td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9214 [post_author] => 46 [post_date] => 2020-01-22 12:46:54 [post_date_gmt] => 2020-01-22 02:46:54 [post_content] => ‘Precautionary and active surveillance’ is required to manage the risk of a novel coronavirus outbreak in China, Australia’s Chief Medical Officer Professor Brendan Murphy said yesterday. However, the risk to the Australian public remains ‘relatively low’, he said. Chinese health officials have confirmed up to 300 cases1 of a SARS-like infection, first detected in the city of Wuhan four weeks ago. Six cases have now been discovered outside of Wuhan2, including in other Chinese cities and in Japan, South Korea, Thailand and the United States (US). Three deaths have been confirmed. The Centers for Disease Control and Prevention1 (CDC) is closely monitoring the outbreak with the first US case1 identified in Seattle this week. The virus has been linked to a seafood market in Wuhan, but authorities have since established it has spread to people who had not visited the market. Coronaviruses3 are a large family of viruses that cause illness ranging from the common cold to more severe diseases. They can be transmitted between animals, people and between animals and people. A coronavirus was responsible for the Severe Acute Respiratory Syndrome (SARS), which also began in China and killed nearly 800 people globally during an outbreak in 2002-2003. The novel coronavirus identified in Wuhan is a strain not previously identified in humans. Professor Murphy said4 the risk to the Australian public remained ‘relatively low’ and that the Department of Health was ‘alert but not alarmed’. However, he said it was necessary to implement additional measures to manage the risk. ‘There has been a significant increase in case numbers, evidence of some human-to-human transmission and we've heard reports now of six deaths, even though the case numbers are probably over 300,’ Professor Murphy told the ABC5 this morning. ‘So, we have more concern than we had last week, but we're well prepared in this country to respond.’ With three direct flights a week from Wuhan to Sydney, NSW Health officers and border security staff will begin assessing passengers arriving at Sydney Airport for signs of the virus from tomorrow. All passengers on direct flights from Wuhan will receive information about the virus on arrival. They will be requested to identify themselves to biosecurity officers if they are unwell. If they have symptoms of an infectious disease they will be assessed by a NSW Health officer. While there have been no confirmed cases of the virus in Australia to-date, results are pending for a Brisbane man who recently returned from Wuhan and presented to his GP with flu-like symptoms. NSW Health Director of Health Protection Dr Jeremy McAnulty said advice was also being provided to travellers who may have already returned from Wuhan, as it can take up to two weeks for symptoms to develop. Common signs of infection3 include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome and kidney failure. ‘There is no need for alarm, but people should be aware of the emerging situation and if they develop symptoms on returning from affected areas overseas, they should call ahead before seeing their GP,’ Dr McAnulty said6. For more information, consumers can visit the Department of Health website4. References
[post_title] => Coronavirus: Australia ‘alert but not alarmed’ [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => coronavirus-department-of-health-alert-but-not-alarmed [to_ping] => [pinged] => [post_modified] => 2020-01-23 15:07:22 [post_modified_gmt] => 2020-01-23 05:07:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9214 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Coronavirus: Australia ‘alert but not alarmed’ [title] => Coronavirus: Australia ‘alert but not alarmed’ [href] => https://www.australianpharmacist.com.au/coronavirus-department-of-health-alert-but-not-alarmed/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9215 )
- Centres for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China: Situation Summary. 2020 January 21. At: www.cdc.gov/coronavirus/2019-ncov/index.html
- Centres for Disease Control and Prevention. First travel-related case of 2019 novel coronavirus detected in United States. 2020. At: www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html
- World Health Organization. Health topics: coronavirus. At: www.who.int/health-topics/coronavirus
- Australian Government Department of Health. Canberra. Novel coronavirus update: a statement from the chief medical officer about novel coronavirus. 2020 January 21. At: www.health.gov.au/news/statements/novel-coronavirus-update
- Lane S. Australia ‘well prepared’ for coronavirus: chief medical officer. 2020 January 22. At: www.abc.net.au/radio/programs/am/australia-well-prepared-for-coronavirus:-chief-medical-officer/11888456
- NSW Government Health Department. NSW Health advice to travellers returning from Wuhan, China. 2020 January 21. At: www.health.nsw.gov.au/news/Pages/20200121_00.aspx
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9200 [post_author] => 23 [post_date] => 2020-01-22 12:06:05 [post_date_gmt] => 2020-01-22 02:06:05 [post_content] => Two proactive pharmacists are providing pain management and virtual dental services to a wider reach than previously possible via videoconferencing. Pharmacist Nicolette Ellis MPS is a member of Beyond Pain, Australia’s first interdisciplinary videoconferencing service for complex chronic health conditions such as pain, fatigue and mental health disorders, based in a Melbourne clinic. And in an Australian first, Krysti-Lee Rigby MPS facilitates a virtual dental service by videoconference from a pharmacy in regional New South Wales (NSW). Both initiatives came about by chance. [caption id="attachment_9209" align="alignright" width="319"] Beyond Pain founder Angelo Ratnachandra and Nicolette Ellis MPS[/caption] Ms Ellis attended a Beyond Pain workshop with its founder, physiotherapist Anjelo Ratnachandra two years ago. Through his own journey with chronic pain he had experienced a lack of tailored services with specialised healthcare professionals. He wrote the book Beyond Pain, became a counsellor, and started a videoconferencing service some years ago to reach clients in remote areas with poor access to adequate care. At the workshop, Ms Ellis convinced him of the benefits of including a pharmacist on the team. She joined the team 12 months ago. Similarly, dentist Christine May was frustrated that people in remote areas needing dental care had difficulty accessing it when and where they needed it. Telehealth was being adopted by other health disciplines (e.g. medicine, psychology and physiotherapy) so she researched its application for teledentistry. She found a number of positive pilot studies, particularly in vulnerable groups, e.g. aged care. From her Sydney base, she established a virtual dental practice known as ViDe. When Dr May met Ms Rigby, pharmacist-in-charge at Moodie’s Pharmacy in Bathurst, and saw its consultation rooms, they discussed the possibility of a teledental service from the pharmacy. After 12 months of planning, the pharmacy-facilitated ViDe service was launched two months ago, in November 2019.
How does the dental service work?In the pharmacy consultation room a pharmacy assistant, specially trained in the technology, uses an intra-oral camera to take images or a video of the patient's teeth and mouth. The images are shared with the dentist in their practice, who then conducts a video consultation with the patient via a smart device or computer. The dentist uses Zoom video conferencing, for seamless integration with a healthcare-compliant booking platform and secure online application form. The cost per consultation is $69, of which $49 is paid to the dentist and $20 to the pharmacy. Referral to local dentists can be made if required. The patient must agree to ViDe terms and conditions and sign digitally to consent to the service. Professional indemnity insurance applies only to the registered dentist performing the consultation. Dentists may prescribe for dental treatments only. On their website, ViDe lists medicines that they will not prescribe. Prescriptions are sent to the pharmacy, not the patient, lessening the chance of doctor shopping. [caption id="attachment_9211" align="alignright" width="357"] Krysti-Lee Rigby MPS demonstrates the ViDe telehealth technology[/caption] However, Dr Geraldine Moses, Consultant Pharmacist to the Australian Dental Association, told Australian Pharmacist that the dentist and pharmacist need to have strategies in place to overcome the risk of doctor shoppers feigning pain to take advantage of the service. Dr Moses also cautions that the role of the dentist is in ‘real-life dental treatment, such as draining an abscess or filling a hole in a tooth'. Teledentistry may provide access to a dentist for people in remote areas, but ‘an accurate diagnosis or comprehensive advice and counselling is more achievable in a face-to-face consultation,’ she added. The pilot study for dental telehealth finished in December last year, but the Life Pharmacy Group, which includes Moodies in Bathurst, will now roll out the service to other pharmacies across Central West NSW and the Australian Capital Territory. Ms Rigby told Australian Pharmacist the concept has the potential to be rolled out to aged care facilities and disability group homes. ‘If we can make a positive impact on our patients' health by providing this service it will be successful, even if we help just one person,’ she said. There was little expense for the pharmacy as the clinic rooms had been ready for telehealth services for years. ‘Pharmacists should not be afraid to reach out to different professions and connect with these potential partnerships,’ Ms Rigby added.
