Creating Value for Doctors, Pharmacists and Patients Vol:4
ue s Is s i Th n I
Issue: 18 Jan 1 - 15
2008 Price Rs20/-
Doctors Section 1- 2 & 11-12 Pharmacist Pages 3 - 4 & 9 -10 Patient Education 5 - 6 & 7- 8
Editor Desk WISHING ALL READERS A HAPPY AND HEALTHY 2008. Our efforts are to create value for all stake holders in healthcare. We are pleased to inform start of patient education section. This will help our Doctors and Pharmacists to share health related information with their patients. In India we have a funny situation the medical doctor has no time to spend with patients, as he has to see a number of patients. The pharmacist or his assistants do not have the necessary knowledge. Our effort to educate the pharmacist is continuing. Starting April 08 we hope to conduct one day personal contact programmes across India with the support WHO-India office. Now with intense competition in the market there is growing realization among pharmacists to acquire new knowledge, helping their customer to win and offer new value added services. 80% population of India visiting pharmacies, more than 2 lakh brands made pharmacists too busy to think of customer service. However in the name of access to drugs our drug control officials are issuing licenses right and left without following distance norms is creating pressure on pharmacists. The fast growing chain pharmacies offering better services with discounts is adding fuel to fire. Looking back at 2007 provides a sense of satisfaction. Our initiatives have led to a major conference on the role of pharmacists in healthcare- challenges and opportunities on October 30, at New Delhi. This conference is organized by south East Asia Pharma forum in collaboration with WHO-India. Our efforts to sensitize government that pharmacists are trusted, easily accessible basic healthcare workers are fruitful. We sincerely hope the biggest single stake holder of India healthcare –MOHFW will work together with us to build capacity among pharmacists and improve the health literacy of our patients.
(V. Bhava Narayana)
PhaRMeD TRADE NEWS
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Editor & Publisher
V. Bhava Narayana Associate Editors
EDITORIAL BOARD Prof.B.Suresh, President Pharmacy council of India
Dr. Aniruddha Malpani, M.D Dr. Mahesh Sharma,
Dr. Jawahar Bapna, Rtd Director, IIHMR
Prof. G.P.Mohanta
S.W. Deshpande, DG, AIDCOC
M.D (Ayurveda)
Dr. P.Hanumantha Rao, ASCI, Hyd
This Publication is Only for the use of Medical & Pharmacy Professionals Printed, Published and Owned by V. Bhavanarayana, and printed at Kala Jyothi Process Pvt. Ltd., 1-1-60/5, R.T.C. 'X' Roads, Musheerabad Hyderabad - 20. Published at 3-3-62/A New Gokhale Nagar, Ramanthapur, Hyderabad - 500 013, R.R. Dist. Editor : V. Bhavanarayana * RNI No.: APBIL/2004/12036 Postal LIC NO : HSE 806/2004-06. C Pharmed Trade News, 2004 * Person responsible under PRB act for selection of news
THE DOTCOM DOCTOR
NIMESULIDE International Society of Drug Bulletins (ISDB) Press Release 20 December 2007 Nimesulide must be withdrawn worldwide due to serious liver damage Nimesulide exposes patients to fatal liver damage. When a non-steroidal anti-inflammatory drug is needed, it is better to use one with a favourable benefit-harm balance such as ibuprofen. EU authorities fail to protect consumers. The International Society of Drug Bulletins (ISDB) deems it unacceptable that Nimesulide has been allowed to remain on European and some
Dr. Subrahmanyam Karuturi, a name synonymous with a successful dream that went right has shown the world that his story of success is something that anyone can duplicate. “Survival of the fittest” said Charles Darwin to justify the survival of an individual in this world. History is beset with the examples of revolutionaries who inspired their followers by a well thought out vision and vigor. Dr. Subrahmanyam Karuturi is no less as far as stirring people and advancing the engine called “Kify.com”.
other markets in the world. This non-steroidal anti-inflammatory drug
Dr. Subrahmanyam Karuturi provides a role to each of his comrades-in-
(NSAID) offers no therapeutic advantage or better gastrointestinal safety
arms and in turn they accomplish it to the satisfaction of their leader, such
compared
accomplishments have gone into making Kify.com what it is today. No
with other NSAIDs, whereas it exposes patients to a higher risk of fatal
wonder, Dr. Subrahmanyam Karuturi's dreams are at the verge of becoming
hepatic disorders.
realities.
Nimesulide has never been approved for use in countries like USA, UK,
Dr. Subrahmanyam Karuturi, a young and dynamic doctor by profession
Canada, Australia, New Zealand, Japan and other countries in view of
takes delight in accepting challenges.
concerns over its safety profile.
Upon pursing his Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.,)
In 2002, Finland and Spain withdrew Nimesulide from the market following
at Guntur Medical College; Dr. Subrahmanyam Karuturi with his
reports of serious liver damage. Cases including 2 deaths had also been
immeasurable understanding and proficiency in Internet and its associated
reported in France at the time. Ireland and Singapore decided to withdraw Nimesulide from the market in 2007. The European Medicines Agency has confirmed the hepatic risks associated with Nimesulide in 2007, but merely limited the duration of treatment, leaving patients exposed to an unjustifiable fatal risk. These half-hearted measures are all the more unacceptable since numerous other available NSAIDs are just as effective and less dangerous. How did a majority of EU member states' rapporteurs who re-assessed
realms, has successfully launched and made Kify.com a leader and a household name. Being Net savvy this dotcom doctor finds himself devoting and developing challenging Internet applications. Backed by a practiced psyche, this highflying Doctor, a workaholic by nature and an entrepreneur by intuition has ventured to create this website as a first ever entry in to the Cyber World! Dr.Karuturi is founder of kify.com and several medical related websites.
