2017 Revision Pack 2017 Revision Pack - Pharmacy Academy

2017 Revision Pack

2017 Revision Pack

Revision Pack & Final Exam

Welcome to your 2017 Johnson & Johnson Pharmacy Academy

Disclaimer

As stipulated in Section 22A subsection 4 and 5 of the Medicines and Related Substances Act 101 of 1965, product recommendations can only be made by Pharmacists and Pharmacist Assistants acting under the personal supervision of a pharmacist (S1 – S2). Any customer seeking medical advice from a Front Shop Assistant should be referred to the Pharmacist on duty.

KEEP US UPDATEDPlease remember to inform us if your contact details change. If the details we have for you are incorrect, we won’t be able to send you your graduation certificate. You can update your details by contacting us in any of the following ways:

Online learning platform: mypharmacyacademy.com

Email: [email protected]

Telephone: +27 21 480 9625 (Mon – Fri, 8:30 – 17:00)

Facebook: The Pharmacy Academy

This pack is an extract of the most important information covered in Study Packs 1, 2 & 3. Study it carefully, and once you’re confident that you have a clear grasp on all the information, you’ll be more than ready to take the Final Exam.

In order to graduate this year, you have to submit both Class Tests and your Final Exam. Completing your Class Tests is quick and easy, and can be done in one of three ways. You can either visit our user-friendly Online Learning Platform, mypharmacyacademy.com and submit your answers online, email your answers to [email protected] or fax your Answer Sheets to 086 775 5116.

To pass your Final Exam you’ll need a minimum result of 7 out of 15. When you pass, you’ll receive a graduation pack which includes a 2017 Johnson & Johnson Pharmacy Academy Certificate of Completion in recognition of having participated in this year’s programme.

Good Luck!

The Johnson & Johnson Pharmacy Academy Team

CONTENTSModule 1: Cough Remedies Pg. 4

Module 2: Colds & influenza Pg. 8

Module 3: Sinusitis Pg. 14

Module 4: Diarrhoea Pg. 18

Module 5: Worms Pg. 24

Module 6: Dehydration Pg. 28

Module 7: Stop Smoking Pg. 34

Final Exam Pg. 40

Notes Pg. 42

4 5

Module 1: Cough RemediesA cough is your body’s way of keeping your throat and lungs clear of foreign particles, microbes, irritants, fluids, and mucus1.

CausesSome of the more common causes include1:

• Viruses and bacteria leading to respiratory tract infections such as a cold or flu

• Smoking

• Asthma

• Some medication

TreatmentIn most cases, the best way to treat a cough is to allow it to run its course and clear up on its own. However, when a cough lasts a few weeks or impairs breathing or rest, it is best to begin treating it.

Wet / Productive Cough Alleviation

Broncholytic

Agent that dilates/opens the bronchial

tubes/passages4

Anti-inflammatory

Substance or treatment that

reduces inflammation or swelling6

Demulcent

Substance which provides a soothing protective coating on mucous membranes of mouth and throat8.

Mucolytic

Agent that liquefies thick mucus/phlegm and is usually used

to help relieve respiratory difficulties5

Cough calming

Agent that helps to soothe and reduce an

irritating cough7

Anti-inflammatory

Substance or treatment that

reduces inflammation or swelling6

Expectorant

Aid in clearance of mucus/phlegm from the passages of the

lungs7

Dry Cough Alleviation

One, or a combination of the solutions above, can be used to treat a variety of different coughs. Expectorants are ideal to treat wet coughs, while antitussives (cough suppressants) are used to soothe or calm dry coughs7.

Ayurvedic vs. Traditional remedies3

Modern medicine treats symptoms, while Ayurveda treats the body as a whole3. In Western medicine your doctor asks about your symptoms, and checks your temperature and blood pressure before writing a prescription3. Ayurveda, in comparison, finds the root cause of

the problem and, instead of treating symptoms, takes care of any ailments or health issues that are responsible for the symptoms, giving the body the right tools to defend itself, boost the immune system and heal faster3.

Herbal remedies are used world-wide for a variety of diseases and conditions.

of those who used herbal treatments claimed to have used them for respiratory tract infections. 34%

of patients interviewed indicated that they had used herbal medication in the past.

In South Africa traditional medicine plays an important role in many regions2. To assess the importance of herbal remedies in the community, patients were interviewed at a hospital in Ga-Rankuwa, 37 km outside Pretoria2.

This makes respiratory conditions one of the most common ailments for which herbal remedies are employed2.

74%

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Top tip for patientsDOKTOR MOM® Herbal Cough Lozenges can be used whenever a cough or throat irritation develops. Encourage patients to stock up on these convenient packets that are great for on-the-go use.

Over-the-counter treatment

DOKTOR MOM® HERBAL COUGH SYRUPFor the relief of coughs

The syrup contains 11 herbal extracts already mixed for the patient’s convenience:

Aloe | Indian Elecampane | Turmeric | Mint | Cubeb Pepper | Ginger | Holy Basil | Indian Nightshade | Liquorice Root | Bahera Fruits | Malabar Nut

Top tip for pharmacy staff DOKTOR MOM® Herbal Cough Syrup can be used during any stage of illness when you experience a cough or throat irritation. Advise patients to keep a bottle at home, so they can soothe their throats when they start feeling sick.

• Effective partner in assisting in cough relief associated with colds and flu

• Relieves wet and dry coughs

• Soothes the throat

• Loosens mucus

• Opens airways

• Ideal for use day or night

• Helps the body naturally defend against infections to relieve cough

• Alcohol and tartrazine free

Available in a 100 ml bottle.

DOKTOR MOM® HERBAL COUGH LOZENGESFor cough relief on the go

DOKTOR MOM® Herbal Cough Lozenges are made from a blend of 4 herbal extracts:

Liquorice Root | Ginger | Indian Gooseberry | Mint

• Relieves coughs

• Soothes the throat

• Ideal for use day or night

• Alcohol and tartrazine free

• Effective partner in assisting in cough relief associated with colds and flu

Available in a pack of 20 lozenges. Comes in 4 soothing flavours: Lemon | Pineapple | Berries | Mixed Fruit

References:

1. Web MD Cold, Flu, & Cough Health Center. Coughs: Age 12 and Older. Available at www.webmd.com/cold-and-flu/tc/coughs-topic-overview. Accessed on 2 March 2017.

2. Marais A, et al. Conditions frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Gauteng, South Africa. South African Family Practice. Available at www.tandfonline.com/doi/full/10.1080/20786190.2014.977066. Accessed on 2 March 2017.

3. Illuminated Health. The Difference Between Ayurveda and Modern Medicine. Available at illuminatedhealth.com/the-difference-between-ayurve-da-and-modern-medicine/. Accessed on 2 March 2017.

4. Medical Dictionary Online. What is a Broncholytic Agent? Available at www.medicaldictionaryonline.info/medical-term/Broncholytic+Agents. Accessed on 2 March 2017.

