issue 2 volume 8 • summer 2015 assistant pharmacy … · the irish pharmacy union (ipu), the...

I S S U e 2 V o L U M e 8 • S U M M e R 2 0 1 5

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PhARMACY

PhARMACY

When it comes to kids, we understand. Product name and PA number: Calpol Sugar Free 120mg/5ml Infant Oral Suspension PA 823/10/5, Product name and PA number: Calpol Six Plus Sugar/ Colour Free 250mg / 5ml Oral Suspension PA 823/10/4, PA Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24, Ireland. Classification: Products are not subject to medical prescription. Further information is available upon request. IRE/CA/14-0904

Carpal tunnel syndrome

staying healthy on holiday

Putting men’s health in focus

Behind the numbers: a look at the rising incidence of stis in ireland

Check your answer against the latest module on pharmacistcpd. Log on and earn CPD credits at the same time.

Latest moduleChronic low back painThe latest module on PharmacistCPD was written by Rachel Mullen.

This module discusses the causes, diagnosis, prevalence and treatment of chronic lower back pain.

Free independent CPD for Irish pharmacists by Irish pharmacists

Onset of low back pain in a patient less than 20 years of age would raise concerns for possible spinal/nerve root pathology. True or False?

3p h a r m a c y a s s i s t a n t

incorporating p h a r m a c y t e c h n i c i a n

I S S U e 2 V o L U M e 8 • S U M M e R 2 0 1 5

PhARMACY

PhARMACY

assistanttechnicianincorporating

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

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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 [email protected] Maura at [email protected]© Copyright GreenCross Publishing Ltd. 2015

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.

4 news

9 FeATURe

staying healthy on holidayPAPT gives you the lowdown on how you can help your patients stay healthy on holiday.

12 FeATURe

Putting men’s health in focusAs preparations get underway for this year’s International Men’s Health Week (MHW) Mary Corcoran asks why men continue to be reluctant about looking after their health.

15 hOt tOPiC

Let’s talk about sexual healthMore than 10,000 cases of sexually transmitted diseases were notifi ed to the Health Protection Surveillance Centre in 2014. Mary Corcoran examines the latest fi gures to see which STIs are most prevalent.

18 PHARMAcY TecHnIcIAn

Carpal tunnel syndromePharmacy technician, Amy Kealy discusses the symptoms, diagnosis and treatment of Carpal Tunnel Syndrome or CTS.

21 PRoDUcT newS

23 cRoSSwoRD

Check your answer against the latest module on pharmacistcpd. Log on and earn CPD credits at the same time.

Latest moduleChronic low back painThe latest module on PharmacistCPD was written by Rachel Mullen.

This module discusses the causes, diagnosis, prevalence and treatment of chronic lower back pain.

Free independent CPD for Irish pharmacists by Irish pharmacists

Onset of low back pain in a patient less than 20 years of age would raise concerns for possible spinal/nerve root pathology. True or False?

p h a r m a c y a s s i s t a n t incorporating p h a r m a c y t e c h n i c i a n

4

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

health literacy quality mark for pharmacies introduced THE National Adult Literacy Agency (NALA) and MSD have just introduced Ireland’s first health literacy quality mark under the Crystal Clear Pharmacy Programme.

Developed in collaboration with the Irish Pharmacy Union (IPU), the programme recognises the critical role pharmacies play in helping patients understand their health issues and the steps they need to take to improve their health.

The Crystal Clear Mark will be awarded to pharmacies where there is evidence of and commitment to providing

a health literacy friendly service to patients. This requires taking account of the literacy and numeracy needs of patients and looking for ways to consistently communicate clearly.

Pharmacies who wish to participate in the Crystal Clear Programme can log on to www.nala.ie/crystalclear to complete the online audit which will identify what they are already doing to support the literacy and numeracy needs of their patients and what they could do better. Those who are successful in completing this audit can then apply for the Crystal Clear Mark.

in briefPharmacy sector under increasing pressure THE Irish pharmacy sector is under increas-ing pressure as costs rise and sales fall.

According to the latest business trends survey from the Irish Pharmacy Union, more than half of pharmacies are reporting a reduction in sales, with dispensary sales particularly badly hit due to what pharma-cists say is the impact of reference pricing and cuts under FEMPI.

Meanwhile, over a third of respondents report an increase in business costs, with energy costs, waste charges, rents and wages the areas most impacted.

Commenting on the findings, IPU Vice-President Daragh Connolly said, “The results from the survey are worrying but not surprising. The pharmacy sector has

not benefitted from the increase in eco-nomic activity seen in other sectors. It is quite obvious that the impact of reference pricing, in particular, is having a detrimen-tal effect on pharmacies, with many just about ‘holding on’. In common with all small businesses, the cost environment for pharmacies remains a concern. Unless re-medial action is taken to address these and other immediate concerns, pharmacies will continue to struggle and jobs will be lost”.

The survey also shows that 68 per cent of pharmacy owners are reporting falling profits compared to this time last year with many saying that they expect this year will be more difficult than the previous 12 months.

widespread satisfaction with irish pharmaciesIrISH people are broadly satisfied with their pharmacies, with 88 per cent of people saying pharmacy services are easily accessible and two thirds saying pharmacy services represent good value for money.

That’s according to the findings of a major study on how Irish people use the healthcare system, which was undertaken by the Irish Pharmacy Union.

The study found 75 per cent of people felt it was easy to talk about healthcare problems in their pharmacy and 80 per cent said their pharmacy was capable of managing day to day healthcare issues.

Cork pharmacy school ranked in world’s top 50THE School of Pharmacy, and Department of Pharmacology and Therapeutics at University College Cork have been ranked amongst the world’s top fifty programmes by QS, publisher of international university rankings.

The top fifty ranking comes as the School of Pharmacy embarks on a new integrated five-year Masters in Pharmacy programme, which is com-mencing in September 2015.

Commenting on the announce-ment, Professor Stephen Byrne, Head of School of Pharmacy and Chair in Clinical Pharmacy Practice at UCC, said, “I am delighted to see the influ-ence that Pharmacy and Pharmacol-ogy has on a global basis, particu-larly acknowledging the impact of Pharmacy in the healthcare, industry and research arenas. Being ranked in the top 50 of the QS rankings by Subject is an honourable recognition of the efforts of staff and collabora-tors in undertaking ground-breaking research, while delivering innovative research-led teaching to produce highly sought after graduates and postgraduates.”

Minister with responsibility for Primary Care, Deputy Kathleen Lynch; Dr Michael wolf, Professor of Medicine and Learning sciences at northwestern University in illinois; hazel slevin of the Peoples Pharmacy, watch house Cross, Limerick and Kathy Maher, President of the irish Pharmacy Union at the launch of the Crystal Clear Pharmacy Programme.



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

new hand hygiene guidelines launched THE Health Service Executive, in partnership with the royal College of Physicians of Ireland, has just launched updated national hand hygiene guidelines and a core infection prevention and control knowledge and skills handbook.

These two publications aim to build on improved rates of hand hygiene amongst healthcare workers.

The launch of the new guidelines comes at a time when there is increasing evidence of community onset of skin infections like MrSA and bowel infections including Clostridium difficile EBSL, VrE and CrE with more than 25 % of new cases of c.diff arising in the community rather than hospital.

Commenting on the launch of the new guidelines, Dr rob Cunney, HSE Clinical lead in Healthcare Associated Infections said, “hand hygiene is the single most effective measure that healthcare work-ers, patients and the public can undertake to prevent healthcare associated infec-tion which affect hundreds of millions of patients around the world every year. The

HSE aims to build on improved rates of hand hygiene compliance amongst health-care workers. The latest hand hygiene compliance rates show an overall compli-ance rate of 87.2 per cent in late 2014, a significant improvement on the 74.7 per cent achieved in 2011 when hand hygiene audits were introduced. The progress to date is very welcome, but improving it further is a priority for the HSE.

“Good hand hygiene is a fundamental part of quality patient care. The HSE has set a target of achieving rates of compliance of more than 90 per cent and work is on-going with healthcare facilities to develop action plans including education, training and re-audit programmes to reach this goal.”

New materials have been developed including a video and newsletter to demonstrate the huge efforts that are being made in relation to hand hygiene around the country and to share ideas about how hand hygiene can be improved. These are available from www.hse.ie/handhygiene.

