I s s u e 4 V o l u m e 6 • W I N T e R 2 0 1 3

pharmacy

pharmacy

assistanttechnicianincorporating

Your advice on using REGAINE® Foam can stay with them, even if you can’t.

FOR THE TREATMENT

OF HEREDITARY HAIR LOSS IN MEN

Further information available from www.regaine.ie

FOAM

NEW

Regaine for Men Extra Strength Scalp foam 5% w/w Cutaneous Foam. PA Holder: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24. PA Number: 823/48/3. Full prescribing information available upon request. Product not subject to medical prescription.

AVAILABLE IN

PHARMACYONLY

IRE/RE/13-0259b

NEW

FOAM

NEW

Weight loss and weight management

Aromatherapy – uses and efficacy

Infant feeding

Respiratory conditions – the role of the pharmacy technician

Advanced Defence Sensitive blocks 92% of dentine tubules

in just 6 rinses in vitro*1

Introducing the first in a new expert range from Listerine® – a twice-daily mouthwash built on potassium oxalate crystal technology that blocks dentine tubules deeply for lasting protection from sensitivity.2,3

In just six rinses Advanced Defence Sensitive blocks 92% of dentine tubules; twice as many as the leading recommended pastes.1,4

It can be used alone for lasting protection,3 or in combination with the most recommended paste from the leading sensitivity brand, to significantly increase the number of tubules the paste blocks in vitro.4,5

* Based on % hydraulic conductance reduction

Recommend Advanced Defence Sensitivefor expert care when you’re not there

References: 1. Dentine Tubule Occlusion, DOF 1 – 2012. 2. Tubule Occlusion Stability, DOF 3 – 2012. 3. Relief of Hypersensitivity, DOF 4 – 2012. 4. TNS – Sensitivity Market Research 1 – 2012. 5. Combination Tubule Occlusion, DOF 2 – 2012.UK/LI/12-0494m

Do not recommend this product if patients have a history of kidney disease, hyperoxaluria, kidney stones or malabsorption syndrome, or take high doses of vitamin C (1000mg or more per day).

AdvancedDefence-Irish Pharmacist.indd 1 04/03/2013 09:32

1p h a r m a c y a s s i s t a n t

I s s u e 4 V o l u m e 6 • W I N T e R 2 0 1 3

pharmacy

pharmacy

assistanttechnicianincorporating

2 NeWs

6 PHARmACY TeCHNICIANRespiratory conditions – the role of the pharmacy technicianThe technician is uniquely placed to help patients understand how best to use medication in respiratory illnesses

10 HoT ToPIC

Aromatherapy – uses and efficacyThe uses of aromatherapy may not be proven but they are many

15 CHIlDReN’s HeAlTH

Infant feedingAlternatives to breast feeding are explained

21 HeAlTH

Weight loss and weight managementThe pharmacy assistant can offer advice and assistance in the battle of the bulge

26 suPPlemeNT NeWsCalcium, Vitamin D and the menopause

28 PRoDuCT NeWs

29 CRossWoRD

Pharmacy Assistant incorporating Pharmacy Technician is produced by GreenCross Publishing Ltd. as a supplement to Irish Pharmacist.

cont

ents

The contents of Pharmacy Assistant incorporating Pharmacy Technician are protected by copyright. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical or photocopy recording or otherwise – whole or in part, in any form whatsoever for advertising or promotional purposes without the prior written permission of the editor or publishers.

GreenCross Publishing was established in 2007 and is jointly owned by Graham Cooke and Maura Henderson. Graham can be contacted at graham@greenx.ie Maura at maura@greenx.ie© Copyright GreenCross Publishing Ltd. 2013

DisCLAiMerThe views expressed in Pharmacy Assistant incorporating Pharmacy Technician are not necessarily those of the publishers, editor or editorial advisory board. While the publishers, editor and editorial advisory board have taken every care with regard to accuracy of editorial and advertisement contributions, they cannot be held responsible for any errors or omissions contained.

p h a r m a c y a s s i s t a n t2

n e w s t o yo u ?

suAs: new ankylosing spondylitis exercise app launchedThe Ankylosing spondylitis Association of ireland (AsAi) recently launched SUAS (supporting and Understanding Anky-losing spondylitis) – a new iPhone application to support the 1 in 200 people currently living with Ankylosing spondylitis (As).

The SUAS app, developed in partnership with the Waterford regional Hospital rheumatolo-gy team and supported by Pfizer Healthcare ireland, is the first of its kind in ireland and provides As patients with educational information, guided exercise videos and the ability to monitor their progress over time.

Ankylosing spondylitis (As) is a chronic inflammatory disease the most common symptom of which is pain in the lower back. Pain, stiffness, and limited mobility in other joints is also experienced by some patients.

regular exercise is a vital component of As treatment as the fitter and more flexible the

patient, the better able they will be to deal with the stiffness and pain associated with this chronic condition.

Dr Claire sheehy, Consultant rheumatologist at Waterford regional Hospital explained: “exercise is an essential part of

managing As. When carried out regularly, exercise can reduce pain and stiffness, as well as optimise movement and posture for those with As. However patients – typically in their late 20s and 30s – can find it difficult to adjust to a diag-nosis of As and may disengage with physiotherapy or exercise classes.”

The SUAS app is designed to support and empower patients to take charge of their condi-tion. As a flexible, on-the-go tool, SUAS helps those living with As learn about all aspects

of their condition while also teaching daily exercise tech-niques”

Front row: Bindu Irudayaraj, seoirse smith, Catherine Cullinane. second Row: una martin, Nicole o’Keeffe, oriel Corcoran, Paula Dreelan. Back row: emma Coyle, Claire sheehy, Nathan Hennessy, Donncha o Gradaigh.

Generic substitution unlikely to faze Irish consumers The introduction of generic substitution need not faze irish patients, according to new research announced by Actavis.

According to the research, almost half the population (46 per cent) has bought prescription medicines overseas, and of these 43 per cent were not aware of whether the medicine they bought was a branded or generic medicine.

With reference pricing due to commence on No-vember 1, the research was announced as part of a new cam-paign from Actavis entitled ‘Just Ask About Generics’ (www.justaskaboutgenerics.ie) to support consumers and help them better understand the new laws around generic substitution.

Launching the ‘Just Ask About Generics’ campaign, TV doctor Pixie McKenna said: “i’m delighted to support Actavis in its ‘Just Ask About Generics’ campaign. Having worked as a GP in ireland for many years, i know how important it is for patients to understand their health issues and the medicines they may be prescribed, and for pharmacists to be supported in their interaction with patients about medicines. With the new laws mandating the use of generics coming into effect in ireland, it’s essential that people properly understand the difference between generics and branded medicines and that they know that generics are safe and effective and the reasons they cost less. We all take medicines at some time or other, so i would encourage everyone to learn more about generic medicines or

ask their doctor or pharmacist for advice.”The research also found that 85 per cent of all adults are

happy using a generic medicine if it is cheaper than the branded alternative, and 80 per cent of adults in ireland are not con-cerned with the quality of generic medicine if it is recommend-ed by a pharmacist.

The focus of the Just Ask campaign is to reassure patients that a generic drug is equivalent to a branded drug in terms of strength, effectiveness, quality and safety although they might look different in terms of their shape, colour or size and be in a different package.

Actavis said it recognises that the change in legislation will impact the way people obtain their medicines at the pharmacy and the possible confusion around having to potentially co-pay for branded medicines, particularly older people who are likely to be on several medicines. To address this, the campaign website includes a number of features to help consumers better understand generic medicines and what the changes in legislation will mean to them.

