Page 1

INSIDE: INNOVATION • EDUCATION • MANAGEMENT • NEW PRODUCTS • PROFILE

frontshop

Pharmac AUGUST 2017

www.frontshop.co.za

Valuable education for pharmacy staff

MAGAZINE

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Establish healthy lifestyle habits young Too many families opt for convenience foods without considering what such foods do for their sustained mental and physical energy levels

AUGUST 2017

15

CONTENTS EDUCATION

EDITOR'S COMMENT

4

Adult ADHD: Key conceptual issue

Kenyan adventure

The symptoms of ADHD are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions

INNOVATION 6 8

NHI a hot topic at PSSA conference Patent expiry promises more affordable biosimilars

COMPETITION

Pneumococcal vaccines

43 2017

Pharmacy Professional of the Year

12

(PCV13 and PPSV23) 18

Know your products With their smaller bodies and unique physiologies, children have different healthcare needs to adults. We look at three products specially engineered for children

33

45

50

Laureen Smith

2 nd Ru nner-u p 2016 Pharm acist Assista of the nt year

– Pharmacist Assistant and Stock controller, Blombos Pharmacy

“You need to win your customer by providing quality service”

How to effectively treat acute coughs in children A cough can have a major impact on a child’s sleep, school performance, and ability to play

36

SA women are obese At 42% SA women have the highest obesity rate in sub-Saharan Africa, according to a recent study

CUT OUT & KEEP: MORE THAN A BAD HAIR DAY

23 25

Dysmenorrhoea: pharma option To date, pharmacotherapy has been the most reliable and effective treatment for relieving dysmenorrhoea

Mucus acts as a thin, protective blanket preventing the tissue underneath from drying out

Why social media is changing your business

PROFILE

MONTH

21

The vital role of mucus and phlegm

OPINION 49

WOMEN'S

27

Cervical cancer and HPV: education is vital 18.81 million SA women over the age of 15 are at risk of cervical cancer

30

Health and wellness Women’s Month is all about celebrating the women in our lives, we look at 8 products engineered for women

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Pharmacy Magazine AUGUST 2017 |

3


EDITOR’S NOTE

EVENTS AUGUST 2017 15 15 Aug Oct

Bone Marrow Stem Cell Donation and Leukaemia Awareness Month Organ Donor Month

Kenyan adventures

L

ast month I was fortunate enough to travel to

conference last

Kenya for the opening of the Dandu Community

month. We feature

Life Centre in Mandera County. While very busy

photos from the

it is always interesting to meet new people and

event on page 6.

see different places. One of the highlights was a visit we

Our other news

paid to the David Sheldrick Wildlife Trust which operates

story looks at the

the world’s most successful orphan elephant rescue and

fact that with the

rehabilitation programme. In support of the conservation

recent expiry of a

project visitors are able to adopt an orphaned elephant,

number of patent

rhino, or giraffe. I excitedly added a pachyderm to the

protection means

family. Pare will celebrate his second birthday this

there are a number

October. If you’d like to adopt your own elephant

of affordable,

visit www.sheldrickwildlifetrust.org

life-saving

Although I thoroughly enjoyed the trip, it was quite an

treatments for

adventure with numerous dramas along the way. The first

cancers on the cards

of which started when I arrived at the airport. I rather rudely

for SA (page 8).

discovered I needed a Yellow Fever vaccine before I was allowed on the airplane. Why the travel agent, airline, or

We dedicate a section of the August issue in

company arranging the trip failed to inform me of this rather

celebration of Women Month:

important detail I’ll never know, but it was a reminder to

· SA women are obese (page 21)

always do your own research before travelling anywhere.

· Menopausal hair loss (page 23)

Fortunately I was able to get the vaccine from the clinic at

· Dysmenorrhoea: pharma options (page 25)

OR Tambo international, but as Murphy would have it the

· Cervical cancer and HPV (page 27)

clinic was on the complete opposite side of the airport. So,

· Products tailor made for women (page 30)

instead of checking my luggage and then enjoying coffee and a muffin with my sister before boarding the 4-hour flight

Other interesting topics include antimicrobial resistance

to Nairobi, my sister and I found ourselves running through

in vaginal infections (page 32), and the fact that

the airport so I could get the vaccine and then sprinting

osteoporosis is not inevitable (page 34). We pause

back to check-in. You’ve got to love siblings who are always

to understand enuresis – or intermittent nocturnal

around to offer moral support when needed.

incontinence (page 27), before exploring anaemia

Suddenly needing the Yellow Fever vaccine had me pondering how often we really think about vaccines as

(page 31). There are so many other great features in this issue, but I

adults, other than for our children of course. As a result we’re

used up all my space sharing my Kenya experience. May you

featuring an article on pneumococcal vaccines for adults

thoroughly enjoy our August issue.

(page 43). The impending NHI was a hot topic at the annual PSSA

WORDS TO

LIVE BY

Editor Nicky Belseck

“Life shrinks or expands in proportion to one's courage” – Anaïs Nin

FEEDBACK Send your letters and any news or events to nicky.belseck@newmediapub.co.za

4

| AUGUST 2017

Pharmacy Magazine

Child Health Month 1 7 World Breastfeeding Week 1 CANSA Care Week

7

6 12 Polio Awareness Week 4 10 Rheumatic Fever and Rheumatic Heart Disease Week 22 27 HPV Vaccination Campaign 26 31 African Traditional Medicine Week SEPTEMBER 2017

Cervical Cancer Awareness Month Childhood Cancer Awareness Month 19 16 Sept Oct

Eye Care Awareness Month

2 5 Kidney Awareness Week International Gynaecological Health Day

10

14

National ADHD Day World Lymphoma Awareness Day

15


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INNOVATION

NHI a hot topic at PSSA conference

With NHI looming on the horizon the pharmacy industry united to tackle universal health coverage at the 2017 PSSA conference

Andy Gray (Senior Lecturer at the University of KwaZulu-Natal), Christine Venter (SAACP President), Gareth Kilian (Associate Professor at Nelson Mandela Metropolitan University), Joggie Hatting (SAAHIP President), Sarel Malan (PSSA President), and Douglas Oliver (SAAPI President)

P

harmacy professionals

in Industry (SAAPI), Community

flocked to Johannesburg

Pharmacy Association (ICPA),

to attend the annual

and important members of

Pharmaceutical Society

academia – it was the ideal

of South Africa (PSSA) Conference held in July. The PSSA, which has

different pharmacy sectors

the biggest representative body

together, PSSA president Sarel

for pharmacists, pharmacist

Malan assured delegates the

assistants, and pharmacy students

association was in regular

in the country.

contact with the DoH. “We have

| AUGUST 2017

Pharmacy Magazine

had invitations from the DG

attendance, the main topic on

(Dr Anban Pillay, deputy

everyone’s mind was the imminent

director-general for health

National Health Insurance (NHI),

regulation and compliance

the impact it will have on pharmacy

management) to discuss the

professionals, and the role

NHI with her and she’s requested

pharmacy need to play in the new

we submit proposals. One of the

Universal Health Coverage (UHC).

key roles we will play is to bring

With important industry role

the different sectors together,

players in attendance – the

to disseminate, coordinate, and

Department of Health (DoH),

administrate. We will ensure

Pharmaceutical Society of South

everyone has all the information

Africa (PSSA), South African

and is on the same page.”

Association of Community

6

Committed to bringing the

more than 8 000 members, is

Boasting an impressive

Kobus le Roux and Arthur Tannous

forum to unpack NHI.

Apart from interesting lectures

Pharmacists (SAACP), South

and engaging panel discussions,

African Pharmacy Council (SAPC),

there were a number of social

South African Association

events allowing attendees to

for Hospital and Institutional

network before the conference

Pharmacists – SAAHIP), South

closed with a prestigious gala

African Association of Pharmacists

dinner and awards ceremony.


INNOVATION A new Pharmacy Advisory Board has been constituted to bring together stakeholders across various pharmacy bodies and academia, to seek solutions to challenges facing the South African pharmacy sector.

1

2

3

5

6

4

7 1. Godfrey Keele and Palesa Santho 2. Tanya Dube and Kim Ward 3. Willem and MariĂŤtta Basson 4. SAPC team

8

9

5. Adcock Ingram team 6. Specpharm team 7. Aspen team 8. Elsevier Clinicalkey team 9. Tony Wildman, Teboho Kutoane, Raymond Pogir, and Kobus le Roux 10. Pharma Dynamics team

5 10

151

11. Sun Pharma team

Pharmacy Magazine AUGUST 2017 |

7


INNOVATION

Patent expiry promises more affordable biosimilars

Affordable, life-saving new treatment for cancers on the cards for South Africa

The recent expiry of the patent protection on many biological medicines has paved the way for more affordable ‘copies’ or ‘follow on medicines’ to be produced

T

he growing burden of healthcare related to non-communicable diseases (NCDs) and

many biological medicines has paved the way for more

medicines will pave the way for more affordable,

affordable ‘copies’ or ‘follow on medicines’ to be produced.

life-saving ‘biosimilars’ to be produced is encouraging.

Called ‘biosimilars’, these follow-on biotechnology

Lower- and middle-income countries like SA are

medicines are manufactured using the same processes

bearing the brunt of the rise in deaths related to NCDs.

as the original medicine and are comparable in terms of

These conditions, which include cancers and certain

quality, safety, and efficacy. Because the efficacy of the

chronic conditions, account for about 38 million deaths

medicine has already been established by the originator

worldwide annually, with up to 80% of deaths occurring

biological medicine, a less onerous clinical examination

in developing countries.

processes and cost-effective development enable these

Vivian Frittelli, CEO of Generic and Biosimilar Medicine

medicines to be introduced to the market at as much

SA says SA’s already stretched healthcare budget is

as 50% less than their originator counterparts, thereby

coming under increasing pressure to fund the high cost of

providing greater access to these life-saving treatments.

pharmaceuticals, especially biological medicines, which

According to a biosimilars handbook, produced by

have revolutionised the treatment of a variety of these

the European Generic Medicines Association (EGA), the

conditions, including cancers, rheumatoid arthritis, Crohn’s

reduction in cost of treatments brought about by the

disease, and others.

introduction of biosimilars is not only due to increase in usage of these products, but also through competitive price

complex proteins derived from living organisms – human,

reductions of the originator counterparts. The organisation

animal, or microorganisms. They are manufactured using

also predicts annual growth rates of 65.8% per year on the

biotechnology processes under controlled conditions, unlike

use of biosimilars in Europe.

regular medicines which are generally small molecules produced by mixing various chemicals together. “Biologicals are targeted at a cellular level and can halt

Frittelli says that an exciting development in SA is the establishment of a biosimilar plant at the Dube Trade Port near Durban, by a member company of the GBM.

the progression of a disease and in some cases prevent

On completion this plant will be able to provide more

recurrence”, remarks Frittelli.

affordable life-saving treatments where biological drugs

While these medicines have revolutionised treatments for many diseases, they are expensive. The research and

are required. “The Medicines Control Council has approved a

development expenses including the costs of highly skilled

registration guideline for biosimilar medicines in South

scientists, clinical trials, and the specialised equipment

Africa and are based on international best practices”

needed, are the main cost drivers. Companies are required

“The cost efficiencies which generic and biosimilar

to fund these costs, often, in excess of 10 years before

medicines provide are going to assume greater importance

registration for use by patients.

for state and private health funders as the population ages

This makes them unaffordable to many developing markets and contributes to unsustainable healthcare costs | AUGUST 2017

However, the recent expiry of the patent protection on

how the recent patent expiry on many biological

“Biological medicines, as the name implies, are

8

being experienced in developed markets.