Call for posters for FiP Pharm tech symposium AHEAD of the 2015 FIP World Congress of Pharmacy and Pharmaceutical Sciences’ Pharmacy Technicians Symposium, FIP is now calling for abstracts for posters, which “address evidence related to the need, role and impact of a strong pharmacy technician workforce.”

Organisers say that preference will be given to posters demonstrating practice-based research, or evaluation, as well as initiatives designed to advance pharmacy services through the development and/or advancement of pharmacy technicians and other mid level cadres.

For further details see http://www.fip.org/dusseldorf2015/.

Frequent users of emergency department more likely to dierESEArCHErS have found that people who use emergency departments more than 4 times a year are twice as likely as infrequent users to die.

The research, which has just been published in the Emergency Medicine Journal, says the available evidence suggests that frequent users account for up to one in 12 patients seeking emergency department care, and for around one in four of all visits and that this patient cohort may benefit from a more targeted proactive approach.

The research analysis showed that frequent attenders at emergency care departments were around 2.5 times as likely to be admitted as infrequent users and more than 2.5 times as likely to require at least one outpatient clinic after their visit to the emergency care department.

“Our results suggest that, despite heterogeneity, frequent users are a distinct and high risk group, the researchers said.”

in brief

Keeping up with the latest technologies

Pictured are first year pharmacy technician students at it Carlow, Marilyn Brennan and Adam Banaszczyk using the new touchstore Pharmacy software system, which were recently installed at the school with support from touchstore.

Head of the school, Paula Rankin said the installation of the new software will ensure the institute’s pharmacy technician students are up to date with every system in use in the country, guaranteeing they are employment ready.

Gerard Cassidy, CeO, touchstore added, “the past two years has seen a major increase in the number of pharmacies using TouchStore Rx and we are delighted to have our system installed in new lab at Carlow it. it is very important that students have as much experience as possible when entering the dispensary.”


6

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

new hospital contact app launched for hCPsA NEW Hospital Contact smartphone app has been offi cially launched, which will off er Irish healthcare professionals easy access to contact information for every national hospital in the country.

The free app, which currently hosts over 17,000 individual numbers and is compatible with iPhone and Android, off ers a user friendly way to search direct phone, fax and bleep numbers for wards, clinics and departments nationwide, allowing healthcare professionals to bypass the switchboard entirely.

Supported by leading healthcare company MSD, Hospital Contact was developed by Dr Joe Sheehan, radiology registrar, Galway University Hospital and Dr Kieran Coleman, GP trainee working in Mayo General Hospital with the support of app developer Shane McAllister in an eff ort to improve communications between medical staff and increase productivity.

Commenting on the launch, Mick Phelan, Business Unit Director, MSD

Ireland said, “Today’s healthcare professional is increasingly looking for ways to communicate more effi ciently and have that direct line to other teams and departments as quickly as possible. Hospital Contact facilitates this by enabling healthcare professionals quick access to all of the contact details they could possibly need in order to do their work via their smartphone. At MSD, we are committed to supporting innovative solutions for the healthcare community and their patients and as such, we are proud to support Hospital Contact.”

Healthcare professionals who download the app can choose which hospital to set as ‘home’ for speedy access to the numbers they use the most, and can utilise other helpful features such as the option to set favourites for quicker access to frequently dialled numbers, a notes function and a search facility.

To download the app for free, simply visit the App Store for iPhone or Google Play for Android.

half of irish women have experienced bladder weaknessMOrE than half of Irish women have experienced weak bladder issues.

That’s according to new research which has just been published which also revealed a fi fth of those who have experienced bladder problems felt ashamed by the condition and 52 per cent agreed that it is considered a taboo subject and is diffi cult to discuss with others.

The publication of the new research coincides with the launch of a new campaign, Don’t Grin and Bear It, which is being fronted by Dr Ciara Kelly. The campaign is aimed at encouraging women to seek help for this condition.

in brief

health regulators to host major inter-professional learning conference

DETAILS have just been announced of a major inter-professional learning conference, which will take place in Ireland this autumn.

IPL Dublin 2015 is a one-day conference, which will focus on inter-professional learning and education in the health and social care professions.

The conference is aimed at those involved in health and social care including practitioners, educators in academia and practice, patient advocates, regulators, policymakers and workforce planners, as well as students.

The event is being hosted by the Pharmaceutical Society of Ireland, in conjunction with COrU, the Medical Council of Ireland, the Nursing and Midwifery board of Ireland, and supported by the Dental Council of Ireland,

The event will take place in Dublin Castle on October 6, 2015. For more details, to register your interest in attending, or to fi nd out about how to submit abtracts for the event log on to www.iplconference.org.

speakers unveiled for FiP Pharmacy technician symposium OrGANISErS of the 2015 FIP World Congress of Pharmacy and Pharmaceutical Sciences’ Pharmacy Technicians Symposium have released details about some of the speakers who will address pharmacy technicians at the event.

Now in its fourth year, this year’s symposium will take place in Dü sseldorf, Germany as part of the FIP World Congress and will see technicians and pharmacy leaders from across the world come together to discuss the challenges and successes associated with creating a strong pharmacy workforce.

Amongst those due to speak to technicians over the course of the Symposium are Chris John from the UK who will deliver a presentation entitled, “Global workforce analysis – what does

it tell us about the need for pharmacy support workers?” Dan Kibuule from Namibia and Shirley-Anne Boschmans from South Africa will discuss the outcomes of workforce development eff orts in Namibia while Joao Joaquim from Portugal will discuss the topic of creating a mobile workforce in Europe.

As part of the Symposium, a moderated panel will discuss how pharmacy technicians are currently being used in a variety of practice settings and they will set out their vision for enhanced roles for pharmacy technicians in the future.

FIP 2015 will take place in Dü sseldorf from September 29 to October 3 with the Pharmacy Technicians Symposium taking place on September 28 and 29. For further details, or to register, log on to http://www. fi p.org/dusseldorf2015/.

Abbreviated Product Information.Please consult the summary of product characteristics for full prescribing information.

Product information for Panadol 500mg Film Coated Tablets. Each tablet contains paracetamol 500mg. Indications: Mild analgesic and antipyretic, headaches, musculoskeletal disorders, menstrual pains, toothache, pains of colds and �u, mild to moderate pain associated with osteoarthritis (diagnosed by a doctor). Posology: Oral administration. Adults (including the elderly) and children aged 12 years and over: 2 tablets 3 - 4 times a day. Maximum of 8 tablets in 24 hours. Children 6-12 years of age: ½ - 1 tablet 3- 4 times a day. Maximum of 4 tablets in 24 hours. Not suitable for children under 6. Do not repeat more frequently than every 4 hours and not more than 4 doses should be given in any 24 hour period. Maximum duration of continued use without medical advice: 3 days. Contraindications: Hypersensitivity to paracetamol or any of the other constituents. Use in children under 6. Special warnings: Caution is advised in the administration of paracetamol to patients with moderate or severe renal or severe hepatic impairment. The hazard of overdose is greater in those with moderate and severe liver disease. Do not exceed the stated dose. Patients should be advised not to

take other paracetamol-containing products concurrently. If symptoms persist, consult your doctor. Prolonged use except under medical supervision may be harmful. This product should only be used when clearly necessary. Contains parahydroxybenzoates, which may cause allergic reactions (possibly delayed). Side effects: All very rare: thrombocytopaenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema, and Stevens Johnson syndrome, bronchospasm in patients sensitive to aspirin and other NSAIDs, hepatic dysfunction. Overdose: Immediate medical advice should be sought in the event of an ovedose, even if you feel well, because of the risk of delayed, serious liver damage. Management should be in accordance with established treatment guidelines. MA Holder GlaxoSmithKline Consumer Healthcare (Ireland) Limited, Stonemasons Way, Rathfarnham, Dublin 16. MA Number PA 678/107/1. Date of (Partial) Revision of the Text April 2015. Legal Category General Sales. Further information is available on request.

Panadol is a registered trade mark of the GSK group of companies. Contains paracetamol. Always read the label/lea�et.

NOT ALLPARACETAMOL TABLETS ARE CREATED EQUAL

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UNIQUEQUICK RELEASEFORMULA

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Panadol tablet's unique quick release formula can get to work faster than standard paracetamol tablets, which can sit in the stomach for up to an hour.