Also commenting on the campaign, Tony Hynds, Managing Director of Actavis ireland said: “We are delighted to launch our ‘Just Ask About Generics’ campaign and hope that consumers find it useful. Our research has shown that a majority of people are happy to take generic medicines. However, the new legisla-tion is challenging for consumers to understand, and affects all of us whether we have a medical card or pay for our own medicines. Ultimately, the introduction of generic substitution is good news for the consumer and good news for the state, making more money available to spend on new treatments and research into areas like cancer and heart disease.”

The ‘Just Ask About generics’ campaign will include national radio advertising and in-store support for pharmacists, as well as the consumer information website www.justaskaboutgener-ics.ie

Pixie mcKenna

Instant release spray.So fast, it’s breathtaking.

· NICORETTE® QuickMist is clinically proven to relieve cravings in just 60 seconds with 2x1mg/sprays1

· NICORETTE® QuickMist is 46% more effective at helping smokers quit compared with placebo at 4 weeks2

NICORETTE® QuickMist mouthspraynicotine

Product Name:Nicorette QuickMist 1 mg/spray, Oromucosal Spray. Composition: 0,07 ml contains 1 mg nicotine, corresponding to 1 mg nicotine/spray dose. Form: Oromucosal spray. A clear to weakly opalescent, colourless to light yellow solution. Therapeutic indications: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms, thereby facilitating smoking cessation in smokers motivated to quit. Advice and support normally improve the success rate. Dosage: After priming, point the spray nozzle as close to the open mouth as possible. Press the top of the dispenser and release one spray into the mouth, avoiding the lips. Subjects should not inhale while spraying to avoid getting spray into the respiratory tract. For best results, do not swallow for a few seconds after spraying. Subjects should not eat or drink when administering the oromucosal spray. Subjects should stop smoking completely during the course of treatment with Nicorette QuickMist. Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using half the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, the oromucosal spray use should be discontinued. To help stay smoke free after Step III, subjects may continue to use the oromucosal spray in situations when they are strongly tempted to smoke. One spray may be used in situations where there is an urge to smoke, with a second spray if one spray does not help within a few minutes. No more than four sprays per day should be used during this period. Regular use of the oromucosal spray beyond 6 months is generally not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to

smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings. Do not administer Nicorette QuickMist to persons under 18 years of age without recommendation from a physician. There is no experience of treating adolescents under the age of 18 with Nicorette QuickMist. Contraindications: Hypersensitivity to nicotine or to any of the excipients of the oromucosal spray. Special warnings and precautions: Nicorette QuickMist should not be used by non-smokers. Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, uncontrolled hypertensions or recent cerebrovascular accident should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, the oromucosal spray may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine induced catecholamine release can affect carbohydrate metabolism. Allergic reactions: Susceptibility to angioedema and urticaria. A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Swallowed nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and oral NRT preparations should be used with caution in these conditions. Danger in small children: Doses of nicotine tolerated by adult and adolescent smokers can produce severe toxicity in small children that may be fatal. Products containing nicotine

should not be left where they may be misused, handled or ingested by children. Transferred dependence: Transferred dependence can occur but is both less harmful and easier to break than smoking dependence. Stopping smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolised by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. Excipients: The oromucosal spray contains small amounts of ethanol (alcohol), less than 100 mg per spray. Care should be taken not to spray the eyes whilst administering the oromucosal spray. Undesirable effects: Subjects quitting habitual tobacco use by any means could expect to suffer from an associated nicotine withdrawal syndrome that includes four or more of the following: dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, restlessness or impatience; decreased heart rate; and increased appetite or weight gain. These have been observed in those using the oromucosal spray. Nicotine craving with urge to smoke is also recognised as a clinically relevant symptom, and an important additional element in nicotine withdrawal after smoking cessation. In addition to this, other cessation-associated symptoms were seen in those using the oromucosal spray: dizziness, presyncopal symptoms, cough, constipation, mouth ulceration, gingival bleeding and nasopharyngitis. Nicorette QuickMist may cause adverse reactions similar to those associated with nicotine given by other means and these are mainly dose-dependent. Allergic reactions such as angioedema, urticaria or anaphylaxis may occur in susceptible individuals. Local adverse effects of administration are similar to those seen with other orally delivered forms. During the first few days of treatment irritation in the mouth and throat may be experienced, and hiccups are particularly common. Tolerance is normal with continued use. Daily collection of data from trial subjects demonstrated that very commonly occurring adverse events

were reported with onset in the first 2-3 weeks of use of the oromucosal spray, and declined thereafter. Adverse reactions reported in clinical trials of the oromucosal spray include: Nervous system disorders: Very common: Headache, dysgeusia Uncommon: Paraesthesia Eye disorders: Uncommon: Lacrimation increase Not known: Vision blurred Cardiac disorders: Uncommon: Palpitations Not known: Atrial fibrillation Vascular disorders: Uncommon: Flushing Respiratory, thoracic and mediastinal disorders: Very common: Hiccups Uncommon: Dyspnoea, rhinorrhoea, bronchospasm, sneezing, nasal congestion Gastrointestinal disorders: Very common: Nausea, dyspepsia Common: Vomiting, flatulence, abdominal pain, diarrhoea Uncommon: Gingivitis, glossitis Skin and subcutaneous tissue disorders: Uncommon: Hyperhydrosis, pruritus, rash, urticaria Immune system disorders: Uncommon: Hypersensitivity. General disorders and administration site conditions Very common: Oral soft tissue pain and paraesthesia, stomatitis, salivary hypersecretion, burning lips, dry mouth and/or throat Common: Throat tightness, fatigue, chest pain and discomfort Uncommon: Oral mucosal exfoliation, dysphonia Not known:Allergic reactions including angioedema and anaphylaxis. MA Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24 Ireland. MA Number: PA 823/49/29. Revision of text: August 2012. Legal Category: Not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.

References: 1. Hansson A et al. Craving Relief With A Novel Nicotine Mouth Spray Form Of Nicotine Replacement Therapy. Poster POS3-45 Presented at SRNT, Feb 16–19th, 2011, Toronto, Canada. 2. Tønnesen P, et al. Efficacy And Safety Of A Novel Nicotine Mouth Spray In Smoking Cessation. A Randomized, Placebo-Controlled, Double-Blind, Multi-Center Study With A 52-Week Follow-Up. Poster POS2-38 Presented at SRNT, Feb 16-19th, 2011, Toronto, Canada.

IRE/NI/12-0230

For every cigarette, there’s a nicorette®

www.nicorette.ie

QuickMist Irish Pharmacist Ad 01.indd 1 18/12/2012 12:06

p h a r m a c y a s s i s t a n t4

i n t h e n e w s . . .

Rise in resting pulse rates among pre-teens in the past 3 decadesThe resting pulse rate of UK pre-teens may have risen by up to two beats a minute since the 1980s. But the rise does not seem to be linked to the overall weight gain seen in this age group during this period, according to research published in a recent issue of Archives of Disease in Childhood.

resting pulse rate is an indicator of general physical fitness and cardiovascular health and so an increase may result in an increased risk of diabetes and heart disease in later life, they warn.

The authors base their findings on serial resting pulse rate measurements of approximately 23,000 UK children between the ages of 9 and 11, who took part in five studies/surveys between 1980 and 2008.

The increase was greater amongst girls who had a higher average pulse at 82.2 beats per minute than in boys at 78.7 beats per minute.

But the pulse rate rose consistently over the 30 year period for both sexes by an

average of 0.04 beats per minute (bpm) every year. And the rise was steeper among boys (0.07 bpm), than among girls (0.03 bpm), equating to an increase of 2 bpm among boys and 1 bpm among girls.

During the 30 year tracking period, the average weight of this age group rose, and pulse rate is associated with body mass index (BMi). But the rapid increase in BMi did not fully explain the increased resting pulse rate, possibly because BMi is not a very sensitive measure of lean and fat body mass, say the authors.

