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June 2014 Volume 6  Issue 6

Irish Pharmacy Awards 2014

EXCELLENCE IN PHARMACY

THE INDEPENDENT VOICE OF PHARMACY AWARDS 2014 WINNERS ISSUE

Shortlisted BUSINESS TO BUSINESS MAGAZINE OF THE YEAR

Welcome to

In this issue: NEWS: Illegal prescription medicines seized in Ireland Page 5

DEBATE: Ireland's increasing move towards self-care market Page 14

AWARDS: Exclusive coverage of the winners at the 2014 Irish Pharmacy Awards Page 16

CPD: Treating depression in the pharmacy setting Page 35

REPORT: Irish Institute of Pharmacy under the spotlight Page 43

Ireland’s co-operative pharmacy group. On your doorstep.

FEATURE: Category focus on the female health market Page 44


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3 “Not getting enough

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Find out more about us and read what constipation sufferers think and feel at

www.letstalkconstipation.ie

the constipation experts


Contents Page 4 Calls for universal vaccine

Page 6

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Haven pharmacists cycle for charity

Irish Pharmacy News chats to Ingrid Hook in our profile

Long-term medicines strategy for Ireland

Drugs v. Food and Food v. Drugs The cheapest brand of a tube of adult toothpaste in Ireland costs about 49 cents more than the new cost of a prescription dispensed from a pharmacy, which is the equivalent to a 500g loaf of Soda Bread, eight eggs or 1.25g of hard cheese or 150g of brie/ camembert. And, yet everyone is screaming that the new prescription charge is daylight robbery – the patients, the pharmacists and some of their representatives. (See page 5). Do all these people think that most prescription drugs cost any less to dispense than the euros 2.50 being asked? People need drugs if they are ill just as they need food to survive but isn’t it strange when it comes to paying for medicines that the public balks at such costs? For once, IPN finds that the cost per item dispensed is not unreasonable and it is far, far less than in many other countries where there is a charge for medicines. Costs are much higher in much of the rest of Europe and, in the UK roughly four times higher.

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Page 12

Foreword

Where IPN would be at odds with the Government is on the withdrawal of certain Medical Cards for people with special needs. But, the crux of the matter is what does the Irish population want in relation to its healthcare? No-one can possibly expect their healthcare to be free because someone, somewhere has to pay for it, either through taxes, insurance or some type of ‘stealth’ tax.

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Page 52

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Medicines Reconcilliation for depressives

This current Government came in vowing to switch healthcare over to a competent insurance system and the public has been waiting ever since for proper details of this to emerge. (The Government had sufficient time to work all this out in opposition.) This now seems to have been put pretty much on a back burner because the sums are too complex What is required is for all interested parties, including the public – both the sick and the healthy, who are to be the beneficiaries at the end of the chain - to sit down and hammer out a system which would be sensible and viable and which could withstand the test of a timescale of at least fifty years, if not more.

Page 56 Commercial Profile with Fergal Egan, IMS

IPN has mentioned before that a consensus of all parties, including ‘ordinary’ doctors and pharmacists at the ‘sharp end’ would be the best and most sensible way forward yet no-one has, as yet, even pulled out a chair from under a table.

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In all honesty, the increased cost of a prescription in the Republic of euros 2.50 is not unreasonable; it is just that, before the hike, it was so low. And, this is not the first time either - and it probably won’t be the last - that IPN has brought to light the dangers of over-prescribing antiobiotics. A group of medical experts (see page x) has now warned of Armageddon in that, with so many drug remedies becoming ineffective, positive global steps must be taken before it is too late for even the most common of operations to be undertaken. Closer co-operation between pharmacists and GPs in Ireland would be a start but as the doctors are seemingly so against pharmacists, this should be lead from the top. Will it, though?

Regulars

CPD: Treating depression in pharmacy Feature: Bites, stings & wounds

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street Dublin 2 00353 (01) 6690562

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SENIOR JOURNALIST Ciara Jordan EDITORIAL DEPARTMENT editorial@ipnirishpharmacynews.ie

35 51

Feature: Sleep disorders Out and about

60 64

Clinical profiles Appointments

67 70

ADVERTISING MANAGER Nicola McGarvey nicola@ipnirishpharmacynews.ie

OFFICE MANAGER Joe Johnston joe@ipnirishpharmacynews.ie

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CONTRIBUTORS Berna ART DIRECTOR - Smart Page Design

ACCOUNTS cs.ipn@btconnect.com

Irish Pharmacy News is circulated to all independent, multiple and hospital pharmacist, government officials and departments, pharmacy managers, manufactures and wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists subscription rate for Irish Pharmacy News ¤60 plus vat per year. All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission. IPN Communications Ltd. have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

IRISH PHARMACY NEWS

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News news brief MEDICAL CARDS - VULNERABLE TO SUFFER The Irish Pharmacy Union (IPU) and Jack and Jill Children’s foundation have said that the withdrawl of medical cards are forcing the vulnerable to suffer. The newly appointed president of the IPU, Kathy Maher criticised the Government for denial on the issue; "It’s shocking that the Government is still denying what every pharmacist in the country knows...medical cards are being withdrawn on a widespread basis and vulnerable patients are suffering as a result." Maher said that there was no doubt that medical cards were being withdrawn on a widespread basis across the country. She said that pharmacists have reported significant numbers of vulnerable patients distressed at the impact of the loss of their cards. Discretionary medical cards have been one of the main concerns since the budget cuts. According to The Irish Times new applications for discretionary cards have been refused to patients with newly diagnosed motor neurone disease. In a recent letter to the Minister for Health James Reilly TD from Jack & Jill specialist children's they said, “Medical cards have always been an issue since the establishment of Jack & Jill in 1997. However, the situation has become particularly vicious over the past 2 years. The situation is critical.” They added, “The medical card system in Ireland is broken. It lacks humanity. Is unjust. Inconsistent. A hellish lottery. “Pharmacists too are being impacted by this issue. Some are very good, supporting families throughout their appeals process for the medical card. This exposes pharmacists to the stress of the medical card situation too. They are exposed financially, if the application doesn’t work out for the family and for the child at the heart of the process.”

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McSharry takes cancer charity in hand Pharmacy owner and West of Ireland businessman Ray McSharry is taking on the challenge of his life when he runs the Derry City Marathon in aid of the children’s cancer charity Hand in Hand in July. Hand in Hand is a non-profit organisation which provide the families of children with cancer much-needed practical support by giving them access to professional service providers. Families often find they have more precious time to spend with their children rather than trying to keep on top of household chores. Hand in Hand are unique in that they are the only voluntary organisation in the West of Ireland that supports children and their families through cancer treatment. McSharry told Irish Pharmacy News, “At McSharry’s Pharmacy we have been working with the great people at Hand in Hand to raise funds through our stores for a few years now but I really

Ray is running the Derry City Marathon on the 1st July and you can donate by going www.idonate.ie/mcsharrymarathon wanted to take on a bigger personal challenge for the charity. So after speaking with Hand in Hand I’ve decided to run the Derry City Marathon. My target is to raise ¤1000 for them and people can donate thought the iDonate website and just search for Ray McSharry. I think anyone with kids knows it’s such a worthy cause and I just had to get involved”

commented “We are delighted that Ray has taken it upon himself to raise money for Hand In Hand, especially considering the effort he is putting in, having to prepare and run the marathon. Every Euro makes a difference to our families. I would just like to encourage everyone to support him and donate through the iDonate website.”

Jennifer Carpenter, development officer with Hand in Hand also

Need for Universal HPV vaccination A new study by researchers in Trinity College Dublin, has revealed a high rate of vaccine preventable cancer associated Human papillomavirus virus (HPV) infection in men who have sex with men. The scientists report that the incidence of HPV-associated anal cancer is increasing and that men who have sex with men (MSM), particularly those co-infected with HIV, are disproportionately affected. HPV also now accounts for approximately 20% of head, neck and throat cancers in Ireland and the incidence is steadily increasing. The research was just published in the leading, peer reviewed, international journal, HIV Medicine. The researchers working in the Department of Genito-Urinary Medicine and Infectious Diseases (GUIDE) in St James’s Hospital and the School of Medicine, Trinity say that the identified prevalence of HPV associated disease in MSM in Ireland strengthens the call for universal vaccination of boys with the additional provision of catch-up and targeted vaccination of high-risk groups such as MSM and those with HIV infection. The provision of the HPV vaccine for girls-only has been in place in Ireland since 2010. HPV vaccine coverage and completion in girls in Ireland is greater than 85%.

HPV infection is the most common sexually transmitted infection (STI) in Ireland and worldwide. It is highly prevalent in the sexually active population and is rapidly acquired after sexual debut. In this study of MSM in Ireland, half of whom were HIV positive, the researchers found a high incidence of HPV infection (69%) with 27% of those studied having a particular type of HPV (HPV type 16) which has been shown to be associated with over 80% of anal cancers. Speaking about the significance of these findings, Professor Colm Bergin, Clinical Professor of

Infectious Diseases, Trinity and Principal Investigator of the study said: “Our study highlights the burden of anal HPV infection in MSM and those with HIV coinfection. A significant proportion of participants in our study did not have evidence of current infection with HR-HPV types 16 or 18, which are the HPV types most commonly associated with anal cancer. This indicates that a large proportion could benefit from HPV vaccination.”


News Over 100,000 illegal prescription medicines worth almost ¤300,000 detained in Ireland news brief The Irish Medicines Board (IMB), Revenue’s Customs Service and An Garda Síochána confirmed that they have detained over 101,182 tablets and capsules worth over €297,557 in one week in Ireland as part of Operation Pangea VII. This Operation is an international week of action targeting the online sale of counterfeit and illegal medicines where the IMB along with 200 enforcement agencies across 110 countries target criminal networks behind the sale of counterfeit and illegal medicines via illicit online pharmacies. In Ireland, the joint operation by the IMB, Revenue’s Customs Service and Gardaí detained 90,666 individual tablets, 1,800 capsules and 8,155 liquids which included sedatives, painkillers (analgesics), weight loss products as well as medicines indicated for erectile dysfunction and anabolic steroids. The main countries of origin of these counterfeit or illegal products detained in Ireland were China, Pakistan and India. Commenting, John Lynch, Director of Compliance, Irish Medicines Board, “Throughout the past week and during the year IMB routinely works in close co-operation with the Revenue’s Customs Service and An Garda Síochána to intercept the internet supply of prescription only medicines into Ireland. Our combined goal is to stem the flow of medicines from illegal pharmacy websites which present themselves to the general public as perfectly legitimate, but,

in reality are not and many have been shown to be controlled by criminal networks.” “In attempting to buy prescription medicines from such websites not only are the public divulging their personal and financial details, they are also placing their health in very real danger. Some of these medicines have been shown to contain too little or too much of the active ingredient while others contain the wrong active ingredient altogether,” he concluded.

Calls for the ‘regressive policy’ of the prescription charge to be abolished were proposed at The Irish Medical Organisation (IMO) Annual Conference, held in Co Kildare with its President, Dr Matthew Sadlier saying that some patients cannot afford to pay the €2.50 per Item charge, especially if it applies to a large number of items.

The prescription charge was increased by 66% in the last budget, to ¤2.50 per prescribed product, almost five times more than when the proposal was announced in 2010. Prescription items were dispensed free to medical card holders up to

The Royal College of Surgeons in Ireland (RCSI) has announced the development of a new state of the art academic and education building on York Street, Dublin 2. RCSI will invest in the region of ¤80 million for the development of the 120,000 sq ft facility. The new RCSI academic and education building will be the largest redevelopment project in the City Centre in recent years. The 120,000 sq ft building will comprise a state of the art surgical and clinical training suite containing a flexible wet lab, mock operating theatre, clinical training wards, standardised patients rooms and task training rooms. Mr Ruairi Quinn T.D. Minister for Education and Skills opening the new building she said, “This new state-of-theart facility will enhance RCSI’s capacity to deliver outstanding medical education and training and will further strengthen its deserved global reputation as a leader in its field.”

Calls for prescription charge to be abolished

As a result of the new prescription charges, Sadlier said that he was aware that some patients delayed or sometimes did not get their prescriptions dispensed at all and, in some cases patients on multiple prescriptions would choose which to get filled. He concluded by saying that the charges affect the most vulnerable and disadvantaged.

Under Irish law, the sale of prescription only medicines by mail order is prohibited. This includes internet supplies of prescription only medicines. The IMB, in conjunction the Revenue’s Customs Service and An Garda Síochána, continually monitors and investigates instances of illegal supply of medicines products via the internet and actively enforces suspected breaches of the law.

NEW RCSI BUILDING

2010, when a 50c charge was introduced, capped at a monthly total of ¤10. The new monthly cap is ¤25. Chris Goodey, the National Association of General Practitioners' CEO (NAGP) told Irish Pharmacy News, “Prescription charges target the most vulnerable in our society and is further proof that this government is completely out of touch with the needs of patients. It is, once again taking resources from the sick and giving to the well off. The newly appointed President of the Irish Pharmacy Union, Kathy Maher agreed with Goodey.

In a survey published by the IPU, it was found that, because of the prescription levy, 38% of all Medical Card patients 'think twice' before getting the prescriptions dispensed. Maher said that this was causing some patients to 'ration' their use of medicines with potentially harmful consequences and she called on the Government to exempt vulnerable groups from this levy. Looking forward, Maher said that the IPU would be calling on the Government to significantly expand the range of services available from pharmacists as a means of lessening pressure elsewhere in the health services. She said; "The healthcare system is in crisis, GP services are already strained and implementing a healthcare strategy with a shrinking budget requires thought and imagination. The Government needs to waken up to the fact that the Pharmacy profession is a massively underutilised resource, which is accessible locally and which can be used to support the Government's healthcare strategy of 'treating patients in a community setting'."

Work on the site will begin in September this year and the building is due for completion in September 2016. The project will create approximately 500 – 600 jobs over the course of the development. Professor Cathal Kelly, RCSI CEO Registrar said “The College will fund the development of the building through savings accrued from student fees, philanthropic donations, rental income from a number of properties the College owns in the city centre and a loan. “The new academic and education building will be student centred and will promote the development of the RCSI community at the heart of the city. The building will provide students with the opportunity to study in a modern, inspiring and ambitious medical sciences and surgical training facility,” Prof Kelly continued.

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News HSE’s Medicines Management news brief Programme Announces Two New Preferred Drugs MEDICINES IDENTIFIED TO GO OFF POM STATUS

The Irish Medicines Board (IMB) has announced that it has identified around 20 medicines, which could safely be taken off 'prescription only' status and which pharmacists would be allowed to dispense to patients without a prescription. Pat O'Mahony, Chief Executive of the IMB said the body was in advanced preparations on this matter in relation to 12 medicines and had identified in total 20 medicines which could potentially be included in this move over the next year. Irish Pharmacy News contacted the IMB to try to establish which medicines were being reviewed but the IMB said, "We have not, at this point confirmed the individual medicines but the intention is to provide that information when it has completed its review.” Ms Kathy Maher, President of the IPU, said, "We have long argued that too many medicines are prescription only and that pharmacists should be empowered to have greater discretion in deciding whether or not to dispense (certain) medicines to patients. This is key to improving public access to medicines in a safe environment. Today's news is very welcome and we will engage with the IMB as a matter of urgency to ensure that this progresses as quickly as possible." Maher also said that she believes the medicines would involve treatments which are available over-the-counter in other jurisdictions, including Northern Ireland but which currently can only be obtained in the Republic on a doctor’s prescription. That would probably include common oral treatments for thrush, low dose aspirin (75mg), chloramphenicol for minor eye infections and treatments for migraine. She said that the implications for patients would be 'phenomenal' and 'It’s a nobrainer'.

The Medicines Management Programme (MMP) has identified Citalopram as the preferred Selective Serotonin Re-uptake Inhibitor (SSRI) and Venlafaxine as the preferred Serotonin Noradrenaline Re-uptake Inhibitor (SNRI) for the treatment of depression. This is part of an ongoing programme by the MMP, where preferred drugs are recommended to prescribers. In 2013, there were in excess of 1.6 million prescriptions for SSRIs and approximately 700,000 prescriptions for SNRIs dispensed under the community drug schemes. In any one month, over 110,000 patients are expected to be treated with an SSRI and over 40,000 patients treated with an SNRI. These drug classes represent a considerable cost to the health system of in excess of ¤55 million in 2013. Submissions from relevant

The identification of a preferred SSRI and SNRI under the MMP is designed to support prescribers in choosing a medicine of proven safety, efficacy and cost effectiveness in the management of patients with depression. Prof Michael Barry, Clinical Lead for the Medicines Management Programme, says; “Prescribing the preferred drugs as identified by the Medicines Management

Programme makes sense for the patient, prescriber, and for the taxpayer. To date, the Medicines Management Programme has identified six preferred drugs: Statins - SIMVASTATIN PPIs - LANSOPRAZOLE ACE inhibitor - RAMIPRIL ARB - CANDESARTAN SSRI - CITALOPRAM SNRI - VENLAFAXINE

Haven pharmacists charity cycle A group of six Haven Pharmacists along with General Manager Mark McInerney, and over 20 colleagues and friends cycled through challenging and often mountainous terrain across Ireland and Wales with proceeds going to Laura Lynn Foundation and the IRFU Charitable Trust The group left Dublin on 22nd May arriving in Rosslare that evening in time for the overnight ferry to Pembroke – followed by a wet and windy 180k cycle across to Cardiff, in time for the Heineken Cup Final the next day. Mark McInerney, General Manager said “ It started as a casual idea and a casual cycle ending in a good game of rugby – but it didn’t turn out like that! It was incredibly challenging – particular the 50k uphill stretch as we left Pembroke – but also really rewarding. The support we have received has been fantastic and we raised a great deal of money for two very worthwhile causes,I’d love to say we’ll do it again soon but not too soon, it was tough!” Haven Pharmacy has

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stakeholders were sought and considered in the evaluation process of the SSRIs and SNRIs, including those of the pharmaceutical industry and clinical groups.

just celebrated the national roll out their new pharmacy brand which is now across 40 pharmacies all over Ireland. The pharmacies are already becoming a popular destination for local communities

looking for a combination of expert advice and great value – with the regular Haven Hot Spots promotions becoming a firm favourite.

Paul Brennan, Haven Pharmacy Brennan’s Mark McInerney, General Manager, Keith Brennan, Haven Pharmacy Moloney’s Jason Doherty, Haven Pharmacy Doherty’s Daragh Connolly, Chairman Haven Pharmacy Liam Butler, Haven Pharmacy Butler’sOwen Daly, Haven Pharmacy


Working in partnership with Irish pharmacies IMS Health has begun to support pharmacies in Ireland, helping them to operate more efficiently in this challenging and changing market. We are offering national and regional performance benchmarking reports per store and payment options in exchange for your sales data. All data provided to us will be anonymised and aggregated. IMS Health is a leading global information, technology and services company providing the healthcare industry with comprehensive solutions to measure and improve performance. Globally we draw on information from 100,000 suppliers and capture 45+ billion healthcare transactions annually in order to deliver insights to over 5,000 healthcare clients. We work in partnership with tens of thousands of pharmacy chains, independent pharmacies and specialty pharmacies. Through provision of analytical tools and consulting expertise we generate business insights and market views which help pharmacies to understand their performance.

IMS HEALTH 31 THE MALL, BEACON COURT, SANDYFORD, DUBLIN 18 Š2014 IMS Health Incorporated and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.

Find out more If you’re interested in hearing more about how we can work together to support your business then please: Meet us in Room 444 at the United Drug Pharmacy Show on 8th/9th June or Email us at pharmacy@ie.imshealth.com Call 01-2902200 Visit our website www.imshealth.com


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Profile

Pharmacists need to re-establish their unique expertise to the patient Ingrid Hook served for five years as head of the School of Pharmacy and Pharmaceutical Sciences at Trinity College Dublin (TCD) from 2003, a time when it was guaranteed for all Pharmacy students to gain employment. As a researcher in Pharmacognosy, she is an expert on the use of plants in medicine. She believes pharmacists need to re-establish their role as health care professionals in the prevention of serious diseases such as diabetes and obesity and encourage a healthier nation. Hook has watched pharmacy evolve during her time as an academic in pharmacy. She started her career in the UK, graduating from the University of Manchester with an Honours Degree in Pharmacy, specialising in Pharmacognosy. Ingrid worked for short periods both in hospital and community pharmacies.

such as Hospital or Industry. I never considered myself to be a ‘true’ academic and never saw myself as a deep thinker. However I accepted the Lectureship in The College of Pharmaceutical Society of Ireland and I have been there ever since. It’s amazing what a group of good colleagues can do to change one’s mind.”

Hook told Irish Pharmacy News, “I preferred the hands-on approach of hospital pharmacy, where we got experience in Dispsensing, Ward Rounds, Manufacturing and Sterile Products. Community pharmacy wasn’t something that I enjoyed at that age because I didn’t feel comfortable giving advice to patients. Nowadays we teach our students “communication skills”. I also had no interest in business!

Hook has always had a love of botany and became a pharmacist because there was an element of botany within the course since many medicines are derived from plants. It was also a good career choice! By becoming an academic she had the advantage of combining her interest and lectured in Pharmacognosy: the study of medicines derived from natural sources. Many of the modern Food Supplements, Herbal Remedies also fall into this ‘botanical’ category. This is an area that Hook feels pharmacists can have a greater role.

Hook moved to Ireland when she met her husband, George Hook, now a TV and Radio personality. She said, “I couldn’t continue my career as a hospital pharmacist because at the time in pharmacy there was no freedom of movement between Ireland and the UK. I would have had to do my degree all over again because my English Pharmacy Degree was not recognised in Ireland. I wasn’t prepared to do that and I was lucky to get into academia when the opportunity arose .” She became a lecturer at the then College of the Pharmaceutical Society of Ireland, which eventually became the School of Pharmacy at Trinity College. “I never planned to be an academic, never wanted to teach, as I had always favoured the hands-on approach of pharmacy,

“The pharmacist’s expertise was always the preparation and dispensing of medicines. It is what made them unique and the patient could always identify what their role was. Now the patient is handed a pack of ‘pills’ that has already been manufactured and the patient can no longer identify what their pharmacist does. The pharmacist needs to re-establish what is distinctive about the profession and realign him or herself with what they can do. They are the only health professional with currently an ambiguous role, “she commented. “Patient interaction is the role that the pharmacist can develop. Although the pharmacist will be taking business from the GPs, the pharmacist can offer services

Ingrid Hook

to the public that could alleviate the pressure on GPs and the two professions can work together.” Let the Pharmacist be the first port-of-call for the patient! “Services such as asthma control, blood pressure monitoring, vaccinations, weight loss counselling, etc. are all possible since the consultation room is now required in every pharmacy. However there is the issue that

small, one-pharmacist community pharmacies will struggle with these new services, as they require time and money. This new role for pharmacists may also be playing into the hands of the multiples because they can afford to employ several pharmacists.” Hook added, “Independent pharmacy needs a financial incentive to evolve and incorporate these new offerings. A lot of

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Profile and Practice of Pharmacy have gained. This is ‘evolution’ and one much change academically with the changing Profession. More changes are coming soon and I’m glad I’m not involved!”

