created a new world-leader, purely focused on consumer health, with wonderful brands that our consumers and customers know and trust such as Voltarol, Centrum and Panadol, which is manufactured in Dungarvan where we employ over 900 people.”
“Our purpose is to ‘Deliver Better Haleon CountryDaveManagerBarrett
Haleon is inspired by the words 'Hale', which is an old English word that means 'in good health' and Leon, which is associated with the word 'strength'. So what does this new entity hope to deliver?
“What has changed, is that rather than being Consumer Healthcare as a division of GSK, Haleon is now an independent company, with a new brand and identity. Having completed our formal separation from GSK in July, Haleon is now a standalone company. Consumers can still buy and use the same brands they know, love and trust, all over the world. “Guided by our clear purpose of ‘Delivering Better Everyday Health with Humanity’, and with our world class portfolio of brands people know and trust, Haleon stands ready to help address consumer needs and make better everyday health more achievable, inclusive and sustainable.”
Much like the rest of the sector, Dave and his team have not been without their challenges, especially those thrown up by the pandemic. But overcoming these has only served to further showcase their leading position.
to reflect Haleon as the company sponsor, not GSK. This will take a period-of-time to be realised.”
Optimising Support “I’m really proud of the Haleon team in Dungarvan for continuing the supply of Panadol when demand across the world spiked, and also the Irish commercial team for working closely with all our customers to ensure we maintained stock on shelves.
“With the overall global consumer healthcare sector now valued at £160billion, the new business is well positioned for further growth in the years to come.”
“Throughout the last two years, we’ve all been challenged to optimise our support to our teams and customers and ensure we continue to have products available for our consumers when they need them,” Dave told us.
Dave says, “The establishment of two separate companies is designed to support innovation and is focused on opportunities for future growth, so this is great news for all our employees in Ireland.
“With our purpose to deliver better everyday health with humanity, we now have the platform to drive everyday health for people and planet and we are excited to finally get going. This will help us achieve a brilliant culture of self-care at affordable prices and produce easily accessible products”
“In Ireland, our site in Dungarvan produces both ‘over the counter’ pain relief and oral healthcare products for global supply to over 70 “Overmarkets.time, consumers will see their brands and products updating their packaging from GSK to Haleon. Similarly, the brands will update their marketing assets
Supporting Innovation GSK Consumer Health have held a long and renowned presence in Ireland, with over 900 employed at their manufacturing facility in Dungarvan alone. What will this new company mean for them?
As a global company, Haleon has deep technical and scientific expertise, with world-class regulatory and medical capabilities and trusted relationships with more than three million healthcare professionals worldwide. The team use proprietary assets, such as cutting-edge centres for shopper research and social listening to generate deep human understanding to support brand innovation, engagement with experts and education of consumers.
“In relation to Haleon, there was naturally a number of logistical and communication challenges in the years of planning for the demerger but we overcame these. Driven by brands, innovation, leading-edge science and human understanding to deliver better everyday health, we now continue to support our customers and consumers, and invest in our brands that make such a difference to people’s lives.
“Our plan is to create a new world leader in Consumer Healthcare with category leading brands based on deep human understanding and trusted science – and Dungarvan is at the very heart of this vision.
“In Ireland, Haleon employs over 930 people many of which are located in Dungarvan, one of the largest manufacturing sites in Haleon’s Consumer Health network.
“Approximately 9 billion Panadol tablets are produced in Dungarvan each year, while 131m tubes of Poligrip and 3.2bn denture care tablets are produced annually.”
PHARMACYNEWSIRELAND.COM 13 Everyday Health with Humanity’. We now have the platform to drive everyday health for people and our planet and we are thrilled to finally get going.
“The last two years have been challenging for our industry in different ways. Despite the global supply chain issues, I am proud of how we have maintained supply of many of our critical brands and worked with our customers to ensure continued availability on shelves.
Category Development Haleon’s products span five major categories - Oral Health, Pain Relief, Respiratory Health, Digestive Health and Other, and Vitamins, Minerals and Supplements (VMS). “We have a world-class portfolio of longstanding brands - such as Voltarol, Otrivine, Corsodyl, Sensodyne, Centrum and Panadol – that are built on trusted science, innovation and deep human understanding.
“To keep all of our key stakeholders informed, we hosted a Consumer Healthcare Investor Day (called Capital Markets Day) in February to share more about our new company, our new corporate name and an update on our brands and our future strategy.
Of course, self-care is always at the heart of everything Haleon does, as Dave highlights, “Driven
• In the Over-the-Counter Medicines category: Panadol, Voltarol Piriton, Otrivine, Zovirax, Nicotinell
“As mentioned previously, we are aiming to empower people to be more included in opportunities for better everyday health. We aim to achieve this in three key ways: (i) driving change through our brands; (ii) empowering self-care; and (iii) investing in thought leadership and research.”
There, health care professionals can download comprehensive information materials, get advice, order samples, or participate in online trainings and webinars. For example, there are patient materials such as "My Pain Helper" and "Healthy Workout" that pharmacists and physicians can use for their patients. Various e-learnings and webinars are available in the training centre, which provide information on the development and treatment of pain, for example.
Profile Country
“Through our brands and our work with Community Pharmacists to provide the best guidance and advice, we want to empower consumers to take responsibility for their own self-care.”
“Another key focus for us is OTC switches. Haleon is committed to ensuring that more active ingredients find their way out of prescription. We also want to see processes simplified. If medicines are available without a prescription, patients can save themselves a trip to the doctor for minor illnesses and have a greater say in their therapy. They get faster and less complicated access to suitable medicines directly at the pharmacy.
“This not only strengthens their own health competence, but also the role of the pharmacist. For pharmacists, an OTC switch also has a positive effect because they can include innovative products in their advice. At the same time, it also reduces the burden on the health care system, because it reduces the number of visits to the doctor and the corresponding treatment costs.”
DaveManagerBarrett
The self-care market continues to thrive. After 2 years of the pandemic, physical and mental health have gained more traction as consumers face isolation and sickness. Overall, health has broadened and matters to more people globally as self-care has become a major priority. More people in 2022 are reflecting and planning for a healthier, more vibrant year, and this is set to Haleoncontinue.issolely about improving health and well-being, Dave reflects. “We are 100% focused on consumer health, and everything we do is driven by our purpose to deliver better everyday health with humanity. We build category leading brands that have a positive impact on people and their communities, with a strong focus on future innovation. We want to make everyday health easier and more available to more people.
“The health of the world, socially and environmentally, directly affects the health of people. We are focusing on tackling the environmental and social barriers to everyday health and driving health inclusivity through the promotion and delivery of sustainable solutions.
• In the Oral Health Care category: Sensodyne, Pronamel, Corsodyl Medicated and Daily, Poligrip and Biotene
by brands, innovation, leading edge science and human understanding, we believe that ‘self-care’ means better everyday health and this is now the focus of everything we do.
To do this, we combine reliable research findings with our extensive knowledge of human needs.
“Haleon’s focus on continuous supply chain improvements after the global pandemic drove demand for paracetamol to unprecedent levels. With our purpose to deliver better everyday health with humanity, we now have the platform to drive everyday health for people and planet and we are excited to finally get going. This will help us achieve a brilliant culture of self-care at affordable prices and produce easily accessible products.”
“With an increased consumer focus on health and wellness, an ageing global population, an emerging middle class in highgrowth economies, growing self-care in the face of increased pressure on public healthcare systems and sizeable unmet consumer needs. “We believe that self-care is critical to a functioning health care system, and that an appropriate self-care culture brings many benefits to individuals and society. That is why we want to expand the population's knowledge of options for self-treatment, self-medication and self-prevention and impart the relevant skills. Consumers should understand, thanks to Haleon and its brands, how they can promote, better protect and quickly restore their own health in everyday life. In short, we want to increase health literacy among the population.
Haleon
Improving Health and Wellbeing
• In the Vitamin and Mineral Supplements (VMS) category: Centrum Dave adds, “All of Haleon's OHC and OTC products, without exception, are among the most popular in their respective categories. Our power brands have been used for generations – the likes of Sensodyne, Panadol, Advil, Voltarol, Otrivine and Centrum are trusted by consumers, and recommended by experts.
So what is next? Delivering better health is core to Haleon’s development. Haleon Health Partner “Pharmacists, PTAs, physicians, and other health professionals are important partners of Haleon. It is their expertise and advice that makes functioning health selfcare possible in the first place. Our partners are the best way to reach our consumers. Healthcare professionals can help their patients take charge of their own health through direct contact. They can provide the necessary knowhow to close the gap between prevention and professional treatment and thus ensure better health in everyday life.
“To help them do this, we offer health care professionals our exclusive “Haleon HealthPartner” portal which can be found online.
“We want to redefine the role self-care plays in people’s lives because it can bring long term benefits for individuals and society and is also a key component of a sustainable healthcare system.
PHARMACYNEWSIRELAND.COM 14
“Overall, we are committed to empowering people to be more included in opportunities for better everyday health, with the aim of helping 50 million people a year by Haleon2025.”has a portfolio of worldleading healthcare brands in distinct categories. These include, for example:
Dave concludes,”As with much of the economy, community pharmacists have experienced issues with supply chains and rising inflation. There is also increased pressure on public healthcare systems and sizeable unmet consumer needs.
Introducing... Haleon, formerly part of GSK
totalhealth & Haven Pharmacies also thank 28 team members from their Pharmacies and Support Office who participated in the VHI Mini Marathon on the 5th of June.
Diabetes Guide for Pharmacists
As well as supporting pharmacists to upskill themselves as their careers develop, the new FIP publication is intended to guide the design and delivery of education and training programmes by continuing professional development providers. The guide acknowledges that there are some barriers to and regulations around providing diabetes-related services in some countries but emphasises that “the incorporation of pharmacists into multidisciplinary diabetes care teams should always be strongly considered by clinicians and health policymakers”.
“Pharmacists can also assess patients’ risks for developing diabetes as well as signs and symptoms that may indicate they have the condition. From this, pharmacists can then offer screening and detection services that aim to identify those who may have diabetes but have not previously been diagnosed. This is especially important because, in 2019, more than one in two adults living with diabetes were not aware they had the condition, with most of these individuals found to have type 2 diabetes.”
The authors write: “By expanding the full potential of pharmacists in the delivery of diabetes care and associated services, we get closer to offering optimal health services to patients making sure that no one is left behind.”
A new diabetes resource guide has been published for community pharmacists entitled - a “Knowledge and skills reference guide for professional development in diabetes”. The guide has been published by the International Pharmaceutical Federation (FIP) who has been championing the role of pharmacists in preventing and treating chronic diseases, including diabetes, since 2006, and this latest guide, which is intended as a companion to the FIP diabetes handbook for pharmacists published in 2021, will help pharmacists to identify and acquire the competencies, such as screening and clinical management, they need to provide services for patients with diabetes.
“Pharmacists are uniquely positioned to provide a wide array of services to prevent, identify and manage both type 1 and type 2 diabetes as well as support the care provided by other members of the healthcare team. They can also play an important role in referring patients to other healthcare providers for diagnosis of diabetes or specialist care. By leveraging their accessibility and trust, pharmacists can promote the importance of following a healthy lifestyle, including consuming a healthy diet and participating in regular physical activity, to prevent the development of type 2 diabetes, which is particularly important as most cases of type 2 diabetes could be prevented through these measures.
Mini Marathon Support Office Group Photo Thank you from totalhealth & Haven Pharmacy totalhealth & Haven Pharmacies would like to thank their patients and customers of nationwide for their overwhelming support for their recent collection for Ukraine. A total of ¤34,388.84 was raised to support Humanitarian Efforts in Ukraine. This generous amount is in addition to the ¤120,000 donated by totalhealth & Haven owners bringing the total amount raised to ¤150,388.84. All of the monies raised have been donated directly to UNHCR and the Irish Red Cross to support Humanitarian Efforts in Ukraine.
The staff raised a total of ¤1,408 for the Jack and Jill Children’s Foundation which will help fund over 666 hours of specialist home nursing care to 412 Jack and Jill Families in communities across Ireland.
PHARMACYNEWSIRELAND.COM 16 News
Diabetes is a significant public health issue that affects approximately one in 10 adults globally, with type 2 diabetes accounting for 90–95% of cases. This chronic condition causes considerable morbidity and mortality and is growing in impact, with cases projected to rise from 537 million in 2021 to 784 million by 2045. As cases rise, it is imperative to ensure the healthcare workforce is prepared to care for affected individuals. However, there is a growing global shortage of healthcare workers, which was estimated, pre pandemic, to reach 15 million by 2030.
The guide states, “Therefore, all of the healthcare workforce will need to be utilised to their fullest potential in order to address the growing global burden of diabetes.
Pharmacists will continue to be essential in this endeavour. While pharmacists are primarily trained to address health concerns with appropriate, safe medicines, they also have the necessary skills and knowledge to provide prevention and screening services.
in treatment decisions.
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Prior to COVID-19, community pharmacists were more isolated within the wider healthcare ecosystem whereas now we are more visible and should take the opportunity that this gives us. Therein lies one of the key learning from the pandemic: we, as pharmacists, need to respect ourselves as a profession and recognize the key role we play as healthcare professionals.
It is imperative that the role of the Chief Pharmacist be considered so the profession can be given the voice and opportunity to influence policy in a collaborative manner. This lack of presence within the policy structure suggests that pharmacists are overlooked when key decisions are being made and are merely brought to the table as an afterthought.
For all the services we’ve provided communities with right across Ireland over the last number of years, many pharmacists are still facing a real crisis, the biggest challenge being maintaining services for our patients. It appears that the number of pharmacists wanting to work in community pharmacy is decreasing, with greater numbers wanting to locum rather than take full time permanent roles. Therefore, maintaining consistency for patients and providing an excellent patient-centred service is a constant concern and challenge. The beauty of pharmacy as a degree is that it’s very wellrespected. Attracting graduates to a career in pharmacy is not
who worked so diligently we cannot survive and thrive through the pandemic. Everyone went above and beyond the call of duty and worked together selflessly and cohesively when it was becoming more challenging every day. And by and large, communities recognized the efforts being made by pharmacy teams on a daily basis.
With one million COVID-19 vaccines having been administered in community pharmacies in Ireland, Denis O’Driscoll, Superintendent Pharmacist at LloydsPharmacy, explains why pharmacists now need to be brought into the decision-making circle.
Denis O'Driscoll - LloydsPharmacy Superintendent Pharmacist
It is commendable that during and since the pandemic there has been no record of workplace transmission of COVID-19 in WithoutLloydsPharmacy.ourpeople
Post-pandemic Landscape
Lloyds Pharmacy Staff member receiving Covid-19 vaccination from pharmacist, Rory Blackrock
COVID-19 Challenges
The status of the community pharmacist in Ireland has skyrocketed since the onset of the pandemic. GPs and hospitals experienced huge levels of crisis and concern during this period, being completely overrun. With these routes to healthcare less widely available for everyday ailments, questions, and appointments, people increasingly turned to pharmacies. Healthcare professionals in community pharmacies remained fully open throughout the crisis and freely accessible to the public and were depended upon every day for medical advice. And as a result, the past two years have seen pharmacists gain significant trust from Irish society. Despite this, pharmacists continue to sit outside of the ‘inner circle’ within government structures. During the pandemic, we became familiar with the Chief Medical Officer and other key influential personnel on the national stage; yet despite pharmacies playing such an instrumental role as healthcare professionals during this time, there isn’t an equivalent ‘Chief Pharmacist’ post within the Department of Health. Therefore, there wasn’t the appropriate level of influencing and direction for the pharmacy profession during the pandemic.
When I joined my current role with LloydsPharmacy in 2018, conditions within community pharmacy were very different. But COVID-19 hit like a tsunami, and pharmacy colleagues were forced to work more closely together despite the need for social distancing, to ensure that patients received the best possible care. The determination and dedication that is shown by pharmacy teams is indicative of the drive to provide a ‘patient-first’ service.
Community Pharmacy at Threat without Government Intervention
The public were incredibly stressed, and the bigger picture that we were all trying to navigate was having no idea how long this crisis period would last. But rather ironically, the hectic nature of day-to-day pharmacy work did not change dramatically as lockdowns lifted. Although there were fewer emergency scripts from GPs and hospitals, more and more patients were coming in and asking for advice. People now had more trust in their community pharmacist. Patients were semiprepared for another lockdown to happen, and we would experience a rush of people looking for their scripts ahead of national announcements. I would say that pharmacies are in fact much busier locations after lockdowns lifted. It is important to recognize the significance of how the public view community pharmacy. Our position has increased enormously with the public trusting us even more for our opinion and advice.
When COVID-19 arrived in Ireland and lockdowns loomed, the phones rang incessantly. You just couldn’t keep up with the volume of calls. We were inundated with requests. Patients were afraid to leave their homes, stocks of medicines were not arriving in pharmacies quickly enough to keep up with demand and managing a steady supply of inventory proved extremely challenging. Patients were exhausted, the system was completely overrun, yet pharmacy colleagues remained at the coal face. The national electronic prescription transfer system known as Healthmail was not fully implemented within community pharmacies.
Since legislation was first written into effect, pharmacists’ roles have completely transformed –we as pharmacists experience it, and so does the public. There is a need to shift the regulations, so that our evolved role and the digitizing of the pharmacy environment is considered a priority. This is without doubt, the major challenge that our Regulator, the Pharmaceutical Society of Ireland, has alongside other key stakeholders such as the Department of Health in changing this legislative framework.
Employees across all sectors are now demanding a better work life balance, which arguably locum pharmacists have come to enjoy, but the public expects us to be open and more readily available now. That said, during the pandemic we had to reduce our opening hours and people understood and continued to come to the pharmacy when they needed to. We want people to be happy in their workplace, and to return to community pharmacy, and the challenge is how this can be made more attractive for pharmacists: flexible working hours, benefits, terms, and conditions of employment, appropriate renumeration. Then there is the bigger picture the current workloads placed on community pharmacist need to be eased changes to legislation: the need for paper copy retention surely is something that should be a thing of the past! A strong and vibrant community pharmacy presence is an essential element of the overall healthcare eco system. We urgently need policy makers and regulators to engage with our sector to start addressing these issues by looking to pharmacists for their counsel and expertise –just as the rest of society did with the pandemic hit these shores.
Denis O’Driscoll assisting on training and education with student pharmacist with Martin Hynes Parkway Limerick
We have a lot to bring to the healthcare system but often it is just about ensuring that we are there at the beginning so that the voice of the profession can be heard.
Denis O’Driscoll reviewing Covid-19 procedures and protocols with colleagues in Lloyds Pharmacy Naas
PHARMACYNEWSIRELAND.COM 19
For example, recent legislation has been passed that entitles those within the 18-25 age to access free contraception. And even though pharmacists are required to deliver this service, there has been very limited consultation with the profession since the legislation was passed into law. So, the question is, are the government including all the necessary stakeholders for the successful implementation of innovation in health care?
It seems like pharmacists are not being considered as a key stakeholder in healthcare policy. Therefore, it is time to look to have a Chief Pharmacist position in the Department of Health to ensure that the pharmacy profession is central in health policy. Looking Ahead Where we can, we need pharmacies to find out what else their employees - especially pharmacists - are interested in beyond their day job. To consider supporting and offering greater opportunities for pharmacists within community pharmacy to find areas within their work that interest them. For example, one of our pharmacists is amazing at troubleshooting and interrogating data, another likes being involved in improving and designing education programmes within the pharmacy. We need to try and nurture these skills and provide new opportunities to retain our pharmacists. Of course, this can still present challenges in terms of workload, and it will not work in every case. But it is the type of outside-the-box thinking that needs to happen.
an issue, but there is a ceiling in terms of career progression within community pharmacy. In other roles for pharmacists such as industry, hours can be more attractive, and appear to have greater potential for career progression.
We need pharmacists to want to come back into community pharmacy as a career, so it needs to be made more attractive. Therefore, certain HSE contractual obligations and the Pharmacy Act legislation require an overhaul.
*The complete range for the treatment & prevention of allergy symptoms Completeapproachtoallergy PreservativefreeDrug freeNatural100%
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Epidemiology AR is a common condition with a global impact. In Ireland, at least 1 in 5 people suffer
In addition, it is vital to examine the nose whereby you will often see bulky oedematous turbinates with visible increased mucus production. Pallor of the mucosal lining is often present, particularly in longstanding cases. Occasionally the mucosa will lose its smooth appearance and instead will have ridges and pitting from chronic allergic challenge. Pre-polypoid tissue can occasionally be present.
Written by Dr Iseult Sheehan Director, Allergy Ireland (www.allergy ireland.ie) FRACGP, MB BAO, BCh, LRCP&SI, BA (Hons) Biochem & Immunol Rhinitis (AR) is an IgE mediated inflammatory reaction following exposure to an inhalant allergen such as dust mite or grass pollen which results in inflammation of the nasal lining. The characteristic symptoms include rhinorrhoea, nasal obstruction, sneezing and nasal pruritis Patients experience fatigue and a feeling of heaviness in the head or a ‘fuzzy’ head. The appearance of rings under the eyes (allergic shiners) are a common feature for those with nasal and/or sinus congestion.
Pathophysiology
Shiners and image (Right) Allergic Salute these patients will frequently have one or more allergic dermatitis or food allergy. In addition, conjunctivitis, sinusitis AR has also been shown to affect cognitive and impact on sleep as considerably debilitating. considered to be trivial and AR is underdiagnosed and disease. While struggling with AR symptoms the ability to are reduced and underperformance or missed days at worrying impact on a child’s education. impact. In Ireland, at least 1 in 5 people suffer with AR1. It is people worldwide and the prevalence within Europe is prevalence of 26%1 and Ireland is likely to be similar to this. The Union has recently estimated that the indirect cost of cost between €30 and €50 billion per year2.
Written by Dr Iseult Sheehan Clinical Director, Allergy MICGP,(www.allergy-ireland.ie)IrelandFRACGP,MBBAO,BCh,LRCP&SI,BA(Hons)Biochem&Immunol
Furthermore, with repetitive allergen exposure nasal priming occurs. This appears to cause an accumulation of effector cells in the nasal mucosa and results in a hyper-responsiveness to the allergen and prolongation of symptoms. In addition, there appears to be a neural component to this hyper-responsiveness. Changes to the sensory nerves of the nose have been demonstrated in those with AR.
Allergic Rhinitis and Allergic Multimorbidity
Diagnosis of Allergic Rhinitis The diagnosis of AR is generally based on clinical symptoms. However skin prick allergy testing or specific IgE blood testing can be used to confirm the allergen trigger.
Image (Top) Normal inferior turbinate and Image (Bottom) Bulky oedematous inferior turbinate with mucosal pallor
Allergic Rhinitis and Allergic Multimorbidity
Image (Top) Allergic Shiners and image (Bottom) Allergic Salute AR is rarely found in isolation and as such these patients will frequently have one or more allergic comorbidity such as asthma, atopic dermatitis or food allergy. In addition, conjunctivitis, sinusitis and otitis media with effusions can co-exist. AR has also been shown to affect cognitive and psychomotor function. Patients describe the impact on sleep as considerably debilitating. Nevertheless, the symptoms of AR are often considered to be trivial and AR is underdiagnosed and undertreated despite the burden of this disease. While struggling with AR symptoms the ability to participate in social and sporting activities are reduced and underperformance or missed days at work and school are a feature. AR can have a worrying impact on a child’s education.
Allergic Rhinitis (AR) is an IgE mediated inflammatory reaction following exposure to an inhalant allergen such as dust mite or grass pollen which results in inflammation of the nasal lining. The characteristic symptoms include rhinorrhoea, nasal obstruction, sneezing and nasal pruritis. Patients often experience fatigue and a feeling of heaviness in the head or a ‘fuzzy’ head. The appearance of dark rings under the eyes (allergic shiners) are a common feature for those with nasal and/or sinus congestion.
Image (Left) Allergic Shiners and image (Right) Allergic Salute rarely found in isolation and as such these patients will frequently have one or more allergic comorbidity such as asthma, atopic dermatitis food allergy. In addition, conjunctivitis, sinusitis media with effusions can co has also been shown to affect cognitive and psychomotor function. atients describe the impact on sleep as considerably debilitating. Nevertheless, the symptoms of AR are often considered to be trivial and AR is underdiagnosed and undertreated despite the burden of this disease. While struggling with AR symptoms the ability to participate in social and sporting activities are reduced and underperformance or missed days at school are a feature. AR can have a worrying impact on a child’s education. pidemiology common condition with a global impact. In Ireland, at least 1 in 5 people suffer with AR that AR affects at least 400 million people worldwide and the prevalence within Europe is 17 and 29%1. The UK has a prevalence of 26%1 and Ireland is likely to be similar to this. The impact is striking. The European Union has recently estimated that the indirect cost of undertreated AR on work productivity may cost between €30 and €50 billion per year2. often begin early in life but prevalence increases with age. The International Study of Asthma Allergies in Childhood (ISAAC, 2006) phase III study demonstrated this showing a 5% prevalence aged 3 years, an 8.5% prevalence in those aged 6 7 years and a 14.6% prevalence in those 14 years3. and Allergic Multimorbidity www.allergy(Hons)ireland.ie)Biochem & Immunol inflammatory reaction following exposure to an inhalant which results in inflammation of the nasal lining. The rhinorrhoea, nasal obstruction, sneezing and nasal pruritis Patients heaviness in the head or a ‘fuzzy’ head. The appearance of are a common feature for those with nasal and/or sinus congestion.
Image (Left) Normal inferior turbinate and Image (Right) Bulky oedematous mucosal pallor Multimorbid AR6 Multimorbid AR can be s Co morbid allergic diseases such as asthma, atopic dermatitis Co morbid disorders anatomically related to the nose such mediaComorbid disorder of sleep with resultant impact on behaviour IrelandAsthmahas the 4th highest prevalence of asthma globally with at
PHARMACYNEWSIRELAND.COM | 21 with AR1. It is estimated that AR affects at least 400 million people worldwide and the prevalence within Europe is between 17 and 29%1. The UK has a prevalence of 26%1 and Ireland is likely to be similar to this. The economic impact is striking. The European Union has recently estimated that the indirect cost of undertreated AR on work productivity may cost between €30 and €50 billion per year2. AR will often begin early in life but prevalence increases with age. The International Study of Asthma and Allergies in Childhood (ISAAC, 2006) phase III study demonstrated this showing a 5% prevalence in those aged 3 years, an 8.5% prevalence in those aged 6-7 years and a 14.6% prevalence in those aged 13-14 years3. What is most concerning is that the prevalence of AR is increasing globally. This was corroborated by this ISAAC study which found an increase in prevalence of AR from 13% to 19% over an 8 year period in a cohort of 13-14yr olds3. A smaller study in Cork demonstrated an increase in prevalence from 7.6% to 10.6% over a 5 year period in a cohort of 6-9yr olds4
Primary sensitization occurs when an atopic individual is first exposed to an allergen resulting in the differentiation of Th2 helper cells and an environment rich in IL-4, IL-13 and IL-5 cytokines determines the Th2 immune response. T cell dependent activation of B cells stimulates further cytokine production particularly IL-4 and promotes irreversible immunoglobulin class switching to allergen specific IgE antibodies. Allergen specific IgE will attach to mast cells and basophils. On re-exposure to the allergen the sensitised mast cells degranulate releasing pre-stored and newly synthesised inflammatory mediators such as histamine, leukotrienes and prostaglandins. These contribute to vascular permeability, eosinophil infiltration and increased mucus production.
Image (Left) Normal inferior turbinate and Image (Right) Bulky oedematous inferior turbinate mucosal pallor Multimorbid AR6 Multimorbid AR can be subdivided into:
Multimorbid AR can be subdivided into: Co-morbid allergic diseases such as asthma, atopic dermatitis and food allergy. Co-morbid disorders anatomically related to the nose such as conjunctivitis, sinusitis and otitis media. Co-morbid disorder of sleep with resultant impact on behaviour.
Atopic Dermatitis The role of allergy in atopic dermatitis (AD) is complex. AD is a chronic inflammatory condition of the skin with the hallmark feature of skin barrier dysfunction further worsened by inflammation and scratching.
PHARMACYNEWSIRELAND.COM | 23
A more permeable skin barrier results in transepidermal water loss but it is likely that this also acts as a potential portal for developing allergen sensitisation and thus allergic disease. Indeed, AD is frequently the initial manifestation of atopy and allergic disease.
Sub-lingual Immunotherapy (SLIT) to tree or grass pollen can be effective at Multimorbid AR6
The initial presentation of early onset AD appears to be in the absence of IgE-mediated allergen sensitisation. However, within a short period of time, sensitisation occurs with elevation of total IgE alongside specific IgE antibodies to environmental allergens such as house dust mite, pollens and animal dander. In fact, it has been shown that approximately 80% of those with AD have specific IgE sensitisation to at least one environment allergen. Despite this, the IgE sensitisation does not necessarily correlate with the development of an allergy or allergic Nevertheless,disease.children with AD before age 4 years have been found to be twice as likely to develop asthma in later childhood. Indeed 30-50% of children with AD will proceed to developing asthma while 35% will develop allergic rhinitis8. There is also a strong association between having AD and having a co-morbid food allergy which may be as high as 90%.
The genetic predisposition to having a dysfunctional skin barrier and a dysregulated Th2 immune response in AD create the perfect environment for allergen sensitisation.
Food Allergy and Pollen Food Syndrome In Ireland approximately 3% of the population have a primary food allergy such as a nut or fish allergy. There is an association with allergic rhinitis but the more frequent association is with a secondary food allergy referred to as Pollen Food Syndrome (PFS). PFS refers to a cross-reaction between allergens found in grass, tree or weed pollen and raw fruit, vegetables and some nuts. A study in the UK of 110 adults with AR and pollen sensitization identified 47% of these individuals as having PFS9 These patients will experience hay fever symptoms but can also develop oral symptoms on eating certain raw foods depending on their allergen sensitization (see Table). The symptoms are usually limited to the mouth and throat and are mild including pruritis and mild oedema to lips, tongue, soft palate and occasionally the throat. Individuals can usually tolerate these fruit and vegetables in cooked or processed form. It rarely affects young children and often first appears in teenagers and young Theadults.symptoms often resolve spontaneously within an hour and patients infrequently require adrenaline autoinjectors. Antihistamines are usually sufficient at managing symptoms when required.
Adapted from Bousquet et al. Nature Reviews Disease Primers, 20205
Asthma Ireland has the 4th highest prevalence of asthma globally with at least 10% of the population having asthma. AR is a risk factor for asthma. In fact 90% of asthmatics have AR and 30-40% of those with AR have asthma7. Poor asthma control has been shown in those with co-existing rhinitis. A ‘united airways’ disease approach to management is the more favoured approach in recent years. Moreover, the treatment of nasal inflammation in asthmatics has been shown to improve outcomes. This highlights the importance of assessing for both asthma and rhinitis in these patients.
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the frequency and severity of symptoms, has become a much more effective tool for making treatment decisions. This was developed by Allergic7 Rhinitis and the Impact on Asthma (ARIA) guideline in collaboration with the World Health Organization7 In patients with mild intermittent symptoms an antihistamine is often effective. Second generation antihistamines are recommended as they carry less cholinergic and sedating side effects. Oral or nasal decongestants can be used as a rescue medication but for no longer than 5 days to avoid rebound symptoms.
The ARIA guideline recommends intranasal corticosteroids as the first line treatment for moderate-severe intermittent or persistent AR7. A low bioavailability is recommended and so newer generation intranasal corticosteroids are preferred. If the nasal cavity is very obstructed a nasal spray may not be effective until the oedema has been reduced using intranasal corticosteroid drops. If this is ineffective then a combination intranasal treatment is now available combining corticosteroid and antihistamine. Eye symptoms can be managed conservatively with cold compresses and tear supplements. However, if these symptoms persist, it is advisable to consider oral and topical antihistamines, topical mast cell stabilizers (sodium cromoglicate) or decongestants. Topical corticosteroids should ideally be prescribed under the care of an Ophthalmologist. If there is evidence of lower airway irritability or asthma, a leukotriene receptor antagonist can be trialed. In severe cases short courses of oral corticosteroids are occasionally required.
Newer Treatment Options: Immunotherapy Immunotherapy has been shown to significantly reduce symptoms and medication requirements and is recommended by the ARIA guideline. Additionally, the Global Initiative for Asthma (GINA) 2020 guideline recommends immunotherapy can be considered for asthmatics sensitised to dust mite11 Immunotherapy involves exposing a patient to minute quantities of the allergen trigger allowing the immune system to build up a tolerance. It can be given as a subcutaneous injection or as a sublingual tablet. Sublingual therapy is used predominantly in Ireland and is currently available for grass pollen, dust mite and tree pollen. Compliance is crucial and regular follow up advised. It is usually a three year process whereby the patient takes it daily. It is highly effective and well tolerated.
Management of AR
Adapted from Aria Guideline 20197
Apple,
Adapted from Aria Guideline 20197
A new classification system focusing on the functional ability of the patient, including that these individuals are managed correctly not only to reduce rhinitis symptoms the comorbid conditions. Pharmacological Management avoidance should be discussed. Nevertheless avoidance alone is generally not sufficient to symptoms. In cases where the allergen trigger is animal dander avoidance is effective if the removed from the home. cessation should be advised always. Smoking can be associated with chronic nasal may even be associated with the development of polyposis. Passive smoking or to carry similar risk. is an effective way to directly cleanse the nasal cavity with the resultant reduction of inflammatory mediators and bacterial burden. It has also been shown to improve mucociliary PharmacologicalclassificationManagementsystemfocusing on the functional ability of the patient, including the frequency symptoms, has become a much more effective tool for making treatment decisions. developed by Allergic7 Rhinitis and the Impact on Asthma (ARIA) guideline in collaboration Health Organization7.
Newer Treatment Options: Endonasal Phototherapy Phototherapy is well established for skin conditions and is now being used within the nasal cavity to manage AR. It uses UV-A (25%), UV-B (< 5%) and visible light (70%) to induce a local immunosuppressive effect by inhibiting allergen induced histamine release from mast cells and inducing apoptosis of T lymphocytes and Eosinophils. It essentially desensitises the nasal cavity thus reducing symptoms. It is particularly useful when pharmacological treatment is insufficient or contraindicated. References available on request desensitisation with minimal adverse effects to alleviate PFS and hay fever symptoms. Management of AR It is paramount that these individuals are managed correctly not only to reduce rhinitis symptoms but to improve the comorbid conditions.
Non-Pharmacological Management
Allergen avoidance should be discussed. Nevertheless avoidance alone is generally not sufficient to manage symptoms. In cases where the allergen trigger is animal dander avoidance is effective if the animal is removed from the home. Smoking cessation should be advised always. Smoking can be associated with chronic nasal symptoms and may even be associated with the development of polyposis. Passive smoking or ‘vaping’ appear to carry similar risk. Saline irrigation is an effective way to directly cleanse the nasal cavity with the resultant reduction of mucus, inflammatory mediators and bacterial burden. It has also been shown to improve mucociliary function.
Almond, brasil nut, hazelnut, walnut
Adapted from Allergy UK resource on Pollen Food Syndrome: https://www.allergyuk.org10
plum,parsley,kiwi,cherry,apricot,coriander,nectarine,peach,pear,strawberry
Celery, bean sprouts, carrot, mange tout, green pepper, potato, peastomato,soya,parsnip, Basil, pepper,parsley,fennel,coriander,oregano,paprika,thyme
Pharmacological Management
Pollen Fruit Vegetables Seeds and spices Nut Tree (typicallypollenbirch and alder)
Adapted from Allergy UK resource on Pollen Food Syndrome: https://www.allergyuk.org10
Celery, carrot, green pepper, onion Sunflower seed, aniseed, celery salt, mustard, coriander,spices,fennel,parsley
PHARMACYNEWSIRELAND.COM | 25
Weed pollen (typically mugwort) Apple, tomato,orange,melon,peach,watermelon
Grass pollen Kiwi, melon, orange, watermelon, date Potato, swiss chard, tomato, wheat, peas Peanut
1.The Nature’s Bounty Co. research. 2. Survey of 1000 VMS users in the UK in Dec 2020.
USE EMPLOYEE EXPERTISE
ZINC An essential trace mineral vital for many functions in the body including the normal development and function of immune cells and supporting the skin barrier, which protects against foreign invaders entering the body. Whilst diet and lifestyle should always be the first choice to obtain nutrients in today’s world this is not always easy to achieve and supplements can bridge the gap to optimal nutrition.
Clear category merchandising, signposting and point-of-sale materials will ensure customers can find the products they want. Making the fixture easy to navigate is a
s we head towards cold & flu season, people’s attention will once again turn towards how they can best support their immune systems. This has become even more evident since the arrival of coronavirus.
VITAMIN C
The vital role of the VMS category in
Helps to protect cells and keep them healthy, maintaining healthy skin, blood vessels, bones and cartilage and helping with wound healing. Vitamin C cannot be stored by the body so is needed in the diet every day.
A
STOCK THE RIGHT RANGE Start by ensuring you stock the right range of immunity focused products. The key nutrients to look out for include vitamin C, vitamin D and zinc.
