td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9851 [post_author] => 235 [post_date] => 2020-04-01 14:02:53 [post_date_gmt] => 2020-04-01 04:02:53 [post_content] =>PSA is hosting a webinar on COVID-19: Your immunisation questions answered tonight (1 April, 7:30pm EST). PSA members can register here.With Australia’s Chief Medical Officer urging the community’s most vulnerable to remain in self-isolation, pharmacies are ramping up home delivery services to discourage people from venturing out during the COVID-19 pandemic. Australians aged over 70, those over 65 with pre-existing conditions and Indigenous people over 50 with pre-existing conditions should ‘stay at home and isolate for their own protection,’ Professor Brendan Murphy said at a press conference on Sunday. The Federal Government is encouraging this with its $25 million Home Medicines Scheme, which allows pharmacies to claim a $7.77 fee for each eligible medicines delivery made to a person’s home – up from the $5 service fee originally announced. While most pharmacies have delivery services in place, there is a possibility many may need to take on a more significant delivery model as the pandemic progresses.
Options for deliveryThere are a number of delivery models available, including in-house delivery by the pharmacy, using a postal service, and sending parcels in a taxi or Uber. Australia Post launched a new Pharmacy Home Delivery Service on Monday, which allows pharmacies to send medicines and other essential supplies under 500 grams through Australia Post’s Express Post network, and receive the cost back through the government rebate. This could be useful for covering long distances, for example in rural areas where it isn’t practical to deliver medicines by car. However, it appears pharmacies still need to provide the bags medicines are posted in, which is an additional cost. Delivering via the pharmacy can be quicker and helps maintain a connection with local patients, however it is not always possible for staff to leave the store. There is also the question of how to fund the service. Pharmacies may choose to implement a private fee or go through the government’s scheme, or simply offer it as a free service.
Existing examples[caption id="attachment_9859" align="alignright" width="333"] Terry and Janet Murphy have owned their pharmacy in Melbourne for about 30 years[/caption] Pharmacies are also employing family members and out-of-work friends as couriers. This includes Janet Murphy MPS, who, along with her husband Terry, has owned Amcal Pharmacy Rowville in Melbourne’s southeast for about 30 years. The pair has employed one of their daughters, who recently lost her teaching job, to home deliver medicines to a growing number of patients. She also trained as a paramedic and has helped out in the pharmacy for years. ‘We are in a very fortunate situation as we’ve been here for so long, so there’s a lot of trust and a lot of people already know our daughter,’ Ms Murphy told Australian Pharmacist. ‘We used to use either our intern or shop assistants to do deliveries, but we can’t keep up now.’ With three nursing homes nearby, the pharmacy needs to make at least 20 deliveries a day. Delivery is free, and the personalised service has attracted customers through word of mouth. ‘Every day we have another big basket of scripts coming onto our file,’ Ms Murphy said. ‘It’s good for business but we also feel like we’re offering a good service. We’re telling people to please stay at home, don’t come out – we’ll come to you.’ As a large pharmacy in a shopping centre, she said the business was in a strong position to deal with the changing nature of the COVID-19 pandemic. ‘We’re having to think on our feet and adapt all the time,’ Ms Murphy said. ‘We’re very lucky: we have a great tech who looks after our stock levels, a dedicated driver, a bookkeeper – I don’t know how someone in a smaller business could juggle all the changes and demands.’ But the virtual lockdown isn’t affecting all pharmacies in the same way. In the Western Australian town of Collie, population 8,000, things have been relatively normal, says Peter Carr MPS. [caption id="attachment_9860" align="alignright" width="251"] Peter Carr MPS is yet to see a big impact from COVID-19[/caption] Mr Carr, who owns one of the two pharmacies in the town, said he hadn’t been under too much pressure yet. ‘We’ve seen about a 10% increase in the number of customers,’ he said. ‘We still have our normal deliveries [but] we’ve only had about a dozen requests to deliver to isolated people and older patients.’ Mr Carr said he expects this to increase as more people remain at home, and said he has a few plans in place. ‘If we have a downturn in trade [with fewer people coming into the store] I’ll use existing staff for deliveries to keep them employed doing something practical and useful,’ he said. ‘Meanwhile, the town shire has got a series of police-cleared volunteers who will be available to do deliveries to elderly and isolated people for pharmacies and for other businesses as needed. ‘We want to make use of anybody looking for work and to help if we can, so that’s probably where we’ll go first before a commercial service.’ For more information on medicines home delivery, visit NSW Health. For PSA’s latest information, updates and advice on the novel coronavirus outbreak, click here. [post_title] => COVID-19 medicines home delivery services [post_excerpt] => With stricter social distancing measures in place and more Australians, particularly the elderly, choosing to remain at home due to COVID-19, many community pharmacies have had increased demand for home delivery. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => covid-19-medicines-home-delivery-services [to_ping] => [pinged] => https://www.australianpharmacist.com.au/how-the-covid-19-home-medicines-service-works/ [post_modified] => 2020-04-01 19:08:58 [post_modified_gmt] => 2020-04-01 09:08:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9851 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => COVID-19 medicines home delivery services [title] => COVID-19 medicines home delivery services [href] => https://www.australianpharmacist.com.au/covid-19-medicines-home-delivery-services/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9852 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9845 [post_author] => 1425 [post_date] => 2020-04-01 13:55:39 [post_date_gmt] => 2020-04-01 03:55:39 [post_content] =>PSA is hosting a webinar on COVID-19: Your immunisation questions answered tonight (1 April, 7:30pm EST). PSA members can register here.As confirmed cases of COVID-19 in Australia tick over 4,700, many pharmacists face long working hours and the rising challenge of unacceptable customer behaviour. Pharmacists have reported acts of violence and abuse towards them were already increasing before the bushfires, floods and spread of the novel coronavirus – and Victorian statistics back them up. While the rate of pharmacy armed robberies and burglaries in the state has decreased by about 70% since 2011, Victoria Police say there has been a 116% increase in assaults and a 200% increase in reports of threatening behaviour by customers. This year, abuse from customers has become more commonplace, said Pharmacists’ Support Service (PSS) Executive Officer Kay Dunkley MPS. In the past month alone in Victoria, she said there were at least three incidents of pharmacy violence. ‘One customer became angry and punched the young female pharmacist in the face after he was told he could only purchase one box of tissues,’ Ms Dunkley said. ‘The punch caused extensive bruising and on medical advice she subsequently had to have a CT scan to exclude a fracture.’ In another incident, a man who was refused three Ventolin repeats at once threw a large pump pack of sunscreen at a pharmacist, who managed to duck and avoid it. There were many accounts of abuse by customers who objected to being refused a sale or told products were unavailable, Ms Dunkley said. ‘The more typical scenarios involve customers becoming aggressive and shouting at pharmacy staff.'