Ingrid Hook

“When I was head of school, we had a 100% employment rate with our students knowing that they will start on good money and go straight into their chosen career. This no longer is the case and many graduates go abroad. Students also have to keep up with the changing role of the pharmacist. The newest syllabus incorporates counselling the patient and how to communicate with them. This is vital for pharmacists to continue to be at the coal face of health care.”

these independent pharmacists are financially suffering because they can’t offer what a multiple can. I hope that the independent pharmacist can find a way to survive because they serve the communities that a multiple couldn’t such as rural areas with small populations. These areas do not have a financial incentive but a community pharmacist is vitally important to them.” Hook has a great interest and belief in the use of herbal supplements and phytotherapy and feels it is an area pharmacists could integrate into their business. “Prevention of diseases may be something the pharmacist can take on by speaking knowledgeably with their patients about supplementation or life style changes. By doing this the pharmacist can have a greater input into and impact on the public’s health. People in the UK and Ireland are not as interested in supplementation or herbal remedies as much as continental people are. Prevention of chronic illness must be publicised to a greater extent by the health executive.” “The real question is; Where do you start? With the children or with the parents? Pharmacists are in an ideal position to speak to parents about healthier lifestyles and if a patient may be at risk for a chronic illness such as obesity or diabetes they can have a consultation with the patient and discuss preventative measures.”

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Hook was head of school of Pharmacy at a time when there were many changes and she watched the degree and sector change. “When I first came to Ireland there was such a stark contrast to UK pharmacy. Ireland had few regulations and there were a lot of transactions going on under the counter.” Over the years much has changed for the better in the profession as well as in academic pharmacy. “When I was Head of School in the Pharmacy school in TCD the Pharmaceutical society of Ireland (PSI) introduced a new syllabus and format for the pharmacy degree. The PSI had a lot of involvement and control, for the betterment of the Profession they would argue. Regulators never had that much control in other jurisdictions. It is important to note that this was in compliance

with EU requirements of European Credit Transfer and Accumulation System (ECTS) –“ a standard for comparing the study attainment and performance of students of higher education” “This dictates how many hours of teaching we had to do and impacted on the subjects that we teach. This meant we had to overhaul the syllabus and look at the hours allotted to each of the subjects. By reducing some of the subjects it created animosity in some areas such as chemistry and other non-pharmacy subjects.” “One must remember that the Pharmacy Degree has to be accredited by the PSI. They therefore have the power to dictate what they require in the subject areas. Some areas have lost out, such as pharmaceutical chemistry and pharmacognosy, but others such as pharmacology

There are many possibilities for the pharmacist! A health promotion role and the treatment of minor ailments is very achievable and only requires minimum training and not a lot of equipment. I know that some pharmacists in the UK have become specialists in certain areas such as cancer medication and I am sure within Ireland individual pharmacists have devised specialist services required in their area. Hook sees the future of pharmacy as a bright one with the profession evolving from a dispensarybased profession to a front-ofshop counselling role where the pharmacist delivers special expert knowledge and fosters a closer relationship with the patients. Hook has officially stepped down from her role in Trinity. She is now chairwoman of the RDS Science and Technology Committee and the moment, one of the key interests is to promote novel science and maths teaching methods to primary school-aged children which hopefully will encourage a better understanding of food, environment and health.

I never planned to be an academic, never wanted to teach, as I had always favoured the hands-on approach of pharmacy, such as Hospital or Industry. I never considered myself to be a ‘true’ academic and never saw myself as a deep thinker.


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The source of liquid solutions. First Call for exempt sourced medicinal products* For enquiries contact Fannin Pharmaceutical at: Tel: +353 1 290 7000 Fax: +353 1 290 7111 Email: info@fannin.eu www.fannin.eu FN 2013/05/003 Date of Preparation: May 2013. *Under Medicinal Products (Control of Placing on the Market) Regulations 2007 (SI 540 of 2007), it is permitted to supply products without a product authorisation on the order of a practitioner for a patient(s) under his/her care. Subject to Schedule 1 Requirements.


News news brief GUT BACTERIA CAN REGULATE WEIGHT GAIN Researchers at the Alimentary Pharmabiotic Centre in University College Cork (UCC) have discovered how gut bacteria communicate with their host to regulate specifically weight gain and serum cholesterol levels. The research, funded by Science Foundation Ireland, has implications for the rational selection and design of probiotics for the control of obesity, high cholesterol and diabetes. The findings are published this week in the Proceedings of the National Academy of Sciences USA. The team led by Dr Cormac Gahan and Dr Susan Joyce has analysed a bacterial protein that modifies bile acids (a major component of bile secretions) in the gut. This protein, bile salt hydrolase, is commonly made by gut bacteria and functions to change the chemical properties of bile acids in the gut. The research team has shown that specifically increasing levels of this protein reduces serum cholesterol levels and weight gain in mice. The group are currently exploring the relevance of these findings to humans. “Recent work by other groups has shown that bile acids act as signalling molecules in the host, almost like a hormonal network, with an ability to influence host metabolism. What we have done is to show that a specific mechanism exists by which bacteria in the gut can influence this process with significant consequences for the host,” commented Dr Gahan. Dr Joyce added “the findings may be used as a basis for the future selection of probiotics or dietary interventions which target this mechanism to regulate weight gain or high cholesterol. We now have the potential for matching probiotic strains with specific end-user needs. Work is underway to determine how this system operates in humans.”

Ireland needs long-term medicines strategy Ireland needs a long-term strategy which maps out and plans what Ireland’s future medicine needs will be and how this demand can be met. The annual symposium brought together national and international experts to debate and discuss where medicine policy in Ireland now stands and to examine how we manage, meet and afford medicine needs of the Irish population in the years ahead. According to Sandra Gannon General Manager of Teva Pharmaceuticals Ireland, “Demands on our health services are growing so long-term planning is critical. We already know that the provision of medicines to patients is facing challenges brought about by an aging population which is living longer and the increase in chronic diseases such as diabetes or obesity. This will place huge pressures on our current provision of medicines to patients, not least in terms of the affordability, sustainability and availability of such medicines, However, we currently do not have a long term strategy mapping how we achieve this objectives – we need to start planning for the future now’.

Adrian van den Hoven, Director General of the European Generic Medicine Association, speaking at the symposium added, “‘It is

estimated that speciality or hightech medicines will account for up to 50% of national medicine expenditure across the EU by 2018. However, a pro-active move to increased use of biosimilar medicines and complex generics in European healthcare systems offers a significant opportunity for national governments to maintain the affordability and availability of medicines to patients, without compromising on patient care’.

Patrick Moore, Trinity College Health Economist and a Researcher and Adrian van den Hoven, Director General of the European Generic Medicine Association

The event was attended by healthcare professionals, including pharmacists, GPs and consultants, health policymakers, healthcare economists and patients’ representatives. Fellow speaker, Patrick Moore, Trinity College Health Economist and a Researcher currently working as part of the Government’s TILDA Research Project, said, “Projecting ahead based on emerging health data, it is reasonable to expect the

Bayer to launch OTC PPI Bayer Consumer Care will be launching Losec Control proton pump inhibitor (PPI) as an over the counter (OTC) medication at the 2014 United Drug Pharmacy Trade show. Losec Control, which is currently available as a prescription only medication will now also be available without prescription in pharmacies nationwide. The PPI with Patented Mups Technology, allows rapid absorption and lasting relief for patients suffering from severe heartburn. Losec will further strengthen Bayer’s presence in the GI category in Pharmacy. Country Division Head of Bayer

12

number of medicine prescriptions prescribed in Ireland will increase by almost 40% (38%) by 2021. This amounts to an increase from 76 million prescriptions per annum in 2012 to 105 million by 2021 and will present huge challenges, particularly in terms of affordability.”

Consumer Care, Matthew Burbridge told Irish Pharmacy News, "Attending the show gives Bayer Consumer Care an ideal opportunity to meet their valued customers and show them what Bayer has to offer them for the future." Bayer Consumer Care is among the largest global manufacturers of over-the-counter (OTC) medicines and nutritional Supplements in the

world. In Ireland, Bayer Consumer Care is the fifth largest OTC company. Bayer will also be showcasing their range of brands including Bepanthen, Berocca, Canesten, Canespro, new Losec Control, Rennie and more at the United Drug Trade Show from Sunday 8th June until Tuesday the 10th in the Aviva Stadium, Dublin.


REFLUX & REGURGITATION:

A big problem for little people Almost 1 in 5 babies will suffer from reflux and regurgitation . Cow & Gate anti-reflux is clinically proven to provide relief in the dietary management of reflux and regurgitation: 1

• 78% reduction in regurgitation episodes

2

• 67% reduction in regurgitation severity

2

• 17% of reduction in reflux episodes

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Important Notice:

Cow & Gate anti-reflux is a food for special medical purposes. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for use as the sole source of nutrition for infants from birth, and as part of a balanced diet from around 6-12 months. Not suitable for enteral use.

Cow and Gate anti-reflux, thickened with carob bean gum, clinically proven to alleviate reflux and regurgitation2. For healthcare professional use only. References: 1. Huang RC et al. The Cochrane Library. Issue 1. Wiley, 2009. 2. Wenzl TG et al. J Paediatr 2003;111:e355-e9.

Complete Dietary Solution for Bottlefed Babies.


Debate

The advancement of POM to P Switches Pharmacy in Ireland has been the increasingly moving towards self-care with the expansion of services and screening. Prescription Only Medicines (POM) to Pharmacy (P) medicines switches are helping in this respect and with the Irish Medicines Board announcement of the introduction of 12 medicines from POM to P and the possibility of a further 6 medications which could potentially be included in this move over the next year.

Pat O Mahoney

Mr Pat O'Mahony, Chief Executive of the Irish Medicines Board, said “The IMB has identified approximately 20 medicines which it believes could safely be taken off prescription only status and which pharmacists will be empowered to dispense without prescription and that they could potentially be included within the next 12 months.” Pharmacists also recently called for the migraine medication Sumatriptan, to be available here without prescription, as it is in the UK. They argued it would allow migraine sufferers to access appropriate and effective treatment from their pharmacist without delay. With the recent changes in the

industry, pharmacists have called for greater recognition and utilisation of their knowledge and skills in the delivery of an accessible, professional and costeffective healthcare system. The Pharmacy Ireland 2020 interim report by the Pharmaceutical Society of Ireland (PSI) has identified several ways in which community pharmacists could improve the services they provide to their patients and how costeffective solutions to problems within the health care system could be delivered. One of the specific measures envisaged was the proposal to provide wider access to medicines for the public by POM to P switches, which pharmacists have been requesting, for some time.

70% of respondents in a recent national Behaviours and Attitude survey of 1,000 members of the public strongly agreed with the suggestion that pharmacists should be able to prescribe some medicines for minor ailments and 72% said they were strongly in favour of pharmacies offering services such as blood pressure monitoring and cholesterol testing.

In the interim report a number of medications were recommended for switching, such as analgesics for migraine, treatments for motion sickness, malaria prophylaxis, antifungal treatments for topical and oral use and inhaled bronchodilators. A few of these medications are now available OTC but there are many more that still remain prescription only.

Ms Kathy Maher, President of the Irish Pharmacy Union, said that the pharmacy sector could play a critical role in a reformed Irish healthcare system. She said, "Our members want to engage with the Government to see how we can help alleviate pressures elsewhere in the health system".

Many medications are available in the UK that are still prescription only in Ireland. The risk assessment for a drug being switched from POM to P considers the public benefits and whether people can safely assess their symptoms in collaboration with the pharmacist to take medication unaided with appropriate signposting regarding lifestyle changes or to the doctor for more severe symptoms.

The interim report points out; a national policy should be developed with regard to POM to P switching, and the introduction of a “pharmacist prescribed” category given serious consideration’. This may require the development of an efficient system to allow access to patient medication records throughout the healthcare system. In 2010, The Irish Medicines Board published guidelines for POM to P switching in Ireland but, for all that, it was just guidance and, up until now there has been a distinct lack of a co-ordinated approach of POM to P switches. The IMB are yet to reveal what medications will be considered to be switched but medication that is available OTC in the UK have been suspected to be on this list such as migraine and thrush medication.

The PSI 2020 report outlines the need for a new category of ‘pharmacist prescribed’ (PP) medicines i.e. those medicines which could be supplied only after a pharmacist had carried out a number of clinical checks with a patient and with that pharmacist having to record details of the consultation. Some PP drugs have been switched recently, such as codeine and the emergency contraceptive and, hopefully they will play an even more important role in the future. Angelina McDonnell, Pharmacy Manager in the Prescription Centre Limerick told Irish Pharmacy News, “I am not sure if there

the IMB has identified approximately 20 medicines which it believes could safely be taken off prescription only status and which pharmacists will be empowered to dispense without prescription and that they could potentially be included within the next 12 months. Pat O'Mahony, Chief Executive of the Irish Medicines Board 14


are too many medications that I would be comfortable switching to pharmacy only drugs as it allows the patient to walk into any pharmacy and purchase their medication regardless of other drug interactions. The risks are too high in that regard.” “Some migraine medications such as Sumatriptan can interact with patient’s serotonin and those patients could be on an anti depressant. I would prefer to have the back up of a GP for most medications for the safety of the patient.” When asked if the introduction of certain medications being available pharmacy only in Ireland that are available in the UK, could be a method to encouraging Irish patients to stay local, McDonnell said, “ The reason patients are going to the North of Ireland is because of price not because medications are available without a prescription. If the price of drugs went down, that would encourage patients to shop local.”

Goretti Brady, Managing Director, Lloydspharmacy

established that the product meets these defined criteria that the IMB will grant a licence and assign the legal supply status.” They continued, “The determination of the legal supply status is based on factors including the overall safety profile of the product, the proposed indication and expected duration of use, suitability of a condition for self-diagnosis and self-treatment, requirement for monitoring of efficacy/side-effects, interaction potential, possibility of misuse etc. All of these factors are considered in the context of the need for appropriate healthcare professional interventions/advice. Medicines that are deemed to have potential risks for users and that require healthcare intervention is restricted to prescription or pharmacy - only supply, as appropriate.”

McDonnell believes that some medications should be available without a prescription but only those that are low risk such as thrush medication and certain gels and creams like Voltarol 50g.

Liz Kerr, Director of Pharmacy, Boots Ireland said, “At Boots Ireland, our mission is to empower our patients to take control of their health by making healthcare more accessible and affordable. We welcome this move from the IMB to reclassify several medicines, improving access for patients to a greater range of medicines to treat their conditions under the expert guidance of the pharmacist.'

Irish Pharmacy News asked the IMB why it has taken so long to introduce these long awaited switches, they commented, “The IMB assesses all license applications received across a wide range of parameters to ensure medicinal products placed on the Irish market meet strict requirements in terms of safety, quality and efficacy in accordance with legislation and guidance. It is only after an assessment has

John McNamara, Supervising Pharmacist in McNamara’s Pharmacy Swords contradicts McDonnell’s opinions, “This is a long overdue change in pharmacy. Widening access to medication has to be a good thing, and patients are responsible enough to take medication that has had a long history of being successfully available in other jurisdictions with no interactions. The pharmacist will need to interact with their

Liz Kerr- Director of Pharmacy, Boots Ireland

patient more but that is a natural progression with the introduction of the consolation room. ” McNamara added, “GPs will more than likely feel threatened as they did with the introduction of the emergency contraceptive but that initial reaction always dies down.” Goretti Brady, Managing Director of Lloydspharmacy said, “Pharmacists are highly-trained, informed, expert healthcare providers with a speciality in safe, clinically-sound medicines use. They have an in-depth understanding of medicines from the production basis through to the chemical and physiological means by which these medicines bring positive therapeutic outcomes. We are then ideally placed to advise on and recommend the correct medication, in the correct dose to our patients, especially in the area of minor ailments. Therefore I would like to see as many switches as possible in areas where the switch makes

therapeutic sense, is considered low-risk and ultimately enhances patients’ lives by providing a safe, convenient method by which they can access the healthcare system, in a manner which encourages responsible self-care and independent options. The provisional list of 20 molecules is a good start. At LloydsPharmacy, we have an ethos of promoting patient self-care. This move is therefore greatly welcomed by us and our customers.” Brady added, “There is potential for more drugs to switch in Ireland. When you consider the myriad of minor ailments, the potential list of associated medicines is vast. Also, I believe that Pharmacist prescribing needs to be seriously considered. There are many health issues with which the Pharmacist is presented each day, which are easily-diagnosable and treated. This would be a welcome step in tandem with the POM-P mechanism.”

15


Awards Award Winners

The Irish Pharmacy

The award ceremony provided an occasion to celebrate the success of staff and projects but also an opportunity to mix and build networks with industry peers.

Our 14 winners of each category truly represent excellence throughout Ireland's pharmacy industry and worked hard for each coveted title.

Conall Lavery, Director of Real World Retail said, “IPN put on a great awards event, the whole event was a slick operation, the food was very good with great opportunity meeting all the players in pharmacy in a relaxed environment. The host Miriam O Callaghan was excellent , and the whole awards process was very professional. It was evident from the winners that there is excellent innovation going on in the sector. Such positive publicity for a well deserving sector.”

To win one of the 14 categories this year is a true accolade to the hard work these individuals and their teams put into their pharmacy. The quality of applications and projects this year was of an increasingly high level. What struck our elite panel of judges is the level of innovation and dedication pharmacy professionals are displaying and providing the communities they serve with enhanced care and medicines advice. To be a winner or indeed a finalist, is a great achievement. The applications for this year’s awards surpassed the previous two years with over 85 submissions representing over 350 pharmacies nationwide. Whilst the short listing process was extremely difficult – with some strong entries failing to make it to the shortlist – it’s important to highlight that it is not just about winners and losers. Everyone who entered this year’s awards deserves commendation. Cormac Tobin, Managing Director of Celesio said, "The 2014 Irish Pharmacy Awards was another triumph, it is such a great opportunity to have so many people from the industry in one room with such electric atmosphere. The awards are passionately supported because they recognise each area of pharmacy from the Pharmacist to the OTC colleagues, demonstrating that team work is what makes our industry renowned. I can't wait for next year!" We encourage all of our winners and finalists to broadcast this positive publicity to their customers and local communities, using local media outlets and social media. Let your customers know about your achievements!

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EXCELLENCE IN PHARMACY

2014

The third annual Irish Pharmacy Awards showcased the extraordinary talent and hard work Irish Pharmacists are undertaking throughout the country.

The winners were announced at a glittering gala dinner attended by over 500 of the industry’s most influential players at the DT Hilton Hotel, Burlington Road, Dublin.

Irish Pharmacy Awards 2014

The Irish Pharmacy Awards have raised money for their chosen charity every year, The Jack and Jill Foundation, Jonathon Irwin, CEO of the Foundation said, “We are so grateful to the Irish Pharmacy Awards for making Jack & Jill their chosen charity and for the proceeds of the money raised. We also thank you for giving us this platform to speak directly to pharmacists, we salute you on behalf of all the children under our wing who have severe development delay as a result of brain damage.”

AWARDS 2014

Investing in education and the health of the nation

Miriam O’Callaghan

Over the following pages we feature each winner with their sponsor. Look out for the July and August issue of Irish Pharmacy News, where we will have exclusive, in-depth interviews with all of our winners. Congratulations to all our finalists and winners and IPN Communications would like to thank all who nominated this year. We can’t wait for next year!

Barry Fitzpatrick, Clonmel Healthcare, Oonagh O’Hagan, Meaghers Pharmacy, Ronan Kennedy Laurence O’Carroll, Ashfield Healthcare, Aine McCabe, Anne McNeil, McCabes Pharmacy

The winning team from David O’Meara Pharmacy Plus, Birr- Eleanor Grennan, David O’Meara, Noelle Horan, Dorris Claffey, Anne O’Connell, Lisa Deane


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Awards Award Winners The Irish Pharmacy

THE INDEPENDENT VOICE OF PHARMACY

2014

Irish Pharmacy News Pharmacy Representative of the Year 2014 - Diane Owens

Winner of the Pharmacy Representative of the Year Award Diane Owens, Pharmacy Sales Representative, Johnson & Johnson with Nicola McGarvey, Advertising Manager, IPN Communications

The Pharmacy Representative of the Year Award sponsored by IPN communications category provides a well deserved recognition for achievement, and excellence within the pharmaceutical industry. This year’s winner was decided by their industry colleagues, peers and customers who were invited to vote for each of the category finalists. It was an exciting battle for the winner of the category with all finalists getting behind their campaigns. Diane Owens was the triumphant winner. She told Irish Pharmacy News,

To be voted Rep of the Year by the public and customers who I am dealing with on a daily basis means so much to me. An award like this has built my moral and even campaigning for votes gave me the opportunity to build relationships with my customers even further. I really enjoyed the whole experience from being nominated, to winning; it is a category that is well worth entering. Nicola McGarvey, Advertising Manager for IPN communications said, “It was a privilege to present an award that recognises the commitment and dedication that representatives have to the relationships with their customers. Each finalist displayed success in terms of sales, training, recruitment, customer service, product development and other areas of business development. These qualities are vital ingredients to the success of the industry. Congratulations to Diane, she is a worthy winner who is passionate about her role and enjoys having a great working relationship with all of her customers.”

18


Awards The Irish Pharmacy

Award Winners

2014

People’s Pharmacist of the Year 2014 Aine McCabe, McCabes Pharmacy

The People’s Pharmacist of the Year in association with Jack and Jill Children’s foundation, is voted on by patients and customers to whom pharmacists have made a difference in their lives. The People’s Pharmacist of the Year is a pharmacist that has an outstanding relationship with the community, gives un-paralleled advice and goes beyond the call of duty for their patients and customers. We had an awe-inspiring response for this award this year with heartfelt and emotional nominations. The winning pharmacist and team, Aine McCabe in McCabes Pharmacy Malahide received a phenomenal amount of votes by her patients and was presented the award by Jack and Jill representative Saundra Nolan. An emotional and delighted Aine said,

For a patient to have taken the time and write a nomination for our pharmacy and to know that we have touched a patient in that way is such a complement and so touching. McCabes Pharmacy has done a lot with Cystic Fibrosis in the past year because that is our nominated charity. This charity is close to our hearts in McCabes because we have some patients who have children with the condition and a member of staff has a child with Cystic Fibrosis. Doing whatever I can to make my patient’s life easier is what makes my job so special and why I enjoy being a community pharmacist. To receive an award for doing my job that I love, and getting the gratitude back is so special.