How does the pain management service work?Clients are referred by corporations and health insurers. An initial assessment is undertaken and a quote provided to the referrer with a cost breakdown of services. Plans are individualised and may not require every team member to be involved. Nicolette Ellis conducts client consultations by videoconference, and provides a report to their relevant pain specialist or psychiatrist by video case conference or in writing. The team can use tools and videos to explain challenging concepts or when the functional team is developing specific exercises. ‘I like to show clients drawings of ways in which medication works or how the body/brain is impacted by persistent pain,’ she told Australian Pharmacist. Improvement in functional capacity is the goal. Patients generally self-report, but measurement tools are also used. In a positive measure, ‘we have many clients who return to work or begin volunteering’, she said. Professional indemnity insurance covers her full scope of pharmacy practice. While diagnosis is outside her scope of practice, Ms Ellis screens for red and yellow flags requiring medical referral. Client consent is requested if needed for clarification of the medical history with a doctor or community pharmacy, or for a joint consultation.
Opioid dependenceMs Ellis believes many patients living with persistent pain self-escalate their opioid analgesics out of desperation and not knowing what to do about their pain. ‘We as pharmacists should be ready to have an honest conversation, understand the reason for dosage escalation, and not jump to the conclusion that they are dependent,’ she said. She also provides guidelines for the client and doctor on how medicines should be managed. As a guide, opioids should be reviewed for improvement in function every 6 weeks. An opioid monitoring tool can be useful. Ms Ellis urges pharmacists to look for non-traditional opportunities within and outside the profession. ‘We should be recognising our skills and not selling ourselves short,’ she said of the rewarding work on this new frontier.' [post_title] => New ways of providing services [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-ways-of-providing-services [to_ping] => [pinged] => [post_modified] => 2020-01-23 15:07:29 [post_modified_gmt] => 2020-01-23 05:07:29 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9200 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New ways of providing services [title] => New ways of providing services [href] => https://www.australianpharmacist.com.au/new-ways-of-providing-services/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9212 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9202 [post_author] => 675 [post_date] => 2020-01-22 11:37:39 [post_date_gmt] => 2020-01-22 01:37:39 [post_content] => More than 40 roles for pharmacists in disasters have been identified in a new study, which also recommends that pharmacy bodies provide specialist training and advocate for supportive disaster pharmacy legislation. Published last month in PLoS One, the study evaluated the roles pharmacists have in disasters, as accepted by the international disaster health community.1 It concluded pharmacists could undertake 43 roles in the four phases of a disaster – prevention, preparedness, response and recovery – depending on individual jurisdiction. ‘Together, pharmacy professional bodies and policymakers can provide better integration of pharmacists’ roles in disaster management teams, whether assisting in the community or on deployment,’ the authors concluded.1 Consensus among 15 members of an expert panel drawn from international and Australian non-governmental organisations, government, pharmacy, military, public health and disaster management agencies, by pharmacy researchers based in Queensland and Canada, found the overall top priority roles were to:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9177 [post_author] => 23 [post_date] => 2020-01-15 15:32:20 [post_date_gmt] => 2020-01-15 05:32:20 [post_content] => Since Christmas, the NSW south coast, East Gippsland, the Hume region and Portland in Victoria and Kangaroo Island off South Australia have been devastated by bushfires resulting in 28 deaths, more than 6.5 million hectares of land burnt – the size of South Korea – and the destruction or damage of about 3,000 homes. Challenges to pharmacy services have included loss of power, road closures, reduced staff access to workplaces, provision of medicines to displaced people without prescriptions or money and stock shortages. Smoky conditions have increased the risk of asthma for vulnerable patients.
Kangaroo Island[caption id="attachment_9178" align="aligncenter" width="450"] Kangaroo Island fires. Photos courtesy Kerry Tyley[/caption] Already one-third devastated by fires including major tourism infrastructure, Australia’s third largest island benefited from rain on Friday, but residents remain on guard with higher temperatures predicted later this week. The pharmacist-in-charge at Kildea Pharmacy in Kingscote, Patrick Tiong MPS, told Australian Pharmacist that community members had rallied in support of one another. Last week, tourists and locals alike, during the busiest period of the year, were evacuated to the mainland. Mr Tiong needed to make emergency deliveries, including supplying asthma inhalers to the local hospital, and dispense after-hours to evacuees. Some medicines were provided without prescriptions. ‘We often have to rely on the goodwill of and to trust patients during tough times and hope to be paid later,’ Mr Tiong said. Emergency dispensing rulings should rectify this situation. After the devastating effect of the fires on wildlife and livestock, pharmacy staff and the community rallied to provide necessities for local fauna including dressings and saline irrigations with donations of expired stock and via a community account paid for by the pharmacy staff and community. Personal care products were given to people in need, and discounts on certain over-the-counter (OTC) medicines offered. Mr Tiong was thankful that Nick Panayiaris, the Pharmacy Guild’s SA Branch President, established a local bushfire relief appeal. Kildea Pharmacy had procedures in place to respond to bushfires but they didn’t need to be activated. Power was not lost and data backups were in ‘cloud-storage’. It's been an emotional time for many in the profession, including Mr Tiong, but, ‘as pharmacists, we have an obligation … to act in the patient’s best interest and ensure continuity of care and supply’. A good relationship with the local hospital and doctors also helps.
Asthma riskBushfires have increased the risk of asthma in vulnerable people due to smoke, ash and poor air quality. Professor Sinthia Bosnic-Anticevich MPS, Research Leader of the Quality Use of Respiratory Medicines Group at the University of Sydney’s Woolcock Institute, told Australian Pharmacist that it is more important than ever to speak to patients with asthma in the pharmacy. Professor Bosnic-Anticevich, who is also a pharmacist, stressed that patients need to be on top of their condition and to monitor how they feel and how much reliever they are using – a very important indicator of asthma control. ‘Many patients overestimate how well controlled their asthma actually is,’ she said. ‘This puts them in a very vulnerable position during times like this, when the air quality is poor and their asthma can flare up very quickly.’ Her advice comes as a recent study from the Woolcock Institute found that more than 70% of people with asthma believe they are managing their condition, when they are not.1 ‘It is critical that people with asthma have and are using their preventer regularly and correctly.’ Professor Bosnic-Anticevich said it is also important for patients to know they are able to access vital medicines at regular prices without a prescription in an emergency. P2 masks are being supplied from the National Medical Stockpile to protect people, including Defence Force personnel in bushfire-affected areas. Masks provided or reserved since the bushfires started now total almost 3.5 million, according to the Minister for Health, Greg Hunt, with resupplies underway.2
Supply issuesHazardous conditions and road closures have affected deliveries in numerous areas, exacerbating stock shortages. A national infrastructure network involving governments and military services was deployed, ensuring cross-border capabilities by air and sea, and logistics networks to support a collaborative emergency response. Pharmacist Jenny Brichacek from Prumms Pharmacy in Pambula on the south coast of NSW reported that the supply of asthma inhalers ran out in all the town's pharmacies, around New Year at a time of increased need because of smoke following intense fires. Extra stock requests were directed to the local base hospital before supplies were flown in from Victoria. A similar situation evolved at Narooma Pharmacy about 100 kilometres further north. Patrick Tiong on Kangaroo Island is accustomed to problems with freight deliveries across an expanse of water, so he always ensures sufficient supplies are ordered. Delays during the bushfires were solved by contacting the local airport service coordinator. [caption id="attachment_9179" align="aligncenter" width="600"] Photo: Sean McGowan[/caption]
Pharmacist supportEmotionally, the toll on pharmacists in fire-ravaged areas is yet to be reckoned with, but support is available. The Pharmacists’ Support Service on 1300 244 910 is available daily between 8 am and 11 pm. [caption id="attachment_9180" align="aligncenter" width="600"] Helen Feng, owner of the Alliance Pharmacy in Tallangatta, VIC, with members of the local Country Fire Authority crew. Photo: supplied.[/caption] With eight affected pharmacies in NSW and Victoria, the Pharmacy Alliance has set up a bushfire appeal which aims to raise $250,000 to provide free medication and personal care items to affected communities. The alliance wants industry partners, member-owners and their customers to donate via the Alliance Pharmacy Bushfire Appeal on GoFundMe. In addition, 50 Pharmacy Alliance member pharmacies will donate all non-prescription sales to the appeal tomorrow [Thursday] with customer donations also accepted at a number of member pharmacies across Australia. Queensland pharmacists have also established a GoFundMe page to raise $130,000 for practical assistance to pharmacists in financial stress due to the bushfires and who have lost homes or belongings. Donations can be made to the Bushfire Relief for Community Pharmacists. PSA President Associate Professor Chris Freeman reminds members who are experiencing challenges in delivering care to their local communities can email firstname.lastname@example.org and your requirements will be passed to the relevant State and or Commonwealth Departments.
