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EDUCATION AND TRAINING GUIDE FOR PHARMACY ASSISTANTS

Benylin Phlegm Cough Menthol 100mg/5ml Oral Solution contains guaifenesin. Non-Drowsy Sudafed Decongestant 60 mg Tablets contain pseudoephedrine. Calpol 120mg/5 ml Sugar Free Infant Oral Suspension contains paracetamol. Nicorette Quickmist 1mg/spray, oromucosal spray contains nicotine. ALWAYS READ THE LABEL. Please ask your pharmacist for advice. IRE/CA/13-0544. For more information on the Centrum* range please contact your local Pfizer Consumer Healthcare representative (*Trade mark)


Head to toe beauty Viviscal Hair Growth Programme Our Viviscal Supplements, produced here in Ireland are the No1 Supplements in the USA, are backed up by 7 clinical trials and are multi award-winning. The Hair Growth Range includes, a Gentle Shampoo and Moisturising Conditioner along with 5 shades of Hair Fibres to instantly add volume to thinning hair. MICRO Pedi MICRO Pedi is the No1* at home pedicure system. Selling at a rate of 3 per minute in Europe the range includes the awardwinning MICRO Pedi, MICRO Pedi Man, Pedicure/Manicure kit, Ultra Finishing Foot Cream and 3 varieties of replacement rollers. SLIM Sonic SLIM Sonic brings a whole new dimension to sonic toothbrushes. With 22,000 brush strokes per minute it brings innovation, style and value to the dental category. 6 designs to choose from. *Based on 52wk sales data.

Call: +353 91 750811 Email: retailsupport@lifes2good.com Visit: www.lifes2good.com 2461.1 L2G FP Ad_IPN Diary_V5.indd 1

13/11/2013 16:01


3

2014 Calendar


4

2014 Year Planner JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE


2014 Year Planner JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

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Contents 9

Our Pharmacy

10-13 Category Management hints and tips

47 49

Sinusitis and Sore throat Headache and Migraine

14

Womens health

23

Baby care

52

Allergic rhinitis

28

Skin care

54

Head lice

32

Weight management

55

Hair loss

33

Footcare

59

Sleep disorders

34

Warts and Veruccas

60-61 Digestion

35

Vitamins, Minerals and Supplements

66-67 Male health

36-37 Vitamins, Minerals and Supplements Chart

50-51 Travel health

7

PUBLISHER IPN Communications Ireland Ltd. Clifton House, Lower Fitzwilliam Street, Dublin 2 00353 (01) 6024715 Advertising & Sales Manager Nicola McGarvey Sales Executive Maeve McGourty

www.pharmacynewsireland.com

69

Diagnostics

71

Sexual health

73

Smoking cessation

39

Oral care

75

Animal health

41

Arthritis

77

Haemorrhoids

43

Analgesics

78

Diary

45

Cold and flu

288

Company listings

The views and opinions expressed within this Pharmacy Assist directory are those of the authors and it is provided to you only as guidance. All of the information is published in good faith and for general information purpose only. Please share with your supervising pharmacist for his/her review in order to tailor it to the specific needs and practices of your individual pharmacy. All rights reserved by IPN Communciations Ltd. All material published in Pharmacy Assist is copyright and no part of this document may be reproduced, stored in a retrieval system or transmitted in any form without prior written permission. IPN Communications Ltd have taken every care in compiling Pharmacy Assist to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

Clinical decision-making and the WWHAM approach The pharmacy is a focal point of any community when it comes to identifying, managing and treating minor aiments and health complaints. An increase in the number of medicines has meant an increased need for the further training of counter assistants. There are associated risks with regards to the public having a wider access to a wider variety of over-the-counter medicines and it is the job of pharmacy staff to ensure the safe, effective and evidencebased supply of these medicines. Inappropriate supply can have many implications, including misdiagnosis and delayed access to treatment Counter assistants now play a key role in being a central interface between customer and pharmacist and thus it is is essential they are educated and knowledgeable.

This Pharmacy Assist Directory has been designed with counter assistants in mind. Using the popular WWHAM acronym. This stands for: W - Who is the patient W - What are the symptoms H - How long have the symptoms been present A - Action already taken? M - Medication? It is also important that counter assistants and pharmacy staff employ clinical reasoning when helping customers with a diagnosis and over the counter medicines advice.


Triple Action FAST EFFECTIVE RELIEF FOR HEARTBURN, ACID INDIGESTION PLUS TRAPPED WIND PLACE AN ORDER WITH YOUR SANOFI REPRESENTATIVE TODAY Padhraic Speight Tel: 086 0456 817

South

Colm Moran Tel: 086 0470 989

Midlands, North West

Laurence O’Carroll Tel: 086 0456 816

East Coast

Contact your Sanofi representative for further details Always read the label ABBREVIATED PRESCRIBING INFORMATION (Ireland) MAALOX PLUS™ CHEWABLE TABLETS 200mg/200mg/25mg. Presentation: Chewable tablet containing 200 mg of Magnesium Hydroxide (as magnesium hydroxide paste); 200mg of Hydrated Aluminium Oxide; 25mg of Dimeticone (as simeticone). Indications: The treatment of heartburn, indigestion, flatulence and dyspepsia. Dosage and Administration: Adults: One to two tablets four times a day (after meals and at bedtime) or as required. Contraindications: Severely debilitated patients. Kidney failure. Allergy to any of the ingredients in Maalox Chewable Tablets. Patients with rare hereditary problems of fructose intolerance. Warnings and Precautions: Use in advanced renal disease. Caution in patients with porphyria undergoing haemodialysis. Phosphate depletion syndrome, particularly in patients on a low phosphate diet e.g. malnutrition. Diabetics due to sugar content Pregnancy and Lactation: Do not take during the first trimester of pregnancy Adverse Reactions: Gastrointestinal side-effects are uncommon. High doses may cause diarrhoea or constipation. Marketing Authorisation Holder: sanofi-aventis Ireland Ltd. T/A SANOFI ,Citywest Business Campus, Dublin 24. Marketing Authorisation No. PA 540/109/2 Legal Category: P Further information: Available from Sanofi, Citywest Business Campus, Dublin 24 or contact IEmedinfo@sanofi.com. Tel.: (01) 4035600. Please refer to Summary of Product Characteristics which can be found on IPHA at http://www.medicines.ie/ before prescribing. Information about adverse events reporting can be found at www.imb.ie. Adverse events should be reported to the Sanofi Drug Safety Department at the above address. Date of Preparation: September 2012 IE-MAG-13.11.01


Our Pharmacy No two pharmacies are the same. Whether you are working within a pharmacy chain or in a smaller, independent pharmacy; staff, opening hours, protocols and allied healthcare professionals will differ. It is important therefore that you are knowledgeable as to your pharmacy's business and services provided. In addition, you should be educated in knowing the roles and remits of your colleagues. Pharmacy name: Pharmacy address:

Pharmacy telephone number: Pharmacy fax number: Pharmacy email address:

Pharmacy website: Pharmacy opening hours: Pharmacy Holiday closures:

Mon-Fri:

Sat:

Sun Christmas & New Year:

Easter: Bank Holidays: Doctor Localities Local Health Centre: Address:

Telephone number:

Email:

Dentist Localities Local dentist surgery: Address:

Telephone number: Locum Contacts: 1 2 3 Lead Pharmacist: Pharmacy Manager: Pharmacy Technician: Accredited Checking Technician: Dispensing Assistant: Medicines Counter Assistant: Locum Pharmacist: Other:

Email:

9


10

Category Management

Strategic Importance of Category Management In these challenging economic times, Irish pharmacies are looking for means to ensure that their front of shop is working hard and delivering to the bottom line of their businesses. Whereas many have now heard of category management and believe that it could improve the shopper experience in their pharmacy and contribute to the performance of their front of shop business, there remains some uncertainty around what category management actually involves and how best to harness it’s potential. The Category Management Department in United Drug have outlined below what category management is, how its techniques are applied and what that can mean for the front of shop business. In addition to this, included are some quick, easy and affordable tips to improve the front of shop shopping experience for your customers. Remember, the strategic significance of the front of shop should not be underestimated, this area is responsible for the look and feel of the pharmacy and attracts and most importantly retains customers… Category management is a practice which has been used extensively in grocery retail since it was first conceived in the 1980s by Dr Brian Harris. In its essence, category management is about optimising retail performance and in simple terms is often described as a tool which can help to get the right product, to the right customers, at the right time. Key global retailers and suppliers alike use its principles to drive improved results. When correctly applied, category management techniques may result in improved sales performance, greater profitability, reduced stock holding and greater customer satisfaction. Below we will explain category management techniques from a micro and macro perspective and outline how United Drug can work with you to apply category management expertise to your pharmacy. Category management involves combining similar or related products together into a group or ‘category’ and then managing that category as a distinct business unit in order to optimise its performance. The implications on the total category must be considered when any action is taken on a specific brand or SKU. Managing the category so as to improve performance should involve; • Defining the category, determining what its subcategories are and deciding what products fall into each sub-category

• Developing an understanding of the role of a category within the pharmacy. For example, baby might be a core strategic destination category for a pharmacy located in an area populated by young families. This is due to the fact that the pharmacy’s baby category will be key to attracting young parents into the pharmacy and retaining them as loyal customers as their families grow • Analysis of store EPOS data to determine; the share of total sales that a category accounts for, what share each sub-category holds of the total category, top selling SKUs and non-performing SKUs • Comparison of store EPOS data to the market to identify any opportunities for your business • Ensuring that the correct amount of space on the category fixture is allocated to each sub-category based on its share of total category sales and its potential for growth/decline • Ensuring that the ‘flow’ or order of products on the fixture correctly reflects how the category is shopped and how shopper decisions are made (the shopper decision tree) • Using key brands strategically placed at eye level to sign post the category to the shopper • Determining the correct category range to drive category performance and

best meet shopper needs • Allocating the correct amount of facings to each individual product, based on that products sales performance All of the above actions are then reflected visually in a map of the category or a ‘planogram’ as it should appear on shelf. This planogram should then be used as a tool to implement and maintain the ideal category layout in store. The above actions are categorised as practices of category management at a micro level as they are performed on each individual category within the store. Category management at a macro level/macro store planning has become more widely practiced in Ireland in recent years as retailers seek to maximise each square centimetre of their shop floor. Applying a macro planning view to the shop floor should involve; • Ensuring that each category has the correct share of total front of shop space based on its contribution to overall sales and its potential for growth/ decline • Ensuring that ‘linked’ categories are located close to each other so as to maximise the relationships that exist between them • Developing an understanding of the natural shopper flow around the pharmacy through shopper observation and exploiting opportunities that arise from this understanding. For example, at Christmas it is effective to place seasonal

gift sets in a hot-spot along the natural path that the shopper takes through the pharmacy as this will increase the chance of an impulse purchase • Ensuring that shopper demographics are taken into account when considering the overall store layout • Taking account of key shopper missions when determining optimum store layout. This involves taking a broader view of the shopper’s true need. For example, taking a narrow view we might consider the need of the shopper entering a pharmacy in July to be 'purchase a bottle of sunscreen'. Taking a more expansive view we might consider their broader mission to be ‘getting ready for my summer holiday’. Thinking about the shopper’s mission in this broad sense could lead to placing insect repellent or travel sized toiletries adjacent to sunscreen. Considering shopper missions and tailoring your store layout to meet these greatly increases the chances of the shopper picking up additional items which tie into their broader shopper mission. Below we have outlined some simple, quick and affordable steps which you can take to improve your front of shop offering from the moment the shopper enters the pharmacy until they leave, a satisfied customer… • First impressions do count so make your pharmacy


11 appealing from the outside; ensure that your shop front is clean, well maintained, has a functioning green cross, clean windows and your hours of business clearly displayed • Ensure that there are ample shopping baskets available just inside the door, you want to ensure that you make it as easy as possible for shoppers to pick up several items in your pharmacy • Ensure that the store is bright and well lit, make it a pleasure for the shopper to shop in your store • Signpost key categories so that they are easily located by the shopper, strong brand blocking can also be effective in sign posting the category • Ensure that the floor is kept clear at all times. Totes abandoned on the floor are a health and safety hazard, they also make it more difficult for shoppers with impaired mobility or parents with buggies to navigate aisles which may result in them choosing a different pharmacy over yours in the future • Reduce the clutter – less is more as an overabundance of posters, POS etc. can just confuse and frustrate the shopper • Keep fixtures and fittings clean and dust free • Consider the impact of price points, a ¤2.99 price point may sound more clear and appealing to the shopper than ¤3.04 • Ensure that all products are priced. Many shoppers are more likely to leave a product on the shelf than go to the bother of asking, resulting in a lost sale • Merchandise related categories close together. A shopper who enters your pharmacy to buy fake tan for a big night out may easily pick up an item from your cosmetic stand if they are situated close together • Maximise the impact of promotions. Use POS such as a price card or shelf talker to highlight the promo price/ discount. If the offer is not

clearly visible the shopper is unlikely to take the time to investigate the detail themselves • Recognise the opportunity that lies in the couple of minutes while the customer waits for their prescription to be filled. Ensure that attractive, promo ends with clearly marked promo price points are close to the dispensary waiting area, this will increase the chance of a shopper making an impulse purchase. Use the Pharmacy Channel to promote products and services available in your pharmacy to waiting customers • Tailor impulse items around the till area to the season e.g. individual packets of tissues and chap sticks are good impulse items during winter Our Category Management team here in United Drug can provide you with category management expertise to help to optimise the performance of your front of shop categories, to free up cash by reducing stock holding and ultimately improve margin and also advise on how to best implement category practices using a simple approach based on 3 core steps; plan, do and review. For an annual fee we will provide you with category management support on a micro level including; • Access to our Category Management website where you can find category planograms and market analysis on key front of shop categories • Detailed analysis of EPOS data to help you to make better decisions on the correct range for your pharmacy • Identification of potential growth areas for your business based on a comparison of your sales data vs. the market

And on a macro level; • Provision of detailed recommendations on overall layout and category positioning within your pharmacy following a consultation in store • Advice on correct space allocation for front of shop categories based on an analysis of your sales data, to ensure that categories which are driving your business are getting sufficient space • Delivery of recommendations on the overall look and feel of the pharmacy so as to improve the shopper experience within your store

The Category Management team in United Drug invite you to contact us to see how we can help you to apply category management

principles to your pharmacy. Additional information can be found on our website http://udretailinitiatives.ie/ Sources www.igd.com www.thepartneringgroup.com The Missing Metric Missing Shelf-Space Profitability Booz & Co 2007 Mary Magner, Category Manager 01 4632538/087 3777035 Kim D’Arcy, Category Management Associate 01 4632514


12

Category Management

Common questions and comments Pharmacy owners, pharmacists and staff frequently ask our Category Management team here at United Drug questions about the theory and practical implementation of category management. Our team has extensive category management experience in the areas of planogram building, macro space planning, market data analysis and interpretation, range analysis, development of category reviews and management of category partnerships. In addition to this, we have retail management, channel management and customer service experience. Below, we have used this experience to answer some questions on these subjects and to respond to some of the most common comments that we hear about category management.

“I do my own category management. I print out and review my top sellers every week and review the core department’s growth regularly. What else would I possibly need to do?” There are multiple interpretations of category management but, in reality it is much broader than knowing your top sellers or implementing a handful of planograms sporadically. Category management is about optimising retail performance and involves combining similar or related products together into a group or ‘category’ and then managing that category as a distinct business unit, in order to optimise its performance.

category’s potential for growth or decline; the correct range to ensure optimum category health and the flow in which a shopper makes their purchase decisions (the shopper decision tree). ·

·

ensuring that each category has the correct share of total front of shop space based on its contribution to overall sales and that ‘linked’ categories are located close to each other

·

taking shopper behaviour and demographics into account when considering the overall store layout

·

developing an understanding of the natural shopper flow around the pharmacy through shopper observation and exploiting opportunities that arise from this understanding

“What benefits would I see from applying category management to my pharmacy?” Category management techniques can result in; ·

improved sales performance (through having the right product, in the right place at the right time for the shopper)

·

reduced stock holding (by using range analysis to identify those products which simply are not performing and delisting them; proper range planning could free up approximately �30,000 to �50,000 for your business)

Managing the category involves; ·

determining the role of a category

·

analysis of store EPOS data and comparison of EPOS data to the market to identify opportunities

·

implementation of planograms, which reflect the share of the total category held by each sub-category and each sub-

·

·

Key brands should be strategically placed at eye level to sign post the category to the shopper:

greater profitability (by having less cash tied up in products which do not perform) greater shopper satisfaction (through improved range, category positioning and pharmacy look and feel)

“I have a strong prescription business; do I really need to worry about front of shop performance?” It cannot be denied that recent changes in the pharmacy sector have resulted in reduced earnings for pharmacies from their prescription business and that this will continue into the future. Therefore, it is imperative, even for those who traditionally enjoy a strong prescription business, to ensure that they are maximising the contribution of the front of shop to the total business. Application of category management practices to the front of shop is core to ensuring that it delivers to the best of its potential.

“My front of shop is very small, is it worth applying category management to such a small space?” We are frequently asked this question and we believe that having a smaller front of shop space means that you need to be shrewd about how every precious square centimetre is used. Therefore, category management practices are ideal for smaller pharmacies as they will ensure that total floor space is split appropriately based on each category’s share of total sales and that shelf space is allocated to top performing SKUs (Stock Keeping Units). In this way, category management can help to ensure that even a limited amount of front of shop space is maximised.

“I feel that my front of shop looks well, so I don’t think that I need category management…” A pleasing, aesthetic appearance for the front of shop is only one output of category management. By applying category management practices, we ensure that the front of shop not only looks well but performs well. Decisions about category space allocation, positioning, adjacencies and individual category shelf layout (planograms) are based on robust

EPOS and market sales analysis and an understanding of shopper demographics and behaviour.

“How do I get the most from my EPOS data for category management purposes?” Like all processes, the quality of inputs has a direct impact on the quality of outputs. Therefore, to ensure quality and, importantly usable EPOS system reports, we would recommend dedicating some time and resource to data accuracy. For example, it would be difficult to determine if Hair Care is performing ahead or behind last year’s position if you are not confident that a new hair range, listed during the year has been categorised correctly as Hair Care and, therefore may or may not appear in the numbers. In our experience, SKUs can very often end up sitting within the incorrect department on the system, i.e. a specific shampoo classified as belonging to the dental department. The more accurate your data, the more confident you will be in your interpretations of EPOS reports. This will lead to more meaningful actions for your front of shop based on these interpretations.

“I don’t have an EPOS system in place for my front of shop; can you still help me from a category management perspective?” Yes, our team can certainly help you to make improvements even if you do not have an EPOS system in place for the front of shop. Our contact details are below should you wish to discuss this further.

“What exactly is a planogram and how is it built?” A planogram is basically a map or a visual representation of the category as it should appear on shelf. Planograms are built on robust analysis of sales data in combination with an understanding of shopper insight. Planograms are used as a

Category Management advice and recommendations brought to you by United Drug Supply Chain Services


13 tool to implement and maintain the ideal category layout in store.

“I am considering a refurbishment of my pharmacy. Once this is complete, can you review it from a category management perspective?” We would encourage customers to approach us as early in this process as possible. It is easier and much more time efficient to put in place correct category positioning, adjacencies and planograms from Day One of a refurbishment. If involved early in the process, we can also help to ensure that you do not end up buying too many new gondolas, new bay shelving, etc.

“I want to review and change my floor layout, do I need planograms in addition to this?” Some pharmacists may be happy with their existing floor plan but feel that their individual category ranges or layouts may need improvement. Others may be happy with individual category ranges and layout but feel that their floor plan needs refreshment. To get the most from applying category management to your pharmacy we would recommend focusing on both. The benefits of having categories in the right positioning with smart adjacencies may be reduced if the right products do not appear with the correct number of facings in the optimum position on the fixture. Likewise, the health of a category will be optimised by having the correct planogram in place, in conjunction with the ideal positioning for that category on the shop floor.

“OTC is my most significant FOS category and I implemented a new planogram early last year. Do I really need to consider a new planogram at this point?” All categories change over time, be that in terms of sub-category

share of total category, SKU performance, NPD, delisted lines etc. As a consequence, planograms should be updated as regularly as is practical. Some categories are more subject to change and seasonality than others.

“I implemented a new floor plan and planograms this year and I am very pleased with the results. Is it OK for me to review the floor layout and planograms in two to three years’ time?” To obtain the maximum benefit from category management, it needs to become a continuous process as opposed to a once off event. As mentioned above, we recommend updating planograms as regularly as is practical to keep abreast of changes within the category. Macro space planning/ floor plan reviews should be completed on an annual basis. The benefits of completing this work annually are as follows: ·

improvements made in an initial floor plan review will be capitalised on going forward. For example, the development of a new floor plan this year results in improved positioning for Baby, which was previously hidden in a corner far from the eyes of the many ‘young family’ shoppers in a pharmacy.

·

A macro space plan review conducted in year two shows that, due to the improved positioning Baby has grown in terms of share of total front of shop, resulting in a decision to expand from one bay to two bays. The additional space further improves the health of the Baby category. If the year two review had not been conducted, improvements might have plateaued at the original level and an opportunity to grow the category further would have been missed

·

the pharmacy team are always aware of the importance of each category to the total front of shop and how this evolves over time. For example, Hair Care may have

generated four percent of total front of shop value in Year One. A review conducted in Year Two may show that this has increased to seven percent. This may result in a shift in staff focus on this category from year two onwards ·

by conducting macro reviews on an annual basis, you are ensuring that space allocation and positioning always reflects the current state of your front of shop business

“What outputs will I see if I engage United Drug to carry out category management work in my pharmacy?” You will receive log-in access to our website www.retailinitiatives.ie where our planograms and category guides are housed. Following a review in the pharmacy and analysis of sales data you will receive a comprehensive presentation detailing:

·

observations from our visit (e.g. incorrect SKU positioning and category positioning anomalies etc.)

·

range analysis (highlights which SKUs are delivering for a category and which are not)

·

space vs. sales analysis (highlights under and over spacing by category)

·

category share - in store vs. market (highlights opportunities and threats by category)

·

a revised floor plan including the rational for category positioning and adjacencies

·

a revised space vs. sales analysis (showing improvements in space allocation)

Please feel free to contact our team on the numbers below or visit our website http://udretailinitiatives.ie/ for more information on our service

ment team are dedicated The United Drug Category Manage management service to delivering an exceptional category ision of market led prov for our customers; incorporating the category guides p sho of planograms, delivery of core front oor plans. fl ro and development of bespoke mac

g unprecedented pressure caused The Irish pharmacy sector is facin ’s ion side of the business; our team by reduced revenue in the prescript agement outputs for man gory cate ity qual llent exce commitment to delivering hard for that your front of shop is working the front of shop is key to ensuring ent. onm envir ging ever-chan your total business in this current rs want and using our expertise to ome cust Through understanding what our their r to help our customers to achieve create quality solutions we endeavou tiveness, reducing stock effec l retai asing incre e, spac goals in the front of shop ow. holding and improving customer fl s management experience in the area Our team have extensive category sis and analy data et mark , ning plan e spac of planogram building, macro ws lopment and leading of category revie interpretation, range analysis, deve to this this we also tion addi In ips. ersh partn gory and management of cate management and customer service have retail management, channel experience. agement project you are ensuring In working with us on a category man for rtise is applied to your front of shop that the above experience and expe n. factio satis per shop and lts optimum resu ce please contact; For further information on our servi

r | 087 377 7035 / 01 463 2538 Mary Magner Category Manage t Associate | 01 463 2514 Kim D’Arcy Category Managemen

UnitedDrug Wholesale


14

Womens Health

Women will present to the pharmacy with a range of conditions and from various age-groups such as teenagers, young women and the elderly. It is important to be knowledgeable across the spectrum of common female health problems.

Menstrual problems Most women have a regular menstrual cycle that's around 28 days long (28 days from the start of one period to the start of the next), and they bleed for three to seven days each cycle. However, some women experience problems with their periods. Women may notice symptoms including problems related to water retention, such as edema of the hands and feet, weight gain, and swelling and/or tenderness of the breasts as well as gastrointestinal problems such as upset stomach, abdominal fullness, bloating, and constipation or diarrhoea may arise. Acne can appear or existing acne can worsen. Over the counter NSAIDs, such as ibuprofen and aspirin can help alleviate symptoms. Paracetamol can also be advised. Heat can be applied to the lower abdomen to ease cramping. Heating pads or therapeutic heat wraps can be recommended. Diuretics are also safe and effective for relieving temporary water weight gain, bloating, swelling, and the full feeling that can often accompany PMS. A pharmacy is frequently the first place pregnant women will turn to for advice regarding medication use during pregnancy. As a large proportion of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and may visit her local pharmacy for further education.

Endometriosis Endometriosis is a common condition in which small pieces of the womb lining (the endometrium) are found outside the womb. This could be in the fallopian tubes, ovaries, bladder, bowel, vagina or rectum. Endometriosis is usually diagnosed in those between the ages of 25 and 40. Endometriosis is a long-term (chronic) condition that causes painful or heavy periods. It often causes pain in the lower abdomen (tummy), pelvis or lower back. It may also lead to lack of energy, depression and fertility problems. Common symptoms include painful, heavy or irregular periods, problems with bowel movements and fatigue. The amount of endometriosis does not always correspond to the amount of pain and discomfort. A small amount of endometriosis can be more painful than severe disease. It depends, largely, where the endometriosis is actually growing inside the body. The symptoms of endometriosis can also indicate many other conditions, such as

irritable bowel syndrome (IBS), and because endometriosis manifests itself in a variety of ways, diagnosis can be difficult. Pain medications may work well if the pain or other symptoms are mild. Because hormones cause endometriosis patches to go through a cycle similar to the menstrual cycle, hormones also can be effective in treating the symptoms of endometriosis. Hormone therapy is used to treat endometriosis-associated pain. Hormones come in the form of a pill, a shot or injection, or a nasal spray.

Menopause The menopause happens when the ovaries stop producing eggs. As the ovaries make the hormone oestrogen, when they stop functioning there is a drop in the levels of oestrogen in the blood. This fall in hormone level disrupts the menstrual cycle and causes the symptoms associated with menopause. Menopausal transition stage usually begins when women are in their mid-to-late 40s. The final menstrual period (FMP) usually occurs between the ages of 40 and 58. Average age of menopause is 51 years. Menopausal symptoms are attributed to tissue sensitivity to lower oestrogen levels. This primarily affects the oestrogen receptors in the brain. The experience of women varies widely, with some being debilitated and others unaffected by their symptoms. Some women experience symptoms while still menstruating and others not until a year or more after their last period. Symptoms include menstrual irregularity, hot flushes and sweats which commonly affect the face, head, neck and chest, possible vaginal symptoms such as dryness and urinary incontinence. HRT is undoubtedly the most effective treatment to completely relieve the symptoms caused by the menopause. It also prevents and reverses bone loss. HRT is extremely effective in the control of menopausal symptoms, particularly vasomotor symptoms (hot flushes/night sweats), mood swings and vaginal and bladder symptoms.

A healthy diet can help protect the body against some of the long-term effects of the menopause and sufferers should try to include two to three portions of calcium-rich foods in their diet daily.

Cystitis The term cystitis actually means an inflammation of the bladder although it's usually understood to mean an infection of the urine affecting the bladder. Infection from intestinal bacteria is by far the most frequent cause of cystitis, especially in women, who have a very short urethra (the tube through which the urine passes from the bladder to the outside). Normally, urine is sterile (there are no micro-organisms such as bacteria present). It is possible to have bacteria in the bladder without having any symptoms (especially in the elderly). Almost all women will have cystitis at least once in their lifetime. Around one in five women who have had cystitis will get it again (known as recurrent cystitis). Cystitis can occur at any age, but it is more common in: • pregnant women • sexually active women • women who have been through the menopause Over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen can reduce pain and discomfort. Advise sufferers on maintaining good fluid intake.

Urinary incontinence Urinary incontinence is a common problem, affecting women more commonly than men. Stress incontinence and urge incontinence are the most common types of incontinence. Urinary incontinence can range from a small dribble now and then, to large floods of urine. Incontinence may cause distress as well as being a hygiene problem. Urinary incontinence can occur at any age but it is more likely to develop as sufferers age.

Pharmacy staff can advise customers on taking practical steps to deal with hot flushes by keeping cool and avoiding possible triggers such as spicy foods, caffeine, smoking or stress.

Many people do not tell pharmacist or GP about their incontinence, due to embarrassment. Some people wrongly think that incontinence is a normal part of ageing or that it cannot be treated.

Regular exercise may help improve some symptoms of the menopause, including hot flushes and night sweats, difficulty sleeping and mood changes. Pelvic floor exercises can help strengthen the pelvic muscles and improve bladder control.

Stress incontinence may happen when there is an increase in abdominal pressure, such as when someone laughs or cough. Urine leaks due to weakened pelvic floor muscles and tissues. Causes of stress incontinence include


Womens Health

15

WWHAM Menstural Problems

Who? Any females that have started menstruation What are the symptoms? Feeling bloated, cramps, back pain How long has the patient had the symptoms? Symptoms will usually appear just prior to onset of menstruation Action already taken? Heat applied to the stomach area in the form of hot water bottles or wraps is a popular choice for sufferers as symptoms arise Medication? Ibuprofen, aspirin and paracetamol

Endometriosis

Who? Endometriosis usually affects those aged 25-40 What are the symptoms? Tiredness, pain during and after sex, painful periods How long has the patient had the symptoms? Some sufferers may have symptoms only appear, or worsen, at the time of their menstruation Action already taken? Sufferers may already be treating pain with pain relievers prior to further investigation Medication? Pain relievers including NSAIDs may be effective in reducing pain with paracetamol as an alternative

Menopause

Who? Most commonly affects women aged around 51 What are the symptoms? Hot flushes, vaginal problems, irregular periods How long has the patient had the symptoms? Menopause can multiple pregnancies and childbirths, which cause stretching and damage, being overweight and other chronic conditions. Urge incontinence is often called "overactive bladder": Sufferers have an urgent need to go to the bathroom, and may not get there in time, leaking urine. Overflow incontinence affects those not able to completely empty their bladder when they urinate. As a result, they have a constant or frequent dribble of urine. This is the type of urinary incontinence that most often strikes men. With functional incontinence, physical problems such as athritis or cognitive problems prevent sufferers from getting to the bathroom in time. Anticholinergic and antispasmodic medications are most often prescribed to help with urge incontinence. These drugs relax the bladder muscles to prevent spasms or contractions, and also may increase bladder capacity. These medicines can sometimes cause a dry mouth, blurred vision and constipation, though these are not that common in practice providing one commences the patient on a relatively low dose, allowing them to become accustomed to the treatment before increasing the dose as required. Hormone Replacement Therapy is useful in helping urge incontinence in women after the menopause. It's not particularly effective in stress incontinence There are several incontinence products that might assist the management of urinary incontinence whilst sufferers are waiting to be assessed or waiting for treatment to start. These include absorbent products, such as incontinence pants or pads, hand-held urinals (urine collection bottles), a catheter, devices that are placed into the vagina or urethra to prevent urine leakage. Lifestyle changes should also be recommended such as reducing caffeine intake, drinking 1-1.5 litres (six to eight glasses) of fluid a day and losing weight for those overweight or obese.

begin from the mid to late forties Action already taken? Diet and exercise can help with the symptoms and increased intake of Vitmain D Medication? Hormone Replacement Therapy

Urinary Incontinence Who? Mainly affects women over the age of 40 What are the symptoms? These range from small leaks of urine during periods of activity to bed-wetting How long has the patient had the symptoms? Sufferers may find leakage occurance increasing from occassionally to often Action already taken? Sufferers may already be engaging in pelvif floor exercises to help minimise the problem Medication? Anticholinergic medicines are amongst those available

Cystitis Who? Can occur at any age but mainly pregnant women and those who have been through the menopause What are the symptoms? Pain, burning or stinging during urination and urine that is dark or foul smelling are amongst the symptoms How long has the patient had the symptoms? Symptoms may appear gradually Action already taken? Medication? Paracetamol and ibuprofen can assit with pain symptoms. Antibiotics can be prescribed, Mild cases can often disappear without treatment

WHEN TO REFER TO THE PHARMACIST: > Those who have not managed to control their menstrual pain after three months of treatment > Those whose periods become irregular and/or heavier than usual > NSAIDs are not suitable for people with asthma, or those with stomach, kidney or liver problems > Pregnant or breastfeeding women > Aspirin should not be given to anyone under 16 years of age > Menopause sufferers showing signs of osteoporosis > Those noticing more urine leakage than usual > Men and children with cystitis symptoms > Those who have had cystitis more than 3 times in one year

SELF-CARE AND ADVICE > Those suffering from menstrual pain and cramps may not want to exercise but keeping active can help reduce pain > Applying heat to the stomach area can help to ease pain > Relaxation techniques can help distract from feelings of pain and discomfort > Pelvic floor muscle training can assist those suffering from urinary incontinence > Advise on the benefits of losing weight for the overweight and/or obese

PATIENT SUPPORT The Well Woman Centre | www.wellwomancentre.ie | Tel: 01 660 9860 The Endometriosis Association of Ireland | www.endo.ie Tel: 1 873 5702 The Miscarriage Association of Ireland www.miscarriage.ie | Tel: 0845 070 4636 www.rollercoaster.ie


Recommending a pregnancy and breastfeeding supplement? Many mums and mums-to-be take a multivitamin and mineral supplement – but it’s important they choose the type that’s right for them and their baby. A good supplement contains a suitable combination of essential vitamins and minerals to help mum and the healthy growth of their baby. Some ingredients, such as folic acid, should be taken before conception, while others, such as the essential fatty acid omega 3, are of importance to the developing baby. Here are some of the key micronutrients for pregnant or breastfeeding women: Folic Acid: required for the healthy development of the baby’s spinal cord. Iron: needed for the normal formation of red blood cells and oxygen transport in the body. Calcium: to help maintain strong bones Iodine: contributes to normal brain function and helps release energy from food. Omega 3: contains DHA, which can help babies’ brain and eye development. The beneficial effect is obtained with a daily intake of 200 mg of DHA in addition to the recommended daily intake of omega-3 fatty acids in the diet, that is 250 mg DHA and EPA.

