FRONTLINE
FRONTLINE TACTICS
AGAINST WINTER PAIN & FEVER
Monthly crossword WIN!
Boosting immunity: strategies for winter and beyond
Tibolone’s clinical efficacy in treating menopausal symptoms
BONE HEALTH SIMPLIFIED
Calcium For strong bones and teeth
Vitamin D3 Promotes calcium absorption
Magnesium
Regulates calcium levels and helps prevent muscle cramps
Vitamin K2
Directs calcium to bones and helps prevent arterial calcification
Vitamin C Promotes collagen formation
EDITOR’S
EDITOR: Nicky Belseck
Email: nicky.belseck@newmedia.co.za
LAYOUT AND DESIGN: Beku Mbotoli
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Understanding seasonal trends and the appropriate therapeutic approaches will not only enhance the quality of care provided but also reinforce the role of pharmacists as essential healthcare providers in managing winter health challenges.
EDUCATION
Pregnancy nutrition: what patients should know Your patients’ may have broken every diet they’ve ever started but there’s little wiggle room when it comes to healthy eating during pregnancy.
WEBINAR REPORTS
Advanced wound care
Dry skin, the scaly rash
DIRECTOR: David Kyslinger
COMMERCIAL DIRECTOR: Maria Tiganis
STRATEGY DIRECTOR: Andrew Nunneley
CHIEF FINANCIAL OFFICER: Venette Malone
25 Boosting immunity: strategies for winter and beyond
Beyond the well-known cold and flu season, mid-year slumps in energy and overall well-being are frequent concerns at this time of year.
27 Managing traumatic wounds & infection control
29 Conquering obesity with lifestyle & phentermine
With over two-thirds of women in SA and 30% of men facing obesity or overweight conditions, weight-related diseases have eclipsed TB and HIV as leading causes of morbidity and mortality in SA.
31 Tibolone’s clinical efficacy in treating menopausal symptoms
Tibolone’s unique pharmacological profile, combining estrogenic, progestogenic, and rogenic properties, sets it apart from traditional hormone replacement therapy.
Editor's Note
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SA’s challenge achieving smoke-free future
Smoking rates are rising in SA, exacerbated by negative attitudes towards vapes, unlike other countries that use these safer alternatives to combat tobacco's harm. Indeed, the countries that have been most successful in reducing smoking rates, such as Sweden and New Zealand, have embraced smoke-free nicotine alternatives in recent years, thereby significantly reducing smoking prevalence.
Sweden, which initiated the process much earlier, has already seen significant progress in public health outcomes, including an incidence of lung cancer death 41% lower than the EU average. New Zealand successfully halved its smoking rates from 13.3% in 2018 to 6.8% in 2023 by endorsing vapes, which are considered 95% safer than cigarettes.
In contrast, SA faces a ‘misinformation epidemic’, with 78% of smokers wrongly believing vapes are as harmful as cigarettes. This has led to proposals for strict regulations similar to those for cigarettes. Experts suggest SA could save
lives by adopting New Zealand's approach to tobacco harm reduction. In this month’s issue ICPA chairman, Kgabo Komape, writes about the role of the pharmacist in promoting a tobacco free future (page 9).
OTHER INTERESTING TOPICS IN THIS MONTH’S ISSUE INCLUDE:
• Frontline tactics against winter pain & fever (page 11)
• Common hypertension misconceptions (page 13)
• Osteoarthritis: early signs & risk factors (page 19)
• Boosting immunity — strategies for winter and beyond (page 25)
• Managing traumatic wounds & infection control (page 27)
CROSSWORD CHALLENGE
Congratulations to the winner of Crossword #64 Cherise Van Schalkwyk . For your chance to win a R500 Woolworths voucher don’t miss this month’s crossword puzzle on page 33.
WORDS TO LIVE BY
“Sometimes you will never know the value of a moment until it becomes a memory.” – Dr Seuss
10 September 7pm
NASAL DECONGESTION -
SELECTING SAFE, EFFECTIVE OTC TREATMENTS
The role of primary healthcare practitioners in guiding patients in the selection of a safe and effective medication among the overwhelming array of OTC products that are available for symptoms of common cold and AR.
Speaker: Dr Tshegofatso Mabelane
Dr Tshegofatso Mabelane is the first HPCSA certified Family Physician Allergist in SA. She obtained her subspecialist qualification in Allergology through the University of Cape Town and College of Medicine SA. She also did the allergy exam with the European Academy of Allergy and Clinical Immunology under the European Union of Medical Specialists.
research & development Innovation
New antibiotic class effective against multidrug-resistant bacteria
A new weapon in the arsenal as discovery offers hope in the fight against antibiotic resistance
In the relentless war against infectious diseases, a breakthrough has emerged: a novel class of antibiotics demonstrating efficacy against multidrug-resistant (MDR) bacteria. With the alarming rise of resistance threatening the effectiveness of conventional antibiotics, the discovery of this new class offers a ray of hope in combating some of the most challenging pathogens.
Describing a new class of antibiotics developed as a part of multi-national consortia, researchers at Uppsala University published their work in the Proceedings of the National Academy of Sciences of the USA . The class of compounds they describe target a protein, LpxH, which is used in a pathway by Gram-negative bacteria to synthesise their outermost layer of protection from the environment, called lipopolysaccharide. Not all bacteria produce this layer, but those that do include the organisms that have been identified by the World Health Organization as being the most critical to develop novel treatments for, including Escherichia coli and Klebsiella pneumoniae that have already developed resistance to available antibiotics.
Traditional antibiotics struggle to penetrate the complex cell structures of Gram-negative bacteria, making them particularly challenging to treat. However, the researchers have homed in on a promising target: the lipid A biosynthesis pathway, a crucial component of the outer membrane of Gram-negative bacteria.
Inhibiting the biosynthesis of lipid A disrupts the integrity of the outer membrane, rendering bacteria vulnerable to attack. One key enzyme in this pathway, LpxH, has emerged as a prime target for the development of new antibiotics. By blocking LpxH, researchers aim to cripple the bacteria's defence mechanisms and restore the efficacy of antibiotic treatments.
The journey towards this breakthrough has been marked by challenges and setbacks. Through strategic adjustments, researchers have overcome hurdles and produced analogs with improved affinity and efficacy against MDR bacteria. While initial studies have focused on efflux-defective strains, efforts are underway to broaden the spectrum of activity to include highpriority pathogens like A. baumannii and P. aeruginosa.
In vitro and in vivo experiments have underscored the potency of these new antibiotics against a diverse array of MDR strains. Importantly, these compounds have demonstrated effectiveness in animal models of infection, offering hope for their clinical application in treating life-threatening bacterial infections.