[post_title] => Pharmacy services in bushfire crises [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pharmacy-services-in-bushfire-crises [to_ping] => [pinged] => [post_modified] => 2020-01-15 17:12:25 [post_modified_gmt] => 2020-01-15 07:12:25 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9177 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Pharmacy services in bushfire crises [title] => Pharmacy services in bushfire crises [href] => https://www.australianpharmacist.com.au/pharmacy-services-in-bushfire-crises/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9181 )
- Kritikos V, Price D, Papi A, et al. A multinational observational study identifying primary care patients at risk of overestimation of asthma control. Primary Care Respiratory Medicine 2019;29:43.
- Number of P2 masks provided for bushfires almost 3.5 million. Media Release. Greg Hunt MP. 2020 Jan 10.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9173 [post_author] => 23 [post_date] => 2020-01-15 15:14:16 [post_date_gmt] => 2020-01-15 05:14:16 [post_content] => Federal, state and territory governments have worked quickly in the past week to introduce legislation that enables those affected by the bushfire crisis to access full quantities of prescription-only medicines without a prescription and with the usual Pharmaceutical Benefits Scheme (PBS) subsidy. Yesterday (14 January), in a permanent regulation change welcomed by PSA, the South Australian Government introduced provisions that allow its health minister to declare an emergency area and timeframe in which greater amounts of Schedule 4 medicines can be legally dispensed where it is impractical to obtain a prescription.1 South Australian Health and Wellbeing Minister Stephen Wade said the new regulations under the Controlled Substances Act, 1884 apply only to Kangaroo Island and not other fire-affected areas of the state. These new regulations will allow pharmacists to fulfil their duty of care to patients in times of emergencies and also better support the health and wellbeing of their local communities,’ Mr Wade said. Yesterday’s South Australian announcement follows provisions similar to those established last week in NSW, ACT and Victoria to enable access to full quantities of prescription-only medicines without a prescription.
Recent changesHowever, after unprecedented bushfire devastation, particularly on the NSW South Coast, on Tuesday 7 January, NSW Health approved emergency dispensing rules allowing NSW pharmacists to dispense standard PBS quantities and standard pack sizes of non-PBS medicines without a prescription, where there was a need. The same day, the Therapeutic Goods Administration granted permission for pharmacists – until 30 March – to advertise the availability of over-the-counter salbutamol. While such advertising is normally banned, pharmacies can advertise that people with asthma or COPD can obtain salbutamol puffers or dry powder inhalers from a particular pharmacy – with or without prescription if necessary. On Thursday 9 January, following catastrophic fires in the East Gippsland area of Victoria, emergency dispensing provisions were established in Victoria until midnight on 1 April.2 On Friday 10 January the ACT Government introduced emergency dispensing provisions which expire on 31 March. The federal health minister, Greg Hunt, also announced on Friday that Australians affected by bushfires can access medicines through a temporary expansion to continued dispensing that allows pharmacists to dispense the full quantity of their PBS medicines without a prescription.3 On Monday 13 January the expanded PBS Continued Dispensing provision took effect. It expires on Tuesday 31 March. The temporary expansion of PBS Continued Dispensing will cover nearly all PBS medicines except for Controlled Drugs. [caption id="attachment_9174" align="aligncenter" width="831"] HMAS Adelaide leaves Eden Harbour this week as fire threat abates. Photo credit: Eden Pharmacy[/caption] An addendum to PSA’s Continued Dispensing Guidelines was published today to provide further guidance to pharmacists supplying bushfire-affected people PBS medicines through this initiative.4 Australians without a prescription will be able to access standard quantities of ongoing PBS medicines for the standard co-payment – $6.60 for concession card holders, and up to a maximum of $41.00 for general patients – where PBS medicines are supplied without a prescription in an emergency situation. PSA National President Associate Professor Chris Freeman said PSA had been working with state and territory governments around the country to improve access to prescription medicines in emergency situations. ‘After the current bushfire crisis subsides, we are keen to work collaboratively with all governments to permanently incorporate these more effective and affordable emergency sup-ply provisions into our health system for future disasters.’ ‘PSA’s guidelines for the continued dispensing of eligible prescribed medicines by pharmacists provide clear information to pharmacists on how to appropriately supply medicines in these situations,’ A/Prof Freeman said. ‘I am confident pharmacists will adhere to these requirements when supplying PBS medicines under this temporary expansion.’
[post_title] => Bushfire update and emergency dispensing provisions [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => bushfire-update-and-emergency-dispensing-rulings [to_ping] => [pinged] => [post_modified] => 2020-01-15 17:11:16 [post_modified_gmt] => 2020-01-15 07:11:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=9173 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Bushfire update and emergency dispensing provisions [title] => Bushfire update and emergency dispensing provisions [href] => https://www.australianpharmacist.com.au/bushfire-update-and-emergency-dispensing-rulings/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 9175 )
- Prescription pressure lifted in emergencies. Media Re-lease. Steven Marshall, Premier of South Australia. 2020 14 January.
- Advice for pharmacists supplying medicines to patients in areas affected by Victorian Bushfires. Victoria State Government. 2020 January 9. At: www2.health.vic.gov.au/public-health/drugs-and-poisons/supplying-patients-affected-by-bushfires
- Ensuring continued access to affordable PBS medicines for those impacted by the bushfires. Media release: Greg Hunt, Minister for Health. Canber-ra. 2020 Jan 10. At: www.greghunt.com.au/ensuring-continued-access-to-affordable-pbs-medicines-for-those-impacted-by-the-bushfires/
- Guidelines for the continuing dispensing of eligible prescribed medicines by pharmacists. Pharmaceutical Society of Australia. 2018 October. At: https://my.psa.org.au/s/article/Continued-dispensing-guidelines
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.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 9094 [post_author] => 285 [post_date] => 2019-12-16 14:49:07 [post_date_gmt] => 2019-12-16 04:49:07 [post_content] => Adapted by Ann Winkle MPS. Regulatory bodies are warning of the potential for diabetic ketoacidosis (DKA) as a serious complication of sodium-glucose co-transporter 2 (SGLT2) inhibitor therapy, particularly in people who undergo surgical or medical procedures.1 Many patients presenting with SGLT2 inhibitor-induced DKA are euglycaemic, making it difficult to identify as blood glucose levels (BGLs) and ketone levels can be near normal.1
Case studyA 60-year old man was admitted to hospital for a bilateral hemi-knee replacement. His regular medicines were: [table id=6 /] Empagliflozin/metformin was ceased 3 days prior to surgery and recommenced the day after surgery while still an inpatient. Two days after the operation he became unwell with an increased respiratory rate. Pathology results [table id=7 /]
DiscussionSodium-glucose co-transporter 2 (SGLT2) inhibitors add to the armament for treating type 2 diabetes, with a mode of action that is independent of beta-cell function in the pancreas. They inhibit SGLT-2 proteins located in the renal tubules responsible for reabsorbing glucose back into the blood. As a result, more glucose is excreted in the urine. SGLT2 inhibitors carry a low risk of hypoglycaemia and are usually well tolerated. However, diabetic ketoacidosis (DKA), including euglycaemic DKA (euDKA), has emerged as a challenging adverse effect. One possible mechanism is that SGLT2 inhibitors blunt insulin production in the face of stress hormones leading to increased ketotic metabolism.2 DKA is an acute complication of diabetes in which ketone bodies build up in the blood. Early signs and symptoms, typically developed over 24 hours, include abdominal pain, nausea, vomiting, anorexia, excessive thirst, difficulty breathing, unusual fatigue and sleepiness. DKA typically presents with high glucose levels, however, atypical euDKA may occur at lower levels. If DKA is not diagnosed early and treatment initiated more serious signs and symptoms including dehydration, deep gasping breathing, confusion and coma can develop.1 The TGA has received reports of DKA, including euDKA, associated with surgical or medical procedures requiring anaesthesia or light sedation, including cardiovascular, bariatric, orthopaedic or gastrointestinal procedures.1 DKA has also been linked to the pre- and post-surgical use of SGLT2 inhibitors (empagliflozin, dapagliflozin) in major surgery since their introduction into Australia. From March 2018 to August 2019, the TGA received a total of 219 reports of DKA (or metabolic acidosis) where empagliflozin or dapagliflozin were the suspected causative medicine. Reports include cases of SGLT2 inhibitors prescribed outside their licensed indication for type 1 diabetes.1 Other DKA risk factors are infections, gastrointestinal conditions, cardiovascular conditions, dehydration, malnourishment/reduced calorie intake and non-adherence with insulin or reductions in insulin dose.1 The clinical chemistry features of euDKA include2:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8823 [post_author] => 23 [post_date] => 2019-12-03 13:55:21 [post_date_gmt] => 2019-12-03 03:55:21 [post_content] => The balance between adequate pain relief and safety with opioids is now more achievable with the release of a handy new resource for patients on discharge from hospital. NPS MedicineWise produced the patient resource as part of a broader opioid education program for health professionals and consumers, ‘Opioids, chronic pain and the bigger picture,’ using the Choosing Wisely Australia initiative recommendations and principles relevant to opioid use.