Seek supportIn such a stressful time, it's important pharmacists seek support. This could include talking to a colleague, using your Employee Assistance Program or contacting Lifeline or PSS. Pharmacists can also apply to PSS for one of 20 grants of $500 each, which are designed to support the mental health of pharmacists and pharmacy staff who have been impacted by bushfires and are now feeling the impacts of COVID19. The funding can be used to assist with:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9838 [post_author] => 235 [post_date] => 2020-04-01 13:40:58 [post_date_gmt] => 2020-04-01 03:40:58 [post_content] =>PSA is hosting a webinar on COVID-19: Your immunisation questions answered tonight (1 April, 7:30pm EST). PSA members can register here.Emergency measures to allow continued access to essential medicines through the Pharmaceutical Benefits Scheme (PBS) – put in place during the bushfire season and due to expire yesterday – have been extended to at least 30 June this year. The extension, announced by Federal Health Minister Greg Hunt yesterday, was made to help manage demand on the health system as the COVID-19 outbreak continues, and to ensure Australians can access medicines they need. Under strict conditions, pharmacists can give patients up to 1 month’s supply of their usual medicine without a script, at the usual PBS price.
|COVID-19 key points this week
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9813 [post_author] => 235 [post_date] => 2020-03-25 15:13:24 [post_date_gmt] => 2020-03-25 05:13:24 [post_content] =>PSA is hosting a live webinar on COVID-19: Your questions answered tonight (25 March, 7:30pm EST). PSA members can register here.Elective surgeries will be cancelled, Australians are banned from travelling overseas and more non-essential businesses will close their doors as cases of COVID-19 in Australia surge past 2,000. And for the next 6 months, consumers in New South Wales (NSW) can receive a maximum PBS quantity of medicine or pack size under an extension to the special authority for emergency supply of medicines without a prescription. In a move welcomed by PSA, which extends the emergency supply provisions that were put in place during the bushfire crisis only months ago, pharmacists can supply the medicines if satisfied there is immediate need. The medicine must have been previously prescribed and be for the continuation of current essential treatment when obtaining a prescription is impractical, PSA NSW President Professor Peter Carroll announced in a press release this afternoon. ‘We are hearing from patients that their GPs are overwhelmed and [it] can be difficult to get an appointment. This flexible approach to health care will ensure pharmacists can continue to support the community during the COVID-19 pandemic,’ he said.
|COVID-19 key points this week|
COVID-19: Latest advice for pharmacists For PSA’s latest information, updates and advice related to the novel coronavirus outbreak, visit: www.psa.org.au/coronavirus[post_title] => COVID-19: Medicine supply changes and increased social distancing [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => covid-19-medicine-supply-changes-increased-social-distancing [to_ping] => [pinged] => [post_modified] => 2020-03-25 16:49:46 [post_modified_gmt] => 2020-03-25 06:49:46 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9813 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => COVID-19: Medicine supply changes and increased social distancing [title] => COVID-19: Medicine supply changes and increased social distancing [href] => https://www.australianpharmacist.com.au/covid-19-medicine-supply-changes-increased-social-distancing/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9814 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9796 [post_author] => 235 [post_date] => 2020-03-25 14:16:21 [post_date_gmt] => 2020-03-25 04:16:21 [post_content] =>PSA is hosting a live webinar on COVID-19: Your questions answered tonight (25 March, 7:30pm EST). PSA members can register here.As businesses including pubs, gyms and beauty salons close tonight to promote social distancing, community pharmacies remain open as one of the most essential services. Pharmacist Matthew Soliman MPS works across four pharmacies in South Australia. He said the biggest problem he faces at the moment is ‘the unknown’. Despite Australians being urged not to stockpile to ensure equitable access to medicines, Mr Soliman said customers were still attempting to purchase more than they need. ‘People are confused; they don’t know if they’re going to end up in quarantine,’ he said. [caption id="attachment_9801" align="alignright" width="275"] Matthew Soliman MPS[/caption] ‘I think that’s a big part of the stocking up mentality – people don’t know whether to panic … We can give people an idea of what to expect using other countries as a model, but the truth is – we don’t know.’ There are now restrictions in place that require pharmacists to limit the dispensing of certain prescriptions to 1 month's supply. Pharmacists are also strongly encouraged to limit the dispensing and sale of all other medicines to 1 month’s supply or one unit. Pharmacists are also now required to place paracetamol paediatric formulations behind the counter and to follow new procedures for dispensing salbutamol, including labelling the product and recording the supply. New South Wales-based pharmacist Kelly Lim MPS said these recent initiatives are positive steps to address the hoarding she has seen. ‘A lot of people are starting to panic-buy their medicines; they’re not buying based on need but just in case,’ she said. ‘We’re getting a lot more requests for Ventolin, cold and flu medicine and paracetamol – we’re getting calls all day long asking if we have any.’ Ms Lim said it was important to explain to customers why the restrictions are necessary. ‘Some of our elderly customers are a bit worried that they might not be able to leave their homes for various reasons, and I know some pharmacists have been getting abused by customers who haven’t been able to get more repeats,’ she said. [caption id="attachment_9807" align="alignleft" width="277"] Kelly Lim MPS[/caption] ‘I try and explain the reasons behind it and I have printed out some information to give them. I also tell customers that I can remind them when their scripts are due. This way, we’re not giving them an early supply but we’re making it easier for them.’ PSA has created a poster explaining the changes that pharmacists can print out here. Along with asthma medicines and paracetamol, Mr Soliman said hand sanitiser was the most-requested item at the pharmacies he works in. However, with out-of-stocks across the country, he said customers had been compounding their own formulas, often with problematic results. ‘I’ve had to talk a few people out of it,’ Mr Soliman said. ‘They come into the pharmacy so confident and happy that they’ve come up with a formula and I need to tell them it can have bad outcomes.’ Mr Soliman pointed to a man who had been using a combination of aloe vera gel and lighter fluid as an at-home hand sanitiser. ‘He kept putting more and more on and then lit a cigarette – he set his hand on fire,’ Mr Soliman said. ‘That’s a more extreme case, but you do need to tell people to be careful.’
Taking precautionsBoth Mr Soliman and Ms Lim said their pharmacies had been introducing measures to help protect pharmacists and their customers from the spread of COVID-19. ‘We have hand sanitiser on the counter, which we encourage every customer to use,’ Mr Soliman said. ‘We also wipe down benches after every customer and have put signs up outside asking people not to enter the pharmacy if they have symptoms or are meant to be self-isolating.’ Ms Lim said she was considering putting safety tape 1.5 metres from the counter so people know where to stand. Other pharmacists have reported:
Coronavirus (COVID-19) information for pharmacists For PSA’s latest information, updates and advice on the novel coronavirus outbreak, click here.[post_title] => Community pharmacists and COVID-19 [post_excerpt] => As businesses including pubs, gyms and beauty salons close tonight to promote social distancing, community pharmacies remain open as one of the most essential services. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => community-pharmacists-covid-19 [to_ping] => [pinged] => [post_modified] => 2020-03-25 17:00:48 [post_modified_gmt] => 2020-03-25 07:00:48 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9796 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Community pharmacists and COVID-19 [title] => Community pharmacists and COVID-19 [href] => https://www.australianpharmacist.com.au/community-pharmacists-covid-19/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9810 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9791 [post_author] => 23 [post_date] => 2020-03-25 14:52:36 [post_date_gmt] => 2020-03-25 04:52:36 [post_content] => Despite anecdotal reports in the media and the World Health Organization’s (WHO) previous position on the issue, there is currently no peer-reviewed, published scientific evidence to support a direct link between use of the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen and more severe infection with COVID-19.1,2 WHO initially recommended people with COVID-19 avoid taking ibuprofen for symptomatic relief; however, it retracted that advice days later on its official Twitter account.2 As of 18 March, WHO is not aware of any clinical or population-based data on this topic. It is currently consulting with doctors treating patients with COVID-19, and is not aware of any negative effects beyond the usual known adverse effects that limit its use in certain populations.2 In a statement, the TGA said it will continue to monitor the issue.