Nimesulide conclude that the product should remain on the market? Why is there such inconsistency among EU member states? The Committee for Medicinal Products for Human Use (CHMP) assessed the harm caused by Nimesulide in total secrecy and it is quite unacceptable for the EU health authorities to decide to limit only the
SMS Survey Population stabilization is beneficial
duration of use without presenting the rationale behind this decision. EU Commission's unwillingness to withdraw Nimesulide leads to EU citizens being unjustifiably exposed to preventable harm. Nimesulide must be banned in the European Union and the rest of the world.
Medical Practicenior YES/NO SMS to 919849551183
The ISDB is a worldwide network of bulletins and journals on drugs and therapeutics that are financially and intellectually independent of pharmaceutical industry. More info on: www.isdbweb.org
For Hospital Management Software EDITORS NOTE
Contact : V.N.Swaroop Raybright Technologies Pvt Ltd #1-10-73,2nd Floor,Sai Towers; Opp:Reebok Showroom; Begumpet,Hyderabad-AP Mobile : 098495 59380 Email: vnswaroop@raybright.com
In India, Nimesulide is not only permitted for use in adults without any limit but also for neonates, infants and children for fever and pain. To our knowledge, India is the only country in the world where Nimesulide is permitted for use in children
PhaRMeD TRADE NEWS
JAN, 1-15, 2008
Page 2
GPP - INTRODUCTION The practice of pharmacy in the country has undergone rapid changes. Change is inevitable, and it is essential to change with the times. Merely “selling” medicines across the counter would be a thing of the past, as
be the foundation on which the working in a pharmacy can be based, and which can give the best outcomes in delivery of medicines, service and care of the patient.
shifts would take place, in view of the opening up of the economies,
While the basic concepts of Pharmaceutical Care & GPP are largely
evident entry of foreign players in retail pharmacy market, and changing
identical, it can be said that GPP is the way to implement pharmaceutical
health care needs of our clients. The recent amendment to the Indian
care.
Patent
The main requirements of GPP are
Act would throw up newer challenges. Stringent compulsions of GMP (Good Manufacturing Practice), sudden attention to high pricing of generics, pricing regulations, all have begun to affect the smaller players in the pharmaceutical industry, and this would lead to closures, mergers and acquisitions. In the present era of information technology and information overload the client looks towards the pharmacist as a major source of correct information. As the healthcare needs and provision of care are undergoing change the pharmacist is in a unique position to steer the patient towards correct medication. Pharmacists in India must seize this opportunity and respond to changes. There is an urgent need to shift focus from the 'product oriented approach' of today, to a 'patient oriented approach'. Pharmacists in the developed world are making a huge difference in the quality of patient care through the concept of pharmaceutical care.
❑ GPP requires that a pharmacist's first concern in all settings is the welfare of patients. ❑ GPP requires that the core of the pharmacy activity is the supply of medication and other healthcare products of assured quality, appropriate information and advice for the patient , and monitoring the effects of use. GPP requires that an integral part of the pharmacist's contribution is the promotion of rational and economic prescribing and of appropriate use of medicines. ❑ GPP requires that the objective of each element of pharmacy service is relevant to the patient, is clearly defined and is effectively communicated to all those involved. Applying Good Pharmacy Practices GPP involves 4 main groups of activities namely: A) Activities associated with the promotion of good health, of the avoidance of ill health and the achievement of health objectives.
They have made pharmaceutical care their mission, and have achieved
B) Activities associated with the supply and the use of medicines and of
high standards of practice, and with it the due respect and recognition
items for the administration of medicines or for other aspects of treatment.
from the people.
C) Activities associated with self care, including advice about & where
Today, in India, while there seems to be no demand for pharmaceutical
appropriate, the supply of a Medicine or other treatment for symptoms
care in the market, it is because the people are not yet aware of it. There
of ailments that tend themselves to self-treatment.
is a absence of even the word “Pharmacist” in the latest National Health
D) Activities associated with influencing the prescribing and use of
Policy of India. It is evident that “merely” selling medicines has very little
medicines.
value and recognition. It is up to us pharmacists to create, and cater to
These guidelines are recommended as a set of professional goals in the
this demand, not only in the interest of the health of the people but also in
interest of the patients.
our own interest. It is hard to see how pharmacy and its practitioners will
Copyright : WHO-INDIA
survive if we do not keep abreast of the changes we are facing. The time has come to change. Good Pharmacy Practice Guidelines drafted by the IPA (Indian Pharmaceutical Association) in March 2002, has laid the path on which we all have to tread and move forward. The mission of pharmacy practice is to provide medications, other health
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care products, relevant information, and professional services and to help people and society to make the best use of them. Every activity in the pharmacy (from procurement, storage, to handling & filling of prescriptions, to providing patient information and rational use of medicines) needs to
Pharmed Trade News Post Box No. 1522 Hyderabad-500 013
be done with certain systems and confidence, in order to give the right touch of professionalism and care. GPP (Good Pharmacy Practice) could
PhaRMeD TRADE NEWS
JAN, 1-15, 2008
Page 3
SIGNS&SYMPTOMS
Hypothermia Definition Hypothermia is dangerously low body temperature, below 95째F (35째C). Alternative Names Low body temperature; Cold exposure Considerations People most likely to experience hypothermia include: Very old or very young Chronically ill, especially with heart or circulation problems Malnourished Overly tired Under the influence of alcohol or drugs Causes Hypothermia occurs when more heat is lost than the body can generate. It is usually caused by extended exposure to the cold. Common causes include: Being outside without enough protective clothing in winter. Falling overboard from a boat into cold water. Wearing wet clothing in windy or cold weather. Heavy exertion, not drinking enough fluids, or not eating enough in cold weather. Symptoms As people develop hypothermia, their abilities to think and move are often lost slowly. In fact, they may even be unaware that they need emergency treatment. Someone with hypothermia also is likely to have frostbite. The symptoms include: Drowsiness Weakness and loss of coordination Pale and cold skin Confusion Uncontrollable shivering (although at extremely low body temperatures, shivering may stop) Slowed breathing or heart rate Lethargy, cardiac arrest, shock, and coma can set in without prompt treatment. Hypothermia can be fatal.