Saundra Nolan, Jack & Jill Foundation of Ireland with the People's Pharmacist 2014 Aine McCabe, McCabe's Pharmacy, Malahide

Saundra Nolan a nurse with Jack and Jill said, “We are so grateful to be the chosen charity for the third year at the Irish Pharmacy Awards. Pharmacists play a vital role in the community and with many families who have sick children. They are in the front line of care in the community and our home nursing care model couldn’t function without them. Congratulations to Aine and her team, they are commendable winners.”

19


Awards Award Winners The Irish Pharmacy

2014

UnitedDrug Consumer

United Drug OTC Retailer of the Year Award 2014 - LloydsPharmacy, Limerick

Donal Clarke, Tara Jackson, Sian Gray, Marie McCarthy, Joanne Kissane, Liam Kelleher, Marie Bonar and Linda O'Brien, LloydsPharmacy, Flan Hassett, Commercial Director, United Drug Consumer, Fionnuala Moloney, Emily Kelly, Goretti Brady and Peter Monaghan, LloydsPharmacy

LloydsPharmacy scooped one of the most coveted and prestigious awards for the second time this year. Supervising Pharmacist for Lloydspharmacy, Limerick Linda O’Brien said,

20

To come back again this year and win this award for Lloydspharmacy is fantastic. Winning this award proves that what we have done has been worthy and noticed and we will strive to work harder and come up with more innovative ideas for the future. The OTC category is important in pharmacy and our highly trained staff understands that and this is a accolade to them. This really is a team award.

Flan Hassett, Commercial Director with United Drug Consumer commented, “The OTC category is crucial to pharmacy in these tough times, retail will always be part and parcel of the pharmacy business. Sponsoring this award has been great for our business, especially with our rebrand and it has given us exposure by putting our brand front and centre.”


Awards The Irish Pharmacy

Award Winners

2014

Lloyds Online Doctor Young Pharmacist of the Year 2014 - Sarah Marshall, O’Sullivans Pharmacy, Frankfield Cork Sarah Marshall holds the new title of 2014 Lloyds Online Doctor Young Pharmacist of the Year. Sarah was described as a high-achieving, self-motivating individual with a passion for research and community pharmacy. Sarah told Irish Pharmacy News straight off the stage after receiving her award,

I am in total shock that I have won and it is a great feeling and such an honour. Pharmacy in Ireland is such a small world and building your profile is so important to advance your career, even being nominated has done that for me. Winning has encouraged me to try to reach my full potential and go further in my career. Knowing that my management team saw the potential and appreciated me enough to put me forward is great encouragement and so motivating. Rebecca Matthews, Practice Manager with Lloyds Online Doctor Ireland said on the evening, “It is very exciting for Lloyds Online Doctor to sponsor this category because we are excited about all the new talent in pharmacies. A platform such as the Irish Pharmacy Awards raises young pharmacist’s profiles and gives them the recognition for all the hard work that so many young pharmacists are doing in community pharmacy. Winning this award will give them the motivation to carry on being as great as they are. Sponsoring this award has done so much for Lloyds Online Doctor, It has allowed us to communicate with pharmacists and let them understand our business. Now when our patients go into a pharmacy, they will know who we are!” Rebecca Matthews, Practice Manager, Lloyds Online Doctor with Sarah Marshall, O'Sullivans Pharmacy, Young Pharmacist of the Year 2014

21


Awards Award Winners

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The Irish Pharmacy

Service

2014

Pinewood Community Pharmacist of the Year 2014 - Roisin Mulhern, Healthwise Pharmacy, Ballyraine Roisin received the highly recognised and sought after title of Community Pharmacist of the Year 2014. Roisin is described as a professional, committed and conscientious Pharmacist and Business Manager who has achieved outstanding results in the 4 years she has managed the Ballyraine branch of Healthwise Pharmacies. She has a strong business acumen, excellent people management skills and technical expertise in range of specialist areas, including fertility medication and children’s healthcare, and is a trained nutritional and skincare consultant. An overwhelmed and elated Roisin said,

This is a tremendous award and a tribute to all the work I have done with my team on a number of projects throughout the year. I have extended the role of the community pharmacist outside of the remit and I have connected to all health care professionals from the doctors to the nurses and that has fed back down directly to patients and the community. To be awarded and recognised by fellow colleagues and peers makes this award special and I think it will cement the work I have done for years to come. Cormac Kearney, Pharmacy Business Manager, Pinewood Healthcare said, “We at Pinewood are in existence because of the immense support we have received from pharmacists. It is a privilege to sponsor this award and give something back. These awards give pharmacists such positive press and highlights the incredible support that pharmacists provide in the community.� Roisin Mulhern, Healthwise Pharmacy Ballyraine receives her award from Mr Cormac Kearney, Pharmacy Business Manager, Pinewood Healthcare

22


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Awards Award Winners The Irish Pharmacy

2014

Sanofi Ireland Counter Assistant of the Year Award 2014 - Sandra Finlay

Winner of the Sanofi Counter Assistant of the Year Award Sandra Finlay, Rose Finlay Pharmacy with Ingrid Walsh, Head of Commercial, Sanofi Ireland

Counter assistants are the crucial interface between customers and the pharmacist and they carry out their daily work duties with the ultimate goal of effectively meeting the needs of their customers. The 2014 Counter Assistant of the Year Sandra Finlay was a finalist last year but returned triumphantly this year as winner. She said,

The standard is always so high in this category I really didn’t think I had a chance of winning. From being here last year and coming back a winner, I highly recommend other counter assistants who haven’t won to enter again. I could see what the judges were looking for last year and had that knowledge for this year. It is a huge honour to be selected from all the dedicated and talented counter assistants that have applied, this is such a boost and so motivating.

Allyson Madden, Burkes Pharmacy, Highly Commended in the Sanofi Counter Assistant of the Year Award receives her trophy from Ingrid Walsh, Head of Commercial, Sanofi Ireland

Ingrid Walsh, Head of Commercial with Sanofi Ireland said, “We chose this category because it is so important to us as a company and are particularly thrilled to be associated with this award. Counter assistants are the face of pharmacy and can make a difference to a customer’s experience and those who do it well deserve to be recognised.”

As a result of the exceedingly high standard of submissions within this category, Allyson Madden, Burkes Pharmacy was the highly commended winner for the category. She said, “This is going to give me a platform to further in my career and do more within my workplace. To be a finalist is already so flattering but to be highly commended has really made my evening and year!”

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Awards Award Winners The Irish Pharmacy

2014

Clonmel Healthcare Innovation and Service Development (Chain) Award 2014 Molloy’s Lifestyle Pharmacy, Ballina Molloy’s Lifestyle Pharmacy, Ballina were announced as the 2014 winners of the Clonmel Innovation and Service Development (Chain) Award. Michael Brogan, Pharmacist with Molloy’s Lifestyle Pharmacies was delighted to win the award in such a tough category. He said,

Winning this award is a tribute to what we do in Molloy’s. It entices you do more and offer more innovative services for our patients. This is the second award that we have won this year and it has definitely encouraged us to come back next year and enter more awards.

Martin Gallagher Director of Marketing of Clonmel Healthcare explained why they sponsored this award. “We have always been involved in the Irish Pharmacy Awards and we sponsor this particular category because Clonmel are an innovative company ourselves. Being involved in these awards gives us continuity with our customers and allows us the opportunity to see what the future is going to look like and that is invaluable.”

Martin Gallagher, Director of Marketing, Clonmel Healthcare with Michael Brogan, Molloys Lifestyle Pharmacy, winners of the Clonmel Innovation and Service Development (Chain) Award 2014

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LOOKING AFTER YOU AND YOURS SINCE 1970 Here’s to the next 40 years, when we look forward to serving patients in Ireland even further. For over four decades, Clonmel Healthcare has worked with GP’s and pharmacists to improve the quality of life for Irish patients, making us the longest serving Generic partner in Ireland. And with our commitment to the community – including a nurse specialist team – we’re also one of the most trusted names in Generic medicine. Our diverse product portfolio includes single source products that serve both the community and hospital markets, broadening our reach into every corner of Irish life. 2013/ADV/GEN/052 www.clonmel-health.ie


Awards Award Winners The Irish Pharmacy

2014

McLernon Computers Innovation and Service Development (Independent) Award 2014 Brookes Pharmacy Brookes Pharmacy were awarded the McLernon’s Computers Innovation and Service Development (Independent) Award for their response to the changes in pharmacy and successfully adapting new services including a text and collect service. Michelle O’Driscoll, Supervising Pharmacist for Brookes Pharmacy commented,

It is great to have the hard work that we have put in to our services acknowledged and the exposure like this for our pharmacy that we go the extra mile for all of our patients. Innovation in pharmacy is so important because of the saturation and competition in the market, pharmacies need to have an edge to stand out. Being involved in these awards has outlined to our patients what we can offer them. The community has stood behind us in the run up the awards and I am sure they will be delighted that we are coming home as winners. Tim O'Brien, Sales Executive with McLernon Computers, “Rewarding a pharmacist who sees the value of innovation is in line with the ethos of McLernon’s. We would like to think that we are innovative as a company so we are delighted to be associated with this particular award. Sponsoring an award like this allows McLernons to let our customers know that we are behind them as they move their business into the future.”

Norman Brookes and Michelle O'Driscoll, Brookes Pharmacy Bandon with Mr Tim O'Brien, Sales Executive, McLernon Computers

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Awards The Irish Pharmacy

Award Winners

2014

GlaxoSmithKline Health Promotion Award 2014 - Marrons Pharmacy, Clane Health Promotion is the way forward for the future of pharmacy and the GSK Health Promotion winner, Marrons Pharmacy Clane, understand that. The Pharmacy was revealed as the winner of this new award and Supervising Pharmacist, Jonathon Morrissey and his Mother Maura Morrissey told Irish Pharmacy News what this award means to them as a family pharmacy. Jonathon said,

It means everything to me to win. This award is for my patients which is extra special. The award is a testimony to making the effort to offering services for your patients and to win an award like this that is peer reviewed is a true honour. Maura Morrissey added,

Alan Downey, Commercial Operations Manager, GSK, Des Marron, Moira Morrissey and Edel Marron, Marrons Pharmacy, Clane, winners of the GSK Health Promotion Award 2014

Marrons pharmacy have always been focused on health promotion but since Jonathon came on board he has taken it to a new level. He is so forward thinking and understands what promoting health can do for the patient and for the business.

Alan Downey, Commercial Operations Manager, GSK said, “For GSK sponsoring this award is allowing us to give something back to pharmacy. Health Promotion has a bigger role in the sector now more than ever. Sponsoring an award like this gives us the opportunity to show the respect we have for the industry and hopefully respects us back as a manufacturer.�

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Awards Award Winners The Irish Pharmacy

2014

PharmaConex Technician of the Year 2014 - Kirstie Kilpatrick, Healthwise Pharmacy, Ballyraine

Paolo Iacovelli, Managing Director, PharmaConex with Kirstie Kilpatrick, Healthwise Pharmacy, Ballyraine, Community Pharmacy Technician of the Year and Barbara Kelly, Recruitment Consultant, PharmaConex

Kirstie Kilpatrick made history at the Irish Pharmacy Awards as the first ever PharmaConex Pharmacy Technician of the Year in Ireland. Kirstie stood out in a category that got an overwhelming response with the many projects that she led in her pharmacy in Ballyraine. Paolo Iacovelli Managing Director of PharmaConex said, “To be associated with this award in particular is extra special because we believe in the role of technicians and feel that an award like this will build up the profession. We hope it will lead to the recognition for technicians. Sponsoring this award has led to better exposure for our business and we are so proud of the deserving winner.” Kirstie said,

It is an unbelievable honour to be the first ever Pharmacy Technician of the Year. I have qualified recently as a technician so it is extra special. I can’t recommend entering an award like this enough. It has given me a time to shine and allowed me to showcase the hard work that I have done. This award is so special because it is an accolade to technicians and I hope that having an award like this will contribute to the battle for technicians to be recognised. I want to thank all at IPN for this tribute. The highly competitive category of Technician of the Year led to a highly commended Technician of the Year. Sinead Casey, Molloy’s Lifestyle Pharmacy, walked away with the recognition. She said, “I was shocked to be nominated but winning highly commended in this category is such a compliment, especially because it is the first award of its kind in Ireland. Everything about the evening has made me feel so cherished and to have this on my CV will give me so many opportunities in my future. What a great honor for me and for all my team at Molloy’s.”

Paolo Iacovelli, Managing Director, PharmaConex with Sinead Casey, Molloys Lifestyle Pharmacy, Highly Commended Community Pharmacy Technician of the Year and Garry O'Riordan, Operations Director, PharmaConex

30


Benetor

®

Olmesartan medoxomil

Benefit from Benetor® For the Effective Management of Essential Hypertension Greater BP reduction vs. other ARBs*1-7 Effective BP control maintained over 24 hours1,8 Proven achievement of recognised BP targets9,10 * vs. losartan, valsartan and candesartan

ABBREVIATED PRESCRIBING INFORMATION. BENETOR® 10, 20, 40mg film-coated tablets (olmesartan medoxomil). Refer to Summary of Product Characteristics (SmPC) before prescribing. Presentation: Film-coated tablets containing 10mg, 20mg, 40mg olmesartan medoxomil. Uses: Treatment of essential hypertension. Dosage: Recommended starting dose: one 10 mg tablet daily. Administer once a day, at the same time each day, with or without food. Take tablet with sufficient fluid and do not chew. Where blood pressure (BP) not adequately controlled, increase dose to 20 mg once daily as optimal dose. If additional BP reduction required, increase dose to maximum 40 mg daily or addition of hydrochlorothiazide therapy. Older people: No dose adjustment generally required. If up titration required to maximum daily dose (40 mg), closely monitor BP. Children and adolescents (below 18 years): Not recommended. Renal impairment: Mild to moderate: Maximum dose 20 mg once daily. Severe: Not recommended.. Hepatic impairment: Mild: No dosage adjustment required. Moderate: Initially one 10 mg tablet daily; maximum dose 20 mg once daily. Closely monitor BP/renal function in hepatically-impaired patients already receiving diuretics and/or other antihypertensive agents. Severe: Not recommended. Contraindications: Hypersensitivity to any ingredient; 2nd and 3rd trimesters of pregnancy, biliary obstruction. Warnings/precautions: Pregnancy: Contraindicated in 2nd and 3rd trimesters. Do not initiate during pregnancy. Patients planning pregnancy should change to alternative anti-hypertensive treatment. Stop BENETOR® immediately if pregnancy diagnosed and start alternative therapy, if appropriate. Should exposure occur from 2nd trimester, recommend ultrasound check of renal function/skull and closely monitor infant for hypotension. Breast feeding: Not recommended. Renal impairment: Periodic monitoring of serum potassium and creatinine levels recommended. Severe: Not recommended. Renovascular hypertension: Increased risk of severe hypotension and renal insufficiency when patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney are treated with medicinal products that affect the renin-angiotensin-aldosterone system (RAAS). A similar effect may be anticipated with angiotensin II receptor antagonists. Intravascular volume depletion: Correct sodium and/or volume depletion before starting treatment. Aortic or mitral valve stenosis (obstructive hypertrophic cardiomyopathy): Special caution recommended. Primary aldosteronism: Not recommended. Hyperkalaemia: Risk increased (may be fatal) in older people; patients with renal insufficiency, diabetes; concomitant use with potassium-lowering medicines, and/or patients with intercurrent events. Close monitoring of serum potassium levels in at risk patients recommended. Hepatic impairment: Severe hepatic impairment: Not recommended. Ethnic differences: BP-lowering effect of BENETOR® may be reduced in black patients. General: Combination of lithium and BENETOR® not recommended. In patients with severe congestive heart failure or underlying renal disease including renal artery stenosis, treatment with drugs that affect RAAS has been associated with acute hypotension or, rarely, acute renal failure. The possibility of similar effects cannot be excluded with angiotensin II receptor antagonists. As with any antihypertensive agent, excessive blood pressure decrease in patients with ischaemic heart disease or ischaemic cerebrovascular disease could result in a myocardial infarction or stroke. Contains lactose: Patients with rare hereditary problems of galactose intolerance, Lapp-lactase deficiency or glucose-galactose malabsorption should not take product. Interactions:: Concomitant use of lithium, NSAIDs, potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium and drugs that may increase serum potassium levels not recommended. BP-lowering effect of BENETOR® may be increased by concomitant use of other antihypertensive agents. Effects on ability to drive and use machines: BENETOR® has minor or moderate influence on the ability to drive and use machines. Dizziness or fatigue may occasionally occur in patients taking antihypertensive therapy, which may impair the ability to react. Side effects: Classification very common ((≥ (≥1/10); 1/10); common ((≥ (≥1/100 1/100 to <1/10); uncommon ((≥ (≥1/1000 1/1000 to<1/100); rare ((≥1/10000 to <1/1000); very rare (<1/10000). Common: Abdominal pain, arthritis, back pain, blood creatine phosphokinase increased, blood urea increased, bronchitis, chest pain, cough, diarrhoea, dizziness, dyspepsia, fatigue, gastroenteritis, haematuria, headache, hepatic enzymes increased, hypertriglyceridaemia, hyperuricaemia, influenza-like symptoms, nausea, pain, peripheral oedema, pharyngitis, rhinitis, skeletal pain, urinary tract infection. Uncommon: Allergic dermatitis, anaphylactic reaction, angina pectoris, asthenia, exanthema, face oedema, malaise, myalgia, pruritus, rash, thrombocytopenia, urticaria, vertigo, vomiting. Hypotension in Older people. Rare: Acute renal failure, angioedema, blood creatinine increased, hyperkalaemia, hypotension, lethargy, muscle spasm, renal insufficiency. Please consult the SmPC for the full list of reported side effects. Pack Sizes: Blister containing 28 film-coated tablets. Legal Category: POM. Product Authorisation Numbers: PA 1595/1/1-3. Product Authorisation Holder: Daiichi Sankyo Ireland Ltd., Riverside One, Sir John Rogerson’s Quay, Dublin 2. BENETOR® is a registered trademark, the property of Daiichi Sankyo Co., Ltd, Tokyo, Japan. Additional information is available on request from: Daiichi Sankyo Ireland Ltd. Building 1, Swift Square, Northwood Avenue, Santry, Dublin 9. Telephone: (01) 489 3000. Fax: (01) 489 3033. Email: medinfo@daiichi-sankyo.ie Date of Preparation: February 2014. References: 1. Smith D et al. Am J Cardiovasc Drugs 2005; 5(1):41-50. 2. Oparil S et al. J Clin Hypertens 2001;3;283−291,318. 3. Brunner HR et al. Clin Drug Invest 2003;23(7):419−430. 4. Brunner H and Arakawa K. Clin Drug Invest 2006;26(4):185−193. 5. Ball KJ et al. J Hypertens 2001;19(Suppl 1):S49−S56. 6. Stumpe KO and Ludwig M. J Hum Hypertens 2002;16(Suppl 2):S24−S28. 7. Giles TD et al. J Clin Hypertens 2007;9:187−195. 8. Fabia M J et al. J Hypertension 2007, 25:1327-1336. 9. Püchler J et al. J Hypertension 2001, 19(Suppl 1):S41-48. 10. Barrios V et al. Vascular Health and Risk Management 2009:5 723-729. Date of item: March 2014. DSIE/BEN66.


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Date of Preparation: April 2014. NA-019-01.

Date of Preparation: April 2014. NA-019-01.


Awards The Irish Pharmacy

Award Winners

2014

Actavis Business Development of the Year (Independent) Award 2014 Marron’s Pharmacy Marron’s Pharmacy took home their second award for the evening with the Actavis Business Development of the Year (Independent) Award . Supervising Pharmacist, Jonathon Morrissey was thrilled with the win. He commented,

This award is very personal to me. I took on a family business and suggested doing things differently. To have those changes acknowledged and deemed a success by my peers is such a personal victory and so fulfilling. This is the first time I have entered the Irish Pharmacy Awards and I can’t recommend it enough, our patients have been so involved and supportive throughout the whole process.

Barry Doyle, Key Account Manager with Actavis said, “To be involved with this prestigious award and support pharmacists who are adapting to change in these challenging times is a privilege. Sponsoring the award has given us the opportunity to promote our brand to independent pharmacy, it would be impossible to visit every independent pharmacy in the country but the awards make this possible. The professionalism of these awards and the rigorous judging panel makes Actavis proud to be associated with them.”

Jonathon Morrissey, Marrons Pharmacy, Clane with Louise Mooney, Key Account Executive and Barry Doyle, Key Account Manager, Actavis

33


CPD 42: DEPRESSION Biography - Rebecca Kate Kilfeather graduated with a BSc Hons Biological Science and a Master of Pharmacy in The Robert Gordon University, Aberdeen in 2011. She completed her pre-registration year in The Royal Infirmary Edinburgh in 2012, taking in rotations in the Sick Kids Hospital Edinburgh and the Chalmers Sexual Health and HIV clinic in Edinburgh. Upon moving back to Ireland Rebecca worked with Pharmaconex locuming in Dublin. Currently Rebecca is working in Perrystown Pharmacy. She was recently nominated for young pharmacist of the year 2013. 1. REFLECT - Before reading this module, consider the following: Will this clinical area Educational distance be relevant to my practice. 2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.

Module 1 June 2012

Published by IPN and supported with an unrestricted educational grant from Pfizer learning content for healthcare professionals in Ireland Healthcare Ireland. Copies can be downloaded 4. EVALUATE - Did this article meet my from www.irishpharmacytraining.ie

- will this article satisfy those needs - or will more reading be required? learning needs - and how has my practise changed as a result? Have I identified further learning needs?

Disclaimer: All material published in CPD and the Pharmacy is copyright and no part of this can be used within any other publication without the permission of the publishers and author.