Where did the issue surrounding ibuprofen and COVID-19 originate?On 14 March, French Health Minister Olivier Véran advised that anti-inflammatory drugs could aggravate symptoms during the infection. This was partly based on anecdotal reports from a doctor who reported worsening symptoms in four patients with COVID-19 after taking ibuprofen. The minister recommended paracetamol for symptoms rather than anti-inflammatory drugs.3 This concurred with previous advice from the French National Agency for the Safety of Medicines and Health Products not to treat fever or infections with ibuprofen.3 Some United Kingdom experts have endorsed this stance, stating that prolonged illness or complications of respiratory infections, including cardiovascular complications, are more common when NSAIDs are used. A virologist suggested that ibuprofen’s anti-inflammatory properties could ‘dampen down’ the immune system, therefore slowing the recovery process.3 Adverse effects with NSAIDs are well known in certain patient groups (e.g. impaired renal function, heart failure). Conjecture on their effects in COVID-19 infection is not yet supported by strong evidence.1,2 Experts are displaying caution, however. A British epidemiologist said, ‘more research is needed into the effects of specific NSAIDs among people with different underlying health conditions. In the meantime, for treating symptoms such as fever and sore throat, it seems sensible to stick to paracetamol as first choice’.3 A recent study in The Lancet hypothesised that human pathogenic coronaviruses bind to their target cells through angiotensin-converting enzyme-2 receptors, which are boosted by anti-inflammatory drugs such as ibuprofen. That is, ibuprofen could facilitate and worsen COVID-19 infections. This remains a hypothesis. WHO spokesman Christian Lindmeier said the United Nation’s health agency experts were looking into this to give further guidance. The complex role that the immune system might play in COVID-19 is underscored by reports that Roche has secured approval from the US Food and Drug Authority (FDA) to begin a Phase 3 clinical trial to test the effectiveness of the anti-inflammation drug Actemra (tocilizumab) to treat patients developing severe complications from COVID-19.4
What does this mean in the Australian context?Evan Ackerman, immediate past Chair of the Royal Australian College of General Practitioners (RACGP) Expert Committee – Quality Care, and author and advisor on RACGP resources, does not believe patients need to cease long-term ibuprofen use, and strongly encourages them to continue taking their medicine. He contends that evidence linking worsening symptoms in respiratory illnesses and sepsis is very low-level.5 At this stage, however, Dr Ackerman advises patients with COVID-19 to use paracetamol as first-line instead of ibuprofen for symptomatic relief. Associate Professor Louis Irving, Director of Respiratory and Sleep Medicine at the Royal Melbourne Hospital, also advocates for a more cautious use of NSAIDs for symptomatic relief of COVID-19.5 Both experts believe more research is needed.5
Information for pharmacistsPharmacists should refer to relevant Australian clinical guidelines when advising on treatment for pain or fever, and consider the risks and benefits to the individual on a case-by-case basis.1 Advise patients taking ibuprofen or another NSAID for a chronic health problem, not to stop taking it without discussing the issue with their doctor.1 If pharmacists observe any adverse events suggesting a potential link between the use of ibuprofen, or any other medicine, and worse clinical outcomes in COVID-19 patients, they should report it to the TGA.1 Refer to PSA’s dedicated site on current coronavirus information for pharmacists.6 References
[post_title] => Should ibuprofen be used for COVID-19 symptoms? [post_excerpt] => There is currently no peer-reviewed, published scientific evidence to support a direct link between use of ibuprofen and more severe infection with COVID-19. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => should-ibuprofen-used-covid-19-symptoms [to_ping] => [pinged] => [post_modified] => 2020-03-25 17:00:33 [post_modified_gmt] => 2020-03-25 07:00:33 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9791 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Should ibuprofen be used for COVID-19 symptoms? [title] => Should ibuprofen be used for COVID-19 symptoms? [href] => https://www.australianpharmacist.com.au/should-ibuprofen-used-covid-19-symptoms/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9794 )
- Australian Government Department of Health. Therapeutic Goods Administration. No evidence to support claims ibuprofen worsens COVID-19 symptoms. 2020. At: www.tga.gov.au/alert/no-evidence-support-claims-ibuprofen-worsens-covid-19-symptoms
- World Health Organization. At: twitter.com/WHO/status/1240409217997189128
- Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ. 2020;368:m1086.
- Roche. Roche initiates Phase III clinical trial of Actemra/RoActemra in hospitalised patients with severe COVID-19 pneumonia. 2020. At: www.roche.com/media/releases/med-cor-2020-03-19.htm
- Lewin E. Ibuprofen and COVID-19: What GPs need to know. RACGP: newsGP. At: www1.racgp.org.au/newsgp/clinical/ibuprofen-and-covid-19-what-gps-need-to-know
- Coronavirus disease (COVID-19) information for pharmacists. PSA. At: my.psa.org.au/s/article/Coronavirus-COVID-19
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9779 [post_author] => 100 [post_date] => 2020-03-19 13:01:45 [post_date_gmt] => 2020-03-19 03:01:45 [post_content] => What infection control measures should pharmacists take to protect themselves, patients and staff against infectious diseases, such as COVID-19? Pharmacists are regularly at risk of exposure to infections, from the common cold to influenza to new and emerging infectious diseases such as the recent novel coronavirus. We are often the first port of call for patients seeking advice, symptom relief and reassurance. This is a privilege. However, it is also important that pharmacists help limit the spread of infection and protect themselves, other staff members and the Australian community.
Standard infection control precautionsStandard infection control procedures and precautions should be practiced at all times. The 5 moments for hand hygiene aims to minimise infection transmission between a healthcare professional, patient, and their surroundings. Healthcare professionals should clean their hands in the following situations4:
Performing hand hygiene correctly (through using an alcohol-based handrub containing 60–80% v/v ethanol or equivalent5 and washing hands with soap and water) is important to minimise the spread of infection. Hand Hygiene Australia has several useful resources (www.hha.org.au/), including posters. Pharmacists and their staff can also improve infection prevention and control practices by6:
- Before touching a patient (e.g. shaking hands).
- Before a procedure (e.g. immunisation, wound dressings).
- After a procedure or a risk of being exposed to bodily fluids.
- After touching a patient.
- After touching a patient’s surroundings (e.g. personal belongings, the dispensary counter).
HELP US HELP YOUProfessionals learn and develop from the experience of their peers. AP welcomes member contributions of practice advice as well as questions to be answered in this column. Advice contributions may be about ethical dilemmas, pearls of wisdom or integrating new roles or technology into practice. Responses should be between 250–500 words, and may be edited for space, legal, accuracy or privacy purposes. Lodge your questions or advice at firstname.lastname@example.org
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9347 [post_author] => 23 [post_date] => 2020-02-12 13:20:33 [post_date_gmt] => 2020-02-12 03:20:33 [post_content] => Air pollution is making us sick according to local and global research, including a study linking exposure to air pollution with subsequent acute cardiac events. The health impacts of bushfire smoke are mainly mediated by fine particulate matter, which affects our respiratory, cardiovascular and immune systems when inhaled. Vulnerable people with existing medical conditions such as asthma, diabetes and cardiovascular disease, as well as older people, pregnant women and children are most affected, according to the Centre for Air pollution energy and health Research (CAR).1 And bushfire smoke worsens asthma symptoms to a greater extent than vehicle emissions.1 CAR says weather conditions caused by climate change will likely increase the frequency of extreme bushfires around the world. It advocates that a global approach to tackling climate change is crucial to minimise the health effects of air pollution, including that caused by bushfires.1 Following bushfires in five states, a nationally representative population survey commissioned by the Australia Institute last month found 57% of respondents nationwide were directly affected by bushfires or smoke over the previous three months. Effects included a change in usual routine (e.g. avoiding outside activity including jogging), illness due to smoke haze or an uninhabitable home.2 When the institute combined survey data with Australian Bureau of Statistics (ABS) data, an estimated 5.1 million adult Australians self-assessed health impacts from bushfire smoke. Residents within the five largest Australian capital cities experienced some impact, while those outside cities reported multiple impacts. Common themes resulting from the impact of bushfire smoke were missed work, changed travel plans and closure of a place of business or leisure.2 New South Wales (NSW) residents were impacted most (74%), followed by Victorians (61%). Thirty percent of Western Australian respondents reported impact by fires and smoke. The survey also gauged respondents’ attitudes and concerns about climate change. Those directly impacted by bushfires were much more likely to agree with statements expressing concern about impacts or the need for climate change leadership.2 The Federal Government has announced $5 million in funding for bushfire-related health research. Professor Guy Marks, a respiratory physician and epidemiologist at the University of NSW and a chief investigator with CAR, has gathered experts to take part in world-leading research into the effects of smoke pollution, including the effectiveness of masks.3