* With worldwide opioid misuse and overdose the Managing pain and opioid medicines resource was released on 21 November after testing in hospital surgical wards and emergency departments. Every day in Australia 3 people die and 150 are hospitalised because of harm from pharmaceutical opioids.1 The risk increases over time. Around 80% of people taking opioids for 3 months or more experience harm which ranges from mild to severe and fatal effects.2 Opioids can be an effective component of the management of acute and cancer-related pain. However, evidence shows that for most patients with chronic non-cancer pain, opioids do not provide clinically important improvement in pain or function compared with placebo.2 An opioid medicine should only be considered for patients with chronic non-cancer pain once non-pharmacological therapies (e.g. patient education, gradually increasing physical activity and cognitive behavioural therapy [CBT]) and non-opioid medicines (e.g. paracetamol and non-steroidal anti-inflammatories) have been optimised.2 Once started, the opioid continues to be one component of a multimodal treatment approach. Opioid analgesia attenuates with time, while the harm persists or increases with time and increasing doses. For some patients, the primary benefit of opioids becomes the avoidance of withdrawal.1 Recent evidence suggests that tapering opioids improves pain, function and quality of life. However, this is often challenging and can take time.1 Importantly, a personal pain management plan should be created by a patient with their health professional (e.g. pharmacist). That plan needs to include criteria for ceasing the medicine.1 The aim of the Managing pain and opioid medicines resource is to ensure patients use their pain medicine safely and effectively, as well as using other ways of managing pain. It has three key elements: 5 questions to ask a health professional before leaving hospital, tips for taking and storing opioids at home, and a personal pain management plan for development with a health professional. The questions are based on Choosing Wisely Australia’s 5 questions to ask your doctor resource to guide better conversation and tests, treatments and procedures. Hospital staff will be encouraged to provide the two-page patient resource to people prescribed opioids for non-cancer pain as inpatients, or on discharge, and encourage a conversation about using opioids for short-term pain, their adverse effects and other ways of managing pain. Health professionals practising in primary care are encouraged to print copies for their patients and initiate discussions about opioid medicines. * Do not continue opioid prescription for chronic non-cancer pain without ongoing demonstration of functional benefit, periodic attempts at dose reduction and screening for long-term harms. (Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists).1 References
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8796 [post_author] => 23 [post_date] => 2019-11-27 09:54:55 [post_date_gmt] => 2019-11-26 23:54:55 [post_content] => Men who have sex with men and use the human immunodeficiency virus (HIV) prevention pill have lower anxiety, new Australian research has revealed. Those who take the pre-exposure prophylaxis medication (PrEP) against HIV infection have significantly lower levels of HIV-related anxiety, according to a study from the Kirby Institute at UNSW Sydney, published last week in the Journal of Acquired Immune Deficiency Syndromes ahead of World AIDS Day.1 Anxiety about HIV transmission has affected sexual behaviours of men who have sex with men for more than 30 years, but this new research provides the strongest evidence globally that, as well as driving down HIV infection rates, PrEP may be enhancing the mental health and wellbeing of men at risk of HIV.1 PrEP refers to the biomedical prevention of HIV using antiretroviral agents. This includes a fixed-dose combination pill of tenofovir+emtricitabine (e.g. Truvada), which was listed on the Pharmaceutical Benefits Scheme (PBS) in April 2018. Only patients who are at least 18 years old and who are at medium to high risk of infection, as defined by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) guidelines, are eligible for the treatment.2 The co-lead author on the paper, Phillip Keen [PhD candidate] at the Kirby Institute, said the findings had important implications for understanding the benefits of PrEP. ‘We’ve known for some time that PrEP is very good at protecting people from HIV. This new evidence suggests that another benefit of taking PrEP is improved mental health, through reduced anxiety about HIV,’ he said.1 Data was analysed from the ‘Following Lives Undergoing Change’ study, a national, online survey of the sexual and drug use behaviours of more than 2,500 men at risk of HIV in Australia in 2018. An earlier 2018 Australian study (pre-PBS listing) showed that less than half of those at high risk for HIV were currently taking PrEP. The authors of the Kirby Institute study concluded that their findings could inform how PrEP is promoted to men and used to support higher PrEP use in Australia.1 This conclusion was endorsed by the Australian Federation of AIDS Organisations (AFAO) CEO Adjunct Associate Professor Darryl O’Donnell, who said the research represents a turning point in our understanding of how fear of HIV has influenced sexual relationships for many men who have sex with men. ‘[PrEP] has helped many gay men enjoy sex without being fearful of HIV,’ he said. However David Crawford, Treatments Officer with Positive Life NSW, which has assisted people living with HIV since 1988, said this isn't the case for all people living with HIV. 'Prior to this new Kirby Institute study, the prescribing of PrEP has been recognised as a game changer as it had appeared to alleviate the anxiety of many who were taking it,' he said. '[But] for people who were assessed as being ineligible for PrEP, this led them to exhibit or express higher levels of anxiety.' Mr Crawford said pharmacists should keep in mind that for people living with HIV, assurances of privacy are paramount. 'The main concerns people living with HIV have, particularly in smaller communities, are the maintenance of their confidentiality and how they will be responded to and treated when they attend a community pharmacy to collect their medicines,' he said. World AIDS Day, held every 1 December, raises awareness around the world about the issues surrounding HIV and AIDS. It is a day for people to show support for those living with HIV and to commemorate people who have died.3 The national World Aids Day theme for Australia in 2019 is ‘Every Journey Counts’. Australians are encouraged to educate themselves and others about HIV, promote HIV prevention strategies, be aware of and educate others that undetectable = untransmissable (U=U), and ensure that and ensure that people living with HIV can fully participate in the life of the community, free from stigma and discrimination.In line with Australia's aim to be one of the first countries to eliminate new HIV transmissions – new diagnoses are now at the lowest level in 20 years – the federal Health Minister Greg Hunt announced yesterday an extension of almost $3 million in funding for six national peak organisations.The funding for 2020–21 will support people living with HIV and other blood-borne viruses and sexually-transmitted infections.And from next week an estimated 850 Australians living with HIV will save more than $8,500 a year with the Pharmaceutical Benefits Scheme listing of the once-daily combination medicine Dovato (dolutegravir with lamivudine).A red ribbon is the international symbol of HIV awareness and support.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8690 [post_author] => 23 [post_date] => 2019-11-13 09:54:04 [post_date_gmt] => 2019-11-12 23:54:04 [post_content] => With increasing overdose deaths from both prescription opioids and heroin, naloxone nasal spray – now listed on the Pharmaceutical Benefits Scheme – is a life-saving and easy-to-use opioid reversal agent to stock in your pharmacy. And pharmacists this week have been urged to re-think social attitudes to reduce the stigma of drug use, addiction and overdose to ensure easy access to naloxone nasal spray. Guidance for provision of naloxone is now available in the PSA document Guidance for provision of a Pharmacist Only medicine – Naloxone for the treatment of opioid overdose.1 As John Jackson, Chair of PSA’s Harm Minimisation Committee told Australian Pharmacist: ‘Naloxone is not a new drug. It has been used extensively in a parenteral form, especially in hospitals where pharmacists have a sound knowledge of its use as a narcotic antagonist.’ But there is growing recognition of its potential benefit for suspected opioid overdose in the community. Deaths due to illicit drug overdose (e.g. heroin or diverted fentanyl) commonly occur in the presence of another person. There may be a reticence to call an ambulance because of possible police involvement. Broader availability of naloxone among users, their family and friends can save lives. The potential for overdose also exists with opioids prescribed for chronic pain (e.g. oxycodone), particularly when used with other central nervous system depressants such as alcohol and benzodiazepines. Australian research has found that most chronic pain patients prescribed opioids either expect to be offered naloxone or would appreciate it.2
Human storiesThe director of the Australian Research Centre in Sex, Health and Society at LaTrobe University, Professor Suzanne Frazer, led a recent research project into why naloxone was not accessed more widely. Researchers interviewed 37 health professionals and also 46 people in New South Wales and Victoria who take opioids and found that many were either unaware of how to obtain the reversal agent or were too embarrassed. Yesterday (Tuesday) the experiences and stories collected through that research were shared on Overdoselifesavers.org, a website launched at the Australasian Professional Society on Alcohol and Other Drugs conference in Hobart. ‘Many people we interviewed were keen to know about naloxone, and access it, but were concerned about confidentiality when speaking to pharmacists, or didn’t want to bring it up with their GP in case it affected their relationship in the future,’ Professor Frazer said. ‘We need to rethink our social attitudes to opioid consumption and overdose if naloxone programs are to fully achieve their life-saving potential,’ she said yesterday.