5. HowMed. Anti Tussives, Mucolytics and Mucokinetics. Available at howmed.net/pharmacology/anti-tussives-mucolytics-and-mucokinetics/. Accessed 2 March 2017.

6. The Free Medical Dictionary. Anti-inflammatory. Available at medical-dictionary.thefreedictionary.com/anti-inflammatory. Accessed 2 March 2017.

7. NPS. Cough and cold medicines. Available at www.nps.org.au/medicines/respiratory-system/cough-and-cold-medicines/for-individuals/types-of-cough-medicines. Accessed on 2 March 2017.

8. Symonowicz M. et al. Flavonoids and their properties to form chelate complexes. Institute of General Food Chemistry, Lodz University of Technol-ogy, Poland, 2012.

S0 DOKTOR MOM® HERBAL COUGH SYRUP (ALCOHOL & TARTRAZINE FREE). Each 10 ml contains extracts derived from: Ocimum

sanctum 100 mg, Glycyrrhiza glabra 60 mg, Curcuma longa 50 mg, Zingiber officinale 10 mg, Adhatoda vasica 60 mg, Solanum

indicum 20 mg, Inula racemosa 20 mg, Piper cubeba 10 mg, Terminalia belerica 20 mg, Aloe barbadensis 50 mg, Menthol 6 mg;

Contains Sugar.

S0 DOKTOR MOM® HERBAL COUGH LOZENGES (ALCOHOL & TARTRAZINE FREE). Each lozenge contains dry extracts derived from:

Liquorice root (Glycyrrhiza glabra) 15 mg, Common ginger rhizome (Zingiber officinale) 10 mg, Indian gooseberry fruits (Emblica

officinalis) 10 mg, Levomenthol 7 mg; Contains Sugar.

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Module 2: Cold and InfluenzaColds and flu are both classified as viral infections1.

The definition of a virus

A virus is a small infectious organism – much smaller than a fungus or bacterium – that must invade a living cell in order to reproduce (replicate)1.

The lifecycle of a virus

The organism or virus secures itself to a cell and then enters it, turning the cell into its host. Here it releases its genetic material, DNA or RNA, and starts to manipulate the cell, forcing it to duplicate the virus. After this replication

process the infected cell may die, since it cannot return to its natural function1. When the cell dies, it releases newly cloned viruses, which can in turn infect other cells1. And so the virus spreads.

The Common Cold What we refer to as the common cold is a viral infection of the membranes of the nose, sinuses, throat and large airways2. It usually leaves the patient with unpleasant symptoms (acute), but

is not usually accompanied by a fever (afebrile) and the condition is one that resolves itself when its course is run (self-limited)3.

Symptoms Key symptoms of a cold2,3,4

Symptoms

• About 95% of influenza cases are caused by type A.

• Within type A and B there are a wide variety of subtypes or strains that cause seasonal flu.

• Type C occurs less frequently, mainly in children, and does not cause a typical influenza illness.

InfluenzaFlu is a viral infection of the lungs and airways by an influenza virus5.

There are 3 types of influenza virus5.

• Type A

• Type B

• Type C

• Cough – generally mild and can last up to 2 weeks

• Runny or congested nose

• Discharge from the nose may become thick and yellow or green as the cold progresses

• Itchy or sore throat

• Low-grade fever – occasionally

• Mild fatigue

• Watery eyes

• Slight body aches or a mild headache

• Sneezing

° Scratchy sore throat ° Dry cough, which may develop into a wet cough ° Runny nose and watering eyes ° Burning sensation in the chest

Chills or chilly sensations (usually the first symptom)

Body aches and pains

Severe headaches and light sensitivity may occur

Respiratory symptoms include:

Warm, flushed skin

Fatigue and weakness

Fever (up to 39° C)

Key symptoms of influenza1,5

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Colds cannot be cured once they have started2, which is why over the counter (OTC) treatments relieve symptoms. A variety of over the counter remedies – often sold as combinations2 – can assist patients while they wait for their body to fight off the virus or for the symptoms to abate.

When a cold or flu comes with a cough, Benylin® is there to help you get better and get back out there as fast as possible.

The Benylin® range of products treats the symptoms of coughs, colds and flu quickly and effectively.

These over the counter (OTC) treatments work to relieve fever, aches, pains, coughs and nasal congestion - only to be recommended by pharmacists.

What is it for? What’s inside? Dosage

BENYLIN® 4 FLU (TABLETS AND LIQUID)

For relief of symptoms associated with cold and flu, including:

fever, body pains, blocked nose and cough.

Active ingredients:

Paracetamol – reduces pain and fever.

Pseudoephedrine – for nasal congestion and runny nose.

Diphenhydramine HCl6,7,8 (starts to work in 15 min and lasts up to 12 hours) – relieves cough.

Tablets

Adults: 2 tablets 4 times daily. Do not exceed 8 tablets within 24 hours.

Children (6 – 12 years): 1 tablet 4 times daily.

Do not exceed 4 tablets within 24 hours.

Do not recommend for children under 6 years.

Liquid

Adults, elderly and children over 12 years: 20 ml 4 times daily.

BENYLIN® DAYTIME FLU (TABLETS)

For effective daytime relief of symptoms associated with cold and flu, including:

fever, blocked nose, body pains and headaches.

Active ingredients:

Pseudoephedrine – for nasal congestion and runny nose.

Ibuprofen – to reduce pain, fever and inflammation.

1 tablet every 4 – 6 hours.

Do not exceed 6 tablets in 24 hours.

Do not recommend this product for children under 12 years old.


Alleviation of wet cough.

Helps thin and loosen

chest mucus.

Active ingredient:

Guaifenesin9 (starts to

work in 30 min and lasts

up to 6 hours) – used to

reduce chest congestion.

Contains sugar.

Adults: 10 – 20 ml every

4 hours.

Not recommended for

children under 12 years old.

Alleviation of wet cough.

Helps thin and loosen

chest mucus.

Active ingredient:





Sugar, alcohol and

colourant free.

Adults: 10 – 20 ml every

4 hours.

Children 6 – 12 years:

5 – 10 ml every 4 hours.


2.5 – 5 ml every 4 hours.

Not recommended for


To alleviate coughing in

children. Helps thin and

loosen chest mucus.

Active ingredient:





Sugar, alcohol and

Colourant free.





Not recommended for


BENYLIN® WET COUGH MENTHOL

BENYLIN® WET COUGH

BENYLIN® CHILDREN’S WET COUGH

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Relief of a general non-

specific cough.

Active ingredients:

Diphenhydramine HCl6,7,8

(starts to work in 15 min

and lasts up to 12 hours)

and ammonium chloride

– reduce coughs. Contains

sugar and alcohol.

Adults & children over

12 years: 5 – 10 ml every

3 – 4 hours.



Maximum of 4 doses

per day.

Not recommended for


Cough suppressant.

Active ingredients:

Diphenhydramine HCl6,7,8


and lasts up to 12 hours),

codeine phosphate and

ammonium chloride – to

relieve coughs. Contains

sugar and alcohol.

