Allergy-asthma connection: strategies to improve patient outcomes
STARTS TO RELIEVE PAIN IN JUST 15 MINUTES*2 Not all
References : 1. Wilson CG, Clarke CP, Starkey YY, Clarke GD. Comparison of a novel fast-dissolving acetaminophen tablet formulation (FDAPAP) and standard acetaminophen tablets using gammascintigraphy and pharmacokinetic studies. Drug development and industrial pharmacy. 2011;37(7):747-53. 2. Yue Y, Collaku A, Brown J, et al. Efficacy and Speed of Onset of Pain Relief of Fast-Dissolving Paracetamol on Postsurgical Dental Pain: Two Randomized, Single-Dose, Double-Blind, Placebo-Controlled Clinical Studies. Clinical Therapeutics. 2013;35(9):1306-1320 * At 1000 mg dose. Than standard paracetamol tablets.
The complex relationship between climate change, the surge in ultraviolet (UV) radiation, and the increase in skin cancer cases globally, is a growing concern for medical professionals and the Cancer Association of South Africa (CANSA)
EDITOR’S NOTE
EDUCATION
Characterised by a slow loss of cognitive function and memory, early detection and prevention of Alzheimer’s are crucial in managing the disease and improving the quality of life for those affected. Unpaid Covid vaccine doses
Allergy-asthma connection: strategies to improve patient outcomes
Spotting Alzheimer'searly: 7 reasons why it matters
Pharmacists key allies in ADHD management
Pharmacists play a crucial role in the management of ADHD, encompassing a wide range of responsibilities that extend beyond dispensing medications.
Preventing & managing osteoporosis in postmenopausal women
DIRECTOR: David Kyslinger
COMMERCIAL DIRECTOR: Maria Tiganis
STRATEGY DIRECTOR: Andrew Nunneley
CHIEF FINANCIAL OFFICER: Venette
22 Role of pharmacists in hypertension management
A significant public health issue in SA, hypertension affects more than 40% of adults.
23 Navigating contraception: special considerations for women with health issues
When considering contraceptive options for women with health conditions, it's crucial to take into account their specific health issues and how they might interact with various contraceptive methods.
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Unpaid Covid vaccine doses leave pharmacies in limbo
SA’s independent pharmacies are still struggling to receive full reimbursement for their role in the Covid-19 vaccination programme, causing concern about future engagements under National Health Insurance (NHI).
Business Day recently reported that according to the Independent Community Pharmacy Association (ICPA) many members have not been paid for extra doses administered from Pfizer vials, despite following guidelines from the US FDA and SA Health Products Regulatory Authority.
ICPA CEO Jackie Maimin expressed frustration, noting that the unresolved payment issues make it difficult to trust future NHI engagements. Independent pharmacies played a crucial role in the vaccination programme, administering Pfizer and Johnson & Johnson shots. However, the health department's vaccination programme was designed to extract only six doses per Pfizer vial, leaving no mechanism to pay for a seventh dose.
Nearly two years later, the issue remains unresolved, with many ICPA members still awaiting payments. The health department's electronic vaccination data system has also been inaccessible, complicating reconciliation efforts. Additionally, the ICPA questioned the department's decision to make pharmacies bear the cost of unused or expired vaccines, which were purchased at higher prices than
WORDS TO LIVE
BY
what the state paid.
The health department claims it is working to resolve the payment issues while adhering to the Public Finance Management Act, citing discrepancies in vaccination records and unauthorised stock transfers as complicating factors.
INTERESTING TOPICS IN THIS MONTH’S ISSUE INCLUDE:
• Unlocking the brain's role in metabolic syndrome (page 7)
• FIP Congress 2024: a call for unity and innovation in pharmacy (page 8 & 9)
• Gender & age differences in dry eye prevalence (page 11)
• Pharmacists key allies in ADHD management (page 16)
• Link between diabetes & cardiovascular disease (page 19)
CROSSWORD CHALLENGE
Congratulations to the winner of Crossword #65 Bonolo Mookaneng. For your chance to win a R500 Woolworths voucher don’t miss this month’s crossword puzzle on page 25.
“A life without love is like a year without spring.”
– Octavian Paler
INVITE
Speaker: Dr Alice Prevost WEBINAR
UV radiation on the skin The effect of
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DATE: Thursday, 10 October 2024
TIME: 19h00
SPEAKER: Dr Alice Prevost
Dr Alice Prevost is a medical doctor and specialist dermatologist who has trained and worked in all aspects of dermatology, including medical, surgical, paediatric and cosmetic dermatology. She completed her undergraduate training (MBChB) at the University of Cape Town in 2010. Following this, she completed an MSc (Med) at the University of Cape Town, where she worked with stem cells, attempting to model early hair follicle development. After that, she worked in Internal Medicine at Groote Schuur Hospital, where she obtained a Diploma in Primary Emergency Care and a Diploma in HIV Management. She completed her specialisation in Dermatology at Tygerberg Hospital over four years in a busy
dermatology clinic where she treated and managed patients with the full spectrum of dermatological concerns. She became a fellow of the College of Dermatologists of South Africa in May 2021, passing her final exams cum laude. Dr Prevost has a deep passion for connecting with people and considers it a privilege to serve as a doctor. She firmly believes that a doctor of integrity is devoted to upholding the highest standards of care, consistently guided by the best available evidence. Dr Prevost was born and raised in the Southern Suburbs of Cape Town, which she feels so lucky to still call her home. She shares a busy home with her husband, Brandon, and four growing sons, Jack, Kai, Luc and Noah.