The significance of this breakthrough extends beyond the laboratory. With antibiotic resistance posing a growing threat to public health, the discovery of a new class of antibiotics heralds a potential turning point in the fight against MDR bacteria. By targeting vulnerabilities in the bacterial cell wall, these antibiotics offer a powerful weapon against some of the most formidable pathogens.
Hope in the fight against resistance as novel antibiotics target multidrugresistant bacteria
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TOOTH PAIN SORE THROAT
ProfR myParker
19 September 7pm Brought
THE PATIENT BEHIND THE PAIN
WHAT PATIENTS WANT HEALTHCARE PROVIDERS TO KNOW ABOUT THEIR PAIN EXPERIENCE
Speakers: Prof Romy Parker & Nishern Govender
Prof Romy Parker is a professor and director of the Pain Management Unit in the Department of Anaesthesia and Perioperative Medicine at the UCT. She actively researches pain management, supervises postgraduate students, and is the course convenor of Africa's first Postgraduate Diploma in Interdisciplinary Pain Management. Dr Parker integrates her expertise as a physiotherapy clinician in chronic pain management at Groote Schuur Hospital.
Her research focuses on developing mechanism-based treatments relevant to SA. Dr Parker serves as a Councillor for the International Association for the Study of Pain (IASP) and has held leadership roles in PainSA and the IASP Pain, Mind and Movement Special Interest Group. She received the UCT Distinguished Teacher's Award in 2019, the university's highest teaching honor. Dr Parker's goal is to ensure every South African with pain can access knowledgeable healthcare professionals.
Nishern Govender is an experienced clinical pharmacist with a Pharmacy degree from WITS, a Master of Pharmacy, and a Postgraduate diploma in Clinical Pharmacology from UKZN. With over 25 years in the pharmaceutical and healthcare sector, he has held various roles in clinical practice, research, and academia. Currently, he serves as the head of medical and scientific affairs for Haleon South and sub-Saharan Africa while actively contributing to clinical pharmacy and pharmacist education focused on rational medicine use and patient safety.
AUTHOR: Kgabo Komape, ICPA chairman.
Role of the pharmacist in promoting a tobacco free future
Smoking prevalence among South African adults increased from 19% in 2017 to 24% in 20211 and 31 000 South Africans die annually due to tobacco-related diseases,2 writes Kgabo Komape, ICPA chairman
It is indeed concerning that these deaths are completely preventable through effective tobacco control mechanisms and other related interventions.
Another concern is the introduction of vaping using electronic nicotine delivery systems (ENDS), to inhale small amounts of nicotine, which is purported as a harm reduction approach aimed at the fully smoking populations. Unfortunately, due to their appeal, availability and affordability to people who do not smoke, including children and young people, they contrarily initiate new users into this habit. The dopamineinducing effects of nicotine induces a short-lived euphoric feeling 3 quickly leading to dependence and possibly to the use of conventional cigarettes or other illegal drugs to sustain the pleasurable effect.
Stopping smoking is the single most important thing an individual can do for their health. Surveys suggest that 70% of smokers want to quit, 30% try to quit yet less than 5% each year succeed. This is evidenced by the fact that 93% of unaided quit attempts, even with Nicotine Replacement Therapy (NRT), ultimately end in failure. 4
HOW CAN PHARMACISTS HELP TO IMPROVE QUIT RATES?
Clearly dispensing NRT alone is not enough but there is an opportunity for pharmacists to provide an evidencebased smoking cessation service which triples a quitter’s chance of successfully stopping smoking. The service includes pharmacotherapy, behavioral change techniques (BCT) and support.5
Pharmacists as the most accessible healthcare professionals together with their expertise in medicines, are well-positioned to provide effective and affordable smoking cessation support. Reducing the prevalence of smoking lowers healthcare costs associated with treating smokingrelated diseases and reduces economic losses due to smoking-related deaths. As trusted professionals, the involvement of pharmacists in smoking cessation can enhance community trust and engagement in public health initiatives.
Recommendations going forward:
F Standardise an evidence-based smoking cessation approach
F Train pharmacists and pharmacy nurses in BCT and motivational interviewing
F Encourage medical schemes to fund the service
F Lobby government to enact stricter nicotine regulation policies
F Engage Pharmacy Council to update minimum standards for smoking cessation services
F Initiate regular public health awareness campaigns
F Participate in WHO Tobacco cessation consortium initiative 6 .
By offering clinical smoking cessation services, pharmacists in South Africa can play a crucial role in reducing smoking prevalence, improving public health outcomes, and supporting the healthcare system's sustainability.
31 000
South Africans die annually due to tobacco-related diseases2
infectious diseases Education
Frontline tactics against winter pain & fever
Understanding seasonal trends and the appropriate therapeutic approaches will not only enhance the quality of care provided but also reinforce the role of pharmacists as essential healthcare providers in managing winter health challenges.
COMMON WINTER AILMENTS LINKED TO PAIN AND FEVER
INFLUENZA
COMMON COLD
PNEUMONIA
BRONCHITIS
SINUS INFECTIONS
ARTHRITIS FLARE-UPS
PHARMACISTS' ROLE IN TREATMENT
SYMPTOMS
Fever, chills, muscle aches, cough, congestion, runny nose, sore throat, headaches, and fatigue.1,2
Mild fever, runny nose or nasal congestion, sneezing, cough, sore throat, and slight body aches or mild headache.4,5
High fever, chills, chest pain, difficulty breathing, and coughing that produces phlegm, fatigue, nausea and vomiting in small children, confusion in older people.8
Persistent cough (may cough up clear, white, yellow or green mucus), chest congestion, slight fever, chills, runny or stuffy nose.11,12
Pain and pressure in the face, nasal congestion, postnasal drip, fever, and cloudy nasal discharge.14,15
Increased joint pain, stiffness, swelling, warmth, redness, and reduced mobility.17,18
Patient education: Educate patients on the proper use of medications, the importance of completing prescribed courses, and preventive measures. OTC medications: Advise on the best OTC medications for various symptoms.
Monitoring drug interactions: Ensure patients' medication regimens for chronic conditions do not interfere with acute treatment for winter ailments.
PREVENTIVE MEASURES
TREATMENT
Antiviral drugs, increased fluid intake, rest, and OTC fever reducers and pain relievers.1,3
Decongestants, throat lozenges, increased fluid intake, and OTC pain relievers.6,7
Antibiotics (for bacterial pneumonia), antivirals (for viral pneumonia), NSAIDs for fever reduction, increase fluid intake, and hospitalisation in severe cases.9,10
Mostly supportive care, including rest, increased fluid intake, and possibly cough suppressants and pain relievers.11,13
Decongestants, nasal corticosteroid sprays, nasal saline rinses, pain relievers, and antibiotics for bacterial infections.15,16
NSAIDs, corticosteroids, counterirritants, heat therapy, and joint-specific treatments.