So, how can pharmacies ensure their VMS category is meeting the immunity needs of their customers throughout the winter months?
Data shows many people enter the VMS category buying vitamin C and vitamin D products before expanding their repertoire. The willingness of VMS consumers to engage with new products offers an excellent opportunity for pharmacies to provide education and support. Having staff trained on specific products can increase their sales by up to 26%1 and will help consumers find the right product for their needs and in turn drive customer satisfaction and repeat purchase. What’s more, 58% of VMS buyers prioritise quality2 Pharmacies should therefore offer a range of more premium quality products, thus providing the opportunity for shoppers to trade up.
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VITAMIN D Benefits are numerous but particularly regarding immune and bone health. The body creates vitamin D from direct sunlight on the skin, however we do not make enough all year round. Whilst it is found in a small number of foods, a good quality supplement (particularly between October and March when sunlight is limited) is often recommended to ensure requirements are met.
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Furthermore many other treatments such NSAIDs are not without risk e.g. gastrointestinal side effects. 70% of patients with chronic pain say their medication is unsatisfactory at treating their pain some of the time, and 40% say some medications are always inadequate all the time (Breivik et al., 2006 ). So it is clear that there is an urgent need for more efficacious treatments that have fewer severe side effects. The National University of Ireland (NUI) Galway’s Centre for Pain Research, established in 2007, was born of the need to discover the most novel and cutting edge therapies of the future. It hopes to bring together, academics, basic scientists, clinicians and researchers from all corners of the healthcare system to tackle the need for better patient outcomes.
Updates in Research on Chronic Pain
Estimates predict an 80% probability of having LBP at some stage of life, and that 19% of the Irish population have experienced some LBP over the last year (Andersson, 1999; Raftery et al., 2011). In 2015, the
Written by Mary Hopkins, PhD Researcher Mary Hopkins M.P.S.I. - Mary Hopkins holds a Masters of Pharmacy from RCSI and has worked as a community pharmacist in Ireland since 2013. After graduating from a Neuropharmacology MSc from NUIG, she began her PhD in October 2020 after securing funding from the Irish Research Council. Her translational research under the supervision of Prof. David Finn and Prof. Brian McGuire focuses on the role of the endocannabinoid system in chronic low back pain in both sexes.
Medicinal cannabis and cannabis based medicines has been a novel research area that has exploded in the last 20-30 years.
Professor David Finn, Principal Investigator and Founding Co-Director, Centre for Pain Research, NUI Galway Chronic pain is a complex condition that imposes a huge burden on patients, and the healthcare system. It is estimated that between 13% and 36% of the Irish population are affected by Chronic Pain (Purcell et al., 2022). The Prevalence, Impact and Cost of Chronic Pain (PRIME) study published in 2012 highlighted the cost of chronic pain in Ireland (Raftery et al., 2011). The mean cost of this condition per patient per year at that time was estimated to be just under €6000. For all chronic pain patients in Ireland this amounted to over €5bn, which is largely in line with other European countries (around 1.5-3% GDP per country). Treating chronic pain and the socioeconomic problems that it presents is not an easy challenge. There is a severe shortage of specialist pain services generally in Ireland, and specifically there is a shortage of multidisciplinary pain management programmes which contributes to the challenge of delivering a multimodal treatment approach.
One of the projects in Prof Finn’s group, funded by the Irish Research Council, is looking at how the endocannabinoid system changes in chronic low back pain.
Furthermore chronic pain is highly comorbid with anxiety and depression. According to the PRIME study, clinically significant depression was nearly 5 times more common in patients with chronic pain (Raftery et al., 2011). There is a need to understand the influence of stress, anxiety and depression on chronic Furthermorepain.there is a need for more research into the different presentations of pain between males and females. Chronic pain is more prevalent in females, which is often linked to the increased occurrence in females of comorbid conditions like arthritis, fibromyalgia, migraine and TMD (temporomandibular disorder). The relative lack of research involving females is now starting to be redressed in order to clarify and better understand the sex differences that exist at the neurobiological level in chronic Treatmentspain.for chronic pain have advanced in looking to a more holistic way of treating the individual. However there will always be a demand for pharmacological options as 1st line treatments. The rise of the opioid crisis in North America has highlighted the need for treatments with less addictive properties.
Cannabis sativa has been cultivated and used for recreational and medicinal purposes for at least 5000 years (Crocq, 2020 ). However, it is only in the last 20-30 years that we have observed research progressing in this field, and this is largely to do with the scientific identification of receptors and ligands within the endocannabinoid system. Knowledge of this physiological system has allowed for the development of drugs that can target our own endocannabinoid system and also gives us a better understanding on the use of medicinal cannabis and cannabis based medicines as therapeutics. Research in the Finn group looks at the relationship between pain, comorbid conditions and the endocannabinoid system as a potential biomarker and a novel therapeutic target.
Stephanie Bourke, PhD - Stephanie Bourke is a 3rd year PhD student in Professor David Finn’s research group in NUI Galway. Stephanie graduated with a BSc in Neuroscience from University College Cork in 2016 and an MSc in Neuropharmacology from NUI Galway in 2017. In 2019, Stephanie was awarded the Irish Research Council Postgraduate Scholarship. Currently, Stephanie's research focuses on pain, focusing on translational studies aimed at understanding the role of the endocannabinoid system in stress-pain interactions, and endocannabinoid alterations in clinical pain states.
Chronic low back pain (LBP) is a serious medical and socioeconomic problem, and a leading contributor to disability. The point prevalence of LBP in 2017 was estimated to be about 7.5% of the global population, or around 577 million people (Wu et al., 2020).
Professor David Finn, PhD - David Finn is Professor and Head of Pharmacology and Therapeutics, Principal Investigator and Founding Co-Director of the Centre for Pain Research at the National University of Ireland (NUIG) Galway. Professor Finn’s research focuses on the affective and cognitive dimensions of pain, stress-pain interactions, and neuroinflammatory processes, with an emphasis on the endogenous cannabinoid system. He is the immediate Past-President of the International Cannabinoid Research Society (ICRS) and a Past President of the Irish Pain Society. He has been a member of the Presidential Task Forces for Cannabis, Cannabinoids and Chronic Pain of both the International Association for the Study of Pain (IASP) and the European Pain Federation (EFIC), and leader of the Basic Science Work Package for the IASP Task Force. He is a member of the EFIC Working Group for Translational Pain Research, and was a member of EFIC Council and the Scientific Programme Committee for the EFIC 2022 Congress.
Stephanie Bourke, PhD Researcher, NUI Galway
28 | PHARMACYNEWSIRELAND.COM
Professor David Finn is a founding CoDirector of the Centre for Pain Research. His research focuses on the basic sciences and translational clinical research on pain. His research group focuses on investigating the body’s own endogenous cannabinoids, called endocannabinoids, which are produced in the brain and other tissues. Endocannabinoids have been shown to change in response to pain, stress and other causes. They present a novel target for discovering biomarkers of pain, and also as a novel therapeutic target.
PHARMACYNEWSIRELAND.COM | 29 Healthy Ireland national report showed that back pain is the most common health condition reported in Ireland, ahead of the well-recognised conditions of high blood pressure, heart disease, asthma, diabetes and depression ([DoH], Department of Health, 2015). Treating back pain accounts for about 25% of doctor’s visits. Current treatments for low back pain range from pharmacological (nonsteroidal anti-inflammatory drugs, opioids, gabapentinoids, etc.) to highly invasive medical procedures such as spine fusion and artificial disk replacement. However there is need for a greater understanding of the mechanisms of how people develop ongoing LBP, and novel treatments which have greater efficacy and fewer side effects associated with their use. We know that there can be changes in the endocannabinoid system in patients with LBP. There is evidence for alterations in blood levels of these molecules in healthy participants versus patients in pain (Degenhardt et al., 2007; Woodhams et al., 2017), and there are changes seen in the expression of genes and underlying gene polymorphisms between patients who report LBP and healthy controls (Starkweather et al., 2016; Ramesh et al., 2018). Consequently this project aims to use a pre-clinical model of LBP, which involves the degeneration of intervertebral discs in the spine to mimic the clinical phenotype. This model will help to understand the underlying mechanistic molecular and biochemical pathways that are involved in the changes we see in the endocannabinoid system in LBP. Running in parallel to this work is an ongoing clinical study involving healthy participants, and those who suffer from acute and chronic LBP. This study will investigate whether male and female human patients with LBP have altered pain sensitivity associated with changes in endocannabinoid levels. The findings from this study will advance understanding of the nuances of the clinical presentation of LBP and how the endocannabinoid system is changing in LBP. In this clinical study participants will be asked about how have been experiencing pain, their comorbidities, their anxiety and fear related to their pain, their ongoing therapies and how this affects their daily quality of life. Depending on how long they have had the pain, participants will be assigned to either acute or chronic LBP groups for research purposes. Then participants will have some special tests to see how sensitive they are to stimulo on their skin such as heat, cold and pressure. This will use a state of the art quantitative sensory testing equipment. During this session two blood and saliva samples will be taken. The research will be carried out at Clinical Research Facility in University Hospital Galway.
Therefore, the Finn group are investigating the relationship between anxiety, pain and endocannabinoids in healthy human participants in order to better understand the impact of stress on pain. Specifically, they investigate the extent to which anxiety and circulating endocannabinoid levels predict pain sensitivity and modulation of pain by stress in both healthy male and female human participants using methodologies that allow us to quantify pain sensitivity in humans. This research, funded by the Irish Research Council, will significantly advance our understanding of the modulation of pain by stress and anxiety in both sexes and will determine the extent to which the endocannabinoid system plays a role.
Stress, anxiety and depression are frequently found to co-occur in patients with chronic pain conditions. Stress has a complex effect on pain, it can enhance or dampen our sensation of pain depending on the nature of the stressor, the duration for which it lasts and the intensity of the stressor itself.
Ultimately the group at NUI Galway aim to investigate the role that endocannabinoids play in clinical pain states. The results from their clinical studies will inform the development of endocannabinoids as potential novel biomarkers and/ or therapeutic targets for pain and its comorbidity with anxiety.
Studies have shown that concentrations of blood endocannabinoid levels correlate with emotional variables such as depression and anxiety (Hill et al., 2008 ). Preclinical literature on stress response, pain sensitivity and endocannabinoid levels, indicates a possible relationship that is yet to be thoroughly investigated in humans.
References available on request
Recent findings suggest that anxiety may play a significant role in how individuals respond to pain and may influence the significant differences between male and female pain sensitivity (Thibodeau et al., 2013). Gender differences in stress reactivity may be involved in the differences observed in pain sensitivity and assessment has relied primarily on measuring physiological responses to acute stressors in laboratory settings, including Hypothalamic-PituitaryAdrenal (HPA) axis and sympathetic nervous system activity. HPA response patterns differ markedly between males and females. There is also now a substantial volume of evidence that endocannabinoids, are involved in the control of both anxiety and pain sensitivity.
The LBP project overall will look at a translational approach to examine the novel hypothesis that a reduction in endocannabinoid signalling underpins the development and maintenance of chronic LBP and that altered pain sensitivity in patients is associated with alterations in blood endocannabinoid levels. By clarifying the neurobiological mechanisms contributing to chronic LBP in the pre-clinical model, the project aims to pave the way for the development of endocannabinoids as potential novel diagnostic biomarkers and/or therapeutic targets for chronic LBP.
Pharmacy teams play a pivotal role as a community and health asset across Ireland. High quality public health and clinical interventions drive delivery that is focused on prevention, health improvement and protection of local communities.
We will hear stories of compassion and dedication which go above and beyond – resulting in a shortlisting of six of the most deserving finalists. A nation-wide voting process takes place after we announce the finalists, with an anticipated reach of over 1 million - further bringing awareness into every home
With over 2 million Irish people visiting a community pharmacy every month, pharmacists are ideally placed to be the first port of call before a visit to the local GP Surgery. Pharmacist’s expert knowledge and skills enable them to support their communities by promoting healthy lifestyles, delivering flu vaccines, managing blood pressure and cholesterol checks, preventing long term illness such as asthma and diabetes and guiding individuals to better manage their medicines.
Now more than ever before, it has become clear to everyone that pharmacists are the most critical member of Ireland’s health service family, embedded in the heart of every community.
Irish Pharmacy News is delighted to announce the search is on to find The People’s Pharmacist for 2022, in association with Panadol; giving the Irish public the opportunity to nominate and vote for, their local pharmacist who has gone above and beyond.
The People’s Pharmacist Award seeks nominations from across
The Search is on to find The People’s Pharmacist 2022 the country, giving patients the opportunity to recognise and salute their local pharmacist. Through this Award, we are enabling the public to have a voice in recognising the unwavering support and spirit that makes pharmacists the backbone of our health service in every community across Ireland.
To the public, community pharmacy is the most accessible face of the healthcare service.
In 2021, the public’s recognition of how pharmacists stepped up to the frontline was evident as over 700 nominations were received. With a reach of over 500,000 (half a million) and over 13,000 actual votes – the 2021 search for the People’s Pharmacist took the nation by storm.
Think Hi Techs, Think Accord
Further information is available on request from Accord Healthcare Ireland Ltd, Euro House | Euro Business Park | Little Island | Cork | T45 K857 | Ireland. Tel: 021-461 9040 or from the SmPC available on www.accord-healthcare.ie or www.hpra.ie
*Pack sizes do not represent actual size Date of Preparation: February 2021. IE-01616.
Further information is available on request from Accord Healthcare Ireland Ltd, Euro House | Euro Business Park | Little Island | Cork | T45 K857 | Ireland. Tel: 021-461 9040 or from the SmPC available on www.accord-healthcare.ie or www.hpra.ie Products subject to prescription. Supply through pharmacies only.
Think Hi Techs, Think Accord
Accord Healthcare Ireland Limited, Euro House, Euro Business Park, Little Island, Cork T45 K857, Ireland and Accord Healthcare S.L.U. World Trade Center, Moll de Barcelona, s/n, Edifici Est 6ª planta, 08039 Barcelona, Spain. Pack sizes do not represent actual size. For Irish Health Care Professionals only. Date of Preparation: July 2021. IE-01676.
Accofil Filgrastim Ambrisentan Ambrisentan Bicalutamide Bicalutamide Capecitabine Accord Capecitabine Cinacalcet Accordpharma Cinacalcet (as hydrochloride) Entecavir Accord Entecavir Granpidam Sildenafil Imatinib Accord Imatinib Linezolid Linezolid Mycophenolate Mofetil Accord Mycophenolate Mofetil Pelgraz ▼ Pegfilgrastim Posaconazole Accord Posaconazole Temozolomide Accord Temozolomide TenofovirAccordpharmadisoproxil Tenofovir disoproxil (as fumarate) Valganciclovir Valganciclovir Voriconazole Accord Voriconazole This does not represent the full Accord Healthcare Hi Tech portfolio. To see our full range visit www.accord-healthcare.ie
Products subject to prescription. Supply through pharmacies only. Accord Healthcare Ireland Limited, Euro House, Euro Business Park, Little Island, Cork T45 K857, Ireland and Accord Healthcare S.L.U. World Trade Center, Moll de Barcelona, s/n, Edifici Est 6ª planta, 08039 Barcelona, Spain.
In other news, Martin Slattery has joined Uniphar Supply Chain & Retail division as Wholesale Commercial Director having spent the last 15 years in senior leadership roles across both the retail and FMCG wholesale sectors. Martin brings with him a wealth of experience in driving good business and the importance of customer partnerships.
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Louise Martin has recently been appointed as the new Retail Director for Uniphar Supply Chain & Retail. Louise joined Uniphar 2 years ago as Consumer Business Unit Manager. Prior to Uniphar, Louise held several senior commercial positions in McKesson UK, Lloyds Pharmacy Ireland and Tan Organic. During her time as Head of Category Management for McKesson UK, Louise built a strong team, grew retail sales in what was a challenging retail environment at the same time as managing an aggressive store refit
Louise Martin, Retail Director for Uniphar Supply Chain & Retail
Professor Fergal O’Brien, Deputy Vice Chancellor for Research and Innovation at RCSI, said, “This programme will support our talented researchers at a critical career transition stage to establish themselves as independent health investigators. Their research has the potential to bring about vital improvements for the benefit patients with conditions such as cystic fibrosis and osteoarthritis, in Ireland and globally.”
WHY
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Dr Tom Hodgkinson, Department of Anatomy and Regenerative Medicine, RCSI, has been awarded funding for his project “Development of a gene activated construct targeting proinflammatory signalling to promote zonal regeneration of osteoarthritic cartilage”. This project aims develop a specialised implant designed to simultaneously support weight-bearing and treat inflammation to promote cartilage repair. This paradigm shifting approach has the potential to revolutionise treatment of degenerative diseases like osteoarthritis.
Overprogramme.thelast two years during Louise’s management the Consumer business has doubled its turnover and profit. Louise has brought an energy and passion for pharmacy retail, customer focus, brilliant basics and cross functional collaboration to the Consumer business. She has fostered a positive work culture within Consumer, focused on building a commercially focused and highly motivated team.
The successful RCSI projects have the potential to improve quality of life for those living with cystic fibrosis and osteoarthritis.
Two researchers from RCSI University of Medicine and Health Sciences were among those awarded Health Research Board (HRB) Emerging Investigator Awards (EIA) for Health 2022 as part of a ¤7 million investment from the HRB to nurture a talented new generation of academic researchers.
PHARMACYNEWSIRELAND.COM 32 News Director Post for Louise
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The overarching aim of the HRB EIA programme is to create a cohort of talented new independent academic investigators by facilitating and supporting their transition from postdoctoral researchers to independent and self-directed health research investigators.
Dr Irene Oglesby, Department of Medicine, RCSI, will receive an award for her project 'Interrogating the role of miRNA in predicting responses to novel modulator therapies in children with cystic fibrosis'. In this study, the researchers will pair with the clinical teams working on the RECOVER study, which is examining the day-today effects of the latest triple combination drug, Kaftrio.
086 411 4597 t: (044) 939 6188 e: www.macu-save.ieinfo@pharmed.ie *Clinical studies available on request InvestigatorsEmerging
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There are two forms of emergency contraception: oral emergency contraceptive pills and copper intrauterine devices.
•know:Date of last normal menstrual period (LMP), usual cycle length, whether currently using any hormonal contraception or whether breast-feeding
• ECPs do not provide any protection from sexually transmitted infections
Take the opportunity to dispel myths and misinformation about ECPs during a consultation:
Women should be advised about all methods of EC available and their effectiveness. They should also be advised that ECPs do not provide contraceptive protection for the rest of the cycle, so it is important to avoid sexual intercourse or to use effective contraception after taking Pharmaciststhem.should advise women that emergency contraception is not 100% effective.
Barrier methods such as condoms or abstinence should be advised during this time.
The copper coil is the most effective method of EC, with a failure rate of less than 1%. It can be used up to 5 days after UPSI or 5 days after earliest possible estimated ovulation - although this is very difficult to ascertain with certainty.
• ECPs do not cause abortion; if a woman is already pregnant, emergency contraception will not displace the pregnancy
34 | PHARMACYNEWSIRELAND.COM Emergency Contraception:
An IUCD can remain in the uterus to provide long-term contraception or can be removed at the next period.
As these are sensitive consultations, it is important to have a private consulting room available and a visible sign advertising its availability. Staff should be discreet and should not ask intimate questions where they can be overheard.
• Any serious illness or current medication (think of liver enzyme-inducing medications)
Emergency contraception (EC) is a method of preventing pregnancy after sex. It may be used when contraception has failed, no contraception has been used or in cases of rape.
• Weight/BMI (weight over 70 kilos or BMI over 30 may affect the effectiveness of ECPs)
Two types of ECPs are available from pharmacies; Levonorgestrel (brand names Norlevo and Prevenelle), which can be taken up to 72 hours after unprotected sexual intercourse (UPSI), and Ulipristal Acetate (brand name ellaOne), which can be taken up to 120 hours after unprotected sex.
All ECPs are more effective if given as soon as possible after UPSI. The ECP works primarily by delaying or preventing ovulation. The ECP is not effective if ovulation has already taken place and will not displace an implanted pregnancy.
To best advise on the most suitable emergency contraceptive option, the pharmacist needs to
If EC fails and a pregnancy would be a crisis, women still have treatment options and there are supports available. If a woman wants more information or is feeling anxious or confused, she should be advised that the HSE’s dedicated website, MyOptions.ie, is there to help.
The emergency contraceptive pill (ECP)
If UPA is given and the woman is starting or restarting hormonal contraception before the next period, she should be advised to wait 5 days after taking UPA before she starts. Otherwise, the hormonal contraception could displace the UPA from the receptors, causing it to fail as an emergency contraceptive. When the hormonal contraception is started after 5 days, the woman should be advised that it will take 7 days for a combined pill and 48 hours for a progestogen only pill to become effective.
• Date of UPSI, any other episodes of UPSI since LMP, any previous EC since LMP
Ulipristal Acetate (UPA) and interaction with hormonal contraception UPA binds to progestogen receptors and may displace progestogens or be unable to bind if there are progestogens already bound to the receptor. Therefore, if hormonal contraception containing a progestogen has been taken within the last 5 days, the efficacy of UPA may be reduced. In this case, Levonorgestrel (LNG) might be safer to use. Copper IUCD is always the most effective.
It may also be appropriate to advise the woman regarding risk of STIs and availability of testing.
• ECPs are safe even for women who cannot normally take hormonal contraception
If a woman is considering having an IUCD fitted for emergency contraception, the pharmacist should still suggest that she take a hormonal ECP while she is waiting for an appointment. This will prevent a delay in accessing emergency contraception if she cannot find an IUCD provider in the necessary timeframe or if the provider is unable to fit an IUCD.
The copper IUCD is effective either before or after ovulation. Copper is toxic to sperm and eggs: the primary mode of action of the IUCD is to prevent fertilisation.
The ECP is often called the “morning after pill”. However, ECPs can be used up to 3 or 5 days after an episode of UPSI, depending on the type. Both types are more effective the sooner the pill is taken.
Written by Dr Caitríona Henchion, Medical Director, Irish Family Planning Association (IFPA)
• ECPs can be taken as often as needed, there is no limit to the number of times they can be used. However, other methods of contraception are more reliable. (NB: information should be provided on more reliable methods if needed)
Key Points for Pharmacists
Copper ContraceptiveIntrauterineDevice (IUCD), also called the “copper coil”
• ECPs have no impact on long term fertility
Emergency consultationContraceptive
Non enzyme inducing antibiotics have no effect on efficacy. Non enzyme inducing antibiotics have no effect on efficacy. Drugs which increase gastric pH have no effect on LNG Drugs which increase gastric pH (any antacid or medication for peptic ulcer or gastro oesophageal reflux) reduce the bioavailability of UPA, which may theoretically affect efficacy. Use LNG or omit medication on the day ECP is taken. No interactions with hormonal contraception Interacts with progestogens in hormonal contraception with potential for reduced efficacy of both. Always check hormonal contraceptive use to avoid providing incorrect EC advice. Contraindications and Cautions No concern with oral steroid dependent asthma Contraindicated in oral steroid dependent asthma
Anne, aged 25 attends for EC.
effective
2
Anne should be advised that the risk of EC failure is higher as there are now 2 chances for EC failure.
IFPA clinic Cathal Brugha street 01 872 7088
of
Anne can have another dose of ellaOne. Because ellaOne was given around the time of ovulation, it is likely that ovulation was postponed and may be imminent at this stage. This means Anne is at risk of pregnancy from the most recent episode of UPSI. It is again, too late for a copper IUCD as ovulation may have occurred, despite taking ellaOne. If a pregnancy occurred from the earlier episode of UPSI, UPA will neither displace that pregnancy nor cause any harmful effects.
Case study 2
Progestogen Selective progesterone
Comparison of the types Emergency Contraceptive Pill
Case study 1 Sarah, aged 20 attends for EC. LMP 3 weeks ago, 4-week cycle, not on hormonal contraception. UPSI last night but also on the day after her period finished, day 4 of cycle, no EC on that Sarahoccasion.canhave the ECP, either type.
The Irish Family Planning Association (IFPA) is a leading provider of sexual and reproductive healthcare. IFPA provides a comprehensive range of services including abortion care, contraception, STI screening and treatment and specialist pregnancy counselling.
postpones ovulation Prevents or postpones ovulation 1.5 mg as a single dose 30mg as a single dose Licensed for use up to 72 hours after unprotected sexual intercourse Licensed for use up to 120 hours after unprotected sexual intercourse Repeat
occurs within 3 hours
Levonorgestrel LNG (Norlevo and Prevenelle) Ulipristal Acetate
modulator Prevents
Liver enzyme inducing drugs may reduce efficacy, double dose is occasionally used but this is outside the product licence and efficacy is unknown, copper IUCD best. Liver enzyme inducing drugs may reduce efficacy, copper IUCD best. No increased dose regimen is approved by any guidance.
Do not use if previous hypersensitivity to any ingredients Do not use if previous hypersensitivity to any ingredients
IFPA clinic Tallaght 01 459 7685 IFPA Appointment Line 0818 49 50 51 My Options Helpline 1800 828 010. My Options is a HSE freephone line. The helpline provides information and support including contact details for abortion services nationwide and continued pregnancy supports.
Exclude pregnancy as far as possible but LNG will not disrupt an existing pregnancy and no teratogenic effects have been demonstrated. Exclude pregnancy as far as possible but UPA will not disrupt an existing pregnancy and no teratogenic effects have been demonstrated. No restrictions for women who are breast feeding Women who are breastfeeding should be advised to take dose immediately after feeding and discard milk for 7 days after
PHARMACYNEWSIRELAND.COM | 35
On day 21 of cycle, it is too late to consider a copper IUCD. Sarah should be advised that the risk of EC failure is higher if there has been more than one episode of UPSI since the last period since the ECP cannot protect against pregnancy from the earlier episode. Sarah should be advised that in the unlikely event that pregnancy occurred from the first episode of UPSI, on day 4 of her cycle, the ECP she receives today will not be for this incident. UPA (ellaOne) receptor or dose if vomiting Repeat dose if vomiting Failure rate 1.5 2.5% Failure rate 0.5 1.5% Interactions
UPSI last night. LMP 3 weeks ago, 4-week cycle and not on hormonal contraception. She also had UPSI 10 days ago and took ECP (ellaOne) at that time.
Contacts
Most likely, Sarah has passed ovulation, but there is a possibility that she has ovulated late, in which case the ECP would be beneficial. In the unlikely event that a pregnancy occurred from the earlier episode of UPSI, neither LNG nor UPA will displace that pregnancy or cause any harmful effects.
occurs within 3 hours
2. Migraine with aura - refers to a range of neurological disturbances that occur before the headache begins, usually lasting about 20-60 minutes. Roughly 20% of people with migraine experience ‘aura’ in addition to some or all the symptoms.
• Slurring of speech
• Muscular weakness
• Confusion Basilar migraine - (the new name for this is migraine with brain stem sura) is a rare form of migraine that includes symptoms such as loss of balance, double vision, blurred vision, difficulty in speaking and fainting. During the headache, some people lose consciousness. These are very frightening sensations for the migraine sufferer, and often people describe the feeling of terror and fear that they are about to suffer a stroke. Basilar migraine occurs when the circulation in the back of the brain or neck is affected. It usually affects young women but is sometimes seen in children too.
4. Hemiplegic migraine - is a rare type of migraine where the person experience many of usual migraine symptoms, but may also suffer from temporary numbness, weakness or even paralysis on one side of their body.
Phases of MigraineBefore, During and After an Attack
Ophthalmoplegic migraine - is a very rare type of migraine that occurs mainly in young people in which there is weakness of one or more of the muscles that move the eye. In addition to headache, symptoms of ophthalmoplegic migraine include dilation of the pupils, inability to move the eye upward, downward, or across, as well as a drooping of the upper eyelid.
• Other motion problems in the head, eyes, or body • Diminished eye focus • Muscle spasms in the upper spine
• Zig-zag patterns Other sensory symptoms include:
Weakness and numbness usually go away within 24 hours but may last a few days. Hemiplegic migraine can be one of the most difficult types of migraine to diagnose as many of the symptoms can mimic stroke, seizures, or other conditions. MRIs, CT scans and other tests are done to rule out other more sinister causes of the symptoms.
• Vertigo
1. Migraine without aura - The majority of migraine sufferers have migraine without aura. The most common symptoms of migraine with aura are an intense throbbing headache, usually on one side of the head, worsened by movement and lasts anywhere from 4-72 hours.
Written by Hazel Breen Communications and Information Officer, Migraine Association of Ireland
5. Migraine aura without headache - affects about 1% of migraineurs where they experience migraine aura without ever having a headache. The most common symptoms of migraine aura are visual disturbances such as:
• Blind spots
36 | PHARMACYNEWSIRELAND.COM
• And much more. Visit migraine.ie to see the full list of symptoms for each type of migraine condition In addition, the MAI have seen a significant spike in vestibular migraine diagnosis since the beginning of 2022, mostly in women.
3. Vestibular migraine - or migraine association vertigo (MAV) is a disorder which causes problems with the coordination of the sensory information sent to your brain from your eyes. Up to 40% of all migraine sufferers experience some vestibular symptoms during their lifetime, such as dizziness, sensitivity to light/sound and stiffness in the neck. However, people who suffer with vestibular migraine specifically, experience a whole gamut of other symptoms, including but not limited to:
The word hemiplegia comes from the Greek language where ‘hemi’ means half and ‘plegia’ from the words ‘plege’ or ‘plessein’, means stroke or meaning to strike. Unlike a stroke, the symptoms of hemiplegic migraine begin slowly and build up as the migraine progresses.
• Loss of co-ordination
• Pins and needles on one side usually starting in the fingers/arm, sometimes spreading up into the face
Migraine is a complex neurological condition that affects over 600,000 people in Ireland alone, that’s 12-15% of our population! The Global Burden of Disease states that migraine is the 2nd most disabling disease in the world in their most recent figures (over an eighth of the global population). Migraine is often considered ‘just a headache’ which could not be further from the truth. “There are many types of migraine, many triggers, and many symptoms before, during and after a migraine attack that many people and health care professionals are unaware of.” – Hazel Breen, Communications Officer, Migraine Association of Ireland. Migraine can be episodic or chronic. Episodic migraine lasts from 4-72 hours whereas chronic migraine can last 15 days or more per month! Before delving into the phases of migraine, let’s look at the different types of migraine and some of their symptoms first:
• Flashing lights
Pregnancy and Lactation: Pregnancy: During the first and second trimester of pregnancy, ibuprofen should not be given unless clearly necessary. If ibuprofen is used by a woman attempting to conceive, orduring the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. Contraindicated during the third trimester of pregnancy. Breast-feeding:Ibuprofen and its metabolites can pass in low concentrations into the breast milk. No harmful effects to infants are known to date, so for short-term treatment with the recommended dose for pain and feverinterruption of breast feeding would not generally be necessary. Fertility: There is some evidence that substances which inhibit cyclo-oxygenase/ prostaglandin synthesis may cause impairment of femalefertility by an effect on ovulation. This is reversible upon withdrawal of treatment.
Dosage: Infants aged 3-6 months who weigh more than 5kg. Do not dose more frequently than at 6 hourly intervals and do not exceed the recommended dose. For infants aged 3-5 months medical adviceshould be sought if symptoms worsen or not later than 24 hours if symptoms persist and no later than 3 days in children aged from 6 months and in adolescents. Recommended time interval is 3 times in 24hours: 100 mg/5 ml: 3-12 months (5-9 kg bodyweight): 2.5 ml; 1 to 3 years (10-16 kg): 5 ml; 4 to 6 years (17-20 kg): 7.5 ml; 7 to 9 years (21-30 kg): 10 ml (two 5ml spoonfuls); 10 to 12 years (31-40kg): 15 ml (three 5ml spoonfuls). 200 mg/5 ml: Not for use in children under 6 years of age or under 20 kg body weight. 6-9 years (20-29 kg): 5ml (200 mg); 10-12 years (30-40 kg): 7.5ml (300 mg).
Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie Date of Preparation: 07-22 CCF 25112
grown-ups
Legal Category: Not subject to medical prescription. Date of Preparation: March 2021
Product Name: Brupro for Children 100mg/5ml Oral Suspension & Brupro for Children Six Plus 200mg/5ml oral suspension. Composition: Each 5 ml of oral suspension contains 100 mg or 200 mg ibuprofen respectively.
Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing Rowex pv@rowa-pharma.ie Date of Preparation: 07-22 CCF 25112
Description: White or almost white suspension, homogeneous after agitationIndication(s): 100 mg/5 ml: Reduction of fever and relief of mild to moderate pain, such as cold and flu symptoms, teething pain, headache, sprains and strains and to ease the pain of sore throats andearache. For short term use only. 200 mg/5 ml: For the short-term symptomatic treatment of mild to moderate pain. For the short-term symptomatic treatment of fever. Dosage: Infants aged 3-6 months who weigh more than 5kg. Do not dose more frequently than at 6 hourly intervals and do not exceed the recommended dose. For infants aged 3-5 months medical adviceshould be sought if symptoms worsen or not later than 24 hours if symptoms persist and no later than 3 days in children aged from 6 months and in adolescents. Recommended time interval is 3 times in 24hours: 100 mg/5 ml: 3-12 months (5-9 kg bodyweight): 2.5 ml; 1 to 3 years (10-16 kg): 5 ml; 4 to 6 years (17-20 kg): 7.5 ml; 7 to 9 years (21-30 kg): 10 ml (two 5ml spoonfuls); 10 to 12 years (31-40kg): 15 ml (three 5ml spoonfuls). 200 mg/5 ml: Not for use in children under 6 years of age or under 20 kg body weight. 6-9 years (20-29 kg): 5ml (200 mg); 10-12 years (30-40 kg): 7.5ml (300 mg).
Undesirable Effects: Gastro-intestinal: abdominal pain, nausea and dyspepsia, diarrhoea, flatulence, constipation, heartburn, vomiting and slight gastrointestinal blood losses that may cause anaemia inexceptional cases. Refer to the SPC for other undesirable effects. Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Bantry, Co. Cork.
Ability to Drive and Use Machinery: For short-term use this medicinal product, has no or negligible influence on the ability to drive and use machines.
Undesirable Effects: Gastro-intestinal: abdominal pain, nausea and dyspepsia, diarrhoea, flatulence, constipation, heartburn, vomiting and slight gastrointestinal blood losses that may cause anaemia inexceptional cases. Refer to the SPC for other undesirable effects. Marketing Authorisation Holder: Rowa Pharmaceuticals Ltd., Bantry, Co. Cork.
Supply status: Supply through pharmacies only
Elderly: Have an increased frequency of adverse reactions to NSAIDs especially gastrointestinalbleeding and perforation which may be fatal. Are at increased risk of the consequences of adverse reactions. Caution in: Systemic lupus erythematosus as well as those with mixed connective tissue disease,due to increased risk of aseptic meningitis; Congenital disorder of porphyrin metabolism (e.g. acute intermittent porphyria); Gastrointestinal disorders and chronic inflammatory intestinal disease (ulcerativecolitis, Crohn’s disease). Consider combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) and also for patients requiring concomitant low dose acetylsalicylic acid, or otherdrugs likely to increase gastrointestinal risk; A history of hypertension and/or heart failure as fluid retention and oedema have been reported in association with NSAID therapy; Renal impairment as renalfunction may further deteriorate; Hepatic dysfunction; Dehydration; Directly after major surgery; Hayfever, nasal polyps or chronic obstructive respiratory disorders as an increased risk for them of allergicreactions occurring. These may be present as asthma attacks (so-called analgesic asthma), Quincke’s oedema or urticaria; In patients who have already reacted allergically to other substances, as anincreased risk of hypersensitivity reactions occurring also exists for them on use of this product; Bronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergicdisease.
Marketing Authorisation Number: PA0074/067/004-005 Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417E-mail: rowex@rowa-pharma.ie.
Product Name: Brupro for Children 100mg/5ml Oral Suspension & Brupro for Children Six Plus 200mg/5ml oral suspension. Composition: Each 5 ml of oral suspension contains 100 mg or 200 mg ibuprofen respectively.
Pain relief for lit tle ones And a sigh of relief for grown-ups
Ability to Drive and Use Machinery: For short-term use this medicinal product, has no or negligible influence on the ability to drive and use machines.
ACTS FAST ON PAIN & FEVER
Description: White or almost white suspension, homogeneous after agitationIndication(s): 100 mg/5 ml: Reduction of fever and relief of mild to moderate pain, such as cold and flu symptoms, teething pain, headache, sprains and strains and to ease the pain of sore throats andearache. For short term use only. 200 mg/5 ml: For the short-term symptomatic treatment of mild to moderate pain. For the short-term symptomatic treatment of fever.
