Codeine Abuse: what are you doing?

Should codeine containing products be regulated? How do we curb the rampant concerns of abuse we face in our daily settings as pharmacists? 

Well this short article raises a few suggestions but many more questions. 

We've all seen the typical codeine suspect coming in to get yet another box of "codein" with a friendly smile and a ready-to-use excuse. 

It's for family, I forgot mine at home, I travelled... etc etc. 

We indulge them more often then not and advise them to only buy for themselves and not for other family members but is it enough? 

It's especially worrying when they directly request (by name) specific codeine syrups and combination flu tablets without allowing the dispenser to suggest anything else or even slightly deviate from their request! There's no telling what goes in their private homes.. do they drink the whole bottle and take multiple pills at once? 

We often see notes or alerts left by previous dispenser warning the next dispenser of a possible addiction or misuse; But when do we say NO and refuse to sell?

Should there be a form that they fill much like that of the morning after/ emergency contraception? 

Should the law change yo limit the number of purchases of pack size and frequency per month? 

Should health care professionals make a bigger effort to educate populations against the misuse of codeine and its dangers? 

If we have sugar tax and other bizzar regulations surely the state can be more stringent concerning its beloved citizens' health? 

If you had a say and a national impact how would you address the issue of codeine abuse and misuse. 

Codeine:

You work too well for your own good. 

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What are Consultant Pharmacists?

Have you heard of consultant pharmacists?

Do you perhaps know one?

Consultant pharmacists are a new thing in Africa! This specialty is more common abroad, however it is still growing and patients are now getting to know what it's all about.

So what is consulting pharmacy?

 In summary, it's a one-on-one specialized consulting service provided by a pharmacist to a client. It goes deeper than what you typically experience at your retail pharmacy when you go in to fill a prescription or inquire to buy some over the counter medication. Consultant pharmacists provide information, dig much deeper, and perform complex investigations to provide well rounded, complete health care analysis and assessments.

They are therefore suitable for:

Private patients: who seek private one-on-one sessions. 

Those with Co-morbidities : patients who have multiple chronic diseases or illnesses and find themselves with many regimens to follow. Eg. A diabetic, hypertensive hyperlipidemic patient with heart failure.

The elderly: apart form falling in the first described category, the elderly have fragile sensitive systems. Excretion, metabolism and other functions usually decrease with age and therefore dose monitoring and drug adjustments are frequently necessary.

The miscellaneous: anyone with unusual, uncommon or rare conditions seeking additional support, resources or health care guidance.

Consultant Pharmacist also provide drug information to patients with uncomplicated prescriptions and those seeking daily medicinal advice.

MRs (medicines review) are individualized drug reviews done in certain pertinent instances.

CMRs (Complete Medicines Reviews)  or sometimes called comprehensive medication review are done on the entire patient profile. Whether annually or quarterly, Therese thorough reviews are done to monitor and track hidden issues unperceived by patients or their carers.

MTMs (medication therapy management) are a combination of reviews and action plans set to streamline, and simplify misunderstandings and complexities.

This specialty comes as a result of therapy gaps, mistakes, and non-adherence due to mis-coordination, multiple prescribers, and patient misunderstandings exacerbated by unbearable side effect profiles.

As pharmacists we always try to encourage patients to participate in their health care and thus become empowered to improve it.

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The Morning after Pill: Did You Know?

Here's a WHO, WHAT, WHEN, WHERE, & WHY breakdown about the mighty, infamous morning after pill. If you've ever wondered about it's uses, or have been too scared to ask; here is the 411.

Who: the pill is made to work on the female reproductive system to alter female hormones (for those who are of child bearing age and fertile) and it should therefore only be purchased and ingested by them, in an "emergency" situation.

What: these POP (progesterone only pills) /emergency contraceptives are high dose progesterone pills taken orally to prevent pregnancy. They should NOT therefore be taken if pregnancy is suspected or has been established.

When: the 'emergency pill' is preferably taken within 12h of unprotected intercourse. The sooner it is taken after intercourse, the  greater the percentage chance of preventing pregnancy. Its efficacy decreases with passing time. It should NOT be taken as a regular contraceptive pill and should not be repeated frequently as it may cause severe hormonal stress and disturbances.

Where: it acts to prevent ovulation and implantation of a fertilized egg (ovum) in the uterus. Depending on the stage of menstrual cycle at which it is taken.

Why: Pops are taken to prevent pregnancy when the female is in her fertile period of her menstrual cycle. Typically during ovulation time. It should be avoided otherwise.

Many times ladies rush into the pharmacy with a panic and request the morning after pill without considering some very important points.

It is not warranted if:

-She is pregnant

-She wishes to fall pregnant

-She takes daily contraceptives or other forms of contraception ( however some antibiotics and other drugs may decrease the efficacy of contraceptives in which case a second preventative measure is needed)

-She has had her period within a week  (5 days) or is expecting it within a week.