Vaccination: Highlight the importance of flu shots and pneumonia vaccines for eligible populations. Hygiene practices: Promote regular hand washing, use of sanitisers, and wearing masks when necessary. Lifestyle tips: Encourage a balanced diet, regular exercise, and adequate hydration.
Proactive engagement and continuous education of patients on winter health issues is key. By staying informed about the latest developments in treatment and preventive care, you can be a valuable resource for patients seeking relief during the colder months.
*References available on request
SOURCE: Mediclinic
Pseudogout 101
This is a type of crystal disease with deposition of calcium pyrophosphate dihydrate crystals within the joint and joint cartilage
Many elderly people have asymptomatic chondrocalcinosis on X-ray, reaching nearly 30% by age 85
The term pseudogout arises from the similarity in presentation to the wellknown common condition of gout. Patients present with an acute episodic inflammatory arthritis, much like that seen in gout. However, the crystals involved are different, hence the treatment is also different.
In pseudogout, CPPD crystals are deposited in the joint cartilage at the joint surfaces. It is a joint disease that manifests with intermittent attacks of acute joint inflammation. Degenerative arthritic changes can be severe but are often asymptomatic.
CAUSES
While the causes of pseudogout are unknown, there’s a striking association with age, and the condition is rare under 50 years. It is often associated with other conditions like trauma, surgery, hyperparathyroidism, gout, and haemochromatosis. Thus, it seems that the deposits of the CPPD crystals follow degenerative or metabolic changes in cartilage.
SYMPTOMS
the elderly, may have a fever and be generally unwell and even confused. The acute attack usually clears within 1-3 weeks but may recur in another joint. Between attacks symptoms may be completely absent, or there may be low-grade symptoms like those of rheumatoid arthritis. These patterns can persist for life.
A more chronic form of this condition resembles rheumatoid arthritis in the elderly. Presentation is with chronic pain, stiffness, and limitation of mobility in the knees, wrists, shoulders, elbows, hips, and midfoot. Acute attacks may be superimposed on this chronic background of pain and inflammation. Pseudogout may coexist with and aggravate osteoarthritis. Joint swelling and local heat and thickening of the joint lining (the synovium) occur.
TREATMENT
There are two common presentations of pseudogout. The first is that of acute inflammation in a single joint (monarthritis), mimicking the classic acute attack of gout. The commonest presentation is sudden onset of severe pain, stiffness, and swelling developing over 6-24 hours. The knee is usually the site of involvement, followed by the wrist, shoulder, ankle, and elbow. The joint is acutely inflamed, red, and swollen and the patient, especially
The aims of treatments are to reduce symptoms, identify and treat triggering illnesses and rapidly mobilise the patient once inflammation has settled. Elderly patients often have other coexisting conditions and local therapies are often the best. Low dose oral colchicine may be quite effective. If the joint is swollen from inflammation, it should be drained and injected with cortisone. Symptomatic therapy is also possible using anti-inflammatories (NSAIDs), or newer safer antiinflammatory drugs known as COXIBs. Patients with progressive large joint involvement such as the knee may benefit from joint replacement.
cardiology Education
Common hypertension misconceptions
More than one in three adults in SA live with hypertension but more than 50% of patients don’t even know they have it1
Hypertension, commonly known as high blood pressure, is a prevalent condition worldwide, affecting millions of individuals. However, despite its widespread occurrence, hypertension is often misunderstood, leading to various misconceptions that can impact both diagnosis and management. Addressing these misconceptions is essential for promoting better understanding and improving patient outcomes.
MISCONCEPTION: I have no symptoms, therefore I don’t need to worry:
FACT: Hypertension is often asymptomatic, earning it the moniker of the ‘silent killer.’ Statistics from SA reveal that more than onethird of adults live with hypertension, with over half unaware of their condition. This underscores the importance of routine checkups for early detection and intervention.1
MISCONCEPTION: Reducing salt intake alone is sufficient to control blood pressure: FACT: While moderating salt consumption is advisable, it is not the sole factor influencing blood pressure regulation. Many processed foods contain hidden sodium, contributing significantly to overall intake. Patients are encouraged to read food labels diligently, looking out for terms like ‘sodium’ or ‘NaCl,’ and to be mindful of their overall dietary habits. 2,3,4
MISCONCEPTION: If my blood pressure is controlled after taking medication, then I can stop taking medication:
FACT: Abruptly stopping medication without medical supervision can lead to rebound hypertension and increase the risk of complications.5 Patient education on the importance of medication adherence and regular follow-ups with healthcare providers is crucial.
MISCONCEPTION: It’s just at the doctor’s office:
FACT: It’s quite common for blood pressure to go up in times of stress. Known as white-coat hypertension, patients may have elevated blood pressure readings in medical settings due to stress or anxiety, which can lead to misinterpretation and unnecessary concern.6,7,8 Similarly, masked hypertension is where a patient’s blood pressure is fine when measured in a medical professional but can spike when measured in other settings.7,8 As a result, patients are advised to monitor their blood pressure regularly at home to provide a more comprehensive picture of their cardiovascular health as they should never ignore multiple readings of high blood pressure.
MISCONCEPTION: High blood pressure runs in my family so I can’t prevent it:
FACT: While family history can increase the risk of developing hypertension, lifestyle factors play a significant role in its prevention and management. Adopting a healthy lifestyle, including a balanced diet, regular exercise, smoking cessation, moderation of alcohol consumption, and weight management, can help mitigate genetic predispositions and promote cardiovascular health.9,10
Dispelling misconceptions surrounding hypertension is crucial for empowering individuals to take control of their cardiovascular health. By promoting accurate understanding and emphasising the importance of regular monitoring, lifestyle modifications, medication adherence, and proactive healthcare management, pharmacists can contribute to better outcomes for patients living with hypertension.
*References available on request
Hypertension is one of the most serious risks factors for death from heart diseases and strokes
COLD SORES?
infectious diseases Education
HSV1 & cold sores
Effective management involves early intervention, patient education, and preventative measures to reduce the frequency and severity of outbreaks
Herpes simplex virus Type 1 (HSV1) is a common viral infection that often manifests as cold sores, also known as fever blisters. These painful, fluid-filled blisters typically appear on or around the lips.1,2,3
WHAT IS HSV1?