SMS Quiz Name 3 Dangerous drugs
SMS to : 919849551183
PhaRMeD TRADE NEWS
BAYER RECALLS GLUCOSE TEST STRIPS Bayer asks consumers to check the lot number on the bottles of Contour TS strips. Lot numbers appear on the bottom of the box and on the side of the bottle containing the strips. The affected lots begin with WK followed by the characters 7D, 7E, 7F or 7G and then followed by a series of other numbers and letters (for example WK7ED3E52C). Only bottles of test strips with the characters 7D, 7E, 7F, or 7G in the third and fourth position in the sequence are affected. Bottles with a lot number including 7J through 7M after WK are not affected and need not be returned. Consumers who purchased the recalled strips should call Bayer customer service (in the U.S., 1-800-348-8100) to return any affected bottle of strips and to get a replacement. The recalled strips have been distributed in the U.S., France, Turkey, Austria, Korea, India, and Mexico. Xxx The Lotus Eye Care Hospital has entered into the Limca Book of World Records for organizing a five-day international ophthalmic conference aboard a cruise liner. The conference 'Eyetrendz 2006' was the first international ophthalmic conference on a cruise liner. The conference held on the ship named Super Star Libra, starting from Mumbai to Lakshawdeep with a stopover at Goa and then back to Mumbai. Lotus Eye Care Hospital is known for conducting such unique conferences regularly. The first ophthalmic conference was conducted in Ooty while the second conference was conducted in Coimbatore city. The ophthalmic conference was conducted on the Arabian Sea, was the third one, which got the Lotus eye care hospital an entry into the Limca Book of Records.
Share with your Patients pages 5-6 & 7-8 Create Value for your Customers JAN, 1-15, 2008
Page 4
All ABOUT CONDOMS Why do I need to use a condom? Condoms are the only form of protection which can both help to stop the transmission of sexually transmitted diseases (STDs) such as HIV and prevent pregnancy. Getting ready, Choosing the right condom A number of different types of condom are now available. What is generally called a condom is the 'male' condom, a sheath or covering which fits over a man's penis, and which is closed at one end. There is also now a female condom, or vaginal sheath, which is used by a woman and which fits inside her vagina. The rest of this page is about the male condom. What are condoms made of? Condoms are usually made of latex or polyurethane. If possible you should use a latex condom, as they are slightly more reliable, and in most countries they are most readily available. Latex condoms can only be used with water based lubricants, not oil based lubricants such as Vaseline or cold cream as they break down the latex. A small number of people have an allergic reaction to latex and can use polyurethane condoms instead. Polyurethane condoms are made out a type of plastic. They are thinner than latex condoms, and so they increase sensitivity and are more agreeable in feel and appearance to some users. They are more expensive than latex condoms and slightly less flexible so more lubrication may be needed. However both oil and water based lubricants can be used with them. It’s not clear whether latex or polyurethane condoms are stronger – there are studies suggesting that either is less likely to break. With both types however, the likelihood of breakages is very small if used correctly. The lubrication on condoms also varies. Some condoms are not lubricated at all, some are lubricated with a silicone substance, and some condoms have a water-based lubricant. The lubrication on condoms aims to make the condom easier to put on and more comfortable to use. It can also help prevent condom breakage. Spermicides and Nonoxynol 9 Condoms and lubricants sometimes contain a spermicide called Nonoxynol 9. Nonoxynol 9 was thought in the past to help to prevent pregnancy and the transmission of HIV and other STDs, but it is now know to be ineffective. Some people have an allergic reaction to Nonoxynol 9 that can result in little sores, which can actually make the transmission of HIV more likely. Because of this, you should only use condoms and lubricants containing Nonoxynol 9 if you are HIV negative and know that your partner is too. However, using a condom (even if it contains Nonoxynol 9) is much safer than having unprotected sex. What shapes are there and which should I choose? What about flavoured condoms? Condoms come in a variety of shapes. Most have a reservoir tip although some do have a plain tip. Condoms may be regular shaped (with straight sides), form fit (indented below the head of the penis), or they may be flared (wider over the head of the penis). Ribbed condoms are textured with ribs or bumps, which can increase sensation for both partners. Condoms also come in a variety of colours. It’s up to you which shape you choose. All of the differences in shape are designed to suit different personal preferences and enhance pleasure. It is important to communicate with your partner to be sure that you are using condoms that satisfy both of you. Some condoms are flavoured to make oral sex more enjoyable. They are also safe to use for penetrative sex as long as they have been tested and approved. What about the condom size? Condoms are made in different lengths and widths, and different manufacturers produce varying sizes. There is no standard length for condoms, though those made from natural rubber will in addition always stretch if necessary to fit the length of the
PhaRMeD TRADE NEWS