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MGK3379 A4 Pharmacy Assistant and Technician.pdf 1 11/05/2015 14:25


8

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

Getting the bus may help patients lose weightSWITCHING from driving to work to using public transport may help people to lose weight.

That’s according to new research just published in the Journal of Epidemiology & Community Health.

The researchers used a series of analyses to see if changes in mode of transport were linked to changes in weight over a two-year period.

In the fi rst analysis, which included 3,269 respondents, 179 people had stopped driving to work and were either walking or cycling or taking public transport.

Switching from a car to walking, cycling, or public transport was associated with a statistically signifi cant average reduction in BMI of 0.32 kg/m2 after taking account of other infl uential factors—equivalent to a diff erence of around 1 kg a person, on average.

The longer the commute, the stronger was the association, with a reduction in BMI of 0.75 kg/m2 (equivalent to a weight loss of around 2 kg) associated with journeys of more than 10 minutes, and 2.25 kg/m2 associated with journeys of more than 30 minutes—equivalent to weight loss of around 7 kg, on average.

In the second analysis, which included 787 people, 268 switched from active to passive travel. Some 156 stopped walking or cycling and 112 switched from public transport (usually a bus or coach) to the car.

Those who stopped walking or cycling to work were signifi cantly less likely than those who stopped using public transport to be in a managerial or professional post. They also tended, on average, to have a shorter commute, which lengthened after the switch.

Those who had previously used public transport, on the other hand, had a short commute after the switch.

Switching to a car was associated with a signifi cant weight gain of around 1kg per person (or 0.34 kg/m2) after taking account of other infl uential factors.

The authors noted, “Combined with other potential health, economic, and environmental benefi ts associated with walking, cycling and public transport, these fi ndings add to the case for interventions to promote the uptake of these more sustainable forms of transport.”

hse urges caution against Lyme diseaseAT A time of year when pharmacy techni-cian’s are more likley to see patients coming in to pharmacies who are taking part in outdoor pursuits, the HSE’s Health Protection Surveillance Centre is urging people to take precautions against Lyme disease.

Lyme disease is spread by tick bites and while in most cases infected people will not have any symptoms at all, in a minority of cases, cause severe debilitating heart and nervous system disease.

Lyme disease has been notifi able in Ireland since 2012 and there are between 8-13 cases notifi ed in Ireland each year. However, according to HPSC specialist in public health medicine, Dr Paul McKeown, some people will not be aware that they are infected or will not seek medical help when unwell and the true incidence of Lyme disease is not known. It is likely that there are at least 50-100 cases in Ireland every year.

According to Dr McKeown, between 5 per cent and 25 per cent of the population in Europe have antibodies in their blood to Lyme disease, meaning they have been bitten by an infected tick at some stage in their lives. “The commonest feature is a rash, which occurs in about three-quarters of patients. This rash generally develops between three days and a month after a tick

bite. It can last up to a month and be several inches in diameter. People can also complain of fl u-like symptoms such as headache, sore throat, neck stiff ness, fever, muscle aches and general fatigue. Occasionally, there may be much more serious complications involving the nervous system, joints, the heart or other tissues,” he explained.

Prevention and management Pharmacy technician’s can advise patients who they know will be tak-ing part in outdoor pursuits during the summer that tick bites can be prevented by:• Wearing long trousers, long

sleeved shirts and shoes• Using an insect repellent• Checking skin, hair and warm

skin folds (especially the neck and scalp of children) for ticks, after a day out

• removing any ticks and consulting with a GP if symptoms develop

• If you have been walking your dog, check him/her too.

new irish study fi nds high prevalence and low awareness of hypertensionA NEW Irish study has made a number of concerning fi ndings about hypertension amongst older adults in Ireland including high prevalence, lack of awareness, poor control despite treatment and disparities in treatment related to possession of a medical card.

The study, undertaken by researchers at the Irish Longitudinal Study on Ageing (TILDA) in Trinity College Dublin found older adults without a medical card were signifi cantly less likely to be on medication to control their blood pressure, compared to those who did have a medical card.

Almost half of those who were on medi-cation to control hypertension did not ac-tually have their blood pressure controlled to normal levels.

The study also found 45 per cent of those with high blood pressure were una-

ware of their condition. Lack of awareness was higher in males and in the youngest group examined (50-64 years).

Commenting on the study, lead author, Dr Catriona Murphy, research Fellow at TILDA in Trinity College Dublin said, “The fi ndings of this study are of concern as high blood pressure is usually a silent condition with no symptoms until it has caused damage to organs such as the heart or kidneys. The study results are consistent with this silent profi le. The level of awareness we found in this Irish study is a combination of individual lack of aware-ness of the condition and the absence of a comprehensive system to detect this important risk factor in the community.”

Full details of the research have just been published in the Journal of Public Health.



TRAVELhEALTh

Staying healthy on holidayAs the school term draws to a close, pharmacies often witness an influx of families looking for last minute advice and first aid essentials for their summer getaway. PAPT gives you the lowdown on how you can help your patients stay healthy on holiday.

ailments, counselling them about sun safety and helping them to prepare an essential first aid kit.

Avoiding bitesTravellers heading to sunny climes, where they may be at risk of bites and stings, should be offered advice about how they can protect themselves from being bitten and what they can do to treat any potential bites. This is particularly important in relation to families who may be travelling to countries where malaria is endemic. In such situations, patients should be advised that the mosquitoes which transmit malaria, usually bite between dusk and dawn and travellers should stay indoors during this time. Insect repellent should be applied to exposed skin and if necessary a mosquito bed net should be erected. Patients should be advised that anti-malarial treatments need to be started before they travel and they should visit their GP for a prescription for same and any travel vaccines they may require.

feature

TRAVELhEALTh

with our somewhat tempermental climate, it’s not surprising that as the summer arrives in Ireland, many people chose to get away to get some sun.

Last year, Irish people made a staggering 3,658,000 trips abroad, staying away for an

average of nine nights and spending €3,423.5 million in the process.While many of those tourists will have an uneventful and

enjoyable break, others will succumb to relatively harmless, but bothersome illnesses while away such as travellers’ diarrhoea, motion sickness, prickly heat rash or allergies.

Those who have experienced an illness on holiday previously are usually quite smart when it comes to preparing for their holidays and will often ensure they prepare a well stocked first aid kit before travelling, saving them the hassle of trying to find a pharmacy while away if they do become ill.

Pharmacies can help ensure their patients stay safe and healthy on holidays by offering them advice on common holiday


10

TRAEL

hEALT

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Sun safetyThe importance of protecting their skin against the harmful rays of the sun cannot be underestimated.

Patients should be advised that they should avoid the sun between noon and 4pm and they should seek the shade regularly to avoid being burned. Loose clothing, hats and clothes with Ultraviolet Protection Factors (UPF) will off er some protection from UV rays. Sunscreens are vital, especially when travelling abroad. There are a huge variety of sunscreen products on the market, all of which work the same way once they are applied correctly. Sunscreen should have an SPF of 15 or higher, should be applied 20 minutes before going out in the sun and should not be used too sparingly – for the average adult you will need 35mls of sunscreen to cover the whole body. The Irish Cancer Society recommend using a measure of half a teaspoon of sunscreen to cover each arm, the face, neck and ears. They also suggest using a measure of one teaspoon for each leg, the front and the back of the body. For more tips on how your patients can stay safe in the sun, see www.cancer.ie.

DiarrhoeaTravellers’ diarrhoea is the most common illness aff ecting travellers and each year between 20 per cent and 50 per cent of international travellers will succumb to this illness. Most commonly caused by Escherichia coli (ETEC), patients report urgent, frequent, loose stools often accompanied with vomiting, nausea, fatigue and general malaise. Patients can reduce their risk of diarrhoea on holidays by avoiding eating raw or undercooked foods including fruit, unless they have prepared them themselves and by being very vigilant with their hand hygiene. rehydration solutions are helpful in ensuring patients do not become dehydrated.

ConstipationWhile many travellers experience diarrhoea while away, many others experience constipation while on holidays. Susceptible patients should be advised to drink plenty of fl uids while travelling, particularly if they are taking a long haul fl ight. Motility medicines, bulking agents or a laxative can help relieve patients suff ering from constipation.