Pharmacy Magazine

and the prevalence of cancers and other noncommunicable diseases increases,” he says.


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EDUCATION NATIONAL ADHD DAY

SEPTEMBER

Adult ADHD: Key conceptual issues

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), ADHD is a neurodevelopmental disorder, reflecting a persistent pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development

T

he symptoms of ADHD are not solely a

ASSOCIATED FEATURES

manifestation of oppositional behaviour,

The DSM also refers to associated features that

defiance, hostility, or failure to understand

are often seen in ADHD and can be used to support

tasks or instructions.

SYMPTOMS Prof Philip Asherson, professor of clinical and molecular psychiatry in the UK, explains that symptoms of inattention as defined in DSM-5 are mostly behavioural – easily distracted, forgetful, trouble completing tasks. Hyperactive symptoms relate to fidgetiness, restlessness, and being on the go all the time. In terms of impulsivity, Prof Asherson emphasises how people

Hyperactive symptoms relate to fidgetiness, restlessness, and being on the go all the time

with ADHD have great difficulty waiting in queues, some

diagnosis. These include: · Developmental traits: Mild delays in language, motor, or social development, which are not specific, but often co-occur with ADHD. · Emotional symptoms: Low frustration tolerance, irritability, mood lability, is very commonly seen in adults with ADHD. · Educational problems: Even in the absence of a specific learning difficulty, academic or work performance is often impaired. · Cognitive deficits: May exhibit cognitive problems

of whom would put down their shopping and leave the

on tests of attention, executive function, or

store rather than wait in a line.

memory – although tests are not sufficiently

In general, the hyperactive and impulsive symptoms

sensitive or specific to serve as diagnostic tests.

decline as people with ADHD become adults. The inattentive symptoms are a greater problem in adults.

MIND WANDERING

“The disorder improves to varying degrees in different

Prof Asherson explores the concept of the mind

people. However, ADHD symptoms that are frequent

wandering excessively. “In ADHD, mind wandering is

and severe enough to cause impairment are seen in up to

spontaneous and poorly controlled. Thoughts are ‘on the

80% of adults who had ADHD as children.”

go’ all the time, jumping from one topic to another, with multiple thoughts at the same time.” TREATMENT “The types of drugs which reduce ADHD symptoms work on two main neurotransmitter systems – the dopamine system and the noradrenergic system. The stimulants, which give the biggest effect sizes in the treatment of ADHD, target both neurotransmitters. They bring about direct release as well as blocking reuptake (of the neurotransmitter) and have an immediate effect,” he says. Prof Asherson emphasises that treatment with stimulants should be carefully titrated to each patient, based on individual response. CONCLUSION “In most cases ADHD is a treatable adult mental health condition. Missed or mistaken diagnosis is however common, related to the overlap of symptoms with other disorders, and the limited training and experience of treating ADHD for many adult healthcare professionals,” says Prof Asherson. Medical treatments such as stimulants are effective and go beyond core ADHD symptoms to include symptoms such as emotional instability, and lead to improved behaviour and function. Effective care pathways need to be developed in both primary and secondary care to recognise and treat Adult ADHD.

10

| AUGUST 2017

Pharmacy Magazine


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REPUTATION. CONSISTENCE. CONFIDENCE. RESPONSIBLE. HOPE. COURAGE. JANSSEN PHARMACEUTICA (PTY) LTD, (Reg. No. 1980/011122/07), Building 6, Country Club Estate, 21 Woodlands Drive, Woodmead, 2191. www.janssen.co.za. Medical Info Line: 0860 11 11 17. PHZA/CONC/1116/0003


Children in daycare are more likely to be exposed to respiratory and gastrointestinal infections 1 Benefits of Essential Nutrients for Growing Children: Nutrient

Benefit

Lactobacillus rhamnosus

Supports pp growth g of lactic acid bacteria (LAB) ( ) in the e gutt

Zinc

Normal cognitive and immune function 3

Calcium

Bone strength 3,4

Vitamin A

Normal vision, growth and immune system function 3

Vitamin C

Wound healing, tissue repair, maintenance of teeth and bo ones 5

Vitamin D

Bone growth and muscle function 3

Vitamin E

Antioxidant protection from tissue damage 3

ALA & DHA*

Brain growth and development, and eye health 6

Promotes immune response against respiratory trract ct inffections 2

* ALA = Alpha linolenic acid; DHA = Docosahexaenoic acid IMPORTANT NOTICE: The World Health Organisation (WHO) recommends exclusive breastfeeding during the first 6 month hs o of liffe e and and contin continued ued bre breastfeeding eding for as long as p possible. As babies grow at different paces, health professionals should advise the mother on the appropriate time when her baby y shou should ld start start rec ceiving complementary foods. References: 1. Lu N, Samuels ME, Shi L, Baker SL, et al. Child day y care e risk riskss of com common infectious diseases revisited. Child Care Health Dev. 2004;30(4):361-8. 2. Hat Hatakka akka a K, Savi Savilaht la i E, E Pönkä A, Meurman JH, et al. Effect of long ng term term cons consumpt umptiion of probiotic milk on infections in children attending day care centres: double blind,, random ndomised ised tri trial al. BM BMJ. 2001;322(7298):1327. 3. WHO. Joint FAO/ WHO Expe Expert rt Consu Consultat ltatiion on Human Vitamin and Mineral Requirements. Second edition. Vitamin and miner ineral al requi requireme rements nts in i human h man nutrition: report of a joint FAO/WHO exper expert consultatio atio ion, n, Bangk Bangk g ok, ok Thailand, 21-30 September 1998. 4. Calcium. Healthcare professional factsheet. U.S U.S.. Depart Department ment off Health & Human Services. N National i l IInstitutes i utes off H Health. Heal lth. h A Availlable Avai labl ab ble o onliline ne at http htt ht ttp ps://ods. / s od.nih.gov/ g factsheets/Calcium-HealthProfessional// [accessed 26 June ne 2017] 2017]. 5. Vit Vitamin C. Healthcare profe ro ssional factsheet. U.S. S. Depa Departme rtment nt of of He ealth th & Huma Huma uman Service ces. s National Institutes of Health. Available ble online at https://ods.od.nih.g p ih.gov/f gov/facts actsheet heets/Vi /Vi V taminC-HealthProfessional// [ac [access cessed ed 26 26 June June 2017] 2017].. 6. Kur Kuratko atko o CN CN, Bar Barrett rett EC EC, Nelson N l EB, Norman S. The Relationship of Docosa EB cosahexa hexaenoi enoic Ac A id (DHA) A) with th Learning Lea a g and and Behavi Behavio or in Health Healthyy Childr Children: en: A Review Review. Nutr Nutrient ients. 20 2013;5(7): ):2777 2777-281 -281 2810 0. N lé South Africa, July 2017, 906945. Nest


EDUCATION

CHILD

HEALTH

Establish healthy lifestyle habits young

MONTH

Family life presents the ideal environment for implementing healthy lifestyle changes

M

any adults today carry the burden

Parents shouldn’t underestimate the daily

of unhealthy habits established in

vitamins their children require. These are vital for

childhood, and find it extremely

healthy growth and development. Their diets

difficult to break the pattern of too

should contain a wide variety of fruits, vegetables,

little exercise in combination with poor diet. Parents

cereals, proteins, and dairy foods. Due to their

are perfectly placed to help pre-empt these problems

relatively smaller stomachs, children cannot eat large

for their children.

amounts of food at one sitting. Aside from the main

“A significant proportion of the health conditions

three meals of the day, it is beneficial to introduce a

affecting adults arise as a result of the choices we

mid-morning and mid-afternoon nutritious snack.

make from a young age. Lifestyle diseases – in

An easy way to support children’s diet is by including

particular cardiovascular disease, type 2 diabetes,

a probiotic-rich, fortified drink that will aid in closing

and certain types of cancer – can largely be avoided

the nutritional gap that table foods might not fulfil,

if an understanding of the importance of healthy

especially in the case of a toddler that may not be

behaviours is established during early childhood,”

easting as well as they should.

says Dr Jacques Snyman, director of product development at Agility Health. “Our lifelong relationship with food begins when

Snyman highlights that the key risk factors for non-communicable diseases are physical inactivity, an unhealthy diet, and smoking. “These are all

babies are weaned off mother’s milk and introduced

avoidable lifestyle choices, all the more so if healthy

to the flavours and textures that will provide us with

habits are formed in childhood.

nourishment for the rest of our lives. During childhood

“Above all, children learn health-related

we should also learn a pattern for mealtimes and what

behaviours through imitating their parents.

constitutes an appropriate snack, as these ideas and

If you want your child to grow up to be a

behaviours are likely to carry through to adulthood.

healthy adult, it is important to set them

“We learn food preferences from our parents,

a good example. A number of

although there is evidence to suggest that humans

studies have suggested,

are biologically programmed to crave sweet and

for example, that children of

high-fat foods. This is probably to do with the fact

parents who smoke

that such foods were not as readily available to our

cigarettes are more likely

ancestors and which they were more likely to burn

to pick up the habit

off, as their lifestyles were generally more active

themselves and be heavier

than ours are today.”

smokers, compared to

Children are therefore more likely to develop a taste for high-calorie foods and can soon become fussy eaters if these unhealthy food preferences are indulged

Too many South African families opt for convenience foods without considering what such foods do for their sustained mental and physical energy levels

children of non-smokers,” Dr Snyman explains. Continued on next page...

too often. “If children are given sweets and biscuits as snacks between meals, they will often fill up on these and refuse to eat nutritious meals prepared for them. “Sadly, in our busy working lives, too many South African families opt for convenience foods without considering what such foods do for their sustained mental and physical energy levels, not to mention their long-term health,” Dr Snyman adds. “It is important to keep in mind that complex carbohydrates, to be found in unrefined whole grain products, sustain the cognitive functions that support memory function far better than simple carbohydrates, such as those found in sugar or white bread. This can have a major impact on children’s performance at school.”

Pharmacy Magazine AUGUST 2017 |

13


EDUCATION

CHILD

HEALTH

MONTH

Children are more likely to develop a taste for high-calorie foods and can become fussy eaters if these unhealthy food preferences are indulged too often

10 tips “Through encouraging healthful eating and exercise habits, you are not only equipping them for a healthy life, but you will also feel the benefits yourself – and these positive lifestyle changes might mean that you have more years of quality life with your children. They might cry and nag for sweets now, but they will thank you for it in the long run,” he observes. Resolution Health Medical Scheme’s Principal Officer, Mark Arnold, says that family life presents the ideal environment for implementing healthy lifestyle changes.

dieticians recommend to help children lead a healthy lifestyle:

1

Introduce children to staple foods with a low glycaemic index such as whole wheat or rye

bread, brown rice, oats, beans, or chickpeas. These will give your whole family more sustained energy.

2

Give your child a taste for fresh fruit and vegetables, chopping them into more

manageable slices or bite-sized chunks. These

Resolution Health, which is administered by Agility Health

great-tasting snacks supply the body with

and is one of South Africa’s largest medical schemes,

essential micronutrients.

has long recognised the value of preventative care, for individuals as well as for families. “What better motivation for sustained efforts to improve our health than the wellbeing of the people who are closest to us? It is also easier to stick to our resolutions if we have support and can see the positive effects of balanced diet and regular exercise in our loved ones. If the whole family embraces this winning combination, in the long run this represents the best assurance of better quality of life for longer,” Arnold concluded.

