PAIPHARMACYASSISTIRELAND2020EDUCATIONTRAININGDIRECTORY
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No two pharmacies are the same. Whether you are working within a pharmacy chain or in a smaller, independent pharmacy; staff, opening hours, protocols and allied healthcare professionals will differ. It is important therefore that you are knowledgeable as to your pharmacy's business and services provided. In addition, you should be educated in knowing the roles and remits of your colleagues.
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PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) ADVERTISING6690562DIRECTOR - Debbie Graham 00353 (87) 288 2371 | debbie@ipn.ie ADVERTISING SALES - Amy Evans 00353 (0) 87 062 2025 | amy@ipn.ie www.pharmacynewsireland.com Our Pharmacy Page 5 Adult Incontinence Page 9 Adult Pain – Pain Page 11 Allergies Page 13 AMD Eye Health Page 15 Baby Skin Page 17 Baby VitaminHealthD Page 19 Bacterial Vaginosis Page 21 CBD Oil Page 23 Cold Sores Page 25 Cough Page 27 Cow’s Milk Allergy Page 29 Dry Skin Page 31 Eczema Page 33 Eye Health in Elderly Page 37 Haemorrhoids Page 39 Hair Loss Page 41 Healthy Skin Page 43 Heartburn & Dyspepsia Page 45 Migraine Page 49 Mild Moderateto Pain Page 51 Nappy Rash Page 53 Omega Fish Oils Page 55 Oral Health Page 57 Osteoarthritis Page 59 Pain Relief Page 61 Pre-Pregnancy and Fertility - Page 65 The views and opinions expressed within this Pharmacy Assist directory are those of the authors and it is provided to you only as guidance. All of the information is published in good faith and for general information purposes only. Please share with your supervising pharmacist for his/her review in order to tailor it to the specific needs and practices of your individual pharmacy. It can be shared with counter staff at your discretion for training purposes. All rights reserved by IPN Communication Ltd. All material published in Pharmacy Assist is copyright and no part of this document may be reproduced, stored in a retrieval system or transmitted in any form without prior written permission. IPN Communications Ltd have taken every care in compiling Pharmacy Assist to ensure that it is correct at the time of going to print, however the publishers assume no responsibility for any effects from omissions or errors. Psoriasis Page 67 Scarring Page 69 Skincare: Beauty Page 71 Smoking Cessation Page 73 Topical Analgesics Page 75 Vaginal Dryness Page 77 AilmentsWinter Page 79 Diary 2020 Page 80 Company Listings Page 186 Training guide content by page number and sources of further information CONTENTS6
MAH: McNeil Healthcare (Ireland) Ltd. & Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland. Products not subject to medical prescription. Full prescribing information available from Johnson & Johnson (Ireland) Ltd. Airton Road, Tallaght, Dublin 24, Ireland.
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1 in 3 Women experience light bladder weakness at some point in their lives.** This can be brought on by pregnancy, childbirth, obesity, menopause and natural changes in the body. ARE YOU FULLY STOCKED TO REALISE THIS OPPORTUNITY? *Nielsen Scantrack data to 6th Oct 2019 NEW www.tena.ie
Overflow incontinence - happens when the bladder does not empty completely. Urine builds up and then may overflow, often as frequent dribbling. This type of incontinence is more common in men and may be due to an enlarged prostate gland, but constipation may also be a cause.
Urinaryyear.Incontinence (UI) can have a hugely negative impact on a person’s quality of life, mood and confidence with some sufferers becoming virtual prisoners in their own Urinaryhomes.incontinence
Stress incontinence - happens when a person wets themself during exercise, coughing, sneezing, laughing or other movements that put pressure on the bladder. It is the most common type of incontinence and usually affects women, however, men can also develop stress incontinence after a prostate operation.
• Devices that are placed into the vagina or urethra to prevent urine leakage – for example, during exercise
When diagnosed with urge incontinence, one of the first treatments offered is bladder training. Bladder training may also be combined with pelvic floor muscle training if a person is suffering from mixed urinary incontinence. It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least six weeks.
Action already taken? Lifestyle changes or pelvic exercises may help.
Mid-urethral slings are minimally invasive procedures developed in Europe in the 1990s to treat female stress urinary incontinence. These slings are narrow, polypropylene (a commonly used suture material) tapes that are surgically placed beneath the middle part of the urethra (water pipe) to provide dynamic support to stop leakage from the bladder. They have been shown to be as effective as more invasive traditional surgery with major advantages of shorter operating and admission times, and a quicker return to normal activities together with lower rates of complications.
Incontinence products
Pelvic floor muscle training (Kegel exercises)
Surgery
Urgency/urge incontinence - occurs when a person cannot hold on long enough to reach a toilet. This may be caused by an over-active bladder, infection, medication or poor mobility. In men, it may be sign of an enlarged prostate.
Bladder training
Bladder control problems have a significant effect on the quality of life of sufferers on a physical, emotional and social level. Continence is a necessity for comfortable social adjustment and conversely, urinary incontinence frequently causes profound psychological and social consequences and restricts social activities.
Who? Anyone, regardless of age. Women are more prone to stress incontinence than men.
There’s also a range of disposable undergarments with built-in protection - not just in the crotch, but throughout the entire garment. Styles range from pull-ons with elasticised legs and waists resembling a traditional cloth underwear to underwear that slips on with Velcro or adhesive tabs for a customised fit. There are also open-sided “thong style” pants held together by straps in the front and back that rest on top of the hip bone. Incontinence bed sheets are also available.
While incontinence products aren’t a treatment for urinary incontinence, they are useful for managing the condition while a person is waiting to be assessed or for treatment to take effect.
ADULT INCONTINENCE
9
• Absorbent products, such as incontinence pants or pads. Liners, pads, disposable underwear, and reusable underwear absorb moisture. Products made for incontinence control catch the leaks and pull moisture away from the skin. That allows sufferers to go longer between changes.Many disposable pads, liners, and undergarments have a waterproof backing. This helps prevent overflow from reaching clothes. The waterproof systems use a “breathable” plastic film that helps reduce skin irritation.
• Handheld urinals
Conservative treatments, which don’t involve medication or surgery, can be recommended first. These include:
• reducing caffeine intake – caffeine is found in tea, coffee and cola, and can increase the amount of urine the body produces
is loss of control of the bladder. It can affect anyone, regardless of age. It is a condition which ranges from mild to uncontrollable and embarrassing wetting. Incontinence can often be caused by an illness, such as a urinary tract infection, and often when the infection gets better the incontinence improves.
Medication?A range of products to manage the condition are available.
Lifestyle changes
Treatments
The pelvic floor muscles are the muscles used to control the flow of urine as the body urinates. They surround the bladder and urethra, the tube that carries urine from the bladder outside the body. Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended. A GP may refer a patient to a specialist to start a programme of pelvic floor muscle training.
• A catheter, a thin tube that is inserted into the bladder to drain urine
How long have they had the symptoms? Medical advice should be sought when symptoms present.
• altering how much fluid is drunk a day –drinking too much or too little can make incontinence worse
ADULT INCONTINENCE
The specialist will assess whether the person is able to squeeze (contract) their pelvic floor muscles and by how much. If they can contract their pelvic floor muscles, they’ll be given an individual exercise programme based on their assessment.
The treatment a medical professional will recommend for urinary incontinence will depend on the type of incontinence a patient has and the severity of their symptoms. If the incontinence is caused by an underlying condition, they may receive treatment for this alongside incontinence treatment.
What are the symptoms? Depends on the type of incontinence, but generally wetting oneself or dribbling.
Reflex incontinence - is where the bladder empties when it is full and the person is usually unaware of this. The cause is a break in the signals between the brain and bladder, which may be caused by a stroke or spinal injury.
Incontinence is a condition that most people are too embarrassed to talk about, yet one that affects one in three women and one in nine men, and costs the HSE ¤100 million every
• losing weight
ESSENTIAL INFORMATION
DON’T LET PAIN HOLD YOU BACK
Solpa-Extra 500mg/65mg Soluble Tablets contain paracetamol and caffeine. For the treatment of mild to moderate pain. Adults and children over 16 years: 1-2 tablets dissolved in water every 4-6 hours. Max 8 tablets a day. Children 12-15 years: 1 tablet disolved in water every 4-6 hours. Max 4 tablets a day. Not suitable for children under 12 years. Contraindications: Hypersensitivity to the ingredients. Precautions: Particular caution needed under certain circumstances, such as renal or hepatic impairment, chronic alcoholism and malnutrition or dehydration. Precautions needed in asthmatic patients sensitive to acetylsalicylic acid, patients on a controlled sodium diet and with rare hereditary problems of fructose intolerance. Patients should be advised not to take other paracetamol containing products concurrently. Pregnancy and lactation: Not recommended during pregnancy and breastfeeding. Side effects: Rare: allergies. Very rare: thrombocytopenia, anaphylaxis, bronchospasm, hepatic dysfunction, cutaneous hypersentitivity reactions. Unknown: nervousness, dizziness. Further information is available in the SmPC. PA 1186/017/001. P. MAH: Chefaro Ireland DAC, Treasury Building, Lower Grand Canal Street, Dublin 2, Ireland. Date of preparation: April 2017. IRE/NHPT/SOL1/2019-003.
• Nociceptive pain: aching, worse on movement, anatomically defined, fluctuates in severity.
While neuropathic pain is caused by damage to or dysfunction of the nerves, spinal cord, or brain, nociceptive pain is the type of pain which results from injury or damage to body tissues, such as an accident or trauma, injury or burn, post-operative or due to a break or Headache,fracture.inallits
What are the symptoms? Pain in one or more sites in the body.
forms, is a very common type of pain, while musculoskeletal problems, such as lower back pain and osteoarthritis, are also widespread.
When it comes to patients complaining
Action already taken? The patient may have already used OTC pain Medication?relief.
How long has the patient had the symptoms? If the pain lasts longer than three months it is considered chronic.
Neuropathic pain remains among the most difficult to treat of all the chronic pain syndromes and often antidepressants are prescribed as an adjuvant therapy to alleviate the Antidepressantspain.are also widely used to manage irritable bowel syndrome, temporomandibular joint dysfunction, atypical facial pain and fibromyalgia.
Opioids to be used sparingly due to addictive properties.
• Visceral pain: dull, diffuse, ill-defined.
Chronic pain, as the name implies, is pain that persists longer than usual tissue healing time, or in cases in which healing does not take place at all. The timeframe for a condition to be described as chronic is usually from three to six months.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for more severe migraine attacks, with evidence showing ibuprofen to be highly effective. Triptans are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70 to 80 per cent of patients.
Back problems are also very common and have a variety of causes, from slipped disks to Osteoarthritis,arthritis.
ADULT PAIN
for chronic pain depends on the type of pain the person is experiencing. For migraine, aspirin is the traditional first line of defence, and has anti-inflammatory properties that can help alleviate many of the physical symptoms.
In terms of chronic pain, it is particularly important to take account of the type of pain the person is experiencing, how long they have been experiencing it, and if they are taking medication for relief.
Practically speaking, the two most common types of chronic pain seen in pharmacies are the result of headaches and back pain.
Chronic pain is thought to affect 1.65 million people in Ireland, with chronic back pain one of the more common diagnoses. It has been widely suggested that there is a strong case for community pharmacists and their teams to contribute more to cost-effective and timely pain management services for chronic pain.
Triptans target the neural serotonin receptors specifically involved in migraine attacks and can be used in the treatment of migraine
According to the International Association for the Study of Pain, chronic pain can be experienced by those who do not have evidence of tissue damage or biological reason for pain, which can often make diagnosis difficult.
• Autonomic symptoms: colour and temperature changes, sweating, trophic changes.
11ADULT PAIN
commonly co-exists with psychiatric conditions such as depression, anxiety and other stress related disorders. It affects approximately 2% of people by the age of 20, increasing to 8% of people by the age of Treatment70.
Contrary to the assumption of the initial trials, pain relief and relief of depression are independent effects.
A much under-diagnosed chronic pain condition is fibromyalgia. The condition affects connective tissues which include the muscles, ligaments and tendons.
caused by ageing and longterm wear-and-tear in the joints, is by far the most common form of arthritis and should be considered particularly in patients over the age of 40.
Pain is something that many feel, but it cannot be seen and is quickly forgotten. For those living with persistent chronic pain conditions they often feel isolated as others cannot comprehend the impact pain has on every aspect of life.
• Neuropathic pain: burning, stabbing, tingling, insect crawling, shooting, associated with allodynia, hypersensitivity or other sensory changes.
whether the patient is suffering from focal neurological symptoms <aura> or not.
The pain can be consistent or intermittent, and can be classified as follows:
of headache, it is important to consider that migraine is the most common form of chronic headache and it is still under-recognised by many health professionals and patients.
Myalgia, which means muscle pain, is the main symptom while debilitating fatigue, sleep disturbances, joint stiffness, headaches and mood disturbances can also Fibromyalgiaoccur.
Other adjuvant therapies for pain may include anti-seizure medications (gabapentin, pregabalin, topiramate for example); muscle relaxants (baclofen, cyclobenzaprine, methocarbamol, and diazepam ); sedatives/anti-anxiety medications, and spasm medication (botulinum toxin).
Tricyclic Antidepressants (TCAs) were the first medication category proven effective for chronic neuropathic pain in double blind, placebo controlled trials.
• Mixed pain: i.e. a combination of both neuropathic and nociceptive pain symptoms.
Who? Anyone.
Neurological conditions, such as multiple sclerosis and thyroid disease, can also cause chronic forms of neuropathic pain.
We recommend using Stérimar Isotonic and Stérimar Baby two to six times a day (or more) in each nostril for as long as you need it or as long as and as often as your doctor recommends.
Yes, Stérimar Isotonic is suitable for the whole of the family, even babies from 3 months old. Stérimar Hypertonic is suitable for all adults and children over three years of age and Stérimar Baby can be used with babies from birth to 3 years old.
Why is it important to clean the nozzle after each use?
Yes. Stérimar is drug-free and doesn’t contain preservatives so there is no known risk of interaction with any other medication. However, in all cases it is best to check with your doctor.
Can Stérimar be used with other medication?
How long will Stérimar keep?
Why are the copper and manganese in Stérimar Hypertonic important?
Copper and manganese are found in very small amounts in the human body. They stimulate the body’s self defense mechanisms and help keep it healthy.
Stérimar Isotonic and Stérimar Baby are purified sea water solutions with the
Yes. The Stérimar nozzle has been specifically designed to fit any shape and size of nostrils.
Yes, Stérimar is completely safe to use with these conditions, but it is always a good idea to check with your doctor.
Stérimar Baby has a specific nozzle with a protective flange. The nozzle cannot be pushed too far into the nose to avoid any risks of injury.
same concentration of salts as the cells in the human body. As such, irritation is highly unlikely. Stérimar Hypertonic has a higher salt content than Stérimar Isotonic but the solution is still less salty than sea water. A sensation of dryness may occur and should disappear within a few Alwaysdays.follow instructions and/or doctor’s recommendations.
What does micro-diffusion mean?
How often should I use Stérimar?
Stérimar products can be kept for a maximum of three years after manufacture or until all solution has been used. The expiry date can be found at the bottom of the can and carton. Each dose of Stérimar delivered is aseptic. The valve on top of the can prevents air from entering. Also, because the solution is kept in a sterilised pouch it never comes into contact with either the aluminium can or the non-flammable nitrogen gas within.
Is the nozzle safe to use?
You must clean the nozzle in soapy water to remove any microorganisms left after use to help avoid any cross-contamination.
Stérimar Hypertonic is recommended for a short period. Use two to four times a day in each nostril for light congestion and up to six times a day for severe congestion.
Can I use Stérimar if I am pregnant, diabetic or suffer from high blood pressure?
Please contact your Pemberton Rep to place your order on 01 4632424 12
Can I use Stérimar for my three year old?
The unique Stérimar micro-diffusion system produces a fine spray of sea water. As the droplets produced by Stérimar are microfine, they remain in contact with the walls of the nasal passages for longer, making Stérimar even more effective.
Am I likely to experience any irritation from using Stérimar?
ALLERGIES
• Itchy, watery, swollen or red eyes
Pet dander - the allergic reaction to an animal is not caused by the animal’s hair. It is caused by substances in the animal’s saliva, urine, and especially dander (dead skin flakes that become loosened from the animal’s skin). The allergens become crusted on the animal’s fur and skin from urination or the animal licking or scratching itself; once dry, the allergens are released into the air, where they join the other components of house dust. Cats and dogs are most likely to cause allergic reactions.
• Tightness in the chest
They are particularly common in children. Some allergies go away as a child gets older, although many are life-long. Adults can develop allergies to things they weren’t previously allergic to.
House dust - although many allergens in the environment can trigger allergic symptoms, house dust is the main culprit in indoor allergies. House dust is an airborne mixture that might contain fine particles of soil and plant material from indoors or outdoors, particles of human and animal skin dander and hair, fabric fibres, mould spores, dust mites, fragments of insects that have died and their waste, food particles, and other debris. Some dust is present in every home, regardless of how often or how thoroughly the house is cleaned.
Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon.
Symptoms of indoor allergies
• Reactions to animal allergens may be very mild or quite severe. Symptoms may occur immediately after exposure to the allergen, or they may build gradually for 8-12 hours after exposure or become persistent.
• Coughing or wheezing
What are the Symptoms? Itchy, congested nose, clear nasal discharge, irritated eyes, sneezing, tickly throat, coughing or wheezing.
How long have the symptoms been present? Indoor allergies tend to be at their worst in the late summer, when dust mites are at most prevalent.
excess heat and humidity. They grow and produce mildew which thrives in places like shower cubicles. Non-visible moulds can grow in unseen areas of the house, such as under flooring materials and behind walls. To grow, mould requires water; for example, from a leaking pipe or roof, or condensation. As it grows, mould releases more spores, many of which become part of house dust. While moulds can trigger allergic symptoms, like any other allergen, they rarely cause serious health problems, except in people who are seriously immune-compromised or on chemotherapy.
Maintaining clear and nasal pages is important - the tiny hairs (cilia) inside the nasal passage work to carry dust, pollution and allergens to the back of the throat where they are swallowed and destroyed, before they can multiply and cause harm. If the nasal passages are dry or blocked, they become less efficient.
Common causes of indoor allergies
• Sneezing
• Tickly, swollen throat
13
ALLERGIES
Moulds - moulds generally live outdoors but can normally be found in almost any indoor environment. They easily pass through open doors and windows and settle indoors, especially where there is
An allergy is a reaction the body has to a particular food or substance. Allergies are very common. They’re thought to affect more than one in four people at some point in their lives.
• Itchy, congested nose
Self-Care Treatment Options
First generation antihistamines are more likely to cause drowsiness. Depending on the product, the duration of action is often shorter than newer antihistamines and may necessitate taking the drug three to four times each day.
nasal rinses and sprays are drug free and do not contain preservatives, so will not interact with other medication.
Dust mites - often, when people believe they are sensitive to dust, they are in fact sensitive to the dust mites and their waste particles that are found in household dust. Dust mites can be found in most homes, usually in beds and bed covers, upholstered furniture and fabrics. Preventative measures include: using a dehumidifier or air conditioner, washing bedding on a hot cycle (non-washable bedding can be frozen overnight to kill dust mites), replacing wool or feathered bedding with synthetic materials or allergen-proof bedding, using a vacuum cleaner with a HEPA filter and avoiding the vacuumed area for 20 minutes to allow any dust and allergens to settle.
Action already taken? Patients may have tried antihistamines but not be aware of the benefits of nasal Medication?hygiene.Saline
• Clear nasal discharge
Secondgeneration antihistamines can be taken over the long term with minimal side effects and are unlikely to cause sleepiness. The non-sedating antihistamines are convenient to take since they are taken once or twice daily. Saline nasal rinses reduce the symptoms of nasal allergies and can offer relief in conjunction with conventional treatment.
Who is the patient? Sensitivity to indoor allergens is very common and occurs at every age.
A Scientifically formulated eye health food supplement with Zinc to help maintain healthy vision ASK INFORMATIONWHOLESALERYOURFORMORE Contains Lutein, Zeaxanthin and Astaxanthin Added vitamins and minerals Freephone 1800 816 005 emailvisitinfo@scopeophthalmics.comwww.scopeophthalmics.com
• eyelids that stick together when waking up
• an enlarged lymph node in front of the ear
The symptoms of dry eye syndrome usually affect both eyes and may include:
Pharmacistsevenly.need to repeat one message to patients at every visit: when applying any ointment to lid margins, using a clean application device, such as a cotton swab or a clean fingertip, is critical, as is gentle eyelid handling.
How long have they had the symptoms? If this persists for longer than a few weeks or is a particularly severe case, refer to GP
• watering eyes, particularly when exposed to wind
Blepaharitis
Most people with dry eye syndrome also have blepharitis, which is a common and usually mild condition that causes inflammation (redness and swelling) of the rims of the eyelids. Patients with blepharitis may present with eyelash changes, watering, crusting and mattering around the lashes and canthus, photophobia, pain, and vision changes. The symptoms are
Pharmacists should keep certain tips in mind when helping patients who have blepharitis. First, pharmaceutical preparations like ointments and gels will stay in contact with the lid margin longer than solutions. These are usually preferred for blepharitis, but drops are preferred for corneal disease because they spread
Eye health can easily be overlooked because eye conditions often don’t present symptoms early on Encouraging customers to have regular eye tests, at least every two years, will mean any general health problems and signs of eye conditions are picked up.
Onceformulations.thecause of the allergic symptoms has been identified, patients should be advised to avoid the allergen to control symptoms and avoid future flare-ups.
For more information: Freephone UK: 0800 270 0253 Freephone IRL: 1800 816 005
Take the opportunity to talk about specific eye health issues. For example, ensure customers who have a positive diabetes screening test result are made aware of the importance of annual screening to prevent diabetic retinopathy.
Red and watering eyes are the main symptoms of conjunctivitis. Others are:
Dry Eye
function may decline pursuant to corneal damage and inflammation, scar formation, loss of surface smoothness, and clouded corneas. If severe inflammation develops, corneal perforation can occur. The normal progression may include eyelid damage to the lids with trichiasis, or entropion and ectropion (respectively, inward or outward turning lids that cannot close properly).
AMD EYE HEALTH
For occasional or mild dry eye symptoms, OTC eyedrops (artificial tears) used regularly may provide relief. Preservative-free artificial tears are preferred, as they cause less irritation. Wearing
• a sticky coating on the eyelashes
Whenenvironments.apatientpresents
Who? Dry eye is usually older people; red eye, anyone
What are the symptoms? dry, gritty eye for dry eye; grit and stick eye for conjunctivitis
Action already taken? Customers may have already tried eye drops
Medication? check the medication of patients with dry eye as it may be causing it, check if patients are contact lens wearers and what lubricants they use.
An estimated 10% to 30% of the population older than 40 years suffers from some degree of dry eye disease (DED). The condition tends to affect people above 60, and it is more common in women than men.
DED,syndrome.whichisalso
• feelings of dryness, grittiness or soreness, which get worse throughout the day
• a burning sensation in your eyes
with symptoms of a dry eye condition, such as irritation, grittiness, burning, soreness, watery eyes and visual disturbances generally affecting both eyes, a detailed history should be recorded by the pharmacist because it may elicit information about contributing factors.
EYE HEALTH 15
Contact dermatoconjunctivitis and giant papillary conjunctivitis are frequently caused by contact lenses and lubricating eye drops. Eye drops that contain a preservative agent, commonly benzalkonium chloride, are long established irritants. Hence, patients that present with symptoms of irritation that can be linked to onset of use of eye drops should be advised to switch to preservative-free
sometimes referred to as dry eye syndrome or keratoconjunctivitis sicca, is considered the most prevalent ophthalmic disorder that affects the anterior eye and is most often associated with the aging process, especially in postmenopausal women.
• a feeling of grit in your eyes
usually worse in the morning, after a night of closed eyes has kept eyelids in contact with the ocular Patients’surface.visual
glasses or sunglasses that fit close to the face (wraparound shades) or that have side shields can help slow tear evaporation from the eye surfaces.
Around one in 13 people who are in their fifties experience dry eye syndrome, and the condition becomes more common with age. Up to a third of people age 65 or older may have dry eye
Email:Visit:info@scopeophthalmics.comwww.scopeophthalmics.com
• redness of the eyes
Conjunctivitis is one of the most common causes of ‘red eye’ and one that presents very often in the pharmacy. The term ‘conjunctivitis’ refers to an inflammatory condition that affects the conjunctiva, which is the thin transparent mucous membrane covering the white of the eye. It can become inflamed due to a variety of reasons and is normally subdivided into origins that are either infective or non-infective in nature. This can be further divided into acute or chronic conjunctivitis.
Briefly, this should include details of the signs and symptoms, duration of symptoms and exacerbating factors, such as the environment, changes in humidity or computer use. Topical ocular lubricants are the mainstay of dry eye treatment, with the choice of tear substitute depending on the severity of the condition. Pharmacological interventions in all forms of dry eye conditions range in formulation, such as drops, sprays, gels and ointments.
These symptoms may get worse in smoky or hot
In older children, from about 1-2 years onwards, atopic eczema is most often seen on the inner sides of the arms at the elbow creases, behind the knees, and on the face and
Symptoms include a rash made up of tiny spots, bumps or sometimes blisters, surrounded by a patch of red skin. The symptoms can be accompanied by mild swelling, itching, and a stinging or prickling sensation. It is commonly found on the face, back, neck, chest and thighs.
Chickenpox
For most children affected, the disease is mild. However, often those who have seemingly outgrown the condition will continue to have life-long sensitive skin and may have recurrences of eczema following long symptom-free spells.
Emollientsneck.
BABY SKINCARE
can be used for daily use on dry skin – including bath soap substitutes that are free of sodium lauryl sulphate; topical corticosteroids during flare-ups. Advise parents to try and encourage their child not to scratch and help them avoid triggers.
usually begins in babies during their first three months and tends to last a few weeks or months. It usually clears up by the time the child is two years old, although in rare cases children can have cradle cap for a lot longer.
The cause of cradle cap is not clear, although it may be linked to overactive sebaceous glands, which are glands in the skin that produce an oily substance called Pharmacistssebum.can
How long have they had the Actionsymptoms?already taken. Avoiding itch, bathing hair and scalp.
Treatments include hydrocortisone cream (but not to the face), calamine lotion, antihistamines (where appropriate); wearing cotton clothing, avoiding excessive heat and humidity, and keeping skin cool.
Cradle Cap
Medication? Emollients, topical corticosteroids, calamine lotion, antihistamines.
Eczema
advise that cradle cap requires no specific treatment, although gently washing the baby’s hair and scalp may prevent a build-up of the scale.
usually itch or cause any discomfort to the Cradlebaby.cap
Advise parents to call a health professional urgently if a rash does not fade when the skin is pressed with the side of a glass.
Skin dryness, red itchy skin; greasy scaly patches on the scalp; itchy rash of spots resembling blisters on chest and back; rash made up of tiny spots surrounded by patch of red skin.
Advise parents to keep their child away from others – especially pregnant women or immunosuppressed individuals. Ibuprofen is no longer advocated as it can make the lesions worse.
Atopic eczema is a very common skin condition, affecting one in five children. Atopic dermatitis is the most common form of eczema affecting young children.
Babies are a customers most prized possession, and therefore any signs of in their child can be worrying – and their concern is not helped by the alarmist information that can be found on the internet. One of the most important things pharmacy teams can do is provide reassurance.
In infancy, the first noticeable signs of atopic eczema may be skin dryness and roughness, but other symptoms (e.g. red itchy skin which can affect the cheeks and forehead, and/or the trunk and outer aspects of arms and legs) do not usually occur before two months of age.
Also known as varicella zoster virus, chickenpox is often seen in children under eight years of age. Symptoms include an itchy rash (mainly on the chest and back) comprising of spots that resemble blisters. Discomfort is notably worse if the skin is too Chickenpoxwarm.
tends to last between 7-21 days. Paracetamol should be given in the case of fever and cooler baths. Calamine lotion is the traditional option for topical use but is drying in nature. Newer cooling gels/ sprays are available to reduce itching and limit any potential scarring.
Prickly heat
Cradle cap is the name given to the yellowish, greasy scaly patches that appear on the scalp of young babies. It is a very common, harmless condition that does not
Recommend a GP if you notice very red and weepy eczema with small blisters, as this could signal an infection. Similarly, if the skin is cracked or the problem is persistent or worsening.
Who? Babies and children aged under Symptoms?8.
17BABY SKINCARE
Prickly heat is a skin irritation that occurs when the sweat glands are blocked. Babies and children are more at risk because of their under-developed sweat glands.
Recommend a GP if the child appears to be very unwell.
An intense itch is the major symptom of atopic eczema. Scratching only provides momentary relief, and leads to more itching (the itch-scratch cycle). Scratching worsens eczema and can make the skin more vulnerable to infection. The intense itch is very uncomfortable, can disrupt sleep and negatively impact on the child’s quality of life, as well as that of his/her parents and the wider family. Some children with more pronounced eczema can also experience social embarrassment due to the visibility of their condition.
What are the dietary sources of vitamin D?
Vitamin D deficiency was thought to have been eradicated in Ireland after the Second World War, due to better nutrition. However, over 20 cases of rickets in infants and toddlers have been reported at two Dublin hospitals in the last four to five years. Further evidence is emerging that there is widespread low levels of vitamin D in the general population in Ireland.
How long has the patient had the symptoms? N/A
There are several factors which have contributed to this.
The recent re-emergence of rickets (a severe form of vitamin D deficiency causing deformity of the bones) amongst infants in Ireland indicated the widespread low levels of vitamin D in the Irish population.
RecentlyA.updated
dietary guidelines in North America recommend an intake of 5µg of vitamin D per day for infants and young children up to 3 years of age. In Canada, which is at a similar northerly latitude to Ireland, all babies taking less than 500ml of infant formula are supplemented with 10µg of vitamin D.