Adults & children over

12 years: 5 – 10 ml every

4 hours.



Not recommended for


Max 4 doses a day.

For relief of an

irritating

non-productive cough.

Active ingredient:

Dextromethorphan hydrobromide10 (starts to

work in 15 min and lasts up

to 6 hours) – elevates the

threshold for coughing.

Reduces frequency and

intensity of coughs. Sugar

and alcohol free.

Adults: 5 ml every 4 hours

or 10 ml every 6 – 8 hours.


2.5 – 5 ml every

6 – 8 hours.


2.5 ml every 6 – 8 hours.

Not for children under

2 years old.

Symptomatic relief

of cough associated with

bronchospasm

in children.

Active ingredients:

Terbutaline sulphate11,12


and lasts up to 8 hours)

and guaifenesin9 (starts

to work in 30 min and

lasts up to 6 hours) – used

to reduce tight chest

congestion. Sugar, alcohol

and colourant free.

Children 7 years and older:

5 – 10 ml three times daily.


2.5 – 5 ml three

times daily.

Not recommended for


References

1. Porter RS (Ed). Viral Infections: Overview of Viral Infections. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/infections/viral-infections/overview-of-viral-infections. Accessed on 2 March 2017.

2. Porter RS (Ed). Viral Infections: Common Cold. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/infec-tions/viral-infections/common-cold. Accessed on 2 March 2017.

3. Porter RS (Ed). Respiratory Viruses: Common Cold. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/profes-sional/infectious-diseases/respiratory-viruses/common-cold. Accessed on 2 March 2017.

4. Medicine.net. Definition of Bacteria. Available at www.medicinenet.com/script/main/art.asp?articlekey=13954. Accessed on 2 March 2017.

5. Porter RS (Ed). Viral Infections: Influenza. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/infections/viral-infections/influenza-flu. Accessed on 2 March 2017.

6. Nurses Drug Handbook. 2010, Jones and Bartlett Pub. 9th Edition, pp. 332 – 333.

7. Donaldson, M., Gizzarelli, G. & Chanpong, B. 2007, Oral Sedation: A Primer on Anxiolysis for the adult patient. Anaesth Prog. 54: pp. 118 – 129.

8. Goodman and Gilman’s. 2011, The Pharmacological Basis of Therapeutics, Twelfth Edition, Diphenhydramine HCl. p. 921: Table 32-2.

9. Data on file.

10. Drugs.com. Dextromethorphan Hydrobromide. Available at www.drugs.com/monograph/dextromethorphan-hydrobromide.html?printable=1. Accessed on 25 February 2016.

11. AHFS Monograph 2013 – Terbutaline Sulphate.

12. Terbutaline Sulphate Monograph. Martindale. 32nd Edition. 1999. p. 764.

S2 BENYLIN® ORIGINAL. Each 5 ml contains: Ammonium Chloride 125 mg and Diphenhydramine HCl 12.5 mg. Ref. No. G829 (Act

101/1965).

S2 BENYLIN® WITH CODEINE. Each 5 ml contains: Ammonium Chloride 125 mg, Codeine Phosphate 10 mg and Diphenhydramine HCl

12.5 mg. Ref. No. G830 (Act 101/1965).

S2 BENYLIN® DRY COUGH. Each 5 ml contains: Dextromethorphan HBr 15 mg. Reg. No. Z/10.1/5.

S0 BENYLIN® WET COUGH. (ALCOHOL, SUGAR & COLOURANT FREE LIQUID). Each 10 ml contains: Guaifenesin 200 mg. Reg. No.

37/10.1/0061.

S0 BENYLIN® CHILDREN’S WET COUGH (ALCOHOL, SUGAR & COLOURANT FREE LIQUID). Each 5 ml contains: Guaifenesin 50 mg.

Reg. No. 35/10.1/0266.

S0 BENYLIN® WET COUGH MENTHOL. Each 10 ml contains: Guaifenesin 200 mg. Reg. No. 28/10.1/0374.

S2 BENYLIN® 4 FLU TABLETS. Each tablet contains: Diphenhydramine HCl 12.5 mg, Paracetamol 500 mg and Pseudoephedrine HCl

22.5 mg. Reg. No. 33/5.8/0509.

S2 BENYLIN® DAYTIME FLU TABLETS. Each tablet contains: Pseudoephedrine HCl 30 mg and Ibuprofen 200 mg. Reg. No.

36/5.8/0206.

S2 BENYLIN® BRONCHOSPECT. Each 5 ml contains: Guaifenesin 66.5 mg, Terbutaline Sulphate 1.5 mg. Reg. No. 31/10.1/0487.

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BENYLIN® ORIGINAL

BENYLIN® WITH CODEINE

BENYLIN® DRY COUGH

BENYLIN® BRONCHOSPECT

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Module 3: SinusitisSinusitis is the inflammation of the air cavities within the passages of the nose (paranasal sinuses)1.

Each year 10 to 15 million people develop sinusitis symptoms making it a widespread medical condition2.

The sinuses are air-filled spaces or cavities within the skull that are lined with mucous membranes3.

Categories of sinusitis

Sinusitis can generally be divided into the following categories5:

• Acute: Resolved within 30 days

• Subacute: Resolved in 30 to 90 days

• Recurrent: A cycle of four or more acute episodes per year, each resolved in less than 30 days – with 10 days in between finish and start of a new episode

• Chronic: Symptoms lasting for more than 90 days

CausesSinusitis, or the inflammation of the sinuses, can be caused by any of the following1,3,4,5,6:

• Viral infections, such as rhinovirus and influenza

• Bacterial infections, such as streptococci and pneumococci

• Fungal infections, such as aspergillus and sporothrix

• Allergic reactions, to factors such as pollen or animal hair, to irritants, including car exhaust, petrol and paint fumes, perfume, insect spray and household chemicals, or to the presence of topical fungi, often aspergillus

• Structural abnormalities, such as nasal polyps

• Dehydration and lack of sufficient humidity

• Medications that dry out the mucous membranes of the nose

12

3

4Frontal sinuses – in the forehead

Ethmoid sinuses – between the eyes

Maxillary sinuses – behind the cheeks

Sphenoid sinuses – deep behind the ethmoids

1

2

3

4

Humans have four pairs of sinuses1

• Congestion in the nose

• Swelling over the infected sinus

• Facial pain and tenderness

• Decreased sense of smell

• Possible bad breath or halitosis

• Headache – due to pressure in

blocked sinuses, bending down

can increase pain

• Toothache – caused by

pressure on surrounding nerves

and tissues

• Earache – caused by pressure on

surrounding nerves and tissues

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SymptomsPain in the sinus area(s) is one of the most common symptoms of sinusitis2 - Acute and chronic sinusitis share similar symptoms, but pain tends to be more pronounced in acute sinusitis5.