man's erect penis. The width of a condom can also vary. Some condoms have a slightly smaller width to give a "closer" fit, whereas others will be slightly larger. Condom makers have realised that different lengths and widths are needed and are increasingly broadening their range of sizes. The brand names will be different in each country, so you will need to do your own investigation of different names. There is no particular best brand of condom. So when do you use a condom? You need to use a new condom every time you have sexual intercourse. Never use the same condom twice. Put the condom on after the penis is erect and before any contact is made between the penis and any part of the partner's body. If you go from anal intercourse to vaginal intercourse, you should consider changing the condom. Where can I get condoms? There are no age limitations on buying condoms. Buying a condom no matter how old you are shows that you are taking responsibility for your actions. Family planning and sexual health clinics provide condoms free of charge. Condoms are available to buy from supermarkets, convenience stores and petrol/gas stations. Vending machines selling condoms are found in toilets at many locations. You can also order then online from different manufacturers and distributors. How can I check a condom is safe to use? Condoms that have been properly tested and approved carry the British Standard Kite Mark or the EEC Standard Mark (CE). In the USA, condoms should be FDA approved, and elsewhere in the world, they should be ISO approved. Condoms have an expiration (Exp) or manufacture (MFG) date on the box or individual package that tells you when it is safe to use the condom until. It’s important to check this when you use a condom. You should also make sure the package and the condom appear to be in good condition. Condoms can deteriorate if not stored properly as they are affected by both heat and light. So it’s best not to use a condom that has been stored in your back pocket, your wallet, or the glove compartment of your car. If a condom feels sticky or very dry you shouldn’t use it as the packaging has probably been damaged. How do you use a condom? Open the condom package at one corner being careful not to tear the condom with your fingernails, your teeth, or through being too rough. Make sure the package and condom appear to be in good condition, and check that if there is an expiry date that the date has not passed. Place the rolled condom over the tip of the hard penis, and if the condom does not have a reservoir top, pinch the tip of the condom enough to leave a half inch space for semen to collect. If the man is not circumcised, then pull back the foreskin before rolling on the condom. Pinch the air out of the condom tip with one hand and unroll the condom over the penis with the other hand. Roll the condom all the way down to the base of the penis, and smooth out any air bubbles. (Air bubbles can cause a condom to break). If you want to use some extra lubrication, put it on the outside of the condom. But always use a water-based lubricant (such as KY Jelly or Liquid Silk) with latex condoms, as an oil-based lubricant will cause the latex to break. The man wearing the condom doesn't always have to be the one putting it on - it can be quite a nice thing for his partner to do. What do you do if the condom won't unroll? The condom should unroll smoothly and easily from the rim on the outside. If you have to struggle or if it takes more than a few seconds, it probably means that you are trying to put the condom on upside down. To take off the condom, don't try to roll it back up. Hold it near the rim and slide it off. Then start again with a new condom. When do you take off the condom? Pull out before the penis softens, and hold the condom against the base of the penis while you pull out, so that the semen doesn't spill. Condom should be disposed properly for example wrapping it in a tissue and throwing it
JAN, 1-15, 2008
Page 5
away. It's not good to flush condoms down the toilet - they're bad for the environment. What do you do if a condom breaks? If a condom breaks during sexual intercourse, then pull out quickly and replace the condom. Whilst you are having sex, check the condom from time to time, to make sure it hasn't split or slipped off. If the condom has broken and you feel that semen has come out of the condom during sex, you should consider getting emergency contraception such as the morning after pill. What condoms should you use for anal intercourse? With anal intercourse more strain is placed on the condom. You can use stronger condoms (which are thicker) but standard condoms are just as effective as long as they are used correctly with plenty of lubricant. Condoms with a lubricant containing Nonoxynol 9 should N be used for anal sex as Nonoxynol 9 damages the lining of the rectum increasing the risk of HIV and other STD transmission. Is using a condom effective? If used properly, a condom is very effective at reducing the risk of being infected with HIV during sexual intercourse. Using a condom also provides protection against other sexually transmitted diseases, and protection against pregnancy. In the laboratory, latex condoms are very effective at blocking transmission of HIV because the pores in latex condoms are too small to allow the virus to pass through. However, outside of the laboratory condoms are less effective because people do not always use condoms properly. How do you dispose of a used condom? All condoms should be disposed of by wrapping in tissue or toilet paper and throwing them in the bin. Condoms should not be flushed down the toilet as they may cause blockages in the sewage system and pollution. Latex condoms are made mainly from latex with added stabilizers, preservatives and vulcanizing (hardening) agents. Latex is a natural substance made form rubber trees, but because of the added ingredients most latex condoms are not biodegradable. Polyurethane condoms are made from plastic and are not biodegradable. Biodegradable latex condoms are available from some manufacturers. How can I persuade my partner that we should use a condom? It can be difficult to talk about using condoms. But you shouldn't let embarrassment become a health risk. The person you are thinking about having sex with may not agree at first when you say that you want to use a condom when you have sex. These are some comments that might be made and some answers that you could try..