Babies who don’t get enough vitamin D are said to have a deficiency. If the levels are low enough, they are at risk of getting rickets, a disease that affects the way bones grow and develop.
BABY HEALTH - VITAMIN D
FSAI recommendations
Vitamin D is found in a small range of foods including oily fish, egg yolks and fortified foods such as milk, breakfast cereals and infant formula. In addition, offal meat such as liver and kidney are a good source of Vitamin D but these foods are not suitable for infants and pregnant women because they provide too much Vitamin
3. Health professionals and parents need to be made aware that vitamin D deficiency is prevalent in Ireland, particularly among dark-skinned infants and young children.
Who? All babies living in Ireland
• Vitamin D is mainly produced in the body by exposure of the skin to sunlight. However, because of Ireland’s northerly latitude, in the months between November and March there is inadequate quality and quantity of sunlight to enable sufficient production of vitamin D by the body (the current recommended dietary daily amount of vitamin D is 5 µg). Even on sunny days in the winter, the sun’s rays are of the wrong type for the production of vitamin D. In addition, with more people working indoors and using sunscreen when outside, vitamin D from sunlight exposure has decreased.
The recommendations are as follows:
Medication: All babies living in Ireland should be given a vitamin D only supplement providing 5µg Vitamin D from birth; Supplements that provide only vitamin D and are in a suitable form to be given to infants should be used to supplement infants in Ireland. The daily amount of vitamin D provided by such supplements should be 5µg per day.
19BABY HEALTH - VITAMIN D
Babies need vitamin D for healthy growth and development. It helps them build strong, healthy bones and teeth.
• Darker skinned people living in Ireland are particularly at risk as they require more sunlight to produce vitamin D (10 to 50 times more exposure to sunlight required). Also, some religious practices preclude any skin exposure.
• Dietary sources of vitamin D are not consumed in sufficient quantities to counter the lack of sunlight exposure and do not form part of the weaning diet for infants. Examples of dietary sources of vitamin D include oily fish (e.g. salmon, mackerel, sardines), egg yolks and fortified foods such as milk and breakfast cereals. In addition, offal meat such as liver and kidney are a good source of Vitamin D but these foods are not suitable for infants and pregnant women because they provide too much Vitamin A.
2. Supplements that provide only vitamin D and are in a suitable form to be given to infants should be used to supplement infants in Ireland. The daily amount of vitamin D provided by such supplements should be 5µg per day.
What are the symptoms? N/A
1. All babies living in Ireland should be given a vitamin D only supplement providing 5µg Vitamin D from birth. This is necessary because babies aged 0-12 months are at high risk of vitamin D deficiency, due to their rapid growth rates during this period.
Action already taken?
There are a number of conditions that may upset the natural acidity of the vagina; these include fluctuating hormone levels during a period, pregnancy and menopause3. Other influencing factors include antibiotics, sexual intercourse (semen is alkaline), intrauterine devices (the coil), douching, use of perfumed intimate body products, and smoking1
of abnormal vaginal discharge1
19981 Kora Relactagel 6page Leaflet Proof.indd 2
ABOUT BACTERIAL VAGINOSIS (BV)
A HEALTHY VAGINA
ABOUT BACTERIAL VAGINOSIS (BV)
Vaginal discharge is not uncommon, can vary in consistency and usually has an inoffensive slightly sweet odour which is unique to every woman. A healthy vagina is naturally acidic with a low pH of approximately 3.8 – 4.51 . This natural acidity is maintained by lactic acid producing bacteria known as lactobacilli2. The growth of lactobacilli is dependent on the presence of naturally occuring glycogen. Lactobacilli flourish in an acidicenvironment and form a very important part of thenatural defences, acting as a barrier to infections2
A HEALTHY VAGINA
• BV is the most common cause of abnormal vaginal discharge in women of childbearing age.
Vaginal discharge is not uncommon, can vary consistency and usually has an inoffensive slightly sweet odour which is unique to every woman. healthy vagina is naturally acidic with a low pH approximately 3.8 – 4.51 . This natural acidity maintained by lactic acid producing bacteria known as lactobacilli2. The growth of lactobacilli is dependent on the presence of naturally occuring glycogen. Lactobacilli flourish in an acidicenvironment and form a very important part of thenatural defences, acting a barrier to infections2
• BV develops where there is less of the normal bacteria (lactobacilli) present in the vagina. This results in the pH of the vagina changing, resulting in the growth of bacteria1
GreenLight
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Is CBD legal in Ireland?
Further Education
Supplements
At the recommended maximum daily dose there are no serious interactions with medicines reported. However, it is known that CBD is metabolised via the Cytochrome P450 CYP3A4 enzyme and therefore its elimination could be delayed when taking medicines that inhibit this enzyme such as medicines to treat AIDS or antifungals such as ketoconazole. Conversely, there are medicines that promote this enzyme activity such as antiepileptics such as phenobarbital and carbamazepine and this will reduce the bioavailability of metabolised CBD. Therefore, it is advised that consumers taking other medicines should talk to their doctor or pharmacist beforehand.
What is CBD oil?
Yes. Under current European legislation Cannabis can be grown if the THC content is below 0.2%. The Misuse of Drugs Act 1977 in Ireland defines certain compounds of the cannabis plant including the psychoactive compound THC under schedule 1 and therefore a special licence is required where these compounds are present in the product. CBD is not included in the schedule 1 list of controlled substances as it is not psychoactive. CBD is considered a food supplement under the European Directive 2002/46/EC as it is a substance providing a nutritional physiological effect in concentrated small quantities.
23
body’s demand on the ECS increases, or a consumer’s diet may not always be able to make sufficient endocannabinoids to meet the demand from the body. By taking an exogenous CBD it helps work with the body’s endocannabinoid system (ECS).
What are phytocannabinoids?
1. Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017 Jun 1;2(1):139-154.
What are the potential side effects of CBD oil?
In July of this year, Minister for Health Simon Harris TD signed legislation which will allow for the operation of the Medical Cannabis Access Programme on a pilot basis for five years. The Programme will facilitate access to cannabisbased products for medical use in line with legislation. This new law means that pharmacists are now also able to dispense cannabis for medical use to patients.
CBD OIL IN PHARMACY
CBD is either pressed from the plant i.e. cold pressed or extracted from the plant. When the plants are cold pressed the
various extraction methods with the most common being alcohol extraction or super critical CO2. Depending on the extraction method the CBD can be extracted with a lot of other cannabinoids from the plant, this is referred to as Broad Spectrum or only a few other cannabinoids, this is referred to as Narrow Spectrum. These are sometimes incorrectly termed Full Spectrum. Due to processing, the CBD is usually in the non native form. The extract can be purified further to become an isolate i.e. only CBD is in the product. These products can usually be termed “THC Free”.
Because of the minimal evidence of the potential effects on the developing foetus or new-borns, CBD oil is not recommended during pregnancy or breastfeeding.
CBD interacts with the bodies endocannabinoid system (ECS). The ECS is a regulatory system made up of endocannabinoids (the body’s own cannabinoids) which shuttle messages around the body to help maintain homeostasis, or simply, they aid the body in keeping itself in balance. These hemp-like molecules interact with various receptors (CB1 and CB2) which can be found in the brain, immune and central nervous system. Cannabinoids from plants, such as CBD, interact with this same Sometimessystem.the
Taking medicines with CBD oil?
With the emergence and rapid growth of CBD product offerings in the Irish market over the past few years, there has also been a rise in misleading information about these products, the potential benefits they can offer and how the various products differ.
Cannabinoids are found in plants such as marijuana and hemp. Cannabinoids found in the cannabis plant are also known as phytocannabinoids. Phytocannabinoids occur naturally in the cannabis plant. Several hundred compounds have been found in the cannabis plant and of those, many have been identified as cannabinoids. The most high-profile of these are CBD, THC and cannabinol (CBN). The most abundant cannabinoid found in the hemp plant is CBD.
Is CBD suitable for pregnant or breastfeeding mothers?
cannabinoids stay mainly in their native form e.g. CBD stays in the form of CBDa. The cannabinoids are lipophilic i.e. they are soluble in oil. Therefore, CBDa will naturally reside in the oil of the plant. Cold pressed products are always classified as Full Spectrum as they contain all the cannabinoids available from within the Thereplant.are
Sometimes taking too much of a supplement can be linked to undesired side effects, therefore GreenLight have reviewed the potential side effects of a CBD oil food supplement. A review of CBD use reports that the most commonly reported side effects were tiredness, diarrhoea, and changes in appetite and/or weight.1
What medical conditions will CBD help with?
the necessary clinical trials to allow them to make these claims. Always be wary of CBD providers making claims as they may give false hope to those with medical conditions. It is recommended that anyone considering taking CBD oil speaks with a pharmacist before taking CBD. CBD oil is sold as a food supplement and should not replace a balanced diet.
How does CBD Work?
Many companies claim that their CBD range will help with specific conditions. The truth is, while many scientific studies show potential therapeutic effects of CBD, very few products will have gone through
CBD stands for Cannabidiol. CBD is one of the many compounds found in the hemp plant. Unlike THC (tetrahydrocannabinol),CBD is not a controlled substance.
cannabinoids-cpd-training-course/www.greenlightsupplements.com/
• Fever
• Sore throat
Damaging the skin as it reproduces itself and creating cold sores, the virus enters the body initially through a break in the skin around or inside the mouth. HSV invades the cells of the epidermis, the outer layer of the skin, causing fluid-filled blisters to appear.
Examples of way that the virus can spread in this way include through the sharing eating utensils or razors or kissing an infected person. Cold sores can also be spread to other areas of the body such as the nose or chin.
Prior to a breakout, there are certain sign to look out for such as:
Cold sores often start with a tingling, itching or burning sensation around the mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip. Those affected can seek a number of treatments from pharmacists that reduce the duration of cold sores when used at first sign of a break out.
The virus travels from the epidermis along the nerve paths to the roots of the nerves where it becomes inactive. The virus is extremely contagious, and spreads when a person has interaction a cold sore. They can also spread when a person has interaction with infected fluid such as saliva.
Symptoms
Nothing can prevent an outbreak, however there are a number of treatments that work to reduce the duration of cold sore symptoms such as:
• Wash hands regularly using soap and water before and after applying cold sore creams
There are other triggers for people who get cold sores such as sunlight, fever, stress and menstruation. Most people will have come into contact with the virus at an early age (between the ages of three and five) but will often not show any symptoms until after puberty.
Cold sores are small blisters that develop on the lips or around the mouth. They’re caused by the herpes simplex virus and usually clear up without treatment within seven to 10 days.
• If brushing teeth is painful, use an antiseptic mouthwash
25
• Avoid too much direct exposure to sunlight as it can cause cold sores to flare
Causes
COLD SORES
Who? Anyone infected with the herpes simplex virus, but predominantly HSV1.
• Cold sores can become infected by bacteria
• OTC antiviral creams can speed up the healing process
How long have they had the symptoms? Cold sores should clear within two weeks, but a patient may need referred to a GP if symptoms persist.
• Tingling lips
Around one in three people will experience recurrent infections. The HSV-1 virus ‘wakes up’, infects the cells in or around the lip or mouth and causes a visible and contagious sore.
Treatment
• Herpetic whitlow (whitlow finger). Should the cold sore virus spread to another part of the body it may cause a secondary infection. The whitlow finger is such an infection, when the virus has come into contact with a graze or cut on the skin
Possible Complications
• Try to avoid acidic or salty foods and eat cool, soft foods
Symptoms of cold sores usually occur after something has triggered the virus, like a rundown immune system or cold, dry weather leading to dry, chapped lips.
Sufferers may not have any symptoms when they first become infected with the herpes simplex virus. An outbreak of cold sores may happen some time later.
• Cold sore patches containing hydrocolloid gel that ordinarily treats skin wounds. The patch is placed over the cold sore while it heals
The herpes simplex virus has two distinct types: HSV-1 and HSV-2. Both types can cause sores around the mouth (herpes labialis) and on the genitals (genital herpes). Up to 80% of the global population has the HSV-1 virus because it’s so contagious.
Cold sores are caused by a form of the herpes simplex virus. Once infected, the virus never leaves the body. The virus is usually first contracted in early childhood where it may not appear as a visible cold sore.
• Sore mouth that makes eating, and drinking uncomfortable
• If the condition spreads to the eyes, a secondary infection of the cold sore virus (herpetic keratoconjunctivitis) can occur. It is easily treated, but if left untreated it can damage vision
• Swollen lymph nodes in the neck
At break out of a cold sore, the skin around the blister is often red, swollen, and sore. Blisters usually open, leak a clear fluid, and scab over after a few days. Without treatment, these cold sores can heal themselves within 10 days.
• Drink plenty of fluids to avoid dehydration
• Dab creams on to sores – avoid rubbing them
What are the symptoms? Tingling, swollen lip, pain, blisters.
• Avoid triggers such as stress and colds
COLD SORES
Action already taken? Customers may already have purchased cream to speed up the healing process.
• Dehydration can occur if the lesions are so painful as to discourage drinking. Young children in particular may be at risk of dehydration
Medication: Caution should be taken with patients who have existing skin conditions and are applying creams or treatments to skin.
• In severe cases, the patient should be referred to their GP so that antiviral tablets may be prescribed General Advice on management
1Associated with a cold. For children from 1 year NEW RelieveTo ANY Cough1 IRE/NHCPT/BRO/19-015
•
27
COUGH
It is important to get a detailed overview of the patient’s symptoms. Is their cough productive? How long have they had the cough and what action has been taken? Pharmacists should ask if a patient has any medical conditions that may affect any treatment or product you recommend.
•
•
Action already taken? Customers may already have purchased cough
Night sweats
The role of cough medicine is to ease symptoms while the body heals. There are many brands of OTC cough medicines. But there are only three basic types:
Medication?medicines.Some of the ingredients in cough medicines should not be given to children such as opioids. Antacids may interfere with other medicines.
Cold and flu season is the time of the year when pharmacists are more likely to see patients scanning the pharmacy shelves in search of the perfect remedy to manage a cough. Patients may be overwhelmed by the numerous OTC cough products, but pharmacists are in an ideal position to evaluate and aid patients in selecting a cough product for self-treatment, as well as to encourage patients to seek further medical care when warranted.
Cough worsening after three weeks
Voice changes
Unexplained
• Coughing up blood
A dry cough is caused by inflamed airways due to a viral infection such as a cold or flu. A chesty cough produces phlegm. This is caused by the lungs producing extra fluid due to an infection.
The Right Medicine
Combination cough products have more than one active ingredient. They have both guaifenesin and dextromethorphan. Cough medicines may also contain ingredients to help coat and soothe the throat.
Medicated nasal sprays aren’t recommended for young children. Fortunately, there are several easy ways to clear up a stuffy nose without medication.
Expectorants help thin mucus, making
• weight
Children under the age of 6, and particularly under age 2, are at an especially high risk during cold and flu season. Whilst it is known that antibiotics won’t help when it comes to clearing up an infection, there are steps pharmacists can advise parents to take to help their child feel better while their immune system battles the virus.
Combination products may have medicines to ease other symptoms, that may include decongestants for stuffy nose, antihistamines for allergies or a runny nose, or painkillers.
What are the symptoms? Depend on type of cough to suggest if it is allergic or viral
•
During winter, most coughs are caused by viruses such as colds and flu and can be safely managed at home using OTC remedies. Coughs are classified as “acute” or “chronic”. An acute cough is most common and lasts up to three weeks. It’s usually caused by a cold or flu virus and most improve after one to two weeks.
dehydration. Children suffering with the cold or flu may not feel as thirsty as they normally would, and they may be uncomfortable when drinking, so it’s important to encourage them to drink plenty of fluids.
Suppressants help cut the number of times someone coughs. The active ingredient listed is usually dextromethorphan (DM). Other cough suppressants include camphor, eucalyptus oil, and menthol.
it easier to cough up. The ingredient is guaifenesin.
Chronic cough lasts for eight or more weeks. The most common causes include acid reflux, asthma, TB, COPD, bronchitis and smoker’s cough. Red-flag signs include:
Chest pain
Lumps/swellings in neck
loss
•
Cough drops can also help relieve a cough and may ease a sore throat
The Paediatric Patient
When temperatures start turning colder and kids are inside and interacting with each other in greater numbers, cold and flu season inevitably follows.
Shortness of breath
•
Advise on keeping the child hydrated to help reduce cold and flu symptoms and make them feel better. Fevers can result in
Use a cool-mist humidifier in the child’s room. This will help break up mucus. Another option is using a saline nasal spray or drops, which makes thin mucus easier to blow out or remove with a bulb syringe. This is especially helpful before feeding and bedtime.
How long have they had the symptoms? Coughs should clear after 3 weeks, is it short or persistent?
COUGH
Dry or chesty cough?
Who? Anyone can be affected
IMPORTANT NOTICE: Aptamil Pepti 1 & 2 are foods for special medical purposes for the dietary management of cows’ milk allergy. They be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Aptamil Pepti 1 use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6-12 months. Aptamil Pepti 2 is suitable over 6 months as part of a mixed diet.
References: 1. Verwimp JJ . Eur J Clin Nutr. 1995;49 (Suppl1):S39-S48. 2. Giampietro PG et al . Pediatr Allergy Immunol. 2001;12:83-86. S et al . J Biol Regul Homeost Agents. 2012;26:49-59. O’ Carroll, E, Redmond, M et al. (2018), A blinded palatability study comparing two hydrolysed infant formula used for the dietary management of Cows’ Milk Allergy in Ireland. The Nutrition Society Advancing Nutritional Conference OC18. Pepti
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How long has the patient had the symptoms? Only around 2–7.5% of babies under one year old are allergic to cows’ milk. By the age of three most children will have grown out of cows’ milk allergies.
COWS’ MILK ALLERGY
Action already taken? If a baby is being formula fed and has been diagnosed with cows’ milk allergy, the doctor may have prescribed an extensively hydrolysed formula.
• immediate CMA – where symptoms typically begin within minutes of having cows’ milk
Managing a cows’ milk allergy involves removing all cows’ milk from the baby’s diet, so parents should always read ingredients on food labels. Common allergens, like milk, must be declared on pre-packaged foods.
What are the symptoms? Stomach cramps, vomiting, diarrhoea, rashes, hives, eczema, and difficulty breathing.
Cows’ milk allergy (CMA), also called cows’ milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect between 2% and 7.5% of babies under one, though most children grow out of it by the age of five.
two main types of lactose intolerance. The first is primary lactose intolerance, and is caused by a deficiency in the enzyme lactase. It normally affects Hispanic, Asian and American Indian populations, but is uncommon in Europeans. Primary lactose intolerance doesn’t mean that lactose must be removed from the diet entirely: depending on the individual, those with primary lactose intolerance can often tolerate a certain amount of lactose.
It’s common for babies who are allergic to cows’ milk to be allergic to goats’ milk and sheeps’ milk too, as they contain similar proteins. Unfortunately, there is no single diagnostic test for cows’ milk allergy and a combination of tests and a series of elimination and reintroduction diets are often
Feeding and milk allergies
Identifying Lactose Intolerance
Another difference is that lactose intolerance will not show up in a blood or skin-prick test. However, the baby’s reaction will be noticeable, if not as severe as that of an Thereallergy.are
Who? Babies and infants.
An intolerance is caused by an inability to deal with certain substances in milk, such as lactose. Lactose intolerance is when some individuals don’t produce any or enough of the enzyme lactase which breaks down lactose. Undigested lactose causes symptoms like diarrhoea, bloating and wind.
Babies can either be allergic or intolerant to milk. Because some of the symptoms of milk allergy and milk intolerance are similar, they are difficult to diagnose. A milk allergy involves an immune reaction to one or more of the proteins present in milk, whereas an intolerance does not involve the immune system.
If a baby is being formula fed and has been diagnosed with cows’ milk allergy, The doctor may prescribe an extensively hydrolysed formula. The protein in these formulae has been broken down into smaller pieces so that the baby’s immune system does not recognise it as an allergen – a process which does not affect the nutritional value of the formula.
• delayed CMA – where symptoms typically begin several hours, or even days, after having cows’ milk
as much detail about the baby’s symptoms as possible can help speed up the diagnosis process. By keeping
a diary of their symptoms, including when they occur and how long they last for, can help the doctor identify or rule out cows’ milk allergy. Taking photos of any skin reactions, such as a rash, can be helpful too. They should advise the doctor if there is a history of allergy in the family.
A baby with lactose intolerance usually experiences less severe reactions than one with an allergy. As with a milk allergy, symptoms of lactose intolerance can include diarrhoea, vomiting, and stomach cramps but not usually hives or breathing difficulties.
Secondary lactose intolerance is usually caused by damage to the gut, after a severe stomach bug, for example. But this form of the condition is usually temporary, until the gut heals. In very severe cases, lactose may need to be removed from the diet for a few weeks.
COWS’ MILK ALLERGY
More rarely, it can affect babies who are exclusively breastfed because of cows’ milk from the mother’s diet passing to the baby through breast milk.
29
There are two main types of CMA:
Recognising milk allergy
Medication? Parents may be using creams or emollients to treat the symptoms affecting their baby’s skin.
In rare cases, the baby may be reacting to the milk proteins passing from the mothers’ diet into breast milk. If a breastfeeding mothers’ baby is diagnosed with cows’ milk allergy, she may have to change her diet but this is quite rare.
Soya formulae are not recommended before six months as they contain phytoestrogens (plant-based compounds with oestrogen-like properties), and infants who react to cows’ milk-based formulae often also react to soyabased formulae.
If a baby is allergic to milk, they will react to infant formula which is based on cows’ milk and sometimes, but very rarely, to breast milk the mother recently consumed dairy products. Symptoms include stomach cramps, vomiting, diarrhoea, rashes, hives, eczema, and difficulty breathing. Individual symptoms can sometimes be related to a bug, but if the baby is affected in two separate areas of the body – for example, the stomach (vomiting) and skin (hives), parents should ask their health visitor or doctor for advice.
Givingnecessary.thedoctor
CMA typically develops when cows’ milk is first introduced into a baby’s diet either in formula or when a baby starts eating solids.
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• Lanolin, mineral oil, and petroleum jelly (petrolatum). These help skin hold on to water absorbed during bathing.
• Advise customers not to apply face cream to the eye area, as this requires a specific eye cream. Many moisturisers may be too rich in oils for the eye area and cause puffiness, or contain high levels of hydroxy acids, which may cause irritation.
The average skincare category accounts for 5 per cent of total OTC shelf space. It is important this space works hard for you and the range stocked provides maximum return in terms of profitability as well as offering customers the right range of specialist skincare treatments to meet their needs.
rehydrates the epidermis, seals in moisture, and soothes dry, itchy skin. In winter, sufferers may need to moisturise more frequently and/or use a ‘heavier’ moisturiser such as an ointment rather than a cream or lotion; ointments tend to work better when the skin is very dry.
• Hyaluronic acid. Like ceramides, hyaluronic acid helps skin hold water.
2: Choose products that are bland, unfragranced and preservative free
Use emollient wash products (soap substitutes) when hand-washing, bathing or showering, which leave the skin coated with a protective film afterwards.
want to consider using a humidifier indoors when the heating is on.
People suffering from dry skin, shouldn’t use harsh, alcohol-based products as these can irritate skin and dry it out. People who have oily skin should avoid oil-based products and choose water-based ones instead. A good moisturiser is not necessarily an expensive one. Deciding what is best for skin depends on ingredients. There are various ingredients that provide different functions including:
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5: Wear sunscreen
Applying moisturiser
• Skipping long, hot showers: hot water strips oils from the skin faster than warm water. Long showers or baths actually dry out the skin. Anyone suffering from dry skin should limit themselves to a single 5- or 10-minute warm shower or bath a day.
Washing Dry Skin
In addition to moisturising, dry skin needs to be washed appropriately. This includes:
• Moisturising while skin is still moist. Patting skin with a towel after a shower or washing the face or hands, leaving it damp. Apply a moisturiser within three to five minutes of washing to lock moisture in.
• Ceramides. Ceramides help the skin hold water and soothe dry skin. Synthetic ceramides may mimic the natural substances in the outermost layer of skin that help keep moisture in.
Self Care Tips
• Using a gentle cleanser or shower gel with moisturizer. Instead of harsh cleansers, suggest unscented, soap-free, or mild soap cleansers.
Dry skin occurs when the epidermis does not hold on to sufficient moisture, so skin can feel tight, rough, flaky and itchy. A number of things can contribute to its development, for example; too frequent bathing, use of harsh drying soaps, the ageing process (the production of natural oils in the skin slows as we age, and sun damage is cumulative so a lifetime of sun exposure and sun damage can result in thinner skin that doesn’t retain moisture so well), or certain conditions such as eczema or psoriasis.
Here are 6 tips pharmacists and pharmacy staff can advise sufferers on as efficient self-care management:
4: Avoid harsh soaps - Ordinary soaps and bubble baths can dry out the skin by stripping away its natural oils. Skin pH is a measure of acidity and alkalinity, ranging on a scale form 0 (most acidic) to 14 (the most alkaline). Healthy skin is naturally acidic, with a pH of around 5.5. This acidity plays an important role in skin barrier function and skin health. Soaps and detergents raise skin pH which disrupts this delicate balance.
• Application should be even, across the whole area, especially when using a day cream with in-built sun protection. Moisturisers can be applied immediately after a serum or, if not using a serum, directly after cleansing, to help trap essential moisture inside the skin.
Who? Anyone
What are the symptoms? Red and inflamed skin.
Medication: If the patient has other skin conditions refer them to a GP so they can provide the appropriate topical cream.
How long has the patient had the symptoms? Dry skin is particularly prevalent in the winter months.
• Apply a 50p piece-sized amount of moisturiser to the face and neck, from the chest upwards.
DRY SKIN
Action already taken? Patients may already be using moisturisers.
Moisturisers
• Dimethicone and glycerin. These draw water to the skin and keep it there.
3: One quick daily dip! Staying in the bath or shower too long can be dehydrating, so keep the duration short (5-10minutes) and the water temperature should be lukewarm rather than hot.
DRY SKIN
1: More moisturiser Emollients are moisturisers that are used in two ways: applied directly to the skin as a leave on moisturiser, and as a soap substitute instead of soap and shower gel. Dry skin itches. Moisturising
After bathing or showering, gently pat the skin dry. This is a great time to apply emollient all over as it helps to seal in moisture while skin is still damp.
6: Consider using a humidifier - Humidifiers moisten the air to increase the level of humidity. To combat the drying effects of central heating and lower humidity during winter, some may
Distributed by: A.Menarini Pharmaceuticals Ireland Ltd, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. www.relife.ie IE19031 IR-REL-49-2019 Date of item August 2019 DRYECZEMANEW&SENSITIVE SKIN BABY CARE A unique range of Italian emollients and cleansers, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin. All products are dermatologically tested Relizema™ ORDER NOW OMAURA CRONIN 086 –Maura.Cronin@united-drug.com8198271 MERVYN CONNAUGHTON 086 –Mervyn.Connaughton@united-drug.com8198271 YVONNE QUIGLEY 087Yvonne.Quigley@united-drug.com0524507
Reports of skin reactions such as burning, stinging, itching and redness after using Aqueous cream have been highlighted over a number of years.
Emollients
One area for which there is a considerable demand in primary care for advice and support is dermatology and some evidence suggests that many people with skin problems manage their condition t hrough Eczemaself-care.affectsapproximately 1 in 5 children and 1 in 12 adults in Ireland. While the exact cause of eczema is not known, certain factors are thought to be important in its development, these include an inherited (genetic) predisposition to have a weakened skin barrier, as well as altered inflammatory and allergy responses.
Ordinary soaps, bubble baths and shower gels should be avoided as they dry out the skin by stripping away its natural oils. Instead, advise customers to choose emollient wash products when bathing which leave the skin coated with a protective film afterwards.
already taken? The patient may already be using topical creams
SLS is a component of emulsifying wax and is a detergent and surfactant – which means it breaks surface tension and separates molecules – and allows products to lather (causing bubbles and suds). It helps to maintain the creamy consistency of emollients.
What are the symptoms? Itch, rash, skin pigmentation
Eczema (or atopic dermatitis) is a common, inflammatory skin condition characterised by red, dry, itchy skin. Those with eczema can experience acute worsening of their condition, which are referred to as flares. During flares the skin becomes red which can sometimes weep, become blistered, crusted and thickened.
Atopic eczema can be triggered or aggravated by exposure to a number of environmental irritants or allergens. Common irritants include soap, bubble bath, shampoo, laundry detergents, fragrances, clothing that feels ‘itchy’ next to the skin (e.g. wool), changes in temperature, or allergens like animal dander, the house dust mite or pollen, but sometimes no cause can be identified.
Eczemacondition.isrecognizable
• Wet or weepy, with yellow/brownish crusts
Soap substitutes/emollient wash products
Emollients come as lotions, creams and ointments. Finding the right emollient is often a matter of trial and error but the best emollients are ones that the sufferer prefers to use and will continue to use every day.
Sometimes it can be difficult for children or indeed anyone who suffers with eczema to find comfortable clothing, particularly when there has been a flare up of the condition. Clothing can aggravate eczema as skin can be very hot and heat increases itch.
One common emollient, Aqueous cream, has been on the market for decades but
Infection
according to some studies the negative effects on the skin barrier are thought to be related to a particular ingredient: sodium lauryl sulfate (SLS) 1%.
How long has the patient had the symptoms? The patient may need prescription corticosteroids if other treatments are not helping with flareActionups
by the presence of red, dry, itchy skin, which can sometimes weep, become blistered, crusted and thickened. However, the appearance of eczema, and the locations of the body affected, can vary greatly depending on the age of the person.
Irritants and allergens
The symptoms of this skin disorder can range from mild to severe, and all forms of eczema can have a significant impact on the quality of life for the person with eczema, caregivers and their loved ones.