Breastfeeding diet It’s usual to feel hungrier while breastfeeding, so mums should make eating regularly a priority while eating smaller meals more frequently. Not consuming enough calories while breastfeeding may affect the vitamins and nutrients in breast milk, so now is not the time to be cutting out food to lose any extra pregnancy weight. On average, women need about 450 extra calories per day while breastfeeding. This is equivalent to a bowl of soup with two slices of bread, a cheddar cheese and pickle sandwich with a banana or two wholegrain pitta breads filled with lettuce, cucumber and houmous.

Centrum* Pregnancy Care A multivitamin-multimineral containing 19 vitamins and minerals developed by experts to help support the nutritional needs of Mum and Baby. Includes the following micro nutrients: Folic Acid: contains 400 µg as recommended for all women of childbearing age who are sexually active Iron: needed due to the expansion of blood volume Iodine: an important nutrient required during pregnancy. 200 µg is recommended by WHO and UNICEF Beta Carotene: as vitamin A supplementation should be avoided during pregnancy this vitamin A precursor is very important Recommended for use BEFORE and DURING pregnancy Each pack contains 30 film coated tablets * Trade mark


Centrum* Pregnancy Care Plus Omega 3 As Pregnancy Care, a multivitamin-multimineral containing 19 vitamins and minerals with the addition of Omega 3 capsules Omega 3 is a group of essential fatty acids used in many important biological processes. They can not be synthesised in the body and must come from the diet. DHA is the most important Omega 3 and contributes to brain and eye development in unborn and breastfed babies Centrum* uses refined Omega 3 which importantly reduces reflux odours and tastes Recommended for use DURING pregnancy and breastfeeding Each pack contains 30 film coated tablets PLUS 30 Omega 3 capsules

The power of omega-3 Centrum* Pregnancy Care Plus Omega 3 is suitable for use during pregnancy and breastfeeding. Each capsule contains 645 mg of high-purity omega 3 fish oil. This is produced using only sustainable tuna, which contains a high ratio of DHA to EPA. The combination of essential vitamins and minerals will help mum and the healthy growth of her baby.

Seven-point plan Centrum* Pregnancy Care Plus Omega 3 helps to provide these seven health benefits: • A tailored combination of essential vitamins and minerals to help mum and her baby • Contains folic acid, which is necessary for the healthy development of baby’s spinal cord • Zinc is important for the production of DNA • Omega 3 is important for baby’s normal brain and eye development • Calcium, vitamin D and magnesium help maintain strong bones • Iron, vitamin B12 and folic acid help maintain normal blood formation, important for blood supply during pregnancy • Vitamin C helps maintain a healthy immune system Pfizer Consumer Healthcare, Citywest, Dublin 24


Child Health Consultation: Common discussions with parents

Pharmacy assistant: Good morning, can I help you?

Customer: Yes, I hope so. My baby has a temperature and is really bunged up. It’s making her really miserable and she is not sleeping well. I’m not sure if she is teething, has a cold or a bit of both. The symptoms started yesterday, but I haven’t given her any medicine yet.

Parents often worry when their child has a temperature, and they will want to seek reassurance about its likely cause and how to treat it appropriately. Fever in children is a problem that you are likely to be commonly asked about in the pharmacy. This guide will help you recommend suitable products and offer the right advice to each customer.

Calpol Infant Suspension contains the active ingredient paracetamol, which is suitable for treating fever and the symptoms of colds and flu in babies and young children

Pharmacy assistant: Try not to worry. It is very common for young children to get fevers. Would you mind if I ask you a couple of questions. How old is she? Customer: Four months. Pharmacy assistant: What symptoms does she have? Customer: As well as a temperature, she has a runny nose which gets blocked at night. Pharmacy assistant: It sounds as if she has a cold. When children are suffering with a cold they can sometimes have a mild temperature as well as being bunged up.2 If your baby is teething, she might be chewing on her gums. Have you noticed this? Customer: No, she seems fine. Pharmacy assistant: In that case, I think a painkiller should help. Calpol Infant Suspension contains the active ingredient paracetamol, which is suitable for treating fever and the symptoms of colds and flu in babies and young children. It can be used from 2 months so is suitable for your daughter. It will help bring down her temperature and also treat any aches or pains she might have due to the cold. Customer: Ok, I’ll try the Calpol Infant Suspension. Is there anything else you would recommend to ease her congestion? Pharmacy assistant: To help her breathing at night, you could try either a nasal spray or nasal drops. Calpol Soothe and Care Saline Nasal Spray and Saline Nasal Drops both provide natural congestion relief by helping wash away the mucus that can cause a blocked nose. Customer: I think I’ll try the Calpol Soothe & Care Saline Spray too please. [The pharmacy assistant now runs through with the customer the key advice before concluding the consultation.] Pharmacy assistant: Remember to read all the information on the packs and the leaflets inside before using the medicines. This will tell you how much your baby can take and how often. When she has a fever, it is also very important to give her plenty to drink and not to over-heat her.

Fever: A common problem l Fever in children is very common. It can be a sign that the body is fighting an infection1 l A fever helps the body to fight infections by stimulating the immune system1 l A normal temperature is between 36 and 36.8°C (96.8 and 98.24°F). Any temperature above 38°C in children is classified as a fever.3

D


t

Product Options advertisement feature

Discussed and recommended in this consultation From 2 months

From birth CALPOL® Soothe & Care Saline Nasal Spray

CALPOL® Soothe & Care Saline Nasal Drops

CALPOL® Infant Suspension

3 Congestion n

3 Congestion n

caused by colds & flu

caused by colds & flu

post-immunisation fever

3 Allergies, n

3 Allergies, n

including hayfever

including hayfever

3 Sinusitis n

3 Sinusitis n

3 Sore throat n

Non-medicine. Does not contain paracetamol. Suitable from birth.

Non-medicine. Does not contain paracetamol. Suitable from birth.

Paracetamol. Suitable from 2 months, weighing over 4kg and not premature.

3 Fever, including n 3 Aches & pains n 3 Cold & flu n symptoms

References: 1. NHS Choices, Fever in Children available at http://www.nhs.uk/Conditions/feverchildren/Pages/Introduction.aspx Last accessed October 2013 2. HSE Introduction to Cold available at http://www.hse.ie/portal/eng/health/az/C/Cold,-common/ Last accessed October 2013. 3. HSE Introduction to Fever, Childhood available at http://www.hse.ie/portal/eng/health/az/F/Fever,-childhood/ Last accessed October 2013.

Product Name: Calpol 120mg/5ml Infant Oral Suspension. Composition: Calpol Infant Oral Suspension contains 120mg Paracetamol in each 5 ml. Indications: Calpol Infant Oral Suspension is indicated for the treatment of pain (including teething pain), and as an antipyretic. Dosage: Oral. Spoon or syringe dosing device. Infants aged 2-3 months: Postvaccination fever and other causes of pain and fever – if your baby weighs over 4 kg and was born after 37 weeks: 2.5ml. If necessary, after 4-6 hours, give a second 2.5 ml dose. Do not give to babies less than 2 months of age. Do not give more than 2 doses. Leave at least 4 hours between doses. If further doses are needed, talk to your doctor or pharmacist. It is important to shake the bottle for at least 10 seconds before use. Children aged 3 months – 6 years: 3 – 6 months: 2.5ml 4 times a day. 6 – 24 months: 5ml 4 times a day. 2 – 4 years: 7.5ml 4 times a day. 4 – 6 years: 10ml 4 times a day. Contra-indications: Calpol Infant Oral Suspension is contra-indicated in patients with known hypersensitivity to paracetamol, or any of the other components. Special warnings and special precautions: Calpol Infant Suspension should be used with caution in moderate to severe renal impairment or severe hepatic impairment. The label contains the following statements: Store below 25°C. Protect from light. Contains paracetamol. Do not exceed the stated dose. Keep out of reach of children. Do not take more than 4 doses in 24 hours. Dose 4 times a day. Do not repeat doses more frequently than 4 hourly. Do not give for more than 3 days without consulting a doctor. If symptoms persist consult your doctor. If you child is taking any other medicine, consult your doctor or pharmacist before taking this product. Immediate medical advice should be sought in the event of an overdose, even if you feel well. (label). Immediate medical advice should be sought in the event of an overdose, even if you feel well, because of the risk of irreversible liver damage. (leaflet). Do not take with any other paracetamol containing products. The following precautions should be followed when taking this medicine: Do not take with any other paracetamol-containing products. Never give more medicine than shown in the table. Do not give to babies less than 2 months of age. For infants 2-3 months no more than 2 doses should be given. Do not give more than 4 doses in any 24 hour period. Leave at least 4 hours between doses. Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist. As with all medicines, if your child is currently taking any medicine consult your doctor or pharmacist before taking this product. Keep out of reach and sight of children. Undesirable effects: Paracetamol has been widely used and, when taken at the usual recommended dosage, side effects are mild and infrequent and reports of adverse reactions are rare. Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal. Nephrotoxic effects following therapeutic doses of paracetamol are uncommon. Papillary necrosis has been reported after prolonged administration. Adverse effects of paracetamol are rare but hypersensitivity, including anaphylaxis and skin rash may occur. Blood and the lymphatic system disorders: Thrombocytopenic purpura, haemolytic anaemia, agranulocytosis. Hepato-biliary disorders: Anaphylaxis, Chronic hepatic necrosis, liver damage, Nephrotoxic effects. Immune system disorders: Papillary necrosis. Skin and subcutaneous: Skin rashes (with or without itching). Social circumstances: Overdosage. MAH name and address: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24, Ireland. MAH number: PA 823/10/2. Date of revision of text: November 2012. Classification: General sale in child resistant packs containing not more than 60ml of the 120mg/5ml dose form. Retail sale through pharmacy in child resistant packs containing not more than 140ml of the 120mg/5ml dose form. Further information is available upon request from Johnson & Johnson (Ireland) Ltd. IRE/CA/13-0481

No part of this diagnostic aid may be reproduced without the written permission of the publishers: McNeil Products Ltd in association with Training Matters. © 2013 Communications International Group Ltd, Linen Hall, 162-168 Regent Street, London W1B 5TB. Tel: 020 7434 1530.


START HERE

The SMA Product Range

YES

A range to meet the specific nutrition needs of babies and young children.

Is the bottle-fed baby full term?

Does the baby have any diagnosed special nutritional needs?

NO

SMA First Infant Milk From birth

SMA H.A. Infant Milk From birth

SMA Comfort Easy to Digest Infant Milk From birth

YES

SMA SMA SMA Toddler Extra Hungry Follow-on Milk Infant Milk Milk From 1 year From birth From 6 months

For babies with high energy needs

SMA High Energy From birth Prescribable

For babies with significant reflux

SMA Staydown Formula From birth Prescribable

This chart is intended as a guide only and is not a diagnostic tool. For healthcare professional use only. IMPORTANT NOTICE: Breastfeeding is best for babies. You should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant formulae and on all matters of infant feeding. SMA Follow-on Milk is for babies over 6 months, as part of a varied weaning diet. Not intended to replace breastfeeding. These products must be used under medical supervision: SMA Staydown,


MADE IN IRELAND

NO Is the preterm baby receiving breast milk?

YES

SMA Breast Milk Fortifier From birth In hospital

NO

SMA Gold Prem 1 Low birthweight formula From birth In hospital

For babies intolerant to lactose/sucrose

SMA LF Lactose Free From birth Prescribable

SMA Gold Prem 2 Post discharge formula In hospital or at discharge

SMA Gold Prem 2 Post discharge formula For use at home Prescribable

SMA Gold Prem 2 Post discharge formula For use at home Prescribable

For cows’ milk intolerant babies SMA Wysoy Infant Formula From birth Prescribable

SMA LF Lactose Free, SMA High Energy, SMA Breast Milk Fortifier, SMA Gold Prem 1 and SMA Gold Prem 2. For more product information read the label or visit www.smahcp.ie.

For advice and support FREEPHONE

1800 931 832 For more information visit

hcp.ie ZRI 107/10/13


Not everyone has a licence to heal. Unlike some nappy rash creams, Sudocrem Antiseptic Healing Cream is a licensed medicine, which actually treats nappy rash and doesn’t just soothe the symptoms.

CT

OT

ROTE . P

HES .

HEALS

S . SO

Always read the label

For the science bit go to:

www.sudocrem.ie Available from supermarkets & pharmacies nationwide


Baby Health

23

The baby OTC market is varied and covers many topics. Pharmacy staff are ideally placed to educate parents with skills to offer their baby relief from symptoms of minor ailments such as colic, teething, and constipation. Interaction with and giving advice to parents will help reassure them whilst reducing levels of dependency on the pharmacist and wider primary care team.

Nappy Rash Nappy rash is a skin inflammation. A wet or dirty nappy, which has been left touching the skin for too long, is the most common cause of nappy rash. This is especially true of children with diarrhoea. Human waste products can turn into ammonia if the nappy isn't changed for a long time. Nappy rash can occur or worsen when a baby is teething. It is unclear why teething can lead to nappy rash although it is thought that it is due to them producing more saliva. Most nappy rashes are mild or moderate, and are not serious. Occasionally, conditions

WWHAM such as eczema, psoriasis, infections, and some rare skin diseases cause unusual nappy rashes.Nappy rash is very common – most babies will get it at some point. Most common treatments include barrier creams, such as zinc and castor oil. A rash that doesn’t go away or if the baby develops a persistent bright red, moist rash with white or red pimples, which spreads to the folds of the skin, may be a thrush infection. Anti-fungal creams are available for this.

Teething Most babies start teething at around six months. However, all babies are different and the timing of teething varies.Some babies are born with their first teeth. Others start teething before they are four months old, and some after 12 months. Early teething should not cause a child any problems, unless it affects their feeding. Babies and children can vary greatly with the symptoms they can have when they are teething. For many babies, teething leads to mild symptoms that just last a few days. However, for others, teething is painful and

can last much longer. Symptoms of teething often occur a few days (or even weeks) before the tooth comes through the gum. Common symptoms include red and swollen gums, flushed cheek or face, dribbling more than usual and inconsistent feeding. Paracetamol or ibuprofen may help. Teething gels contain a local anaesthetic or mild antiseptic, are safe to use in children and may provide some relief. These should be applied with a clean finger.

Colic: Colic is a common condition in babies. Between one and three out of 10 babies have colic; it affects boys and girls, babies who are breastfed and those who are bottlefed equally. Colic usually starts when baby is a few weeks old. Most babies ‘grow out of it’ by the age of three or four months, or six months at the latest. It’s not known exactly what causes colic, but it usually gets better on its own. However, as a parent or carer, it

can be very upsetting. Several self-care tips may help such as carrying baby in a front sling or backpack, using a baby swing, changing baby’s position by propping him or her up, taking baby for a drive in the car or a walk in the buggy. Simeticone may help to improve the symptoms of colic. It is given as a liquid, which is added to milk. It is used to relieve trapped wind.

Teething Who? All babies but most commonly those from 4 months upwards What are the symptoms? Red and swollen gums, flushed cheeks, excessive dribbling How long has the patient had the symptoms? Symptoms can last from a few days to a few weeks Action already taken? Rubbing the gums with a clean finger prior to applying any medication may help Medication? Paracetamol, inbuprofen and teething gels Colic Who? Boys and girls from a few weeks old What are the symptoms? Excessive crying, pulling their knees up, irritability How long has the patient had the symptoms? Symptoms can last up to six months Action already taken? Propping baby up, walking with them and soothing movements can help Medication? Simeticone can be used to relieve trapped wind

WHEN TO REFER TO THE PHARMACIST: > Babies with a fever, high temperature or diarrhoea > Babies that are particularly difficult to console > Babies experiencing vomiting and/or losing weight

SELF-CARE AND ADVICE > General rubbing over babies gums with a clean, dry finger may help ease teething pain > Letting babies chew on chilled fruit or teething rings may also help >Teething biscuits should be avoided as they contain sugar > Parents should try to create a relaxed atmosphere for themselves, to help cope with colicky babies, who can often pick up on anxiety

PATIENT SUPPORT Breastfeeding.ie www.breastfeeding.ie | Tel: 1 850 24 1850 Women's Health Group www.womenshealth.ie | Tel: 056 779 5302


Infant Colic Drops Tried and trusted relief from colic pain.

Cradle Cap Treatment Shampoo

Dentinox Teething Toothpaste

Many babies suffer from colic at one time or another. Whether they are bottle or breast fed, they're bound to take in a certain amount of air when they feed. This can build up in a baby's immature digestive system, causing distressing pain and prolonged crying.

Cradle cap is very common in babies. Cradle cap is a form of seborrhoeic dermatitis, which can cause a dry, flaky, itchy scalp. It usually appears during the first couple of weeks after birth. The condition is not serious but is unsightly, appearing as scaly patches on the scalp.

Gently cleans baby’s first teeth and soothes sore gums too

With Dentinox® Infant Colic Drops you can help to relieve your baby's discomfort. Just half a teaspoon given with or after the feed will help your baby enjoy feeding without suffering afterwards.

It’s not a problem though. All it takes is a little Dentinox® Cradle Cap Treatment Shampoo massaged gently but firmly over the entire scalp, like a shampoo, to help lift the scaly patches and help to leave the scalp clear.

Dentinox® Infant Colic Drops contain an ingredient called activated dimethicone that gently disperses trapped air bubbles. It is pleasant tasting and can be given to babies from birth onwards. Dentinox® Infant Colic Drops do not contain alcohol

Dentinox Infant Colic Drops: • Gently disperses trapped air • Pleasant tasting & alcohol free • Add to baby's bottle • Suitable from birth

You can use Dentinox Cradle Cap Treatment Shampoo for even the youngest baby although, as with most shampoos, contact with the eyes should be avoided. Dentinox Cradle Cap Treatment Shampoo can also be used as a general shampoo once cradle cap has been treated to maintain the cleanliness and health of your baby's scalp and hair.

Dentinox Cradle Cap Treatment Shampoo: • Helps maintain clean, healthy scalp & hair • Suitable from birth

Contains activated dimeticone. Always read the label.

Always read the label.

About Colic:

About Cradle Cap:

• The cause of colic isn’t known, although eating too much, too fast or swallowing too much air without burping are all thought to be linked to colic. • Colic appears at around two to four weeks of age and can last for three months, or longer in some cases. • A sign of colic is when baby cries loudly, roughly at the same time of day (usually in the evening) and cannot be comforted. Baby pulling his feet up under his body and clenching fists can also be a sign of colic. • It can be helpful to rock baby or massage baby’s stomach with a little almond oil to ease discomfort.

• Cradle cap is a condition of the skin called seborrhoeic dermatitis, which causes a dry, flaky, itchy scalp. • The cause is unknown but the condition is temporary and harmless. Cradle cap is not caused by allergy or lack of hygiene, and is not contagious either. • The affected area can suffer from hair loss. It is important to remember not to pick the plaques off, as this can mean baby loses more hair.

New teeth are a big event for baby and for you, but they can bring problems too. They can be tricky to clean (especially if baby’s reluctant), and their arrival can make baby’s gums sore. Dentinox has the answer new improved Dentinox Teething Toothpaste. It’s a really gentle toothpaste made especially to clean and care for brand new teeth. It comes complete with a unique Fingertip Toothbrush which you wear on your finger to make brushing much easier and more pleasant for baby. And as it cleans, it soothes too. Dentinox Teething Toothpaste contains clove oil, a natural essential oil to help ease the pain of teething.

About Dentinox Teething Toothpaste: • Clove oil to help ease pain • Comes with an easy-to-use fingertip brush • Sugar-free with fluoride • Pleasant tasting • Suitable for babies from 0-2 years

About New Teeth: • Occasionally, children are born with one or more teeth. Other children may not develop any until they are more than a year old. • Six months is a common age for the first tooth to appear. It often pops through in the middle of the bottom gum. • Some babies go through teething with little fuss, while others find it painful. • Most children will have all of their milk teeth by the time they are two and a half years old.


25


Inspired by Breastmilk, Proven by Science with Pronutra+

Aptamil with Pronutra+ Standard Range Aptamil First milk

From birth

• From 0-12 months • Breastmilk substitute if baby is not being breastfed or to complement breastfeeding Available in 70ml ready-to-feed plastic bottle (hospital only product), 200ml plastic bottle, 1 litre plastic bottle and 900g powder EaZypack

Aptamil Hungry milk

For hungrier infants

• From 0-12 months • Casein-dominant milk to delay the early onset of weaning1 Available in 200ml plastic bottle, 1 litre plastic bottle and 900g powder EaZypack

Aptamil Follow On milk

From 6-12 months

• From 6-12 months to complement the weaning diet • With extra iron to meet increasing nutritional needs2 Available in 200ml plastic bottle, 1 litre plastic bottle and 900g powder EaZypack

Aptamil Growing Up milk 1-2 yrs

From 1-2 yrs

• For toddlers from 1-2 yrs as part of a healthy, balanced diet • Contains vitamins A, C and D, which contribute to the normal functioning of the immune system • Contains key nutrients (including iron and vitamin D), helping toddlers reach their daily nutrient requirements3 during these important developmental stages • Nutritionally superior to cows’ milk Available in 200ml plastic bottle, 1 litre plastic bottle and 900g powder EaZypack

Aptamil Growing Up milk 2-3 yrs

From 2-3 yrs

• For toddlers from 2-3 yrs as part of a healthy balanced diet • Nutritionally superior to cows’ milk with 28 key nutrients supporting toddlers’ rapid growth and development. Available in 1 litre plastic bottle and 800g powder EaZypack

Important Notice: Breastfeeding is best for your baby as it is perfectly suited to nourish infants and protect them from illnesses such as ear infections, stomach upsets, diabetes, eczema and obesity. Infant formula is suitable from birth when babies are not breastfed. It is recommended that all formula milks be used on the advice of a doctor, midwife, public health nurse, dietitian, pharmacist or other professional responsible for maternal and child care.

4

All Aptamil standard powdered milks are manufactured manufactured in Ireland

Join Aptamil’s programme for Healthcare Professionals in Ireland For Healthcare Professional Use Only

Go Online at www.aptamilhcp.ie Freephone 1800 22 12 34 Email hcp@aptamil.ie


Inspired by Breastmilk, Proven by Science Foods for Special Medical Purposes (FSMP) Aptamil Comfort

For colic and constipation

• From 0-12 months • Thickened formula for the dietary management of colic and constipation5,6 • 100% whey-based, partially hydrolysed formula • Switching to Aptamil Comfort significantly improves symptoms of digestive discomfort in 95% of infants5 Available in 900g powder EaZypack Suitable for use as a sole source of nutrition from birth, and as part of a balanced diet from around 6-12 months

Aptamil Anti-Reflux

For frequent reflux and regurgitation

• From 0-12 months • Thickened formula for the dietary management of frequent reflux and regurgitation7-9 • Thickened with carob bean gum and clinically proven to reduce regurgitation episodes and severity8 • Contains LCPs (AA and DHA), important for brain, eye and nervous system development10-11 Available in 900g powder EaZypack 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

For Cows’ Milk Protein Allergy (CMPA) The Aptamil Pepti Range • For the dietary management of cows’ milk protein allergy/intolerance12 • 100% whey-based, extensively hydrolysed formula (eHF) • The only range of eHF to contain our unique blend of Prebiotics (GOS/FOS), LCPs, and Nucleotides

For CMPA from birth

For CMPA from 6 months+

Aptamil Pepti 1 • From 0-6 months • Suitable as a sole source of nutrition from birth until 6 months Aptamil Pepti 2 • From 6-24 months • Not suitable as a sole source of nutrition, but as part of a balanced diet from 6 months onwards • With extra calcium and iron to meet increasing nutritional needs2

Important Notice: Food for special medical purposes (FSMP). For the dietary management of specific diseases, disorders, or medical conditions for which the product is intended after full consideration of feeding options, including breastfeeding. Only to be used under medical supervision. For enteral use only. References: 1. Bleakney, G. Infant Feeding Guidelines 2006; EHSSB. 2. Department of Health (1991). Report on Health and Social Subjects No. 41. London: HMSO 01 132 1397 3. Food Safety Authority of Ireland. Recommended Dietary Allowances for Ireland, 1999. 4. AC Nielsen Multiples Data, Volume MAT, January 2013. 5. Savino F et al. Acta Paediatrica Suppl 2003, 441:86-90, 2003. 6. Savino F et al., European Journal of Clinical Nutrition 2006, 1–7. 7. Vandenplas Y et al. Eur J Pediatr 1994;153:419-23. 8. Wenzl TG et al. J Paediatr 2003;111:e355-e9. 9. Grosse K et al. Kinderärztliche Praxis 1998;69:204-10. 10. Koletzko, B et al., J. Perinat Med. 2008; 36(1):5-14. 11. Makrides M et al. Am J Clin Nutr 2000;71(1):120-9. 12. Vandenplas Y et al., Arch. Dis. Child; 2007; 92: 902-908.

For Healthcare Professional Use Only

ML2089-1111

Available in 450g tins. Pharmacy only products. GMS Listed


28

Skin Care

There are many common presenting symptoms within the various skin conditions pharmacy staff will encounter from customers. Knowing the difference and the appropriate treatments to recommend is key.

Acne Acne vulgaris, which is characterised by whiteheads, blackheads, and blemishes, affects almost everyone at some point in their lives. Acne manifests primarily in 80% to 90% of teenagers, but occurs in many adults as well, with women more likely to be affected as adults. The condition is most prevalent among males younger than 16 years and among women older than 23 years. Acne is thought to be caused by a number of factors, and

its development is thought to be greatly influenced by both genetic and hormonal factors. Non-pharmacologic methods for preventing and treating acne include avoiding and/or minimising exacerbating factors, such as restrictive clothing, resting hands on the face and/or skin, using oil-based cosmetics, infrequent washing of oily hair, exposure to environmental factors and picking or squeezing acne lesions. Sufferers of the condition should gently wash the face twice daily to remove excess sebum from the skin. Cleaners with pumice, polyethylene, or aluminum oxide may irritate the skin, producing inflammatory lesions, and should be avoided. In addition, antimicrobial soaps should be avoided. A variety of topical skin care products is available for selftreatment and management of mild to moderate cases of acne. These products are available in a range of formulations, such as medicated cleansing bars and pads, liquids, lotions, creams, gels, foams, and pads or wipes. They typically contain the active ingredients benzoyl peroxide, salicylic acid, or sulfur, either as single-entity products or in combination. Benzoyl peroxide works helps prevent dead skin plugging up hair follicles and kills the bacteria on the skin that can cause plugged follicles to become infected. Benzoyl peroxide is usually available as a cream or gel. It's used either once or twice a day and should be applied 20 minutes after washing to all of the parts affected by acne. Side effects

are usually mild and should pass once the treatment has finished. Most people need a six-week course of treatment to clear most or all of their acne. Salicylic acid is a mild comedoyltic agent that acts as a surface keratolytic. It is a lipidsoluble beta hydroxy acid that may penetrate sebum-plugged pores. Salicylic acid is found in many body washes and cleansers, as well as in topical creams and gels. Generally, the body washes and cleansers are not very effective, because the contact time on the skin is short. Adverse effects include transient stinging or burning of the skin, as well as redness or irritation. Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.It is available as a cream or gel and is also usually applied twice a day. Most people will need to use azelaic acid for a month before their acne will improve. The general goals of treating acne are to prevent or minimise the incidence of pimples and to prevent scarring. Acne can be very common during pregnancy, often more than one out of every two pregnant women can expect to develop acne and in some cases, the acne may be severe. The main cause of acne occurring during pregnancy is the increased hormone levels in the first trimester.The higher level increases the skin's production of natural oils. Those with a higher risk of developing acne whilst they are pregnant are those with a history of acne or have acne flares at the start of their menstrual cycle. Managing acne in pregnant women can be difficult as many prescription and OTC treatments come with high risks. This customer population should always be referred to the pharmacist.

Psoraisis Psoriasis is an inflammatory skin condition which causes rapid multiplication of skin cells leading to abnormal thickening of the outer layers of the skin and scaling. It is not contagious, not infectious and not a result of bad hygiene. Those most at risk of developing or suffering psoriasis are those who have family members with psoriasis, especially if they are exposed to stress, alcoholism, infections,

medical treatment, or events such as divorce, bereavement or moving house.

joints. Psoriatic arthritis primarily occurs in fingers and toes and in rare cases the spine.

Psoriasis affects the skin by the appearance of raised, red lesions covered with a silvery white build up of dead skin cells called scale. It produces itching and pain on different parts of the body more commonly on elbows, knees, scalp, and back.

Between 8 and 9 out of 10 people with psoriasis have chronic plaque psoriasis. The rash is made up of patches on the skin, called plaques. Each plaque usually looks pink or red with overlying flaky, silvery-white scales that feel rough. There is usually a sharp border between the edge of a plaque and normal skin.

Around 6% of the people who have psoriasis also get psoriatic arthritis in the


Skin Care

29

WWHAM

The most common areas affected are over elbows and knees, the scalp, and the lower back. However, plaques may appear anywhere on the skin. But, they do not usually occur on the face. Pustular psoriasis usually just affects the palms of the hands and soles of the feet. In this situation it is sometimes called palmoplantar pustulosis. Affected skin develops crops of pustules, which are small fluid-filled spots. The pustules do not contain germs (bacteria) and are not infectious. Moisturisers or Emollients are substances which help to lubricate and soothe dry, scaly, and inflamed skin. Moisturisers come in lotion, cream and ointment formulations. They work by reducing dryness, scaling, cracking, soreness and itching. They also prepare the plaques for active topical therapies, thus enabling them to work more effectively.

wide variety of skin problems. As a psoriasis treatment, it acts as a scale lifter, helping to soften and remove psoriasis scales. Coal tar can help slow the rapid growth of skin cells and restore the skin's appearance. In addition, it can help reduce the inflammation, itching and scaling of psoriasis. Preparations based on variations of vitamin D (calcipotriol, tacalcitol, and calcitriol) have been introduced. They are helpful, safe and cosmetically acceptable. They are not used during pregnancy and breastfeeding. Treatment is applied either once or twice a day, and can be continued for as long as required. Some Vitamin D analogues are combined with steroid ointments and are used in the short term.

Who? Acne manifests mainly in teenagers, psoriasis occurs predominantly in those with family members suffering from the condition, dry skin can affect all people of all ages What are the symptoms? Acne will present as whiteheads, blackheads and blemishes, psoriasis as red or pink areas of thickened, raised, and scaling skin. Flaking, tight, itchy skin and, on some occasions pain due to cracking will occur in those suffering from dry skin How long has the patient had the symptoms? Teenage acne can last 5-10 years. Patients may have suffered from dry skin throughout their lives. However, during the winter months the symptoms can worsen Action already taken? Patients may already be using moisturisers and avoiding trigger factors Medication? Benzoyl peroxide, salicylic acid, or sulfur are effective in treating acne. Salicylic acid, coal tar and moisturisers are effective in treating psoriasis. Unless dry skin is due to a skin condition, it is advisable for the patient to use over the counter solutions, such as emollients and ointments, to combat their symptoms.

Vitamin A gels that are applied once daily to patches of psoriasis are also available. It should not be used on the face or skin folds or on large areas of the body, where it can cause irritation.

WHEN TO REFER TO THE PHARMACIST:

Dry skin anywhere on the body is uncomfortable and unpleasant to deal with.

preservatives, it is possible that a few people may be sensitive to them.

SELF-CARE AND ADVICE

Patients with dry skin should take special care during the winter months because the combination of cold winds, icy conditions and the drying effects of indoor heating can cause significant skin damage. Dressing properly can provide some protection from harsh weather conditions but certain parts of the body, such as the face will still remain exposed to the elements.

Ointments do not generally contain preservatives. They can be very greasy and some people find them cosmetically unacceptable. However, because they are effective at holding water in the skin, they are useful for very dry and thickened skin conditions.

Salicylic acid is classified as a keratolytic, or peeling agent, and works by causing the outer layer of skin to shed. It is a common and effective treatment for a

Dry skin

Occlusive ingredients in moisturisers provide a protective layer on the skin’s surface to prevent it from losing moisture. Occlusive-based products, such as emollients are generally recommended for use on dry skin.

Lips and hands usually suffer the worst in the winter time. Lips are vulnerable to becoming sore and chapped and hands are prone to becoming dry and flaky. Thick moisturisers, containing shea butter, jojoba butter or avocado oil provide the best protection and should be applied to the skin regularly, and especially before going outside and at bed-time.

Emollients, such as petroleum or shea butter soften and sooth the skin and they also keep it moist and flexible, which prevents cracking. They also increase the skin’s ability to retain moisture and create a protective layer to prevent the skin from dehydrating.

Soap is drying to the skin and is best avoided by people with dry skins. Hands are particularly at risk because they are washed frequently. Liquid soaps or cleansers and perfumed products should be avoided as they tend to irritate the skin even more.

Creams contain a mixture of fat and water and feel light and cool when applied to the skin. For this reason, many people with dry skin prefer to apply creams for day time use. As most creams contain

Emollient soap substitutes do not foam but are just as effective as soap for at cleaning the skin. Soap substitutes can be applied before bathing, showering or washing.

> Those with severe acne and scarring > Those with no improvement or worsening of acne after using OTC acne products

> Factors that should be considered when selecting an acne treatment include the type and severity of the acne, the patient’s level of skin sensitivity, and patient preference > Adherence and patient compliance to treatment are crucial to controlling acne and decreasing the incidence of scarring > Psoriasis sufferers should discover what certain things make their condition worse and try to avoid them > When applying a moisturiser, advise customers to dot it over the required area and then apply with a downward stroking motion in the direction of hairs > The most effective time to apply a moisturiser is straight after a bath or shower, because the skin is warm and absorbs it better

PATIENT SUPPORT The Irish Skin Foundation www.irishskinfoundation.ie Tel: 01 214 7860 My Psoriasis Ireland www.mypsoriasis.ie Tel: 01 490 1606 The Psoriasis Association of Ireland www.psoriasisireland.ie | Tel: 87 204 6789


100% Natural Skin Therapy for Eczema & Psoriasis

Ten - Minute Tutor

Learn about Salcura Your Questions Answered

&

DermaSprayTM Who are Salcura Skin Products for? Eczema  Dry Skin  Rosacea 

ZeodermTM

Psoriasis  Itchy Skin  Hives 

Dermatitis  Urticaria 

What does ‘Natural’ actually mean? ALL Our Products contain ONLY Natural Vitamins and Minerals essential for skin repair and ongoing good health. Salcura skin products contain NO: Parabens  Steroids  Cortisones  Alcohol  Paraffin  Antibiotics  Lanolin  SLS  What will happen Whatwhen will happen What someone will when uses happen someone Salcura when uses skin someone Salcura products? uses skinSalcura products? skin products?