Don't you trust me? It does not feel as good with a condom I don't stay hard when I put on a condom I don't have a condom with me. I am afraid to ask him to use a condom. He'll think I don't trust him. I can't feel a thing when I wear a condom I don't stay hard when I put on a condom I don't have a condom with me It's up to him...it's his decision I'm on the pill, you don't need a condom It just isn't as sensitive and I can't feel a thing Putting it on interrupts everything I guess you don't really love me I will pull out in time But I love you Just this once
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There are many reasons to use condoms when having sex. You could go through these reasons with your partner and see what s/he thinks. Reasons to use condoms Condoms are the only contraceptive that also helps prevent the spread of sexually transmitted diseases (STDs) including HIV when used properly and consistently. Condoms are one of the most reliable methods of birth control when use properly and consistently. Condoms have none of the medical side-effects of some other birth control methods may have. Condoms are available in various shapes, colours, flavours, textures and sizes- to increase the fun of making love with condoms. Condoms are widely available in pharmacies, supermarkets and convenience stores. You don't need a prescription or have to visit a doctor. Condoms make sex less messy. Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex. Condoms are only needed when you are having sex unlike some other contraceptives which require you to take/ or have them all of the time. Here are also some tips that can help you to feel more confident and relaxed about using condoms. Confidence tips Keep condoms handy at all times. If things start getting steamy- you'll be ready. It not a good idea to find yourself having to rush out at the crucial moment to buy condoms- at the height of the passion you may not? When you buy condoms, don't get embarrassed. If anything, be proud. It shows that you are responsible and confident and when the time comes it will all be worthwhile. It can be more fun to go shopping for condoms with your partner or friend. Nowadays, it is also easy to buy condoms discreetly on the internet. Talking with your partner about using a condom before having sex. It removes anxiety and embarrassment. Knowing where you both stand before the passion stands will make you lot more confident/ that you both agree and are happy about using a condom, will make you both lot more confident. If you are new to condoms, the best way to learn how to use them is to practice putting them on by yourself or your partner. It does not take long to become a master. If you feel that condoms interrupt your passion, then try introducing condoms into your lovemaking. It can be really sexy if your partner helps you put it on or you do it together.
Trust isn't the point, people can have infections without realising it I'll feel more relaxed, If I am more relaxed, I can make it feel better for you. I'll help you put it on, that will help you keep it hard. I do. If you can't ask him, you probably don't trust him. Maybe that way you'll last even longer and that will make up for it I'll help you put it on, that will help you keep it I do It's your health. It should be your decision too! I'd like to use it anyway. It will help to protect us from infections we may not realise we have. Maybe that way you will last even longer and that will make up for it Not if I help put it on I do, but I am not risking my future to prove it Women can get pregnant and STDs from pre-ejaculate Then you'll help us to protect ourselves. Once is all it takes
JAN, 1-15, 2008
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PhaRMeD TRADE NEWS
JAN, 1-15, 2008
Page 7
TESTS FOR DIABETES
DANGEROUS DRUGS:
The blood is drawn and tested for amount of glucose present in
THESE DRUGS HAVE BEEN GLOBALLY DISCARDED BUT ARE AVAILABLE IN INDIA.
one deciliter of blood (mg/dL). If suspected, the tests must be repeated about two more times on different days for the doctor
The most common ones are D cold, action 500 & Nimulid.
to actually say that the patient is diabetic. Fasting Blood Sugar
ANALGIN: This is a pain-killer. Reason for ban: Bone marrow depression. Brand name: Novalgin
The patient is asked not to eat anything for about 10 hours (usually overnight), hence the name 'fasting'. The blood is analyzed for glucose. The results are interpreted as follows:
CISAPRIDE: Acidity, constipation. Reason for ban: irregular heartbeat Brand name: Ciza, Syspride
Normal: 70 to 110 mg/dL (milligrams per deciliter). Pre-diabetes: 110 to 126 mg/dL The patient is at risk of developing diabetes Diabetic: 140 mg/dL or greater on two different days Patients with low glucose levels (40 mg/dL for women, and 50mg/
DROPERIDOL: Anti-depressant. Reason for ban: Irregular heartbeat. Brand name: Droperol FURAZOLIDONE: Antidiarrhoeal. Reason for ban: Cancer. Brand name: Furoxone, Lomofen
dL for men) may be suffering from insulinoma or other diseases. Random Blood Sugar
NIMESULIDE: Painkiller, fever. Reason for ban: Liver failure. Brand name: Nise, Nimulid
This test is conducted several times during day irrespective of food intake. This test gives the physician an idea how the glucose levels vary. The average level is determined. The normal level is 126 mg/dL. You may have diabetes if the test results in
NITROFURAZONE: Antibacterial cream. Reason for ban: Cancer. Brand name: Furacin
200 mg/dL or higher. The 200 mg/dL is being considered for
PHENOLPHTHALEIN: Laxative. Reason for ban: Cancer. Brand name: Agarol
change to 180 mg/dL for early detection and intervention by the physicians. The physician will run a Fasting Blood Sugar test if its 200 mg/dL to determine if you have diabetes. 2-hour postprandial sugar: Soon after we ingest food, the blood glucose starts to rise, peaking about one hour after taking the food, then it starts to come down. This test is performed exactly 2 hours after eating a meal. The normal level is 140 mg/dL. Patient is at risk of developing diabetes if the level is between 140 and 200 mg/dL. The 200 mg/dL is being considered for change
PHENYLPROPANOLAMINE : Cold and cough. Reason for ban: stroke. Brand name: D'cold, Vicks Action-500 OXYPHENBUTAZONE: Non-steroidal anti-inflammatory drug. Reason for ban: Bone marrow depression. Brand name: Sioril
to 180 mg/dL for early detection and intervention by the physicians. Oral Glucose test This is done in a physician’s office in a controlled environment by actually ingesting a specific amount of glucose dissolved in
PIPERAZINE: Anti-worms. Reason for ban: Nerve damage. Brand name: Piperazine QUINIODOCHLOR: Anti-diarrhoeal. Reason for ban: Damage to sight. Brand name: Enteroquinol
water. Blood is drawn at given intervals for three hours and tested. This is a common diagnostic tool for gestation diabetics PhaRMeD TRADE NEWS
JAN, 1-15, 2008
Page 8
NIPER- FAQ ON PHARMACY PRACTICE This document provides the answers to some of the most frequently asked questions (FAQs) in Pharmacy Practice. These have been prepared on the basis of the most common queries received in the past at NIPER. Just in case you have an un-answered question at the end of reading this document, please contact us at pp@niper.ac.in. NIPER-National institute of Pharmaceutical Education and Reserch Q1. What is Pharmacy Practice? A. The application of unique knowledge and skills of the pharmacist to improve the health of the people is called Pharmacy Practice. It includes hospital, clinical, and community pharmacy.
healthcare team. This contribution, gradually, will make the pharmacist earn more respect within the team. Q10. What are the job opportunities after I complete? A. After completing the M. Pharm. in Pharmacy Practice, one can work as a hospital pharmacist, clinical pharmacist, and drug information pharmacist; or as a teacher since there is lack of first generation teachers; the option of working in the industry in the areas of pharmacovigilance and clinical trial research is also open to the graduates. Q11. Is the pharmacy practice program relevant in India?