-She has a known allergy or hypersensitivity to any component in the pill.

-She' s at high risk of arterial disease or has undiagnosed vaginal bleeding.

NOTE:

The pill is neither a first line (condom, pessary, foam, etc) nor a second line (patch, daily pill, injection etc) pregnancy prevention mechanism. It should therefore be taken seriously and strictly in emergencies. They also do not prevent against sexually transmitted diseases. Ladies (and their partners) should be adequately informed before opting to take it.

Be in the know. Stay safe.

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Why do we eat when taking tablets

We've all been advised to take our medication with food. Since childhood, it's a common thing to hear. Although most drugs don't actually require food, here's a couple of reasons why:

1. Disguise taste : many drugs have unpleasant tastes. By taking them with food, their foul tastes can be masked and avoided altogether. 

2. Reduce side effects (nausea and vomiting): drugs that have known and pronounced nausea and vomiting side effect profiles can be improved by advising patients to take them with food in an attempt to attenuate these reactions. Penicillins can cause nausea and by taking them with food, tolerance in most patients is improved. 

3. Metabolism: in some cases, food can delay, speed up or improve the absorption of certain drugs. In the case of some oral anti fungals for example, fatty food promotes absorption of acidic drugs. 

4. Sensitivities: the gastrointestinal tract is lined with soft delicate epithelial cells and these can often become sensitive in some patients; having food with drugs ensure that no direct contact with these cells and potentially abrasive drugs occur. In this case food acts as a protective lining to reduce irritations. 

It's important to note that, needing to take your medicine with food is not a call to gluttony. I'm most cases a piece of fruit or snack is enough. No need to fill up your plates and overindulge under pretext of medicine. 

Another point to note is that certain foods like grapefruit shouldn't be taken with medicine as it may induce metabolism 

And reduce drug efficacy. 

For these reasons and more, it is a rule of thumb to take medicine with food; Unless specifically indicated to be taken on an empty stomach. 

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Pharmacist Or Superhero? The extraordinary Lengths

We can all pull a list of some of the lawful, common duties that are required to be performed by a pharmacist in a retail setting, but what about those extra miles that go unnoticed, unspoken of and unwritten?

Here's a break down of just 6:

*They are babysitters: Mostly to certain identified less than careful GPs (some interns and/or weirdos) who often let a lot of basic mistakes slide in their prescriptions. Imagine phoning for dosages, directions or dates?! The validity of a script is one thing, but some errors are more fatal than others of course... thankfully your pharmacist is their to double check those discrepancies and save your life! They have to call, email, follow up, adjusting doses and rectifying drug mistakes or drug interactions. If you ever have a treatment concern or a question your pharmacist is the first person to ask.

*They are health care "bouncers": To ensure safety for patients, pharmacists monitor use of all medication. They are often shouted for refusing to refill expired prescriptions, early refills or excessive OTC purchases, but it's for patients' own good. Codeine abuse for example can only be curved by strict one item per patient enforcing rules. Let them responsibly safeguard your drug intake.

*They are life coaches: When patients have difficulties (even personal) they usually rant and ramble at the counter. Fortunately there's a pharmacist with a listening ear ready to indulge and advise that patient as best they can (esp when time allows). Both in a professional but empathetic manner. They get stopped at the grocery store, at the bank and pretty much anywhere in their community to answer pertinent personal questions and give guidance. When you have no one else to go to, pour out your heart to your pharmacist, they really care.

*They are multipurpose jugglers: Whether its your specialist, your medical aid, your GP or your dentist, pharmacists plat a key role in co ordinations with other health care practitioners. Between phone calls, prescriptions, compounding, emails, and  counselling; their juggling game is strong. They also know about unusual things not necessarily pertaining to the pharmacy. They sometimes go the extra mile to book appointments and make sure you are on track with your next check up.

*They are your advocate & supporter: They really care for your treatment adherence and outcomes. So much so that they often break the rules to help their patients obtain medicine or treatment promptly. They borrow, lend, and outsource all sorts of medication to ensure patients have their supply. Sometimes procedure will take days to be approved, but trust your pharmacist to make miracles happen. They are also known to supporting your wallet by saving you some coins on your medicines bills. They know what's on special, which generics to substitute and how to make your Rands go further. Some have even made personal home deliveries outside of work hours.

*Some are even magicians: The most unforeseen circumstances may occur where medicine is unavailable but your trusted pharmacist will make it appear in your dispensary ready for you to take home. They will mix, extract, compound and manipulate drugs in order to achieve the desired outcome but if the drug isn't even registered in the country, they are known to pull strings, obtain favours and deliveries from suppliers at the drop of a hat. When your medical aid refuses to pay for certain medicine under certain conditions, they have a few tricks up their sleeves that could work too. Marvel at their prowess.