Chronic Pain – assessment and management in primary care

3. PLAN - If I have identified a knowledge gap

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

Treating depression in the pharmacy

60 Second Summary

Globally Sheehan et al reported in 1996 that the estimated cost of depression is a pain for 95 patients to the Irish Health Services when added mental disorder Pain is one of the commonest reasons for patients to seek that to the amount ofaffects Socialmore Welfare payments received and 1 than 350 million medical attention. A recent survey has shown that as many the lost earnings of of each patient amounted to 1.9 million people all ages. as 8.3 visits per year to primary care physicians in Ireland 6 pounds at the time of referral. The recent data from PRIME There are differing were due to symptoms of pain.2 A large scale survey carried survey that theofmean cost per chronic pain patient prescribing antidepressants. It can be seen thatshowdegrees INTRODUCTION depression out in 15 European countries and Israel in 2006, screening can cause a across all grades of pain, the burden of depression and mental health is estimated which at €5,665 per year Depression encompasses a wide range of 46,394 respondents reported that the prevalence chronic5,6 person to suffer greatly and problems are on the riseofglobally. which was extrapolated to €5.34 billion or 2.86% of Irish mental health problems,pain characterised by to severe intensity in adult Europeans was impact their daily activities. This of moderate 7 It is always difficult to estimate the exactGDP per year. can place a burden on society.6 a loss of interest and enjoyment in ordinary This demonstrates an urgent need for cost 3 number of people suffering from depression as strategies to manage chronic pain effectively. things, low mood and a 19%. range of emotional, effective Women are more likely to suffer from

Introduction

many people do not get help or are not formally physical and behavioural symptoms.1-4 It is depression, however men are more likely to More recent survey data from anotherwith study, out5 The World Health diagnosed thecarried condition. different from the common experience of feeling commit suicide which may be due to men Assembly resolution in May 2012 called for a unhappy or miserable for short people period of in a2,019 with chronic pain and 1,472 primary Understanding chronic painhelp for depression. being less likely to seek 5 coordinated and comprehensive response to degrees of depression time. There are differingcare physicians across 15 European countries, have 6 mental disorders at a country level. core symptoms classifinormal ed as healing Chronic painThe is defined as pain can thatbe outlasts that can be distinguished by mood changes. demonstrated that chronic pain affects 12-54% of adult low mood, fatigue, and lack of interest or Depression is strongly associated with cognitive It can be seen that women are more likely time three to six months), and is most frequently to (usually enjoyment in things. Europeans, andmemory its prevalence in Ireland is up to 13%.2 The abnormalities, suicidal events, impaired suffer from depression than men, with 1 associated in 4 with musculoskeletal disorders such as low 13 and action. PRIME (Prevalence, Impactwomen and Cost of Chronic Pain)for study, Depression can be further classified depending requiring treatment depression at

back pain and arthritis. However, it can also be associated

on severity as mild, moderate or severe.14 one point in their lives, compared to 1 in 10 the other hand, determined the prevalence of chronic Depression is a commononmental disorder, with other disorders such as depression or metabolic men, however 4 men are more likely to commit with more than 350 million people ages pain to be of asall high as 35.5% in Ireland. The PRIME study The management of depressive disorders or frequently neurologicinvolve conditions such aseither multiple suicide, which may be because men aredisorders less be adesigned serious health suffering globally.6 It canwas drug therapy alone or to investigatelikely the to prevalence offorchronic pain Depression seek help depression. in combination with other therapies. sclerosis. problem, especially when it is long-lasting with 5 in Ireland; compare the psychological and physical health can affect people of any age including children. severe or moderate intensity. This can cause Psycological treatments include cognitive

profiles thosetheir with and without chronic pain; and explore the person to suffer greatly and of impact Pain (acute or chronic) can be categorised nociceptive DIAGNOSIS behavioural therapy, interpersonalas therapy, 4 daily activities such as school, work and family. pain-related disability. Responses to survey questions were problem solving therapy and counselling these or neuropathic. Nociceptive pain is caused by an active Depending on the severity of the disorder, it It may even lead to suicide, whichfrom results in anpeople. are generally well accepted by patients. obtained 1,204 illness, injury and/or inflammatory process associated with 6 can be classified as mild, moderate or severe. estimated 1 million deaths per year. Regardless of the severity, symptoms should The various available have actualbeor potential tissueantidepressants damage i.e. Nociceptive pain Despite magnitude of the problem, chronic pain is There are effective treatments forthe depression, different modes of action, side effect profile present for two or more weeks. results from activity in neural pathways secondary to actual although fewer than halfboth of those affected in the and undertreated in primary care.2,5 and monitoring. The decision on the choice of under-recognised There are two main diagnostic criteria which are or potential tissue damage. Nociceptive pain mediated antidepressant should be based on is the patient world receive such treatment. There are various Indeed, up to 38% of patients beingdepression. inadequately usedreported to diagnose The International individual requirement. barriers in getting effective care including by pain receptors located in skin, musculoskeletal system, 2 Classification of DiseasesIn(ICD-10), which is a managed in primary their pain symptoms. lack of resources, lack of trained health care care for 8 bone, and joints. Neuropathic on experienced the other hand, Withdrawl symptomspain, can be WHO of mental addition, people painclassification reported waiting up toand behavioural professionals, inaccurate assessment andwith chronic when discontinuing treatments such as upset results from direct injury to a peripheral or central sensory disorders. Alternatively, a Diagnostic and social stigma. stomach, flu like symptoms, anxiety, dizziness, 2.2 years between seekingStatistic help andManual diagnosis, and 1.9 of mental disorders (DSM-IV) nerve; the affected nerves do not produce transduction and vivid dreams. Sometimes the effects can at 2 before theirthe pain wasisadequately managed. Correct diagnosis is vitalyears as occasionally produced and favoured by the American 8 mild however it depends on the patient. be nociceptors. Pain characteristics and associated conditions disorder can be misdiagnosed, resulting in Psychiatric Association. The extent of for both types of pain are shown in Table 1.

use by Healthcare Professionals in the Republic of Ireland only Learning, Evaluation,For Accredited, Readers, Network | www.learninpharmacy.ie © Copyright 2012 Pfizer Healthcare Ireland Date of Preparation: Module 1 June 2012 EPBU/2012/XXX

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CPD 42: DEPRESSION

Module 1 June 2012

sionals in Ireland

anagement in primary care

ehan et al reported in 1996 that the estimated cost of n for 95 patients to the Irish Health Services when added he amount of Social Welfare payments received and lost earnings of each patient amounted to 1.9 million nds at the time of referral.6 The recent data from PRIME vey show that the mean cost per chronic pain patient stimated at â&#x201A;Ź5,665 per year across all grades of pain, symptoms present is crucial in determining the ch was extrapolated to â&#x201A;Ź5.34 billion or 2.86% of Irish severity of depressive illness and helps as a 7 5,6 cost P per year. This demonstrates an the urgent need for guide on the treatment for individual. ctive strategies to manage chronic pain effectively.

Core symptoms can be classified as low mood, fatigue and lack of interest or enjoyment in things. Other symptoms derstanding chronic paininclude weight loss or gain, insomnia/hypersomnia, psychomotor feeling worthless/guilty, onic painagitation/retardation, is defined as pain that outlasts normal healing reduced concentration/indecisiveness and e (usually three to six months), and is most frequently thoughts of suicide. Core symptoms would ociated with musculoskeletal disorders as low normally be present most of thesuch time over a twoarthritis. week period for major to be k pain and However, it candepression also be associated diagnosed. Both require h other disorders such as diagnostic depressionsystems or metabolic at least one (DSM-IV) or two (ICD-10) core orders orsymptoms neurologictoconditions such as multiple be present. For major depression rosis. the DSM-IV system requires a score of five out of nine on symptoms. Patients who do not fit all chronic) the criteria have minor depression or chronic n (acute or can be categorised as nociceptive low Nociceptive mood.6 europathic. pain is caused by an active

AND AETIOLOGY ss, injuryPATHOPHYSIOLOGY and/or inflammatory process associated with ual or potential tissue damage i.e. Nociceptive Depression is a complex disorder and pain ults from itactivity in neural pathways secondary is possibly influenced by genetic and to actual It is thought there otential environmental tissue damage.factors. Nociceptive pain isthat mediated is an association with the serotonin transporter pain receptors located in skin, musculoskeletal system, gene. However, the relationship between 8 e, and joints. Neuropathic pain, is onprobably the othervery hand, genetics and depression complex andto not fully elucidated. Environmental ults from direct injury a peripheral or central sensory factors such asdo stress are main transduction contributory at ve; the affected nerves not produce factors.13 iceptors.8 Pain characteristics and associated conditions both types of pain are shown in Table 1.

There is a hypothesis that suggests a deficiency in monaminergic neurotransmission in the brain mediated by serotonin and noradrenaline. Given that reduced serotonin levels do not cause depression in all people, it is unclear if decreased serotonin synthesis is the cause or a consequence of depression.6,13 It is thought that disturbed receptor signalling, decreased sensitivity of 5-HT auto receptors, which regulate serotonin function have been associated with depression. It can also be noted that modulation of noradrenaline release by feedback inhibition was increased in depressed patients. Moreover altered receptor signalling could also be as a result of a malfunctioning of G-protein, which may also alter or impair neurotransmitter function.13 However, only 50%-70% of patients respond to these drugs, which may indicate a more complex mechanism for depression. Dopamine deficiency has also been associated. This is supported by the antidepressant activity of dopamine reuptake inhibitors and dopamine agonists. MANAGMENT When diagnosed, mild depression may improve by itself and progress monitored, known as watchful waiting, and antidepressants are not

normally recommended as first line treatment. A GP may recommend self help books or cognitive behavioural therapy. Chronic mild depression, which last two years or more is more common in the over 55 years and sometimes antidepressants are prescribed.13 However, for severe depression, the patient may require a combination of an antidepressant and talking therapy or cognitive behavioural therapy. Mental health teams made up of psychologists, psychiatrists, specialist nurses and occupational therapists provide intensive specialist treatments.14 PHARMACOTHERAPY The management of depressive disorders frequently involves drug therapy, either alone or in combination with other therapies. Psycological treatments include cognitive behavioural therapy, interpersonal therapy, problem solving therapy and counselling. These are generally well accepted by patients. Many of these can also be effective in minor depression where drug therapy would not be recommended due to the low risk benefit ratio. SIGN guidelines give reliable recommendations on these alternatives.1-4 The various antidepressants available have different modes of action, side effect

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CPD 42: DEPRESSION

profile and monitoring. The decision on the choice of antidepressant should be based on the patient's individual requirement. Traditional pharmacotherapy includes trcyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) and newer selective reuptake inhibitors (SSRIs), all of which are the first line treatment.

MAOIs

(sexual dysfunction, weight gain) and suicidal behaviour.14 These inhibit and reduce monoamine SSRIs degradation. They are used much less frequently than TCAs and SSRIs due to the SSRIs block the reuptake of serotonin in1 Module dangers of dietary and drug interactions. presynaptic neurones, the major Juneproblems 2012 with Response to MAOI treatment may take up their use are nausea and vomiting. Bleeding to three weeks or more to become maximal. disorders, due to serotonin reuptake inhibition Phenelzine, isocarboxazid and tranylcypromine has been reported. Stopping these drugs is Most people with moderate to severe are irreversible nonselective inhibitors, their often associated with withdrawl symptoms. Educational distance learning content for healthcare professionals in Ireland depression benefit from the use of effect can persist for weeks until regeneration They are relatively safe in overdose, so they antidepressants. However, people respond of monoamine oxidase. The use in traditional can be recommended in suicidal patients. The differently to antidepressants. It may take therapy is decreasing due to their serious balance of the benefits and risks in treatment two or more treatments before a patient finds side effects. For example, acute hypertensive in the under 18 years shows that SSRIs what works for them because side effects vary reactions after consumption of tyramine citalopram, paroxetine, sertraline, mirtazapine between people and treatments. rich foods such as mature cheese. Also and venlafaxine have higher harmful outcomes. drug interactions are equally serious, such There is very little in the difference in efficacy These may be started under specialist as interactions with narcotic medication, when it comes to choosing an antidepressant. supervision where there is clinical need. pseudoephedrine and SSRIs. Newer MAOIs However, the choice should be based on the However, the exception is fluoxetine. Clinical act by reversible inhibition of monoamine. An individual patient requirement, presence of trials have shown this to be effective in children example of this is moclobemide. This does not concomitant disease, existing therapy, suicide and in adolescents. SSRIs should be used require such strict dietary restrictions; however risk and previous response to treatment. It in caution in patients with epilepsy, cardiac it still has a risk of drug interaction for example must also be considered that it may take up disease, diabetes and bleeding disorders. The 1-4,13 ephedrine and pseudoephedrine. to two weeks for the antidepressant to take side effects of SSRIs include GI effects, weight effect. Also, it should be recognised that loss, hypersensitivity reactions and suicidal TCAs during the first few weeks there may be a risk of behaviour.14 The mechanism of action of TCAs involves anxiety, agitation and suicidal behaviour. Where OTHER ANTIDEPRESSANTS noradrenaline and serotonin inhibition. They necessary the patient should be monitored, are rapidly absorbed and highly plasma bound particularly in the beginning and if the dose is New antidepressants such as venlafaxine, and they have large volume of distribution. changed.14 mirtazapine and nefazodone are known as SNRI They are primarily metabolised by CYP450 Sheehan et(serotonin al reported in 1996 that the estimated cost of Introduction norepinephrine reuptake inhibitors). It should be noted that as anxiety is often enzymes and are renally excreted. They can These can be more effective than an SSRI pain for 95 patients to the Irish Health Services whenbut added present in depression and may be the interact with for SSRIs by thetoinhibition of the Pain is one of the commonest reasons patients seek they can cause a rise in blood pressure. presenting symptom, the use of anxiolytics CYP450 isoenzymes. They are used lessto the amount of Social Welfare payments received and 1 medical attention. A recent survey has shown that as many or antipsychotics may mask the diagnosis. frequently, due mainly to their adverse effects, In severe depression the lost earnings of each patienttreatments, amounted to 1.9 million Therefore, these should as be 8.3 used in caution in to primary visits per year in Ireland whichcare limitphysicians the dose that can be tolerated. They electroconvulsive therapy may be advised, it 6 pounds at the time of referral. The recent data from PRIME depression, although they aredue useful in agitated of pain. also 2pose a potential problem of toxicity in an were to symptoms A large scale survey carried is only used when antidepressants or other 14 survey show that the mean costbeen per successful. chronic painHowever, patient patients. overdose; therefore limited quantities should treatments have not out in 15 European countries and Israel in 2006, screening is estimated at €5,665 per year across all grades of pain, be prescribed at any one time. Due to the long it is linked with unpleasant side effects, such Hyponatraemia can be associated with 46,394 respondents reported that the prevalence of chronic half life, this allows for once daily administration short term to headaches, memory problems, which was as extrapolated €5.34 billion or 2.86% of Irish antidepressant treatment, especially with 13 Europeans was pain of moderate to severeusually intensity adult at in night. muscle aches and nausea. 7 SSRIs, patients, who present with drowsiness, GDP per year. This demonstrates an urgent need for cost 3 19%. confusion or convulsions but they should There are various side effects with the use Lithium may also bechronic prescribed no response effective strategies to manage painif effectively. be monitored. Patients should be monitored of TCAs, including cardiovascular (such as has been obtained from other medication. every 1-2 weeks during More the start of treatment recent survey data from another study, out nervous arrhythmias, heart carried block) central Lithium must build up in the system and a and treatment should beincontinued for four 2,019 people with chronic pain and 1,472 primary confusion) Understanding system (anxiety, dizziness, therapeutic level achieved. chronic pain Toxicity must also weeks (six in the case of the elderly) before be monitored. Therefore, regular blood tests are antimuscarinic (dry mouth, blurred vision, care physicians across 15 European countries, have considering switching due to lack of efficacy. is defined asthree pain months. that outlasts normal healing required every Salt restrictions constipation, urinary retention) endocrineChronic pain demonstrated that chronic pain affects 12-54% of adult If the patient partially responds, continuing time (usually three to six months), and is most frequently treatment for a further 2-4 weeks should be prevalence in Ireland is up to 13%.2 The Europeans, and its associated with musculoskeletal disorders such as low considered.5,14 PRIME (Prevalence, Impact and Cost of Chronic Pain) study,

Chronic Pain – assessment and management in primary care

Following remission, treatment shouldhand, be determined the prevalence of chronic on the other continued at the same dose at least 6 as 35.5% in Ireland.4 The PRIME study pain for to be as high months (12 in the elderly) or 12 months in designed to investigate the prevalence of chronic pain patients with co-existingwas general anxiety in Ireland; compare disorder. Patients with recurrent depression the psychological and physical health 14 should keep on treatment for at of least 2 years. profiles those with and without chronic pain; and explore

disability.4 Responses to survey questions were Failure to respond to thepain-related initial treatment of an SSRI may require aobtained dose increase or from 1,204 people. switching to an alternative SSRI or mirtazapine. Tricyclic antidepressantsDespite and venlafaxine may of the problem, chronic pain is the magnitude be considered in more severe depression. 2,5 both under-recognised Irreversible MAOIs should only be prescribed and undertreated in primary care. uptotoa 38% of patients reported being inadequately by specialists. Failing toIndeed, respond second antidepressant may require an additional managed in primary care for their pain symptoms.2 In antidepressant or an augmenting agent, addition, people with chronic pain reported waiting up to such as lithium, aripiprazole, quetiapine or 2.2only years help and diagnosis, and 1.9 risperidone. These should be between started byseeking a specialist. years before their pain was adequately managed.2

use by Healthcare Professionals in the Republic of Ireland only Learning, Evaluation,For Accredited, Readers, Network | www.learninpharmacy.ie © Copyright 2012 Pfizer Healthcare Ireland Date of Preparation: Module 1 June 2012 EPBU/2012/XXX

back pain and arthritis. However, it can also be associated with other disorders such as depression or metabolic disorders or neurologic conditions such as multiple sclerosis.

Pain (acute or chronic) can be categorised as nociceptive or neuropathic. Nociceptive pain is caused by an active illness, injury and/or inflammatory process associated with actual or potential tissue damage i.e. Nociceptive pain results from activity in neural pathways secondary to actual or potential tissue damage. Nociceptive pain is mediated by pain receptors located in skin, musculoskeletal system, bone, and joints.8 Neuropathic pain, on the other hand, results from direct injury to a peripheral or central sensory nerve; the affected nerves do not produce transduction at nociceptors.8 Pain characteristics and associated conditions for both types of pain are shown in Table 1.

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CPD 42: DEPRESSION

Module 1 June 2012

sionals in Ireland must also be in place as salt can affect the lithium levels. An electrocardiogram must be performed before initiating lithium treatment.14

anagement in primary care CLINICAL CONSIDERATIONS

Withdrawl symptoms can be experienced when discontinuing treatments, such as upset stomach, flu like symptoms, anxiety, dizziness, and vivid dreams. Sometimes the effects can be mild but it depends on the patient. These withdrawl symptoms most likely occur with paroxetine and venlafaxine. The antidepressant should not be stopped suddenly if the patient has been on treatment for 8 weeks or more. The dose should be reduced gradually over 4 weeks or longer if symptoms emerge.14

with depression, such as poor motivation and concentration may contribute to non compliance. Often it is due to the side effects experienced and lack of efficacy. For successful treatment, therefore by choosing an adequate, well tolerated and effective drug with optimal formulation along with effective communication between the patient and healthcare professional is important in establishing compliance. The newer antidepressants are better tolerated and so promote better compliance. Furthermore, longer half-life and once daily dosing is favourable. TALKING TREATMENTS 'Cognitive behavioural therapy (CBT) concentrates on how the patient thinks, behaves and feels in the present.' It teaches them to challenge the negative thoughts. On the other hand, interpersonal treatment focuses on relationships and communication difficulties. Counselling is also effective because this helps the patient to think about problems and how to deal with them. Counsellors will support the patient in finding ways to deal with their issues. IN SUMMARY

There are opportunities to be gained from promoting mental health through public WITHDRAWAL/SWITCHING/STOPPING policies. By achieving better mental health, this ehan et Withdrawl al reportedofinMAOIs 1996 that theinestimated results symptom cost of in turn will contribute to the achievement and withdrawal on cessation therapy. This includes n for 95 patients to the Irish Health Services when added development of education, economic and social agitation, irritability, ataxia, movement goals. he amount of Social Welfare payments received and disorders, drowsiness, insomnia, vivid dreams lost earnings of each patient amounted to 1.9 million Depressive disorders are likely to develop from and cognitive impairment. Therefore, these should slowly. nds at the time be of withdrawn referral.6 The recent data from PRIME a vartiey of different factors including age, marital status, family breakdown, migration, vey showThe thatdanger the mean cost per chronic pain up patient of interactions can persist changing patterns of work, climate change, weeks after discontinuation of the stimatedtoattwo €5,665 per year across all grades of pain, risk of debt and substance abuse. A decrease nonselective to MAOI treatment and other of Irish in mental health can therefore impact hugely ch was extrapolated €5.34 billion or 2.86% antidepressants should not be started for two socially, economically and physically. By 7 P per year. This demonstrates an urgent need for cost weeks after stopping treatment (3 weeks if addressing these challenges, links between ctive strategies manage chronic pain effectively. startingto clomipramine or ipramine). Reversible mental health, economic performance and MAOIs have a shorter duration of action so no poverty can be understood and may help to treatment-free period is required on stopping. provide opportunities to educate and help derstanding chronic pain people. However, when starting a reversible MAOI it not be foroutlasts at least anormal week after onic painshould is defined asstarted pain that healing Therefore, there is a need for more health SSRI, or relatedand antidepressant has economic research to address mental health. e (usuallyan three to TCA six months), is most frequently been stopped (at least five weeks in the case of This may help to develop an improved global ociated with musculoskeletal disorders such as low fluoxetine). Furthermore, nonselective MAOIs architecture for mental health, which may in k pain and arthritis. However, it canatalso associated should not be started until leastbe 7-14 days turn strengthen the links between mental health after a tricyclic or depression related antidepressant has and social development, allowing people with h other disorders such as or metabolic been stopped. In addition an MAOI should mental health problems to succeed socially and orders or neurologic conditions such as multiple not be started for at least two weeks after a economically. rosis. previous MAOI has been stopped.14 REFERENCES In the case can of SSRIs,withdrawal symptoms n (acute or chronic) be categorised as nociceptive 1. NATIONAL INSTITUTE FOR HEALTH AND CLINICAL are higher with paroxetine. Symptoms include EXCELLANCE (NICE), 2009. Depression: the treatment europathic. Nociceptiveheadache, pain is caused byand an active GI disturbance, anxiety sleep and management of depression in adults. [online]. ss, injurydisturbance. and/or inflammatory with The most process commonassociated side effects, London: National institute for health and clinical excellence. Available from: http://guidance.nice.org. such astissue palpitations and disturbance ual or potential damage i.e.visual Nociceptive pain uk/CG90. can occur on abrupt withdrawal or marked ults from activity in neural pathways secondary to actual 2. NATIONAL INSTITUTE FOR HEALTH AND CLINICAL reduction of dose. Therefore, withdrawal should otential be tissue damage. Nociceptive EXCELLANCE (NICE), 2010. Clinical knowledge tapered over a few weeks.pain is mediated

pain receptors located in skin, musculoskeletal system, COMPLIANCE e, and joints.8 Neuropathic pain, on the other hand, is injury a major in the ults from This direct to obstacle a peripheral oreffective central sensory management of depression. There are various ve; the affected do not produce transduction at reasonsnerves why a patient would discontinue 8 iceptors.treatment. Pain characteristics andexperienced associated conditions The symptoms both types of pain are shown in Table 1.

summaries:Depression. [online]. London: National institute for health and clinical excellence. Available from: http: www.cks.nhs.uk/depression.