Q
Q2. What is the role of a practicing pharmacist?
Q3. What is the principle of pharmacy practice?
A. As drug use is increasing, there is increased risk of drug-related morbidity and mortality. Expenditure on the healthcare has also increased due to irresponsible use of medications. In India, the level of self-medication is very high as one can buy any medication across the counter. A pharmacist is the right professional to handle the drugrelated situations.
A. The principle of pharmacy practice is pharmaceutical care.
Q12. When did the discipline of pharmacy practice start in India?
Q4. What is pharmaceutical care?
A. It is almost ten years when the postgraduate program in pharmacy practice was started by some pharmacy colleges in the country.
A. A practicing pharmacist shares responsibilities with other healthcare professionals (doctors, nurses etc) and with patients for the outcome of therapy. The patient and the community are the primary beneficiaries of the pharmacist’s actions.
A. Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. The four outcomes of treatment are: - cure of disease, elimination or reduction of symptoms, arresting/slowing disease process and preventing a disease or symptoms. Can you explain more?
A. Pharmaceutical care is that component of pharmacy practice that entails the direct interaction of the pharmacist with the patient for the purpose of caring for that patient’s medication-related needs. Translated into everyday practice, pharmaceutical care is what an individual pharmacist does when he or she: ❑ evaluates a patient’s drug-related needs,
❑ determines whether the patient has any actual or potential drugrelated problems, and ❑ works with the patient and other healthcare professionals to design, implement and monitor a pharmacotherapeutic plan that will resolve/prevent the problem. Q5. What is a drug-related problem?
A. The drug related problem could be anyone of these: - untreated indication, improper drug selection, sub therapeutic dosage, failure to receive drugs, over dosage, adverse drug reactions, drug interactions and drug use without indication.
Q6. Why a pharmacist should be consulted for a drug-related problem? A. By virtue of being an expert on the knowledge of drugs and their use, a trained and competent pharmacist is the only professional in the healthcare team who can effectively handle a drug-related problem. Q7. What are the advantages of solving a drug-related problem? A. The presence of any of these drug-related problems will harm the patient. Hence, a meaningful solution of a drug related problem would certainly benefit the patient. Q8. Why not the doctors solve the drug-related problems? A. True! The doctors are experts in the diagnosis and treatment of diseases and their efforts need to be constantly supplemented by contributions from all the healthcare professionals. One of the ways to supplement this role is by providing current, reliable and authentic information on medicines and their use. Q9. How does solving these problems make a pharmacist more respectable? A. A meaningful solution provided by the pharmacists in a patientcentered setting will lead to appreciation of their inputs in the
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Q13. How will such training change the current scenario in the profession? A. Yes, it will. You may be surprised to note that in USA & UK - often the most commonly used models for comparison - have taken 3035 years to come to the stage we see them today regarding the role(s) of the practising pharmacist. In India, a beginning made now will yield results - a tangible change - after a fair period of time. Fortunately, the initial steps have already been taken! Q14. When did this course start at NIPER?
A. The masters program in pharmacy practice at NIPER was started in 2002 in collaboration with School of Pharmacy, University of London, U K . The department has also been awarded the “Higher Education Link” from the British Council that facilitates the interaction between the School of Pharmacy at University of London, UK and NIPER’s department. Q15. Do I have to study subjects different than other disciplines? A. Yes, at NIPER, there are a few common subjects like Biostatistics, Computer applications, Biopharmaceutics & Pharmacokinetics. However, the subjects like clinical pharmacy, applied therapeutics are taught only to the pharmacy practice students. Q16. I also hear it is all about visits to hospitals and patients. Is that true? A. Yes, to provide real time clinical experience & training to the students in this program, NIPER has collaboration with two major hospitals (Fortis Heart and Multispeciality Centre and Postgraduate Institute of Medical Education & Research PGIMER). Q17. What does a student do in a hospital? A. The student gets a chance to go on clinical rounds with the doctors and gain practical knowledge of the patients’ problems. The student studies the patient case file(s) and performs case presentation - the analysis of drug related problems - to the doctors. The student, thus, provides solutions for solving the drug related problems and contributes in patient care. Q18. How does it help the student? A. By actually attempting to solve a drug-related problem for a patient, one not only contributes to the well being of the patient but also gets identified about his/her contribution. Q19. Is it then not the same as clinical pharmacy? A. Clinical Pharmacy is one of the three components of the pharmacy practice program at NIPER. The other two are hospital pharmacy and community pharmacy.