Travel sicknessTravel or motion sickness is more common than you might think with children, and those who usually suff er from migraine, being particularly susceptible. Symptoms can include nausea, dizziness, cold sweats, vomiting and pallor. Patients concerned about mo-tion sickness should be advised that deep breathing and staring at a fi xed object in the distance might help to temporarily relieve symptoms. Acupressure bands can be helpful to some people, while Hyoscine can be eff ective in more severe cases. Others re-port that ginger supplements, or products such as ginger biscuits or ginger tea may also be helpful in helping them to feel better.

AllergiesAllergies and holidays unfortunately can often go hand in hand with many travellers, who may not usually suff er from allergies, experiencing an allergic reaction while away often to a bite, a new pollen or food. Antihistamines can off er relief from allergies and regular allergy suff erers should consider taking preventative measures to avoid an allergic reaction such as taking an antihistamine prophylactically, using a barrier cream or nasal spray and showering after returning from a day outdoors.

First aid kit essentialsHere’s a brief list of the holiday essentials, which you can recommend to your patients to include in their fi rst aid kit.

Painkillers: Headaches are commonplace when travelling, particularly after long fl ights and patients should be advised to pack some ibuprofen or paracetamol.

Antacid: To relieve heartburn.

Antihistamines: Can help relieve allergies, heat rash and provide relief from sunburn.

Oral rehydration solution: A must for all fi rst aid kits, especially if travelling with children who are particularly susceptible to dehydration.

Diarrhoea treatment: An antidiarrhoel will help to reduce the symptoms of diarrhoea.

Acupressure bands/motion sickness tablets: These are particularly important if travelling with children who are susceptible to travel sickness.

sterile wipes: Great for cleaning cuts or grazes.

Plasters and bandages: Essential for cuts and grazes.

Antiseptic cream: To reduce risk of infection following cuts/stings.

Gloves and scissors

thermometer: Important if travelling with children.

tweezers: For removing ticks, splinters or broken glass (as many people often go barefoot on holidays).

Blister plasters: A must for anyone who is going to be wearing heels/fl ip fl ops or pumps for the fi rst time in a year.

Insect Repellent/mosquito nets: Particularly important when travelling to countries where malaria is endemic.

hydrocortisone: A mild hydrocortisone cream is a must have for any fi rst aid kit

eye wash: Often required more often than you might think, particularly in places where travellers may get sand in their eyes.

sun screen and after sun: T o provide protection from the sun and to relieve sunburn.

Cetirizine is the No. 1treatment for Hayfever*

No.1TREATMENT

*IMS Health Dec 2014

Our new website www.cetriz.ie will explain all you need to know about hayfever and other allergies. Live feed to Met Éireann for a daily pollen count update or talk to us about adding a link to your website.

Cetriz is supported by above the line advertising and in-store support.Driving footfall in to store and encouraging pick up at store level.MARKETING SUPPORT

All you need toknow about Cetriz.

ABBREVIATED PRESCRIBING INFORMATION

Please refer to the Summary of Product Characteristics (SmPC) before prescribing Cetriz 10 mg Film-coated Tablets.

Cetriz 10 mg Film-coated Tablet; each fi lm-coated tablet contains 10 mg cetirizine. Indications: Adults and paediatric patients over 6 years: Relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis; relief of symptoms of chronic idiopathic urticaria. Dosage: Children 6 to 12 years: 5 mg twice daily (a half tablet twice daily). Adults and adolescents over 12 years of age: 10 mg once daily (1 tablet). Tablets to be swallowed with a glass of liquid. Renal impairment: Mild (CLcr 50-79 ml/min) 10 mg once daily, Moderate (CLcr 30-49 ml/min) 5 mg once daily, Severe (CLcr 10-29 ml/min) 5 mg every 2 days. Elderly: No dose adjustments. Contraindications: Hypersensitivity to cetirizine, to any of the excipients, to hydroxyzine or to any piperazine derivatives. Severe renal impairment at less than 10 ml/min CLcr. Warnings and precautions: Caution is recommended if alcohol is taken concomitantly, although at therapeutic doses, no clinically signifi cant interactions have been demonstrated. Caution in patients predisposed to urinary retention. Caution in epileptic patients and patients at risk of convulsions. Wash-out period of 3 days required before performing allergy skin tests. The use of the fi lm-coated tablet formulation is not recommended in children aged less than 6 years since this formulation does not allow for appropriate dose adaptation. Contains lactose. Interactions: No interactions are expected with this antihistamine [neither pharmacodynamic nor signifi cant pharmacokinetic interaction was reported in drug-drug interactions studies performed, notably with pseudoephedrine or theophylline (400 mg/day)]. Absorption of cetirizine is not reduced with food, although the rate of absorption is decreased. Pregnancy and Lactation: Very rare clinical data on exposed pregnancies are available (animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/fetal development, parturition or postnatal development). Caution should be exercised when prescribing to pregnant or breast-feeding women because cetirizine passes into breast milk. Side Effects: Common: Adults: fatigue, dizziness, headache, dry mouth, nausea, somnolence, pharyngitis; Paediatric population: diarrhoea, rhinitis and fatigue. Shelf Life: 2 years. Pack size: 7 and 30 Tablets. Marketing Authorisation Holder (MAH): Actavis Group PTC ehf., Reykjavikurvegi 76-78, 220 Hafnarfjordur, Iceland. Marketing Authorisation Number: PA 1380/54/1. Legal Category: Medicinal product not subject to medical prescription.

Full prescribing information including the SmPC is available on request from Actavis Ireland Limited, Euro House, Little Island, Co. Cork or email [email protected]. Information about adverse event reporting can be found on the HPRA website (www.hpra.ie) or by contacting Actavis Ireland Limited [email protected] of Generation of API: January 2015.

Date of preparation: February 2015. FADHCP-013-04.

notably with pseudoephedrine or theophylline (400 mg/day)]. Absorption of cetirizine is not reduced with food, although the rate of absorption is decreased. Very rare clinical data on exposed pregnancies are available (animal studies do not indicate direct or indirect harmful effects with

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12p h a r m a c y a s s i s t a n t incorporating p h a r m a c y t e c h n i c i a n

the reluctance of many men to look after their health is a subject that has often been laughed and joked about. We’ve all been regaled with tales of Mr Murphy, who wouldn’t go to the doctor if his leg was falling off and we’ve smiled and nodded, agreeing, ‘sure aren’t men all the same.’

The problem with this though is it does little, but reinforce a troubling stereotype at a time when men in Ireland are experiencing a disproportionate burden of ill health.

The latest fi gures show that male life expectancy is worryingly low, with the average man in Ireland living to just 75.1 years, fi ve years younger than their female counterparts.

According to the Health Service Executive, men also have higher death rates at all ages, and for all leading causes of death.

Slow improvements“Things are getting better, but there is always room for improve-ment,” explains Finian Murray, Spokesperson for the Men’s Health Forum in Ireland, who are organising a range of events across the country for International Men’s Health Week. “When I started work-ing in this area back in 2002, life expectancy for men was about 73 years on the island of Ireland and this is up to almost 79 years now. The gap between life expectancy for men and women is also nar-rowing. While men are living longer though, not all of those years are healthy years and there is room for this to be improved,” he said.

As part of this year’s event, men are being encouraged to take more interest in their health; to look at their diet to reduce their risk of obesity, look after their mental health, quit smoking and reduce their alcohol intake.

Putting men’s health in focusAs preparations get underway for this year’s International Men’s Health Week (MHW) Mary Corcoran asks why men continue to be reluctant about looking after their health

feature



One of the key problems in men’s health is that while younger men are starting to take more interest in their health, older men are still reluctant to access healthcare services. “The research shows that men see cost as a barrier to visit their GP, but they also under-utilise pharmacy services even though many of the services there are free of charge. Our information also shows us that men are less likely than woman to access the HSE’s Quitline smoking cessation service and new evidence is also showing us that men are also less likely to take part in BowelScreen, the national bowel screening programme than their female counterparts,” he said.

Men reluctant to access pharmacy servicesMurray says pharmacies are in a very unique position to encourage men to take control of their health and wellbeing, but they need to help patients overcome the reluctance to access their services.

“Cost has been cited as a huge barrier as to why men do not access health services, but this factor is removed in the pharmacy and staff here are in a great position to take the opportunity to talk to patients about their health, and if necessary, suggest that they may need to go to their doctor. research has found that men are under utilising the pharmacy and there’s a lot to gain by encouraging men to engage with pharmacy teams,” he said.