The authors suggest that a decrease in physical activity in this age group and an increase in sedentary behaviour, may have contributed to the rise as both of these are associated with poorer physical fitness. These trends could have important public health repercussions. “Although modest, it is important to monitor these trends, especially in boys, as they appear to have increased at a faster rate in recent years,” they write.

Checkyourskin.ie – new resourceear to the Ground presenter Helen Carroll was joined by Kevin O’Hagan of the irish Cancer society to urge people not to be ‘sheepish’ and check their skin for actinic keratosis (AK), a serious skin condition caused by prolonged sun exposure that can lead to cancer. New research shows that only 94% of irish people are aware of AK.

For more information go to www.checkyourskin.ie.

Children today cannot run as fast as their parents did at a similar age

Children’s fitness is declining and this could have implications for heart disease in later life according to a paper presented American Heart Association’s annual meeting.

researchers analysed data involving more than 25 million children in 28 countries and spanning 46 years.

On average, children today run a mile 90 seconds slower than children 30 years ago.

According to the study, reported on the BBC website, cardiovascular endurance – gauged by how far children can run in a set time – has dwindled consistently by about 5% every decade.

The decline is seen in boys and girls and across all ages from nine to 17 years, and is linked to obesity, with some countries faring worse than others.

Lead researcher Dr Grant Tomkinson of the University of south Australia’s school of Health sciences said: “in fact, about 30% to 60% of the declines in endurance running performance can be explained by increases in fat mass.”

Dr Tomkinson said children needed to be inspired and encouraged to do more vigorous exercise.

if not, the public health consequences could be dire.“if a young person is generally unfit now, then they

are more likely to develop conditions like heart disease later in life,” said Dr Tomkinson.

To stay healthy, children and young people need to do at least an hour of physical activity – such as walking or cycling to school and running in the playground – every day. it can be done in small chunks rather than one session.

Prof Michael Gwitz of the American Heart Association said: “The type of exercise is really important.”

He says exercise must be something that “makes you sweat” and is “sustained and dynamic” to promote cardiovascular fitness.

RECOMMEND SUDAFED

FOR A CLEARER

HEAD THIS WINTER

Sudafed is the brand in Decongestants1.

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

No. 1

Non - Drowsy

✔Fast Acting

✔

1. IMS Value Sales MAT August 2013

IRE/SU/13-0506

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

As seen on TV

Sudafed-TradePharmAd-Irish Pharmacist.indd 1 22/10/2013 14:57

p h a r m a c y a s s i s t a n t6

Pharmacy Technician

Emmett Moran

Respiratory conditions

respiratory conditions range from mild to

self-limiting, from the common cold to life-threatening entities like bacterial pneumonia and lung cancer.1 Two of the most prevalent respiratory conditions in community pharmacy are asthma and chronic obstructive pulmonary disease (COPD).

in a day or week in affected individuals, and in some people symtoms worsen during physical activity or at night.

During an asthma attack, the lining of the bronchial tubes become swollen, causing the airways to narrow which reduces airflow into and out of the lungs. recurrent asthma symptoms can frequently cause sleeplessness, daytime fatigue, reduced activity levels and school/work absence. Asthma has a relatively low fatality rate in comparison to other chronic diseases. some 235 million people currently suffer from asthma. it is the most common chronic disease among children.2

The highest risk factors for developing asthma are a combination of a genetic predisposition with environmental

and the role of the technician

Respiratory condition is a term that encompasses the study and diagnosis of conditions affecting the organs and tissues that make gas exchange possible and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, and the nerves and muscles of

breathing.

AsTHmAAsthma is a chronic disease which is characterised by recurrent attacks of breathlessness and wheezing, which vary in frequency and severity in each person. symptoms may occur several times

7p h a r m a c y a s s i s t a n t

Pharmacy Technician

Respiratory conditions

‘‘since CoPD develops slowly, it is frequently diagnosed in people aged 40 or older. CoPD is not curable, however, it is preventable.’’exposure to inhaled substances and particles that may

antagonise allergic reactions or act as an irritant to the airways, such as:• indoor allergens (for example, house dust mites in bedding,

carpets and stuffed furniture, pollution and pet dander)• outdoor allergens (such as pollens and moulds)• tobacco smoke• chemical irritants in the workplace• air pollution.

Other triggers can also include cold air, physical exercise, and extreme emotional provocation such as anger or fear. in some cases, certain medications can trigger asthma, for example, aspirin, non-steroid anti-inflammatory drugs, and beta-blockers.2

even though asthma cannot be cured, appropriate management can control the disease and enable people to enjoy a good quality of life. short-term medications are used to relieve symptoms. People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms and exacerbations.2

Medications are not the only way to control asthma. it is also important to avoid asthma triggers – stimuli that irritate and inflame the airways. With medical support, each asthma patient must learn what triggers they should avoid. Although asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.2

CHRoNIC oBsTRuCTIVe PulmoNARY DIseAseChronic obstructive pulmonary disease (COPD) is characterized

by a persistent blockage of airflow from the lungs. it is an under-diagnosed, life-threatening lung disease that interferes with normal breathing and is not fully reversible.3 The more familiar terms of chronic “bronchitis” and “emphysema” are no longer used; they are now included within the COPD diagnosis.

The most common symptoms of COPD are breathlessness (or a “need for air”), abnormal sputum (a mix of mucus and saliva in the airway) and a chronic cough. Daily activities, such as walking up a short flight of stairs or carrying a suitcase, can become very difficult as the condition gradually worsens.3

since COPD develops slowly, it is frequently diagnosed in people aged 40 or older. COPD is not curable, however, it is preventable. Various forms of treatment can help control its symptoms and increase quality of life for people with the illness. As an example, medicines that help dilate major air passages of the lungs can improve shortness of breath. At one time, COPD was more common in men, but because of increased tobacco use among women in high-income countries and the increased risk of exposure to indoor air pollution (such as solid fuel used for cooking and heating) in low-income countries, the disease now affects men and women almost equally.3 Almost 90% of COPD deaths occur in low – and middle-income countries, where effec-tive strategies for prevention and control are not always imple-mented or accessible. in 2005, more than 3 million people died of COPD.4 The primary cause of COPD is tobacco smoke (including second-hand or passive exposure). Other risk factors include:• indoor air pollution (such as solid fuel used for cooking and

heating);• outdoor air pollution;• occupational dusts and chemicals (vapors, irritants, and fumes);• frequent lower respiratory infections during childhood.

Total deaths from COPD are projected to increase by more than 30% in the next 10 years unless urgent action is taken to reduce underlying risk factors, especially tobacco use.3 estimates indicate that COPD will become the third leading cause of death worldwide by 2030.4

INHAleR TeCHNIqueinhalation is the preferred method of delivering medication for respiratory conditions such as asthma and COPD. The drug is delivered directly to the affected organ allowing a lower dose to be used. incorrect use of inhalers reduces any potential benefit of the medication, so respiratory guidelines recommend that patients are carefully taught how to use prescribed inhalers. Most pressurised metered dose inhalers (pMDis) involve the user’s co-ordinating correct timing and appropriate inspiratory flow rate (iFr). some pMDis (Autohaler, easibreathe) and all dry powder inhalers (DPis) do not require timing, but do demand that the inspiration produce a certain iFr or peak inspiratory flow (PiF). Written instructions alone on how to use an inhaler are not sufficient. When patients are first prescribed inhaled medication they must be taught how to use their inhaler, and their technique should be checked at further consultations. This is where the role of the pharmacy technician is so essential and it is crucial that the technician themselves can perform the technique.