3. SCOTTISH INTERCOLLEGIATE GUIDELINES NETWORK (SIGN), 2010. Non-pharmaceutical management of depression in adults. [online] Edinburgh: Scottish intercollegiate Guidelines Network.

Available from: http://www.sign.ac.uk/guidelines/ fulltext/114/index.html 4. NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLANCE (NICE), 2010. Common Mental Health Disorders: Identificationand pathways to care.[online]. London: National Institute for health and clinical excellance. Available from: http://guidance.nice.org. uk/CG123 5. HEALTH SERVICE EXECUTIVE (HSE), 2014. Depression. [online] Ireland: Health service executive. Available from: http://www.hse.ie/eng/health/az/D/ Depression/ 6. WORLD HEALTH ORGANISATION, 2014. Depression; factsheet. [online] world health organisation. Available from: http://www.who.int/ mediacentre/factsheets/fs369/en/ 7. MEHTA, S. et al. ‘Psychosocial functioning in depressive patients: A comparative study between major depressive disorder and bipolar affective disorder.’ Depression research and treatment. Research article. Article ID 302741, 2014 8. NUTTING, P et al. ‘Barriers to initiating depression treatment in primary care practice’. J gen intern med, 2002; 17: 103-111. 9. JENKINS, R et al. ‘Social, economic, human rights and political challanges to global mental health’. Mental Health in Family Medicine 2011; 8:87-96. 10. JENKINS, R et al. ‘Health system challanges and solutions to improving mental health outcomes’. Mental Health In Family Medicine 2011;8:119-27. 11. JENKINS, R et al. ‘mental health and the global agenda: core conceptual issues’. Mental Health in Family Medicine 2011;8:69-82. 13. PEROVIC, B et al. ‘Getting the balance right: established and emerging therapies for majordepressive disorders’. Neuropsychiatric disease and treatment. 2010;6;343-364. 14. BRITISH NATIONAL FORMULARY. No 67. March 2014. BNF online www.bnf.org.uk

Pfizer Healthcare Ireland are committed to supporting the continuous professional development of pharmacists in Ireland. We are delighted to be supporting Irish Pharmacy News in order to succeed with this. Pfizer’s support of this programme is the latest element in a range of activities designed to benefit retail pharmacy. Other initiatives include the Multilingual Pharmacy Tool, Pharmacy Dietitian programme, host your own website with www.mylocalpharmacy.ie and the support of Pfizer for a year, pharmacy Consultation Room brochures and posters as well as a host of other patient-assist programmes including the Quit with Help programme and www.mysterypain.ie. If you would like additional information on any of these pharmacy programmes, please contact Pfizer Healthcare Ireland on 01-4676500 and ask for the Established Products Business Unit. Supported by Pfizer through an unrestricted educational grant. The opinions expressed are the authors and not the sponsors.

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Awards The Irish Pharmacy

Award Winners

2014

Nurofen for Children Baby Health Pharmacy of the Year 2014 Healthwise Pharmacy, Sligo It was three times a charm for Healthwise Pharmacy who returned to the Irish Pharmacy Awards for the third time. The pharmacy scooped the Nurofen for Children Baby Pharmacy of the Year by setting their pharmacy apart from the others by identifying a niche market in Sligo and making Healthwise Sligo the go-to pharmacy for all baby and childcare needs. A proud James Cassidy, Director of Healthwise Pharmacy commented,

To win this award is a real compliment to our team in Sligo, I am very proud of them. Everybody has to specialise to stand out in pharmacy and Healthwise Sligo decided to stand out in the mother and baby category. They became experts at it and this award recognises that. Success is in numbers and their customers recognise the success of having a mother and baby pharmacy as they visit it from far and wide. Philip Wilkinson, Field Sales Manager, Reckitt Benckiser commented, â&#x20AC;&#x153;It means a lot to us at Reckitt Benckiser to sponsor this new category and support the pharmacists in the community who are working so hard to support and guide the new mothers in their area. For our business it was an opportunity to recognise a sector of pharmacy that has gone unnoticed until now and we are delighted to be associated with an accolade such as this.â&#x20AC;?

Philip Wilkinson, Field Sales Manager - Ireland, Reckitt Benckiser presents the award James Cassidy, Managing Director, Healthwise Pharmacies, winners of the Nurofen for Children Baby Health Pharmacy of the Year Award

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Awards Award Winners The Irish Pharmacy

2014

opean quality

mpanies*, n the production .

KRKA Business Development of the Year (Chain) Award 2014 - Care Pharmacy Care Pharmacy received the accolade for the KRKA Business Development of the Year (Chain) Award. Linda O’ Connor, Pharmacist in Care Pharmacy said,

We are a new company in the Irish Market so to get this award so early on in our development of our business is so gratifying. We introduced a niche service in a community by offering blood tests to customers. In order to survive in pharmacy you have to create a niche selling point. To have that project acknowledged in this way it encourages us to go further and continue to develop our business. Paul Neill, General Manager, KRKA Pharmaceuticals Ireland said, “We are delighted to be associated with this award again. This award is in recognition of the hard work and development that is going on in pharmacies around the country. Care Pharmacy is a particularly deserving winner this year for the work that they have done. For us to be associated with the Irish Pharmacy Awards gives us the perfect platform to showcase KRKA in the Irish pharmacy market.”

Shauna McGuinness, Linda O’Connor, Cathriona Mulryan, Care Pharmacy and Mr Paul Neill, General Manager, KRKA Pharmaceuticals Ireland

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IT’S TIME TO TAKE A CLOSER LOOK

IT’S CLEAR WHAT WE DO!

Supply

Consistency

Quality

Value


Awards Award Winners The Irish Pharmacy

2014

Johnson and Johnson Community Pharmacy Team of the Year 2014 Pharmacy Plus, Birr, Co. Offaly There were a record number of submissions for this category of an unbelievably high calibre. David O’Meara Pharmacy Plus in Birr Co. Offaly was the winning team for 2014. A proud Supervising Pharmacist, David O’Meara commented,

This whole experience from being nominated to winning as being such an overwhelming and joyous experience. We are a young pharmacy so it is extra special for all of us in the team to win. I know all pharmacy teams work hard but we have known for quite some time that we have something special with our team. We always have customers who comment on how our team is so helpful and will always go beyond what is required. To win this award will change our outlook that we are doing things right and should move forward with a successful and hard working team. Doris Claffey, Noelle Horan, Anne O’Connell, Geraldine Freeman, Channel Manager, Johnson and Johnson, David O’Meara, Eleanor Grennan, Lisa Deane, David O’Meara Pharmacy Plus, Birr

And Highly Commended Team of the Year was the team in Boots Stephens Green. Liz Kerr, Pharmacy Director Boots Ireland said, “It’s great to have the work and relationships the team have their patients acknowledged. A pharmacy can’t work without a team. This award is a real testament to the team work that they have done. Each member brought their own skills and talent individually to make a successful and a fantastic experience for their customers.”

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Geraldine Freeman, Commercial Director with Johnson and Johnson said “It is an honour to be involved with the Team of the Year Award, as everyday when we are out and about and visiting pharmacies we experience what good work pharmacy teams are doing. For Johnson and Johnson to be involved and supporting that is great for us. Being involved in these awards has brought us closer to our customers.”

Anna Jurak, Laura Dempsey, Michelle Doyle, Boots Pharmacy, Geraldine Freeman, Channel Manager, Johnson and Johnson, Michelle Greaney, Rose Kinsella the Boots St. Stephens Green Pharmacy Highly Commended Team


News

IIOP Under the spotlight The Irish Institute of Pharmacy was recently established to promote excellence in the areas of patient care, professional standards, education and research in pharmacy. As with any new development in the profession, this change has naturally prompted pharmacists to ask questions about the Institute and continuing professional development (CPD). To help this transition the IIOP is currently holding pharmacist information events nationwide which are delivered by a team of peer support pharmacists. This article aims to address some of the common questions asked by pharmacists at these sessions. WHAT WILL THE E-PORTFOLIO LOOK LIKE? A recurring theme from the information events is that pharmacists are eager to see the e-portfolio that they will be using to record their CPD, and some are disappointed not to be able to see it yet. I can understand that people are impatient to get started, but in order for the e-portfolio to reflect the needs of the pharmacists it is important that we firstly hear the views of pharmacists. We have received great feedback at the pharmacist information events and the resounding message is that the e-portfolio needs to be simple and easy to use. Pharmacists want to be able to access it on their smart-phones and tablets as well as on computers. One pharmacist even suggested that we consider the use of voice recognition technology, which I believe we can do. The challenge is to develop something that is comprehensive but simple, and the IIOP is committed to trying to make the e-portfolio as simple as possible. This summer the e-portfolio will developed and piloted with pharmacists before being rolled out to the profession later in the year. WHAT COUNTS AS CPD? The new CPD system recognises that there is a broad spectrum of ways in which pharmacists maintain their professional development. It allow for informal learning, such as learning from colleagues on the job or reading journal articles, as well as more formalised learning, such as attending courses or seminars and completing formal education. The beauty of our new CPD system is that we are not being told what we have to do. We aren’t being asked to attend specific courses, complete a target number of hours of learning or achieve a certain number of “points”. We can decide what we learn and how we learn. However, we will be expected to record our learning in a systematic way in our e-portfolio and we will need to explain how it has resulted in an improvement

in our practice or our patient care. Our model focusses on outputs rather than inputs, which represents a very progressive approach to CPD. HOW MANY CPD ENTRIES DO I NEED TO SUBMIT FOR A PORTFOLIO REVIEW? This is a question that is asked at every information event, to which there is no specific answer. Portfolio reviews will be part of a quality assurance system to ensure that pharmacists are carrying out satisfactory CPD. Therefore, all aspects of the portfolio will be considered, including the way in which needs are identified, how these needs are addressed and how the learning has been used in practice. In creating their portfolio, pharmacists should consider their learning needs across all the areas of our core competency framework and the IIOP will help them to do this, by providing a Core Competency Self-Assessment Tool later in the year. Pharmacists should also make sure that they use a variety of approaches to address there learning needs – including informal learning as well as more formal approaches. The number of CPD cycles needs to be reasonable to reflect each pharmacists’ commitment to maintaining their competence and knowledge and the Institute will support pharmacists to understand what this entails. I see it as a positive move that the IIOP does not intend to stipulate the number of entries or cycles required in a portfolio submission. WILL THE PSI BE INFORMED OF THE OUTCOMES OF MY REVIEW? No. There will be no communication to the PSI if a pharmacist’s review is deemed unsatisfactory. Instead the IIOP will work directly with that pharmacist, to understand the possible reasons for an unsatisfactory review. If there is a cause for concern, remediation processes will be put in place to support a pharmacist who does not appear to be maintaining adequate CPD. Whilst the

CPD Cycle

IIOP will not be providing any information to the PSI, pharmacists themselves will have to provide a declaration in SELF EVALUATEtheir annual APPRAISAL IMPACT ON application PRACTICE for registration indicating that ePortfolio they are DEVELOP DOCUMENT competent PERSONAL YOUR LEARNING PLAN and fulfilling the requirements for CPD. ACTION Therefore, it is in everyone’s interest to engage fully with the new CPD system, so that they can be in a position to provide this declaration. HOW CAN WE BE SURE THAT THE IIOP WILL RESULT IN INCREASED RECOGNITION OF THE PHARMACIST’S ROLE? The IIOP will be the vehicle for change, but cannot achieve change by itself. Its role will be to enable pharmacists to demonstrate their competence and the value that they can bring to patient care, which should lead to a greater recognition of their role. The IIOP can only achieve its aims with the support of pharmacists, their representative bodies, the regulator, the schools of pharmacy and the Department of Health. PHARMACIST INFORMATION EVENTS The pharmacist information events, contrary to what the name suggests, are not just about providing information to pharmacists but are equally about providing an opportunity for pharmacists to communicate their views back to the IIOP. There has been great debate, discussion and interaction at each event. It has been wonderful to see pharmacists from all areas of practice coming together to discuss their thoughts on how their profession is evolving. Many pharmacists are absolutely

thrilled to see the establishment of the IIOP and see it as a very positive step for the profession, while others remain dubious and do not feel so positive about the development. The key to the success of the information events is that all pharmacists, regardless of their area of practice, have the opportunity to express their opinions and views. The peer support pharmacists have done a great job of ensuring that all voices have been heard and, after each event, they have communicated their peers’ comments and questions back to us here in the IIOP. This information is being used to shape the work of the Institute, which will help ensure that our activities are meeting the needs of the profession. The IIOP requires input from the profession, and these pharmacist information events play an important role in helping us to hear and understand pharmacists’ views. If you haven’t had the chance to attend an event yet, please go to www.iiop.ie to find an event near you so that you can play your part in shaping your profession.

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Women’s Health Feature

Focus on females through the ages On the whole, women find that they are quite comfortable talking to health care professionals about their health problems. Irish women are healthier now than they have ever been because women’s health has improved dramatically in the last two decades. Life expectancy is now 83 years of age and, on average women live five years longer than their male counterparts. Women have a slightly lower risk of certain headline diseases than their male counterparts but are more likely to suffer from chronic conditions, such as cancer. In 2007, the Irish Government released a National Women’s Strategy 2007-2016, which addressed some key issues facing women in Ireland today from a health perspective. These included interventions to address certain illnesses and causes of death, which are gender specific, such as breast and cervical cancers, sexual and reproductive health, mental health, and lifestyle issues, including obesity, alcohol misuse and smoking. To date the government has implemented a national breast and cervical screening programme, a national smoking quit line and has backed a number of mental health awareness charities. Pharmacists play a key role in the management of women’s health, especially as regards prevention

and more specifically screening for chronic conditions, such as diabetes and offering advice on sexual and reproductive health. PREGNANCY Women also seek advice on a variety of problems during pregnancy, including morning sickness. University College Dublin researchers have demonstrated that Irish women often are lacking in vitamin D, particularly during pregnancy. However, the HSE recommends 10 ug of Vitamin D per day for pregnant women. Taking any more than this could have adverse results. Omega-3 DHA is an essential fat that cannot be produced by the body and is fundamental to building a healthy brain. PRE-NATAL Pre-natal care is important to minimise any complications in pregnancy and to advise the expectant mother about what she can take to ensure a healthy and happy pregnancy and what is good or bad for the expected baby. Mothers-to-be should be advised about which vitamins should be taken and what should be avoided,

including alcohol and cigarettes. Recent studies by University College Dublin have shown that Irish women are lacking in vitamin D, especially during pregnancy. The HSE, however recommends 10 ug of Vitamin D per day for pregnant women. Taking any more that this could have adverse results. Omega-3 DHA is an essential fat that cannot be produced by the body and is fundamental to building a healthy brain. A study on Maternal seafood consumption in pregnancy and neurodevelopment outcomes in childhood researched 11,075 mothers and their children and concluded that women who consumed more of the essential fatty acid, Omega-3 were more likely to have children with higher IQs, better motor skills and improved co-ordination. During foetal development, the baby sources DHA from the mother. Therefore it is important for all mothers to ensure an adequate intake of Omega-3, from at least the third trimester of pregnancy right up to the first six months of baby’s life when breast fed because a child’s brain experiences a rapid growth spurt during this period. Recent research by the University of Surray has shown that a lack of iodine in pregnant women’s diet can lead to babies being born with a low IQ. According to the research; “Babies deprived of iodine in the womb were 50 per cent more likely to be among the least intelligent quarter of children at the age of 8, the research indicated.” Milk and fish are both excellent sources of iodine and expectant mothers should be advised to include them in their diet. The successful introduction of new services, such as blood pressure monitoring, weight assessments and health screening means that

44

there is an opportunity to build on this new role for pharmacy in the context of the development of preand post-natal and women’s health service delivery in primary care. While offering advice and health check-ups to pregnant women may not result in direct sales, it will probably encourage new mums to ask the pharmacist for increasing advice in the future. INFERTILITY The HSE Health in Ireland report states, “While numbers of births increased substantially from 2003 to 2009, since 2010 there has been a gradual decrease. This is due in part to a slight reduction in fertility rates but, more significantly, to the fact that the numbers of women of child-bearing age are beginning to decline. This is a demographic feature, which is likely to result in a steady reduction in numbers of births over the coming decade even if, as expected, Ireland continues to experience fertility rates which are higher than other EU countries.” A sexually active woman in her mid-twenties has a one in four chance of conceiving. However, the quality of a woman’s eggs often decline after the age of 32. Women over 35 are also considered at a ‘higher risk’ of miscarrying or delivering babies with chromosomal abnormalities. Pharmacies are able to offer ‘at home’ fertility tests, such as male fertility tests that identify normal or low sperm count or female hormone monitoring devices that identify the days that a woman is more fertile in her cycle. IVF is not provided by the public health services. However, there is no law preventing IVF but there is no legal framework regulating it either. A GP may refer couples to private specialists and clinics and, according to the HSE these services are generally available to applicatns who are in a ‘stable relationship’. IVF is not usually recommended for women who are over the age of 42, because


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ease of use3 • More than 95% of women rarely or never had a problem inserting or removing NuvaRing3

Actual NuvaRing user.

The unique delivery system of NuvaRing1,2,† may increase the chance of ring disconnection. Pregnancy and Lactation: Not recommended.Common Undesirable effects: Vaginal infection, depression, decreased libido, headache, migraine, abdominal pain, nausea, acne, pelvic pain, breast tenderness, genital pruritis, female dysmenorrhoea, vaginal discharge, weight increased, discomfort, device expulsion. See SPC for full details of other uncommon side effects. Overdose: No reports of serious effects from overdose. Legal Category: Prescription Medicine Product Authorisation Number: PA 61/29/1. Product Authorisation holder: Organon Ireland Limited, P.O. Box 2857, Drynam Road, Swords, Co. Dublin, Ireland. © Merck Sharp & Dohme Ireland (Human Health) Limited, 2013. All rights reserved. Date of review: July 2013 Further information is available on request from: MSD, Red Oak North, South County Business Park, Leopardstown, Dublin 18 or from www. medicines.ie. Date of Preparation: May 2014. † The only vaginal contraceptive ring in Ireland References: 1. Nuvaring Summary of Product Characteristics August 2010 2. MIMS Ireland, Dec 2011 3. Novák A, de la Loge C, Abetz L, van der Meulen EA. The combined contraceptive vaginal ring, NuvaRing: an international study of user acceptability. Contraception. 2003;67(3):187-194.

www.talkoptions.ie

Red Oak North, South County Business Park, Leopardstown, Dublin 18, Ireland

WOMN-1120830-0000

Nuvaring 0.120 mg/0.015mg per 24 hours vaginal delivery system® (See SPC before Prescribing) Etonogestrel and ethinylestradiol • Presentation: Vaginal ring. Uses: Contraception. Dosage and Administration: A ring should be inserted into the vagina and left in for 3 weeks. Strictly follow insertion instructions. Contraindications: Presence/history of venous thrombosis, with/without the involvement of pulmonary embolism. Presence/history of arterial thrombosis or prodromi of a thrombosis. Known predisposition for venous/arterial thrombosis, with/without hereditary involvement or the presence of severe/multiple risk factors. History of migraine with focal neurological symptoms. Diabetes mellitus with vascular involvement. Pancreatitis or history thereof if associated with severe hypertriglyceridemia. Presence/history of severe hepatic disease if liver function values abnormal. Presence/history of liver tumors. Known/suspected sex-hormone dependent tumors. Undiagnosed vaginal bleeding. Hypersensitivity to any ingredients. Precautions and Warnings: No epidemiology data available on vaginal administration but the warnings for combined OCs (COCs) are considered applicable. Risk of breast cancer possibly similar to that associated with COCs. This may be due to earlier diagnosis in COC users, the biological effects of the COC, or a combination of both.. Use of any combined hormonal contraceptive (CHC), including NuvaRing, carries an increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) compared with no use. The excess risk of VTE is highest during the first year a woman initially starts using a CHC or when she restarts CHC use after an interval of no use of at least one month. • Remove ring in event of a thrombosis and before long-term immobilisation. Council patients on symptoms of thrombosis. Increased risk of cervical cancer in long term COC users has been reported, but this may be confounded by other factors. Abnormal liver function or liver tumors. Increased risk of pancreatitis in women with hypertriglyceridemia taking hormonal contraceptives. Hypertension. Diabetes. Crohn’s disease/ulcerative colitis. Chloasma. Sickle cell disease. History during pregnancy/previous use of sex steroids: jaundice and/or pruritis related to cholestasis, gallstone formation, porphyria, SLE, HUS, Sydenham’s chorea, herpes gestationis, otosclerosis. Remove ring if there is increased frequency/severity of migraine. Increased risk of thromboembolism in the puerperium. May not be suitable for women with a prolapse or severe constipation. Consider incorrect positioning in case of cystitis. Occasional vaginitis. Very rarely it has been reported that the ring adhered to vaginal tissue, necessitating removal by a healthcare provider.If ring accidentally expelled follow SPC instructions. Interactions: Possible interactions with phenytoin, phenobarbital, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin, penicillins, tetracyclines, ciclosporin, lamotrigine and St John’s Wort. Use of antimycotic ovules


Women’s Health Feature MENOPAUSAL DEPRESSION Menopausal depression is a very common condition among women and there are several different potential causes. Medical professionals believe that hormonal complications may play a large role in the development of menopausal depression. Frustration with the condition could also be a cause. According to statistics, up to 15% of all women experience some degree of depression during the menopause. In most instances, the condition makes itself known during the perimenopause phase when the oestrogen and androgen levels in the body start to fluctuate and the serotonin levels in the brain start to drop.

the chances of a successful conception (5%) are thought to be too low to justify the treatment. ENDOMETRIOSIS Up to 50% of women, who are infertile suffer from endometriosis and the Endometriosis Society of Ireland estimates that the condition affects between 2%-10% of all Irish women. The condition is intrinsically linked to the menstrual cycle and for most women symptoms persist throughout their menstrual life. In a number of cases symptoms persist following the menopause. Endometriosis occurs when the endometrial tissue is not shed as normal during a menstrual cycle but, instead deposited outside the uterus and can be found elsewhere in the body, usually the pelvic area. The endometriosis deposits cause an inflammatory reaction, adhesion formation which can be very painful. This pain may occur during menstruation. Other symptoms can include painful bowel motions, urination and pain during or after sex. Cyclical rectal bleeding can occur as can cyclical haematuria (red blood cells in urine) or cyclical shoulder pain. Painkillers and anti-inflammatory drugs are usually prescribed for pain associated with endometriosis. Hormone therapies and surgery are used to treat endometriosis deposits and to help preserve or improve fertility. In some cases surgery, normally via laparoscopy is used to excise endometriosis

46

deposits and to eliminate endometriomas. In some cases a hysterectomy and removal of the ovaries is considered, usually when there are associated symptoms such as endometrial tissue growing in the uterine wall or heavy menstrual bleeding after a woman has completed her child bearing. A hysterectomy alone does not resolve the symptoms of endometriosis; all endometriosis deposits must be removed at the time of the hysterectomy in order for it to be eliminated. MENOPAUSE The menopause is the time when a woman's menstrual periods become infrequent and eventually stop altogether, due to a lack of oestrogen and progesterone being produced. The menopause is officially defined as having taken place when a woman has not menstruated for a year. The average age of the menopause is 51 but it can occur much earlier or later than that. During the menopause the following may be experienced: • Irregular periods. Periods can come more or less often; heavy or light, short or long. If a woman misses a few periods, it does not necessarily mean that she has started menopause; it may be because of another illness. • Hot flushes. Heavy sweating occurs anywhere on the body. Cold shivering can follow and can be very uncomfortable all round. • Trouble sleeping. Night sweats are particularly uncomfortable

• Vaginal and urinary problems. These problems may start or increase around the menopause when the walls of the vagina may become drier and thinner because of the lower levels of oestrogen. Additionally, sex may become less comfortable with lower oestrogen levels. Women may become more susceptible to vaginal infections or urinary tract infections during the menopause and others may find it hard to hold their urine long enough to get to the bathroom in good time, although this is a normal occurrence in older women who have had children and is generally known as urinary stress incontinence. There are many OTC products available to help women who suffer from this complaint. Exercises may help to overcome this. • Mood changes. Mood changes at this time are often experienced and many suffer from a general feeling of tiredness. Mood swings are not the same as depression. Women who suffer from mood swings or changes during their monthly period may be more susceptible to mood changes during the menopause. • Changing feelings regarding sex. Some women feel less aroused, while others feel more comfortable with their sexuality after the menopause. Some women may be less interested in sex because it can be more physically uncomfortable, due to feminine dryness.