HSV1 is a highly contagious virus primarily responsible for oral herpes. It is transmitted through direct contact with an infected person’s saliva or skin, especially when cold sores are present. Although the virus can be dormant in the body, it can reactivate, leading to recurrent cold sores.1,3
SYMPTOMS OF COLD SORES
Cold sores typically progress through several stages:
• Tingling and itching: Initial symptoms include a tingling or itching sensation around the lips or mouth3
• Blisters: Small, painful blisters filled with clear fluid appear 3
• Oozing and crusting: Blisters burst, leaving open sores that crust over 3
• Healing: The sores usually heal in 2-3 weeks without scarring.3
COMMON TRIGGERS FOR COLD SORE OUTBREAKS
Understanding the triggers that can reactivate HSV1 is essential for managing and preventing outbreaks. Key triggers include:
• Stress: Emotional or physical stress can weaken the immune system, making it easier for HSV1 to reactivate1,3
• Illness: Colds, fevers, or other infections can trigger outbreaks due to the body’s lowered resistance1,3
• Sun exposure: UV radiation from the sun can damage the skin and activate the virus1,3
• Hormonal changes: Fluctuations in hormones, such as during menstruation, can trigger outbreaks1,3
• Injury to the lips: Trauma or injury to the lips, including dental work, can provoke an outbreak 1,3
• Weakened immune system: Conditions or medications that suppress the immune system can increase the likelihood of outbreaks.3
MANAGEMENT AND TREATMENT
While there is no cure for HSV1, several treatments can help manage symptoms and reduce the frequency of outbreaks:
• Antiviral medications: Prescription antivirals like acyclovir, valacyclovir, and famciclovir can reduce the severity and duration of cold sores1,2,4
• Topical treatments: Over-the-counter creams and ointments containing docosanol or acyclovir can alleviate pain and speed up healing 4
• Pain relief: Analgesics such as ibuprofen or paracetamol can help manage pain and discomfort 1,4
• Preventative measures: Educating patients on avoiding known triggers and practicing good hygiene can prevent the spread and recurrence of cold sores.1,3
PATIENT EDUCATION AND COUNSELLING
Focus on the following points when counselling patients:
F Avoiding triggers: Encourage patients to identify and avoid their personal triggers1,3
F Early treatment: Advise starting treatment at the first sign of an outbreak to reduce severity
F Preventing transmission: Emphasise the importance of avoiding close contact, sharing utensils, or kissing during an outbreak 3
F Sun protection: Recommend using lip balm with SPF to protect against UV rays 4
F Healthy lifestyle: Promote a healthy diet, regular exercise, and stress management techniques to strengthen the immune system.
By understanding HSV1 and the factors that trigger cold sores, pharmacists can provide valuable guidance and support to patients.
*References available on request
90%
90% of the world’s population are infected by the age of 40 years, and 40% of these will experience a recurrent infection2
Pregnancy nutrition: what patients should know
Your patients’ may have broken every diet they’ve ever started but there’s little wiggle room when it comes to healthy eating during pregnancy
There’s nothing like the wellbeing of their unborn baby to keep patients motivated when changing their eating habits. “Pregnancy is the critical window in which nutrition impacts foetal development,” said Dr Leneque Xanthe Lindeque, a gynaecologist and obstetrician at Mediclinic Highveld in Mpumalanga.
BEFORE BABY
Boosting nutritional intake is vital from the moment patients start trying to fall pregnant. “The nutritional state of a mother should be assessed prior to falling pregnant and certain vitamins, such as folic acid should be supplemented in this period, and others avoided, such as vitamin A,” said Dr Lindeque. “The use of cigarettes, alcohol, and illicit drugs not only impacts the health of the foetus directly but also interferes with the mother’s intake of a nutritional diet. Patients with special diets and those who skip meals are also more likely to have nutritional deficiencies and inadequate weight gain in pregnancy.”
FOOD GROUPS TO AVOID
When patients fall pregnant, they’ll often find themselves approaching meal preparation with more care than ever before. “Avoiding food-borne illnesses that can have an adverse effect on pregnancy starts with good personal hygiene, frequent hand washing, and thorough food preparation,” said Dr Lindeque. She recommends you advise pregnant patients to avoid the following food groups:
F Partially cooked or uncooked
meats, fish, and poultry (including eggs) can cause infections such as Toxoplasmosis and Listeria and can be detrimental to the pregnancy.
F Unpasteurised dairy products (like certain soft cheeses) can cause an infection called Brucellosis causing severe illness effecting the brain, muscles, and bladder system.
While expectant patients can still have their morning cup of coffee, limiting caffeine intake is advisable as excessive amounts can be detrimental to their pregnancy or result in a low birth weight.
WHAT TO EAT
Dr Lindeque recommends patients add the following vitamins and foods to their pregnancy diet:
• Folic acid supplementation is extremely important in the prevention of neural tube defects in the foetus and should be started when planning to fall pregnant.
• Fruits are full of healthy nutrients (for mom and baby), especially avocados because they contain healthy omega-3 fats, which are good for helping the development of the baby’s brain. Prunes are packed with fibre and keep the digestive system running smoothly. A diet rich in fibre may help decrease the risk of developing preeclampsia. Patients should aim for 25 grams of fibre daily.
• Lean meats such as chicken are an excellent source of protein and help provide energy for the demands of the pregnancy on the metabolism. Fish is also an excellent protein but avoid eating too much tuna with high levels of mercury.
• Starches are best consumed in forms that sustain energy longer, like oats and whole-wheat products.
Once a day dosage
OSTEOARTHRITIS: EARLY SIGNS & RISK FACTORS
With ageing populations and increasing rates of obesity and injury, the prevalence of osteoarthritis is expected to continue to increase globally
What is osteoarthritis?
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It is a degenerative joint disease that causes the breakdown of cartilage, the cushioning tissue between bones in the joints.1
73%
344m
About 73% of people living with osteoarthritis are older than 55 years, and 60% are female 2
344 million people living with osteoarthritis experience severity levels (moderate or severe) that could benefit from rehabilitation 2
With a prevalence of 365 million, the knee is the most frequently affected joint, followed by the hip and the hand 2
365m
40s
The typical onset is in the late 40s to mid-50s, although osteoarthritis may also affect younger people, including athletes and people who sustain joint injury or trauma 2
EARLY SIGNS3 RISK FACTORS4
• Joint pain, especially after activity
• Stiffness, particularly in the morning or after inactivity
• Tenderness around the joint
• Loss of flexibility in the joint
• Swelling around the joint.
*References available on request
• Older age
• Sex
• Obesity
• Joint injuries
• Repeated stress on the joint
• Genetics
• Bone deformities
• Metabolic diseases.
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Advanced wound care wound care Webinar Report
Teresa Hagens (global medical training manager for Hansaplast, Elastoplast, and Curitas) and licensed pharmacist and expert in wound care Sonja Kruenholz recently presented a webinar for Pharmacy Magazine on Advanced wound care made possible by Elastoplast.
Delving into advanced wound care know how and practice for daily recommendation in pharmacy, the webinar aimed to bolster the knowledge of pharmacists and pharmacy assistants, equipping them with the latest insights into wound care management.