For Children
Pain relief for lit tle ones
Renal insufficiency: No dose reduction in mild to moderate impairment. Hepatic insufficiency: No dose reduction in mild to moderate impairment.Contraindications: Hypersensitivity to the active substance or to any of the excipients. In patients: - who have previously shown hypersensitivity (e.g. bronchospasm, asthma, rhinitis, angioedema or urticaria)associated with acetylsalicylic acid, ibuprofen or other non-steroidal anti-inflammatory (NSAID) medicinal products; - with a history of gastrointestinal bleeding or perforation, related to previous NSAIDtherapy; - with active, or a history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding); - with cerebrovascular or other active bleeding; - with severe hepaticfailure or severe renal failure; - with severe heart failure; -with unclarified blood-formation disturbances; -with severe dehydration (caused by vomiting, diarrhoea or insufficient fluid intake). During the lasttrimester of pregnancy. Warnings and Precautions for Use: Refer to the SPC for detailed warnings. Undesirable effects may be minimized by using the lowest effective dose for the shortest durationnecessary to control symptoms and patients should report any unusual symptoms especially any GI bleeding.
Marketing Authorisation Number: PA0074/067/004-005 Further information and SPC are available from: Rowex Ltd., Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417E-mail: rowex@rowa-pharma.ie. Legal Category: Not subject to medical prescription. Date of Preparation: March 2021
Dermatological effects: Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely inassociation with the use of NSAIDs. Patients appear to be at highest risk of these reactions early in the course of therapy, the onset of the reaction occurring in the majority of cases within the first month oftreatment.
Acute generalized exanthematous pustulosis (AGEP) has been reported. Discontinue Brupro for Children at the first appearance of signs and symptoms of severe skin reactions, such as skin rash,mucosal lesions, or any other sign of hypersensitivity. Symptoms of underlying infections and fever can be masked which may lead to delayed initiation of appropriate treatment and thereby worsening theoutcome of the infection. This has been observed in bacterial community acquired pneumonia and bacterial complications to varicella. Monitoring of infection is advised. In nonhospital settings, the patientshould consult a doctor if symptoms persist or worsen. Exceptionally, varicella can be at the origin of serious cutaneous and soft tissues infectious complications. It is advisable to avoid use of ibuprofen in caseof varicella. Cardiovascular and cerebrovascular effects: Ibuprofen, particularly at a high dose (2400 mg/day) may be associated with a small increased risk of arterial thrombotic events (for examplemyocardial infarction or stroke). Low dose ibuprofen (e.g. ≤ 1200 mg/day) is suggested not to be associated with a small increased risk of arterial thrombotic events. Patients with uncontrolled hypertension,congestive heart failure (NYHA II-III), established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with ibuprofen after careful consideration andhigh doses (2400 mg/day) should be avoided and consider carefully if long term treatment is needed. Other notes: Severe acute hypersensitivity reactions (for example anaphylactic shock) are observedvery rarely. Discontinue treatment immediately and seek medical attention. Ibuprofen may temporarily inhibit the blood-platelet function (thrombocyte aggregation). Monitor patients with coagulationdisturbances carefully. Check liver values, kidney function and blood count in prolonged treatment. Be aware of diagnosis of medication overuse headache (MOH), suspected in patients who have frequent ordaily headaches despite (or because of) the regular use of headache medications. Alcohol may increase adverse effects that concern the gastrointestinal tract or the central nervous system. Renal: Habitualuse of analgesics, especially the combination of different analgesic drug substances, can lead to lasting renal lesions with the risk of renal failure (analgesic nephropathy). There is a risk of renal impairment indehydrated children. Contains sorbitol and propylene glycol. Interactions: Refer to the SPC for detailed information on the interactions. Avoid in combination with: Other NSAIDs including cyclooxygenase-2selective inhibitors; Acetylsalicylic acid; Antihypertensives, (ACE inhibitors, beta-receptor blocking medicines and angiotensin-II antagonists) and diuretics; Cardiac glycosides: e.g. digoxin; Lithium; Potassiumsparing diuretics; Phenytoin; Methotrexate; Tacrolimus; Ciclosporin; Corticosteroids; Anti-coagulants; Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs); Mifepristone; Sulphonylureas;Zidovudine; Probenecid and sulfinpyrazone; Baclofen; Ritonavir; Aminoglycosides; Quinolone antibiotics; Cholestyramine; Captopril; CYP2C9 inhibitors: e.g. voriconazole and fluconazole.
And a sigh of relief for
ABBREVIATED PRESCRIBING INFORMATION
Acute generalized exanthematous pustulosis (AGEP) has been reported. Discontinue Brupro for Children at the first appearance of signs and symptoms of severe skin reactions, such as skin rash,mucosal lesions, or any other sign of hypersensitivity. Symptoms of underlying infections and fever can be masked which may lead to delayed initiation of appropriate treatment and thereby worsening theoutcome of the infection. This has been observed in bacterial community acquired pneumonia and bacterial complications to varicella. Monitoring of infection is advised. In nonhospital settings, the patientshould consult a doctor if symptoms persist or worsen. Exceptionally, varicella can be at the origin of serious cutaneous and soft tissues infectious complications. It is advisable to avoid use of ibuprofen in caseof varicella. Cardiovascular and cerebrovascular effects: Ibuprofen, particularly at a high dose (2400 mg/day) may be associated with a small increased risk of arterial thrombotic events (for examplemyocardial infarction or stroke). Low dose ibuprofen (e.g. ≤ 1200 mg/day) is suggested not to be associated with a small increased risk of arterial thrombotic events. Patients with uncontrolled hypertension,congestive heart failure (NYHA II-III), established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with ibuprofen after careful consideration andhigh doses (2400 mg/day) should be avoided and consider carefully if long term treatment is needed. Other notes: Severe acute hypersensitivity reactions (for example anaphylactic shock) are observedvery rarely. Discontinue treatment immediately and seek medical attention. Ibuprofen may temporarily inhibit the blood-platelet function (thrombocyte aggregation). Monitor patients with coagulationdisturbances carefully. Check liver values, kidney function and blood count in prolonged treatment. Be aware of diagnosis of medication overuse headache (MOH), suspected in patients who have frequent ordaily headaches despite (or because of) the regular use of headache medications. Alcohol may increase adverse effects that concern the gastrointestinal tract or the central nervous system. Renal: Habitualuse of analgesics, especially the combination of different analgesic drug substances, can lead to lasting renal lesions with the risk of renal failure (analgesic nephropathy). There is a risk of renal impairment indehydrated children. Contains sorbitol and propylene glycol. Interactions: Refer to the SPC for detailed information on the interactions. Avoid in combination with: Other NSAIDs including cyclooxygenase-2selective inhibitors; Acetylsalicylic acid; Antihypertensives, (ACE inhibitors, beta-receptor blocking medicines and angiotensin-II antagonists) and diuretics; Cardiac glycosides: e.g. digoxin; Lithium; Potassiumsparing diuretics; Phenytoin; Methotrexate; Tacrolimus; Ciclosporin; Corticosteroids; Anti-coagulants; Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs); Mifepristone; Sulphonylureas;Zidovudine; Probenecid and sulfinpyrazone; Baclofen; Ritonavir; Aminoglycosides; Quinolone antibiotics; Cholestyramine; Captopril; CYP2C9 inhibitors: e.g. voriconazole and fluconazole.
Pregnancy and Lactation: Pregnancy: During the first and second trimester of pregnancy, ibuprofen should not be given unless clearly necessary. If ibuprofen is used by a woman attempting to conceive, orduring the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. Contraindicated during the third trimester of pregnancy. Breast-feeding:Ibuprofen and its metabolites can pass in low concentrations into the breast milk. No harmful effects to infants are known to date, so for short-term treatment with the recommended dose for pain and feverinterruption of breast feeding would not generally be necessary. Fertility: There is some evidence that substances which inhibit cyclo-oxygenase/ prostaglandin synthesis may cause impairment of femalefertility by an effect on ovulation. This is reversible upon withdrawal of treatment.
Supply status: Supply through pharmacies only
Renal insufficiency: No dose reduction in mild to moderate impairment. Hepatic insufficiency: No dose reduction in mild to moderate impairment.Contraindications: Hypersensitivity to the active substance or to any of the excipients. In patients: - who have previously shown hypersensitivity (e.g. bronchospasm, asthma, rhinitis, angioedema or urticaria)associated with acetylsalicylic acid, ibuprofen or other non-steroidal anti-inflammatory (NSAID) medicinal products; - with a history of gastrointestinal bleeding or perforation, related to previous NSAIDtherapy; - with active, or a history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding); - with cerebrovascular or other active bleeding; - with severe hepaticfailure or severe renal failure; - with severe heart failure; -with unclarified blood-formation disturbances; -with severe dehydration (caused by vomiting, diarrhoea or insufficient fluid intake). During the lasttrimester of pregnancy. Warnings and Precautions for Use: Refer to the SPC for detailed warnings. Undesirable effects may be minimized by using the lowest effective dose for the shortest durationnecessary to control symptoms and patients should report any unusual symptoms especially any GI bleeding. Elderly: Have an increased frequency of adverse reactions to NSAIDs especially gastrointestinalbleeding and perforation which may be fatal. Are at increased risk of the consequences of adverse reactions. Caution in: Systemic lupus erythematosus as well as those with mixed connective tissue disease,due to increased risk of aseptic meningitis; Congenital disorder of porphyrin metabolism (e.g. acute intermittent porphyria); Gastrointestinal disorders and chronic inflammatory intestinal disease (ulcerativecolitis, Crohn’s disease). Consider combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) and also for patients requiring concomitant low dose acetylsalicylic acid, or otherdrugs likely to increase gastrointestinal risk; A history of hypertension and/or heart failure as fluid retention and oedema have been reported in association with NSAID therapy; Renal impairment as renalfunction may further deteriorate; Hepatic dysfunction; Dehydration; Directly after major surgery; Hayfever, nasal polyps or chronic obstructive respiratory disorders as an increased risk for them of allergicreactions occurring. These may be present as asthma attacks (so-called analgesic asthma), Quincke’s oedema or urticaria; In patients who have already reacted allergically to other substances, as anincreased risk of hypersensitivity reactions occurring also exists for them on use of this product; Bronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergicdisease.
ABBREVIATED PRESCRIBING INFORMATION
Dermatological effects: Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely inassociation with the use of NSAIDs. Patients appear to be at highest risk of these reactions early in the course of therapy, the onset of the reaction occurring in the majority of cases within the first month oftreatment.
Employers can reduce sick days per year if they were more aware of migraine as a condition and how vast it is. Sick days from migraine add up to over €240 million in losses for the Irish economy alone which could be avoided if employers were more educated about migraine.
The Migraine Association of Ireland is Ireland’s only patient charity that provides information, support, education, and reassurance to the 600,000 people suffering with migraine and headache disorders in Ireland, whilst seeking further research, better treatments/access to care and increased public awareness of the condition. MAI services include providing free educational events/courses to help people manage their migraine, and certified HP courses for GPs and other HCPs. In addition, they lobby and advocate on behalf of migraineurs for access to new treatments and better access to care. About migraine Migraine is a complex neurological condition which is classified by the World Health Organisation as the 7th most disabling disease worldwide, the 4th for women. Migraine is the most common neurological condition in the world, affecting 12 – 15% of the population. It is 3 x times more common in women than it is in men and is usually inherited. On any given day in Ireland over 13,000 people suffer from migraine. It is a very individual condition. Some people experience only one or two attacks per year while others suffer on a weekly basis. An attack can last from 4 to 72 hours.
This phase can cause moderate to severe head pain. The headache is typically throbbing and is made worse by movement. It is usually on one side of the head, especially at the start of an attack. However, you can get pain on both sides, or all over the head. Nausea (sickness) and vomiting (being sick) can happen at this stage, and you may feel sensitive to light, sound, smell, and movement. Painkillers work best when taken early in this stage. As you now know from the list of types of migraine and symptoms above, the symptoms for each person can vary as migraine is so individual and so can each attack be. Visit www.migraine. ie to read more detail on each type of migraine, their symptoms, and triggers too. Resolution phase Most attacks slowly fade away, but some stop suddenly after the person with migraine is sick or cries a lot. Sleep seems to help many people, even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack.
The Migraine Association of Ireland
People with migraine want to work, want to study, and want to be able to live life to the fullest but need awareness, education, the right access to care and medication and reasonable accommodations to do so. For more information visit www.migraine.ie
This is the final phase of an attack, and it can take hours or days for a drained, fatigued or ‘hungover’ type feeling to fully disappear. Symptoms can be like those of the first stage (premonitory). Often, they mirror these symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, you might feel full of energy.
The Headache phase “I become very ill with vomiting, and I must go to bed and block out all light and all noise and have a cold wet flannel over my head. These attacks could last a couple of hours, but in the past before I started Ajovy medication, I was getting them daily! If I wake up with a migraine, it will last most of the day even with extra medication and I would be completely incapacitated.” - Susan Doyle, migraine patient
Premonitory phase
and this range of reversible neurological symptoms (aura) develop. This stage can last up to 60 minutes. In adults, they usually happen before the headache itself, but in children, they may happen at the same time as the headache. It is possible to have the aura symptoms without the headache, this is often referred to as ‘silent migraine’.
For further information: Hazel Breen, Communications and Information Officer, Migraine Association of Ireland, Unit 14 Block 5 Port Tunnel Business Park Clonshaugh Dublin D17 WK24 Email: communications@migraine.ie
References: Global Burden of Disease 2019 Migraine Trust, UK Susan Doyle – migraine patient and sufferer
Being aware of the different phases of a migraine attack can be helpful. It can help you prepare for an attack, get a diagnosis, and decide when to take acute or alternative treatment, such as painkillers or make migraine smart lifestyle changes. It is useful to have a rescue treatment plan for when attacks occur. This may include painkillers such as a triptan, a NSAID (e.g., ibuprofen) or paracetamol. It often also includes anti-sickness medication. Please note that too many painkillers can create a different type of headache called Medication Overuse Headache (MOH) so it is important for Healthcare professionals to advise to use only as prescribed or as directed on the package of medication.
Therefore, it is paramount that Migraine Ireland create wide scale awareness so migraineurs know they are ‘not alone’, learn to manage their condition and educate others about migraine.
“After each attack, I feel completely drained of any energy and completely ‘wiped out’! I have often compared this to feeling of having a hangover but without the alcohol.”Susan Doyle, migraine patient. Recovery or Postdrome phase
38 | PHARMACYNEWSIRELAND.COM
Aura is the result of a wave of nerve activity that spreads over the brain (known as cortical spreading depression). As this electrical wave spreads, the nerves fire in an abnormal way
The phases of migraine – Before, during and after the attack… Being aware and informed on the different phases of a migraine attack can be very useful. You may get one, some, or all the following phases, which can vary from each attack in length or severity. This information and patterns can provide Healthcare Professionals with information that can help them make a diagnosis and provide the appropriate access to care and medication. Taking medication as soon as you notice the pain may fully prevent an attack or shorten an attack. It’s important to note that migraine attacks in childhood are often much shorter than in adulthood which might make it easier to tell different headache stages in a child. The phases of a migraine attack are as follows:
“When I feel a migraine attack coming on, I feel a fuzziness and pain building up in my head. I can feel very nauseous and sometimes I feel a bit dizzy. I would feel the buildingheadacheupto a more severe headache quite quickly.”Susan migraineDoyle,patient This is sometimes referred to as the onset of migraine or the warning stage in which certain physical and mental changes occur which can include: feeling changesfoodexcessivetiredyawningcravingsinyourmood such as feeling down or irritable (high or low) feeling thirsty neck passingstiffnessmore urine (wee) These feelings can last up to 24 hours. Aura phase Migraine without aura does not include this stage. The aura part of migraine includes a wide range of neurological symptoms usually before the headache stage. These symptoms include:changes in sight (visual disturbances) such as dark spots, coloured spots, sparkles or ‘stars’, and zigzag lines numbness or pins and needles dizzinessweakness or vertigo (sensation of spinning and poor balance) speech and hearing changes Some people experience memory changes, feelings of fear and confusion, and more rarely, partial paralysis or fainting.
Individuals can experience migraine without aura, with aura, aura no headache, basilar, hemiplegic, ophthalmoplegic and vestibular. They can also experience chronic migraine, cluster headaches, medication overuse headache and new daily persistent headache.
also help with the frustration and lack of understanding people often face around migraine, especially at work and in education. Therefore, migraine awareness and education are vital and must be taken seriously as it has a huge impact on just under one eighth of the Irish population which in turn impacts the workplace economy with sick leave equating to €252 million per year in Ireland. The better we as a nation get at managing migraine, the more beneficial it will be to everyone overall.
For other people, being aware of the types, symptoms and phases of a migraine attack can help their understanding towards loved ones in your life with migraine. It may
*Based on IQVIA sales data MAT 07/2022. Nytol One-A-Night 50 mg Tablets contains diphenhydramine hydrochloride. A symptomatic aid to the relief of temporary sleep disturbance in adults. Adults: One tablet to be taken 20 minutes before going to bed, or as directed by a physician. Do not exceed the maximum dose of one tablet in 24 hours. Elderly patients or patients with liver or kidney problems should consult their doctor before taking this medicine. Children under 18 years: Not recommended. The product should not be taken for more than 7 days without consulting a doctor. Contraindications: Hypersensitivity to the active substance or to any of the excipients, stenosing peptic ulcer, pyloroduodenal obstruction, phaeochromocytoma, known acquired or congenital QT interval prolongation, known risk factors for QT interval prolongation. Special warnings and precautions: Pregnancy/lactation, renal and hepatic impairment, myasthenia gravis, epilepsy or seizure disorders, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis, COPD. Patients should be advised to promptly report any cardiac symptoms. Tolerance and / or dependence may develop with continuous use. Do not take for more than 7 consecutive nights without consulting a doctor. Should not be used in patients currently receiving MAO inhibitors (MAOI) or patients who have received treatment with MAOIs within the last two weeks Use in the elderly should be avoided. Avoid concomitant use of alcohol or other antihistamine-containing preparations. Do not drive or operate machines. Cases of abuse and dependence were reported in adolescents or young adults for recreational use and/or in patients with psychiatric dis-orders and/or history of abuse disorders. Contains lactose. May suppress the cutaneous histamine response to allergen extracts and should be stopped several days before skin testing. Interactions: Alcohol, CNS depressants, MAO inhibitors, anticholinergic drugs (e.g. atropine, tricyclic antidepressants), metoprolol and venlafaxine, CYP2D6 inhibitors, Class Ia and Class III anti-arrhythmics. Side effects: Dry mouth, fatigue, sedation, drowsiness, disturbance in attention, unsteadiness, dizziness, thrombocytopenia, hypersensitivity reactions, confusion, paradoxical excitation, convulsions, headache, paraesthesia, dyskinesias, blurred vision, tachycardia, palpitations, thickening of bronchial secretions, gastrointestinal disturbance, muscle twitching, urinary difficulty, urinary retention. Legal classification: P. PA1186/016/001. MAH: Chefaro Ireland DAC. The Sharp Building. Hogan Place. Dublin 2. Ireland. Date of preparation: 07/2022. RRP (ex. VAT): 20s €9.00. SPC: https://www.medicines.ie/medicines/nytol-one-a-night-50-mg-tablets-34889/smpc
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Coughing occurs when there is a forceful release of air from the lungs to help expel inhaled particles, irritants, infectious microorganisms, and secretions from the lower respiratory tract. Seek medical care for your cough if you have fever, shortness of breath, bloody mucus, hoarse voice, vomiting, weight loss, leg swelling, difficulty swallowing, or are a current or former smoker.
2. IDENTIFY If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.
Specific findings that are common and which may be found in association with a cough include malaise, fatigue, insomnia, lifestyle changes, musculoskeletal chest pain, hoarseness, excessive perspiration, urinary incontinence, syncope, cardiac dysrhythmias, headache, orhaemorrhage,subconjunctivalinguinalherniation,gastroesophagealreflux.
A cough is an innate reflex, and important defence mechanism of the lungs that acts as part of the body’s immune system to protect against the entry of foreign materials. Coughing helps expel inhaled particles, irritants, fluids, or microorganisms, and helps clear secretions from the lungs. 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.1, 2 For most people, coughs are self-limiting, however, some coughs can be ominous and indicate serious underlying disease. As there are no objective tools to measure or clinically quantify a cough, evaluation is initially a subjective and highly variable assessment. Given the vagueness of cough as a presenting symptom, along with the risk of insidious underlying aetiologies and lack of objective tools, a cough should be evaluated and treated as an important clinical symptom, until a benign source is confirmed. Globally, cough affects approximately 10% of the adult population, and is associated with impaired quality of life.3 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 A cough can often accompany other symptoms such as rhinorrhoea, fever, sore throat, earache and general aches and pains. Most coughs are selflimiting 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).2 There are many causes of cough, and most are benign. However, cough can also be due to malignancies, nerve injuries, and serious infections,
1. REFLECT Before reading this module, consider the following: Will this clinical area be relevant to my practice?
AcuteCough An acutecough isdefinedaslastinglessthan3weeksandisoneof themostfrequentsymptomsevaluatedbyprimarycareclinicians. Forapersonwithanacutecough,aclinicianperformsaphysical examinationandasksaboutenvironmental,occupational,and travelexposures.
Upper respiratory tract Lower respiratory tract Trachea NasalLarynxPharynxpassages LungPrimaryBronchiolesbronchus
to relieve ANY coughbased on traditional use Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty coughs and dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use as a traditional remedy. Adults and children over 12 years: 15ml every 4 hours, 4 times per day. Max 6 doses (90ml) per day. Max dose should not be exceeded. To be taken 30 to 60 minutes before or after intake of other medicines. Not recommended for children under 12 years. To be administered undiluted or diluted in water or warm tea. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Hypersensitivity to marshmallow root, thyme, to other members of the Lamiaceae family or to any of the excipients. Warnings and precautions: Asthmatics and atopic patients should consult a doctor before using the medicine. Contains E218 and E216 that may cause allergic reactions (possibly delayed). Patients with HFI, glucose-galactose malabsorption or sucrase-isomaltase insu ciency should not take the medicine. The additive e ect of concomitantly administered products containing fructose (or sorbitol) and dietary intake of fructose (or sorbitol) should be considered. Pregnancy and lactation: Not recommended. Side e ects: pruritus, rash, urticaria, angioedema, anaphylactic reaction, oral mucosal blistering, abdominal pain, diarrhoea, nausea, vomiting, dyspnoea, exacerbation of asthma. Legal classification: GSL. TR 2006/001/001.TR Holder: Kwizda Pharma GmbH, E ngergasse 21, A-1160 Vienna, Austria. RRP (ex VAT): €4.99. Date of preparation: 05/2022. SPC: http://www.medicines.ie/ medicine/16380/SPC/Buttercup%2BBronchostop%2BCough%2BSyrup/ http://www.medicines.ie/medicine/16380/SPC/Buttercup+Bronchostop+Cough+Syrup/ Date of preparation: July 2022. IRE BRO 2022 31 BronchoStop IPN Strip Ad (210x35mm) v3 (Hires).pdf 1 15/08/2022 12:06
60 Second Summary
Pharmacological management of coughs and upper respiratory tract infections in the community pharmacy consists primarily of symptomatic relief for the presenting symptoms. Choice of product should be based on patient preference, presenting symptoms, and clinical considerations such as contraindications and potential
Acoughistheforcefulreleaseofairfromthelungsagainstclosedvocalcords, whichresultsinitscharacteristicsound. Coughinghelpsexpelinhaledparticles,irritants,fluids,ormicroorganismsandhelpsclearsecretionsfromthelungs.Acoughcanalso spreadviralorbacterialinfectionstootherpeople. WhenDoesaCoughRequireMedicalAttention? Evaluationbyamedicalspecialistisrecommendedforcoughingthat isaccompaniedbyanyofthefollowingsymptoms:fever,shortness ofbreath,bloodymucus,hoarsevoice,vomiting,weightloss,leg swelling,anddifficultyswallowing.Smokersolderthan45yearsor formersmokersaged55to80yearswhodevelopanewcoughalso shouldseekmedicalevaluation.
Acute cough <3
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.
CPD 41CPD: Cough CPD ContinuingDevelopmentProfessional
JAMAPATIENTPAGE
JAMA. 2021; 325(22):2322. doi:10.1001/jama.2021.2323
5. WHAT NEXT At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your Publishedfindings.by IPN. Copies can be downloaded
Pharmacy Role in the Management of Cough
SubacuteCough
copyright, no part of this can be used in any other publication without permission of the publishers and author. Bronchostop has no editorial oversight of the CPD programmes included in these modules.
3. PLAN If I have identified a knowledge gap - will this article satisfy those needs - or will more reading be required?
4. EVALUATE Did this article meet my learning needs - and how has my practise changed as a result? Have I identified further learning needs?
Disclaimer:www.irishpharmacytraining.iefromAllmaterialpublished is
AUTHOR: Theresa Lowry Lehnen, RGN, PG. Dip. Coronary Care, RNP, BSc, MSc, PG. Dip. Ed (QTS), M. Ed, PhD Clinical Nurse Specialist and Associate Lecturer South East Technological University
Themostfrequentcauseofacutecoughisacommoncold,a short-livedviralinfectionoftheupperrespiratorytract.Infections ofthelowerairways,includingacuteviralbronchitis,pertussis,and tuberculosis,arealsopotentialcausesofacutecough.SARSCoV-2,thevirusthatcausesCOVID-19,isanewcauseofacutecough andmayleadtosevererespiratoryfailureanddeath.Acutecough mayalsobeduetoaworseningunderlyingmedicalcondition,such asasthma,chronicobstructivepulmonarydisease,otherchroniclung conditions,orheartfailure.
FORMOREINFORMATION AmericanThoracicSociety www.thoracic.org/patients/patient-resources/resources/cough.pdf
COUGHINGWEEKS 830
apatient’smedicalhistoryandphysicalexamination.Ifacoughpersistsaftertheinitialtreatment,medicationscanbeaddedbecause patientsmayhavemorethan1conditionthatcausescough.Patientswithapersistentchroniccoughdespiteadequatetreatment shouldundergofurthertestingtoevaluateforaforeignbodyinthe lung,lungcancer,oraspiration.Patientswithanunexplainedchronic coughthatfailstoimproveevenafteracompletemedicalevaluationandtreatmentshouldbereferredtoseeacoughspecialist.
Subacuteweekscough3-8weeksChroniccough>8weeks
TofindthisandotherJAMAPatientPages,gotothePatient
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 can be described as either productive (chesty), where sputum is produced, or non-productive (dry, tickly or irritating), where no sputum is produced. Non-productive coughs may be the result of increased throat irritation due to sensitisation from a virus, and a productive cough results from increased mucosal secretions. Given the vagueness of cough as a presenting symptom, along with the risk of insidious underlying aetiologies and lack of objective tools, a cough should be evaluated and treated as an important clinical symptom, until a benign source is confirmed.
A subacutecough,definedaslasting3to8weeks,ismostoften duetoarecentrespiratoryinfection.Ifacoughdoesnotimprovein 4to6weeks,patientsshouldseekfurthermedicalevaluation. quiresafullmedicalexaminationandachestx-ray.Physiciansmay advisepatientstakinganangiotensin-convertingenzyme(ACE)inhibitortostopusingthisdrugbecauseitcancausechroniccough. Smokersshouldbecounseledtoquittobaccouse.The3mostcommoncausesofchroniccoughinnonsmokerswhoarenottakingan
Typically caused by acute respiratory infection Medical evaluation needed if no improvement in 4-6 Typicallyweekscaused by asthma, acid reflux, postnasal drip, certain blood pressure drugs (ACE inhibitors), or Requiressmokingfull medical evaluation and chest x-ray to determine treatment Typically caused by upper respiratory tract infection (common cold) and sometimes lower respiratory tract infection (viral bronchitis, pertussis, tuberculosis)
Cough
A cough can be short-lived (acute) or become chronic, requiring treatment.
• Occupational history—is the cough due to the patient’s occupation or an environmental factor?
Pharmacological management of coughs and upper respiratory tract infections in the community pharmacy consists primarily of symptomatic relief for the presenting symptoms.
Self- limiting coughs, do not usually need to be referred/seen by the GP, and the person should be advised to rest, drink plenty of fluids, stay at home and avoid contact with other people if they have a high temperature, and do not feel well enough to do their normal activities.7 There is no valid evidence for or against the effectiveness of OTC medicines in acute cough.8
In 2011, HPRA restricted the sale of certain cough and cold remedies in Ireland for children under six years of age. 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. 9 Children under
• Have green, yellow or rusty coloured phlegm
• Age of patient-child, adult or an elderly person?
Pink, frothy sputum Pulmonary oedema
•
• Have symptoms suggestive of whooping cough
• Are there any other symptoms associated with the cough e.g. fever, runny/blocked nose, sneezing and/or sore throat indicates cold or flu
• Have a recurrent nocturnal cough
• Drug history e.g. ACE inhibitors, check for potential drug interactions
APPEARANCE/CHARACTERISTIC OF SPUTUM POSSIBLE CAUSES
• Smoking history including those who have recently quit smoking
Rust-coloured sputum Pneumococcal (lobar) pneumonia
Choice of product should be based on patient preference, presenting symptoms, and clinical considerations such as contraindications and potential drug–drug interactions. Healthy adults usually do not experience side effects from OTC cough medicines, however, some OTC cough medicines can cause irritability, sleepiness, or dizziness. Side effects may be a concern for people who have health problems, older people, or those who use cough medicines for long periods of time.5 A cough can be described as either productive (chesty), where sputum is produced, or non-productive (dry, tickly or irritating), where no sputum is produced.8 Nonproductive coughs may be the result of increased throat irritation due to sensitisation from a virus, and a productive cough results from increased mucosal secretions.
• Past medical morbidities—ishistory/co-thecough due to an exacerbation of a pre-existing condition e.g. asthma or COPD
• Are there any red flags/danger symptoms that require a referral to the GP or seek urgent medical attention
Considerations and questions to ask the patient presenting to the pharmacy with a cough
During a cold, a cough is often caused by a nasal drip irritating the back of the throat. Steam inhalations can be a useful hometreatment, particularly in productive (chesty) coughs. Hot drinks such as lemon and honey can also provide a soothing effect. Sugar-free versions of cough mixtures are also available for diabetics.9
Yellow or green sputum suggest infection Bronchiectasis (foul-smelling sputum), https://www.resourcepharm.com/cough-in-the-pharmacy-a-practical-approach.htmlpneumonia to relieve ANY cough
• Are coughing up blood (Haemoptysis)
• Have chest pain
• Colour of sputum
42 CPD: Cough therefore, an inter-professional approach is required when a cough is persistent.1
Blood-stained sputum or haemoptysis Lung cancer, tuberculosis, pulmonary embolism
• Experience a change in the nature of a smoker’s cough2, 7, 8
based on traditional use Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty coughs and dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use as a traditional remedy. Adults and children over 12 years: 15ml every 4 hours, 4 times per day. Max 6 doses (90ml) per day. Max dose should not be exceeded. To be taken 30 to 60 minutes before or after intake of other medicines. Not recommended for children under 12 years. To be administered undiluted or diluted in water or warm tea. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Hypersensitivity to marshmallow root, thyme, to other members of the Lamiaceae family or to any of the excipients. Warnings and precautions: Asthmatics and atopic patients should consult a doctor before using the medicine. Contains E218 and E216 that may cause allergic reactions (possibly delayed). Patients with HFI, glucose-galactose malabsorption or sucrase-isomaltase insu ciency should not take the medicine. The additive e ect of concomitantly administered products containing fructose (or sorbitol) and dietary intake of fructose (or sorbitol) should be considered. Pregnancy and lactation: Not recommended. Side e ects: pruritus, rash, urticaria, angioedema, anaphylactic reaction, oral mucosal blistering, abdominal pain, diarrhoea, nausea, vomiting, dyspnoea, exacerbation of asthma. Legal classification: GSL. TR 2006/001/001.TR Holder: Kwizda Pharma GmbH, E ngergasse 21, A-1160 Vienna, Austria. RRP (ex VAT): €4.99. Date of preparation: 05/2022. SPC: http://www.medicines.ie/ medicine/16380/SPC/Buttercup%2BBronchostop%2BCough%2BSyrup/ http://www.medicines.ie/medicine/16380/SPC/Buttercup+Bronchostop+Cough+Syrup/ Date of preparation: July 2022. IRE BRO 2022 31 BronchoStop IPN Strip Ad (210x35mm) v3 (Hires).pdf 1 15/08/2022 12:06
• Are short of breath or have a wheeze
• Nocturnal cough e.g. asthma
Types of presenting cough and OTC pharmacy treatments
A class of blood pressure medication called ACE inhibitors can cause a persistent dry cough in some people. Examples include ramipril, perindopril, and Lisinopril. Approximately 10-15% of people who use this class of blood pressure medication experience a dry cough, and the incidence appears to be higher in women.9 If the cough is due to the patient taking angiotensin-converting enzyme inhibitor medication, this medicine should be discontinued by the GP, and an aldosteronereceptor blocking medicine started in its place.1 The 3 most common causes of chronic cough in non-smokers who are not taking an ACE inhibitor are asthma, acid reflux, and postnasal drip.5 Through careful questioning and the identification of red flags and danger symptoms, the pharmacist can determine whether the patient needs to be referred to the GP or seek urgent medical attention. Individuals presenting to a pharmacy with a cough should be referred to the GP if they;
• Have a hacking cough or cannot stop coughing and it is getting worse
• Have a persistent cough for more than three weeks
• Have hoarseness lasting more than 3 weeks
• Onset (acute or gradual) and duration of cough
• Have systemic symptoms e.g. fever, night sweats, unexplained weight loss
• Have asthma or a chronic lung condition
• Have a weak immune system
An acute cough, of less than three weeks’ duration, is often caused by a viral respiratory tract infection, and is one of the most common reasons for accessing healthcare in the community. The most common causes of acute cough in adults are acute viral upper respiratory tract infections (URTIs), such as the common cold. Infections of the lower airways, including acute viral bronchitis, pertussis, and tuberculosis, are also potential causes of acute cough. Acute bronchitis is typically viral in aetiology, but bacterial infection is the source in approximately 10% of cases. Antibiotics are not usually prescribed for coughs, and will only be prescribed if a bacterial infection is present, or the patient is at risk of complications.1, 2 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 SARSCoV-2 (Covid-19) infection, and this must always be considered when a patient presents with a cough, and investigated and treated appropriately.
finding
• Have excessive sputum production Experience recurrent chest infections Experience difficulty swallowing when eating or drinking
•
• Describe the cough e.g. productive, dry, barking, tickly
• Are it difficult to breathe
1, 4, 5
• Have a suspected adverse drug reaction
• Travel history e.g. recent travel to a TB prevalent area or a recent long-haul flight
• Have pain on inspiration
• Substance misuse—does the patient display any warning signs of substance misuse or addiction
OTC Cough Treatments8 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. There is limited quality evidence for the benefit of these agents, however, consumer demand can be high. Caution should be taken with preparations that may cause drowsiness such as codeine and notknownatoxicity.knownpatientsandimplicatedDextromethorphandihydrocodeine.hasbeeninserotonintoxicityshouldnotbegiventotakingotherdrugstocontributetoserotoninPatientspresentingwithnon-productivecoughwhoaretohaveasthmashouldbegivencoughsuppressants
Certain(decongestants)coughremedies
• guaifenesin or ipecacuanha (expectorants) • phenylephrine oxymetazoline,ephedrinepseudoephedrinehydrochloride,hydrochloride,hydrochloride,or xylometazoline hydrochloride
• dextromethorphan or pholcodeine suppressants)(cough
Over the counter cough and cold medicines can be considered for children aged 6-12 years, after the basic principles of best care have been tried, but treatment should be restricted to 5 days or less. Children should not be given more than one brand of cough or cold preparation at a time because different brands may contain the same active ingredients. Care should always be taken to give the correct dose.10 Steam inhalations, used safely under adult guidance congestion and make it easier for a child to expel built-up mucus. A humidifier can be used to keep the air moist and clear, and products such as vapour rub or balms containing essential oils such as eucalyptus can also help loosen nasal and chest congestion.11
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. It is important to check with the pharmacist which cough remedies are suitable for children under 6 years of age, and if there are any contraindications or possible interactions to its use for each individual child.9
The best advice for coughs in the under sixes, is to rest and drink plenty of fluids. If the child is over 1 year of age, a warm drink of lemon and honey may be useful. However, honey should not be given to a child under 1 years of age. Most coughs and colds in children under six resolve quickly, however, if the cough is not improving, or there are signs of a bacterial infection, it is advisable to be seen by the GP as an antibiotic may be needed. Over 80% of coughs and colds however, are viral in nature, and antibiotics do not treat viral infections.9
43 six years should not be given OTC cough and cold medicine containing;10 • diphenhydramine,chlorphenaminebrompheniramine,maleate,doxylamine, promethazine or triprolidine (antihistamines)
as these may contribute to respiratory depression or mask signs and symptoms of asthma flare-ups. Narcotic cough suppressants may be subject to abuse and misuse and this must be considered when supplying.