There's a lot more that goes on behind the counter all for the sake of PATIENTS well being and there s nothing (almost) a pharmacist wouldn't do for their patient. Appreciate all the effort because most of it is definitely out of their scope.

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The "Generic" Myth Finally Debunked!

To substitute or not to substitute! That is the question!

It's not as clear-cut as we'd like it to be. Many drugs on the market are generics to originator (branded) drugs. Do they differ? Can they be substituted? To simplify it, the answer is two fold.

Yes, because they are (bio) equivalent but no because sometimes they are metabolized differently and therefore the experience is that: they're not the "same"?!

Some pharmacists will tell you 'it's the same'! And quite rightly so, often when addressing patient fears, uncertainties and issues of treatment accuracy. It's a quick answer to calm the patient down. A generic drug contains the same active ingredient, at the same dose than it's original counterpart. Therefore in this light, they ARE the same!

However, when it comes to efficacy and side effect profile, generic drugs might differ. This is because formulations (processes of manufacturing the drug and excipients or other additives) can differ.
Potency may also differ, as drug concentrations, release rates and absorption into plasma rates also differ. The regulated ranges for plasma concentrations (AUC) usually fluctuate between 85-110% match. Meaning a generic drug can be less or more potent than the original drug even at the same dose. Generic drug bio-equivalence have to be the same by law, but bio-equivalence doesn't necessarily mean tolerance equivalence either.
Patients may often complain that one generic doesn't work for them, or that the generic "feels" different. Besides a strong possibility of them just being picky or playing mind games, there is a real rationale behind it. It might actually be that they metabolize the generic differently and hence experience (effect and side-effect of) the generic drug more or less than with the originator.

The other common patient phobia is with pricing. Many patients feel cheated if a drug is too cheap. They actually want to pay more as they think it will "work better". Again it often is a mind game associated with perceived value. But the truth is, big price difference are  because of research setbacks.

The originator drug took time (including clinical trials) and lots money to develop, and so once it reaches the market for the first time, it benefits from patent exclusivity in sales. Usually 15-20 years. This is to recuperate the heavy research costs incurred and make profit for that manufacturing company.
After this period, the originator drug patent expires and is then made available to other manufacturers who can simply "copy" the 'recipe' for much less monetary investment and no research time. They therefore can slash the prices radically - hence cheaper generics.

At the end of the day, a generic drug will act in the same way as an original drug in effecting it's desired pharmacological effect. It may however feel different to a patient  who experiences it differently due to a difference in overall metabolism.

Next time a patient asks you if "they're the same", what will you say?


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10 Baby Pharmacy Hacks

So here are 10  helpful baby health tips for you when it comes to easing your baby routine!

Skip the queue: most facilities will agree to let a parent with a baby receive priority assistance especially if the child is in distress or crying. Kindly ask your pharmacist for prompt assistance.

Sooth Teething : with a clean finger, apply drops of the medicated solution dose to the gums and rub gently every 1-2hours. By dividing the dose into smaller intakes, pain threshold (local) coverage is better  experienced by baby. This is a great alternative to giving a full oral dose 4-6 times daily.
You get better symptomatic relief at the site and you can apply more frequently for soothing and control.

No spill: never use a spoon to give baby their medication. Rather use a syringe. It is better calibrated hence accurate and it also doesn't spill if they knock it with their hands or heads. Always dilute medicine in a bit of milk, or juice rather than the whole feed. This helps to mask the taste. If they don't finish the feed at least the full dose is taken.

Nappy rash: you will never have a nappy rash again if you apply an oil to baby's bum after each change. Unlike water based creams, oils don't completely absorb and therefore they form a good protective (anti-rash) layer on top of baby's skin.

Home made re-hydration: if baby has lost a lot of fluids, they easily become dehydrated especially if they've been vomiting or had diarrhea. This could quickly become dangerous and send you to the ER. However with one tbsp of sugar, half a tbsp of salt and a tall glass of pure/boiled/ filtered water, electrolytes can be replenished and resolve the situation. Administer in small intervals until diaper trends return to normal.

Baby change bag: when packing for baby, the usual diapers, wipes and bottles should be included but don't forget to add a change of clothes for the parent too! If baby throws up or squirts you during a change, your clothes may be embarrassingly messing afterward.

Baby medicine:  when giving an antibiotic or other liquid medicine to baby, to keep track of administered doses, draw a chart with all required doses on the side of the bottle with a permanent marker and tick as you go along. It can get quite confusing and losing track is easy.

Nail clipping: when baby has just falling asleep, wait 20 minutes and proceed to clipping their nails. This ensures no fussing and crying during this mandatory task.

Spit up or vomit stains: whether on the couch, catpet or your clothes, use a paste made with sodium bicarbonate (baking soda) and water. Apply generous amount to stain and let dry over night. Vacuum or wash in the morning!



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