Patients suffering from menopausal depression should be referred to their doctor for treatment with antidepressants, hormone therapy or psychotherapy. POSTMENOPAUSAL OSTEOPOROSIS Osteoporosis is a disease categorised by a person with low bone mass and loss of bone tissue leading to weak and fragile bones. It can affect both sexes but women over 50 are at the greatest risk. The effect of osteoporosis is a risk of fractured/broken bones, particularly affecting the hips, spines and wrists. Providing patients with information on osteoporosis and the importance of their daily calcium intake requirements is an extremely important role for pharmacists. Postmenopausal osteoporosis is the most common form of osteoporosis, affecting many women. Bone loss increases after the menopause, sometimes as much as 20%. Osteoporosis is often seen as the silent disease because there are few visible symptoms. Often it is only discovered when a patient suffers a severe fracture or break. Patients who have been taking steroids for a long period are also at risk of developing the disease. Hormone therapy can help to alleviate the risk of bone loss for post menopausal women, especially those who experienced an early menopause or who are at high risk due to a family history of osteoporosis.


S

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For Long Lasting Bones

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ABBREVIATED PRESCRIBING INFORMATION (Please refer to Summary of Product Characteristics before prescribing)

Worldâ&#x20AC;&#x2122;s No.1 Calcium Supplement

CALTRATE* 600 mg/400 IU, film-coated tablet

3

Presentation: Each tablet contains 600 mg of calcium (as calcium carbonate) & 10 micrograms of cholecalciferol (equal to 400 IU vitamin D3). Contains sucrose & partially hydrogenated soya bean oil. Indications: Correction of combined vitamin D & calcium deficiencies in the elderly. As an adjunct to specific treatments for osteoporosis, in patients where combined vitamin D & calcium deficiencies have been diagnosed or those at high risk of deficiency. Dosage & Administration: Adults & Elderly: One tablet twice a day (morning/evening). Pregnant women: One tablet a day. Oral (Swallow with 200mls water). The elderly or patients with known difficulties in swallowing, may break the tablet into two parts before taking with water. Do not suck or chew. Contraindications: Hypersensitivity to any ingredients including peanut or soya. Patients who now have, or have had renal failure, kidney stones, hypervitaminosis D, hypercalciuria & hypercalcaemia & diseases &/or conditions that lead to hypercalcaemia &/or hypercalciuria. Precautions: In prolonged treatment, check calcaemia & renal function, particularly in the elderly (see interactions). If renal function deteriorates, the dose must be reduced or treatment interrupted. Caution is advised in immobile patients. This product contains vitamin D; further administration of vitamin D or calcium must be medically supervised with regular monitoring of calcaemia & calciuria. Patients with sarcoidosis calcaemia & calciuria must be monitored. Risk of soft tissue calcification must be considered. In severe renal insufficiency, vitamin D3 as cholecalciferol is not metabolised normally & other forms of vitamin D3 must be used. Cases of asphyxiation due to tablet choking have been reported. This product contains sucrose; patients with sugar intolerance should not take this medicine. Not intended for use in children & adolescents. Interactions: Thiazide diuretics & systemic corticosteroids (calcium monitoring required). Orlistat, combined ion-exchange resins (cholestyramine) or laxatives (paraffin oil) can reduce the GI absorption of vitamin D3. Take tetracycline 2 hours before or 4 to 6 hours after taking calcium. Cardiac glycosides (monitor patients regularly with ECG check & calcaemia). Phenytoin or barbiturates (may reduce the activity of vitamin D3). Iron, zinc or strontium preparations, estramustin or thyroid hormones should be spaced at least 2 hours from calcium medicines. Bisphosphonate, sodium fluoride or fluoroquinolone administration, (Caltrate Vitamin D3 should be spaced by at least 3 hours from these medicines). Oxalic acid (found in spinach & rhubarb) & phytic acid (found in wholegrain cereals) can inhibit calcium absorption by forming insoluble compounds with calcium ions. Patients must not take calcium containing-products in the two hours after consumption of foods rich in oxalic acid & phytic acid. Pregnancy & lactation: Caltrate may be used during pregnancy & breastfeeding. Daily intake in pregnancy should not exceed 1500mg calcium & 600IU cholecalciferol. Avoid prolonged use as hypercalcaemia can affect the developing foetus. Calcium & vitamin D3 pass into breast milk; should be considered when vitamin D3 is given concomitantly to infants. Side-effects: Hypercalcaemia, hypercalciuria, constipation, flatulence, nausea, abdominal pain, diarrhoea, pruritis, rash, nephrolithiasis & urticaria. Legal Category: P. Pack Size: 90 tablets. PAH: Pfizer Healthcare Ireland, Citywest, Dublin 24, Ireland. PA number: PA822/173/1. Further information is available upon request from Pfizer Consumer Healthcare, Citywest, Dublin 24 or look up, www.medicines.ie. Date of preparation: February 2013. Reference: 1 Prentice A., Diet, nutrition and the prevention of osteoporosis, 2004, Public Health Nutrition, Vol 7, issue 1a, February 2004, 227-243, http://dx.doi.org/10.1079/PHN2003590 (About DOI), Published online: 02 January 2007. Reference: 2 Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academics Press, 2011. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Reference: 3 Based on sales (data on file). Artwork version: April 2014. Ref: MAT-335. * Trade Mark.


NEW

COOLING GEL and SPRAY GEL A revolutionary new approach to cooling and soothing skin NE

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What Itcheze is used for:

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prickly heat

superficially reddened skin

insect bites & stings

dry itchy skin

Cutting edge technology ● Contains OsmoCare, a unique

technology

● Works through osmosis to draw water from the inner layers of the skin in order to re-hydrate the surface layers

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conditions such as:

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● To cool and soothe the uncomfortable itch caused by skin M AY FOR

A

ItchEze on surface of skin

Skin

● Generates a cooling effect that soothes the skin and can help reduce itching

Osmosis draws water to the surface layers

Water

and discomfort

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Bites and Stings Feature

The Sting of Summer With the advent of summer and the warmer weather comes the onslaught of patients seeking advice on the treatment of insect bites, stings and other summer related illness. Most minor insect-related reactions can be treated with over the counter (OTC) products. However, it is the pharmacist's responsibility to be able to distinguish between minor reactions that can be treated with self-care products and the more serious conditions that are generally caused by insect bites or stings. Over half a million people experience insect bites or stings every year in Ireland. Stinging insects that are common in Ireland include wasps, bees and hornets. The sting is due to venom, which the insect ‘injects’ into the skin. Other biting insects, common to Ireland include midges, gnats, flies, fleas, mites, ticks, ants and bedbugs. Insect bites are less painful than stings and often the first sign of a bite is a swollen localised area on the skin. Saliva from the insect causes irritation and the swelling can last up to a couple of days before it will fade away. A bite is a deliberate attack by an insect, generally in order to feed. After the initial bite, saliva is injected into the wound to allow the blood to flow, thus allowing the insect to feed. It is the saliva, which causes the bite to become red and swollen and, subsequently to itch. Stings are the result of an insect feeling threatened and needing to protect itself. Other than the initial pain of the attack, a sting can cause varying degrees of allergic reaction. When stung, the victim will feel an immediate, intense, burning pain. The area around the sting will swell, redden almost straight away and, later, may blister and produce an itchy rash. In general, this rash will usually ease after a few hours. Most stings do not require special treatment. Patients should be advised to wash the site of the sting and apply an antiseptic cream. If itching persists, an application of calamine lotion or an antihistamine

cream may help or other mild anaesthetics or steroids may be used to help alleviate pain and itching. . An antihistamine tablet may also be taken if the reaction is severe. Ordinary pain killers, such as paracetamol may also be taken. Patients should be advised to avoid scratching a bite or a sting because this will only make the itch/pain worse, and may cause an infection. Some patients may be allergic to bee stings and suffer more serious reactions than the normal red and swollen welt on their skin. Symptoms will range from mild to severe, with most severe allergic reactions to bee stings developing within minutes of the sting. In some cases, serious reactions around the bee sting area may take hours, or even a few days to develop. Even if a person has only had a minor reaction to bee stings in the past, it is possible that they may develop a more serious allergic reaction the next time around. Patients who are allergic to bee stings will have a large area of swelling at the site of the sting and an itchy rash will start to spread all over the body. The patient may also experience anaphylaxis - a full-blown allergy attack that can be life-threatening. If a patient has symptoms of anaphylaxis following a bee sting, emergency treatment must be sought for the patient immediately.

they are allergic to bee stings should carry adrenaline. New moves are under way to try to loosen the restrictions on the use of life-saving adrenaline injections for people in danger of dying from severe, allergic reactions. Health Minister James Reilly confirmed that he was looking at ways of making these adrenaline injections more readily available for use by trained volunteers – known as first responders – in schools and workplaces. In response to a parliamentary question on the topic, Reilly said, “My department is considering a review of the Medicinal Products (Prescription and Control of Supply) Regulations 2003. This is in light of a request to pilot a study regarding the administration of adrenaline in the treatment of anaphylaxis by trained anaphylaxis first responders. "My department is currently examining the legal basis upon which adrenaline can be administered to a patient where the adrenaline has not been prescribed for the patient by a medical practitioner or other prescriber." Under the emergency supply

provisions of Regulation 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003 permit pharmacists, in emergency circumstances, to supply certain Prescription Only Medicines without a prescription. Emergency supply can be carried out at the request of a patient or at the request of a prescriber. When supplying a medicine under these provisions, the pharmacist must be satisfied that there is an immediate need for the medicine to be supplied and that it is impracticable to obtain a prescription without undue delay. Emergency supply does not include controlled drugs. Apparently, the Pharmaceutical Society of Ireland is yet to establish if adrenaline is seen to be a controlled drug and therefore cannot be administered without a prescription. A Pharmacist Independent Prescriber scheme was introduced into the UK in 2006. Other complications from stings include an infection at the site of the sting - this is usually caused by scratching the site, allowing bacteria to infect it. If this infection has spread to other parts of the body, the patient can either try

Symptoms of anaphylaxis are: • tightness of the chest • shortness of breath • a light head – possibly loss of consciousness • diarrhea or vomiting • weak and rapid pulse As a precaution people who know

49


Feature Other environmental factors play their part in causing patients to develop an increased sensitivity, such as being exposed to animal fur or cigarette smoke. Symptoms Symptoms of seasonal allergic rhinitis include: • Sneezing • Itchy, blocked or runny nose • Red, itchy or watery eyes • Itchy throat, inner ear or mouth • Headaches • Loss of concentration • Sleep disturbance

treating it with an antiseptic cream or gel or they should consult their doctor. Avoiding insect bites and stings The following advice should be given to patients in order to avoid insect bites and stings. • Prevention is better than cure use a repellent • Choose an insect repellent carefully and reapply according to instructions • Avoid strong repellents when pregnant • If outside in the evenings, cover as much of the body as possible with clothing • Spray insect repellent on skin under light clothing • Refrain from scratching itchy bites Some people suggest eating garlic or taking vitamin B1 to repel insects, however there is no evidence to support either of these claims. Prickly Heat or Miliaria Prickly heat is an itchy, red rash that often causes a stinging or prickling sensation on the skin. It usually occurs when a person sweats more than usual, for

50

example in a hot or humid climate. People often experience it when abroad on holidays but it can occur during the winter months as well. The rash can develop anywhere on the body but it most commonly occurs on the neck, back and chest. The rash is made up of tiny bumps or spots, the spots sometimes looking like tiny blisters. They can cause mild swelling and a stinging or an intense prickling sensation, particularly when scratched. Patients who are overweight or sweat easily are more likely to suffer from prickly heat. Prickly heat is not a serious condition but it can be very uncomfortable. Most prickly heat rashes will heal within a few days. Patients can be advised to take an antihistamine if the rash is very uncomfortable, to try to stay cool with cold compresses and/or to wear loose clothes. Pharmacists should advise new mothers that newborns are more likely to have heat rash when the temperatures rise because they have immature sweat ducts. Patients, who are on certain medications are also more susceptible to heat rashes, such as bethanechol, clonidine, the acne medication isotretinoin, and chemotherapy drugs

Allergic Rhinitis Seasonal allergic rhinitis is an allergic response to pollen or other microscopic substances that are present only at certain times of the year. Once a person has developed a sensitivity to an allergen, whenever particles of that specific allergen come into contact with the inside of the sufferer’s nose and throat, immunoglobulin E (IgE) or antibodies are released. These cause blood cells to release chemicals, such as histamine, which result in allergic rhinitis. Histamine causes the mucus membrane to swell and produce excess mucus which, in turn blocks the airways, resulting in congestion, runny noses and sneezing. Although the symptoms are not usually harmful, they can be irritating and affect the patient’s quality of life. Identifying the allergen that causes the patient’s rhinitis and, if possible, avoiding it altogether is an important first step in managing the condition effectively. Causes There are over 30 types of pollen and 20 types of spores that are known to trigger seasonal allergic rhinitis. Grass pollen and tree pollen are the most common of the pollens.

If the symptoms of allergic rhinitis are mild, over the counter (OTC) medications, such as antihistamines and decongestants can ease the patient’s discomfort. Rinsing the nasal passages regularly with salt water to keep the nose free of irritants may also help but patients with more severe symptoms should be referred to their doctor. Medications may ease symptoms but will not cure them. Antihistamines will help allergic rhinitis by blocking the action of the chemical histamine, which the body releases naturally when it comes under attack from an allergen. Newer antihistamines do not have the side effect of drowsiness, whilst the older types, such as chlorpheniramine may still produce this side effect. Pharmacists should advise patients not to take the older-type of anti-histamines if they are going to drive, operate machinery or take an exam of any kind. Corticosteroids If symptoms are frequent or persistent or there are nasal blockages or nasal polyps, GPs may recommend the use of a nasal spray or drops containing corticosteroids. Corticosteroids help to reduce inflammation. Although they take longer to work than antihistamines, their effects last longer. Side effects from inhaled corticosteroids are rare but can include nasal dryness, irritation and nosebleeds. Nasal decongestants can help to relieve a blocked nose but should not be used for more than five to seven days. Using them for longer can actually worsen the congestion..


atovaquone/proguanil

Now you can prescribe Malarone® tablets for > 28 days in an endemic P. falciparum malaria area1 In residents (semi-immune subjects) of endemic areas, the safety and effectiveness of Malarone has been established in studies of up to 12 weeks. In non-immune subjects, the average duration of exposure in clinical studies was 27 days. Abridged Prescribing Information (please see SPC for full prescribing information). Trade name: Malarone 250 mg/100 mg film-coated tablets. Composition: Each tablet contains 250 mg atovaquone and 100 mg proguanil hydrochloride. Therapeutic indications: Prophylaxis (adults) of Plasmodium falciparum malaria. Treatment (adults and children) of acute, uncomplicated Plasmodium falciparum malaria. Posology: Prophylaxis: One tablet daily. Prophylaxis should commence 24 or 48 hours prior to entering a malaria-endemic area, continue during the period of the stay and for 7 days after leaving the area. In residents (semi-immune subjects) of endemic areas, the safety and effectiveness has been established in studies of up to 12 weeks. In nonimmune subjects, the average duration of exposure in clinical studies was 27 days. Treatment: Dosage (Adults): Four tablets as a single dose for three consecutive days. Dosage (Children): 11-20kg bodyweight - one tablet daily for three consecutive days; 21-30kg bodyweight - two tablets as a single dose for three consecutive days; 31-40kg bodyweight - three tablets as a single dose for three consecutive days; > 40kg bodyweight - dose as for adults. Dosage (Elderly): No dose adjustments needed. Dosage (Hepatic Impairment): No dose adjustments needed. Dosage (Renal Impairment): Mild to moderate; no dose adjustments needed. Severe (creatinine clearance < 30mL/min); alternatives should be recommended. Administration: The daily dose should be taken with food or a milky drink at the same time each day. In the event of vomiting within 1 hour of dosing a repeat dose should be taken. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Prophylaxis of P. falciparum malaria in patients with severe renal impairment (creatinine clearance < 30mL/min). Precautions and warnings: Safety and effectiveness has not been established for prophylaxis of malaria in patients less than 40kg and for treatment of malaria in paediatric patients who weigh less than 11kg. Discontinue promptly and initiate appropriate treatment if patients experience severe allergic reactions. No efficacy against hypnozoites of Plasmodium vivax. Interactions: Caution advised when initiating or withdrawing Malarone in patients on continuous treatment with warfarin and other coumarin based anticoagulants as proguanil may potentiate their anticoagulant effect. Concomitant administration with efavirenz or boosted protease-inhibitors should be avoided whenever possible. Concomitant treatment with metoclopramide and tetracycline

have been associated with significant decreases in plasma concentrations of atovaquone. Concomitant administration of rifampicin or rifabutin is not recommended as it is known to reduce atovaquone levels by approximately 50% and 34%, respectively. Caution advised in patients receiving concomitant therapy with etoposide. Fertility, pregnancy and lactation: Use in pregnancy should only be considered if the expected benefit to the mother outweighs any potential risk to the foetus. Folate supplements should be continued while taking Malarone. Should not be taken by breast-feeding women. Effects on ability to drive and use machines: Patients experiencing dizziness after taking Malarone should not drive, operate machinery or take part in activities where this may put themselves or others at risk. Undesirable effects: Very common (≥1/10): Headache, nausea, vomiting, diarrhoea, abdominal pain. Common (≥1/100 to <1/10): Anaemia, neutropenia, allergic reactions: hyponatraemia, anorexia, abnormal dreams, depression, insomnia, dizziness, elevated liver enzymes, pruritus, rash, fever, cough. For less frequent undesirable effects, please see SPC. Legal category: POM Marketing Authorisation Number: PA 1077/111/1. Further information is available from the Marketing Authorisation Holder: GlaxoSmithKline (Ireland) Limited, Stonemasons Way, Rathfarnham, Dublin 16, Tel: 01 495 5000, Fax: 01 495 5225 Job number: IE/ APH/0002/12 Date of preparation: September 2012

Adverse events should be reported. Reporting forms and information can be found at: www.medicines.ie/yellowcardreporting.aspx. Adverse events should also be reported to GlaxoSmithKline on 1800-244-255 or mail ireland.drugsurveillance@gsk.com Reference: 1. Malarone Summary of Product Characteristics, September 2012 Date of Prepetration: May 2013 IE/APH/0002/13


Report

Medicines Reconcilliation for Depressives  

BACKGROUND

metabolic disease.

Although a clear distinction is often made between the ‘mind’ and the ‘body’, physical health and mental health are inextricably linked.

Furthermore, rates of depression are double in those with diabetes, hypertension, coronary artery disease and heart failure, and triple in those with endstage renal failure, chronic obstructive pulmonary disease and cerebrovascular disease. In addition, depression is also a predictive factor in the development of many other future physical illnesses.