Role of the pharmacistExperience with naloxone may be limited in the community, but pharmacists are uniquely placed to identify people at risk of opioid toxicity and provide them with a reversal agent. Being alert for the signs of opioid overdose, and then facilitating access to naloxone and training for family and friends, presents a good opportunity for pharmacists to undertake early intervention. And naloxone is safe with no abuse potential. Australian and international studies have demonstrated that supplying naloxone for a layperson to administer is safe, feasible and cost-effective.2 ‘In the nasal formulation, a simpler, more convenient preparation is able to be readily administered without extensive training,’ Mr Jackson said. Naloxone is a competitive antagonist at opioid receptors with a fast onset of action and a short half-life. When administered in the presence of an opioid, it displaces the opioid at the receptor and reverses its effects – importantly respiratory depression which can be fatal. It works for all opioids, e.g. heroin, morphine and oxycodone as well as opioid substitution therapies such as methadone. It is also safe in nonusers. When given to healthy volunteers with no recent exposure to opioids, naloxone showed no adverse effects.2 In 2016, naloxone injection 400 microgram/mL became available as a Schedule 3 medicine, available over-the-counter (OTC) and on prescription. It is approved for intramuscular, intravenous and subcutaneous use in Australia, and has been used by ambulance and paramedical staff to treat overdose for over 40 years.2 Naloxone nasal spray, 1.8 mg/actuation, became available OTC and on prescription (PBS subsidised on 1 November), earlier this year. Mr Jackson said that ‘pharmacists need to develop the capability to identify and assess high-risk individuals in a non-stigmatising manner’. From the PSA guidance document, pharmacists can identify high-risk factors (e.g. high opioid dose (>100 mg morphine equivalents/day)), long-acting form (e.g. methadone) or extended-release preparation). The person may have a respiratory condition, or smoke or take other central nervous system depressants, or may be part of a methadone or detoxification program. Pharmacists should discuss with patients/carers the risks associated with opioids, and supply naloxone where appropriate. Also, ensure the person has been provided with an emergency opioid overdose protocol.2 ‘In training people to recognise the symptoms of opioid overdose and how to administer the nasal spray, pharmacists should ensure [they] understand it is not a substitute for professional medical care, and further doses of naloxone may be required,’ Mr Jackson warned. Although the nasal spray contains two single dose devices, ‘emergency assistance should be sought whenever an opioid overdose is suspected and the spray administered’, he added. ‘The [nasal] spray can be administered even if the person is not breathing.’ Inform users that ‘each device contains only one spray and should not be pumped or “primed” before use.’ Be mindful that naloxone has a half-life <1 hour, which is shorter than all the opioids. Observe the patient for 2–3 hours after naloxone administration for relapse. This is particularly important following methadone or controlled-release opioids, where narcosis may persist for >24 hours.3
ResourcesRefer to the PSA guidance document for the use of naloxone nasal spray in children, pregnancy and while breastfeeding, where the infant needs to be monitored for opioid withdrawal symptoms. Also, refer to the recommendations when supplied to a third party and follow–up advice.1 A training resource is available at: www.penington.org.au/programs-and-campaigns/resources/cope-overdose-first-aid Although the nasal spray formulation is expensive at present, Mr Jackson said we can expect to see a price reduction, especially as multiple brands are available overseas. References
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- Pharmaceutical Society of Australia. Guidance for provision of a Pharmacist Only medicine: Naloxone. Canberra: PSA; 2019.
- Jauncey ME, Nielsen S. Community use of naloxone for opioid overdose. Aust Prescr 2017;40:137–40.
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Case scenarioHarold, a 68–year–old man who regularly visits your pharmacy, has come in today to have a new prescription dispensed for isosorbide mononitrate controlled–release 60 mg tablets (one daily) for recent episodes of angina. Harold isn’t happy. He tells you his wife and his GP want him to quit smoking because of his heart. However, when he has tried to quit in the past it was too hard, he believes it is because he has been smoking for too long. He has a 40 pack–year history. Harold knows smoking isn’t good for his health and would like to stop but finds the habit too hard to break. When counselling him on his prescription, what advice would you give to encourage him to consider quitting smoking again?
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
Figure 2 – Benefits of quitting20 MINUTES Resting heart rate reduces– which is a key indicator of overall fitness level 12 HOURS The carbon monoxide in the blood reduces dramatically which improves oxygen levels 2–12 WEEKS The risk of heart attack begins to reduce and blood circulation improves. Lung function improves as well, making it much easier to exercise 1– 9 MONTHS Coughing, wheezing and breathing problems reduce as lung function continues to improve 1 YEAR The risk of heart attack reduces by half 5 YEARS The risk of stroke reduces to that of a non-smoker 5–15 years after quitting 10-15 YEARS The risk of heart attack reduces to that of someone who has never smoked before. The risk of lung cancer reduces to about half of that of a smoker Reference: WHO9
Case scenario continuedAssure Harold that evidence shows that stopping smoking can be done, even with his long-term high dependency. Explain the health benefits of quitting, especially the cardiovascular benefits, and offer him the WHO fact sheet: https://who.int/tobacco/quitting/benefits/en/ Discuss NRT with Harold. Considering his high dependency, suggest a combination of a nicotine patch and a short-acting preparation of his preference. Refer to appropriate references and ensure his dose is adequate. He could see his GP for a nicotine patch, which is available on the PBS. Refer him to Quitline. Offer your support throughout the quitting journey and ask him to return in 2 weeks to see how he is going.