PollutantsSuspended fine particulate matter (PM2.5*) in bushfire smoke is the most significant component affecting health. When inhaled, it enters the lungs and bloodstream, affecting respiratory, cardiovascular and immune systems.1 Face masks are useful in limited circumstances, but need to fit correctly to work well.1 Pharmacists can access the CAR bushfire smoke fact sheet which has more information on health impacts and strategies to minimise risk.1 In Australia, air quality is monitored by state-based agencies and reported as an air quality index (AQI). The index is based on a pollutant’s environmental standard and can be compared with other pollutants and regions. As the AQI rises, air quality worsens with noticeable health effects at an AQI ≥150, where air quality is categorised as ‘very poor’.4
Air pollution and cardiac eventsGrowing evidence supports concern about an association between air pollution and cardiovascular disease. A nationwide case-crossover study in Japan published in The Lancet Planetary Health journal last month demonstrated an independent association between ambient air pollution and the risk of cardiac arrest outside hospital – a major medical emergency and public health problem as global survival rates are under 10%.5 The study found an increase in daily exposure to fine particulate matter (PM2.5*) was associated with the risk of out-of-hospital cardiac arrests (OHCA), even at PM2.5 levels lower than existing air quality standards. In the largest study of its kind to date, the data on OHCAs was collected over 2 years in 2014–15. Air quality measurements on the day of an individual’s arrest, or up to 3 days before, were recorded for a possible link. More than 90% of OHCAs occurred at PM2.5 levels lower than the World Health Organization (and Australian) daily standard level of 25 microgram per cubic metre (microgram/ m3), the study showed. Also, 99% of OHCAs occurred at levels lower than the Japanese or American daily standard level of 35 microgram/ m3. Older people were found to be more susceptible. An association between short-term exposure to carbon monoxide, photochemical oxidants, and sulphur dioxide (emissions from coal burning/mining, bushfires and motor vehicles) and increased risk of all-cause OHCAs was also shown. No association was found with nitrogen dioxide. The authors recommended that world leaders, governments and policy makers reassess current air quality standards and improve air quality further by turning to cleaner energy sources.5 References
* Fine particulate matter with a diameter less than 2.5 micrometres [post_title] => The impact of air pollution [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-impact-of-air-pollution [to_ping] => [pinged] => [post_modified] => 2020-02-13 09:44:04 [post_modified_gmt] => 2020-02-12 23:44:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9347 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => The impact of air pollution [title] => The impact of air pollution [href] => https://www.australianpharmacist.com.au/the-impact-of-air-pollution/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9387 )
- Centre for Air pollution energy and health Research. Bushfire smoke: what are the health impacts and what can we do to minimise exposure? 2019. At: www.car-cre.org.au/factsheets
- The Australia Institute. Polling – Bushfire crisis and concern about climate change. January 2020. At: www.tai.org.au/sites/default/files/Polling%20-%20January%202020%20-%20bushfire%20impacts%20and%20climate%20concern%20%5Bweb%5D.pdf
- Greenbank A. Pollution experts team up to propose major new study into health impacts of bushfire smoke. ABC 2020. At: www.abc.net.au/news/2020-01-14/pollution-experts-propose-study-into-fire-smoke-health-impacts/11866756
- Australia State of the Environment: Air Quality Index. 2016. At: soe.environment.gov.au/theme/ambient-air-quality/topic/2016/air-quality-index#ambient-air-quality-box-10
- Zhao B, Johnston F, Salimi F, et al. Short-term exposure to ambient fine particulate matter and out-of-hospital cardiac arrest: a nationwide case-crossover study in Japan. Lancet Planet Health 2020;4:e15–23.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9236 [post_author] => 235 [post_date] => 2020-01-29 13:25:38 [post_date_gmt] => 2020-01-29 03:25:38 [post_content] => Pharmacists are encouraged to get a travel history for patients presenting with flu-like symptoms, with five cases so far in Australia1 of the novel coronavirus (2019-nCoV) first identified in China last month. In a letter to the PSA on Monday, Australia’s Chief Medical Officer Professor Brendan Murphy asked pharmacists to ‘identify additional cases that may be in Australia or come to Australia in coming weeks’.2 He urged pharmacists to ask patients with flu-like symptoms whether they had been in the Hubei province of China – including the city of Wuhan where the virus may have originated – or had been in contact with people with the coronavirus infection. ‘If the answer is yes, please ask your patient to put on a surgical mask and present to their GP or emergency department (after first phoning ahead to warm them that they are coming),’ Professor Murphy wrote.2 There have been 106 confirmed deaths from the virus in China, with more than 4500 confirmed cases. The majority of cases are in Hubei, with small numbers reported in other Chinese provinces. Cases have also been reported in Hong Kong, Macau and Taiwan.2 Around the world, there have been 56 confirmed cases across 14 countries: Australia, Japan, South Korea, Vietnam, Singapore, Malaysia, Cambodia, Thailand, Nepal, Sri Lanka, the USA, Canada, France and Germany.3 ‘Nearly all of these cases have reported travel to Hubei Province,’ Professor Murphy wrote.2 However, Japan has now reported its first case of human-to-human transmission, with a 60-year-old man who did not travel to Wuhan but drove buses full of tour groups from the city diagnosed with the virus. Speaking to ABC Radio this morning, Professor Murphy said reports of human-to-human transmission outside of China was ‘a concern’.4 ‘The thing that we are determined to avoid internationally and nationally is what we call sustained human-to-human transmission, where you go from one person to another,’ he said.4 ‘These are isolated cases in Japan and Germany, but they are obviously of some concern and we are having that reviewed today by our peak communicable diseases advice panel, to have a look at those cases.’ He said the ‘major goal’ in Australia is to detect early cases in order to isolate them and ensure there is no sustained human-to-human transmission.4 Speaking to the media this afternoon, Professor Murphy confirmed experts believe the virus is contagious before people show symptoms. The update came after a meeting of the Australian Health Protection Principal committee (AHPPC). 'The committee is aware of very recent cases of coronavirus who are at the time of diagnosis asymptomatic or minimally symptomatic,' Professor Murphy said. 'We're also aware of one fairly convincing case of probable transmission from a pre-symptomatic case to other people two days prior to the onset of symptoms.' In a statement,5 the AHPPC said it still believes 'most infections are transmitted by people with symptomatic disease'. However, it said it was important to take a 'highly precautionary approach' and made two recommendations:
'AHPPC recognises that the evidence for pre-symptomatic transmission is currently limited, and this policy is highly precautionary,' the statement said.5 'At this time, the aim of this policy is containment of novel coronavirus and the prevention of person to person transmission within Australia.' Prime Minister Scott Morrison has also announced the Federal Government would try to evacuate about 600 isolated and vulnerable Australians registered as being in Hubei province in China for quarantine on Christmas Island.
- People who have been in contact with any confirmed novel coronavirus cases must be isolated in their home for 14 days following exposure;
- Returned travellers who have been in Hubei Province of China must be isolated in their home for 14 days after leaving Hubei Province, other than for seeking individual medical care.