KEY TAKEAWAYS
F Evolving role of pharmacy professionals: With patients being discharged earlier from hospitals, there's a growing reliance on pharmacists for post-surgical care. This shift underscores the importance of pharmacists as trusted advisors in wound care, highlighting the need for continuous education and training in this field.
lacerations and chronic wounds should be professionally managed.
F Moist wound healing conditions: The benefits of maintaining moist conditions for wounds were discussed. Such conditions prevent crust formation and promote faster, more aesthetically pleasing healing. Products like polyurethane wound pads that support these conditions were recommended due to their ability to reduce scarring risk and suitability for sensitive skin.
F Post-operative wound care: The importance of protecting wounds from infection and managing pain during the post-operative phase was emphasised. Kruenholz outlined a typical timeline for post-operative care, from initial dressing in the hospital to home care, including regular dressing changes and the use of sterile, waterproof dressings.
Be sure to watch the webinar replay for a full breakdown of advanced wound care know how and practice for daily recommendation in the pharmacy
F Types of wounds and appropriate care: Various wound types such as cuts, abrasions, and lacerations were discussed. Kruenholz stressed the importance of choosing the right wound care products to ensure effective healing and patient satisfaction. She also highlighted that while minor wounds like cuts and abrasions can often be self-treated, more severe
F Role of pharmacists in wound care: Hagens concluded by reinforcing the critical role of pharmacy teams in advising patients on proper wound care, especially in the absence of direct doctor consultations. The discussion also covered specific products like Elastoplast sensitive and waterproof plasters, which are designed to protect the wound while being skin-friendly. The session provided valuable insights into the advancements and best practices in wound care, aiming to enhance the role of pharmacists in facilitating optimal healing outcomes for their patients.
For those who missed the live session, a replay and additional resources are available to ensure all pharmacy professionals can benefit from the shared knowledge. Visit www. pharmacymagazine.co.za to watch the replay.
Teresa Hagens
Sonja Kruenholz
Webinar Report
Dry skin: the scaly rash
Dermatologist, Dr Zandile Spengane recently presented a webinar for Pharmacy Magazine on Dry skin made possible by Eucerin. The webinar explored the science behind the skin barrier, what causes dry skin, how it manifests, a closer look at specific skin conditions that cause dry, scaly skin and suitable treatment options.
KEY TAKEAWAYS
Our skin, the largest organ of our body, plays a crucial role in protecting us from the environment, regulating body temperature, and even synthesising vitamin D. But what happens when this vital barrier weakens? Dry skin, also known as xerosis, is a common condition that can cause discomfort and itchiness.
THE SCIENCE BEHIND THE SKIN BARRIER
Healthy skin relies on a complex barrier made up of lipids (fats) like ceramides and fatty acids, and cholesterol. This barrier helps retain moisture and keeps out irritants and allergens. When this barrier function weakens, the skin loses moisture, leading to dryness, irritation, and even cracks.
WHAT CAUSES DRY SKIN?
Several factors can contribute to dry skin. Here's a breakdown of some common culprits: Endogenous factors: Age, menopause, certain medical conditions like diabetes and thyroid problems, and medications can all play a role. Exogenous factors: Dry climates, hot or cold weather, excessive showering or handwashing, harsh soaps and detergents, and even friction from clothing can contribute to dry skin.
HOW DOES DRY SKIN MANIFEST?
Dry skin can present itself in various
ways, including:
• Rough, dry, and scaly patches
• Itchiness and irritation
• Redness and cracking
• Worsening of pre-existing skin conditions like eczema or psoriasis.
DRY SKIN AND SPECIFIC CONDITIONS
Certain medical conditions can cause or worsen dry skin. Here are a few examples:
F Menopause: Hormonal changes can lead to drier skin
F Diabetes: Reduced blood flow to the skin can impact its health
F Hypothyroidism: This condition can affect skin hydration
F HIV: Dry skin and itchiness can be symptoms of HIV.
COMBATING DRY SKIN: EFFECTIVE MANAGEMENT STRATEGIES
The good news is that dry skin can be effectively managed with the right approach. Here are some key strategies: Moisturisers: Regularly applying moisturisers with ingredients like emollients, occlusive agents, and humectants can help trap moisture in the skin.
Gentle cleansers: Avoid harsh soaps and opt for gentle cleansers that won't strip away natural oils.
Lifestyle modifications: Reduce hot showers, manage stress, and stay hydrated to support healthy skin.
UNDERSTANDING SPECIFIC SKIN CONDITIONS
During the webinar Dr Spengane broke down several specific skin conditions that can cause dry, scaly skin discussing suitable treatment options including ichthyosis vulgaris, eczema, seborrheic dermatitis, psoriasis, pityriasis rosea, lichen planus, and keratosis pilaris.
Be sure to watch the webinar replay for a full breakdown of these skin conditions and their treatment options online at
Dr Zandile Spengane
QuatroFlora KEEPS THE COLON HEALTHY
QuatroFlora
QuatroFlora
E PS TH E C O L O N HEA LTH Y
KE E PS TH E C O L O N HEA LTH Y
A L L P R O B I OT I C S AR E N OT TH E SAM E
ALL PROBIOTICS ARE NOT THE SAME
A L L P R O B I OT I C S AR E N OT TH E SAM E
ALL PROBIOTICS ARE NOT THE SAME
ALL PROBIOTICS ARE NOT THE SAME
Gastro-intestinal problems affect all of us at some time or another. Diarrhoea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord.
Gastro-intestinal problems a ffect all of usat some time or another. Diarrhea, constipation, bloating andthe like are often causedby over-indulgence or e ating somethingath t doesn’t agree with us , and quick ly clear up of their own accord.
Gastro-intestinal problems a ect all of us at some time or another Diarrhoea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord
Gastro-intestinal problems affect all of us at some time or another. Diarrhea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord.
Gastro-intestinal problems a ffect all of usat some time or another. Diarrhea, constipation, bloating andthe like are often causedby over-indulgence or e ating somethingath t doesn’t agree with us , and quick ly clear up of their own accord.
Beneficial bacteria in the gut are known to:
❖ Beneficial bacteria in the gut are known to:
ALL PROBIOTICS ARE NOT THE SAME
Beneficial bacteria in the gut are known to:
Beneficial bacteria in the gut are known to:
Gastro-intestinal problems a ect all of us at some time or another. Diarrhoea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord.
One of the greatest challenges for human wellbeing in the 21st centur y will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where
Beneficial bacteria in the gut are known to:
• prevent and stop diarrhoea or constipation
One of the greatest challenges for human wellbeing in the 21st centur y will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where
Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines.
One of the greatest challenges for human wellbeing in the 21st century will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where probiotics can play a significant role.
Distressing and unpleasant conditions such as these can however become chronic – and that can be caused by a bacterial imbalance in the intestines.