10 October 7pm
Dr Alice Prevost
Unlocking the brain's role in metabolic syndrome
Metabolic syndrome affects 20-25% of the global population and includes conditions like obesity, type 2 diabetes, and systemic metabolic inflammation, leading to severe diseases and increased premature mortality
In a recent review published in the Gene Expression, researchers looked at (Epi) genetic aspects of metabolic syndrome pathogenesis in relation to brainderived neurotrophic factor expression, explaining that the hypothalamus, crucial for regulating eating behaviour, plays a pivotal role in Metabolic syndrome (MetS) development. Psychoneurotic disorders and MetS are interconnected, highlighting the brain's significant role in the syndrome's progression. MetS is also linked to cancer development, likely due to hypothalamic dysfunction.
According to the study, inflammation and hypothalamic alterations can trigger MetS. Animal studies show that a high-fat diet (HFD) in mothers causes hypothalamic inflammation and gliosis in offspring, leading to metabolic dysregulation. This disrupts the blood-brain barrier (BBB), allowing inflammatory mediators and fatty acids to affect foetal hypothalamus development, altering neuronal communication and promoting obesity and insulin resistance.
Maternal and paternal obesity can epigenetically reprogramme offspring, affecting their metabolic health.
Maternal HFD exposure increases inflammatory gene expression and alters neuronal signalling in offspring, with female offspring being more susceptible to metabolic disorders. Paternal obesity also influences
offspring through epigenetic modifications, contributing to metabolic dysfunctions.
Todosenko et al. explained that a maternal hypercaloric diet affects lipid metabolism and the endogenous cannabinoid system in the hypothalamus of adult offspring, leading to sex-specific metabolic responses. This diet increases the expression of lipid metabolism-related genes and cannabinoid receptors, disrupting normal metabolic processes and contributing to obesity and other metabolic disorders.
Developmental programming during critical periods can permanently alter hypothalamic structure and function, predisposing individuals to metabolic disorders later in life. Epigenetic mechanisms, such as DNA methylation and histone modifications, mediate these long-lasting effects. miRNAs, crucial for hypothalamic development and function, are influenced by maternal diet.
Key hypothalamic signalling pathways, like the Notch signalling pathway and POMC neurons, are disrupted by maternal obesity, leading to altered neuronal development and metabolic dysfunction. The researchers concluded that understanding these epigenetic and developmental mechanisms provides insights into potential therapeutic targets for preventing and managing metabolic disorders.
Understanding these epigenetic and developmental mechanisms provides insights into potential therapeutic targets for preventing and managing metabolic disorders
FIP Congress 2024: a call for unity and innovation in pharmacy
The 82nd World Congress of Pharmacy and Pharmaceutical Sciences, hosted by the International Pharmaceutical Federation (FIP), took place in Cape Town, South Africa, from 1 to 4 September 2024. This landmark event, themed "Innovating for the Future of Healthcare," brought together pharmacy professionals from around the globe to discuss advancements and challenges in the field.
UNITY FOR UNIVERSAL HEALTH COVERAGE
During the opening ceremony, Dr Sandile Buthelezi, SA's Director General of Health, emphasised the crucial role of pharmacies in achieving universal health coverage. "Located in the heart of local communities, pharmacies are one of the most easily accessible healthcare providers," he said. Dr Buthelezi highlighted the World Health Organization’s six pillars for an efficient health system, noting that pharmacists are the custodians of the second pillar — access to essential medicines — and play an integral role in the other pillars to ensure health system stability.
Dr Mari-Alet Staats (NWU RIIP/CENQAM) and Adele Naude (NWU MUSA).
Magda Kriel and Nadia Baker from Embecta.
Marique Aucamp, Michelle Viljoen, and Candidah Nephawe from UWC School of Pharmacy.
Tiyani Sono (Saselamani Pharmacy in Limpopo), Mmcengeli Sibanda (SMU), and Tinyiko Mhangwana (SAPC).
ADVANCEMENT AND INNOVATION IN PHARMACY
FIP President Paul Sinclair called for greater progression and innovation within the pharmacy profession to tackle challenges such as inequitable healthcare access, medicines shortages, antimicrobial resistance, and substandard and falsified medicines. "Innovation is not just beneficial – it’s essential," Sinclair stated. He cited pharmacy-based vaccination as an example of an innovative approach that has had a significant impact. Sinclair emphasised the application of three principles – integrity, performance, and passion – to facilitate the advancement of the profession. He introduced FIP’s "Think Health, Think Pharmacy" campaign, aimed at promoting the professional identity of pharmacists and expanding pharmacy services for community benefit.
CONGRESS HIGHLIGHTS
The congress featured various sessions and workshops, including the Basel Statement Workshop on supply chain excellence, educational sessions on pharmacovigilance and combating malaria, and poster sessions for research presentations. Social events like the Welcome Reception and the HPS Dinner provided networking opportunities for attendees.
The FIP Congress 2024 in Cape Town was a significant event, fostering discussions on innovation and unity in pharmacy to improve global health outcomes.
Hanne Hoje Jacobsen and Lisbeth Haagen from Denmark.
Pauline Boachie-Ansah and Afia Marfo from Ghana.
Denise Carolussen and Tracy Walters from the ICPA.
Thato Motshoane and Andiswa Jezile from Organon.
Zaid Morkel, Fazila Fakier, Zaarena Tiry, and Zaakiyah Essack (National Department of Health).
Elze Rossouw (Theunnisen Apteek), Willem Petrus Grobbelaar from Vrystaat, Rakesh Daya (ICPA), Magologolo Pasha (President at South African Pharmacy Council) and Cobus le Roux (Retail sector WC).