Medication? Corticosteroids should only be taken after other eczema treatments have failed in adults and children over age 2. Younger children should not take these medications.
Stress
Emotional stress can aggravate eczema. Finding ways to reduce stress may lessen the frequency and, hopefully, the intensity of the flare-ups. Whilst stress is associated with flares of atopic eczema, it is not yet fully understood.
33ECZEMA
Used several times a day, emollients help to soothe dry, itchy skin and repair the skin’s barrier, thereby preventing entry of irritants and allergens, which can trigger eczema flares.
Clothing & Wet Wraps
Atopic eczema and dry skin go hand-inhand; medical moisturisers / emollients have been used for managing eczema for many years and are still the recommended first-line treatment.
Atopic skin is more vulnerable to infection and infection is often associated with a worsening of eczema. Advise customers to seek medical attention if skin becomes:
Who? Anyone, some babies may outgrow it
Atopic eczema can run in families and frequently occurs alongside other atopic conditions, including hayfever and asthma. Although there is no cure for eczema yet, treatment are available to manage the
Emollients are an essential part of daily care, even when skin is clear. Emollients are moisturisers that are used in two ways – applied directly to the skin as a leaveon moisturiser, and as a soap substitute instead of soap or shower gel.
• Very sore, with clusters of painful itchy blisters, particularly if there has been contact with someone who has a cold sore.
Sodium lauryl sulfate (SLS) and Aqueous cream
ECZEMA
Embrace Your Moment
The gel-plug is dispelled over the course of a few days - normally 3-5 days - with the natural shedding of dead skin cells.
SENSITIVE Perspirex Original roll-on, 20ml
SENSITIVE Perspirex Comfort roll-on, 20ml
Perspirex works so effectively thanks to aluminium chloride in an alcohol-base.
The skin care system has been added to the formulation to counteract the low pH. The skin care system consists of a weak acid which is a moisturising agent, and is part of the NMF (Natural Moisturising Factor**). The skin care system balances the pH and thereby reduces potential skin irritation.
IS YOUR PROBLEM?SWEATING SKIN TYPE THE PERSPIREX SOLUTION
Ensures maximum dryness for days
and water. Do not re-apply after showering, as soap and water do not affect the antiperspirant’s performance. You can still use your scented deodorant or fragrance.
This reacts with the water in your sweat duct,
** Natural Moisturising Factors are elements that ensure an intact structure of the outer layer of the skin (epidermis)
WASH OFF IN THE MORNING Maintain sweat and odour control by applying Perspirex 1-3 nights per week, or as often as needed.
NORMAL Perpirex Strong / For Men Maximum roll on 20ml
When the antiperspirant is applied, the formulation can cause irritation and pain to the skin due to low pH value.
NORMAL Perspirex Original / For Men Regular roll on 20ml
My sweating from the underarms is INTOLERABLE and ALWAYS interferes with my daily activities.
The gel-plug is dispelled over the course of a few days with the natural shedding of dead skin cells. UNCOMFORTABLE
Perspirex containing the active ingredient aluminium chloride is applied on the skin at night.
SUPERIOR PROTECTION
Controls excessive sweat and odour
The aluminium forms a temporary gel-plug when it comes into contact with water and protein contained within the sweat duct. In this process Hydrochloric Acid is formed (HCl). HCI is a strong acid and could cause irritation on the skin due to low pH. The Perspirex skin care system balances the pH and thereby reduces potential skin irritation.
PERSPIREX SKIN CARE SYSTEM
withFREQUENTLYandinterferesmydailyactivities.
down“Whenchangedanormalforpuberty. 21343211234HOW
My sweating from the underarms is BARELY TOLERABLE
WashAPPLYapplication.ATNIGHToffinthemorning with soap
The Perspirex formulation is activated in the sweat duct.
Provides a comfortable skin feel
* Perspirex Original and Perspirex Comfort roll-on
APPLY TO DRY AND UNBROKEN SKIN
HOW PERSPIREX WORKS
Apply at night before going to bed, when the sweat glands are less active. Allow to dry fully after
The unique and patented formulations* of Perspirex contains a skin care system that provides a comfortable skin feel. Thus the irritation that is commonly associated with other aluminium chloride-based antiperspirants is minimised.
HOW TO 21PERSPIREXAPPLY
EFFECTIVE FOR 3-5 DAYS
NO PERSPIREX SKIN CARE SYSTEM
MODE OF PERSPIREXACTIONSKINCARESYSTEM112234 21
ACTIVE SKIN CARE SYSTEM*
temporarily forming a gel-plug preventing the sweat from reaching the surface of the skin.
The “wet” form of macular degeneration is characterized by the growth of abnormal blood vessels from the choroid underneath the
Who? In all three cases mostly older people.
There are several eye problems that become more common among people as they age, although they can affect anyone at any age. Many of them while bothersome are not particularly serious such as presbyopia (loss of ability to see close objects or small print), dry eyes, and tearing (having too many tears from light sensitivity). Others however can be both serious and have a huge impact on a patient’s life. Sensitivity to the patient is extremely important as is offering help to aid the symptoms. The most serious of these conditions are macular degeneration, glaucoma and cataracts.
Macular Degeneration
Dry Form
macula. These blood vessels leak blood and fluid into the retina, causing distortion of vision that makes straight lines look wavy, as well as blind spots and loss of central vision. These abnormal blood vessels and their bleeding eventually form a scar, leading to permanent loss of central vision.
Most patents are affected by this form and it is characterised by the presence of yellow deposits (called drusen) in the macula. A few small drusen should not cause changes in vision; however, as they grow in size and increase in number, they may lead to a dimming or distortion of vision that people find most noticeable when they read. In the advanced stages, patients lose central vision.
Cataracts
Cataracts are cloudy areas that cover part of or the entire lens inside the eye. In a healthy eye, the lens is clear like a camera lens. This means that light has no problem passing through it to the back of the eye to the retina where images are processed. When a cataract is present, the light cannot get through the lens as easily and, as a result, vision can be impaired. Cataracts often form slowly, and normally without pain, redness, or tearing in the eye. Some stay small and do not alter eyesight. But, if they become large or thick, cataracts can usually be removed by surgery. Surgery is often not needed or can
EYE HEALTH IN THE ELDERLY 37
be delayed for months or years. Many people with cataracts treat the symptoms with the help of glasses, contact lenses, and other vision aids.
What are the symptoms? Distortion of vision in all three cases.
Wet Form
There is currently no cure for macular degeneration, but treatments may prevent severe vision loss or slow the progression of the disease considerably. Several options are available, including:
Medication? If patient wears contact lenses and has been prescribed eye drops, they may need to stop wearing lenses as medication in the eye drops can build up in the lenses and damage the eye.
Macular degeneration is the leading cause of severe vision loss in people over age 60. It occurs when the small central portion of the retina, known as the macula, deteriorates. The retina is the light-sensing nerve tissue at the back of the eye. Because the disease develops as a person ages, it is often referred to as agerelated macular degeneration (AMD). Although macular degeneration is almost never a totally blinding condition, it can be a source of significant visual disability. There are two main types of age-related macular degeneration:
Eye Health in Older Patients
This condition develops when there is too much fluid pressure inside the eye. It occurs when the normal flow of the watery fluid between the cornea and the lens of the eye is blocked. If not treated early, this can lead to permanent vision loss and blindness. Glaucoma is less commonly caused by other factors such as injury to the eye, severe eye infection, blockage of blood vessels, or inflammatory disorders of the eye. Because most people with glaucoma have no early symptoms or pain, it is very important to get your eyes checked by an eye doctor regularly. Treatment may include prescription eye drops, oral medications, or surgery.
How long has the patient had the symptoms? If symptoms worsen with cataracts or glaucoma, surgery should be suggested.
EYE HEALTH IN THE ELDERLY
Action already taken? The patient may already be using glasses or contacts.
• Anti-angiogenesis drugs: These medications block the development of new blood vessels and leakage from the abnormal vessels within the eye that cause wet macular degeneration. This treatment has been a major change in the treatment of this condition and many patients have actually regained vision that was lost.
Treatment
Glaucoma
• Vitamins: A large study performed in America by the National Eye Institute of the National Institutes of Health, called AREDS (Age-Related Eye Disease Study), showed that vitamins C, E, beta-carotene, zinc and copper can decrease the risk of vision loss in patients with intermediate to advanced dry macular degeneration
New! Anusol Soothing & Cleansing Wipes. From the UK’s No. 1 piles treatment brand*New This is a cosmetic product. *Source: Nielsen Scantrack data to 10.08.2019. For verification please visit www.anusol.co.uk **AcuPoll Testing 2018. UK, N=343, 30%M + 70%F, L12M sufferes Clinically tested, naturally derived formula for: Soothing Cleansing Cooling When experiencing piles, it’s important to use a soothing wipe that cleanses effectively** Designed for use with other Anusol™ products for a complete treatment of haemorrhoids or anal fissures. The nation’s favourite treatment range for piles*. Haemorrhoid solutions that are proven to shrink piles, reduce inflammation, soothe itching and relieve discomfort? No wonder AnuSol™ is the nation’s favourite* *Source: IQVIA | OTC Non Rx l Value Sales l MAT | data to 30.04.18 Anusol Cream, Ointment & Suppositories Product Information: Presentation: Cream, Ointment and Suppositories. Cream: Each 100g contains Bismuth oxide 2.14g, Balsam Peru 1.8g, Zinc oxide 10.75g. Ointment: Each 100g contains Bismuth subgallate 2.25g, Bismuth oxide 0.875g, Balsam Peru 1.875g, Zinc oxide 10.75g. Suppositories: Each suppository contains: Bismuth subgallate 59mg, Bismuth oxide 24mg, Balsam Peru 49mg, Zinc oxide 296mg. Uses: Symptomatic relief of internal and external (cream and ointment only) haemorrhoids and other related ano-rectal conditions. Dosage: Apply cream or ointment or insert one suppository to the affected area at night, in the morning and after each evacuation until the condition is controlled. Not recommended for children. Contraindications: Hypersensitivity to the active substance(s) For more information please contact your Pemberton Rep or Customer Service on 01-4632424 The nation’s favourite treatment range for piles*. Haemorrhoid solutions that are proven to shrink piles, reduce inflammation, soothe itching and relieve discomfort? No wonder AnuSol™ is the nation’s favourite* *Source: IQVIA | OTC Non Rx l Value Sales l MAT | data to 30.04.18 Anusol Cream, Ointment & Suppositories Product Information: Presentation: Cream, Ointment and Suppositories. Cream: Each 100g contains Bismuth oxide 2.14g, Balsam Peru 1.8g, Zinc oxide 10.75g. Ointment:
• having a family history of haemorrhoids
OTC treatments - various creams, ointments and suppositories are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort. These medicines should only be used for five to seven days at a time. They may irritate the sensitive skin around your anus if you use them longer than this.
• a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
What are the symptoms? Pain or discomfort, especially when sitting, pain during bowel movements, itching or irritation around the anal region, bright red blood on stools, swelling around the anus.
Who? The risk of haemorrhoids increases as a person gets older.
How long have they had the symptoms? If OTC products have not helped the symptoms within a week they sufferer should be referred to a Actiondoctor.already
Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation – this is often due to a lack of fibre in a person’s diet. Chronic (long-term) diarrhoea can also make sufferers more vulnerable to getting
• sitting down for long periods of time
• a persistent cough or repeated vomiting
HAEMORRHOIDS
• bleeding after passing a stool (the blood will be bright red)
39
HAEMORRHOIDS
Sclerotherapy - may be used as an alternative to banding.During sclerotherapy, a chemical solution is injected into the blood vessels in the back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.
• itchy bottom
Surgery - although most haemorrhoids can be treated using the methods described above, around one in every 10 people will eventually need surgery.Surgery is particularly useful for haemorrhoids that have developed below the dentate line –unlike non-surgical treatments, anaesthetic is used to ensure sufferers don’t feel any pain.
The exact cause of haemorrhoids is unclear, but they’re associated with increased pressure in the blood vessels in and around the anus. This pressure can cause the blood vessels in the back passage to become swollen and inflamed.
As haemorrhoidal tissues are inflamed, topical vasoconstrictors are commonly used to shrink blood vessels in the anorectal area and temporarily relieve swelling. Topical analgesics may also be used to relieve pain, itch, and irritation.
Corticosteroid cream - a GP may prescribe corticosteroid cream, which contains steroids, if there is severe inflammation in and around the back passage.
Constipation, pregnancy, heavy lifting, or strenuous exercise may exacerbate these symptoms. Prolonged sitting, obesity, and low-fibre diets are other possible contributing factors.
What causes haemorrhoids?
Most haemorrhoids are mild and sometimes don’t even cause symptoms. When there are symptoms, these usually include:
• age – as a person get older, the body’s supporting tissues get weaker, increasing the risk of haemorrhoids
taken? Sufferer can be advised of a number of lifestyle changes which can lessen the symptoms or reduce the risk of haemorrhoids returning.
Symptoms may include rectal bleeding resulting from irritation of internal haemorrhoids, with bleeding usually occurring immediately after defecation. Other symptoms may include itching, perianal discomfort, and soiling.
Also known as piles, these are swellings that contain enlarged blood vessels that are found inside or around the bottom (the rectum and anus).
Banding - carried out as a day procedure, this involves placing a very tight elastic band around the base of the haemorrhoids to cut off their blood supply. The haemorrhoids
Medication and treatments
Haemorrhoids are one of the most common ano-rectal ailments. More than half of people will develop haemorrhoids, usually after the age of 30. A HTA on referral thresholds for haemorrhoid procedures has shown that half the Irish population “experience symptomatic haemorrhoid disease at some point in their lives, with the peak incidence of symptomatic disease between the ages of 45 and 65 years.”
Any medication should be combined with the diet and self-care advice discussed above. Pharmacists can advise about which product is most suitable.
• being pregnant – which can place increased pressure on your pelvic blood vessels, causing them to enlarge
Otherhaemorrhoids.factorsthat might increase the risk of developing haemorrhoids include:
Supportive care strategies may include lifestyle changes, such as adopting a highfibre diet, increasing fluid intake, avoiding straining during defecation, and using topical products for symptom relief.
Medication? A number of OTC treatments are available. Sufferers should avoid ibuprofen and codeine.
• being overweight or obese
Painkillers - common painkilling medication, such as paracetamol, can help relieve the pain of haemorrhoids. But if a sufferer has excessive bleeding, they should avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen, as they can make rectal bleeding worse. They should also avoid using codeine painkillers as they can cause constipation.
• regularly lifting heavy objects
should then fall off within about a week of having the treatment. Banding is usually a day procedure that doesn’t need an anaesthetic, and most people can get back to their normal activities the next day.
Ourresearchfeedsupplementstherootfromwithin25yearsofinthescienceofhairAvailable from your local Pharmacy For further information please contact your Pemberton representative or call customer services on 01 463 2424 Supported by 10 clinicaltrials
Medications?Finasteride is only licensed in Ireland for BPH.
Which vitamins may help thinning hair?
Biotin: A B vitamin often recommended for hair health. Since biotin deficiency can lead to thinning of the hair, proponents claim that taking biotin supplements (in pill or tablet form) or using biotin-enriched shampoo and hair products can thicken hair and stimulate hair and nail growth.
Minoxidil usually needs to be used for at least four months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon.
Finasteride is a medicine that is used in the UK for treating male pattern baldness. It is also used for treating Benign Prostatic Hypertrophy (BPH). It is only licensed in Ireland for BPH.
Who? Both men and women can be affected by thinning hair due to a number of factors.Androgenetic alopecia will affect 30% of men will by the age of 30 years, 50% by the age of 50 years, and 80% by the age of 70 years. In addition, up to 13% of premenopausal women experience some degree of androgenetic Whatalopecia.are the symptoms? Most people will lose some hair every day. Patients with androgenetic alopecia experience hair loss with no signs of inflammation or scarring.
HAIR LOSS
Some experts believe that zinc deficiency actually can lead to deterioration of the protein structure that makes up the hair follicle. This weakening of follicles can in turn cause hair shedding and hair loss.Zinc is also believed to play a crucial role in DNA and RNA production. This is required for the normal division of hair follicle cells, leading to healthier hair growth.
Androgenetic alopecia, commonly known as male-pattern baldness, is the most common form of hair loss for both men and women. It can be caused by either hormonal or hereditary Androgeneticfactors.alopecia is an androgendependent hereditary disorder in which dihydrotestosterone is a significant contributing factor. The condition affects Caucasian men more than men of other ethnicities. It can start at any age, but approximately 30% of men will experience some hair loss by the age of 30 years, 50% by the age of 50 years, and 80% by the age of 70 years.
Treatments: Minoxidil is available as a lotion that you rub on your scalp every day.
HAIR LOSS
Alopecia areata is another type of hair loss, involving patches of baldness that may come and go. It can occur at any age, but mostly affects teenagers and young adults. Six of 10 people who are affected develop their first bald patch before they are 20 years old.
Causes: Hair loss – in the form of male pattern baldness – is often a genetic disorder. Male pattern baldness occurs when hair follicles convert testosterone into another hormone called dihydrotestosterone (DHT).
Hair loss is a symptom of biotin deficiency, so biotin supplementation is thought to benefit people with hair loss or thinning hair who have a biotin deficiency.
41
How long has the patient had the symptoms? If a patient develops sudden hair loss they should be referred to a GP.
Losing hair isn’t usually anything to be worried about but it can be upsetting. Treatment may help with some types of hair loss.It’s normal to lose hair. Most people can lose between 50 and 100 hairs a day, often without noticing. Occasionally it can be a sign of a medical condition.
Zinc is a vital mineral for healthy hair, skin and nails. A zinc supplement for hair loss will supply a good amount of the mineral, as well as other key hair nutrients such as biotin, vitamin C and iron.
It is available from pharmacies without a prescription. It is not clear how minoxidil works, but evidence suggests that it can cause hair regrowth in some men.
Action already taken? Eating a balanced diet can aid hair health.
Male pattern baldness
Some types of hair loss are permanent, like male and female pattern baldness. This type of hair loss usually runs in the family.Other types of hair loss may be temporary. They can be caused by an illness, stress, cancer treatment, weight loss, iron deficiency.
In addition, up to 13% of premenopausal women experience some degree of androgeneticalopecia, and the incidence may increase significantly after menopause. By the age of 70 years, approximately 40% to 50% of women experience hair loss.
Iron: People who are anaemic, can start to see hair loss. If you believe that a patient may be anaemic, they should be referred to a GP.
The most common supplements advised for hair growth are:
The quality of hair growth can be influenced by diet, so supplements that include minerals needed to stimulate hair growth are often advised for thinning hair and hair loss. The quality of diet can be reflected in the quality of hair so it pays to eat a balanced diet and include foods such as oily fish, spinach and eggs.
Zinc: It’s thought that this mineral is useful for hair growth because people who are deficient in it due to other medical conditions can often have dry, brittle hair.
Affected hair follicles (typically at the sides and the top of the head) become more sensitive to DHT, which causes the hair follicles to shrink, weaken, and eventually die. This slows down hair production and can stop hair growth altogether.
Zinc also may help keep hormone levels balanced. As a bonus, zinc for hair growth may help eliminate dandruff on the scalp as well.
Distributed by: A.Menarini Pharmaceuticals Ireland Ltd, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. www.relife.ie IE19031 IR-REL-49-2019 Date of item August 2019 DRYECZEMANEW&SENSITIVE SKIN BABY CARE A unique range of Italian emollients and cleansers, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin. All products are dermatologically tested Relizema™ ORDER NOW OMAURA CRONIN 086 –Maura.Cronin@united-drug.com8198271 MERVYN CONNAUGHTON 086 –Mervyn.Connaughton@united-drug.com8198271 YVONNE QUIGLEY 087Yvonne.Quigley@united-drug.com0524507
Because many medications can compromise skin health, brown bag sessions are ideal not only for reviewing patient medications, but also the risks of developing preventable conditions. Counseling patients can also help to prepare them for serious or cosmetic adverse effects that include rash, itching, redness, or discoloration.
43HEALTHY SKIN
Community pharmacy teams play a significant role in helping patients to maintain the health of their skin. From reducing the risk of sun exposure by recommending appropriate sunscreens to advising patients on the use of OTC acne medications, pharmacists and their staff frequently are the frontline health care professional for what is the body’s largest Pharmacistsorgan.are ideally positioned to counsel patients about the importance of appropriate skin care. It is important for community pharmacy teams to be aware of skin disorders and cancer risks so they are able to help their patients by providing preventive and early-stage care.
• Scan the label for active ingredients. Good choices include the highly effective sun blocks titanium dioxide and zinc oxide, and the chemical sunscreen avobenzone
Action already taken? Customers may already be using sun creams.
• Covering up with a T-shirt, hat and sunglasses
Customers need to be urged to use emollients regularly, particularly once symptoms are brought under control. Your range of products should be extensive as there is no-one-size-fits-all remedy.
Consider incorporating regime into your category display. Regime is encouraged to help reduce and relieve symptoms on a long-term basis.
• Reporting mole changes or unusual skin
• Use an SPF (Sun protection factor) no lower than 15. The SPF theoretically means that the wearer is 15 times more protected by wearing the cream, but since most people apply less than half the amount of sunscreen used in lab tests, they get only about half the protection. Most dermatologists suggest using an SPF 30.
Sun Cream
Pharmacy staff should have a thorough knowledge of the products available and which skin conditions most customers want advice and products for. With the increasing trend for natural products, a good category should include some newer natural remedies alongside familiar brands.
• Avoiding the sun at its most powerful between 11am and 3pm
Sun protection is essential to skin cancer prevention – about 90 percent of nonmelanoma skin cancers and about 86 percent of melanomas are associated with exposure to UV radiation from the sun. Key to staying healthy is protecting yourself from the sun. Pharmacies play an important role through education. When customers purchase sun cream, engage them in conversation and explain about the purchase they are buying as well as offering advice on staying safe in the sun.
HEALTHY SKIN
In addition to providing advice on sun cream, there are other ways to prevent sun damage. These include:
• Look for “broad-spectrum”, “complete” or “total protection” on the bottle. This means that the wearer is protected against UVB and UVA rays. Sunlight emits up to 95 percent UVA (the rays that penetrate deeply into skin, causing wrinkles, spots, and skin cancer) and around 5 percent UVB (the more energetic rays that cause sunburn and can also contribute to skin cancer). If the sun cream is not broad- spectrum,
• Trying not to burn
• Find a sunscreen formula that fits their life and lifestyle: if the sun cream is too sticky, heavy or expensive, the customer may not wear it
How long have they had symptoms? These will probably be seasonal.
• That does not mean that higher is better, however, as really high SPFs do not offer that much more protection. An SPF of 30 absorbs about 96 percent of UVB rays, but a 45 is only about one percentage point better.
Who: Everyone.
Use health promotion displays that focus on a specific skin condition and are linked to a national promotion, such as National Eczema Week.
the wearer may be exposed to massive doses of UVA.
• People with fair skin that burns in strong sun, red or fair hair, a lot of moles or freckles, or a personal or family history of skin cancer should use higher SPFs.
Medication: Do not apply sun cream to children under 6 months.
What are the symptoms? N/A
Keeping Safe in the Sun
There are various things you sun cream needs to do to protect skin, so it is important that the customer is aware of what to look for. There are many sun creams out there, but to provide adequate protection, the customer needs to:
Description: Light pink oval film coated tablet. Indication(s): Proton Pump Inhibitor (PPI): Short-term treatment of reflux symptoms (e.g. heartburn and acid regurgitation) in adults. Dosage: Swallow tablets whole with liquid, do not chew or crush. Disperse in half a glass of non-carbonated water if difficulty in swallowing. Stir until tablets disintegrate, drink liquid with pellets immediately or within 15 min, or administer through a gastric tube. Do not chew or crush pellets. Adults: The recommended dose is 20 mg esomeprazole (one tablet) per day. It might be necessary to take the tablets for 2-3 consecutive days to achieve improvement of symptoms. Duration of treatment is up to 2 weeks. Once complete relief of symptoms has occurred, treatment should be discontinued. If no symptom relief is obtained within 2 weeks of continuous treatment, the patient should be instructed to consult a doctor. Elderly (≥ 65 years old): As per adults. Paediatric population (< 18 years): Not recommended. No relevant use in this group in the indication: “short-term treatment of reflux symptoms (e.g., heartburn and acid regurgitation)”. Severe impaired renal function: Caution. Severe liver impairment: 20 mg max daily dose. Contraindications: Hypersensitivity to esomeprazole, substituted benzimidazoles or any of the excipients. Not with nelfinavir. Warnings and Precautions for Use: On demand treatment: Contact a physician if symptoms change in character. In the presence of any alarm symptom (e.g. significant unintentional weight loss, recurrent vomiting, dysphagia, haematemesis or melaena) and when gastric ulcer is suspected or present, malignancy should be excluded, as treatment with esomeprazole may alleviate symptoms and delay diagnosis. Treatment with proton pump inhibitors (PPIs) may lead to a slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter and in hospitalised patients, also possibly Clostridium difficile. Patients should consult their doctor before taking this medicinal product if they are due to have an endoscopy or urea breath test. Absorption of vitamin B12 may be reduced due to hypo- or achlorhydria. Not recommended for long-term use as the following may also occur: Hypomagnesaemia; Risk of fracture. Consider stopping Emazole Control in cases of Subacute cutaneous lupus erythematosus (SCLE) accompanied by arthralgia. Interference with laboratory tests: Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Emazole Control treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of PPI treatment. Contains glucose and sucrose.
Interactions: Effect of esomeprazole on other drugs: Co-administration with atazanavir is not recommended. If the combination of atazanavir with a PPI is judged unavoidable, close clinical monitoring is recommended in combination with an increase in the dose of atazanavir to 400 mg with 100 mg of ritonavir; esomeprazole 20 mg should not be exceeded. Esomeprazole is a CYP2C19 inhibitor. When starting or ending treatment with esomeprazole, the potential for interactions with drugs metabolised through CYP2C19 should be considered. Serum levels of cilostazol, cisapride, tacrolimus, methotrexate may be increased. An interaction is observed between clopidogrel and esomeprazole, but the clinical relevance is uncertain. As a precaution, concomitant use of esomeprazole and clopidogrel should be discouraged. Gastric acid suppression by PPIs increase or decrease absorption of drugs with pH dependent absorption (decreased absorption of ketoconazole, itraconazole); esomeprazole inhibits CYP2C19 metabolising enzyme and could increase plasma concentrations of diazepam, citalopram, imipramine, clomipramine, phenytoin (monitor plasma levels of phenytoin), etc. resulting in need of a dose reduction; monitor INR when given with warfarin or similar. Caution as absorption of digoxin can increase. Effect of other drugs on esomeprazole: CYP2C19 and CYP3A4 inhibitors (clarithromycin, voriconazole) may increase the esomeprazole exposure. Dose adjustment not regularly required, except in severe hepatic impairment and long-term use. CYP2C19 and/or CYP3A4 inducers (rifampicin and St. John’s wort) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.
Undesirable Effects: Common: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting, fundic gland polyps (benign). Uncommon: Peripheral oedema, insomnia, dizziness, paraesthesia, somnolence, vertigo, dry mouth,
Product Name: Emazole Control 20 mg Gastro-Resistant Tablets
Composition: Each tablet contains 20 mg esomeprazole (as magnesium dihydrate).
ABBREVIATED PRESCRIBING INFORMATION
Pregnancy and Lactation: Caution in pregnancy due to lack of clinical data. No studies in lactating women, therefore, not recommended during breast-feeding. Ability to Drive and Use Machinery: Minor influence on the ability to drive or use machines. Adverse reactions such as dizziness (uncommon) and blurred vision (rare) have been reported. If affected, patients should not drive or use machines.
NEW MarketedTREbyATS HEARTBURN AND ACID REFLUX. ONE TABLET PER DAY LASTS 24 HOURS AVAILABLE IN PACKS OF 7s AND 14s.
increased liver enzymes, dermatitis, pruritis, rash, urticaria, fracture of the hip, wrist or spine. For other side effects refer to the SPC. Marketing Authorisation Holder: IQ Pharmatek Ltd., Gurtnafleur, Old Waterford Road, Clonmel, Co. Tipperary. Marketing Authorisation Number: PA 22777/001/001. Further information and SPC are available from: Rowex Ltd, Bantry, Co. Cork. Freephone: 1800 304 400 Fax: 027 50417. E-mail rowex@rowa-pharma.ie Legal Category: Not subject to medical prescription. Date of Preparation: September 2019 Adverse events should be reported. Reporting forms and information can be found on the HPRA website (www.hpra.ie) or by emailing medsafety@hpra.ie or by emailing Rowex pv@rowa-pharma.ie CCF:22656 Date of preparation: (10-19)
Medication? Antacids can be taken safely during pregnancy to treat indigestion.
For patients with persistent symptoms that
Action already taken? People may have taken antacids but not be aware how to eliminate triggers until they start to keep a food diary
Refer those who have been self-treating unsuccessfully continuously for ≥4 weeks; are ≥45 years old with new or recently changed indigestion symptoms; have unintended weight loss in association with Dyspepsiaindigestion.ispain that manifests in the gastroduodenal region. Symptoms may include postprandial fullness, epigastric pain, and GORDburning.iscaused
are not relieved by antacids or alginates, acid suppressants are available, including histamine H2 receptor antagonists (H2 blockers) and proton pump inhibitors (PPIs).
Incidence of GORD is certainly rising as obesity rates accelerate. People are also binge drinking and eating more fatty or calorific food, which increases acidity levels and contributes to poorer digestive health.
patients elect to self-treat mild to moderate cases of heartburn and dyspepsia, pharmacists are likely to encounter patients seeking advice on the various non-prescription products available for the prevention and treatment of both conditions. Pharmacists also are instrumental in identifying patients at increased risk for developing heartburn and dyspepsia because of certain medications, medical conditions, or lifestyle habits.