• prevent and stop diarrhoea or constipation
• Prevent and stop diarrhea or constip ation
• Prevent and stop diarrhea or constipation
• aid digestion and break down toxins
• Prevent and stop diarrhea or constip ation
• aid digestion and break down toxins
• Aid digestion and break down toxins
• Aid digestion and break down toxins
• prevent and stop diarrhoea or constipation
• produce vitamins B12 and K
• produce vitamins B 12 and K
Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines
Distressing and unpleasant conditions such as these can however become chronic – and th at can be causedby a bacterial imbalance in the intestines.
Some groups of bacteria can cause acute or chronic illness, but another group of bacteria offers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhoea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption. In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic effects thought to be due to their ability to bind with heterocylic amines, which are carcinogenic substances formed in burnt red meat.
• Produce vitamins B12 and K
• aid digestion and break down toxins
• Produce vitamins B12 and K
• Aid digestion and break down toxins
following ailments:
A good probiotic can be beneficial in the following ailments:
• stimulate the immune system.
• produce vitamins B 12 and K
Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines.
Distressing and unpleasant conditions such as these can however become chronic – and th at can be causedby a bacterial imbalance in the intestines.
Probiotics are critical for normal digestion and for defence against infec tion.
Probiotics are critical for normal digestion and for defence against infection.
Bac teria in the gut are k nown to:
Bacteria in the gut are known to:
• Stimulate the immune system
Bac teria in the gut are k nown to:
• Stimulate the immune system
• Enhance the mucosal barrier
• Enhance the mucosal barrier
• Stimulate the immune system
• Enhance the mucosal barrier
• Aid digestion and break down toxins
• Aid digestion and break down toxins
• Inhibit adherence of pathogens
• Inhibit adherence of pathogens
• Aid digestion and break down toxins
• Inhibit adherence of pathogens
Some groups of bacteria can cause acute or chronic illness, but another group of bacteria offers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption In laborator y investigations, some strains of of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic effects thought to be due to their ability to bind with heterocyclic amines, which are carcinogenic substances formed in burnt red meat.
• Stimulate the immune system
• Diarrhoea or constipation
• stimulate the immune system
• Diarrhoea or constipation
following ailments:
• Produce vitamins B12 and K
• Stimulate the immune system
• Diarrhoea or constipation
• stimulate the immune system.
• Stimulate the immune system
• Bad breath, gas & bloating
• Bad breath, gas & bloating
• Bad breath, gas & bloating
• Allergies, rhinitis, lac tose intolerance
• Allergies, rhinitis, lactose intolerance
• Allergies, rhinitis, lac tose intolerance
Some groups of bacteria can cause acute or chronic illness, but another group of bacteria o ers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhoea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption. In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic e ects thought to be due to their ability to bind with heterocylic amines, which are carcinogenic substances formed in burnt red meat.
Somegroups of bacteria can cause acute or chronic illness , but anothergroup of bacteria o ffers protective and nutritive properties . Imbalances between the two can lead to a number of unpleasant conditions such as diarrhea , constipation , bloating , IBS, allergies, poor digestion and poor nutrientabsorption . In laboratory investigations , some strains of of LAB (Lactobacillus bulgaricus) h ave demonstrated anti-mutagenic effects thought to be due to theirability to bind with heterocyclic amines , which are carcinogenic substancesformed in burnt red ame t.
Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora®, with clinical documentation available on the health benefits of the strains it contains.
Probiotics are critical for normal digestion and for defence against infec tion.
Some groups of bacteria can cause acute or chronic illness, but another group of bacteria o ers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhoea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic e ects thought to be due to their ability to bind with heterocylic amines, which are carcinogenic substances formed in burnt red meat
The two most important groups of friendly intestinal flora, or probiotics, are Lactobacilli – found mainly in the small intestine, and Bifidobacteria – found mainly in the colon.
Somegroups of bacteria can cause acute or chronic illness , but anothergroup of bacteria o ffers protective and nutritive propertiesImbalances between the two can lead to a number of unpleasant conditions such as diarrhea , constipation , bloating , IBS, allergies, poor digestion and poor nutrientabsorptionIn laboratory investigations , some strains of of LAB (Lactobacillus bulgaricus) h ave demonstrated anti-mutagenic effects thought to be due to theirability to bind with heterocyclic amines , which are carcinogenic substancesformed in burnt red ame t.
Tel: 084 561 1144 sales@betapharm.co.za www.betapharm.co.za
Tel: 041 3781189 sales@betapharm.co.za www.betapharm.co.za
Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health benefits.
The two most importantgroups of friend ly intestinal flora , or probiotics , are Lactobacilli – found main ly in the small intestine , andBifidobacteria – found main ly in the colon.
The two most important groups of friendly intestinal flora, or probiotics, are Lactobacilli – found mainly in the small intestine, and Bifidobacteria – found mainly in the colon.
Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora®, with clinical documentation available on the health benefits of the strains it contains.
Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora® with clinical documentation available on the health benefits of the strains it contains.
Just as all humans are not the same , all probiotics are not the sameInsist on QuatroFlora ® with clinical documentation available on the health benefits of the strains it contains.
The two most important groups of friendly intestinal flora, or probiotics, areLactobacilli– found mainly in the small intestine, andBifidobacteria– found mainly in the colon.
The two most importantgroups of friend ly intestinal flora , or probiotics , are Lactobacilli – found main ly in the small intestine , andBifidobacteria – found main ly in the colon.
Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health benefits.
Probiotics are live micro-organisms ,which when consumed in adequate amounts , have strong health benefits .
Probiotics are live micro-organisms which, when consumed in adequate amounts, have strong health benefits
Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora®, with clinical documentation available on the health benefits of the strains it contains.
Just as all humans are not the same , all probiotics are not the same . Insist on QuatroFlora ® with clinical documentation available on the health benefits of the strains it contains.
• Gastroenteritis and playschool diseases in young children
The two most important groups of friendly intestinal flora, or probiotics, areLactobacilli– found mainly in the small intestine, andBifidobacteria– found mainly in the colon
• Gastroenteritis and playschool diseases in young children
• Gastroenteritis and playschool diseases in young children
Probiotics are live micro-organisms ,which when consumed in adequate amounts , have strong health benefits . Beneficial bacteria in the gut are known to:
QuatroFlora™ capsules contain the following strains of probiotic bacteria for improving gastro-intestinal health and well-being:
Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health benefits.
QuatroFlora ™ capsules contain thefollowing strains of probiotic bacteriafor improving gastro-intestinal health and well-being: Bifidobacterium, BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27, Streptococcus thermophilus, STY-31
bacteriafor improving gastro-intestinal health and well-being:
Bifidobacterium, BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27,
QuatroFlora ™ capsules contain thefollowing strains of probiotic
Bifidobacterium, BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27, Streptococcus thermophilus, STY-31
Boosting immunity: strategies for winter and beyond winter ailments CPD activity
Winter months often see a surge in patients seeking remedies for common illnesses. Beyond the wellknown cold and flu season, mid-year slumps in energy and overall well-being are also frequent concerns.