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Case scenarioYou have been asked to perform a home medicines review (HMR) for Jack. Jack is an 82-year-old man who had an ischaemic stroke 3 weeks ago and is having his medicines reviewed by you as part of his HMR. He has a past medical history of hypertension and was prescribed atenolol prior to his stroke. He has no allergies nor other comorbidities. He has had a few dizzy spells recently and his blood pressure is on the low side. He tells you he has otherwise recovered well from his stroke and is currently taking:
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|MODIFIABLE RISK FACTOR||STROKE DEATHS (%)||TYPE OF STROKE MOST LIKELY CAUSED||FIRST-LINE TREATMENTS|
|Hypertension||28||I or H||ACEI, CCBs|
|Carotid artery stenosis||Unclear||I||Antiplatelets, Statins|
|Current tobacco use||Unclear||I or H||NRT, buproprion, varenicline|
|Diabetes||Unclear||I||Metformin, SGLT2 Inhibitors|
|Poor diet||Unclear||I or H||Non-drug treatments preferred|
|Physical inactivity||Unclear||I||Non-drug treatments preferred|
|Increase in waist to hip ratio||Unclear||I or H||Non-drug treatments preferred|
|Excessive alcohol||Unclear||I or H||Non-drug treatments preferred|
BOX 1 – STRATEGIES TO REDUCE BLEEDING
|Mechanism||Vitamin K antagonist||Factor Xa inhibitor||Factor Xa inhibitor||Direct thrombin inhibitor|
|Dosing frequency||Daily||Twice daily||Daily||Twice daily|
|Oral bioavailability (%)||100||50||>80||6.5*|
|% excreted unchanged in urine||0||34||36||85|
|Half-life in healthy volunteers (hours)||Highly variable 20-60||12||5-15 (mean=7)||13.4|
|Potential for drug interactions||CYP2C9, CYP1A2, CYP3A4 plus many others||PGP, CYP3A4||PGP, CYP3A4||PGP, PPIs|
|Antidote||Vitamin K (phytomenadione)||Andexanet alfa||Andexanet alfa||Idarucizumab|
|TRIAL||TRIAL TYPE||PATIENTS||STUDY LOCATION||DURATION (YEARS)||HR FOR ALL-CAUSE MORTALITY (95% CI)||HR FOR STROKE (95% CI)||HR FOR BLEEDING (95% CI)|
|ASPREE||Double blind placebo controlled RCT||n = 19,114||Australia/US||Median follow up 4.7||1.14* (1.01–1.29), NS||0.89 (0.71–1.11), NS||1.38* (1.18–1.62), P<0.001|
|ARRIVE||Double blind placebo controlled RCT||n = 12,546||Mainly Germany/UK||Median follow up 5||0.99 (0.80– 1.24), NS||1.12* (0.80–1.55), NS||2.11* (1.36–3.28), p=0·0007|
|ASCEND||Double blind placebo controlled RCT||n = 15,480||UK||Mean follow up 7.4||0.94 (0.85– 1.04), NS||1.12* (0.70–1.77), NS||1.29* (1.09–1.52), p=0.003|
|ATT||n = 40,821 with acute IS||Any antiplatelet||Placebo||11% RRR composite of IS/MI/death in patients with acute stroke||P= 0.00002|
|ATT||n = 23,020 with prior IS/TIA||Any antiplatelet||Placebo||22% RRR composite of IS/MI/death for long term secondary prevention||P=0.0003|
|ESPS-2||n = 6,602 with prior IS/TIA||Aspirin with dipyridamole (A+D)||Either drug alone or placebo||18% RRR IS, aspirin vs placebo 37% RRR IS, (A+D) v placebo||P=0.013 P<0.001|
|CAPRIE||n = 12,033 with prior IS||Clopidogrel||Aspirin||7% RRR in composite outcome of any stroke /MI/ death from any cause 8.7% RRR in IS, MI or vascular death||P=0.26 P=0.043|
|SOCRATES||n = 13,199 with IS/TIA||Ticagrelor||Aspirin||11% RRR in composite outcome of IS/MI/death 14% RRR stroke||P = 0.07 P = 0.046|
|DUAL ANTIPLATELET THERAPY|
|ESPIRIT||n = 2,739 with prior IS/TIA||Aspirin with dipyridamole (A+D)||Aspirin||20% RRR in a composite of CV death non-fatal stroke, non-fatal MI, bleeding complication 16% RRR in IS||p-value not stated 95% CI 0.66–0.98 p-value not stated 95% CI (0.64-1.10)|
|ESPS-2||n = 6,602 with prior IS/TIA||Aspirin with dipyridamole||Either drug alone or placebo||18% RRR IS Aspirin vs placebo 37% RRR IS (A+D) v placebo||P = 0.013 P<0.001|
|PROFESS||n = 20,332 with IS||Aspirin with dipyridamole||Clopidogrel||No difference in recurrent IS (HR = 1.01)||P value not stated 95% CI (0.92-1.11)|
|MATCH||n = 7,599 with IS/TIA||Aspirin with clopidogrel||Clopidogrel||No difference in IS (HR = 1.00) 6.4% RRR in composite end point of IS, MI, vascular death or rehospitalisation for ischemic events||P value not stated 95% CI (-4.6% to 16.3%)|
|CHANCE||n = 5,170 with IS/TIA||Aspirin with clopidogrel||Aspirin||32% RRR in IS (8.2% vs 11.7%) after 90 days||P<0.001|
|POINT||n = 4,881 with stroke or TIA||Aspirin with clopidogrel||Aspirin||25% RRR in IS (5% vs 6.5%) after 90 days||P = 0.02|
|TRIPLE ANTIPLATELET THERAPY|
|TARDIS||n = 3,096 with IS/ TIA||Aspirin + Dipyridamole + clopidogrel||Clopidogrel OR Aspirin + Dipyridamole||RRR=10% but stopped early due to significantly increased risk of bleeding (RRI 154%)||P = 0.47 P = 0.0001|
Case scenario continuedAs part of your HMR, you confirm that Jack does not suffer from AF. He tells you that he often forgets to take his tablets, which hasn’t been an issue in the past. You are concerned that Jack’s dizzy spells and low blood pressure may result in syncopal episodes. In your recommendation to his doctor, you suggest that Jack down titrates and ceases his atenolol. You recommend that he continues taking clopidogrel 75 mg daily and atorvastatin 40 mg daily, with a potential consideration to increase atorvastatin to 80 mg daily if tolerated. BP, lipid levels, U+Es and LFTs should be monitored routinely. Jack should be provided with both verbal and written education. Jack may have some cognitive deficit as a result of his stroke. He may benefit from a dose administration aid. You advise him that, should he wish, this can be organised for him. Jack feels that this may help him remember to take his tablets and thanks you for your time.
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IntroductionHypertension is a significant burden on the Australian healthcare system. In 2017 to 2018, close to 6.3 million adult Australians reported having measured high blood pressure (BP), hypertension as a medical condition or the use of antihypertensive medicines.1
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
BOX 1 – PARAMETERS FOR ABSOLUTE CARDIOVASCULAR RISK CALCULATION
|DIAGNOSTIC CATEGORY*||SYSTOLIC (mmHg)||DIASTOLIC (mmHg)|
|Grade 1 (mild) hypertension||140–159||and/or||90–99|
|Grade 2 (moderate) hypertension||160–179||and/or||100–109|
|Grade 3 (severe) hypertension||≥180||and/or||≥110|
|Isolated systolic hypertension||>140||and||<90|
|CLASS||PHARMACODYNAMICS||PLACE IN CLINICAL PRACTICE|
||Reduce blood pressure by reducing vasoconstriction, sodium reabsorption and aldosterone release through inhibition of conversion of angiotensin-1 to angiotensin-2, and subsequent reduction of angiotensin-2-induced effects.14 ACE inhibitors also inhibit the breakdown of bradykinin, commonly resulting in a persistent dry cough.14||ACE inhibitors are considered a suitable first-line option for the treatment of hypertension that is uncomplicated by other co-morbidities.3 ACE inhibitors (or ARBs) are recommended as first-line hypertension therapy in patients with chronic kidney disease (CKD) with micro or macro albuminuria.3 ACE inhibitors are recommended for secondary prevention of ischaemic heart disease (IHD) in patients with certain concurrent indications, including hypertension.32 ACE inhibitors are recommended in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF), in order to reduce mortality and hospitalisation.33|
||Reduce blood pressure by reducing vasoconstriction, sodium reabsorption and aldosterone release through competitive antagonism of type 1 angiotensin-2 receptors, and subsequent reduction of angiotensin-2-induced effects.14 ARBs do not inhibit bradykinin breakdown and are therefore often used as an alternative to ACE inhibitors if a patient experiences a persistent, dry cough with ACE inhibitor therapy.14||ARBs are considered a suitable first-line option for the treatment of hypertension that is uncomplicated by other co-morbidities.3 ARBs (or ACE inhibitors) are recommended as first-line hypertension therapy in patients with CKD with micro or macro albuminuria.3 ARBs are inferior to ACE inhibitors in the prevention of IHD,22 and in reduction of mortality in patients with HF.34 However, it is reasonable to use ARBs instead of ACE inhibitors in this population if there is an intolerance to ACE inhibitors (caution in angioedema).3,14|
||Induce diuresis via inhibition of sodium and chloride reabsorption in the distal convoluted tubule of the nephron, with additional increased potassium excretion.14 Antihypertensive effects at low doses are hypothesised to be the result of various direct and indirect vasodilatory actions, with no clear consensus for the mechanism thiazide-induced vasodilation.35||Thiazide (and thiazide-related) diuretics are considered a suitable first-line option for treatment of hypertension that is uncomplicated by other comorbidities.3 However, thiazide diuretics are associated with an increased risk of diabetes onset, requiring careful consideration of this risk against the benefit gained from managing hypertension in the context of patient age.3,36 In practice, thiazide diuretics do not often end up being first-line agents in treating hypertension in co-morbid conditions such as CKD, IHD, HF and atrial fibrillation. This is due to the preference of other agents (such as ACE inhibitors, ARBs and beta blockers) for the treatment and secondary prevention of the co-morbid condition.3,32,33,37|
|Calcium channel blockers