Sometimeseffects.pointed questions about lifestyle can help patients select appropriate lifestyle modifications. Pharmacists should remember that for gastrointestinal reflux, certain symptoms should raise an alarm. If patients report any symptom indicative of one of these, referral to a physician is warranted.
Pharmacists should ask open-ended questions about concurrent medications and supplements, such as NSAIDs, aspirin, glucosamine, and others, that may list heartburn among their side
Lifestyle Issues
Dyspepsia usually occurs when stomach acid irritates the stomach lining, oesophagus or top part of the bowel, perhaps after a heavy meal, whereas most cases of acid reflux or gastro-oesophageal reflux disease (GORD) occur due to weakening of the lower oesophageal sphincter.
PPIs, such as lansoprazole, omeprazole, pantoprazole, rabeprazole and esomeprazole, are more commonly prescribed or recommended for managing GORD than H2 antagonists, and are also used to treat H. pylori infections. They work by reducing the production of stomach acid by inhibiting the hydrogen-potassium adenosine triphosphatase enzyme system, otherwise known as the ‘proton pump’. This reduction in acid reduces reflux symptoms, helping to heal the oesophagus as well as ulcers in the stomach or duodenum.
HEARTBURN AND DYSPEPSIA
Lifestyle modifications can help to ease the severity of symptoms of GORD and dyspepsia, although many patients will also need to take medication. For example, eating smaller, more frequent meals can help to control reflux and indigestion by reducing pressure on the abdomen, as can avoiding dietary triggers, such as coffee, alcohol, citrus fruits, chocolate and fatty foods. These may relax the lower oesophageal sphincter and/or delay gastric emptying.
Becausefoods.many
HEARTBURN AND DYSPEPSIA
H2 blockers, such as cimetidine, famotidine, nizatidine and ranitidine, prevent the parietal cells in the stomach from responding to histamine by releasing acid.
Giving up smoking may also help, as smoking can exacerbate GORD symptoms by relaxing the lower oesophageal sphincter. Losing weight, if overweight or obese, should also help to control symptoms, but sufferers should avoid over-exertion and exercises like sit-ups, as these can provoke acid reflux.
What are the symptoms? Pain in the lower chest, abdomen or top of the stomach, feeling bloated, needing to burp or pass wind, nausea or vomiting and loss of appetite.
Antacids are alkali liquids or tablets that provide immediate relief by neutralising excess stomach acid, although the effects are often short-lived so extra doses may be needed. Care should be taken to avoid taking antacids alongside other medicines, as they can interfere with absorption or damage the coating of certain tablets. Alginates protect the oesophagus by forming a barrier or ‘raft’ over the top of the stomach contents, helping to suppress the backflow of Antacidsacid. and alginates are available in combination to provide dual action relief against both heartburn and indigestion.
by acid leaking up from the stomach and coming into contact with the oesophagus. While the stomach is able to withstand litres of acid without pain, the gullet is not. GORD has a significant impact on quality of life and productivity, with sufferers reporting impaired sleep and interference with social activities and work.
The symptoms of GORD are often worse at night, especially for overweight individuals, but raising the head of the bed by 20cm by placing blocks underneath it may help. Propping the head up with pillows is not advisable as this may put extra pressure on the abdomen. It may also be beneficial to avoid wearing tight clothes, stooping or bending forwards.
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Who? 73% of people can experience indigestion and interchangeably.heartburnAsmany as eight out of 10 women experience indigestion at some point during their pregnancy.
Treatment Options
How long have they had the symptoms? The symptoms are usually experienced after eating or drinking, but there can sometimes be a delay between eating a meal and developing indigestion. Women may experience indigestion at any point during their pregnancy. Symptoms may be more frequent and severe during the third trimester.
For anyone experiencing the discomfort associated with heartburn and dyspepsia, finding rapid relief is a top priority. Heartburn and dyspepsia are common gastrointestinal (GI) complaints that, if left unresolved, may negatively affect an individual’s overall quality of life and restrict or limit activities or ingestion of certain
Heartburn, or pyrosis, is characterised as a burning sensation arising from the substernal area and moving toward the neck or throat. There are 2 main types: postprandial heartburn occurs within 2 hours after a meal, when bending over, or when lying down, and nocturnal heartburn occurs during sleep and often is responsible for interrupting it.
Alongside lifestyle measures and reviewing medication, the first-line treatment options for mild to moderate GORD and dyspepsia are antacids and alginates.
People often confuse the symptoms of upper gastrointestinal (GI) disorders, but in the main, indigestion or dyspepsia refers to pain or discomfort in the upper abdominal area after eating, while heartburn refers to the burning pain felt behind the sternum associated with acid reflux, which is often accompanied by nausea, water brash or regurgitation of acid or bile.
The aim of this training guide is to provide information and reassurance about the condition and offer practical advice on a non-medicinal solution.
1) 78% of Healthcare Professionals agree that the most common cause of colic in young babies is caused by digestive or feeding problems, including swallowing air and trapped wind*
Caring for a baby with colic can be very difficult for parents, particularly first-time parents.
2) Temporary gut sensitivity to certain proteins and sugars found in breast milk and formula milk, such as Lactose Intolerance.
Reassure parents as to what the signs and symptoms of Colic are
• Bath baby in a warm bath
Product Options: There is a natural solution – suggest to parents to change their baby bottle to Dr Brown’s Options+ bottles or recommend they use Dr Brown’s from day one as prevention is better than cure!
• Baby’s face may become red and flushed when they cry
Colic is the name given to excessive, frequent crying in a baby who appears to be otherwise healthy. It’s a common problem with almost half of babies in the UK developing Colic*.
Infantile Colic is a common ailment which can affect the whole family. The intense crying that defines the condition makes it highly distressing for both baby and parents and can have a major impact on family life.
CHILD HEALTH CONSULATATION: SESSION ON
Colic is very distressing for both baby and parent!
Explain the common causes of Infantile Colic
Explain that a baby suffering from colic may appear to be in pain but the condition is not harmful to baby’s health in the long term, as long as baby continues to feed and gain weight normally.
• Gently rock baby over your shoulder
• Intense crying bouts
• Gently massaging baby’s tummy
As baby becomes more developed and no longer experiences feeding issues parents now have the convenient option to remove the vent. Without the vent Dr Brown’s Options+ provides a feeding experience
Traditional and restrictive vented bottles tend to develop vacuums because babies have to suck progressively harder on the one hole in the bottle to obtain the liquid. This causes teat collapse and baby has to stop feeding. Air enters the bottle when the teat reinflates; the air is ingested which can cause the colic symptoms.
• Crying in the late afternoon or evening that lasts at least 3 hours a day, 3 days per week.
Practical Advice for Parents?
3) Gastro-Oesophageal Reflux Disease (GORD)
Colic is defined by:
Explain what Colic is
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Dr Brown’s Options+ Baby Bottles feature a unique system with a removable green vent designed to create a “vacuum free” environment. Dr Brown’s is clinically proven to help reduce wind related colic by removing the air bubbles in the feed*.
There are also a number of techniques you can advise parents to try that can help alleviate the symptoms of windy colic:
INFANTILE COLIC Dr Brown’s Options+ bottles offer the complete feeding system that grows with baby and helps alleviate symptoms of windy colic.
Preventing baby from swallowing air is extremely important in helping to avoid wind related colic and choosing the right baby bottle can help.
• Burp baby after feeds
• Baby will tend to clench their fists, draw their knees up to their tummy, and arch their back while crying
PHARMACY ASSISTANTS Q & A
Reassure parents that Colic will not harm baby?
Explanation as to how a Dr Brown’s Options+ bottle works?
Article sponsored by:
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References: Results from a HCP Colic Survey carried out by Consumer Analysis – May 2010 and research conducted by Mustard Research Ltd amongst a sample of 200 UK Health Care Professionals during May 2017.
Other useful information sources you can offer to parents.
similar to most teat-vented bottles. The teat venting creates a controlled flow, offering babies an easy and convenient way to feed at their own pace.
Parents can see a fully animated explanation on www.drbrowns.co.uk
When can parents expect their baby to stop suffering from Colic?
Dr Brown’s is the most recommended baby bottle for the relief of wind related colic*.
NHS - https://www.nhs.uk/conditions/ colic/
NCTcoping-colichttps://www.nct.org.uk/parenting/
Dr Brown’s availability: Dr Brown’s Options+ bottles and feeding accessories are available for pharmacies to purchase http://www.murrayshealthandbeauty.com/from
Cry-sis - the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems - https://www.cry-sis.org.uk/
Thankfully babies tend to grow out of Colic between four and six months, as baby’s feeding become more developed.
DON’T GET BFLATTENEDYMigraine *Sumatran Relief is a non prescription migraine treatment, containing s cal prescription Further nformation and SPC are available from: Rowex Ltd , Bantry, Co 09-19) CCF No:22529 E XCLUSIVE OTC PRODUCT FOR PHARMACIES ONLY* ABBREVIATED PRESCRIBING INFORMATION Product Name: Sumatran Relief 50 mg Tablets Composition: Each tablet contains 50 mg sumatriptan (as sumatriptan succinate) Description: Pink, biconvex, oblong tablet with a break-l ne on both sides Indication(s): The acute treatment of migraine attacks with or without aura Only to be used where there is a clear diagnosis of migra ne Dosage: Only n Adults aged 18 to 65 years: Recommended adult dose s a single 50 mg tablet If a patient responds to the first dose of sumatriptan, but the symptoms recur a second dose may be taken for the same attack but no sooner than 2 hours after the first tablet was taken If a patient does not respond to the first dose, a second dose should not be taken for the same attack (in these cases the attack can be treated with paracetamol acetylsalicyl c acid or non steroidal anti-inflammatory drugs) No more than 100 mg (2 tab ets) should be taken n 24 hrs The recommended dose should not be exceeded Contraindications: Hypersensitivity to the active substance or to any of the excipients or sulphonam des; Should not be used prophy act cally; A history of myocardia infarction, ischaemic heart disease or coronary vasospasm (Prinzmetal’s angina;) Peripheral vascular disease; Symptoms or signs consistent with ischaem c heart disease; A h story of stroke (cerebrovascu ar accident (CVA)) or transient ischaemic attack (TIA) or cardiac arrhythmia; Rena or hepatic impairment; Hypertension or a history of hypertension; History of seizures or other risk factors which ower the thresho d; Concomitant administration of preparat ons containing ergotamine or ergotamine derivatives (including methysergide) or any tr ptan/5-hydroxytryptamine 1 (5-HT1) receptor agonist; Concom tant use of monoamine oxidase inh bitors and the use of sumatriptan within 2 weeks after discontinuation of therapy with monoam ne oxidase inh bitors; Management of basilar, hemiplegic or ophthalmoplegic migraine Warnings and Precautions for Use: Only for use where a clear diagnosis of “migraine” has been made by a doctor initally For pharmacy supply, patients should have an established pattern of migraine (a history of five or more m graine attacks occurring over a period of at least 1 year) M graineurs whose typical headaches persist for longer than 24 hours, who experience four or more migraine attacks per month, or in whom the pattern of symptoms has changed or whose attacks have become more frequent, more persistant, or more severe, or who do not recover completely between attacks, should seek adv ce from the r doctor Following adm nistration, sumatriptan can be associated with transient symptoms including chest pain and tightness, which may be intense and involve the throat Where such symptoms are thought to ndicate ischaemic heart disease no further doses of sumatriptan should be given A medical eva uation should be obtained immediately Note that migraineurs may be at ncreased risk of certain cerebrovascu ar events (e.g CVA, TIA) Medication should be stopped if they experience atypica symptoms (i.e uni ateral motor weakness, double vision, ataxia etc.) and they should seek medical adv ce Not to be used in migraineurs without a pr or cardiac risk assessment by a doctor or pharmacist As migraine is a chron c condition cardiovascular risk should be evaluated regular y n patients who use sumatriptan intermittently, over the longer term Sumatr ptan is effective for migra ne occurring during menstruation, but women with migraine who are taking the combined oral contraceptive have an increased risk of stroke and should seek advice from their doctor if migraine attacks started recent y (within the last 3 months), migra ne symptoms have worsened, or they have migraine with aura Not to be given to patients (especia ly postmenopausal women and males over 40 years of age) with risk factors for schaemic heart disease, including those patients who are heavy smokers or users of nicotine substitution therapies, without prior cardiovascular evaluation Risk factors for heart disease include hypercholestero aem a, regular smoking, marked obesity, diabetes or a fami y history of early heart d sease (father/brother developed heart disease before the age of 55 mother/sister developed heart disease before the age of 65) The diagnosis of medication overuse headache (MOH) should be suspected in patients who have frequent or daily headaches desp te (or because of) the regular use of headache medications (e.g triptans, opioids, ergotamine or combination of these drugs for 10 days or more per month) Patients with headache present on more than or 15 days per month for three months whose headache has developed or markedly worsened dur ng medication overuse should be referred to their doctor for further management Contains lactose monohydrate Interactions: There have been rare post-marketing reports descr bing pat ents with serotonin syndrome (inc uding a tered mental status, autonomic instability and neuromuscular abnormal ties) following the use of SSRIs and sumatriptan Serotonin syndrome has also been reported fo lowing concomitant treatment with triptans and SNRIs and is also a risk with concomitant use with lithium Undesirable effects may be more common during concomitant use with herbal preparations containing St John’s Wort (Hypericum perforatum) Pregnancy and Lactation: Not to be used during pregnancy or breast-feed ng unless on the advice of their doctor Ability to Drive and Use Machinery: Drowsiness, d zziness and weakness may occur as a result of m graine or its treatment with sumatriptan This may influence the ability to drive and to operate machinery Undesirable Effects: Common: Dizziness, drowsiness, sensory disturbance including paraesthesia and hypoaesthesia Transient increases in blood pressure aris ng soon after treatment, flushing Dyspnoea Nausea and vomiting occurred in some patients, but it is unclear if this is re ated to sumatriptan or the underlying condition Sensat ons of heaviness (usually transient and may be intense and can affect any part of the body ncluding the chest and throat), myalgia Pain, sensations of heat or cold, pressure or t ghtness (these events are usually transient and may be intense and can affect any part of the body nclud ng the chest and throat); feelings of weakness fatigue (both events are mostly mild to moderate in intensity and transient) Marketing Authorisation Holder: Rowex Ltd., Bantry, Co Cork Marketing Authorisation Number: PA 711/272/1 Further information and SPC are available from: Rowex Ltd , Bantry, Co Cork Freephone: 1800 304 400 Fax: 027 50417 E-ma l rowex@rowa-pharma.ie Legal Category: Not Subject to medical prescription Date of Preparation: April 2018
• Aura can occur with or without headache - Typical aura symptoms include visual, sensory, speech disturbance and occasionally motor symptoms which are reversible
Furthermore, there is an increased risk of certain medical co-morbidities in patients with chronic migraine including depression, anxiety, fibromyalgia and obesity.
In the hopes of helping to prevent future migraines, keeping track of potential triggers and pre-headache symptoms is recommended – as each individual person might experience a different set. People can track any triggers and possible patterns in their migraines by keeping a migraine headache diary. Understanding each individual’s own personal migraine patterns and symptoms will be key to controlling them.
MIGRAINE
Confirmation of the diagnosis of migraine is a very important part of the consultation. In children and adolescents, migraine attacks are generally of shorter duration than those seen in adults. Children often give a history of travel sickness and recurrent abdominal pain or cyclical vomiting syndrome, prior to the development of headaches in their late teens or adulthood.
Migraine is considered to be a primary disorder of the brain. It is a complex neurovascular condition that involves activation and sensitisation of neuronal pathways within the peripheral and central nervous systems. This involves sensory information passing from the periphery to more central areas such as the trigeminovascular complex. Neuronal activation, cortical spreading depression (CSD) and vascular changes are present during the migraine attack. However, blood vessel dilatation and constriction are not necessary or sufficient to induce an attack.
Migraine patients may experience episodic or chronic symptoms, and the latter is usually associated with the most significant disability. There is often a component of overuse of painkillers or analgesics (medication overuse) in patients with more chronic symptoms.
As migraine is most often seen in females of childbearing ages, most pharmacists will have seen women who relate their migraine to their menstrual cycle. Most will also have many children with infantile colic. In such cases, it is now considered important to ask if there is a family history of migraine.
Migraine is the most common headache disorder seen by pharmacists and their Migraineteams.isthe
• Sensitivity to light, sounds and smells –which becomes even more heightened during the migraine – is a common premonitory symptom, while others are impacted by things like excessive thirst, lethargy and constipation or diarrhoea. Some migraine sufferers experience vision impairment or temporary loss (most commonly in aura migraines).
49
in mood (irritability is frequently reported), though for some the opposite happens and they get a surge of energy afterwards. Muscle weakness accompanied by tiredness is also a common post-migraine complaint, with many sufferers needing to sleep following an attack.
Who? Anyone - there are half a million migraine sufferers in Ireland.
What are the symptoms? Severe head pain that generally has throbbing or pulsating peaks, often on one side of the head, nausea and vomiting.
• Unilateral or bilateral, typically lasts 4 to 72 hours
• Pulsating or throbbing pain, moderate or severe
taken?Paracetamol, aspirin or ibuprofen can be effective for patients with mild-moderate migraine although the data suggests that their efficacy is limited to about one third of Medication?patients.Codeine is a major cause of rebound headache.
How long have they had the symptoms? Migraines are best controlled as soon as the warning signs appear. After-effects can last up to 24 Actionhours.already
• Associated with other symptoms such as sensitivity to light/sound, nausea, vomiting, diarrhoea, disequilibrium, neck pain
Many migraine sufferers report experiencing prodrome — early symptoms that can serve as a warning sign of an impending migraine. These premonitory symptoms can take place anywhere from days to hours prior to a migraine, and their frequency and severity can vary depending on many different variables. People may experience irritability, restlessness, depression or a combination of these feelings right before a migraine begins.
Diagnosis Summary
Emphasise the importance of regular lifestyle, diet, exercise, avoidance of stress, alcohol, smoking and other stimulants.
The duration of a migraine can be excruciating, but even once the worst of the attack has passed, there’s often aftereffects to deal with for up to 24 hours later. Following the headache, sufferers often feel depleted of energy and can face a shift
• Frequency < 15 days per month = EPISODIC MIGRAINE +/- aura ≥ 15 days per month = CHRONIC MIGRAINE +/aura
leading cause of YLD in the age group 15-49 years. YLD is considered to be the most appropriate measure of disability in non-fatal medical conditions. It is estimated that there are currently more than a billion people with migraine on the planet and there are approximately 600,000 to 700,000 people in the Republic of Ireland with this condition.
MIGRAINE
Warning signs
References: 1. Merry A, et al. AFT-MX-1, a prospective parallel group, double-blind comparison of the analgesic effect of paracetamol and ibuprofen, paracetamol alone, or ibuprofen alone in patients with post-operative pain. Department University of Auckland, New Zealand 2008. *compared with the same daily dose of standard paracetamol or ibuprofen Easolief Duo 500 mg/150 mg film-coated tablets Each tablet contains paracetamol 500 mg and Presentation: A White, capsule shaped tablet with breakline on one side and plain on the other side. Indications: symptomatic treatment of mild to moderate pain. Dosage: Adults/elderly: The usual dosage is one to two six hours up to a maximum of six tablets in 24 hours. Children: Easolief Duo is contraindicated in children Contraindications: Severe heart failure, known hypersensitivity to paracetamol, ibuprofen, other NSAIDs excipients, active alcoholism, asthma, urticaria, or allergic-type reactions after taking acetylsalicylic acid or other of gastrointestinal bleeding or perforation related to previous NSAID therapy, active or history of recurrent haemorrhage, severe hepatic failure or severe renal failure, cerebrovascular or other active bleeding, blood-formation during the third trimester of pregnancy. Warnings and precautions: This medicine is for short term use and is for use beyond 3 days. Clinical studies suggest that use of ibuprofen, particularly at a high dose may be associated increased risk of arterial thrombotic events. Patients with uncontrolled hypertension, congestive heart failure, established heart disease, peripheral arterial disease and/or cerebrovascular disease should only be treated with ibuprofen consideration and high doses should be avoided. Careful consideration should be exercised before initiating long-term of patients with risk factors for cardiovascular events. The use of paracetamol at higher than recommended hepatotoxicity, hepatic failure and death. Patients with impaired liver function or a history of liver disease or who ibuprofen or paracetamol therapy should have hepatic function monitored at regular intervals. Severe hepatic jaundice and cases of fatal hepatitis, though rare, have been reported with ibuprofen. Paracetamol can be used chronic renal disease without dosage adjustment. There is minimal risk of paracetamol toxicity in patients with renal failure. Caution should be used when initiating treatment with ibuprofen in patients with dehydration. DUALNOWAVAILABLECallourfreephone A new analgesic30%brandmore IN ONE
Paracetamol can be used for most types of mild pain. It can be bought it from a pharmacy or supermarket. It has few side effects, but it is very important not to take more than the recommended dose. Higher doses can damage the liver. Paracetamol does not reduce
may have local analgesic, anesthetic, antipruritic, and/or counterirritant effects.
containing low doses
Compound analgesics are made from a combination of two different drugs.New combination painkillers combining full strength paracetamol and ibuprofen are available and suitable for the treatment of mild to moderate Compoundpain.analgesics
Action already taken? Rest and exercise can help with managing mild to moderate pain.
anti-inflammatory gel, which you can rub onto the Whenskin.taking
Anti-inflammatoryinflammation.drugs
• Support from bandages or compression hosiery can help with sprains and strains.
Mild pain is often successfully treated with painkillers such as paracetamol and antiinflammatory drugs.
Effective assessment is the keystone of pain management and it is important to focus on the patient’s experiences and circumstances. Acute pain is short-term and usually follows an injury, such as an operation, fracture or infection. Acute pain is usually self-limiting, resolves once the underlying problem is treated or heals –which generally takes days or weeks – and typically responds well to analgesics, including those available OTC from pharmacies.
On the whole, pains encountered in community pharmacies will be mild to moderate and selflimiting (less than one week), and will generally respond to any one of the wide range of over-the-counter analgesic products available. Typical conditions presented include toothache, headache, dysmenorrhoea and musculoskeletal injuries.
Medication? A number of painkillers are available OTC. Stronger painkillers are available with prescription.
Pain is one of the most common symptoms presented to pharmacists and its presence is almost ubiquitous in all diseases and injuries. Pain can be mild, moderate or severe. It can be treated using different strengths of painkiller, depending on the level of pain. A pharmacist can assess a patient’s pain before prescribing the best painkillers to help control it.
these drugs, always check the recommended dose on the packet and never take a higher dose.
A number of other methods can be recommended for managing pain
Acute pain is often treated with non-opioid drugs and anti-inflammatory drugs. Sometimes opioids are used to treat mild pain.A patient’s description of pain should be considered the most reliable indicator of suffering.
Anti-inflammatory drugs can cause indigestion and may irritate the lining of the stomach, so it’s important to take them after a meal or snack. A doctor may prescribe another medicine to help protect the stomach. If a patient has had problems with stomach ulcers before, a doctor may suggest they don’t take anti-inflammatory drugs at all. Or they may suggest they use an
What kinds of pain can be helped by OTC medicines?
Topical OTC treatments
• Rest
• Acupuncture or Transcutaneous Electrical Nerve
What are the symptoms? Persistent and nagging pain.
• Toothache
Other medicines or tablets that are sold from a pharmacy or supermarket, such as cold and flu remedies, may also contain paracetamol or anti-inflammatory drugs. If a person is taking painkillers, they should be careful which other medicines they take, so that they don’t take more than the recommended doses. A pharmacist can give advice about over-thecounter medicines.
of codeine are available over the counter from pharmacists, but stronger ones are only available on prescription. They can be used for moderate pain.
Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted. External analgesic products may contain one or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine salicylate.
Other ways to manage pain
Who? Anyone suffering mild to moderate pain.
• Applying heat to the skin can help some types of pain. Use compresses or products such as sprays, creams, ointments, gels and patches to help swelling and inflammation.
Topical OTC treatments broadly divide into those with active ingredients and those that are Formatsdrug-free.available include gels, creams, ointments, sprays, patches and wraps. Patients will often use
Compound analgesics
• Headache, migraine
• Backache, muscle aches, joint pains
OTC topical analgesics for the treatment and management of musculoskeletal injuries and Thesedisorders.products
MILD TO MODERATE PAIN
Non-opiod drugs
such as ibuprofen help reduce inflammation and swelling. They are good for treating pain in the skin, muscle or bone. These can be bought from a pharmacy or supermarket. Other anti-inflammatory medicines need to be prescribed by a doctor.
• Period pain
How long have they had the symptoms? If the symptoms persist after taking OTC medication further advice should be offered.
• Stimulation (TENS) are alternatives to medication for pain control
• Minor injuries, strains and sprains
51
Painful conditions are among the most commonly presenting minor ailments in general practice, and the scope for pharmacy input into self-care for painful minor ailments is evident. It is imperative that pharmacists and pharmacy support staff have relevant and evidence-based knowledge to inform their practice.
Advice should be given by a medical professional before these types of medicines are taken. They do not always work for everyone and may not mix well with other medicines you’re taking.
• Exercise (if the patient is able to)
MILD TO MODERATE PAIN
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There are various causes of a nappy rash. Examine the rash and explain what type it is, and how to treat it most effectively.
• Corticosteroids help to reduce the inflammation of the skin and relieve any itching and redness.
If a patient’s baby has severe or reoccurring nappy rash, they should be advised to visit their GP as it will usually require prescribed medication. Nappy rash should clear up within a few days of over the counter Theretreatment.area number of treatments for severe nappy rash.
NAPPY RASH
Where there has been close contact with the nappy, the baby’s skin will look red and inflamed. Most affected will be the genitals, the outer skin on the folds of thighs, and the bottom. The affected areas can appear either dry or moist, and look shiny or pimply.
• Matricaria Chamomilla (chamomile) is effective in that it is both a demulcent and antibacterial.
Chafing, due either to skin rubbing against the nappy, or from skin folds, can damage and irritate the skin and ongoing contact of the skin with urine, faeces or both, can lead to a formation of ammonia which can irritate a baby’s skin.
To treat a fungal infection, the parent should apply a barrier cream every time the baby’s nappy is changed. Zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams.
Severe Nappy Rash
Fungal nappy rash is often a complication of initial nappy rashand looks different. If the baby’s skin is warm and damp for long periods of time, it can cause the fungus ‘candida’, to grow. Like ammonia, candida can irritate the baby’s skin. The area of skin will be inflamed, with spots around the edges. The infection will be bright red and also present in the folds of the skin.
Most children aged 0-3 years old develop nappy rash in some way and it is usually presents in babies from 6-8 months.
• Changing the nappy regularly.
• Dexpanthenol (pro-vitamin B5) is an advantageous ingredient in baby care products as it encourages the regeneration of the skin, is a demulcent, activates the lipid synthesis and strengthens the skin’s protective barrier.
• Standard talcum powder should not be used when changing nappies.
Medication? If baby’s rash is caused by thrush, don’t use a barrier cream or ointment, as this can make the rash worse.
• Hydrocortisone cream, which should only be applied once a day should not be used for more than seven days
Fungal Nappy Rash
How long has the patient had the symptoms? Severe nappy rash or recurring nappy rash should be Actionreferred.already taken? Parents may already be following self-care tips such as leaving baby’snappy off and changing regularly.
Nappy rash can occur a baby soils or wets itself and the nappy is left on for a longer time than usual, the urine and faeces can encourage the production of the chemical ammonia, which can irritate the baby’s skin, causing it to become sore and inflamed.
The best way to treat this is to keep the bottom as clean and dry as possible and change nappies often. It’s also a good idea to apply a barrier ointment/cream or medicated powder after every change.
What are the symptoms? Nappy rash can affect the genitals, the outer skin on the folds of the thighs and the buttocks. The affected areas can appear either dry or moist and may sometimes look shiny or pimply.
Nappy rash is one of the most common skin conditions in babies and it is also the most common skin problem in early childhood.
• Zinc Oxide works by providing a skin barrier to prevent and help heal skin irritation.
Prevention
Who? Predominantly newborn babies up to one year of age.
• Applying a barrier cream after each nappy change.
This involves:
• Tight-fitting plastic pants over nappies should not be used.
• Leaving the nappy off for as long as possible.
Nappy rash can be caused by a number of factors including a combination of excess moisture, warmth, urine, faeces and friction in a baby’s nappy. It is a difficult environment for baby skin.
The nappy rash creates an enclosed area around the bottom and this increases warmth, moisture and encourages the growth of micro-organisms that can cause infection.
• An anticandidal medicine helps to treat any fungal infection that may cause a rash. Some commonly prescribed anticandidal medicines include: Clotrimazole, econazole, ketoconazole, miconazole and nystatin.
Ultimately, prevention is key and, in order to avoid painful nappy rashes, pharmacists should advise parents to follow the same steps involved in treating a mild nappy rash.
53NAPPY RASH
There is also a common link made between nappy rash and teething, as well as the transition to solid foods.
Causes and Symptoms
• Using only water to wash the baby’s bottom.
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• Fish oil supplements appear, in general, to be safe. However, patients on anticoagulants or with blood clotting disorders should be monitored.
Fish oils are a type of polyunsaturated fatty acids (PUFAs). They are the omega-3 and omega-6 fatty acids. Regarding heart health, the active ingredients in fish oils are DHA and EPA. The hypothesis is that omega-3s offer protection from cardiovascular disease by reducing the heart’s susceptibility to arrhythmias, decreasing platelet aggregation and lowering blood pressure and triglyceride levels.
How long have they had the symptoms? N/A
for conditions related to the heart and blood system. They may also be used for many kidney-related problems.
Action already taken? Some customers may have already commenced a more balanced and healthy approach to diet and lifestyle, recommend continuation of this to include exercise.