THE IMMUNE SYSTEM: A COMPLEX NETWORK
The human immune system is a marvel of cellular and molecular interactions, constantly working to defend the body against pathogens like bacteria, viruses, and parasites. While there's no single magic bullet to boost immunity, we can support its function through various strategies.
WHY SUPPORT THE IMMUNE SYSTEM?
A well-functioning immune system is crucial for:
Reduced incidence of infections: A stronger immune system can decrease the frequency and severity of common colds and flu.1 Faster recovery times: Enhanced immunity aids in quicker recovery from illnesses.1 Chronic disease prevention: A healthy immune system helps regulate inflammation, potentially reducing the risk of chronic conditions, contributing to better overall health. 2
KEY IMMUNE BOOSTERS TO CONSIDER
Macro- & micronutrients
• Vitamin C: Known for its antioxidant properties, vitamin C is crucial for immune function. It enhances the production of white blood cells and helps the body fight off infections1,2
• Vitamin D: Essential for immune regulation, vitamin D deficiency is common in winter due to reduced sunlight exposure. Supplementation can help maintain adequate levels1,2
• Vitamin E: Studies have found that vitamin E enhances T cell-mediated immune function in the face of age-related decline2
• Zinc: This mineral is vital for immune cell function and signalling. Zinc supplementation can reduce the duration of cold symptoms1,2,3
• Omega-3: Known for their anti-inflammatory properties, omega-3 fatty acids play a significant role in managing and reducing inflammation throughout the body, including the respiratory tract. 2
Herbal supplements
• Echinacea: Popular for its immuneboosting properties, Echinacea can reduce the chances of catching a cold and shorten the duration of symptoms1,4,5
• Elderberry: Rich in antioxidants, elderberry has been shown to reduce the severity and length of flu symptoms6,7
• Astragalus: An adaptogen that helps the body resist stress and boosts the immune system.8,9
Probiotics
Probiotics support gut health, which is closely linked to the immune system. A healthy gut microbiome can enhance immune responses and prevent infections.10
Ideally, the best way to obtain these nutrients is by eating a varied and balanced diet, but this may not always be feasible for many people, who might need to take supplements. Supporting the immune system optimally might necessitate consuming amounts of certain micronutrients that exceed the recommended dietary allowances (RDA). Keep in mind, infections and various stress factors can deplete micronutrient levels in the body. 2
While there's no guaranteed way to prevent every illness, supporting a healthy immune system can significantly improve overall well-being.
*References available on request
During winter, people are more susceptible to colds, flu, and other respiratory infections
SCAN ME
Managing traumatic wounds & infection control
Traumatic wounds, caused by blunt or sharp force trauma, require proper management to prevent complications and promote optimal healing
Traumatic wounds, resulting from incidents such as cuts, lacerations, or punctures, are common occurrences in both everyday life and clinical settings. Effective management of these wounds is crucial to prevent infection and ensure proper healing.
WOUND ASSESSMENT
• Initial presentation: Upon presentation, assess the wound for size, depth, location, bleeding, and presence of foreign objects
• Wound classification: Classify the wound based on the type of tissue injury (eg. abrasion, laceration, puncture) and contamination level (clean, contaminated, dirty, infected)
• Tetanus status: Ensure the patient's tetanus vaccination is up to date.
WOUND MANAGEMENT
• Cleaning and irrigation: Clean the wound with sterile saline, clean water, or an irrigation solution to remove debris and reduce bacterial load
• Debridement: Carefully remove devitalised tissue to promote healing and prevent infection
• Haemostasis: Control bleeding with direct pressure or elevation
• Closure: Depending on the wound type and severity, closure with sutures, staples, or dressings may be necessary. Pharmacists can advise on appropriate dressings based on the wound stage (eg alginates for exudate management, hydrogels for moist wound healing).
INFECTION PREVENTION
• Antibiotics: Pharmacists can dispense prophylactic antibiotics in high-risk cases (eg deep wounds, bites)
• Patient education: Educate patients on proper wound care techniques, signs and symptoms of infection (eg redness, swelling, pus), and the importance of medication adherence.
• Vaccination: Advise on appropriate vaccinations, such as tetanus booster, to prevent future infections.
PHARMACIST INTERVENTIONS
• Pain management: Recommend pain medication based on severity
• Referral: Refer patients to a physician for complex wounds, signs of infection, or if closure is necessary.
PATIENT EDUCATION
• Proper wound care: Educate patients on proper wound cleaning and dressing techniques. Emphasise the importance of hand hygiene before and after wound care
• Signs of infection: Teach patients to recognise signs of infection and seek prompt medical attention if needed
• Product selection: Guide patients in selecting appropriate wound care products based on the type and condition of the wound.
ADDITIONAL CONSIDERATIONS
• Underlying cause: If the underlying cause of the wound is not addressed, it will not be appropriately managed which can impact wound healing
• Chronic conditions: Be aware of underlying medical conditions (eg diabetes) that can impede wound healing
• Nutritional support: Advise on a balanced diet or nutritional supplements to support healing.
Pharmacists play a key role in supporting patients with traumatic wounds. By effectively assessing wounds, recommending appropriate management strategies, and educating patients on infection control, you can significantly improve patient outcomes.
*REFERENCE: Nagle SM, Stevens KA, Wilbraham SC. Wound Assessment. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482198/
SCAN ME
Conquering obesity with lifestyle & phentermine
Obesity is a complex and multifaceted health issue that affects millions of people worldwide. With over twothirds of women in SA, 30% of men, and a significant proportion of children facing obesity or overweight conditions, it was reported that weight-related diseases have eclipsed TB and HIV as leading causes of morbidity and mortality in SA earlier this year.1
As healthcare professionals, pharmacists are uniquely positioned to provide support and guidance to individuals struggling with obesity. This article focuses on the critical aspects of lifestyle modification, healthy eating, exercise, and accountability, with a special emphasis on the role of phentermine in obesity management.
UNDERSTANDING OBESITY
Obesity is not just a cosmetic concern but a medical problem that increases the risk of diseases such as heart disease, diabetes, high blood pressure, and certain cancers.2 The root causes of obesity can be complex, involving genetic, behavioural, metabolic, and hormonal influences.3
LIFESTYLE MODIFICATIONS
The cornerstone of obesity management, lifestyle modification involves a sustained change in daily habits and behaviours, focusing on diet and physical activity. Pharmacists can play a crucial role in guiding patients through these changes by providing education, resources, and continuous support.