People with diagnoses of severe and enduring mental illnesses are at increased risk of a range of physical illnesses, including heart disease, diabetes, infections, respiratory disease and greater levels of obesity and are four times as likely to die as those who do not suffer from such illnesses. Given that those with mental ill health are more likely than the general population to cross healthcare boundaries, medicines' reconciliation for this population can prove complex. IMPACT OF MENTAL HEALTH ON PHYSICAL HEALTH While good mental health is known to be a protective factor against physical illness, the contrary is true i.e. poor physical health increases the risk of developing mental health problems. People with depression are twice as likely to smoke and those with schizophrenia are three times as likely to smoke as the general population yet they are less likely to be offered helpt to quit – or to reduce their alcohol consumption or to make positive dietary adjustments. While different mental illnesses carry different risks for specific illnesses, it is clear that physical health problems amongst those with mental ill health have a negative impact on the morbidity and mortality of this vulnerable group. DEPRESSION AND PHYSICAL HEALTH Depression is associated with a 67% increased risk of death from heart disease, a 50% increased risk of death from cancer, a 200% increased risk of death from respiratory disease and a 300% increased risk of death from

52

SCHIZOPHRENIA, BIPOLAR DISORDER AND PHYSICAL HEALTH It is a little known fact that people with schizophrenia and bipolar disorder die on average 25 years earlier than the general population, largely because of physical health problems. Given that the average life expectancy in Ireland is approximately 80 years, it is unacceptable that the lives of those with these illnesses will be cut short at the age of around 55 years of age as a result of poor physical healthcare. Schizophrenia is associated with double the risk of death from heart disease, three times the risk of death from respiratory disease and four times the risk of death from infectious disease. MEDICINES' RECONCILIATION FOR THOSE WITH MENTAL ILLNESS Considering this data on the level of physical comorbidity in those with mental ill health and their increased risk of death, it is likely that this group will be subject to more complex medicines' regimes, incorporating both physical and mental health medicines. As medicines’ reconciliation on transfer between care settings is an important intervention in the detection and prevention of medication errors, it is especially vital for those patients who are prescribed both physical and mental health medicines. However, medicines' reconciliation in this group is complicated by the fact

Holistic  approach  to  medicines  reconciliation     The  most  appropriate  way  to  avoid  medication  errors  in  those  with  m on  transfer  between  care  settings  is  to  adopt  a  holistic  approach  to  t reconciliation.  Every  effort  should  be  made  to  clarify  if  those  on  men medicines  are  also  taking  physical  health  medicines.  Prescriptions  of Writtenalone   by: Caroline PG Dip PsychAlthough  GPs  m medicines   should  be  qHynes uestioned   and   clarified.   MPSI MCMHP, Senior Pharmacist, of  Pharm both  physical   and   mental  health   medicines,   community  pharmacis Saint ofthe   God Hospital placed   to  John support   medicines   reconciliation  process  for  this  group community  pharmacist  is  at  the  centre  of  the  supply  of  each  patient’ medicines.  As  a  result,  they  have  the  most  in  depth  insight  into  the  r medicines  that  an  individual  with  multiple  comorbidities  is  taking  and communicate  this  to  hospital  pharmacists  carrying  out  medicines  rec cardiologist last week where that different specialists usually   prescribe both physical health Case   study  and –  Patient  his A   cardiac medicines’ regime was adjusted. He has not yet mental health medicines and their   beenmtoale   see hisrecurrent   GP withdhis new type  II  diab GPs may not alwaysPatient   have the A  is  most a  58  year-­‐old   with   epression,   prescription a supply up-to-date record ofhypertension.   their current He  was   admitted  to  but a  mobtained ental  healthcare   facility  follow of hisThe   new medicines fromis  his medicines. As a result, a person his  for recurrent   depression.   patient’s   diabetes   managed  by  his  G with an enduring mental illness is  managed   community pharmacy just priorPatient  A  atte hypertension   by  a  consultant   cardiologist.   transferred to/from aconsultant   healthcare to admission. The hpatient is medicines  regime cardiologist   last  week  where   is  cardiac   facility, extra efforts should out-patient He  has  nbe ot  yet  been  admitted to  see  his  following GP  with  his  an new   prescription,  but  obta made to ensure that his   both physical appointment with phis consultant new   medicines  from   his  community   harmacy   just  prior  to  admis and mental health medicines His last admission to with  his  co patient  is  aare dmitted  fpsychiatrist. ollowing  an  out-­‐patient   appointment   prescribed. facilityto  was ago psychiatrist.  His  last  this admission   this  three facility  months was  three   months  ago  w he was taking the following taking  the  following  when medicines:   HOLISTIC APPROACH TO medicines:   MEDICINES RECONCILIATION     Rx   The most appropriate way to   Valsartan  80mg  PO  Mane   avoid medication errors in those   Metformin  500mg  PO  TDS   with mental ill health on transfer   Gliclazide  MR  60mg  PO  Mane   between care settings is to   Sertraline  150mg  PO  Mane   adopt an holistic approach to   Quetiapine  XR  300mg  PO  Nocte   their medicines’ reconciliation.     Every effort should be made to   clarify if those on mental health On  admission  to  the  mental  healthcare  facility  in  the  evening,  the  cli medicines are also taking physical On admission to the mental prescribes  the  medicines  listed  in  the  patient’s  previous  discharge  su health medicines. Prescriptions healthcare facility, the clinicianAlthough  the  patient  mentions  that  his  medicines  have  been  change of mental health medicines on-call prescribes the medicines of  the  changes.     alone should be questioned and listed in the patient’s previous   clarified. Although GPs may discharge summary. And, although     have a record of both physical the patient mentions that his and mental health medicines, medicines have been changed, he community pharmacists are best is unsure of the changes. placed to support the medicines’ On receiving the medication reconciliation process for this chart in the pharmacy the group. The community pharmacist following morning, the mental is at the centre of the supply of health pharmacist, with the each patient’s full list of medicines. patient’s permission, telephones As a result, they have   the most his community pharmacist. The in depth insight into  the range of community pharmacist provides medicines that an individual with details of the inew cardiacthe  following  mornin multiple comorbidities taking the  medication   On  isreceiving   chart   n  pharmacy   prescribed and the and can communicate thispto health   harmacist,  wmedicines ith  the  patient’s   permission,   phones  his  commu treatingpteam are informed hospital pharmacistsThe   carrying out pharmacist   community   rovides   details   of  the  new  cardiac  medi accordingly. The new prescription medicines’ reconciliation. and  the  treating  team   are  informed   accordingly.   The  new  prescriptio is as follows:   EXAMPLE OF A PRESCRIPTION   OF MENTAL AND PHYSICAL   Rx   HEALTH MEDICINES   Valsartan  160mg  PO  Mane     Amlodipine  5mg  PO  Mane   Patient A is a 58 year-old male   Metformin  500mg  PO  TDS   with recurrent depression, type II   Gliclazide  MR  60mg  PO  Mane   diabetes and hypertension. He was   Sertraline  150mg  PO  Mane   admitted to a mental healthcare   Quetiapine  XR  300mg  PO  Nocte   facility following relapse of his   recurrent depression.   The patient has diabetes, which  is managed   CONCLUSION by his GP and his hypertension Conclusion   is managed by a consultant   Unfortunately, mental health and cardiologist. Unfortunately,  mental   health  ahealth nd  physical   health   ontinue  to  be  see physical continue tocbe two   separate  entities,   despite   an  established   link  between  the  two.  P seen by many as two separate Patient A attended his consultant diagnoses  of  severe  and  enduring  mental  illnesses  are  at  increased  r physical  illnesses  and  have  a  higher  mortality  rate  than  those  in  the  g population.  This  gives  rise  to  more  complex  medicines  regimes,  often different  specialists,  complicating  the  medicines  reconciliation  proce


entities, despite an established link between the two. People with diagnoses of severe and enduring mental illnesses are at increased risk for a range of physical illnesses and have a higher mortality rate than those in the general population. This gives

 

Facts  and  Figures  

rise to more complex medicines regimes, often prescribed by different specialists, complicating the medicines' reconciliation process for this population. As a result of this, special care should be employed when carrying out medicines’ reconciliation in those

with an enduring mental illness. An holistic approach to medicines' reconciliation, integrating both mental and physical health medicines is required, which often involves a collaborative effort on the part of the community and hospital pharmacist. This

collaboration is clearly necessary and demonstrates a step in the right direction in the effort to break down the barrier between these two areas that are so inextricably linked.

 

FACTS AND FIGURES

Every  year,  at  least  one  person  in  six  experiences   a  mental  health  problem   Depression  and  anxiety  are  the  most  common,  affec5ng  about  half  of  the  adult   popula5on  at  some  point  in  their  lives.  

Half  of  all  life5me  mental  health  problems  emerge  before  the  age  of   14   Early  detec5on  and  treatment  of  mental  ill  health  can  drama5cally  reduce  the   dura5on,  severity  and  loss  of  quality  life  associated  with  mental  ill  health  

People  with  a  severe  mental  illness  die  up  to  25  years  younger  than   their  peers   This  is  predominantly  due  to  higher  rates  of  poor  physical  health,  for  example   related  to  smoking  

Thirty  per  cent  of  people  with  a  long-­‐term  physical  condi5on  also   have  a  mental  health  problem   This  increases  the  cost  of  health  care  for  each  person  by  45%  

More  than  one  quarter  of  general  hospital  pa5ents  have  a  mental   disorder   Concomitant  prescribing  of  mental  and  physical  health  medicines  is  therefore  not   restricted  to  mental  healthcare  facili5es  alone     53


First Aid Feature

Wound Care in the pharmacy Patients will regularly present to the pharmacy to treat minor wounds rather than attending a GP clinic. Most wounds can be treated cheaply and effectively with over the counter products. Wound care management in the pharmacy could potentially be a service that pharmacists offer in the consultation room. This is a practice that other jurisdictions offer such as Australia and US and has been successful. In these situations it is utilising the skills of community pharmacists to provide enhanced first aid and wound management services and freeing up other highly skilled health professionals to perform health interventions requiring specialised skills. The Pharmacy Guild of Australia report that the introduction of this service gives greater recognition of the role of community pharmacists as a member of the primary health care team and allows community pharmacy the opportunity to develop a viable business involving service provision as an adjunct to product supply. The Irish Pharmacy Union (IPU) have asked for a greater expansion of pharmacy services as part of the HSE Health Ireland initiative. • Burns that are more severe than minor second degree. • Gaping wounds that may require stitches. • Wounds that have exposed fatty tissue, white tissue, or muscle. • Wounds with visible foreign material (dirt, plant material, glass, metal, or gravel). • Bleeding wounds • Wounds causing severe pain or resulting in a numb feeling or inability to move structures below the wound (such as the knee or elbow).

Wound care is valued at ¤4.3 million in Ireland. Many pharmacy counter assistants and pharmacists are trained in first aid and are familiar with the appropriate equipment and advise for certain ailments and this can encourage loyal and repeat customers. Skin Wounds are a common health concern, which can vary from abrasions, lacerations, rupture injuries, punctures, to penetrating wounds. Treating pressure sores in bedridden or elderly patients is a large part of wound care. Addressing wounds appropriately and timely with dressings and wound closures will minimise cosmetic scaring and infection while making the patient more comfortable. When offering patients advice on wound care it is essential to ask the patient about their lifestyle and general health so the dressing and healing process is appropriate for the patient. The pharmacist should ask the patient about the duration of the wound, if a patient who has

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had a wound for longer than one week should be referred to their doctor. A wound is a physical injury to the body consisting of a laceration or breaking of the skin or mucous membrane, or an opening made in the skin because of a surgical operation or procedure. Wounds may be acute or chronic trauma resulting from an injury where the injury does not heal. Acute wounds may be a planned or unplanned event. Examples of acute wounds include a cut, graze or burn. Examples of chronic wounds include leg ulcers, pressure wounds and diabetic wounds. COMMON TYPES OF WOUNDS There are three different classes of wounds; superficial, partial thickness and full thickness. Healing, dressing and bandages and medications. Wounds that should be referred to a gp or doctor are; • Puncture wounds or animal bites.

• New wounds in patients with diabetes or bleeding problems. • Chronic wounds that do not heal or appear to be infected. FIRST AID A member of staff, who is competent in first aid can mean the difference between life and death in an emergency situation. It is always advantageous to employ at least one member of staff, who has been formally trained in first aid and it is also advantageous to have items on hand in the pharmacy that may be able to help in emergencies. HEART ATTACK A heart attack or myocardial infarction is a serious medical emergency where the blood supply to the heart is blocked. Coronary heart disease (CHD) is the leading cause of a heart attack. CHD is when the coronary arteries are clogged with cholesterol. It is particularly important to act quickly when a person is having a heart attack because the longer the delay in treatment, the worse the outlook for the patient tends to be.

STROKE A stroke is caused by a part of the brain being starved of oxygen. This occurs when a blood vessel, which carries oxygen and nutrients to the brain bursts or is blocked by a clot. This results in an interruption of the blood supply to part of the brain. There are two kinds of stroke, ischemic, where the blood supply is blocked by a blood clot and haemorrhagic, where a blood vessel to the brain bursts and causes brain damage. A stroke will destroy two million brain cells every minute so time is of the essence. The faster a sufferer receives treatment, the less damage the stroke will have on their health. The FAST acronym is a recommended guide for dealing with stroke victims: FAST stands for Face, Arms, Speech and Time. The Face contorts on one side, the patient can’t raise their arms and their speech becomes slurred. If a patient fails the FAST test it is time to call for an ambulance. ASTHMA ATTACK During an asthma exacerbation or attack, the patient’s airways become inflamed and swollen because the muscles around the airways have contracted and the bronchial tubes have narrowed. A severe attack of asthma can be life threatening. Asthma triggers can vary, depending on the sufferer. Pollen, pets, tobacco smoke, exercise or respiratory infections can all trigger an attack. In some instance an asthma attack can occur for no reason at all but whatever the reason for the attack, it is important to ease the patient's breathing.


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55


Commercial Profile

Benchmark your business for success IMS Health is the world’s leading information, services and technology company dedicated to making healthcare perform better.

By applying cutting-edge analytics and proprietary application suites the company connects complex healthcare data on diseases, treatments, costs and outcomes to enable their clients to run their operations more efficiently.

medicines such as in oncology. This change will affect both retail and hospital pharmacy businesses and pharmacists will need to change their business models to keep up to date with the changing market,” Egan said.

Globally their customers include pharmaceutical, medical device, consumer health manufacturers, distributors, providers, payers, government agencies, policymakers, researchers and the financial community. However, in Ireland their customers are pharmacy, pharmaceutical and biotech companies and wholesalers who receive product reports that allow them to track products and their market performance on a regional and national basis. The company has recently made a move to analysing data and providing benchmarking services to Irish retail pharmacies that enables a pharmacist to operate their pharmacy in the most efficient manner possible.

At present, IMS Health capture data from 100,000 suppliers internationally, collecting more than 45 billion healthcare transactions annually to offer insights for over 5,000 healthcare clients globally. This includes the collection of sales data from more than 30,000 pharmacies across Europe.

Fergal Egan, Commercial Director, IMS Health Ireland, explained to Irish Pharmacy News the trends that IMS Health have observed since establishing in Ireland in 1998. “There have been huge changes in the pharmacy sector in Ireland and in the pharmaceutical sector globally. Locally, the most notable change is the overall decline in the pharmaceutical market in value terms. This has had a massive impact on pharmaceutical companies, but also on retail pharmacy. A significant reduction in the price of medications over the last few years, coupled with the genericization of the market in Ireland, has led to a different pharmacy market. Looking to the future pipeline of medicines in development, we see a shift away from small molecule medicines for mass markets such as statins and a move towards niche, specialist

56

In Ireland, IMS Health has started to work in partnership with pharmacies to offer analytics and benchmarking services on the performance of their pharmacy. The feedback services that are immediately available are based on the purchase or sell in data for each store and compare the performance of each pharmacy to the average regional and national performance. However, this feedback will evolve to sell out data analytics and reports based sales transactions once a threshold of pharmacies included in their panel has been reached. The service is provided free of charge in exchange for each pharmacy sharing their sales data. Alternatively IMS Health are offering a payment to pharmacies for sharing their data instead of receiving the feedback services. Egan said, “A pharmacy can benchmark business growth or decline for each medicine and therapeutic area to discover their market share for individual products and identify the potential for growth or where there is a decline in sales.” He continued, “The trends we (IMS Health) are seeing is that the prescription and OTC markets are in decline at present in volume and value terms, where

"Pharmacists will need to change their business models to keep up to date with the changing market" the impact on medicine costs is being significantly affected due to reference pricing. This has put extra financial pressures on pharmacies that are already under strain because of several government cuts. In order for the pharmacies to run a more successful business and act strategically, the business manager needs to understand these trends for their store and that is what IMS Health are enabling pharmacists to do in Ireland.” IMS Health data for the market over the last year for public and private patients shows: • Total Pharmaceutical Market (Retail and Hospital): Value ¤2.2bn and declining by -2.8% in value and -0.7% in volume • Total Pharmaceutical Market for Retail Pharmacy Only: ¤1.75bn and declining by -4.7% in value and -1.2% in volume • Prescription Medicines Market (Retail Pharmacy): Declining by -5.0% in value and -0.5% in volume • OTC Market (Retail Pharmacy): Declining by -3.8% in Value and -2.3% in Volume Egan said, “The continued impact of reference pricing of medications and the loss of patents for some key medicines, leading to price reductions, will mean that this trend of market decline will continue in Ireland for the next two years according to our forecasts.” He further added that, “IMS Health’s experience tracking the pharmaceutical market internationally over the last

60 years allows it to be able to apply market trends and factors affecting the market to predict these forecasts”. Regarding the pricing of medicines Egan noted that, “it is important to look into the detail of prices in Ireland when comparing them to other countries. For patented prescription medicines, Ireland has an average price of the other 9 European reference countries, as is agreed between the industry and the HSE. For medicines that are no longer patent protected, it has been well recognised in the media that there are price differentials in Ireland across Europe, but this is being addressed through the reference pricing legislation introduced in 2013”. In relation to the new benchmarking services, the pharmacists who agree to share their sell-out data will receive an analysis of the market as a whole by product, therapeutic area and for key molecules. They have developed two reporting tools, one tailored to pharmacy chains and the other specifically designed for independent pharmacies to reflect the different dynamics in these two pharmacy structures. IMS Health are insistent that, as in all countries where they are partnering with pharmacies, the data of each individual pharmacy is kept confidential and benchmarking will only be done against the average of aggregated pharmacies. In the reports it is not possible to identify the performance of another individual pharmacy. For example the regional benchmark is compared to a group of typically 10-12 pharmacies. For those pharmacies who do not wish to receive the analytics, IMS Health is offering to pay a fee. Egan said, “Once a pharmacy agrees to share their data with us we set up online reporting tools and will support each chain or independent pharmacy to interpret and understand trends in their data”. “We have been working with pharmacies in Ireland for one year now, providing reports on their


Fergal Egan, Commercial Director, IMS Health Ireland

purchase or sell-in data. In the current changing and challenging market this data is invaluable as it highlights what is successful in the business and enables the pharmacist to make their store as efficient as it possibly can beâ&#x20AC;?. IMS Healthâ&#x20AC;&#x2122;s analysis allows pharmacies to get the pertinent information, analyse it and to be able to act on it today. If you wish to engage with IMS Health to receive their pharmacy services then please see their contact details on page 7.

"In order for the pharmacies to run a more successful business, the business manager needs to understand these trends for their store"

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z Putting the zzz's into sleep zz z Sleep Disorders Feature

having a set routine before going to sleep and avoiding watching television in bed. Sufferers should also be encouraged to practice certain relaxation techniques.

Patients should also be encouraged to keep a sleep diary and if they find that their insomnia is affecting their daily lives, they should consult their doctor. However, before doing so, patients should address the source of their insomnia before attempting to obtain treatment for it. Sleeping tablets (hypnotics) should be used as a last resort because they are highly addictive.

SOMNIOPATHY Somniopathy is the term used for abnormal sleep patterns or sleep disorders. Sleep-related disorders are remarkably common but most are still not understood very well. In fact, certain sleep disorders can interfere with some people's normal physical, mental and emotional functioning. The growth and development of understanding sleeping patterns has been a gradual process, with the first clinical sleep laboratory being established in St. Vincentâ&#x20AC;&#x2122;s Hospital, Dublin in 1985. Over the intervening years, several other laboratories have sprung up in other parts of the country. While some sleep disorders may require specialist consultations, there are certain over the counter (OTC) solutions that can help to alleviate the symptoms of others. INSOMNIA Insomnia is quite common. They have difficulty falling asleep or feel that they do not obtain enough sleep to wake feeling sufficiently refreshed in the morning. Stress and anxiety tend to be the main causes of insomnia. According to the Irish Sleep

58

Society (ISS), insomnia is a symptom, not a condition and is usually related to circumstances. Most people will experience insomnia at some stage during their lives but chronic insomnia, which is considered to last more

than three months, will affect 10% to 15% of the general population at any given time. There are a number of self-help measures that insomniacs can take, such as avoiding caffeine,

Doctors may prescribe benzodiazepines for their patients, such as temazepam, loprazolam and lormatezepam but they should only be taken for a short periods of time. Patients should be advised to avoid drinking alcohol when taking these type of drugs. When the dosage is progressively decreased of such drugs, it is important to explain to patients that if there is a transient rebound it is not necessarily an indication for continuance of the drug therapy. There are a number of OTC products, which can aid sleep. Products containing melatonin can be effective, as can some 'natural'

MAJOR SYMPTOMS AND CLINICAL FEATURES ASSOCIATED WITH OBSTRUCTIVE SLEEP APNOEA, SUPPLIED BY THE IRISH SLEEP SOCIETY (ISS). Daytime Symptoms

Night-time Symptoms

Clinical Features

Asymptomatic

Snoring (often loud) / Snorting

Narrowed upper airway/ Craniofacial anatomy/retrognathia

Excessive daytime sleepiness (EDS more likely to be reported by men)

Witnessed apnoea

Systemic hypertension

Fatigue (this is more likely to be reported by women)

Fragmented/Restless sleep

Obesity

Neurocognitive dysfunction

Nocturia/Enuresis

Cardiac arrhythmias

Depression

Night time sweating

Automatic Behaviour

Nightmares/Unpleasant dreams

Personality changes

Recurrent arousals Morning headache/Respiratory failure Nocturnal choking/Gasping Impotence


z products. Patients should not try to use anti-histamines to hep alleviate insomnia. OBSTRUCTIVE SLEEP APNOEA (OSA) Sleep apnoea or snoring is a condition that causes interrupted breathing during sleep and is associated with being overweight or obese. Airflow into and out of the lungs is reduced or diminished due to closure of the upper airway, despite continued respiratory effort. It is caused by the muscles in the back of the throat collapsing inwards during sleep. People who suffer from OSA tend to snore very loudly and they should be advised to make lifestyle changes, such as losing weight, limiting alcohol and/ or smoking, and trying not to sleep on their side. Continuous positive airway pressure (CPAP) is an effective treatment for OSA, which prevents the airways from closing during sleep. Unfortunately, there is very limited data available at present on the prevalence of OSA in the Irish population, but international data indicates that at least 4% of the middle aged people suffer from OSAS in Ireland, which would equate to over 50,000 sufferers in Ireland. NARCOLEPSY Narcolepsy is a neurological disorder that affects the sufferer's ability to control sleep. The patient will experience daytime fatigue and may have uncontrolled periods of falling asleep. Excessive daytime fatigue, hallucinations and a sudden loss of muscle tone leads to feeling weak. The

prevalence of narcolepsy in European communities has been estimated at around 0.05% and there is no research available for its prevalence in Ireland. Onset is most frequently when a patient is in their teens and it is a lifelong disorder. There are a number of sleep studies on narcolepsy, with the Bon Secours Hospital Cork having a respiratory and sleep medicine department, which conducts studies on a regular basis. SYMPTOMS OF NARCOLEPSY • Excessive daytime sleepiness. • Cataplexy • Sleep Paralysis • Hypnogogic Hallucinations • Disturbed nocturnal sleep and associated sleep disorders • Parasomnias including nightmares, night terrors, sleepwalking and talking are reported more frequently in this group of patients. There also appears to be a higher rate of REM sleep behaviour disorder. • Miscellaneous Symptoms Cognitive symptoms such as poor short-term memory and concentration are also reported.

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• Psychosocial difficulties and mood disorders • Accidents and Safety Issues Patients should be advised to keep a sleep diary for at least three weeks before they see a specialist.