Other symptoms include1,2:

• Eye pain – caused by

pressure on surrounding nerves

and tissues

• Productive cough – especially

at night

• Discoloured nasal discharge – in

severe cases

• General feeling of malaise –

fatigue due to fever, immune

response or coughing

• Postnasal drip – this irritates the

throat tissue1 and is associated

with chronic sinusitis

16 17


Sinutab® is designed to offer relief from hay fever and the symptoms of sinusitis, colds and flu. Treatment is aimed at improving sinus drainage and controlling the infection2, as well as treating symptoms1, such as pain, pressure-related discomfort and fever1.

Sinutab® has a variety of over the counter (OTC) remedies, which can be used in conjunction with each other to assist.

References

1. MedicineNet.com. Allergies Centre. Sinus Infection (Sinusitis). Available at www.medicinenet.com/sinusitis/article.htm. Accessed on 2 March 2017.

2. Porter RS (Ed). Nose and Sinus Disorders: Sinusitis. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/ear-nose-and-throat-disorders/nose-and-sinus-disorders/sinusitis. Accessed on 2 March 2017.

3. Fae Farrer. Sinusitis and Allergic Rhinitis. South African Pharmacy Journal 2014; 81(8): 11–12. Available at www.sapajournal.co.za/index.php/SAPA/article/view/598/917. Accessed on 2 March 2017.

4. Porter RS (Ed). Biology-of-the-Ears, Nose and Throat: Nose and Sinuses. The Merck Manual Home Health Handbook. Available at www.merck-manuals.com/home/ear-nose-and-throat-disorders/biology-of-the-ears-nose-and-throat/nose-and-sinuses. Accessed on 2 March 2017.

5. Porter RS (Ed). Nose and Paranasal Sinus Disorders: Sinusitis. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis. Accessed on 2 March 2017.

6. NHS Choices. Five facts about colds. Available at www.nhs.uk/Livewell/coldsandflu/Pages/Fivefactsaboutcolds.aspx. Accessed 2 March 2017.

S2 SINUTAB® Sinus Pain Extra Strength. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Codeine Phosphate 10 mg,

Chlorpheniramine Maleate 2 mg, Paracetamol 500 mg. Reg No. 37/5.8/0139.

S2 SINUTAB® Sinus Pain Non-Drowsy. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Paracetamol 500 mg. Reg. No.

37/5.8/0138.

S2 SINUTAB® 3-Way. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Ibuprofen 200 mg. Reg. No. 36/5.8/0207.

S2 SINUTAB® Sinus Allergy Congestion and Pain. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Chlorpheniramine

Maleate 2 mg, Paracetamol 500 mg. Reg. No. 37/ 5.8/0260.

S1 SINUTAB® Nasal Spray. Xylometazoline Hydrochloride 1 mg per ml (0,1% w/v). Reg. No. P/16.1/184.

SINUTAB® SINUS PAIN EXTRA STRENGTH

Severe sinus pain

Symptomatic relief of:

• Severe sinus pain

• Malaise and fever

• Nasal and sinus congestion

• Hay fever, influenza and common cold

SINUTAB® SINUS PAIN NON-DROWSY

Multi-symptom daytime relief (non-drowsy)

Symptomatic relief of head cold symptoms:

• Nasal congestion

• Pressure

• Headache

SINUTAB® 3-WAY

Multi-symptom relief

Symptomatic relief of colds and flu:

• Nasal congestion

• Headache

• Fever

• Body aches and pains

SINUTAB® NASAL SPRAY

Works within 10 minutes and lasts up to 10 hours

Fast, effective, long-lasting


• Nasal congestion caused by colds, allergies and sinusitis

SINUTAB® SALINE NASAL SPRAY

Safe to use as often as required – all year round

• Daily nasal hygiene

• Cleans and moisturises nasal passages

• Soothes irritated nasal passages

• Supportive treatment for nasal congestion

SINUTAB® SINUS ALLERGY CONGESTION AND PAIN

Four benefits in 1


• Sinus pain

• Malaise and fever

• Nasal and sinus congestion

• Hay fever, influenza and common cold

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Module 4: DiarrhoeaDiarrhoea is the result of disturbances to the digestive system, specifically the lower gastrointestinal tract1, leading to an increase in the amount of wateriness, and regularity of bowel movements2.

Digestive system

The digestive system consists of the gastrointestinal tract as well as other organs, such as the liver, gall bladder and pancreas3.

The intestines and colon absorb 99 % of fluid that pass through the gastrointestinal tract4. When not

enough fluid is absorbed, and thus removed from the stool, diarrhoea or loose stool is the result2.

Stool that passes through the digestive tract too fast or holds matter that stops the large intestine from easily absorbing fluids usually contains too much water2.

Causes

During diarrhoea, less water is absorbed by the body and stool becomes loose. Adapted from Digestive Disorders www.webmd.com/digestive-disorder/understanding-diarrhea-basics9

Stomach

Intestines

Water reabsorbed by the body

Normal

Diarrhoea

Stool has too much water to absorb

Stool

Diarrhoea can be acute, where symptoms are resolved in less than 7 days, or chronic, where symptoms last for over 4 weeks2.

Causes of acute diarrhoea2,5,6

• Gastroenteritis, which can be from a viral, bacterial or parasitic infection

• Food poisoning

• Side-effects of certain drugs including antibiotics

• Food allergy or intolerance

• Stress – nervousness can make bowels move faster

• Menstruation – hormones can cause diarrhoea just before or during menstruation

• Jogging – Runner’s diarrhoea happens just after a run and is likely to be caused by stimulated bowel activity

Causes of chronic diarrhoea2,5

• Dietary factors, such as lactose intolerance and overeating of certain fruits or juices like cherry, pear, apple, or prune, as well as over-consumption of caffeine

• Irritable bowel syndrome (IBS)

• Inflammatory bowel disease, caused by Crohn’s disease or ulcerative colitis, among others

• Malabsorption disorders, such as coeliac disease or chronic pancreatitis

• Certain tumours

• Hyperthyroidism

SymptomsKey symptoms of diarrhoea2

• Gas

• Cramping

• An urgency to pass stool

• Nausea and vomiting, when an infection or toxin is present

When diarrhoea is severe or continues over a long period of time, serious dehydration could be a risk. This can happen when fluid and electrolytes (sodium chloride, potassium and bicarbonate) that are lost through liquid stools, vomit, sweat, urine and breathing are not replaced7. If large amounts of water and electrolytes are lost, the patient will feel weak, and his/her blood pressure can drop enough to cause fainting, abnormalities in heart rhythm, and other serious medical complications2.

Urgent assistance

Patients with the following symptoms must consult a physician urgently as these signs suggest a serious cause2:

• Blood or pus in the stool

• Fever

• Signs of dehydration

• Diarrhoea at night

• Weight loss

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Imodium®

Imodium® has a range of products that you can trust to start working within 1 hour10. These over the counter treatments slow down the increased motility of the bowel wall and return stool to normal8.

Over the counter (OTC) treatments of diarrhoea often focus on adding fluids and electrolytes to treat dehydration.