In order to combat abuse and misuse, some formulations contain laxatives such as sorbitol to discourage consumption of supratherapeutic doses.5
Productive coughs present as a cough where mucus is expectorated when coughing. 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. Expectorants, such as guaifenesin, stimulate the secretion of mucus in the airways and reduce adhesion to improve the efficacy of coughing in clearing mucus. Mucolytics, for example, bromhexine, act to thin the mucus to facilitate easier clearance. Mucolytics and expectorants are sometimes sold in combination products to provide a synergistic effect in aiding cough management. Similar to antitussives, quality to relieve ANY coughbased on traditional use Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty coughs and dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use as a traditional remedy. Adults and children over 12 years: 15ml every 4 hours, 4 times per day. Max 6 doses (90ml) per day. Max dose should not be exceeded. To be taken 30 to 60 minutes before or after intake of other medicines. Not recommended for children under 12 years. To be administered undiluted or diluted in water or warm tea. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Hypersensitivity to marshmallow root, thyme, to other members of the Lamiaceae family or to any of the excipients. Warnings and precautions: Asthmatics and atopic patients should consult a doctor before using the medicine. Contains E218 and E216 that may cause allergic reactions (possibly delayed). Patients with HFI, glucose-galactose malabsorption or sucrase-isomaltase insu ciency should not take the medicine. The additive e ect of concomitantly administered products containing fructose (or sorbitol) and dietary intake of fructose (or sorbitol) should be considered. Pregnancy and lactation: Not recommended. Side e ects: pruritus, rash, urticaria, angioedema, anaphylactic reaction, oral mucosal blistering, abdominal pain, diarrhoea, nausea, vomiting, dyspnoea, exacerbation of asthma. Legal classification: GSL. TR 2006/001/001.TR Holder: Kwizda Pharma GmbH, E ngergasse 21, A-1160 Vienna, Austria. RRP (ex VAT): €4.99. Date of preparation: 05/2022. SPC: http://www.medicines.ie/ medicine/16380/SPC/Buttercup%2BBronchostop%2BCough%2BSyrup/ http://www.medicines.ie/medicine/16380/SPC/Buttercup+Bronchostop+Cough+Syrup/ Date of preparation: July 2022. IRE BRO 2022 31 BronchoStop IPN Strip Ad (210x35mm) v3 (Hires).pdf 1 15/08/2022 12:06
• Indicated for the symptomatic relief of non-productive (dry, tickly or irritating) coughs
• Codeine can cause sedation and constipation
• Codeine, pholcodine and dextromethorphan all carry the potential for abuse, however, pholcodine and dextromethorphan have a lower abuse potential compared to codeine
•contraindicated.5Demulcentcough preparations coat and soothe the back of the throat and they contain soothing ingredients such as glycerol, syrup and/or honey.
• Guaifenesin has no known clinically significant drug interactions
Antihistamines8
• Cough/cold preparations containing sodium: Check sodium content and assess whether the cough/cold preparation is suitable for the patient e.g. low sodium diet, renal impairment, cardiovascular disease
• Cough suppressants should be used with caution in asthmatics
• OTC cough and cold medicines containing guaifenesin and ipecacuanha should not be used
• Codeine and pholcodine are opioid cough suppressants, whereas dextromethorphan is a non-opioid cough suppressant
• Antihistamines dry up the nasal and bronchial secretions and are indicated for the relief of cough and/or nasal symptoms e.g. rhinorrhoea, and sneezing
• e.g. guaifenesin, ammonium chloride, ipecacuanha, squill
44 CPD: Cough evidence for the clinical efficacy of expectorants and mucolytics is limited.5
• Indicated for the symptomatic relief of cough
Herbal medicines are popular in the treatment of minor medical conditions, including coughs. Herbal medicinal products on the Irish market must be either authorised or registered with the HPRA. Effective regulation of herbal medicines is considered necessary in order to ensure that safe products of appropriate quality continue to be available in pharmacies and other outlets. If an herbal medicinal product does not meet the criteria for registration as a traditional herbal medicinal product (THMP), it can still be granted a marketing authorisation (MA) in the same way as nonherbal medicines.11
• Demulcent cough preparations are inexpensive, and are safe
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. It is always important to check with the pharmacist if traditional herbal remedy products for coughs or other illnesses are suitable, and if there are any contraindications or possible interactions with its use for the individual Consumersperson.12should also be made aware that THR products are intended for conditions that can be self-medicated and which do not require medical supervision such as minor coughs, colds and general aches and pains. Using THR products for more serious conditions could be harmful, especially if there is delay in individuals seeking medical advice. Claims made for THR products are based on traditional use, and not on evidence of the products effectiveness.12
Other Important OTC Cough Treatment Considerations8
• Do not recommend a cough/ cold preparation containing illogical combinations such as an antitussive and expectorant
Medical Devices for Coughs
• Cough/cold preparations containing alcohol: Check alcohol content and assess whether the cough/cold preparation is suitable for the patient. Is there a history of alcohol abuse? Is the patient taking an existing medicine that may interact with the alcohol present in the cough/cold preparation? Who is it for, e.g. child, pregnant or breastfeeding woman?
Cough (Antitussives)Suppressants8
• Indicated for the symptomatic relief of productive coughs
• Antihistamines can cause anticholinergic adverse effects such as dry mouth, constipation, blurred vision, urinary retention, exacerbation and precipitation of acute angle-closure glaucoma and should not be recommended in patients with glaucoma or prostate enlargement
• Examples include paediatric simple linctus, simple linctus, glycerine, lemon and honey linctus
Demulcents8 Demulcents relieve irritation of the mucous membranes by forming a protective film. Demulcents such as simple syrup or honey are non-medicated alternative for cough syrups. These ingredients are included in many cough syrups and may increase salivation and the secretion of pulmonary mucus.
• OTC cold/cough preparations containing promethazine,diphenhydramine,chlorpheniramine,brompheniramine,doxylamine,andtriprolidine should not be used in children under 6 years of age
• OTC cough and cold medicines containing dextromethorphan and pholcodine should not be used in children under 6 years of age
• Recommend a sugar-free cough/cold preparation over one containing sugar in children or people with diabetes
These are safe to use in children and other populations where medicated syrups or lozenges are
Prescribed inhalers are available for a number of respiratory conditions associated with cough such as asthma and COPD. The GP or Pharmacist should be consulted on the most suitable medical devices for coughs and respiratory symptoms.
• Pholcodeine is contraindicated in bronchiectasis- bronchiolitis in children; chronic bronchitisCOPD in adults; and in patients at risk of respiratory failure10 Expectorants8
• There is little evidence on the effectiveness of expectorants. More likely they serve as a placebo effect, however, some report them as being useful in alleviating cough symptoms
• e.g. codeine, pholcodine, dextromethorphan
Traditional Herbal Remedies (THRs)
• Codeine-containing OTC liquid medicines should not be used for cough suppression in children and young people less than age 18 years of age
• They are pharmacological inert, and used mainly for their placebo effect
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.12
A range of medical devices for coughs and respiratory symptoms are available at pharmacies nationwide, including humidifiers, inhalers, and nebulizers among other products. A nebulizer is a type of breathing device that can be used to inhale medicated vapours. While not always prescribed for a cough, nebulizers may be used to relieve coughs and other symptoms caused by respiratory illnesses. Steam mist humidifiers release soothing vapour into the air to help provide temporary relief from cough and congestion. The warm mist helps reduce respiratory discomfort by increasing humidity levels to help the individual breathe better and sleep more comfortably.
Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty coughs and dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use as a traditional remedy. Adults and children over 12 years: 15ml every 4 hours, 4 times per day. Max 6 doses (90ml) per day. Max dose should not be exceeded. To be taken 30 to 60 minutes before or after intake of other medicines. Not recommended for children under 12 years. To be administered undiluted or diluted in water or warm tea. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Hypersensitivity to marshmallow root, thyme, to other members of the Lamiaceae family or to any of the excipients. Warnings and precautions: Asthmatics and atopic patients should consult a doctor before using the medicine. Contains E218 and E216 that may cause allergic reactions (possibly delayed). Patients with HFI, glucose-galactose malabsorption or sucrase-isomaltase insu ciency should not take the medicine. The additive e ect of concomitantly administered products containing fructose (or sorbitol) and dietary intake of fructose (or sorbitol) should be considered. Pregnancy and lactation: Not recommended. Side e ects: pruritus, rash, urticaria, angioedema, anaphylactic reaction, oral mucosal blistering, abdominal pain, diarrhoea, nausea, vomiting, dyspnoea, exacerbation of asthma. Legal classification: GSL. TR 2006/001/001.TR Holder: Kwizda Pharma GmbH, E ngergasse 21, A-1160 Vienna, Austria. RRP (ex VAT): €4.99. Date of preparation: 05/2022. SPC: http://www.medicines.ie/ medicine/16380/SPC/Buttercup%2BBronchostop%2BCough%2BSyrup/ http://www.medicines.ie/medicine/16380/SPC/Buttercup+Bronchostop+Cough+Syrup/ Date of preparation: July 2022. IRE BRO 2022 31
• Patients should be advised of the possibility of sedation occurring with pholcodine or dextromethorphan
BronchoStop IPN Strip Ad (210x35mm) v3 (Hires).pdf 1 15/08/2022 12:06
• Check that the cough/cold preparation is age-appropriate
• Antihistamines used in cough and cold preparations include first-generation antihistamines such as diphenhydramine, promethazine and triprolidine
• Antihistamines cause sedation and may be suitable to recommend where the cough is disturbing sleep
References available on request to relieve ANY coughbased on traditional use
We welcome you to use the content we provide for your reflective practice to identify new learnings or how you can improve your knowledge, skills, behaviours, or attitudes within the pharmacy. To recap on any of webinar videos or materials, please contact the United Drug Marketing Department on udwmarketing@united-drug.com Providing meaningful insights, opportunity for business growth and educational experiences to help our pharmacists optimise their Retail Pharmacy and improve patient care. Monthly webinars focused on business growth and improved patient care CPD Learning for your ePortfolio Hear from the industry’s most influential Exclusivespeakers industry insights and trends United Previous2022WebinarDrugSeriesspeakersinclude:LarryRyan Director Behaviour & Attitudes Adam Shanley MPOWER Programme Manager, HIV Ireland Luke O’Neill Professor of Biochemistry Trinity College Dublin Catherine O’Keeffe Menopause Coach and International Speaker Wellness Warrior
“Our work with our covid vaccine clinics has allowed us to be part of the recovery of our society and our communities by delivering almost 3000 doses of covid vaccines so far. When the pharmacy vaccination program was announced, our Superintendent Pharmacist Elaine Lillis and the team were determined that we would play our part in Meaghers to bring our country and our communities out of the isolation and desperation caused by the pandemic, Elaine successfully rallied our pharmacists to organise the swiftest and most efficient system of vaccination within the stores and her efforts certainly were successful. We will continue to deliver booster doses and run vaccine clinics within the Meaghers Group.
PHARMACYNEWSIRELAND.COM 46 Awards
“We truly believe that the position of the pharmacist can be utilised to help our patients live healthier lives
Awards2022The PharmacyIrish
Pharmacy Group – Winners of the GSK Self-Care Award 2022
In 2019 the team opened up our 9th store in Churchtown in Dublin 14. Meagher's continues to be a family run, communitybased pharmacy business. It was recently recognised as a Deloitte Platinum Standard best managed company, and A Great Place to Work, and continues to be recognised as a leader in both customer service and a supplier of leading product ranges. Today, Meagher’s Pharmacy Group is a leader in the Dublin area for delivering excellence in patient care and in the provision of Consultation Services, serving our community and expanding the role of the pharmacist.
Outlining the pharmacy chains’ commitment to self-care, Joanne O’Hagan says, “Meaghers have championed a number of health initiatives over the years. Despite the significant challenges posed during the pandemic, with hard work and tenacity the team at Meaghers Pharmacy has helped countless people in our communities.
Championing Self-Care in Pharmacy
when Oonagh O’Hagan (who had served her Pre-Reg year under the guidance of Pierce Meagher) purchased the store from the Meagher's family. Based on its reputation as a “Community Pharmacy”, it was important to Oonagh to retain the name; Meagher’s Pharmacy as a trading name. Over the next 10 years, five more Meagher’s Pharmacies followed; Ranelagh Village, Glenview Tallaght, Castletymon Tallaght, Barrow Street Dublin and Sandford Road Ranelagh. In 2016 Meagher's opened two new stores, inside the Mater Hospital in Dublin and Kinvara Pharmacy in Dublin 7.
“We truly believe that the position of the pharmacist can be utilised to help our patients live healthier lives and we can not only care for our patients when they are ill but can help them remain well”
Oonagh O’Hagan, Managing Director, Meaghers Pharmacy Group with Dave Barrett, Haleon/GSK Country Manager
Meaghers Pharmacy Group has an extensive portfolio of services and initiatives to assist patients and customers in every aspect of self-care management. Their dedication within this area led to the team winning the GSK Self-Care Award. Meaghers
The GSK Self-Care Award recognises community pharmacy’s commitment to tackling health inequalities and serves to reward achievement in the development and implementation of health promotion, self-care and community excellenceItstrategies/initiatives.wellbeingisdesignedtoencourageintheproduction and dissemination of accessible, welldesigned and clinically balanced patient support. The Meagher’s Pharmacy Group had its roots in Baggot Street, Dublin, Ireland. It was first opened in 1921 and was operated by the Meagher's family up to 2001 Delivering Excellence
Furthermore, they are in the process of setting up Meaghers Pain Clinics. Oonagh says, “This will be the first type of pain clinic run in pharmacies in Ireland. The free appointment will allow patients to review their current pain medication with a specifically trained pharmacist and then allow them to use Bio-electric devices to assist in managing their pain. These devices are showing to have a huge benefit in managing chronic pain, musculoskeletal pain and injury and also helping to reduce recovery time from acute injury or surgery.”
There is a silent epidemic of Non-Alcoholic Fatty Liver Disease (NAFLD) in Ireland and patients with type 2 diabetes, obesity, and high cholesterol are at greater risk of developing this disease which, if undiagnosed and left untreated, may lead to cirrhosis of the liver. Meaghers Pharmacy teamed up with leading Consultant Hepatologist and Gastroenterologist Professor Suzanne Norris, to run several successful liver scans clinics in a number of our pharmacies, the country's only pharmacy-led Diabetes Liver Screen Initiative.
“In the past number of years, we have expanded our marketing communication channels from social media to You tube, TV advertising and now a Meaghers expert Podcast called “Meaghers Matters.” All these communications aid the customer to research and make the decision to purchase and reinforce their belief that they and we can not only care for our patients when they are ill but can help them remain well.”
Dave Barrett, Country General Manager with GSK Consumer Healthcare said, “GSK is delighted to sponsor the 'Self Care Award' which recognises the critical role pharmacists play in our community and the unique engagement pharmacists have with their patients and consumers. “Never has this role been more important than over the last 2 years, when the care and wellbeing of the community has been our industry priority and focus. The award is closely aligned with GSK’s focus on training, and our commitment to adding value through education and other services. Huge well done to Oonagh and the team from Meaghers Pharmacy Group.”
As a pharmacy group and as the gatekeepers of the healthcare system, it has been of paramount importance that we navigate the ever-changing customer preferences and rapidly innovate to redesign customer experience journeys as is needed. We found we are uniquely placed to offer people the extra information, guidance, and support to navigate a novel set of challenges, from keeping their families safe to helping with healthcare concerns like supporting their immune systems, coping with anxiety and children’s health.”
“We are particularly proud and delighted to receive this Award as we champion self-care every day. As we always say, you can’t pour from an empty glass. Huge Thank You to Irish Pharmacy News and to GSK for their support of this very important area.”
The team also recently launched a Travel Antigen Testing Service within Meaghers to enable local communities to travel safely and limit the spread of infection and in March of this year Oonagh and her team partnered with a qualified physiotherapist to supply online pelvic training exercises to customers.
Driving Growth for the Group Joanne concludes, “Meaghers Pharmacy have employed a number of strategies that in the last number of years that has brought our business from local community pharmacy group to a nationally recognised brand of health care providers catering for all health and beauty needs.
As well as adding additional services to the Meaghers portfolio for the benefit of their local community, the team have worked hard to engage with community groups to deliver education and expertise to help their members and reinforce the special position of the pharmacist in the community.
Pictured at a Meaghers Pharmacy World Cancer Event are Oonagh O’Hagan, Managing Director, Meaghers Pharmacy Group with Lisa Murray, Pharmacist, Meaghers Pharmacy and Dr Pranshul Chauhan
are purchasing from the best possible source in Meaghers, it is an objective of Meaghers to continue to innovate and bring the customer on that journey with us. We will continue to grow our online business and access new markets with this approach.”
Detailing more about this Joanne adds, “We have devised a series of healthcare talks to male community groups including Men’s health with Men’s sheds and a PREP awareness talks to Emerald Warriors an inclusive rugby club based within Dublin's LGBT community. This provides content for internal staff bulletins of local offices with the aim of educating their staff on topics such as flu vaccines, COVID vaccines & boosters and making staff aware of pharmacy services available.
Easing Pressure Managing Director Oonagh O’Hagan explains, “We have also mobilised our pharmacists having them personally call to our vulnerable patients to assess their medicine compliance and assist in the area of medical devices, such as stoma care, diabetes equipment and medical dressings. We worked with other healthcare professionals in this regard in an attempt to take pressure off local GP’s and nursing agencies.
“Seeing the pressure our local GP surgeries were under, we launched The Meaghers Online GP service, the Meaghers digital pharmacist service and a nationwide prescription delivery service where patients had access to a 360-degree healthcare service when it came to having prescriptions refilled and health concerns addressed within Meaghers from the safety of their homes during lockdown.”
Oonagh commented after winning their award, “We are beyond thrilled to have our work on preventative screening recognised by the judges, in particular our work with Professor Suzanne Norris from the Liver Wellness Unit at St James’s Hospital. This was the first ever NAFLD screening service in a community pharmacy setting in Europe.
PHARMACYNEWSIRELAND.COM 47
“We have explored through our digital campaign’s subjects such as menopause, fertility, gut health and HIV. Our newest initiative is our Podcast that seeks to explore these subjects even further and bring the information to a wider audiencethe Meaghers Matters podcast.
The Manly Way Manly, Ireland’s Men’s Health Pharmacy takes a pharmacist-led, whole-man approach to men’s health and wellness.
Nuala’s website offers the personal approachable style men want from their pharmacy, combined with the convenience and discretion of online ordering. “That’s the Manly way,” she says.
Outlining the triggers that prompted this customer-led digital transformation, Nuala tells us, “The challenges were felt very strongly throughout the pandemic, forcing businesses to create new roadmaps for success. COVID-19 and the digital imperative have rapidly recalibrated the business landscape, especially in pharmacy.
As a small local business, we felt and saw a huge decline in our business and revenues while being expected to offer excellent personalised service to customers online and off, and an exceptional employee experience.
She adds, “Manly is unique as it is for men, speaks to men and focuses on products relevant to men. Manly provides a convenient, confidential and discreet healthcare platform for men to access healthcare without waiting rooms.
“Our existing online pharmacy website, glenpharmacy.ie, was competing in a hugely competitive and saturated market due to the pandemic forcing almost all pharmacy owners to create an online presence for their business.”
PHARMACYNEWSIRELAND.COM 48 Awards
Nuala Carey, Pharmacist & Owner, Glengarriff Pharmacy with Adam Lee, General Manager for Ireland, Reckitt With their existing online pharmacy website glenpharmacy.ie, competing in a hugely competitive market, Nuala Carey recognised a niche in the market which wasn’t being catered for and set about creating manly.ie as a second online business. Having consulted with industry and retail experts, she set about creating a solution for this market. Manly.ie – Ireland’s only online pharmacy offering for men was launched in November 2021 after nine months of research, development and hard work. Glengarriff
Nuala explains, “There’s no one way to be manly – with our website, men are able to define their own goals and we help them to achieve them.
“Manly makes it easy for men to take care of themselves from the inside out.
Pharmacy: Winners of the Reckitt OTC Online Pharmacy Retailer of the Year Award 2022
“Whether they want to improve their fitness, find solutions to medical niggles, ask advice on an issue they find embarrassing, or get their presentation on point, we’re here to help.”
Overcoming Challenges
Anduncomfortablemenwepharmacies,communityknowthatoftenfeelinapharmacysetting.clear,practicalandsupportiveadviceaboutmen’shealth,careandgroomingcanoftenbehardtofind”
Nuala Discovers a Winning Niche
Awards2022The PharmacyIrish
“Health is the foundation of feeling good. Manly has a full range of men’s pharmacy products. And also customers can call on our confidential online consultation services to make sure they get back to their best fast and effectively.”
“From our years of experience gained in Irish
“Our Manly Health Hub is a no-nonsense, fact filled information centre for men and all things related to men’s health, from erectile dysfunction to vegan diet tips, we aim to create a huge library of articles for men to refer to and gain knowledge and expertise from.”
“Our hand-picked pharmacist team is equipped with expert knowledge, as well as years of experience and training. And each one of us is ready to listen, give advice, and tailor solutions to customer-specific needs.
Nuala recognised a niche in the market which wasn’t being catered for. And so set about creating manly.ie as a second online business with the hope of increasing revenue and productivity.
A 2012 survey by the UK’s National Pharmacy Association found that:
Men visit their GP four times a year, while women visit six times, on average.
“Producing a second website proved costly in terms of revenue and time,” she adds. “Cost is the biggest challenge when driving a digital transformation, especially in uncertain times. Getting the workforce to embrace new tech and processes was challenging. And, as Glenpharmacy.ie was focused on a predominantly female market, we had to develop an online voice to connect with men too.
Accepting the Award, Nuala said, “Firstly, I would like to thank the Irish Pharmacy Awards for this Award. To say we are delighted would be an understatement. As a small, independent, family-run pharmacy business it means so much to even be in such esteemed company as the fellow finalists, not to mind to win the Award!
More men than women admit to having a poor understanding of medicines.
“Creating a new identity online for Manly included creating social media platforms also. Growing a platform on social media is extremely challenging and we continue to work and train on this on an ongoing basis.
“Last year, we set out to create an Irish pharmacy to support men's health, wellness, and grooming. So to be named best online pharmacy website of the year for manly.ie, against such stiff competition, is truly rewarding. This recognition is such a boost for our team that has dedicated so much time and hard work to this project.
Adam Lee, General Manager –Health, Reckitt commented, “On behalf of Reckitt, I am honoured to recognise the excellent work of OTC and online pharmacy retailer teams this year, and to thank them for their relentless hard work and dedication providing the public with the medication, advice, and self-care products they have needed to protect their health.
“We offer discreet home delivery, specialist advice, and tailored solutions through our subscription
grooming can often be hard to find. As a result, many men can find themselves buying unsuitable products when they do visit a chemist or order online. Others avoid calling in for advice in the first place.
Men visit a pharmacy four times a year while women rack up 18 visits on overage.
Discreet, Tailored Support for Men’s Health
PHARMACYNEWSIRELAND.COM 49
Nuala Carey, Pharmacist & Owner, Glengarriff Pharmacy
“At Reckitt, we also recognise the importance to be prepared for change and to do this, we are always looking for ways to provide you with any necessary support. Our ultimate objective is to ensure we have the right product portfolio that will best meet your needs and sharing world-leading data that will help drive your businesses forward.
“Most worrying was the review’s finding that nearly nine in ten men are uncomfortable calling on a doctor or pharmacist for advice unless they have a serious problem. Men are less likely to access disease screening or healthy-living programmes like ‘stop smoking’ and weight management schemes too.
“Thanks to all of you for the support that's helped us get off to a great start - we've only just begun!”
“Unless men feel more comfortable accessing supports that help them to optimise their health and wellness, they face poorer outcomes, as well as the discomfort and worry that comes from trying to manage without back-up.
“Our marketing has been challenging as we do not have the same kind of budget to allocate as some of the larger pharmacy companies. To date, we have been featured in Hot Press Magazine, The Sunday Business Post, Stellar Magazine with features coming in Irish Golfer, The Gloss and Gay Community News.”
Men are twice as likely to take a new prescription medicine without reading the patient information leaflet or seeking professional advice.
“As a former pharmacist, I understand the vital role pharmacies play in communities across the country, particularly throughout the Covid-19 pandemic. In what was a very uncertain time, all of you went above and beyond for your customers. When people were unable to travel to pharmacies in person during the pandemic, you demonstrated an ability to innovate the customer experience, including the introduction of consultations online. All of you were agile, managed change when it was needed most and worked harder than ever to make sure local communities could access the products they needed.
“We are looking forward to working together in the year ahead to drive more positive change in communities nationwide. To all the finalists in the OTC and online pharmacy retailer category and to Nuala Carey and her team as winners of this Award, we congratulate you on your incredible achievements.”
Nuala goes on to add, “From our years of experience gained in Irish community pharmacies, we know that men often feel uncomfortable in a pharmacy setting. And clear, practical and supportive advice about men’s health, care and
packages, online doctor services, online pharmacist consultations and prescription delivery service.”
PHARMACYNEWSIRELAND.COM 50 Awards Dynamic forAll-CaringandPrinciplesPerrystown
Collectively, they have shown that there is nothing to beat fantastic teamwork and have undertaken a number of initiatives to enhance their customer experience and to better look after their patients.
performing services that would help people manage their health and to feel listened to during their face-to-face consultation.
The Allcare Perrystown team with Gary Kelly, Key Account Manager with Originalis It was Perrystown Allcare Pharmacy that took the final accolade of the evening, the Originalis Community Pharmacy Team of the Year Award 2022.
Awards2022The PharmacyIrish Perrystown Allcare Pharmacy: Winners of the Originalis Community Pharmacy Team of the Year Award 2022
Through communication with this co-ordinator, we were directed to a nurse who had specialist knowledge of all thing’s ostomy.
Emma says, “We noticed during the pandemic that a lot of the older people felt nervous and lonely, and we could best help by
“One project that was managed by us was to set up an ostomy clinic in our pharmacy as we had a wellknown older patient who had a new ostomy and was struggling to come to terms with this new way of life. We wanted to help her liaise with the best person to help. We collaborated with the pharmacist trainer in the Allcare head office who put us in touch with a coordinator in Coloplast company.
really centred ourselves around community in Perrystown and surrounding areas. We are a tight knit, dynamic group who are open and willing to lend an ear when someone needs to have a chat, we are the point of call for the mothers who need someone to understand what they’re going through. We are the pharmacy that will help the elderly make it home safe.”
Reaching out to the Community
The team at Perrystown Allcare Pharmacy are a dynamic team whose main principle is to provide a valuable service to the community by being part of that community. Each member of staff thrives in a supportive environment by receiving positive feedback from the community which always keeps them motivated to strive for excellence. They are the pharmacy who makes a difference in someone’s life. Playing to Strengths Managing Pharmacist Emma Vaughan says of her team “We have really learned to play to our strengths and have provided a strong front for our community and patients time after time regardless of a pandemic. We have
“We also have a great number of ostomy patients and we communicated with them to see if they would also benefit from meeting with the nurse. The nurse called each patient beforehand to prepare any necessary queries in advance. The clinic was conducted in our consultation room and so a familiar environment for our patients and close to their home in which we received great feedback on. The clinic was a huge success, and our patients gave us very positive feedback on it. So much so we are intending on doing another ostomy health check in a few months’ time as requested by our patients.
“We are big believers in the power of the pharmacy being in a prime location in the community to impact the health and connectedness of the people in the area.”
Other projects the team have managed include blood pressure checking clinics in various community centres in the area and in the store. Blood glucose testing clinics, and inhaler technique clinics with the pharmacist in the privacy of the consultation room. “We are big believers in the power of the pharmacy being in a prime location in the community to impact the health and connectedness of the people in the area,” says Emma.
Liaising Locally Emma has a specialist knowledge in children’s allergies, skin conditions and asthma which so many young children are affected by. “We saw a lot of new mothers coming here for advice on this as many heard of it through word of mouth. I organised follow up consultations with new mums and babies to see how much progress was made and to check with new mums how they were doing.”
“At Christmas we did a colouring competition for the children in the neighbourhood, and we displayed all their art in the pharmacy which not only brought a smile to the children’s faces but also to everyone who walked into the pharmacy. Some team members
of the local dentist team also to be community focused.
“We do this to make work enjoyable for all the team and to spread some happiness in the community here- we are rewarded for this with small gestures throughout the year from our loyal customers and at Christmas time especially in which the customers bring hundreds of gifts which is lovely to see.
Probably covering extra shifts or working extra hours and even doing tasks that you never signed up for initially. Some of you may even have been giving vaccinations and we have even seen and heard stories of pharmacies going the extra mile and delivering to customers when it was never expected. At Originalis we also want to leave a footprint.
“We run an efficient business - we are a dispensary focused pharmacy, and we are very busy. We are a dynamic team,” Emma adds.
The team liaised with a local school here in Perrystown and attended their sports day and supplied soccer bibs and a first aid kit for the school. The pharmacy team also held a denim day for dementia to raise money for the Alzheimer’s society of Ireland which was attended by a member
On winning the award Emma said, “This is tremendous for us as a team. Our community in Perrystown is predominantly an older population and so our customers really enjoy coming into the pharmacy daily for advice. This Award really is an appreciation of all the work the team behind me put in, we rally together for our patients and to achieve our goals but most importantly we have fun while we do it and really foster that community spirit. We have just had the best possible night.”
Gary Kelly, Key Account Manager, Originalis said, “These Awards present an exciting opportunity to reward and recognise our Community Pharmacy Teams of the year and to say thanks for the hard work and persistent effort in supporting your local communities through an unusual time of a pandemic.
“Many congratulations to the team at Perrystown Allcare Pharmacy.” Perrystown team celebrating Denim Day for Dementia Christmas Jumper Day for the Allcare Perrystown Pharmacy Team
“Also, from this day we organised an information day for all the staff here with the nurse about all the ostomy products to better our knowledge and therefore be more helpful to our ostomy patients on a day-to-day basis.”
Always keeping everyones spirits high, the team have dress up days for Christmas (Christmas jumper day), Valentines, pancake Tuesday, birthdays. “Basically we bring fun to the community whenever we can think of an excuse,” Emma reflects.
even visited a patient in their home to help her write Christmas cards as she had very bad arthritis in her hands and was struggling to do itshe was over the moon.”
To bring your communities a world class product of the highest quality.
“The great thing about Allcare is they are a very community focused pharmacy group and encourage us to be as inventive as possible to extend our services into the community wherever we can. The targets set for us very much depend on the team reaching out to the patients’ that we already have and to new people who need us.
“In these times everyone needs someone to lean on. The communities lean on you for support and I’m sure you lean on each other for support and stability.
PHARMACYNEWSIRELAND.COM 51
“A target set was to attract new customers to the pharmacy - we decided that the best way to do this was to organise events in the community. During the pandemic we noticed more people in the community relying on us more than even usual. As people could walk into us here, we were in a prime location to help as much as possible. Firstly, us as a team were upskilled by doing vitamins and minerals course provided by Allcare called ‘OTC expert’ as this was in great demand. We also liaised with the GP next door to do many blood pressure checks for them while they weren’t seeing many patients in their rooms so they could keep prescribing as much as possible when necessary.”
“Our main principle is to provide a valuable service to the community here by being part of that community. We want to bring a smile to people’s faces, especially during the past few years when people needed it most. We do this by creating an environment of enjoyment for the staff and then by extension the community we serve here in Perrystown. We run a calendar of events and campaigns through the year in addition to head office marketing plans. Our most recent events included a tree planting ceremony which brought together members of our nursing home, community leaders, community members and team members here. We bought a cherry blossom tree and commissioned a plaque and had a minute’s silence for everyone affected by covid in the last few years- it was a very heart-warming occasion. The cherry blossom is a symbol of hope for better times to come- our area here is an older neighbourhood so we lost a lot of patients and friends that we wanted to remember.
“We supported our local GP’s especially during the pandemic when they were limiting their appointments by doing blood pressure checks for their customers and by running a very efficient vaccine service to take some of the pressure off them. The team have an excellent relationship with the GPs in the area but especially with Perrystown surgery next door which we have a strong bond, which is our main ethospositive relationships.”
“The safety impact of the dissatisfaction with this task was that often more junior members of staff were delegated these tasks. The preparing of blister packs is complex, and the delegation could add increased risk of errors.
PHARMACYNEWSIRELAND.COM 52 Awards
much safer and faster manner and that the pharmacy team have more time with their patients
Innovation forResolving a Need in Pharmacy
“We worked as pharmacy to ensure that the machine was designed for the specific needs of the Irish market including weekly and monthly layouts and that all the warnings and advice required in Ireland was available to the patient in an easy-to-understand format,” she adds.
Awards2022The PharmacyIrish Stacks Pharmacy group: Winners of the
“Our staff feel their requests and voices have been listened to- they are excited with the new system in situ and enjoy using the hassomethingsystem-whichincreasedstaffwellbeingandjobsatisfaction.”
The benefit to the patient is that the blister packs are produced in a
of Ireland Payment Acceptance (BOIPA) Innovation & Service Development Award 2022
Both the machine and software are in house designed in Spain for European systems. The software is web-based so there is access from any computer in the pharmacy and integrates with all Irish pharmacy software.
This system also integrates with any PMR software in Ireland which avoids double entry of data reducing dispensing errors.
Overcoming Challenges
“We surveyed our team and asked them what were the areas of their job that took them away from the patients and that they least enjoyed. The survey showed that blister pack management was number one on this list, so we decided to find a solution.
Explaining more about this innovation and how it came about, Ade Stack, Managing Director of Stacks Pharmacy Group explains, “The average pharmacy has less than a hundred patients per month who require the blister packing service to help manage their medication. The only other options on the market cost five times more than the machine sourced and is larger, more complex with much higher service costs.
“The solution we have introduced provides one that is available to most pharmacies in Ireland. The average patient is on nine different medications all prescribed for different times of the day. This essential task also introduced multiple opportunities for error. The machine from Farmadosis reduces the risk while increasing the speed at every step of the process.”
One of the issues we needed to mitigate was the amount staff removed from customer facing roles,” says Ade. “Pharmacy is a community-based health service but there is a constant demand for backroom (non-patient facing) work including preparing blister packs and the administration relating to the packs “Patient and customer care is an integral part of the pharmacy but often the staff resource was limited especially during Covid, and this put increased pressure on the teams to complete their workload. We were also determined to increase the services and the pharmacies were vaccinating, which was an increase demand on their resources
The team from Stacks Pharmacy Group Niamh Weldon, Helga Murcia, Mary Hahesy, Amy McMahon, Ade Stack, Conor Quirke, Managing Director with BOI Payment Acceptance, Clare Dunne, Helena Walsh, Diana Griffin and Thao Phan Stacks Pharmacy Group have installed the first community sized blister packing machine in Ireland or the UK and the first one outside of Spain. The machine and system simplify the blister packing process helping to reduce errors and staff required for this process. The system decreases processing times significantly. Bank
We have already had a number of pharmacists visit our pharmacies. We are open to sharing our process stream with anyone who wants it.”
“These machines allow any pharmacy to offer a better and safer product to their customers whilst reducing staff time required to deliver their tasks, this in turn, allows the staff to enter more customer facing roles. This is a win-win for both pharmacies and their customer and the template process we have developed will allow community pharmacies to benefit from the invocation in both process and the use of technology
“Our staff feel their requests and voices have been listened to- they are excited with the new system in situ and enjoy using the systemsomething which has increased staff wellbeing and job satisfaction.”
“Overall, we have reduced errors and near misses by 92% and
“Of these deliverables- blister packing is something that requires both close attention and time but is a process that every pharmacy needs to complete.
“Freeing up staff time was a key objective, to be able to focus on more customer facing roles, and we achieved this by training our staff to use the robot to its full potential thus allowing the machine to take away tedious tasks to free up this resource.
“Stacks Pharmacy group use automation in 14 of our 18 pharmacies. We operate 10 sachet production machines, two Consis vending type machines and 10 blister partner machines which use artificial intelligence to record and check the identity of medications. This is the highest penetration of automation in any group in Ireland and we felt that our 20 years of experience in automation would allow us to best select the innovation required to solve the blister packing need in community pharmacy.
Ensuring Functionality Ade and her team visited a number of working sites in Europe of the suppliers of the machines where they observed the machines at work for at least two days. They assessed the current use of the machines and the company’s openness to modify the machine to best suit the Irish market. She continues, “Farmadosis were the clear winner with regard to current functionality, ability to design for the Irish market and future development plans.
“The research our team has done, stakeholder engagement, time in motion studies pre and post selection and after each subsequent installation, option sourcing, selection of final product and risk management has been a journey which started back in 2019 but increased in urgency during Covid.
The average error-near miss rate in the manual preparation of blister packs is 15%.
Offering Safer Products With an ageing population and increased shortage of staff, Ade and her team needed to ensure that they continue to offer an elevated level of service that tackles both issues.
“We reviewed our work flow for each step of the blister pack dispensing and developed a checklist so we could compare the solutions to our ideal outcomes.”
“Our final decision and the system we have implemented has decreased human error and increased the productivity of our pharmacies allowing our staff to spend critical time looking after customers, facilitating other pharmacy tasks all whilst we were able to take more patients requiring blister packs.
increased blister patients by 17 % without needing to hire additional members of the team. We were also able to introduce additional services such as vaccination without increasing staff numbers because of the amount of time freed up.