1. Eating healthily
• Balanced diet: Encourage a diet rich in fruits, vegetables, whole grains, and lean proteins. It's important to reduce the intake of high-calorie, low-nutrient foods 4,5
• Portion control: Educating patients on appropriate portion sizes can help prevent overeating 6
• Consistency: Maintaining a regular eating schedule can prevent binge eating 7 and promotes better metabolism8,9
2. Exercising regularly
• Tailored recommendations: Based on the
patient’s physical condition and preferences, you can recommend specific types of exercises, such as walking, swimming, or cycling
• Building routine: Help patients incorporate physical activity into their daily routine, starting with small, achievable goals.
3. Accountability
• Self-monitoring: Encourage the use of food diaries or apps to track dietary intake and physical activity
• Regular check-ins: Offer regular follow-up appointments to discuss progress, challenges, and adjust plans as needed.
THE ROLE OF PHENTERMINE
Phentermine is a prescription medication that acts as an appetite suppressant. It is typically used for a short period (a few weeks) in a regimen of weight reduction based on exercise, behaviour change, and calorie restriction, however recent studies have found longer duration of phentermine use to be associated with clinically significant greater weight loss without increase in risk for cardiovascular events or death.10 It is classified as a Schedule IV drug due to its potential for abuse and dependence, however the rate of misuse appears to be low.10,11,12
Mechanism of Action
Phentermine stimulates the release of brain chemicals that will help reduce the sensation of hunger, making it easier to adhere to a strict diet.12
PHARMACISTS' ROLE
• Counselling: Before dispensing phentermine, pharmacists should counsel patients on the proper use of the medication, potential side effects, and the importance of adhering to prescribed dosages
• Screening: It’s crucial to screen for contraindications such as history of cardiovascular diseases, uncontrolled hypertension, or history of drug abuse
• Monitoring: Regular monitoring of weight loss and side effects is important to assess the effectiveness and safety of the treatment.
*References available on request
Obesity remains a significant health concern in SA, with trends indicating an increase in obesity rates among both adults and children
SCAN ME
Tibolone’s clinical efficacy in treating menopausal symptoms
Menopause is a significant phase in a woman's life marked by the cessation of menstrual periods and a decline in ovarian function. This transition often brings a variety of symptoms which affects more than 95% of women, including vasomotor symptoms (hot flashes and night sweats), mood swings, and urogenital atrophy, which can significantly impact quality of life.1,2 Tibolone, a synthetic steroid, has emerged as a popular choice for hormone replacement therapy (HRT) due to its unique pharmacological profile and clinical benefits. 2
PHARMACOLOGY OF TIBOLONE
Tibolone is a synthetic steroid that mimics the activity of oestrogen, progesterone, and androgens, making it a multifunctional hormone therapy. Unlike conventional HRTs that contain oestrogen or a combination of oestrogen and progesterone, Tibolone provides a comprehensive approach by being metabolised into three major metabolites which contribute to its estrogenic, progestogenic, and androgenic effects. This unique action helps in alleviating a broad spectrum of menopausal symptoms while also offering benefits like mood stabilisation and libido enhancement. 2,3,4,5,6
CLINICAL EFFICACY IN TREATING MENOPAUSAL SYMPTOMS
Vasomotor symptoms: Tibolone is highly effective in reducing the frequency and severity of hot flashes and night sweats. 2,5 Studies have shown that Tibolone achieves significant reductions in these symptoms, comparable to traditional oestrogen-based HRTs. 4,5,6
Urogenital health: Tibolone helps in maintaining urogenital health by improving
vaginal dryness and reducing urogenital atrophy.2
Bone health: Postmenopausal women are at increased risk of osteoporosis due to declining oestrogen levels. Tibolone helps in preventing bone loss and contributes to bone density improvement, reducing the risk of fractures. 4,5,7
Mood and sexual function: Due to its androgenic properties, Tibolone has a positive effect on mood and sexual function. It can improve libido and reduce depression or anxiety associated with menopause. 2,4,5,6
SAFETY AND SIDE EFFECTS
While Tibolone is generally well-tolerated, it is not devoid of side effects. Common adverse effects include vaginal bleeding, breast tenderness, and gastrointestinal disturbances. The risk of myocardial infarction, 8 venous thromboembolism and breast cancer with tibolone is generally lower compared to conventional HRT. 2 Pharmacists should counsel patients on these potential risks and advise regular monitoring.
PATIENT COUNSELING TIPS
Adherence: Encourage patients to adhere to prescribed dosages and discuss any side effects experienced.
Lifestyle modifications: Advise on lifestyle changes such as diet, exercise, and smoking cessation to complement the therapy. Regular check-ups: Recommend regular follow-ups with healthcare providers to monitor the therapy's effectiveness and adjust dosages if necessary.
A versatile and effective option for managing menopausal symptoms, tibolone offers benefits that extend beyond simple hormone replacement.
*References available on request
WOMEN’S MONTH
Tibolone’s unique pharmacological profile, combining estrogenic, progestogenic, and androgenic properties, sets it apart from traditional hormone replacement therapy
SCAN ME
CROSSWORD #66
TO ENTER
Use the letters in the highlighted blocks to find the final answer for this month’s crossword puzzle. Email the answer with your name, surname, and cell phone number to PharmacyMagazine@newmedia.co.za. Competition closes 20 September 2024. Winners will be contacted directly. Visit www.pharmacymagazine.co.za for full terms and conditions.
ACROSS
1. The human immune system the body against pathogens like bacteria, viruses, and parasites. (PAGE 25)
2. With patients being discharged earlier from hospitals, there's a growing reliance on for post-surgical care. (PAGE 21)
5. Arthritis flare-ups can be treated with . (PAGE 11)
8. acts as an appetite suppressant. (PAGE 29)
10. Acitop Fever Blister Cream reduces severity of . (PAGE 14)
12. Boosting nutritional intake is vital from the moment patients start trying to fall . (PAGE 17)
13. More than one in three adults in SA live with . (PAGE 13)
14. Scientists have discovered a novel that targets multidrug-resistant bacteria. (PAGE 7)
DOWN
1. On 10 September 2024 Pharmacy Magazine will be hosting a webinar on nasal . (PAGE 6)
3. Tibolone’s unique profile sets it apart from traditional hormone replacement therapy. (PAGE 31)
4. Vitamin C collagen formation. (PAGE 2)
6. is the most common form of arthritis, affecting millions of people worldwide. (PAGE 19)
7. Elastoplast’s new Waterproof XL dressings boast an advanced wound pad. (PAGE 26)
9. The webinar on 19 September 2024 will look at what patients want providers to know about their pain experience. (PAGE 8)
11. Our skin helps us to our body temperature. (PAGE 23)
CROSSWORD #64 WINNER
CHERISE VAN SCHALKWYK
CROSSWORD #65