Imodium® Melt TabletsImodium® MELT tablets contain loperamide hydrochloride which slows down the increased motility of the bowel wall8.

Imodium® MELT tablets, which are ideal for the symptomatic relief of acute and chronic non-specific diarrhoea, are fast-dissolving and should be placed on the tongue, instead of being swallowed with water. It melts instantly for effective relief and starts to work within 1 hour10.

Imodium® MELT tablets are ideal for people who are:

• Unable to swallow tablets

• Travelling

• Unable to access water

Suitable for adults and children 6+

For treating acute non-specific diarrhoea:

Adults: take 2 immediately, followed by 1 after each loose stool.

Children over 6 years: take 1 immediately, followed by 1 after each loose stool.

Imodium® 2 mg TabletsImodium® 2 mg tablets contain loperamide hydrochloride which slows down the increased motility of the bowel wall8.

What are the benefits of Imodium® 2 mg tablets?

• The passing of faeces is slowed down

• The reabsorption time is therefore increased

• The stool is normalised and becomes firmer and less frequent

For treating acute non-specific diarrhoea:

Adults: 2 tablets (4 mg) as an initial dose, followed by 1 tablet (2 mg) after each subsequent loose stool.

Children of 6 years and older: 1 tablet (2 mg) as an initial dose, followed by 1 tablet (2 mg) after each subsequent loose stool.

Imodium® SyrupImodium® syrup is indicated for the control and symptomatic relief of acute and chronic non-specific diarrhoea in children from 2 years of age.

What are the benefits of Imodium® syrup?

• It slows down peristalsis (contraction and relaxation of the muscular walls of the digestive tract)

• It slows down intestinal transit time

• It normalises stool consistency

• It’s an alternative for adults who can’t swallow pills

Children over 2 years: 5 ml per 12,5 kg body mass immediately, followed by 2,5 ml per 12,5 kg after each loose stool.

Adults: 15 – 20 ml immediately, followed by 7,5 – 10 ml after each loose stool.

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References

1. Porter RS (Ed). Symptoms of GI Disorders: Overview of GI Symptoms. The Merck Manual of Diagnosis and Therapy. www.merckmanuals.com/ professional/gastrointestinal-disorders/symptoms-of-gi-disorders/overview-of-gi-symptoms. Accessed on 3 March 2017.

2. Porter RS (Ed). Symptoms of Digestive Disorders: Diarrhea in Adults. The Merck Manual Home Health Handbook. Available at www.merckmanu-als.com/home/digestive-disorders/symptoms-of-digestive-disorders/diarrhea-in-adults. Accessed on 3 March 2017.

3. Web MD Digestive Disorders Health Centre. The Digestive System. Available at www.webmd.com/digestive-disorders/digestive-system. Ac-cessed on 3 March 2017.

4. Porter RS (Ed). Symptoms of GI Disorders: Diarrhea. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/profes-sional/ gastrointestinal-disorders/symptoms-of-gi-disorders/diarrhea. Accessed on 3 March 2017.

5. Porter RS (Ed). Symptoms in Infants and Children: Diarrhea in Children. The Merck Home Health Handbook. Available at www.merckmanuals.com/ home/children-s-health-issues/symptoms-in-infants-and-children/diarrhea-in-children. Accessed on 3 March 2017.

6. MedBroadcast. Diarrhea - Did You Know? Available at www.medbroadcast.com/HealthFeature/GetHealthFeature/Diarrhea---Did-You-Know. Accessed on 3 March 2017.

7. World Health Organization. WHO Facts Sheets: Diarrhoeal Disease. Available at http://www.who.int/mediacentre/factsheets/fs330/en/. Ac-cessed on 3 March 2017.

8. NEW ZEALAND DATA SHEET, DIAMIDE Loperamide Hydrochloride Capsules 2 Mg". http://www.medsafe.govt.nz/profs/Datasheet/d/Diamide-cap.pdf . N.p., 2017. Web. Accessed on 18 April 2017.

9. Adapted from Digestive Disorders: Understanding Diarrhea (Basics). Available at www.webmd.com/digestive-disorders/understanding-diar-rhea-basics. Accessed on 8 November 2015.

10. Loperamide.” Journal of Pain and Symptom Management 42.2 (2011): 319-323. Web. Accessed on 10 July 2017.

For full prescribing information please refer to package insert approved by MCC.

S2 IMODIUM® 2mg TABLETS. Each tablet contains 2 mg loperamide HCl. Reg. No. H/11.9/152.

S2 IMODIUM® MELT TABLETS. Each tablet contains 2 mg loperamide HCl. Reg. No. 29/11.9/0213.

S2 IMODIUM® SYRUP. Each ml contains 0,2 mg loperamide hydrochloride. Reg. No. J/11.9/166.

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Module 5: WormsWorms or helminths are parasites that live on or in human or animal hosts, and draw nutrients from their host1.

They are multi-cellular, have complex organ systems and can be divided into two groups1:

Flatworms are visible in stool or are coughed or vomited up. Tapeworm segments are white and particularly distinctive2. In the case of Bilharzia eggs are identified in stool, urine or biopsy specimens4.

• Fever and chills

• Nausea

• Abdominal pain, diarrhoea

• Malaise, and myalgia

Roundworms11

Worm infestations are spread through:

• Poor sanitation and lack of access to clean water

• Playing with contaminated toys, blankets and pets

• Playing/walking in sand contaminated by worm eggs

• Eating unwashed fruit/vegetables grown in contaminated soil

• Unhygienic food preparation

• Direct transfer from an infected person

Hookworms are transmitted when walking barefoot in contaminated soil where hookworm larvae can penetrate the skin through the feet7.

• Flatworms (Platyhelminthes) include tapeworms and flukes1.

• Roundworms (nematodes) differ from flatworms in that they have a body cavity3 and include Ascaris, Hookworms, Trichuris (whipworms) and Threadworms (pinworms)3.

Flatworms

Flatworms are transmitted when an adult tapeworm living in the intestines of its main host, lays eggs which are later excreted within faeces, and then ingested by an intermediate host. Humans usually get tapeworms from eating undercooked meat from an

intermediate host, such as beef or pork infected with tapeworm cysts2.

People become infected with bilharzia through walking, wading or swimming in fresh water contaminated by flatworms4.

Symptoms of flatwormsIn severe cases, these infestations can cause permanent organ damage, anaemia, stunted growth, poor intellectual development and impaired

cognitive function5. Worms may be seen in stool or coughed or vomited up, which helps with diagnosis.

Different kinds of roundworms may be visible in the stool or coughed up or vomited up9.

Threadworm6

Intense irritation around the anus area – especially at night

Loss of appetite and weight

Irritability from lack of sleep

Non-specific abdominal pains, sometimes with

accompanying diarrhoea

A cough, wheezing or pneumonitis can suggest worm

infestation in the lungs

Hookworm7

Itchy rash where the larvae penetrated the skin

Abdominal pain or other GI symptoms

An iron deficiency may develop later due to chronic blood loss

Pinworm infection occurs after pinworm eggs are swallowed8.