Presenting the Award to the Stacks Pharmacy team on the night was Conor Quirke, Managing Director with BOI Payment Acceptance. General Manager of BOI Payment Acceptance Brian Cleary congratulated all the finalists and Stacks Pharmacy on their win stating, “BOI Payment Acceptance (BOIPA) is a leading payment technology and services provider. BOIPA offers an array of innovative, reliable, and secure payment solutions to merchants ranging from small and mid-size enterprises to large corporates across Ireland. We offer solutions for debit and credit card acceptance across physical point of sale, eCommerce, unattended and in-app payments.
There has also been additional time saving has been due to the pharmacist’s increased confidence in the reliability of the machine over manual packing.
Stacks Pharmacy Group this year installed a new state-of-the art blister packing machine
production of both monthly blisters where all of their medication for one time of the day is in one card as well as the weekly cards which are standard in Europe.”
“We have worked with Farmadosis and Edia Healthcare who are their Irish agents and service support company plus the software vendors to ensure that the process has been refined to the benefit of future installations starting at our first installation. We used the PDSA cycle model starting with models which checked each step compared to manual and then once the system was dispensing and producing successfully, we refined the system continuously so that it became quicker and more efficient.
“Each installation has brought efficiency to the process which will make it easier to be rolled out in other community pharmacies.
“During Covid, we were often short staffed due to illness and isolation. Our staff have deliverables which require close attention but with a quick turnaround. With the reduction in staff, this increased the risk of errors. The machine completely mitigates human error and decreases this risk.
“In addition to this, an objective was to eliminate packing errors, human errors. We ensured that the machine we identified would mitigate this risk by be willing to integrate with all of the software vendors used in community pharmacy in Ireland.
With the machine we now can produce a blister pack in a tenth of the staff time taken previously, freeing these resources to patient facing activities.
Ade continues, “By reducing this by over 90%, we have freed up a lot of pharmacist time on rechecks. This saves at least two hours of pharmacist’s time per week.
“BOIPA is delighted to be sponsoring the Innovation & Service Development (Chain) Award recognising pharmacy chains that have prioritised innovation to best serve the needs of their customers, notably during the Covid-19 pandemic while navigating unprecedented challenges. We would like to thank the pharmacy sector as a whole for going above and beyond for communities across the country throughout the pandemic.”
“After testing the first machine for a few months on our site in Kilbarrack (Co. Dublin) it proved to be a success and we have since purchased another 4 machines for different sites in 4 different counties. We have been very involved in the development of the machine and there have been a number of physical and software changes to the machine based on our feedback during those first few months to make it more reliable and easier to use. This included revised design of some parts that need to be more robust due to the physical movement in the pharmacies, software changes to allow for the
PHARMACYNEWSIRELAND.COM 53
Being first to market, the CarePlus Pharmacy group have proven just how digitally advanced they are as a brand, as well as their commitment to providing exceptional service to their members and customers. The team are continuously working to improve their offering, with a real drive for progression and innovation when it comes to their customers' health and wellbeing. Sarah-Jane Bruton, Head of Merchandising with CarePlus Pharmacy group tells us, “CarePlus didn't develop the automationcentric design with COVID-19 in mind as it was in development prepandemic. However, eliminating clutter in the store, creating more open floorspace for customers to move around, and minimising the need for staff to manually move items on shelf has definitely been a bonus in recent times.
“Our development team also worked closely with the Commercial and Buying teams to design a bespoke solution to support the best planograms and categories that would appeal to the customer demographic. The digital design of each screen was built to our brand guidelines to ensure seamless incorporation within the store and on our other digital channels, such as website and social media.
for
“In our digital fit outs, we install a bespoke robotic system to support the introduction of multiple digital screen points throughout the store, from large format 55", to smaller, portable, handheld devices at consultation points. The fulfilment and delivery system to support the screens was designed to not only add theatre, but to ensure efficiencies at every customer touchpoint.
“We worked in tandem with the Store Development and Design teams to develop a brand-new customer journey and store layout. The updated store layout was worked around the design of the ScreenVend solution to ensure we elevated the in-store customer experience.
“We designed privacy screens at each digital screen to ensure the greatest level of comfort for the customer, as well as sanitation stations at each screen to ensure hygiene standards were maintained.
Award 2022
“The new generation, digital screen system appeals to both the customer and the owner as it frees up so much floorspace. The design proves particularly useful for pharmacies with an empty floor above the shop, where the Gollmann robot which dispenses the stock could be held. This digital and robotics solution is ideal for any pharmacy size, even pharmacies with smaller store footprints.”
A new Generation Pharmacy
Awards The PharmacyIrish CarePlus Pharmacy Group: Winners of the Easolief DUO Business Development (Chain)
Sarah-Jane Bruton and Aisling Smith, CarePlus Pharmacy Group with Samantha Doundoulakis, Marketing Manager for Easolief DUO, Clonmel Healthcare CarePlus Pharmacy Group are not afraid to explore how new technology can enhance their service offering. Their new generation, digital system offers both theatre and commercial appeal, as it frees up so much floorspace.
Launching their first digital pharmacy was a huge opportunity for CarePlus, who quickly set about engaging and involving stakeholders. “We hosted consultation sessions with the owner, pharmacist and store teams to gain an insight into the demographics of the CarePlus customer and a broader understanding of the day to day running of the pharmacy,” Sarah-Jane explains.
2022
“This system frees up the pharmacist to do what they were trained to do – help and advise customers. The conceptpioneeringprovides a robust, secure and efficient way to meet customers’ needs”
PHARMACYNEWSIRELAND.COM 54 Awards
This innovation demonstrates that CarePlus are not afraid to explore how this technology can integrate with the current systems easily, and being the first to market has proven how digitally advanced the CarePlus brand is.
Sarah-Jane adds, “We are continuously working to improve our offering; for both our customers and our store owners. The CarePlus support team proactively work with retail pharmacists to provide them with the technology that allows them more time to focus on the health and wellbeing of their customers in the community.
“CarePlus Pharmacy is one of the first in the world to fully embrace a digital model. Shelves are replaced with screens, allowing a much wider range to be carried, replicating the experience that consumers have become accustomed to when shopping online. That experience is combined with the benefit of having staff nearby to assist, while allowing pharmacists to spend more time at the front of the store. We are delighted to have introduced this digital model into 5 of our CarePlus stores nationwide, with many other stores in the pipeline for the near future.”
“At first glance, the main difference is the absence of large shelving units and product displays on the shop floor. Screens around the store are either self-navigated or staff-assisted, and enable customers to choose from a full range of over-the-counter products, vitamins and beauty products, from a series of easy-tonavigate virtual shelves. There is considerably less stock on display on physical shelves, as it is stored in the robot, and dispensed when a purchase is made at the screen.”
The team discovered early in the process that this innovation could tackle some of the perennial problems in pharmacies, such as human error, operational inefficiencies, date rotation and theft or shrinkage.
retail pharmacy landscape, when Eoghan’s second outlet opened as a fully digital pharmacy in Loughrea, Co. Galway – the first of its kind in Ireland and Europe. Customers who visit the fully digital pharmacy will find a completely re-imagined environment. There are no physical shelves, now replaced with digital screens, and the layout is bright, airy and open, allowing for a more spacious shop floor and a new, interactive customer experience, with plenty of room for social distancing.
Sarah-Jane said on winning the award, “The entire team at CarePlus are delighted with this award. I think it’s important that community pharmacy teams embrace technology and the digital model, and get behind it as it really pays off when you do. The Irish Pharmacy Awards allow us to celebrate our success, find out what has worked well for us during the year and have a night out together after having worked at a distance. There are better things yet to come.”
Sarah-Jane continues, “Fast forward through many months of development of a bespoke platform and software, plus investing in a top-of-the-range Gollmann robot, and the first digital CarePlus Pharmacy was unveiled in May 2020 in Dunboyne, County Meath.
“Business development is now more vital than ever, to ensure the sustainability of this sector into the future. On behalf of Easolief DUO, a unique combination analgesic from Clonmel Healthcare, we say a huge congratulations to CarePlus Pharmacy group, and we recognise the extremely high standard of all of this year’s entries.” The new generation, digital pharmacy at CarePlus
“This system frees up the pharmacist to do what they were trained to do – help and advise customers. The pioneering concept provides a robust, secure and efficient way to meet customers’ needs.
“Pharmacy owners who make the transition to a new generation, digital set-up will see benefits including growth in average basket size and value, as well as an increase in their non-ethical margin. OTC medicine sales have been shown to record a significant increase. Rates of stock loss (thought to run at >10%) and damages fall, while the robotic system eliminates expiry date
Pharmacist Eoghan Hanly has been a member of the CarePlus Pharmacy network since the early days of the company. In early 2021 he marked a major milestone for CarePlus and the “We wanted to include customers in the focus group, as they have personal experience interacting within the pharmacy. We found this step very important to gather feedback and ensure we were meeting customers' needs.”
Sam Doundoulakis, Marketing Manager, Easolief DUO, Clonmel Healthcare said, “Clonmel Healthcare is delighted to be associated with the annual Irish Pharmacy Awards. We are very pleased to see that such an important event in the social calendar is finally able to take place again. The contribution made by pharmacists and pharmacy staff to the health of the community over this historically difficult period must be applauded.
CarePlus introduced new technology to enhance their service offering
The screens and dispensing system are linked to a large Gollmann robot at the rear of the store, which delivers the customer's chosen products to the point of sale, via a specially designed chute system which can deliver product to multiple points in the store. The robot can store up to 20,000 individual items in an incredibly efficient manner, all of which are accessible through a click on the screen or via the dispensary system.
PHARMACYNEWSIRELAND.COM 55 concerns and human error. For perhaps the first time, business owners can look forward to a perfect till reconciliation at the end of each day.”
• Visible flexural eczema
• Flexural orwrists,knees,suchinvolvinginvolvement,skincreasesasbehindthebendsofelbows,frontofankles,neck
A strong risk factor for AE is a positive family history. The strongest known genetic risk factor in AE is associated with null mutations in filaggrin gene (FLG), which encodes a key epidermal structural protein filaggrin, which is necessary for skin barrier function.
The causes of this common inflammatory skin disease are complex, and comprises an interplay of genetics, immunologic and environmental triggers, that contribute to a skin barrier disruption and abnormal immune system response.
The epidermis acts as a barrier, preventing water loss, as well as entry of foreign substances such as irritants, microbes and allergens. The epidermal barrier is made up of structural proteins including filaggrin (FLG). FLG deficiencies or mutations in the epidermis result in a weakened skin barrier, as it is less able to retain water, and the lipids that surround and support the cells break down more quickly. The impaired skin barrier allows loss of moisture and irritants or allergens to pass through the skin more easily. This can ultimately prompt an inflammatory cascade.
• Onset of signs and symptoms in the first two years of life Validated measures of severity in AE, include SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Patient Orientated Eczema Measure (POEM). Measurement techniques can be helpful in assessment, monitoring and guidance on effective Amanagement.reallyuseful health-related quality of life measurement tool used in clinical practice is the Dermatology Life Quality Index (DLQI). This tool is not AE specific, however it helps clinicians to assess the impact of AE on the person’s
According to the UK Working Party diagnostic criteria, a diagnosis for AE requires: patients must have a history of itchy skin plus a minimum of 3 of the following;
• History of generally dry skin in the last 12 months
56 | PHARMACYNEWSIRELAND.COM
Assessment atopicmanagementandofeczema
Written by Michelle Greenwood, Health Promotion Manager, Irish Skin Foundation
Atopic eczema (AE), also known as atopic dermatitis, is a chronic, inflammatory skin condition characterised by intense itch and recurring eczematous lesions. This common inflammatory skin disorder affects people of all ages and ethnicities, approximately affecting up to 20% of children and 10% of adults.
Presentation
Clinical presentation varies from mild to severe and depending on severity, symptoms can include severe dryness caused by a dysfunctional epidermal barrier, intense itching, cutaneous inflammation and vesicle formation. AE symptoms have a chronic, or relapsing disease course.
Cause and risk factors
Triggers of AE may include, allergen exposure such as house dust mite, whereas, non-allergic factors such as Staphylococcus aureus infection, abrasive garments, temperature changes, stress, and exposure to irritants such as detergents, harsh soaps and fragrances and habitual scratching can disrupt the skin barrier function.
Focusing on Eczema in Pharmacy The Irish Skin Foundation highlights World Eczema Day: 14 September 2022
Itch is a major symptom of AE, and scratching only provides temporary relief, and leads to more itching and scratching, which is often referred to as the ‘itch-scratch-cycle’. The clinical appearance of AE may be modified by scratching, which in time may produce lichenification, broken skin surface resulting in excoriations, exudate and secondary infection. Appearance and location of eczematous lesions of AE may vary with age, and three stages have been recognised, infancy, childhood and adolescent/adult.
• Personal history of asthma or hay fever (or history of atopic disease in a first degree relative, if patient is under 4 years)
Key principals in AE management are: restoring the skin barrier with emollient therapy, baseline trigger avoidance, anti-inflammatory treatment with topical steroids or topical calcineurin inhibitors. In moderate to severe AE, phototherapy or systemic agents may be considered.
Trigger avoidance and Topical treatments Trigger avoidance: Taking a careful history to help identify any relationship between suspected triggers and AE skin symptoms is important.
Emollients: Ongoing, practical application of over-the-counter emollients is the cornerstone of treatment for the condition, as dry skin is one of the predominant manifestations of AE. The purpose of emollients is to improve the skin barrier by restoring and maintaining skin hydration, therefore soothing the skin and reducing pruritus. Emollients are also a crucial element of maintenance treatment and also in the prevention of flares. Adults require at least 500g/ per week and children at least 250g/per week. Pump dispensers are preferable, in order to prevent contamination. The use of emollient wash products instead of ordinary soaps and bubble baths are also recommended. Bathing should be limited to short periods of time (e.g. 5-10 minutes) with warm water, and when finished, followed by application of emollients. When choosing an emollient, individual preference, skin type, skin dryness, inflammation and body area may be considered to help promote adherence.
Identification, elimination and/or control of exacerbating triggers maybe helpful in preventing recurrent symptoms and disease deterioration. Irritants in the environment, such as physical (fabrics such as wool) household chemicals (bleaches or solvents) can aggravate affected skin in people living with AE.
In July 2020 the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK, in partnership with the National Fire Chiefs Council, launched a campaign
PHARMACYNEWSIRELAND.COM | 57 life and assists the clinician to measure effectiveness of treatments. DLQI scores range from 0 (no impairment of quality of life) to 30 (maximum impairment). For children, there is the Children’s Dermatology Life Quality Index (CDLQI) which is also available with added cartoons. The aim of the questionnaire is to measure how much did the child’s skin condition affect them in the last week. Once a diagnosis of AE is established, treatment decisions are based on disease activity and impact of the disease on the patient’s quality of life. Management AE is a life-long skin condition, so the main aim of treatment is to improve symptoms and achieve long-term control. Typically a multistep treatment approach may be considered, according to severity of the disease, patients age, its extent and distribution.
Consideration for non-allergic triggers, may include, psychological stress, temperature extremes, and dry wintery or conditioned air.
For some, the burden of AE often extends beyond the immediate dermatological effects of this disease. AE can place a serious mental health burden on patients, particularly those living with moderate-to-severe disease, with research indicating that the more severe the AE, the more quality of life is impacted. It has been associated with anxiety, depression and attention deficit hyperactivity disorder. Research has indicated that the health related quality of life in children with AE is comparable to that of other chronic childhood diseases such as diabetes or asthma.
Quality of life
Phototherapy Phototherapy is a form of artificial ultraviolet light treatment, comprised of either ultraviolet A (UVA) or ultraviolet B (UVB) wavelengths of light, delivered in hospital dermatology day care centres. Phototherapy may be given in combination with topical steroids and emollients to prevent flare-up. Systemic agents In circumstances where AE is moderate to severe or widespread, and has not responded to topical or phototherapy treatments or when quality of life is significantly impacted, systemic immunosuppressive treatments may be prescribed. Current options include, methotrexate, ciclosporin, mycophenolate mofetil, and azathioprine. The individual patient profile, lifestyle factors, associated comorbidities, side effect profile along with patient preference all influence choice of drug. These medications have different toxicity profiles, therefore patients are reviewed and monitored regularly to avoid any potential side effects. Newer systemic agents which can be prescribed in secondary care for patients with moderate to severe AE, through the HSE managed access programme include; abrocitinib (Cibinqo®), dupilumab (Dupixent®), tralokinumab (Adtralza®) and upadacitinib (RINVOQ®). These agents are available to patients that meet a certain criteria set out by the Managed Access Protocol and prescribing is confined to consultant dermatologists. AE associated infections AE is often complicated by bacterial, viral and fungal infections, due to a weakened skin barrier, trauma from scratching and impaired cellular immunity. Staphylococcus aureus, is the most common organism, to cause bacterial infection in AE. Distinctive signs may include honey-coloured crusts, weeping and pustules, and folliculitis in hair-bearing areas. Topical or oral antimicrobials may be prescribed. Common viral Infections seen in individuals with AE include molluscum contagiosum, cutaneous warts and herpes simplex virus. Itch AE is often referred to as the “itch that rashes” due to the pruritus that patients with AE often experience. The urge to scratch can be overwhelming but only provides temporary relief, leading to more itching and scratching (the itch-scratch cycle) which may lead to excoriation and skin barrier damage. Itch interferes with sleep and negatively impacts on an individual’s quality of life, as well as that of the wider family, with sleep deprivation contributing to difficulties concentrating at school, and/or work. Sufficient sleep is crucial for health and well-being. In children, both acute and chronic sleep disruption has been associated with a range of ‘cognitive, mood and behavioural impairments’, as well as poor performance in school. In a ISF ‘Living with Atopic Eczema Survey’ in 2019, respondents reported interrupted/ loss of sleep in 86% of children and 84% of adults. Additionally, 26% of carers of children with AE, reported that their child missed 1-2 days of school per month due to their skin condition.
to raise awareness around the potential fire risks of emollients (moisturisers) often used in the management of skin disease. The British Association of Dermatologists (BAD) released a statement on their website in July 2020 on fire risk associated with emollient use. According to the BAD “emollients represent a safe treatment option, for most patients. That said, it is important that patients, carers, and healthcare professionals are aware of the potential fire risks associated with these products, and how to minimise them. It is important to stress that emollients are not flammable in themselves, nor when they are on the skin. The risk comes when emollient residue dries onto fabrics such as clothing or bedding and then comes into contact with a naked flame or lit cigarette causing them to catch fire. To reduce the fire risk, patients using these products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly.”
Topical calcineurin inhibitors (TCI): Considered as a second-line option for short-term and intermittent treatment of AE. These prescribed non steroidal, anti-inflammatory agents do not cause skin atrophy, and are beneficial in treating sensitive skin areas such as the face and groin. Stinging on application is the most common side-effect, but this usually settles within a few days, also sun protection is advised, in patients treated with TCI.
Wet-wrap therapy: This is a technique used in people with moderate to severe eczema by using two layers of open-weave tubular bandage applied over emollients. The bottom layer is soaked in warm water, squeezed out and then put onto the skin over the emollient wet and then followed by the top layer which is dry. This treatment is reported to introduce moisture, soothe and protect irritated skin from damage caused by scratching and is applied for short periods of time. Caution should be taken when wet wrapping using topical steroids, as absorption is increased. Occlusive medicated dressings or dry bandages should not be used in infected AE. Topical corticosteroids: Recognised as first-line anti-inflammatory prescribed treatments in acute exacerbations. Selection of agent varies depending on potency, the location and severity of skin affected by AE, patient age and formulation. Topical corticosteroids are grouped into classes depending on their potency, ranging from mild, moderate, potent and very potent. A fingertip unit (FTU) is a useful method for individuals to apply topical corticosteroid in safe quantities. A FTU refers to the amount of ointment or cream applied from the end of an adult index fingertip, to the distal crease (first joint) in the finger, and is equivalent to approximately 0.5grams. The recommended FTU of topical corticosteroid will depend on the part of the body being treated and whether the patient is an adult or child. The Irish Skin Foundation has a useful guide describing the number of FTU’s required for different parts of the body in adults and children in the eczema booklet on https://irishskin.ie/eczema/.
58 | PHARMACYNEWSIRELAND.COM
Conclusion AE is often associated as a disease of childhood, but it is important not to forget that AE can be a very distressing condition for adults as well. While severity of AE varies greatly, most are affected by mild disease. Due to a variety of treatments for AE and different individual symptoms, it is important to educate patients and their families about the disease, and self-care to ensure compliance and effective management. These include, basic skin care routines that fits in with the individual’s lifestyle, management of future flares and trigger avoidance. Also consideration around any potential fears with regards to side-effects of medications such as topical steroids should be addressed, as this may impede sufficient treatment. Education for self-managing AE, are reported to improve the severity of the disease and also improve the quality of life for these individuals and their carers. The Irish Skin Foundation operates a Ask-a-Nurse Helpline that provides free, direct, accessible and specialist guidance about skin conditions, delivered by dermatology clinical nurse specialists on an appointment model. For information on eczema or other skin conditions log onto www.irishskin.ie
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Fighting Blindness is an Irish patient-led charity with a vision to cure blindness, support people living with sight loss and empower patients. It is the only Irish charity funding research into treatments for sight loss.
While metabolic surgery is not currently offered as part of standard care in Ireland, many diabetes and obesity organisations recommend it as an accepted treatment option for people with comorbid type 2 diabetes and obesity. HIQA’s review included evidence from 24 randomised controlled trials examining metabolic surgery with short- to medium-term follow-up (maximum 10 years).
David leads advocacy at the European Parliament and Trade Committees for MFI and as a Board member of Medicines for Europe. David helps manage the MFI relationship with Ireland’s Department of Health, other Government Departments, regulators and media on key industry related matters.
Type 2 Diabetes Treatment Pathway
Adam Shanley, co author of the report and MPOWER Programme manager said “The continued increase in waiting times risks eroding the high degree of enthusiasm for PrEP among gay, bisexual and other men who have sex with men in Ireland as frustration with the overburdened system sets in. A successful national HIV prevention strategy depends heavily on timely and barrier free access to services” he added.
Ensuring Stable Medicines Access
Fighting Blindness will be bringing together top international and Irish researchers and clinicians in the global effort to find treatments and cures for conditions causing vision impairment and blindness. For more info visit www.fightingblindness.ie or email at info@fightingblindness.ie
Delays in access to services is detrimental to communities and will further reduce Ireland’s ability to meets its ambitious target of ending new HIV transmissions by 2030,” he Researchadded.published in 2022 by HIV Ireland points to ongoing difficulties in accessing PrEP.
David, who is Head of Policy and Market Access for Europe with Viatris met with Noah in London representing Medicines for Europe – whose member companies make and research & develop the majority of medicines used daily in Northern Ireland and across Europe.
Radisson Blu Royal Hotel Dublin City.
AvailabilityIncrease of PrEP HIV Ireland has called on Government to increase funding and resources to ensure timely and barrier free access to PrEP services in Ireland. The call comes amid a reported doubling of the number of newly notified cases of HIV in Ireland compared to the first six months last year (293 v 145), as highlighted in the Weekly HIV and STI Report published by the Health Protection Surveillance Centre (HPSC).
Date for your Diary: Retina Conference
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The recently published EMERGE Study, conducted by the London School of Hygiene and Tropical Medicine in partnership with HIV Ireland’s MPOWER programme found that more than half of gay, bisexual and other men who have sex with men who reported difficulty in accessing STI services during COVID-19 restrictions were attempting to access PrEP.
David Delaney, Medicines for Ireland Chair of EU Affairs Committee recently met with the UK Department of Health and Social Care’s Noah Thorold.
“Stakeholders continue work to ensure continued stable patient access to medicines in Northern Ireland, in the context of the Northern Ireland Protocol and beyond,” he said.
David Delaney, Chair of EU Affairs Committee, Medicines for Ireland with Noah Thorold, UK Department of Health
The Health Information and Quality Authority (HIQA) has published a health technology assessment (HTA) recommending the introduction of a metabolic surgery programme as part of the clinical pathway for type 2 diabetes in Ireland. HIQA undertook this HTA at the request of the HSE. Bariatric surgery involves changing how the stomach and small intestine process food, resulting in weight loss and improvements in obesity-related health complications. Traditionally, it is used as a weight-loss intervention in patients with obesity. The term metabolic surgery refers to the use of bariatric surgery procedures with the aim of improving type 2 diabetes control in patients with comorbid (both) type 2 diabetes and obesity.
Standard care options for patients with comorbid type 2 diabetes and obesity include patient education programmes, behavioural interventions (such as, dietary changes, physical activity and smoking cessation advice), interventions to reduce the risk of cardiovascular disease, and diabetes medications. Weight loss is an important part of the management of type 2 diabetes. Successful weight loss can result in lower cardiometabolic risk factors and less chance of complications.
Fighting Blindness is announcing the details about hostingyearsconference:award-winningtheirRetinaaftertwoofsuccessfullytheconference virtually, they will be back to a fully hybrid event. This year Retina conference will be running on November 3, 4 and 5 at the
Speaking ahead of a public seminar on the role of communities in memorialising HIV and AIDS, Executive Director of HIV Ireland Mr Stephen O’Hare said, “PrEP [pre-exposure prophylaxis] is highly effective at preventing a person who is HIV negative from acquiring HIV through sexual intercourse and is a vital component in our strategy to reduce HIV transmissions.
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Usually, a trigger is required for psoriasis to develop, and this could be a throat infection, an injury to the skin, certain medications or physical or emotional stress. There are also others, as triggers can vary from one person to the next.
The answer is no. Nor can it be transferred from one part of the body to another. However, some people may have a family history of psoriasis and certain genes have been identified as being linked to the condition. Many genes need to be involved though and even if the right combination of genes has been inherited, psoriasis still may not appear.
People who are unfamiliar with the condition sometimes ask whether psoriasis can be transmitted from person to person through contact.
Around 80% of people with psoriasis have plaque psoriasis, with plaques appearing most often on the elbows, knees, lower back and quite often in the scalp. However, there are several different types of psoriasis, and any area of the body can be affected.
Written by Laura Stevenson, Deputy Chief Executive, Psoriasis Association
The plaques can appear in a variety of shapes and sizes, varying from very small to several centimeters in diameter. They have a well-defined edge, making it easy to tell where the psoriasis ends, and non-psoriatic skin begins. For some people, plaques may be thin or flat to the skin surface but for others they may be much thicker. It is not unusual for psoriasis to be itchy, and it can often feel painful or sore.
What does it look like?
Psoriasis can range in appearance from mild to severe.
treatment and advice, many people are able to live well with the condition.
the skin replacement process speeds up, taking just a few days to replace skin cells that usually take 21-28 days. This results in an accumulation of skin cells on the surface of the skin, in the form of psoriatic plaques. This process is the same wherever it occurs on the Psoriasisbody.
PHARMACYNEWSIRELAND.COM 62 Psoriasis
Patches of psoriasis, which are often called plaques, are raised red or dark patches of skin, covered with silvery white scales. These scales are the buildup of skin cells waiting to be shed and the redness is caused by the increase in blood vessels required to support the increase in cell production.
affects men and women equally and can occur at any point in the lifespan, affecting children, teenagers, adults and older people. However, there seem to be two peaks: from late teens to early adulthood and between the ages of around 50-60. It is a long-term condition that may wax and wane. Sometimes it can appear mild and other times it can be more severe. Although there is no cure, it can be managed and with the right
Guttate psoriasis, which is most often seen in children and teenagers, can result in small and scaly patches (often less than What is psoriasis? Psoriasis is a common skin condition that is thought to affect between 2% and 3% of the population of the United Kingdom and Ireland. It is an immune condition which affects the skin but is also associated with a condition called psoriatic arthritis which affects the joints. However, psoriasis is much more than just a skin condition. It can also affect people physically and psychologically.
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Phototherapy treatment with ultraviolet light can be considered. UVB is the most commonly prescribed although treatment with UVA and the use of a chemical agent called psoralen can also be prescribed. This is referred to as PUVA therapy. Phototherapy treatment can necessitate attendance at a phototherapy centre 2 to 3 times a week for several weeks.
Managing psoriasis extends far beyond applying treatments and taking medications. Learning to cope with a skin condition can take time as the psychological impact is not always related to the clinical severity of psoriasis.
Finally, psoriasis treatment has been revolutionised over the last ten years with the increased use of biologics which can be used to treat severe psoriasis that has not responded to any of the abovementioned treatments. Biologics work by blocking the action of certain immune cells (T cells) or the chemicals released by them.
Topical therapies such as creams, lotions, ointments, foams and gels can be prescribed by a GP and are usually tried first by most people with psoriasis. These can include topical steroids, dithranol, vitamin A and D derivatives and coal tar preparations. If psoriasis is particularly widespread or doesn’t respond to topical treatment, a referral to a dermatologist can take place, who can then offer a wider range of treatment options.
PHARMACYNEWSIRELAND.COM 64 Psoriasis
1cm in diameter). These can be numerous and cover all areas of the body. This type of psoriasis can be triggered by a throat infection.
How can it be treated? How psoriasis is treated is dependent upon the type and the severity, although the available treatments fall broadly into four main categories.
Guttate Psoriasis Plaque Psoriasis
The main types used in the UK are methotrexate, ciclosporin and acitretin. All require ongoing monitoring with blood tests and blood pressure checks. They do have potential risks and some cannot be prescribed in conjunction with other medications or if the individual is thinking of having children within the next two years.
It can be reassuring to hear about how other people cope with their psoriasis and live with their condition. The Psoriasis Association, a leading national charity for people affected by psoriasis in the UK, offers help in this regard by funding research, providing information and raising awareness of the condition. The tailored support offered by the charity’s helpline, and peer-to-peer support offered through its website forums and social media platforms can be Everyoneinvaluable.hastheir own way of coping with psoriasis. Some people cover their skin, either with clothing or special skin camouflage make-up, whilst others are comfortable not covering up at all. Some may wear lighter clothes on the top half of their body to hide flakes from scalp psoriasis, whilst for others this is less of an issue. The most important thing is honesty with any healthcare professional offering treatment, especially if experiencing feelings of anxiety or distress due to the impact of psoriasis.
Pustular psoriasis is different again and can take the form of small sterile blisters usually on the hands and feet. Nail psoriasis can result in changes to the appearance and texture of nails. In sensitive areas, such as the armpits and groin, psoriasis is often red and shiny, with little or no scaling. What causes it? Traditionally psoriasis was thought to be a condition of the uppermost layer of the skin (the epidermis), but now it is known that the changes in the skin begin in the immune system when certain immune cells (T cells) are triggered and become overactive.
Systemic treatments, which are treatments that are taken into the body, can also be used for moderate to severe psoriasis.
People with psoriasis can also be prescribed biologics if the systemic treatments mentioned above cause side effects which means the person should not take them, or if the person has another condition or medication which means that they should not take the other systemic treatments.
Links between severe psoriasis and conditions such as diabetes and heart disease have been found but this does not necessarily mean that psoriasis causes these conditions, or that these conditions cause psoriasis. Research is ongoing to try to understand the true nature of this link, why these conditions sometimes occur in the same people and if this is also true of mild or moderate psoriasis.
There are now over 13 biologics approved by the National Institute for Health and Care Excellence (NICE) for treating severe psoriasis currently available. Additionally, there are a number of biosimilars available for adalimumab, etanercept and infliximab.
The T cells produce inflammatory chemicals and act as if they were fighting an infection or healing a wound, which leads to the rapid growth of skin cells, causing plaques to form. As a result, psoriasis is sometimes referred to as an ‘auto-immune disease’ or ‘immune-mediated condition’. It is not yet clear what triggers the immune system to act in this way.
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Crohn’s disease (CD) is a chronic inflammation of the intestine where current treatment options are limited, it affects up to 3 million people across Europe and leads to health costs of over 5 billion euros per Nowyear.
“The multidisciplinary team in GENEGUT will pioneer the development of the next generation of therapeutics for the treatment of Crohn’s Disease by producing a patient friendly orally administered RNA medicine. The project will span the pre-clinical to clinical space thus accelerating the clinical translation of orally available RNA therapeutics and ensuring early access of lifealtering medicines for the patient.
For these patients, this would be the first option to finally manage the chronic disease and lead a life of improved quality,” says Professor Caitriona O’Driscoll, GENEGUT Project Co-ordinator
Future of pharmacIE Event
Next Generation Treatment for Crohn’s Disease
The European Commission recently selected the GENEGUT research and innovation action for funding as one out of 84 submitted project proposals. This UCC lead project aims to transfer the revolutionary RNA technology to treat ileal Crohn’s Disease – a potential gamechanger. The expertise required to achieve this ambitious aim is as diverse as the nine partners from eight European countries that will collaborate in GENEGUT.
The Future of pharmacIE, hosted by APPEL, will return on October 20th, 2022. This event is an online careers event for pharmacy students and professionals. Panel discussions will take place with pharmacy professionals which will showcase the varied and exciting career paths for Thosepharmacists.whoattend will get inspiration for their future in pharmacy and the chance to meet future Exhibitioncolleagues.booths will allow APPEL placement providers to promote their business or practice area to the pharmacists of the future and build their talent pipeline. This is a unique networking event with many opportunities for pharmacy students and professionals alike. Visit www.appel.ie to register your interest in attending.
GENEGUT, a four-year research project funded by Horizon Europe, is to develop the first oral RNA-based therapy for ileal Crohn’s Disease. CD drastically impacts the quality of life of affected patients - and that of their families, friends, and caregivers. Most significantly, however, there is no satisfactory treatment. Despite advances, there is a pressing need for novel, advanced therapies.
Dr Joey O’Shea, Professor Caitriona O’Driscoll, Dr Piotr Kowalski and Dr Patrick O’Dwyer, School of Pharmacy, University College Cork Daragh McSweeney/Provision
Through a patient-centred approach, the project, coordinated by the School of Pharmacy of University College Cork, brings together the European Federation of Crohn's & Ulcerative Colitis Associations with renowned researchers, expert clinical scientists, SMEs and large pharma companies with expertise and patented technologies in global proteomics, nanotechnologies, novel biomaterials, multicellular models, drug delivery systems and production as well as innovation management, stakeholder involvement and science communication.
A research project, led by the School of Pharmacy in partnership with APC Microbiome Ireland SFI Research Centre at University College Cork (UCC), that is seeking to revolutionise how Crohn’s disease is treated has just been awarded €5.4 million in funding by the European Union (EU).
Over the course of four years, GENEGUT’s aim to develop a noninvasive, safe, effective, and targeted treatment will be realised in the form of a first-in-class, orally administered RNA-based therapy. This breakthrough RNA therapy will be developed using complementary technologies that selectively target inflamed intestinal cells that reside in specific regions of the small intestine.
Directions: Adults, children and the elderly: Use as a shampoo, once or twice weekly until the condition improves. Thereafter, occasional use may be necessary. Wet the hair thoroughly. Massage a small amount of the shampoo into the scalp, leaving on for a few minutes. Remove as much lather as possible with the hands, before rinsing out thoroughly under running water. Repeat if necessary.
Dandruff? CAPPR022/SEP21
Shampoo
Contra-indications, warnings, side effects etc: Please refer to SPC for full details before prescribing. Do not use if sensitive to any of the ingredients. If there is no improvement after 4 weeks, or the condition is aggravated, discontinue treatment. Keep away from the eyes. Keep out of the reach of children. Use in pregnancy: avoid use during first trimester. Package quantities, trade prices and MA number: 100ml bottle €3.48, 250ml bottle €6.96, PA23128/008/001. Legal category:Supply through pharmacy only. Further information is available from the MA holder: Dermal Laboratories (Ireland) Ltd, Head Office Tatmore Place, Gosmore, Hitchin, Herts, SG4 7QR, UK.
ShampooSalicylicacid0.5%w/w, coconut oil 1.0% w/w, distilled coal tar 1.0% w/w.
Uses: As a shampoo in the treatment of dry, scaly scalp conditions such as seborrhoeic eczema, seborrhoeic dermatitis, pityriasis capitis, psoriasis and cradle cap in children. It may also be used to remove previous scalp applications.
What dandruff?
Capasal Therapeutic
Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Dermal.
Capasal™ Therapeutic
Prescribing information
Shampoo
Date of preparation: February 2021.‘Capasal’ is a trademark.
Triple Action Therapy
Salicylic acid removes scales, distilled coal tar relieves itching, with coconut oil to soften and moisturise the scalp
Recommend Capasal Therapeutic
Pelvic floor dysfunction is a common and often debilitating set of symptoms that can result in many issues for women in particular. It is more common as women get older but contributing factors can include pregnancy, childbirth, menopause and lack of exercise. Associated health issues include urinary incontinence, emptying disorders of bladder and bowel, pelvic organ prolapse, sexual dysfunction, chronic pelvic pain and menopausal impact.
important as many people feel embarrassed about the issue.
Soothing Solutions, a start-up based in Dundalk Co. Louth that manufactures children’s healthcare products, has announced it has signed a retail deal with Boots Ireland. The deal will see its first product, Tonstix, available in 90 stores.