What are the symptoms of a coronavirus infection?The most common symptom is a fever.2,6 Other symptoms include a cough, sore throat and shortness of breath. In more severe cases, infection can cause pneumonia with severe acute respiratory distress.2,6,7
Tips for preventionWhile confusion remains about transmission, other human coronavirus strains are spread from person to person through contaminated droplets from a person who is sick with the illness (through coughing or sneezing) or contaminated hands. It is likely this novel coronavirus spreads the same way.8 To minimise the risk of infection, NSW Health advises people8:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9171 [post_author] => 23 [post_date] => 2020-01-14 15:49:56 [post_date_gmt] => 2020-01-14 05:49:56 [post_content] => Guidelines for stroke management have been updated. The time window for thrombolysis has been extended to 9 hours if brain imaging shows it will be of benefit, according to updates to the Stroke Foundation’s Clinical Guidelines for Stroke Management.1 And, in a strong recommendation approved by the National Health and Medical Research Council (NHMRC), aspirin and clopidogrel should be prescribed together for the first 3 weeks after a minor stroke or transient ischaemic attack (TIA). The Clinical Guidelines for Stroke Management are living guidelines, updated as new evidence emerges in accordance with the 2011 NHMRC Standard for clinical practice guidelines. The updated 2019 version — approved in November by the NHMRC — supersedes the Clinical Guidelines for Stroke Management 2017. Updates to thrombolysis recommendations include an extension of the time window to 9 hours with alteplase (including 9 hours from the mid-point of sleep for patients who wake with stroke symptoms). In a new weak recommendation, tenecteplase may be used as an alternative to alteplase for patients meeting specific eligibility criteria, in a time window of 4.5 hours.1 As the new generation thrombolytic tenecteplase is faster-acting than alteplase, the Director of Neurology at the Royal Melbourne Hospital (RMH), Professor Mark Parsons, told media outlets that, with the use of tenecteplase in an extended window, many patients could avoid the need for surgery.2 An RMH trial will test whether the time window for tenecteplase thrombolysis can be abandoned, and brain imaging (to check for salvageable healthy brain tissue) used to better predict who can still benefit from thrombolysis up to 24 hours after having a stroke.2 With one in five patients currently undergoing clot retrieval surgery, Prof Parsons said he hoped the RMH trial could increase treatment access so more patients achieved positive outcomes following a stroke.2 The recommendation for dual antiplatelet therapy with aspirin and clopidogrel for the first 3 weeks after a minor stroke or high-risk TIA is consistent with research reported in Australian Pharmacist.3 For patients without atrial fibrillation, dual antiplatelet therapy offers a small incremental benefit over monotherapy with aspirin with respect to stroke recurrence.3 Trials of antiplatelet therapy in secondary prevention of stroke have shown the use of monotherapy with aspirin (as soon as imaging has excluded intracerebral haemorrhage) significantly reduces the rate and severity of early recurrent stroke compared to placebo.3 Dual aspirin and clopidogrel therapy was found to reduce subsequent strokes by about 20 per 1,000 population, with an increase in bleeding of 2 per 1,000 population compared to aspirin monotherapy. The authors concluded that discontinuation of therapy within 21 days is likely to maximise benefit and minimise harm.3 However, the combination should not be used in severe stroke where haemorrhagic transformation can occur, and should not be used long-term unless patients have other indications.3 The expert working groups for the clinical guidelines concluded that other recommendations are up-to-date in the Clinical Guidelines for Stroke Management 2017. Recommendations remain unchanged for topics including acute blood pressure-lowering therapy, intracerebral haemorrhage management, anticoagulant therapy and pre-hospital care. A full list of new and updated recommendations, and unchanged recommendations, is available here.4 Pharmacists are integral to drug selection, dose adjustment and monitoring of drug therapy. Their role in secondary stroke prevention includes ensuring medication adherence, optimising blood pressure management, recommending step-down of dual antiplatelet therapy where appropriate, and consideration of gastroprotection in high-risk patients.3 References
[post_title] => Stroke management in 2020 [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => stroke-management-in-2020 [to_ping] => [pinged] => [post_modified] => 2020-01-14 15:49:56 [post_modified_gmt] => 2020-01-14 05:49:56 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9171 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Stroke management in 2020 [title] => Stroke management in 2020 [href] => https://www.australianpharmacist.com.au/stroke-management-in-2020/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 8937 )
- Clinical guidelines for stroke management. Stroke Foundation. At: https://informme.org.au/Guidelines/Clinical-Guidelines-for-Stroke-Management
- O’Connell B. Doctors test clot treatment’s extended window. Courier Mail 2019 December 14.
- Barras M and Winckel K. Primary and secondary prevention of stroke. Australian Pharmacist. 2019;12:42–51.
- Living guidelines updates. Stroke Foundation.
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IntroductionMultiple sclerosis (MS) is a chronic immune-mediated neurodegenerative disease of the central nervous system. It causes inflammation, demyelination and plaque formation in the brain and spinal cord, leading to an array of neurological deficits.1–3 MS is defined by4:
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|MEDICINE AND ROUTE||VARIOUS ADVERSE REACTIONS|
|Cladribine (Mavenclad) - oral||Lymphopenia, herpes zoster, headache|
|Dimethyl fumerate (Tecfidera) – oral||Gastrointestinal upset, flushing, lymphopenia, PML, hepatotoxicity|
|Fingolimod (Gilenya) – oral||Bradyarrhythmia (cardiac monitoring required on initiation and treatment interruption), skin cancers, visual pain and changes, macular oedema (increased risk with history of uveitis or diabetes), lymphopenias, PML|
|Teriflunamide (Aubagio) – oral||Nausea, diarrhoea, alopecia, rash, paraesthesia, peripheral neuropathy, interstitial lung disease|
|Alemtuzumab (Lemtrada) – intravenous||Autoimmune disorders (e.g. thyroid autoimmunity, immune thrombocytopenic purpura, cytopenias and nephropathies), routine monitoring required. Infusion-related reactions. Risk of listeria meningitis, prophylaxis and dietary restrictions required|
|Natalizumab (Tysabri) – intravenous||PML (risk increased with previous or concurrent immunosuppressant use, treatment duration exceeding 2 years and seropositive for anti-JC serum antibodies), infusion-related reactions, hepatotoxicity|
|Ocrelizumab (Ocrevus) – intravenous||Neutropenia (usually transient), infusion and hypersensitivity reactions|
|Interferon beta 1a (Avonex) – intramuscular||Myalgia, headache, flu-like symptoms (reduced with paracetamol beforehand and night-time administration), depression, leucopenia, hepatotoxicity|
|Interferon beta 1a (Rebif) – subcutaneous|
|Interferon beta 1b (Betaferon) – subcutaneous|
|Peginterferon beta 1a (Plegridy) – subcutaneous|
|Glatiramer acetate (Copaxone) – subcutaneous||Injection site reactions Immediate post-injection reactions (chest pain, dyspnoea, flushing, palpitations)|
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OverviewTuesday 24 March is the World Health Organization’s World Tuberculosis Day. The goal is to end the global epidemic by 2035.1
After successful completion of this CPD activity, pharmacists should be able to:
|ADULTS||CHILDREN<14 YEARS OLD||TREATMENT DURATION|
|Ethambutol 15 mg/kg up to 1,200 mg daily||Child <14 years 20 mg/kg up to 1,200 mg once daily||2 months|
|Pyrazinamide 25 mg/kg up to 2,000 mg||Child <14 years 35 mg/kg up to 2,000 mg once daily||2 months|
|Isoniazid 10 mg/kg up to 300 mg daily||Isoniazid 10 mg/kg up to 300 mg once daily||6 months|
|Rifampicin 10 mg/kg up to 600 mg daily||Child <14 years (>50 kg) 600 mg once daily Child <14years (<50 kg) 15 mg/kg up to 450 mg once daily||6 months|