For using pMDis:5

• remove the cap• shake the inhaler• Breathe out gently• Place mouthpiece between lips• Actuate the inhaler and breathe in slowly and deeply at a low iFr• Hold breath for 5-10 seconds then breathe out• Wait a few seconds then repeat the above process• replace inhaler cap

and the role of the technician

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Pharmacy Technician

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Along with providing advice on how to use inhalers, pharmacy technicians should also stress the importance of maintaining and cleaning inhalers after use to prevent patients from getting oral thrush.

References1. Public Health Agency of Canada (2013) Centre for Chronic

Disease Prevention and Control Chronic respiratory Diseases, available at: http://www.phac-aspc.gc.ca/cd-mc/crd-mrc/index-eng.php

2. World Health Organization (2011) Asthma, available at: http://www.who.int/mediacentre/factsheets/fs307/en/index.html (Accessed: 7th November 2013).

3. World Health Organization (2013) Chronic Obstructive Pulmonary Disease, available at: http://www.who.int/mediacentre/factsheets/fs315/en/index.html

4. World Health Organization (2013) Burden of Chronic Obstructive Pulmonary Disease, available at: http://www.who.int/respiratory/copd/burden/en/index.html

5. siGN (2012) British Guideline on the Management of Asthma, scotland: Healthcare improvement scotland.

6. Nursing Times (2011) How to teach inhaler technique, available at:http://www.nursingtimes.net/nursing-practice/clinical-zones/asthma/how-to-teach-inhaler-technique/5026288.article

For those who find pMDi technique difficult, a spacer device can be attached to the inhaler. The autohaler and the easibreathe devices are activated when the patient inhales, which removes the need to co-ordinate activation and inspiration, although an appropriate iFr and continuous breathe in is still vital. Fine mist pMDi (or respimat) requires an initial priming and activation in accordance with the manufacturer’s instructions; this should always be done by the pharmacy technician in the pharmacy so as to ensure the respimat has been correctly primed for use. Placebo inhalers, which are available from manufacturers, can help with demonstrating correct inhaler technique. Be aware that these placebo devices are for single-person use.

A HandiHaler inhalation device is used where a patient removes a capsule from its blister pack, places it into the piercing chamber of the inhalation device and closes the mouthpiece. The capsule is then pierced and the medication is inhaled through the mouthpiece. it is recommended that inhalations are repeated 2 to 3 times to ensure all medication is drawn from the capsule. Once the powder capsules are removed from the blister pack, it should be taken immediately. if a capsule is exposed to the air, it will rapidly degrade to the point the dose will become ineffective. The capsules cannot be taken orally as they will not be effective if absorbed through the gastrointestinal tract. Along with providing advice on how to use inhalers, pharmacy technicians should also stress the importance of maintaining and cleaning inhalers after use to prevent patients from getting oral thrush. Most inhalers should not be washed with soap and water; the mouthpiece can be cleaned with a dry cloth.

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Many consider this type of treatment mere wishful thinking. There is no doubt that aromatherapy makes you feel good although there is no evidence that it makes you well.

Aromatherapy is a widely used term for a range of traditional therapies that use

essential oils. These may include massaging oils, or any topical application that uses pure, essential oils – the essential oils are either absorbed through the skin or inhaled. The benefits attributed to aromatherapy may be simply down to the massage, or the smell or both.

The essential oils used in aromatherapy have a different composition compared to other herbal products because of the distillation process. The oils are extracted from flowers, seeds, fruits, roots, and leaves.

Products that include synthetic ingredients are not to be confused with essential oils. it should be noted that perfume oils or fragrance oils are not the same as essential oils. Perfume oils contain synthetic chemicals and practitioners say they do not provide the therapeutic benefits of essential oils.

it is believed that the inhalation of essential oils stimulates the part of the brain connected to smell – the olfactory

Aromatherapy is a type of alternative medicine that uses essential oils and other aromatic plant compounds to enhance physical and psychological well being

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aromatherapyThe uses and efficacy of

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system; a signal is sent to the limbic system of the brain that controls emotions. This causes chemicals to be released which make the person feel relaxed, calm, or even stimulated. if the aromatherapy includes massage the effect is to further relax the person.

The essential oils are said to have a direct pharmacological effect. Aromatherapists claim there is a synergy between the body and aromatic oils; however there is no scientific proof that this is the case. Nevertheless, some preliminary clinical studies have revealed positive results.

essential oils, phytoncides and other natural volatile organic compounds work differently. When targeting our sense of smell they activate the limbic system and emotional centers of the brain. When applied to the skin they activate thermal receptors and destroy microbes and fungi. internal application may stimulate the immune system.

ARomATHeRAPY Is some CouNTRIesin France, and much of Western europe aromatherapy is incorporated into mainstream medicine as an antiseptic, antiviral, antifungal and antibacterial, in fact, there are some essential oils that are regulated as prescription drugs in France, and can only be administered or prescribed by a doctor.

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The inhalation of essential oils stimulates the part of the brain connected to smell – sending a signal to the part of the brain that controls emotion.

CommoN PlANTs useD IN ARomATHeRAPY

Tea Tree (Melaleuca alternifolia). The oil is obtained from the leaves and small branches of this Australian shrub. Powerfully antibacterial it is used to treat acne, athlete’s foot and other fungal infections. Clinical trials show positive results in the treatment of acne and in clearing skin sites infected with MrsA. significant risk of contact dermatitis.

eucalyptus (Eucalyptus globulus). eucalyptus oil is colourless with a strong woody scent. The oil may have antibacterial, anti-imflammatory and analgesic properties. The vapour from eucalyptus oil is commonly used to treat colds and flu and is used as a decongestant.

Neroli (Citrus aurantium subsp.amara). This is also known as bitter orange blossom. Widely used for its soothing effect on the nervous system. There is some laboratory evidence of an anxiolytic effect. it has been reported to cause dermatitis in some individuals.

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lemon Balm (Melissa officinalis). Used in aromatherapy as an antispasmodic, for headaches, nervous anxiety, palpitations and insomnia. Laboratory studies show that it has a depressant effect on neural activity. A clinical trial in severe dementia patients showed a significant reduction in agitation and in time spent socially withdrawn with an increase in time spent on constructive activities.

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sandalwood (Santalum album). The oil comes from the roots and heartwood. it is used for urinary, throat and especially skin problems caused by allergy or eczema. it has relaxing effects on human brain waves when inhaled.

Roman Chamomile (Chamaemelum nobile). The oil from the flowers is pale blue to the formation of azulene during distillation. it has antispasmodic and sedative effects. studies on the human brain have sghown it to be a relaxant. Because it is a member of the Daisy family there is a risk of cross-allergy in those allergic to other Compositae(Asters, Chrysanthemums etc.)

German Chamomile (Matricaria recutita). The blue oil from the flowers is well-known for its soothing anti-inflammatory effects on muscles , joints and the skin. it also has calming sedative effects. As a member of the Daisy (Compositae) family it may cause allergic reactions in those already allergic to Daisy-type flowers.

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Jasmine (Jasminum grandiflorum). Aromatherapists use it in cases of apathy, fear, hysteria and hypochondria. it has a stimulating effect on brain waves but low concentrations may be relaxing.

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lavender (Lavandula angustifolia). This quintessential aromatherapy oil is said to be relaxing and soothing on muscles/joints and in skin problems including chilblains and minor burns. Clinical trial evidence suggests that it has modest efficacy in reducing agitation in dementia patients, that it could alleviate premenstrual problems and also improve sleep quality in cases of insomnia.

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Citronella (Cymbopogon nardus). The oil is distilled from the grass-like leaves and has a very distinct lemony smell. it is extremely well known for its insect repellent activity. it is also used to soothe rheumatic aches and pains as well as insect bites. it is a very powerful bactericide but may have irritant and sensitising effects.