Customers can do the exercises in their own time, wherever they are, with no one having to know they are doing them – this is considered
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Aoife Ní Eochaidh, CEO of IPPM, adds, “We want to get the message out to men and women – of all ages – that no amount of leaking is normal; not even one drop. A lot of people think leakage is a normal part of aging or it is normal after giving birth or when going through the menopause. But it is not. People should not accept it especially when there are ways to alleviate it. I’m delighted to partner with Meaghers Pharmacy on this project as they always put the customer at the centre of all care; I am delighted with the response we have had already since launching and am confident that together we will improve the quality of lives of Meaghers Pharmacy customers in Ireland and abroad who need pelvic floor muscle training, either for prevention or essential therapy.”
Soothing Solutions Signs Deal with Boots Ireland
Meaghers Pharmacy Group, which operates a chain of nine pharmacies in the Dublin area, has become the first pharmacy in Ireland to introduce online pelvic floor routines for its customers.
Aoife developed the routines after perfecting them over the last 25 years working directly with thousands of male and female patients and decided to partner with Meaghers Pharmacy Group in order to create a more affordable and convenient online solution for patients that was discreet and easy to access.
An innovative children’s product, Tonstix, take on the form of a traditional lollipop to encourage the sucking reflex which facilitates lubrication of the throat to soothe the effects of seasonal ailments such as irritated throats caused by allergies, infections or viruses.
Another ‘First’ for Meaghers Pharmacy
The routines, offered in partnership with International Pelvic Physiotherapy Management (IPPM), give customers a step-bystep guide on how to improve their pelvic Oonaghfloor.O’Hagan, Managing Director of Meaghers Pharmacy Group, decided to launch the service after she got an incredible 3,000 responses to an Instagram survey on the subject – with 97% of respondents saying they suffered from some form of incontinence.
Uniquely shaped, Tonstix resemble stick people - an important feature as the arms prevent a child from inserting the pop too far into their mouth. The jelly has also been specially formulated to melt in the mouth.
Honey, an ingredient with timehonoured soothing properties, is found in each pop’s jelly and slowly dissolves to create a coating that temporarily supresses distress. The jelly is made using only natural ingredients giving a fruity flavoursome taste to appeal to children’s tastebuds and includes added Vitamin C and Zinc, known to support healthy functioning of the immune system.
Urinary incontinence impacts one in three women and one in eight men are affected by pelvic floor muscle dysfunction, leading to urinary incontinence and bladder leaks. People can be reluctant to talk about this problem and many suffer in silence.
The exercises, which are affordable, discreet and available across devices, have been developed by IPPM’s Aoife Ní Eochaidh, Chartered Physiotherapist and a Clinical Specialist in Women’s, and Men’s Health, who is a global expert in pelvic, women’s and men’s physiotherapy.
Home Pelvic Routines can be accessed through the Meaghers Pharmacy website www. meagherspharmacy.ie and, so far, 100 per cent of people who have used Home Pelvic Routines have reported a 45 per cent improvement in just three weeks.
L-R Sinead Crowther and Denise Lauaki of Soothing Solutions
Ms Aoife Ni-Eochaidh and Meaghers Pharmacy Group owner and MD Oonagh OHagan Oonagh O’Hagan, Managing Director of Meaghers Pharmacy Group, says, “We’re very excited about partnering with Chartered Physiotherapist Aoife Ní Eochaidh and IPPM to provide this confidential, accessible and affordable solution. The huge response to our Instagram survey was unprecedented. This is a big problem, but people don’t want to talk about it even to their doctor or pharmacist; they are embarrassed. It is still a taboo subject, and most people think they are on their own so it is great to be able to provide this excellent service in partnership with IPPM.”
The innovative product is the brainchild of founder and CEO, Sinead Crowther, a mum of four and a pharmacy technician with more than 25 years’ experience. Tonstix are the first product from parent company Soothing Solutions Ltd, which has established its purpose-built manufacturing facility in Louth to produce the product at home in Ireland. Already available in 600 pharmacies, the deal with Boots Ireland will increase its availability and county-by-county footprint.
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Mariosa Kieran (Pharmacist, Mater Misericordiae University Hospital)
Gout is the most common form of inflammatory arthritis in adults. The incidence of gout is rising. People with gout have an increased risk of cardiovascular disease, and gout is associated with a number of comorbidities including diabetes and renal impairment. The increased incidence of gout together with increased cardiovascular risk and comorbidities is a significant public health challenge.
The use of low dose colchicine as a prophylaxis is an example of this gap in knowledge translation.
However, pharmacists frequently report a lack of patient treatment plan information and clinical connection to other healthcare professionals as barriers to providing optimal care to patients.
Professor Geraldine McCarthy (Consultant Rheumatologist, Mater Misericordiae University Hospital/UCD)
low dose of anti-inflammatory prophylaxis, such as colchicine, is recommended for at least the first three to six months following initiation of urate lowering therapy.
An important issue in urate lowering therapy is that paradoxically, initiation of urate lowering therapy can actually induce a gout attack. This happens because the urate lowering therapy causes MSU crystals to be shed from the articular cartilage into the joint space, resulting in acute inflammation. To prevent this, a
Colchicine use in gout is most commonly used in the treatment of acute gout flares in a strictly time limited fashion. Legacy prescribing, whereby short or intermediate-term medications are not appropriately discontinued, is prevalent. Patients, and indeed pharmacists, can be unsure whether the prescribed colchicine is intended as a prophylaxis or is a legacy prescription that was previously prescribed in case of flare. This confusion can be magnified by lack of clear, definitive statements on updated best practices from national bodies and the time lag in incorporating professional body recommendations into readily accessible drug information sources, e.g. the product Summary of Product Characteristics, the British National Formulary. Pharmacists have reported that the advice on use of colchicine as a prophylaxis in their typical reference manuals is poorly defined in comparison to its use for acute flares. This can lead to conflicting advice being given to
Community pharmacists are the most easily accessible members of a patient’s health care team. Pharmacists are often a key source of information on disease management and patients have confidence in them. Pharmacists act as a critical resource for effective management of disease, particularly when chronic such as gout. Thus, open communication and education between the pharmacy and prescriber communities is essential to provide the most up-to-date and appropriate patient care.
Unlike other common rheumatic diseases, the underlying cause of gout is well understood. Gout is caused by hyperuricaemia, too much uric acid in the body. This can occur due an underexcretion and/or overproduction of urate, which leads to monosodium urate (MSU) crystal formation and deposition in joints and tissues in susceptible individuals (figure 1). Acute gout flares occur as an inflammatory response to the MSU crystals. The goal of urate lowering therapy is to reduce serum urate to a therapeutic target level, thereby permitting MSU crystals to dissolve, in addition to preventing further crystal formation and deposition.
Written by Dr. Emma Dorris (Scientist, UCD), Mariosa Kieran (Pharmacist, Mater Misericordiae University Hospital),
Professor Nicola Dalbeth (Consultant Rheumatologist, University of Auckland) and Professor Geraldine McCarthy (Consultant Rheumatologist, Mater Misericordiae University Hospital/UCD)
Dr. Emma Dorris (Scientist, UCD) Professor Nicola Dalbeth (Consultant Rheumatologist, University of Auckland)
Closing the Gap: Improving Pharmacist Knowledge of Gout Management
Our research showed that pharmacistknowledge of gout management in Ireland was not in line with current European (EULAR) gout management guidelines. However, we also demonstrated that pharmacists do not typically use disease management guidelines as standard sources of information
PHARMACYNEWSIRELAND.COM 70 Gout
The Dynamic 100 is a network of the most influential professional in the Irish pharmacy industry who act as ambassadors and role models for their peers, colleagues and the rising stars of tomorrow within Community Pharmacy. How to enter: Please submit 250-800 words, describing how you/they have achieved something special, gone above and beyond or behaved dynamically. We also require a high-resolution photograph of the entrant for print publication. Each entry must be within the pharmacy industry. Pharmacists have continued to provide a first-class service in the face of adversity, with each pharmacy team displaying the highest levels of resilience, determination, and courage. And now the time has come to reward that resilience. That determination. That courage… Nominations are sought from across the pharmacy profession in Ireland. DYNAMIC 100 NOMINATE TODAY Email nomination(s) to aoife@ipn.ie or Kelly-jo@ipn.ie DEADLINE MONDAY 3rd OCTOBER Dynamic
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Image Copyright: Emma Dorris Figure 1
72 Gout patients from their pharmacists and rheumatologists about gout management, particularly in relation to colchicine use. This prompted research into the pharmacist knowledge of gout management, leading to the development of an educational intervention for pharmacists. Our research showed pharmacist-knowledgethatof gout management in Ireland was not in line with current European (EULAR) gout management guidelines. However, we also demonstrated that pharmacists do not typically use disease management guidelines as standard sources of information. As such, there is a knowledge gap in the most up to date recommendations for gout management. Given the wide number of conditions encountered on a daily basis in community pharmacy, this is somewhat understandable. As such, a dedicated effort must be made by prescribers and professional societies to communicate treatment standards to pharmacists.
In response to our initial findings, an education intervention was co-developed by two consultant rheumatologists and gout specialists, a pharmacist and general practitioner. We worked closely with the site founder of Pharmabuddy, the eLearning platform designed for and used by pharmacists. A thirteen minute video tutorial on the pharmaceutical management of gout was produced and is hosted on the Pharmabuddy eLearning platform. Nine months after the initial launch of the video, the impact of the educational intervention was assessed. Pharmacists who had watched the tutorial had significantly greater knowledge of gout management than the pharmacists who had not. Importantly, pharmacists who had watched the tutorial had greater knowledge about colchicine and its use as prophylaxis following initiation of ULT. This demonstrates that low-cost educational interventions can greatly improve pharmacist knowledge of gout management.
The original research paper is available open access at BMC Rheumatology: Pharmacist knowledge of gout management: impact of an educational intervention. ER Dorris, M. Kieran, N. Dalbeth & G. McCarthy. BMC Rheumatol 6, 30 022-00259-xhttps://doi.org/10.1186/s41927-(2022).
Gout recommendationsmanagement can be impeded if translation into pharmacy practice is neglected. Our research acts as a proof of concept that a co-designed educational intervention on gout management is effective. The Pharmacy Act 2007 requires that all pharmacists in Ireland undertake continuing professional development (CPD). For wider implementation, our intervention could be integrated into a CPD for gout management. This could increase the reach of this information to pharmacists. Pharmacists, particularly community pharmacists, have a hugely broad remit. The onus is on the rheumatology community to communicate to pharmacists and other health care providers about up-to-date recommendations for gout management. Improved pharmacist knowledge can in turn empower patients to assume selfmanagement of gout.
Figure Pathophysiology1: of Gout Both the overproduction of urate and the underexcretion of urate can contribute to hyperuricaemia, leading to gout. The goal of urate lowering therapy is to reduce serum uric acid levels below its saturation point, thereby preventing crystal formation and deposition. The rate of crystal reduction is dependent upon both the total crystal load and reduction in serum uric acid. Urate lowering therapy initiation can cause rapid dissolution of crystal deposits and may lead to increased flare rate and associated pain due to the removal of protein deposits protecting the underlying surface from attack by inflammatory cells. Thus an anti-inflammatory prophylaxis, such as Colchicine, is recommended for the first six months following initiation of urate lowering therapy.
*suitable for children from 6 months & pregnant women DulcoEase Hydrate can be used for up to 28 days, after which the causes of constipation should be investigated by a doctor who will advise on the suitability to continue treatment. Always read the label. Distributed in Ireland by Clonmel Healthcare Ltd. *consultation with a doctor is advised. Pharmacy only brand To place an order, contact your Clonmel Healthcare Area Representative or call our freephone order line on 1800 262626 RELIEFGENTLEWORKSWITHIN24to72hrsGLUTENLACTOSE&SUGARFREERELIEFGENTLEWORKSWITHIN24to72hrsGLUTENLACTOSE&SUGARFREE RELIEFGENTLEWORKSWITHIN24to72hrsGLUTENLACTOSE&SUGARFREE2022/ADV/DUL/098H Gentle & effective relief of andconstipationirregularity
In general women experience menopause between 45 and 55 years of age however, the average age for women to enter the menopause is 51. Some women experience what is known as early or premature menopause before the age of 40
The report State of the Heart: Heart Failure in Ireland, by Roche Diagnostics and the Irish Heart Foundation, analysed data from a first-of-its-kind survey of heart failure patients in Ireland, conducted by Censuswide, which identified a significant gender disparity between the experiences of male and female patients, with female patients waiting longer to be diagnosed with heart failure than men.
The Menopause and heart health
This September the Irish Heart Foundation is running the ‘Her Heart Matters’ campaign with support of the HSE and Healthy Ireland, to increase awareness of the risk of heart disease and stroke in women and the fact that this risk increases as women enter menopause.
Janis Morrissey- HPIT-IHF
The Her Heart Matters Campaign will unapologetically focus on women’s hearts because research has shown that heart disease in women has been underresearched, under-diagnosed, and under-treated for far too long.
As we age and particularly around the time of menopause, the level of cholesterol in our blood increases, in particular the bad cholesterol or LDL , often triglycerides also increase and the good cholesterol or HDL decreases. This leads to an increased risk of cardiovascular disease – heart attack and stroke. Lower oestrogen levels as a result of the menopause lead to a stiffening of the arteries of the heart which can increase blood pressure. Furthermore, as its easier to gain weight and harder to lose it as we age, and this can also lead to an increase in blood pressure- another risk factor for heart disease.
to a survey carried out by Ipsos MRBI on behalf of the Irish Heart Foundation more than half or 59 percent of people surveyed were surprised that the risk of death from heart disease and stroke was so high for women compared to breast cancer. They stated that the five-time risk was “higher than they thought.”
While the Irish Heart Foundation’s Her Heart Matters campaign aims to raise awareness of heart health among all women, part of the campaign will focus on menopause as this is a particular time in a woman’s life when their cardiovascular health is most at risk.
While a lot of people have heard about menopausal symptoms such as night sweats, hot flushes, vaginal dryness and low mood or anxiety, what is less well known is that the menopause also affects the heart and in particular puts women at increased risk of heart disease and stroke. While the menopause itself doesn’t cause cardiovascular disease, lowering hormone levels coupled with the ageing process, increase your chances of developing risk factors for heart disease and stroke such as high blood pressure and high cholesterol.
PHARMACYNEWSIRELAND.COM 74 Heart Health Her Heart Matters – Women’s Cardiovascular Health
represented in clinical trials.”
September is Heart Month and this year the Irish Heart Foundation is running a new campaign focusing on women’s cardiovascular health.
A report launched earlier this year found that female patients in Ireland were waiting almost twice as long as men to be diagnosed with heart failure, with delays to diagnosis associated with poorer quality of life, mental health issues, and impact on relationships.
According to the Lancet women and cardiovascular disease commission published in May last year “despite being responsible for causing 35% of deaths in women each year, cardiovascular disease (CVD) in women remains understudied, treated,under-diagnosed,under-recognised,andunder-withwomenunder-
On average, women have to wait five weeks to receive a formal diagnosis of heart failure, compared to men who have to wait three weeks. Women are also more likely to delay seeking help from health professionals after first developing symptoms, with females making appointments at four weeks – almost twice as long as males.
Furthermore, studies from the Polish Registry of Acute Coronary Syndromes (PL-ACS) presented at Acute Cardiovascular Care 2019 –a European Society of Cardiology (ESC) congress revealed that women call an ambulance for husbands, fathers, and brothers with heart attack symptoms but not for themselves. Further confirmation that women tend to play down their symptoms and are less likely to call an ambulance for themselves, putting the pain down to “indigestion.”
Women are five times more likely to die from heart disease and stroke than breast cancer yet new research has shown that the majority of people are not aware of Accordingthis.
Adults aged 50 years and older: When Prevenar 13 was given concomitantly with trivalent inactivated influenza vaccine (TIV), the immune responses to Prevenar 13 were lower compared to when Prevenar 13 was given alone, however, there was no long-term impact on circulating antibody levels. The immune responses to Prevenar 13 were noninferior when Prevenar 13 was given concomitantly with quadrivalent inactivated influenza vaccine (QIV) compared to when Prevenar 13 was given alone. As with concomitant administration with trivalent vaccines, immune responses to some pneumococcal serotypes were lower when both vaccines were given concomitantly. Fertility, Pregnancy & Lactation: There are no data from the use of pneumococcal 13-valent conjugate in pregnant women. It is unknown whether pneumococcal 13-valent conjugate is excreted in human milk. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Side Effects: Analysis of postmarketing reporting rates suggests a potential increased risk ofconvulsions, with or without fever, and HHE when comparing groups which reported use of Prevenar 13 with Infanrix hexa to those which reported use of Prevenar 13 alone. Adverse reactions reported in clinical studies or from the post-marketing experience for all age groups are listed in this section per system organ class,in decreasing order of frequency and seriousness. The frequency is defined as follows: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (≤ 1/10,000), not known (cannot be estimated from available data). Infants and children aged 6 weeks to 5 years: Very common (≥ 1/10): Decreased appetite, fever, pyrexia, irritability, any vaccination-site erythema, induration/swelling or pain/tenderness, somnolence, poor quality sleep. Vaccination-site erythema or induration/swelling 2.5cm – 7.0 cm (after the booster dose and in older children [age 2-5 years]. Common (≥ 1/100 to < 1/10): Vomiting, diarrhoea, rash, pyrexia >39 °C, vaccination-site movement impairment (due to pain), vaccination-site erythema or induration/swelling 2.5cm – 7.0cm (after infant series). Uncommon (≥ 1/1,000 to < 1/100): Convulsions (including febrile convulsions), urticaria or urticaria-like rash, vaccination-site erythema, induration/swelling >7.0cm, crying. Rare: Hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, hypotonic-hyporesponsive episode. Not known: Lymphadenopathy (localised to the region of the vaccination site), anaphylactic/anaphylactoid reaction including shock, angioedema, erythema multiforme, vaccination site urticaria, vaccination-site dermatitis, vaccination-site pruritus, flushing. In clinical studies infants vaccinated at 2, 3 and 4 months of age, fever ≥ 38°C was reported at higher rates among infants who received Prevenar (7-valent) concomitantly with Infanrix hexa than in infants receiving Infanrix hexa alone. After a booster dose at 12 and 15 months of age, the rate of fever ≥ 38°C was greater in infants who received Prevenar (7 valent) and Infanrix hexa at the same time compared to infants receiving Infanrix hexa alone. These reactions were mostly moderate (less than or equal to 39°C) and transient. Additional information in special populations: Apnoea in very premature infants (≤ 28 weeks of gestation). Children and adolescents aged 6 to 17 years of age: Very common (≥ 1/10): Decreased appetite, irritability, any vaccination-site erythema, induration/swelling or pain/ tenderness, somnolence, poor quality sleep, vaccination-site tenderness (including impaired movement). Common (≥ 1/100 to < 1/10): Headaches, vomiting, diarrhoea, rash, urticaria or urticaria-like rash, pyrexia. Additional information in special populations: Children and adolescents with sickle cell disease, HIV infection or an HSCT transplant have similar frequencies of adverse reactions, except that headaches, vomiting, diarrhoea, pyrexia, fatigue, arthralgia, and myalgia were very common. Adults ≥18 years of age, and the elderly: Very common (≥ 1/10): Decreased appetite, headaches, diarrhoea, vomiting,(in adults aged 18 to 49 years), rash, chills; fatigue; vaccination-site erythema; vaccination-site induration/swelling; vaccination-site pain/tenderness (severe vaccination-site pain/ tenderness very common in adults aged 18 to 39 years); limitation of arm movement (severe limitation of arm movements very common in adults aged 18 to 39 years), arthralgia; myalgia. Common (≥ 1/100 to < 1/10): Vomiting (in adults aged 50 years and over), pyrexia(very common in adults aged 18 to 29 years). Uncommon (≥ 1/1,000 to < 1/100): Nausea, hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, lymphadenopathy localized to the region of the vaccination site. Additional information in special populations: Adults with HIV infection have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common and nausea common. Adults with an HSCT have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common. For full prescribing information see the Summary of Product Characteristics. Legal Category: S1A. Package Quantities: Pack of 1 single-dose prefilled syringe (with separate needle) or pack of 10 single- dose pre-filled syringes. Marketing Authorisation Numbers: Single-dose pre-filled syringe (with separate needle) pack of 1: EU/1/09/590/002, single-dose pre-filled syringe pack of 10: EU/1/09/590/003. Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at EUMEDINFO@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer Building 9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500. Date of preparation: 11/2018. *Trade mark. Ref: PN 11_0 IE.
2. Bonten M.J.M., Huijts S.M, Bolkenbaas M, et al. Polysaccharide Conjugate Vaccine Against Pneumococcal Pneumonia in Adults. The New England Journal of Medicine. 2015;372:1114-25. 3. Pfizer Inc. Press Release Mar 18, 2015.
The persons depicted are models used for illustrative purposes only.
Presentation: Each 0.5ml dose of Prevenar 13 contains 2.2 micrograms of each of the following pneumococcal polysaccharide serotypes: 1, 3, 4, 5, 6A, 7F, 9V, 14, 18C, 19A, 19F, 23F and 4.4 micrograms of pneumococcal polysaccharide serotype 6B. Each pneumococcal polysaccharide is conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate. 1 dose (0.5 ml) contains approximately 32 µg CRM197carrier protein and 0.125 mg aluminium. Indications: Active immunisation for the prevention of invasive disease, pneumonia and acute otitis media caused by Streptococcus pneumoniae in infants, children and adolescents from 6 weeks to 17 years of age. Active immunisation for the prevention of invasive disease and pneumonia caused by Streptococcus pneumoniae in adults ≥18 years of age and the elderly. Dosage and Administration: The immunisation schedules for Prevenar 13 should be based on official recommendations. It is recommended that infants who receive a first dose of Prevenar 13 complete the vaccination course with Prevenar 13. For intramuscular injection. Infants aged 6 weeks-6 months: Three dose primary series: The recommended immunisation series consists of four doses, each of 0.5ml. The primary infant series consists of three doses, with the first dose usually given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age. Two dose primary series: Alternatively, when Prevenar 13 is given as part of a routine infant immunisation programme, a series consisting of three doses, each of 0.5ml, may be given. The first dose may be administered from the age of 2 months, with a second dose 2 months later. The third (booster) dose is recommended between 11 and 15 months of age. Preterm infants (< 37 weeks gestation): In preterm infants, the recommended immunisation series consists of four doses, each of 0.5 ml. The primary infant series consists of three doses, with the first dose given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age. Unvaccinated infants and children ≥ 7 months of age: Infants 7-11 months: Two doses, each of 0.5 ml, with at least a 1 month interval between doses. A third dose is recommended in the second year of life. Children aged 12-23 months: Two doses, each of 0.5 ml, with at least a 2 month interval between doses. Children and adolescents aged 2-17 years: one single dose of 0.5 ml. Prevenar 13 vaccine schedule for infants and children previously vaccinated with Prevenar (7-valent) (Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F): Infants and children who have begun immunisation with Prevenar may switch to Prevenar 13 at any point in the schedule. Children aged 12-59 months: Children who are considered completely immunised with Prevenar (7-valent) should receive one dose of 0.5 ml of Prevenar 13 to elicit immune responses to the 6 additional serotypes. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Children and adolescents aged 5-17 years: One single dose of Prevenar 13 if they have been previously vaccinated with one or more doses of Prevenar. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Adults ≥18 years of age and the elderly: One single dose. The need for revaccination with a subsequent dose of Prevenar 13 has not been established. Regardless of prior pneumococcal vaccination status, if the use of 23 valent polysaccharide vaccine is considered appropriate, Prevenar 13 should be given first. Special Populations: Individuals who have underlying conditions predisposing them to invasive pneumococcal disease (such as sickle cell disease or HIV infection) including those previously vaccinated with one or more doses of 23-valent pneumococcal polysaccharide vaccine may receive at least one dose of Prevenar 13. In individuals with an haematopoietic stem cell transplant (HSCT), the recommended immunisation series consists of four doses of Prevenar 13, each of 0.5 ml. The primary series consists of three doses, with the first dose given at 3 to 6 months after HSCT and with an interval of at least 1 month between doses. A fourth (booster) dose is recommended 6 months after the third dose.
ABBREVIATED PRESCRIBING INFORMATION Prevenar 13* Suspension for Injection Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed)
Contra-indications: Hypersensitivity to any component of the vaccine or to diphtheria toxoid. As with other vaccines, the administration of Prevenar 13 should be postponed in subjects suffering from acute, severe febrile illness. However, the presence of a minor infection, such as a cold, should not result in the deferral of vaccination. Warnings and Precautions: Do not administer intravascularly. Appropriate medical treatment and supervision must be readily available in case of a rare anaphylactic event. This vaccine should not be given as an intramuscular injection to individuals with thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injection, but may be given subcutaneously if the potential benefit clearly outweighs the risks of administration. Prevenar 13 will only protect against Streptococcus pneumoniae serotypes included in the vaccine, and will not protect against other microorganisms that cause invasive disease, pneumonia, or otitis media. As with any vaccine, Prevenar 13 may not protect all individuals receiving the vaccine from pneumococcal disease. Individuals with impaired immune responsiveness, whether due to the use of immuno-suppressive therapy, a genetic defect, human immunodeficiency virus (HIV) infection, or other causes, may have reduced antibody response to active immunization. Safety and immunogenicity data are available for a limited number of individuals with sickle cell disease, HIV infection, or with an HSCT. Safety and immunogenicity data for Prevenar 13 are not available for individuals in other specific immuno-compromised groups (e.g., malignancy or nephrotic syndrome) and vaccination should be considered on an individual basis. Infants and children aged 6 weeks to 5 years: Prevenar 13 does not replace the use of 23-valent pneumococcal polysaccharide vaccine in at risk children ≥ 24 months of age. Children ≥ 24 months of age at high risk, previously immunised with Prevenar 13 should receive 23-valent pneumococcal polysaccharide vaccine whenever recommended. The potential risk of apnoea and the need for respiratory monitoring for 48-72 hours should be considered when administering the primary immunisation series to very premature infants (born ≥ 28 weeks of gestation) and particularly for those with a previous history of respiratory immaturity. When Prevenar 13 is administered concomitantly with Infanrix hexa (DTPa-HBV-IPV/Hib), the rates of febrile reactions are similar to those seen with concomitant administration of Prevenar (7-valent) and Infanrix hexa. Increased reporting rates of convulsions (with or without fever) and hypotonic hyporesponsive episode (HHE) were observed with concomitant administration of Prevenar 13 and Infanrixhexa. Antipyretic treatment should be initiated according to local guidelines for children with seizure disorders or with a history of febrile seizures and for all children receiving Prevenar 13 simultaneously with vaccines containing whole cell pertussis.
PNEUMOCOCCAL VACCINATION PNEUMOCOCCAL PNEUMONIAVS Date of Preparation: February 2021 | PP-PNA-IRL-0005
Help prevent pneumococcal pneumonia with the proven protection of Prevenar 131,2
Proven to reduce the risk of community-acquired pneumonia: Results from the Community-Acquired Pneumonia Immunisation Trial in Adults (CAPiTA) – one of the largest vaccine efficacy trials ever conducted in older adults.2,3
1.References: Prevenar 13 Suspension for Injection Summary of Products Characteristics.
INDICATED FOR THE PREVENTION OF PNEUMOCOCCAL PNEUMONIA IN ADULTS1
The Irish Heart Foundation was keen to address the issues that concerned real women; therefore, the Her Heart Matters campaign was developed with collaboration and insight from polls, focus groups, and representative groups including Travellers, ethnic minorities, people with disabilities, the trans communities, and Speakingacademics.about the importance of the Her Heart Matters campaign, Janis Morrissey, Director of Health Promotion, Information and Training at the Irish Heart Foundation said cardiovascular disease (CVD) is a leading cause of death in women.
Ms Morrissey said that all women are different and unique, so what one woman needs most to protect her heart health was not necessarily what another woman needs.
Ms Morrissey also said that the Her Heart Matters campaign included a focus on the menopause as this was a time in a woman’s life when she is at high risk for heart disease and stroke.
“We are on a mission to help women in Ireland, but we can’t do it alone. Let’s get talking about menopause and heart health – with your sisters, mothers, friends, and daughters. Let’s talk – share –empower,” she concluded.
On World Heart Day, the 29th of September, the Irish Heart Foundation will host a free webinar about women’s heart health with insights from health professionals including menopause specialist Dr Deirdre Lundy and a woman living with heart Throughoutdisease.themonth of September, the Irish Heart Foundation will also be encouraging donations to help support its valuable and lifesaving work.
PHARMACYNEWSIRELAND.COM 76 Heart Health
The demands of a busy lifestyle mean that for many women, taking care of their own wellbeing can fall by the wayside. That’s why the Irish Heart Foundation aims to inform, empower, and support women in taking care of their heart health this September.
The campaign also includes a selfcare and wellbeing journal that can be downloaded for free, which is full of information and activities that will support women in protecting their heart health every day.
So, it’s a big problem, but we don’t hear enough about it because cardiovascular disease in women is under-researched, underdiagnosed and under-treated.
There is a false belief that CVD is a man’s disease, but there are important women-specific risk factors throughout women’s lives, like menopause.”
“We have created a holistic selfreflection tool to support women to find out where what areas of their life they could benefit from extra support in – be that stress and mental wellbeing, physical activity, or healthy eating. Visit irishheart.ie and use the tool there or download our Self-care and wellbeing journal,” she explained.
To support these women, we need to make health promotion interventions available and accessible and responsive to their specific needs. The Irish Heart Foundation has a range of programmes targeted at underserved communities for example of Mobile Health Unit which offers free blood pressure checks,” she said.
The Irish Heart Foundation wants to empower women to share information and stories with each other. To help with this a number of women have generously shared their experiences of stroke and heart disease which are available to read on irishheart.ie
For more information on the Irish Heart Foundation’s September campaign Her Heart Matters please see www.irishheart.ie for more information or to donate.
“Some of the most important long-term effects of menopause often go unnoticed. The loss of oestrogen means less protection for heart and bone health. So, it’s important for women as they approach menopause to really take stock of their health.”
Research has shown that women from more backgroundssocio-deprivedaremoreatrisk from heart disease, and according to Ms Morrissey it is wrong to say that our risk of heart disease and stroke is our individual responsibility and solely under our own control.
“We are encouraging women, particularly those in their 40s and 50s or those entering menopause, to take stock of their heart health in September by identifying what small changes they can make now to benefit their heart health into the future. The Irish Heart Foundation has a range of information and resources to support women on their heart health journey,” she said.
“Most women know that makes a healthy lifestyle, but life can get in the way. 1 in 3 women feel they don’t get enough time to focus on their health every day. That’s very understandable when you consider how busy many women’s lives are as they juggle careers, family, caring for elderly parents maybe financial pressures. This is a time when so many women are busy looking after everyone else in their lives, that it’s hard to look after themselves.”
“Many people from marginalised groups are at higher risk of heart disease because of the influence of the wider determinants of health –forces around them that they can’t control. These increase biological, behavioural, and psychosocial risk factors for heart disease and stroke. Women are known to be more affected by these factors than men.
Finally, Ms Morrissey said the good news was that 8% of premature heart disease and stroke can be prevented through very simple changes to lifestyle changes.
The Her Heart Matters campaign will support women by sharing information about lifestyle factors that contribute to the risk of cardiovascular disease and how to address them. It will also include an online self-assessment tool of cardiovascular risk factors so that women can take stock of their heart health, and plan to develop more heart-healthy habits.
The chances of a heart attack increase in menopause as a result of lower oestrogen levels which adversely affect your cholesterol levels, arteries, and blood pressure all of which increasing the risk of a heart attack. Her Heart Matters
“In Ireland, women are 5 times more likely to die from heart disease and stroke than breast cancer, yet only a third (34%) of women aware of this. Sadly, one in four women in Ireland die from heart disease and stroke.
Without Ginkgo-Biloba Pharma Nord: After 10 minutes, the skin temperature increased from 12.6° to approx. 20.0° C. With PharmaGinkgo-BilobaNord: After 10 minutes, the skin temperature increased from 13.8° to approx. 30.9° C.
Traditional herbal medicinal product used to alleviate the symptoms of poor blood flow in conditions such as cold hands and feet, exclusively based upon long-standing use. Always read the leaflet. Ginkgo-Biloba Pharma Nord has a high content of active compounds: The high content of active compounds makes it possible to obtain the desired effect with 1 tablet twice a day. What is ginkgo biloba?
Ginkgo biloba is a traditional herbal me dicinal product used to alleviate the symp toms of poor blood flow in conditions such as cold hands and feet. To get the desired effects, it is essential that you choose a product with a documented content of active compounds.
Speed up your blood flow
Your bloodstream carries oxygen and nu trients to every single part of your body – from head to toe – to ensure that all your body functions work properly. However, the flow of blood through the smallest capillaries can decrease for various rea sons, and that may cause problems like cold fingers and toes.
the underlying mechanisms of these ac tive ingredients, it is possible to manufac ture high-quality extracts that deliver the exact same amount of active compound with each tablet. Ginkgo-Biloba Pharma Nord represents this new generation of pharmaceutical-standard ginkgo biloba products that have become increasingly popular, namely among the elderly.
IE_Biloba_Ad_MedicalIndependent_210x297_0322
Tel: 01 899 1650 • Fax: 01 885 3893 ireland@pharmanord.com • www.pharmanord.ie
Ginkgo biloba is a plant extract made from the leaves of ginkgo biloba, an ancient tem ple tree that is also known as maidenhair tree. The extract contains a variety of bio logically active compounds. Two specific compounds – ginkgoflavone glycosides and terpene lactones – are particularly well-documented and have been shown to support good blood circulation and good cognitive function. Today, thanks to scientific research that has delved into
Every inch of the body depends on a wellfunctioning blood supply that delivers oxy gen and nutrients to the cells. As we hu mans age, our blood circulation becomes less efficient, leading to problems like cold hands and feet. Supports your blood circulation It stands to reason that ginkgo biloba is so popular among older people. The active compounds in the extract dilate your blood vessels, helping your blood to flow more easily through them.
Cold hands and feet? This problem may be a result of having poor blood circulation, and the solution could be tablets with ginkgo biloba. Warm hands and feet again
35° C 30° C 15° C 10° C 5° 10°20°25°CCC30°C15°CC5°C25°C20°C35°C
A thermo-graphic camera can be used to test ginkgo biloba's ability to improve circulation in the hands. When the test subject takes ginkgo biloba, their hands become significantly warmer in the minutes right after they have been cooled down in very cold water.
treatments that are licensed and funded. Currently there are 3: Benralizumab, Mepolizumab and Reslizumab. One key thing to note about these drugs is that Benralizumab, and Mepolizumab are available through the PCRS once they have been prescribed by a physician working within the Severe Asthma Network, a part of the National Clinical Programme for Respiratory Medicine.” Professor Stephen Lane
An Overview of Asthma Care with
Digitalisation of Respiratory Care
“Within the field of digitalisation, there is certainly a way forward whereby you might have an inhaler that records each dose that might be connected to the patient’s phone via Bluetooth technology and the patients can then interrogate that or send it to their doctor.
Ireland has one of the highest rates of asthma prevalence in the world. It is estimated that approximately 500,000 people in Ireland have a degree of asthma, though usually mild. It is the most common chronic respiratory disease in Asthmaadults.may affect a person all their lives, but it can be managed so effectively that a person has a high quality of life and health. However, many people with asthma live and work with avoidable asthma illness, due to having uncontrolled disease. This is despite the availability of excellent national and international evidenced-based guidelines and effective, accessible and safe medicines.
New Developments in Asthma Therapy
Professor Lane states, “This is a relatively new field. There are currently a number of devices that can be prescribed to improve adherence and allow doctors to remotely control patients’ compliance particularly in asthma where compliance and adherence to medication is one of the biggest problems we face. This is because asthmatics do not use their inhalers once they are feeling well; this is the most common reason for asthma to be uncontrolled.
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Professor Lane is Consultant Respiratory Physician at Tallaght University Hospital and Peamount Healthcare and Professor of Respiratory Medicine at Trinity College Dublin. He is Chair of the Clinical Advisory Group of the National Clinical Program for Respiratory Medicine.
Over the past few decades, technology and improvements in artificial intelligence have dramatically changed major sectors of our dayto-day lives, including the field of healthcare. E-health includes a wide range of subdomains, such as wearables, smart-inhalers, portable electronic spirometers, digital stethoscopes, and clinical decision support systems. E-health has been consistently shown to enhance the quality of care, improve adherence to therapy, and allow early detection of worsening in chronic pulmonary diseases.
Whilst I do see a role for it, it hasn’t taken off as a standard of care yet but anything that improves adherence to treatment when well is to be welcomed.
“This is a new class of treatment that is indicated in patients with severe asthma who are getting frequent exacerbations despite maximal inhaled treatment and whose asthma is associated with high levels of eosinophils on their blood count. Most asthmatics will not need this treatment but for those who do, it is very
Professor Lane’s main interest is asthma, related allergies, and COPD.
We recently spoke to Professor Stephen Lane to understand more about the future of this condition within Ireland.
Anti-interleukin 5 therapy
Professor Stephen Lane
“This is, however, a clear opportunity for the future albeit with some challenges. Patients will need to be able to use Bluetooth, use the peak flow meter and the dose counter. Clearly digitalisation is a way forward both for recording lung function like peakflow and oxygen saturations.