3 4 5

Teach your child that breakfast is the most important meal of the day. Lead by example

and never skip breakfast. Liven up school lunchboxes with healthy snacks, such as nuts or dried fruit. Junk foods are high in refined carbohydrates and sugar, which give short-lived energy

boosts but are followed by feelings of sleepiness and poor concentration. These foods should be given to children only in moderation.

6

Avoid giving your children sugar-laden cakes and sweets, as the addictive

“sugar high” soon gives way to a “sugar crash”. Also consider the affect this may have on your child’s behaviour at school before including sugary treats in the lunchbox.

7

Do not allow your children to develop a taste for fizzy drinks, as these contain acids

and large quantities of sugar that promote tooth decay. Rather, encourage your children to drink plenty of water and milk.

8

Do not introduce your child to caffeinated beverages, such as coffee or cola, as these

can make your child feel twitchy and anxious. Remember that like sugar, caffeine is addictive. It also has a more pronounced effect on children.

9

Never bribe or reward children with food. This may establish a psychological

relationship with food that can be very difficult to break in later life.

10

Introduce sports and exercise as a regular family activity, associated

with fun and togetherness to help establish a lasting positive relationship with physical activity. Exercise gets the blood pumping and supplies the brain with additional oxygen, which is highly beneficial for schoolwork and behaviour.

14

| AUGUST 2017

Pharmacy Magazine


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www.impo.co.za

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EDUCATION

Know your products

Focus on kids With their smaller bodies and unique physiologies, children have different healthcare needs to adults. The aim of Child Health Month is to increase public awareness of the value of preventive healthcare for children. We look at three products specially engineered for children

Eating fruit and vegetables every day helps children and teenagers grow and develop, boosts their vitality and can reduce the risk of many chronic diseases - such as heart disease, high blood pressure, some forms of cancer and being overweight or obese 16

| AUGUST 2017

Pharmacy Magazine


EDUCATION

{

56% of primary and 80% of secondary school students do not eat the recommended daily amount of vegetables

S0 PRODUCT:

S0

Calpol Paediatric Suspension ®

{

Calpol® Paediatric Suspension is indicated for effective relief of pain and fever, teething pains, toothache, sore throats, and headaches.

MONTH

Hydroxybenzoate and 0.02% m/v Propyl Hydroxybenzoate Sugar (per 5ml): 2ml Hydrogenated glucose syrup, and 0.75ml Sorbitol solution.

INDICATION:

CHILD

HEALTH

S0

DOSAGE: · 3-6 months (average weight 6-8kgs): 3.75ml · 6-24 months (average weight 8-12kgs): 5ml

S0 PRODUCT:

Floradix Kindervital® for children

· 2-4 years(average weight 8-12kgs): 7.5ml · 4-6 years (average weight 8-12kgs): 10ml

INDICATION:

INGREDIENTS:

· Infants under 3 months: Not recommended

Floradix Kindervital® is a liquid

Each 5 ml contains: Paracetamol 120mg

www.calpol.co.za

multivitamin and mineral formula

Preservatives: 0.1% m/v Methyl

011 745 6000

for children. Young and old alike can benefit from the essential vitamins which help to maintain health and vitality, together with Calcium – so vital for strong bones and teeth and many other important biological processes. INGREDIENTS: Aqueous Herbal Extract (43.4%) from:

S0

Carrot Root (Daucus Carota), Anise Fruit (Pimpinella Anisum), Watercress Herb (Nasturtium Officinale), Coriander Fruits (Coriandrum Sativum), Nettle

S0 PRODUCT:

Leaf (Urtica Dioica), Spinach Leaf

ADDvance Child – Memory and Concentration Capsules

(Spinacia Oleracea), Camomile Flower

(Matricaria Recutita). Mixture of fruit juice concentrates (27%) of: Pear, orange, grape, water,

INDICATION:

carob extract, acerola, lemon, apple.

ADDvance™ Child is indicated

Maple Syrup, Malt Extract from Barley,

as a supplement to support

Calcium Lactate, Calcium Gluconate,

concentration, memory, and

Aqueous Rosehip soft extract (Rosa

learning in all children.

Canina) containing 4% Vitamin C,

INGREDIENTS: Each capsule contains 250mg Fish Oil (containing 15mg EPA AND 87.5mg DHA), 3.3µg Vitamin D, 2.2µg Vitamin E, 29mg Vitamin C.

Thickener: Carob Gum. Vitamin C (Ascorbic acid), Natural Flavour, Nicotinamide (Niacin), Vitamin E (as D-Alpha-Tocopheryl Acetate). Vitamin B6 (as Pyridoxine Hydrochloride), Riboflavin (as Riboflavin Sodium Phosphate), Thiamin (as Thiamine

DOSAGE:

Hydrochloride), Vitamin A (as Retinyl

Children and Adults:

Palmitate), Vitamin D (Cholecalciferol),

First 3 months: Chew or swallow

Vitamin B12 (Cyanocobalamin).

4 capsules daily – all at once or split into 2 capsules twice daily. Maintenance dose: Chew or swallow 2 capsules daily – all at once or split into 1 capsule twice daily.

DOSAGE: Take one multivitamin and mineral tablet and one omega-3 soft gel capsule daily with a meal, as directed by your healthcare provider. Do not exceed the recommended dose.

www.adcock.co.za

www.peppina.co.za

080 011 3844

011 314 0445

Pharmacy Magazine AUGUST 2017 |

17


Your baby’s needs change, so should your supplements.

Introducing CHELA-PREG™ TRIMESTER

Trimester 1

RANGE Individualised micronutrition for each unique stage of pregnancy. South Africa’s most compliant pre-natal supplement in terms of international best practice recommendations by the Institute of Medicine, World Health Organisation and United Nations.

Specially formulated for the 1st trimester of pregnancy with 25 micronutrients, including 10 often-ignored nutrients that are essential for optimal growth and development of placenta and foetus, including: DHA omega-3 to boost mother’s red blood cells and for placental development.1 Extra vitamin B6 to help reduce morning sickness.2 Gentle non-constipating chelated iron, Ferrochel®, for the formation of extra red blood cells to carry more oxygen in preparation of baby’s metabolic needs.3 Quatrefolic®, a natural 5-MTHF folate form of folic acid, which is better absorbed, is more effective for more people and is essential for spinal cord closure (neural tube development).4

FPM_9823/E

No vitamin E, which is best avoided in the 1st trimester.5 References: 1.https://www.ncbi.nlm.nih.gov/pubmed/19500960 2.https://www.ncbi.nlm.nih.gov/pubmed/7573262 3.https://www.ncbi.nlm.nih.gov/pubmed/1799918 4.http://www.gnosis-bio.com/pdf/White%20paper.pdf 5.http://www.telegraph.co.uk/news/health/news/5112656/Vitamin-E-can-increase-the-risk-of-heart-defect-in-babies.html 6.http://www.fao.org/3/a-i1953e.pdf 7.https://americanbonehealth.org/tools-and-resources/bonesense-newsletter/457-the-importance-of-calcium-during-pregnancy

A first to market innovation in SA

Ascendis Supply Chain (Pty) Ltd Consumer care line / Verbruikersnavraelyn: T: 011 036 9420 E: healthinfo@ascendishealth.com W: www.ascendis.co.za


Trimester 2

Trimester 3

Specially formulated for the 2nd trimester of pregnancy with 26 micronutrients that are essential for tissue and organ differentiation and development, including:

Maximal micronutrition for rapid growth during the 3rd trimester of pregnancy with 26 micronutrients, including:

Extra DHA omega-3 to support baby’s brain and nervous system development.6 Additional calcium for skeletal development.7 Vitamin E, extra vitamin C, choline and zinc for organ and tissue growth.8 More Ferrochel®, a gentle non-constipating chelated iron, for the formation of additional red blood cells to carry more oxygen to meet baby’s growing metabolic needs.3

Maximal amounts of calcium for strong bones, and DHA omega-3 for brain growth and for future health, immunity and intelligence.9 Extra Ferrochel®, a gentle non-constipating chelated iron, for the formation of extra red blood cells to carry more oxygen to meet growing baby’s high metabolic needs.3 More choline, a nutrient most important in the 3rd trimester, for baby’s health and to help prevent diseases later in life.10 Extra zinc, vitamin C and vitamin E to support rapid 3rd-trimester cell division and tissue growth, and to reduce the risk of pregnancy complications.11

8.http://www.nature.com/ejcn/journal/v58/n10/full/1601976a.html 9.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621042/ 10.https://www.eurekalert.org/pub_releases/2014-01/epr-nss012814.php 11.http://www.fao.org/3/a-y2809e.pdf More information on ingredients available on request. This medicine has not been evaluated by the Medicines Control Council. This medicine is not intended to diagnose, treat, cure or prevent any disease. Health supplements are intended only to complement health or supplement the diet.

A PROUD BRAND OF


Feeling trapped by constipation?

Free Yourself S0 Duphalac SyrupÂŽ & Duphalac DryÂŽ. Composition: 5ml of Duphalac Syrup contains lactulose 3,3 g. 10 g of Duphalac Dry contains 10 g lactulose. Pharmacological Classification: A. 11.5 Laxatives. Reg.No. K/11.5/180; 28/11.5/0427. Name and business address of license holder: Abbott Laboratories S.A. (Pty) Ltd. Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel: (011) 858 2000. Reg No. 1940/014043/07. For full prescribing information refer to package insert approved by the Medical Regulatory Authority. Date of publication of this promotional material: January 2017. Promotional Material Reference Number: Duphalac - ZAEDULAC160217. www.duphalac.com


STUDY EDUCATION

{

{

WOMEN'S

MONTH

Research shows that obesity contributes to health risks such as cardiovascular disease, cancer, diabetes, osteoarthritis, and chronic kidney disease

Shocking results from a new study by the University of Washington reveal that almost half of SA women are obese

SA women are obese

A

t 42% SA women have the highest obesity rate in

In sub-Saharan Africa, the highest obesity rates (42%)

sub-Saharan Africa, according to a recent study.

are seen among SA women.

About 14% of men and almost 9% of SA children

are also considered obese, the study shows.

Topping the list of obese nations is Egypt at 35%, while the

lowest rates are in Bangladesh and Vietnam at 1% of adults. SA has an average 30% obesity rate among adults (10 million). The study by the University of Washington – which is the

Overweight is defined as having body mass index (BMI) or weight to height ratio greater than or equal to 25 and lower than 30 while obese is defined as having a BMI equal to or greater than 30. Research shows that obesity contributes to health risks such as cardiovascular disease, cancer, diabetes,

most comprehensive research on global obesity to date –

osteoarthritis, and chronic kidney disease. If left unchecked,

found that just over 30% of the world’s adult population are

obesity may lead to a decline in life expectancy.

either obese or overweight leading to widespread health

SA health and wellness expert, Vanessa Ascencao, says all South Africans should review their lifestyles and

problems and millions of premature deaths. According to the study, globally, more than two billion

diets and follow a plan aimed at good health. “Follow a

children and adults suffer from health problems related

diet rich in fruit, vegetables, and lean protein, choose

to being overweight or obese and an increasing

quality health supplements, eliminate toxins, sugar,

percentage of people die from these health conditions.

and processed foods,” she said.