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How do the How products do the work? How products do thework? products work? Salcura DermaSpray™ Salcura DermaSpray™ Salcura DermaSpray™

IMPORTANT NOTE: These time-lines represent an average Salcura customer’s experience. Actual timings may vary from person to person.

Salcura Zeoderm Salcura Zeoderm Salcura Zeoderm

Nourishes new skinNourishes cells in the new base skin Nourishes layers cells in ofnew the base skin cells layersin of the base layers Repairs and of rejuvenates Repairs and rejuvenates Repairs and rejuvenates the skin. These then thegrow skin.through These then the andskin. grow make These through thenand grow make through and make surface skin layers surface when they skin layers surface whenskin theylayers when they for surface skin cells for that surface are healthier skin cells for surface that and are skin healthier cells thatand are healthier and are dry, damaged or arecracked. dry, damagedare or dry, cracked. damaged or cracked. less likely to develop lessinto likely problem to develop less skin.likely into problem to develop skin. into problem skin.

EPIDERMIS

EPIDERMIS

EPIDERMIS

Proderma Limited Martinstown Lodge, Martinstown, The Curragh, County Kildare, Ireland proderma@eircom.net


Real Results from Real Customers Psoriasis

Dermatitis

Eczema

Used the following Salcura Products.

Used the following Salcura Product.

Used the following Salcura Product.

• DermaSpray Intensive

• DermaSpray Intensive

• DermaSpray Gentle

Before this customer suffered from very dry, cracked and irritated hands. Having tried almost everything he very nearly gave up hope of ever finding a product that works.

Before Any parent who cares for an infant with a skin complaint knows what a struggle it can be. From the picture above you can see that this one was no exception.

After around 6 weeks of using Salcura DermaSpray Intensive the condition of this customer’s hands changed remarkably and he now enjoys healthy looking hands.

After Salcura DermaSpray Gentle provided comfort to this child’s life and dramatically reduced the aggravated state of the skin. Life for the parents was also made enjoyable again. This was the result after 3 weeks of use.

Before this nine year old girl suffered terribly with uncomfortable and aggravated skin on her back, face and chest. After conventional treatments failed her parents were forced to seek alternative therapies. After using Salcura DermaSpray Intensive in conjunction with Salcura Zeoderm her skin became clearer, less irritated and more comfortable after 6 weeks of use.

AFTER

AFTER

3

WEEKS

advice line open 9am - 5pm 045

WEEKS

445715

BEFORE

6

BEFORE

BEFORE

6

WEEKS

AFTER

• Salcura Zeoderm


32

Weight Management

According to the World Health Organisation (WHO), overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of their height in metres (kg/m2).

WWHAM Who? Overweight and/or obese people seeking to lose weight What are the symptoms? High BMI How long has the patient had the symptoms? Weight gain may have been gradual or following other conditions such as pregnancy Action already taken? Exercise and a more nutricious programme may already be implemented Medication? Orlistat is available, meal replacements and slimming aids

WHEN TO REFER TO THE PHARMACIST: > Pregnant women or those currently breast-feeding > Those with diabetes, high blood pressure or malabsorption problems

PATIENT SUPPORT > Irish Nutrition and Dietetic Institute www.indi.ie Tel: 01 280 4839

Medication to help with weight loss may be an option for some people who want to lose weight. However, there are no wonder drugs available, and lifestyle changes to improve their diet and increase their physical activity levels are still important. To lose weight and to keep it off, it is vital that customers should be motivated, really want to lose weight, and want to improve aspects of their lifestyle. No weight-loss plan will work unless they have a serious desire to lose weight. There are a number of points to be included when helping someone formulate a plan of action for losing weight, such as: identify the causes that have made the person obese; reiterate why the patient wants to lose weight to emphasise potential benefits; examine what can be done to facilitate weight loss, such as an exercise programme, and; the setting of realistic targets for rate of loss of weight and desired end point. The WHO definition is: • a BMI greater than or equal to 25 is overweight; • a BMI greater than or equal to 30 is obesity. Pharmacy staff are ideally placed to help patients to manage their weight. Counter assistants can encourage life-style modifications and can aid the customer in selecting an appropriate agent considering patient-specific factors. It is important to be sympathetic to patients suffering from this chronic disease. Over-the-counter dietary slimming aids, available without a prescription, that promise easy weight loss are clearly an attractive proposition but counter assistants must be knoweldgeable on their ingredients and indications. There are many weight loss clinics that can be

held within the pharmacy to monitor weight loss and offer support. Attendants can be weighed in the privacy of the consultation room which also offers a one-on-one service for advice on diet and exercise. Slimming aids help people to lose weight in a number of ways: they can help with ‘fat binding’ to reduce the amount of fat that the body absorbs from food or they can make people feel fuller so that they eat less. Meal replacements are also popular, where patients replace some of their usual meals with bars, ‘milkshakes’ or soups that are balanced in calories and nutrients. However, if someone attempts to follow a low-calorie diet (only 1,000-1,600 calories a day) by simply changing the foods they eat without professional advice, they may miss out some of the vital nutrients they need to stay healthy. Advise the dieter about the nutritional aspects of a patient’s weight-loss plan and recommend dietary supplements, if necessary. Orlistat products, being licensed medicinal products, have been assessed for quality, safety and efficacy as part of the licensing process. It reduces the absorption of dietary fat from the intestine. Orlistat should only be used in those with a BMI of 28 or over. Overweight or obese people are at increased risk of heart disease, stroke, some cancers, high cholesterol, type 2 diabetes and raised blood pressure. Seeking weight loss treatments can be an important sign of a commitment to losing weight. Maintaining weight loss will also require behavioural and lifestyle change, and speaking to their local pharmacy staff can be an important opportunity to seek advice and support to achieve these goals and successful weight loss.


Footcare

33

Those suffering from common foot complaints will be looking for straight forward, knowledgeable advice and direction to the best and most appropriate OTC treatments for them.

Fungal nail infection

Fungal nail infection or onychomycosis is the most common of fungal infections. Fungal nail infections may be seen in pharmacy more often in the summer months because the warmer weather is an ideal environment for the fungus to grow. When a nail is damaged, it can be more vulnerable to the infection by bacteria. A mild fungal nail infection will affect a small part of the nail. A smooth pink nail is a healthy nail. However, if the nail becomes yellow or brown in colour, a fungus will have infected the nail plate or, on occasion the nail bed. The nail will also lose its smoothness and ridges may appear. A mild case of fungal nail infection is considered to be on two or less toenails. The nails will not be fully discoloured and the patient will not have had the symptoms for more than two years. If a patient is presenting the symptoms of a mild nail infection, an anti-fungal nail lacquer is to be recommended. The treatment is advised from three or four weeks up to one year depending on the infection.

Foot care

People with problem feet will generally visit their pharmacy for advice first, rather than seeing a podiatrist or a doctor because they know that it will save them time and money. Bunions or hallux valgus is a condition where a bulge appears at the base of the big toe because of a bone deformity,

The lacquer should be continued to be used after the infection has cleared up as a preventative to the infection returning. It can take a toenail up to one year to heal and completely re-grow. Severe nail infections will require an oral anti-fungal medication. Severe nail infections affect several nails, with the nails being completely discoloured and the person will have suffered these for more than two years. If a patient presents with severe nail infection, he or should should be advised to go and visit their GP. It is important that severe or even mild nail infections should be treated because they may spread and cause complete destruction of the nail, which will mean removing it. Laser treatments have become popular in recent years. A laser beam is directed onto the infected nail, which will kill the infection and will allow a new, unaffected nail to regrow. Depending on the infection, this may require several sessions. Patients should be referred to a certified and qualified laser technician if they chose to use this treatment. normally caused by wearing high heels for long periods over years. Bunions are often painful because the joint swells and becomes inflamed. Bunions may also develop as a result of an inherited structural defect, stress on the foot or a medical condition, such as arthritis.

Athletes foot or tinea pedis

Athletes foot or tinea pedis is highly contagious and is, therefore one of the most common fungal infections. It can be contracted through wet floors, socks, wet or damp towels or shoes. The infection can also be spread by the skin of an infected foot touching an uninfected foot. There are several fungi

that cause Athletes Foot trichophyton rubrum and trichophyton mentagrophytes. Trichophyton mentagrophytes is the cause of the most common type of Athletes Foot. Prevention is the best solution because, once a patient has contracted the complaint, they will be more susceptible to infection in the future.

Diabetic foot health

Diabetes can limit the blood supply to the feet and, therefore special care should be taken

because neglect can lead to gangrene and amputation.

Corns and hard skin

Corns and hard skin can be treated with OTC products and, again toenails should be cut regularly. If the skin breaks and a blister appears or the feet swell,

the patient should be referred to their doctor.

WWHAM Fungal nail infection

Who? Adults are more likely to present with the condition, especially those who visit health clubs, gyms and/or swimming pools. What are the symptoms? Yellow or brown nails with ridges on two or less nails. Nails can also become thick. How long has the patient had the symptoms? A nail infection can take up to two years to present itself. Action already taken? Patients may not realise that they have a nail infection so may not have tried to treat it. Medication. Prescription oral anti-fungal medications are available if other overthe-counter medications fail to resolve the issue. Laser treatment is a relatively new treatment for fungal nails.

Footcare

Who? Women who wear high heels on a regular basis or patients who suffer from arthritis are susceptible to bunions. What are the symptoms? A bulging, painful bump at the base of the big toe with swelling and possible thickening of the skin. How long has the patient had the symptoms? The onset of bunions is often gradual and a patient often does not realise that they are developing until they have become severe enough to affect walking comfortably in shoes. Action already taken? Patients may have stopped wearing inappropriate foot-wear or are using padding to reduce the stress. Medication? Acetaminophen or ibuprofen may help control the pain and cortisone injections can also ease the pain. Bunions may be operated on but the operation is not always successful

Athletes foot or tinea pedis

Who? Swimmers or those attending health clubs and gyms are more exposed to the risk of contracting Athletes Foot. What are the symptoms? Itchy red rash (especially between the toes), cracking of the skin on the feet and occasionally blisters will occur and burst. How long has the patient had the symptoms? The patient may have had the symptoms for some time before they present to the pharmacy. Action already taken? Patients may have tried washing their feet every day and making sure that their feet are dry after bathing and avoiding tight shoes or they may have tried to cure the complaint themselves with a non-specific cream or liquid. Medication? Anti-fungal medications are available, such as special creams or liquids, which have been manufactured especially for the relief of the symptoms are available, as are sprays for those areas, which may be hard to reach, such as between the toes. There are also special powders, which can be applied to shoes and socks to prevent the infection spreading. Tablets for more serious infections may be prescribed such as, itraconazole, griseofulvin and terbinafine. Patients should be advised never to walk barefoot and toenails should be cut regularly.

WHEN TO REFER TO THE PHARMACIST: > Those whose foot condition is not improving > Sufferers of persistent foot pain > Decreased movement in the toes or foot

SELF-CARE AND ADVICE > Advise on appropriate footwear and proper hygiene practice > Sufferers of foot conditions can bathe their feet in warm water to prevent infection > To prevent drying and cracking, lotion should be applied to the top and bottom of the feet but not between the toes

PATIENT SUPPORT Diabetes Federation of Ireland (Diabetic foot) | www.diabetes.ie | Tel: 1850 909 909


34

Warts and Veruccas

Warts are small rough lumps on the skin caused by the human papillomavirus, which causes a reaction in the skin. Warts can occur anywhere on the body but occur most commonly on hands and feet. They range in size from 1 mm to over 1 cm.

WWHAM Who? Those aged over 3 What are the symptoms? Warts and veruccas can come in all shapes and sizes but are predominatly a bumpy growth on the hands and feet How long has the patient had the symptoms? Warts and veruccas can last anything from months to two years Action already taken? Sufferers may already be rubbing off dead tissues Medication? Creams containing imiquimod are available as is salicylic acid preperations

WHEN TO REFER TO THE PHARMACIST: > Anyone worried or concerned about a growth on their skin > Those with bleeding warts or those that have changed in appearance > Sufferers with warts that are spreading > Those with diabetes or poor circulation > Those for whom OTC treatment does not work

SELF-CARE AND ADVICE > Advise customers on how to reduce the chance of passing on warts to others through not sharing towels, covering warts and veruccas with a waterproof plaster when swimming and not sharing socks or shoes > Sufferers should not scratch their warts or suck fingers that have warts > Those with veruccas should change their socks daily

Warts are rarely seen on children under the age of three, but after this age they become more frequent. Among children between four and six, 5 to 10% get warts, while 15 to 20% of children between the ages of 16 and 18 have them. The frequency drops drastically again on reaching adulthood. Sometimes only one or two warts develop. Sometimes several occur in the same area of skin. The shape and size of warts vary, and they are sometimes classed by how they look. For example: common warts, plane (flat) warts, filiform (finger-like) warts and mosaic warts. Most warts are harmless and clear up without treatment. The length of treatment will vary from person to person, it may take up to two years for the viral infection to leave someones system and for the wart to disappear. Common wart (verruca vulgaris) These are firm, raised growths with a rough surface, which might look like a very small cauliflower. They are most commonly found on the backs of the hands, fingers, toes and on the knees. Mosaic wart A mosaic wart is usually a number of warts or verrucas packed together in a small area, often on the hands and feet. Filiform wart These are long, slender growths, most often found on the face and neck. Genital warts Genital warts are usually caused by different types of HPV. They usually spread from other parts of the body, or most often, by sexual contact. Warts and verrucas are usually caused by direct skin contact or contact with contaminated surfaces. There are a number of precautions sufferers can follow to prevent warts and veruccas including trying not to touch other people’s warts or verrucas, not sharing towels, shoes or socks with someone who

has a wart or verruca; wearing flip-flops in communal showers and covering warts or verruca with a plaster or glove. Verrucas, like all warts, are caused by a virus that invades the skin through tiny cuts or scrapes. It can take some weeks, or even months, for a verruca to appear once the infection has been caught. This is called the incubation period. The symptoms of verrucas include small, bumpy growths on the soles of the feet, often with a tiny black dot, or dots, on the surface, pain in the soles of the feet when standing or walking and There are various lotions, paints and special plasters that contain salicylic acid. These usually need to be applied each day for up to three months. This acid burns off the top layer. Every few days customers should rub off the dead tissue from the top of the wart, with emery paper. Gradually the wart is burnt off and rubbed away. With the correct and appropriate usage, warts should clear up within three months. Creams containing imiquimod can be applied to sensitive areas of the skin, like your face and genital areas, to get rid of warts. Imiquimod stimulates the immune system to recognise and attack the wart virus. Creams that contain imiquimod or retinoids are prescribed for those that have had no success with other treatments. Quite often, some people may need their warts and verrucas frozen away with liquid nitrogen. Often up to four freezing treatments will be necessary 2 weeks apart before the warts are totally removed. This treatment is not suitable for areas of skin with a poor blood supply or for use in young children. There's a small risk of damage to underlying structures (eg tendons) and scarring. It is a quicker treatment than the corrosive solutions.


Vitamins, Minerals and Supplements

35

Millions take vitamins and dietary supplements hoping to achieve good health, ease illnesses or defy ageing. Recent years have seen a massive boom in supplement use as products that were once the preserve of specialist health food stores have become more widely available, especially in pharmacy. However, the huge range of dietary supplements now available makes the area something of a minefield for consumers. Customers will take supplements for all kinds of reasons, usually relating to their health. They hope these will boost vitality, limit the signs of ageing, extend life, cut the risk of chronic disease such as cancer and treat specific ailments such as arthritis. Supplements are products that contain vitamins, minerals, herbs or plant material and come in pill, capsule, tablet or liquid form. Women are more likely to purchase VMS products than men, as will older people with poor health. Over 50% of children are given vitamins regularly and/or a mineral supplement. The Department of Health & Children recommend specific vitamins for specific groups of people. Vitamin D is recommended for all pregnant and breastfeeding women. Older people also require additional vitamin D and it is recommended for children aged from six months to five years, together with vitamins A and C. Vitamin B9 (more commonly known as folic acid) is recommended for women who are trying to conceive and who are in the first 12 weeks of pregnancy – 400mcg daily is recommended for women at low risk of conceiving a child with neural tube defects and 5mg daily for those at high risk. Some pregnant women might require additional calcium or iron. Vitamin C is the most popular single vitamin supplement. Other supplements that people often turn to when they have a cold include zinc and echinacea. All of these have been found to have antiviral properties in animal or laboratory studies. Researchers have been interested in using vitamin C to prevent and treat colds for more than 60 years. Some animal studies have found that vitamin C strengthens resistance to infections. One theory for this is that the vitamin protects cells against oxidative stress. Vitamin C is not suitable for everyone. It can cause dangerous rises in the blood sugar levels of people with diabetes. It can also be dangerous for people with genetic conditions that cause an excessive build-up of iron in their body, such as haemochromatosis. Large doses may cause nausea, diarrhoea and stomach cramps. Refer to the pharmacist anyone with any medically significant conditions.

Zinc is a trace element that is essential for normal growth. The mineral has been promoted for many years as being able to boost the immune system. Customers purchasing zinc must keep to the recommended dosages. The correct dose is important and there may be side effects including nausea and an unpleasant taste in the mouth, or more serious events such as vomiting, diarrhoea and abdominal pain. Combination products are also growing in popularity, such as combined fish oils and garlic for heart health. In fact, along with multivitamin formulations, products containing fish oils are amongst the highest top-selling supplements in recent years in Ireland. When selecting and displaying a range of VMS supplements, it is always useful to keep in mind the customer base. For example, commuter towns and suburban areas are likely to have a younger population with many new mums and young children. More settled areas will typically have an older customer base. Supermarkets are more likely to stock general VMS items, such as multivitamins, so unless pharmacies can compete on price, they should offer more tailored products to suit their clientele. Pharmacies should also consider merchandising VMS according to complaint or target area, for example heart health, bones, menopause or stress. VMS products should ideally be located next to or near the OTC medicines' section, which should encourage linked sales. ‘Shelf talkers’ and point-of-sale information help to highlight the products and guide the patient to the best product/s for their needs. The VMS category is broad and customers often need help, finding the right product/s for them. Pharmacy staff should understand the evidence regarding the efficacy of supplements and be able to explain this to patients. They must also be up-todate on any new products and formulations and be familiar with the benefits of each item. It is essential that customers feel that they are being recommended the correct VMS for them, not just whichever product is on special offer that particular day.

WWHAM Who? Certain vitamins are recommended for specific patient groups. Keep educated on their target populations What are the symptoms? Take a full symptom and medical history in order to direct the customer to the most appropriate vitamin/ supplement How long have they had the symptoms? N/A Action. Some customers may have already commenced a more balanced and healthy approach to diet and lifestyle, recommend continuation of this to include exercise Medication. A full medication history is essential to ensure the right product is selected for the right customer as many vitamins and supplements can cause side effects if used inappropriately

WHEN TO REFER TO THE PHARMACIST: > Those taking prescribed medications > The elderly > Those with poor kidney/liver function > Pregnant and breast-feeding women

SELF-CARE AND ADVICE > Approriate dietary and nutrition advice should be given > Customers must be educated on the dangers of mixing their VMS products

PATIENT SUPPORT The Food Safety Authority of Ireland www.fsai.ie | Tel: 1 890 336677 HSE www.hse.ie/eng/health/az/V/ Vitamins-minerals-and-supplements/


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Vitamins, Minerals and Supplements Chart

VMS Vitamin / Mineral Source

Indication

Efficacy

Claims

Deficiency: Night blindness; reduced hair growth in children; loss of apetite; dry, rough skin; lowered resistance to infection; dry eyes. Overdose: Headaches; blurred vision; fatigue; diarrhea; irregular periods; joint and bone pain; dry, cracked skin; rashes; loss of hair; vomiting, liver damage

Assists body in ridding environmental pollutants

Vitamin A Retinol Men: 3 000 IU Women: 2 700 IU

Liver, fortified Milk (Retinol form – see below for Carotene sources.)

Eyes ( Night Vision), Skin, Hair, Bones, Teeth, Immune System, Liver, Reproductive Organs, Pregnancy & Lactation

Beta Carotene (Pro-Vitamin A) (See Vitamin A)

Alfalfa sprouts, Avocado, Bannana, Bee pollen, Brocolli, Cayenne pepper, Carrots Yellow orange fruit, Garlic, Squash, Broccoli, Green & Yellow Vegetables

Antioxidant. Converted to Vitamin A in the body. (See Vitamin A)

Vitamin D Men: 100 IU Women: 100 IU

Egg Yolk, Milk, Exposure to sun enables body to make its own Vitamin D., Cod liver Oil, Salmon, seeds, lemongrass, dandelion root, alfalfa sprouts, avocado, garlic, greens leafy

Teeth & Bones - Immunity - Enhances calcium & phosphorus absorption Regulates mineral absorption - Stabilizes nervous system & heart - Normal blood clotting

Deficiency: Rickets in children; bone softening in adults; osteoporosis Overdose: Calcium deposits in organs; fragile bones; renal and cardiovascular damage.

Vitamin E Men: 9-10 mg Women: 6-7 mg

Corn or Cottonseed Oil, Butter, Brown Rice, Soybean Oil, Vegetable oils such as Corn, Cottonseed or Soybean, Nuts Wheat Germ.

Antioxidant. Helps form red blood cells, muscles and other tissues. Preserves fatty acids. - Reproduction - Lacation - RBC protection - Wounds - Prevention blood clots

Deficiency: Rare, seen primarily in premature or low birth weight babies or children who do not absorb fat properly. Causes nerve abnormalities. Overdose: Unknown.

Vitamin K None established. Estimated at 0.03 mcg/kg

Green Vegetables, Liver, also made by intestinal bacteria.

Needed for normal blood clotting.

Deficiency: Defective blood coagulation. Overdose: Jaundice in infants.

Thiamine Vitamin B1 Men: 0.8 – 1.3 mg Women: 0.8 mg

Sunflower Seeds, Pork, whole and enriched Grains, dried Beans., kelp, dates, garlic, parsley, wild rice, watercress, wheatgrass

Carbohydrate metabolism - Muscle coordination. - Proper nerve function. - VIP consistent growth in children - Helps with Stress - Stabilizes appetite by improving digestion and assimilation of nutrients - Fertility & Lactation - Provides Energy Mental attitude , focus & concentration

Deficiency: Anxiety; hysteria; depression; muscle cramps; loss of appetite; in extreme cases beriberi (mostly in alcoholics).Overdose: Unknown, although excess of one B vitamin may cause deficiency of others.

Riboflavin Vitamin B2 Men: 1.3 – 1.6 mg Women: 1.1 mg

Liver, Milk, Spinach, enriched Noodles, Mushrooms., alfalfa sprouts, apple , apricot, avocado, dates, figs, garlic, kelp, parsley, wild rice rosehips, seeds

Needed for metabolism of all foods and the release of energy to cells. Essential to the functioning of Vitamin B6 and Niacin. - RBCs & antibodies - Vision - Skin, nails , hair - Stress

Deficiency: Cracks and sores around the mouth and nose; visual problems. Overdose: See Vitamin B1

Niacin Vitamin B3 Men: 16-23 mg Women: 14-16 mg Niacin is converted to niacinamide in the body.

Mushrooms, Bran, Tuna, Chicken, Beef, Peanuts, enriched Grains., rice brown, wild , alfalfa, almonds, apricots, chamomile, figs, garlic, nuts

Needed in many enzymes that convert food to energy. Helps maintain a healthy digestive tract and nervous system. In very large doses, lower cholesterol (large doses should only be taken under the advice of a physician)

Deficiency: In extreme cases, pellagra, a disease characterized by dermatitis, diarrhea and mouth sores. Overdose: Hot flashes; ulcers; liver disorders; high blood sugar and uric acid; cardiac arrythmias

Pantothenic Acid Vitamin B5 Men: 2.5 mg Women: 2.5 mg

Abundant in animal tissues, whole grain cereals and legumes., alfalfa, almonds, avocado, broccoli, honey faw, oats, oranges, peas, seeds, soybeans, walnuts

Converts food to molecular forms. Needed to manufacture adrenal hormones and chemicals that regulate nerve function. Wounds - Adrenals - Produced in the body by the beneficial bacteria in the intestines

Deficiency: Unclear in humans. Overdose: See Vitamin B

Vitamin B6 Pyridoxine Men: 1.8 mg Women: 1.5 m

Animal protein foods, Spinach, Broccoli, Bananas, alfalfa, bell pepper, beets, cantaloupe, greens, lemon, nuts,peas, sprouts, veggies green

Protein metabolism and absorption Carbohydrate metabolism. - Helps form red blood cells. - Promotes nerve and brain function. - Skin , Teeth, muscles , nerves - Antibodies, RBCs - Balance of Sodium & Phosphorus, - Balance of Sodium & Potassium

Deficiency: Anemia, irritability, patches of itchy, scaling skin; convulsions.Overdose: Nerve damage.

The antioxidant properties of this nutrient may be a factor in reducing the risk of certain forms of cancer.

The antioxidant properties of this nutrient may be a factor in reducing the risk of certain forms of cancer


Vitamins, Minerals and Supplements Chart

37

Vitamin / Mineral Source

Indication

Efficacy

Vitamin B12 Cyanocobalamin Men: 2 mcg Women: 2 mcg

Found almost exclusively in animal products, alfalfa, beans, dulse, garlic, Korean, Siberian ginseng, klep, nuts, seeds,

Builds genetic material. Helps form red blood cells. - Growth - Energy - RBC s Concentration, memory , balance

Deficiency: Pernicious anemia; nerve damage. (Note: Deficiency rare except in strict vegetarians, the elderly or people with malabsorption disorders.) Overdose: See Vitamin B1.

Biotin 60 mcg

Cheese, Egg, Yolk, Cauliflower, Peanut Butter, alfalfa sprouts, banana , beans, fruits, grains, nuts ,brown rice, seeds, soybeans

Needed for metabolism of glucose and formation of certain fatty acids. Essential for proper body chemistry. - Formation RNA & DNA - Food into energy - Prevent exhaustion - Muscle pain - Helps prevent baldness

Deficiency:Seborrhic dermatitis in infants. Rare in adults, but can be induced by consuming large amounts of egg whites – anorexia, nausea, vomiting, dry scaly skin. Overdose: See Vitamin B1

Folic Acid (Folacin) Men: 180-220 mg Women: 160-190 mg

Green, leafy vegetables, Orange Juice, organ Meats, Sprouts

Essential for the manufacture of genetic material as well as protein metabolism and red blood cell formation - Brain Function RBCs - Circulation

Deficiency: Impaired cell division; anemia; diarrhea; gastrointestinal upsets.Overdose: Convulsions in epileptics. May mask pernicious anemia (see Vitamin B12 deficiency).

Adequate amounts of this nutrient in the first stage of pregnancy may reduce the risks of neural tube birth defects.

Vitamin C Ascorbic Acid Men: 40 mg Women: 30 mg

Citrus Fruits, Strawberries, Broccoli, Green Peppers

Antioxidant. Helps bind cells together and strengthens blood vessel walls. Helps maintain healthy gums. Aids in the absorption of iron. - Collagen, Connective Tissue - Bones, Teeth, - Natural laxative Formation of adrenalin

Deficiency: Muscle weakness, bleeding gums; easy bruising. In extreme cases, scurvy. Overdose: Loose bowls

The antioxidant properties of this nutrient may be a factor in reducing the risk of certain forms of cancer. May reduce the effects of the common cold.

Calcium Men: 800 – 1000 m Women: 700-800 mg

Milk, Yogurt, Cheese, Sardines, Broccoli, Turnip Greens

Bones & Teeth - Muscle & Nerve Function Blood Clotting - Activates enzymes needed to convert food to energy

Deficiency: Muscle cramps, Brain function, Rickets in children; osteomalacia (soft bones) and osteoporosis in adults. Overdose: Constipation, Kidney Stones, calcium deposits in body tissues. Hinders absorption of iron and other minerals.

Chromium

Beets, cardamom, cloves, dulse, garlic, kelp, mushrooms, wheatgrass, onions

Glucose to Energy - Metabolism of amino acids ( building blocks of proteins) and fats

Deficiency: Glucose intolerance or insulin resistance hyperglycemia Raised serum lipids & weight changes Overdose: Hinders body’s absorption of calcium.

Copper 2-3 mg

Liver and other organ Meats, Seafoods, Nuts and Seeds., pomegranates, prunes, green veggies , parslety , peas, raisins, grains, almonds , avocado

Proteins involved in growth - Nerve function - Energy release - Enzymes for Iron metabolism ( ceruplasmin ( ferroxidase I) and ferroxidase II - Antioxidant - Regulation of gene expression. Component of several enzymes, including on needed to make skin, hair and other pigments. Stimulates iron absorption. - Needed to make red blood cells, connective tissue and nerve fibres.

Deficiency: Anemia that is unresponsive to iron therapy but corrected by copper - Low WBC’s thus lower immunity Rare in adults. Infants may develop a type of anemia marked by abnormal development of bones, nerve tissue and lungs. Overdose: Liver disease; vomiting; diarrhea

Iron (Elemental) Men: 8-10 mg Women: 8-13 mg

Liver, lean Meats, Kidney beans, enriched Bread, Raisins., alfalfa sprouts, almonds, apricot, asparagus, beets, cherries, dates, figs, grains, grteens, lentils , parsley, peacans, pistachio nuts, seeds, swiss chard, walnut Note: Oxalic acid in spinach hinders iron absorption.

Essential for making hemoglobin, the red substance in blood that carries oxygen to body cells - Most iron is stored in bone marrow that makes blood cells - If there is not enough in the body , it goes to the bone marrow reserves. If this iron stored in the bone marrow is low, RBCs don’t form properly, they are smaller than usual (microcytosis) and fewer

Deficiency: Skin pallor; weakness; fatigue; headaches; shortness of breath, difficulty concentrating, brittle nails, cracked lips Overdose: Constipation Type II diabetes ( J of A Medical Assn) Toxic buildup in liver and in rare instances the heart

Magnesium Men: 230 – 250 mg Women: 200 – 210 mg

Spinach, Beef Greens, Broccoli, Tofu, Popcorn, Cashews, Wheat Bran,

Activates enzymes needed to release energy in body. Needed by cells for genetic material and bone growth. - Low calcium - Low serum potassium - Retention of sodium - Low circulating levels of parathyroid hormone - Muscular tremors, spasms - Loss of appetite, nausea, vomiting, personality changes - Alkalinity Lung & Brain Function - Aids digestion

Nausea, irritability, muscle weakness; twitching; cramps, cardiac arrhythmias. Overdose: Nausea, vomiting, low blood pressure, nervous system disorders.Warning: Overdose can be fatal to people with kidney disease.

Manganese 2-5 mg

Tea, whole Grains and Cereal products are the richest dietary sources. Adequate amounts are found in Fruits and Vegetables. coconut, dates, figs, beets, avocado, honey raw,

Antioxidant. Interacts with Vitamin E to prevent breakdown of fats and body chemicals -

Deficiency: Impaired growth, reproduction, skeletal system, glucose tolerance, altered carbohydrate and lipid metabolism Overdose: Caution may be toxic at high doses Generally results from inhalation of manganese containing dust or fumes, not dietary ingestion.

Acid neutralizer - Proper fx of muscles and nerves - Prevents clotting - Enhances digestion

Deficiency: Maybe related to low blood pressure Overdose: May elevate blood pressure

Sodium

Claims

Antioxidant


Interdental brushes for every need

Angled or straight brush head, long or short handle, TePe’s range of interdental brushes are the easy-to-use alternative to dental floss. Why should your pharmacy stock Tepe? • TePe is promoted to dental professionals who assist in driving demand through pharmacy • Expect significant profitability and turnover from a small shelf space • Retail sales of TePe are regularly within the top 3 oral care lines • The brand is supported with significant consumer advertising

All our interdental brushes are sold as retail-ready blister packs (6 brushes per pack)

FAQs for Counter Staff What is Interdental cleaning? Interdental cleaning is the removal of plaque and impacted food from between the teeth, which cannot be reached by regular toothbrushes. Cleaning with an interdental brush prevents gum inflammation, cavities and bad breath. TePe Brushes are also suitable for use on dental appliances, crowns, bridges and implants.

How do I sell my customers the correct size brush? Ideally, a dental professional will advise on the correct size. More than one brush size may be required and the Interdental Brush Mixed Pack is the ideal, cost-effective way for customers to trial different size interdental brushes.

FREE TePe Angle™ Sample To receive your free sample:

Approximately 1 week, or when the bristles become worn or the wire distorted.

• Visit: tepe.com/uk/ product-requestpharmacy and use code IPA11a

What is the correct way to use a TePe Interdental Brush?

• Or, use the QR code below.

How long do brushes last?

The brush should be inserted in the space between teeth at gum level, turning slightly; once inserted, a gentle movement of the brush backwards and forwards is sufficient for the removal of plaque and debris. The brush should be rinsed in clean water during and after use. To order consumer leaflets, please email: infoUK@tepe.com or call +44 (0) 1934 710022. For more information, search the web: ‘TePeUK’


Oral Care

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Good oral care is essential and there is a plethora of products available in pharmacy, as well as OTC treatments for some of the most common presenting problems.

WWHAM

Gingivitis Gingivitis is a form of periodontal disease. Periodontal disease is the inflammation and infection that destroys the tissues, such as the gums, ligaments and the tooth sockets, which support the teeth. This is caused by a build-up of plaque over periods of time and is caused by poor dental hygiene, undiagnosed diabetes or a poor diet. The disease can often remain silent for many years and will only present itself when the gums become swollen or bleed. Gum disease can result in teeth loss. Patients who smoke or suffer from diabetes are at a higher risk of developing the disease. If a patient presents with symptoms of gingivitis, they

should have their teeth professionally cleaned and they should also be advised to practice good oral hygiene. In order to prevent a build-up of plaque, toothbrushes or water irrigation devices can be advised, along with anti-bacterial mouthwashes and anti-plaque or anti-tartar toothpastes. Soft bristle brushes should be used and the recommended time for cleaning the teeth is two minutes. Interdental brushes in particular can help by getting rid of pieces of food and plaque from between the teeth. Interdental brushes have small bristled heads available in different widths to suit the sizes of the gaps between individual teeth.