AUTHOR: Bada Pharasi, Innovative Pharmaceutical Association of South Africa CEO
Unleashing innovation is key in the battle against antimicrobial resistance
Since their discovery in 1928, antimicrobial medicines have been crucial in treating infections. However, the rise of antibiotic-resistant superbugs has created a global health crisis, demanding innovative solutions to protect modern healthcare systems, writes Bada Pharasi, CEO at the Innovative Pharmaceutical Association of South Africa (IPASA)
1.27 million
Bacterial AMR was directly responsible for as many as 1.27 million global deaths, while contributing to an additional 4.95 million deaths in 2019
As one of the top global public health and development hazards, antimicrobial resistance (AMR) has become a looming menace to healthcare worldwide, threatening to unravel decades of medical progress and jeopardising the foundations of modern healthcare.1
So much so that in 2019, bacterial AMR was directly responsible for as many as 1.27 million global deaths, while contributing to an additional 4.95 million deaths.1 Alarmingly, recent studies suggest that AMR is expected to kill 10 million people by 2050, and cost the global economy over $100 trillion. 2
Arising from the misuse and overuse of antimicrobials, including antibiotics, AMR occurs when bacteria, viruses, fungi, or parasites develop resistance to antibiotics, rendering infections challenging, and sometimes impossible, to treat. This not only heightens the risk of severe illness for patients, potentially resulting in disability or death, but also elevates the likelihood of disease transmission.
In the face of this escalating threat, innovation stands as our most potent weapon. The emergence of digital therapeutics presents a promising frontier in the battle against AMR. By seamlessly integrating with traditional treatments, these digital interventions offer novel approaches to managing infections while minimising the risk of resistance development.
To this end, several promising avenues have emerged to combat resistance, including
antivirulent therapy, passive immunisation, antimicrobial peptides, vaccines, phage therapy, and botanical and liposomal nanoparticles, which all offer diverse methods to effectively fight infections.3
While these cutting-edge methodologies aim to reduce reliance on antibacterial drugs and alleviate resistance pressure2 , there is a dire need to adapt the current regulatory landscape to accommodate these cutting-edge solutions.
One of the most innovative means is the convergence of artificial intelligence (AI) and precision medicine, poised to revolutionise healthcare. Precision medicine methods identify patient phenotypes with unique treatment responses or specific healthcare needs, whereas AI utilises advanced computation to generate insights, enabling reasoning, learning, and enhancing clinician decision-making through augmented intelligence.3
Current research indicates that this convergence will address precision medicine's most challenging issues, particularly those involving genomic and non-genomic determinants, alongside patient symptoms, clinical history, and lifestyles, facilitating personalised diagnosis and prognostication.3
Faced with the threat of AMR, the industry stands at a critical junction to shape the future of healthcare. By collaborating and leveraging digital therapeutics, precision medicine, and innovative treatments, together we can pave the way for a healthier future.
*References available on request
Gender & age differences in dry eye prevalence
Characterised by a lack of sufficient lubrication and moisture on the surface of the eye, dry eye is a prevalent condition that significantly affects quality of life1
Dry eye disease can lead to various symptoms including irritation, redness, discharge, and visual disturbances.1,2,3 Prevalence varies across different genders and age groups and is more commonly observed in older adults and women, especially post-menopausal women.3
PREVALENCE
AMONG DIFFERENT DEMOGRAPHICS
P Gender differences: Research indicates that dry eye disease is more prevalent in women than in men. 4 Hormonal fluctuations, particularly oestrogen and androgen, play a significant role in this disparity.3 Oestrogen can influence the lacrimal gland, which is responsible for producing tears,5 and androgen deficiency has been linked to the dysfunction of the meibomian glands in the eyelids, crucial for tear stability.6
P Age differences: Age is a significant risk factor for dry eye disease.3,4 As people age, the production of tears decreases, and the tear film's stability is compromised. The prevalence of dry eye disease increases notably after the age of 50. This is partly due to general health decline and the increased incidence of comorbidities such as diabetes and rheumatoid arthritis, which are linked to higher rates of dry eye.7
OLDER ADULTS AND POST-MENOPAUSAL WOMEN
P Older adults: The tear film is composed of three layers: lipid,
aqueous, and mucous. Each component plays a vital role in maintaining eye health. 8 In older adults, there are changes in the composition of these layers, often exacerbated by systemic medications that affect tear production, such as antihistamines and antidepressants.1 Additionally, age-related eyelid changes can lead to increased tear evaporation, further aggravating dry eye symptoms.9
P Post-menopausal women: For women, menopause marks a significant risk period for developing dry eye disease. The decrease in androgen and oestrogen levels during menopause directly affects the ocular tissues involved in tear production and regulation. Studies have shown that post-menopausal women report higher rates of dry eye symptoms compared to premenopausal women and men of the same age group. 4,10
Understanding the demographic differences in dry eye prevalence helps in tailoring more effective treatment and management strategies. Recognising these variations is crucial in advising and managing care for patients with dry eye disease, especially in older adults and post-menopausal women. Pharmacists can guide patients in selecting suitable OTC products and advise on the potential benefits of systemic treatments like hormone replacement therapy.
*References available on request
1 in 5
Dry eye disorder affects 1 in 5 people, with increased prevalence in women than men11
'Wet' Macular Degeneration
Normal
'Dry' Macular Degeneration
Climate change & unsu specting risk factor for skin cancer
The complex relationship between climate change, the surge in ultraviolet (UV) radiation, and the increase in skin cancer cases globally, is a growing concern for medical professionals and the Cancer Association of South Africa (CANSA)
As global weather patterns undergo shifts due to climate change, the consequential increase in UV rays poses a heightened environmental risk for skin cancer, particularly in regions like SA with its subtropical location, climate, and topography.
squamous cell carcinoma, which are the most common types of skin cancers.”
There are two main types of skin cancer: cutaneous melanoma and non-melanoma skin cancer
According to the International Journal of Women’s Dermatology, the warming climate, coupled with factors such as air pollution from (burning) fossil fuels, contributes to a surge in carcinogenic effects, amplifying the potential harm of UV radiation on human health. This escalating exposure to solar UVR emerges as a significant risk factor for skin cancer caused by intensified UV exposure.