{

Health & Wellness expert’s tips for great health and to get into shape:

Eat a wellbalanced diet and pursue a healthy lifestyle

Start the day with a nourishing breakfast to help keep blood sugar levels balanced

Do not overeat. Aim for three well-balanced meals a day

Increase intake of low GL fruit, vegetables, healthy fats like seeds, nuts, avos and natural whole foods

Patients should review their lifestyles and diets and follow a plan aimed at good health

{

Avoid fried, salty or sugarloaded foods, coffee, tea and carbonated soft drinks

Drink lots of water and exercise regularly

Choose quality health supplements that will help boost health and aid weight loss

Pharmacy Magazine AUGUST 2017 |

21


INTRODUCING SOLAL® VITA PQQ (Pyrroloquinoline Quinone)

THE

“HEALTHY AGING” VITAMIN ABOUT VITA PQQ Naturally occurring in some foods, PQQ was discovered in 1948. It acts as a catalyst, to rejuvenate and generate new mitochondria, providing the cells of the body with the energy needed for life itself. This energy is also needed to repair and rejuvenate DNA and other cellular structures, and to optimise brain function and energy supply to the body. This is why we say that Vita PQQ is the ultimate healthy aging vitamin, because it supplies molecular energy that cells need to survive, revive and thrive. WHY SUSTAINED RELEASE? Vita PQQ is in a micronized, sustained-release matrix.

Since Vita PQQ is released over time it stays in the blood longer – it’s therefore active longer than regular PQQ. In fact, a human study showed that the sustained release PQQ contained in Vita PQQ is more bioavailable than regular PQQ and has a sustained release for continuous cellular energising and rejuvenation. WHEN CELLS DON’T GET ENOUGH ENERGY THEY DIE Degradation of energy-producing mitochondria is a key contributing factor to aging, since cells age more quickly and die prematurely if they are starved of the energy they need for life. Therefore, Vita PQQ may slow the aging process, with the added benefit of increased energy levels of the body and brain at the same time. ADDITIONAL BENEFITS OF PQQ Scientific research has shown that PQQ: • Protects nerve cells • Improves cognitive function • Alleviates stress and sleeplessness

IS PQQ SAFE AND NATURAL? PQQ is a safe, naturally occurring essential nutrient found in foods such as green peppers, tofu and green tea. It has been the subject of numerous safety studies, in both humans and animals, and has been found to be safe within the prescibed dosage regiment. Unfortunately foods don’t supply the PQQ dosage needed to provide the many benefits described here. Furthermore, the processing of modern foods strips many foods of PQQ. This means that supplementation is important if you want to your cells to optimally survive, revive and thrive.


EDUCATION CUT& OUTEP KE

Source: www.womens-health-concern.org

WOMEN'S

MONTH

MORE THAN A BAD HAIR DAY Menopausal hair loss can be upsetting and cause anxiety, but is not usually a sign of an underlying medical disorder, unless accompanied by other symptoms

T

he average age

hairs are brushed away.

WHY DOES IT HAPPEN?

of the onset of

Some women will go on to

FPHL is very common and increases with age and varies

menopause is

experience a more profound

across ethnic groups. Although it can happen at any age,

around 50 and in

hair loss, with thinning at the

the condition occurs most commonly following menopause.

the months or years leading

crown of the head, the sides

This does not mean that hormones alone are to blame,

up to this, some women

or more general hair thinning

although oestrogen may have a protective role, helping

notice a change in hair

all over the head. This is

to keep hair in the ‘growing phase’.

pattern. Very commonly, the

described as female pattern

Age itself is a factor and while women can take care of

volume and condition of the

hair loss (FPHL). A complete

their hair cosmetically, it is one aspect of the ageing process

hair appears to worsen, with

loss of hair, as seen in men

we cannot always control. Genetics are important too and you

some women noticing that

who sometimes go bald,

may notice a family link with both male and female hair loss.

hair does not grow as much

is much rarer in women

as previously. More hair

and is usually caused by

influence hair growth, e.g. illness, emotional stresses, and

seems to come out in the

a medical condition or by

crash dieting. Some medications may have an influence too.

basin when washing and hair

medical treatment such as

brushes soon fill up as loose

chemotherapy.

Occasionally times of acute stress on the body will

IS SOMETHING WRONG? Most women, who notice hair loss around the time of the menopause, do not have anything medically wrong.

}WHEN TO SEEK HELP} Advise patients to consult their doctor if they:

Are losing hair in an unusual pattern

Are losing hair rapidly or at an early age (for example, in their teens or twenties)

Have any pain or itching with the hair loss

The skin on their scalp under the involved area is red, scaly, or otherwise abnormal

Have acne, facial hair, or an abnormal menstrual cycle

Have additional symptoms which concern you

Pharmacy Magazine AUGUST 2017 |

23


Trusted pain and fever relief for the whole family. BRUFEN® ask for it by name.

S1 BRUFEN® 200. 10’s & 20’s: Each tablet contains 200 mg ibuprofen. Reg. No.: A/3.1/727. S1 BRUFEN® 400 EXTRA STRENGTH. Each tablet contains 400 mg ibuprofen. Reg. No.: H/3.1/39. For full prescribing information refer to the package insert approved by the Medicines Regulatory Authority. Further information is available on request from the holder of the registration. Abbott Laboratories S.A. (Pty) Ltd. Co. Reg. No. 1940/014043/07. Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel: (011) 858 2000. Date of publication of this promotional material June 2017. Promotional material number ZAEBFN170112.


EDUCATION Source: Medscape WOMEN'S

MONTH

Dysmenorrhoea: pharma options To date, pharmacotherapy has been the most reliable and effective treatment for relieving dysmenorrhoea

{

NSAIDs and combination oral contraceptives (COCs) are the most commonly used therapeutic modalities for the management of primary dysmenorrhea

D

{

ysmenorrhea refers to the symptom of painful menstruation. It can be divided into two broad

categories: primary (occurring in the

absence of pelvic pathology) and secondary (resulting from identifiable organic diseases). PHARMACOLOGIC THERAPY Treatment of primary dysmenorrhoea is directed at

menstrual pain by decreasing intrauterine pressure and

providing relief from the cramping pelvic pain and

lowering prostaglandin F2� (PGF2�) levels in menstrual

associated symptoms (e.g., headache, nausea, vomiting,

fluid. NSAIDs that inhibit type I prostaglandin synthetase

flushing, and diarrhoea) that typically accompany or

and suppress production of cyclic endoperoxides (e.g.,

immediately precede the onset of menstrual flow.

fenamates, cyclooxygenase [COX]-2–selective agents,

The pelvic pain can be distressing and occasionally

propionic acids, and indole acetic acids) alleviate

radiates to the back and thighs, often necessitating

symptoms by decreasing endometrial and menstrual

prompt intervention. Because the pain results from

fluid prostaglandin concentrations.

uterine vasoconstriction, anoxia, and contractions

If taken early enough and in sufficient quantity, NSAIDs

mediated by prostaglandins, symptomatic relief

are extremely successful in alleviating menstrual pain.

can often be obtained by using agents that inhibit

Because they are used for short periods in otherwise

prostaglandin synthesis and possess anti-inflammatory

healthy young women, they are generally well tolerated

and analgesic properties.

and free of serious toxicity.

NSAIDs and combination oral contraceptives

Gastrointestinal (GI) upset is the most common

(COCs) are the most commonly used therapeutic

adverse effect associated with NSAIDs, and patients

modalities for the management of primary

receiving these medications should be monitored for

dysmenorrhea. These agents have different

more serious adverse effects, including GI bleeding and

mechanisms of action and can be used adjunctively in

renal dysfunction.

refractory cases. Lack of response to NSAIDs and COCs

Patients should also be monitored for potential

(or a combination thereof) may increase the likelihood of

pharmacokinetic and pharmacodynamic drug

a secondary cause for dysmenorrhoea.

interactions and possible effects on platelet aggregation.

Treatment of secondary dysmenorrhoea involves

If taken early enough and in sufficient quantity, NSAIDs are extremely successful in alleviating menstrual pain

NSAIDs are contraindicated in patients with renal

correction of the underlying organic cause. Specific

insufficiency, peptic ulcer disease, gastritis, bleeding

measures (medical or surgical) may be required to treat

diatheses, or aspirin hypersensitivity. These agents must

pelvic pathologic conditions (endometriosis) and to

be used on a regular basis (as needed use is not adequate

ameliorate the associated dysmenorrhoea. Periodic use of

in most patients) for several days. To avoid inadvertent

analgesic agents as adjunctive therapy may be beneficial.

exposure to these agents during early pregnancy, NSAIDs should be started at the onset of menstrual bleeding.

NONSTEROIDAL ANTI INFLAMMATORY DRUGS

Aspirin may not be as effective as these NSAIDs, and

NSAIDs are the most common treatment for both

acetaminophen may be a useful adjunct for alleviating

primary and secondary dysmenorrhea. They decrease

only mild menstrual cramping pain.

Pharmacy Magazine AUGUST 2017 |

25


ACHES AND PAINS

IN THE MUSCLES AND JOINTS?

® IBUPROFEN GEL Inflammation Muscle Pain Joint Pain

Brought to you by Mentholatum – the makers of Deep Heat® - the company with a proven history in pain relief and market leaders in the production of topical analgesics.

TARGETED PAIN RELIEF 1

WHAT IS DEEP RELIEF®? Deep Relief is a powerful pain and inflammation relieving gel. Deep Relief gel formulation contains 5% Ibuprofen and 3% Menthol, it forms part of a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).

WHY IS DEEP RELIEF® DIFFERENT? Deep Relief is the only Ibuprofen Gel available on the South African market.(2) The Deep Relief formulation has penetration enhancers which speed up the absorption of Ibuprofen through the skin directly to the point of pain in the muscles and joints. Deep Relief specifically targets the Prostaglandins which cause pain and inflammation, acting right at the source of the problem. Only Deep Relief combines the powerful pain-relieving action of Ibuprofen with the immediate cooling sensation of menthol. You will feel Deep Relief the moment you apply it.

WHEN SHOULD DEEP RELIEF® BE USED? Deep Relief is recommended as a topical anti-inflammatory and analgesic intended for the symptomatic relief of acute painful musculo-skeletal conditions caused by trauma such as sports injuries, sprains, strains and contusions.

Deep Relief is available in 25g and 50g

(1) Green S, Buchbinder R, Bransley L., Halls S, White M, Smidt N, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults (Cochrane Review). The Cochrane Library 3.2004. (2) Database of Medicine Prices 27th May 2017. S1 Deep Relief Gel. A 3.1. Each 1 g Gel contains: 50 mg of Ibuprofen. Registration number 29/3.1/0654. Marketed under licence from Mentholatum South Africa (Pty) Ltd. Unit G1, Westlake Square, 1 Westlake Drive, Tokai, 7945. For full prescribing information, refer to the package insert approved by the Medicines Regulatory Authority.

www.deepheatsa.co.za


EDUCATION

Cervical cancer and HPV: education is vital

WOMEN'S

MONTH

Cervical cancer is not something that happens to “other women only”. 18.81 million SA women over the age of 15 are at risk

T

he subject of cervical cancer has not

and it is recommended that girls as young as nine get

received nearly as much attention as other

vaccinated. However, it is never too late to get the

life-threatening illnesses affecting women,

injection, even though you may have come into contact

says Dr Thandi Mtsi, a gynaecologist and

with some of the HPV strains.

obstetrician practising at Netcare Park Lane Hospital

“The gold standard these days is the HPV test

in Parktown, Johannesburg.

which checks for the virus that can cause these cell

“And yet, according to a recent report of the HPV

changes on the cervix. It may be used to screen for

Information Centre, as many as 7 735 South African

cervical cancer together with the Pap test and may

women are diagnosed with cervical cancer every

also be used to provide more information when the

year while 4 248 lose their lives annually because of

results of a Pap smear are unclear. The HPV test is

the disease,” she adds.

unfortunately not yet widely available and is also costly,” says Lohlun.