||Reduce blood pressure by reduction of peripheral vascular resistance through reduction of calcium influx into smooth muscle.14 This effect is seen in arteriolar smooth muscle with dihydropyridine calcium channel blockers, and, to a lesser extent, diltiazem.14 Non-dihydropyridine calcium channel blockers (diltiazem and verapamil) also have this effect on cardiac smooth muscle, resulting in; reduction of heart rate, cardiac contractility, myocardial oxygen requirements and angina symptoms.14||Calcium channel blockers are considered a suitable first-line option for the treatment of hypertension that is uncomplicated by other co-morbidities.3 The combination of calcium channel blockers with ACE inhibitors is superior to either ACE inhibitors with diuretics or beta-blockers with diuretics for the reduction of cardiovascular events and mortality in the treatment of uncomplicated hypertension.38,39 In practice, calcium channel blockers do not often end up being first-line agents for monotherapy in treating hypertension in co-morbid conditions such as CKD, IHD and HF. This is due to the preference of other agents (such as ACE inhibitors, ARBs and beta blockers) for the treatment and secondary prevention of the co-morbid condition.3,32,33 Conversely, non-dihydropyridine calcium channel blockers are a first-line option for rate control in the treatment of atrial fibrillation (in patients without heart failure).37 Thus, treatment of hypertension in this population should be balanced with and account for the antihypertensive effects of rate control agents already employed.|
||Reduce blood pressure mainly by reduction of cardiac output via antagonism of beta-1 adrenoreceptors on cardiac tissue. Antagonism of beta-1 adrenoreceptors causes reductions in heart rate, cardiac contractility, cardiac conduction and relaxation rate.14 Additionally, beta-blockers can antagonize peripherally located beta-2 adrenoreceptors accounting for a myriad of additional, non-cardiac physiological effects.14 Finally, carvedilol and labetalol also antagonize peripheral alpha-1 receptors, causing additional antihypertensive effects from vasodilation.14 Differences in the selectivity of individual beta-blockers for the different types of adrenoreceptors account, for the most part, for the preference of certain betablockers in certain clinical conditions, and the variation in side-effect profiles.||Beta-blockers are not recommended as a first-line option for the treatment of hypertension that is uncomplicated by other co-morbidities, due to the unfavourable balance between safety and efficacy.3 However, selected beta-blockers are recommended for: secondary prevention of ischaemic heart disease in patients with reduced LVEF.32 management of heart failure in patients with moderately or severely reduced LVEF (may be considered in patients with mildly reduced LVEF).33 a first-line option for rate control in the treatment of atrial fibrillation with co-morbid heart failure (alternative beta-blockers are considered suitable in the absence of heart failure).37 Thus, the treatment of hypertension in the co-morbid populations listed above should be balanced with and account for the antihypertensive effects of agents used for management and secondary prevention of the relevant co-morbid condition. Selected beta-blockers: carvedilol, bisoprolol, slow-release metoprolol and nebivolol.3|
|MEDICATION||BRAND NAME||MEDICATION||BRAND NAME||MEDICATION||BRAND NAME|
|Angiotensin Receptor Blocker Combinations||Angiotensin Converting Enzyme Inhibitor Combinations||Other Combinations|
|Olmesartan||Olmetec||Enalapril||Multiple brands||Triamterene||Not available|
|+amlodipine||Sevikar||+hydrocholorthiazide||Enalapril/HCT, Sandoz, Renitec Plus||+Hydrocholorthiazide||Hydrene|
|+amlodipine +hydrochlorothiazide||Sevikar HCT||Fosinopril||Monopril Fosipril||+Hydrocholorthiazide||Moduretic|
|+amlodipine +hydrochlorothiazide||Exforge HCT||+Indapamide||Coversyl Plus|
|+Hydrochlorothiazide||Avapro HCT, Karvezide||+verapamil||Tarka|
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Case scenarioImogen is a 15-year-old girl who comes into the pharmacy with her mother. She states that she started to develop acne about 1 year ago. Recently her acne has become worse and she is now embarrassed about the appearance of her skin. You notice that she has some comedones and a few pustules on her nose and chin. She wants to know what she can apply to clear up her pimples. Imogen has not previously used any products on her acne and is not on any other medicines.
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8617 [post_author] => 131 [post_date] => 2019-11-10 00:56:34 [post_date_gmt] => 2019-11-09 14:56:34 [post_content] => The most fundamental change in asthma management in 30 years is currently happening. The Global Initiative for Asthma (GINA) no longer recommends treating asthma in adults and adolescents with short-acting bronchodilators alone. Instead, they should receive a symptom-driven (in mild asthma) or daily corticosteroid-containing inhaler, to reduce the risk of severe exacerbations.1
Learning objectivesAfter successful completion of this CPD activity, pharmacists should be able to:
|GOOD CONTROL||PARTIAL CONTROL||POOR CONTROL|
||One or two of:
||Three or more of:
|PATIENT CHARACTERISTICS||SALBUTAMOL||BUD MAINTENANCE||BUD-FOR|
|Mean age (years)||35.8||34.9||36|
|Current smoker (%)||24||22||18|
|SABA use ≤2 occasions per week (%)||57||58.7||47.7|
|Median puffs per week||4||4||4|
|Any severe exacerbations in previous year (%)||9||7.6||5.5|
|TRIAL||BUDESONIDE MAINTENANCE GROUP||BUDESONIDE/FORMOTEROL AS-NEEDED GROUP|
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 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8769 [post_author] => 235 [post_date] => 2019-11-27 09:13:11 [post_date_gmt] => 2019-11-26 23:13:11 [post_content] => Three outstanding pharmacists recognised at the 2019 Victorian Pharmacists Dinner in Melbourne last week represent the difference dedicated members of the profession make every day to healthcare in the community. The executive officer of the Pharmacists’ Support Service (PSS), Kay Dunkley MPS, was awarded the PSA Victorian Excellence Award for her commitment to improving the wellbeing of health professionals, particularly through peer support. [caption id="attachment_8788" align="alignright" width="219"] Kay Dunkley MPS[/caption] This includes her involvement with the PSS and her help in establishing the AMA Victoria Peer Support Service in 2008. She has also travelled extensively in Australia and the United Kingdom promoting the welfare of pharmacists and pharmacy students. Ms Dunkley said a highlight of her work was ‘being able to make a difference to the lives of those we care for as pharmacists’. ‘PSS is about caring for each other within the pharmacy profession to ensure that as a profession we can care for the Australian community,’ she said. ‘I really value the generosity of the PSS volunteers in giving their time and energy to be there for their colleagues in times of stress.’ The inaugural Victorian Early Career Pharmacist (ECP) of the Year title was won by Amanda Cross MPS. A postdoctoral research fellow at the Monash Department of Clinical Epidemiology, Cabrini Institute, Dr Cross has already gained a high level of expertise in research and clinical practice and is an exemplary role model for other ECPs. She is also an Australian Pharmacist columnist. [caption id="attachment_8791" align="alignright" width="219"] Amanda Cross MPS[/caption] Her PhD, awarded this year just months before giving birth to her second child, focused on the prevalence and impact of potentially inappropriate medication use in older people with cognitive impairment, which has implications for medicine safety in Australia. Dr Cross said she chose to do a PhD to try and make a difference on a larger scale. ‘I would frequently see patients struggling with medicine adherence and commonly using inappropriate medicines,’ she said. ‘Medicine safety is important to me because as a pharmacist it is my responsibility to ensure people are taking the right medicines, at the right dose, for the right duration to ensure the medicine is creating more benefit than harm.’ [caption id="attachment_8782" align="alignright" width="219"] Roslyn Stewart MPS[/caption] The Victorian Pharmacist Medal was awarded to Roslyn Stewart MPS, in recognition of her wide-ranging, 40-year career which included time at the Fairfield Infectious Diseases Hospital during the AIDS epidemic and as a senior pharmacist at the Royal Melbourne Hospital before 20 years in community pharmacy. She has also conducted medicines reviews in aged care facilities and the community, and does volunteer work as a Mental Health First Aid Instructor. Reflecting on her career, Ms Stewart said being a pharmacist offered a wealth of options. ‘I have taken advantage of this, working in research, hospital and community pharmacy,’ she said. ‘I have enjoyed each new challenge. Few careers provide this type of flexibility.’ [post_title] => Leading Victorian pharmacists honoured [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => leading-victorian-pharmacists-honoured [to_ping] => [pinged] => [post_modified] => 2019-11-27 13:43:06 [post_modified_gmt] => 2019-11-27 03:43:06 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=8769 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Leading Victorian pharmacists honoured [title] => Leading Victorian pharmacists honoured [href] => https://www.australianpharmacist.com.au/leading-victorian-pharmacists-honoured/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 8785 )
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8664 [post_author] => 11 [post_date] => 2019-11-12 13:31:18 [post_date_gmt] => 2019-11-12 03:31:18 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Claire O’Reilly was an intern pharmacist when a patient experience got her thinking about a pharmacist’s role in improving mental health care. Now she’s Dr Claire O’Reilly FPS – academic, mental health researcher and trainer.