Gingivitis

as eating, drinking, oral hygiene, sleeping and the effect that these activities have on saliva flow. Mouthwashes will reduce halitosis, due to the anti-microbial influences of the products.

Xerostomia

Halitosis Halitosis or bad breath can be caused by excessive amounts of volatile sulphur compounds (VSCs) being produced by bacteria in the mouth. This can be influenced by any number of factors, such

Xerostomia Xerostomia or dry mouth occurs due to a reduction or absence in the flow or saliva. Xerostomia is not a disease per se but it may be a symptom of various medical conditions, such as a side effect of radiation to the head and neck or as a side effect to different medications. It is more common in older adults. Some common complications associated with xerostomia include a constant sore throat, a burning sensation in the mouth,

difficulty speaking and swallowing, hoarseness and dry nasal passages. Patients who present with the symptoms of xerostomia should be advised to perform daily selfexaminations of their mouth for ulcers and/or sores and possible signs of tooth decay. Soft bristled toothbrushes and mildly flavoured, lowabrasive fluoride toothpastes are recommended to minimise the pain.

Who? Adults are more likely to present to the pharmacy with gingivitis, especially smokers, those with a poor diet and some experts believe women on some of the contraceptive pills may be extra-susceptible. What are the symptoms? Swollen or bleeding gums How long has the patient had the symptoms? Gingivitis can be present for years without the patient knowing. Actions already taken? Patients may have already attended their dentist and are looking for pharmacy over-the-counter solutions. Medication. Soft brushes and anti bacterial mouthwashes and toothpastes are advised.

Halitosis Who? People, who have poor oral hygiene. The problem can affect anyone of any age. What are the symptoms? Bad breath How long has the patient had the symptoms? If the patient has persistent bad breath that cannot be resolved, it may be a symptom of another condition. A referral should be made to a doctor, dentist or health hygienist. Medication. Anti bacterial mouth washes and better dental hygiene. Who? Older patients or as a result of certain medicines or those who have received radiotherapy. What are the symptoms? Sore throat, difficulty speaking or swallowing and a burning sensation in the mouth. How long have they had the symptoms? The duration depends on the cause. Action. Patients should be sipping water regularly and avoiding cigarettes and alcohol. They should also ensure that their bedroom does not become dry. Medication. At present, there is not a cure for xerostomia

WHEN TO REFER TO THE PHARMACIST: > Diabetic patients and those with heart disease > Those with unexplained swelling > Gingivitis not responding to usual oral hygiene measures > Unexplained red and white patches

SELF-CARE AND ADVICE > Advise on the benefits of giving up smoking > Offer tips and guidance on proper teeth brushing, flossing and the use of mouthwashes > Foods and confectionary containing free sugars should be minimised and restricted to meal times. > Cheese may actively protect against caries and is a good highenergy source for toddlers. > Sugar substitutes are better for teeth than free sugars but advise on the possible salt content and additives used

PATIENT SUPPORT The Dental Health Foundation| www.dentalhealth.ie Tel: 1 672 8870


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Arthritis

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It is estimated that arthritis affects 70% of over 65s in Ireland. Arthritis translates to inflammation of the joints. Most people with arthritis will experience pain and difficulty moving around. Arthritis is not just a disease of older people – it can affect people of all ages, including children. It is not clear what causes arthritis and there is no cure at present. However, there is plenty that can be done to manage the condition.

The overall occurrence of RA is two to four times greater in women than men. The peak age of incidence for both genders is the 70s, but people of all ages can develop the disease.

There are over 200 kinds of rheumatic diseases – the word rheumatic means aches and pains in joints, bones and muscles. Two of the most common forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis(RA).

Symptoms of rheumatoid arthritis usually develop gradually. Often they are first felt in small joints, such as the fingers and toes, although shoulders and knees can also be affected early, and muscle stiffness can be a prominent early feature.

In people affected by osteoarthritis, the cartilage (connective tissue) between their bones gradually wastes away, leading to painful rubbing of bone on bone in the joints. The most frequently affected joints are in the hands, spine, knees and hips.

The symptoms of rheumatoid arthritis vary from person to person. They can come and go, and may change over time. Sufferers will occasionally experience flare-ups when the condition will deteriorate and the symptoms will be more intense and severe.

Osteoarthritis often develops in people who are over 50 years of age. However, it can develop at any age as a result of an injury or another jointrelated condition.

There is good evidence that early treatment and support can reduce joint damage and limit the impact of rheumatoid arthritis. Lifestyle changes, drug and non-drug treatments and surgery can all help reduce the negative effects of rheumatoid arthritis.

Medication can help relieve the symptoms of arthritis. In severe cases, surgery may be recommended. For osteoarthritis, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are available. Rheumatoid arthritis (RA) is an inflammatory disease. It largely affects synovial joints, which are lined with a specialised tissue called synovium. Rheumatoid arthritis typically affects the small joints of the hands and the feet, and usually both sides equally and symmetrically, although any synovial joint can be affected. It is a systemic disease and so can affect the whole body, including the heart, lungs and eyes.

ARTHRITIS CAN BE A DEBILITATING CONDITION

Painkillers reduce pain rather than inflammation and are used to control the symptoms of rheumatoid arthritis. The most commonly prescribed is paracetamol whilst codeine is sometimes given as a combined medicine. Non-steroidal anti-inflammatory drug (NSAID) can be used to relieve pain and swelling in the joints. There are two types of NSAIDs and they work in slightly different ways. These are traditional NSAIDs – such as ibuprofen, naproxen or diclofenac and COX-2 inhibitors (often called coxibs) – such as celecoxib or etoricoxib. NSAIDs help relieve pain and stiffness while also reducing inflammation. However, they will not slow down the progression of rheumatoid arthritis. Corticosteroids help reduce pain, stiffness and swelling. They can be used as a tablet or an injection into the muscle. They are usually used when NSAIDs fail to provide relief. Corticosteroids are usually only used on a short-term basis, as long-term use of corticosteroids can have serious side effects. Although arthritis is often associated with older people, it can sometimes affect children. Most types of childhood arthritis are referred to as juvenile idiopathic arthritis (JIA). JIA causes pain and inflammation in one or more joints for at least six weeks. Although the exact cause of JIA is unknown, the symptoms often improve as a child gets older, allowing them to lead a normal life. It is important for pharmacies to be aware of the layout and placement of products. Simple things, such as placing arthritis-specific products at eye level can make a big difference to an arthritis patient's shopping experience.

WWHAM Who? Mainly those over the age of 65 for rheumatoid arthritis and those over 50 for osteoarthritis What are the symptoms? Pain and stiffness in the joints How long has the patient had the symptoms? These may appear gradually or flare up suddenly Action already taken? Lifestyle changes can help reduce negative effects Medication? Analgesics, NSAIDs, corticosteroids are available

WHEN TO REFER TO THE PHARMACIST: > Those suffering with persistent pain (from, for example, joint damage or other soft tissue cause) > Those with worsening joint function > Progressive deformity > Persistent localised synovitis

SELF-CARE AND ADVICE > RA patients should have easy access to physiotherapy, occupational therapy, psychological services and podiatry > Exercise has been found to reduce bone loss in premenopausal women with RA > A Mediterranean diet should be encouraged (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on vegetable and plant oils)

PATIENT SUPPORT Arthritis Ireland www.arthritisireland.ie Tel: 01 661 8188


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Available in regular & extra large size – ideal for backs

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Pain relieving heat for muscular pain & backache


Analgesics

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When visitors to the pharmacy are suffering from painful joints, muscle ache and other types of pain, topical pain killers may offer relief. Pain is the most common reason for people to seek medical advice, pain medicine is the most frequently purchased over-the-counter (OTC) medication. Acute pain is experienced by everyone; it is usually short in duration with an identifiable pathology, a predictable prognosis, and treatment that usually includes analgesics. Acute pain from such injuries can respond well to OTC pain medication. Muscle soreness also may respond well to heat and massage. Patients will often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders. These products may have local analgesic, anesthetic, antipruritic, and/or counterirritant effects. The successful drug management of pain relies on selecting the appropriate drug at the correct dosage and balancing efficacy against adverse effects. For this reason, the World Health Organisation introduced the concept of the analgesic ladder. The ladder advocates a stepped approach to the use of painkillers from these analgesic groups: • Simple analgesics i.e. paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) • Weak opioids i.e. tramadol, codeine • Strong opioids i.e. morphine, fentanyl, oxycodone, pethidine • Adjuvants - adjuvant analgesics are drugs which were not originally for pain but rather for other conditions but have been found to be effective in difficult to manage pain, particularly neuropathic pain. They are a diverse group of drugs that includes antidepressants, anticonvulsants (antiseizure drugs), and others. At every step of the analgesic ladder non-opioid analgesics form the basis of the pain management. Paracetamol and NSAID (if not contraindicated) should always therefore be prescribed with opioid analgesia (weak or strong). Counterirritants are approved for the topical treatment of minor aches and pains of muscles and joints. They are often employed for the treatment of acute musculoskeletal injuries and as an adjunct therapy in the treatment of chronic musculoskeletal disorders. Counterirritants differ from other external analgesics in that pain relief results more from nerve stimulation than depression. Topical pain killers, or analgesics, are sprayed on or rubbed into the skin over painful muscles or joints. Although are all designed to relieve pain, different products use different ingredients. Ingredients such as menthol, methylsalicylate, and camphor are called counterirritants because they create a burning or cooling sensation that

distracts the mind from the pain. Salicylates: These same ingredients that give aspirin its pain-relieving quality are found in some creams. When absorbed into the skin, they may help with pain, particularly in joints close to the skin, such as the fingers, knees, and elbows. Capsaicin: The main ingredient of hot chili peppers, capsaicin is also one of the most effective ingredients for topical pain relief. When first applied, capsaicin creams cause a warm tingling or burning sensation. These creams may need to be applied for a few days up to a couple of weeks before users will notice relief from pain. Benzocaine is a topical analgesic that has a number of different uses. Depending on the dose and form, the active ingredient benzocaine can be used to relieve throat and mouth pain; to alleviate external vaginal itching and burning; to stop pain and itching due to hemorrhoids; or to relieve minor skin irritations, pain, and itching. Benzocaine can be the only active ingredient in oral treatments that relieve sore throat or address mouth pain caused by cold sores, canker sores, teething, and other issues. It also can be combined with other active ingredients in oral treatments that not only relieve mouth and throat pain, but also protect irritated areas, provide a soothing coating, or relieve dryness. Hydrocortisone is a corticosteroid that temporarily relieves external itching associated with minor skin irritations, inflammation, and rashes. It may be written as hydrocortisone or hydrocortisone acetate, but these are different forms of the same active ingredient. Hydrocortisone can be the only ingredient in a topical pain reliever (meaning products, such as creams and ointments, used on the body surface) and it can be found in single active ingredient topical medicines that are also labeled to treat anal itching. It is important to get to the root of what’s causing the pain suffered by a customer, how long they have had the pain, what triggered it, for example. Then pharmacy staff can advise on what the best analgesic solution is and also offer lifestyle advice. Many common conditions cause oral pain or discomfort such as toothaches; tooth sensitivity; teething; minor oral mucosal injury or irritation and oral mucosal disorders. There are OTC products available for the selftreatment of each of these sources of oral pain and discomfort, including topical analgesics/anesthetics, toothpastes formulated for sensitive teeth, artificial saliva products for dry mouth, and oral mucosal protectants, as well as products that provide treatment of and relief from pain due to cold sores.

WWHAM Who? Anyone suffering from pain including muscular and oral pain What are the symptoms? Chronic pain is defined as pain still present after three months How long has the patient had the symptoms? Pain can appear suddenly or have been present for a prolonged periof Action already taken? Sufferers may already be avoiding trigger factors, or using heat wraps for muscle pain Medication? Medication is available in creams, sprays, lotions and heat wraps

WHEN TO REFER TO THE PHARMACIST: > Those showing signs of depression as a result of pain experienced > Those whose symptoms get more severe, or do not respond to OTC treatment

SELF-CARE AND ADVICE > Advise customers to always follow directions carefully > Analgesics should never be applied to wounds or damaged skin > Analgesics should not be used under a tight bandage > Those using analgesics should always wash their hands well after using them and avoid touching their eyes with the product on their hands


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Benylin Phlegm Cough Menthol PA 823/66/1. MAH: McNeil Healthcare (Ireland) Ltd., Airton Rd, Tallaght, Dublin 24, Ireland. Benylin Phlegm Cough & Cold Multi Relief Tablets PA 1120/1/1. MAH: Wrafton Laboratories Limited (T/A Perrigo), Braunton, Devon, EX33 2DL, UK.Products not subject to medical prescription. Further information available upon request. Benylin Phlegm Cough Menthol PA 823/66/1. MAH: McNeil Healthcare (Ireland) Ltd., Airton Rd, Tallaght, Dublin 24, Ireland. Benylin Phlegm Cough & Cold Multi Relief Tablets PA 1120/1/1. MAH: Wrafton Benylin Phlegm Cough Menthol PA 823/66/1. MAH: McNeil Healthcare (Ireland) Ltd., Airton Rd, Tallaght, Dublin 24, Ireland. Benylin Phlegm Cough & Cold Multi Relief Tablets PA 1120/1/1. MAH: Wrafton Laboratories Limited (T/A Perrigo), Braunton, Devon, EX33 2DL, UK.Products not subject to medical prescription. Further information available upon request. Laboratories Limited (T/A Perrigo), Braunton, Devon, EX33 2DL, UK.Products not subject to medical prescription. Further information available upon request. IRE/BE/13-0505

IRE/BE/13-0505 IRE/BE/13-0505


Cold and flu

45

Although there is no cure for the common cold, a quick scan of pharmacy shelves reveals a host of nonprescription products formulated to manage and treat its symptoms. Pharmacy staff are in a pivotal position to assist patients in the selection and proper use of these OTC products, and can provide patients with updates and changes regarding the products on the market. Influenza season typically occurs between October and May, with the peak of the flu season occurring between late December and March. Cold and flu share many of the same symptoms, such as sneezing, cough and sore throat but they are caused by different viruses. Some sufferers need extra care and attention as they are more at risk of serious infection such as bronchitis and pneumonia, especially those over the age of 65, those with serious heart conditions and those with kidney/liver disease. Cold symptoms usually begin with a sore throat, which usually goes away after a day or two. Nasal symptoms, runny nose, and congestion follow, along with a cough by the fourth and fifth days. Fever is uncommon in adults, but a slight fever is possible. Children are more likely to have a fever with a cold. Cold symptoms usually last for about a week. During the first three days that someone has cold symptoms, they are contagious. Flu symptoms are usually more severe than cold symptoms and come on quickly. Symptoms of flu include sore throat, fever, headache, muscle aches and soreness, congestion, and cough. Swine flu in particular is also associated with vomiting and diarrhoea. Most flu symptoms gradually improve over two to five days, but it's not uncommon for sufferers to feel run down for a week or more. Just like cold viruses, flu viruses enter the body through the mucous membranes of the nose, eyes, or mouth. Frequent washing can help prevent both flu and cold symptoms. Decongestants, antihistamines, expectorants, cough suppressants, and antipyretics/analgesics can help patients manage their cold and flu symptoms. Cough, cold, and flu products are available in many dosage forms, including liquids; tablets; caplets and capsules; orally disintegrating tablets; soft chews; nasal swabs, strips, and sprays; topical vapor patches; and dissolvable medicated strips. Many of these formulations provide convenient administration, accurate dosing, and easy-to-use drug delivery systems. Factors to consider when selecting products include the patient’s symptoms, medical conditions, allergy history, and current drug regimen, as well as lifestyle and personal preferences. Products formulated for the diabetic patient population are free of sugar, alcohol, dextrose, sucrose, sorbitol, sodium, fructose, glycerin, and dyes. Nasal decongestants narrow the blood vessels in the nose, thereby preventing fluid from leaking and the lining from swelling. These can be used for short-term relief in older children and adults. Analgesic/antipyretic medications are often sold

in combination with other ingredient to treat cold and/or flu symptoms.

WWHAM

Antihistamines are commonly used to block the histamine effect that causes the symptoms of an allergic reaction, including swelling, congestion, irritation, and itching.

Who? All age-groups but especially those recently exposed to infection What are the symptoms? These include runny nose, temperature, tiredness, sore throat and sneezing How long has the patient had the symptoms? Symptoms are at their worse after 1-2 days Action already taken? Sufferers may already have taken to their bed with plenty of fluids Medication? Ibuprofen, paracetamol, lozenges and nasal sprays/drops provide relief

Dextromethorphan is an oral cough suppressant that is available OTC. Dextromethorphan is chemically related to codeine and acts on the brain to suppress cough, but it does not have the pain-relieving and addictive properties of codeine. Diphenhydramine is another non-narcotic medication that acts on the brain to suppress cough. It is also an antihistamine. Dextromethorphan and diphenhydramine can be used to relieve a dry, hacking cough. They are not generally used to suppress a productive cough (when sputum is coughed up). Suppressing a productive cough impairs the clearing of secretions and mucous from the airways, which is generally undesirable. However, cough suppressants are sometimes used to suppress even productive coughs if they are especially bothersome and prevent restful sleep. Guaifenesin is an oral expectorant that is believed to increase the leaking of fluid out of the lung tissue and into the airways. This action thins (liquefies) the thick mucous in the airways and facilitates the clearing of the mucous by coughing. Clearing of mucous from the airways decreases cough.

WHEN TO REFER TO THE PHARMACIST: > Those with ear ache that is severe > Vulnerable patient groups such as the very young and the elderly > Those with chest pain > Persistent fever and cough > Cough lasting longer than two weeks > Anyone, especially children, with a rash

SELF-CARE AND ADVICE > Sufferers should be advised to stay at home, to avoid passing on infection > They must drink plenty of fluids to prevent dehydration > Parents should not use OTC cough and cold medicines in children under the age of 6

PATIENT SUPPORT Health Promotion Agency www.healthpromotion.ie


RECOMMEND SUDAFED FOR A CLEARER HEAD THIS WINTER

As seen on TV

No. 1

Sudafed is the brand in Decongestants1.

For relief from: • Nasal and Sinus Congestion. • Sinus Pressure. • Catarrh.

Non - Drowsy

Fast Acting

1. IMS Value Sales MAT August 2013

Trade Name: Non-Drowsy Sudafed Decongestant 60 mg Film-Coated Tablets. Qualitative and Quantitative Composition:Each Film-Coated Tablet contains Pseudoephedrine hydrochloride 60.0 mg. Excipients contains Lactose Monohydrate 112.0mg. Pharmaceutical Form: Film-coated tablet. Reddish-brown, circular,biconvex, film-coated tablets, embossed ‘Sudafed’ on one side. Therapeutic Indications: Non-Drowsy SUDAFED is a decongestant of the mucous membranes of the upper respiratory tract, especially the nasal mucosa and sinuses and is indicated for the symptomatic relief of nasal congestion in conditions such as allergic rhinitis, vasomotor rhinitis, the common cold and influenza. Posology and Method of Administration: Adults and Children over 12 years: The usual dose is 1 tablet (60 mg) every four to six hours, up to four times a day. Use in the Elderly: There have been no specific studies of Non-Drowsy SUDAFED Decongestant Tablets in the elderly. Experience has indicated that normal adult dosage is appropriate. Hepatic Dysfunction: Caution should be exercised when administering Non-Drowsy SUDAFED Decongestant Tablets to patients with severe hepatic impairment. Renal Dysfunction: Caution should be exercised when administering Non-Drowsy SUDAFED Decongestant Tablets to patients with severe renal impairment. Contra-Indications: Non-Drowsy SUDAFED Decongestant Tablets are contra-indicated in individuals hypersensitive to pseudoephedrine or any of the product excipients.Non-Drowsy SUDAFED Decongestant Tablets are contra-indicated in individuals who are taking or have taken monoamine oxidase inhibitors within the preceding two weeks. The concomitant use of pseudoephedrine and this type of product may occasionally cause a rise in blood pressure.Non-Drowsy SUDAFED Decongestant Tablets are contra-indicated in individuals with hypertension, acute ischemic heart disease, thyrotoxicosis, glaucoma or urinary retention.Non-Drowsy SUDAFED Decongestant Tablets are contra-indicated in individuals at risk of developing respiratory failure.Non-Drowsy SUDAFED Decongestant Tablets are contraindicated in individuals who are currently taking other sympathomimetic drugs.The antibacterial agent, furazolidone, is known to cause a dose-related inhibition of monoamine oxidase. Although there are no reports of hypertensive crises caused by the concurrent administration of Non-Drowsy SUDAFED Decongestant Tablets and furazolidone, they should not be taken together. Do not exceed the stated dose. Special Warnings and Special Precautions for Use: Although pseudoephedrine has virtually no pressor effects in normotensive patients, Non-Drowsy SUDAFED Decongestant Tablets should be used with caution in patients taking antihypertensive agents, tricyclic antidepressants, or other sympathomimetic agents (such as decongestants, appetite suppressants and amphetamine-like psychostimulants). The effects of a single dose of Non-Drowsy SUDAFED Decongestant Tablets on the blood pressure of these patients should be observed before recommending repeated or unsupervised treatment.There have been no specific studies of Non-Drowsy SUDAFED Decongestant Tablets in patients with hepatic and/or renal dysfunction. Caution should be exercised when using the product in the presence of severe hepatic impairment or moderate to severe renal impairment.There is insufficient information available to determine whether pseudoephedrine has mutagenic or carcinogenic potential.The physician of pharmacist should check that sympatomimetic containing preparations are not simultaneously administered by several routes i.e. orally and topically (nasal, aural and eye preparations).Patients with prostatic hypertrophy may have increased difficulty with micturition.This product may act as a cerebral stimulant giving rise to insomnia, nervousness, hyperpyrexia, tremor and epileptiform convulsions.Patients with rare hereditary problems of galactose intolerance, the Lapp lactose deficiency or glucose-galactose malabsorption should not take this medicine. Interaction with other Medicaments and other forms of Interaction: Concomitant use of Non-Drowsy SUDAFED Decongestant Tablets with tricyclic antidepressants, other sympathomimetic agents (such as decongestants, appetite suppressants and amphetamine-like psychostimulants) or with monoamine oxidase inhibitors, which interfere with the catabolism of sympathomimetic amines, may cause a rise in blood pressure.Because of their pseudoephedrine content, Non-Drowsy SUDAFED Decongestant Tablets may partially reverse the antihypertensive action of drugs which interfere with sympathetic activity including bretylium, bethanidine, guanethidine, reserpine, debrisoquine,methyldopa, alpha- and beta-adrenergic blocking agents. Use with caution in diabetic patients as the product may cause an increase in blood sugar level.Concurrent use with halogenated anaesthetic agents such as chloroform, cyclopropane, halothane, enflurane or isoflurane may provoke or worsen ventricular arrhythmias. Undesirable Effects:Serious adverse effects associated with the use of pseudoephedrine are extremely rare. Symptoms of central nervous system excitation may occur, including sleep disturbances and rarely hallucinations have been reported.Skin rashes with or without irritation have occasionally been reported. Urinary retention has been reported occasionally in men receiving pseudoephedrine, prostatic enlargement could have been an important predisposing factor. Marketing Authorisation Holder:McNeil Healthcare (Ireland) Limited,Airton Road,Tallaght,Dublin 24,Ireland.Marketing Authorisation Number: PA 823/9/3. Date of (Partial) Revision of the Text: June 2011. Classification: Product not subject to medical prescription. Full prescribing information available upon request from Johnson & Johnson (Ireland) Ltd IRE/SU/13-0506


Sinusitis & Sore throat

47

Sinusitis usually clears up by itself but there are various treatments available to help ease symptoms of both this condition, and sore throats.

Sinusitis Sinusitis is inflammation of the lining of the sinuses, caused by a viral or bacterial infection. Symptoms include a blocked or runny nose, facial pain and tenderness, a high temperature (fever) of 38째C (100.4째F) or more and a sinus headache. A viral infection is the most common cause of sinusitis. It's usually the result of a cold or flu virus that spreads to the sinuses from the upper airways. If acute sinusitis fails to clear up completely, it may develop into chronic sinusitis. Alternatively, chronic sinusitis may develop without any preceding illness. In both cases the development of infection follows blockage of the opening from the

WWHAM involved sinus into the nose. Following a cold or flu, a secondary bacterial infection can sometimes develop, causing the membranes that line the inside of the sinuses to become inflamed. An infected tooth can also sometimes cause the sinuses to become infected. Acute sinusitis will often settle on its own, but in severe cases may be treated with an antibiotic, such as amoxicillin eg Amoxil, doxycycline eg Vibramycin or erythromycin eg Erythroped. Decongestant medication may help but should only be used for five to seven days in the case of nasal sprays or drops.

Sore Throat Sore throat (pharyngitis) is very common. It is usually caused by an infection in the throat. Soreness in the throat may be the only symptom. In addition, sufferers may also have a hoarse voice, mild cough, fever, headache, feel sick, feel tired, and the glands in their neck may swell.

hexylresorcinol, and/or menthol or camphor. Some products also may contain phenol. Lozenges are the most commonly used OTC products for the treatment of sore throat pain. There are 3 main types: lozenges with a weak topical anesthetic, lozenges with menthol, and unmedicated lozenges.

It may be painful to swallow. The soreness typically gets worse over 2-3 days and then usually gradually goes within a week. In about 1 in 10 cases the soreness lasts longer than a week. Sufferers may also develop a sore throat if they have a cold or flu-like illness.

There are a number of self-care tips pharmacy staff can offer to customers. Avoiding food or drink that is too hot, eating cool, soft food, sucking lozenges, hard sweets, ice cubes or ice lollies and regularly gargle with a mouthwash of warm, salty water to reduce any swelling or pain.

Sore throat products are available as lozenges, sprays and gargles. These agents usually contain anesthetics, such as benzocaine and dyclonine hydrochloride, which provide temporary relief. Most of these products can be utilised every 2 to 3 hours. Paracetamol and ibuprofen can also help.

Tonsillitis is an infection of the tonsils at the back of the mouth. Symptoms are similar to a sore throat, but may be more severe. In particular, fever and generally feeling unwell tend to be worse. You may be able to see some pus which looks like white spots on the enlarged red tonsils.

Other products available contain local antiseptics, such as cetylpyridinium chloride,

Sinusitis

Who? Sinusitis is a common condition that can affect people of any age. What are the symptoms? Pain in the forehead, cheeks and bridge of nose How long has the patient had the symptoms? Cold symptoms that have last for more than two weeks may be sinusitis Action already taken? Home treatments may help such as steam inhalation and sleeping with a raised head Medication? Decongestants should only be used for five to seven days

Sore Throat

Who? Adults and children, particularly those suffering from cold and/or flu What are the symptoms? Sore throat and possible hoarse voice, mild cough and fever How long has the patient had the symptoms? Soreness typically gets worse over 2-3 days Action already taken? Smokers may have already tried to give up as this will reduce irritation to the throat and strengthen defences against infection. Medication? Lozenges and sprays are most commonly used. Self-care tips should be advised

WHEN TO REFER TO THE PHARMACIST: > Those with very severe symptoms, such as severe pain and/or swelling around at the front of the head > Those with other medical conditions, such as heart problems > Those whose symptoms are not settling or are getting worse after 5-7 days > Those with recurring sore throat or recurring sinusitis > Those with fever, rash and/or flushed cheeks as this may be the result of streptococcal infection

SELF-CARE AND ADVICE > Those with sore throat should rest and avoid social contact as much as possible to prevent spread of infection > Decongestant nasal sprays or drops can help those suffering from sinusitis > Advise on the benefits of keeping hydrated > Warm face packs over the sinuses may help

PATIENT SUPPORT Allergy Ireland www.allergy-ireland.ie | Tel: 1 2000 500


Introducing the NEW range from

Modern NEW Pack Design

NEW Pharmacy Only 24’s Pack

New PARAEXTRA

Offering Quality, Choice and Value for your customers Backed by consumer research*

66% like the new paracetamol pack and 80% would be likely to buy

Ask your local Pfizer representative for more details

Abbreviated Prescribing Information

(Please refer to Summary of Product Characteristics before prescribing)

PARAEXTRA Hard Capsules Presentation : Each capsule contains Paracetamol 500 mg and caffeine 32 mg. Pharmaceutical Form: Size 0, hard gelatin capsules with an opaque blue cap and an opaque yellow body, imprinted longitudinally on both sections with “500/32”, containing a white, free flowing granule mix. Indications: The capsules are recommended for use in short term management of headaches, migraine and tension headaches, backache, rheumatic pain, muscle pain, period pain, neuralgia, toothache and for relieving fever, aches and pains of colds and influenza including the pain of sore throat. Dosage & Administration: For oral administration. Adults/Elderly only: 1 to 2 capsules, which may be repeated 4 hourly as necessary. A maximum of 8 capsules in any 24-hour period. Contraindications: Use in children under 12 years. Hypersensitivity to any of the active substances or to any of the excipients. Precautions: Caution should be exercised in patients with impairment of hepatic or renal function (avoid if severe). The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease. Prolonged use without medical advice may be harmful. Do not recommend this medicine to patients taking other Paracetamol containing products. Immediate medical advice should be sought in the event of overdosage even if the patient feels well. Use only when clearly necessary. Interactions: Cholestyramine - the absorption of Paracetamol is reduced by cholestyramine. Therefore the cholestyramine should not be taken within one hour if maximal analgesia is required. Metoclopramide and Domperidone - the absorption of Paracetamol is increased by metoclopramide and domperidone. However, concurrent use need not be avoided. Warfarin - Potentiation of warfarin with continual high dosage of Paracetamol. Chloramphenicol - Increased plasma concentration of chloramphenicol. Pregnancy & lactation: There is epidemiology evidence of safety of Paracetamol in pregnancy and therapeutically relevant doses of caffeine shows no increased risk in relation to pregnancy and foetal development. Paracetamol and caffeine appear in breast milk. Irritability and poor sleeping patterns in infants have been reported. Adverse effects on the infant are unknown. For short-term use of the product interruption of breast-feeding is not necessary. With prolonged use or ingestion of higher doses, breast-feeding is not recommended. Side Effects: Side effects are rare but hypersensitivity reactions, including skin rash may occur. There have been isolated reports of thrombocytopenia purpura, methaemoglobinaemia and agranulocytosis. Itching, stomach problems (such as pain, nausea, vomiting), any unexplained bruising or bleeding more easily than usual may occur. High doses of caffeine can cause tremors and palpitations. Legal Category: General Sales. PAH: Pfizer Healthcare Ireland, Citywest, Dublin 24. PA Number: PA 822/169/1. For further information please contact: Pfizer Consumer Healthcare, Citywest, Dublin 24 or look up, www.medicines.ie. Date of Preparation: October 2013.

Pfizer Healthcare Ireland, Citywest, Dublin 24.

* Empathy Research. May 2013. Based on all participants (304).

Ref MAT: 000158 - Oct 13

PARACETAMOL 500 mg Film-coated Tablets Presentation: Each tablet contains 500 mg of Paracetamol. Pharmaceutical Form: White capsule shaped film coated tablets embossed on one face with “P-500” and with a break bar on the reverse. The score line is only to facilitate breaking for ease of swallowing and not to divide into equal halves. Indications: Paracetamol is a mild analgesic and anti-pyretic. Recommended for use in the short-term management of headaches, including migraine and tension headaches, backache, rheumatic and muscle pain, period pains, nerve pains, toothache and for relieving fever, aches and pains of colds and flu. Dosage & Administration: Adults and children over 12: 1 to 2 tablets, 3 to 4 times daily. Do not take more than 8 tablets in any 24 hour period. Children aged 6- 12 years: ½ to 1 tablet, 3-4 times daily. Do not take more than 4 tablets in any 24 hour period. Contraindications: Do not take give to children under 6 years of age. If hypersensitive to Paracetamol or any other ingredients in this product. Precautions: Caution should be exercised in patients with impairment of hepatic or renal function (avoid if severe). The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease. Do not take give with other Paracetamol containing products. If patients symptoms persist for more than 3 days, they should see their GP. Prolonged use without medical supervision may be harmful. Interactions: Care should be taken in patients treated with any of the following drugs as interactions have been reported; Cholestyramine: The absorption of Paracetamol is reduced by cholestyramine. Therefore, the cholestyramine should not be taken within 1 hour if maximal analgesia is required. Metoclopramide: The absorption of Paracetamol is increased by metoclopramide. However, concurrent use need not be avoided. Domperidone: The absorption of Paracetamol is increased by domperidone. However, concurrent use need not be avoided. Warfarin: Potentiation of warfarin with continued high doses of Paracetamol. Chloramphenicol:Increased plasma concentration of chloramphenicol. Pregnancy & lactation: There is epidemiological evidence of safety of Paracetamol in pregnancy. Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data do not contraindicate breast feeding. Side-effects: Side effects are rare but hypersensitivity, including skin rash may occur. Isolated report of thrombocytopenia purpura, methaemogolobinaemia, agranulocytosis and hepato-biliary disorders have been reported for Paracetamol containing products. Legal Category: GSL/ P. Pack Size: 12 & 24 tablets. PAH: Pfizer Consumer Healthcare Ltd, Ramsgate Road, Sandwich, Kent, CT13 9NJ, United Kingdom. PA number: PA172/21/1. Further information is available upon request from Pfizer Healthcare Ireland, Citywest, Dublin 24 or look up, www.medicines.ie Date of preparation: September 2013.