The Human Papillomavirus and Related Disease Report published by the ICO HPV Information Centre

Continued on next page...

The primary role of HPV vaccination is to protect women against cervical cancer

on HPV and Cancer last year, indicated than 18.81 million South African women, over the age of 15 are at risk of cervical cancer. “Given that approximately 80% of women will be exposed to the human papilloma virus (HPV) in their lifetime, this is clearly not something that happens to ‘other’ women only. These statistics are all the more disconcerting when one considers that cervical cancer is nowadays a preventable disease,” says Mtsi. “With the aid of annual Pap smears and timeous vaccination against the cancer-causing human papillomavirus, a sexually transmitted infection, cervical cancer should have been totally eradicated by now. “However, because of the incorrect perception that sexual promiscuity lies at the heart of this disease, it has been a difficult issue to tackle. Also of great concern, is the fact that girls are nowadays exposed to the virus at a younger age. “Vaccinations against HPV became part of the national vaccination programme in 2014 when SA became the first African country to fund cervical cancer vaccines for schoolgirls. While awareness of the importance of the Nobel Prize-winning HPV vaccine has grown, take-up has sadly been slow,” says Mtsi. According to Dr Kim Lohlun, an oncologist at Netcare Olivedale Hospital, despite the fact that cervical cancer is a preventable disease, it causes more deaths in South African women than of any other type of cancer. “Vaccination against HPV is highly effective, but it is best to be vaccinated before becoming sexually active

{

HPV types 16, 18, 31, 33, and 45 are the five most frequent cancer-causing HPV types, and are responsible for over 82% of cervical cancer cases globally

{ Pharmacy Magazine AUGUST 2017 |

27


EDUCATION

HPV types 16 and 18 are the most common cancercausing virus types and account for over 70% of all cervical cancer cases globally

“Young women in their teens or early 20’s carry

“If you can protect yourself from getting an HPV

the highest rates of HPV infection. However, these

infection, your chances of developing cervical cancer

are mostly cleared by the immune system. A positive

are miniscule,” says Mtsi.

HPV test in an older women is more likely to indicate persistent infection and this puts her more at risk of

HOW IS THE HPV TRANSMITTED?

developing cervical cancer.”

The virus is transmitted through sexual contact and in

“At the advent of the HIV/AIDS outbreak, people

rare cases from a mother to her newborn baby, explains

were very hesitant to talk about the disease, the HI virus

Mtsi. Because the virus is not carried by bodily fluids but

and how it is transmitted. With the introduction of

is transferred by contact, having protected sex will not

anti-retroviral treatment, which essentially rendered

give 100% protection against becoming infected. This

HIV infection a manageable ‘chronic disease’, this

also means penetration does not have to take place

stigma was greatly reduced. In the same way, we now

before the HPV is transmitted – rubbing against your

need to get discussions going on and spread awareness

partner can be enough to contract the virus.

of HPV and cervical cancer. South Africans need to know that there is no shame in discussing this

WHAT IS THE LINK BETWEEN THE HPV AND CERVICAL CANCER?

condition openly,” notes Lohlun.

The high-risk HPV virus types are responsible for WHAT IS THE HUMAN PAPILLOMA VIRUS?

virtually all cervical cancer, which is cancer of the cervix,

The human papilloma virus (HPV) is a double-stranded

the small canal between the womb and the vagina.

DNA virus. Up to 80% of sexually active women will

The more a woman comes into contact with the

acquire an HPV infection in their lifetime, with the risk of

HPV, the greater her chances are of developing cervical

persistence increasing with age.

cancer. “When your cervix is scarred from frequent

Approximately 100 types of HPV have been

infection, your cervical cells multiply to heal themselves.

identified to date and, of these, nearly 15 virus types

However, abnormal cells can multiply out of control

are considered to cause cervical cancer. Together the

as a result of the HPV infection and can cause

highest-risk virus types 16 and 18 are responsible for

pre-cancerous cervical lesions, which ultimately cause

over 70% of cervical cancers globally.

cervical cancer,” explains Mtsi.

{ The stages of cervical cancer {

{

Cervical cancer is caused by a virus called human papilloma virus, which is transmitted through sexual activity

{

WHAT ARE THE SYMPTOMS OF CERVICAL CANCER? According to Mtsi, there are no early symptoms for cervical cancer. “The first symptoms only appear as the disease progresses. Women should, however, look out for pain during sex, any change in their menstrual periods, an increased vaginal discharge, and any abnormal vaginal bleeding,” she advises. According to Lohlun cervical cancer can be difficult to treat if it is diagnosed at a late or advanced stage. If caught early, however, the disease can be very effectively treated. “This is why screening is so important. Treatment is either surgery or chemo-radiation, depending on how advanced the cancer is.”

28

| AUGUST 2017

Pharmacy Magazine


• To prevent and treat vaginal infections1

Betadine® Douche Internal use

Betadine® Vaginal Gel

ZA/128/BFH/072017/SA

Internal and/or external use

1. Approved package insert 2. Kanagalingam J., et al (2015). Int J Clin Pract, November 2015;69(11):1247-1256. S2 Betadine® Douche. Each 1 ml contains povidone-iodine 100 mg, equivalent to 10 mg available iodine. Registration No. C/18.6/143. S2 Betadine® Vaginal Gel. Each gram contains povidone-iodine 100 mg, equivalent to 10 mg available iodine. Registration No. C/18.6/144.

For full prescribing information refer to the package insert approved by the medicines regulatory authority. For further product information contact: Mundipharma (Pty) Ltd 2nd Floor, Mariendahl House, Newlands on Main, Claremont, 7708. PO Box 23162, Claremont, 7735, South Africa. Tel: +27 21 671 5251 | Fax: +27 21 671 5216

www.betadine.co.za


EDUCATION HEALTH & WELLNESS

Feminine touch 30

| AUGUST 2017

Pharmacy Magazine


EDUCATION HEALTH & WELLNESS Women’s Month is all about celebrating the women in our lives: mothers, sisters, daughters, aunts, and girlfriends with uniquely special needs, here are 8 products engineered for women

{

WOMEN'S

MONTH

{

FRESH CONFIDENCE:

EVERYDAY COMFORT:

Femolene Ultraberry

GynaGuard intimate wipes

Kotex® Everyday Panty Liners

Femolene Ultraberry

Use GynaGuard

Kotex® Everyday

is the most potent and

intimate wipes to

Panty Liners are super

effective cranberry

delicately cleanse your

supplement for use in

most intimate area,

urinary tract infections.

helping you stay fresh and confident all day.

www.kotex.co.za

FIGHT UTI:

www.gynaguard.co.za

www.femolene.co.za

Consuming fewer than 1 500 calories per day, even in attempts to lose weight, can put women at nutritional risk and can result in malnutrition and poor health

thin for discretion. They have a soft cover and are body shaped for everyday comfort.

GynaGuard intimate wipes has a gentle pH balanced formula to cleanse and refresh.

DAILY SUPPLEMENT SUPPLEMENT:

SOLALWOMAN™ SOLALWOMAN™ is

TIRED LEGS:

SO SENSUAL:

RELIEVE AND SUPPORT:

at last™ for women

Gynaecare

that combines

Antistax® Massage Cream

8 different classes of

Antistax , the leg

micronutrients into

health specialist,

a single supplement

a comprehensive

Inversion® Femme Inversion® Femme

The original, safe,

comprehensive

is the first

vitamin enriched gel

formulation for

all-in-one nutritional

has developed a leg

that enhances orgasm

regulating the

“anti-ageing” food

pack, specifically

massage cream

at last for women

menstrual cycle and

supplement which,

formulated for women.

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It includes natural

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so that you can be

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enhance sex have been added to complete the formula.

Pharmacy Magazine AUGUST 2017 |

31


EDUCATION

The vital role of mucus and phlegm With cold and flu season upon us, it’s worth noting that as much as nobody likes to cough, it can actually be good for you. In order to better understand this, it is important to understand what mucus is, how it is different to phlegm, and the role that both play in our bodies, especially in relation to coughs WHAT IS MUCUS AND WHAT FUNCTION DOES IT SERVE?

producing over a litre of mucus a day. This ensures that

Mucus is the slippery liquid made by our mucus

newly made mucus. Many cells lining the airways have

membranes or mucosa. These membranes line the

long, tail-like hair called cilia, which beat 10-12 times

passageways in our bodies that come into contact with

per second. The mucus blanket rests on top of the cilia,

the outside environment, these include the nose, mouth,

which propel it forward like an escalator. Once mucus

airways, digestive tract, the reproductive tract, the white

reaches the throat, it is swallowed, usually unnoticed, and

part of the eye, and on the inside of the eyelids.

recycled in the stomach. The normal amount of mucus

the protective mucus blanket is constantly supplied with

Mucus is a useful material with important functions in the body. It acts as a thin, protective blanket preventing the tissue underneath from drying out. Without mucus,

Mucus plays an essential role in the maintenance of a healthy body and respiratory tract

produced daily is very effectively handled and cleared by the mucus escalator to prevent it from accumulating. Continued on next page...

the mucosa will be exposed to elements from the outside world, which will cause it to dry out and crack. So mucus serves an important role to keep these tissues healthy. Mucus is also able to trap unwanted substances like bacteria and dust before it gets into our bodies. Furthermore, mucus contains elements of the immune system that kill any invaders it traps.

HOW MUCUS MOVES ALONG THE MUCUS ESCALATOR The respiratory tract is a mucus-making machine,

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The respiratory tract is a mucus-making machine, producing over a litre of mucus a day

{ Pharmacy Magazine AUGUST 2017 |

33


EDUCATION

WHY MUCOLYTICS WORK BEST This is where mucolytics have a key role to play. Mucolytics are useful to alleviate coughing, mucus production and airway obstruction. They break the chemical bonds that hold mucus together in a sticky elastic gel. When the bonds are broken, the mucus becomes less sticky and thick, making it easier to move along the mucus escalator and cough up. This also makes it harder for germs to infect the mucus and cause chest infections. N-Acetylcysteine (NAC) is the most commonly used mucolytic to loosen secretions from the airway. A scientific review has shown that NAC is effective for wet cough with good overall safety in adults and children older than two years. NAC is available as an effervescent tablet and is suitable for children and adults, however the package insert of the product should always be consulted before use. CONCLUSION Mucus plays an essential role in the maintenance of a healthy body and respiratory tract. Infections, irritants, Mucus is able to

PHLEGM: MUCUS ACCUMULATION

and allergies can stimulate mucus overproduction,

trap unwanted

A bad cold or an allergy can throw the body’s

causing large volumes of thick, sticky mucus to

substances like

mucus production into overdrive. This is the body’s

accumulate in the respiratory tract.

bacteria and dust

way to flush away infection, irritants, or allergens.

before it gets into

However, the mucus escalator may not be able to

encouraged, rather than suppressed. N-acetylcysteine

our bodies.

keep up with the increased volume of mucus, or may

(NAC) is a mucolytic that breaks the chemical bonds that

become inefficient due to the stickiness of the mucus.

hold mucus together, making it less thick, less sticky and

As a result, large volumes of thick, sticky mucus

easier to cough up.

accumulate in the airways. Mucus from the lungs is sometimes referred to as phlegm and is produced by the lower airways. A CHESTY COUGH When the mucus escalator can’t keep up, the body deploys other strategies such as coughing. A cough that produces mucus is known as a chesty or wet cough. Unlike a dry cough, a wet cough should be encouraged because it prevents mucus from pooling in the lungs, which can impair breathing and the ability of lungs to fight infection.