OMEGA FISH OILS
• Fish oil appears to reduce the risk of CHD. It may help to reduce the risk of thrombosis (by increasing bleeding tendency), reduce blood levels of triacylglycerols, prevent atherosclerosis and arrhythmias and reduce blood pressure
Fish oil’s popularity has soared in recent years, propelled by research that suggests consuming omega-3 fatty acids can ward off heart disease. Community pharmacists play an important role in helping patients make informed decisions about fish oil and omega-3 supplementation.
55OMEGA FISH OILS
• Those who could benefit from an increased intake of n-3 fatty acids. The typical Irish diet contains relatively low amounts of these.
Importance of Fish Oils
Who? Certain vitamins are recommended for specific patient groups. Keep educated on their target populations.
Pharmacy team should be aware of, and understand, the following key points:
Fish oils are sometimes called the beauty and brains supplement. The DHA ingredient in fish oils is known to be a building block for brain and nerve formation.1 It is added to baby formulas to support brain and nerve development.
But with hundreds of OTC options available (and labels claiming that the supplements treat everything from bipolar disorder to menstrual cramps) how can pharmacists distinguish between them to help patients make the best choice?
There is little doubt that n-3 fatty acids have an important role in nutrition. They are significant structural components of the phospholipid membranes of tissues throughout the body, particularly in the brain and
their role in cell membranes, n-3 fatty acids are essential for the formation of new tissue and are therefore important for development and growth (eg, during foetal and infant development). During the last three months of pregnancy, n-3 fatty acids rapidly accumulate in the brain and nervous system of the foetus. Babies born pre-term may miss some of this period and could have a suboptimal ability to synthesise long chain fatty acids. Thus, they may require these to be provided pre-formed. Long chain n-3 fatty acids (and other fatty acids) are present in breast milk and European Union regulations now allow their addition to infant formulas.
• Fish oil may have a role in various mental disorders, such as depression, schizophrenia and Alzheimer’s disease, but research in this area is in its infancy
Becauseretina.of
Sold by pharmacists since the early years of the 20th century, cod liver oil is one of the oldest and most well-known food supplements. The oil first gained its reputation as an effective preventative against rickets because of its high vitamin D content and it was taken by generations of children, decreasing in popularity only when, in the 1960s, the British government decided to phase it out as a welfare food. Fish oils are most commonly used in supplements
• Fish oil could have beneficial effects in inflammatory conditions such as rheumatoid arthritis, Crohn’s disease and ulcerative colitis, but evidence of any benefit in asthma and psoriasis is poor.
What are the symptoms? Take a full symptom and medical history in order to direct the customer to the most appropriate vitamin/ supplement
Medication: A full medication history is essential to ensure the right product is selected for the right customer as many vitamins and supplements can cause side effects if used inappropriately.
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presents with symptoms of gingivitis, they should have their teeth professionally cleaned and they should also be advised to practice good oral hygiene. In order to prevent a build-up of plaque, toothbrushes or water irrigation devices can be advised, along with anti-bacterial mouthwashes and anti-plaque or anti-tartar toothpastes. Soft bristle brushes should be used and the recommended time for cleaning the teeth is two minutes.
What are the symptoms? Swollen or bleeding gums
be able to advise on brushing technique as well as the types of product available to manage specific oral health problems, such as acid erosion, staining and gum disease
At the frontline of healthcare, pharmacists and pharmacies have a substantial role to play in improving oral health. Many people visiting a pharmacy are looking for pain relief and medication to rid themselves of toothache, mouth ulcers and other areas of discomfort in the mouth and jaw.
The disease can often remain silent for many years and will only present itself when the gums become swollen or bleed. Gum disease can result in teeth loss. Patients who smoke or suffer from diabetes are at a higher risk of developing the
There is more to oral hygiene than a toothbrush and some toothpaste. Pharmacy teams need to
Mouth Ulcers
Oral disease is one of the most common diseases in contemporary society. In spite of considerable advances in preventive dentistry, the vast majority of the population will have experienced both dental decay and gum disease by their early twenties.
Halitosis
Oral disease impacts on the vast majority of the population and despite advances in preventive dentistry the prevalence of dental decay and gum disease remains high.
Action already taken? Sufferers may already be aware of tell-tale signs.
Who? People, who have poor oral hygiene. The problem can affect anyone of any age.
Gingivitis
Most people don’t realise that their diet can have a significant impact on their oral health. Crash dieting, fasting and low-carbohydrate diets can have nasty side-effects on breath due to acetone caused by ketosis, or an excess of protein in the diet producing volatile sulphur compounds in the breath.
Gingivitis is a form of periodontal disease. Periodontal disease is the inflammation and infection that destroys the tissues, such as the gums, ligaments and the tooth sockets, which support the teeth. This is caused by a build-up of plaque over periods of time and is caused by poor dental hygiene, undiagnosed diabetes or a poor diet.
Mouth ulcers affect up to 20% of the population, particularly women and young people. They are usually white, red, yellow or grey in colour and inflamed around the edge. Mouth ulcers can be uncomfortable, especially when sufferers are eating, drinking or brushing their teeth, but they are usually harmless. Most mouth ulcers will clear up on their own within a week or two, but a GP or dentist should be consulted if the ulcer gets worse, lasts for longer than three weeks, or if the patient develops ulcers on a regular basis.
mask bad breath, an alcohol-free mouthwash should be advised to kill bacteria. Alcohol is also a drying agent and will reduce saliva flow, in turn creating a perfect breeding ground for bacteria.
How long have they had symptoms? Symptoms will usually clear up within 7 days of treatment.
Who? Adults are more likely to present to the pharmacy with gingivitis, especially smokers, those with a poor diet and some experts believe women on some of the contraceptive pills may be extrasusceptible.
ORAL HEALTH
For customers who do smoke but want to
Good oral hygiene is the cornerstone of dental health, but there are other lifestyle factors that also have an effect, such as diet, smoking, smokeless tobacco and alcohol.
High sugar intake, for example, is linked to obesity, heart disease, diabetes and dental decay. Smoking is linked to cardiovascular disease, respiratory disease, gum disease and cancer, including oral cancer. In addition to sharing common risk factors, poor oral health appears to impact on general health.
Certain types of food can also feed the bacteria in the mouth that cause bad breath. Hard sweets are a major culprit. Similarly, ice lollies are known to stain the teeth because of the amount of sugar they contain.
How long has the patient had the symptoms? Gingivitis can be present for years without the patient knowing.
What are the symptoms? Bad breath
Medication: If using Ibuprofen avoid smoking or drinking large amounts of alcohol.
Actions already taken? Patients may have already attended their dentist and are looking for pharmacy over-the-counter solutions.
57ORAL HEALTH
Who: Those suffering from mouth ulcers.
It is important to brush twice daily for two minutes each time with a good toothbrush and a good whitening toothpaste, and to floss at least three times a week to prevent dark stains between the teeth.
How long has the patient had the symptoms? If the patient has persistent bad breath that cannot be resolved, it may be a symptom of another condition. A referral should be made to a doctor, dentist or health hygienist.
Medication:Customers who express concern about sensitive teeth should choose a product formulated to reduce this.
Advances in the prevention and treatment of oral diseases mean that most children born in this century will keep their teeth into old age, and the condition of these teeth will depend on how well they are looked after over a lifetime.
Halitosis or bad breath can be caused by excessive amounts of volatile sulphur compounds (VSCs) being produced by bacteria in the mouth. This can be influenced by any number of factors, such as eating, drinking, oral hygiene, sleeping and the effect that these activities have on saliva flow. Mouthwashes will reduce halitosis, due to the anti-microbial influences of the products.
What are the symptoms? Ranging from burning and tingling before sores appear, pain in the mouth.
Reinforcing the message about twice-daily brushing remains the most important priority and is one of the most effective ways of preventing dental decay.
Medication: Customers who express concern about sensitive teeth should choose a product formulated to reduce this.
Lifestyle
Routines and Products
Ifdisease.apatient
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Treatments
Action already taken? Lifestyle changes, such as exercise and losing weight, can help to relieve symptoms.
Stiff and painful joints are the main symptoms. Symptoms vary from one person to the next. The level of physical activity can make a difference. The weather (especially damp and low pressure) may affect symptoms.
The condition affects 400,000 people in Ireland. There has been an increase in the number of people with osteoarthritis in Ireland for two reasons; our ageing population and more obese people putting an increased strain on their Osteoarthritisjoints.
With knee and hip osteoarthritis, daily tasks such as going up or down stairs can become difficult to perform. Mobility can be affected due to pain and walking.
Osteoarthritis occurs when there is damage in and around the joints that the body cannot fully repair.It’s not clear exactly why this happens in some people, although the chances of developing the condition can be influenced by a number of factors, such as age and weight.
In some circumstances a non-steroidal antiinflammatory drug (NSAID) may be prescribed as a painkiller by a GP. NSAIDs are painkillers that work by reducing inflammation. Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription.
Capsaicin cream - a GP may prescribe capsaicin cream if a patient has osteoarthritis in the hands or knees and topical NSAIDs haven’t been effective in easing the pain.Capsaicin cream works by blocking the nerves that send pain messages in the treated area. The patient may have to use it for a while before it has an effect.
Steroid injections - steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems.Some people with osteoarthritis may be offered steroid injections when other treatments haven’t worked.
What are the symptoms? Pain and stiffness in the joints, joint tenderness, increased pain and stiffness when a person has not moved their joints for a while, joints appearing slightly larger or more ‘knobbly’ than usual, a grating or crackling sound or sensation in the joints, limited range of movement in the joints.
Painkillers - the type of painkiller (analgesic) you may recommend will depend on the severity of the pain and other conditions or health problems the patient has. Paracetamol is often used in the first instance and sufferers can be advised to take it regularly rather than waiting until the pain becomes unbearable.
with a normal life. Symptoms can peak for a few years, and then subside. For others, one or more joints may worsen, causing pain and disability. Unfortunately, it is difficult to predict the outcome for a person affected with the condition.
Topical gel - pharmacists will be able to advise on the use of topically applied gel to ease joint pain associated with osteoarthritis. Gels work by delivering lubricating ingredients directly into joints that have become damaged due to osteoarthritis. By improving lubrication within the joints they can relieve pain and reduce joint stiffness. They can be used safely with other medicines.
Symptoms
In osteoarthritis of the knee, pain is felt at the front and sides of the knee, and in severe causes it causes the legs to become bent (bow-legged). With hip joints, the pain is usually in the front of the groin, but can radiate around the side and front of the thigh, the buttock and even down to the knee. Sometimes when osteoarthritis is severe, the affected leg may shorten.
A complication of osteoarthritis, especially knee osteoarthritis, is calcification, which is when chalky deposits of calcium crystals form in the cartilage of joints. This process tends to make the osteoarthritis more severe and painful.
OSTEOARTHRITIS
The pain and stiffness in the joints can make carrying out everyday activities difficult for some people with the condition.
is more common and often more severe in women, especially in the knees and hands. It often starts after the menopause.
Pain tends to be worse on exercising the joint and at the end of the day. The joints do not move as freely as normal and may cause a ‘cracking’ sound when moved.
Medication?There’s no cure for osteoarthritis, but the condition doesn’t necessarily get any worse over time and a number of treatments are available to help relieve the symptoms.
There are many different types of osteoarthritis, which can affect a number of the body’s joints. The knees are the most common sites for osteoarthritis. The hips, hands, spine and big toes are also often affected.
59OSTEOARTHRITIS
Osteoarthritis is caused by wear and tear of cartilage in the joints. It is the most common form of arthritis in Ireland. In osteoarthritis, the surface of a joint becomes damaged and the surrounding bone grows thicker.
There’s no cure for osteoarthritis, but the condition doesn’t necessarily get any worse over time and a number of treatments are available to help relieve the symptoms. One of the main treatments for osteoarthritis is changes to lifestyle – such as maintaining a healthy weight and exercising regularly
Opioids, such as codeine, are another type of painkiller that may ease pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.
Most people with osteoarthritis can carry on
Who? Osteoarthritis usually develops over the age of 45. It is more common and severe in women than men.
Osteoarthritis usually develops in people over 45 years of age, although younger people can also be affected.It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not quite true. People may in fact be able to reduce their chances of developing the condition by doing regular, gentle exercises and maintaining a healthy weight.
How long have they had the symptoms? Medical help should be sought if a patient has persistent symptoms.
EXTRAPANADOLSOLUBLE RELIEVES 5 TYPES OF TOUGH PAIN Headaches Back pain Period pain Dental pain Joint pain Panadol Extra 500mg/65mg Soluble E ervescent Tablets. Contain paracetamol. Always read the label/leaflet. Product Information: Please consult the summary of product characteristics for full product information. Panadol Extra 500mg/65mg Soluble E ervescent Tablets, paracetamol 500mg, ca eine 65mg. Indications: Relief of mild to moderate pain including rheumatism, neuralgia, musculoskeletal disorders, headache, symptoms of colds and flu, fever, toothache and menstrual pain. Dosage: Adults and children 16 years and over: 2 tablets up to 4 times a day. Do not exceed 8 tablets in 24 hours. Children aged 12-15 years: 1 tablet up to 4 times a day. Do not exceed 4 tablets in 24 hours. Do not give to children under 12 years. Minimum dosing interval: 4 hours. Contraindications: Hypersensitivity to paracetamol, ca eine or any ingredients. Precautions: Avoid concurrent use with other paracetamol-containing products. Diagnosed liver of kidney impairment. Patients with depleted glutathione levels or chronic alcoholism or sepsis. Avoid excessive ca eine intake. Caution in those with hereditary sugar intolerance or on a low sodium diet. Should not be used in pregnancy or lactation without medical advice. Do not exceed the stated dose. Prolonged use except under medical supervision may be harmful. Side e ects: See SPC for full details. All very rare: Thrombocytopenia, hypersensitivity reactions including anaphylaxis and skin rash, angioedema, Stevens-Johnson syndrome, bronchospasm, hepatic dysfunction. Frequency unknown: Nervousness, dizziness. When combined with dietary ca eine intake, higher doses of ca eine may increase potential for ca eine related adverse events such as insomnia, restlessness, anxiety, irritability, headaches, GI disturbances and palpitations. Overdose: Immediate medical advice should be sought in the event of an overdose, even if symptoms of overdose are not present. Legal Category: Supply through pharmacy only. MA Number: PA 678/39/10. MA Holder: GlaxoSmithKline Consumer Healthcare (Ireland) Limited, 12 Riverwalk, Citywest Business Campus, Dublin 24. Additional information is available upon request. Text prepared: November 2019. CHGBI/CHPAN/0107/19 RECOMMEND PANADOL EXTRA SOLUBLE for fast pain relief Reference. 1. Laska EM et al. JAMA. 1984; 251(13):1711-1718. Panadol Extra Soluble has a dual active formula which provides up to 30% more powerful pain relief than standard paracetamol.1 paracetamol/ca eine HEADACHEBACKPAINJOINT PAIN
Oral Pain
Dental Pain
Paracetamol: Taking excessive amounts can cause Liver damage and less frequently kidney damage following over doses. It should be used with caution for patients with impaired kidney or liver function, alcohol dependence, chronic malnutrition or dehydration
Opioid: Opioid analgesics block or decrease sensitivity to pain in the body’s peripheral and central nervous systems. Most of the opioid analgesics are prescription-only medicines and are suitable for moderate to severe pain, particularly of visceral origin. They can be further classified into two categories: mild and potent opioids. Mild opioid analgesics include codeine and tramadol. Strong opioid analgesics examples are morphine and methadone.
Toothache can either come and go or be constant. Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold. Painkillers such as paracetamol and ibuprofen may help reduce pain and discomfort whilst sufferers are waiting for an appointment.
Action already taken? Sufferers may already have tried analgesics. If the pain persists longer than 2 weeks, the patient should be referred to a GP.
PAIN RELIEF
Toothache is pain in and around the teeth and jaws that is most often caused by tooth decay.The pain usually starts suddenly and it can vary from mild discomfort to a severe throbbing, which is often worse at night. The area of the jaw close to the infected tooth may also be sore and tender to the touch.
PAIN RELIEF
Who: Those suffering from pain such as dental pain.
In an effort to self-medicate, some patients may try using analgesics to ward off pain caused by more serious health conditions and pharmacy staff are in an ideal position to monitor such situations without being too intrusive.
There are two kinds of analgesics:
• Painkillers should not be shared with anyone else, as different people may experience pain with different cause and severity.
General Advice when taking Oral Analgesics
In general, the goals involved in the treatment of minor oral pain are to provide immediate symptomatic relief from discomfort and irritation and to promote healing. Patients should be assessed for the appropriateness of therapy and educated on the proper use of these products. Pharmacy teams should advise patients to seek medical care if their conditions worsen or show signs of infection.
• Always follow the dosage instructions on the packaging or as instructed by your doctor or pharmacist. Do not take more than the recommended dose as this will increase the risk of serious side effects.
Oral pain is a big market for analgesics. Many common conditions cause oral pain or discomfort. Examples of these conditions include cold sores (see separate entry), toothaches; tooth sensitivity; teething; minor oral mucosal injury or irritation; oral mucosal disorders, such as recurrent aphthous stomatitis ([RAS]; and xerostomia (dry mouth). There are OTC products available for the self-treatment of each of these sources of oral pain and discomfort, including topical analgesics/anaesthetics, toothpastes formulated for sensitive teeth, artificial saliva products for dry mouth, and oral mucosal protectants, as well as products that provide treatment of and relief from pain due to cold sores.
How long have they had symptoms? Symptoms will usually clear up within 7 days of treatment.
Medication: check for underlying conditions before suggesting a specific pain relief, see the warning box above.
• Avoid drinking alcohol if you are taking analgesics as it may increase the risk and severity of side effects of the medicines.
Types
Oral analgesics are used commonly for relieving pain such as headache, menstrual pain, toothache, back pain and arthritis. Some analgesics work on the body’s peripheral and central nervous systems to block or decrease sensitivity to pain. Others act by inhibiting the formation of certain chemicals in the body that mediate pain. They are available in various oral forms such as tablets, capsules, syrups, suspensions and powders. The analgesics market has experienced its fair share of ups and downs in recent years but is still growing and is likely to continue doing so.
alcohol as these activities can increase the risk of developing a stomach ulcer
What are the symptoms? Pain anywhere in the body.
61
Warnings for Oral Analgesics
NSAIDS: These should always be taken with food or milk. The medication should be stopped immediately and the patient referred to a GP if the patient has abnormal or black stools. Those taking NSAIDS should avoid smoking and drinking large amounts of
Non-opioid: Non-opioid analgesics include paracetamol and non-steroid anti-inflammatory drugs (NSAIDs) such as Aspirin and Ibuprofen.Non-opioid analgesics are the first choice analgesics for treating mild to moderate pain and are also used in moderate to severe pain to potentiate the effects of opioids.
Drontal is clinically proven to treat every type of intestinal worm commonly found in dogs in Ireland.
But often go unnoticed by their owners
Ask your customers when they last wormed their pets.
All dogs can get parasitic worms but often don’t show any signs.
Use Medicines Responsibly Drontal® Dog Tasty Bone/Drontal® Dog Tasty Bone XL contains praziquantel, pyrantel embonate and febantel CAM . Further information from the datasheet at www.drontal.ie or on request. Registered trademark of Bayer AG. Bayer plc, The Atrium, Blackthorn Road, Dublin 18, Ireland. Tel: 01-2999313. L.GB.MKT.10.2019.20774 TastyshapebonestrengthVet Killswormsintestinal
Amino acids are the building blocks of proteins necessary for growth and repair in the body. Look for: L’Arginine, L’Carnitine, L’Citruline, L’Glutamine, N-Acetyl-L-cysteine, Glycine, Taurine.
Factors Affecting Fertility
For Women: Supplements can support the nutritional needs of the female reproductive system. Getting the environment right and developing good quality egg cells are key factors when trying for a baby.
Nutrients play an important role in the development of the egg, womb and the hormonal system. Each month, the reproductive and hormonal cycle develop an egg cell, prepare the womb and a myriad of other processes have to be performed to create the right fertile balance.
Vitamins are vital for the production of energy in the body. Sufficient energy production is required for reproductive health. Key reproductive vitamins are: Beta Carotene, Vitamin B1 (Thiamin), Vitamin B2 (Riboflavin), Vitamin B3 (Niacin), Vitamin B5 (pantothenic acid), Vitamin B6 (Pyridoxine), Folic acid, Inositol, Biotin, Vitamin C, Vitamin D, Vitamin E, Vitamin K1.
The growing demands of a modern lifestyle are having a significant impact on our nutritional health. Stress, anxiety, lack of sleep, dieting and poor nutrition all impact the bodies ability to absorb the nutrition needed to optimise reproductive health.
Improving nutrition and lifestyle for as little as three months before trying to conceive can make a noticeable difference to both genders as both the male and female reproductive systems need adequate nutritional support to contribute to sperm and egg quality.
Look for a combination of Folic Acid, Vitamins, Minerals, Amino Acids, CO-Q10 & Omega 3 DHA.
Antioxidants such as Co-Q10 are important for reproduction. Co-Q10 is a powerful antioxidant and energy power house. It is present in the membrane of almost every cell in the body.
Omega 3 DHA contributes to the maintenance of normal brain function and vision. During pregnancy, essential fatty acids are important to the baby’s brain and eye development.
Folic acid contributes to normal maternal tissue growth during pregnancy. The HSE recommends all women begin taking 400ug folic acid at least 3 months before conception.
Smoking: Smoking can affect fertility in both men and women, it can affect the chances of conceiving for women and sperm quality in men.
PRE-PREGNANCY & FERTILITY
65 Who? Men and Women trying to Whatconceive.arethe symptoms? Those unable to conceive within first 6 months. How long has the patient had the symptoms? N/A Action already taken? Ovulation kits and fertility lubricants may have been Medication:tried. N/A
Around 1 in 6 couples in Ireland may experience issues with fertility.
Key Nutrients for Conception
Alcohol: For women planning to get pregnant, the HSE recommend the safest approach is not to drink alcohol at all. While for men drinking too much alcohol can affect the quality of sperm.
Weight: A body mass index (BMI) of 30 or over is known to reduce fertility in men and women. While, for women, being underweight (BMI less than 18) can also affect ovulation.
Diet & Lifestyle: The HSE recommends all women begin taking folic acid at least 3 months before conception. There are number of other vitamins, minerals and amino acids that are known to be beneficial to the reproductive system, however it can be difficult to get all of these nutrients in the diet in today’s busy world. This is where supplements can help, by providing extra support needed to support good pre-conception health.
Stress: Stress can affect your relationship and cause a loss of sex drive. In severe cases, stress may also affect ovulation and sperm production.
For Men: Men have to produce between 40 and 300 million sperm cells to be fertile. This is an intensive process and the energy involved in creating these cells is significant. Getting the environment right and developing good quality sperm cells are key factors when trying for a baby. A deficiency in any nutrient may have an impact on male fertility.Improvements to both sperm quality and quantity can be made in as little as 3 months.
Just over a third of couples will conceive in the first month of trying, while for others it can be a much longer road, with factors such as age, general health and reproductive health affecting how long it takes.
Age: For women, the most fertile period is in their mid-twenties and fertility starts to decrease after the age of 35.For men, sperm is strongest in their mid-twenties and starts to decrease after the age of 40.
Minerals including Calcium, Magnesium, Iron, Zinc, Copper (gluconate), Manganese, Selenium, Chromium, Molybdenum, Iodine, Boron, are essential for both male and female reproductive health. Minerals work together creating a synergy. Multiple mineral deficiencies are common amongst many women particularly those who have been using hormonal contraception.
PRE-PREGNANCY & FERTILITY
How Do Fertility Supplements Work?
Egg quality can be enhanced if it is released into a healthy nutritious environment. Fostering a good diet and ensuring that you are taking the essential nutrients can positively effect the health of your eggs and subsequently the developing foetus.
Supplements can help to correct nutritional deficiencies associated with the reproductive cycle by supplying the raw materials needed to support the reproductive system so it can function optimally.
Distributed by: A.Menarini Pharmaceuticals Ireland Ltd, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. www.relife.ie IE19031 IR-REL-49-2019 Date of item August 2019 DRYECZEMANEW&SENSITIVE SKIN BABY CARE A unique range of Italian emollients and cleansers, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin. All products are dermatologically tested Relizema™ ORDER NOW OMAURA CRONIN 086 –Maura.Cronin@united-drug.com8198271 MERVYN CONNAUGHTON 086 –Mervyn.Connaughton@united-drug.com8198271 YVONNE QUIGLEY 087Yvonne.Quigley@united-drug.com0524507
• If the scales are gently scraped off, a number of small, bleeding points can be seen underneath
Some symptoms that may be associated with psoriatic arthritis include;
Occasionally psoriasis can disappear without treatment but more usually, it is a chronic disease that requires treatment. Patches (also called plaques or lesions) can occur on various parts of the body, including the scalp, elbows, and or knees.
PSORIASIS
Red, scaly patches (also called plaques or lesions) with sharply defined edges, that occur most commonly on both elbows, both knees, the scalp, under arms, under breasts, natal cleft (groove between the buttocks) and genitalia, or at the site of an injury
• Joint pain, especially with redness, swelling, and tenderness
• Nail changes – loosened, thickened or pitted nails (pits are small dents/ice pick like depressions on the surface of the nails)
Those presenting into the pharmacy who suffer from psoriasis and exhibit any of these symptoms, should be referred to their local GP for follow-up.
Action already taken? Patients may already be using a moisturiser to reduce Medication:drynesspustular psoriasis can be caused by cessation of topical or systemic medicine check with the patient about their medications.
Psoriasis is a chronic, systemic, inflammatory skin disorder in which there is an increase in the rate at which skin cells are produced and shed from the skin. Psoriasis can affect any part of the skin surface, but most commonly involves the elbows, knees, scalp, and the sacrum (lower back).
Psoriasis treatments
seem only skin deep, but it begins inside the body within the immune system. The red, scaly, flaky, and itchy patches occur when the skin cells grow too quickly as a result of inflammation caused by the body’s immune system.
•departments.Systemictreatments: medications taken in the form of tablet, liquid or injection that work throughout the body to control the psoriasis.
Psoriasis is a condition which tends to run in families. Several different genes have been identified but the exact way in which the disorder moves from generation to generation has not yet been established. What is known is that both the immune system and genetics are important in its development. So although the potential to develop psoriasis is genetically inherited, it is by no means certain that it will ever
• Phototherapy: a form of artificial ultraviolet light, delivered in hospital dermatology
Psoriasisoccur.may
Who? The skin condition usually starts affecting people from the age of 15 and into their twenties.
Along with the physical burden of psoriasis, the often-visible nature of the disease means people living with the condition may have to cope with the reactions of others to the appearance of their skin. This can impact negatively on quality of life, self-esteem, social and personal relationships, which can then take an emotional, psychological and psychosocial toll on people with psoriasis.
Pregnancy and Psoriasis
Approximately 50% of women experience an improvement in their psoriasis symptoms during pregnancy, while others report no change or a worsening of their condition. However, it is thought that good disease control during pregnancy may optimise the health of both the mother and the baby.
• Pain in the heel(s) or tennis elbow
What are the symptoms? Painful red, itchy raised patches with visible silvery scales, typically on the knees, scalp and elbows.
• Biologic agents: targeted medicines used to inhibit part of the immune system that drive inflammation. These are mainly injections but some are now being developed in table form.
Psoriasis is a common, non-contagious, longterm, immune-mediated inflammatory disease in which there is an increase in the rate at which skin cells are produced and shed from the skin. Psoriasis affects at least 100 million people worldwide, including upwards of 73,000 people in Ireland, suggesting a prevalence of close to 2% of the Irish population. It is estimated that around 9000 people in Ireland have severe psoriasis.
Triggers for this abnormal immune reaction can include physical injuries or infections (in particular, a streptococcal throat infection), certain medicines, and emotional stress. Psoriasis varies in severity from person to person and can vary in severity in the same person at different times.
Treatment can be divided into four main categories: Topical treatments: e.g. creams, ointments, lotions, gels, foam or mousse applied directly to the skin.
Symptoms
• Morning stiffness/pain in the back that improves with movement
Over the last decade or so, research has provided greater insights about the course of psoriasis during pregnancy and the safety of newer treatments, particularly for moderateto-severe psoriasis. This is an evolving area and the science is complex, so it is important pharmacy tams are educated and knowledgeable so as to be able to effectively advise sufferers when considering planning a Fiftypregnancy.percent of psoriasis patients are women and the majority of these are diagnosed with psoriasis during their reproductive years. With this in mind, if a woman is considering becoming pregnant, it is important she has a conversation with her consultant.
People who have psoriasis are at risk of developing psoriatic arthritis, which commonly
How long has the patient had the symptoms? Most psoriasis sufferers will have flare ups if they do not adhere to a good skin care routine or if they experience stress.
In recent years, the new biologic agents have significantly broadened the range and efficacy of treatment options available, revolutionising the care of psoriasis patients and have become the ‘mainstay treatment’ for many with moderate to severe psoriasis.
PSORIASIS 67
affects the joints of the fingers, toes and spine. Psoriasis is associated with a slightly higher risk of diabetes, high blood pressure, high cholesterol, cardiovascular disease (angina, heart attack, stroke), and obesity. There is also a strong association between psoriasis and depression.
• A finger or toe that was completely swollen (sausage shaped) and painful for no apparent reason
HELP KELO-COTEFADESCARSWITH For more information about Kelo-Cote, or to access Scar Management Training Modules, please visit www.kelo-cote.ie JB-000032 Date of Preparation: Oct 2019 CLINI CALLY PROVEN
Fine line scars are common following a wound or after surgery. They aren’t usually painful, but they may be itchy for a few months.
Like keloid scars, hypertrophic scars are the result of excess collagen being produced at the site of a wound. But not as much collagen is produced in hypertrophic scars compared with keloid scars.