Headache and Migraine

49

Most headaches and migraines are unpleasant but harmless and can be relieved with self-help measures and painkillers. Only a few (around 5%) are a sign that something is seriously wrong. These more serious headaches are often accompanied by other warning signs. For example, a headache accompanied by a rash and a very high temperature. Approximately half a million Irish people suffer from migraine and it is essential for pharmacy staff to obtain an accurate headache history from the sufferer before any treatment is recommended. Past patients should be encouraged to return to the pharmacy for a review of the severity of their illness and response to treatment of their headaches/migraine on a regular basis. There are three types of migraine: Migraine with aura - This occurs with a warning sign, known as aura, before the migraine begins. Approximately a third of people with migraine will have this. Warning signs may include visual problems (such as flashing lights) and stiffness in the neck, shoulders or limbs. Migraine without aura Migraine without headache - This is also known as silent migraine, when an aura or other migraine symptoms are experienced, but a headache does not develop. Migraines usually begin in young adults. Around 9 in 10 have their first migraine before they are 40 years old. However, it is possible for migraines to begin later in life. There is no cure for migraines, but it is possible to control them with a range of treatments. Around 10% of people who have migraines also experience aura symptoms. These are disturbances that start 15 minutes to an hour before the headache. They can include blind spots, flashing lights, zigzag patterns, tingling, pins and needles, or numbness in the limbs. Migraines are believed to be caused by the release of a chemical called serotonin into the bloodstream, resulting in changes in the brain. Certain factors that can trigger attacks in susceptible people include emotional stress, such as anger, tension or shock, physical stress, such as overexertion or travelling, diet and environmental causes. Painkillers/analgesics are usually the first treatment for migraine. They tend to be more

effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease the symptoms. Some people only take painkillers when their headache becomes very bad. However, this is not advisable because it is often too late for the painkiller to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good option because they are absorbed quickly by the body. Painkillers relieve pain and reduce stiffness associated with migraine. The non-steroidal anti-inflammatory drugs (NSAIDs) also reduce inflammation by inhibiting the production of certain chemicals in the body. If ordinary painkillers are not helping, triptan medicines might be the next option such as sumatriptan. Triptan medicines are not the same as painkillers. They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process. Triptans are available as tablets, injections and nasal sprays. Enteric coated preparations are less suitable for treating migraine attacks because they are absorbed more slowly and therefore may take longer to work. Codeine is an analgesic which blocks pain signals in the spinal cord and brain. Anti-emetics relieve the nausea associated with migraine attacks. Metoclopramide and domperidone also promote normal activity of the gut and can accelerate the absorption of analgesics. Anti-emetics should be taken before or at the same time as analgesics. Metoclopramide is associated with serious side effects (resulting in symptoms very like Parkinson’s disease) and should be avoided in children and young adults.

WWHAM Who? Young adults under the age of 40 What are the symptoms? These may range from blind spots and flashing lights to pins and needles and numbness How long has the patient had the symptoms? Predominantly symptoms will begin 15 minutes to one hour prior to a headache Action already taken? Customers may already keep a 'trigger diary' and should be advised to do so which will help predict attacks. Healthy diet and exercise are key Medication? The selection of treatment should take into account patient preference, cost, safety and likely efficacy

WHEN TO REFER TO THE PHARMACIST: > Children under 16 > Those who have, or have had in the past, stomach problems, such as a peptic ulcer, liver problems or kidney problems > Those for whom painkillers are not effective > Pregnant or breastfeeding women

SELF-CARE AND ADVICE > Taking any form of painkiller frequently can make migraine worse - often referred to as 'medication overuse headache' > Those who cannot swallow painkillers due to nausea or vomiting may find suppositories to be a better option

PATIENT SUPPORT The Migraine Association of Ireland www.migraine.ie Tel: 1 850 200 378


50

Travel Health

The most common issues customers in the pharmacy will enquire about include travel sickness, tummy upsets, sun protection, vaccinations and malaria. Children will experience travel sickness more often than adults, symptoms include nausea, vomiting, yawning, headache and rapid breathing.

WWHAM Malaria

Who? Those who have travelled to malariaendemic areas What are the symptoms? Flu-like symptoms such as muscular pain and fever How long has the patient had the symptoms? Malignant malaria causes symptoms within three months of infection. benign malaria is mild but may have a dormat stage of up to one year Action already taken? Sufferers may already be taking OTC flu medications or checked their travel schedule for malaria infection potential Medication? Anti-malarials are available for before and after travel

Deep Vein Thrombosis

Who? Those at increased risk of DVT including pregnant women, those with a history of DVT and dehydration What are the symptoms? Pain and swelling in a leg, warm skin in the area of the clot and redness of the skin How long has the patient had the symptoms? Symptoms may not appear until a complication arises Action already taken? Sufferers may be increasing fluid intake and wearing appropriate clothing Medication? Warfarin and anticoagulants, compression stockings and preventative measures

WHEN TO REFER TO THE PHARMACIST: > Those preparing to travel with significant preexisting medical problems > Pregnant women > Children travelling to high risk countries > Those unwell after travel to malaria-endemic areas

SELF-CARE AND ADVICE > Educated sun protection advice is essential, especially for those travelling with babies and small children > Advise on appropriate hygiene to avoid travellers stomach upsets and diarrhoea > Those travelling to exotic destination should be advised on the necessary travel vaccinations and time frames for having these

PATIENT SUPPORT Irish Vaccines Authority www.vaccine.ie

Malaria is a mosquito-bourne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases progressing to coma or death. It is widespread in tropical and subtropical regions, including much of Sub-Saharan Africa, Asia and the Americas. Individuals presenting with flu-like symptoms including headache, nausea, muscular pain and fever should be asked if they have travelled to a malaria-endemic area within the last 12 months. Chloroquine and proguanil are two OTC anti-malarials. They should be taken one week before travel and continued for four weeks after leaving. Malaria symptoms may occur from six days of naturally acquired infection to many months later. Most patients with P. falciparum infection present in the first month or within the first six months of infection. P. vivax or P. ovale infections commonly present later than six months after exposure and sometimes after years. There are no specific symptoms of malaria, most missed malarial infections are wrongly diagnosed as nonspecific viral infections, influenza, gastroenteritis or

hepatitis. Children, in particular, are more likely to present with nonspecific symptoms (fever, lethargy, malaise, somnolence) and to have gastrointestinal symptoms. The main symptoms include oftenrecurring fever, chills, headache, cough, myalgia and gastrointestinal upset. Behavioural modifications, such as avoiding outdoor activity after sunset, wearing long-sleeved shirts and trousers, using ITNs and insect repellant must be recognised as important and should be advised to all travellers visiting malaria-endemic areas. Encouraging migrant travellers visiting family and friends to take prophylactic medication should be a priority, any immunity to malaria accrued by growing up in a malarious country is rapidly lost on emigration and second-generation family members will have no immunity, rendering them (and particularly children) vulnerable. Antihistamines such as cinnarizine work well with the vomiting aspects of travel sickness but also the inner ear balance mechanism. They should be taken 2 hours before travel and can prevent sickness for up to 8. Hyocsine prevents the the confusing nerve signals going to the brain and needs to be taken 30minutes before travel. Side effects may include sleepiness and dry mouth.


51

Most travellers will be going on holiday and eager to tan, so it is essential to educate them on sun safety. Advise on precautions to take to reduce damage including making sure they never burn, using adequate sun protection, taking extra care with babies and small children, cover up during the hottest parts of the day.

Venous Thromboembolism (VTE) or Deep Vein Thrombosis (DVT) are terms used to describe the formation of a clot, or thrombus, in one of the deep veins, usually in the lower leg. VTE can occur as a result of periods of immobility, for example following surgery, but can also occur spontaneously in otherwise healthy persons.

Infective diarrhoea (also often referred to as gastroenteritis) is a common travellers' complaint, often associated with changes in water and food. The most important determinant of risk is destination.

Several factors that increase the risk of VTE have been identified. These include, having a history of DVT or pulmonary embolism, haematological hypercoaguable disorders (e.g. Factor V Leiden deficiency, thrombocythemia, antithrombin deficiency), pregnancy and

High-risk destinations include most of the developing countries of Latin America, Africa, the Middle East and Asia. Mediumrisk destinations include most southern European countries and a few Caribbean islands. Lowrisk destinations include Canada, northern Europe, Australia, New Zealand, the US and a number of Caribbean islands.

including travelling as an asthmatic or diabetic and travelling with medication. Asthmatics and diabetics, for example, should obtain a letter from their local GP confirming their condition, along with a prescription for their medication, enough for the trip, and a bit more. This will help with an emergencies. Advise on carrying inhalers at all times and to keep a spare one. Diabetics should research their destination carefully and think through the practicalities of how long you plan to be away. In addition, the purchase of a diabetic identity bracelet may give some travellers the piece of mind they need. Those travelling with medicines must make sure they comply with the rules and regulations of their airline or other carrier with regards to inhalers, poweders, tablets, creams and gel medications.

Diarrhoea usually strikes within the first week when first exposed to bacteria and viruses that are new to but which the locals have learned to tolerate. But it may occur at any time during the holiday - even after returning home.

Many diseases are transmitted via insects to holiday travellers including as Crimean Congo Haemorrhagic Fever (CCHF), dengue, Japanese encephalitis, leishmaniasis, Lyme disease, malaria and yellow fever.

Individuals may or may not also have nausea and vomiting. If symptoms persist for more than 24 hours, if they pass blood in the motions or if they develop a high temperature, they should immediately be referred.

Mosquitoes are attracted by several factors, including the presence of carbon dioxide, heat, odours and movement. Black flies, the vectors of onchocerciasis, bite during daylight hours and live close to fast-flowing water.

Over-the-counter diarrhoea medicine can help. Loperamide, slows down the action of the bowel and is very effective in treating diarrhoea. Many of the problems pregnant women might encounter on international trips are the same as any other traveller, including exposure to infectious diseases and availability of good medical care. There's the additional potential problem that air travel in late pregnancy may precipitate labour Most airlines won't allow women who are more than 36 weeks pregnant to fly and may require a medical certificate of fitness to travel from week 28 onwards. They are at increased risk of thrombosis during pregnancy and should therefore make sure they: • Walk around regularly while on the plane • Do leg exercises

puerperium, malignancy and dehydration. There are a number of measures that can be taken to reduce the risk of travel related VTE. All travellers intending to take long haul flights or other forms of travel where they will be seated or immobile for >4 hours should avoid dehydration and excessive consumption of alcohol, not wear constrictive clothing around the waist or lower extremities, walk around the cabin as much as is practical at regular intervals during the flight and regularly flex and extend the ankles which will encourage blood flow from the lower legs. Customers to the pharmacy who are planning a holiday or other travel arrangement can be advised on a number of other issues,

Ticks typically live in long grassy areas. Their usual hosts are small mammals. On humans, ticks crawl on skin or clothing until they find a suitable place to attach and feed, often at a skin fold in the groin, under the arm, at the scalp line, or at the edge of underclothes. Tickborne diseases, such Repellents should be reapplied at regular intervals, after swimming and in hot, humid conditions when they may be removed by perspiration. When both sunscreens and repellents are used, the repellent should be applied over sunscreen. Holiday travellers should be advised to only use insect repellants on exposed areas of skin, remove with soap and water when the repellent is no longer needed and not spray it directly on the face.


52

Allergic Rhinitis

Allergic rhinitis is clinically defined as a symptomatic disorder of the nose induced, after allergen exposure, by an IgE-mediated inflammation of the membranes lining the nose.

WWHAM Who? Allergic rhinitis affects 10-40% of the population What are the symptoms? Naasal itching, eye and nasal symptoms How long has the patient had the symptoms? Allergies can start in childhood and lessen by the age of 30-40 Action already taken? Sufferers may avoid going outdoors during times of high pollen count Medication? Antihistamines, nasal drops and eye drops are available

WHEN TO REFER TO THE PHARMACIST: > Pregnant or breast-feeding women > Those with severe cough, persistent wheeze, painful ears, swollen glands and yellow, sticky discharge from eyes > Those whose symptoms worsen after OTC treatment > Individuals with severe aversion to bright lights

SELF-CARE AND ADVICE > Always question patients with persistent rhinitis for symptoms of asthma > The presence of conjunctivitis should always be considered >Advise sufferers on social factors such as avoiding going outdoors when pollen count is high, wearing sunglasses and avoiding long grass and lawn mowing

PATIENT SUPPORT Anaphylaxis Ireland www.irishanaphylaxis.org | Tel: 0818 300 238 Allergy Ireland www.allergy-ireland.ie | Tel: 01 200 0500

Allergic rhinitis represents a global health problem affecting at least 10% to 40% of the population. Although it is not usually a severe disease, it alters the social life of patients and affects school performance and work productivity. Some patients who consult in the pharmacy will have had allergic rhinitis previously diagnosed by a their GP, others will have made an appropriate self-diagnosis, some will not have received any diagnosis of rhinitis or may even have an incorrect diagnosis (e.g. a viral infection or a cold). Allergic rhinitis has symptoms similar to those of a number of other conditions and may be confused with a viral infection such as the common cold or chronic sinusitis. The presence of nasal itching, rhinorrhea, sneezing and eye symptoms are usually consistent with allergic rhinitis. Hay fever, also known as seasonal allergic rhinitis, is an allergic reaction to airborne substances such as pollen that get into the upper respiratory passages – the nose, sinus, throat – and also the eyes. Hay fever is the most common of all the allergic diseases. Symptoms usually appear in childhood first and then lessen by the age of 30 or 40. Perennial allergic rhinitis is a similar allergy that occurs all year round and is caused by things such as house dust mites and pets. However the predominant allergen changes from time to time. Antihistamines treat allergies by blocking the action of the chemical histamine, which the body releases when it thinks it is under attack from an allergen. Antihistamines can be taken in tablet, cream or liquid form, or as eye drops or nasal sprays. Nasal sprays can be used to reduce swelling and irritation in the nose, and eye drops will help to relieve sore, itchy eyes. Some sprays

and drops are only suitable for adults, and in these cases refer to the pharmacist for children medication. Antihistamines can occasionally cause drowsiness, so if customers are taking them for the first time, see how they react to the medication before advising on driving or operating heavy machinery. Antihistamines can cause drowsiness if drinking alcohol whilst taking them. Corticosteroids: If symptoms are frequent or persistent and individuals have nasal blockage or nasal polyps, recommend a nasal spray or drops containing corticosteroids. Corticosteroids help reduce inflammation (swelling). They take longer to work than antihistamines, but their effects last longer. Side effects from inhaled corticosteroids are rare, but can include nasal dryness and irritation, and nosebleeds. Nasal steroids reduce inflammation in the nasal passages and are better than oral antihistamines at relieving most nasal symptoms, including a blocked nose. They also relieve eye symptoms. Nasal steroids have to be used regularly to be effective. They are best started a couple of weeks before the pollen season begins. Nasal sprays containing sodium cromoglicate are also used to prevent nasal symptoms, ideally starting treatment a couple of weeks before the pollen season. They are less effective than nasal corticosteroids, but are often the first choice for young children. Antihistamine eye drops can be useful if eye symptoms are the biggest problem. They include antazoline and azelastine, epinastine, ketotifen and olopatadine, which must be prescribed by a GP. The drops provide rapid relief from itchy, red, watery eyes.


53

A GREAT HEALTHCARE FAMILY

Calpol Infant Sugar-free Suspension contains paracetamol. Imodium LiquiRelief Soft Capsules contains loperamide. Nicorette Extra Strength 25mg Invisipatch contains nicotine. Non-Drowsy Sudafed Tablets contain pseudoephedrine hydrochloride. Regaine for Men Extra Strength Scalp Foam 5% w/w cutaneous formula contains minoxidil. Colpermin Gastro-Resistant Capsules contains peppermint oil. Nicorette QuickMist 1mg/spray contains nicotine.

ALWAYS READ THE LABEL. Please ask your pharmacist for advice. IRE/NI/13-0546


54

Head lice

Infestations of head lice in the hair are far more common in children than in adults and are, therefore more prevalent in nurseries and schools.

WWHAM

It is an exceedingly itchy condition because the head lice move around and feed on the blood in the scalp.

This method should be used over the entire head of hair until the nits have been completely eradicated.

Head lice Who? Head lice tend to affect children more than adults. What are the symptoms? The patient will have an itchy scalp and may have already found lice. Action already taken? A patient may have already tried to use a medicated shampoo or to pick the lice off the head or even pull the nits off the strands of hair. Medication? There are medicated shampoos and lotions and chemical insecticides available to treat head lice.

The females attach their eggs (nits) to the base of the hair near the scalp and a new generation of lice will hatch seven to ten days later.

Certain medicated products containing dimeticone physically coat and ‘smother’ the lice.

WHEN TO REFER TO THE PHARMACIST > Babies under 6 months old > Pregnant women > People with asthma or allergies > Those for whom other conditions such as eczema is suspected rather than head lice > Anyone who has not successfully managed to get rid of the head lice following treatment

SELF-CARE AND ADVICE > Differing head lice drugs should not be used at the same time > Those dealing with alopecia should cover their heads when exposed to the sun

While the adult louse cannot survive for more than two days off the human head, the nits can survive for up to ten days away from the body, such as on clothes, hairbrushes or carpets. Lice spread by adults and children sharing belongings that are infested, although lice can transfer from one head to another by head-tohead contact. Once a patient becomes affected, there are a number of treatments available. Treatment for headlice is cyclical so it is important to discuss the correct treatment with the patient as lice can become immune to some products. Advice for patients when treating head lice: Do not use extra amounts of any lice medication unless instructed to do so. The drugs used to treat lice are insecticides and can be dangerous if they are misused or overused. Do not treat an infested person more than 2–3 times with the same medication if it does not seem to be working. This may be caused by using the medicine incorrectly or by resistance to the medicine. Do not use different head lice drugs at the same time. The wet combing method uses a special, finetoothed comb on hair that has been washed with a special treatment. The combing should start at the bottom of the hair by the scalp and the comb should be drawn upwards on strands of the hair in sections, to rid it of any nits, which may be clinging on to a strand.

Medicated alcoholic lotions arew recognised as being preferable to the shampoos because they are undiluted and have greater contact time on the hair. However, anyone with an allergy, such as a bad scalp condition, such as eczema, should use a shampoo because the alcoholic content in a lotion may irritate the skin. Chemical insecticides that are available for use in the Republic of Ireland are malathion, permethrin, phenothrin and carbaryl. In time, lice become resistant to these insecticides. Chemical insecticide treatments should only be used if a living (moving) head louse is found and should be applied to clean hair, free of conditioner or styling products. Head lice can be difficult to treat due to a high reinfestation rate and their ability to develop resistance to traditional insecticides contained in some medications. It is thought head lice will not develop immunity to the newer silicone and oil-based preparations because they have a physical rather than a chemical action on lice. Afro hair or tightly curled hair can make treating a head lice infestation particularly difficult. If a presenting child has afro hair and they develop head lice, keeping their hair short will make treating it easier. Alternatively, parents could try plaiting or braiding their hair as this can make it difficult for head lice to attach themselves to the bottom of the hair strand.


Hair loss

55

At any one time, about 90% of the hair on a person's scalp is growing. Each follicle has its own life cycle that can be influenced by age, disease, and a wide variety of other factors. This life cycle is divided into three phases: • Anagen -- active hair growth that lasts between two to six years • Catagen -- transitional hair growth that lasts two to three weeks • Telogen -- resting phase that lasts about two to three months; at the end of the resting phase the hair is shed and a new hair replaces it and the growing cycle starts again. Alopecia Alopecia is the name given to abnormal hair loss. There are three different kinds of alopecia. Androgenic Alopecia is the most common form and may be caused by genetics or hormonal changes and ageing, all of which can alter and affect the hair follicles. The condition can start at any age but not normally pre-teens and will affect both males and females. In men, androgenic alopecia usually starts by the hair beginning to thin in the front and/ or crown of the head and, at first, sufferers think they are beginning to go bald. However, the hair loss continues and progresses to the traditional, horseshoe-shaped fringe of hair around the sides of the head. It is generally referred to as 'male-pattern baldness'. In women, androgenic alopecia normally starts by the hair beginning to thin all over the crown and the top of the head. Alopecia Areata is an auto-immune condition that causes round patches of hair loss on the head or body. It can occur at any age in both sexes but it often tends to start in childhood. It is thought that genetic and environmental factors play their part in bringing on the condition. However, this type of alopecia is often associated with thyroid disease. Alopecia Areata is treated by using both topical and systemic medications, and localised steroid injections, which will help to speed growth. The injections may cause some side effects, such as thinning of the skin at the injection site so this should be monitored closely. Postpartum Alopecia Another common form of hair loss, Postpartum Alopecia is the result of hormonal changes during pregnancy, which cause the growth pattern of hair follicles to change. There is usually very little sign, if any that this type of alopecia is developing during the pregnancy itself and it generally occurs three to nine months after the birth of the child. The hair loss is sudden and extreme. While this is often very traumatic for a new mother, the hair's growth cycle typically returns to normal within a year. Telogen Effluvium Telogen Effluvium occurs when sudden or severe stress causes an increase in the shedding of the hair. In Telogen effluvium a sudden or stressful event can cause the hair follicles to prematurely stop growing and enter into a resting phase. The hair will then stay in the resting phase for about 3 months after which time a large

amount of hair will be shed. Often the person involved will have recovered from the event before the hair loss occurs. In most cases the hair loss is temporary and the hair soon recovers. However in some cases the hair loss continues until the underlying cause is fixed. Telogen Effluvium appears to affect more women than men because more of the precipitating event such as childbirth are experienced by women. It is quite common for some women to experience some hair loss approximately 3 months after childbirth. This hair loss is triggered by the sudden changes in hormone levels. Many woman notice that their hair is thicker and healthier during pregnancy, this is due to the increased levels of hormones oestrogen and progesterone which cause more hairs than normal to remain in the growth phase. When the child is born however many of the hair follicles that had delayed entering the resting phase suddenly enter the resting phase due to the rapid drop in hormone levels. As a result of this these hairs are then shed about 3 months after the birth. Because hair loss may cause emotional distress and affect self-esteem, pharmacy staff should be supportive and empathetic to patients experiencing it. Counter assistants can help patients experiencing hair loss by reviewing medication profiles and possibly identifying pharmacologic agents that may be associated with increased risk of hair loss. It is always important to determine whether self-treatment is appropriate and whether the cause of the hair loss has been identified. Customers should always be referred to the pharmacist for further evaluation if the cause of their hair loss is unknown or sudden. It is particularly important for women who experience sudden hair loss be referred. To ensure that their medication is effective, customers should be educated on how to properly apply their treatment.

WWHAM Alopecia Who? Androgenic alopecia mainly affects adult men and women. What are the symptoms? Thinning hair on the head. How long has the patient had the symptoms? Hair can start to thin for some time before it becomes of concern. Action already taken? Patients may have already tried the use of wigs, hairpieces and spray camouflages. Medication? There are several treatments, including local steroid injections, contact sensitization treatments and Minoxidil Lotions. Alopecia Areata Who? Mostly children and/or people suffering from a thyroid condition. What are the symptoms? Round patches of hair loss on the head or body. How long has the patient had the symptoms? The bald patches develop quite quickly - in some cases a matter of days. Action already taken? Patients may have been trying to cover up the patches or trying shampoos for hair loss. Medication? Corticosteroid topical treatments may be used as well as systemic corticosteroid injections into the bald patches. Postpartum Alopecia Who? New mothers. What are the symptoms? Hair loss in clumps or thinning hair. How long has the patient had the symptoms? Postpartum Alopecia happens very quickly. Action already taken? New mothers may have tried wigs or cover ups for the bald patches. Medication? Postpartum alopecia is a temporary condition and because of this there is very little effective medication.

WHEN TO REFER TO THE PHARMACIST: > Those for whom medicines appear to be causing the hair loss > Those who find it difficult to cope with their hair loss, or suffer depression and/or anxiety

SELF-CARE AND ADVICE > Hair loss can severely affect a sufferers confidence so pharmacy staff must be able to educate and offer counselling in this area > Advise sufferers on the most effective way of using their chosen treatment > Hair loss product should not be applied more than twice a day or to damaged skin

PATIENT SUPPORT Alopecia.ie | www.alopecia.ie | Tel: 1 260 8874


UNDERSTANDS HAIR LOSS. No longer one of the last great taboos ON AVERAGE 8 MILLION WOMEN IN THE UK ARE EXPERIENCING SOME DEGREE OF HAIR LOSS Resting Phase

Transition Phase

46% of women suffer in silence IT IS IMPORTANT THAT YOU KNOW YOU ARE NOT ALONE

At the ďŹ rst signs of hair loss, it is essential to understand that the normal Hair Growth Cycle (HGC) is likely experiencing a

Normal

disruption. A normal HGC has three phases, Growth, Transition and Resting. This means that at any given time 85-90%

Growth Phase Resting Phase can become prolonged

of your hair is actively growing (Growth Phase), which can last between 2-6 years. At the same time, 10-15% of your hair sits inactive in the follicle (Resting Phase), after having reached its full growth potential.

When the normal HGC becomes disrupted, the Growth Disrupted

Phase is reduced and the Resting Phase increased, resulting in greater than normal hair loss. Over time, the hair loss symptoms become more prominent as the follicles become less active and eventually dormant when

Growth Phase can become reduced

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Sleep Disorders

59

Somnipathy is the term used for abnormal sleep patterns. Some sleep disorders can be serious enough to interfere with normal physical, mental and emotional functioning.

WWHAM

Insomnia Insomniacs have difficulty falling asleep or feel that they do not obtain enough sleep to awake feeling refreshed in the morning. Stress and anxiety tend to be the main causes of insomnia. Insomnia is very common and most people will experience it at some stage during their lives. There are a number of self-help measures that people can take to combat insomnia, such as avoiding caffeine, 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 be encouraged to keep a sleep

diary and if they find that their insomnia is affecting their daily lives, they should go to see 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. Prescriptions for benzodiazepines, such as temazepam, loprazolam and lormatezepam can be prescribed by a doctor for insomniacs but they should only be taken for a short period of time. Patients should be advised to avoid alcohol when taking these type of drugs.

Sleep apnea Sleep apnea is a condition that causes interrupted breathing during sleep and is associated with being overweight or obese. It is caused by the muscles in the back of the throat collapsing inwards during sleep. People who suffer from sleep apnea tend to snore very loudly. Patients

should be advised to make lifestyle changes such as losing weight, limiting alcohol and/or smoking, and trying not to sleep on their side, if they do. Continuous positive airway pressure (CPAP) is an effective treatment, which prevents airways from closing during sleep.

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.

Insomnia Who? Insomnia tends to affect adult women more than men and it may also affect people, who are suffering mental health issues. What are the symptoms? Difficulty falling asleep or disturbed sleep and/or finding it difficult to function during the day. How long has the patient had the symptoms? Most patients will not present to the pharmacy unless symptoms are on-going. Action. The patient may have tried to help their insomnia, such as avoiding caffeine but, sooner or later they feel that their efforts are being frustrated and ineffective. Medication? The patient may need to visit a doctor, who will in all probability give them a prescription for benzodiazepines.

Sleep Apnea Who? Overweight males over the age of 40 and who smoke tend be at high risk. Women who are menopausal are also at risk. What are the symptoms? Tiredness during the day, headaches, episodes of not breathing and loud snoring. How long has the patient had the symptoms? Often patients will not realise that they have sleep apnea and pass themselves off as loud snorers. Patients will usually present at the pharmacy when their snoring becomes a problem or they have experienced episodes of not breathing. Actions. Patients may try various methods to control their snoring. Medication? In general, doctors do not prescribe medication for sleep apnea. Patients who are overweight should be advised to implement some lifestyle changes. There are certain breathing devises available on the market that attach to the outside of the nose and keep airways open.

Sleep Apnea Who? The disorder usually effects both males and females in their teens. What are the symptoms? Excessive daytime fatigue, hallucinations and a sudden loss of muscle tone, which leads to a feeling of weakness. How long has the patient had the symptoms? Patients may not be aware they have the disorder until they have experienced all the symptoms. Actions. Patients may have tried to treat their fatigue with relaxation techniques or made some lifestyle adjustments, such as avoiding caffeine and taking several naps throughout the day. Patients suffering from narcolepsy should not drive or operate machinery. Medication? Sufferers may be prescribed stimulants, such as Modafinil to keep the sufferer awake.

WHEN TO REFER TO THE PHARMACIST: > Those with high blood pressure > Young children > Anyone who feels an illness is causing their insomnia

SELF-CARE AND ADVICE > Weight loss is appropriate if obesity is an issue > Sufferers should be encouraged to quit smoking > Alcohol should be avoided in the evening, as should sedative and hypnotic medication and any other stimulants > Daytime exercise and relaxation techniques can help

PATIENT SUPPORT The Irish Sleep Apnoea Trust | www.isat.ie | Tel: 86 605 3891 The Irish Sleep Society | www.irishsleepsociety.org Narcolepsy Support Group Ireland | www.sleepy-heads.org | Tel: 1 8858 164


60

Digestion

Gastrointestinal upset is very common amongst both adults and children, and the causes may range from minor conditions to complex problems. Heartburn and irritable bowel syndrome are just two of the conditions which pharmacy staff can educate customers on.

Heartburn and Indigestion Indigestion or dyspepsia is a general term used to describe a variety of different symptoms relating to the gastrointestinal system. Symptoms of indigestion include bloating, wind, nausea, vomiting and abdominal pain. Indigestion is caused when acid in the stomach flows back up the oesophagus or when the stomach is irritated or inflamed. Although indigestion is most common after meals, it can be brought on at any time. Symptoms include pain, fullness or discomfort in the upper part of the abdomen or chest; heartburn; loss of appetite and flatulence, burping or belching. Depending on the cause of indigestion, symptoms may go very quickly, come and go, or they may be regular and last for a long time. Antacids can relieve symptoms of indigestion by neutralising acid in the stomach. They usually contain magnesium or aluminium. Some medicines for indigestion contain alginate, which forms a barrier that floats on top of the stomach contents to prevent reflux.

Side-effects of antacids can include diarrhoea and constipation. Some indigestion medicines contain both antacids and alginates, and other ingredients such as simeticone and peppermint oil (both for wind and bloating). These are especially useful for people with irritable bowel syndrome. A chemical called histamine (which is produced naturally by the body) causes cells in the stomach to make acid. H2-blockers can stop histamine from working on these cells and so lower the amount of acid produced in the stomach. Proton pump inhibitors work by completely blocking the production of stomach acid. They do this by shutting down (inhibiting) a system in the stomach known as the proton pump. Prokinetics work by helping food pass more quickly through the stomach. They are used if an individual still has symptoms after taking the medicines above. Gastro-oesophageal reflux disease (GORD) is a common cause of indigestion. The disorder comes from a dysfunction of the sphincter muscle, causing stomach

acid to leak out of the stomach and into the oesophagus. This causes a severe burning sensation in the chest or upper abdomen and is commonly known as heartburn. The most obvious symptom is a painful burning sensation after eating. In some cases, chronic coughing and difficulty breathing can occur. Simple antacid medicines (alkalis) will neutralise stomach acid and form a protective layer over the lining of the stomach. If a patient has a chronic problem with stomach acid or gastro-oesophageal reflux disease (GORD), a doctor may prescribe proton-pump inhibitor (PPI) drugs and H2 blockers as they can ease the pain and/ or symptoms. H2 Antagonists, such as cimetidine, famotidine, nizatidine and ranitidine may be short term solutions for GORD. A common complication of GORD is that the stomach acid often irritates and inflames the lining of the oesophagus, which is known as oesophagitis. In severe cases of oesophagitis, ulcers can form, which can cause pain and make swallowing difficult. A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer. The most common symptom of a gastric ulcer is a burning pain in the centre of the abdomen. The main cause of a gastric ulcer is Helicobacter pylori (H. pylori) bacteria, which can irritate the stomach or upper lining of the intestine. Antibiotics are generally prescribed if this is the cause of the ulcer,. If symptoms are reoccurring, the patient should address the cause of their heartburn. They should be advised to avoid fatty foods, smoking and alcohol, to lose weight if they are overweight or obese and try to minimise stress.

Irritable Bowel Syndrome (IBS) Irritable Bowel Syndrome (IBS) is a common and chronic condition of the digestive system, often recognised by irregular bowel habits. The exact cause of IBS is unknown but it is thought to be related to a sensitivity of the gut. IBS is diagnosed when a person has experienced abdominal pain or discomfort for at least three times in a month for three consecutive months, without experiencing


Digestion

61

WWHAM any other disease or injury, which could explain the pain. Stress can be a factor of an IBS flare up and the pain or discomfort can, sometimes be relieved by a bowl movement. Symptoms of IBS include abdominal pain, bloating, constipation, diarrhoea and/or excessive wind. Some patients may experience bouts of diarrhoea and others may have constipation, whilst others may experience alternating bouts of constipation and diarrhoea. The condition is unpredictable and flare ups can occur without notice. For this reason the condition can be debilitating for patients. So far, there is no cure for IBS. A controlled diet and change of lifestyle may ease symptoms. An increased intake of fibre and minimising food with a high fat content may help. As larger meals can cause cramping and diarrhoea, patients should be advised to eat little and more often. Probiotics, live microorganisms that are usually sold as dietary supplements or are to be found in special yogurts have been found to improve symptoms of IBS in some people, when taken in large enough amounts. Medications such as fibre supplements, anti diarrheals and laxatives can all ease the symptoms of IBS flare ups. Antispasmodics, such as hyoscine, cimetropium and pinaverium may help to control colon muscle spasms and reduce abdominal pain. Irritable bowel syndrome (IBS) is a disorder that leads to abdominal pain and cramping, changes in bowel movements, and other symptoms. It is not clear why patients develop IBS. Sometimes it occurs after an infection of the intestines. This is called postinfectious IBS. There may also be other triggers. IBS can occur at any age, but it often begins in the teen years or early

adulthood. It is twice as common in women as in men. IBS is not the same as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. In IBS, the structure of the bowel is not abnormal. IBS causes various symptoms including (but not limited to) pain and discomfort in different parts of the abdomen; bloating and swelling of the abdomen and bouts of diarrhoea and/or constipation. Antispasmodic medicines relax the muscles in the wall of the gut. There are several types of antispasmodics. For example, mebeverine, hyoscine and peppermint oil. They work in slightly different ways. Therefore, if one does not work well, it is worth trying a different one. If one is found to help, then customers can take it as required when pain symptoms flare-up. Many people take an antispasmodic medicine for a week or so at a time to control pain when bouts of pain flare up. Some people take a dose before meals if pains tend to develop after eating. Constipation is sometimes a main symptom of IBS. If so, it may help if individuals increase their fibre. Sometimes laxatives are advised for short periods if increasing fibre is not enough to ease a troublesome bout of constipation. An antidepressant medicine in the tricyclic group is sometimes used to treat IBS. In particular, it tends to work best if pain and diarrhoea are the main symptoms. (Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including IBS.) Unlike antispasmodics, customers need to take an antidepressant regularly rather than as required. Therefore, an antidepressant is usually only advised if they have persistent symptoms, or frequent bad flare-ups that have not been helped by other treatments.