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Symptoms

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Vermox® offers a range of 4 products that kill a variety of intestinal worms. These over the counter treatments (OTC) are available in a variety of choices depending on the type of worm and the severity of the infestation.

Vermox® SD Suspension

For adults and children older than 1 year:

Whipworm, hookworm, large roundworm, pinworm:

10 ml given as a single dose.

A second dose may be given to patients who are still

infected, but only 3 to 4 weeks after the first dose.

Vermox® Suspension



5 ml twice daily for 3 consecutive days

Tapeworm: 5 ml twice daily for 6 consecutive days

Threadworm: Adults: 10 ml twice daily for

3 consecutive days

Children: 5 ml twice daily for 3 consecutive days

25 ml can be given as a single dose for adults and

children older that 1 year for whipworm, hookworm,

large roundworm and pinworm.

Vermox® 500 mg Tablet

For adults and children older than 1 year: Whipworm,

hookworm, large roundworm, pinworm:

1 tablet (500 mg) given as a single dose - A single

dose of Vermox® 500 mg may not be sufficient

to cure infestations of hookworm and whipworm,

although it can dramatically reduce the number of

eggs in the body.

A second dose may be given to patients who are still

infected, but only 3 to 4 weeks after the first dose.

References

1. Porter RS (Ed). Infectious Diseases: Approach to Parasite Infections. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanu-als.com/professional/infectious-diseases/approach-to-parasitic-infections/approach-to-parasitic-infections . Accessed on 6 March 2017.

2. Porter RS (Ed). Infectious Diseases: Cestodes (Tapeworms). The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/infectious-diseases/cestodes-tapeworms/overview-of-tapeworm-infections . Accessed on 6 March 2017.

3. Porter RS (Ed). Infectious Diseases: Nematodes (Roundworms). The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/infectious-diseases/nematodes-roundworms/introduction-to-nematodes . Accessed on 6 March 2017.

4. Escargot. Environmental Management: Bilharzia. Available at www.escargot.ch/personel/schisto.htm . Accessed on 6 March 2017.

5. International Medical Outreach (IMO) (2015). Rapid Appraisal on Soil-transmitted helminthiasis (Intestinal parasites) in Croix-des-Bouquet, Haiti. Croix-des-Bouquet, Haiti.: International Medical Outreach (IMO), pp.1 - 23.

6. Barnard K. The Basics – Management of threadworms. GPonline.com June 2011. Available at www.gponline.com/basics-management-thread-worms/gi-tract/article/1073433 . Accessed on 6 March 2017.

7. Porter RS (Ed). Infectious Diseases: Nematodes (Roundworms). Hookworms. The Merck Manual of Diagnosis and Therapy. www.merckmanuals.com/professional/infectious-diseases/nematodes-roundworms/hookworm-infection . Accessed on 6 March 2017.

8. Porter RS (Ed). Parasitic Infections: Pinworm Infection. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/infections/parasitic-infections/pinworm-infection . Accessed on 6 March 2017.

9. De Carvalho IMC, Caudwell R. Worm Infestations. Front Shop Pharmacy Magazine 2012. Available at www.frontshop.co.za/worm-infestations/ .Accessed on 6 March 2017.

10. Vermox HCP Claims Study, Study completed for Johnson & Johnson (PTY) LTD, Prepared by Kantar South Africa (PTY) LTD, May 2017.

11. Organicnutrition.co.uk. (2017). How do people get Parasitic Worms and Parasites Symptoms. [online] Available at: https://www.organicnutrition.co.uk/articles/parasitic-worms-symptoms-causes.htm . Accessed on 30 Aug. 2017.

S1 VERMOX® Suspension. Each 5 ml suspension contains 100 mg Mebendazole ( Polymorph C). Reg. No. K/12/206.

S1 VERMOX® 100 mg tablets. Each tablet contains 100 mg Mebendazole (Polymorph C). Reg. No. G/12/105.

S1 VERMOX® SD Suspension. Each bottle (10 ml suspension) contains 500 mg Mebendazole (Polymorph C). Reg. No. 34/12/0058.

S1 VERMOX® 500 mg tablet. Each tablet contains 500 mg Mebendazole (Polymorph C). Reg. No. W/12/42.

Vermox® 100 mg Tablets



1 tablet (100 mg) twice daily for 3 consecutive days

Tapeworm: 1 tablet (100 mg) twice daily for 6

consecutive days.

Threadworm: Adults: 2 tablets (200 mg) twice daily

for 3 consecutive days Children: 1 tablet (100 mg)

twice daily for 3 consecutive days.

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SA’s #1 Deworming Solution10

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Module 6: DehydrationWater is essential for the body to keep performing its everyday functions1, which is why it is so important to stay hydrated. We naturally lose water every day in the form of water vapor in the breath we exhale and in our excreted sweat, urine, and stool1. When there is

not enough water in our bodies, or more water is leaving the body than what is being taken in, we become dehydrated2.

When the body loses more water than it replaces it often goes hand in hand with the loss of electrolytes – especially sodium and potassium2.

Electrolytes

On a chemical level, an electrolyte is a substance that becomes an ion in a solution and can conduct electricity3. Electrolytes are also present in our bodies and they need to be balanced for

cells and organs to function normally3. Electrolytes play an important role in the amount of water present in the body, the acidity of the blood (pH), muscle function and other essential processes4

Causes2,5,6

SymptomsDepending on how severe the fluid loss is and how long the process above lasts, dehydration can be anywhere from mild or moderate to severe2.

Mild to moderate dehydration

Symptoms of mild to moderate dehydration include2,7:

• Increased thirst

• Less sweating

• Reduced skin elasticity

• Decreased urine production

• Dry or sticky mouth

• Sleepiness or tiredness

• No wet diapers for three hours for infants

• Few or no tears when crying

• Headache

• Constipation

Severe dehydration

Symptoms of moderate to severe dehydration may also include2,5,7:

• Very dry mouth, skin and mucous membranes

• Little or no urination — any urine that is produced will be darker than normal

• Decreased blood pressure – hypotension – may cause light-headedness or fainting upon standing

• Confusion – a good indication that dehydration has become severe, since brain cells are being affected

• Faster than normal heart rate – tachycardia

• Increased or rapid breathing

• Lethargy

• Sunken eyes

• Sunken fontanelles – the soft spot at the top of the baby’s head

If dehydration worsens, the internal organs, such as the kidneys, brain and liver, may go into severe shock2. Extremely severe dehydration can lead to the patient falling into a coma2.

Vomiting or diarrhoea or both as in the case of gastroenteritis

Excessive sweating, as experienced during heat waves or prolonged physical exertion

Use of diuretics – substances that increase urination such as coffee, tea, fruit juices and alcohol

Disorders, such as diabetes and Addison disease, that lead to increased excretion of urine

Burns

Inability or unwillingness to drink or eat, due to cold sores, nausea and a sore throat, such as associated with pharyngitis

Fever or a variety of serious illnesses

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The common treatment for dehydration is oral replacement therapy, in other words the replacement of fluids by consuming them orally.