Hypertrophic scars
By ensuring the pharmacy team are trained and knowledgeable across all levels of primary care in minor skin conditions, those visiting the pharmacy for advice will be receiving the best support and care, both physically and emotionally.
Keloid scars
If a wound takes 10 or more days to heal, this increases the risk of scarring. Once the wound is completely healed, lots of massage will help to break down scar tissue.
Silicone gels are the first line treatment for scars by healthcare professionals including plastic surgeons. This treatment forms an occlusive layer over the scar tissue to help create an optimal healing environment for scars to normalise collagen production and help improve the appearance of scars. It has a patented formulation which helps to soften and flatten raised scars as well as reducing discolouration and redness. It also relieves itching, discomfort and pain associated with scars.
Most people will, at some time, have experienced a burn, cut, or surgery that has left a scar. When the scar is located in an inconspicuous place, it is not so bad. When an existing scar or a new injury occurs in a noticeable place, however, many consumers will turn to their community pharmacy team for advice and guidance, and will appreciate knowing that there are OTC products that can reduce scarring.
Pitted or sunken scars
SCARRING
Like any sensitive topic, asking questions can be a good way to initiate a positive discussion. Scars and stretch marks are extremely common – so reassure customers that it is something the pharmacy team is used to advising on. Ask a customer if they would prefer to talk in private and, if so, move the conversation to a consultation room.
Normal fine line scars
• Considering the aspects of wound and skincare that they need to address, and keeping up-to-date with product developments and launches
• Engaging with customers to research what they are looking for in a skincare range and whether anything is missing from a pharmacy’s skincare category
• Setting up a campaign to support wound care, promoting good practice to customers.
Action already taken? Many may already be moisturising with a regular lotion, but this won’t penetrate the skin deeply enough to keep it hydrated.
• Stocking a range of products including dressings, surgical tape, antiseptic wipes, wound cleaners, spray skin, swabs, plasters, adhesive removers, bandages, massage oil (for aftercare), and antiseptic creams and ointments
Offering Advice
How long have they had the symptoms? Some scars may continue to thicken after 6 months.
Also, unlike keloid scars, hypertrophic scars don’t extend beyond the boundary of the original wound, but they may continue to thicken for up to six months. Hypertrophic scars are red and raised to start with, before becoming flatter and paler over the course of several years.
On darker skin types, the scar tissue may fade to leave a brown or white mark. A pale scar may be more obvious on tanned skin because scar tissue doesn’t tan.
SCARRING
69
Who? Those who at some time, have experienced a burn, cut, or surgery that has left a scar.
A keloid scar is an overgrowth of tissue that occurs when too much collagen is produced at the site of the wound. The scar keeps growing, even after the wound has healed. Keloid scars are raised above the skin and are red or purple when newly formed, before gradually becoming paler. They’re often itchy or painful, and can restrict movement if they’re tight and near a joint.
A minor wound like a cut will usually heal to leave a red, raised line, which will gradually get paler and flatter over time. This process can take up to two years. The scar won’t disappear completely and the customer will be left with a visible mark or line.
Some scars caused by skin conditions, such as acne and chickenpox, can have a sunken or pitted appearance. Pitted scars, also known as atrophic or “ice-pick” scars, can also occur as a result of an injury that causes a loss of underlying fat.
• Avoiding overstocking the category by focusing on the top two or three brands, including ones that pharmacy teams particularly advocate and use
What are the symptoms? The first sign is itchiness of the skin at the scar site.
• Featuring the best sellers and sizes in each brand and focusing on a specific skin concern
Be sure to ask a patient what aspect of their scar or stretch marks is troubling them so you can advise them accordingly.
Customers can use a hand massager and an evidence-based silicone product as soon as possible. Some of these products are rubbed on the skin, normally twice a day. The sheets need to be applied to the skin for seven to 12 hours a day.
Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark. BioCell Collagen II® is a registered trademark of BioCell Technology LLC. For more details on opening an account or to place an order, please call +44 (0) 1442 821 419 or email enquiries4@solgar.com Increase your skin hydrationAwardwinninggluten free collagen support formula Includes patented ingredient BioCell Collagen II®, a unique & highly absorbable form of collagen Premium unique complex designed to support skin structure & elasticity Protects against free radicals to support beautiful & radiant skin
Physical appearance is very important for many people, and skin complaints can have a significant impact on confidence. Problems such as ageing, dry and sun damaged skin tend to be very visible and can have a significant impact on confidence and lifestyle. When thinking of ways to address your customers’ skin issues an initial recommendation may be to try a range of topical creams and lotions.
Ageing
break
Fish oil - supplements are loaded with Omega-3 fatty acids. These fatty acids have a number of proven health benefits. They support collagen growth and promote skin moisture, both of which help to keep skin healthy.
GLA oils - also known as gamma-Linolenic acid oils, GLA oils are Omega-6 fatty acids. Like their cousin, the Omega-3 fatty acids, Omega-6s are also intended to keep skin healthy. While they’re important for healthy skin, the body doesn’t produce them. GLA oils are found in vegetable oils. The most common GLA supplements are evening primrose oil (EPO), borage oil, and black currant seed oil. All these varieties of GLA oil can be found in tablet form.
As people age, the skin undergoes what is known as natural (chronological) ageing which is thought to occur as a result of the photoageing process (from exposure to UV light). This occurs primarily on the face and arms as they are the areas on the skin that are most exposed to the elements. Signs of photoageing include dryness, deep furrows, irregular pigmentation, elastosis and a leathery appearance.
• Vitamin C helps prevent damage to cells, thus facilitating the production of elastin and collagen.
Sun-damaged Skin
Sun exposure is important as it allows the body to produce vitamin D. However, skin is vulnerable to photoageing and damage from overexposure to the sun and excessive exposure to UV carries health risks, including atrophy, pigmentary changes and wrinkling. Ultraviolet B (UVB) is the primary component of sunlight that causes sunburn as well as UV light from tanning beds.
While a healthy, balanced diet, which includes plenty of essential vitamins and minerals, is required for healthy skin, more and more people are using beauty supplements (nutraceuticals) to help add further benefit.
The skin is the largest organ of the human body, accounting for approximately 16% of total body weight. Skin is organised into two primary layers; the epidermis and the dermis, and plays a key role in protecting the body from the environmental threats including smoking, sun exposure and pollution.
SKINCARE: BEAUTY
As experts and trusted advisors to your customers it could enhance their experience to also advocate the use of supplements that can target specific beauty concerns, supporting the health and balance of the complexion from the inside out.
SKINCARE: BEAUTY everyone, but women and older people purchase to down.
There are several specific nutritional supplements available through pharmacy which can support beauty from the inside out, in addition to the usual skin creams and topical lotions.
Biotin - an essential B vitamin, also known as vitamin B7, that helps promote healthy skin, as well as healthy nails and hair. Researchers also think that Biotin works to reduce the death of skin cells. Biotin is found in foods like cheese, beans, eggs, and leafy greens. People can add more of these foods to their diet to ensure they’re getting plenty of Biotin, or can take a tablet as a supplement. Hyaluronic acid – also known as sodium hyaluronate, has strong moisture-retaining properties, which benefits healthy skin. While this compound is an ingredient in many creams and serums, there’s little evidence to suggest hyaluronic acid is effective when applied topically. It’s best to ingest an oral tablet to receive maximum benefits from this skin supplement.
BioCell Collagen® - Biocell Collagen® is a healthy ageing ingredient containing a patented composition of naturally occurring hydrolysed collagen type II (60%), chondroitin sulfate (20%) and hyaluronic acid (HA)(10%) in a highly absorbable matrix form that has been the subject of numerous human clinical trials determining safety, efficacy and bioavailability.
• Vitamin A increases cell reproduction and stimulates collagen production.
more Symptoms?supplements.Asaperson ages the collagen and elastin in their skin begins
The structural integrity of the dermis is vital for the normal function and youthful appearance of the skin, as this layer provides structural support for the epidermis.
• Vitamin D also regulates sebum glands and without enough the glands can produce too much sebum, contributing to acne.
Coenzyme Q10 - commonly referred to as CoQ10, this antioxidant helps get rid of free radicals and other toxins in the body. Thus, it has the effect of promoting healthy skin and allowing the body to make as much collagen as possible.
Normally collagen in its unhydrolysed form has a large molecular structure making it difficult for the body to absorb and use. BioCell Collagen® undergoes patented manufacturing process which significantly reduces the molecular size allowing for easier absorption and quicker action.
VITAMINS (A, C, D & E) - it’s widely knownthat vitamins are good for general health. But it’s worth stressing how important these Vitamins A, C, and E are for skin health.
71 Who? Available to
Hydrolysed Collagen Type II - Hydrolysed collagen type II has a major role in the integrity of the dermis layer of the skin. Research shows that daily ingestion of BioCell Collagen Type II® over 3 months increased the collagen content in the facial skin leading to a significant reduction in skin dryness and wrinkles.
Atopic dermatitis (AD), commonly known as eczema, is an inflammatory condition characterised by skin dryness and intense itching. AD is associated with a reduction in the barrier function of the epidermis, and impacts up to 20% of children and 3% of adults. Factors that can contribute to dry skin include the weather, chemicals and cosmetics.
How long have they had the symptoms? Part of the natural ageing Actionprocess.already taken. A balanced diet is recommended to achieve necessary vitamins and minerals. Medication? N/A
Atopic Dermatitis
• Vitamin E is an antioxidant that protects skin cells and helps maintain moisture.
formats* Nicorette Icy White 2mg Medicated Chewing Gums, Nicorette Invisi Extra Strength 25mg/16 hours Patch. Nicorette 15mg Inhaler, Nicorette Cools 2mg Lozenges, Nicorette Quickmist 1mg/spray Spray, Nicorette 15mg Inhaler: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms, thereby facilitating smoking cessation in smokers motivated to quit. Helping smokers temporarily abstain from smoking (Gum and Inhaler only). In smokers currently unable or not ready to stop smoking abruptly. Gum, Inhaler and Loz enges may also be used as part of a programme to reduce smoking prior to stopping completely. 2mg Gum or Inhaler may be used in combination with Invisi 10mg and 15mg Patch for the treatment of tobacco dependence as part of a stop smoking programme. Dosage: Smoking ces sation: Gum: The gum should be used whenever there is an urge to smoke. Not more than 15 pieces of the chewing gum may be used each day. Nicorette Gum may be used for up to 3 months during which time the habits associated with smoking will be lost. If not successful after 12 weeks the patient should be encouraged to make a fresh attempt to stop
Clinically Proven to Help your patients quit for good widest of smoking. Inhaler: Inhaler should be used whenever the urge to smoke is felt, up to a maximum usage of 6 cartridges per day. In the treatment of nicotine dependence, a course not exceeding three months is sug gested, the patient stopping smoking completely at the start of the course. Patch: Heavy smokers: start at Step 1 with the 25 mg/ 16 hours patch and use one patch daily for 8 weeks. Gradual weaning from the patch should then be initiated. One 15 mg/16 hours patch should be used daily for 2 weeks followed by one 10 mg/16 hours patch daily for 2 weeks. Light smokers: start at Step 2 (15 mg) for 8 weeks and decrease the dose to Step 3 (10 mg) for the final 4 weeks. Lozenges: 2mg lozenge is suitable for smokers with low nicotine dependency e.g. those smoking their first cigarette of the day more than 30 minutes after waking up or those who smoke fewer than 20 cigarettes per day. 4mg Lozenges are suitable for smokers with high nicotine dependency e.g. those smoking their first cigarette of the day 30 minutes after waking up or those who smoke more than 20 cigarettes per day. Should not be used for more than 9 months. One lozenge should be placed in the mouth and allowed to dissolve. Periodically, the lozenge should be moved from one side of the mouth to the other, and repeated, until the lozenge is completely dissolved. The lozenge should not be chewed or swallowed whole. Sufficient lozenges should be used each day and most smokers usually require 8 to 12, not to exceed 15 lozenges. The duration of treatment is individual, but up to six weeks treatment is recommended to break the habit of smoking. The nicotine dose should then be gradually reduced, by decreasing the total number of lozenges used per day. The treatment should be stopped, when the daily consumption is down to 1-2 lozenges. Quickmist: Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using half the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, the spray use should be discontinued. Temporary Abstinence: During periods of temporary abstinence, the patient should use Gum or Inhaler when required to relieve nicotine cravings and with drawal symptoms. Gradual cessation: For smokers who are unwilling or unable to quit abruptly. Use the gum/inhaler/lozenge whenever there is a strong urge to smoke in order to reduce the number of cigarettes smoked as far as possible and to refrain from smoking as long as possible. The number of cartridges/gums/lozenges is variable and depends on the patient’s needs. Not more than 15 pieces of the gum, 6 cartridges, 15 lozenges should be used per day. If a reduction in number of cigarettes per day has not been achieved after 6 weeks, professional advice should be sought. Reduced tobacco consumption should lead to complete cessation of smoking. A quit attempt should be made as soon as the number of cigarettes has been reduced to a level whereby the smoker feels ready to quit completely, then start as outlined for “smoking cessation” as given above. Combination therapy: Step 1: The 15mg Patch would be applied daily on waking for 16 hours and removed just before bedtime for a total of 8 weeks. The 2mg gum or Inhaler would be used ad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces of gum per day or 6 cartridges per day. Step 2: After the initial 8 weeks the lower dose Invisi 10mg Patch should be used for a total of 4 weeks. The 2mg gum or Inhaler would be used ad libitum when the smoker felt an urge to smoke or in situations where he/she feels that breakthrough cravings may occur, up to a maximum of 15 pieces of gum per day or 6 cartridges per day. Step 3: Use of the Invisi Patch should be stopped after the 12 week treatment program. The Nicorette 2 mg gum or In haler can continue to be used for a further 3 months during which time the habits associated with smoking will be lost. Contraindications: Use in non-smokers, Use in persons hypersensitive to nicotine or any ingredient in the formulation. Children under the age of 12 years (Lozenges) or under 18 years (Quickmist). Special Warnings and Precautions: The benefits of quitting smoking outweigh any risks associated with correctly administered nicotine replacement therapy (NRT). A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: - Cardiovascular disease: Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, recent cerebrovascular accident, and/or who suffer with uncontrolled hyper tension should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, Nicorette may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Allergic reactions: Sus ceptibility to angioedema and urticaria. Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Gastrointestinal Disease: Nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and NRT preparations should be used with caution in these conditions. Phaeochromocytoma and uncontrolled hyperthyroidism: Nicotine, both from NRT and smoking, causes the release of catecholamines from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with uncontrolled hyperthyroidism or pheochromocytoma. - Diabetes Mellitus:. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated, as reductions in nicotine-induced catecholamine release can affect carbohydrate metabolism. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. - Smok ers who wear dentures may experience difficulties in chewing Nicorette Gum. The chewing gum may stick to, and may in rare cases damage dentures. Transferred dependence: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. Danger in children: Doses of nicotine tolerated by smokers can produce severe toxicity in children that may be fatal. Products containing nicotine should not be left where they may be handled or ingested by children. Nicorette Inhaler should be used with caution in smokers with chronic throat diseases and bronchospastic disease. The spray contains small amounts of ethanol (alcohol), less than 100 mg per dose (1 or 2 sprays). This medicinal product contains less than 1 mmol sodium (23 mg) per spray, i.e. essentially ‘sodium- free’. This medicine contains 12 mg propylene glycol in each spray which is equivalent to 150 mg/mL. Due to the presence of butylated hydroxytoluene, Nicorette QuickMist may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes. Care should be taken not to spray the eyes whilst administering the spray. Inhaler should be used with caution in smokers with chronic throat diseases and bronchospastic disease Invisi Patch should be removed prior to undergoing any Magnetic Resonance Imaging (MRI) procedures to prevent the risk of burns. Undesirable Effects: Regardless of the means used, a variety of symptoms are known to be associated with quitting habitual tobacco use. These include emotional or cognitive effects such as dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, and restlessness or impatience. There may also be physical effects such as decreased heart rate; increased appetite or weight gain, dizziness or presyncopal symptoms, cough, constipation, gingival bleeding or aphthous ulceration or nasopharyngitis. In addition, and of clinical significance, nicotine cravings may result in profound urges to smoke. Adverse Drug Reactions: Nicorette may cause dose dependent adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Most of the undesirable effects reported by the subjects occur during the early phase of treatment. Gum: Immune System Disorders: Hypersensitivity - Common Anaphylactic reaction - Not known. Psychiatric Disorders – Abnormal Dreams – Uncommon. Nervous System Disorders: Headache - Very Common, Burning sensation, Dysgeusia, Paraesthesia – Common. Eye Disorders: Blurred Vision, Lacrimation increased – Common. Cardiac Disorders: Palpitations, Tachycardia - Not known. Vascular Disorders: Flushing, Hypertension – Uncommon. Respiratory, Thoracic and Mediastinal Disorders: Cough, Throat irritation - Very common. Bronchospasm, Dysphonia, Dyspnoea, Nasal Congestion, Sneezing, Throat tightness – Uncommon. Gastrointestinal Disorders: Hiccups, Nausea - Very common. Abdominal pain: Diarrhoea, Dry mouth, Dyspepsia, Flatulence, Salivary hypersecretion, Stomatitis, Vomiting – Common. Eructation Glossitis, Oral mucosal blistering and exfoliation, Paraesthesia oral – Uncommon. Dysphagia, Hypoaesthesia oral, Retching – Rare. Dry throat, Gastrointestinal discomfort Lip pain - Not known. Skin and Subcutaneous Tissue: Hyperhidrosis, Pruritus, Rash, Urticaria Disorders – Uncommon. Erythema - Not known. Musculoskeletal and Connective Tissue Disorders: dysgeusia, common cough, hiccups, throat Bronchospasm, dyspnoea, nasal congestion, oropharyngeal pain, sneezing, throat tightness. Gastrointestinal disorders: Very common - nausea, mouth/throat and tongue irritation Common - Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting, heartburn. Uncommon - Eructation, glossitis, oral mucosal blistering and exfoliation, paresthesia oral. Rare - Dysphagia, hypoaesthesia oral, retching. Not known - Dry throat, gastrointestinal discomfort, lip pain. Skin and Subcutaneous Tissue Disorders: Uncommon - Hyperhidrosis, pruritus, rash, urticaria. Not known – Erythema. General Disorders and Administration Site Conditions: Common – burning sensation, fatigue. Uncommon - Asthenia, chest discomfort and pain, malaise QuickMist: Immune system disorders Common Hypersensitivity Not known Allergic reactions including angioedema and anaphylaxis disorders Abnormal dream Nervous system disorders common Headache Common Dysgeusia, paraesthesia Eye disorders Not known Blurred vision, lacrimation increased Cardiac
paraesthe sia. Eye disorders: Not known – blurred vision, lacrimation increased. Cardiac Disorders: Uncommon - palpitations, tachycardia, atrial fibrillation. Vascular disorders: Uncommon – flushing, hypertension. Respiratory, thoracic and mediastinal disorders: Very
dysphonia,
range
IRE/NI/19-3994 *IMS OIRMTH MAT 11/2019
Pain in jaw – Uncommon. Muscle tightness - Not known. General Disorders and Administration Site Conditions: Fatigue – Common. Asthenia, Chest discomfort and pain, Malaise – Uncommon. Allergic reactions including angioedema - Rare. Inhaler: Immune system disorders: Common – Hypersensitivity. Not known - Anaphylactic reaction. Psychiatric Disorders – Abnormal Dreams – Uncommon. Nervous system disorders Very common Headache Common Burning sensation Dysgeusia Paraesthesia Eye disorders Not known Blurred vision Lacrimation increased Cardiac disorders Uncommon Palpitations Tachycardia Vascular disorders Uncommon Flushing Hypertension Respiratory, thoracic and mediastinal disorders Very common Cough Throat irritation Bronchospasm Dysphonia Dyspnoea Nasal congestion Sneezing Throat tightness Gastrointestinal disorders Very common Hiccups Nausea Common Abdominal pain Diarrhoea Dry mouth Dyspepsia Flatulence Salivary hypersecretion Stomatitis Vomiting Uncommon Eructation Glossitis Oral mucosal blistering and exfoliation. Paraesthesia oral Rare Dysphagia Hypoaesthesia oral Retching Not known Dry throat Gastrointestinal discomfort Lip pain Skin and subcutaneous disorder Uncommon Hyperhidrosis Pruritus Rash Urticaria Not known Angioedema Erythema Muscoskeletal and connective tissue disorders Uncommon Pain in jaw Not known Muscle tightness General disorders and administration site conditions Common Fatigue Uncommon Asthenia Chest discomfort and pain Malaise. Patch: Immune system disorder Uncommon Hypersensitivity Rare Anaphylactic reaction Nervous system disorder Common Headache Uncommon Paraesthesia Cardiac disorders Uncommon Palpitations Tachycardia Vascular disorders Uncommon Flushing Hypertension Respiratory, Thoracic and Mediastinal Disorders Uncommon Dyspnoea Gastrointestinal disorders: Common Nausea Vomiting Rare Gastrointestinal discomfort and/or pain Skin and subcutaneous tissue disorders Very common Pruritus Common Rash Urti caria Uncommon Hyperhidrosis Rare Angioedema Erythema Musculoskeletal and Connective Tissue Disorders Uncommon Myalgia Rare Pain in extremity General disorders and administration site conditions: Uncommon Application site reactions Asthenia Chest discomfort and pain Malaise Fatigue. Lozenge: Immune System Disorders: Common - hypersensitivity Uncommon -allergic reactions including angioedema and anaphylaxis. Psychiatric disorders: Uncommon - abnormal dreams. Nervous system disorders: Very common – headache. Common -
Psychiatric
Uncommon
disorders Uncommon Palpitations, tachycardia, Atrial fibrillation Vascular disorders Uncommon Flushing, hypertension Respiratory, thoracic and mediastinal disorders Very common Hiccups, throat irritation Uncommon Bronchospasm, Rhinorrea, dysphonia, dyspnoea, nasal conges tion, oropharyngeal pain, sneezing, throat tightness Gastrointestinal disorders Very common Nausea Common Abdominal pain, dry mouth, diarrhoea, dyspepsia, flatulence, salivary hypersecretion, stomatitis, vomiting Uncommon Eructation, gingival bleeding, glossitis, oral mucosal blister ing and exfoliation, paraesthesia oral Rare Dysphagia, hypoaesthesia oral, retching Not known Dry throat, gastrointestinal discomfort, lip pain Skin and subcutaneous tissue disorders Uncommon Hyperhidrosis, pruritus, rash, urticaria Not known Erythema General disorders and adminis tration site conditions Common Burning sensation, fatigue Uncommon Asthenia, chest discomfort and pain, malaise MA Holder: Johnson & Johnson (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. MA Number: Gum –PA 330/37/8. Patch – PA 330/37/7. Inhaler - PA 330/37/10. Quickmist - PA 330/37/13. Lozenge – PA 330/37/11. Date of Revision of the Text: PA 330/17/10 - April 2018, PA 330/37/8 – April 2018. PA 330/37/7 – May 2019. PA 330/37/13 – May 2019, PA 330/37/11 – November 2019. Legal Category: Products not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd., Airton Road, Tallaght, Dublin 24, Ireland
-
Nicorette® is the No.1 NRT Brand with the
irritation. Uncommon -
Very
• Has failed to quit using NRT previously
How long have they had the symptoms? The length of time they have smoked and the volume is essential to determining what NRT to Sufferers may already be trying to cut down or stop smoking all together.
It is suitable if your customer:
Cartridges - these can be used when the urge to smoke occurs and are generally ideal for patients who feel that they would miss the hand to mouth action of smoking. No more thansix of the 15mg inhalators should be used per day. An inhalation cartridge last 40 minutes of intense use.
Combination Therapy
Smoking is the leading cause of preventable death in Ireland. Each week, over 100 people die from diseases caused by tobacco use; this represents almost one in five of all deaths. In addition, many people live with conditions related to smoking, with people who smoke, on average, losing at least 10 quality years of life.
Including combination therapy in a quit a smoking strategy means you can offer a patient a nicotine patch throughout the day but also provide an oral NRT product for use during the day when patients may find craving for cigarettes difficult to manage.
Mouth Spray
The choice of therapy depends on patient’s preference; previous treatment should also be taken into account. Combination therapy may benefit some people who have a high level of nicotine dependence or who have tried previously to quit and failed.
Gum - for patients who smoke less than 20 cigarettes per day should use one piece of the 2mg strength gum when they get the urge to smoke. The gum should be chewed until the taste becomes strong and then placed between the cheek and gum, one piece generally lasts about 30 minutes.
NRT Treatments
who smoke less than 10 cigarettes per day can start on a medium strength patch for six to eight weeks and then a low strength patch for two to four weeks.
Nicotine patches are a prolonged release formulation that can be applied for 24 or 16 hours. Patients who experience cravings on waking should use a 24 hour patch. For those who smoke more than 10 cigarettes per day a high strength patch can be advised to be applied per day for six to eight weeks, followed by a medium strength patch for two weeks and then a low strength patch for two
Who? who
For people smoking more than 20 cigarettes per day or those who require more than 15 pieces of the 2mg gum should use the 4mg
Patches
Combination therapy is suitable for those smokers who are still experiencing significant cravings and nicotine withdrawal symptoms while using one form of NRT, or for those who have not been able to quit altogether using one form of NRT alone.
SMOKING CESSATION
For example, sometimes a craving can be hard to manage early in the morning, before a nicotine patch has time to work. This is a situation where oral NRT can be very helpful. Some people may have concerns that they may get too much nicotine with combination therapy. Research shows that, for a smoker who is suited to this kind of therapy, there is no increased risk of side effects from combination therapy. The amount of nicotine in all NRT products is typically lower than the amount a person receives from regular smoking.
Ireland is committed to becoming tobacco free by 2025. A range of policy measures are being taken by the Department of Health and the Health Service Executive (HSE) to achieve this goal by strengthening the prevention of initiation and through further promoting smoking cessation.
Pharmacy teams are ideally placed to advise people on how to stop smoking and to provide information on the supply of medication. Many will also be able to provide treatment for smokers who want to stop.
Inhalationstrength.
A lower strength lozenge should be used in patients who smoke less than 20 cigarettes per day, and the higher strength lozenge should be used in those who smoke more than 20 cigarettes per day.One lozenge can be used every one to two hours when the urge occurs.
• Is a heavy smoker
Actionrecommendalready taken?
Lozenges
Nicotine mouth spray is a nicotine replacement therapy (NRT) product that looks a bit like breath freshener.It helps a smoker to quit by replacing some of the nicotine they would normally get from a cigarette. They may still get cravings but the nicotine mouth spray takes the edge off. Using the mouth spray can help to reduce nicotine withdrawal symptoms after quitting, such as cravings, difficulty concentrating, frustration, restlessness and anxiety.
• Experiences acute breakthrough cravings
Nicotine replacement therapy (NRT) increases the chance of quitting smoking. But, the level of smoker and previous attempts at quitting should always be considered to suggest the right product.
The usual combination therapy is the nicotine patch combined with oral nicotine replacement products. It is suitable for those smokers who are still experiencing significant cravings and nicotine withdrawal symptoms while using one form of NRT, or for those who have not been able to quit altogether using one form of NRT alone.
SMOKING CESSATION
Any adults
smoke What? N/A
Medication: No more than 15 of the higher strength NRT lozenges should be used per day. Inhalators should be used in caution with patients with COPD or chronic throat disease.
73
Inweeks.those
Patient confusion regarding the wide array of topical products and formats available can also hinder usage. Consumers want help and reassurance when it comes to self-treating. They do not understand the difference between various types of topical – hot, cold and non-steroidal anti-inflammatory drugs –or how to use them.
Products may have local analgesic, anaesthetic, antipruritic, and/or counterirritant effects. Topical pain killers, or analgesics, are sprayed on or rubbed into the skin over painful muscles or joints. Although all are designed to relieve pain, different products are made up different ingredients.
TOPICAL ANALGESICS 75
single-entity or combination formulations. Topical heat therapy patches are also available in various sizes for treating joint and muscle pain and provide eight to 12 hours of continual, portable heat therapy.
TOPICAL ANALGESICS
Action already taken?Pain relief.
main ingredient of hot chilli peppers, capsaicin is also one of the most effective ingredients for topical pain relief. When first applied, capsaicin creams cause a warm tingling or burning sensation. This gets better over time. Users may need to apply these creams for a few days up to a couple of weeks before they will notice relief from Topicalpain.analgesic
Helping customers choose the right topical analgesic for their individual needs is key if they are to gain optimum benefit.
Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted. External analgesic products may contain one or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine salicylate.
products are available in a variety of formulations, including gels, ointments, creams, lotions, and patches in
Musculoskeletal pain is likely to affect a significant percentage of the population and encompasses a huge range of conditions. Low back pain, for example, is acknowledged to be the leading cause of disability worldwide and osteoarthritis is purported to affect 60% of 60-year-olds.”
Counterirritants are approved for the topical treatment of minor aches and pains of muscles and joints. They are often employed for the treatment of acute musculoskeletal injuries and as an adjunct therapy in the treatment of chronic musculoskeletal disorders.
Counterirritants differ from other external analgesics in that pain relief results more from nerve stimulation than depression. Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted. External analgesic products may contain or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine
Who? Anyone suffering from pain, musculoskeletal problems or fever.
How long has the patient had the symptoms? Dependent on the condition suffered.
While musculoskeletal conditions and the pain, stiffness and immobility that go with them can compromise the lives of sufferers in many obvious physical ways, mental health and wellbeing is also affected.
Patients will often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders. These products may have local analgesic, anaesthetic, antipruritic, and/or counterirritant effects.
Salicylates:salicylate.Thesesame
OTC topical analgesics are intended to be used for mild to-moderate pain for no longer than seven days. The factors that a pharmacist may consider when recommending a topical analgesic include dosage form, cost, ease of use of product, as well as the patient’s medical history, including possible allergies.