Heartburn and Indigestion Who is the patient? Indigestion can affect all ages, including children. However, GORD is more common in adults over 40. Gastric Ulcers can also occur at any age but are more common in adults over 60. If a patient is over 45 years of age and has developed indigestion for the first time, he or she should be referred to the doctor. What are the symptoms? Burning sensation in the chest or abdomen, bloating, severe wind, belching, nausea or vomiting. How long has the patient had the symptoms? It is estimated that most people will suffer from indigestion at least once a week. If a patient is experiencing constant indigestion that will not ease, they should be referred to their doctor. Actions already taken? Patients can alter their lifestyles to minimise the occurrence of indigestion. Eating smaller portions and at regular intervals may help, as will avoiding fatty foods, smoking and alcohol and stress, as mentioned above. Medication. Certain medicines can irritate the lining of the gastro intestinal tract, such as aspirin. If a patient has experienced reoccurring indigestion and has taken antacid medicines, they should address the cause of their heartburn or be referred to their doctor.

Irritable Bowel Syndrome (IBS) Who? IBS can occur at any age but is more likely to affect women in their late teens or twenties. What are the symptoms? Common symptoms are bloating, diarrhoea, constipation, cramping, feeling that bowel movements are incomplete and passing mucus in stools. How long has the patient had the symptoms? Most IBS sufferers will experience symptoms of IBS at least three or more days in a month. Actions already taken? Has the patient looked at their lifestyle and tried to change their diet? Have they completed a food diary? Medication - There is a wide variety of medication available over the counter, which addressed the symptoms of IBS, such as anti diarrheals, laxatives and supplements, i.e. fibre supplements and probiotics.

WHEN TO REFER TO THE PHARMACIST: > Those with particularly severe heartburn > Those with heartburn and a persistent cough > Those suffering dysphagia

SELF-CARE AND ADVICE > Advise sufferers of heartburn on losing weight > Heartburn patients should stop smoking and reduce alcohol intake > Some may find relief in raising their head of the bed at night > Small, regular meals are best > Refer any IBS sufferers with sudden weight loss or rectal bleeding

PATIENT SUPPORT The Irish Society for Colitis and Chron's Disease www.iscc.ie Tel: 01 872 1416 Irritable Bowel Syndrome Association www.ibsgroup.org


Are you recommending Symprove? The average person is home to about 100 trillion microbes which are mostly bacteria and the majority are found in the gut. These gut flora are normal inhabitants and make up part of the human microbiome - a vast internal ecosystem. They are vital for survival and important for human health. Gut microflora are thought to support many physiological functions including but not limited to, preserving key nutrients and the synthesis of vitamins such as folic acid and biotin, stimulating the repair mechanism of cells, fermenting complex indigestible carbohydrates, as well as playing a crucial role in host defence. Within the first few months of birth, gut flora undergoes huge changes several times, as different species of bacteria establish and flourish responding to a baby’s needs and diet. By the age of three, the gut microbiome has matured and the majority inhabit the colon. Once established the normal intestinal microbiome tends to remain relatively stable. Whilst we all share a number of the same species, it is also becoming more widely accepted amongst scientists, that modern day living, stress and diet, influence the variations and may have an impact on the composition of the intestinal microflora and our health. A healthy gut flora requires balance. Certain types of bacterial strains produce natural antibiotics called ‘lactocidin’ and ‘acidophilin’ and increase immune resistance against harmful or pathogenic bacteria. Others secrete a substance called ‘peptidoglycan’ which supports the natural defences of the body and stimulates immune responses in the intestinal tract. If the microflora in the gut becomes unbalanced, given the space or opportunity, pathogenic bacteria may invade these spaces. Due to their important properties, specific strains of ‘friendly’ bacteria such as those from the Lactobacilli family have raised considerable interest with scientists in recent times, although these ‘life-giving’ bacteria have existed within us for millions of years. As a result, more and more people are using products containing ‘friendly’ bacteria daily. With so many products on the market today, Pharmacy teams have a challenge when it comes to recommending products delivering the right bacteria to their customers. Needless to say, it’s hard for consumers to make informed choices and over 70% of them ask pharmacy staff for guidance before buying a product.

Here are some of the key considerations when guiding customers: Efficient delivery system

Dosage

In order for probiotics to work effectively and to their optimum, they need to be directed to specific sites within the gut without triggering digestion. For food products such as dairy containing ‘friendly’ bacteria, this is a challenge as the stomach acids and bile salts released during digestion can weaken the bacteria, and they may never reach the site where needed.

Dose-response studies in human trials have only been performed in very few cases. Doses are not interchangeable between products, are strain-specific and efficacy varies widely. More is not necessarily better.

Lyophilised products, on the other hand, like capsules and powders take several hours to rehydrate before they are ready to begin work. By this time, many of the bacteria have passed through the gut.

Individual product evaluation

Viability stated on the box Ensure Colony Forming Units (CFUs) stated per dose concur with ‘best before date’ not time of manufacture.

Each product is unique based on strain, formulation and dose, so what may apply to one product is different for another.


So what should you look for? • Water-based, ready-to-work, multi-strain bacteria • Efficient delivery system which provides protection and does not set-off the digestive process • Viable cultures containing Colony Forming Units (CFUs) • Non-dairy and gluten free formula • Strain specific dose and course evidence

Symprove delivers the right bacteria to the gut Symprove is a non-dairy, gluten free supplement delivering multiple strains of bacteria. These naturally occurring bacteria are grown on extract of germinated barley and ready-to-work as soon as Symprove has passed through the stomach. Symprove is the only product to deliver multi-strain bacteria in this way because of its Unique Delivery System (UDS™). The unique formula protects them from the volatile conditions throughout the gastrointestinal tract, delivering the bacteria to targeted areas of the gut where they colonise.

How to take Symprove

It’s recommended that first-time users drink a 3-month course of Symprove. This gives the bacteria enough time to build momentum in the gut. Drink 1ml per kilo of bodyweight first thing in the morning on an empty stomach. Wait 5 minutes and then have breakfast.

Start recommending Symprove today Join the growing numbers of pharmacies who’ve found that stocking Symprove is bringing more and more new customers into their store.

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Phone or email to set up an account today with Allegro at (01) 8580801 or email: pharmacyorders@allegro.ie

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Dulcolax has been helping consumers with constipation for over 60 years.

We are the number 1 laxative range * d n a el Ir in

• Dulcolax has the highest level of TV spend in the category • Dulcolax has the highest level of loyalty and satisfaction in the category**

Dulcolax® 5mg gastro-intestinal Tablets Offers predictable overnight relief. It is an overnight laxative that works to treat the constipation and also tell the body when it's time to go to the toilet. Taken at night customers should be able to go to the toilet in the morning in the comfort of their own home. It has a comfort coating which means it is gentle on the tummy and only works where its needed! Contains Bisacodyl, always read the label

Dulcolax® 100ml and 300ml Pico Liquid For people who prefer a liquid. It is sugar free, fruit flavored and offers predictable overnight relief. Contains Sodium picosulfate always read the label

Dulcolax® 10mg and 5mg Suppositories For people happy to use suppositories, and who need fast relief from their symptoms. They are manually inserted into your back passage, and they dissolve and get to work in about 20 minutes (usual range 10-30 minutes), giving quick relief from constipation

*latest IMS world wide data and IMS Ireland data YTD **Data on file UK/Ireland, YTD

Contains Bisacodyl, always read the label

www.letstalkconstipation.ie


When you start talking about constipation you’re sure to hear one of these...

There are a lot of myths and misconceptions surrounding constipation and the use of laxatives, and this can be really confusing. Some are true, but some are not, and here we try and provide some simple advice on the most common myths!

Eating more fibre can help prevent the symptoms of constipation Sometimes Although some people find that eating lots of fibre rich foods helps prevent constipation, some people with severe constipation actually find it gets worse if they up their fibre intake.

Not getting enough exercise can make you constipated Sometimes

Myth Busted

Experts say constipation doesn't cause a build-up of toxins in the body.

Women get constipated before their period Sometimes

Women get constipated when they are pregnant True

Myth Busted

It's unlikely that taking the recommended number of laxatives will do you any harm. Although some people with chronic constipation find that they need laxatives to be able to go most of the time, it's not because they've become 'tolerant' to them.

Using laxatives can lead to 'rebound constipation' Myth

Myth Busted

There's no evidence that constipation comes back as soon as you stop taking laxatives for constipation.

Myth Busted

Some people can misuse laxatives but they aren't addictive.

Laxatives help with weight loss Myth

for it. I mean I eat a really

healthy diet, I drink plenty of fluids, I exercise every day and I still get constipated

regularly. Some people must

just be more prone to getting regardless of their diet and lifestyle.’

‘It frustrates me because it makes me reconsider what I

Pregnancy hormones do seem to affect the speed that food and waste travels through the gut, slowing it down and sometimes leading to constipation.

Laxatives are addictive Myth

from constipation, there isn’t

constipated than others

The experts say that hormones only play a small part in constipation, but some women swear that the time of the month affects how often they go to the loo.

It's possible to get dependent on laxatives Myth

‘I think if you are suffering always a logical explanation

Older people especially tend to find that being inactive can lead to getting constipated, or makes it worse. There are usually other factors, too, though

Being constipated causes toxins to build up in your body Myth

Sarah’s story

Myth Busted

Categorically NO - they are licensed for constipation and do not cause weight loss. Taking a laxative where there is no need for constipation relief will merely result in the loss of water, salts and nothing more.

wear. It sounds crazy but if

you go to the toilet it makes you feel better, so you think you look better. So I hate it

when I’m feeling bloated as it stops me from wearing fitted clothes.’

‘I find it helps talking to my

friends about it sometimes. It’s actually quite surprising how many other women do suffer from constipation once you start talking about it.’


66

Male Health

When it comes to discussing health matters men have always had reservations, particularly with health care professionals. In recent years a number of campaigns have attempted to abolish the taboo nature of the subject and encourage men to talk about their health. In 2009 a National Men’s Health Policy was published as a guide for healthcare professionals on all matters regarding men’s health in Ireland. The aim of the policy was to increase awareness on men’s health issues and to encourage men to act on problems.

Men in Ireland live on average five years less than women. Pharmacy staff can play a critical role in supporting men’s health. The National Men's Health Policy in Ireland acknowledges that men under-use. Many men are reluctant to

visit their pharmacy or GP surgery to seek advice or treatment, pharmacies can act as a first point of contact between these men and the medical world - especially as pharmacies also sell non-medical products which men require.

Erectile Dysfunction Erectile dysfunction, commonly referred to as ED, is the inability to achieve and sustain an erection suitable for sexual intercourse. This condition is not necessarily considered regular at any age and is different from other problems that affect sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Most men will suffer with erection problems at least once in their lives. Failure to attain an erection less than 20% of the time is not uncommon and treatment is seldom needed. Failure to attain an erection more than 50% of the time, however, generally indicates there is a problem and treatment will be required.

ED can be caused by many issues including diseases that affect blood flow, nerve diseases and psychological factors, such as stress, depression, and performance anxiety. Chronic illness, certain medications, and a condition called Peyronie's disease can also cause ED.

vacuum pumps, and surgery are all used to treat ED. Each type of treatment has its own advantages and disadvantages.

Age can be a factor with ED but is too often believed that if ED occurs later in life it should be accepted as part of getting older and many men leave the issue untreated.

The earlier ED is diagnosed, the easier and faster it is to treat. It is important that men are aware of the symptoms, treatment and the importance of regular, physical check-ups.

Treatment for ED depends on the cause of the problem. Oral medications, sex therapy, penile injections, suppositories,

A healthier lifestyle with regular exercise and low amounts of alcohol and no smoking can reduce a man’s chance of ED.

lower testosterone such as infection, a serious illness, injury or the loss of the testicles.

physical exam will diagnose low testosterone.

ED can be a sign of more serious health problems. It may mean a patient’s blood vessels are clogged or they have nerve damage from diabetes.

Low testosterone Testosterone is a hormone responsible for chest hair, sexual characteristics, muscle mass, the deepening of the voice, and keeping bones strong, most of the characteristics associated with masculinity. Most of these developments happen during puberty. After age 30, most men begin to experience a gradual decline in testosterone. A decrease in sex drive sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that their loss of libido is simply due to getting older. Low testosterone (LT) effects muscle mass and can increase body fat. It can also influence cholesterol and body hair. There are other reasons, other than age that results in

LT can leave a patient feeling excessively fatigued, weaker, depressed, and that they have lost their sex drive. These are all common symptoms of LT. It is important these symptoms are recognised by the patient and the pharmacy staff. It’s also important for a patient to feel they can confide in their pharmacist and pharmacy staff. The symptoms for LT can often present themselves as other health issues such as diabetes, depression or high blood pressure. For this reason a number of tests may be carried out on the patient in order to rule out the other health risks. A blood test and

In recent years Testosterone Replacement Therapy has evolved and there are more options available. LT or a testosterone deficiency can be treated using Testosterone Replacement Therapy or TRT. TRT can be prescribed as an intramuscular injection usually given on a bi-weekly basis, as a patch or gel placed on the skin, or as putty that is applied to the gums of the mouth. Each of the treatments has its risks and benefits. The decision as to which form of testosterone to use depends upon the on the cause of the problem, the patient's preference and tolerance, and cost.

Prostate Cancer In 2010, 2,978 Irish men were diagnosed with prostate cancer according to the latest figures from the Irish Cancer Society. Over 2,500 men are diagnosed with prostate cancer in Ireland each year. After skin cancer, it is the leading cause of cancer in men, however there is a considerable gap between the awareness between the two cancers. The risk of a man developing prostate cancer before the age of 50 is 1 in 485 and before the age of 70 is 1 in 13. Prostate cancers usually only cause symptoms when they are large enough to disturb the bladder or press on the tube that

drains urine. For that reason, the symptoms of prostate cancer, when they appear, are like the symptoms of an enlarged prostate. The symptoms of prostate cancer include: • Passing urine more often, especially at night. • Pain or difficulty when passing urine • Trouble starting or stopping the flow of urine • The feeling of not having emptied the bladder • Frequent pain in the lower back, hips or upper thighs

• Trouble having or keeping an erection • Blood in urine or sperm (very rare) Awareness of these symptoms and encouragement to visit a healthcare professional is essential for men’s good health. Many of these symptoms can also be due to complaints other than cancer, but regardless patients should be instructed that they should be tested for prostate cancer. When caught at the early stages, prostate cancer is 100% curable. Prostate cancer treatments vary: From newer techniques like cryotherapy, to surgery, or hormone therapy.


Male Health

67

WWHAM Erectile Dysfunction

Male Baldness Hair loss or male patterned baldness can be an embarrassing issue for men. For a few men this process starts as early as their late teens, with others it can happen in their late 20s and 30s. Thinning of the hair may be first noticeable, and then a more noticeable hair loss, allowing more of the scalp to become visible. Male baldness has been found to be linked to a certain gene and is inherited. Other causes can be stress, under active thyroid, medication side effects, and anaemia. The hair is usually lost at the temples and the crown. This happens because of an oversensitivity of hair follicles to a hormone called dihydrotestosterone (DHT) which the body makes from

testosterone. Hair follicles will continue to become thinner and thinner hair until they are eventually gone. The receding hairline will gradually meet the bald patch, leaving a completely bald scalp. For some men male baldness is not an issue, however, for others it can cause anxiety, low self-esteem or depression. Men should be encouraged to see a medical professional to ensure the issue is not caused by something more sinister. Treatments include wigs, hair transplants, lotions, preventative pills and surgery. The correct treatment depends on the patient.

Who? Can occur in males of all ages that are sexually active What are the symptoms? Inability to achieve and retain an erection How long has the patient had the symptoms? Failure to achieve an erection more than 50% of the time Action already taken? Erectile dysfunction may be the result of many factors but those suffering from stress can try and implement anxiety-reducing measures Medication? Oral medications, sex therapy, penile injections, suppositories, vacuum pumps, and surgery

Low testosterone

Who? Mainly those over the age of 30 What are the symptoms? Fatigue and a loss of sex drive are amongst the symptoms How long has the patient had the symptoms? Sufferers may find the onset of symptoms happens gradually past the age of 30 Action already taken? Sufferers may already have confided in pharmacy staff about a loss of libido and other common symptoms Medication? Testosterone Replacement Therapy

Prostate Cancer

Who? Mainly those over the age of 50 What are the symptoms? Passing more urine than normal, frequent pain in lower back, difficulty in maintaining an erection How long has the patient had the symptoms? Symptoms similar to that of an enlarged prostate may begin in a mild fashion and continue to worsen Action already taken? All male patients displaying the symptoms should be urgently referred for further testing Medication? Cryotherapy, surgery, or hormone therapy.

Male baldness Who? Can start as early as late teens What are the symptoms? Gradual thinning of hair How long has the patient had the symptoms? Thinning of the hair will develop into noticeable hair loss over time Action already taken? Sufferers may already be taking preventative medication to slow down hair loss Medication? Wigs, hair transplants, lotions and preventative pills

WHEN TO REFER TO THE PHARMACIST: > Those with symptoms of prostate cancer > Those suffering from depression and/or anxiety due to their condition > Those with blood in the urine > Those for whom diabetes or high blood pressure is suspected

SELF-CARE AND ADVICE > Advise ED sufferers on the benefits of increasing exercise, decreasing alcohol intake > Advise on giving up smoking

PATIENT SUPPORT Irish Cancer Society www.cancer.ie Tel: 1 800 200 700 The Everyman Centre www.everymancentre.ie Tel: 1 678 8010


Diagnostics

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In an era of convenience and easy access to medical information, the public has become much more pro-active in looking after its own health. Now that pharmacies have consulting rooms, they are in an ideal position to offer counseling to patients on testing and self-testing, particularly as this will also offer pharmacies the opportunity of competing with other primary health care providers. Self-diagnostic kits have become an important part of health care and should be displayed prominently. Since the advent of pregnancy testing, the selfdiagnostic market has expanded as new diagnostic

ranges have come along. Diagnostic tests cover the early detection, targeted screening and monitoring of diseases and are especially important in the areas of diabetes and blood pressure testing.

Diabetes With the incidence of diabetes rising every year, blood glucose monitoring devices have become a significant part of managing diabetes. Regular testing helps patients to measure the effectiveness of their dietary planning, exercise and medication. Products in this category range from meter systems and testers to insulin pumps and infusion sets. Diabetes will probably show up with repeated requests for something to cure regular thirst and tiredness so it is essential that counter assistants know and recognise the signs and symptoms of specific

conditions so as to best offer guidance to customers. Diabetes is detected by carrying out a simple blood test that highlights how much glucose is in a person's blood. Diabetes self-diagnostic kits should be fully explained to patients buying these products, in order to avoid confusion and unnecessary worry to the patient because sometimes tests for diabetes can be misleading. False readings often depend on the time of day that they were taken.

Prostate Tests At-home prostate cancer kits in the pharmacy can alleviate embarrassment for the male customer and may encourage more men to test for the disease as it gives them the option to take the test in the privacy of their own homes. Testing for prostate cancer involves checking for

elevated levels of a protein called Prostate Specific Antigen (PSA), which can be an early sign of the disease. The tests do not diagnose the presence of prostate cancer but, by detection of high levels of PSA will probably encourage men to seek further testing.

Sexually Transmitted Infections Home testing for Sexually Transmitted Infections (STIs) is a category that has grown in popularity as awareness of STIs has increased but the stigma and embarrassment of carrying such infections often results in women (and men) from willingly consulting with their GP or local clinic. Carrying home testing STI kits in the pharmacy makes it easier and more accessible for these patients to do this testing themselves.

Additionally, offering confidential advice on common STIs can give a pharmacy the upper hand, as opposed to patients obtaining the tests online, where there isn't any counselling. Patients should be advised to see their doctor if their tests prove positive so that the infection can be treated immediately.

Blood Pressure/ Cholesterol Tests Blood Pressure and cholesterol testing in pharmacies has made the screening for these conditions much more accessible. Most pharmacies offer tests for under â‚Ź20, compared to a GP visit costing between â‚Ź40 and â‚Ź60. According to research, four out of five Irish people over the age of 45 suffer from high cholesterol. Heart disease is one of the biggest killers of men in Ireland.

An initial consultation with a patient who has symptoms of high cholesterol or blood pressure can lead to the pharmacist recommending a consultation. Also promotional awareness weeks such as Healthy Heart Week can encourage patients to avail of the screening services.

Pregnancy Tests and Ovulation Tests Pinpointing ovulation is essential when a woman is trying to conceive. To be able to identify the point of ovulation is of significant benefit to many hopeful mothers. Pregnancy tests are probably the most common of all the self-diagnostic kits. While some supermarkets may stock these tests, pharmacists have the advantage of being on hand to answer any questions that may crop up. Some self-diagnostic kits have the ability to mislead those patients who do not follow the instructions correctly. However, counter assistants should be able to advise patients and, if any of the results prove positive, to point them in the direction of their pharmacist and/or GP.

WWHAM Who? Diabetics, those with high blood pressure, women suspecting pregnancy and all customer who wish to take advantage of self-help care What are the symptoms? Symptoms will be dependent on the appropriate diagnostic kit How long has the patient had the symptoms? This will be dependent on the appropriate diagnostic kit Action already taken? Customers will already have diagnosed the condition for which they seek a diagnostic kit Medication? Customers can be referred to the pharmacist/GP following use of any diagnostic kit for further management and treatment plans

WHEN TO REFER TO THE PHARMACIST: > Male users with evidence of high PSA levels > Those with positive STI results > Those with high blood pressure

SELF-CARE AND ADVICE > Advise customers on the correct and appropriate use of their chosen diagnostic kit > Those requiring advice on STI kits should be offered the use of a private consultation room and follow-up

PATIENT SUPPORT Diabetes Federation of Ireland www.diabetes.ie Tel: 1 850 909 909 Family Planning Association www.fpa.org.uk Tel: 0845 1228690 Irish Cancer Society www.cancer.ie | Tel: 1 800 200 700


Easofen – for the relief of pain

Easofen 200mg film-coated tablets. Easofen Max Strength 400mg film-coated tablets. Ibuprofen. Clonmel Healthcare Ltd., Waterford Road, Clonmel, Co. Tipperary. A copy of the summary of product characteristics is available on request. Medicinal product available for retail sale through pharmacy only. 2012/ADV/IBU/113. Date prepared: January 2013


Sexual Health

71

Community pharmacies and their staff have a vital role to play in giving sexual health advice and information to the public. Ano-Genital Warts Ano-genital warts usually first appear as small, painless bumps in, on or around the cervix, vagina, anus, penis or scrotum. They may vary in size and shape and usually appear within weeks or months of sexual contact with an infected person. Ano-genital warts are caused by infection with certain types of the human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. Ano-genital warts caused by infection with HPV can be transmitted during vaginal, oral or anal sex, or during genital contact with an infected partner. They are highly infectious and approximately two thirds of people who have sexual contact with a partner with genital warts will develop warts. Warts usually disappear even if left untreated, but this can take months or even years. Diagnosis is usually made on visual examination. However, ano-genital warts may not be easy to recognise or may be in locations where they are difficult to see. Sufferers should never attempt to get rid of genital warts with over-the-counter remedies. The genital area is too sensitive for many products. Instead, they should be referred to the pharmacist or local GP. Chlamydia Chlamydia is a curable sexually transmitted infection caused by the bacterium, Chlamydia trachomatis. Chlamydia can be transmitted during unprotected vaginal, anal or oral sex with an infected person. Symptoms may be mild or absent in at least 70% of women and 50% of men. Even if a person is asymptomatic they can still transmit the infection to a sexual partner. If present, symptoms in women include; vaginal discharge, abdominal pain, bleeding between periods or after sexual intercourse and a burning sensation during urination. Men may experience discharge from the penis, burning and itching in the genital area, and pain when passing urine. If the infection is transmitted via anal sex, it can cause rectal pain, bleeding or discharge. Chlamydia transmitted via oral sex is usually asymptomatic but redness and soreness in the mouth or throat can occur. If symptoms do occur, they usually appear within 1-3 weeks of infection. They can persist or they may only last for a few days. Treatments for STIs depend on the type of infection. The bacterial infections Chlamydia, gonorrhoea, syphilis, Mycoplasma, Ureaplasma and non-specific urethritis are treated with a course of antibiotics such as a penicillin, tetracycline, doxycycline, azithromycin, cefixime or metronidazole.

Thrush Thrush is caused by forms of a fungus called Candida. A small amount of this fungus lives in the mouth most of the time. It is usually kept in check by the immune system and other types of germs. However, when the immune system is weaker, the fungus can grow, leading to sores (lesions) in the mouth and on the tongue. Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a couple of weeks. Symptoms include vaginal discharge, usually resembling a cottage cheese-like appearance and is often described by many women to be white, thick, cheesy, sticky and gluey. Itching and burning are the most common symptoms. Sufferers should avoid scratching as this will make the condition worse. Redness, soreness and pain, vaginal fissuring and satellite lesions are also common. For thrush in infants, treatment is often not necessary. It generally gets better on its own within 2 weeks. Those developing a mild case of thrush after taking antibiotics, eating yogurt or taking acidophilus capsules can help. Advise on the use of a soft toothbrush and rinsing of the mouth with a diluted 3% hydrogen peroxide solution several times a day. Antifungal mouthwashes (nystatin) or lozenges (clotrimazole) to suck on are also available. These products are usually used for 5 - 10 days. If the infection has spread throughout the body or they have HIV/AIDS, stronger medications may be used, such as fluconazole (Diflucan) or ketoconazole (Nizoral). Genital Herpes Simplex Genital herpes simplex is an incurable sexually transmitted infection caused by the herpes simplex virus (HSV). There are two distinct subtypes of HSV. Type 2 is most commonly associated with genital infection. Type 1 has also been found to cause genital infection but is more commonly associated with oral herpes (cold sores). Most infected individuals experience no symptoms or mild symptoms. If present, symptoms include blisters/inflammation at the site of infection and a burning sensation during urination. When the blisters break, they leave a tender sore, which may take a few weeks to heal. Most people with genital herpes simplex infections are asymptomatic and may never know that they are infected. When symptoms do occur they are usually most severe during the first episode. Symptoms usually occur within two to ten days of infection and vary from person to person.

WWHAM Who? Those who are sexually active but also infants in the case of thrush What are the symptoms? These can include visibility of genital warts; discharge and pain in chlamydia patients; itching and burning in thrush sufferers How long has the patient had the symptoms? Usually appearing within 1-3 weeks of infection Action already taken? Those experiencing sexual infection may have akready had a screening test, reduced their sexual partners or employed full sexual avoidance Medication? Antibiotics, antifungal mouthwashes and acidophilus capsules; self care tips including the use of condoms and reduction in the number of sexual partners

WHEN TO REFER TO THE PHARMACIST: > Pregnant women > Those suffering from warts planning to get pregnant > For child protection issues, any child or young person with chlamydia, particularly when they are aged <13 years without clear evidence of vertical transmission during birth, or of blood contamination > Presence of ongoing symptoms despite treatment

SELF-CARE AND ADVICE > Individuals can reduce their risk of getting genital HPV infection by changes in sexual behaviour including abstinence from any sexual activity or lifelong monogamy. Reducing the number of sexual partners and the frequency of new partners will also reduce the risk. > Women with genital warts, should have a regular cervical smear test which looks for changes in the cells of the cervix that could indicate that cells have become pre-cancerous or cancerous. > For those with uncomplicated chlamydial infection sex should be avoided until treatment is completed and recent sexual contacts (within the last three months) of an infected person should also be tested regardless of whether they are symptomatic. > Protection against STI's can include abstinence, mutually monogamous relationships, correct use of male latex condoms and reductions in the numbers of sexual partners

PATIENT SUPPORT The Drug/HIV Helpline Tel: 1800 459 459 Family Planning Association www.fpa.org.uk Tel: 0845 1228690


Smoking Cessation

73

Approximately 40% of all smokers try to quit every year. Only a small fraction (2–3%) is successful but smokers can double their chances of quitting using support from their pharmacy team. Reducing the prevalence of smoking among people in routine and manual groups, some minority ethnic groups and disadvantaged communities will help reduce health inequalities more than any other measure to improve the public’s health. Pharmacists and their staff should offer behavioural counselling, group therapy, pharmacotherapy or a combination of treatments that have been proven to be effective with the aim of ensuring customers receive behavioural support from a person who has had training and supervision. A target should also be to provide tailored advice, counselling and support, particularly to those from minority ethnic and disadvantaged groups. NRT is a way of getting nicotine into the bloodstream without smoking. There are nicotine gums, patches, inhalers, tablets, lozenges, and sprays. Nicotine patches are stuck onto the skin releases nicotine into the bloodstream. Some patches last 16 hours, which are only worn when awake. Other types last 24 hours, worn the whole time. The 24 hour patch may disturb sleep, but is thought to help with early morning craving for nicotine. The patches come in different strengths. Manufacturers normally recommend strength is gradually reduced. However, some research studies suggest that stopping abruptly is probably just as good without the need to gradually reduce the dose. Skin irritation beneath the patch occurs in some users.

gum available - 2mg and 4mg. The 4mg strength should be used if an individual smokes 18 or more cigarettes a day. They may need about 12-15 pieces of gum per day to start with (about one per hour). To release the nicotine, gum should be chewed slowly until the taste is strong, then rested between the cheek and the gum to allow absorption of nicotine into the bloodstream. Use a fresh piece of gum after about an hour. After 2-3 months gum should be gradually reduced. Gum is not suitable for denture wearers. Inhalers resemble a cigarette. Nicotine cartridges are inserted into it, and inhaled in an action similar to smoking. Each cartridge provides up to three 20 minute sessions. Approximately 6-12 cartridges per day should be used for eight weeks, gradually reducing over four further weeks. The nicotine from nasal spray is rapidly absorbed into the bloodstream from the nose. This form of NRT most closely mimics the rapid increase in nicotine level received from smoking cigarettes. This may help to relieve sudden surges of craving. Sideeffects such as nose and throat irritation, coughing, and watering eyes occur in about 1 in 3 users. Varenicine is a selective nicotine receptor partial agonist, which is used as a smoking cessation aid. It requires a commitment from the patient to stop smoking and is started one to two weeks before the patient has established a quit date. The treatment is a 12-week course, which can be repeated if there is a relapse. Varencine should not be offered as combination therapy with NRT.

Nicotine is absorbed through the mouth into the bloodstream. There are two strengths of

REDUCING THE PREVALENCE OF SMOKING WILL HELP REDUCE HEALTH INEQUALITIES

WWHAM Who? All smokers What are the symptoms? Wanting to kick the habit, those who have previously been unsuccessful in going 'cold turkey' How long has the patient had the symptoms? N/A Action already taken? Smokers may have already began to cut down their nicotine intake Medication? Patches, inhalers, sprays, lozenges and gum are all available

WHEN TO REFER TO THE PHARMACIST: > Ask people who smoke how interested they are in quitting > If they want to stop, refer them to an intensive support service and smoking cessation aids > If they are unwilling or unable to accept a referral, offer a stop smoking aid (pharmacotherapy) as a primary measure with advice on the benefits of stopping smoking > The smoking status of those unwilling to quit could be recorded and reviewed with the individual after twelve months > Monitoring systems could be set up so that you know whether or not your patients smoke

PATIENT SUPPORT Irish Cancer Society www.cancer.ie Tel: (0)1 231 0500 HSE Smoking Cessation Service www.quit.ie National Smokers’ Quitline on 1850 201 203 Action on Smoking and Health www.ash.ie 0818 305055


Animal Health

75

PAREXTM THE NON PRESCRIPTION SPOT ON FLEA/TICK TREATMENT FOR DOGS AND CATS  ParexTMSpot-On Solution – The first Non-prescription fipronil  Kills fleas and ticks in dogs and cats.

PAREXTM SPOT-ON is currently available in 4 presentations 1. Parex 50 mg spot-on solution for cats 2. Parex 67 mg spot-on solution for small dogs :2-10kg 3. Parex 134 mg spot-on solution for medium dogs:10-20kg 4. Parex 268 mg spot-on solution for large dogs:20-40kg Cats : Indications for use, specifying the target species. Fleas: For the treatment of cats against flea infestations (Ctenocephalides spp.).Insecticidal efficacy against new infestation with fleas persists for up to 4 weeks. Ticks: Acaricidal efficacy for up to 1 week against the tick Ixodes ricinus has been shown. If ticks of Ixodes ricinus are present when the product is applied, all the ticks may not be killed within the first 48 hours, but they may be killed within a week. Dogs :Indications for use, specifying the target species Fleas: For the treatment of dogs against flea infestations (Ctenocephalides spp.). Insecticidal efficacy against new infestation with fleas persists for up to 6 weeks. Ticks: Acaricidal efficacy (several ticks may be present after 48 hours), it has a persistent acaricidal efficacy for up to 4 weeks against Dermacentor variabilis and up to 3 weeks against Rhipicephalus sanguineus

Administration: Part the coat so the skin is visible and apply to skin level where licking cannot occur.