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SPIRITUAL HEALTH Why do we wear marks (tilak, pottu and the like) on the forehead? The tilak or pottu invokes a feeling of sanctity in the wearer and others. It is recognized as a religious mark. Its form and colour vary according to one’s caste, religious sect or the form of the Lord worshipped. In earlier times, the four castes (based on varna or colour) Brahmana, Kshatriya, Vaishya and Sudra - applied marks differently. The brahmin applied a white chandan mark signifying purity, as his profession was of a priestly or academic nature. The kshatriya applied a red kumkum mark signifying valour as he belonged to warrior races. The vaishya wore a yellow kesar or turmeric mark signifying prosperity as he was a businessman or trader devoted to creation of wealth. The sudra applied a black bhasma, kasturi or charcoal mark signifying service as he supported the work of the other three divisions.
prevents energy loss. Sometimes the entire forehead is covered with chandan or bhasma. Using plastic reusable “stick bindis” is not very beneficial, even though it serves the purpose of decoration. Why do we not touch papers, books and people with the feet? To Indians, knowledge is sacred and divine. So it must be given respect at all times. Nowadays we separate subjects as sacred and secular. But in ancient India every subject - academic or spiritual was considered divine and taught by the guru in the gurukula. The custom of not stepping on educational tools is a frequent reminder of the high position accorded to knowledge in Indian culture. From an early age, this wisdom fosters in us a deep reverence for books and education. This is also the reason why we worship books, vehicles and instruments once a year on Saraswathi Pooja or Ayudha Pooja day, dedicated to the Goddess of Learning. In fact, each day before starting our studies, we pray: Saraswati namasthubhyam Varade kaama roopini Vidyaarambham karishyaami Sidhirbhavatu me sadaa
Also Vishnu worshippers apply a chandan tilak of the shape of “U”, Shiva worshippers a tripundra of bhasma, Devi worshippers a red dot of kumkum and so on).
O Goddess Saraswati, the giver of Boons and fulfiller of wishes, I prostrate to You before starting my studies. May you always fulfill me?
The tilak cover the spot between the eyebrows, which is the seat of memory and thinking. It is known as the Aajna Chakra in the language of Yoga. The tilak is applied with the prayer - “May I remember the Lord. May this pious feeling pervade all my activities. May I be righteous in my deeds.” Even when we temporarily forget this prayerful attitude the mark on another reminds us of our resolve. The tilak is thus a blessing of the Lord and a protection against wrong tendencies and forces.
To touch another with the feet is considered an act of misdemeanor. Why is this so?
The entire body emanates energy in the form of electromagnetic waves - the forehead and the subtle spot between the eyebrows especially so. That is why worry generates heat and causes a headache. The tilak and pottu cools the forehead, protects us and
Man is regarded as the most beautiful, living breathing temple of the Lord! Therefore touching another with the feet is akin to disrespecting the divinity within him or her. This calls for an immediate apology, which is offered with reverence and humility.
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Rational Use of Antimicrobials Dr Trupti Rekha Swain Asst. Professor, Pharmacology, S.C.B Medical College, Cuttack & WHO fellow, PRUDC Antibiotics have been called the single most important therapeutic discovery in the history of medicine. But to ensure their survival, organisms started developing resistance. Death due to infection is still the leading cause of death in developing countries like ours. Significant global burden of resistant hospital acquired infections adding to this problem. Factors that contribute to antibiotic resistance can be: - Misuse and overuse of antibiotics in humans, animals and agriculture - Demand for antibiotics when antibiotics are not appropriate - Availability of antibiotics without a prescription Treatment for non responsive infections with antibiotics I.e. viral fever, seasonal rhinitis Improper dosage and irrational combination of Antibiotics Inappropriate reliance on chemotherapy like its use in the presence of abscess, necrotic tissue or foreign body. - Non availability of drugs also contributes to development of multi drug resistance tuberculosis. - Availability of irrational drug combinations, fake or substandard drug in the market Self medication and patient pressure for prescribing antibiotics is a very important area of concern, which needs intervention The community costs for irrational use of antimicrobials is alarming. For all the blunders that the medics, pharmacists and nursing staff commit in AM prescription, supply and administration, it is the patient who is the recipient, sufferer and payee. Surgical prophylaxis: should be in Intravenous route one hour (or 3 hour orally) before surgery and repeated once after 6 to 12 hours only if the surgery lasts for longer than 5 to 6 hours. Studies 1 suggest that the chances of postoperative infections are proportionately reduced if antimicrobials are given it 4 , 3, 2, and 1 hour before surgery, and there is no difference between the rate of infection if the antimicrobials are given anytime before 4 hours prior to surgery and no prophylaxis at all. The choice of antimicrobial agent is first generation of Cephalosporins for all surgeries and addition of Aminoglycosides if gram negative infections are likely (abdominal surgery). Interventions to reduce Antimicrobial Resistance can be at different level: For Doctors: - To Introduce periodic re-exam for medical license to practice - To make 10 hour credits for RUM and essential medicines for every re-exam compulsory - Bring in accountability through prescription audits - Identify the irrationalists, taking strong measures for them. For Hospitals: - To Run the hospital on EML, ban prescriptions for buying medicines from outside (if outside medicines have to be purchased then the prescription should have clear indication - Making prescription audits compulsory - To Start medicine information bulletins for the prescribers and patients as well - To Initiate action against irrationalists and misusers of medicines. For Government: - To weed out all irrational, bannable, dangerous medicines and unwanted combinations. - To upgrade the list of medicines being manufactured in the country - To allow production of only essential medicines in the country. Till this is attained, to have differential pricing structure by making irrational medicines costly. Making essential medicines affordable and allow higher mark ups
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for non essential medicines to enable industry to earn from these. - Starting medicine information service for IEC of the patients Interventional strategy at pharmaceutical industry level, is very vital and effective means to prevent misuse. Package imprint or package inserts like “Avoid antibiotic misuse� to prevent antimicrobial misuse can be an excellent method.A promotional campaign on awareness about antibiotic misuse is also suggested. Role of Pharmacists in promoting rational use of Antimicrobials: Data collection is first step to rational use of antibiotics to identify areas that need targeting.Clinical Pharmacists can collect data regarding, whether antibiotics are prescribed orally / IV, for surgical prophylaxis ?, duration? Drug combinations? From reserve list of antibiotics? Reason? Approved by microbiologist? This will serve as data for bench marking which can be compared with previous studied. One of the most useful ways to present it as defined daily dose (Total quantity of drug used divided by the average daily dose). When this figure is divided by population denominator the resulting figure can be compared with different institutions2 Providing training to pharmacists, for providing appropriate information, instruction and warning to the patients regarding use and misuse of antimicrobials and making all purchase and sell of antibiotics accountable can prevent misuse. Fever charts can serve as a good tool to predict requirement of antibiotic use incase of undiagnosed fever3. Health education of the community regarding the antimicrobial use is a practicable solution to the problem. This can be achieved by health education through media & magazines A team effort through infection control committee, which is responsible for formulating, implementing and auditing an infection control policy, is a vital strategy to contain antimicrobial resistance. Control measures should be based on local epidemiology and tailored to suit local needs. Documented disinfectant policy for decontamination of equipments, therapeutic devices, spills and environment proper biomedical waste management will also help in containing AM resistance in future. PATIENTS&ANTIBIOTIC RESISTANCE— Do not demand antibiotics from your physician. When given antibiotics, take them exactly as prescribed and complete the full course of treatment; Do not hoard pills for later use or share leftover antibiotics. Wash your hands properly to reduce the chance of getting sick and spreading infection. Wash fruits and vegetables thoroughly; avoid raw eggs and undercooked meat, especially in ground form. When protecting a sick person whose defenses are weakened, soaps and other products with antibacterial chemicals are helpful, but should be used according to established procedures and guidelines.