How did you find this role?There was a situation when I was an intern pharmacist and a regular patient was having an acute psychotic episode. I learned so much watching the senior pharmacist that day – she was wonderful at keeping the patient calm and in the pharmacy until we could get help. It led me to reflect that we don’t really teach pharmacists how to handle those situations.
What did you learn early, during a University of Sydney project evaluating the role of pharmacists within community mental health teams?I was doing medication reviews and participating in team handover meetings and saw pharmacists could really help address polypharmacy and the many physical health issues that arise, particularly in complex mental health cases.
Now you’re a senior lecturer, what are your research focusses?One focus is on how we can better prepare and upskill pharmacists to feel confident supporting people with a mental illness. The other is growing the evidence base for how pharmacists can contribute to better outcomes for people with mental illness. We’re doing projects around how pharmacists can screen people who might be at risk of depression, and how they can intervene and support in a mental health crisis.
Day-to-day, what are the biggest challenges you face?In a university academic role there is always the challenge of juggling teaching and research commitments and there’s often pressures around publishing your work and sourcing grants to support it. Before I embarked on this career pathway it would have been helpful to have more insight into challenges around getting grant funding but, having said that, I don’t think it would have changed my decision.
What is the most satisfying part of your job?The most tangible rewards are related to pharmacists who have come along to a training course I’ve run and contacted me afterwards to say, ‘thank you so much for the skills that I learned. This person came into the pharmacy in a crisis and I felt so much more confident to be able to help them due to the training’.
Where will this career path take you?I hope to continue to develop the evidence base for pharmacists in mental health care so that we can design some more specific career pathways. Ideally, I’d like to see the creation of a primary health care mental health pharmacist role. I’d also like to see more opportunities in the community pharmacy setting, for embedding pharmacists within community mental health teams, and for pharmacists playing roles in mental health triage, early intervention, crisis support and suicide prevention.
POINTERSPharmacists interested in mental health can consider PSA CPD point offerings at https://my.psa.org.au/s/education-catalogue:
A DAY IN THE LIFE OF
Dr Claire O’Reilly FPS University of Sydney senior lecturer in pharmacy practice8:00 am: Prepare response to research paper review Arrive at work, check and respond to colleague and student emails, prepare response to reviewer comments on a research paper investigating peoples’ experiences of stigma and discrimination in mental illness. Get a coffee! 9:00 am: Honours student supervision Meet with pharmacy honours student to discuss progress with honours research project investigating pharmacists’ experiences of people who have died by suicide and resulting personal and professional impacts. 10:00 am: Video conference on research project Join a video conference with interstate research colleagues to discuss details of an upcoming research project developing a pharmacist-led support service for people living with severe and persistent mental illness, focussing on improving adherence and physical health care needs of consumers. 11:00 am: Curriculum planning Meeting with pharmacy academic colleagues to discuss development of our new pharmacy undergraduate curriculum. 12 pm: Working lunch Lunch and prepare materials for afternoon of teaching pharmacy students. 1-5 pm: Mental health training for students Deliver a session of Mental Health First Aid (MHFA) training to fourth year pharmacy students. This is provided to all our final pharmacy students as an embedded part of our BPharm and MPharm curricula. In the weeks following MHFA training our students undergo simulated patient assessment to test their newly acquired MHFA skills. 5:00 pm: Academic day ends Head home to spend the evening with my family.
td_module_mega_menu Object ( [authorType] => [post] => WP_Post Object ( [ID] => 8658 [post_author] => 82 [post_date] => 2019-11-12 13:11:54 [post_date_gmt] => 2019-11-12 03:11:54 [post_content] => [vc_row][vc_column width="2/3"][vc_column_text]Dimitra Tsucalas FPS, co-owner of Ascot Vale Supercare Pharmacy, has seen it all. From late-night triage, shift workers, opioid seekers and everything in between, she says the best thing about 24-hour trade is the ability for patients to access a healthcare professional at any time.
What are the patient benefits of Supercare 24-hour pharmacies?The benefits are essentially that they can approach a health professional to ascertain whether they need to get something that can resolve their problem reasonably quickly or [whether] they need to get to the next level to an Emergency Department or see a doctor; whether it’s something they need to worry about or not. Essentially, they are seeing a health professional to triage – to either treat at a primary care level or move into the next stage – and they’re accessible at all hours. So, at 2am when the itch becomes absolutely intolerable they can come and see someone. Or if symptoms are so problematic that it’s causing them anxiety they can come and see someone and decide whether they need to go to the Emergency Department.
What are challenges you might face after hours?One of the biggest challenges was managing patients seeking over-the-counter codeine products. Now that has shifted to codeine containing and/or other medicines that are dependence inducing or potentially dangerous. This issue is addressed to a great extent by SafeScript. But the challenge with SafeScript is that the pharmacist then becomes a police officer. Certainly at night, people will try to obtain medicines when they shouldn’t. A refusal to fill a script can create the potential for confrontation – both physical and verbal. For young graduates or new employees working overnight, it can be quite confronting.
How long has your practice been using SafeScript?Since the beginning. We use FRED pharmacy software, so any SafeScript warnings pop up as an alert, urging us to look into the person’s supply history.
What are you most proud of from your involvement in a Supercare pharmacy?It is a big job transitioning from eight staff to 28 staff. It introduces a lot of new learning opportunities and challenges and you’ve got to keep making it work. You are professionally stimulated. I think all after-hours work can be, especially if you are working on your own. So, pharmacists working on their own of an evening and overnight have to make calls that they don’t make necessarily on their own through the day. They can’t call a doctor and they can’t call a colleague so they will have to make the call. I think it’s empowering. The best thing about 24-hour trade is professional accessibility.
Dimitra Tsucalas on a typical overnight shift11.00 pm Unsure about whether to go to hospital for stitches, a mum brings in her two-year-old boy with a minor gash over his eyebrow. It is a small, clean cut. The bleeding has stopped and there are no red flags in his behaviour or appearance. I suggest some Solosite® gel to keep it moist and promote healing, and tell her to monitor for redness, inflammation or easily visible pus. I tell her to come back in or see a GP for review in 1–2 days if the wound is not healing. Midnight A mother brings in her daughter, 17, who has an exam the next day. Unwell and unable to focus or study, she has urinary frequency indicating a possible urinary tract infection. Her options: call overnight doctor services for assessment and possibly an antibiotic script if indicated; purchase hexamine as a stop-gap until her GP can be seen next morning or after her exam; or try the Instant-Script® service which assesses and allows for a trimethoprim script so she can begin treatment before review by her GP. 1.00 am A pregnant lady is brought in by her partner with dizziness, weakness and fainting. She is unable to keep anything down so dehydration is possible. We provide a private consult room for her to lie down while taking her blood pressure and blood sugar, and then decide to call an ambulance. She is taken to the Emergency Department for assessment. 3.00 am A regular customer arrives with a script she forgot to fill earlier. She asks about an itchy eye corner for which she had already tried allergy drops numerous times in recent months. A slightly elevated area near her nose bridge is visible, which is still itchy. I don’t supply her a product. Instead, I suggest a referral to an ophthalmologist or at least an optometrist for triage. She calls a month later: it was a malignant growth which has been removed. She gives her thanks. Dawn The phone rings. It is a dad with an 18-month-old baby calling about a dose of paracetamol, but he only has a bottle of Panadol® 5–12 Years at home. He asks if this is ok, and about the size of the dose. I tell him that it’s fine and ask how much the baby weighs so I can calculate the dose.
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