|*Pyridoxine 25 mg with each dose of isoniazid||Child *Pyridoxine 6.25–12.5 mg with each dose of isoniazid||Duration of isoniazid treatment|
|Isoniazid 10 mg/kg up to 300 mg daily||Isoniazid 10 mg/kg up to 300 mg once daily||6 months OR 9 months|
|Rifampicin 10 mg/kg up to 600 mg daily||Child <14 years (>50 kg) rifampicin 600 mg once daily Child <14 years (<50 kg) rifampicin 15 mg/kg up to 450 mg once daily||4 months|
|Rifampicin 10 mg/kg up to 600 mg daily PLUS Isoniazid 10g/kg up to 300 mg daily||Child<14 years (>50 kg) Rifampicin 600 mg once daily PLUS Isoniazid 10g/kg up to 300 mg once dailyChild <14 years (<50 mg) Rifampicin 15 mg/kg up to 450 mg once daily PLUS Isoniazid 10g/kg up to 300 mg once daily||3 months|
|Rifapentine 900 mg weekly PLUS Isoniazid 15 mg/kg up to 900 mg weekly||Child ≥12 years (>50 kg) Rifapentine 900 mg once weekly Child ≥12 years (32.1–50 kg) Rifapentine 750 mg once weekly Child 2–11 years (10–14 kg) Rifapentine 300 mg once weekly Child 2–11 years (14.1–25 kg) Rifapentine 450 mg once weekly Child 2–11 years (25.1–32 kg) Rifapentine 600 mg once weekly Child 2–11 years (32.1–50 kg) Rifapentine 750 mg once weekly Child 2–11 years (>50 kg) Rifapentine 900 mg once weekly PLUS Child≥12 years Isoniazid 15 mg/kg up to 900 mg once weekly Child 2–11 years Isoniazid 25 mg/kg up to 900 mg once weekly||3 months|
|*Pyridoxine 25 mg with each dose of isoniazid||Child *Pyridoxine 6.25–12.5 mg with each dose of isoniazid||Duration of isoniazid therapy|
|THERAPEUTIC AGENT||COMMON ADVERSE EFFECTS (>1%)||PRECAUTIONS||SELECTED COUNSELLING POINTS|
|Isoniazid||Nausea, rash, fever, peripheral neuritis, aminotransferases, hepatitis, acne, fatigue, alertness, antinuclear antibodies||Epilepsy, CNS toxicity with cycloserine, risk of peripheral neuropathy (malnutrition, diabetes, HIV infection, alcoholism)*||Best absorbed when taken on an empty stomach. Tyramine or histamine rich foods can cause tachycardia, postural hypotension, flushing, itch, headache or sweating – avoid if affected|
|Rifampicin||GI symptoms (nausea, vomiting, cramps), rash, LFTs, orange-red colouration of body fluids#||Contraindicated in jaundice, may worsen hepatic impairment, risk of hepatotoxicity in combination with hepatotoxic drugs (e.g. isoniazid), effectiveness of the pill||Best absorbed when taken at least half an hour before food. Take it regularly (allergy is more likely with intermittent dosing). Inform prescriber if: rash, fever and swollen glands, loss of appetite, nausea, vomiting, unusual tiredness, jaundice, dark urine or pale faeces|
|Rifapentine27||Endocrine and metabolic disturbance, haematologic reactions, genitourinary symptoms, GI, CV, CNS, respiratory and ophthalmic symptoms, rash, LFTs, neuromuscular and skeletal symptoms, orange-red discolouration of body fluids#||Use with caution in hepatic impairment. Not recommended for use in patients with porphyria||Best absorbed with meals – high fat meals increase absorption|
|Ethambutol||Optic neuritis||Contraindicated in optic neuritis. May cause changes in vision. May precipitate gout||Vision may be affected (e.g. clarity and colour). Cease and inform prescriber of any changes to eyesight|
|Pyrazinamide||Hyperuricaemia, polyarthralgia, nausea||Contraindicated in acute gout and significant liver disease||Cease and inform prescriber if: continuous nausea, vomiting, unusual tiredness, yellowing of the skin or whites of eyes, dark urine or pale faeces|
|Pyridoxine||None listed||None listed||Avoid unnecessary use. Prolonged high doses may be toxic and cause peripheral neuropathy|
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Case scenarioDanielle is a 45-year-old Australian who approaches the counter with a box of hypocaloric meal replacements. You know from previous interactions with Danielle that she is currently managing her bipolar disorder with olanzapine for maintenance therapy of bipolar I. From her dispensing history you see the last time Danielle was supplied with olanzapine (10 mg orally, once daily) was more than six weeks ago.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|Bipolar I: one or more manic episodes and usually episodes of depression Bipolar II: episodes of hypomania (not mania) and depression Mania: marked functional impairment, psychotic features and hospitalisation required Hypomania: No marked functional impairment or psychotic features; hospitalisation not required Mixed episodes: episodes characterised by manic/hypomanic and depressed features Rapid cycling disorder: four or more episodes within a 12-month period.|
|DRUG CLASS||TGA APPROVED||PBS LISTED||TGA APPROVED||PBS LISTED|
|Olanzapine tablets or wafers||✔||✘||✔||✔|
|Olanzapine IM injection||✘||✘||✘||✘|
|Risperidone (tablets, oral solution)||✔||✔ (Adjunctive up to 6 months with mood stabiliser)||✘||✘|
|Risperidone long-acting injectable||✔||✔ (Refractory to treatment, + lithium or sodium valproate)|
|Quetiapine immediate-release||✔||✔ (Monotherapy only up to 6 months)||✔||✔|
|Quetiapine extended-release||✔||✔ (Monotherapy only up to 6 months)||✔||✔|
|Ziprasidone||✔*||✔* (Monotherapy only up to 6 months)||✘||✘|
|Aripiprazole tablets||✔*#||✘||✔* (Monotherapy only)||✘|
|Aripiprazole long-acting injectable||✘||✘||✘||✘|
|Asenapine||✔*#||✔* (Up to 6 months)||✔*#||✔ (Monotherapy only)|
|Paliperidone oral and long-acting injectable||✘||✘||✘||✘|
|DRUG CLASS||KEY INTERACTIONS||KEY MONITORING|
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Case scenarioAlice, aged 9, comes into the pharmacy with her mother complaining of pain in the sole of her foot when she walks. On inspection, you note a round 1.5 cm lesion on the sole of her foot which appears to be a plantar wart. On questioning you discover that Alice has been having swimming lessons on a weekly basis for the last few months. How can you assist Alice?
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|Duofilm||Salicylic acid 16.7% Lactic acid 15%||Apply 2–4 drops daily using applicator|
|Scholl wart removal system||Discs containing salicylic acid 40%||Apply over wart, cover with plaster and change every 48 hours|
|Scholl verucca and wart freeze remover kit||Dimethyl ether and propane||Freezes warts. Follow manufacturer’s instructions. For adults and children >4 years|
|Surgipack Caustic Pencil||Silver nitrate 427.5mg Potassium nitrate 22.5mg||Wet tip of pencil with water before application|
|Wart eze||Dimethyl ether, propane, butane||Freezes warts. Follow manufacturer’s instructions. For adults and children >4 years.|
|Wartie Freeze||Dimethyl ether and propane||Freezes warts. Follow manufacturer’s instructions. For adults and children >4 years.|
|Wartie Advanced||Dimethyl ether plus conductive gel||Freezes warts. Adults and children aged 12+ years. Gel is claimed to increase freezing potential|
|Wartner common wart remover and Plantar wart remover||Dimethyl ether and propane||Freezes warts. Follow manufacturer’s instructions. For adults and children >4 years.|
|Wart-Off Stick||Salicylic acid 40%||Apply daily according to manufacturer’s instructions|
|Wart-Off Paint||Salicylic acid 20%, lactic acid 12.5%, podophyllum resin 10%||Apply daily according to manufacturer’s instructions|
|Wart-Off Freeze Spray||Dimethyl ether and propane||Freezes warts. Follow manufacturer’s instructions. For adults and children >4 years|
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OverviewGout, a common form of inflammatory arthritis, is a considerable burden to patients and the health system. The rate of gout and hyperuricaemia in Australia is high relative to comparable countries and is increasing.1
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|TREATMENT OPTIONS||USE IN ACUTE FLARE MANAGEMENT|
|NSAIDs||Oral dose (at upper end of dosing range) until symptoms abate (typically 3–5 days)|
|Colchicine||Orally 1 mg, then 0.5 mg one hour later, as a single one-day course (total dose is 1.5 mg)|
|Corticosteroids||Prednisone/prednisolone, orally 15–30 mg daily until symptoms abate (typically 3–5 days)|
|TREATMENT OPTIONS||USE IN CHRONIC MANAGEMENT|
|Allopurinol||Allopurinol 50 mg orally, daily for 4 weeks; then increase the daily dose by 50 mg every 2–4 weeks or by 100 mg every 4 weeks to achieve the target serum urate concentration, up to a maximum maintenance dose of 900 mg daily|
|Probenecid||Probenecid 250 mg orally, twice daily for 1 week, then increase to 500 mg twice daily; increase the daily dose by 500 mg every 4 weeks to achieve the target serum urate concentration, up to a maximum maintenance dose of 2 g daily in divided doses|