Contra indications warnings etc  ParexTM should not be used on puppies less than 8 weeks old or 2 kg; or kittens less than 8 weeks old and/or less than 1 kg. Weight.  Do not use on sick (systemic disease, fever, etc.) or convalescent animals.  Do not use on rabbits, as adverse drug reactions and even death could occur.  This veterinary medicinal product has been developed specifically for dogs and separately for Cat . Do not interchange products as this could lead to overdosing.  Do not use on animals with hypersensitivity to the active substance or any other excipients

Key Selling Points:  ParexTM is LM (Licensed Merchant) Product and does not need a prescription .  Long Lasting – Fleas -6 weeks in Dogs and 4 weeks in Cats  Water resistant – Your pet can swim or be bathed as usual from 48 hours after application.  ParexTM Spot – is safe to use on breeding, pregnant or lactating animals on consultation by your veterinary surgeon.  ParexTM is brought to you by a CF Pharma Ireland Ltd – A local Irish Company And your Irish pharmacist owned Uniphar Wholesale.  For more information see : www.uniphar.ie/divisions/unipar-wholesale/veterinary/pharmachem


NEW

Tasectan

The treatment suitable for Adults, Children & Infants

Mode of Action

1. Tasectan forms a film which protects the intestinal wall 2. It limits the contact of the toxins 3. It promotes their excretion Composition: Gelatin Tannate www.diarrhoea.ie

Available from Ocean Healthcare & all Wholesalers www.oceanhealthcare.ie | Tel 01 2968080


Haemorrhoids

77

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.They are very common, especially during pregnancy and after childbirth. They result from increased pressure in the veins of the anus. The pressure causes the veins to swell, making them painful, particularly when you are sitting.

WWHAM

Hemorrhoids Hemorrhoids may be caused by straining during bowel movements, constipation, sitting for long periods of time and anal infections. Hemorrhoids may be inside or outside the body.

themselves. These products should only be used for five to seven days at a time. If they are used for longer than this, they may irritate the sensitive skin around the anus.

Symptoms of hemorrhoids include anal itching, anal ache or pain, bright red blood on toilet tissue, stool or toilet bowl and pain during bowel movements.

Creams containing corticosteroids can also be used to reduce the inflammation around the anus. These should not be used for longer than a week as they can make the skin around the anus thinner.

Over-the-counter creams and medicines can be used to soothe any inflammation (swelling and redness) around the anus. These will only treat the symptoms of haemorrhoids, and will not cure the haemorrhoids

Painkillers, such as paracetamol, can be taken to relieve the pain caused by haemorrhoids. Witch hazel (applied with cotton swabs) can reduce itching.

Constipation Constipation is thought to affect a quarter of the population at some time but is more common in the elderly because the power of the bowel muscles diminishes with age and the elderly tend to take more medicines that have constipating side-effects. Passing stools may feel more difficult for several reasons. It may also seem more difficult because stools are dry, hard and lumpy; abnormally large or abnormally small. As well as causing a change in normal bowel habits, constipation can also cause stomach ache and cramps, feeling bloated, feeling nauseous and loss of appetite. Sometimes, constipation may be a side effect of medicines being taken such as aluminium antacids, antidepressants, antiepileptics (medicine to treat epilepsy), antipsychotics (medicine to treat schizophrenia and other mental health conditions) and calcium supplements. Constipation in babies and children is quite common. Approximately one in three parents

report constipation at some time in their child's life. Poor diet, fear about using the toilet and poor toilet training can all be responsible. As well as infrequent or irregular bowel movements, a child with constipation may also have the following signs and symptoms: • loss of appetite • lack of energy • being irritable, angry or unhappy • foul-smelling wind and stools Bulk-forming laxatives work by helping the stools to retain fluid. Bulk-forming laxatives also make stools denser and softer, which means they should be easier to pass. Osmotic laxatives increase the amount of fluid in the bowels. Stimulant laxatives stimulate the muscles that line the digestive tract, helping them to move stools and waste products along the large intestine to the anus.

Diarrhoea Diarrhoea is the passing of increased amounts (more than 300g in 24 hours) of loose stools. Most people are affected by diarrhoea at some time in their lives. It is often accompanied by stomach pains, feeling sick and vomiting. Diarrhoea can be acute (sudden onset and lasts less than four weeks) or chronic (persistent). In most cases, diarrhoea eases and goes within several days, but sometimes takes longer. The main risk is dehydration. For most adults, fluids drunk to keep hydrated should mainly be water. It is best to advise sufferers not to have drinks that contain a lot of sugar, as they can sometimes make diarrahoea worse.

Rehydration drinks can be recommended for people who are frail, or over the age of 60, or who have underlying health problems. Antidiarrhoeal medicines are available such as loperamide.

Haemorrhoids Who? Women after pregnancy are particularly at risk, as are those who are overweight and over 50 What are the symptoms? Anal itching and anal ache How long has the patient had the symptoms? Some patients have no symptoms or very mild symptoms. Sometimes prolonged constipation can bring about haemorrhoids Action already taken? Eating wholegrain bread, cereal, fruit and vegetable can help Medication? Painkillers, creams and anti-itch treatments

Constipation Who? Babies, young children and adults but predominantly the elderly What are the symptoms? Feeling bloated, stomach ache and cramps How long has the patient had the symptoms? Action already taken? Increasing fibre intake Medication? Laxatives are available

WHEN TO REFER TO THE PHARMACIST: > Pregnant women > Babies and young children > Those with persistent and severe haemorrhoids > Those with blood in their stools

SELF-CARE AND ADVICE > Advise on a change of diet and lifestyle, for example increasing daily intake of fibre and avoiding dehydration for those suffering from constipation > Advise on avoiding straining when passing stools as this may make haemorrhoids worse > The use of baby wipes can help with any discomfort after passing a stool when suffering from haemorrhoids


December 2013/January 2014 Week 1

30 Monday

31 Tuesday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

1 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

2 Thursday


January 2014 Week 1

3 Friday

4 Saturday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

5 Sunday

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

Notes


January 2014 Week 2

6 Monday

7 Tuesday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

8 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

9 Thursday


January 2014 Week 2

10 Friday

11 Saturday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

12 Sunday

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

Notes


January 2014 Week 3

13 Monday

14 Tuesday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

15 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

16 Thursday


January 2014 Week 3

17 Friday

18 Saturday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

19 Sunday

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

Notes


January 2014 Week 4

20 Monday

21 Tuesday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

22 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

23 Thursday


January 2014 Week 4

24 Friday

25 Saturday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

26 Sunday

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

Notes


January 2014 Week 5

27 Monday

28 Tuesday


December 2013 M 2 9 16 3 10 17 T 4 11 18 W 5 12 19 T 6 13 20 F 7 14 21 S S 1 8 15 22

23 30 24 31 25 26 27

28 29

January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

29 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

January 2014

27

28

30 Thursday


January/February 2014 Week 5

31 Friday

1 Saturday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

2 Sunday

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 Notes


February 2014 Week 6

3 Monday

4 Tuesday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

5 Wednesday

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 6 Thursday


February 2014 Week 6

7 Friday

8 Saturday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

9 Sunday

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 Notes


February 2014 Week 7

10 Monday

11 Tuesday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

12 Wednesday

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 13 Thursday


February 2014 Week 7

14 Friday

15 Saturday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

16 Sunday

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 Notes


February 2014 Week 8

17 Monday

18 Tuesday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

19 Wednesday

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 20 Thursday


February 2014 Week 8

21 Friday

22 Saturday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

23 Sunday

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 Notes


February 2014 Week 9

24 Monday

25 Tuesday


January 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

26 Wednesday

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

February 2014 27 Thursday


February/March 2014 Week 9

28 Friday

1 Saturday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

2 Sunday

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 Notes


March 2014 Week 10

3 Monday

4 Tuesday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

5 Wednesday

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 6 Thursday


March 2014 Week 10

7 Friday

8 Saturday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

9 Sunday

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 Notes


March 2014 Week 11

10 Monday

11 Tuesday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

12 Wednesday

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 13 Thursday


March 2014 Week 11

14 Friday

15 Saturday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

16 Sunday

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 Notes


March 2014 Week 12

17 Monday

18 Tuesday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

19 Wednesday

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 20 Thursday


March 2014 Week 12

21 Friday

22 Saturday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

23 Sunday

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 Notes


March 2014 Week 13

24 Monday

25 Tuesday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

26 Wednesday

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 27 Thursday


March 2014 Week 13

28 Friday

29 Saturday


February 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28

30 Sunday

March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

March 2014 Notes


March/April 2014 Week 14

31 Monday

1 Tuesday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

2 Wednesday

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

3 Thursday


April 2014 Week 14

4 Friday

5 Saturday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

6 Sunday

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

Notes


April 2014 Week 15

7 Monday

8 Tuesday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

9 Wednesday

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

10 Thursday


April 2014 Week 15

11 Friday

12 Saturday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

13 Sunday

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

Notes


April 2014 Week 16

14 Monday

15 Tuesday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

16 Wednesday

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

17 Thursday


April 2014 Week 16

18 Friday

19 Saturday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

20 Sunday

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

Notes


April 2014 Week 17

21 Monday

22 Tuesday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

23 Wednesday

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

24 Thursday


April 2014 Week 17

25 Friday

26 Saturday


March 2014 3 10 M 4 11 T 5 12 W 6 13 T 7 14 F S 1 8 15 S 2 9 16

17 24 31 18 25 19 26 20 27 21 28 22 29 23 30

27 Sunday

April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

April 2014

28 29 30 31

Notes


April 2014 Week 18

28 Monday

29 Tuesday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

30 Wednesday

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

April/May 2014 1 Thursday


May 2014 Week 18

2 Friday

3 Saturday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

4 Sunday

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 Notes


May 2014 Week 19

5 Monday

6 Tuesday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

7 Wednesday

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 8 Thursday


May 2014 Week 19

9 Friday

10 Saturday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

11 Sunday

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 Notes


May 2014 Week 20

12 Monday

13 Tuesday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

14 Wednesday

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 15 Thursday


May 2014 Week 20

16 Friday

17 Saturday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

18 Sunday

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 Notes


May 2014 Week 21

19 Monday

20 Tuesday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

21 Wednesday

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 22 Thursday


May 2014 Week 21

23 Friday

24 Saturday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

25 Sunday

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 Notes


May 2014 Week 22

26 Monday

27 Tuesday


April 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 28 22 29 23 30 24 25 19 26 20 27

May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

28 Wednesday

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

May 2014 29 Thursday


May 2014 Week 22

30 Friday

31 Saturday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

1 Sunday

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 Notes


June 2014 Week 23

2 Monday

3 Tuesday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

4 Wednesday

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 5 Thursday


June 2014 Week 23

6 Friday

7 Saturday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

8 Sunday

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 Notes


June 2014 Week 24

9 Monday

10 Tuesday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

11 Wednesday

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 12 Thursday


June 2014 Week 24

13 Friday

14 Saturday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

15 Sunday

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 Notes


June 2014 Week 25

16 Monday

17 Tuesday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

18 Wednesday

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 19 Thursday


June 2014 Week 25

20 Friday

21 Saturday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

22 Sunday

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 Notes


June 2014 Week 26

23 Monday

24 Tuesday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

25 Wednesday

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 26 Thursday


June 2014 Week 26

27 Friday

28 Saturday


May 2014 M 5 T 6 W 7 T 1 8 F 2 9 S 3 10 S 4 11

12 13 14 15 16 17 18

19 26 20 27

21 22 23 24 25

28 29 30 31

29 Sunday

June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

June 2014 Notes


June/July 2014 Week 27

30 Monday

1 Tuesday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

2 Wednesday

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 3 Thursday


July 2014 Week 27

4 Friday

5 Saturday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

6 Sunday

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 Notes


July 2014 Week 28

7 Monday

8 Tuesday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

9 Wednesday

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 10 Thursday


July 2014 Week 28

11 Friday

12 Saturday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

13 Sunday

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 Notes


July 2014 Week 29

14 Monday

15 Tuesday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

16 Wednesday

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 17 Thursday


July 2014 Week 29

18 Friday

19 Saturday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

20 Sunday

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 Notes


July 2014 Week 30

21 Monday

22 Tuesday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

23 Wednesday

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 24 Thursday


July 2014 Week 30

25 Friday

26 Saturday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

27 Sunday

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 Notes


July 2014 Week 31

28 Monday

29 Tuesday


June 2014 M 2 3 T 4 W 5 T 6 F 7 S S 1 8

9 16 23 30 10 17 24 11 18 25 12 19 26 13 20 27 14 21 28 15 22 29

July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

30 Wednesday

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

July 2014 31 Thursday


August 2014 Week 31

1 Friday

2 Saturday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

3 Sunday

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 Notes


August 2014 Week 32

4 Monday

5 Tuesday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

6 Wednesday

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 7 Thursday


August 2014 Week 32

8 Friday

9 Saturday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

10 Sunday

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 Notes


August 2014 Week 33

11 Monday

12 Tuesday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

13 Wednesday

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 14 Thursday


August 2014 Week 33

15 Friday

16 Saturday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

17 Sunday

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 Notes


August 2014 Week 34

18 Monday

19 Tuesday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

20 Wednesday

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 21 Thursday


August 2014 Week 34

22 Friday

23 Saturday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

24 Sunday

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 Notes


August 2014 Week 35

25 Monday

26 Tuesday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

27 Wednesday

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 28 Thursday


August 2014 Week 35

29 Friday

30 Saturday


July 2014 M 7 T 1 8 W 2 9 T 3 10 F 4 11 S 5 12 S 6 13

14 15 16 17 18

21 22 23 24 25 19 26 20 27

28 29 30 31

31 Sunday

August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

August 2014 Notes


September 2014 Week 36

1 Monday

2 Tuesday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

3 Wednesday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

4 Thursday


September 2014 Week 36

5 Friday

6 Saturday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

7 Sunday

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

Notes


September 2014 Week 37

8 Monday

9 Tuesday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

10 Wednesday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

11 Thursday


September 2014 Week 37

12 Friday

13 Saturday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

14 Sunday

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

Notes


September 2014 Week 38

15 Monday

16 Tuesday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

17 Wednesday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

18 Thursday


September 2014 Week 38

19 Friday

20 Saturday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

21 Sunday

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

Notes


September 2014 Week 39

22 Monday

23 Tuesday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

24 Wednesday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

25 Thursday


September 2014 Week 39

26 Friday

27 Saturday


August 2014 M 4 11 T 5 12 W 6 13 T 7 14 F 1 8 15 S 2 9 16 S 3 10 17

18 25 19 26 20 27 21 28 22 29 23 30 24 31

28 Sunday

September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

September 2014

28 29 30 31

Notes


September 2014 Week 40

29 Monday

30 Tuesday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

1 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

2 Thursday


October 2014 Week 40

3 Friday

4 Saturday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

5 Sunday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

Notes


October 2014 Week 41

6 Monday

7 Tuesday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

8 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

9 Thursday


October 2014 Week 41

10 Friday

11 Saturday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

12 Sunday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

Notes


October 2014 Week 42

13 Monday

14 Tuesday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

15 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

16 Thursday


October 2014 Week 42

17 Friday

18 Saturday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

19 Sunday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

Notes


October 2014 Week 43

20 Monday

21 Tuesday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

22 Wednesday

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

23 Thursday


October 2014 Week 43

24 Friday

25 Saturday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

26 Sunday

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

Notes


October 2014 Week 44

27 Monday

28 Tuesday


September 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

29 Wednesday World Stroke Day

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26

October 2014

27

28 29 30

30 Thursday


October/November 2014 Week 44

31 Friday

1 Saturday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

2 Sunday

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 Notes


November 2014 Week 45

3 Monday

4 Tuesday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

5 Wednesday

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 6 Thursday


November 2014 Week 45

7 Friday

8 Saturday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

9 Sunday

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 Notes


November 2014 Week 46

10 Monday

11 Tuesday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

12 Wednesday

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 13 Thursday


November 2014 Week 46

14 Friday

15 Saturday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

16 Sunday

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 Notes


November 2014 Week 47

17 Monday

18 Tuesday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

19 Wednesday

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 20 Thursday


November 2014 Week 47

21 Friday

22 Saturday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

23 Sunday

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 Notes


November 2014 Week 48

24 Monday

25 Tuesday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

26 Wednesday

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 27 Thursday


November 2014 Week 48

28 Friday

29 Saturday


October 2014 M 6 13 T 7 14 W 1 8 15 T 2 9 16 F 3 10 17 S 4 11 18 S 5 12 19

20 21 22 23 24 25 26

27

28 29 30 31

30 Sunday

November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

November 2014 Notes


December 2014 Week 49

1 Monday

2 Tuesday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

3 Wednesday

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

4 Thursday


December 2014 Week 49

5 Friday

6 Saturday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

7 Sunday

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

Notes


December 2014 Week 50

8 Monday

9 Tuesday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

10 Wednesday

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

11 Thursday


December 2014 Week 50

12 Friday

13 Saturday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

14 Sunday

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

Notes


December 2014 Week 51

15 Monday

16 Tuesday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

17 Wednesday

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

18 Thursday


December 2014 Week 51

19 Friday

20 Saturday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

21 Sunday

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

Notes


December 2014 Week 52

22 Monday

23 Tuesday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

24 Wednesday

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

25 Thursday


December 2014 Week 52

26 Friday

27 Saturday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

28 Sunday

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

December 2014

28 29 30 31

Notes


December 2014 Week 1

29 Monday

30 Tuesday


November 2014 3 10 17 M 4 11 18 T 5 12 19 W 6 13 20 T 7 14 21 F S 1 8 15 22 S 2 9 16 23

24 25 26 27

28 29 30

December 2014 M 1 8 15 22 29 T 2 9 16 23 30 W 3 10 17 24 31 T 4 11 18 25 F 5 12 19 26 S 6 13 20 27 S 7 14 21 28

31 Wednesday

January 2015 M 5 12 T 6 13 W 7 14 T 1 8 15 F 2 9 16 S 3 10 17 S 4 11 18

19 26 20 27

21 22 23 24 25

28 29 30 31

December 2014/Jan 2015 1 Thursday


288 Company Listings Pharmaceutical wholesalers and manufacturers

ALLEGRO Jamestown House, Jamestown Business Park, Finglas, Dublin 11, Ireland Tel: 353 1 858 0600 Fax: 353 1 8642408 Email: info@allegro.ie Order Tel: 353 1 858 0801 Order Email: pharmacyorders@allegro.ie Products: Refresh, Astral, Autan, Philips Avent, Blistex, Caldease, Caldesene, CaldeSpray, Clinomyn, Colgate, Dentinox, Dr Whites, Efamol, Elastoplast, Eucerin, Fenjal, Fiacla, Healthpoint, Lil-Lets, Nivea, Odor Eaters, Palmolive, Philips Personal Care, Robinsons Cottonwool, Sanex, Simple, Snuffle Babe, Witch, Wrights, Atrixo, Medijel, Vosene. Services: Sales, Marketing & Distribution

months+) 4. Aptamil Growing Up milk 1 yr+ (from 1 year+) 5. Aptamil Growing Up milk 2 yr+ (from 2 years+) 6. Aptamil Comfort (from birth to 1 year) – for the dietary management of colic and constipation 7. Aptamil Anti-Reflux (from birth to 1 year) – for the dietary management of frequent reflux and regurgitation 8. Aptamil Pepti 1 (from birth) – for the dietary management of cows’ milk protein allergy 9. Aptamil Pepti 2 (from 6 months+) – for the dietary management of cows’ milk protein allergy Call freephone 1 800 22 12 34 for your local Aptamil Representative Important Notice: Breastfeeding is best for babies as it is perfectly suited to nourish infants and protect them from illnesses such as ear infections, stomach upsets, diabetes, eczema and obesity. Infant formula is suitable from birth when babies are not breastfed. Follow-on milk is only for babies over 6 months as part of a mixed diet, and should not be used as a breastmilk substitute before 6 months. . It is recommended that all formula milks be used on the advice of a doctor, midwife, public health nurse, dietitian, pharmacist or other professional responsible for maternal and child care. For Healthcare Professional use only.

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APTAMIL Block 1, Deansgrange Business Park, Deansgrange, Co Dublin, Ireland Order products through pharmacists and usual distributor Helpline for Parents and Healthcare Professionals: 1 800 22 12 34 Website for parents: www.aptaclub.ie Website for healthcare professionals: www.aptamilhcp.ie Expert2Expert Quarterly Ezine for Irish healthcare professionals A range of booklets/information leaflets covering from pregnancy through to toddler years Aptamil Product Portfolio: 1. Aptamil 1 – First milk (from birth to 12 months) 2. Aptamil 2 – Hungry milk (from birth to 12 months) 3. Aptamil 3 – Follow on milk (from 6

Barry Packaging Monavalley Industrial Estate, Tralee, Co Kerry. Type of company: Packaging Website: www.barrypackaging.com Telephone Number: 066 7118200 Fax Number: 066 7180640 Products: Branded Carrrier Bags specialising in Pharmacy Bags. Stock Range of Pharmacy Design Bags Counter Bags - A,B,C,D,F. SOS - Flat Bottom Bags. Resealable Polybags. Gift Wrap. Gift Tissue. Reusable Bags Local Contacts: Eileen Browne 087 6869132

Beiersdorf UK Limited

Clonmel Healthcare Ltd

2010 Solihull Parkway Birmingham Business Park, Birmingham B37 7YS, England Type of company: Health & Beauty Website: www.nivea.ie Help Line Number: 00 44 845 644 8556 Order Line: To place an order please call your Allegro representative: 01 8580801 Products: Nivea, Nivea Men, Nivea Sun, Eucerin, Elastoplast, Labello. Local contacts: Georgina Cunningham Marketing Manager for Ireland

Unit 20A, Second Floor, Beckett Way, Park West Business Park, Nangor Road, Dublin 12 Tel: 353 1 620 4000 Help Line: 353 1 620 4000 Order Line: 1800 26 26 26 Website: www.clonmel-health.ie Services: Distributors of Medicines and OTC Products direct to Pharmacies, Hospitals and via Wholesalers Products: Ethical: Aceomel; Amidex; Amitriptyline; Amlotan; Anxicalm; Apo-Go; Arthrimel; Atenomel; Axid; Azithromycin; Calvepen; Candist; Candist Plus; Casomide; Cimeldine; Ciprotan; Clavamel; Clavamel Forte; Clonactil; Clonamox; Clonocid; Clopidogrel; Cozatan; Cozatan Comp; Crystapen; Denzapine; Donesyn; Doxatan; Doxatan Prolonged Release; Estelle; Fluclon; Folic Acid; Fungasil; Fungasil Cream; Furosemide; Hexopal; Hexopal Forte; Ibandronic Acid, Irbesartan Clonmel; Isomel SR; Keflex; Lercanidipine; Letrozole; Levetiracetam Clonmel; Losamel; Maxilief; Melfen; Minodene; Montelair Mycophenolate mofetil; Nebimel; Nepramel; Nytamel; Olanzapine; Olanzapine ODT; Osteomel; Pantium; Paracetamol; Perdamel; Phenobarbital; Pipercin; Pravamel; Prednisolone; Prindace; Profloxin; Prozamel; Ramitace; Rectogesic; Rinozal; Serimel; Seropia; Sildenafil Clonmel, Simtan; Tamnic; Tamnexyl XL; Temozolomide; Tipuric; Torvacol; Tostran; True Result; Trimega; Valtan; Valtan Comp; Venex XL; Xymel; Xymel SR; Zestan; Zomel; Zopitan; Zycron MR

Boehringer Ingelheim Ltd Ellesfield Avenue, Bracknell, Berkshire, RG12 8YS UK Tel: +44 1344 424 600 Website: www.boehringer-ingelheim. co.uk Distributer: Ashfield Healthcare (Ireland) Ltd United Drug House, Magna Business Park, Magna Drive, Citywest Road Dublin 24 Phone: +353 1 4632444 Fax: +353 1 4632430 David Clancy – Retail Sales Manager Laurence O Carroll – Leinster Padhraic Speight – South Colm Moran – West

Clonmedica Consumer Division: Accurate; CaldeKids Travel Pops, Caldesene; Caldease; CaldeSpray; Caldesun; Clonfolic; Desenex; Easofen; Easofen Max; Ferrum; Gastrolief; Hedrin Once; Hedrin Treat & Go, Hedrin Protect & Go, Itcheze; JointAid; Lactease Infant Drops; Maxilief; Mobilise Plus; Paralief; Viralief; Virasoothe

Colgate-Palmolive (UK) Limited Guildford Business Park, Middleton Road, Guildford, Surrey GU2 8JZ Telephone number Allegro Tel: +353 1 858 0818 Fax: +353 1 858 0656 Website www.colgate.ie


289 Email e.simmington@allegro.ie tom_farrelly@colpal.com Key contacts Esmé Simington, Tom Farrelly

Cow & Gate Block 1, Deansgrange Business Park, Deansgrange, Co Dublin, Ireland Order products through pharmacists and usual distributor Dedicated Healthcare Professionals Careline: 1 800 371 371 Careline for Parents: 1 800 570 570 Infant Nutrition Website for parents: www.cowandgate.ie Website for healthcare professionals: www.cowandgatehcp.ie Mums Babies & You, Quarterly newsletter for Irish healthcare professionals A range of booklets/information leaflets covering from pregnancy through to toddler years Cow & Gate Product Portfolio 1. Cow & Gate first infant milk (from birth to 12 months) 2. Cow & Gate infant milk for hungrier babies (from birth to 12 months) 3. Cow & Gate follow on milk (from 6 months+) 4. Cow & Gate growing up milk 1+ (from 1 year+) 5. Cow & Gate growing up milk 2+ (from 2 years+) 6. Cow & Gate comfort (from birth to 1 year) – for dietary management of colic and constipation 7. Cow & Gate anti-reflux (from birth to 1 year) – for dietary management of reflux and regurgitation 8. Cow & Gate infasoy (from birth)-Soya formula for a milk free diet 9. Cow & Gate instant carobel – Thickening agent for the dietary management of recurrent vomiting, dysphagia and rumination 10.Cow & Gate pepti junior – For the dietary management of malabsorption and multiple food intolerances 11.Cow & Gate nutriprem 2 – (For Preterm babies on discharge) For the dietary management of preterm and low birthweight babies on discharge from hospital Call freephone 1 800 371 371 for your local Cow & Gate Representative Important Notice: Breastfeeding is

best for babies as it is perfectly suited to nourish infants and protect them from illnesses such as ear infections, stomach upsets, diabetes, eczema and obesity. Infant formula is suitable from birth when babies are not breastfed. Follow-on milk is only for babies over 6 months as part of a mixed diet, and should not be used as a breastmilk substitute before 6 months. It is recommended that all formula milks be used on the advice of a doctor, midwife, public health nurse, dietitian, pharmacist or other professional responsible for maternal and child care. For Healthcare Professional use only

Daiichi Sankyo Ireland Ltd Daiichi Sankyo Ireland Ltd. Building 1 Swift Square, Northwood Avenue, Santry, Dublin 9, Ireland Sales and Marketing of Ethical Pharmaceuticals. Website: www.daiichi-sankyo.ie Telephone Number: 01 4893000 Fax Number: 01 4893033 Email address: medinfo@daiichisankyo.ie Products: Efient, Konverge, Konverge Plus, Benetor, Benetor Plus, Cardicor, Emcor, Evista Local Contacts: Management: Mr. Aidan Curley: Manager Country Operations Mr. Michael Cooper: Commercial Operations Manager Ms. Liz Kehoe: Senior Brand Manager Ms. Tanya O’ Shea: Medical Liaison Manager

Ebrington Medical Ivy House, 24a Church Road, Derry BT47 3QQ Type of company: Surgery Supplies, wholesale Website: www.en-med.com Telephone Number: Head Office Dublin 048 71345188 Fax Number: 048 7134 4800 Products: Urinalysis strips, Single use instruments, Procedure packs, Spirometery filters and mouthpieces, ECG paper, electrodes and

accessories, Paper products and holloware, Medical equipment and furniture.

Eurosales International Unit 3, Ballymount Business Park, Dublin 12, Ireland Marketing, Sales& Distribution of Cosmetics, Toiletries & OTC Products Distribution: Direct to Pharmacies & Department Stores Website: www.eurosalesinternational.ie Telephone Number: 01-450-7771 Fax Number: 01-450-7796 Help line Number: 01-4507771 Order Line: 01-4507771 Products: Cosmetics, Toiletries & OTC Products Local Contacts: Management: Sean Conlon Managing Director, John Meany O’Brien Sales & Marketing Director, Brian Morgan General Manager, John McCormack Financial Controller, Stephen McCarney Regional Sales Manager, Catherine Cullen Marketing Manager

multipurpose mixes, pasta and pizza bases. Please contact us for more details. Local Contacts: For more information on our product range please contact Pat Toner 0863831772 To order – contact your main wholesaler.

Good Night 14 Duleek Business Park, Duleek, Co Meath Type of company: Health and beauty Website address: www.goodnightsnoring.com Telephone Number: 041-988-2255 Help Line Number: 041-988-2255 Order Line: 041-988-2255 Products: Good Night Anti-Snoring Ring Local Contacts: Pharmaher Pantone 021C Healthcare

Godrej UK

Glutafin Dr. Schär UK Ltd. Station Court, 442 Stockport Road, Warrington, Cheshire, WA4 2GW Gluten Free Food Manufacturer Website: www.glutafin.ie/ Telephone Number: 1 800 818 551 (freephone) 376 Help Line Number: 1 800 818PMS551 (freephone) PMS 2747 Order Line: To Order- Contact your main wholesaler Products: Our pharmacy range includes a selection of breads and cereal, biscuits and crackers, multipurpose mixes, pasta and pizza bases. Please contact us for more details. Local Contacts: For more information 59% C 100% Y on our product range please contact 100% C Pat Toner 0863831772 95% M 16% K To order – contact your main wholesaler. Products: Our pharmacy range includes a selection of breads and cereal, biscuits and crackers,

2nd Floor, Central House, Balfour CMYKHounslow, TW3 Block, Balfour Road, 1HY, UK Type of company: Skincare Website: www.bio-oilprofessional.co.uk Telephone Number: 0044 208 538 1250 Fax Number: 0044 02088 140185 Help Line Number: 0044 208 538 1255 Products: Bio-Oil 60ml; Bio-Oil 125ml; Bio-Oil 200ml Local Contacts: Eurosales International, Unit 3, Ballymount Business Park, Dublin 12, Ireland Tel: 353 1 450 7771 Fax: 353 1 450 7795 Email: info@eurosalesinternational.ie Sales: sales@eurosalesinternational.ie

Keito Europe Ltd Unit 10, Hanwood Business Park, Old Dundonald Road, Belfast, BT16 1DE


290 Sole importer for Keito health monitors www.keito.com Telephone Number: 048 904844226 Fax Number: 048 90484226 Products: Keito health monitors provide customers with a print-out of height, weight, BMI, blood pressure, body fat and heart rate analysis. The latest K8 model now also offers an internet connection allowing customers to register and to view their statistics online making it an ideal tool for patient consultation and for developing customer loyalty Local Contacts: Brian Andrews 0044 7989606783

Kelkin Ltd Unit 1, Crosslands Ind Park, Ballymount Cross, Dublin 12 Type of company: Distributors of Natural Vitamins, Minerals and Herbal Supplements, Aromatherapy Oils, and Dietary Foods. Website: www.kelkin.ie Telephone Number: +353 1 4600 400 Fax Number: +353 1 4600 411 Order Line: +353 1 4600 400/ sales@ kelkin.ie Products: Extensive range of VMS & herbal products including: GR Lanes (Olbas Oil Decongestants, Kalms, Lanes Co-Q-10, Lanes Tea Tree Skincare Range, GOPO (Joints & Bones)), Vitabiotics (Menopace, Osteocare, Wellwoman, Wellman, Perfectil), Ortis (Pure Plan, Ginseng, Fruit & Fibre Cubes), FSC, Kelkin Vitamins/Aromatherapy Oils and Gluten Free Range, Bassetts Multivitamins for Kids, Fisherman’s Friend. Halos & Horns kiddies range (natural hair & body products for kids), Kwai & Kira range (Garlic & St Johns Wort), Biofreeze Range, Dextro energy tabs, Jakemans medicated confectionery, Kobayashi Healthcare (Cura Heat & Kool N Soothe ranges) , Ultradex range, Sula sugar free drops, Holex chocolate, Nanny Goats Milk, Hipp Baby Food Local Contacts: Mr Fintan Byrne Munster 087 647 0764 Mr John Farrell Midlands, North Leinster 087 647 0765 Mr Stephen Moloney North Leinster/ Midlands 087 699 9344 Mr Eamon Connolly West, North West 087 238 5648

Mr Patrick Jordan South Leinster/South East 086 836 7011

KRKA Pharma Dublin Suite 6 The Mall, Beacon Court, Sandyford, Dublin 18 Type of company: Sales and Marketing of Ethical and OTC Pharmaceuticals. Website: www.krka.ie Telephone Number: +353 1 293 9180 Fax Number: +353 1 293 9185 Help Line: info.ie@krka.biz Products: Amlodipine Krka, Candesartan Krka, Candesartan HCTZ Krka, Carvedilol Krka, Clopidogrel Krka, Dasselta (desloratadine), Diacronal MR (glicklazide), Donepezil Krka, Esomeprazole Krka, Galsya SR (galantamine), Icorvida SR (indapamide), Ifirmasta (irbesartan),Kamiren PR (doxazosin) Levocetirizine Krka, Losartan Krka, Maruxa (memantine), Nimvastid (rivastigmine), Nolpaza (pantoprazole), Oprymea (pramipexole), Perindopril Krka, Quetiapine Krka, Ramipril Krka, Rolpryna SR (ropinirole), Rosuvastatin Krka, Sertraline Krka, Simvastatin Krka, Valsartan Krka, Valsartan HCTZ Krka, Venlafex XL (venlafaxine XL), Vizarsin FCT & ODT (sildenafil), Zalasta (olanzapine), Zalasta ODT (olanzapine) Local Contacts: Management: Mr Paul Neill, General Manager 086 8337616 Sales Team: Mr Paul Nash, District Manager and North East Territory 087 290 9218 Mr Kingsley Lewis, South East Territory 087 920 6604, Ms Claire Madigan, Munster Territory 087 632 7437 Mr John Clancy, Connacht Territory 087 702 0070 Mr Daniel Byers, Product Manager, 087 995 7499

Lifes2good Health & Beauty Irish Response Ltd., t/a Lifes2Good 7 Racecourse Business Park,

Ballybrit, Galway, Ireland Tel: 353 91 750 800 Order Line: 353 91 750 811 Helpline: 1890 601 801 Website: www.lifes2goodgroup.com Services: Our philosophy is to bring to market clinically proven health & beauty products to improve people’s lives. We’re passionate about improving consumer lifestyles with products that work, from head to toe, inside & out. Vision: A Lifes2good product for everyone… Mission: To source, develop, test & globally market health & beauty products Products: Viviscal Hair Growth Programme which includes: Viviscal Maximum Strength Supplements; Viviscal Man Supplements; Viviscal Moisturising Shampoo; Viviscal Gentle Conditioner; Viviscal Hair Fibres in a range of 5 colours. Viviscal supplements maintain healthy hair growth from the inside while the shampoo, conditioner and serum help create the ideal environment for healthy hair growth on the outside. Plus our Volumising Hair Fibres give the appearance of thicker hair in seconds.