“Theseeffective.arerevolutionary
80 | PHARMACYNEWSIRELAND.COM Move away from mono reliever therapy with short acting (SABINAbronchodilatorsProject)toMART
“House dust mite SLIT is effective for all year round rhinitis in patients who are allergic to HDM It is also indicated for difficult asthma. Acarizax, a HDM product, is now available in Ireland but not yet on the GMS so prices can vary between pharmacies.
“Grass pollen SLIT with Grazax or Oralair, grass pollen molecules, is indicated for the treatment of refractory, seasonal rhinitis which is known to everybody as summer hay fever in May, June and July. We usually start treatment in the autumn, out of season ad continue it for 3 years. It can treat hay fever, can get rid of it for good, and possibly prevent the development of asthma. It is a very effective treatment which is very under prescribed in Ireland.
“The two main treatments for COPD are LABAs alone or LAMAs (long acting anti muscarinic agents) alone or usually as a LABALAMA combination. But despite the LABALAMA treatment, patients with COPD continue to have day-to-day symptoms and frequent exacerbations even though they are doing all the right things such as stopping smoking. The next level is to add in an ICS. In selected
Chronic spontaneous urticaria refers to hives that come and go without any obvious trigger, lasting for longer than 6 weeks. It is a common condition affecting 1 in 100 people and is almost three times more common in females. While many people will experience acute urticaria at some point in their lives in the form of hives which resolve within a few days, chronic urticaria is a debilitating condition which can be challenging for clinicians to treat. In Europe, the mean time to diagnosis is 2-4 years. Patients with chronic urticaria report significantly impacted quality of life and poor sleep. Comorbid mood disorders such as anxiety and depression are common. Angioedema, a term referring to swelling of the deeper layers of the skin, is a feature in approximately half of patients. The first line of treatment for chronic urticaria is a second generation antihistamine. Up to 40% of patients however will not respond to this treatment. A high-cost monoclonal antibody, Omalizumab, is used in patients with refractory urticaria on a case-by-case basis. Omalizumab is currently only accessible to patients who are under the care of a specialist centre, since it requires in-hospital administration and support. In St. James's Hospital, home administration of Omalizumab is an option for suitable candidates once they are established on treatment. While home administration of omalizumab is not available at all centres, it offers the important benefit of reducing the frequency of hospital visits for these patients.
‘UCARE accreditation represents a significant step forward for St. James’s Hospital Immunology in our efforts to more effectively help patients with this challenging and distressing skin condition. I am very grateful for the efforts not only of our immunology doctors and nurses, but also our pharmacists and hospital management who have supported the delivery of such high standards of care for this neglected and often misunderstood patient group. We are looking forward to collaborating with the UCARE network and improving outcomes for people who suffer from urticaria, angioedema and related disorders over the coming years,’ said Prof. Niall Conlon.
“But I would hope that the pharmacists would see an increase in prescriptions for grass pollen and HDM products going forward. Everybody is looking for the instant fix, but it needs to be explained to patients that these treatments are designed for long-term use.
patients adding an ICS to LAMA and LABA i.e. triple therapy further improves systems, further reduce exacerbations, but the most important thing it can do is reduce mortality. When triple therapy comes in the one device this can improve patient adherence (Trelegy), however, many patients prefer twice daily dosing (Trixeo).
As the first and only centre of excellence for urticaria in Ireland, St James’s Hospital is working to improve the management of this condition. To become a certified UCARE centre, the Immunology Department underwent a comprehensive audit, fulfilling 32 requirements defined by the Global Allergy and Asthma European Network. The UCARE accreditation outlines a comprehensive protocol that aims to provide excellence in urticaria management, to increase the knowledge of urticaria by research and education, and to promote the awareness of urticaria by advocacy activities.
Reliever treatment is moving toward combining the long acting bronchodilator (LABA) formoteral with an inhaled corticosteroid (ICS) for reliever use in asthma. Formoterol is available in the following combination inhalers e.g Symbicort, Flutiform, Bufomix, DuoResp etc. These treatment treat underlying asthma as well as relieving symptoms. Formoterol is a very safe LABA when used with ICS. LABAs are not to be use alone in asthma, although they have a role in COPD. He adds, “Pharmacists should always be on the look-out for patients who are using LABAs as a treatment on their own. These type of drugs on their own in an asthmatic context are dangerous.”
Triple Therapy for patients with COPD, NOT asthma or asthma COPD overla)
“In my view, I would put everybody eligible patient with COPD on triple treatment, as there are studies showing monotherapy with a LAMA is not as good as dual therapy with LABA-LAMA which in turn is not as good asas good as triple therapy.” What do pharmacists need to know about these? Be aware of move from SABAs to MART therapy Monitor how many SABA cannisters a patient with asthma is collecting. More than 3 year indicates poorly controlled asthma Be aware of new triple therapies in COPD Be aware of increasing use of SLIT for rhinitis and asthma Be aware of new monoclonal anti=IL5 treatments for asthma which are now given in the community via the High Tech Scheme
Professor Lane explains the SABa IN Asthma (SABINA) programme aims to describe the magnitude of SABA (blue inhalers) overuse globally and its impact on clinical asthma outcomes and healthcare utilisation. The SABINA project aims to highlight the dangers of SABA therapy alone. Overuse of SABAs is associated with increased mortality from asthma. Maintenance and Reliever Therapy (MART) with the combination of formoterol and inhaled corticosteroids (ICS) has an established scientific rationale and demonstrated to reduce asthma exacerbations.
StNewsJames’s Hospital - Centre of Excellence for Urticaria Care
This work was led by Professor Niall Conlon, Consultant Clinical Immunologist, Dr Cliodhna Murray, Immunology Specialist Registrar and Dr Katie Ridge, Immunology Specialist Registrar and Wellcome Health Research Board ICAT Fellow.
The Immunology Department at St James’s Hospital has been designated the first UCARE Centre (Urticaria Centre of Reference and Excellence) in Ireland, following accreditation from the Global Allergy and Asthma European Network.
Recognize the Symptoms: Dry Cough (also known as a tickly/ irritating/ non-productive cough)
The importance of natural cough syrup
Some preservatives or additives in children’s cough syrups can act as mild laxatives, cause allergic reactions or stomach discomfort. Preservatives are also thought to disturb the gut flora.5 With 70% of our immune system believed to reside in the gut, interfering with the balance and diversity is something you want to avoid. So opting for a natural, preservative free option is key here.
DID YOU KNOW? A child can get up to 8 colds a year, lasting between 5days to 2 weeks but HSE advise children under 6 years should not be given decongestants for a cough or cold unless advised by a GP 4
Cracking the Cough Code A cough is a natural defence mechanism to clear and protect the respiratory tract from irritating agents or infections which are common in winter. So instead of trying to suppress the cough completely, focus on relieving irritation and discomfort by improving the efficiency of the cough.
Congested Cough (also known as a wet/ chesty/ productive cough) A congested cough produces mucus from the lungs or sinuses. The cough sounds soupy and may come with a wheezing or rattling sound and tightness in the chest. Most congested coughs are caused by an infection: a common cold, the flu, bronchitis, or pneumonia. VIVIO® Junior Cough can naturally hydrate and loosen this mucus to make it more fluid and easier to clear.
A dry cough feels like a tickle in the back of the throat triggering the cough reflex, bringing on dry hacking coughs. Dry coughs occur because of an upper respiratory infection, such as a cold or the flu. In both children and adults, it’s common for dry coughs to linger for several weeks after a cold or the flu has passed.
1. Accessedall%20children,not%20be%20given%20vitamin%20supplements.for-children/#:~:text=The%20government%20recommends%20https://www.nhs.uk/conditions/baby/weaning-and-feeding/vitamins-14.07.21 2. https://www.nutraingredients.com/Article/2020/10/23/Vitaminmarket-set-to-hit-500m-but-where-are-the-new-users Accessed 14.07.21 3. Maru Blue Research Omnibus, 2021, Children’s VMS attitudes in UK. Fieldwork: 23/08/21-27/08/21. Base: 1072 All Adults 18+ 4. (accessedhttps://www2.hse.ie/conditions/colds-coughs-children/19.10.21) 5. Yu Caoa,b, et al, 2020: Impact of food additives on the composition and function of gut microbiota 6. Irish Pharmacy News OTC Awards 2021: Judges comments For more information visit www.viviojunior.com
VIVIO® Junior Cough Syrup provides a sensation of calm, hydration and protection of the upper respiratory tract, modulating the cough without suppressing it. The exclusive formula has a soothing and delicious taste thanks to natural honey and strawberry. The added marshmallow extract reinforces the soothing and calming properties of the syrup due to its natural mucilage properties. Dry cough VIVIO® Junior Cough Syrup forms a protective film on the mucosa of the throat, thanks to the xanthan gum and arabic gum action, which protect the throat from the contact of irritant or infectious agents, relieving its irritation and keeping it hydrated and lubricated. Congested cough VIVIO® Junior Cough Syrup also hydrates and reduces the thickness of the mucus thanks to the cane sugar, which stimulates saliva and increases the water content in the mucus to make it more fluid and easier to clear. How it works
Introducing VIVIO® Junior Cough VIVIO® Junior Cough Syrup is a 100% natural and preservative free syrup for children aged 1 year+ that has been formulated for both dry and congested cough.
• Patient is suffering from any medical condition, in particular Type 2 Diabetes
• Shortness of breath or palpitations
• Iron is being requested for a child
• Heavy Periods • Bleeding in the gastrointestinal tract • Chronic Kidney Disease
Key Points: Ensure your team understands and is confident explaining the following: The various types of iron supplements and how they should be taken The potential side-effects of iron supplements and how best to avoid them The importance of vitamin C for iron absorption The food sources of iron WWHAM protocol and which patients must be referred to the pharmacist.
•
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Iron’s Role in the Body Iron is a mineral used in the production of haemoglobin, a protein in red blood cells that carries oxygen from the lungs around the body, and myoglobin, a protein that carries oxygen to muscle tissues. Iron is also required to produce certain hormones, contribute to a healthy immune system, as well as being crucial to foetal and infant brain development. Iron Deficiency
instructions
• Pregnancy
• Patient is showing severe symptoms of iron deficiency
Consider:
Using WWHAM questions, refer patients to the pharmacist if:
• Poor cognitive functioning Fatigue • Poor condition of hair, skin, and nails
Topic Team TrainingIron Deficiency
assessing
Does
Is
Food Sources A diet rich in iron is advisable for everyone. Good sources of iron include:
• Patient is taking any other medication, as iron may reduce the effectiveness of other medicines
• Obesity. It is very rare for a diet low in iron to cause iron deficiency; however, a low-iron diet combined with one of the conditions above can increase the risk of iron deficiency. Iron deficiency can be referred to as anaemia, one of the most common nutritional deficiencies in the world. Symptoms of Low Iron Symptoms of iron deficiency may not be apparent until depletion is significant. Symptoms may include:
Are
• Red meat
• Beans and pulses • Nuts • Dried fruit • Fortified cereals. Iron levels should be closely monitored by vegetarians and vegans, who should ensure they consume enough non-meat food sources of iron. Precautions Despite the importance of iron during infancy, children should never be given OTC iron supplements unless under the care of a doctor. They absorb iron differently than adults and iron supplements can be extremely dangerous.
Actions:
Your
• Pale skin • Slow healing of wounds • Restless Leg Syndrome. Diagnosis And Treatment Iron Deficiency is diagnosed by blood tests for haemoglobin levels. A GP may recommend prescription iron tablets for those with low haemoglobin or recommend OTC supplements. Those who have been recommended to take supplements should be advised to take them on an empty stomach with a drink containing vitamin C, such as orange juice. This is because iron is better and more easily absorbed without food. Vitamin C improves the absorption of iron. Those taking iron supplements should also be made aware of the possible side-effects, most of which should be eased by taking it as directed:
• Stomach pain or discomfort • Nausea • Diarrhoea
• Side-effectsConstipation.usually ease as the body gets used to the supplement, therefore taking a smaller dose to build up tolerance rather than stopping altogether is advised. Trying a different supplement may also help ease side-effects.
Thanks to the team at totalhealth and Haven Pharmacies for this month’s Topic Team Training: Iron Deficiency. In this series of articles, we provide pharmacists with information to develop and implement OTC team training sessions, aimed at ensuring safe and suitable product recommendations and advice for customers and patients. Your checklist for Iron Deficiency advice should include: own knowledge is up to date, on recommended iron intake for all types of patients appropriate training has been provided to all team members, and assessed, for example through observation or role play You have the appropriate range of products available WWHAM Protocol forms the basis of all interactions at the OTC counter Update your CPD record. Reflect on the following in your own knowledge and your team’s training: your knowledge up to date on recommended iron intake? you know what patients should be referred to a GP? the team always follow WWHAM protocol? all staff confident and comfortable explaining the varying and dosages for all iron supplements? Are all staff aware which patients should be referred to the pharmacist?
Most people absorb the required amount of iron from their diets. A lack of suitable iron is called iron deficiency. It affects people of all ages, but there are particular situations where people are at increased risk of iron deficiency:
Do
The
• Patient is on haemodialysis.
Gentl e on stomach Gentl e on stomach Use on-the-go Energy rel ease Iron helps support a Supports a healthy immune s ys tem Suitabl e for vegans
Chronic postsurgical pain is included in the current International Classification of Diseases, ICD-11 (Table 1).
Chronic postsurgical pain typically involves both nociceptive and neuropathic components. Neuropathic features occur in approximately 30% of patients, a prevalence that varies according to the type of operation (e.g., higher after thoracotomy or mastectomy, lower after hip or knee arthroplasty). Nerve lesion is an important although not the sole risk factor for neuropathic chronic postsurgical pain.
Ideally, assessing the risk for development of chronic pain in surgical patients and establishing predictive factors for the condition, would include preoperative and postoperative personalised assessment of psychological and neurophysiological factors, comprehensive intraoperative data on handling of tissue and nerves, and detailed early and late postoperative pain data. The assessment would ideally be good enough to exclude other causes of the chronic pain state. Some attempts were made to study predictive factors but data are inconclusive so far. Thus, personalised assessment is currently not possible.
Genetic susceptibility: Sensitivity to physiological nociceptive and clinical pain varies significantly between individuals. Animal studies indicate that the susceptibility to develop neuropathic pain has a strong heritable component, but the genes responsible have yet to be identified.
Written by Professor Esther Pogatzki-Zahn, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Albert-Schweitzer-CampusMuenster, 1, 48149 Münster, Germany pogatzki@anit.uni-muenster.deE-mail:
Risk factors for chronic postsurgical pain
The next 2023 EFIC Congress – Pain in Europe XIII (https://efic-congress.org/) taking place on 20-23 September 2023 in Budapest, Hungary will showcase the most promising developments in the personalised management of various pain conditions. One such condition will be chronic postsurgical pain.
PHARMACYNEWSIRELAND.COM 86 Pain
A patient’s risk for developing chronic pain after surgery was underestimated in the past. Data now show an incidence, varying with the type of operation, from 5% to 85%. Disabling chronic postsurgical pain that negatively affects the patient’s quality of life is in the range of 2% to 15%.
Sex: Several studies show that women have higher postoperative pain than men. With more risk factors, the risk increases. By estimating the risk of a patient, the strategy to prevent and treat pain can (and should) be adjusted. Thus, pain management after surgery should be personalized, related to specific risk factors of the patient.
Background Chronic pain (defined as pain that persists or recurs longer than 3 months) after surgery is frequent and may have a lasting impact on the functioning and quality of life of the affected person. Despite this, chronic postsurgical is underrecognized and, consequently, undertreated.
Chronic Postsurgical pain – Personalised Management and Prevention Required
EFIC 2023 will bring attention to the need for this type of assessment
Current treatments for postsurgical pain All major international guidelines recommend a balanced, multimodal pain management. This involves a a combination of non-opioid analgesics (like non-
Based on the current literature, we know that genetic susceptibility, presence of prior pain, prior opioid use, psychosocial factors, and one’s sex may increase one’s risk of developing chronic postsurgical pain.
Presence of prior pain: Preceding pain is associated with the development of chronic postsurgical pain. For example, amputees with severe phantom limb pain have more often had intense and persistent preamputation pain than amputees with less intense phantom pain. A similar association is noted between the intensity of acute postoperative pain and subsequent development of chronic pain after breast surgery, thoracotomy, and inguinal hernia repair. Prior opioid use: Preoperative (long-term) opioid intake has been associated with increased risk of developing disabling chronic pain post-surgery. Psychosocial factors: Beliefs, expectation of pain, fear, past memories, social environment, work, and activity levels, all affect the pain experience. Preoperative anxiety is correlated with postoperative pain experience. Fear of pain in the postoperative setting and the avoidance of such pain might also have a negative effect on how pain is perceived and resolved.
www.floradix.ie Floradix® Iron contributes to the reduction of tiredness and to the normal function of the immune system • No preservatives, colourings or artificial flavourings • Non constipating liquid formula • Highly absorbable iron gluconate • Vitamin C to increase iron absorption • Suitable for vegetarians • Suitable during pregnancy and breastfeeding Distributed in Ireland by: The Natural Medicine Company, Burgage, Blessington, Co. Wicklow Tel: 045-865575 email: sales@naturalmedicine.ie www.naturalmedicine.ie Available in Pharmacies Nationwide.
Pain steroidal anti-inflammatory drugs, metamizole or paracetamol) and – if required – opioids.
Chronic postsurgical or post traumatic pain (ICD 11), modified after Schug et al 2019 develops or increases in intensity after a surgical procedure or a tissue injury persists beyond the healing process, that is 3 months after the triggering event
Localisation: • either at the surgical/area of injury, • or projected onto the innervation area of a nerve in this area, • or related to a dermatome or Head’s zone (after surgery or injury to deep somatic and visceral tissue)
Paravertebral block in breast cancer surgery may prevent chronic pain in one of five women. Ketamine infused perioperatively has produced some positive findings but not uniformly. Gabapentinoids overall, lack a significant clinical effect.
EFIC 2023 will have discussions about preventative treatments for chronic postsurgical pain
PHARMACYNEWSIRELAND.COM 88
References available on request
Opioids carry significant harms and so their use should follow certain rules: Opioids should be given orally, where possible Educate patient about benefits and harms of short- and long-term use After discharge, patients should be advised about correct use and maximum dosages should not be exceeded. Also, alternative treatment options should be considered. Here, regional anesthesia techniques are of major importance and build a cornerstone of acute perioperative pain management. All management options should always balance between benefits and harms for each individual patient. Non-pharmacological pain management strategies and treatment options (for example cooling, relaxation, hypnosis, or music) have been shown to provide additional pain reduction after surgery and should be used.
It is distinguished between tissue trauma arising from a controlled procedure in the delivery of healthcare (surgery) and forms of uncontrolled accidental damage (other traumas).
Table 1 EFIC 2023 will showcase the most up to date research on new treatments for postsurgical pain Preventing postsurgicalchronicpain
Epidural analgesia may prevent chronic pain after thoracotomy in one patient out of four thus treated.
Other causes of pain (e.g. pre existing pain conditions, infection, malignancy) are excluded CPSP can often show characteristics of neuropathic pain.
PROSPECT initiative To provide advise on which analgesic drug or techniques are of most benefit after specific surgical procedures, the PROSPECT postoperative(PROcedure-SPECificpainmanagemenT) initiative was formed. There are recommendations for several surgical procedures available including the evidence behind them. The recommendations are available on the prospect website (https://esraeurope.org/prospect/).
Regional anaesthesia may reduce the risk of chronic postsurgical pain in some patients.
References: 1. Merry A, et al. AFT-MX-1, a prospective parallel group, double-blind comparison of the analgesic effect of a combination of paracetamol and ibuprofen, paracetamol alone, or ibuprofen alone in patients with post-operative pain. Department of Anaesthesiology, University of Auckland, New Zealand 2008. *compared with the same daily dose of standard paracetamol or ibuprofen alone. Easolief DUO 500 mg/150 mg film-coated tablets. Each tablet contains paracetamol 500 mg and ibuprofen 150 mg. Presentation: White, capsule shaped tablet with breakline on one side and plain on the other side. Indications: Short-term symptomatic treatment of mild to moderate pain. Dosage: Adults/elderly: The usual dosage is one to two tablets taken every six hours up to a maximum of six tablets in 24 hours. Children: Easolief DUO is contraindicated in children under 18 years. Contraindications: Severe heart failure, known hypersensitivity to paracetamol, ibuprofen, other NSAIDs or to any of the excipients, active alcoholism, asthma, urticaria, or allergic-type reactions after taking acetylsalicylic acid or other NSAIDs, history of gastrointestinal bleeding or perforation related to previous NSAID therapy, active or history of recurrent peptic ulceration/haemorrhage, severe hepatic failure or severe renal failure, cerebrovascular or other active bleeding, blood-formation disturbances, during the third trimester of pregnancy. Warnings and precautions: This medicine is for short term use and is not recommended for use beyond 3 days. Clinical studies suggest that use of ibuprofen, particularly at a high dose may be associated with a small increased risk of arterial thrombotic events. Patients with uncontrolled hypertension, congestive heart failure, established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease should only be treated with ibuprofen after careful consideration and high doses should be avoided. Careful consideration should be exercised before initiating long-term treatment of patients with risk factors for cardiovascular events. The use of paracetamol at higher than recommended doses can lead to hepatotoxicity, hepatic failure and death. Patients with impaired liver function or a history of liver disease or who are on long term ibuprofen or paracetamol therapy should have hepatic function monitored at regular intervals. Severe hepatic reactions, including jaundice and cases of fatal hepatitis, though rare, have been reported with ibuprofen. Paracetamol can be used in patients with chronic renal disease without dosage adjustment. There is minimal risk of paracetamol toxicity in patients with moderate to severe renal failure. Caution should be used when initiating treatment with ibuprofen in patients with dehydration. The use of an ACE inhibiting drug, an anti-inflammatory drug and thiazide diuretic at the same time increases the risk of renal impairment. Blood dyscrasias have been rarely reported. Patients on long-term therapy with ibuprofen should have regular haematological monitoring. Like other NSAIDs, ibuprofen can inhibit platelet aggregation. GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at anytime during treatment. Combination therapy with protective agents (e.g. misoprostol or proton pump inhibitors) should be considered. Use with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided. NSAIDs may lead to onset of new hypertension or worsening of pre-existing hypertension and patients taking antihypertensive medicines with NSAIDs may have an impaired anti-hypertensive response. Fluid retention and oedema have been observed in some patients taking NSAIDs. NSAIDs may very rarely cause serious cutaneous adverse events such as exfoliative dermatitis, toxic epidermal necrolysis and Stevens-Johnson syndrome. Acute generalised exanthematous pustulosis (AGEP) has been reported in relation to ibuprofen-containing products. Products containing ibuprofen should not be administered to patients with acetylsalicylic acid sensitive asthma and should be used with caution in patients with pre-existing asthma. Adverse ophthalmological effects have been observed with NSAIDs. For products containing ibuprofen aseptic meningitis has been reported only rarely. NSAIDs may mask symptoms of infection and fever. In order to avoid exacerbation of disease or adrenal insufficiency, patients who have been on prolonged corticosteroid therapy should have their therapy tapered slowly rather than discontinued abruptly when products containing ibuprofen are added to the treatment program. Interactions: Warfarin, medicines to treat epilepsy, chloramphenicol, probenecid, zidovudine, medicines used to treat tuberculosis such as isoniazid, acetylsalicylic acid, other NSAIDs, medicines to treat high blood pressure or other heart conditions, diuretics, lithium, methotrexate, corticosteroids. Fertility, pregnancy and lactation: Easolief DUO is contraindicated during the third trimester of pregnancy. Driving and operation of machinery: Dizziness, drowsiness, fatigue and visual disturbances are possible after taking NSAIDs. If affected patients should not drive or operate machinery. Undesirable effects: Dizziness, headache, nervousness, tinnitus, oedema, fluid retention, abdominal pain, diarrhoea, dyspepsia, nausea, stomach discomfort, vomiting, flatulence, constipation, slight gastrointestinal blood loss, rash, pruritus, alanine aminotransferase increased, gamma-glutamyltransferase increased, abnormal liver function tests, blood creatinine increased and blood urea increased. Refer to Summary of Product Characteristics for other adverse effects. Adverse reactions should be reported via HPRA Pharmacovigilance, website: www.hpra.ie. Pack size: 24 tablets. Marketing authorisation holder: Clonmel Healthcare Ltd. Marketing authorisation number: PA0126/294/1. Supply through pharmacies only. Date last revised: June 2022. 2022/ADV/EAS/175H.
DUAL ACTION NOW AVAILABLE TO ORDER Call our freephone order line on 1800 26 26 26 An analgesic brand that is clinically proven to provide 30% more effective pain relief1* IN ONE TABLET
The Irish Men’s Sheds Association was formed in 2011 and through over 450 locations nationwide, they provide support, information and resources to members’ sheds in Ireland, north and south of the border.
Drs Hameed and Malone worked with RCSI colleagues, Jemil Saidi and Gina Rizq, and collaborators, Sean Gallagher, Enda O’Dowd and Derek Vallence, in NCAD.
Arthur McPartling with Sarah Kenny, Manager, LloydsPharmacy, Ashleaf Shopping Centre
There are two common types of heart failure: Heart Failure with Preserved Ejection Fraction (HFpEF) and Heart Failure with Reduced Ejection Fraction (HFrEF). Ejection fraction is the measurement used to determine the heart’s ability to pump oxygenrich blood through the body.
LloydsPharmacy Promote Heart Health
Researchers from RCSI University of Medicine and Health Sciences have developed a new lab-based model of a heart and circulatory system that will help test devices to treat patients with one of the most common forms of heart failure.
PHARMACYNEWSIRELAND.COM 90 News
The study, which used two different types of circulatory models including a silicone heart model, was carried out by RCSI in collaboration with the National College of Art and Design (NCAD). The research is published in the current edition of ‘Frontiers in Cardiovascular Medicine’.
Senior author on the study, Dr Aamir Hameed, Lecturer in the Department of Anatomy and Regenerative Medicine and a Principal Investigator with the Tissue Engineering Research Group at RCSI said: “Half of the patients presenting with heart failure have heart failure with preserved ejection fraction and the numbers are increasing in the developed world
New heart model to help treat patients with heart failure
Dr Aamir Hameed RCSI in particular due to the increase in the prevalence of risk factors. The condition can be difficult to treat with medicines and is causing a considerable burden to health services throughout the world.
In this research from RCSI, a model called a ‘mock circulatory loop’ was developed to mimic both a healthy heart and a heart in failure with preserved ejection fraction. The model enables potential heart failure treatment devices to be examined in terms of their effect on both chambers in the left side of the heart. This model can test devices to examine the left atrium, the top chamber responsible for receiving oxygen-rich blood from the lungs, as well as the left ventricle, the lower chamber responsible for pumping the oxygen-rich blood around the body.
Dervila McGarry, Head of Marketing with LloydsPharmacy said: ‘At LloydsPharmacy we are committed to serving the communities in which our stores operate. Partnering with the Men’s Shed networks, allows our LloydsPharmacy colleagues to further integrate and provide an invaluable health check to the men across Ireland. We are delighted to be partnering with the Irish Men’s Association and hope to grow the partnership further in the future.’
The first author on the study, Dr Andrew Malone, Postdoctoral Researcher at RCSI said: “Until now, no lab model had been developed that could both mimic the cardiac cycle and features two independently controlled cardiac chambers to fully simulate the blood flow of the left atrium and the left ventricle during the resting phase of the cardiac cycle. This is a key step forward in the development of a robust means of testing heart failure device treatments’.
“The development of this labbased model is a milestone in heart failure research as it enables devices to be tested that have the potential to treat a condition that affects millions of people around the world, improving their quality of life and reducing the burden on health services.”
In recent years, the number of patients presenting with heart failure with normal or preserved ejection fraction measurement is increasing, most likely due to the increase in prevalence of common risk factors, including old age, high blood pressure and obesity. Women are at greater risk than men.
As part of Men’s Health activities, LloydsPharmacy’s highly trained colleagues are visiting Men’s Shed locations across Ireland to undertake Heart Health Checks and give advice to members. LloydsPharmacy has teamed up with the Irish Men’s Sheds Association to encourage all members to look after their heart health. As part of the partnership, LloydsPharmacy’s highly trained colleagues are visiting various Men’s Shed locations across Ireland to undertake checks and offer knowledge and support to Trainedmembers.colleagues from LloydsPharmacy Ashleaf visited Dublin 12 Men’s Shed and undertook free Heart Health Checks. Eight men were checked on this visit with positive feedback and result from all members. With one in six people having a stroke at some time in their life, it is very important to take care of our hearts. There are simple lifestyle changes we can make to ensure we are doing the best to prevent heart attacks or strokes. Keeping an eye on your blood pressure is essential for maintaining a healthy heart.
3. Bonten M.J.M., Huijts S.M, Bolkenbaas M, et al. Polysaccharide Conjugate Vaccine Against Pneumococcal Pneumonia in Adults. The New England Journal of Medicine. 2015;372:1114-25. 4. Pfizer Inc. Press Release Mar 18, 2015.
Adults aged 50 years and older: When Prevenar 13 was given concomitantly with trivalent inactivated influenza vaccine (TIV), the immune responses to Prevenar 13 were lower compared to when Prevenar 13 was given alone, however, there was no long-term impact on circulating antibody levels. The immune responses to Prevenar 13 were noninferior when Prevenar 13 was given concomitantly with quadrivalent inactivated influenza vaccine (QIV) compared to when Prevenar 13 was given alone. As with concomitant administration with trivalent vaccines, immune responses to some pneumococcal serotypes were lower when both vaccines were given concomitantly. Fertility, Pregnancy & Lactation: There are no data from the use of pneumococcal 13-valent conjugate in pregnant women. It is unknown whether pneumococcal 13-valent conjugate is excreted in human milk. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Side Effects: Analysis of postmarketing reporting rates suggests a potential increased risk ofconvulsions, with or without fever, and HHE when comparing groups which reported use of Prevenar 13 with Infanrix hexa to those which reported use of Prevenar 13 alone. Adverse reactions reported in clinical studies or from the post-marketing experience for all age groups are listed in this section per system organ class,in decreasing order of frequency and seriousness. The frequency is defined as follows: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (≤ 1/10,000), not known (cannot be estimated from available data). Infants and children aged 6 weeks to 5 years: Very common (≥ 1/10): Decreased appetite, fever, pyrexia, irritability, any vaccination-site erythema, induration/swelling or pain/tenderness, somnolence, poor quality sleep. Vaccination-site erythema or induration/swelling 2.5cm – 7.0 cm (after the booster dose and in older children [age 2-5 years]. Common (≥ 1/100 to < 1/10): Vomiting, diarrhoea, rash, pyrexia >39 °C, vaccination-site movement impairment (due to pain), vaccination-site erythema or induration/swelling 2.5cm – 7.0cm (after infant series). Uncommon (≥ 1/1,000 to < 1/100): Convulsions (including febrile convulsions), urticaria or urticaria-like rash, vaccination-site erythema, induration/swelling >7.0cm, crying. Rare: Hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, hypotonic-hyporesponsive episode. Not known: Lymphadenopathy (localised to the region of the vaccination site), anaphylactic/anaphylactoid reaction including shock, angioedema, erythema multiforme, vaccination site urticaria, vaccination-site dermatitis, vaccination-site pruritus, flushing. In clinical studies infants vaccinated at 2, 3 and 4 months of age, fever ≥ 38°C was reported at higher rates among infants who received Prevenar (7-valent) concomitantly with Infanrix hexa than in infants receiving Infanrix hexa alone. After a booster dose at 12 and 15 months of age, the rate of fever ≥ 38°C was greater in infants who received Prevenar (7 valent) and Infanrix hexa at the same time compared to infants receiving Infanrix hexa alone. These reactions were mostly moderate (less than or equal to 39°C) and transient. Additional information in special populations: Apnoea in very premature infants (≤ 28 weeks of gestation). Children and adolescents aged 6 to 17 years of age: Very common (≥ 1/10): Decreased appetite, irritability, any vaccination-site erythema, induration/swelling or pain/ tenderness, somnolence, poor quality sleep, vaccination-site tenderness (including impaired movement). Common (≥ 1/100 to < 1/10): Headaches, vomiting, diarrhoea, rash, urticaria or urticaria-like rash, pyrexia. Additional information in special populations: Children and adolescents with sickle cell disease, HIV infection or an HSCT transplant have similar frequencies of adverse reactions, except that headaches, vomiting, diarrhoea, pyrexia, fatigue, arthralgia, and myalgia were very common. Adults ≥18 years of age, and the elderly: Very common (≥ 1/10): Decreased appetite, headaches, diarrhoea, vomiting,(in adults aged 18 to 49 years), rash, chills; fatigue; vaccination-site erythema; vaccination-site induration/swelling; vaccination-site pain/tenderness (severe vaccination-site pain/ tenderness very common in adults aged 18 to 39 years); limitation of arm movement (severe limitation of arm movements very common in adults aged 18 to 39 years), arthralgia; myalgia.
ABBREVIATED PRESCRIBING INFORMATION Prevenar 13* Suspension for Injection Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed)
INDICATED FOR THE PREVENTION OF PNEUMOCOCCAL PNEUMONIA IN ADULTS1 IN ADULTS AGED ≥ 65 YEARS With each additional comorbid condition, the risk for pneumococcal pneumonia multiplies compared to healthy adults of the same age2 Proven to reduce the risk of community-acquired pneumonia: Results from the Community-Acquired Pneumonia Immunisation Trial in Adults (CAPiTA) – one of the largest vaccine efficacy trials ever conducted in older adults.3,4
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Presentation: Each 0.5ml dose of Prevenar 13 contains 2.2 micrograms of each of the following pneumococcal polysaccharide serotypes: 1, 3, 4, 5, 6A, 7F, 9V, 14, 18C, 19A, 19F, 23F and 4.4 micrograms of pneumococcal polysaccharide serotype 6B. Each pneumococcal polysaccharide is conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate. 1 dose (0.5 ml) contains approximately 32 µg CRM197carrier protein and 0.125 mg aluminium. Indications: Active immunisation for the prevention of invasive disease, pneumonia and acute otitis media caused by Streptococcus pneumoniae in infants, children and adolescents from 6 weeks to 17 years of age. Active immunisation for the prevention of invasive disease and pneumonia caused by Streptococcus pneumoniae in adults ≥18 years of age and the elderly. Dosage and Administration: The immunisation schedules for Prevenar 13 should be based on official recommendations. It is recommended that infants who receive a first dose of Prevenar 13 complete the vaccination course with Prevenar 13. For intramuscular injection. Infants aged 6 weeks-6 months: Three dose primary series: The recommended immunisation series consists of four doses, each of 0.5ml. The primary infant series consists of three doses, with the first dose usually given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age. Two dose primary series: Alternatively, when Prevenar 13 is given as part of a routine infant immunisation programme, a series consisting of three doses, each of 0.5ml, may be given. The first dose may be administered from the age of 2 months, with a second dose 2 months later. The third (booster) dose is recommended between 11 and 15 months of age. Preterm infants (< 37 weeks gestation): In preterm infants, the recommended immunisation series consists of four doses, each of 0.5 ml. The primary infant series consists of three doses, with the first dose given at 2 months of age and with an interval of at least 1 month between doses. The first dose may be given as early as six weeks of age. The fourth (booster) dose is recommended between 11 and 15 months of age. Unvaccinated infants and children ≥ 7 months of age: Infants 7-11 months: Two doses, each of 0.5 ml, with at least a 1 month interval between doses. A third dose is recommended in the second year of life. Children aged 12-23 months: Two doses, each of 0.5 ml, with at least a 2 month interval between doses. Children and adolescents aged 2-17 years: one single dose of 0.5 ml. Prevenar 13 vaccine schedule for infants and children previously vaccinated with Prevenar (7-valent) (Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F): Infants and children who have begun immunisation with Prevenar may switch to Prevenar 13 at any point in the schedule. Children aged 12-59 months: Children who are considered completely immunised with Prevenar (7-valent) should receive one dose of 0.5 ml of Prevenar 13 to elicit immune responses to the 6 additional serotypes. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Children and adolescents aged 5-17 years: One single dose of Prevenar 13 if they have been previously vaccinated with one or more doses of Prevenar. This dose of Prevenar 13 should be administered at least 8 weeks after the final dose of Prevenar (7-valent). Adults ≥18 years of age and the elderly: One single dose. The need for revaccination with a subsequent dose of Prevenar 13 has not been established. Regardless of prior pneumococcal vaccination status, if the use of 23 valent polysaccharide vaccine is considered appropriate, Prevenar 13 should be given first. Special Populations: Individuals who have underlying conditions predisposing them to invasive pneumococcal disease (such as sickle cell disease or HIV infection) including those previously vaccinated with one or more doses of 23-valent pneumococcal polysaccharide vaccine may receive at least one dose of Prevenar 13. In individuals with an haematopoietic stem cell transplant (HSCT), the recommended immunisation series consists of four doses of Prevenar 13, each of 0.5 ml. The primary series consists of three doses, with the first dose given at 3 to 6 months after HSCT and with an interval of at least 1 month between doses. A fourth (booster) dose is recommended 6 months after the third dose.