Oral rehydration solutions (ORS) are available from pharmacies and work effectively for all patients who are suffering from dehydration, regardless of their age, and the cause or type of electrolyte imbalance8.

Rehidrat® offers two oral rehydration solutions (ORS), Rehidrat® and Rehidrat® Sport, that help to replenish electrolytes.

Benefits:

• Optimal balance of sugars, salts and minerals

• No artificial preservatives, sweeteners or colourants

• Suitable for children under 1 year

• 3 palatable flavours: Blackcurrant, Orange and Vanilla

• Available in convenient 6 packs and single sachets

Rehidrat®Rehidrat® is available in three delicious flavours: Blackcurrant, Orange and Vanilla. It’s perfect for travelling, or to keep in your medicine cabinet at home.

Rehidrat® SportRehidrat® Sport, available in Naartjie and Lemon & Lime, is ideal to take in your sports bag to replenish electrolytes after exercise and assist with recovery.

Benefits:

• Optimal balance of sugars, salts and minerals

• No artificial preservatives, sweeteners or colourants

• 2 palatable flavours: Lemon & Lime and Naartjie

• Available in convenient 6 packs and single sachets

Rehidrat® Indication:

For the treatment of dehydration and electrolyte loss due to gastroenteritis and diarrhoea.

Rehidrat® Sport Indication:

Supports optimal hydration before, during and after exercise to assist with recovery.

Dosage:

Dissolve 1 sachet in 250 ml of freshly boiled and cooled water.

Dosage:

Dissolve 1 sachet in 250 ml of cold water.

Maintenance Therapy:

< 1 year old: 100 – 200 ml after every bowel movement.

1 – 5 years old: 200 ml after every bowel movement.

Older children and adults should drink enough Rehidrat® to quench their thirst and replace the fluid lost in every stool.

Mild Dehydration:

50 ml / kg body mass for first 6 hours, followed by maintenance therapy.

Moderate to Severe Dehydration:

100 ml / kg body mass for first 6 hours, followed by maintenance therapy.

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References

1. MedicineNet. Dehydration. Available at www.medicinenet.com/dehydration/article.htm. Accessed on 3 April 2017.

2. Porter RS (Ed). Dehydration: Water balance. The Merck Manual Home Health Handbook. Available at www.msdmanuals.com/home/hormo-nal-and-metabolic-disorders/water-balance/dehydration. Accessed on 3 April 2017.

3. MedicineNet. Electrolytes. Available at www.medicinenet.com/electrolytes/article.htm. Accessed on 3 April 2017.

4. MedlinePlus. Electrolytes. Available at www.nlm.nih.gov/medlineplus/ency/article/002350.htm. Accessed 3 April 2017.

5. Porter RS (Ed). Dehydration and Fluid Therapy in Children: Dehydration in Children. The Merck Manual of Diagnosis and Therapy. Available at www.msdmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-children/dehydration-in-children. Accessed on 3 April 2017.

6. Kaneshiro, N.K. Dehydration. National Library of Medicine. Available at www.nlm.nih.gov/medlineplus/ency/article/000982.htm. Accessed on 3 April 2017.

7. Mayo Clinic. Dehydration. Available at www.mayoclinic.org/diseases-conditions/dehydration/basics/symptoms/con-20030056. Accessed 3 April 2017

8. The Merck Manual of Diagnosis and Therapy. Available at www.msdmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-chil-dren/oral-rehydration. Accessed on 3 April 2017.

S0 REHIDRAT® ORANGE. Reg. No. Y/24/181.

S0 REHIDRAT® BLACKCURRANT. Reg. No. Y/24/214.

S0 REHIDRAT® VANILLA. Reg. No. N/24/103.

Each 14 g sachet of powder contains: Sodium Chloride 0,44 g, Potassium Chloride 0,38 g, Sodium Bicarbonate 0,42 g, Glucose

4,1 g, Sucrose. 8,1 g.

34 35

Module 7: Stop SmokingGlobally more than 3,200 people under the age of 18 smoke their first cigarette each day1. Smoking as defined in this module is the “inhalation of the smoke of burning tobacco encased in cigarettes, pipers, and cigars2.”

The risks of smokingThe use of tobacco is the second leading risk factor for death, after high blood pressure3, across the globe, while smoking cigarettes is the most harmful form of tobacco use4.

Smoking tobacco affects almost every organ in the human body4, and is responsible for the deaths of around 6 million people each year. Of those deaths, more than 5 million are the result of direct tobacco use while over 600 000 are the result of non-smokers being exposed to second-hand smoke5. Overall, tobacco kills up to half of its users5.

Understanding smoking addictionNicotine, the key ingredient in commercial tobacco products, causes smoking dependency4.

Cravings can begin within days of the first cigarette4. Nicotine stimulates the brain’s dopamine reward system4. Dopamine is a chemical or neurotransmitter which is associated with feelings of pleasure6. So, at first, nicotine generates feelings of enjoyment and reduces stress and anxiety6. However, over a long period of time, nicotine has the opposite effect and it becomes increasingly difficult for the brain to experience pleasure. This is what leads to smokers needing more nicotine to reach the same levels of fulfillment6.

Smokers experience both physical or pharmacological addiction and emotional or behavioural dependency on nicotine7.

Benefits of quitting The benefits to quitting smoking begins the minute a smoker stops smoking.

Withdrawal SymptomsCustomers trying to quit smoking may experience9:

Time Period Positive Effect12

20 minutes Blood pressure and pulse rate return to normal

8 hours

Nicotine and carbon monoxide levels in blood reduce by half

Oxygen levels return to normal

48 hours

Carbon monoxide and nicotine are eliminated from the body

Lungs start to clear mucus and other smoking debris

Sense of taste and smell improves

72 hoursBreathing becomes easier

Energy levels increase

2 – 12 weeks Circulation improves

3 – 9 monthsLung function increases by up to 10% – as a result coughs, wheezing and breathing problems improve

5 yearsRisk of heart attacks falls by approximately 50% compared to a person who continues smoking

10 years

Risk of lung cancer falls to half that of a smoker

Heart attack risk is reduced to the same as someone who has never smoked

• Restlessness

• Insomnia

• Hunger

• Weight gain

• Headaches

• Gastrointestinal disturbances

• Strong cravings for cigarettes

• Anxiety

• Depression – usually mild

• Reduced concentration

• Irritability

± 71%of lung

cancer deathsof cardiovascular

diseaseof chronic

respiratory disease

± 10% ± 42%

Globally, tobacco smoking is responsible for3:

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Treatments

Effective treatments for quitting smoking include:

Nicorette® almost doubles the chance of success in quitting smoking through actively controlling cravings and is now available in two new exciting flavours: Freshfruit and Freshmint in 2 mg and 4mg formats, offering smokers a great tasting solution to assist with quitting smoking.