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Peppermint (Mentha X piperita). in aromatherapy it is used to stimulate, refresh and restore the patient. The cooling effect of the oil may be of value in tension-type headaches. internally, it is a clinically proven treatment for iBs. it must never be used on young children because of the risk of a fatal reaction.

Clary sage (Salvia sclarea). A relaxing sedative oil used in cases of irritability due to stress and tension. A clinical study indicated that it may be useful in inducing relaxation in female urinary incontinence patients undergoing urodynamic assessment. it can be irritant and the euphoria associated with its use may cause concentration problems

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Bergamot (Citrus berga-mia). This is described as an uplifting oil used in stress-induced anxiety, for ap-petite loss, skin problems and mild mood disorders although a scientific basis for such applications remains to be discovered according to one study. Particular care is needed with this oil as it can contain phototoxic compounds called furocoumarins (Ber-gaptens) and it is advisable to use only furocoumarin-free oils (Bergamot FCF).

Rose (Rosa damascena). The distilled oil is known as rose Otto to distinguish it from rose Absolute extracted from the petals with solvents. The oil is used for its calming effect on the nervous system especially during stress and grief, for loss of appetite and for problems of PMT and of the menopause. A clinical study demonstrated its usefulness in reducing the pain of renal colic when used as an adjunct to diclofenac.

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Ylang ylang (Cananga odorata). The oil is produced from the flowers grown in the Comoros islands and in Polynesia. it is reputed to be a relaxing oil used in shock and trauma to regulate respiration and reduce hypertension. Clinical studies report a significant decrease in blood pressure and induction of feelings of calm and relaxation. its stimulant effect may help relieve depression.

Geranium (Pelargonium graveolens). Used in cases of tiredness, convalescence, anxiety and skin problems. Two of the oil constituents exhibit excellent anti-Candida activity and act synergistically with fluconazole. Laboratory studies show that the oil does not contain detectable amounts of the stimulant Methylhexaneamine (DMAA) which is the subject of anti-doping concern and which is claimed to be a natural constituent of Geranium/Pelargonium and its oil.

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Access your digital copy today!

www.mindo.ie

Did you know as a pharmacist you can also access our award winning medical newspaper

online at

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health

infant

Despite extensive evidence of the health benefits for both baby and mother, ireland continues to have one of the lowest breastfeeding rates in the world with the majority of mums in this country opting to bottle feed.

Infant feeding Michelle McDonagh

In ireland and the UK, the governments recommend exclusive breastfeeding for the first six months (26 weeks) of life. some mothers choose to combination feed with breast milk and infant formula, while others exclusively bottle-feed.

infant formula is the only recommended alternative to breast milk for babies under the age of six months. Today’s formulas are specially formulated to support the adequate growth of infants under six months of age, when babies are not breastfed. Most formulas are based on modified skimmed cows’ milk and have been designed to match, as closely as possible, the composition of breast milk.

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The Department of Health recommends that cows’ milk should not

be introduced as a drink until 12 months of age, as it contains very little iron, vitamins C

and D and is high in sodium, protein and saturated fat. standard first milk infant formula is primarily whey-based and should suit most term babies born free of health problems.

FRom FIRsT mIlK To FolloW-oNThere is a wide variety of brands of infant formula to chose from including Cow and Gate, sMA and Aptamil. First milks are suitable from birth, while follow-on milks, which have added vitamins and minerals, are only suitable for babies from six months old. Milk ‘for hungrier babies’ has a special balance of milk protein which is aimed at satisfying hungrier babies. Many brands include an easy to digest ‘comfort’ milk for babies with digestive problems, staydown formulas and a lactose-free milk.

Bottles and teatsit’s only once you start to look, that you realise how many

different types of bottles and teats there are available on the market. it is useful to have about six to eight bottles or enough to have a different bottle for each feed over a 24-hour period.

Teats come in different shapes, sizes and flow rates and are usually made of latex or silicone. it is generally best to start with a teat designed for newborn babies, but this may change as your baby grows. some babies continue to feed well on the same size teat, while others may require different sizes or flow rates as they get older.

Companies like NUK, MAM and Avent provide a wide range of bottles, teats, soothers and other products for children ranging from newborn babies through to nursery.

BoTTle FeeDING sAFelYPowdered formula milk is not sterile and it may contain bacteria that could make your baby ill. To reduce this risk, it is important to take care when preparing feeds. The use of hot water (70ºC) is the preferred method for making feeds as it will kill any bacteria that may be in the food. This temperature is achieved by boiling

water in the kettle and letting it cool for 30 minutes before using. Feed made using hot water can be made in advance and

stored provided it is cooled completely, stored at the back of the refrigerator and used within 24 hours. Feed made using cooled pre-sterilised water cannot be kept and should be consumed immediately. Warm the feed in a bottle warmer or place in a container of warm water. Don’t use a microwave to warm a bottle as it unevenly heats the feed and may burn your baby’s mouth.

sTeRIlIsING THe equIPmeNTUntil your baby is a year old, you need to sterilise all equipment before each use to kill any bacteria that may be present after washing. equipment includes bottles, teats, collars, discs, caps and tongs and soothers.

steam is recommended as the best way to sterilise equipment. You can use either an electric steam steriliser or a microwave steam steriliser. Once the equipment is sterilised, use a sterile tongs to handle any part of the bottle that may come into contact with milk or your baby’s mouth or you may contaminate it.

CommoN FeeDING PRoBlemsColic, reflux and constipation are three of the most common feeding conditions babies may experience and it can be as distressing for parents as it may be for baby. However, there is now a wide variety of specially formulated over-the-counter and prescription-only infant formulas and products available to treat and alleviate symptoms of conditions like colic, reflux, constipa-tion and allergy to cow’s milk.

ColICA baby is described as having infant colic if he or she has episodes of irritability and inconsolable crying but is otherwise healthy and well fed. Colic generally occurs in the early weeks of a baby’s life and usually eases by the time a baby is three months old. it is estimated that colic affects between 10 and 15 per cent of all babies.

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infant formula is primarily whey-based and should suit most term babies born free of health problems.

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No one really knows why some babies develop colic. One of the most popular

explanations is that there is too much wind in the baby’s stomach, causing cramp

and pains. some babies may be sensitive to lactose, a sugar found in breast milk and formula

milk. Drops containing activated dimeticone (c colic drops) which

help to release trapped wind and drops containing the enzyme lactase (Colief, Lactease) which helps break down lactose, are available over-the-counter in the pharmacy.

if your baby is bottle fed, and you think that colic is being caused because of an intolerance to the formula milk, there are various types of special formula feeds including c that are available.. if your baby does have an intolerance to lactose or to cow’s milk, it is likely that you will be advised to visit your doctor as many of these special formula feeds can be obtained on prescription.

CoNsTIPATIoNin infants under three months, constipation is rare and if the problem occurs, you should consult your doctor. For older babies who have started on solids, the frequency of bowel movements can depend on diet and on fluid intake. Make sure when preparing the infant formula to only use the quantities stated as adding too much powder or too little water can also lead to constipation. if you feel that your baby needs extra fluids, prepare bottles of freshly boiled and cooled water. When the baby is in transition from solids to fluids, a greater fluid intake is normally required. Make sure that your child’s diet has sufficient fibre, by including fruit and vegetable purees.

sYmPToms oF ReFluxreflux is the passage of stomach contents into the food pipe. it is an entirely normal physiological process which occurs several times a day, even in healthy babies, with few or no symptoms.

The refluxed stomach contents can pass up to the pharynx or mouth, leading to vomiting or effortless regurgitation, also known as ‘posseting’ or ‘spitting up’. However, for some babies the symptoms can be troublesome and include constant or sudden crying, irritability, poor sleeping habits with frequent waking, arching of the back during and after feeding and vomiting after feeds.