Men’s health strategies continue to highlight that men are more open to a preventative healthcare model than seeking help for health issues, and pharmacy assistants and technicians should keep this in mind when treating male patients.

Advice and support Pharmacy teams are in a unique position to off er advice and support to their male patients in a wide range of areas including fi tness, cancer prevention and mental health. Here are some of the most common areas pharmacies are asked to provide support for:

BaldnessMale baldness can be a serious concern to many men and can have signifi cant impacts on their confi dence, particularly in patients dealing with premature hair loss. Patients experiencing hereditary hair loss should be given information about the range of products available which may be able to help slow down hair loss, or in some case, encourage regrowth.

Keep in mind that some of these products will not be suitable for patients with alopecia or hair loss as a result of chemotherapy. Most people with alopecia can expect their hair to grow back within 12 months without treatment.

Erectile dysfunction ED is a condition, which can cause a lot of anxiety for patients, particularly if it is something, which they have not experienced before. Older patients can often think that ED is just part and parcel of the ageing process, but while the chances of ED increase as you age, it is important to remind patients that it can also be caused by emotional issues such as stress, may be as a result of alcohol, illegal drug or medicine use or could actually be a warning sign of illness such as prostate cancer.

Patients experiencing ED should assured that it can be quite normal to experience issues surrounding premature ejaculation or diffi culty in maintaining an erection, but that this is easily treated. Persistent issues should be assessed by their GP to fi nd the underlying cause.

FitnessAs the days get longer and we propel ourselves into the Irish summer, pharmacies may soon fi nd there is no shortage of patients looking for advice and support about getting fi t, how to prepare for endurance events and marathons and how to care for minor injuries and sprains.

For patients who may be getting involved in intensive sporting activity for the fi rst time, it is always worth asking them how they are feeling and reminding them it is important that they are feeling well before starting any major new exercise regimes. Advice can be given on the importance of healthy eating whilst training and a gentle reminder to drink plenty of fl uids to replace those lost during exercise.

Chafi ng is often a concern for athletes and pharmacy teams can recommend that patients apply a barrier such as petroleum jelly or the new Caldesene Adult 10% w/w medicated powder to areas prone to irritation and chafi ng before heading out for a run.

Blisters are commonplace for many athletes and pharmacy assistants and technicians can advise patients on the most suited products for same, depending on the location of blisters.

Finally, pharmacy teams can off er a wide range of gels, creams and bath solutions which may be able to help patients with sore and tired muscles as well as support bandages and, in the case of injury, pain relief if needed.

Men’s cancersThe latest data for that year shows us that non-melanoma skin cancer was the most common cancer in men in 2009 (4,142 cases) followed by prostate cancer (2,859) bowel cancer (1,342), lung cancer (1,079), melanoma skin cancer (308) and testicular cancer (142).

While each of these cancers have diff erent signs and symptoms, there are some signs of illness that should never be ignored which pharmacy assistants and technicians can urge their patients to watch out for. These include changes such as a lump or a swelling, weight loss, pain that doesn’t go away, bleeding after a bowel movement or after sex, coughing up

‘‘’’

One of the key problems in men’s health is that while younger men are starting to take more interest in their health, older men are still reluctant to access healthcare services.

14p h a r m a c y a s s i s t a n t incorporating p h a r m a c y t e c h n i c i a n

cent to 48 per cent by 2030. This will put Irish men are at the top of an “overweight” table of 53 countries.

As obesity is closely linked with a wide range of chronic diseases, it is imperative pharmacy assistants and technicians counsel patients about the importance of losing weight and encourage them to improve their diet and get more exercise. A recent report from safefood found Irish men consume excessive amounts of salt (7.4g/day), have higher intakes of processed meats (30g/day), but not enough fruits and vegetables and pharmacy teams should advise patients to reduce their salt and meat intakes and ensure they are eat enough fi bre.

Weight loss products and/or books on healthy eating may be recommended to some patients.

Men’s Health Week Ireland EventsA host of events will take place across the country as part of this year’s event, which takes place from Monday, June 15 to Sunday, June 21.

Pharmacies are being encouraged to host their own men’s health events as part of the awareness week. “Pharmacies are in a great position to perhaps put together a men’s health display window during the week highlighting the men’s products available in the pharmacy to try to draw male patients in and then they can encourage men if they have any concerns, to bring them to them,” said Murray. “We would be happy to post the details of any such events on our website if pharmacies would like to send an e-mail to me at fi [email protected] or Colin Fowler at colin@mhfi .org.

Pharmacies who would like a copy of the MHIF’s newly published ‘Challenges and Choices’ Man Manual’ or promotional material in relation to the event can order these by logging on to www.mhfi .org.”

blood or noticing blood in urine. Persistent coughs, bloating, heartburn, mouth ulcers or sores should not be ignored. Any changes to bowel or bladder habits, to the breast (yes, in men too) or changes to moles also warrant a trip to the doctor.

The European Code Against Cancer is a great resource for pharmacy teams looking for general advice on how their patients can look after their health and help reduce their risk of cancer. The Code can be accessed at; http://www.cancer.ie/europeancode#sthash.SHimrxOl.dpuf

Mental health Figures show that one in four or fi ve of us will experience some mental health problems in our lifetime and men are particularly vulnerable, with many refusing to seek help and support for themselves.

Sadly, suicide continues to be the leading cause of death in men aged 15-34 years in Ireland, surpassing the number of deaths from road traffi c accidents and the rates of youth suicides in Ireland are now the fourth highest in Europe.

Pharmacy technicians and assistants should be alive to patients showing signs of depression and/or other mental health problems and should make themselves aware of local mental health supports and services so that they can provide information about same if asked. The HSE website, www.yourmentalhealth.ie provides a wealth of information on mental health issues, advice and support contacts and is a great resource for anyone looking to educate themselves about mental health issues or fi nd information for their patients.

ObesityNew data from the world Health Organisation shows Ireland is on course to become the most obese country in Europe with the proportion of obese Irish men expected to increase from 26 per

Local men die, on average, four and a half years younger than women do.Males have higher death rates than women for all of the leading causes of death.Poor lifestyles are responsible for a high proportion of chronic diseases.Late presentation to health services leads to a large number of problems becoming untreatable.

Source: http://www.mhfi .org



TOPIChOT

Let’s talk about sexual healthMore than 10,000 cases of sexually transmitted diseases were notifi ed to the Health Protection Surveillance Centre in 2014, with the incidence of one STI alone increasing by 600 per cent. Mary Corcoran examines the latest fi gures to see which STIs are most prevalent and amongst which population groups.

in focus

sexual health is a subject, which is often shied away from, but the reality is that it is a topic that needs to be high on the health promotion agenda.

The simple fact of the matter is that the number of sexually transmitted diseases being notifi ed to the Health Protection Surveillance Centre is increasing.

According to newly released fi gures from the organisation, in 2014, almost 10,000 STIs were notifi ed to them excluding HIV, Hepatitis B and syphilis as well as ano-genital warts (AGW) and non-specifi c urethritis (NSU).

Incidence of STIsChlamydia (6,707 cases), gonorrhoea (1,336 cases) and genital herpes (1,254) were the biggest off enders, representing 95 per cent of all STIs, which were notifi ed to the HPSC in 2014. An ad-ditional 339 cases of syphilis, 93 cases of Trichomoniasis and 35 cases of Lymphogranuloma venereum (LGV) were also reported.

An Outbreak Control Team was drafted in earlier this year to investigate the rapid increase in notifi cations of the latter mentioned, LGV, the incidence of which increased by 600 per cent. All of these notifi cations have been among men who have

in focus in focus in focus


16

TOPIChOT

A recent irish study found that there was a lack of awareness amongst young people aged between 17-34 years of symptoms that are suggestive of stis.

sex with men. The outbreak is centred in Dublin with 33 of the cases resident in the Greater Dublin area and the remaining two cases resident in adjoining counties.

Prevalence by sexSome infections were identifi ed in more female patients than male patients including Chlamydia (3,623 female patients and 3,047 male patients), genital herpes (937 cases of genital herpes were identifi ed in women compared with 311 cases amongst men) and Trichomoniasis (91 cases in women and two cases amongst men). Gonorrhoea was more prevalent amongst male patients (1,108) than female (233) as was syphilis (301 cases were in male patients compared with 38 cases in female patients).