A wet cough helps to remove mucus and should be encouraged, rather than suppressed

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Without mucus, the mucosa will be exposed to elements from the outside world, which will cause it to dry out and crack

34

| AUGUST 2017

{

Pharmacy Magazine

A wet cough helps to remove mucus and should be


NEW

BE ON GUARD TREAT AND PREVENT BACTERIAL SKIN INFECTIONS Banogon® Ointment is indicated for the topical treatment of primary and secondary bacterial skin infections caused by Staphylococcus aureus and other susceptible organisms

TREATMENT

INFECTED ECZEMA

INFECTED GRAZES

INSECT BITES

MINOR WOUNDS

MINOR BURNS

PREVENTION

MINOR WOUNDS

CUTS

GRAZES

DOSAGE AND DIRECTIONS FOR USE Children, adults and elderly Apply Banogon® Ointment two to three times a day for up to 10 days, depending on the response Treatment duration should not exceed 10 days

Banogon® Ointment. Reg.No.:43/20.1.6/1139. Contains mupirocin 2 % m/m. For full prescribing information please refer to the package insert approved by the medicines regulatory authority. Pharmacare Limited. Co. Reg. No.: 1898/000252/06. Healthcare Park, Woodlands Drive, Woodmead, 2191. ZAR-FTS-0717-0553 07/17 MEBAN139


EDUCATION

How to effectively treat

acute coughs in children Coughs are common in school age children, occurring 7-10 times a year

A chronic cough lasts more than eight weeks and is usually associated with conditions such as asthma, allergy, post-viral cough, and postnasal drip

COUGH IN CHILDREN Cough is a particularly bothersome symptom that

WHAT IS THE DIFFERENCE BETWEEN A WET AND DRY COUGH?

tends to resolve slowly; half of children recover by

A wet cough is typically chesty and produces mucus.

10 days and 90% by 25 days, suggesting that 10% of

It may be difficult to be sure if a young child has a wet

children still cough 3-4 weeks after falling ill.

cough because most young children tend to swallow the

Although cough is an important reflex defence mechanism to protect a child’s lungs and keep them

mucus, which they often vomit later. A dry cough is tickly or irritating and no mucus is produced.

clear, it can have a major impact on a child’s sleep, school performance, and ability to play. A coughing child also disturbs other family members’ sleep, and may be disruptive in the classroom, causing parents considerable anxiety.

WHEN SHOULD PARENTS BE CONCERNED ABOUT A CHILD’S COUGH? Most acute coughs are due to a simple upper respiratory tract infection however children with any of the following signs should be taken to a doctor right away:

WHAT ARE THE COMMON CAUSES OF COUGH? Cough is classified as acute or chronic. An acute cough lasts less than three weeks. A chronic cough lasts more than eight weeks and is usually associated with conditions such as asthma, allergy, post-viral cough, and postnasal drip.

· Blue tint to the lips and/or skin (cyanosis) · Loud squeaking noise when breathing in (stridor) · Difficulty in breathing · An ill appearance · Spasms of uncontrollable, repetitive coughing followed by a high-pitched intake of air (whoop) · Any child suspected of inhaling a foreign body (sudden onset of cough with no other symptoms) · ‘Barking’ cough (croup) · High fever or underlying lung disorders, e.g. asthma or cystic fibrosis HOW IS ACUTE COUGH TREATED? Acute cough following an upper respiratory tract infection is usually self-limiting but it can be difficult to control and significantly impair daily life. Most acute coughs are caused by viruses, which makes antibiotics generally ineffective. However, parents frequently seek over-the-counter (OTC) medicines to relieve their child’s cough. A recent survey of cough mixtures found no good evidence for or against the effectiveness of these medicines in acute cough. Furthermore, cough mixtures may contain a combination of different active ingredients that are potentially harmful to children. Due to their small bodies and frequency of infections, young children are at higher risk of overdose, incorrect dosing, and side effects, especially if a cough mixture contains multiple ingredients. A CLOSER LOOK AT MUCOLYTICS: HOW THEY WORK AND WHEN TO USE THEM Mucus in our lungs is held together by disulphide bonds. Mucolytics work by breaking these bonds. When these bonds are broken, the mucus becomes less sticky and less thick and is easier to cough up. This can make it harder for germs to infect the mucus and cause chest infections. Mucolytics are useful to alleviate coughing, mucus production, and airway obstruction. Continued on next page...

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The Strength of our Immune Product is in the Balance. An underactive or weakened immune system will expose the body to increased susceptibility to infections and disease, therefore there is a definite need to strengthen the immune system; not to boost it or suppress it! The all-natural ingredient EpiCor® found in IMMUNO ARMOUR, has been clinically proven to strengthen the immune system. IMMUNO ARMOUR builds a strong immune system by significantly increasing Natural Killer (NK) Cell activity and antioxidant protection within 2 hours of consumption and helps increase sIgA antibodies, which are important for mucosal health. Marketed by: Kenza Health www.immunoarmour.co.za | Customer Care: 0860 103 359 Refernces: Jensen, G. S.; Redman, K. A.; Benson, K. F.; Carter, S. G.; Mitzner, M. A.; Reeves, S.; Robinson, L., Antioxidant bioavailability and rapid immune-modulating effects after consumption of a single acute dose of a high-metabolite yeast immunogen: results of a placebo-controlled double-blinded crossover pilot study. J Med Food 2011, 14 (9), 1002-10. Jensen, G. S.; Patterson, K. M.; Barnes, J.; Schauss, A. G.; Beaman, R.; Reeves, S.; Robinson, L., A Double-Blind Placebo-Controlled, Randomized Pilot Study: Consumption of a High-Metabolite Immunogen from Yeast Culture has Beneficial Effects on Erythrocyte Health and Mucosal Immune Protection in Healthy Subjects. The Open Nutrition Journal 2008, 2, 68-75.


EDUCATION

surprising, given that parents can choose from an array of dosing tools with which to administer the medication, including the common kitchen spoon, which vary widely in size and shape. In addition, a range of

{

{

N-acetylcysteine is the most commonly used mucolytic to loosen secretions from the respiratory tract

measurement units (millilitre, teaspoon, tablespoon) and their associated abbreviations are used on medicine labels and dosing tools, adding to the confusion and errors. In contrast, effervescent tablets contain a fixed dose per tablet, which eliminates the need for measuring tools and limits dosing errors. Effervescent tablets are also easy to use. CONCLUSION Children average 7-10 coughs a year, with a considerable impact on their wellbeing. Given that a cough can last up to four weeks, parents need to WHAT IS N-ACETYLCYSTEINE (NAC)? NAC is the most commonly used mucolytic to loosen secretions from the respiratory tract. Scientific studies have shown that NAC reduces cough and has good overall safety in children older than two years. Evidence also suggests that NAC makes it harder for bacteria to stick to the inside of the airways. NAC is available as an effervescent tablet and is suitable for children and adults. WHAT ARE SOME OF THE BENEFITS OF AN EFFERVESCENT TABLET OVER A LIQUID FORMULATION?

seek more effective treatment methods for their children. Evidence for the effectiveness of cough mixtures is not convincing and the combination of ingredients found in some cough mixtures is potentially harmful. In addition, dosing errors are common with liquid formulations, which increase the risk side effects in children due to their smaller body size. NAC is the most commonly used mucolytic and works by making mucus inside the lungs less sticky and easier to cough up. It is proven to reduce cough and has good overall safety ratings for children over the age of two. NAC is available as an effervescent tablet, easy to use and convenient to carry around. Each tablet contains a

Studies have shown that more than 40% of parents

fixed dose of NAC and can be pre-mixed in a bottle of

make errors when dosing liquid formulations. This is not

water, limiting the possibility of dosing errors.

Although cough is an important reflex defence mechanism to protect a child’s lungs and keep them clear, it can have a major impact on a child’s sleep, school performance, and ability to play

Pharmacy Magazine AUGUST 2017 |

39


Treating acid reflux and heartburn in the pharmacy – The role of PPIs Gastroesophageal reflux or ‘acid reflux’ occurs when the stomach contents reflux back into the oesophagus or even the mouth.1 In normal digestion, the lower oesophageal sphincter (LOS) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the oesophagus. Gastroesophageal reflux occurs when the LOS is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the oesophagus.2

OTC TC

People who experience acid reflux symptoms at least two to three times a week may have gastroesophageal reflux disease (GERD).1 • Heartburn is the most common symptom of GERD.1 • It is felt as a burning sensation in the centre of the chest, which sometimes spreads to the throat; there may also be an acid taste in the throat.1 • In addition to the cardinal symptoms of heartburn and acid regurgitation, GERD is associated with a range of atypical symptoms including sleep disturbances, chest pain, chronic cough and hoarseness.3 Self-medication for symptoms of heartburn and acid regurgitation is common, usually with antacids, alginates, histamine2 receptor antagonists and proton pump inhibitors (PPIs).4 PPIs are more effective than the other treatments mentioned and represent an ideal class of drug for use as over-the-counter (OTC) therapy for acid reflux symptoms.4 Potential users would include patients who have not previously taken any medication for acid reflux symptoms seeking initial OTC therapy as well as patients with typical symptoms who have tried using less effective OTC medicines without satisfactory symptom control.4 There is a general consensus that PPI therapy, preferably given before breakfast, is currently the therapy of choice for rapid symptom relief, usually within 2 weeks, and rapid healing of lesions.5

The following signs and symptoms or ‘alarm features’ may indicate a more serious problem, and patients should be referred to the doctor immediately:1,4 • Severe, frequent or troublesome symptoms • Symptoms of long duration • Difficulty or pain with swallowing • Unexplained weight loss • Chest pain • Choking • Bleeding (vomiting blood or the presence of blood in the stools; noticed as dark-coloured stools) Initial treatments for mild acid reflux include lifestyle changes and using OTC medicines.1


Lifestyle changes include:1 • Weight loss – Losing weight may help people who are overweight to reduce acid reflux. • Raising the head of the bed so that the head and the shoulders are higher than the stomach can help people with night-time heartburn to use gravity to prevent acid from refluxing. • Avoid acid reflux-inducing foods – Excessive caffeine, chocolate, alcohol, peppermint and fatty foods may cause reflux. • Quitting smoking can reduce or eliminate symptoms of mild reflux. • Avoid large and late meals – Lying down with a full stomach may increase the risk of acid reflux. By eating three or more hours before bedtime, reflux may be reduced. In addition, eating smaller meals may prevent the stomach from becoming over-distended, which can also cause reflux.