“Skin cancer is a serious health issue,” explains Lorraine Govender, CANSA’s national manager, Health Promotion. “There are two main types of skin cancer: cutaneous melanoma and non-melanoma skin cancer (also referred to as keratinocyte carcinoma) which consists of basal cell and
All skin cancers have shown an increase in incidence worldwide, including South Africa which has cost implications relating to diagnosis and treatment. The National Cancer Registry (NCR) 2019 statistics show melanoma as currently ranking fifth in the most common cancers in men and sixth among women in South Africa.
Govender says, “CANSA’s goal is to help people understand skin cancer better, encouraging risk-reduction actions and contributing to the global conversation on this growing health problem.”
Recognising the warning signs of skin cancer is paramount for early detection and timely intervention. Moles, brown spots, and skin growths, while often harmless, can pose risks, particularly for individuals with more than 100 moles who are at a heightened risk for melanoma. Vigilance in understanding one’s skin and promptly identifying changes in moles is crucial.
THE ABCDE SIGNS SERVE AS A VALUABLE GUIDE:
Asymmetry: Halves might not match when you draw a line through the mole.
Border irregularities: Edges may be scalloped or notched.
Colour variations: Different shades or unconventional colours may appear.
Diameter: Moles that are wider than a pencil eraser.
Evolving characteristics: Encompasses any change in size, shape, colour, elevation, or new symptoms like bleeding or itching.
In addition to the ABCDE signs, dermatologists emphasise the ‘FG’ addition, representing ‘Fast Growing.’ Rapid changes in size over a short period, signal potential danger and may need immediate examination by a dermatologist.
Lowering the risk of skin cancer is a proactive approach individuals can adopt to safeguard their health. Key preventive measures include limiting sun exposure, particularly between 10:00 and 15:00 when UV radiation is most intense. Seeking shade
or using an umbrella provides additional protection. Wearing protective clothing, such as wide-brimmed hats and UV-protective attire, shields the skin from harmful rays. Sunglasses with a UV protection rating of UV400 safeguard the eyes. Apply a broadspectrum sunscreen with a sun protection factor (SPF) of 20 or higher, according to skin type. Apply it 20 minutes before sun exposure and reapply every two hours and after swimming.
“Look out for sunscreens, clothing, hats, and summer accessories that bear the CANSA Seal of Recognition,” shares Govender.
Regular skin checks, following the ABCDE guidelines for mole assessment, aid in early detection. Avoiding tanning beds and being mindful of changes in the skin’s appearance or sensation to aid in lowering the cancer risk.
“It’s crucial to cultivate awareness about the risks of skin cancer,” concluded Govender. “CANSA remains dedicated to empowering individuals with knowledge and tools to protect themselves against the impact of prolonged sun exposure.”
Escalating exposure to solar UVR is a significant risk factor for skin cancer caused by intensified UV exposure
Preventing flare-ups in atopic dermatitis
Achronic skin condition characterised by itchy, dry, skin that’s prone to infection, there's no cure for atopic dermatitis. 2,3 However, effective management can significantly reduce flare-ups and improve quality of life.3
TIPS AND STRATEGIES FOR PREVENTING FLARE-UPS
1. Skincare routine
F Moisturisation: Encourage patients to use a fragrance-free emollient at least twice daily, especially after bathing. This helps to lock in moisture and maintain the skin barrier. 4,5
F Bathing: Advise on short, lukewarm baths or showers, lasting no more than 10-15 minutes. Recommend the use of gentle, soap-free cleansers to avoid stripping the skin of its natural oils. 4
F Pat dry: Instruct patients to pat the skin dry with a soft towel rather than rubbing, which can irritate the skin. 4
F Wet wraps: For severe flare-ups, consider wet wrap therapy after moisturising, which can help soothe and hydrate the skin.5
2. Avoiding irritants
F Fragrance-free products: Recommend the use of fragrance-free, hypoallergenic products for skincare, laundry, and household cleaning.1,6,7
F Clothing choices: Suggest wearing soft, breathable fabrics like cotton. Advise against wool or synthetic fabrics, which can be irritating.8
F Patch testing: For new skincare or household products, recommend patch testing on a small area of skin before full application.9
3. Environmental modifications
F Humidity control: Advise the use of humidifiers, especially in dry climates or during winter, to keep indoor air moist.10
F Allergen reduction: Encourage regular cleaning to reduce dust, mould, and pet dander. Suggest using allergen-proof covers on mattresses and pillows.11
F Temperature regulation: Recommend
keeping the home at a comfortable, stable temperature to avoid extremes that could dry out or irritate the skin.12
4. Managing stress
F Stress-reduction techniques: Encourage practices such as mindfulness, meditation, and regular exercise to help manage stress levels.13
F Sleep hygiene: Advise on maintaining good sleep habits, as poor sleep can exacerbate stress and skin symptoms.
5. Diet and Hydration
While the relationship between diet and atopic dermatitis isn't fully understood, some patients may benefit from dietary adjustments.
F Food triggers: Encourage patients to keep a food diary to identify potential dietary triggers. If specific foods seem to exacerbate symptoms, a referral to a dietitian may be appropriate. 15
F Hydration: Remind patients to stay wellhydrated, as this supports overall skin health.8
6. Medication adherence
For patients with more severe atopic dermatitis, adherence to prescribed medications is crucial.
F Topical treatments: Ensure patients understand the correct application of topical corticosteroids or calcineurin inhibitors.1,4,5 Emphasise the importance of applying these medications to affected areas as prescribed.1
F Systemic treatments: For patients on systemic treatments, stress the importance of regular follow-ups and adherence to therapy, even when symptoms improve.1
Flare-ups can be distressing for patients, and as pharmacists, you play a crucial role in educating and guiding them to manage and prevent these episodes effectively. Emphasise the importance of regular follow-ups to monitor the condition, adjust treatment as needed, and address any concerns.1
*References available on request
Atopic dermatitis is often triggered by a combination of genetic and environmental factors. Common triggers include allergens, irritants, climate, stress, infections, and diet
Education neurology
Pharmacists key allies in ADHD management
Pharmacists play a crucial role in the management of ADHD, encompassing a wide range of responsibilities that extend beyond dispensing medications
Attention deficit hyperactivity disorder (ADHD) is characterised by inattention, hyperactivity, and impulsivity. While the exact causes remain unknown, it is believed to be influenced by genetic, environmental, and neurobiological factors.1
Even though ADHD can require varied degrees of diagnostic testing, pharmacists may be among the first medical practitioners to learn about a patient's symptoms. This is due in part to the fact that pharmacists see patients more often than other medical professionals.