|Febuxostat||Febuxostat 40 mg orally, daily for 2–4 weeks; then increase the daily dose by 40 mg every 2–4 weeks to achieve the target serum urate concentration, up to a maximum maintenance dose of 120 mg daily|
|Xanthine oxidase inhibition||Selective||Non-selective|
|Chemical structure||Non-purine||Purine analogue|
|Excretion||Excreted in faeces and urine||Primarily eliminated through the urine|
|Dosing||40–80 mg once daily||100–900 mg once daily to achieve target serum uric acid|
|Dosing in renal impairment||No dosage adjustment required in mild to moderate renal insufficiency||Initiation dose adjustment required|
|STAGES OF CHRONIC KIDNEY DISEASE||eGFR (mL/min/1.73m2)||STARTING DOSE|
|Stage 1||>90||100 mg once daily|
|Stage 2||60–89||100 mg once daily|
|Stage 3||30–59||50 mg once daily|
|Stage 4||15–29||50 mg on alternate days|
|Stage 5||<15||50 mg twice a week|
|ORAL TREATMENT OPTIONS||USE AS PROPHYLAXIS DURING INITIATION OF URATE-LOWERING THERAPY (up to 6 months)|
|NSAIDs||Low dose NSAID (e.g. naproxen 250 mg twice daily) with proton pump inhibitor (PPI) if appropriate|
|Colchicine||0.5 mg once or twice daily|
|Corticosteroids||2nd line only – low dose (e.g. 5 mg daily)|
|1. Start urate-lowering therapy with prophylaxis|
|2. Ensure patient has an acute flare plan|
|3. Monitor serum urate until target reached|
|4. Titrate urate-lowering therapy to achieve target|
|5. Once target achieved, monitor serum urate 6–12 monthly|
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9727 [post_author] => 12 [post_date] => 2020-03-17 14:24:54 [post_date_gmt] => 2020-03-17 04:24:54 [post_content] => Distinguished Professor Gregory Peterson FPS has co-owned two pharmacies, been a hospital pharmacist and advised Sigma Pharmaceuticals. Now it’s teaching, research and other varied roles.
How did you come to lead state and national projects aimed at improving the use of medicines and patient outcomes in community, hospital and aged care sectors?This was a natural progression in my career. I started out as an undergraduate pharmacy student at a school that pioneered clinical pharmacy education, which allowed me to spend time in general medical practices, aged care settings, and community and hospital pharmacies. I then attended nursing home ward rounds and wrote therapeutic bulletins for GPs while an intern pharmacist. After that I worked as a community and hospital pharmacist in low socioeconomic areas of Hobart and Melbourne where medicine-related issues were very prevalent. I’ve also been fortunate to keep practising in community pharmacy throughout my academic career, which is critically important for learning about real-world experiences of consumers and seeing what needs tackling through research to improve outcomes from medicine use.
What sort of person excels in the role you’ve carved out?Someone with an equally short attention span, who rapidly gets bored doing one activity and craves variety, and likes to be in the underdog’s corner.
What’s the biggest challenge you face?The biggest challenge is balancing – somewhat successfully – a multitude of roles and activities ranging from laboratory-based and clinical research through to practice as a community pharmacist, consulting, writing, and being a board director of community organisations that are pivotal to health care delivery in Tasmania.
What’s most satisfying about your work?Apart from the variety, being lucky enough to be in a position to directly help others, whether that be students, fellow academics and pharmacists, patients or the public through ongoing roles in teaching, research, pharmacy practice, consultancy and board director positions.
Any fulfilling experiences you’ve recently experienced?The most fulfilling and motivating aspect I regularly see in our pharmacy, located in a suburb of predominantly older residents, is the many elderly people – some who have reached 100 years of age – who are such positive role models in society. They’re modest and unassuming, they remain active and engaged, and they appreciate assistance when managing their medicines.
What do you wish you’d known before embarking on your career?I was probably naïve in assuming everyone in the profession was focused on improving public health outcomes, when instead there is self-interest and greed at both an individual and organisational level. That has, unfortunately, stymied the advancement of pharmacy practice in this country compared with some others. For example, the routine presence of pharmacists working in general practice and aged care settings as part of a team, with associated prescribing privileges in a collaborative model, should have occurred many years ago.
Any other interesting insights?Ending on a positive note, I think that the self-interest that has held back the profession for so long is now being diluted through pressure from many quarters, including an army of low-paid yet highly skilled pharmacy graduates, continued trimming of Pharmaceutical Benefits Scheme dispensing costs, the Commonwealth, consumers, the impact of the Royal commission into Aged Care Quality and Safety, and Quality Use of Medicines (QUM) and medicines safety becoming the 10th National Health Priority Area. It’s a great time to enter the profession for those committed to helping society.
A TYPICAL DAY for Distinguished Professor Gregory PetersonMORNING Teaching, student meetings, manuscript work
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9502 [post_author] => 1087 [post_date] => 2020-02-25 04:58:55 [post_date_gmt] => 2020-02-24 18:58:55 [post_content] => From 30 December to 7 January, 2020 this pharmacist-in-charge worked 24/7 with no support during unprecedented fires in a remote Victorian town. Like everyone in Mallacoota, in the lead up to the fires that forced locals and tourists to the waterline early on New Year’s Eve 2019, I had to evacuate my home. I slept in my car for two nights at the back of the pharmacy. After cold showers for a fortnight, three weeks later, I still had no power at home and lost everything in my fridge and deep freezer. Considering patients lost houses, I can’t complain. A loaned generator on 11 January was used only to charge my phones, as the town had no fuel. The first petrol tanker arrived on 14 January, escorted by emergency services, a welcome increase from the 4000 litres of petrol airlifted in by the Royal Australian Air Force (RAAF) that was used only for generators. There was a massive increase in the use of puffers as the smoke intensified with the fire’s advance. Within one hour of opening on Monday 30 December, all my puffers were gone. I had ordered what I thought was enough based on our usual usage. P2 masks went quickly as well. Every patient was asking for salbutamol (Asmol/Ventolin) plus a mask. Initially we were selling our P2 masks. Then we got a donation so we now just hand them out – one per patient. After reaching out to a local GP and connecting with various government agencies, an intervention from the Pharmacy Guild’s Victorian Branch Director, Allan Crosthwaite, helped secure a shipment of salbutamol, antibiotics and P2 masks from Sigma, brought by police barge the next day. Suppliers have since sent deliveries to the RAAF Base in East Sale from where they are airlifted to Mallacoota. Initially, during confusion with stock delivery processes, suppliers sent orders normally, which caused holdups. By mid-January orders could be delivered via NSW, but only accompanied by emergency services or the army due to continued road closures. I preferred the RAAF. It’s imperative that every pharmacy have a disaster plan, a clear written procedure on what to do. There must also be a standard procedure to follow that can be activated as soon as the ‘too late to leave’ order is issued. We need a streamlined process to eliminate unnecessary delays getting deliveries to affected areas. Consider these:
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After moving from Sweden 20 years ago, Tasmanian Pharmacist of the Year Fred Hellqvist MPS, owner of Dover Pharmacy, has become a leading voice for rural pharmacies across Australia.
What brought you to Dover, Tasmania, from Sweden?
As part of any degree in Sweden, you have to do a thesis, and Professor Ron Quinn from Griffith University was visiting Gothenberg. We discussed a possible thesis and he was happy for me to come out and do it. I did my six-month thesis in Brisbane in 2000, that’s where I met my wife Katie Stott, and I just stayed in Australia from there.