Prevalence by age groupOf the 6,707 cases of chlamydia notifi ed to the HPSC, the majority of these cases were amongst patients aged between 20 and 34. Some 742 cases were identifi ed in patients in the 15-19 age group, 517 cases were in adults aged 35-44, 133 cases were in people aged 45-54 and 42 cases were identifi ed in the 55-64 age group. Nine cases were identifi ed in patients aged over 65.

Again gonorrhoea cases were most predominant in the 20-34 age groups with 951 of the 1,336 cases notifi ed identifi ed in this category.

Herpes simplex (genital) cases were highest in the 25-34 age group (428 cases) with the fi gures levelling out with age increases (206 cases in 35-44 age group, 88 cases in the 45-54 age group, 28 cases in the 55-64 age group and 7 cases in the 65

and over age group).While 38 per cent of syphilis cases were in the 25-34-age

category, a signifi cant number of cases of this disease were in older patients, with 95 cases identifi ed amongst patients in the 35-44 age group, 43 in the 45-54 age group, 19 in the 55-64 age group and 6 cases in the 65 plus age group.

Awareness of STIsWhile the HPSC fi gures evidence the fact that the prevalence of many STIs is on the rise, a recent Irish study found that there was a lack of awareness amongst young people aged between 17-34 years of symptoms that are suggestive of STIs, and that there were signifi cant levels of high-risk behaviour amongst this group. There is possibly even less awareness however of the prevalence of STIs in older age groups, despite the fact that the incidence of sexually transmitted infections has increased dramatically in the 50 years and older age group in the past decade.

Role of the pharmacy teamThe pharmacy is often the fi rst port of call for patients who are concerned that they may have an STI and pharmacy teams can ensure that they are able to assist their patients by educating themselves about the symptoms and treatments of the diff erent STIs. Assistants and technicians can also counsel patients about how to accurately obtain samples for STI home-tests, which are available in many pharmacies whilst also advising them to abstain from sexual intercourse until they have established that they do or do not have an STI.

A recent irish study found that there was a lack of ‘‘ ’’



TOPIChOT

STIs: Symptoms and treatments

ChlamydiaChlamydia is the most commonly notifi ed STI in Ireland. Symptoms can include abnormal discharge or stinging or burning sensation when you pass urine. Additional symptoms in women can include bleeding between periods or heavy periods and pain or bleeding during or after sex. If left untreated, chlamydia can lead to pelvic infl ammatory disease and infertility. It is treated with antibiotics.

Genital herpesMost people who carry the Herpes Simplex Virus (HSV) will not show any symptoms, but during an outbreak may experience fl u-like symptoms or painful blisters or ulcers in the genital area. The virus will stay in a patients’ system, so they may have future outbreaks, but these are usually less severe.

Genital wartsThese are caused by the Human Papilloma Virus (HPV). Symptoms include painless growths or warts in the genital area. Treatments can include freezing the warts or creams depending on the location, volume and size of the warts.

GonorrhoeaGonorrhoea is a bacterial infection, which is treated with antibiotics. Some patients with gonorrhoea report symptoms such as discharge or itching, burning pain when urinating, soreness or redness of the throat, eye infections or ‘red eye’, pain or swelling of the testicles or stomach pains in women. However, many other patients do not show any symptoms of the infection at all. If left untreated, gonorrhoea can cause serious health problems including infertility.

SyphilisWhile syphilis is a very treatable condition if it diagnosed early, it does not always cause symptoms and so regular STI screening is the only way to tell if a person has the infection. There are three diff erent stages to the infection. During the fi rst stage, usually a few weeks after exposure, the patient may fi nd an ulcer in the genital, anal or mouth area. During the second stage, the patient will usually develop a red spotty rash, usually on the palms of the hands and soles of the feet and in the last stage, a person may experience loss of muscle coordination, paralysis, numbness, gradual blindness and dementia or even death.

TrichomonasSymptoms of Trichomonas can include abnormal discharge, burning or stinging sensation-passing urine, rash on the penis, vaginal discharge or an off ensive smell. If left untreated, it may cause problems in pregnancy such as premature labour. It is treated with antibiotics.

Pubic liceThese are tiny lice, which live in pubic hair and can cause itching. These are easily treated with lice lotions.

ScreeningPublic STI screening services are mainly based in hospitals and special community clinic settings around Ireland and are provided free of charge. For a full list of services see http://www.hse.ie/eng/services/list/5/Sexhealth/

Patients can also access screening services at some GPs and health centres for a fee. A number of home test kits for STIs are now also available.

Future sexual health of the nationFollowing a number of delays, the Government is due to publish a new National Sexual Health Strategy shortly.

This Strategy, they say will “acknowledge the importance of developing healthy attitudes to sexuality throughout childhood and adolescence and builds on that foundation for positive sexual health and wellbeing into adulthood and older age.”

The Strategy’s vision is “that everyone in Ireland experiences positive sexual health and wellbeing, and has access to high quality sexual health information, education and services across the life course.”

Patient resourcesThere are a number of excellent online resources, which you can recommend to patients, which provide a plethora of information on STIs, contraception and other sexual health related topics. These include:http://www.yoursexualhealth.iehttp://www.man2man.iehttp://www.thinkcontraception.iehttp://www.hse.ie/eng/services/list/5/sexhealth/

of the 6,707 cases of chlamydia notifi ed to the hPsC, the majority of these cases were amongst patients aged between 20 and 34.

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IntroductionThe carpal tunnel is a passageway that runs along the palm side of the hand consisting of a nerve known as the median nerve. This nerve is responsible for sensation and movement. When this nerve becomes pinched or trapped it causes a condition called carpal tunnel syndrome to occur.1 Carpal tunnel syndrome, also known as CTS, is an ailment that causes the patient to endure sensations of tingling, numbness and pain in the hand and wrist. It stems from a pinched nerve in the wrist. Mild carpal tunnel aff ects the hand or forearm and can even radiate up to the shoulder.2

SymptomsSymptoms of this condition include:• Numbness or pain in the hand, wrist or forearm causing the

suff erer to rouse during the night. Moving or shaking your hand and fi ngers may help to alleviate the pain.

• Pins and needles sensation very like your hand falling asleep. • Intermittent tingling accompanied by pain or numbness.• Pain or numbness that can worsen whilst using the hand or

wrist. Most likely felt when trying to grab something or bend the wrist.

• Sporadic pain in the forearm diverging from the wrist to the

elbow.• Stiff ness upon waking in the morning.

Moderate to severe CTS has been known to cause weakness in the strength of grip in the hand, fi ngers and wrist. Patients suff ering with CTS may fi nd it quite diffi cult to carry out simple hand actions such as brushing their hair or holding a utensil. They may occasionally drop items due to weakening of the grip or fi nd it impossible to open bottles or jars using the thumb due to thumb muscular atrophy (weaken of the thumb muscles). Loss of pincher grip is also noted.

Carpal tunnel arises in many parts of the hand that are supplied by the median nerve. This aff ects the thumb, index, middle and ring fi nger. The little fi nger is not supplied by the median nerve so is therefore not aff ected. It can happen in both hands but one hand is usually worse than the other. Symptoms generally exacerbate at night. 2

Risk factorsThere are a number of infl uencing factors that may increase the risk of contracting carpal tunnel syndrome.• Anatomical factors such as a dislocation, or fracture, of the

wrist can modify the space within the carpal tunnel, which in turn puts extra pressure on the nerve, which can lead to the

Carpal tunnel syndromeCarpal tunnel syndrome is an ailment that causes the patient to endure sensations of tingling, numbness and pain in the hand and wrist. Pharmacy technician, Amy Kealy discusses the condition

review

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PHARMAcY TecHnIcIAn

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

p h a r m a c y t e c h n i c i a n

development of CTS.• People with a shorter carpal tunnel are generally more likely to

suff er from the syndrome. Women are far more likely to suff er CTS as their carpal tunnel is shorter than men’s CT.

• Certain nerve damaging conditions like diabetes can cause CTS to occur.

• There are infl ammatory conditions such as rheumatoid arthritis that may also lead to carpal tunnel syndrome.

• Arthritis can damage tendons in the hand or wrist putting added pressure on the median nerve.

• Changes in the balance of body fl uids, such as fl uid retention during pregnancy or menopause can likewise add strain to the median nerve causing carpal tunnel syndrome.

• Medical conditions such as obesity, thyroid issues or kidney failure can all be precursors of carpal tunnel syndrome.