Medication? Apply topical products only to intact skin. Areas treated with counterirritants should not be covered with tight bandages or occlusive dressings. Patients on anticoagulation therapy should be advised not to use topical products that contain salicylates, because concomitant use has been associated with prolonged prothrombin time.
Assisting Selection
ingredients that give aspirin its pain-relieving quality are found in some creams. When absorbed into the skin, they may help with pain, particularly in joints close to the skin, such as the fingers, knees, and Capsaicin:elbows.The
When patients experience muscle and joint pain, pharmacists can recommend topical analgesics (rubs, creams and sprays) to help provide relief for their symptoms.
In addition, patients must be made aware of how to use the medication properly and must be informed by pharmacists of the possible side effects that can occur when a product is used after the recommended period of three days.
What are the symptoms? Dependent on the condition suffered.
Following the introduction of the codeine regulations, pharmacists now encourage the use of acetaminophen as first in line choice of pain relief, followed by ibuprofen, before codeine-based analgesics.
If you’re su ering from vaginal dryness and irritation, Replens is the perfect solution for you. Unlike lubricants, Replens is a specially made vaginal moisturiser that helps replenish your natural moisture. This 2 in 1 gel soothes and treats symptoms to give you up to 3 days of long-lasting relief. So, you can wave bye-bye to vaginal dryness and say hello to happier days to come, whether that be rekindling your love life or simply feeling like you again.
For more information please contact your Pemberton Rep or Customer on 01-4632424
GPRECOMMENDED UK’s No.1 THE UK’S NO.1 GP RECOMMENDED BRAND FOR VAGINAL DRYNESS.*
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How long has the patient had the symptoms? Many women will delay seeking medical advise because they may be embarrassed about the Actionsymptoms.already taken? A number of self-care treatments may already have been used by the sufferer.
• give yourself enough time to become aroused before having sex – read more about female arousal and get good sex tips
The most common treatment for vaginal dryness due to low estrogen levels is topical estrogen therapy. These replace some of the hormone the body is no longer making. That helps relieve vaginal symptoms, but it doesn’t put as much estrogen in the bloodstream as the hormone therapy in pills.
• cancer treatment - radiotherapy to the pelvic area, hormonal cancer treatments, and sometimes chemotherapy can cause vaginal dryness
• repeated urinary tract infections (UTIs)
Some women only have symptoms of vaginal dryness at certain times, such as during sex, while others have them all the time.Problems associated with having a dry vagina include:
What are the symptoms? Vaginal irritation, discomfort, itchiness or a burning sensation, discomfort during sex, a reduced sex drive, difficulty getting aroused and reaching orgasm, the surface of the vagina looks pale and thin, narrowing or shortening of the vagina, needing to pass urine more often than usual, repeated urinary tract infections (UTIs).
• a reduced sex drive
It’s available on prescription from a GP either as tablets, a skin patch, an implant under the skin, or a gel that’s applied to the skin.
• needing to pass urine more often than usual
• difficulty getting aroused and reaching orgasm
HRT has a wider effect on the body than vaginal oestrogen, so may be best if the person has other menopause symptoms, such as hot flushes. However, it also has more side effects.
Sufferers of vaginal dryness can be advised that it’s worth trying self-help options first. It can help to:
• try using a lubricant or vaginal moisturiser – these can be bought without a prescription
77
Vaginal moisturisers - creams that are applied inside the vagina to keep it moist. They may be better than lubricants if the dryness isn’t just causing problems during sex, as they tend to have a longer-lasting effect. They usually need to be applied every few days.
Who? All women, but more prevalent during the menopause.
• some types of contraceptionthe combined contraceptive pill and contraceptive injection can occasionally cause vaginal dryness, although this is uncommon
• not being aroused before sex - if a woman doesn’t feel aroused before having sex, her vagina may not produce natural lubricant and sex may be uncomfortable
Lubricants - liquids or gels that are applied to the vulva, vagina or the partner’s penis just before having sex to keep the vagina moist. They offer immediate but short-term relief from vaginal dryness.Several different brands of lubricant are available to buy from pharmacies without a prescription.
It is a common but treatable problem that many women experience at some point in their lives. It can be a problem at any age, but is a particular issue for women who are going through or have experienced the menopause. Sufferers will often feel embarrassed about seeking help but can be advised that there are a number of treatments that can help.
Vaginal oestrogen is available as pills that are placed in the vagina (pessaries), vaginal creams and vaginal rings. Oestrogen treatment can be more effective than lubricants and moisturisers for menopausal women, and it generally causes few side effects.
Causes of a dry vagina include:
Symptoms
VAGINAL DRYNESS
Treatments
• discomfort during sex
Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of your vagina healthy, thick, and elastic. A drop in estrogen levels reduces the amount of moisture available and can lead to vaginal dryness.
Causes
Self-help
Hormone replacement therapy - HRT is a treatment that involves taking medication to replace the hormones that start to decline during the menopause.
• vaginal irritation, discomfort, itchiness or a burning sensation
• the menopause - decreased levels of the hormone oestrogen during the menopause can cause persistent vaginal dryness (also known as vaginal atrophy or atrophic vaginitis)
• breastfeeding or childbirthoestrogen levels can temporarily decrease after giving birth and make the vagina feel drier than usual
Vaginal dryness is also sometimes caused by an underlying condition such as diabetes or Sjögren’s syndrome, where the
immune attacks the glands in the body that produce fluid.
VAGINAL DRYNESS
• narrowing or shortening of the vagina
However, it can take a few weeks to start working, so the patient may want to use a lubricant or moisturiser as well to begin with. Treatment usually needs to be continued indefinitely, as the dryness tends to return if treatment stops.
Medication?Topical estrogen therapies replace some of the hormone the body is no longer making.
Vaginal oestrogen - a GP may prescribe vaginal oestrogen if the dryness is caused by the menopause. This works by increasing the level of oestrogen that declines during and after the menopause.
• the surface of the vagina looks pale and thin
€7.69 PA Holder: Seven Seas Limited, The Heights, Brooklands, Weybridge, KT13 0XP, United Kingdom PA Seven417/18/1Seas Limited is an a liate of the P&G group of companies *Summary of Product Characteristics, Ilvico Cold and Flu-film coated tablets, CRN 2167729: Date Printed December 2019 Further information is available on request from Brandshapers on 053 91 79007 or customerservice@brandshapers.ie €7.69 PA Holder: Seven Seas Limited, The Heights, Brooklands, Weybridge, KT13 0XP, United Kingdom PA Seven417/18/1Seas Limited is an a liate of the P&G group of companies *Summary of Product Characteristics, Ilvico Cold and Flu-film coated tablets, CRN 2167729: Date Printed December 2019 Further information is available on request from Brandshapers on 053 91 79007 or customerservice@brandshapers.ie
Who? Anyone – the young and elderly are more susceptible to winter illness.
How long have they had the symptoms? Symptoms of a cold generally only last a few days, flu symptoms can make people feel very unwell often leaving them unable to leave the house or go to work.
• Lifestyle and hygiene tips and advice on reducing infection
Oral analgesics - Analgesics and antipyretics help to reduce pain and fever associated with sore throats and colds. Ibuprofen also reduces inflammation, which can help if sinuses are inflamed. Paracetamol and ibuprofen can be used in conjunction with one another but should be taken two to three hours apart for maximum benefit.
usually treated with painkillers and decongestants.
SAD: Seasonal Affective Disorder has only recently been recognised as a genuine condition, characterised by ongoing feelings of depression during the winter months, irritability, lethargy and a craving for carbohydrates. Levels of serotonin, which affect moods, appetite and sleep, are thought to be lowered by the shorter sunlight hours, and this stops the hypothalamus from working properly. Advise sufferers to make a point of getting as much natural sunlight as they can. If this isn’t possible, light therapy boxes can simulate exposure to sunlight and
• The importance in ensuring people have adequate supply of prescription medication for the holiday season
• The different types of OTC medications available for sore throat and cough and their indications
• Those who must be referred to the pharmacist such as those with regular indigestion accompanied by additional symptoms
Combination products - Can contain ingredients such as a decongestant, analgesic, cough suppressant, antihistamine or an expectorant. These can be used up to their maximum dose for up to seven days unless they contain sedating antihistamines, when they should only be used for up to three days. Antihistamines work by drying up nasal secretions and should be used with a decongestant as they are relatively ineffective on their own. They can also cause drowsiness, so are often found in combination products to aid insomnia associated with having a cold.
Inhalants, vapour rubs and saline productsInhalants work by helping to clear the nasal passages, while steam inhalation will help ease nasal congestion by loosening mucus. Saline preparations relieve congestion by helping to liquefy mucous secretions. Inhalants, rubs and saline products can be used daily until symptoms are cleared.
• Educate the pharmacy team on the recommended daily alcohol intake for both men and women
Sinusitis: The sinuses are small, air-filled spaces inside the cheekbones and forehead which drain into the nose. Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. Most cases of sinusitis are acute (lasting 1-4 weeks) but some may go on to a more persistent (chronic) sinusitis.
WINTER AILMENTS
Key Points:
Nasal Congestion: Nasal congestion is a blocked, stuffy or bunged-up feeling in the nose. Depending on the cause, it can last a short while (a few days) or can be persistent. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed.
79
Sore throat treatments - Most sore throats are caused by a viral rather than a bacterial infection, so don’t need antibiotics. Medicated lozenges or anaesthetic sprays can help relieve the symptoms of sore throat. Gargling regularly with an antibacterial mouthwash or warm, salty water can reduce any swelling and inflammation, while sucking pastilles or lozenges will stimulate saliva secretion to lubricate the throat and help relieve irritation.
WINTER AILMENTS
Cold/Flu: Adults in general suffer from cold approximately two to four times annually while children can contract the virus three to eight times as their immune systems aren’t as developed. Distinctive symptoms means that people often diagnose and treat themselves through a combination of self-care and OTC products, without needing to go to the doctor. If there is no improvement then an appointment with a doctor should be arranged.
Medication? Pseudoephedrine is contraindicated in patients with diabetes mellitus, cardiovascular disease, severe or uncontrolled hypertension, severe coronary artery disease, prostatic hypertrophy, hyperthyroidism, closed angle glaucoma, and pregnant women.
It’s no coincidence that more people get ill over the winter period than any other time of year. Parties, late nights, bad weather, overindulgence in food and drink, not to mention concerns about the bank balance, all take their toll on people’s bodies.
The flu is the big brother to the common cold and will generally have similar symptoms, but they will be more intense. Other groups are at-risk of harmful or even life-threatening complications from the flu, particularly those with compromised or developing immune systems, including pregnant women, the elderly, and young children.
Decongestants - These help to reduce nasal congestion by constricting the dilated blood vessels in the nasal mucosa. This reduces swelling and oedema of the nasal mucosa, making it easier to breathe. Decongestants are not suitable for pregnant and breast-feeding women and patients with hypertension. Nasal sprays and oral tablets should not be used concurrently.
What are the symptoms? Cold, congestion, sore throat and cough.
Action already taken? People may have tried pain relief – but may not be aware of combination products, for example ones containing combinations of antihistamine, analgesic and stimulant.
The symptoms of sinusitis are mainly nasal congestion, and pain in the area of the affected sinus. This is most commonly in the forehead or cheeks on one or both sides of the nose. The pain may be worse on bending down. Other symptoms which may occur are dizziness and Sinusitisfever.is
help raise seretonin levels. Those who are feeling really low should be referred,
Sore Throat: Sore throats are nearly always the result of a viral infection which means antibiotics won’t be of any use. There is usually no need to seek medical help, unless an individual is getting them very regularly and are taking a long time to recover, which may imply a weakened immune system. One of the easiest home remedies is to gargle warm salty water and take paracetamol to help relieve the pain. Over the counter medications such as throat lozenges will not cure the illness, but they can help with painful symptoms.
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Week 9 24 Monday 25 Tuesday 26 Wednesday February 2020
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 February 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
27 Thursday 28 Friday 29 Saturday 1 Sunday Feb/ March 2020SSFTWTM
1
Week 10 March 2020
2 Monday 3 Tuesday 4 Wednesday
1
March 2020 5 Thursday 6 Friday 7 Saturday 8 Sunday SSFTWTM
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 February 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 11 March 2020
9 Monday 10 Tuesday 11 Wednesday
1 11 12 21 22
13 14 15 16 17 18 19 20
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 February 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10
March 2020 12 Thursday 13 Friday 14 Saturday 15 Sunday SSFTWTM
23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 12 16 Monday 17 Tuesday 18 Wednesday March 2020
19 Thursday 20 Friday 21 Saturday 22 Sunday March 2020SSFTWTM
1
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 February 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 13 23 Monday 24 Tuesday 25 Wednesday March 2020
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 February 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
1
26 Thursday 27 Friday 28 Saturday 29 Sunday March 2020SSFTWTM
Week 14 30 Monday 31 Tuesday 1 Wednesday March/ April 2020
2 Thursday 3 Friday 4 Saturday 5 Sunday April 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
6 Monday 7 Tuesday 8 Wednesday
Week 15 April 2020
April 2020 9 Thursday 10 Friday 11 Saturday 12 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 16 13 Monday 14 Tuesday 15 Wednesday April 2020
16 Thursday 17 Friday 18 Saturday 19 Sunday April 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 17 20 Monday 21 Tuesday 22 Wednesday April 2020
23 Thursday 24 Friday 25 Saturday 26 Sunday April 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 March 2020 30 31 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 18 27 Monday 28 Tuesday 29 Wednesday April 2020
SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 30 Thursday 1 Friday 2 Saturday 3 Sunday April/ May 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 19 May 2020
4 Monday 5 Tuesday 6 Wednesday
May 2020 7 Thursday 8 Friday 9 Saturday 10 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 20 11 Monday 12 Tuesday 13 Wednesday May 2020
14 Thursday 15 Friday 16 Saturday 17 Sunday May 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 21 18 Monday 19 Tuesday 20 Wednesday May 2020
21 Thursday 22 Friday 23 Saturday 24 Sunday May 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 22 25 Monday 26 Tuesday 27 Wednesday May 2020
28 Thursday 29 Friday 30 Saturday 31 Sunday May 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April 2020
Week 23
1 Monday 2 Tuesday 3 Wednesday
June 2020
4 Thursday 5 Friday 6 Saturday 7 Sunday June 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020
8 Monday 9 Tuesday 10 Wednesday
June 2020 Week 24
June 2020 11 Thursday 12 Friday 13 Saturday 14 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020
Week 25 15 Monday 16 Tuesday 17 Wednesday June 2020
18 Thursday 19 Friday 20 Saturday 21 Sunday June 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020
Week 26 22 Monday 23 Tuesday 24 Wednesday June 2020
25 Thursday 26 Friday 27 Saturday 28 Sunday June 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May 2020
Week 27 29 Monday 30 Tuesday 1 Wednesday June/ July 2020
2 Thursday 3 Friday 4 Saturday 5 Sunday July 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020
6 Monday 7 Tuesday 8 Wednesday
July 2020 Week 28
July 2020 9 Thursday 10 Friday 11 Saturday 12 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020
Week 29 13 Monday 14 Tuesday 15 Wednesday July 2020
16 Thursday 17 Friday 18 Saturday 19 Sunday July 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020
Week 30 20 Monday 21 Tuesday 22 Wednesday July 2020
23 Thursday 24 Friday 25 Saturday 26 Sunday July 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 2020
Week 31 27 Monday 28 Tuesday 29 Wednesday July 2020
SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 30 Thursday 31 Friday 1 Saturday 2 Sunday July/ August 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020
3 Monday 4 Tuesday 5 Wednesday
August 2020 Week 32
August 2020 6 Thursday 7 Friday 8 Saturday 9 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020
Week 33 10 Monday 11 Tuesday 12 Wednesday August 2020
13 Thursday 14 Friday 15 Saturday 16 Sunday August 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020
Week 34 17 Monday 18 Tuesday 19 Wednesday August 2020
20 Thursday 21 Friday 22 Saturday 23 Sunday August 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020
August 2020 Week 35 24 Monday 25 Tuesday 26 Wednesday
August 2020 27 Thursday 28 Friday 29 Saturday 30 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2020
Week 36 31 Monday 1 Tuesday 2 Wednesday Aug/ September 2020
3 Thursday 4 Friday 5 Saturday 6 Sunday September 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 October 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31
7 Monday 8 Tuesday 9 Wednesday
Week 37 September 2020
September 2020 10 Thursday 11 Friday 12 Saturday 13 Sunday SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 October 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31
Week 38 14 Monday 15 Tuesday 16 Wednesday September 2020
17 Thursday 18 Friday 19 Saturday 20 Sunday September 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 October 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31
Week 39 21 Monday 22 Tuesday 23 Wednesday September 2020
24 Thursday 25 Friday 26 Saturday 27 Sunday September 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 October 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September 2020 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 August 2020 31
Week 40 28 Monday 29 Tuesday 30 Wednesday September 2020
1 Thursday 2 Friday 3 Saturday 4 Sunday October 2020SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
September 2020 SSFTWTM
30 31 October 2020 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
November 2020 30
Week 41 October 2020
5 Monday 6 Tuesday 7 Wednesday
September 2020 SSFTWTM
November 2020 30
October 2020 8 Thursday 9 Friday 10 Saturday 11 Sunday SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
30 31 October 2020 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Week 42 12 Monday 13 Tuesday 14 Wednesday October 2020
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
15 Thursday 16 Friday 17 Saturday 18 Sunday October 2020SSFTWTM
30 31 October 2020 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
September 2020 SSFTWTM
November 2020 30
Week 43 19 Monday 20 Tuesday 21 Wednesday October 2020
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 October 2020 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
22 Thursday 23 Friday 24 Saturday 25 Sunday October 2020SSFTWTM
September 2020 SSFTWTM
November 2020 30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Week 44 26 Monday 27 Tuesday 28 Wednesday October 2020
26 27 28 29 30 31 October 2020 SSFTWTM
29 Thursday 30 Friday 31 Saturday 1 Sunday Oct/ November 2020SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 29
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
November 2020 30 SSFTWTM
28
30 31 December 2020
Week 45 2 Monday 3 Tuesday 4 Wednesday November 2020
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
5 Thursday 6 Friday 7 Saturday 8 Sunday November 2020SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
November 2020 30 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
December 2020
29 30 31 October 2020 SSFTWTM
Week 46
November 2020
9 Monday 10 Tuesday 11 Wednesday
December 2020
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30 31 October 2020 SSFTWTM
12 Thursday 13 Friday 14 Saturday 15 Sunday November 2020SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
November 2020 30 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Week 47 16 Monday 17 Tuesday 18 Wednesday November 2020
19 Thursday 20 Friday 21 Saturday 22 Sunday November 2020SSFTWTM
31 December 2020
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
29 30 31 October 2020 SSFTWTM
November 2020 30 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Week 48 23 Monday 24 Tuesday 25 Wednesday November 2020
26 Thursday 27 Friday 28 Saturday 29 Sunday November 2020SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
November 2020 30 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
29 30 31 October 2020 SSFTWTM
31 December 2020
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Week 49
Nov/ December 2020
30 Monday 1 Tuesday 2 Wednesday
3 Thursday 4 Friday 5 Saturday 6 Sunday December 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January 2021 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 November 2020 30 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December 2020
Week 50 7 Monday 8 Tuesday 9 Wednesday December 2020
10 Thursday 11 Friday 12 Saturday 13 Sunday December 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January 2021 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 November 2020 30 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December 2020
Week 51 14 Monday 15 Tuesday 16 Wednesday December 2020
17 Thursday 18 Friday 19 Saturday 20 Sunday December 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January 2021 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 November 2020 30 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December 2020
Week 52 21 Monday 22 Tuesday 23 Wednesday December 2020
24 Thursday 25 Friday 26 Saturday 27 Sunday December 2020SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January 2021 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 November 2020 30 SSFTWTM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December 2020
Week 53 28 Monday 29 Tuesday 30 Wednesday December 2020
31 Thursday 1 Friday 2 Saturday 3 Sunday Dec 2020/ Jan 2021SSFTWTM
SSFTWTM
February 2021
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
December 2020
31 January 2021 SSFTWTM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Help Line Number: +353 53 9179007
Specials Range: Aptamil Comfort* (from birth) - for the dietary management of colic and constipation
Helpline for parents: 1800 22 12 34
Aptamil 2 - Follow on Milk (from 6 months+)
Local contacts: Veterinary Business Managers: Carol Griffin RVN and Melanie O’Donoghue RVN
Type of company: Biopharma Website: www.flexiseq.ie Tel:1800939149
Please use the contacts on our global website.
Fax Number: +353 53 9159494
Aptamil 3 – Growing up Milk (1-2 Aptamilyears)Profutura 3 – Growing up milk (1 year +)
Calco LimitedIreland
Tel: +353 1463 7482
Amadeus House, 27B Floral Street, London WC2E 9DP United Kingdom
Local Brands in Ireland include: NuSeals®, MacuShield®, KeloCote®, Vamousse®, Opus® Stoma Accessories, Anbesol®, Gelclair®, Hydromol®, Aloclair®, Naseptinl®, Ametopl®, and Lypsyl®
Type of company: Healthcare group including prescription medicines, devices, OTC brands, cosmetics and herbal remedies.
Products: All FLEXISEQ® products contain Sequessome™ vesicles – the tiny lipid spheres that pass through the skin when the gel is applied topically. FLEXISEQ® (OA) contains the maximum concentration of these vesicles. FLEXISEQ® Active contains a lower concentration of the vesicles, making it lighter and therefore suitable for the daily needs of joint pain and early stage arthritis sufferers, seeking a sustainable drug-free solution.
The Atrium, Blackthorn Road, Sandyford, Dublin 18
Pharmaceuticals: The Pharmaceuticals Division focuses on prescription drugs for the therapeutic areas of cardiology, ophthalmology, oncology, women’s health, haematology and neurology. The division also comprises Radiology.
Animal Health Products: Advantage, Advantix, Advocate, Bayticol, Baytril, Baytril Max, Baycox Multi, Byemite, Drontal Plus Flavours, Drontal Cat, Profender, Veraflox, Seresto
Helpline for professionals:healthcare 1800 22 12 34
Order Line: +353 53 9179007
Aptamil Pepti 2* (from 6 months) – for the dietary management of cows milk allergy from 6 months
Type of company: Wholesale Distribution Website: www.brandshapers.ie Tel: +353 53 9179007
Aptamil Pepti-Junior* For the dietary management of malabsorption and multiple food intolerances. GMS Listed
Ballytramon Business Park, Ardcavan, Castlebridge, Co Wexford Y35 Y19A
Aptamil Lactose Free* (from birth) – for the dietary management of lactose intolerance
Aptamil Profutura 2 - Follow on Milk (from 6 months+)
Aptamil Anti Reflux* (from birth)- for the dietary management of reflux and regurgitation.
LtdPharmaceuticalsAlliance
Block 1, Deansgrange Business Park, Deansgrange, Co. Dublin, Ireland
Help Line Number: 1800939149
Company Information:
Aptamil Profutura – First milk (from birth to 12 months)
Local Contacts: enquiries@flexiseq.com Marketing Manager, Allie Allie.forde@ascension.co.ukForde
Aptamil Pepti 1* (from birth) – for the dietary management of cows milk allergy from birth
An acquisitive company by nature, we have completed more than 35 acquisition or in-licensing deals over the last 20 years, fuelling both our portfolio development and international expansion.
Aptami l
Products: A range of booklets/ Information leaflets covering pregnancy through to toddler years
United Drug House,Magna Business Park,City West Road, Dublin 24, Ireland
Products: Brilliant, IsaDora, Nailner, Real Techniques, Sculpted, Seabond, Seven Seas, TanTastic, Just for Men, Vagisil, Bull Dog, Happy Skin, Old Spice, LifeLine Hangover Defence, Human + Kind, Profusion, Nakd, Trek, V Comb, Vosene, Wartie.
From its origins in the UK 20 years ago, Alliance has grown to become a significant international healthcare group, marketing over 90 products in over 100 countries world-wide and employing over 200 people.
Unit 1-1d Cork Airport Industrial Est., Ballygarvan, Co. Cork. Ireland T12 A470
Recent years have seen a broadening in the scope of Alliance’s product portfolio. In addition to the established niche prescription products which formed the original focus of the company’s activities, our portfolio now includes medical devices and consumer products, covering a wide range of therapy areas.
Consumer Health Products: Aspirin, Alka-Seltzer, Bepanthen, Bepantiseptic, Berocca, Canesten, Canespro, Canestest, Canesbalance, Clarityn, Cystopurin, Diprobase, Kwells, Losec Control, Redoxon, Rennie, Scheriproct Suppositries & Ointment, UItraproct Ointment, Skineron Gel 15’s and Travacort Cream
Type of company: Wholesale Distributors to Pharmacy Website: www.calcoireland.ie
Local Contacts: Business Manager Con Walshe +353 0872164446
Alliance Pharma PLC Registered Office, Chippenham Registered in England Company Number 04241478
COMPANY LISTINGS186
HealthcareAscension
Bayer ConsumerLtd Health
Brandshapers Ltd
In addition to its UK presence, the Group now has eight further offices across Europe, the Far East and the US. This geographic presence is enhanced by a broad network of international distributors, covering more than 100 countries worldwide.
Website: www.alliancepharmaceuticals.com
Type of company: Infant Nutrition
Local Contacts: Liam Dooley, Commercial customerservice@brandshapers.ieliamdooley@brandshapers.ieManager,
Standard Range: Aptamil – First Milk (from birth to 12 months)
Aptamil – Hungry milk (for hungrier infants)
Aptamil 4 - Growing up Milk (from 2 year+)
Website: Website for www.aptamilhcp.ieProfessionals:Websitewww.aptaclub.ieparents:forHealthCare
Help Line Number: Phone +44 [0]1249 466966
Shula Gold +353 0876108058
Local contacts: Commercial Lead: Hayley Claassen, Pharmacy Channel Manager: Patricia Lawrence
Type of company: Life Science Website: www.bayer.ie Tel: 01 2999313
Bayer is a Life Sciences company with a presence in Ireland for over 50 years. Through our innovative products in the areas of pharmaceuticals; consumer health; crop science and animal health, we contribute to finding solutions to some of the major challenges of our time.
Local contact: Managing Director, Itziar Canamasas
Type of company: Accountancy and business advisory firm Website: www.fitzgeraldpower.ie Tel: 051 870152 Fax: 051 871214
Unit 20A, Second Floor, Beckett Way, Park West Business Park, Nangor Road, Dublin 12
COMPANY LISTINGS
Order Line: 00 353 405 0900
Tel: 0035316908888
Local Contacts: F. Callaghan, S. Callaghan
Tel: 353 21 4962511
Local Contacts: Dublin – John O’Sullivan, 01 6794772, josullivan@fitzgeraldpower.ie
Sandra Cheung 01 405 sandra@eurosalesinternational.ie0900
Telesales: Grainne Maughan 086 253 WestmeathMayo,Clare,grainne@eurosalesinternational.ie9556Galway,Leitrim,Longford,Roscommon,Sligo, Mark Keane 086 234 Dublin,Cavan,eurosalesinternational.iemark.keane@4408NorthDublin,WestDublinCityCentre,
187
The Bank of You and Your Business Hub
Local Contacts: United Drug Tel: +353 1 463 2300
Services: Distributors of Medicines and OTC Products direct to Pharmacies, Hospitals and via Wholesalers
SupplementsGreenLight
Carlow, Kildare, Laois, North Tipperary, Offaly, West Dublin, South suzanne@eurosalesinternational.ie087SuzanneDublinCooney2105126
Tel: 353 1 620 4000
We are not a traditional bank. If you’ve been into one of our Hubs, you’ll know why. It’s set up differently – no counters, just comfy seats and booths.