A health professional may recommend dietary changes such as specialist formula milks or adding a thickener such as Gaviscon infant to baby’s milk. reflux symptoms in babies typically peak at around four to six months of age and resolve after 12 to 14 months.

CommeNCING sPooNFeeDINGBreast milk or formula milk provides all the nourishment babies need during the early months. From about six months, babies need more than just milk feeds, so it is appropriate to introduce spoon feeds by then. The exact timing depends on your baby and their readiness for spoon feeds but you should wait until baby is at least four months old.

VITAmIN DThe current recommendations are that all babies born in ireland be given five micrograms (5μg) of vitamin D3 every day from birth to 12 months, whether breastfed or formula fed or taking solid foods. The evidence is that children and mothers in ireland have low levels of vitamin D which can lead to weak bones and in severe cases, can cause rickets in children.

The vitamin D product used should contain only Vitamin D3 and be in a liquid form suitable for infants. The list of products approved by the Food safety Authority of ireland as suitable for infants includes Baby D, BabyVitD3 and Abidec Vitamin D3.

More detailed information on bottle feeding can be found in the booklet ‘Bottle Feeding your Baby’ from the Irish Nutrition and Dietetic Institute

’’‘‘Today’s formulas are

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healTh

Being overweight can lead to heart disease, type 2 diabetes and some cancers and can shorten life expectancy. in ireland at the present time, 39% of adults are overweight and 18% are obese.1 Of these, slightly more men than women are obese and there is a higher incidence of the disease in lower socio-

economic groups. eating healthy food and being physically active are two of the

most important steps that you can take to improve your health. Being a healthy weight means you feel better, have more energy and are less likely to develop chronic illnesses. There is also a range of safe over-the-counter weight loss products available from irish pharmacies which, with the proper advice and guid-ance, can help people in their efforts to lose the pounds.

Being overweight or obese can shorten life expectancy by six to seven years in people over the age of 40. This year about 2,000 premature deaths in ireland will be attributed to obesity and the numbers are growing relentlessly. The lifestyle changes necessary for long-term weight loss – through a healthy calorie-controlled diet and increased exercise – can be challenging to achieve, but there is a wide range of support available.

HeAlTHY eATINGin ireland, it is recommended that adults and children over the age of five years follow the ‘food pyramid’ healthy eating guidelines. Foods that contain the same type of nutrients are grouped together on each of the shelves of the pyramid. This gives you a choice of different foods from which to choose a healthy diet. Following the pyriamid as a guide will help you get the right balance of nutritious foods within your calorie range.

The growing research evidence that energy dense foods promote obesity is impressive and convincing. These are the foods that are high in fat, sugar and starch. Of these, potentially the most significant promoter of weight gain are foods from the top shelf of the food pyramid including spreads (butter and margarine), cakes and biscuits, and confectionery. When combined these are the greatest contributors to fat and sugar intake in the irish diet.

The prevalence of overweight and obesity has increased with alarming speed over the past 20 years and has recently been described by the World Health Organisation as a ‘global epidemic’. Most worrying of all is the fact that childhood obesity has reached epidemic proportions in europe, with body weight now the most prevalent childhood disease.

Michelle McDonagh

Weight loss and management

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HeAlTHY eATING GuIDelINes

• Limit food and drink from the top shelf of the Food Pyramid. This is the most important healthy eating guideline as these are high in fat, sugar and salt

• Prepare and cook your meals using fresh ingredients. ready meals and takeaways tend to be high in fat and salt and should not be eaten regularly.

• Always read the nutrition label – check for high levels of fat, sugar and salt.

• eat a variety of five or more of different coloured fruits and vegetables every day. Choose leafy green vegetables regularly.

• Wholegrain breads, high fibre cereals, especially porridge, potatoes, wholewheat pasta and brown rice satisfy hunger and are the best foods to fuel your body. These provide a slow release of energy. Be aware of the calorie difference – some types may contain more calories than others.

• Choose healthier cooking methods like steaming, grilling, baking, roasting and stir-frying instead of frying foods. Limit bought fried foods, such as chips.

• eat more fish, it’s a good source of protein as well as containing important vitamins and minerals. Try to eat oily fish at least once a week, for example, mackerel, sardines and salmon. These are high in omega 3 fats.

• Choose vegetable oils that are high in monounsaturated fats such as rapeseed or olive oil. Oils high in polyunsaturated fats such as sunflower or corn oil are also good fats.

• Add as little as possible or no salt to your food in cooking or at the table. Try other flavourings instead such as herbs, spices, pepper, garlic or lemon juice. Have fresh foods as much as possible. Look at the salt content on food labels.

• Adults need about 8-10 cups or glasses of fluid every day. One cup is about 200mls. You need more if you are active. Children and teenagers need to drink regularly throughout the day. Water is the best fluid.

• Take time to enjoy three meals a day sitting at a table. eat slowly and chew your food properly. eating while watching TV or the computer screen distracts you from the amount of food you eat and you may end up eating more than you need.

• Always make time to have a breakfast – people who eat breakfast are more likely to be a healthy weight.

• •Alcoholcontainscalories,soifyoudrink,drinksensiblywithin recommended limits and preferably with meals.

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For those who are struggling to lose the pounds, slimming aids like meal replacement programmes, fat-binders and carb-blockers can help weight loss as part of a calorie controlled diet.

To lose WeIGHT AND PReVeNT WeIGHT GAINTo lose weight, you need to do more physical activity than the rec-ommendations for adults at a healthy weight. How much activity you need to do can vary depending on a number of factors, includ-ing how much weight you need to lose. in general, you need to do about one third more activity than the amount recommended by the adult guidelines. This amounts to brisk walking for at least 60 to 75 minutes per day. if you have a very high body mass index (BMi) of 30.0 or above, or you are extremely inactive, start with bouts of ten minutes or less. Gradually increase the duration, and then the intensity of your activity until you reach the adult guidelines.

moNTHlY WeIGH-INTo keep an eye on your weight, it is a good idea to weigh yourself once a month and to measure your waist every few weeks. Waist measurement should be less than 80cm or 32 inches in women and less than 94cm or 37 inches in men. 49% of irish men and 70% of irish women exceed the above waist measurements.2

Where weight is stored in the body is important. People with excess weight around the tummy are more likely to develop health problems, such as heart disease and type 2 diabetes. if you notice your waist measurement increasing, reduce your energy intake from food and increase your activity.

oVeR-THe-CouNTeR PRoDuCTsFor those who are struggling to lose the pounds, slimming aids like meal replacement programmes, fat-binders and carb-blockers available from pharmacies can help weight loss as part of a calorie controlled diet. in response to criticism from the irish Heart Foun-dation last year about the sale of over-the-counter meal replace-ment products, the iPU pointed out that with the proper guidance and advice these products can work for people.

iPU Vice-President rory O’Donnell noted that pharmacists were ideally placed to advise the public and to provide them with infor-mation in finding solutions to obesity.

He said: “Obesity is a major problem in our society and the phar-macy sector continuously supports and promotes sensible weight loss…The reality is that individuals have used meal replacement products as part of a sensibly controlled balanced diet, which has resulted in long lasting weight loss. it is important that individu-als take advice from their pharmacist or GP before they decide to undertake a weight loss programme.”

The popular Lipotrim programme was introduced into phar-macies in 2000 after more than 13 years in GP surgeries and it is now available throughout ireland. Those on the programme use Lipotrim Total Food replacement Formula in place of regular meals and visit the pharmacy weekly to have their progress monitored. Other meal replacement products available in irish pharmacies include the slimfast, Celebrity slim and Nupo ranges.