References: 1. Prevenar 13 Suspension for Injection. Summary of Product Characteristics. 2. Shea K, Edelsberg J, Weycker D, et al. Rates of Pneumococcal Disease in Adults with Chronic Medical Conditions. Open Forum Infectious Disease. 2014;1-9.
Common (≥ 1/100 to < 1/10): Vomiting (in adults aged 50 years and over), pyrexia(very common in adults aged 18 to 29 years). Uncommon (≥ 1/1,000 to < 1/100): Nausea, hypersensitivity reaction including face oedema, dyspnoea, bronchospasm, lymphadenopathy localized to the region of the vaccination site. Additional information in special populations: Adults with HIV infection have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common and nausea common. Adults with an HSCT have similar frequencies of adverse reactions, except that pyrexia and vomiting were very common. For full prescribing information see the Summary of Product Characteristics. Legal Category: S1A. Package Quantities: Pack of 1 single-dose prefilled syringe (with separate needle) or pack of 10 single- dose pre-filled syringes. Marketing Authorisation Numbers: Single-dose pre-filled syringe (with separate needle) pack of 1: EU/1/09/590/002, single-dose pre-filled syringe pack of 10: EU/1/09/590/003. Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium. For further information on this medicine please contact: Pfizer Medical Information on 1800 633 363 or at EUMEDINFO@pfizer.com. For queries regarding product availability please contact: Pfizer Healthcare Ireland, Pfizer Building 9, Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24 + 353 1 4676500. Date of preparation: 11/2018. *Trade mark. Ref: PN 11_0 IE.
Contra-indications: Hypersensitivity to any component of the vaccine or to diphtheria toxoid. As with other vaccines, the administration of Prevenar 13 should be postponed in subjects suffering from acute, severe febrile illness. However, the presence of a minor infection, such as a cold, should not result in the deferral of vaccination. Warnings and Precautions: Do not administer intravascularly. Appropriate medical treatment and supervision must be readily available in case of a rare anaphylactic event. This vaccine should not be given as an intramuscular injection to individuals with thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injection, but may be given subcutaneously if the potential benefit clearly outweighs the risks of administration. Prevenar 13 will only protect against Streptococcus pneumoniae serotypes included in the vaccine, and will not protect against other microorganisms that cause invasive disease, pneumonia, or otitis media. As with any vaccine, Prevenar 13 may not protect all individuals receiving the vaccine from pneumococcal disease. Individuals with impaired immune responsiveness, whether due to the use of immuno-suppressive therapy, a genetic defect, human immunodeficiency virus (HIV) infection, or other causes, may have reduced antibody response to active immunization. Safety and immunogenicity data are available for a limited number of individuals with sickle cell disease, HIV infection, or with an HSCT. Safety and immunogenicity data for Prevenar 13 are not available for individuals in other specific immuno-compromised groups (e.g., malignancy or nephrotic syndrome) and vaccination should be considered on an individual basis. Infants and children aged 6 weeks to 5 years: Prevenar 13 does not replace the use of 23-valent pneumococcal polysaccharide vaccine in at risk children ≥ 24 months of age. Children ≥ 24 months of age at high risk, previously immunised with Prevenar 13 should receive 23-valent pneumococcal polysaccharide vaccine whenever recommended. The potential risk of apnoea and the need for respiratory monitoring for 48-72 hours should be considered when administering the primary immunisation series to very premature infants (born ≥ 28 weeks of gestation) and particularly for those with a previous history of respiratory immaturity. When Prevenar 13 is administered concomitantly with Infanrix hexa (DTPa-HBV-IPV/Hib), the rates of febrile reactions are similar to those seen with concomitant administration of Prevenar (7-valent) and Infanrix hexa. Increased reporting rates of convulsions (with or without fever) and hypotonic hyporesponsive episode (HHE) were observed with concomitant administration of Prevenar 13 and Infanrixhexa. Antipyretic treatment should be initiated according to local guidelines for children with seizure disorders or with a history of febrile seizures and for all children receiving Prevenar 13 simultaneously with vaccines containing whole cell pertussis.
disease Chronic liver disease Chronic pulmonary disease Current TheseDiabetessmokersunderlying conditions included2: Date of Preparation: February 2021 | PP-PNA-IRL-0006 Help prevent pneumococcal pneumonia with the proven protection of Prevenar 131,3 24.2xincreasedriskunderlyingconditions2.1xincreasedrisk 1 conditionunderlying 9.2xincreasedrisk >3conditionsunderlying
PHARMACYNEWSIRELAND.COM 92 Vitamin D
Vitamin D status varies by geographical area in Ireland. For example, those living in
What constitutes vitamin D deficiency? This has only been defined in relation to optimal bone health. A 25-hydroxyvitamin D level of less than 30 nmol/L is generally considered to represent deficiency and can cause rickets in children, osteomalacia in adults and result in betweenhyperparathyroidism.secondaryAlevel30-50nmol/Lrepresents possible deficiency and may be deleterious to bone health though other factors such as calcium and phosphate intake interact with vitamin D and play a role. For this reason, levels in the 30-50 nmol/L range are generally categorised as “insufficient". Despite this, higher calcium intake appears to partially compensate for lower vitamin D status by reducing hyperparathyroidism.secondaryToensure that one is vitamin D replete, it is prudent to maintain a level of ≥50 nmol/L. Vitamin D levels up to 75 nmol/L have been associated with more optimal suppression of serum parathyroid hormone (PTH), bone turnover markers and bone density in several studies though evidence is mainly observational and definitive data is lacking. The Endocrine Society defines vitamin D insufficiency as a level between 50-75 mol/L but this is not widely accepted. Vitamin D levels of up to 60 nmol/l may reduce falls risk in some adults and levels up to 75 nmol/L are associated with better performance in tests of physical function including gait speed. For this reason, a target level of 75 nmol/L is recommended for older adults by some bodies including the American Geriatric Society, particularly for those who are frail and at risk of falls and fractures. Several studies report positive associations between higher levels of 25(OH)D and other health outcomes but definitive data is lacking. Levels above 120 nmol/l may be deleterious though toxicity is rare and generally only found with levels above 300 nmol/l. How common is deficiency? Deficiency is common in Ireland and countries above 32o north latitude, where little or no vitamin D synthesis occurs between the months of November to March giving rise to the so-called “vitamin D winter”. In fact, vitamin D levels are typically highest in August/ September at the end of the summer and lowest in February/ March. Indeed, the level usually drops by about 30 per cent between seasons. In Ireland, overall, 13.1 per cent of the population older than 50 are vitamin D deficient (<30 nmol/L) based on findings from The Irish Longitudinal Study of Ageing (TILDA). In the same study, deficiency affected nearly one in four (24.1%) in the winter with the greatest prevalence (37%) in those aged over 80. Furthermore, more than half (59.2%) had levels below 50 nmol/l in the Winter. There were also regional variations with higher rates of deficiency in the north and west of the country. Using TILDA data, it is also estimated that 27 per cent of over-70s that were cocooning may be deficient. Several other Irish studies report similar rates of deficiency. For example, In in the West of Ireland the overall prevalence of deficiency using a lower cut-off (<25 nmol/l) in a large cohort (n=24,302) was 17%. More specifically, deficiency affected 42% in nursing homes, 37% of outpatient attendees and 13% of community dwellers. More than half (54%) also had vitamin D levels below 50 nmol/l. Similarily, in a study of frail, older Irish adults (n=1,316) attending geriatric outpatient clinics in Dublin, 33% were found to be deficient (<30 nmol/L) with 75 per cent of non supplemented patients having levels below 50 nmol/L. One of the the largest Irish studies of vitamin D status to date included 36,466 people aged 18-90+ in the Leinster area who had vitamin D checked by request of their GP. It identified an on overall rate of deficiency of 13% rising to 23% in the Winter. Furthermore, up to half of adults had levels below 50 nmol/L. Unlike many studies which included older adults, it identified the highest rate of deficiency (21%) in those who were younger (18-39 years) with the lowest rate of 10-11% in those aged 60-79 but rising to 17% in the 80+ age group. A similar 'U" shaped relationship has been identified in the West of Ireland. The highest prevalence of deficiency in a population group in Ireland was found in those of South East Asian ethnicity living in Dublin (n=186) where 66.7% were found to be deficient all year round and with only 6.7% having a level above 50 nmol/l .
Factors affecting vitamin D status
Written by Dr Kevin McCarroll, Consultant Physician, St James’s Hospital, Dublin Leinster have the the lowest rate of deficiency while a higher prevalence is found in all other provinces. In the largest study to geomap vitamin D status in Europe (n=34,466) based on vitamin D samples from Irish adults mainly in Dublin, there was a striking difference in vitamin D status between postal codes areas. Notably, in winter, areas in South Dublin (Dublin 4, Dublin 6/6W, Dublin 14/16) were found to have greater levels when compared to west, central and north Dublin. In Dublin city centre (Dublin 1 and Dublin 2) there were also greater levels of deficiency (34- 37%) versus nearby areas of Dublin 4 and Dublin 6 where prevalence was nearly half this at 19%.
Vitamin D has become the focus of huge interest in recent years, with an increasing number of studies identifying a high prevalence of deficiency. Vitamin D is widely regarded as being important for a healthy immune system and is implicated in the pathogenesis of cancer, autoimmune, cardiovascular and respiratory diseases as well as depression and cognitive impairment. More recently a large body of circumstantial evidence supports a role for vitamin D in ameliorating the symptoms or severity of Covid-19. In fact, to date there are nearly 1000 peer-reviewed studies published on the topic of ‘Vitamin D and Covid-19’. Vitamin D is not a nutrient in the traditional sense as it is a hormone that is largely derived from cutaneous synthesis after UVB exposure. Furthermore, dietary sources are limited and make a small contribution to overall intake but include fortified foods (milks, breakfast cereals), oily fish and eggs.
What is our Understanding of Vitamin D
Several factors may account for these study findings including area differences in levels of UVB irradation, dietary vitamin D intake, sun exposure, ethnicity and lifestyle factors such as smoking. In particular, lower socioeconomic status (SES) is linked with lower vitamin D status in several studies including in the Irish TILDA sample, where lower asset wealth was associated with a 50% increased risk of deficiency. Lower consumption of vitamin D rich or fortified foods which are more expensive, less use of supplements and sun holiday travel in poorer socioecomic areas are factors. Lower SES is also associated with higher rates of obesity which probably lowers vitamin D levels as a result of sequestration in fat tissue. Smoking is also a factor, as it has been independently associated with lower vitamin D in most studies, though the mechanism is not UVBunderstood.irradiationalso varies significantly by latitude even within Ireland (51 -55 N) but is also reduced by cloud cover which is greater in certain parts of the country. In those of nonEuropean ethnicity who have more pigmented skin, there is a greater risk of deficiency as longer sun
TheVitaminSunshine Viatris, Newenham Court, Northern Cross, Malahide Road, Dublin 17, Dublin, Ireland. www.viatris.ie | DOP: August 2022Job code: COL-2022-0005 M A D E I N I R E L A N D Food supplements do not replace a varied, balanced diet and a healthy lifestyle. Always read the label carefully. 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 the national reporting system HPRA Pharmacovigilance, Website: www.hpra.ie Adverse reactions/events should also be reported to the marketing authorisation holder at email address: pv.ireland@viatris.com or phone 0044 (0) 800 1218267. Contributes to: • maintenance of normal bones • normal function of the immune system • maintenance of normal muscle function
2.0 -2.5+ nmol/L per 100 IU, so 800 IU daily should result in an increase of about 20 nmol/L. If additional calcium is required, combined vitamin D / calcium supplements can be used, aiming for total calcium intake (dietary and supplemental) of 1000 mg daily. While there are different recommendations for daily or equivalent daily vitamin D intakes, the National Academy of Medicine advises 600 IU/day for those aged between 9–70 and 800 IU/ day if older than 70.
“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.
7-dehydrocholesterol, the precursor of pre-vitamin D.
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.
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).
Prevention and Treatment
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.
Whilst dietary sources of vitamin D are limited they account for a small but significant contribution to overall status, especially in the winter. Rich sources include oily fish, sundried mushrooms, vitamin D-fortified milk and breakfast cereals. Some fortified foods also have the added advantage of containing additional calcium, which along with vitamin D is important for bone health. However, diet alone is not enough to maintain adequate vitamin D status in the Irish population. In most cases, oral supplementation with 8001,000 IU vitamin D3 daily will be sufficient to maintain a level of 50 nmol/L, though higher doses will be required if there is poor gut absorption, obesity or liver disease. A variety of vitamin D tablets are licensed to treat or prevent deficiency and include daily (800 IU or 1,000 IU), onceweekly (7,000 IU) or once-monthly (25,000 IU). Therapy with 50,000 IU once weekly for about six weeks can be used for more rapid correction of deficiency followed by tosupplements.maintenanceThedoseresponsesupplementsrangesfromabout
Consider rechecking levels to ensure adequate response to treatment, especially if compliance with supplements is in question or in those with osteomalacia or metabolic bone disease. However, there is no need for routine testing or retesting. If using daily supplements, levels should not be checked for at least three months — the time taken to reach steady state. Its also important to factor in the season of testing when interpreting results. For example, vitamin D levels can typically vary by up to 15 nmol/l between seasons. A recent study in Dublin (n=36,458) found that nearly one in four patients were retested though 12.2% were done too early (within 3 months) or too frequent (29% had two or more retests annually) and 57% were in those who were initially vitamin D replete (≥50 nmol/l).
HRB Supports New Projects
“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.”
Vitamin D testing Vitamin D deficiency is often picked up on blood tests in those who either have no or nonspecific symptoms. However, severe deficiency can give rise to generalised aches and pains and osteomalacia, which can be exacerbated by low calcium intake. So who should be tested? Guidelines vary though ‘at-risk’ groups should be considered for testing. These include frail older adults, those with minimal sun exposure, malabsorption syndromes, unexplained musculoskeletal symptoms and low bone density.
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 microbiomeresponsive brain biomarkers of cognitive impairments relevant to schizophrenia.
PHARMACYNEWSIRELAND.COM 94 Vitamin D exposure is required for vitamin D synthesis due to increased UV absorption by cutaneous melanin. In younger adults, a rise in veganism, vegetarian and reduced animal products in the diet may be a factor as meat, vitamin D-fortified dairy and fish consumption account for a significant proportion of overall dietary vitamin D intake. Additionally, younger adults who are shiftworkers may lose out on the opportunity for sun exposure and are found to have a higher prevalence of deficiency. In older adults, the higher prevalence of deficiency is due in part to increasing frailty and less sun exposure. However, the capacity of the skin to synthesise vitamin D may decline by as much as 75 per cent with age, possibly due to reduced levels of cutaneous
Vitamin D and its Role in Dementia
4. Supplementation may be advisable It is also relevant to mention that there is widespread vitamin D deficiency or insufficiency worldwide, even in sunny regions where one would assume that people got enough sun exposure to ensure healthy levels of the nutrient.
Most of us know someone with dementia, a condition that is normally associated with growing old. But who would have expected a common vitamin deficiency to be one of the underlying factors of this disease, which is among the major causes of disability and dependence in old age?
The study, which is published in the American Journal of Clinical Nutrition, has come up with several key findings. Besides mentioning that low vitamin D status is associated with lower brain volume and an increased risk of dementia and stroke, the study points to genetic analyses that support a causal effect of vitamin D deficiency and dementia. Specifically, the researchers mention that in some populations, up to 17 percent of dementia cases could be prevented simply by raising people’s vitamin D in the blood to 50 nmol/L, which is considered to be the normal level.
Source: Vitamin D and brain health: an observational and Mendelian randomization study, The American Journal of Clinical Nutrition, 10.1093/ajcn/nqac1072022;DOI:
The Pharmaceutical Managers’ Institute is hosting a Leaders Forum at Kingswood House Hotel, Naas Road on Thursday, September 15th, 2022. This lunch event takes place on September 15th, with guest speaker Prof Patrick Gibbons, Professor of Strategic Management with UCD Smurfit Graduate School who will discuss the strategic issues and challenges facing senior leaders.
2. Affects 55 million people globally
By increasing everyone to normal levels of vitamin D, as much as 17 percent of dementia cases could be prevented in some populations, according to a whole new study. The figures represent a major breakthrough in the battle against this dreaded condition.
The current study is based on data from 294,514 participants from the UK Biobank, a comprehensive biomedical database and research resource with in-depth genetic and health information about half a million UK participants.
PHARMACYNEWSIRELAND.COM 95
More and more people have become aware of the importance of having adequate levels of vitamin D in their bloodstream and therefore take a daily supplement to be on the safe side. It is always a good idea to choose a vitamin D supplement that is documented in published studies. Pharma Nord’s D-Pearls has been used in multiple studies in different countries and has been shown to provide good bioavailability and a reliable effect.
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However, sun awareness campaigns, indoor living, and other factors contribute to the low vitamin D status in many individuals.
The scientists underline that their study is the first to examine the impact of very low levels of vitamin D on the risks of dementia and stroke by using robust genetic analyses among a large study population. Specifically, in this UK population from the UK Biobank, they observed how 17 percent of dementia cases may have been avoided by boosting vitamin D levels so they reach their normal range. There is no official health claim for vitamin D and mental health. Still, science has found vitamin D receptors (VDR) in virtually all bodily tissues, including the brain, so there is reason to assume that good brain health depends on adequate amounts of the nutrient just like it is the case with bones, teeth, muscles, and other tissues.
It’s the case, nonetheless. A first-of-its-kind study from the University of South Australia shows a direct link between demendia and lack of vitamin D.
The sunshine vitamin appears to protect against dementia
vital importance to investigate new ways to prevent and treat this mental disorder.
Dementia is a potentially devestating condition that affects over 55 million people worldwide. Every year, 10 million new cases are diagnosed. It’s therefore of
Against a background of significant instability, ambiguity and change, many pharmaceutical industry leaders are seeking to evolve their (typically matrix) operating models to adopt more agile ways of working and managing change. In addition, the way we communicate – both externally and internally has changed completely. This session will explore some of the challenges leaders face, with a view to considering and discussing the strategic factors in the development and implementation of future looking and effective organisations.
3. Vitamin D levels should be boosted
1. Many cases could be avoided
• Saving time and costs
• Reducing avoidable service use and hospitalisations.
PHARMACYNEWSIRELAND.COM 96 News
• Raise awareness of how health literacy issues can affect cancer patients
Promoting health literacyfriendly practice While many efforts to address health literacy needs have focused on improving patient skills, healthcare professionals have an important role to play. Clear, efficient communication helps cancer patients to understand and make decisions about their treatment and to manage side-effects.
This was evidenced by the publication of Get Ireland Active - the National Physical Activity Plan (NPAP) in 2016. The NPAP contained 60 actions intended to promote increased physical activity levels across the population, by giving people more opportunities to be active and making physical activity a normal part of everyday life.
• Empowering patients to actively participate in their care
View the Irish Cancer Society and NALA health literacy eLearning course https://www.cancer.ie/sites/literacy-course/https://www.nala.ie/cancer-healthdefault/files/courses/cancerIrishhealth-literacy/story.htmlCancerSocietyEducation and Engagement manager Aoife McNamara says: “We are delighted to have partnered with NALA and MSD Ireland on this course, which highlights cancer literacy issues experienced by patients and supports busy healthcare professionals to reduce the impact of these issues.”
Cancer health literacy poses a particular set of challenges compared to other types of health literacy. Cancer patients’ decisions and treatments are often complex. The distress associated with a cancer diagnosis can further impact patients’ ability to remember, understand and apply information they need to effectively manage their treatment and care.
Erasmus visit to Faculty of Pharmacy, Belgrade
Trinity College Dublin Associate Professor Martin Henman recently made a visit to the Faculty of Pharmacy of the University of Belgrade as part of an Erasmus Mobility Agreement. He lectured to final year undergraduate students and also to academic staff of the Faculty on Assessment strategies and workplace learning.
The Irish Cancer Society and the National Adult Literacy Agency (NALA) have joined forces to launch a short eLearning course for healthcare professionals. It explores the benefits of good health literacy practice in cancer care. MSD Ireland funded the course.
The new self-directed eLearning course aims to:
Professor Henman also held discussions with the Dean of the Faculty and the Vice Dean for International relations to review the Mobility Agreement and other collaborative activities.
The promotion of physical activity has been a priority for the Department of Health and the Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media in the context of the implementation of Healthy Ireland, A Framework for Improved Health and Wellbeing 2013 - 2025, and, more recently, the Healthy Ireland Strategic Action Plan.
Health literacy and cancer care Health literacy is an essential part of quality, patient-centred care, with important implications for patients’ experiences and outcomes. Ireland’s recent Health Literacy Survey shows that nearly 1 in 3 people in Ireland have limited health literacy. This means they may struggle with reading, understanding and using health information to manage their treatment and care.
National Activity Plan Minister of State for Public Health, Wellbeing and the National Drugs Strategy, Frank Feighan, and Minister of State for Gaeltacht Affairs and Sport, Jack Chambers, jointly welcomed the publication of the Implementation Review of the National Physical Activity Plan, and the 2020 Implementation Report.
In 2021, Irish Cancer Society Support Line and Daffodil Centre nurses received almost 7,500 enquiries relating to cancer treatments and side-effects; over 4,000 on managing symptoms and 1,600 on prognosis.
Using health-literacy friendly approaches and tips can benefit both patients and practitioners by:
Vice Dean for International Relations, Professor Dr Sne�ana Savic�, Dean, Professor Dr Sladana �obaji� and Associate Professor Martin Henman
Irish Cancer Society and NALA launch cancer healthliteracy eLearning course
• Making interactions more effective
Colleen Dube, Chief Executive Officer at NALA commented: “NALA is thrilled to have partnered with Irish Cancer Society and MSD Ireland on this course. Healthcare professionals play a vital role in supporting people with health literacy needs. We hope the practical tips in this new course like using plain language and encouraging questions will be mutually beneficial to healthcare professionals and patients to ensure more effective communication, understanding and management of treatment and outcomes.”
• Give an overview of health literacy-friendly communication approaches and tips. These include the universal precautions approach to health literacy, teachback and tips for writing plain language patient information.
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BOOTS IRELAND LAUNCHES THIS YEAR’S BOOTS NIGHT WALK IN AID OF THE IRISH CANCER SOCIETY
Edwards Lifesciences has announced it has begun renovations to convert its existing Shannon facility into a manufacturing centre to produce components that are an integral part of Edwards’ life-saving transcatheter heart valves.
Clinical
Anyone who might be waiting for a procedure in Northern Ireland should contact their local HSCNI services to see if they qualify for the scheme. Mater Private Network is standing by, ready with our team of specialists and patient coordinators in Dublin and Cork, to help patients on their journey back to good health”
This year, the Boots Night Walk is back in person and hopes to be the biggest one yet, with Boots Ireland calling upon the public to sign up and walk 5km together this autumn in support of the Irish Cancer Society Night Nurses. Alongside the walk, Honour Tags are now on sale in Boots stores nationwide for ¤2. Customers can purchase a tag in honour of someone who has survived or passed away from cancer. The front of the tag allows for the name of the individual with space on the back for a personal message. One metre will be walked in honour of that person by members of the Boots Ireland team. All funds raised from the Boots Night Walk will go towards the Irish Cancer Society Night Nursing service which provides end-of-life care for cancer patients, allowing them to spend their final days at home surrounded by family and loved ones, as well as giving much needed respite for the family caring for them.
“The expanded capability at our Shannon facility demonstrates that our operations in Ireland are a key enabler for Edwards to continue helping patients across the globe,” says Andrew Walls, Edwards’ general manager for its manufacturing facilities in Ireland. Edwards established its operations in Shannon in 2018, and officially opened its plant in Limerick in October. At that time, Edwards announced that it will employ up to 850 people in the region by 2025. The Limerick plant manufactures transcatheter therapies to repair or replace damaged heart valves, enabling patients to live longer, healthier lives. Edwards Lifesciences is the global leader of patient-focused innovations for structural heart disease and critical care monitoring. We are driven by a passion for patients, dedicated to improving and enhancing lives through partnerships with clinicians and stakeholders across the global healthcare landscape. For more information, visit Edwards.com and follow us on Facebook, Instagram, LinkedIn, Twitter and YouTube. Edwards, Edwards Lifesciences, the stylized E logo, are trademarks of Edwards CorporationLifesciencesanditsaffiliates.
Speaking on the scheme renewal Mater Private Network CEO, David Slevin said, “I am very pleased that the scheme has been granted additional funding. The popularity of the scheme speaks for itself of the need for a programme like this and it only made sense to extend it further. Applications have grown and continue to grow with the long waiting lists in Northern Ireland. People should not have to wait unnecessarily with chronic pain.
Boots Ireland has partnered with TV presenter and broadcaster Darren Kennedy, to launch this year’s Boots Night Walk in aid of the Irish Cancer Society Night Nursing service which provides end-of-life care for people living with cancer in Ireland. The Irish Cancer Society Night Nursing service provides up to 10 nights of care, free to people who avail of it, and it is funded almost entirely by donations. Boots Ireland has partnered with the Irish Cancer Society since 2012 and through the su pport of their Team Members, patients and customers have raised ¤2.5 million for the service so far, helping to provide 7,200 nights of care.
Mater Private Network are one of the leading hospital networks in the Republic of Ireland providing treatment under the scheme.
Boots Night Walks Campaign ambassador TV Presenter and Broadcaster Darren Kennedy, launches the Boots Night Walks in aid of the Irish Cancer Society Night Nursing service
Profiles
HEALTH SERVICES EXECUTIVE NI EXTENDS THE REIMBURSEMENTROISCHEME
EDWARDS LIFESCIENCES BEGINS RENOVATIONS
The Department of Health has announced that it has allocated a further £5m to continue to operate The Health Services Republic of Ireland Reimbursement Scheme beyond the original 30 June 2022 deadline for another year. Introduced under the Elective Care Framework for an initial period of 12 months on 1 July 2021, the scheme provides an option for patients who are ordinary residents of Northern Ireland to access private treatment in the Republic of Ireland. The scheme is based on the EU Cross Border Healthcare Directive. Patients who are on a waiting list for surgery or medical treatment through the National Health Service (NHS) or Health & Social Care (HSCNI) Board may wish to avail of the scheme. Once approved by the HSCNI Board, patients usually pay for treatment themselves and can be reimbursed afterwards for approximately 5080% of these costs. 540 people have completed treatment under the scheme as of the end of February 2022, with over £3 million spent in reimbursing patients for the cost of treatment, according to data released by the Health and Social Care CommonBoard.treatments include orthopaedic surgery, such as hip and knee replacements, cataract surgery and hernia repairs, according to the HSCB.
New applications of the scheme are now being accepted. They will be processed in chronological order, and the scheme will continue under further funding has been committed.
Managing Director at Boots Ireland, Stephen Watkins, said, “This year the Boots Night Walk is back in person and hopes to be the biggest one yet The Boots Night Walk helps to raise funds and awareness of the incredible work these Night Nurses undertake. Over the past 10 years an incredible ¤2.5 million has been raised for this service so we want to say a big thank you from Boots Ireland to the public as this cannot be done without your fundraising and support.”
Sanofi and Innovent Biologics (HKEX: 1801.HK, “Innovent”) announced a collaboration to bring innovative medicines to patients in China with difficult-to-treat cancers. Innovent is a leading biopharmaceutical company with strong clinical development capabilities and a broad commercial footprint in China. Both companies are committed to accelerating the development and commercialization of two Sanofi key clinical stage oncology assets: Phase III SAR408701 (tusamitamab ravtansine; anti-CEACAM5 antibody-drug conjugate) and Phase II SAR444245 (non-alpha IL-2), combining with sintilimab, the leading checkpoint inhibitor in China. In addition to the collaboration and license agreement, Sanofi will invest ¤300 million in Innovent through subscription of new common shares.
OAT is type of a treatment in which ‘opioid agonists’ – most commonly methadone – are prescribed for people who are dependent on opioids such as heroin. OAT helps to suppress heroin use, improves mental and physical well-being, and reduces risk of death including drug overdose deaths. A 2019 study showed there were over 10,000 people receiving OAT in Ireland. Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. Certain measures, such as rapid assessments and telehealth, enabled services to overcome many of the usual barriers to providing treatment. As a result, waiting lists for OAT were drastically reduced, with over 11,000 people accessing treatment in 2021.
SANOFI AND INNOVENT BIOLOGICS ENTER STRATEGIC COLLABORATION TO ACCELERATE DEVELOPMENT OF ONCOLOGY MEDICINES AND EXPAND PRESENCE IN CHINA
Sanofi’s initial strategic equity investment in Innovent for ¤300 million In addition to the strategic multiproduct collaboration and license agreement, Sanofi, subject to conditions precedent including regulatory approval and customary closing conditions, will invest in new common shares issued by Innovent for ¤300 million, at a price of HK $42.42 per share, representing a 20% premium to the Innovent 30-trading-day average share price as of August 3, 2022, one day prior to the signing of the Subjectagreements.tomutualagreement of both parties in the future, Sanofi will have the right to acquire additional Innovent new common shares for ¤300 million, at a subscription price that represents 20% premium to Innovent 30-trading-day average share price as the date of the separate agreement that may be entered into by both parties.
“These consensus recommendations are intended to inform future policy decisions and discussions regarding the delivery of OAT, identifying which changes should be considered for integration into care models beyond COVID-19. For example, all people on OAT should be prescribed and encouraged to take a supply of Naloxone (a medicine that rapidly reverses an opioid or heroin overdose), particularly during high-risk periods. They should also be trained on how to use Naloxone.”
Clinical development and commercialization of tusamitamab ravtansine SAR408701 (tusamitamab ravtansine) is a potential first-inclass antibody-drug conjugate (ADC) targeting cell(carcinoembryonicCEACAM5antigen-relatedadhesionmolecule5),acellsurface glycoprotein that is highly expressed in non-small cell lung cancer (NSCLC), gastric cancer and other cancers. SAR408701 is currently in a Phase 3 study for 2L NSCLC globally including China, and global Phase 2 studies in additional indications including 1L NSCLC, gastric cancers and other solid tumors. According to the agreement, Innovent will be responsible for developing and exclusively commercializing tusamitamab in multiple indicationsoncology-basedinChina.Sanofi will be entitled to receive up to ¤80 million development milestone payment and royalties on the net sales of the product in China upon approval.
This study, consulted a panel of experts and stakeholders including psychiatrists, GPs and pharmacists, as well as people who were accessing OAT for opioid dependency, to identify which of the OAT contingency measures implemented as a result of COVID-19 should be continued. The panel recommended 16 changes to be continued beyond COVID-19 in Ireland, rather than reverting to pre-pandemic practices. The agreed statements related to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Consensus was not achieved for OAT drug dosing and frequency of urine testing. Dr Gráinne Cousins, Senior Lecturer in the RCSI School of Pharmacy and Biomolecular Sciences and the study’s principal investigator, commented on the findings: “The emergence of the COVID-19 pandemic transformed how OAT was delivered, in Ireland and internationally. While many authors have suggested that recent innovations should be continued beyond the pandemic, this is the first study to seek consensus, among a wide range of stakeholders, on whether beyondguidelinesintroducedrecommendationsinemergencyclinicalshouldberetainedthepandemic.
PFIZER AVAILABILITYANNOUNCESOFCIBINQO® (ABROCITINIB) FOR THE TREATMENT OF ADULTS WITH MODERATE-TO-SEVERE ATOPIC DERMATITIS IN IRELAND CIBINQO® is a once-daily oral treatment with proven efficacy demonstrated in a large-scale clinical trial program
The study, led by researchers in the RCSI School of Pharmacy and Biomolecular Sciences, has been published in the International Journal of Drug Policy.
Clinical development and commercialization of SAR444245 SAR444245 is a potential first-in-class recombinantsite-directed,reprogrammed,singlePEGylated,humanIL-2(rIL-2) variant with extended half-life that specifically binds to the lowaffinity IL-2 receptor but lacks binding affinity for the αlpha chain of the high-affinity IL-2 receptor.
New research from RCSI University of Medicine and Health Sciences recommends that several measures implemented during COVID-19 to maintain access to opioid agonist treatment (OAT) led to improvements in the service and should be continued post-pandemic.
This research was funded by the Health Research Board, Research Collaborative in Quality and Patient Safety [RCQPS-2020-016].
Pfizer Healthcare Ireland has today announced the availability of the 50 mg, 100 mg and 200 mg doses of CIBINQO® (abrocitinib), an oral, once-daily, Janus kinase 1 (JAK1) inhibitor, for the treatment of moderate-to-severe atopic dermatitis (AD) in adults who are candidates for systemic therapy, in TheIreland.availability of abrocitinib in Ireland is based on the results of five clinical studies of more than 2,800 patients including four Phase 3 studies and an ongoing long-term open label extension study. Abrocitinib demonstrated meaningful improvements across measures of symptom relief and disease control versus placebo. In one trial including an active control arm with dupilumab, which evaluated patients on background topical medicated therapy, abrocitinib 200 mg was associated with a greater improvement in itch relief after two weeks than dupilumab.1 Abrocitinib also demonstrated a consistent safety profile across trials, including in a long-term extension study, showing a favorable benefit-risk profile.
PHARMACYNEWSIRELAND.COM 98 Clinical Profiles CHANGES TO METHADONE TREATMENT GUIDELINES IN RESPONSE TO COVID-19 LED TO IMPROVEMENTS IN OVERALL SERVICE, STUDY FINDS
SAR444245(IL-2) is currently under global Phase 2 studies for skin cancers, gastrointestinal cancer, NSCLC / mesothelioma, head and neck tumors, and lymphoma. Innovent and Sanofi will jointly explore the development of SAR444245 in China in various cancer types, where Innovent will lead the clinical development. Sanofi remains the sole Marketing Authorization holder for both assets and will be fully responsible for SAR245 commercialization. Innovent will be entitled to receive up to ¤60 million development milestone payments and royalties on the net sales of the product in China upon approval.
Commenting on the announcement, Caitriona McCarthy, Medical Lead I&I, Pfizer Healthcare Ireland said; “Abrocitinib has shown significant efficacy, including relief from the trademark itch symptom, rapid improvements in skin clearance, extent and severity of disease versus placebo, and a favourable risk-benefit profile.”
CIBINQO is indicated for the treatment of moderate-to-severe atopic dermatitis in adults who are candidates for systemic therapy.2 This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 of the SmPC for how to report adverse reactions.
The GSK ‘Understanding Shingles’ research1 looked at awareness levels, knowledge and perceptions of shingles among the over-50s in Ireland. Ms Mannion made the appeal because despite over half of respondents (56%) perceiving shingles to be a serious disease, a considerable number of respondents - 43% - said they felt it was unlikely that they would develop shingles over the next year. Ms Mannion also urged the over50s to find out about the risk factors as one-in-three people who have had chickenpox are at risk of developing shingles in their lifetime.2, 3 While most people make a full recovery, shingles can potentially lead to serious and long-lasting complications.
Post-herpetic neuralgia (PHN) is the most common complication, a prolonged nerve pain in the area affected by shingles that can last for months or even longer.4 PHN occurs in around 20% of all shingles cases, with the over-50s particularly at risk.5
Chair of Chronic Pain Ireland, Martina Phelan, added: “Shingles can be very painful. This pain is described as burning, shooting, stabbing or even constant unbearable itching. It does not happen to everyone, and it may only last for a few weeks, but some people can experience postherpetic neuralgia (PHN), a chronic condition that is difficult to treat and may cause pain for months, or longer. People don’t know as much as we’d like about shingles and there are many misconceptions. We are pleased to be part of the Understanding Shingles campaign as we find shingles is not always taken as seriously as it should be.”
OVER-50S URGED TO ‘UNDERSTAND SHINGLES’
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PHARMACYNEWSIRELAND.COM 99
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Broadcaster Teresa Mannion has called on the over-50s in Ireland to speak with their doctor, practice nurse or pharmacist about the risk factors for shingles and shingles prevention. New research conducted on behalf of GSK shows that almost one-fifth of respondents (19%) over-50 reported that they had experienced shingles and over half (55%) of those surveyed said they knew someone who was affected by it.
It also demonstrates that some of the main risk factors associated with shingles are well understood, with recognition of a weakened immune system (62%), being under stress (48%) and age-related declining immunity (47%). Additionally, 42% felt that shingles had an ‘extremely negative’ impact on quality of life.
The survey shows that 57% of respondents said they were extremely or somewhat knowledgeable about shingles and reveals good awareness of many of the main symptoms - including a red rash (76%), pain, burning, numbness or tingling in one part of the body (71%) and itching (55%).
Visit www.understandingshingles.ie to learn more about shingles.
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As shingles has a broad range of risk factors, I’d advise anyone in that age group to contact their doctor, practice nurse or pharmacist to discuss options.”
Commenting on the research findings, Ms Mannion said: “I can speak from personal experience as I developed shingles and it really stopped me in my tracks. It can be a severely painful, debilitating condition, and it impacted my personal and professional life, so it is not to be taken lightly. I’m heartened to see that over half of the respondents believe shingles is a serious condition, but I’m also concerned that many of the over 50s don’t feel that they are at risk.