So, where does your passion for rural pharmacy stem from?
I started working in Australia in a regional centre for a couple of years and realised that seeing patients over and over again meant you found out more things about them, they trusted you more, and you could more easily solve their problems. I would encourage pharmacists who haven’t given rural practice a proper go to actually do so because it’s professionally rewarding.
How did you become co-chair of the new Rural Pharmacy Network Australia (RPNA) group?
RNPA has grown out of another group Terry Burnett, my wife and I started a couple of years back called the Small Pharmacies Group. The intention of that group was to connect smaller pharmacies because we all felt isolated. It quickly turned into advocacy and from there we realised there were a lot of issues rural in nature that needed their own forum, the RPNA.
What’s on your RPNA wish list?
Outside the metropolitan areas, the more rural you go, the more the chronic disease burden goes up. But the way the remuneration system works is volume-based. We need to put in mechanisms where clinical work is actually acknowledged and we are rewarded for the work we’re doing.
How do you attract and retain staff in remote locations?
A comprehensive package of workforce incentives is needed that brings pharmacy in line with the incentives available to other professions practicing in rural areas. Community pharmacy employers need to be able to offer better remuneration as well.
What do you believe is the biggest opportunity for rural pharmacy?
It’s a buzzword at the moment with health, but we’re a health hub. We triage a lot, we refer people who are at heightened healthcare risk, and we treat the people we can treat as best as we can to fill holes in the health care system. But we need support to continue to do so.
What are your main goals over the coming years?
Basically, to keep advocating for rural pharmacy and to gain more resources so we can adequately help our patients and our regions. Personally, I’d like to hire more pharmacists so I can do more of the things we are doing. Because there is quite a big unmet need out there.
What do you need out of the 7CPA?
RPNA is calling for a Rural Viability Package as part of 7CPA – a package that compensates rural pharmacies for the higher costs associated with delivering care to disadvantaged patients, the costs associated with attracting and retaining staff in rural and remote locations, and appropriate and flexible funding for clinical healthcare services.
It is vitally important that such a package is delivered to ensure that rural pharmacies are sustainable into the future and able to provide the care their communities need and deserve. Community pharmacy employers need to be able to offer better remuneration as well as other incentives such as extended paid leave, formal career development and recognition opportunities, housing, transport and family support.[post_title] => Rural pharmacy resource advocate [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => rural-pharmacy-resource-advocate [to_ping] => [pinged] => [post_modified] => 2020-02-12 16:23:57 [post_modified_gmt] => 2020-02-12 06:23:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9326 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Rural pharmacy resource advocate [title] => Rural pharmacy resource advocate [href] => https://www.australianpharmacist.com.au/rural-pharmacy-resource-advocate/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9327 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8924 [post_author] => 11 [post_date] => 2020-01-12 11:31:15 [post_date_gmt] => 2020-01-12 01:31:15 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]PSA life member Steve Cohen is not slowing down on a mission to improve medicines safety. He tells of the many changes he’s seen in a career spanning half a century.
What started you on your road to advocacy around consumer information, safety and health literacy?I was born with very bad vision – myopic astigmatism – so I have always been aware of what it’s like not to have good vision. Later I owned a pharmacy in Marrickville, a very multicultural part of Sydney, and I was always concerned that customers might take their medications incorrectly if they couldn’t read their medicine labels.
Before translation software was readily available, how did you improve medicine safety?I always had multilingual staff. I would have someone who spoke Greek, someone who spoke Arabic and someone who spoke Vietnamese. I had also learned German and French at school and could understand a little bit of Italian, Spanish and Portuguese from my days of learning Latin so we had quite a broad knowledge base to be able to help them. Interestingly enough though, in the mid-1980s, I was involved in selling the first computers into pharmacy. I helped train pharmacists to use them and the software that translated labels into different languages.
After 50-odd years in the industry, what are your words of wisdom for pharmacists today?Don’t be confined to traditional ideas of pharmacy – it’s such a broad area. You can work in retail, the pharmaceutical industry, manufacturing but you can also diversify and have your own website for pharmacy-related business. Business has become really, really competitive in the last 50 years so pharmacists today need to start having special business models.
Tell us about your online business – Our Pills Talk – and why you started it.I developed a medicine safety app – Our Pills Talk – where people can scan QR barcode labels and the app will read out their doctor’s prescription information and instructions. It will also translate the labels into their preferred language. All the pharmacist needs to do is print out a QR barcode label that they place alongside their traditional pharmacy label for the patient to scan. What led me down this pathway is that it’s costing our government up to $1.4 billion annually with 250,000 people admitted to public hospitals due to adverse drug events.
What are your thoughts on retirement?I’m allergic to it.[/vc_column_text][/vc_column][vc_column width="1/3"][/vc_column][/vc_row] [post_title] => Diversity is the word [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => diversity-is-the-word [to_ping] => [pinged] => [post_modified] => 2020-01-14 10:53:23 [post_modified_gmt] => 2020-01-14 00:53:23 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=8924 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Diversity is the word [title] => Diversity is the word [href] => https://www.australianpharmacist.com.au/diversity-is-the-word/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 8925 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9141 [post_author] => 23 [post_date] => 2020-01-08 09:09:48 [post_date_gmt] => 2020-01-07 23:09:48 [post_content] => Images of holidaymakers being evacuated by Navy ship as bushfires closed in on Mallacoota have made the Victorian coastal town a global symbol of the unprecedented nature of the bushfire crisis. In the lead-up to New Year’s Eve, up to 5,000 people became trapped after fires closed the only road into the remote coastal town, located just a few kilometres south of the NSW-Victoria border. Like other pharmacists across fire-ravaged parts of the nation, Mallacoota Pharmacy Pharmacist-in-Charge Emmanuel Pasura MPS has been serving a vital role in helping local communities meet their healthcare needs. Running on generator power, the Mallacoota Pharmacy dispensed more than double its usual amount of scripts, facing severe stock shortages, missed deliveries and panicked evacuees. At the peak of the crisis, Mr Pasura was working almost around the clock and spent two nights sleeping in his car beside his pharmacy as he and his three front-of-shop staff dealt with a deluge of people whose medicineshad run out or who had lost theirs while being evacuated. ‘Just a few weeks before the fire I started ordering increased quantities of medicines like Ventolin (salbutamol) and antibiotics just in case,’ he said. ‘We always get a lot of visitors during this time of the year so, naturally, our orders are bigger than normal. Despite having ordered increased quantities when the fire finally roared into town it became apparent that we were very much understocked.’ Mr Pasura said he had run out of salbutamol within an hour of opening on December 30, well before the fire even reached Mallacoota. After reaching out to a local GP and connecting with various government agencies, an intervention from the Pharmacy Guild’s Victorian Branch Director Allan Crosthwaite helped secure a shipment of salbutamol, antibiotics and P2 masks from Sigma, brought in by police barge on the next day. ‘Managing my stock was very difficult,’ he said. ‘At one point, I was dispensing only enough medications for a week if I felt that item was running low.’ As of Tuesday this week, Mr Pasura was still awaiting a new shipment, due in from Sale via helicopter, that had already been delayed for three days due to visibility concerns. ‘I hope I will get it today as I am now very desperate,’ he said. There was a heavy sadness in the town, he said, with many of his patients losing their homes. ‘Nothing prepares you for such a disaster,’ Mr Pasura said. [post_title] => On the ground in Mallacoota: community pharmacy at the front line [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => on-the-ground-in-mallacoota-community-pharmacy-at-the-front-line [to_ping] => [pinged] => [post_modified] => 2020-01-08 13:51:36 [post_modified_gmt] => 2020-01-08 03:51:36 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9141 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => On the ground in Mallacoota: community pharmacy at the front line [title] => On the ground in Mallacoota: community pharmacy at the front line [href] => https://www.australianpharmacist.com.au/on-the-ground-in-mallacoota-community-pharmacy-at-the-front-line/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9142 )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.