Other slimming aids available over-the-counter in pharmacies nationwide include XLs-Medical’s Fat Binder and Carb Blocker products and Pharma Nord’s CLA Booster, DietCare and slim Pre-cise tablets.

For weight loss advice see the Safefood website www.weigh2live.eu and for more ideas on how to get active, go to the Get Ireland Active website at www.getirelandactive.ie

References1. report of National Taskforce on Obesity2. Your Guide to Healthy eating Using the Food Pyramid, Hse

Department of Health Promotion

Be AWARe oF THe CAloRIe DIFFeReNCeBreads, cereals, potatoes, pasta and rice are the best type of calories (energy) for maintaining a healthy weight. it is important to choose mostly wholemeal or wholegrain choices, as these are more filling; check the serving sizes regularly.

Different types of breads and rolls can be used for variety, but be aware that some types may contain more calories than others. For example, two slices of ‘thick cut’ pan bread or a bagel contain almost twice the calories as a bowl of porridge or a medium potato.

PHYsICAl ACTIVITYPhysical activity is an important determinant of body weight. Over recent decades, there has been a marked decline in demanding physical work and this has been accompanied by more sedentary lifestyles generally and reduced leisure-time activity. These observ-able changes, which are supported by data from most european countries as well as the Us, suggest that physical inactivity has made a significant impact on the increase in overweight and obe-sity being seen today.

Children from the age of two to 18 years of age need at least 60 minutes of physical activity every day. Adults from 18 years on-wards (including people over 65) need at least 30 minutes five days a week. This is the minimum for health and should be gradually increased over time.

As well as helping you maintain a healthy weight, being regularly active can give you more energy, help relieve stress, improve your mental health and lower your risk of heart disease and cancer.

Think about your average day and how you might incorporate more activity into your lifestyle, then make a plan and set yourself weekly goals. if you think you don’t have enough time, consider swapping 20-30 minutes of time spent watching TV or using the computer with going for a brisk walk.

To make sure you’re getting the benefits from your activity, you should feel warmer or be sweating slightly and aware that there’s an increase in your breathing and heart rate.

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picturegallery

Honouring Ireland’s leading pharmacists Ireland’s top pharmacists were honoured at the recent Helix Health Pharmacist Awards. Now in their seventh year, the awards are aimed at raising money for the Pharmacy Benevolent Fund and ‘celebrating excellence’ across all disciplines of the pharmacy profession.Ten awards were presented in total at this year’s awards.Pictured here is Aidan o’shea, formerly of o’shea’s Pharmacy, Blackpool Bridge, Cork who was awarded the lifetime Achievement Award at the event with (from left); Jennifer Hughes, marketing manager of Helix Health;Padraig Ferguson, JPA Brenson lawlor Chartered and (right) President of the Pharmacy Benevolent Fund, Aisling Reast

marketing manager of Helix Health, Jennifer Hughes; Concepcion marin de Barcena from Pfizer; excellence in Hospital Pharmacy winner and overall Pharmacist of the Year, Dr Ann Frankish; and President of the Pharmacy Benevolent Fund, Aisling Reast

Jennifer Hughes, marketing manager of Helix Health; Chairman of the organising committee, Fintan moore and President of the Pharmacy Benevolent Fund, Aisling Reast

Young Pharmacist of the Year, Brenda Treacy; overall Pharmacist of the Year, Dr Ann Frankish and Team leader winner mairead Reen Corcoran at the 2013 Helix Health Pharmacist Awards

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SUPPLEMENTNEwS

Preventing stress fracture injuriesVitamin D supplements may be useful a useful source of preventionLast year, researchers published a study of adolescent American girls in the age group 9-15 years to study vitamin D intake levels and the risk of contracting a stress fracture injury. The girls engaged in what is known as high-impact sports activity. Contrary to popular belief, neither dairy nor calcium intake was related to the risk of stress fractures but vitamin D was. The girls in the highest quintile of vitamin D intake levels had

nearly a 50% lower risk of acquiring a stress fracture compared with the girls in the lowest quintile.

50% risk reductionsimilar results were seen in a study that was published one year earlier. in this study, scientists with the Naval Health research Center at the University of California san Diego investigated how vitamin D levels affected the risk of stress fractures among young female navy recruits. They found that

women with the highest levels of vitamin D had approximately 50% less risk of stress fractures. More specifically, the scientists observed that there was double the risk of stress fractures of the tibia and fibula (lower leg) in women with vitamin D levels lower than 20 ng/mL compared with those whose levels were 40 ng/mL or higher. A target for prevention of stress fractures, the researchers concluded, would be vitamin D levels of 40 ng/mL or greater and that is achievable with daily supplementation of 4,000 iU vitamin D3.

Postmenopausal women on hormone replacement therapy are advised to pay special attention to getting sufficient amounts of calcium and vitamin D, according to new research.

it is common knowledge that both vitamin D and calcium contribute to strong and sturdy

bones. Taking supplements of both nutrients is particularly relevant for women who have gone through the meno-pause and are on hormone replacement therapy, research-ers write in the journal The North American Menopause Society. Apparently, calcium and vitamin D support specific hormones that are involved in the building and maintenance of bone tissue.

effect increases with intakeAccording to a study involving nearly 30,000 female participants, those who took supplements of the two nutrients in addition to their standard hormone therapy had 39% fewer hip fractures than those who took either supple-ments or hormones alone. There seems to be some sort of synergistic effect of the nutrients and the hor-mones. The researchers were unable to say exactly how much vitamin D and calcium was needed, yet the ben-efits seemed to increase with the total intake of the nutrients.

Cost-savingOne of the really massive costs on the public healthcare budget is treatment of bone fractures, a problem that typically affects the ageing popula-tion. A good place to start in terms of preventing such fractures is to encour-age the general population to get adequate vitamin D from sunlight, diet and, possibly, supplements. Modern science has found that the majority of us lack vitamin D, and since this particular vitamin is of extreme impor-tance to bone health, there is every good reason to take action. According to published studies, as much as two thirds of europeans, including the otherwise healthy, have insufficient vitamin D levels in their blood.

serious problemThis is serious, as one of vitamin D’s roles is to promote healthy miner-alisation, growth, and remodeling of bone tissue. With too little vitamin

Vitamin D’s many rolesscientists have found over 2,000 different vitamin D receptors in the human body. These receptors are ‘docking stations’ that interact with vitamin D as part of the vitamin’s influence on different body functions. The widespread presence of the vitamin hardly comes a surprise, as it is known to support such important things as:• Healthy bones• A healthy immune function• Normal muscle functioning

How to increase your vitamin D statusThere are things you can do to increase your vitamin D levels. Here is some general advice:• Make sure to get a certain

amount of unprotected sun exposure (sunscreen with a factor above 7-8 is known to block the synthesis of vitamin D in the skin)

• eat plenty of fish• Use supplements with vitamin

D in an oil solution. research shows that it increases the bio-availability of the nutrient.

Important news for postmenopausal women: fewer hip fractures with calcium and vitamin D

D in your bloodstream, you are at increased risk of thin, brittle, or misshaped bones.

low mineral density One of vitamin D’s most important functions is to maintain

your skeletal calcium balance by helping the digestive system absorb calcium. At the same time, vitamin D supports the

embedding of calcium in bone tissue. Lack of vitamin D may result in low bone mineral density and increased loss

of bone tissue. studies have shown a positive correlation between vitamin D levels and bone mineral density in

the hip.

exercise is also importantNot only low vitamin D but a sedentary lifestyle can impair bone mineral density. Therefore, it is vital to be active throughout life. Activities like running impact the bone, stimulating bone formation and helping to maintain strong bone tissue. Combining exercise with sun exposure,

a healthy diet with good vitamin D sources like egg, fish, and meat, and finally a daily supplement,

at least during the winter months, is probably the best strategy for healthy bones.

sources:Archives of Pediatric & Adolescent Medicine 2012

Jul 1;166(7):595-600. Journal of Bone Mineral research. 2011 Oct;26(10):2371-7.