6 KEY ASPECTS
1. Medication management and optimisation Pharmacists are responsible for ensuring the safe and effective use of ADHD medications.
This includes:
• Dispense medications accurately ensuring patients understand their dosing schedules2
• Review medication regimens for potential drug interactions, contraindications, and side effects2
• Optimise medication regimens in collaboration with physicians, which may involve adjusting dosages or switching medications based on patient response and side effects. 2
• Elnaem et al. caution that “a pharmacist must recognise how stimulants influence appetite and growth in children with ADHD. Children using stimulants should have their height and weight assessed regularly, such as semi-annually.”2
2. Patient education and counselling2
• Educate patients and caregivers about ADHD and its treatment, including the importance of adherence to medication and the potential side effects2,3
• Address misconceptions about ADHD medications, such as fears about addiction or stigmatisation 2,3
• Counsel on lifestyle modifications and nonpharmacological interventions that can support medication therapy, such as dietary changes, exercise, and behavioural strategies. 2
3 Monitoring and follow-up
• Conduct follow-up consultations to assess treatment outcomes and patient satisfaction. 2 “It is important for pharmacists to the check blood pressure and heart rate at follow-up sessions,” advised Elnaem et al
• Adjust treatment plans in collaboration with the healthcare team based on patient feedback and clinical outcomes2,3
• Ensure adherence to medication through various strategies, including reminder systems or simplifying medication regimens.2
4. Collaboration with healthcare team
• Communicate with other healthcare providers to share insights on the patient’s progress and any concerns related to medication therapy2
• Participate in case conferences or team meetings to discuss complex cases and contribute to the development of comprehensive care plans.2
5. Advocacy and support
• Provide support and reassurance to patients and families navigating the challenges of ADHD2,3
• Help to navigate insurance coverage and access to medications, including finding cost-effective treatment options2
• Promote awareness about ADHD and reducing stigma associated with the condition and its treatment.2
6. Utilisation of technology
• Offer remote consultations and support for patients who may have difficulty accessing traditional healthcare services2
• Leverage digital health applications to monitor patient adherence, side effects, and overall well-being.2
Pharmacists’ involvement is integral to the comprehensive care of patients with ADHD, contributing significantly to medication management, patient education, monitoring side effects, and overall support.2
*References available on request.
Preventing & managing osteoporosis in postmenopausal women
Asystemic skeletal disorder, osteoporosis is characterised by decreased bone density and deterioration of bone tissue, leading to increased fragility and susceptibility to fractures.1,2 A significant health concern, particularly for postmenopausal women, it is often termed a ‘silent disease’ because bone loss occurs without symptoms until a fracture happens.
IMPORTANCE OF BONE HEALTH
Bone health is essential for maintaining mobility and overall well-being.3 Postmenopausal women are at a higher risk of osteoporosis due to the decline in oestrogen levels, a hormone which plays a crucial role in maintaining bone density. The accelerated bone loss following menopause significantly increases the risk of fractures, particularly in the hip, spine, and wrist.2,4,5
PREVENTIVE MEASURES
1. Lifestyle modifications
• Exercise: Engaging in regular weight-bearing and muscle-strengthening exercises can improve bone density, balance, and muscle strength, reducing the risk of falls and fractures.2,4,6,7
• Diet: A balanced diet rich in calcium and vitamin D is crucial.2,4 Postmenopausal women should aim for an adequate intake of calcium (around 1200 mg/day)4 and vitamin D (800-2000 IU/day), either through diet or supplements.5,6
• Smoking and alcohol: Avoiding smoking and limiting alcohol intake can help prevent bone loss. 2,4,6,7,8
2. Nutritional supplementation
• Calcium and vitamin D: Supplements may be necessary for individuals not getting enough from their diet. Vitamin D plays a crucial role in calcium absorption and bone health.5,6
• Other nutrients: Research suggests that magnesium,9 vitamin K,10 and proteins also play a role in bone health.7,11
TREATMENTS FOR OSTEOPOROSIS
1. Pharmacological interventions:
• Bisphosphonates: These are the first-line treatment for preventing and treating osteoporosis in postmenopausal women, reducing the risk of fractures by inhibiting bone resorption.1,5,6,7
• Denosumab: An alternative to bisphosphonates, especially for women with renal impairment or those who cannot tolerate oral bisphosphonates, denosumab is a monoclonal antibody that reduces bone resorption.1,4,5,6,7
• Selective oestrogen receptor modulators (SERMs): Such as raloxifene, these drugs mimic oestrogen's bone-protective effects.1,6,7
• Parathyroid hormone analogues: Teriparatide and abaloparatide, these are anabolic treatments that stimulate bone formation, used in severe cases.1,4,5,6,7
• Romosozumab: A newer option for high-risk patients, which has shown to significantly reduce fracture risk in postmenopausal women with severe osteoporosis.1,7
• Hormone replacement therapy (HRT): While effective in preventing bone loss, HRT is typically reserved for women with severe symptoms due to associated risks.1,4,6,7
2. Monitoring and reassessment
• Bone mineral density (BMD) testing: Regular BMD testing is essential to monitor the effectiveness of treatment and progression of osteoporosis to adjust therapy as needed. 4,7
• Fracture risk assessment: Tools like FRAX can help in assessing fracture risk and guiding treatment decisions. 4,7
• Patient education: Educate patients on medication adherence, potential side effects, and the importance of a healthy lifestyle in managing osteoporosis.6
INDIVIDUALISED APPROACH
Treatment decisions should be individualised based on the patient's risk factors, preferences, comorbidities, and risk of adverse effects. The choice of therapy may also depend on the specific sites of bone loss and the patient's overall risk profile.