Ethical: Aceomel; Amidex; Amitriptyline; Amlotan; Amoxicillin Clonmel, Anxicalm; Apo-Go; Aspirin; Atenomel; Atorvastatin Clonmel, Axid; Azithromycin Clonmel; Binosto; Bisoprolol; Calvepen; Candist; Candist Plus; Casomide; Caspofungin; Cimeldine; Ciprotan; Clavamel; Clavamel Forte; Cleo Infusion Sets; Clonactil; Clonocid; Clopidogrel TAD; Cozatan; Cozatan Comp; Crystapen; Denzapine; Donesyn; Doxatan; Doxatan XL; Duloxetine; Efestad; Etalopro; Flucloxacillin; Folic Acid; Fungasil; Fungasil Cream; Furosemide; Grastofil; Ibandronic Acid; Imatinib; Irbesartan Clonmel; Isomel SR; Keflex; Lercanidipine Clonmel; Letrozole; Levetiracetam Clonmel; Linezolide; Losamel; Maxilief; Melfen; Memantine; Memantine Drops, Meroponia; Miramel; Montelair; Mycophenolate mofetil Clonmel; Nebimel; Nepramel; Nytamel; Olanzapine; Olanzapine ODT; Olmesartan; Olmesartan HCT; Osteomel; Pantium; Paracetamol; Perdamel; Phenobarbital;
Unit 2, Block E, Nutgrove Office Park, Dublin 14, Ireland
Orders: www.uniphar.ie
You can charge your phone while
Star Medical: 01 contactus@starmedical.ie4688282
Order Line: 1800 26 26 26
Order Line:1850 240 000 –Trade only
Tel: 00 353 1 450 7771
Wholesale Email: Wholesale@united-drug.com
Type of company: Beauty, Cosmetics & Healthcare Distributor Website: www.eurosalesinternational.ie
Help Line Number: 0035316908888
Eoin O’ Hagan 087 777 eoin@eurosalesinternational.ie0882 Cork, Kerry, Limerick Allyson White +44 074 Down,Antrim,Allyson@eurosalesinternational.ie07709109Armagh,Derry,Donegal,Fermanagh,Tyrone
Email: hello@greenlightmedicines.com
Fax: 353 21 4962994
Help Line: 353 1 620 4000
Fitzgerald Power, AccountantsChartered &
Business Advisors
Type of company: Food Supplements
Louth, Monaghan, Meath Helen Fallon 087 961 helen@eurosalesinternational.ie6125
Uniphar: Uniphar Retail Service Help Line 01-4687501
Website: www.clonmel-health.ie
Products: 1000 Hour, 7th Heaven, Bathefex, Broadway, Cuticura, Dentyl Active, e.l.f. Cosmetics, Egypt Wonder, HASK, Inecto, Kennedy & Co Grooming, KISS, Lip Smacker, Madison Makeup, MAM, NOTE Cosmetics, P20, Palmers, Perspirex, Shea Moisture, Soft & Gentle, Tangle Teezer, Touch of Silver, UltraDEX, Vintage Cosmetics, wet n wild, White Glo, Yes To
Products: PHYTALITY RangePeony Rose Root Tincture 100ml; Super Six Mushroom Extract Capsules GreenLight300mgRange - 10% CBD Oil 500mg 5ml (THC FREE); 10% CBD Oil 1000mg 10ml (THC FREE); Cold Pressed CBD Oil 500mg 15ml (full spectrum); Cold Pressed CBD Oil 1000mg 30ml (full spectrum)
Carlow – John McHugh, 059 9141100, jmchugh@fitzgeraldpower.ie
InternationalEurosales Ltd
Unit 3/4, Ballymount Business Park, Ballymount Drive, Ballymount Industrial Estate, Walkinstown, Dublin 12, D12 F884
Fax: 00 353 1 450 7795
Consumer Email: Consumer@ united-drug.com
Kilkenny, Waterford, Wexford, Wicklow, South Tipperary, East Cork
Head office: Greyfriars, Waterford Offices also in Dublin and Carlow
Help Line Number: 353 21 4962511
KBC IrelandBankplc
HealthcareClonmel Ltd
Local Contacts:
Website: greenlightsupplements.comwww.
Products: Demak’Up, White to Brown, Oh My Glam, Manicare, Dove, Sure, Lynx, Alberto, Imperial Leather, Brylcreem, Fish, Mitchum, Pears, Carmex, Radox, Impulse, V05, Badedas, Simple, St Ives, Toni&Guy, Tresemme, Vaseline, Jakemans, Lockets, Fishman Friends, Gillette, Wilkinson Sword, Braun, Colgate, Vicks, Listerine, Tepe, Water Wipes, Eylure, Elegant touch, Dimples, Jolen, Durex, Duracell, Sun Care
Pipercin; Pravamel; Prednisolone; Pregabalin; Prindace; Profloxin; Prosentio; Prozamel; Ramitace; Rasagaline Clonmel; Rabeprazole; Rinozal; Risontel; Rosuvastatin; Serimel; Seropia, Seropia XR; Sildenafil Clonmel; Simtan; Tamnic; Tamnexyl XL; Telmisartan; Telmisartan HCT; Temozolomide; Tipuric; Toltertan SR; True Result Diabetes Monitor, True result Twist; Valtan; Valtan Comp; Venex XL; Xymel; Xymel SR; Xymel Comp; Zestan; Zomel; Zopitan; Zolendronic Acid.
Waterford – Stuart Fitzgerald, 051 870152, sfitzgerald@fitzgeraldpower.ie
Products: Financial health check; Pharmacy valuations; Pharmacy sale brokerage; VAT investigations; Pharmacy specific online management accounts; Year-end statutory accounts production; Outsourced bookkeeping, payroll and company secretarial services; Business advisory; Tax planning and compliance.
Email: drug.comReception.UDW@united-
Distribution Email: Distribution@ united-drug.com
OTC: Accurate; Acriflex; Anti-Hist Allergy; Caldease; Caldesene; Caldesene Adult; CaldeSpray; Caldesun; CaldeBaby Teething Gel; CaldeKids Travel Pops; Cerumol; Cerumol Olive Oil; Clonfolic; Clonfolic Multicare; Covonia; Desenex; Easofen for children strawberry oral suspension; Easofen; Easofen Max; Eucryl; Flexitol Heel Balm, Flexitol heel Balm Platinum, Flexitol Heel Magic, Flexitol Moisturising Foot Cream, Flexitol Hand Balm; Galfer Caps, Galfer FA Caps, Galfer Syrup; Gastrolief; Gloup Swallowing Gel; Hedrin Treat and Go Lotion Spray, Hedrin Treat and Go Mousse, Hedrin Protect and Go Spray, Hedrin Dual Pack, Hedrin ONCE; Joint Aid; Just a Drop; Maxilief, Nicochew 2mg Gum, Nicochew 4mg Gum; Paralief 500mg Tablets; Paralief Effervescent Tablets; Viralief 2g cream; ViraSoothe Gel, ViraSoothe Spray.
Fax: +353 (0)1 890 3016
Order Line: +44 (0) 1442 821 419
Order Line: Ire: 1800 42 62 82 UK: 0845 303 8631
Help Line Number: Freephone 1800 286552
Order Line: Freephone 1800 286552
Email: sales@novalabs.co.uk
Murrays Health & Beauty
Type of company: Healthcare Website: www.korahealthcare.com
Paul Murray PLC, Wide Lane, Southampton, Hampshire, SO18 2FA, UK
Local Contact: Karen Cole, Group Sales & Marketing ManagerSpecials: 07944 450987
Your Business Partner will be available at the end of a mobile or email and keen to help. They will even come out to your office or meet you anywhere that suits you.
Tel: +44 (0) 1442 890 355
Type of company: Full Line Specials Manufacturer
Tel: +44 (0) 116 223 0100
Local Contacts: Head Office: +353 1 890 0406 Fax: +353 1 890 3016
Help Line Number: Ire: 1800 42 62 82 UK: 0845 303 8631
Email: info@korahealthcare.com
Tel: UK +44 (0)23 8046 0600 or IRE +353 (1) 69 50724
Email: Territorysgibson@nbty.comAccountManager: John Kennedy (South Ireland) +353 86 7778771
We offer in-depth training to staff on benefits of supplements. Samples for some products available on request from your Territory Account Manager. Free marketing materials and support available on request.
Swords Business Park, Swords, Co. Dublin, K67K8Y2, Ireland
Order Line: freephone number 0800 975 4840
Help Line Number: +44 (0) 1442 890 355
Products: Vitamins, Minerals, Specialist Food Supplements
Fax: 01 2865533
Products: We have over 10,000
The personnel at Pamex Limited have many years’ experience in dealing with pharmacists and members of the medical and pharmaceutical professions, along with the key influencers and decision makers in the market.
Email: Territoryjkennedy@nbty.comAccountManager: Lorna Kerr (Dublin & Northern Ireland) +353 86 0422500
Fax: +44 (0) 2380 460 601
Help Line: (Customer Care Pharmacist) freephone number 0800 975 4840
Nova Laboratories Limited was established in 1994 and has since gained a global reputation for manufacturing complex and innovative experimental medicines and delivery devices, for a wide range of pharmaceutical and biotechnology companies. Nova is a UK leading independent supplier of both ‘Specials’ and clinical trial medicines to healthcare professionals. Our state-of-the-art facilities allow us to provide virtually any pharmaceutical dosage form, including non-sterile cytotoxic formulations. Our highly skilled team of formulation pharmacists continue to develop and produce new formulations, with >10,000 available.
Type of company: Pharma Distribution Website: www.pamex.com
Your KBC Business Support team contact details
Tel: 094 9024000
Type of company: Food Supplements Website: www.naturesbounty.co.ukwww.solgar.co.uk
24 hour debit & credit card lost/stolen: 1800 93 62 87
Any other info: Pamex Limited is a successful marketing company, specialising in the promotion of prescription pharmaceutical medicines and personal healthcare products to Irish consumers.
Business Internet Banking Support: 1 800 804 414 +353 1 664 6180
Kora Healthcare
Ireland (freephone): 1800 42 62 82 UK: 0845 303 8631
to podophyllin or carbon dioxide laser c) Subacute sclerosing panencephalitis (SSPE)
Any other info: Murray’s Health and Beauty are the Pharmacy and Independent Retailer distributor for Dr Brown’s Anti-colic baby bottles and accessories, plus Dreamgenii Pregnancy Support and Feeding Pillow.
Tel: +353 1 664 6180
Dr Mike Edge - Head of Non-Sterile Manufacturing Tel: +44 (0) 116 223 0100
Email: Categorylkerr@nbty.comandProduct Training Manager: Bethan Carr Email: bcarr@nbty.com
sipping a decent cup of free coffee. You can check your emails with our free FocusedWi-Fi.on your business, we know it’s not always easy to get to the bank in normal working hours. So our Hubs open late and on Saturday mornings to make it easier for you.
LaboratoriesNova Ltd.
Products: Regelle – Long-lasting vaginal moisturiser, PharmacyRelactagel – Treats and Prevents Bacterial Vaginosis, Pharmacy - BabyD – Vitamin D3 supplment for infants, Pharmacy - LiquiD –Vitamin D3 supplement for adults, Pharmacy - Magnaspartate –243mg POWDER for oral solution, treatment for magnesium depletion, POM - Catephen - Indicated for the cutaneous treatment of external genital and perianal warts (condylomataacuminata) in immunocompetent patients from the age of 18 years, POMFluomizin - 10mg Vaginal Tablets (dequalinium chloride) for the treatment of Bacterial Vaginosis, POM - Imunovir – 500mg tablets inosine acedoben dimepranol. Imunovir tablets are indicated in the management of: a) Mucocutaneous infections due to herpes simplex virus (type 1 and/or type II) b) Genital warts as adjunctive therapy
Website: www.novalabs.co.uk
Parle & Hickey Ltd
Website: www.parleandhickey.com
COMPANY LISTINGS188
Tel: Freephone 1800 286552
Tel: 1 800 804 414
Tel: +353 (0)1 890 0406
The Nature’s Bounty Co.
Moneen Business Park, Castlebar, Co. Mayo
Pamex
Aldbury, Tring, HP23 5PT, United Kingdom
Local Contacts: Diarmuid Gavin 086 2205864
Type of company: Wholesaler Website: murrayshealthandbeauty.comwww.
Business Support Team: 1 800 804 414 +353 1 664 6180
formulations available which include: Solutions; Suspensions; Creams; Ointments; Lotions; Capsules; Sachets; Suppositories; Enemas; Ear Drops; Nasal Drops; Cytotoxic Products; Pre-Filled Syringes; Mini Bags; Injectables
Type Of Company: Distributor
Beechwood Close, Boghall Road, Bray, Co Wicklow
Local Contacts: Regional Key Account Manager: Sara Gibson Mobile: +35386 0406686
Help Line Number: +44 (0) 2380460600
Martin House, Gloucester Crescent, Wigston, Leicester LE18 4YL
Products: Alflorex, Thea Pharmaceuticals, Kin Dental Products, Bioxtra, Skin Republic, Carmex, Total Shaving Solution, Dermatonics Once Heel Balm, Mycosan
Any other info: Restoring Health Kora Healthcare is a fully integrated healthcare company with core competencies across Research, Development & Innovation, Scientific & Medical Affairs, Regulatory Affairs & Pharmacovigilance, Quality, Supply Chain, Marketing & Sales, Finance and Customer Services. All departments are led from our headquarters in Dublin, Ireland with UK sales and marketing operations located in York, UK.
Order Line: +44 (0) 2380460600
Gerard Murphy 087 7015701
Sanofi-Aventis
Local Contacts: Sales DirectorMichael Donnellan 087-7995035
Tel: +353 (021) 4510220 Fax: +353 (021) 4510229
Help Line Number: 1800201700
Order Line: Order all product lines through Wholefoods Wholesale, Dublin 01-6262315
00353 52 61 36311 (Clonmel)
Email: customerservicem50@pinewood.ie
Devices: Early Bird Pregnancy Test Kits & Ovulation Kit, Salbutamol CFC-Free Inhaler, Vera Temp Thermometer,
Mr Peadar Flynn: 087 259 4129
Fax: 00353 1 456 9125 (Dublin)
Any Other Info: Group Training Available
HospitalSouth Representative
Hoffmann Park, Little Island, Cork, Co. Cork
Email: info@solvotrin.com
Freephone 1800 286552
Type of company: Pharmaceutical Marketing of Ethical Medicines and OTC Products
Local Contacts: Paul Neill, Director Generic Products Ireland
189COMPANY LISTINGS
Dublin / North East
Ireland Limited 18 CitywestRiverwalkBusiness Campus Dublin 24
Local Contacts: Adrian McCourt, Senior National Account Manager Pharmacy
Tena + 3,000 Lines
Fresenius, Lanafine AFR, Ketozol, Lorat, Pantup Relief, Ranitic 75mg. Brupro, Brupro Max, Carbosan Gel, Decavit Plus, Magnesium Verla, Olive Oil BP
Mr Ciaran Clarke 087 770 0086
Type of company: Consumer Health
Web:
Tel: 00353 1 456 9123 (Dublin)
E-mail: info@ppcgalway.ie
Any other info: We offer highquality generic, specialty and OTC
00353 52 61 86000 (Clonmel)
Forte, Cetrine Allergy, Diclac Relief Gel, Domerid Relief, Lactulose
Management: Mr Fergal Murphy: Company Director
Local Contacts:
Order Line: 1800 304 400
Order Line: 01 4689200
Products: Eskimo-3 Omega-3 Oils, Zerochol Plant Sterols for cholesterol management and ZinCuFlex Ginger and Curcumin Complex
Website: www.rowex.ie Tel: 00 353 27 50077
Type of company: Global pharmaceutical company
Hospital Business Manager
Mr Chris Thompson Leinster 087-820 9011
Munster Sales Manager: Sarah Nelan 086-1890767
Pinewood Healthcare
Newtown, Bantry, Co Cork.
Mr Tom Egan Munster 087-289 6738
Products: Ethical: Alendronic Acid, Amlodipine, Anastrozole, Aripiprazole, Atorvastatin, Bisopine, Calcium Acetate, Caprin, Cetirizine, Chlorpromazine, Clopidogrel, Co-Danthramer, Citric Acid, Citalopram, Clarithromycin, CoTipol Suppositories, Donepezil, Dalmapam, Diflazole, Entacapone, Escitalopram, Flucillin, Grepid, Imatinib, Kopen, Lansoprazole, Levetiracetam, Levothyroxine, Losartan, Metformin, Minosil, Mirtazapine, Memantine, Mobiglan, Nexazole, Olanzapine, Omeprazole, Ondran, Paroser, Pantoprazole, Pinadone, Pinamox, Pregabalin, Pravat, Primacine, Prozit, Ramic, Risedronate, Rosuvastatin, Sereflo Inhaler, Sertraline, Simvastatin, Tipol Suppositories, Tramapine, Venlablue XL, Zileze, Olanzapine Orodispersible.
Line: Healthcare 01 6305429
Products: Bonjela, Dettol, Disprin, Durex, E45, Full Marks, Fybogel, Gaviscon, KY, Lemsip, Mega Red, Nurofen, Optrex, Scholl, Senokot Strepsils, Veet
Mr Danny Lynskey 087 251 3239
Rowex Ltd
Mr Martin Rowe Leinster 087-982 1463
Ms Katie Tobin 087 991 4404
Clodagh Kevans, Director Specialty Medicines Ireland
Mr Jurgen Wegner: 087 741 1411
Dublin / East
Products: ETHICAL - Alfu, Alopur, Amoclav, Amoclav Suspension, Amlode, Anastrazole, Atecor, Atecor-CT, Atorvas, Beta-Prograne andf Half Beta –Prograne, Biluta, Bisop, Bonefurbit, Capecitabine Sandoz, Captor, Captor-HCT, Catasart, Catasart Plus, Ceftal, Cetrine, Cifox, Citrol, Clorom, Clorom XL, Clodel, Co-Vatan, Dancex SR, Deslor, Dexketoprofen Rowex, Diclac, Diltam, Domerid, Doxane XL, Dozept, Emazole, Enap,Eplerenone Rowex, Esciprex, Fental Matrix, Fintrid, Flucol, Fluzac, Gabin, Irbesan, Isomonit Retard, Lanzol, Lanafine, Larig, Latop, Latop-Comp, Letzo, Leuprex 3, Leonore, Levocetirizine, Melcam,Lotanos,Lispril-Hydrochlorothiazide,Lispril,Lorat,LotanosComp,Mefac,Metocor,Methadone
Mr Tom O’ Brien 087 255 9950
Website: www.rb.com Tel: 01 4689200 Fax: 01 4689299 Help
PPC Ltd.
Local Contact:
Tel: 00353 1 9127700
Mr Michael Comerford: 087 226 6899
Mr Jeffrey Walsh: 087 669 4043
Mr David Brannigan - East
MsMid-WestAoifeMcDonnell 087 624 0817
OTC: Acic Cold Sore, Calciup D3
Mr Peter ConnachtHughes087-687 1407
OTCandPharmaceuticalwww.pinewood.ieManufacturerDistributorofEthicalandProducts
Accounts, Manufacturing and Marketing: Ballymacarbry, Clonmel, Co Tipperary, Ireland
Hydrochloride, Memantine LEK, Metophage, Minox, Mirap, Mirap Distab, Mometasone, Montelukast Paediatric, Montelukast, Mycolat, Nebol, Ondansetron,Pantup, Parox, Pendrex, Pendrex Plus, Pravitin, Quetex, Quetex XR, Ramilo, Ranitic, Razole, Rispone, Ridate, Rivastigmine Sandoz, Rolyprexa, Rolyprexa Distab, Romax Once weekly, Romep, Rosuva, Salbul, Serlan, Sidena, Sivatin, Sumatran, Tamox, Tamsu, Telmisartan Rowex, Ternaf, Tolusitol, Tradol, Valotix, Vatan, Vedixal, Vedixal XL, Vensir XL, Verap, Zoledronic Acid Sandoz, ZolnodAirFluSal, Aripiprazole Sandoz, Celecoxib Rowex, Macrolief, Metidate XL, Metformin Aurobindo, Pregabalin Sandoz, Telmisartan HCT, Vertigon
Pharmacy Representatives:Sales Mr Pat Ahern 087 131 6663 - South
Unit 7, Riverwalk, Citywest Business Campus, Dublin 24
Distribution: Direct to Pharmacies, Hospital Pharmacies and via Wholesalers
Mr Pearse Timothy Connacht 087-289 3350
Type of company: Sales and Marketing of OTC Natural Health Products
Products: Active Iron and Active Iron & B Complex Plus for Men and Women
Pharmacy Business Manager
TherapeuticsSolvotrin
PharmaceuticalsTeva
Commercial Development Manager
Consumer (Household) 01 667318
Unit 1, M50 Business Park, Ballymount, Dublin 12, Ireland
OTC Confined: Acidex, Aqueous Cream, Calamine Lotion, Cetirizine, Chlorhexidine, Codinex, Cortopin, Dispensing Bottles, Emulsifying Ointment, Fenopine Suspension, Flamozil woundspray, Glycerine Honey & Lemon, Glycerine Suppositories, Laxose, Micolette, Paratabs, Parapaed Junior, Parapaed Six Plus, Pholcodex, Silcocks Base, Surgical Spirits, Tantum Verde Lozenges, Tefin Suppositories, Tipol Granules, Tipol Suppositories, Viscolex.
Mr Michael O’Halloran: 087 117 Pharmacy9979Business Manager
Digital Office Centre Swords, Suite 101 – 103, Balheary Demense, Balheary Road, Swords, Co. Dublin, K67E5AO
Tel: + 353 (0)1 403 5600
Mr Rodney McCullough Leinster 087-260 6016
Website: www.zerochol.iewww,.eskimo3.ie www.zincuflex.ie Tel: +353 91-753222
Fax: 00 353 27 50417
Freephone: 1800 304 400
RB Ireland
27 Mulvoy Business Park, Sean Mulvoy Road, Galway
Website: www.Teva.ie
Biosimilar Key Account Manager
Spatone Iron Supplement: Spatone Original and Spatone Vit C.
Distribution: Direct to Pharmacies and via wholesalers (specific lines).
Unit 3 Kylemore Ind Estate, Killeen Road, Dublin 10
In additional to the field-based sales teams covering both primary and secondary care in Ireland; Teva’s commercial teams and support functions are based in Swords, near Dublin.
Whether they’re used in hospitals or by GPs, nurses, or independent pharmacists, our medicines are supported by comprehensive advice and information from our Medical teams.
Nupo: Balanced meal replacement.
OTC Confined: A.Vogel Herbal: Prostasan.
Jan De Vries Essences: Night, Craving, Concentration, Emergency, Relaxation, Confidence, Mood.
Silicolgel: Oral gel containing colloidal silicic acid for the treatment of gastrointestinal disorders and IBS.
Herbal: Gingko Biloba, Hypericum Complex, Hypericum Perforatum, Serotone, St John’s Wort
Crossmolina Road, Ballina, Mayo, F26 W6R6, Ireland.
Tel: +353 096 72555
Avalon: Organic skin and body care. Shampoos, conditioner, moisturiser, shower gels.
the sales and support services for Teva’s large portfolio of medicines, both generics and branded innovative medicines, along with over-the-counter consumer health products.
Tel: +353 1 463 2300
Active Edge: Cherry Juice Aromatherapy Oils: Atlantic Aromatics, Absolute Aromas, Ord River Tea Tree, Puressential.
Fax: +353 096 72400
Bio-Strath: Herbal Tonic Celtic Wind: CBD Oil Eskimo Oil: Brainsharp Omega, Eskimo Kids and Eskimo Omega 3. Gluten Free and Dietary Foods: Nanny Goats Milk, Barkat, Eat Natural, Nak’d Bars, Linwood’s, Panda, RJ’s Licorice, Vita Coco.
Optibac Probiotics: A natural range of probiotic supplements suitable for the whole family.
Parasol: Suncare range.
Sea-Band, Hay-Band: Sea-Band Child, Sea-Band Adult, Sea-Band Mama.
Types of Business: Agents and distributors of Herbal Remedies, Nutritional HomeopathicSupplements,Remedies, Flower Essences, Natural and Organic Bodycare, Manuka Honey, Sports Nutrition, Natural Hair colouring, Aromatherapy Oils, Gluten free and Dietary foods.
Bach Original Flower Remedies
Sports Nutrition: Optimum Nutrition, Maximuscle, Plantforce. Te etha: Teething granules and gel.
Sambucol Black Elderberry Extract: Sambucol Original, Sambucol Kids, Sambucol Effervescent.
Territory: Ireland – For details of your local representative please contact the Wholefoods office on 01 6262315.
Permanent, Reflex (Semi Permanent).
Lifestyle Products: Ecover, Lilly’s, The Saltpipe and Natracare (personal hygiene).
Herbal Teas: Pukka, Tea Pigs, Heath & Heather and Yogi.
Jason: Personal and body care range.
Tel: 01 626 2315
Fax: +353 1 463 2333
Fax: 01 626 1233
United WholesaleDrug(Ballina)
Tel: +353 061 315411
Fax: +353 061 315012
Bioglan: OAD Super Fish Oil, Red Krill, Stat-Guard, Glucosamine SR1500mg, Promensil.
We supply medicines to treat a wide range of diseases and conditions – from multiple sclerosis, asthma, cancer and Chronic Obstructive Pulmonary Disease, to pain relief, cholesterol reducers and antibiotics. Dosage forms include extended and immediate release tablets and capsules, injectables, creams, ointments, solutions, suspensions and inhalers.
E: Consumer@united-drug.com Distribution E: Distribution@united-drug.com Wholesale E: Wholesale@united-drug.com
Pre-Conceive: Pre-Conceive preconception supplement Probiotic: Optibac.
Biomedical: Cardio-K, Cardio-P, and Cardio-T.
Zerochol: Zerochol plant sterol supplement.
Number of Sales Force: 8
Hubner: Gastrointestinal Gel, Iron Vital Tonic, Silicea Caps – For Hair, Skin & Nails, Silicea Cold Sore Lip Gel and Silicea Beauty Gel.
E:
A.VogelEthical:
Natural and Organic Bodycare: Jason, Avalon, Faith in Nature, Natura Siberica.
United Drug Magna Drive, Magna Business Park, Citywest Road, Dublin 24, D24 XKE5, Ireland.
Nelsons Remedies:Homeopathic Nelsons Teetha Granules and Gel, Nelsons Arnicare, Nelsons Clikpak, topical and formulated remedies.
Kinvara: Hyaluronic Youth Boost, Active Rosehip Day Cream, 24Hr Rosehip Face Serum, Omega Rich Hand & Nail Cream, Elemental Exfoliating Powder, Eye Wow! Eye Serum.
COMPANY LISTINGS190
Optima: Aloe Vera Gel, Gentle Action Colon Cleanse, Aloe Dent Toothpastes and Mouthwash, Joint Complex, Aloe Pura Juices, Allergenics Skincare, Lecithin, Optima Lifestyle Vitamins, Australian Tea Tree, Montmorency Cherry Juice, Cranberry Concentrate Juice.
medicines to patients across a wide range of therapeutic areas. And, we are continually expanding our range of products and services to better meet the needs of Irish patients and healthcare Tevaprofessionals.employs around 800 people in Ireland and has three sites in the Republic of Ireland and one site in Northern Teva’sCommercialIreland.Divisioncommercialactivities
MAG365: Powder based range of magnesium supplements.
WholesaleWholefoods
comReception.UDW@united-drug.
Consumer
A.Vogel Veterinary: Jan De Vries Animal Essences – Animal Separation, Animal Emergency, Animal Highly Strung Essence, Animal Over-Dominant, Animal Timid. Amina Strath – Feed supplement (combination of yeast & herbs).
LithoLexal® Marine Plant ExtractBone Health, Joint Health, Bone Care
Higher Nature: The Saltpipe, Balance for Nerves, Red Sterol, Kids Range, Teens range, Full Vitamin range.
Nourkrin Hair Supplements: Nourkrin Maintain, Nourkrin Man, Nourkrin Woman, Nourkrin Post Pregnancy, Nourkrin Active, Nourkrin Radiance, Scalp Lotion, Nourkrin Shampoo & Conditioner
Johnsgate House, Old Clare Street, Limerick, V94 E3F1, Ireland.
Mother and Babycare: Earth Friendly Baby, Natural Babycare Nappies, Wipes and Bodycare.
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Zincuflex: Curcumin and Ginger food supplement.
Life Boost: Children’s Honey & Lemon Syrup.
Nourella: Active skin support supplement, Active skin rejuvenation cream.
Rescue Remedy: Rescue Remedy, Rescue Night, Rescue Plus.
Natural Henna: Surya Brasil Naturtint Hair Colours:
Pernaton Green Lipped Mussel Extract: Pernaton Gel, Pernaton Relaxing Bath Therapy, Pernaton Capsules.
Products: Revlon, Mitchum, Cutex, John Frieda, Bondi Sands, Mavala, Brand Arkitechs, Fruit of the Earth, TLC Wipes, Eveready, Optima: Snowfire, Valderma, Reckitts:Scholl, Kora (Relactagel, Regelle & BabyD), Westlabs, Lucy Wolfe, Wisdom, Rockface, Nitty Gritty, Sterimar, St Tropez, Sanctuary, NUK, EllaOne, Compeed, Cleanse Off Mitt, Skingredients, He-Shi, Seavite, Childsfarm, Swedish Nutra, Babyliss, Remington, Viviscal, Batiste, Anusol, First Response, Arm and Hammer, Pearl Drops, Nair, Femfresh, Replens, PreSeed, Tan Organic, Anne French, Waterpik, Plantur, Alpecin, Bionsen, Vagisan
Natura Siberica: Hair and body care range.
Email: info@wholefoods.ie Website: www.wholefoods.ie
Healthy Snacking: Meridian Nut Butters, Protein Bars (Quest, Fulfil, Deliciously Ella, Satisfi).
United (Limerick)WholesaleDrug
Non-OTC Confined: A.Vogel Herbal Tinctures: Echinacea for the family, Atrosan, Atrogel, Milk Thistle tincture and tablets, Passiflora, Dormeasan, Cough Spray, Ivy Thyme, Venaforce, Sinuforce, Eye Drops, Bronchosan, Digestisan and Menoforce as well as a full range of other herbal remedies.
Phizz: Rehydration + Vitamins and Minerals.
2021
SunSatFriThursWedTuesMonSunSatFriThursWedTuesMonSunSatFriThursWedTuesMonSunSatFriThursWedTuesMonSunSatFriThursWedTuesMonSunSat January 31302928272625242322212019181716151413121110987654321 February 2928272625242322212019181716151413121110987654321 March 31302928272625242322212019181716151413121110987654321 April 302928272625242322212019181716151413121110987654321 May 31302928272625242322212019181716151413121110987654321 June 302928272625242322212019181716151413121110987654321 2020 Year Planner The Game Changer The world’s first fish oil with DPA “The Missing Omega. Contact Valeo Healthcare today to learn more.
July 31302928272625242322212019181716151413121110987654321 August 31302928272625242322212019181716151413121110987654321 September 302928272625242322212019181716151413121110987654321 October 31302928272625242322212019181716151413121110987654321 November 302928272625242322212019181716151413121110987654321 December 31302928272625242322212019181716151413121110987654321 ThursThursThursThursThursTuesMonSunSatWedFriSatSunMonTuesWedFriSatSunMonTuesWedFriSatSunMonTuesWedFriSatSunMonTuesWedFriSatSun Contact Valeo Healthcare today to learn more Proud to be one of Ireland’s leading vitamin suppliers
Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Nature’s Bounty® is a registered trademark. For more details on opening an account or to place an order, please call +44 (0) 1442 821 419 or email INNERBOOSTenquiries4@nbty.comYOURBEAUTY Beauty vitamins to nourish your beauty from the inside.