Mundipharma Pharmaceuticals Ltd

Millbank House, Arkle Road, Sandyford, Dublin 18. Tel: 01 206 3800 Fax: 01 294 5104 Email: info@mundipharma.ie Type of Business: Pharmaceutical. Products: Ethical: Adizem SR, Adizem XL, BuTrans Matrix Patches, Codalax Suspensions & Caps, Depocyte Vials, flutiform, Levact Vials, MST Continus Tabs, MST Continus Suspension, OxyContin Tablets, OxyNorm Capsules and Liquid Concentrate, OxyNorm Dispersa tablets, OxyNorm Solution for Injection or Infusion, Palladone Caps/SR Caps, Phyllocontin Continus Tabs, Sevredol Tablets, Targin Tablets, Transtec Matrix Patches, Uniphyllin Continus Tabs. Distribution: Via United Drug Distributors. Management: Mr I A Sutton: General Manager Mr D O’Leary: Sales Manager

Mr B Kennedy: Marketing Manager Mr Tomás Morrissey: Financial Controller Ms G Flanagan: Marketing Manager – New Therapies Mr P Daly: Field Sales Manager Sales Force: Mr G May: Dublin North, Meath, Cavan, Louth, Monaghan, Donegal Ms M Lawless: Dublin South, Wicklow, Wexford, Carlow, Kilkenny, Waterford Ms J Finn: Dublin West, Kildare, Laois, Offaly, Westmeath, Longford, North Tipperary Mr L Buckley: Cork, Kerry, Limerick County, South Tipperary Mr S Henry: Sligo, Mayo, Leitrim, Galway, Roscommon, Clare, Limerick City Mr M Scott: Hospitals: South Leinster Ms D Harten: Hospitals: North Leinster Ms N O’Connell: Hospitals: Munster Mr K Donohue: Hospitals: Connacht and Ulster

Ocean Healthcare Company Address: 6C Nutgrove, Office Park, Rathfarnham, Dublin 14 Type of company: Sales, Marketing & Distribution of OTC & Healthcare products Web site address: www.oceanhealthcare.ie Telephone Number: 01 2968080 Help Line Number: 01 2968080 Order line: 01 2968080 Services: Sales, marketing, warehousing, logistics, IT, administration & finance.. Total Brand management Products: Sudocrem, Infacol, Aloclair Plus, Tasectan, Bisodol, Venos, Exorex, Vasogen, Exorex Range, Bioxet, Bioxsine, Canderel, Vital Baby range, Foster Grant Reading Glasses & Sunglasses, Ricola, Forever Ink. Local contacts: Graham Stafford – Managing Director John Doyle – Financial Controller Catherine Ryan – Customer Service Manager

Omega Pharma Chefaro Ireland Ltd, Block A, First Floor, The Crescent Building, Northwood


291 Office Park, Dublin 9, Ireland. Type of company: Sales and Marketing of OTC Healthcare products Website Address: www. omegapharma.co.uk Telephone Number: 01 8790600 Fax Number: 01 8790601 Help Line Number: 01 8790600 Order Line: 01 8790600 Products: Abidec Multivitamin Drops ,Abidec Multivitamin Syrup, Abidec Vitamin D3 Drops, Beconase Hayfever Spray, Buttercup Cough Syrup, DentuCrème, Dermlaex, Drapolene Cream, Hedex, Hemoclin, Jungle Formula Insect Repellent, Lyclear Crème Rinse, Lyclear Shampoo, Lyclear Spray, Lyclear Sensitive, Lyclear Combs, Milk of Magesnia, Metatone Tonic, Nailner Repair, Predictor Pregnancy Tests, Predictor Digital Thermometer, Prevalin Allergy, Silence Anti-Snoring, Solpadeine, Solpa-Sinus, TCP Liquid, Wartner Wart and Verruca, Wartner Wart & Verucca Pen, Wartner Corn & Callus Pen, Polygrip Super Wernets, Polygrip Ultra Wernets, XLS-Medical Fat Binder, XLS-Medical Carb Blocker, Zantac. Local Contacts: Management: Mr John Sheehy: Head of Sales & Marketing Mr Niall Faul: National Pharmacy Sales Manager Ms Ciara Leahy: Pharmacy Field Sales Manager

Parle & Hickey Ltd. Beechwood Close, Boghall Road, Bray, Co. Wicklow. Type of company: Sales & Distribution Website: www.parleandhickey.ie Telephone Number: 1800 286552 Fax Number: 01 2865533 Help Line Number: 1800 286552 Order Line: 1800 286552 Products: 4,000 Lines Local Contacts: Managing Director: Martin Coen

Pfizer Consumer Healthcare 9 Riverwalk, Citywest, Dublin 24 Manufacturer and Distributor of OTC

and healthcare products Website: www.pfizer.ie Tel: 00353 1 467 6500 Help Line: 00353 1 467 6627 Order Line – Customer Services: 01 463 7474 Fax: 00353 1 4632409 Email: csireland@pfizer.com Products: Advil; Anadin;, Centrum; Caltrate; ChapStick; Imedeen, Preparation H; Pfizer Paracetamol, Pfizer ParaExtra Robitussin; Tramil; ThermaCare Local Contacts: Colm O Connor: North Dublin & North Leinster Frank Cahalan: West Gerald Gately: South Dublin & South Leinster Paul Hayes: South

Pinewood Healthcare Unit 1, M50 Business Park, Ballymount, Dublin 12, Ireland Accounts, Manufacturing and Marketing: Ballymacarbry, Clonmel, Co Tipperary, Ireland Tel: 00353 1 456 9123 (Dublin) 00353 52 61 86000 (Clonmel) Fax: 00353 1 456 9125 (Dublin) 00353 52 61 36311 (Clonmel) Email: info@pinewood.ie Web: www.pinewood.ie Pharmaceutical Manufacturer and Distributor of Ethical and OTC Products Products: Ethical: Amlid, Alendronic Acid, Alzmeran XL, Amlodipine, Anastrazole, Atorvastatin, Blugral, Bisopine, Calcium Acetate, Caprin, Chlorpromazine, Citric Acid, Citalopram, Clarithromycin, Donepezil, Dalmapam, Diclo, Dilacort, Diflazole, Finocar, Flamozil Woundspray, Flucillin, Fosalen, Kopen, Kirnom XL, Lamoro, Laxose, Letrozole, Levetiracetam, Levocetrizine, Levofloxacin, Lisopress, Losepine, Lusert, Losartan Comp, Lozitar, Lozitar Comp, Metformin, Minosil, Mirtazapine, Mobicam, Montelukast, Nexazole, Olanzapine, Omeprazole, Omsil, Ondran, Paroser, Pantoprazole, Pramipexole, Pinaclav, Pinaclor, Pinadone, Pinamox, Pravat, Primacine, Prozit, Purinol, Ramic, Ranopine, Risedronate, Rosuvastatin, Sertraline, Simator, Simvastatin, Tonpular XL, Torvan, Tramapine, Trantalol, Trospium Chloride, Valaciclovir, Venlablue XL, Zileze,

Zirpine, Zolepant, Zotrole OTC Confined: Acidex, Aqueous Cream, Calamine Lotion, Chlorhexidine, Codinex, Cortopin, Dispensing Bottles, Emulsifying Ointment, Ferybar, Fenopine Suspension, Glycerine Honey & Lemon, Micolette, Osteole, Paratabs, Parapaed Junior, Parapaed Six Plus, Pholcodex, Salin Salt Therapy Machines, Silcocks Base, Silderm, Surgical Spirits, Viscolex, Zirpine Devices: Early Bird Pregnancy Test Kits & Ovulation Kit, Easy Reader, MultiCare, Multiparameter, Salin Plus, Vera Temp Distribution: Direct to Pharmacies, Hospital Pharmacies and via Wholesalers Management:Mr Fergal Murphy: Company Director Mr Peadar Flynn: 087 259 4129 Pharmacy Business Manager Mr Jeffrey Walsh 087 669 4043 Commercial Development Manager Mr Cormac Kearney 087 988 8376 Pharmacy Business Manager Mr Jurgen Wegner 087 741 1411 Hospital Business Manager Pharmacy Sales Representatives:Mr Tom O’ Brien 087 255 9950 South Mr Mark Mc Donnell 087 977 3985 Dublin / South East Mr Ciaran Clarke 087 231 3800 Dublin / North East Mr Danny Lynskey 087 251 3239 Mid-West Mr David Brannigan, East Ms Aoife McDonnell 087 624 0817 Dublin / East Mr Padraic O’ Brien 087 413 7555 Midlands / North East Hospital Representative Ms Katie Tobin 087 991 4404

Pocket Heroes We engineer, formulate, manufacture, and pack our product range in Ireland under our direct control. After two years of research, we started manufacturing in April 2013 and as of October 2013 we are being distributed throughout Ireland Mission Statement To sell a range of products that delivers personal care and hygiene in a convenient sized format, available through multiple channels and to do so innovatively, ethically and in partnership with all stakeholders. Consumers can Trust PocketHeroes,

all our products are fully compliant with E.U. / Irish Medicines Board regulations and requirements. We follow best practice in the formulation and manufacturing of our products to International Best Practice. Full product list: “Trusting - Caring – Protecting” Pocket Heroes: Refresh To Go, Refresh Essentials, Refresh Travel, Refresh Fun and Refresh Holiday… they are innovative as single use items and unique in combination, made in Ireland . We are delighted to introduce you to Pocketheroes “on the go” refresh kits, a brand new concept in personal refreshing. The unique combination of four personal care products at a 2/3 ml volume presented in a sharply branded pocket sized kit, is perfect for individuals who lead busy lifestyles. An entire kit is small enough to fit in a suit pocket or the smallest handbag. Address Pocket Heroes Ltd, COLAB, Letterkenny Institute of Technology ( LYIT ), Port, Road Letterkenny, Co Donegal

Proderma Limited Martinstown Lodge, Martinstown The Curragh, Co. Kildare, Ireland. Type of company: Marketing and distribution Website: www.proderma.ie Telephone Number: 045 4445715 Fax Number: 045 442481 Help Line Number: 045 445715 Order Line: 045445715 Products: Salcura Natural Skin Therapy, Zambuk, Freactiv Thermal Support Technology. Local Contacts: Tony Sheridan: 045 445715 Margaret Sheridan: 045 445715 Angela Clifford: 045 445715 Malcolm Shaw: 086 221 2253

Randox Laboratories Ltd. 55 Diamond Road Crumlin, County Antrim, BT29 4QY Type of company: Clinical Diagnostics Web site address:


292 www.confidantetest.com Telephone Number: 02894 451 004 Help Line Number: 02894 451 004 Order line: 02894 451 004 Services: STI Testing Products: Confidante® - The first OTC test which can detect 10 STI’s in a single sample, without the need to visit a GUM or sexual health clinic. Local contacts: Alison Lambert Email: Alison.lambert@confidantetest.com Telephone: 02894 451 004

Ready Girls A.R. Feminine Products Ltd. T/A Ready Girls 23 Tolka Valley Business Park, Glasnevine, Dublin 11 Website: www.readygirls.com Telephone Number: 089 4230331 Order Line: 089 4230331 Products: Ready Girls Essential Period Pack for T’weens & Teens. Ready Girls Period Pack For Top Teens & Club Queens Ready Girls Mild Incontinence Pack For Mums That Giggle & Wiggle Local Contacts: For Sales contact Ruth and Niamh Hayden at ruthhayden@gmail.com & niamhhayden@hotmail.com Ready Girls is a Multi award winning company. Our Aim in is to provide discreet emergency feminine Hygiene packs to women of all ages and at different stages of life.

Rowex 18 Rowex Ltd, Newtown, Bantry, Co. Cork. Tel: 353 27 50077 Helpline: 1800 304 400 Order Line: 1800 304 400 Email: rowex@rowa-pharma.ie Website: www.rowex.ie Type of Company: Pharmaceutical Marketing of Ethical Medicines and OTC Products Products: Ethical: Alfu, Alopur, Amoclav, Amoclav Suspension, Amlode, Atecor, AtecorCT, Atorvas, Biluta, Bisop, Bonefurbit, Captor, Captor-HCT, Catasart, Catasart Plus, Ceftal, Cetrine, Cifox,

Citrol, Clorom, Clorom XL, Clodel, Co-Vatan, Dancex SR, Deslor, Diclac, Diltam, Domerid, Doxane XL, Dozept, Emazole, Enap, Fental Matrix, Fintrid, Flucol, Fluzac, Gabin, Irbesan, Isomonit Retard, Lanzol, Larig, Latop, Latop-Comp, Letzo, Leuprex 3, Leonore, Levocetirizine, Lispril, LisprilHydrochlorothiazide, Lorat, Lotanos, Lotanos Comp, Mefac, Melcam, Metocor, Memantine LEK, Metophage, Minox, Mirap, Mirap Distab, Montelukast Paediatric, Montelukast, Mycolat, Nebol, Nifed, Olanzapine Glenmark, Ondansetron,Pantup, Parox, Pendrex, Pendrex Plus, Pioglitazone Rowex, Prapexin, Pravitin, Quetex, Quetex XR, Ramilo, Ranitic, Razole, Rispone, Ridate, Rivastigmine Sandoz, Rolyprexa, Rolyprexa Distab, Romax, Romep, Rosuva, Salbul, Serlan, Sidena, Sivatin, Sumatran, Tamox, Tamsu, Ternaf, Tolusitol, Tradol, Valotix, Vatan, Vedixal, Vedixal XL, Vensir XL, Verap, Zoledronic Acid Sandoz, Zolnod. OTC: Acic Cold Sore, Calciup D3 Forte, Cetrine Allergy, Diclac Relief Gel, Domerid Relief, Ketozol, Lorat, Pantup Relief, Ranitic 75mg.

Sanofi Ireland Ltd. 18 Riverwalk, Citywest Business Campus, Dublin 24 Type of company: Sanofi, one of the world’s leading global pharmaceutical companies, discovers, develops and distributes therapeutic solutions to improve the lives of Irish people. At Sanofi Ireland Ltd., our commitment is to provide the most efficient and reliable medicines to patients and also to improve their quality of life. Through partnerships with humanitarian associations, professional bodies, patient groups and scientific societies, we work actively to save lives and promote health. Sanofi Ireland Ltd. Provides patients and healthcare professionals in Ireland with efficient and effective therapeutic responses to diseases in its areas of expertise, which include: diabetes, central nervous system disorders, internal medicine, oncology and thrombotic and cardiovascular diseases. Website Address: www.sanofi.ie Telephone Number: 01-4035600 Fax Number: 01-4035601 Customer Services 01-4035667

Products: Sanofi’s extensive portfolio of medicines includes: Apidra, Clexane, Cholestagel, Duoplavin, Epilim, Jevtana, Lantus, Multaq, Plavix, Renagel, Renvela, Solpadol, Stilnoct, Tritace, Xatral Sanofi’s Consumer Healthcare portfolio includes the following familiar OTC brands: Anthisan, Brolene, Corn Silk, Dioralyte, Hydrocortisyl, Maalox, Maalox Plus, Mudd, Opticrom, Phenergan, Selsun and Sun In Local Contacts: General Manager: Mary Dickens Commercial: Ingrid Walsh Pharmacy Manager: Tom MacDonald Customer Services: Grainne Carney

SMA Nutrition Nestle Ireland Ltd, 3030 Lake Drive, Citywest Business Campus, Dublin 24 Type of company: Food and Beverage Company Website: www.smahcp.ie Telephone Number: +353 1 449 7703 Fax Number: +353 1 449 7782 Consumer Help Line Number: SMA Careline® 1800 931 832 (24/7 Freephone) Order Line: United Drug Wholesalers (+353 463 2300) Uniphar (+353 1428 7777) Products: SMA First Infant Milk 450g SMA First Infant Milk 900g SMA HA SMA Comfort 800g SMA Follow-on Milk 450g SMA Follow-on Milk 900g SMA Toddler Milk® 450g SMA Toddler Milk® 900g SMA Extra Hungry Milk 450g SMA Extra Hungry Milk 900g SMA Staydown® 900g SMA Wysoy® 430g SMA Wysoy® 860g SMA Lactose Free® 430g SMA High Energy® 100mL (Hospital only) SMA High Energy® 250mL SMA Breast Milk Fortifier 50*2g sachets SMA Gold Prem 1® 100mL(Hospital only) SMA Gold Prem 1® 250mL SMA Gold Prem 2® 400g SMA Gold Prem 2® 250mL

The Specials Laboratory Unit 2 Regents Drive, Low Prudhoe Ind Est, Northumberland, NE42 6PX Type of company: Specials manufacturer www.specialslab.co.uk Telephone Number: 0800 028 4925 Fax Number: 0800 083 4222 Help Line Number: 0800 977 4035 Order Line: 0800 028 4925 Products: Unlicensed medicines (specials) in virtually all non-sterile dosage forms inc: Oral liquids, capsules, sachets, oral syringes, medicated lollipops, allergy testing kits/solutions, ointments/ creams/lotions, external lotions/paints, potent products (e.g. cytotoxics), ear drops, nasal drops, disinfectants, enema solutions, antibiotics, pessaries, suppositories, coal tar products Over 15,000 unique formulations on file Local Contacts: Customer service & support: 0800 028 4925 Head of Sales: Kevin Patterson – 07703 134669

Teva Pharmaceuticals Ireland Building 1, Finnabair Business Park Dundalk, Co Louth. Tel: + 353 (0)51 321740 Fax: + 353 (0)42 935 1516 FREEPHONE 1800 201 700 Web: www.teva.ie Type of Business: Manufacture and Marketing of Ethical Pharmaceuticals. Ethical: Respiratory/Allergy: Beclazone Easi-Breathe, Beclazone MDI, Nasobec, Nasofan, Qvar, Salamol EasiBreathe & Salamol MDI. Steri-Nebs range: Ipramol, Ipratropium, Salamol & Saline. Retail: Allopurinol, Anastrozole, Amlodipine, Aripez, Atrovastatin, Bicalutamide, Budesonide, Carsem, Ciprofl oxacin, Citalopram, Clarie LA, Clarithromycin, Clopidogrel, Desloratadine, Diaglyc, Esomeprazole, Famciclovir, Fruco, Fungafi ne, Ireven, Lansoprazole, Lercanidipine, Letrozole,


293 Levocetirizine, Lopraz, Losartan, Methadone, Mirtazapine, Movox, Myostin, Nebivolol, Neurostil, Nortem, Norzac, Olanzapine, Ondansetron, Pantoprazole, Pravastatin, Rabeprazole, Risonate, Rispeva, Rosuvastatin, Serenace, Seretral, Simvastatin, Temozolomide, Tevanate, Tevaquel, Tevax, Valaciclovir, Valsartan, Venlafaxine, Warfarin, Zolmitriptan, Zolpidem & Zorclone, Lansoprazole ODT, Perindopril, Perindopril/ Indapamide, Ramipril, Tolterodine. Brands: Actiq, Axsain,Copaxone, Dilzem, Effentora, Eporatio, Gabitril, Lotriderm, Modrasone, Myfenax, Myocet, Naraverg, Polyfax, Provigil, TevaGrastim, Zacin & Zanafl ex. OTC: Aerochamber, Tantum Verde & Tipol. Distribution: Via all wholesalers. Management Ms Sandra Gannon: General Manager Ms Sarah Corry: Retail Business Unit Manager Ms Marina Lowry: Pain & Respiratory Business Unit Manager Ms Clodagh Kevans: MS Business Unit Manager Ms Aideen Kenny: Strategic Marketing and Portfolio Manager Mr Paul Harmon: Hospital Business Unit Manager Sales Force: Please contact Teva Ireland on Freephone 1800 201 700 for your representative’s details.

Uniphar Group 4045 Kingswood Road, Citywest Business Park, Co Dublin Type of company: Pharmaceutical Wholesaler Website: www.uniphar.ie Telephone Number: 00353 1 428 7777 Fax Number: 00353 1 428 7787 Help Line Number: 00353 1 428 7777 Order Line: 00353 1 468 7501 Services: The Uniphar Group comprises of Allphar Services and Uniphar Wholesale. Uniphar Wholesale is a pharmaceutical wholesaler & distributor of Ethical, OTC products, Photographic, Veterinary products & Health and Beauty products. Allphar Services core function is

the warehousing and distribution of pharmaceutical and healthcare products on behalf of its client companies Local Contacts: Group Sales & Marketing Director: Paul G Ryan Tel: 00353 86 629 5470 Allphar Services MD: Brendan O’Connell Uniphar Wholesale Sales Team: Brian Mangan: Business Development Manager Tel: 00353 86 044 3743 Donegal, Leitrim, Sligo, Mayo, Roscommon, Longford, Cavan, Monaghan, Westmeath, Meath, Louth & North Dublin Clodagh Maguire: Business Development Executive Tel: 00353 87 259 5011 Donegal, Leitrim, Sligo, Mayo, Roscommon, Longford, Cavan & Monaghan Ger Gormley: Business Development Executive Tel: 00353 86 814 4796 Cavan, Monaghan, Westmeath, Meath, Louth & North Dublin Pat Kelleher: Business Development Manager Tel: 00353 87 258 5757 Galway, Clare, Limerick, Kerry, Cork, Waterford & Tipperary Joey McNamara: Business Development Executive Tel: 00353 86 607 6019

United Drug Consumer incorporating Pemberton, Intrapharma, Blackhall & Profitlines United Drug House, Magna Drive, Magna Business Park, Citywest Road, Dublin 24 Type of company: Sales, marketing & distribution of consumer products. Website: www.united-drug.ie Telephone Numbers: Blackhall 01 8405071 Pemberton/ Intrapharma 01 4596916 Profitlines 01 4632354 Fax Number: Blackhall 01 8401251 Pemberton/ Intrapharma 01 4596916 Profitlines 01 4632354 Order line: Blackhall 01 8405071 Pemberton/ Intrapharma 01 4596916 email cs.pemberton@united-drug.ie

Profitlines 01 4632354 Blackhall Products: Babyliss, Halls soothers, Lansinoh, Omega 7, Profoot, Seavite & Vials Bags. Intrapharma Products: Baby D,Clevamamma,Colief,John Frieda,Mavala,NUK, Regelle, Relactagel,Sebamed,Sterimar,Top Image & Zirtek Pemberton Products: Baylis & Harding,Flexitol,Remington,So.. & St.Moriz Profitlines products include: Bi monthly brochure containing branded special offers suitable,seasonal promotions & new product launches in line with media campaigns Local Contacts: Blackhall & Intrapharma: Liam Kellegher- Field sales manager: 0876678039 Pemberton: John Ryan- Field sales manager: 0872502854 Profitlines: Christine Flynn- Brands Business Manager: 0872932939

L’Oreal Active Cosmetics Division Styne House, Upper Hatch Street, Dublin 2 Type of company: Dermatological – Skincare Distributors Telephone Number: 01 6750599 Products: La Roche – Posay Dermatological Skincare: Toleriane, Rosaliac, Hydraphase, Nutritic, Hydreane, Effaclar, Derm AOX, Redermic, Substiane, Cicaplast, Physiological Cleanser, Bodycare: Lipikar,Lipikar AP Baume, IsoUrea, Deodorants Haircare: Kerium Suncare: Anthelios Make-up: Mascara Resectissime, Toleraine, Toleraine Minerals, Hydreane

Vichy: Dermatological Skincare Cosmetics: Aqualia Thermal, Aqualia, Normaderm, Nutrilogie, Neovadiol Gf, LiftActiv Derm Source, Purete Thermale, Vichy Homme Makeup: Dermablend, Area Teint. Vichy, La Rache Posay, Roger & Gallet Lumineuse, Flexilift Teint, Normateint Bodycare: Anti – Stretch mark cream,

Deodorants. Suncare : Capital Soleil Hair Care: Dercos, Essentielles Rodger & Gallet French Apothecary Perfumer Selection of Colognes, Body Lotions, Shower Gels, Soaps and Gift Sets Bois d Orange, Fleur d Osmanthus, Rose, Ginger, Citron, Jean Marie Farina, L’Homme,

Virginia Medical Supplies Main Street, Virginia, Co. Cavan Type of company: Medical Products Website: www.virginiamedical.ie Telephone Number: 1890 90 47 37 Help Line Number: 1890 90 47 37 Order Line: As above Products: Salin Plus Air Purifier, Salin Plus Filter Refills, Salin Salt Pipe Inhaler, Nu-Life MDS Trays Local Contacts: Brian O’Donoghue - CEO Jason Clarke - Sales/Marketing Director Lisa Ahearn - Operations Manager Elsie O’Donoghue - Sales Representative Peter Ahearn - Sales and Technical Consultant

Wholefoods Wholesale Unit 3 Kylemore Ind Estate, Killeen Road, Dublin 10 Tel: 01 626 2315 Fax: 01 626 1233 Email: info@wholefoods.ie Web: www.wholefoods.ie Types of Business: Agents and distributors of Herbal Remedies, Nutritional Supplements, Homeopathic Remedies, Flower Essences, Natural and Organic Bodycare, Manuka Honey, Sports Nutrition, Natural Hair colouring, Magnotherapy, Aromatherapy Oils, Gluten free and Dietary foods. Products Veterinary: Jan De Vries Animal Essences - Animal Separation, Animal Emergency, Animal Highly Strung Essence, Animal OverDominant, Animal Timid. OTC Confined: Gingko Biloba, Hypericum Complex, Hypericum Perforatum, Serotone, St John’s Wort and Prostasan. Non-OTC Confined:


294 A.Vogel Herbal Tinctures: Echinacea for the family, Atrosan, Atrogel, Milk Thistle, Passiflora, Dormeasan, Ivy Thyme, Venaforce, Sinuforce, Eye Drops, Bronchosan, Digestisan and Menoforce as well as a full range of other herbal remedies. Aromatherapy Oils: Atlantic Aromatics, Absolute Aromas, Ord River Tea Tree. Bioglan: OAD Super Fish Oil, Red Krill, Stat-Guard, Glucosamine SR1500mg, Promensil Biomedical: Think Krill, Cardio-K Bio-Strath: Herbal Tonic Eskimo Oil: Brainsharp Omega and Eskimo Omega 3. Gluten Free and Dietary Foods: Nanny Goats Milk, Hale & Hearty, Barkat, Eat Natural, Nak’d Bars, Linwood’s, Panda, RJ’s Licorice, Vita Coco. Healthspark: Raspberry Keytones, African Mango, Cranberry extract, Green Coffee, Higher Nature: The Saltpipe, Citricidal, High Stability Active Silver, Kids Range. Hubner: Gastrointestinal Gel, Iron Vital Tonic, Silicea Caps – For Hair, Skin & Nails, Silicea Cold Sore Lip Gel and Silicea Beauty Gel. Jan De Vries Essences: Night, Craving, Concentration, Emergency, Relaxation, Confidence, Mood.Lifestyle Products: Ecover, Lilly’s, The Natural Wheat Bag Company, The Saltpipe and Natracare (personal hygiene).Magnopulse: Ladycare Magnet for Menopause, MN8 Magnet for Period Pain, 4Pain Magnet for Back Pain Manuka Honey: Honey New Zealand, Manuka Gold and Medibee. Mother and Babycare: Childs Farm, Earth Friendly Baby, Natural Babycare Nappies, Wipes and Bodycare. Natural and Organic Bodycare: Jason, Bia Beauty, Avalon, Dr Bronner’s, Faith in Nature. Natural Henna: Surya Brasil Naturtint Hair Colours: Permanent, Reflex (Semi Permanent). Nelsons Homeopathic Remedies: Nelsons Teetha Granules and Gel, Nelsons Arnicare, Nelsons Sootha, Nelsons Pure & Clear, Nelsons H+care Cream, Nelsons Clikpak, topical and formulated remedies. Nourkrin Hair Supplements: Nourkrin Extra, Nourkrin Maintain, Nourkrin Man, Nourkrin Sham & Cond. Optima: Aloe Vera Gel, Gentle Action Colon Cleanse, Aloe Dent Toothpastes and Mouthwash, Joint Complex, Aloe Pura Juices, Allergenics Skincare, Lecithin, Optima Lifestyle Vitamins, Australian Tea Tree. Pernaton Green Lipped Mussel Extract: Pernaton Gel, Pernaton Relaxing Bath Therapy, Pernaton Capsules Pre- Conceive: PreConceive preconception supplement Quest Vitamins: Tum Biotix, Mega 8 Biotix, Cran Biotix, Immune Biotix,

Kidz- Biotix, Forte D4000, Glucosamine Sulphate, Kyolic Garlic, Enzyme Digest, Evening Primrose Oil, Mega B+C, Co enzyme Q10, L.Plantarum, Acidophilus, Cranbiotix, Vit E. Rescue Remedy: Bach Original Flower Remedies, Rescue Remedy, Rescue Night. Sambucol Black Elderberry Extract: Sambucol Original, Sambucol Kids, Sambucol Effervescent. Sea- Band, Hay-Band: Sea-Band Child, Sea-Band Adult, Sea-Band Mama. Spatone Iron Supplement: Spatone Original and Spatone Vit C. Sports Nutrition: Optimum Nutrition, Sunwarrior and Performax. Sun Chlorella: Sun Chlorella nutritional supplement Tanning: Wow Brown, Tan Organic Zerochol: Zerochol plant sterol supplement Zeroxid: Zeroxid vitamin and mineral supplement Distribution: Direct to Pharmacies and via wholesalers (specific lines) Management: Rosemary Byrne – Managing Director; Paul Gaffney – Purchasing Director; Alan Martin – Company Secretary; Peter Noone – Sales & Marketing Manager; Ronan O’Flynn – National Accounts Manager Number of sales force: 9 Territory: Ireland - For details of your local representative please contact the Wholefoods office on 01 626 2315

Technician), Area Manager, Store Manager, OTC Assistant We have recently started providing Pharmacy Technicians either as Locums or Full Time, which is proving very successful. We were the first in Ireland to offer a full payroll solution for Locums and continue to innovate. We have secured our place on preferred supplier lists with some of the top pharmacies and pharmacy outlets nationwide. Our clients include nearly all the major Groups as well as many independents all across the country. Paolo Iacovelli: Managing Director (paolo@pharmaconex.com) Garry O’Riordan: Operations Director (garry@pharmaconex.com) Barbara Kelly: Recruitment Consultant and Locum Co-ordinator (barbara@ pharmaconex.com) Nicola Ryan: Recruitment Consultant and Locum Co-ordinator (nicola@ pharmaconex.com) Dublin Office: Suite 330, The Capel Building, Mary’s Abbey, Dublin 7 Shannon Office: Westpark Business Campus, Shannon, Co Clare Tel: 01 485 3522 (Dublin) / 061 530202 (Shannon) Fax: 01 526 1734 Mobile: 0870547564 Email: info@pharmaconex.com Web: www.pharmaconex.com

Pharmacy Recruitment

Safes & Security

Recruitment Specialists for Pharmacy in Ireland Set up by pharmacists, the Number 1 agency in Ireland for Locums and Pharmacy Recruitment Locum Service: Pharmaconex is the fastest and easiest way to book a locum. Your request will be published on our website, which is accessed by over 1,500 registered locums, most bookings are filled within 24 hours. Key Features: - 24/7 Service - No emergency fees - No tax liability, we payroll the locum, no administration burden. We can help you recruiting: Retail Pharmacist, Pharmacy Technician, Locum (Pharmacist and

Lazer Security Solutions Little Acre, Walshestown, Lusk, Co Dublin Security systems provider Website: www.lazer.ie Telephone number: 01-841-6369 Email address: info@lazer.ie Help Line Number: 086-252-8522 Products: Safes and controlled drug cabinets (free delivery nationwide), CCTV, alarms, monitoring plus panic systems. Local Contacts: Mr Shay Lunney: Managing Director, shay@lazer.ie, 086-252-8522 Mr Tony Lunney: Technical Director, tony@lazer.ie, 086-817-7099

Training

Buttercups Training Ltd 1 – 2 The Courtyard, Main Street, Keyworth, Nottingham, NG12 5AW Pharmacy Services Training Website: www.buttercups.co.uk Telephone Number: +44 (0)1159 374936 Fax Number: +44 (0)1159 371675 Help Line Number: +44 (0)1159 374936 Order Line: +44 (0)1159 374936 Products: Medicine Counter Assistant (MCA) Course MCA Plus Course Dispensing Assistant Course (Level 2 Equivalent) Level 2 Certificate in Pharmacy Service Skills (NVQ)(QCF)* The Healthcare Assistant Course Level 3 Diploma in Pharmacy Service Skills (NVQ)(QCF) with Accredited Technical Certificate (Underpinning Knowledge Programme)* Accredited Checking Pharmacy Technician Course Level 2 Award in Understanding Health Improvement Level 2 Award in Applied Health Improvement Motivational Interviewing Management for Healthcare Professionals Local Contacts: Although we are based in Nottingham, all courses are delivered via on-line/distance/blended learning, and so are available in Ireland- please contact us on training@ buttercups.co.uk or our main office number for more details. Team Leading for Healthcare Professionals Customer Service for Healthcare Professionals Communication for Healthcare Professionals The Pharmacy Student in the Workplace Course *Requires a UK registered Pharmacist/ Pharmacy Technician to act as an Expert Witness


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2015 Calendar


DISCOVER THE MOISTURISER THAT WORKS IN THE SHOWER. 1

Use your normal shower product and rinse off.

2

Apply In-Shower Body Moisturiser while still in the shower.

3

Rinse off.

4

Dry yourself, get dressed and go.

NEW

IN-SHOWER

BODY MOISTURISER niveaireland

IRISH TIMES SAT MAG (IRELAND)


PHARMACY ASSIST IRELAND 2014