*References available on request
1 in 3 women over age 50 will experience osteoporosis fractures1
Link between diabetes & cardiovascular disease
Diabetes and cardiovascular disease (CVD) are two of the most prevalent chronic conditions worldwide, and their interconnection significantly impacts patient health outcomes.1,2 Understanding the intricate relationship between these diseases and the role you can play in managing these comorbid conditions is crucial for improving patient care.
INTERCONNECTIONS BETWEEN DIABETES AND CARDIOVASCULAR DISEASE
Insulin resistance and atherogenesis
Insulin resistance, a hallmark of type 2 diabetes, plays a pivotal role in the development of cardiovascular disease. It leads to dyslipidaemia and atherogenesis, significantly elevating the risk of cardiovascular events in individuals with diabetes. The presence of insulin resistance accelerates the formation of atherosclerotic plaques, which can lead to severe cardiovascular events such as myocardial infarction and stroke.1
Hyperglycaemia-induced oxidative stress and inflammation
Chronic hyperglycaemia in diabetes induces oxidative stress and inflammation, which exacerbate endothelial dysfunction and vascular damage. This process further increases the risk of cardiovascular complications, making it essential to manage blood glucose levels effectively to mitigate these risks.1
Accelerated atherosclerosis
The interaction between diabetes and cardiovascular disease accelerates the development of atherosclerotic plaques. These plaques are more prone to rupture, leading to severe cardiovascular events. Managing both conditions simultaneously is crucial to prevent such outcomes.1
ROLE OF PHARMACISTS
IN MANAGING DIABETES AND CARDIOVASCULAR DISEASE
Pharmacists play a crucial role in managing diabetes and its comorbid cardiovascular conditions. 2
Medication management and optimisation
P Medication review and reconciliation: Assess patient medication lists for accuracy, resolve drug interactions, and ensure medications are appropriate for the patient's current health status. 2
P Dose adjustments: Make recommendations for dose adjustments based on patient response, side effects, and laboratory values. 2
P Adherence support: Implementing strategies to improve medication adherence is crucial for managing chronic conditions effectively. 2
Patient education and self-management support
P Disease and medication education: Educate patients about their conditions, the importance of their medications, and how to manage side effects. 2
P Lifestyle modification counselling: Advise on diet, exercise, smoking cessation, and weight management to control blood glucose levels and reduce cardiovascular risk. 2,3
P Self-monitoring guidance: Teach patients how to monitor their blood glucose and blood pressure at home and interpret the results. 2
Risk factor management
P Blood pressure and lipid control: Recommend and manage medications to control blood pressure and lipid levels, alongside lifestyle interventions.2
P Anticoagulation management: For patients with atrial fibrillation or other conditions increasing stroke risk, manage anticoagulant therapy to prevent complications. 4
Collaborative care
P Coordinating care: Work with physicians, nurses, dietitians, and other healthcare professionals to develop and implement a cohesive care plan. 2,3,5
P Transitional care: Assisting with medication management as patients transition between care settings (eg, hospital to home), is critical for preventing readmissions and ensuring continuity of care. 2,3
*References available on request
Allergy-asthma connection: strategies to improve patient outcomes
Understanding the relationship between allergies and asthma is essential, as managing allergies can significantly help control asthma symptoms.
ALLERGIC ASTHMA
Allergic asthma is the most prevalent form of asthma1,2, triggered by allergens such as pollen, dust mites, mould spores, pet dander, and cockroach droppings. Exposure to these allergens causes the immune system to overreact, leading to airway inflammation and asthma symptoms.2,3
IMMUNOLOGICAL MECHANISMS
Both allergies and asthma involve the production of Immunoglobulin E (IgE) antibodies in response to specific allergens. These IgE antibodies bind to mast cells and basophils, releasing inflammatory mediators like histamines, leukotrienes, and cytokines, which contribute to allergic reactions and asthma symptoms.1,4,5
INFLAMMATION AND AIRWAY HYPERRESPONSIVENESS
Allergic reactions can cause inflammation and swelling of the airways, increasing their sensitivity and reactivity to triggers. This condition, known as airway hyperresponsiveness, is a hallmark of asthma, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing.3,5
ATOPIC MARCH
The ‘atopic march’ describes the progression of allergic diseases from early childhood, often starting with eczema, progressing to food allergies and allergic rhinitis, and eventually leading to asthma.6,7 This progression highlights the interconnectedness of allergic diseases and the importance of early intervention.
ENVIRONMENTAL FACTORS
Environmental factors play a significant role in both allergies and asthma. Exposure to allergens,
air pollution, tobacco smoke, and viral respiratory infections can exacerbate both conditions.8,9
Changes in lifestyle and environment, such as increased hygiene and reduced exposure to diverse microbial environments, have been linked to the rise in allergic diseases and asthma.10
MANAGEMENT AND TREATMENT
Effective management of allergies is crucial for controlling asthma symptoms. Pharmacists can play a pivotal role in advising patients on the following strategies:
F Identifying allergens: Encourage patients to work with an allergist to identify specific allergens and take steps to minimise exposure,3 such as using air purifiers11 and allergen-proof covers.3
F Medication management: Recommend appropriate medications like antihistamines, nasal corticosteroids, and leukotriene inhibitors.12,13 Allergy shots (immunotherapy) can also help reduce the severity of allergic reactions and asthma symptoms.13,14
F Environmental controls: Advise patients on regular cleaning to reduce dust mites, mould, and pet dander.2 Suggest using HEPA filters3,15,16 and maintaining indoor humidity levels between 45% and 50%.3
F Asthma action plan: Collaborate with patients and their healthcare providers to develop an asthma action plan that includes strategies for managing allergies.13
F Regular monitoring and review: Encourage patients to regularly review their management plan with their healthcare provider and keep a diary of symptoms, triggers, and medication use.