• There are also work-related contributing factors. Factors such as repetitive strain injury or the use of vibrating tools can almost defi nitely increase the chances of contracting CTS. 3

DiagnosisInitial diagnosis of CTS can be made by the General Practitioner following an examination of the hands and wrists for any signs of weakness. The GP will tap the patient’s wrist or ask them to hold it above their head for a minute in order to provoke pain or tingling.

The GP may send the patient on for further testing. A nerve conduction test can be implemented in order to measure how fast the nerves are receiving signals. Electrodes are placed on the hands and wrists and a small electrical current passed through to stimulate the nerves of the hands, wrists and elbows. This can highlight the amount of damage done to the nerves.

An electromyography can also be conducted to measure the amount of damage in the nerves. Needles are placed into the muscles to detect any electric activity given off by the muscle. This is done in order to examine how well the muscles react to nerve stimulation. 5

TreatmentPharmacologicalCTS can be either treated medically or surgically, depending on the severity. Treatment usually starts with NSAIDS. NSAIDS will help to bring down any infl ammation and are readily available over the counter. These may only relieve some of the symptoms short term and are not a cure. Corticosteroids are another class of drugs that are recommended for CTS. They can be administered orally or by injection into the wrist. They have been known to give swift relief, but are not a long term solution particularly in severe cases. The GP may prescribe something for nerve pain such as Neurontin or Lyrica, but there are side eff ects and these treatments will not suit all patients. Pyridoxine (vitamin B6) has been known to help with the symptoms of CTS, however how it works is still not known. It is an unlicensed medicine and will have to be prescribed by the doctor.6

Non-pharmacologicalThe other option available is surgery. This surgery is known as carpal tunnel decompression or carpal tunnel release. It may be performed as an open surgery or can also be conducted through keyhole surgery. It is usually undertaken as an out-patient surgery so an overnight stay is not needed. During keyhole surgery (also known as endoscopic surgery) two small incisions will be made in the hand or wrist. A small telescopic

Moderate to severe Cts has been known to cause weakness in the strength of grip in the hand, fi ngers and wrist.

’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘

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PHARMAcY TecHnIcIAn


device with a camera will be placed inside the carpal tunnel. The carpal ligament will then be cut allowing more room in the carpal tunnel and releasing the pressure on the nerve. During open surgery a larger incision will be made across the palm of the hand. The surgeon then cuts the carpal ligament to allow more room which in turn frees up the nerve. The ligament eventually fuses back after surgery allowing more room than ever before. Endoscopic surgery is less invasive and a far less painful route.7 Patients should be reminded to talk through their options fully with their surgeon. They should completely understand what happens during the operation and therefore be competent enough to make an informed decision. As with any operation there are numerous risks attached. It is of the upmost importance to remind the patient to keep the area dry and clean in order to prevent any infection. Dressings should be changed regularly. The patient may be allergic to some of the medications. There is a risk of bleeding. There is also a risk of further damage to the median nerve or any of the nerves that branches off from it. There may be weakness or numbness around the hand or wrist. There is a good possibility of scar tenderness. There is a rare chance of an injury occurring to another nerve or blood vessel. 8 It has been known to happen that even after having the surgery that the symptoms may return. All patients should be made fully aware of these complications before making a decision about their surgery.

Prevention of development of CTSA few recommended techniques that may assist in the prevention of CTS are:• relax your grip: most people use more force than necessary

whilst performing tasks such as using the cash register or computer. Hit the keys softly instead of pressing down. Use a pen with free fl owing ink and an oversized grip so you don’t have to press down on the pen so hard or grip it so tightly.

• Exercise your hands and wrists regularly by bending and fl exing your wrists. Switch between tasks to avoid doing the one movement over and over. If using vibrating tools taking regular breaks is of the upmost importance.

• Improve your posture to keep your shoulder and neck muscles from shortening and putting added strain on the wrists and hands.

• Keeping the hands warm will prevent them from stiff ening up and causing hand pain. These are all good pointers, which we should all try to incorporate in our daily jobs particularly whilst performing repetitive tasks such as blister packing.4

Role of the pharmacy teamIt is always useful to have a few counselling points at the back of your mind for your patients in order to assist them with managing their pain. Most people with CTS fi nd it hard to sleep at night with the pain so suggest the use of a wrist splint and keep some in stock. The use of a wrist support during the day could be equally benefi cial. Inform patients of the importance of resting and stretching the hand and fi ngers. If they work in an offi ce, or with machinery, adjusting the way they sit at the computer or machine and taking regular breaks may ease some of the symptoms. If certain activities aggravate the symptoms take a short break and begin again gradually keeping the wrist straight or slightly bent. Even icing the wrist a few times a day has been proven eff ective.9 You could even recommend they see a massage therapist. Just showing a little compassion can really help suff erers of this terrible condition. The feeling of someone fi nally understanding their pain can go a long way.

References1. Webmd 2015 (online) What is carpal tunnel syndrome,

www.webmd.com/pain-management/carpal-tunnel/ss/slideshow-carpal-overview

2. Webmd 2015 (online) Carpal tunnel syndrome – symptomshttp://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome-symptoms

3. Mayo clinic 2015 (online) carpal tunnel syndrome, risk factorshttp://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/risk-factors/con-20030332

4. Mayo clinic 2015 (online) carpal tunnel syndrome, preventionhttp://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/prevention/con-20030332

5. NHS 2014 (online) carpal tunnel syndrome – diagnosishttp://www.nhs.uk/Conditions/Carpal-tunnel-syndrome/Pages/Diagnosis.aspx

6. medicine.net 2014 (online) what is the treatment for carpal tunnel syndrome? Can carpal tunnel syndrome be prevented? http://www.medicinenet.com/carpal_tunnel_syndrome/page3.htm

7. Mayo clinic 2015 (online) carpal tunnel syndrome, treatment and drugshttp://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/treatment/con-20030332

8. Medline plus 2014 (online) carpal tunnel releasehttp://www.nlm.nih.gov/medlineplus/ency/article/002976.htm

9. Webmd 2015 (online) carpal tunnel syndrome – home treatmenthttp://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome-home-treatment

’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘‘Cts can be either

treated medically or surgically, depending on the severity. treatment usually starts with nSAIDS.



PRODUCTNEWS

Launch of ccRc-led multi-partner international projectAn EU-funded, multi-partner international project led by Dr Mark Tangney, Principal Investigator at the Cork Cancer research Centre (CCrC) and Dr Cormac Gahan, Alimentary Pharmabiotic Centre (APC), UCC, has been formally launched at Novartis Vaccines HQ in Siena Italy.

The four-year project is a collaboration between European universities and the pharmaceutical industry, and focuses on the development of new ways to visualise bacteria in the body.

The work will take place at the Cork Cancer research Centre; the Alimentary Pharmabiotic Centre at UCC; École Polytechnique Fédérale de Lausanne, Switzerland; and Novartis Vaccines, Siena, Italy by scientists from the fi elds of cancer research, immunology, microbiology, and chemistry.

The ‘Vaccines & Imaging Partnership’ (VIP) is an Industry-Academia Partnerships and Pathways (IAPP) project funded by the European Union under the FP7 Marie Curie Programme.

Bayer launches new campaign for BepanthenNew mums make two ‘SOS’ calls per day in the early months of motherhood.

That’s according to new research released today by Bepanthen nappy care ointment to coincide with the launch of their ‘First Moments’ campaign to celebrate the precious early days of motherhood.

The campaign encourages mums all over Ireland to share and celebrate their own fi rst moments and is being led by model mum, Pippa O’Connor who topped the poll as Ireland’s most admired new mum.

Speaking at the launch, Margaret Merrigan-Feenan, Clinical Midwife Manager and Parent Education teacher said, “Many babies will suff er from nappy rash at some stage due to their skin being in constant contact with urine and faecal matter. They are more susceptible if they were premature, during teething, after vaccinations, changing from breast to bottle feeding, starting on solids, while on antibiotics or drinking cow’s milk for the fi rst time. It is my experience and I fi rmly believe that prevention is better than cure. The aim of prevention is to reinforce and support the skin barrier and this starts with good skincare at nappy changing.

“If nappy rash occurs Bepanthen contains Provitamin B5 which gently aids the irritated skin to recover and the lanolin will protect it from wetness and friction while keeping it moisturised”.