Remedy Availability Effect

Nicotine replacement products (NRTs), such as Nicorette®10

NRTs are available over the counter in a variety of forms, including chewing gum, lozenges, patches, nasal sprays and inhalers. Research suggests that using these products in combination is more effective than using one form alone.

Nicotine replacement therapy (NRT) supplies the body with lower levels of nicotine than in cigarettes, but enough to help relieve cravings and withdrawal symptoms. The aim is to gradually reduce the level of nicotine until the smoker no longer needs it.

Supportive counselling10 Take up therapy or join a counselling group

Counselling helps modify behaviour and emotional reactions.

Prescription drugs like bupropion and varenicline10

Available on prescription

Bupropion is an anti-depressant that assists smokers who might be at risk of depression. It is usually taken together with an NRT. Varenicline helps lessen cravings and withdrawal symptoms and is usually taken on its own.

Nicorette® coated gum is a unique nicotine replacement therapy (NRT) that offers a convenient way to make nicotine bio-available. Nicotine is released over 20 – 30 minutes – at a much lower level than the nicotine released by cigarettes.

Nicorette® coated gums is offered in two new exciting flavours: Freshfruit and Freshmint

NEW

How it works

• With nicotine bound to an ion-exchange resin, the 2 mg and 4 mg gum releases nicotine over 20 – 30 minutes and at a lower level than cigarettes.

• Entering the bloodstream through the oral mucosa, peak plasma concentrations are reached in 30 minutes.

• Both 2 mg and 4 mg gum are proven to start working from the 1st chew, fighting cravings for up to 2 hours. Both 2 mg and 4 mg formats are for low and high dependent smokers.

Benefits• Active control over cravings

• Flexible, on-demand dosing when needed

• Available in 2 mg and 4 mg formats for low and high dependency smokers

• Available in palatable flavours: Regular and Mint

• 10 – 12 pieces of gum daily for up to 3 months*

Indication

Nicorette® is indicated as a temporary aid to the cigarette smoker seeking to give up his or her smoking habit while participating in a behavioural modification programme under professional supervision.

The efficacy of Nicorette® use without concomitant participation in a behavioural modification programme has not been established. The benefits of Nicorette® use beyond 3 months has not been demonstrated.

Dosage

• 2 mg (low dependency) and 4 mg (high dependency).

• Treatment should not exceed 3 months.

*Depends on smoking patterns

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4140

References

1. 1.BeTobaccoFree.gov. Tobacco Facts and Figures. Available at http://betobaccofree.hhs.gov/about-tobacco/facts-figures/. Accessed 3 April 2017.

2. Definition of Smoking. Gale Encyclopedia of Medicine (2008). Available at medical-dictionary.thefreedictionary.com/Smoking. Accessed on 3 April 2017.

3. World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks Global Health Risks. Availa-ble at www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf. pp. v, 11, 21. Accessed on 3 April 2017.

4. Porter RS (Ed). Tobacco Use: Tobacco. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/spe-cial-subjects/tobacco-use/tobacco. Accessed on 3 April 2017.

5. World Health Organization. WHO Fact Sheets: Tobacco. Available at www.who.int/mediacentre/factsheets/fs339/en/. Accessed on Accessed on 3 April 2017.

6. ASH Fact Sheet. Nicotine and addiction. Available at ash.org.uk/information/facts-and-stats/fact-sheets / ash.org.uk/files/documents/ASH_114.pdf . Accessed on 3 April 2017.

7. National Institute of Drug Abuse. Tobacco/Nicotine. Available at www.drugabuse.gov/publications/research-reports/tobacco/. Accessed on 3 April 2017.

8. NHS Smokefree (UK). Adapted from ‘What happens when you quit?’ Available at www.nhs.uk/smokefree/why-quit/whathappens-when-you-quit. Accessed on Accessed on 3 April 2017.

9. Porter RS (Ed). Tobacco Use: Smoking Cessation. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/profession-al/special-subjects/tobacco-use/smoking-cessation. Accessed on Accessed on 3 April 2017.

10. Porter RS (Ed). Tobacco Use: Smoking Cessation. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/spe-cial-subjects/tobacco-use/smoking-cessation. Accessed on 3 April 2017.

S0 nicorette® Gum Freshfruit 2 mg: Each piece contains nicotine-resin complex 20 % 10,0 mg equivalent to 2 mg nicotine. Reg.No.:

A40/34/0565.

S0 nicorette® Gum Freshmint 2 mg: Each piece contains nicotine-resin complex 20 % 10,0 mg equivalent to 2 mg nicotine. Reg.No.:

A40/34/0520.

S0 nicorette® Gum Freshfruit 4 mg: Each piece contains nicotine-resin complex 20 % 20,0 mg equivalent to 4 mg nicotine. Reg.No.:

A40/34/0566.

S0 nicorette® Gum Freshmint 4 mg: Each piece contains nicotine-resin complex 20 % 20,0 mg equivalent to 4 mg nicotine. Reg.No.:

A40/34/0523.

Final ExamThe Final Exam consists of 15 multiple-choice questions. Read the questions carefully and choose one answer for each question. By completing your Final Exam you are automatically entered into a lucky draw to win a prize.

Good luck!

The Johnson & Johnson Pharmacy Academy Team

! You have to complete both Class Tests and Final Exam in order to graduate.

How to complete your Final Exam

A. Online Learning Platform

• Visit mypharmacyacademy.com on your mobile phone, tablet or computer

• Log in using your username and password

• Go to ‘Tests and Final Exam’ and select ‘Final Exam’

• Complete the Exam by selecting the right answer for each question

B. Email

• Send the email to [email protected] using J&J Final Exam in the subject line

• Remember to include your first name, surname, mobile number and pharmacy name

• In the body of your email, write the question number followed by your chosen answer, e.g.

1A

2B

3C

C. Fax

• Use the Fax Answer Sheet included separately within this pack

• Complete the short form by filling in your first name, surname, mobile number and pharmacy name

• Choose your answer by colouring in the circle next to it. Only colour in one circle

Do not tick your answer – we won’t be able to mark it

Once you’ve completed the test, fax the page to 086 77 55116

We’re here to support you. Contact us if you have any queries about the exam.





Note: Only write the number and letter, NOT the full answer and no punctuation

Correct Incorrect

NOTES

NOTES

Should you have any questions about the Johnson & Johnson Pharmacy Academy, or wish to update your contact details, please feel free to contact us:

DisclaimerAs stipulated in Section 22A subsection 4 and 5 of the Medicines and Related Substances Act 101 of 1965, product recommendations can only be made by Pharmacists and Pharmacist Assistants acting under the personal supervision of a pharmacist (S1 – S2). Any customer seeking medical advice from a Front Shop Assistant should be referred to the Pharmacist on duty.





ZA

/SI/

17-0

768

a

For J&J product-related information:

Documents

2017 Revision Pack 2017 Revision Pack - Pharmacy Academy