By taking a comprehensive approach to managing allergies, you can help patients significantly reduce their asthma symptoms and improve their quality of life.
*References available on request
Spotting Alzheimer's early: 7 reasons why it matters
Alzheimer's disease is a progressive neurodegenerative disorder that affects millions of people worldwide. Characterised by a slow loss of cognitive function and memory, early detection and prevention are crucial in managing the disease and improving the quality of life for those affected. 1,2
THE POWER OF EARLY DIAGNOSIS
1. Improved quality of life: Early diagnosis allows individuals and their families to access support services, educational resources, and interventions at a stage when these can have a significant impact. It enables individuals to maintain their independence and quality of life for as long as possible.1,3
2. Access to treatments: While there is no cure for Alzheimer's disease, treatments are available that can help manage symptoms. Early detection means these treatments can be started sooner, potentially slowing the progression of cognitive decline. This includes pharmacological treatments that target specific aspects of the disease process, as well as non-pharmacological interventions aimed at supporting cognitive function and managing behavioural symptoms.1,4
3. Opportunity for lifestyle adjustments: Recognising Alzheimer's early allows individuals to make lifestyle changes that may help slow disease progression. This includes engaging in physical activity, adopting a healthier diet, staying socially connected, and participating in cognitive stimulation activities.1,4
4. Planning for the future: An early diagnosis provides individuals and their families with the opportunity to make important decisions about financial planning, healthcare, living
arrangements, and end-of-life care while the individual can still participate in these discussions.1,3,4
5. Participation in clinical trials: Early detection opens the door for participation in clinical trials, which is essential for the development of new treatments. Individuals diagnosed early in the disease process can contribute to research that may lead to breakthroughs in Alzheimer's care and prevention.1,3,4
6. Reducing healthcare costs: Early diagnosis and intervention can potentially reduce the financial burden on families and healthcare systems by delaying the need for more intensive care and support services. 4,5
7. Emotional and social benefits: Early diagnosis can reduce anxiety for individuals and their families by explaining symptoms. It also allows families to connect with support groups and networks, which can be invaluable sources of information and emotional support.3,4
Early detection is essential in managing Alzheimer's disease. By recognising the signs early and adopting a healthy lifestyle, patients can potentially slow the progression of the disease and improve their quality of life. Pharmacists play a crucial role in educating patients about these measures and supporting them in their journey.
*References available on request.
Alzheimer's accounts for 60-80% of dementia cases1 60%
Role of pharmacists in hypertension management
As September marks World Heart Month, the global spotlight turns towards cardiovascular health, with hypertension emerging as one of the most critical areas of focus. Hypertension is a significant public health issue in SA, affecting more than 40% of adults.1 This prevalence is notably higher than the global average of 1.28 billion (approximately 15%) reported by the World Health Organization.2
HYPERTENSION & ASSOCIATED CARDIOVASCULAR RISK
Often referred to as the ‘silent killer’, hypertension is a major risk factor for cardiovascular diseases (CVDs), including heart attacks, strokes, and heart failure.3 Elevated blood pressure exerts excessive force against the walls of arteries, leading to various pathophysiological changes that significantly increase the risk of cardiovascular events. 4,5 Effective management of hypertension is crucial in reducing the risk of these cardiovascular events, involving a combination of lifestyle modifications and pharmacological treatment. 4,6
communication between patients and healthcare providers. FDC products, such as perindopril/ amlodipine, offer additional benefits in managing side effects by lowering the incidence of peripheral oedema and cough associated with monotherapy.5,9
PATIENT EDUCATION ON DIET, EXERCISE & LIFESTYLE MODIFICATION
Non-pharmacological approaches to hypertension management are essential in controlling blood pressure (BP) and improving overall cardiovascular health. These strategies include dietary modifications, regular physical activity, and lifestyle changes.6,11 Pharmacists play a vital role in counselling patients on these lifestyle modifications, providing personalised advice, setting realistic goals, and offering resources such as educational materials and support groups. While lifestyle changes can improve BP and overall CV risk, the majority of patients will require pharmacotherapy.11,12
Hypertension is a significant public health issue in SA, affecting more than 40% of adults1
BENEFITS OF FDC PRODUCTS IN TREATING HYPERTENSION
Fixed-dose combination (FDC) products offer several clinical advantages in the management of hypertension, particularly in improving blood pressure control and patient compliance. By combining two or more antihypertensive agents into a single pill, FDCs simplify the medication regimen, which significantly enhances patient adherence.5,8 Combinations like perindopril/ amlodipine have shown superior outcomes in controlling blood pressure compared to monotherapy or separate pills.5,9
SIDE EFFECTS OF ANTIHYPERTENSIVES
Antihypertensive drugs, while effective, are associated with various side effects that can impact patient compliance and quality of life. Common side effects include persistent dry cough, dizziness, fatigue, and headaches.10 Managing these side effects involves close monitoring and
IMPORTANCE OF PATIENT ADHERENCE TO TREATMENT
Medication adherence in hypertensive patients is a critical factor in achieving optimal health outcomes. To improve adherence, strategies such as using FDC products, patient education, and regular follow-up appointments are essential. Pharmacists can educate patients about the importance of adherence, potential side effects, and the long-term benefits of controlling blood pressure.13
HOME-BASED BLOOD PRESSURE MONITORING
Home-based blood pressure (BP) monitoring is a valuable tool for self-management of hypertension. Regular home monitoring allows patients to track their BP more frequently and in a less stressful environment, leading to improved BP control and early detection of hypertension. Pharmacists play a crucial role in educating patients on accurate home monitoring techniques and interpreting results, contributing to better hypertension management and overall cardiovascular health.6,14
*References available on request
Navigating contraception: special considerations for women with health issues
By understanding the unique needs and considerations of women with certain health conditions, you can ensure that patients receive the most appropriate and effective contraceptive care.