Reference: 1.Mandel's Textbook on Antimicrobials (2006) 2.How to promote rational antibiotic use: The pharmaceutical journal. (Vol 273) ,p-10 3. Integrating hospital acquired lessons into community health practice; Optimising Antimicrobial use in Bangalore. J . Contin Educ Health prof. 2007 spring; 27(2): 105-10 JAN, 1-15, 2008
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RNI NO : APBIL 2004/12036
POSTAL LIC NO : HSE-806/2006-08
Medical News CCMB
XDR-TB
The scientists at the Hyderabad-based Centre for Cellular and Molecular Biology (CCMB) have developed a DNA based diagnostic chip for identifying more of the 15 pathogens that cause eye disease.
The authors write that the best way to address this type of TB effectively is to change the healthcare environment. Use of masks alone would prevent fewer than 10 percent of cases in the general epidemic, though they would help many healthcare workers, say the researchers. Reducing time spent in the hospital and shifting to outpatient therapy could prevent nearly one-third of cases, they note. About half of XDR TB cases could be prevented by addressing hospital overcrowding, improving ventilation, enhancing access to HIV treatment, and providing faster diagnostic tests, say the study authors.
A paper published by the CCMB scientists headed by Dr Ch Mohan Rao and comprised of Dr K Sridhara Rao and Dr P V Ramchander, said " A unique set of DNA sequences are identified and primers designed to meet critical parameters of large multiplexing in a single reaction." The identification of the pathogen was based on the hybridization of PCR (polymerase chain reaction) amplified DNA sequences with specific target sequences immobilised on a membrane. The hybridization would be visualised by colour development, the paper said. The DNA chip, Dr Rao said, "Is a very sensitive and requires a small sample volume (only a few micro litres)". The complete test can be done with minimum facilities at district level hospitals, too, without the need for trained personnel. After the successful demonstration of the efficacy and diagnostic potential of the chip at the laboratory level at the CCMB, the technology was transferred to the Bangalore-based Xcyton Diagnostics for product development. Though the present product was for diagnosing ophthalmic infections, the same pathogens can be detected in other infections, too, with different samples, such as blood, cerebrospinal fluid, etc. The same principles and technology can be extended to identification of infecting organisms in other diseases as well, the scientist said.
MEDICAL MYTHS A review of evidence by researchers from the Indiana University School of Medicine in Indianapolis surrounding seven commonly-hold beliefs suggests they are actually "medical myths". According to researchers Aaron Carroll of the Regenstrief Institute in Indianapolis and Rachel Vreeman of the Indiana University School of Medicine, some are completely untrue, while others have no evidential proof as their basis. The seven beliefs investigated were based on ideas and conversations the authors had heard endorsed on a number of occasions which many doctors thought were true. They were:-
The clinicians at the L V Prasad Eye Institute in Hyderabad, Sankar Nethralaya in Chennai and RP Centre in New Delhi, helped in the development of the DNA chip.
Everyone must drink at least eight glasses of water a day.
FDA REVIEW
Mobile phones are dangerous in hospitals.
The review by the Food and Drug Administration (FDA) in the U.S. has found no evidence that the drugs Prilosec and Nexium increased the rates of cardiac problems.
Eating turkey makes you especially drowsy.
Prilosec and Nexium which are top selling drugs for heartburn are manufactured by AstraZeneca. Concern was raised following the results of two studies which suggested they were linked to an increased risk of heart attacks, heart failure and heart-related sudden death when compared to surgery. AstraZeneca supplied the FDA with data from two long-term studies in patients with severe gastroesophageal reflux disease; the studies were designed to assess the effectiveness of being treated with either Prilosec or Nexium. A large amount of additional information was also submitted to the FDA, who this week announced it had completed a comprehensive review of the information and reached the conclusion that long-term use of the drugs is not likely to be associated with an increased risk of heart problems.
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We only use 10% of our brains. Hair and fingernails continue to grow after death.
Reading in dim light ruins your eyesight. Shaving causes hair to grow back faster or coarser. The researchers trawled through medical literature for evidence on each claim and found no evidence to support them.
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