Drug

Drug Side effects

Modafinil 200-400 mg / day in single or divided doses

Headache, nervousness Contraceptive issues

Methylphenidate 20-80mg / day (Ritalin or Concerta)

Irritability, headache, insomnia

Dexamphetamine 10-60mg / day

As above, reduced appetite, palpitations

Selegiline 40 mg / day

MAOI interactions, nausea, dizziness, diet induced hypertension

Sodium Oxybate (Xyrem) 3-9g / night in divided doses

Nausea, dizziness, eneuresis

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Advertorial Feature

Fibre and Womenâ&#x20AC;&#x2122;s Health By Penny Hunking, Registered Dietitian

Dietary fibre is important for good digestive health and normal bowel function1. Adults should aim to eat 25g of fibre a day1 yet the dietary fibre intake of Irish adults aged 18 years and above has been shown to be inadequate, with 80% not meeting recommended intakes2. Eight out of ten Irish adults therefore fail to eat enough fibre and would benefit from a daily increase. interest in terms of its ability to promote digestive comfort and improved wellbeing10. There is emerging evidence showing that a change in bowel habit is associated with menstruation and that women experience harder stools and have a longer mean transit time during the luteal phase (just before a period)11. Once menstruation starts then stools usually become looser and more frequent5.

for clinical practice therefore is whether increasing fibre in the diet of menstruating women could help to alleviate digestive discomfort related to menstrual fluctuations?

The mechanisms for this are not well researched or understood but the sex hormones progesterone and oestrogen may well contribute. At the United European Gastroenterology (UEG) Conference in Berlin (2013), Professor Louise Dye from the University of Leeds proposed a relationship between the sex hormone cycle and stool form based on their research12. The Leeds team propose that, progesterone has an inhibitory effect on gut motility and since progesterone declines in the late luteal/menstrual phase that this could be responsible for, or at least in part responsible for, the harder stools at this time. Oestrogen is implicated in a range of symptoms such as breast tenderness, headaches, water retention, feelings of bloating, abdominal discomfort and cramps often reported around this time.

It is well established that symptoms of digestive discomfort can be as a result of a low fibre intake6,7,8,9, and that dietary fibre helps to maintain normal bowel function and promote regularity1. Wheat bran fibre is one of the most effective fibres to normalise bowel function and thus improve digestive health, and this fibre is of particular

Once menstruation starts then the hormone prostaglandin may in part be to blame for the looser stools that tend to occur at this time. Prostaglandin helps the womb squeeze and shed its lining and may also make the gut contract more so that stools are moved along the digestive tract faster and without getting drier and harder in the rectum.

Penny Hunking

Each year 40% of adults experience digestive discomfort such as bloating and/or constipation on a regular basis,3 and this particularly affects women4. Since women are affected more frequently than men there has been growing interest in the link between the menstrual cycle and digestive comfort. Research suggests that cyclical changes in hormone levels may have some bearing on bowel function just before and during menstruation5. Dietary fibre has been shown to reduce the level of menstrual pain5. A question

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Given these effects of the sex hormones on the gut and the positive impact of fibre (and particularly wheat bran) on bowel function and digestive health it would therefore seem logical that women could have some relief of adverse menstrual symptoms by simply eating more wheat bran fibre in their daily diet. Wheat bran is a source of insoluble fibre which remains essentially undigested as it passes through the digestive tract, absorbing water and increasing faecal weight. Each 1g of wheat bran absorbs over 5 times its weight in water, giving it a 5g increase in stool weight6. The EU approved health claims for wheat bran assume intakes of 10g wheat bran each day which can be achieved by a few simple daily dietary swaps. A change of breakfast cereal and the inclusion of one high fibre snack each day can quickly correct fibre intake from the current woefully inadequate intake typical of Irish females. In addition, wheat bran-rich breakfast cereals can be substituted or added to a host of traditional recipes to give a fibre boost to meals and snacks eaten over the week. Fibre is an essential part of our daily diet and everyone should ensure they eat a nutritionally balanced diet high in dietary fibre to help maintain bowel regularity1. In addition, something as simple and practical as eating more wheat bran in the daily diet could help to alleviate some of the undesirable and commonly reported symptoms such as bloating and abdominal discomfort that thousands of women suffer around the time of menstruation.


Easy and practical ways to boost wheat bran intake Food

Wheat Bran Fibre per typical portion

Wheat Bran Fibre per 100g

Increase wheat bran from simple dietary swaps per typical portion

High Bran Cereal

27g

11g

Swap from cornflakes = extra 10g

Wholemeal spaghetti

4.5g

10g

Swap from white spaghetti = extra 6.5g

Wholemeal Tortillas

6.3g

2.5g

Swap from white tortilla = extra 1.5g each

Bran Biscuits

16g

6g

Swap from chewy cereal bar = extra 4.3g

Bran Flakes

15g

6g

Swap from mixed grain flakes (i.e. Special K style) = extra 4.5g

Wheat pillow style cereal

8.7g

3.5g

Swap from sweetened puffed wheat = extra 2.3g

Wholemeal pitta bread

8.7g

3.9g

Swap from white pitta = extra 2.5g

Wholemeal flour

12.0g

Swap from white flour = extra 2.0g/tablespoon

Wholemeal bread

7.0g

2.6g

3.0g (1 tbsp)

Swap from white bread = extra 1.8g/2 slices

Source: McCance and Widdowson’s The Composition of Foods (Sixth Edition). Royal Society of Chemistry, Ministry of Agriculture, Fisheries and Food plus brand websites e.g. Kellogg’s, grocery retailers etc.

References: 1. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) (2010) Scientific Opinion on dietary reference values for carbohydrates and dietary fibre. EFSA J 8, 1462-1539 2. S Bannon et al (2011) The National Adult Nutrition Survey: dietary fibre intake of Irish adults. Proceedings of the Nutrition Society 70 (OCE3), E113 3. YouGov. Online survey carried out in April 2010 involving a nationally representative sample of 2,287 adults (aged 18+ years). Data on file

4. Quigley EMM et al (2006) Prevalence and management of abdominal cramping and pain: a multinational survey. Aliment Pharmacol Ther 24: 411-419 5. Davies GJ et al (1993) Bowel Habit and dietary fibre intake before and during menstruation J R Social Health Apr: 113: 64-7 6. Cummings JH et al (2000) Chapter 35. Nutritional management of diseases of the gut. In: Human Nutrition and Dietetics, 10th Edition. Edited by Garrow, James and Ralph. Churchill Livingstone, London. pp 562 – 567

7. Longstreth GF et al (2006) Functional bowel disorders. Gastroenterology 130:1480–1491 8. Slavin JL & Grabitske HA (2008) Laxation and the like assessing digestive health. Nutrition Today, 43:193-198 9. van Kerkhoven LA et al (2008) Gastrointestinal symptoms are still common in a general Western population. The Netherlands Journal of Medicine. 66:18-22 10. Lawton CL et al (2013) Short term (14 days) consumption of insoluble wheat bran fibre-

containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner. Nutrients 5:1436-1455 11. Davies GJ et al (1986) Bowel function measurements of individuals with different eating patterns. Gut Feb; 27:164-9 12. Dye L et al (2013) Bowel function and digestive symptoms during the menstrual cycle. Viewed on-line at http:// www.e-learning.ueg. eu/documents-view. html?nocache=1&eprs %5Br%5D=19069

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News Innovative purchasing model for Irish pharmacists Actavis has launched the Accumulator, a new purchasing model for pharmacists in Ireland. The ‘Accumulator’ is an innovative pricing scheme which will change the way Irish pharmacists purchase generic medicines. The simple pack replacement scheme will make it transparent, easy and profitable to purchase generics through full line wholesalers. Ahead of developing the new purchasing model, Actavis polled over 100 pharmacists to ask what they wanted from a purchasing scheme. Irish pharmacists were clear in their responses which included: transparent purchasing, consistent supply, the best value, and greater control over their purchases and profits.

Keith Hynes, Commercial Director of Actavis Ireland spoke about what the new pricing structure offers their partners “Our customers are at the centre of what we do. Our customers have stressed the need for transparency of pricing, consistency of supply and value across our large portfolio. While pharmacy is facing a huge challenge in margin reduction, the ‘Accumulator’ offers everything our customers have asked for. Our customers are in a unique position within the industry with a scheme which puts them in the driving seat. We’re proud to launch the ‘Accumulator’ which delivers a unique purchasing model within the Irish generics market.”

It is with these qualities in mind that Actavis has created the Accumulator. It will be the first ever purchasing model to offer pharmacists transparency, consistency and value across the full product portfolio. Among the benefits, the pricing structure will offer: the best deal in the market on generics, simple prices, full portfolio inclusion and rewards for valued partners. Launching the Accumulator purchasing model at The Convention Centre in Spencer Dock, Tony Hynds, Managing Director of Actavis Ireland said “I'm delighted to launch this scheme for independent Irish pharmacy groups. At Actavis Ireland, our goal is to become the champion of first class generics. As a result, we’ve created a package which we believe offers Irish pharmacists the best value, choice and delivery for generics. The Accumulator is an innovative proposition which demonstrates our commitment to offering consistent value and quality to our partners.”

1. Harry Crosbie, Guest Speaker at the Accumulator Launch speaks about embracing change

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2. David Ledwith, Centre Pharmacy, Louise Mooney, Actavis, Anna Errofe, Centre Pharmacy 3. Louise Mooney Actavis, Lorcan Macken, Mackens Pharmacy Grainne Macken, Rockville Pharmacy, David Lane, Actavis 4. Barry Doyle, Actavis, Damian Flanagan, Uniphar and Damien McCormack at the launch of the Accumulator 5. Gregg Farrell Actavis & Glen Demangy, O'Deas Pharmacy 6. Aileen Kelly Life Pharmacy & Gregg Farrell Actavis 7. Paul G Ryan, Uniphar speaking to Lorcan Macken, Macken’s Pharmacy 8. Keith Hynes Actavis launches the Accumulator

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Cosmetics Association Out & About Record attendance at trade show The 26th Annual Cosmetic Association Christmas Trade Fair took place in the RDS Main Hall, Ballsbridge from Sunday 18th May to Tuesday 20th May 2014. From a logistical point of view, the set up began at 7:30 on Saturday morning with over 60 members rolling in their stock and many spending the best part of Saturday afternoon merchandising their

displays to perfection. There were a record number of exhibitors at our trade show this year with many of them ensuring they provided the trade with a wide range of product at competitive prices. The attendance was also a record, with over 1,200 attendees representing over 1,400 pharmacy doors. Trading on Sunday was brisk with many independent

pharmacists and pharmacy staff using their day off to attend the show. Trading on Monday and Tuesday was frantic between 11am and 3pm with attendees travelling from as far as Wexford, Belfast, Cork and Donegal. Ninety percent of the association’s exhibitors appeared to be happy with the sales they achieved at the show, reporting low to middle

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single figure percentage growth on 2013. Many of the attendees were impressed with the wide range of products and competitive pricing provided at this year’s trade show. As we left the RDS at 11pm on Tuesday night, somebody quipped, “Only 218 shopping days to Christmas”

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15 1. Anthony Rainbow, Joey McNamara, Alan Bennett, Cormac McDonnell and Rory Culliton, Uniphar 2. Enda Harte, Justscan and Ailsing O'Reilly, Drimoleague Pharmacy 3. Rob Redmond, Haven Reynolds Pharmacy Dublin, Billy Meagher, Haven Pharmacy, Mairead Smith, Errigal Pharmacy Dublin and Nicola Delaney, Allegro 4. Adele Plant, sally Brophy Jones and Sarah McGovern, Saphir Perfumes 5. Eilish Merritt and Jayleigh Kerr, Pixy 6. Liam Ryan and Noel Hume, Johnson Brothers 7. Malcolm Shaw, Tony Sheridan, Margaret Sheridan and Sabina Hayward-Cook, Proderma 8. Nikki Blake, Kerrins Dalkey and Philip Luque, Cofri 9. Andrea Porter, UD and james McElwee, McElwee Pharmacy, Mountmellick 10. John Tooher, Maurice Byrne, John Ryan, Ciaran Branagan, Barbara Kavanagh and Marlene Dillon, UD Consumer 11. Carol Holohan, Jacinta Conroy Ann Fitzpatrick, Mairead Murphy, McElwees and Helen Fallon, Eurosales 12. Caitriona O'Keefe, Flan Hassett and Cliodna Gilroy, UD Consumer 13. Maire Marron Marrons, Clane, Varda Farrell, Shira and Edel Marron, Marrons, Clane 14. Brian Morgan and John Meany O'Brien, Eurosales International 15. Tony Reddin, Dereck McCloskey and Andrew Maher, Pharmaher

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Clinical Profiles New from ClonMedica Lactoflora for Kids - Restores and maintains the intestinal flora.

New from ClonMedica Mobiflex For Healthy Joints

Lactoflora for Kids is a food supplement with prebiotics and probiotics.

Mobiflex is a food supplement which contains undenatured type II collagen, Manganese and Vitamin C which help to maintain healthy, flexible joints.

Lactoflora for Kids helps to restore balance to a damaged intestinal microflora: changes in diet, treatment with antibiotics, stress at school, exams or other worries can result in an imbalance in the intestinal flora.

Collagen is a protein found in all structures of the body. There are various types of collagen. Mobiflex contains 10mg of undenatured type II collagen, the main protein found in cartilage.

Lactoflora for Kids restores the balance of the intestinal microflora and strengthens the body’s natural defences. How does Lactoflora For Kids work? In order for the live bacteria in Lactoflora intestinal protector to reach the intestine in perfect condition, each container, in addition to prebiotics and probiotics, also contains aloe vera and carrageenan. Once the contents of the container have been consumed and the aloe vera and carrageenan come into contact with the gastric acid they turn into a gel that protects the bacteria as they pass through the stomach, to keep them intact when they reach the intestine. With the increase of the pH of the intestine, the gel becomes more viscous, thereby slowing down the transit of the probiotics and improving their adhesion to the intestinal wall, enabling the bacterial flora to be restored. Also intestinal function is normalised and the body’s natural defences are strengthened.

Cartilage is a special type of connective tissue whose main role is to reduce friction between moving joints. Vitamin C contributes to normal collagen formation for the good function of cartilage and bones. Manganese contributes to the maintenance of normal bones and to the good formation of connective tissue. A food supplement should not be used in replacement of a varied and balanced diet and a healthy lifestyle. Always read the label. 2014/ADV/MOB/065

A food supplement should not be used in replacement of a varied and balanced diet and a healthy lifestyle. Always read the label. 2014/ADV/LAC/064

Novartis announces positive results at ATS for once daily Ultibro® Breezhaler® versus combination therapy (tiotropium plus formoterol) Novartis have announced new data from the QUANTIFY study, which demonstrated the non-inferiority of Ultibro® Breezhaler® (indacaterol/ glycopyrronium) 110/50 mcg compared to tiotropium 18 mcg plus formoterol 12 mcg in terms of health-related quality of life (HRQoL) outcomes in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients at week 26. Positive results from QUANTIFY are part of 16 Novartis respiratory abstracts presented at the American Thoracic Society (ATS) International Conference, May 16-21, 2014 in San Diego, CA, USA. In the QUANTIFY study, which included over 900 COPD patients, once-daily Ultibro Breezhaler showed superior improvements in lung function (trough FEV1) at 26 weeks compared to oncedaily tiotropium plus twice-daily formoterol in moderate-to-severe COPD patients. Additionally, patients taking Ultibro Breezhaler were more likely to demonstrate a clinically meaningful improvement in shortness of breath and health-related quality of life (per protocol set) at 26 weeks compared to tiotropium plus formoterol. The safety and tolerability of Ultibro Breezhaler was comparable to the other treatment arm in the study. QUANTIFYwas a 26-week treatment, multicenter, randomized, parallel group, blinded study to assess the efficacy and safety of once-daily Ultibro Breezhaler in 934 patients with moderate-to-severe COPD, versus the free-combination of tiotropium 18 mcg plus formoterol 12 mcg. The primary objective was to demonstrate non-inferiority of Ultibro Breezhaler in HRQoL as assessed by the St. George’s Respiratory QuestionnaireCOPD (SGRQ-C) versus tiotropium plus formoterol after 26 weeks of treatment. Secondary endpoints included transition dyspnea index (TDI) score, trough FEV1, forced vital capacity (FVC) and safety and tolerability.

Phase 3 ARISTOTLE trial evaluates Eliquis® Bristol-Myers Squibb and Pfizer Healthcare Ireland has announced results of a pre-specified subanalysis of the Phase 3 ARISTOTLE trial in relation to patient age. ARISTOTLE was designed to evaluate the efficacy and safety of Eliquis® compared to warfarin for reducing the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). The subanalysis found consistent results across age groups for reducing the risk of stroke and systemic embolism and reducing the risk of all-cause death with fewer bleeding events. Owing to the higher risk at older age (75 years and older), the absolute benefit to patients with NVAF was greater with Eliquis® in the older population. This data were recently published in the European Heart Journal. Eliquis® was more effective than warfarin in reducing the risk of stroke and reducing mortality across age groups. In addition, Eliquis® was associated with less major bleeding, less total bleeding and less intracranial hemorrhage, regardless of age.

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The New medicare® Ultrasonic Portable Nebuliser with Mesh Technology Using state of the art electrospray technology the new medicare® Ultrasonic Portable Nebuliser provides for low medication residue with a better nebulisation rate of 0.32ml and can be used at various angles for flexible nebulisation.

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The new medicare® Upper Arm Automatic Blood Pressure Monitor The new medicare Upper Arm Automatic Blood Pressure Monitor uses the oscillometric method to automatically measure systolic and diastolic blood pressure as well as heart rate. All values can be read in the LCD panel which also incorporates a WHO Risk Category bar. ®

La Roche-Posay Sun Care La Roche-Posay sun care offers the highest PPD and SPF across their range and a variety of textures to suit all skin types. All ANTHELIOS products provide filter distribution, excellent filter stability for lasting protection, ultra water resistance, enriched with Thermal Spring Waterand are tested under dermatological control: Paraben-free, fragrance-free and hypoallergenic.

Ocean Healthcare - Tasectan® Ocean Healthcare is delighted to announce the two winners of their hugely successful educational campaign for new Tasectan® – the diarrhoea treatment suitable for adults, children and infants. The two lucky winners of and iPad are: Lindsay Hogan – Lloyds Pharmacy in Blanchardstown, Dublin Lindsay Dunne Kelly’s Pharmacy, Nenagh, Co. Tipperay Ocean Healthcare would like to thank all the pharmacies and their staff who entered the competition. For further information on Tasectan please visit www.diarrohea.ie or contact Ocean Healthcare at 01-2968080.

Virasoothe Chickenpox Relief Cooling Gel Virasoothe Chickenpox Relief Cooling Gel is a revolutionary new product from ClonMedica specifically formulated and clinically proven to relieve the irritating symptoms of chickenpox. It is suitable for children over six months of age and can be applied to both body and face. It is available in gel and Spray gel.

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Appointments Real World Retail are pleased to announce the appointment of Adele Curran as Customer Success Manager. Adele brings a wealth of retail experience having previously worked for Dunnes Stores and Heatons Department stores in change management roles in Training, IT implementation, Buying, Merchandising & Distribution. Adele will be responsible for training and benchmarking of customers to bring them to the highest level of operational and financial performance in the shortest possible time this will lead to business industry leaders in Pharmacy in Ireland.

Bernard Duggan was elected as Honorary Treasurer to the IPU by the Executive Committee and took up the position at the IPU National Pharmacy Conference on 11 May 2014. Bernard is also one of the Community Employee Group Representatives on the Executive Committee and is the Dublin Regional Representative on the Employee Pharmacists' Committee. Bernard graduated from Trinity College Dublin in 2004 with a BSc(Pharm). He completed his pre-registration training in Dargans Pharmacy in the north inner city of Dublin and has continued to work there ever since. He has been involved with the IPU since 2006 and was previously Chairperson of the Community Pharmacy and Employee Pharmacist's Committees. Bernard is also actively involved in pharmacy education. He previously acted as a tutor for ICCPE, and currently is involved in the development and delivery of material for IPU Academy. He is also an assessor on the IPU's Pharmacy Technician's course.

Daragh Connolly was elected as Vice-President to the IPU by the Executive Committee and took up the position at the IPU National Pharmacy Conference on 11 May 2014. Connolly is also the South-East RegionalRepresentative on the Executive Committee and was previously Vice-Chairperson of the Community Pharmacy Committee. Connolly is a third generation pharmacist. He graduated from the University of Portsmouth in 1996, where he was President of the Pharmacy Students’ Association. He is a native of Waterford and proprietor of Connollys Chemists in Dungarvan. He is also a tutor pharmacist and the IPU representative to the Irish Institute of Pharmacy.

Kathy Maher was elected as President of the IPU by the Executive Committee and took up the position at the IPU National Pharmacy Conference on 11 May 2014. Kathy has been involved with the IPU since 2002, having experience on all of the Committees. Maher was Vice-President from 2012-2014 and Honorary Treasurer from 2010-2012. She was on the Pharmacy Contractors' Committee from 2007-2012. Maher graduated from Pharmacy in Queen’s University, Belfast in 1996. After pre-registration she worked in Dublin before moving to Duleek Pharmacy in 2000, which she bought in 2005. Maher is also involved with the organisation of the IPU National Pharmacy Conference and was a tutor with the Irish Centre for Continuing Pharmaceutical Education for many years.

Reckitt Benckiser are pleased to announce the appointment of Maeve McGourty as Pharmacy Support Executive. Maeve brings on board experience in retail pharmacies having previously worked for a chain of independent stores in Belfast. Following this she joined the sales team here at IPN where she gained further insight into the market. Maeve will be responsible for all telesales ordering for RB and will be on hand at all times for any queries on Promotions, POS and merchandising material.

Merck KGaA has named Marcus Kuhnert as its replacement for chief financial officer Matthias Zachert, who announced his decision to leave Merck to join chemical firm Lanxess as CEO at the beginning of 2014. Kuhnert joins from German consumer goods firm Henkel where he was chief financial officer of its laundry and home care business, which includes the brands Persil and Purex. Johannes Baillou, chairman of the board of partners of Merck KGaA's majority shareholder E Merck KG, said: “He brings profound experience in the areas of transformation and efficiency enhancements to the table and is familiar with the challenges related to acquisitions and the integration of companies."

Send your appointments announcements to Irish Pharmacy News Our appointments page offers you a chance to officially welcome your new colleague to your pharmacy and to let your peers know about positive happenings within your business. Simply send in 100-200 words providing some background career details on the person and a separate high-resolution headshot (preferably a JPEG) to accompany the piece. Send your details and photograph to editorial@ipnirishpharmacynews.ie or call (01) 602 4715 for more details.

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Congratulations to all the winners, nominees and organisers of the Irish Pharmacy Awards 2014. Continued success from all at Barry Packaging.

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Irish Pharmacy Awards 2014

EXCELLENCE IN PHARMACY

AWARDS 2014

Congratulations to the winner of the PharmaConex Community Pharmacy Technician of the Year 2014 - Kirstie Kilpatrick of Healthwise Pharmacy, Letterkenny.


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IRISH PHARMACY NEWS - ISSUE 6 - 2014