OTC PPI therapy Some PPIs are available OTC for the short-term treatment of gastric acid reflux symptoms such as heartburn and acid regurgitation.6

PPIs may be used OTC for mild reflux as:4 • On-demand therapy, during which patients take the PPI at the onset of symptoms and discontinue when symptoms are relieved (typically 2 weeks).4 If no symptom relief is obtained within two weeks of continuous treatment, the patient must be referred to the doctor.6 The treatment period should not exceed four weeks without consulting a doctor.6 An algorithm for pharmacy-based management of typical reflux symptoms (heartburn and/or acid regurgitation) has been developed.4

OTC TC

,

Adapted from Haag S, et al 20094

Takes control of heartburn

References: 1. Kahrilas PJ. Patient education: Acid reflux (gastroesophageal reflux disease) in adults (Beyond the Basics). [Online] 8 March 2016 [cited] 14 Jun 2017. Available from: https://www.uptodate. com/contents/acid-reflux-gastroesophageal-reflux-disease-in-adults-beyond-the-basics? 2. Gastroesophageal reflux disease (GERD). WebMD. [Online] 14 Sep 2015 [cited] 14 Jun 2017. Available from: http://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1#1. 3. Liker H, Hungin P, Wiklund I. Managing gastroesophageal reflux disease in primary care: the patient perspective. J Am Board Fam Pract 2005;18:393-400. 4. Haag S, Andrews JM, Katelaris PH, Gapasin J, Galmiche JP, Hunt R et al. Management of reflux symptoms with over-the-counter proton pump inhibitors: issues and proposed guidelines. Digestion 2009;80:226-234. 5. Tytgat GNJ. Review article. Treatment of mild and severe cases of GERD. Aliment Pharmacol Ther 2002;16(Suppl 4):73-78. 6. TOPZOLE® OTC approved package insert. April 2013. S2 TOPZOLE® OTC. Reg. No. 43/11.4.3/1001. Each enteric-coated tablet contains 20 mg pantoprazole. For full prescribing information refer to the package insert approved by the medicines regulatory authority. 1033706 06/2017. TAKEDA (Pty) Ltd. Reg. No: 1982/011215/07. Building A, Monte Circle, 64 Montecasino Boulevard, Fourways, 2191, South Africa. Tel: +27 (0) 11 514 3000. Fax: +27 (0) 11 514 3001. Marketed by Adcock Ingram Healthcare (Pty) Ltd. Reg. No. 2007/019928/07. Private Bag X69, Bryanston, 2021, South Africa. Tel. +27 11 635 0000. www.adcock.com.


23 SerotypeS. eStabliShed effectiveneSS. PNEUMOVAX 23.

not actual patients.

(pneumococcal vaccine, polyvalent, MSD) S4 PneumovaxTM23 (Pneumococcal Vaccine Polyvalent) Reg. No: T/30.1/0544 Each 0.5 ml dose of vaccine contains 25 mcg of each polysaccharide type dissolved in isotonic solution containing 0.25 % m/v phenol as preservative. MSD (Pty) Ltd (Reg. No: 1996/003791/07), Private Bag 3, Halfway House, 1685. Copyright Š 2017 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. All rights reserved. VACC-05595 0000


EDUCATION Source: CDC

Pneumococcal vaccines (PCV13 and PPSV23)

Addressing common questions about pneumococcal vaccination for adults WHAT DISEASES DO THESE VACCINES PROTECT AGAINST?

nose and throat, and can spread the bacteria without feeling sick.

There are two vaccines that protect against pneumococcal disease, which is caused by infection with

WHAT COULD HAPPEN IF I GET THIS DISEASE?

a common bacterium called Streptococcus pneumoniae.

Pneumococcal disease ranges from mild to very

· PCV13 (pneumococcal conjugate vaccine)

dangerous. Pneumococcal disease can spread from the

protects against 13 of the approximately 90 types

nose and throat to ears or sinuses, causing generally

of pneumococcal bacteria that can cause the most

mild infections, or spread to other parts of the body,

serious types of pneumococcal disease, including

leading to severe health problems such as lung infections

pneumonia, meningitis, and bacteraemia.

(pneumonia), blood infections (bacteraemia), and

· PPSV23 (pneumococcal polysaccharide vaccine) protects against 23 types of pneumococcal bacteria.

infection of the covering around the brain and spinal cord (meningitis).

This vaccine helps prevent invasive infections like meningitis and bacteraemia.

These serious illnesses can lead to disabilities like deafness, brain damage, or loss of arms or legs.

HOW COMMON IS PNEUMOCOCCAL DISEASE?

These illnesses can also be life threatening:

Each year in the United States, pneumococcal disease

· Pneumococcal pneumonia kills about 1 out of 20

kills thousands of adults, including 18 000 adults 65 years or older. Thousands more end up in the hospital because of pneumococcal disease.

people who get it. · Pneumococcal bacteraemia kills about 1 out of 6 people who get it. · Pneumococcal meningitis kills about 1 out of 6 people

HOW DOES PNEUMOCOCCAL DISEASE SPREAD?

who get it.

Pneumococcal bacteria can spread from person to person by direct contact with respiratory secretions, like

Adults with chronic conditions are at increased risk of

saliva or mucus. People can carry the bacteria in their

developing complications from pneumococcal disease.

WHO IS AT RISK FOR PNEUMOCOCCAL DISEASE? · People 65 years and older · People with certain health conditions, such as chronic lung disease or diabetes · People with conditions that lower the body’s resistance to infection (weakened immune system) · People who smoke cigarettes

Continued on next page...

Pharmacy Magazine AUGUST 2017 |

43


EDUCATION

Pneumococcal disease ranges from mild to very dangerous

WHO SHOULD GET THESE VACCINES, WHEN, AND HOW OFTEN ARE THEY NEEDED?

HOW WELL DO THE VACCINES WORK?

PCV13: Adults should get one dose of this vaccine before

the vaccine to be 75% effective in preventing invasive

starting or continuing doses of PPSV23.

pneumococcal disease, like bloodstream infections and

It is recommended for:

meningitis, and 45% effective at preventing non-invasive

· All adults 65 years or older

pneumonia caused by the 13 strains it covers.

PCV13: Studies done on PCV13 use in adults showed

· Adults 19 years or older with certain medical conditions PPSV23: In adults with healthy immune systems, this PPSV23: Adults should get one, two, or three doses of

vaccine has been shown to be 50-85% effective in

this vaccine, depending on their age, health condition,

preventing invasive disease caused by the 23 strains it

and timing of the first dose.

covers.

It is recommended for: · All adults 65 years or older

HOW SAFE ARE THESE VACCINES?

· Adults 19 years or older with certain health conditions

Pneumococcal vaccines are very safe. They went through

· Adults 19 years or older who smoke cigarettes

years of testing before being licensed by the FDA and continue to be monitored for safety by the FDA and CDC.

WHO SHOULD NOT GET THESE VACCINES?

Is it safe to get if I have certain health conditions or

PCV13: Anyone who has ever had a life-threatening

am taking prescription meds?

allergic reaction to a dose of the vaccine, to an earlier

Unless you have had an allergic reaction in the past to

pneumococcal vaccine called PCV7, or to any vaccine

the vaccine or have allergies to certain components of

containing diphtheria toxoid, should not get PCV13.

the vaccine, it is safe to get. It is safe for people taking

Anyone with a severe allergy to any component of PCV13

prescription medications to get vaccines.

should not get the vaccine. PPSV23: Anyone who has ever had a life-threatening allergic reaction to a dose of the vaccine or with a severe

WHAT ARE THE POTENTIAL SIDE EFFECTS OF THESE VACCINES?

allergy to any component of the vaccine should not get

PCV13: Adults receiving the vaccine have reported

the vaccine.

redness, pain, and swelling where the shot was given. Mild fever, fatigue, headache, chills, or muscle pain have also been reported. Life-threatening allergic reactions from this vaccine are very rare. PPSV23: About half of people who get PPSV23 have mild side effects, such as redness or pain where the shot is given. Less than 1% develop a fever, muscle aches, or more severe local reactions. The risk of a vaccine causing serious reaction, or death, is extremely small.

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Adults with chronic conditions are at increased risk of developing complications from pneumococcal disease

44

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Pharmacy Magazine


COMPETITION

2017

Pharmacy Professional of the Year

Calling all Front Shop and Pharmacist Assistants

Are you the 2017 Pharmacy Professional of the Year? In our search for excellence, Frontshop Pharmacy Magazine is excited to announce the launch of our annual competition. The competition will be featured in a dedicated section at the back of the magazine over the next few months. Questions will focus on educational articles and potential products to treat the maladies discussed. With easy entrance online at www.frontshop.co.za, once registered you will automatically receive a monthly email with a link to the newest article and questions.

With cash prizes up for grabs, we’re looking forward to announcing the top three Pharmacy Professionals at the beginning of 2018.

Pharmacy Magazine AUGUST 2017 |

45


COMPETITION Source: Eccles, R., Fietze, I. and Rose, U.-B. (2014) Rationale for Treatment of Common Cold and Flu with Multi-Ingredient Combination Products for Multi-Symptom Relief in Adults. Open Journal of Respiratory Diseases, 4, 73-82. http://dx.doi.org/10.4236/ojrd.2014.43011

STUDY: Treating common cold and flu

with multi-ingredient combination products The common cold and flu are the most common diseases of humans with adults suffering from 2-5 common colds each year and school children suffering from 7-10 colds each year

A

cute upper respiratory tract viral

or choose to use a multi-symptom relief

infections (URTI), often referred

combination medicine. Because of the

to as common cold and flu, are

multi-symptom presentation of common

defined by their multi-symptom

cold, over-the-counter (OTC), multi-active

nature with data showing a variety of

ingredient medicines have been used for over

symptoms reported simultaneously each day

sixty years for the treatment of colds and flu.

over the first six days of illness.

The WHO guidelines for registration of fixed-dose combination medicinal products

A MULTI-SYMPTOM DISEASE

states that if a fixed-dose-combination

Some experts describe the common cold

medicine is intended to relieve different

as a “culturally accepted constellation of

symptoms of a disease state, it is a

respiratory symptoms�. This constellation of

prerequisite that these symptoms commonly

symptoms makes the common cold and flu

occur simultaneously at clinically relevant

unique among common diseases as no other

intensity and for a period of time such that

condition has such a range of symptoms that

simultaneous treatment is appropriate.

occur simultaneously. Each symptom can be treated with a separate active ingredient, products with multiple active ingredients is

BENEFITS OF MULTI-INGREDIENT MEDICINES FOR MULTI-SYMPTOM RELIEF

chosen by many pharmacists.

The safety and efficacy of any medical

but multi-symptom relief, using combination

The multi-symptom nature of common cold

of the patient to take their medicines as

and patients have several different options

directed, as overdosing might lead to an

for treatment, and when they decide to use a

increased risk of side effects occurring and

symptomatic treatment they can choose to

under-dosing may mean that the treatment

{

{

treat each symptom with a different treatment

46

| AUGUST 2017

Pharmacy Magazine

treatment is first dependent on compliance

and flu means that physicians, pharmacists,

Rhinoviruses account for 30- 50% of all colds, and corona viruses are the second most common agent accounting for 10-15% of colds

is ineffective in treating the disease state.