Pictured at the launch of First Moments for Bepanthen are; Bepanthen Brand Manager, Marion Rogan; celebrity mum and model, Pippa O’Connor and Margaret Merrigan-Feenan, Clinical Midwife Manager and Parent education teacher.

Pictured at the launch of the an eU-funded multi-partner international project at the novartis Vaccines hQ in siena Italy are: Dr cormac Gahan, APc; Dr Giuliano Bensi, novartis Vaccines; Dr elena Dubikovskaya, ePFL and Dr Mark Tangney, cork cancer Research centre.

Discontinuation notice – Hexopal 500mg Tablets (inositol nicotinate)Clonmel Healthcare has advised it is no longer in a position to supply Hexopal (Inositol Nicotinate) to the Irish market. Current stocks are expected to run out August/ September 2015.

The company has apologised for the inconvenience and says the decision is beyond their control and due to the international decline in the use of inositol nicotinate resulting in the manufacture of the active ingredient not been viable.

The fi nal batch number is 025597 with an expiry date of end October 2018.

For further information contact Clonmel Healthcare on 05277777.


22

PRODUCTNEWS

ClonMedica take over distribution of Flexitol ClonMedica, the OTC division of Clonmel Healthcare, will now be selling and distributing the Flexitol OTC range of skincare products.

The Flexitol range includes:• Flexitol Heel Balm • Flexitol Heel Balm Platinum • Flexitol Lip Balm• Flexitol Hand Balm• Flexitol Moisturising Foot Cream• Flexitol Heel Magic• Flexitol Nail revitaliser Gel

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

Positive results for Zerochol Phytosterols in cholesterol managementThe University of Bratislava has presented the fi ndings of two Zerochol research studies at the 83rd EAS Congress (European Atherosclerosis Society) which took place in March 2015.

The research results indicate Zerochol is an eff ective treatment option in cholesterol reduction. Participants in the trial were encouraged by the results, with 83% participants satisfi ed with Zerochol, 98% showing no side eff ects and 79% participants requesting to stay on Zerochol after the 12 week period.

Results:study OneZerochol (one tablet, twice a day) was eff ective in Cholesterol Management for people who were not taking cholesterol lowering medication, or people who had stopped taking cholesterol lowering medications due to minor side eff ects. Taking 800mg phytosterols twice daily for 12 weeks resulted in:

– 12.80% reduction in Total Cholesterol– 17.37% reduction in LDL Cholesterol– 8% increase in HDL– 17.31% reduction in Triglycerides

study twoZerochol (one tablet, twice a day) proved eff ective in cholesterol management for people who were taking cholesterol lowering medication, but whom weren’t achieving the required results, or could not tolerate a higher dose. Taking 800mg phytosterols twice daily resulted in:

– 18.79% reduction in Total Cholesterol (99.99% reliability)

– 26.77% reduction in LDL Cholesterol (99.99% reliability)

There are no secondary side eff ects and has no known interaction with medications. Plant sterols do not interfere with cholesterol lowering medications and research shows that Zerochol can actually increase the eff ect of cholesterol lowering medication.

For more information, e-mail [email protected]

For Stockist information, contact Wholefoods Wholesale – 01-6262315 or

visit www.wholefoods.ie

requesting to stay on Zerochol after the 12 week period.

Zerochol (one tablet, twice a day) was eff ective in Cholesterol Management for people who were not taking cholesterol lowering medication, or people who had stopped taking cholesterol lowering medications due to minor side eff ects. Taking 800mg phytosterols twice daily for

– 12.80% reduction in Total Cholesterol– 17.37% reduction in LDL Cholesterol

– 17.31% reduction in Triglycerides

reliability) – 26.77% reduction in LDL Cholesterol (99.99% reliability)

There are no secondary side eff ects and has no known interaction with medications. Plant sterols do not interfere with cholesterol lowering medications and research shows that Zerochol can actually increase the eff ect of cholesterol lowering medication.

For more information, e-mail [email protected]@ppcgalway.ie

For Stockist information, contact Wholefoods Wholesale – 01-6262315 or

visit www.wholefoods.ie

FDA grants fast track designation of therapy for Fabry diseaseSANOFI and its subsidiary, Genzyne have announced that the US Food and Drug Administration has granted Fast Track designation for the development of GZ/SAr402671, a new investigational oral substrate reduction therapy for the treatment of Fabry disease.

FDA’s Fast Track Drug Development Program is designed to facili-tate frequent interactions with the FDA review team to expedite the clinical development and review of a New Drug Application (NDA) for medicines with the potential to treat serious or life-threatening conditions and address unmet medical needs for such diseases or conditions. It also provides the opportunity to submit sections of an

NDA on a rolling basis before a sponsor submits the complete appli-cation. Genzyme is currently enrolling patients in its Phase 2a trial of GZ/SAr402671, and plans to enroll nine treatment-naïve male adult patients with Fabry disease in this international, multicenter study.

Fabry disease is a rare lysosomal storage disorder that results in abnormal tissue deposits of a particular fatty substance (called glo-botriaosylceramide, also referred to as GL-3 or Gb3) throughout the body. GZ/SAr402671 is a glucosylceramide synthase inhibitor that blocks the formation of glucosylceramide (GL-1), a key intermediate in the synthesis of GL-3.

PRODUCTNEWS



Name:

Address:

Email:

Congratulations to the winner of the last Pharmacy Assistant and Technician Crossword: Mr Eoghan Guinan, 2 South Main Street, Bandon, Co Cork. Send your completed crossword with your name and address by 17 August 2015 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

AcRoSS

1 The breastbone of Munster (7)4 The I.C. for a moral code (5)7 This could be bloody pernicious (7)8 M.P. sum adds up to parotid gland problem (5)9 Notice verbose altercation (7)10 Discordant opuses for marriage partner (6)12 Sickness caused by a U.N. sea (6)15 Ken and lady cavorting in the nude! (7)17 Evade an American car! (5)19 Print a hub slip, perhaps (7)20 View is part of the act, in play! (5)21 John Steed, Purdy or Emma Peel (7)

Down

1 Assorted maps about the south leading to Cramp? (5)2 Mixed semen is ones downfall! (7)3 A dog went to mow one, in song (6)4 Peers using modified laser (5)5 The funny-bone? (7)6 Hole in smashed car causes acute infection of small

intestine (7)10 Sewing vocalists? (7)11 Teak roe hybrid produced from an acorn (3,4)13 Blue aid can be heard (7)14 It is short-sighted of one to have this condition! (6)16 Ball (5)18 Oddly, three was a number used by anaesthetists! (5)

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Solpadeine Soluble Tablets (P) contain Paracetamol, Codeine Phosphate Hemihydrate and Caffeine. For the treatment of acute moderate pain not relieved by other analgesics such as paracetamol or ibuprofen alone; for symptoms of headache, including migraine, toothache, backache, common cold, influenza, menstrual pain, muscoskeletal pain. Adults and children 12 years and over: 2 tablets in water three to four times in 24 hours as required; not more frequently than once every four hours. Maximum 8 tablets in 24 hours. Children under 12 years: Not recommended. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Avoid excessive caffeine intake. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Lactation, acute asthma, known hypersensitivity to ingredients, known CYP2D6 ultra-rapid metabolisers, patients under 18 years who undergo tonsillectomy or adenoidectomy for obstructive sleep apnoea syndrome, rare hereditary fructose intolerance. Precautions: Caution in renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy, hypertension, oedema. Interaction with coumarins (including warfarin), domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Side effects: anaphylaxis, bronchospasm, dependency or worsening of headache following prolonged use, dizziness, GI disturbances, hepatic dysfunction, thrombocytopenia. PA 1186/11/1. MAH: Chefaro Ireland Limited, 1st Floor, Block A, The Crescent Building, Northwood Business Park, Dublin 9. RRP (excl. VAT): 12s €4.99, 24s €7.99, 60s (GMS) €12.15. SPC: www.medicines.ie/medicine/6826/SPC/Solpadeine+Soluble+Tablets.

THAN PARACETAMOL ALO

NE

Always read the label. Can cause addiction. For three days use only. **IMS MAT Value Oct 2014 SOL/IRE/14-003

IRELAND’S N O 1 PHARMACY ONLY PAIN RELIEVER

**

issue 2 volume 8 • summer 2015 assistant pharmacy … · the irish pharmacy union (ipu), the...

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