When considering contraceptive options for women with health conditions, it's crucial to take into account their specific health issues and how they might interact with various contraceptive methods.1
Here are some general considerations for women with certain health conditions:
CARDIOVASCULAR DISEASES (INCLUDING HYPERTENSION)
Contraceptive options:
Progestin-only methods: These include progestinonly pills (POPs), injectables, and implants. They are generally safer for women with cardiovascular diseases as they do not contain oestrogen, which can increase the risk of thrombosis.1,2,3,4
Non-hormonal methods: Copper IUDs are a highly effective non-hormonal option that do not carry the same risks as hormonal methods.1,3,5
Considerations:
Women with cardiovascular diseases or risk factors for cardiovascular disease should avoid combined hormonal contraceptives (CHCs) that contain oestrogen and progestin due to the increased risk of thrombosis.1,2,3,4
BREAST CANCER
Contraceptive options:
Non-hormonal methods: The copper IUD is often considered the best option for women with current or past breast cancer.3,6,7
Progestin-only methods: These may be considered in certain situations based on the time since cancer treatment and other factors.7
Considerations:
Hormonal methods could potentially stimulate cancer growth, so non-hormonal methods are preferred.
DIABETES
Contraceptive options:
Progestin-only methods: These include progestin-only pills, injectables, and implants.3,9 Non-hormonal methods: Copper IUDs are a suitable option.3,8,9
Considerations:
Women with diabetes without vascular disease can generally use all forms of contraception.9 However, those with complications or long-standing diabetes should avoid CHCs due to the increased risk of cardiovascular disease.3,8
OBESITY
Contraceptive options:
All methods: Obesity itself is not a contraindication to any specific contraceptive method. However, because obesity is felt to be an independent risk factor for venous thromboembolus, Abou-Ismail et al. recommend “alternative non-hormonal contraceptive methods such as progestin-only contraception or IUD”.3 Copper IUD: Recommended for emergency contraception in women with a higher body mass index (BMI).10
Considerations:
Combined hormonal methods may have a slightly increased risk of thrombosis in obese women.11 The efficacy of emergency contraception pills may be reduced in women with a higher BMI.10
When considering contraceptive options, it’s crucial to thoroughly discuss patient’s individual situations. Help them weigh the risks and benefits of each option, taking into account their health status, preferences, and any potential interactions with existing medications or conditions.6
By understanding the unique needs and considerations of women with certain health conditions, you can ensure that patients receive the most appropriate and effective contraceptive care.
*References available on request.
60% of SA women aged 15-49 use some form of contraception 60%
CROSSWORD #67
WIN:R500 WOOLWORTHS VOUCHER
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 October 2024. Winners will be contacted directly. Visit www.pharmacymagazine.co.za for full terms and conditions.
ACROSS
1. Dry eye is characterised by a lack of sufficient and moisture on the surface of the eye. (PAGE 11)
5. women are at a higher risk of osteoporosis due to the decline in oestrogen levels. (PAGE 17)
7. As global weather patterns undergo shifts due to climate change, the consequential increase in UV rays poses a environmental risk for skin cancer. (PAGE 12 & 13)
10. affects more than 40% of adults in SA. (PAGE 22)
11. Insulin resistance leads to dyslipidaemia and . (PAGE 19)
12. Since their discovery in 1928, medicines have been crucial in treating infections. (PAGE 10)
13. The 82nd World Congress of Pharmacy and Sciences took place in CT in September. (PAGE 8 & 9)
14. Ferrous Forte Somal contains the smallest endosomal iron particles with 99% and no expected digestive system side effects. (PAGE 24)
15. Pharmacy Magazine is hosting a webinar on the effect of UV on the skin on 10 October 2024. (PAGE 6)
DOWN
2. Women with cardiovascular diseases or risk factors for cardiovascular disease should avoid combined hormonal that contain oestrogen and progestin. (PAGE 23)
3. Atopic dermatitis, or eczema, has a profoundly negative physical, , and economic impact on patients and their families. (PAGE 15)
4. Alzheimer's disease is a progressive disorder that affects millions of people worldwide. (PAGE 21)
6 disorders and MetS are interconnected, highlighting the brain's significant role in the syndrome's progression. (PAGE 7)
8. asthma is the most prevalent form of asthma. (PAGE 20)
9. ADHD is characterised by inattention, hyperactivity, and impulsivity. (PAGE 16)
CROSSWORD #65 WINNER
BONOLO MOOKANENG
To enter scan QR code
Kit Kat Group, Engen) 12 months ending November 2023.
13 February 2024]. Available from https://knowledgehub.health.gov.za/content/standard-treatment-guidelines-and-essential-medicines-list
0 CALPOL Paediatric Suspension. Reg no: B/2.7/767. Each 5 ml suspension contains 120 mg Paracetamol. Preservatives: Methyl Hydroxybenzoate 0,1 % m/v, Propyl Hydroxybenzoate 0,02 % m/v. Contains sugar (glucose and sorbitol). Alcohol Free. Haleon South Africa (Pty) Ltd. 11 Hawkins Avenue, Epping Industria 1, Cape Town, 7460. Reg. No: 2014/173930/07. For full prescribing information refer to the professional information approved by the medicines regulatory authority. Always read the label prior/before to use. For any further information, including safety, please contact the Haleon Hotline on +27 11 745 6001 or 0800118274. Trademarks are owned by or licensed to Haleon group of companies. Promotion Number: PM-ZA-CALP-24-00008