COMPETITION This is where the pharmacist has an important

combination of several active ingredients

role in instructing the patient on the use of

into a single dose ensures that the needed

any medicine and particularly OTC multi-active

medicines are all taken together. This simple

ingredient medicines, as pharmacists are the

treatment can help improve compliance, to

only healthcare professionals specifically

ensure the optimal efficacy of the medicines.

trained in non-prescription therapeutics, and also trained to ask the patient about

SAFETY

symptoms of their condition in order to

No evidence has been found that

assess their chief complaint and determine

multi-ingredient combination products

the best course of therapy.

inherently introduce any additional safety risks compared to corresponding single active

COMPLIANCE AND EASE OF TREATMENT

ingredient products. Multi-symptom relief

In any medical treatment it is self-evident

active ingredients therefore provide a safe,

that the simpler the dosing regimen the

effective, cost-effective, and convenient

more likely it is that the medicines will be

way of treating the multiple symptoms

taken in the correct dose at the correct time.

of common cold and flu, when used as

If a patient needs to take three different

directed. This therapy requires some special

medicines it greatly simplifies the treatment

information for the patient to be provided by

regimen if all the medicines can be taken

the physician and the pharmacist.

combination products containing several

in a single dose. In any medical treatment it is self-evident that the simpler the

CONCLUSION

dosing regimen the more likely it is that the

Multi-ingredient combination products

medicines will be taken in the correct dose

for multi-symptom relief are formulated

at the correct time. If a patient needs to take

to safely, simply, and simultaneously treat

three different medicines it greatly simplifies

multiple symptoms when used as directed.

the treatment regimen if all the medicines

The rationale for the formulation combination

can be taken in a single dose. A meta-analysis

products for common cold and flu is therefore

of research on how fixed dose combinations

practical, logical, and reasonable. With this

affect compliance with a treatment regimen

multi-ingredient combination, products

reported that non-compliance to medication

do have an important place compared to

decreased by 26% when patients took fixed

other available therapies, ranging from a

dose combinations.

mono phytotherapy, and traditional Chinese medicine, up to antiviral therapy.

EFFICACY

Multi-ingredient combination therapy

The efficacy of any medicine depends on

should be a first-line treatment, at least if

taking the correct dose at the correct times.

multiple symptoms are found, no bacterial

Under-dosing by missing a dose or taking

infection is present, and if preventive actions

doses of medicine at extended dose intervals

fail such as physical intervention, vaccination,

will affect the efficacy of any medicine. The

or passive immunisation.

{ QUESTIONS { 1 2 3 4 5

TRUE OR FALSE: No evidence has been found that multi-ingredient combination products inherently introduce any additional safety risks compared to corresponding single active ingredient products. Under which circumstances should multi-ingredient combination therapy be a first-line treatment? Why is a multi-ingredient product preferable to a single-ingredient product when treating colds and flu? Name 2 ingredients in Sinucon? How many drops of Sinucon Nasal Drops do you need in each nostril?

Visit www.frontshop.co.za to read the full study: Rationale for Treatment of Common Cold and Flu with Multi-Ingredient Combination Products for Multi-Symptom Relief in Adults with detailed references.

Pharmacy Magazine AUGUST 2017 |

47


Email: greg@storysamurais.com

OPINION

Greg Zurnamer (B.Com MBA), the Story Samurai, is an innovative thinker that challenges conventional approaches in both sales and marketing

Why social media is changing your business “We don’t have a choice on whether we do social media today, the question is how well we do it” – Erik Qualman

S

ocial media has become second nature it on a daily basis and we can most likely

This is what happens every minute on the internet:

not escape its influence on our lives.

· 900 000 login’s on Facebook

to most of us. We are all consumed by

We communicate via WhatsApp, share memories with Facebook, show our pictures

· 16 million WhatsApp messages

on Instagram, tweet our peeps, and make a fool of

· 4.1 million YouTube videos are viewed

ourselves on Snapchat.

· 342 000 apps are downloaded

HOW DID WE LIVE WITHOUT OUR PHONES?

· 452 000 tweets are sent

In 1996, man had already been to space, dropped

· 46 200 pictures uploaded to Instagram

the atomic bomb, broken the sound barrier, been through two world wars, seen the decimation of

· 3.5 million search queries on Google

communism, and South Africa had won the rugby

· 70 017 hours of movies are watched on Netflix

world cup, but we had no Facebook or Twitter to share the news. We had in fact used social media

· R9 769 786 is spent on, online purchases.

tools that were in some cases more than 100 years old. Our earliest method of social contact was the

These statistics are staggering and are almost

postal services. Remember the day’s people wrote

unbelievable. What is even more impressive is that most

letters to each other. This service dates back as

of these activities are taking place on smart phones. It is

far as 500BC. A few years later in 1792 the

estimated that 54% of the world population or 2.3 billion

telegraph system was created and allowed a man

people now own a smart phone. In SA, 16 million people

to send short messages quickly over vast distances.

already have access to smart phones. Consider that 81%

Who can remember the pneumatic post, those

of smart phone users in SA use their phones to access

pressurised tubes that were used to send messages

the internet, we can appreciate that we are becoming a

and post around companies? They were indeed a

connected country. South Africans with internet access

sign of the future when they were developed in 1865,

are online for more than 5 hours per day.

but it was the invention of the telephone and the

81% of smart phone users in SA use their phones to access the internet

As South Africans, we also like to spend time on social

radio that really revolutionised how we consumed

media platforms. We spend more time on Facebook and

information on a social level.

other social media platforms every day than watching television. Almost 27% of our population are active social

SOCIAL MEDIA GROWS The development of social media rapidly followed

media users. These statistics have great significance for individuals

the computer revolution that started in the 1940’s.

and business owners. As a business owner, you avoid

Six Degrees is commonly acknowledged as the

or dismiss social media as a serious marketing and

initiator of social media. This service, started in 1997,

communication tool at your own peril. You cannot afford

allowed users to upload a profile and make friends

not to include a detailed and well thought out digital

with others. Blogging soon followed in 1999 and sparked

strategy as part of your marketing. If you are selling

the real shift to social media.

commodities and other consumable goods then you most

Today social media platforms dispense

likely would need a sales focussed website and online

thousands of terra-bytes of data per day. The facts

store. If you have consumers who buy your products on a

are just staggering.

daily basis then you should be active on social media. Pharmacy Magazine AUGUST 2017 |

49


PROFILE

“When you have happy clients, word spreads and the business grows”

Self empowered p nner-u d 2n Ru rmacist ha 2016 P stant s s A i year of the

1

Where did you grow up?

I was born in Johannesburg, later I moved to Cape Town, then to Heidelberg in the Western Cape. We

off and becomes an

able to work myself up to

example to her that

where I am now. This is my

3

tenth year in in this field

anything is possible.

then moved back to

Order. When everything

NAME & SURNAME:

Johannesburg, before

is organised and runs

once again moving to

smoothly, and you have

Laureen Smith

Heidelberg. Now I’m

a good day with happy

2

living in Still Bay.

PHARMACY: Blombos Pharmacy JOB TITLE: QPB Pharmacist Assistant and Stock controller

clients. When you have happy clients, word

Who inspires you and why?

My daughter. If it was not for her I don’t think that I would have achieved all that I already have.

spreads and the

4

business grows.

What is the hardest part of your job?

AGE:

Being a single mother

Definitely difficult clients,

35

with a full time job takes

stock shortages, and

its toll on one, but at the

bad communication.

end of the day it pays

6

and I still enjoy every day.

What do you enjoy most about your job?

5

Why did you choose a career in the pharmacy industry?

How long is your commute to work?

7

Ten minute walk.

9

What advice do you have for front shop and pharmacist assistants?

Every day is a learning process. If you don’t know something, ask. Everyone is there to help. Read package

What do you do to relax?

inserts, read the MIMS, medical magazines, and

Usually I take a walk

ask representatives

down to the beach,

questions. Pay attention

I do some adult colouring,

to detail when watching

and catch up on much

what the pharmacist

8

needed sleep.

does and says. These are all ways to

What is your dream (where would you like to be in say 5 or 10 years time)?

10

empower yourself.

pharmacy field, although

What have you learnt that you wish you could tell your 16-year-old self?

I may have changed

Not to be so stubborn,

I still see myself in the

from the community to

to be more considerate

I knew from a young

institutional sector. You

and patient, and to

age that I wanted to do

are never too old to learn.

listen more.

something medically related, I was just not sure in which field. I got a position as a cashier in a pharmacy which opened up a whole new world to me. From there I was

“You are never too old to learn”

Do you want to feature on our profile page or perhaps nominate a worthy colleague? Email the editor: nicky.belseck@newmediapub.co.za

50

| AUGUST 2017

Pharmacy Magazine


Relieves pain Reduces inflammation Speeds healing2

*vs. non-medicated gels, demonstrated in a neck pain model1 References: 1. Predel H-G, Gianetti B, Hug A-M, Burnett I. Efficacy and safety of diclofenac diethylamine 1.6% gel in the treatment of acute neck pain: a randomized, double-blind, placebo-controlled study, 2012. 2. Zacher J, Altman R, Bellamy N, Bruhlmann P, Da Silva J, Huskisson E, Taylor RS. Current Medical Research and Opinion Vol. 24 No. 4; 2008: 925-950. S1 VoltarenÂŽ Emulgel. Each 100g contains 1,16 g diclofenac diethylammonium corresponding to 1 g diclofenac sodium. Reg. no.:U/3.1/77. Botswana: S3 Reg. no.: B9305535. Namibia: NS1 Reg. no.: 04/3.1/0344. Applicant: GlaxoSmithKline Consumer Healthcare SA (Pty) Ltd, Company Reg. No. 2014/173930/07. 39 Hawkins Avenue, Epping Industria 1, 7460. Tel. No. +27 011 745 6000. CHZAF/CHVOLT/0001/17


OTC TC The heartburn solution that works1,2 •

High rates of symptom relief1

Has a low potential for drug interactions3

Offers the benefits of a once-daily dose2

If no symptom relief is obtained within 2 weeks of continuous treatment, the patient must be referred to the doctor.2 Treatment should not exceed 4 weeks without consulting a doctor.2

Takes control of heartburn

References: 1. Bardhan KD, van Rensburg C. (On behalf of the investigators). Comparable clinical efficacy and tolerability of 20 mg pantoprazole and 20 mg omeprazole in patients with grade I reflux oesophagitis. Aliment Pharmacol Ther 2001;15:1585-1591. 2. TOPZOLE® OTC approved package insert. April 2013. 3. Blume H, Donath F, Warnke A, Schug BS. Pharmacokinetic drug interaction profiles of proton pump inhibitors. Drug Safety 2006;29(9):769-784. S2 TOPZOLE® OTC. Reg. No. 43/11.4.3/1001. Each enteric-coated tablet contains 20 mg pantoprazole. For full prescribing information refer to the package insert approved by the medicines regulatory authority. 1029727 04/2017. TAKEDA (Pty) Ltd. Reg No: 1982/011215/07. Building A, Monte Circle, 64 Montecasino Boulevard, Fourways, 2191, South Africa. Tel: +27 (0) 11 514 3000. Fax: +27 (0) 11 514 3001. Marketed by Adcock Ingram Healthcare (Pty) Ltd. Reg. No. 2007/019928/07. Private Bag X69, Bryanston, 2021, South Africa. Tel. +27 11 635 0000. www.adcock.com.

Frontshop Pharmacy Magazine - August 2017  

Valuable education for pharmacy staff for Pharmacists, Pharmacist Assistants, Front Shop Assistants, and Clinic Sisters

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