Tel: 01 630 5470 • Fax: 01 630 5475Email: ireland@pharmanord.com. Web: www.pharmanord.ie

D-Pearls:• Have a high dose – 38 μg (1,520 IU) of vitamin D3 per capsule• Come in small, easy-to-swallow “pearls” • Dissolved in cold pressed olive oil for

optimal absorbtion

Please contact us if you would like more information on D-Pearls Pharma Nord®

+ Available in pharmacies and health food stores!

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productnews Maalox Plus campaign supports seasonal marketit is estimated that up to 60 per cent of the population suffer regular bouts of heartburn and indigestion1 each year. The digestive remedies market is worth €372 million in ireland.

sanofi is undertaking a new campaign to support the seasonal overindulgence market launching their heartburn and indigestion brand, Maalox Plus. The general sale packs offer customers a wide choice of treatment options to suit their individual needs and can be conveniently self-selected from pharmacies.

The campaign is being supported by Pr, radio and print advertising from september to December 2013, promoting the product at a key time of over indulgence.

eleonore Baco, brand manager at sanofi said: “We are excited to be gaining momentum on Maalox Plus at such a key time. The heartburn and indigestion market is large, there are very few products which target all three areas of overindulgence; heartburn, indigestion and bloating. it’s a staple medicine cabinet product.”

Maalox Plus has a triple actionformula to aid recovery from; o Heartburn

o indigestion o Bloating caused by trapped windLarger bottle sizes are suitable for ongoing home use, while

the chewable tablets are convenient for travelling and on-the-go.

Maalox Plus is a lemon flavoured indigestion relief remedy available in liquid format and as a chewable tablet. relieving the indigestion symptoms of excess acid, heartburn and bloating3,4, Maalox Plus and its combination of ingredients works by neutralising the excess acid in the oesophagus and the stomach. This soothes the pain and gives fast5, effective and long-lasting relief from heartburn and indigestion. Available in pharmacy only. Always read the label.

For trade enquiries contact your Sanofi representative or Sanofi Customer Service on 01-4035600 or visit www.medicines.ie for a full summary of product characteristics.

60% of parents struggle to keep cool when a fever hits – Nurofen surveyFever is one of the key symptoms that young children develop when suffering from cold and flu and with the season of sniffles upon us, timely research* conducted by Nurofen for Children indicated that 60% of parents admitted to panicking when their child developed a fever.

The research conducted among 300 parents of under 6s also showed that this was more common during the first year of par-enthood, with almost two-thirds (60%) of respondents admitting to panicking with the onset of fever in their child.

However the majority of parents surveyed (86%) said that they are confident of the steps to take to reduce fever in their child, with mothers fairing slightly better than dads. ibuprofen, the active ingredient in Nurofen for Children can provide fever reducing ben-efits from 15 minutes and provides long lasting relief up to 8 hours.

The research also indicated that almost half of respondents (46%) would be more likely to avail of the free GP service for under 5s instead of visiting their local pharmacy when it comes to managing their child’s fever. Furthermore new parents with children under 12 months were more likely (56%) to avail of the free GP care compared to parents of 4 – 6year olds (44%).

The guide Nurofen for Children, available to download from www.nurofenforchildren.ie offers simple advice about fever and when to seek advice.

New 56 blister pack for Clonmel Healthcare Folic Acid 5mg Tablets Clonmel Healthcare would like to advise that Folic Acid 5mg Tablets are now available in blister packs of 56. These replace the previous packs of 250.

The formulation has also changed. The tablet is now around, yellow to orange yellow, speckled biplane tablet.

A GMs code for this new pack size has been available from November 1, 2013.

Full prescribing information for Folic Acid is available on request or go to www.clonmel-health.ie. This product is subject to medical prescription.

If you require any further information, please contact Clonmel Healthcare on 01 620 4000

Flexiseq creates big buzz in Irish marketThe buzz surrounding Flexiseq has certainly made the irish phar-macy community sit up and take notice – it is the biggest selling OTC product ireland has seen in years, with 15,000 tubes being sold per week, the company said.

With Arthritis CeO John Church publically welcoming the “in-novative” new pain-relieving gel when it launched here in June, the company said it is no wonder pharmacists have described Flexiseq as the big hit of the summer.

The drug-free “wonder gel” is being heralded as a godsend by an increasing number of ireland’s 450,000-plus osteoarthritis suf-ferers – particularly those at risk from the common gastrointesti-nal and cardiovascular side effects associated with NsAiDs, such as celecoxib and diclofenac.

eamonn Brady, owner of Whelehan’s Pharmacy in Mullingar, said: “What i like about it is that it’s not a drug but it works.

“To have a drug-free way of relieving joint pains from osteoar-thritis is great because we have many patients who are on a lot of medication and can’t use conventional painkillers, but because it’s drug free they can use Flexiseq.

“it’s rare that you get something like that – when i recommend it to somebody i can feel confident that it should give them relief.”

The innovative, award-winning OA treatment from Pro Bono Bio relieves pain and restores joint mobility without posing any risk to the patient’s heart and stomach thanks to sequessome Technology.

it’s on sale in most pharmacists in ireland, retailing at around €22 a tube or €58 for a three-pack – though keeping it in stock has been the big challenge for many shops around the country, the company said.

29p h a r m a c y a s s i s t a n t

Name:

Address:

email:

Congratulations to the winner of the last Pharmacy Assistant and Tecnician Crossword: Christina Hennessy, irwin’s Pharmacy, shandon street, Cork City.

send your completed crossword with your name and address by 1 March 2013 to the editor, Pharmacy Assistant and Technician, 7 Upper Leeson street, Dublin 4 or fax 01 547 2388. The first correct entry will win a cheque for e50.

crOSSWOrD No.24

Across1 Far removed from TV zapper, perhaps. (6)4 Buck. (4)8 is able to get tin? (3)9 sharpest, but cuts tea badly! (7)10 and 1 down. event where you’ll find eight

in a row! (4)11 African striped horse. (5)14 savour a wild state. (5)16 Bad and strangely vile. (4)18 Pleased, strangely, how time went by. (7)20 Much of it is about nothing, according to

shakespeare. (3)21 The red planet. (4)22 The coming church season? (6)

Down1 run and see 10 across. (4)2 Monster strangely leads to teachers (7)3 Hot bread. (5)5 Foot digit. (3)6 French cake. (6)7 Bee sound for Mr. Lightyear. (4)12 strangely abridge an army unit. (7)13 Master reorgaised a small river. (6)15 Compass point. (4)16 Finished in sudden deduction. (5)17 Lock the door like Usain the Olympian? (4)19 it’s gas how it’s all around us! (3)

ANsWeRs FoR CRossWoRD No. 23

Across: 1 Wicked, 4 Gang, 8 FBi, 9 redskin, 10 itch, 11 elope, 14 Ounce, 16 roes, 18 Typhoid, 20 Dog, 21 rule, 22 Totems. Down: 1 Wife, 2 Clinton, 3 earth, 5 Ark, 6 Gander, 7 edge, 12 Overdue, 13 Doctor, 15 eros, 16 radio, 17 eggs, 19 Pal.

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For further information please contact: Ricesteele manufacturing ltd, unit 21, Cookstown Industrial estate, Belgard Road, Tallaght, Dublin 24. Tel: 01 4510144

This crossword is sponsored by an educational grant from

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NEW

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COUGHS & COLDSCOUGH & COLD SEASON IS ON ITS WAY, SO DON’T FORGET TO STOCK UP

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.

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